Self-regulatory behaviour change techniques in interventions to promote healthy eating, physical activity, or weight loss: a meta-review

Recommender systems use in weight management mHealth interventions: A scoping review

The use of recommender systems in mobile health apps for weight control has grown, but user app uptake and engagement remain limited. The objective of our scoping review was to explore the influence of recommender systems on mHealth app user engagement, identify the theoretical frameworks that have been applied on digital health interventions designed for weight management, and examine the key aspects that support tailoring user engagement through recommender systems. Based on existing literature, we identified 13 articles on recommender systems for weight management. Themes emerged, including theoretical underpinnings, authors' domain knowledge, user motivation, and design. Most studies used constructs from the social cognitive theory. We found inconsistencies between authors' domain knowledge and the intervention's content, with few professionals from the health and psychology fields. Only 46% of articles measured user engagement, whereas gamification and tailored messages were common app features. Despite some positive weight change results, more attention is needed toward implementing behavior theory and other strategies to promote app user engagement. Future studies should more accurately measure user motivation and identify the best features and behavioral constructs to increase app user interaction. Larger studies with a more diverse population are needed to generalize findings and evaluate weight loss maintenance and physical activity habits among users of recommender system.

Proposing and refining a physical activity intervention for individuals living with COPD

Preliminary test a two stage, self-determination theory (SDT) and participation-based physical activity and peer support intervention for individuals with Chronic Obstructive Pulmonary Disease (COPD). In Stage 1, four focus groups were conducted to provide insights about individuals' needs and experiences with physical activity. In Stage 2, four individuals with COPD aged 76-90 years (50% female) participated in an eight-week online physical activity and peer support intervention. Pre-post assessments evaluated acceptability, feasibility, and functioning. Participants (n = 14; 36% female) identified that a physical activity-based program using functional task-based exercises and peer support is acceptable for adults with COPD in Stage 1. Three of the four participants improved their satisfaction with and self-reported participation in physical activity in Stage 2. Participants reported the intervention supported their psychological needs, associated with SDT. The online, peer support, participation-based physical activity intervention is feasible in its virtual delivery for physical activity promotion for individuals with COPD.

Optimising an immersive virtual reality behaviour change intervention to support retired and non-working adults to reduce their sedentary behaviour: a mini-focus group interview study

OBJECTIVE

Prolonged sedentary behaviour is associated with numerous negative health outcomes. Immersive virtual reality (IVR) offers opportunities for retired and non-working adults to take part in meaningful non-sedentary activities that may not be available to them in their natural environment. Using the behaviour change wheel and theoretical domains framework, an IVR intervention prototype was developed. This study aimed to explore and optimise the prototype with retired and non-working adults. A secondary aim was to explore participants' perceptions of IVR more generally.

METHODS AND MEASURES

Five semi-structured mini-focus group interviews were conducted with 12 retired and non-working adults. Each group explored the intervention prototype together and discussed their experiences afterwards. A rapid analysis and reflexive thematic analysis (TA) were conducted on the data.

RESULTS

Several feasible intervention design changes were generated through the rapid analysis. The reflexive TA generated three themes relating to participants' past experiences reducing their time spent sedentary, how they experienced the intervention prototype as a means to reduce their time spent sedentary, and their perspectives on using such an intervention in the future.

CONCLUSION

The results indicate that retired and non-working adults may enjoy using IVR to reduce sedentary time but generally favour natural experiences when possible.

Effectiveness and Components of Health Behavior Interventions on Increasing Physical Activity Among Healthy Young and Middle-Aged Adults: A Systematic Review with Meta-Analyses

Physical inactivity contributes to various health risks; however, approximately one-third of the global population remains insufficiently active. Many researchers have attempted to increase physical activity levels; however, the effectiveness and the specific components of these interventions remain unclear. This systematic review with meta-analyses utilized a behavior change technique taxonomy to identify and extract effective intervention components, aiming to develop more efficient programs to promote physical activity. We searched the PubMed and Ichu-shi Web databases for studies targeting healthy young and middle-aged adults with data on physical activity changes and extracted the intervention components. A random-effects model was used for the primary meta-analysis, and a meta-regression was conducted for the selected outcomes. Overall, 116 studies were included, with 102 used for the primary analysis. The interventions showed a small effect on overall physical activity promotion. Subsequent meta-regressions identified 1.5 Review behavior goal(s) as a significant positive intervention component, as well as four and three potential positive and negative components, respectively. This systematic review and meta-analysis demonstrated the effectiveness of physical activity interventions and highlighted effective and negative components. These findings may inform the design of future programs aimed at promoting physical activity.

Online Cognitive-Behavioral Therapy-Based Nutritional Intervention via Instagram for Overweight and Obesity

BACKGROUND/OBJECTIVES

Obesity is a multifactorial chronic disease treated through lifestyle modifications, pharmacotherapy, and surgery. With the rise of social media, platforms like Instagram have become tools for lifestyle interventions. This study evaluated the impact of a cognitive-behavioral-therapy-based nutritional intervention via Instagram on body weight, eating behavior, and mental health in individuals with overweight and obesity.

METHODS

A 5-week online intervention delivered daily nutritional, cognitive, and behavioral content via a private Instagram account using live sessions, reels, feed posts, polls, and stories. Standardized dietary plans were sent by e-mail. Self-reported weight and waist circumference and questionnaires on eating behavior, self-esteem, stress, and anxiety were collected. Engagement and interaction were measured through comments, likes, number of followers, story retention, participation in live sessions, and direct messages.

RESULTS

The final sample included 66 participants (63 women), 27 with overweight and 39 with obesity, and a mean age of 40.5 ± 10.6 years. After the intervention, body weight decreased by 1.1 kg, while waist circumference remained unchanged. Participants with obesity showed significant improvements in binge eating, uncontrolled eating, self-esteem, stress, and anxiety, while those with overweight showed improvements in binge eating and stress. Weight loss was associated with reduced binge eating and lower cognitive restriction, while lower uncontrolled eating was related to decreased emotional eating, anxiety, and stress. Additionally, participation in live sessions was associated with reduced binge eating.

CONCLUSIONS

This online intervention via Instagram was effective in improving weight loss, eating behavior, and mental health symptoms in participants with overweight and obesity.

Moderating Role of Self-Regulation Difficulties in the Momentary Associations Between Depressive Symptoms and Participation Poststroke

IMPORTANCE

Because depressive symptoms are momentarily associated with lower levels of participation poststroke, it is crucial to investigate what moderates such associations to identify a potential intervention target to reduce the momentary links between depressive symptoms and participation poststroke. Self-regulation seems to be a potential moderator of such associations.

OBJECTIVE

To investigate the extent to which difficulties in self-regulation moderate the momentary associations between depressive symptoms and participation poststroke.

DESIGN

This study uses a real-time, repeated-measures design using smartphone-based ecological momentary assessment surveys five times a day for 10 days. We performed multilevel modeling to uncover the momentary associations among the study variables.

SETTING

Community.

PARTICIPANTS

39 people with stroke.

OUTCOMES AND MEASURES

We obtained real-time data for difficulties in self-regulation (total, cognitive, behavioral, and emotion regulation), depressive symptoms, and participation in daily activities (performance in daily activities and satisfaction with performing daily activities).

RESULTS

We included 1,612 survey responses in the analysis. Higher depressive symptoms were momentarily associated with lower levels of performance (β = -0.05 to -0.07, p < .001) and satisfaction (β = -0.04 to -0.06, p < .05), regardless of adjusting for self-regulation variables and other covariates. Difficulties in total self-regulation (β = -0.01, p < .001) and emotion regulation (β = -0.02, p < .001) magnified the negative associations between depressive symptoms and satisfaction with performing daily activities.

CONCLUSIONS AND RELEVANCE

Using self-regulation and emotion regulation strategies may be a target for just-in-time intervention for reducing the momentary associations between depressive symptoms and satisfaction with performing daily activities poststroke. Plain-Language Summary: Depressive symptoms have immediate and real-time associations with lower levels of participation in daily activities in people with stroke. Self-regulation, including cognitive regulation (e.g., goal setting, planning strategies), behavioral regulation (e.g., controlling impulsive behaviors), and emotion regulation (e.g., managing negative feelings), may be an intervention target for reducing the immediate associations between depressive symptoms and lower levels of participation poststroke. Thus, we investigated whether difficulties in self-regulation variables magnify the negative real-time associations between depressive symptoms and participation poststroke. To obtain real-time data on difficulties in self-regulation variables, depressive symptoms, and participation (i.e., performance and satisfaction), we asked 39 community-dwelling people with stroke to answer smartphone surveys. The results showed that difficulties in total self-regulation and emotion regulation magnified the negative associations between depressive symptoms and satisfaction with performing daily activities. Our findings suggest that self-regulation and emotion regulation strategies may be a target for real-time intervention for reducing the momentary associations between depressive symptoms and satisfaction with performing daily activities poststroke.

Self-regulatory and self-efficacy mechanisms of weight loss in women within a community-based behavioral obesity treatment

Given the traditional methods of treating obesity through education on controlling eating and increasing exercise have largely failed beyond the very short term, a more intensive focus on psychosocial correlates of those weight-loss behaviors has been suggested. Multiple behavioral theories incorporate self-regulation, self-efficacy, and mood; however, their interrelations and effects over both the short and long term within cognitive-behavioral obesity treatments remain unclear. Within a novel community-based program with women with obesity who had either low (n = 29) or high (n = 71) mood disturbance scores, there were significant improvements in exercise- and eating-related self-regulation and eating-related self-efficacy-primary targets of that intervention-with no significant difference in those changes by mood disturbance grouping. Changes in the summed exercise- and eating-related self-regulation scores significantly mediated relationships between changes in eating-related self-efficacy and weight (over both 6 and 12 months). There were similar results with mediation assessed via the extent exercise-related self-regulation carried over to eating-related self-regulation. In both of those models a reciprocal relationship between self-regulation and self-efficacy changes was indicated. In serial multiple mediation equations, paths of changes in exercise-related self-regulation → eating-related self-regulation → eating-related self-efficacy → weight were significant. However, paths were not significant when change in self-efficacy was entered as the predictor (initial) variable. Findings suggest viability in first focusing on exercise-related self-regulation, then eating-related self-regulation, in the course of increasing self-efficacy and probabilities for inducing enough sustained weight loss to improve obesity-associated health risks. Benefits of field-based research findings generalizing to weight-management applications were suggested.

Theory-Driven Behavioral Obesity Treatment and Carry-Over of Exercise-Related, to Eating-Related, Self-Regulation: Effects on Short- and Long-Term Weight/Waist Circumference Reductions

The predominant method for treating obesity has been suggesting and providing information on a controlled diet and, to a lesser extent, increased exercise. That approach has largely failed beyond the short term for many decades as obesity rates continue to rise. Therefore, leveraging improvements in psychosocial correlates of weight-loss behaviors has sometimes been suggested instead. The aim of this study was evaluation of targeted improvements in self-regulation and self-efficacy within a theoretically derived weight-loss program. Women with obesity (N = 103) participated in a year-long community-based program emphasizing self-regulatory skills development to counter lifestyle barriers/challenges to first exercise, then controlled eating. Within a structured treatment protocol administered by community facility employees-and based on tenets of social cognitive theory, self-regulation theory, self-efficacy theory, and coaction theory-self-regulatory skills were initially developed to foster adherence to exercise. Those skills were then adapted to promote eating-behavior changes, emphasizing fruit and vegetable intake. Improvements in measures of exercise self-regulation, eating self-regulation, and self-efficacy for controlling eating, their corresponding behaviors, and weight and waist circumference were significant. Greater within-participant carry-over of changes in exercise self-regulation to eating self-regulation was significantly associated with more weight and waist circumference reductions over both 6 and 12 months. Change in eating-related self-efficacy significantly mediated those relationships. The mean weight reduction of approximately 6% indicated positive effects on obesity-related health risks. The community-based setting indicated potentials for large-scale dissemination of theory- and evidence-driven behavioral obesity treatments focused primarily on self-regulatory skills development.

A cluster randomized controlled trial of a brief positive healthy eating intervention

Excessive sugar intake poses a significant risk factor for non-communicable diseases. A positive healthy eating (PHE) intervention was developed to promote low-sugar dietary practices in families. The PHE intervention capitalized on positive psychological constructs to overcome barriers to health behavior change by helping families associate feelings of joy, gratitude, and savoring with healthy eating. In a cluster randomized controlled trial, 1983 participants from 1467 families were recruited in Hong Kong. PHE included a core and booster session. Data were collected at pre-intervention, post-intervention, and at 1-month and 3-month follow-up. Compared to the control, PHE showed greater increase in intention to change at post-intervention, engagement in low-sugar dietary practices individually and with family members at 3-month follow-up, and greater reduction in sugar-sweetened beverage intake at 1-month and 3-month follow-up. Intentions to change mediated PHE's effects on low-sugar dietary practices. Focus group interviews revealed the behavior-change process and family quality of life.

The Walking and Lifestyle Coaching (WALC) Program for University Students: A Pilot Study

Background: The purpose of this study was to evaluate the implementation of the 3-week Walking and Lifestyle Coaching (WALC) program with university college students to promote health behavior change and reduce chronic disease risk. Methods: During the 3-week WALC program, students received weekly peer health and wellness coaching while engaging in a 30-minute walk throughout campus. Each week, physical activity was directly measured using pedometers, and self-report physical activity behavior, steps, and daily reflections were reported using a self-monitoring journal. At baseline and follow-up, students completed biometrics screening, mental health questionnaires, and the Cooper 1.5 mile walk test to evaluate cardiovascular fitness. Results: A total of 35 college students participated in the WALC program. The mean daily steps number of steps during the WALC program was 6315 (SD = 2073.16). Only 25/35 participants reported steps for the entire WALC program (71.43%). There was not a statistically significant difference in generalized anxiety, perceived stress, depression, quality of life, or self-compassion. There was a slight decline in body fat percentage, although not statistically significant. There was an average improvement of 89 seconds on the 1.5-mile walk/run test. Discussion: The WALC program was developed to be inclusive, feasible, and a mechanism to synergize campus resources to collaborate on behalf of student wellness. It is necessary for this program to be utilized on university campuses in diverse geographical regions (i.e., rural, urban, or suburban), with diverse students (i.e., racially, ethnically, gender-identity, and religious affiliation.), and with universities of all sizes and funding levels. Future research could consider the use of a control group as well as an online self-monitoring journal.

Examining the Impact of a Behavior Modification Program on Disease Prevention Behaviors among Individuals at Risk of Diabetes: A Quasi-Experimental Investigation

This study aimed to develop and test a behavior modification intervention to prevent type 2 diabetes (T2DM) among at-risk individuals. The primary goal was to compare diabetes prevention behaviors and fasting blood sugar levels between the intervention and comparison groups. This study utilizes a quasi-experimental design to develop a behavior modification intervention for preventing diabetes. It involves two groups, each with pre- and post-intervention assessments, comprising 60 at-risk individuals equally divided into intervention and comparison groups. The 8-week intervention includes components like risk assessment, dietary skill enhancement, exercise, stress management, and social media platforms (data recording training, follow-up visits, reminders, and visual aids). Data collection includes self-administered questionnaires and blood sugar level measurements. Statistical analysis involved paired t-tests for within-group comparisons and independent t-tests for between-group differences. The findings showed that the intervention group achieved significantly higher average scores in nutrition, exercise, and stress management, and had significantly lower average blood sugar levels compared to the comparison group. These results suggest that healthcare providers and policymakers should develop community health programs and public health policies that incorporate integrative care, leverage social media platforms, and foster collaboration with other health professionals to improve outcomes for individuals at risk of T2DM.

Exercise for peri- and postmenopausal women: Recommendations from synergistic alliances of women's medicine and health psychology for the promotion of an active lifestyle

Adopting healthy behaviors is a multifaceted and complex process that poses significant challenges for individuals. Despite awareness of the detrimental effects of certain behaviors on health, many individuals continue to engage in risky practices. Traditional medical advice and prescriptions, while well intentioned, often fall short in fostering lasting lifestyle changes. Although individuals may also have good intentions, solely relying on doctor's counsel does not ensure successful lifestyle adjustments. One primary reason for this limitation is the lack of specialized expertise in behavioral modification among gynecologists and healthcare providers. Health psychologists are specialized professionals capable of effectively guiding and assisting individuals in modifying health-related behaviors. Their expertise in behavior change strategies and psychological interventions proves invaluable in empowering individuals to embrace healthier lifestyles and contributes to people's well-being. This paper emphasizes the importance of collaborative efforts between medical professionals, such as gynecologists, and health psychologists to promote healthy behaviors among peri- and postmenopausal women and enhance women's health. By forging integrative alliances, they can develop comprehensive and tailored interventions. By bridging the gap between medical advice and behavior modification, this collaborative effort has the potential to ensure a more effective intervention process. This holistic approach not only addresses women's specific health needs but also fosters sustainable behavior change when promoting healthy behaviors among middle-aged women. The ultimate goal of such a synergy is to improve women's health outcomes and contribute to a healthier society overall.

Relationship of increased fruit/vegetable intake with reduced consumption of sweets: Psychological mechanisms and associated weight loss in women within behavioral obesity treatments

Although an increase in fruit and vegetable (FV) consumption in adults might result in reductions in their intake of sweets, there has been minimal direct testing of this. Women participated in 6-month community-based obesity treatment conditions where either their psychological skills development (n = 66) or knowledge regarding healthful eating and exercise (n = 39) was emphasized. Improvements in FV and sweets intake, eating-related self-regulation, self-efficacy for controlled eating, and negative mood were significantly more pronounced in the psychological skills group participants. Together, participants' change in self-regulation, self-efficacy, and mood significantly mediated the relationship of their changes in FV and sweets. Within simple mediation analyses, participants' changes in self-efficacy and negative mood were significant mediators, and their treatment group membership moderated effects on sweets. We provided suggestions for future treatments based on the present findings.

Determining the Right Levels of Health Coaching and Heart Rate Variability Biofeedback in a Workplace Behavior Change Intervention: Multiphase Optimization Strategy Preparation Study

BACKGROUND

Work-related stress is associated with poor job performance and negative health outcomes. Changing health behaviors through corporate wellness programs can improve physical and mental health and help employees manage stress. This project sought to pilot the potential addition of brief coaching and biofeedback to an 8-week web-based self-help program to improve employee stress using the multiphase optimization strategy.

OBJECTIVE

This study aims to determine which candidate components will be tested in a later optimization phase and at what dose they will be tested, examine the feasibility and acceptability of delivering the different components, investigate whether the outcomes can be feasibly measured, and review evidence to build a conceptual model before the optimization phase.

METHODS

The study was positioned within the preparation phase of the multiphase optimization strategy. It is a 2×2×2×2 design with 4 components: 2 types of health coaching and 2 types of biofeedback. All components were tested by turning them on or off. A total of 16 adult office workers (mean age 40, SD 14.3 years; n=15 women) completed an 8-week self-paced web-based stress management and health behavior change program and were randomly assigned to 1 of the 16 conditions, created from a combination of the 4 candidate components. Assessments included web analytics, surveys, and interviews regarding program recommendations, likes, and dislikes.

RESULTS

Findings from the interviews provided suggestions to improve the intervention (eg, separating wellness from stress content) and trial conduct (eg, streamlining the onboarding process). On average, participants logged into the wellness program 83 times (range 36-291), with 75% (12/16) participant retention and 67% (8/12) survey completion. There were no reported problems with coaching or obtaining data from interviews or apps. The interview findings suggested potential mediators to include and assess in a future conceptual model.

CONCLUSIONS

The results provided areas to improve the intervention content and trial methods. Instead of progressing to the next scheduled large-scale optimization phase, our plan to iterate through a second preparation phase after making changes to the protocol, apps, and corporate coaching partner.

Leisure-time management and subjective well-being among older adults: A three-wave longitudinal survey

AIM

As older adults have longer leisure time and the types and influences of leisure activities they participate in are diverse, appropriate management of their leisure time would be important to optimize their subjective well-being. Although greater use of time management in educational and occupational settings is associated with better job performance, academic achievement, and the well-being of workers and students, few studies have investigated time management in leisure settings. This study aimed to examine the longitudinal association between leisure-time management and subjective well-being among older adults.

METHODS

Data on 879 individuals in Nada Ward, Kobe, Japan were obtained from a three-wave questionnaire-based longitudinal survey (Wave 1: December 2017 to January 2018; Wave 2: after one year; Wave 3: after three years). In each survey, leisure-time management (newly developed in this study) and subjective well-being (simplified Japanese version of the World Health Organization Five Well-Being Index) were measured. This study used a cross-lagged model to analyze the longitudinal association between leisure-time management and subjective well-being after considering their inverse association.

RESULTS

The cross-lagged model indicated that that the standardized path coefficients from leisure-time management in Wave 1 to subjective well-being in Wave 2 (0.13, p<0.001) and from leisure-time management in Wave 2 to subjective well-being in Wave 3 (0.06, p=0.042) were positive and significant.

CONCLUSIONS

This study found that leisure-time management is a determinant of subjective well-being among older adults. This finding indicates that the management of leisure time elevates one's subjective well-being among them.

Improving Adherence to Physical Therapy in the Development of Serious Games: Conceptual Framework Design Study

BACKGROUND

Insufficient levels of treatment adherence can have adverse effects on the outcomes of physical rehabilitation. To address this issue, alternative approaches to traditional therapies, such as serious games, have been designed to enhance adherence. Nevertheless, there remain gaps in the development of serious games concerning the effective implementation of motivation, engagement, and the enhancement of treatment adherence.

OBJECTIVE

This study aims to design a conceptual framework for the development of serious games that incorporate essential adherence factors to enhance patient compliance with physical rehabilitation programs.

METHODS

We formulated a conceptual framework using iterative techniques inspired by a conceptual framework analysis. Initially, we conducted a comprehensive literature review, concentrating on the critical adherence factors in physical rehabilitation. Subsequently, we identified, categorized, integrated, and synthesized the concepts derived from the literature review to construct the conceptual framework.

RESULTS

The framework resembles a road map, comprising 3 distinct phases. In the initial phase, the patient's characteristics are identified through an initial exploration. The second phase involves the development of a serious game, with a focus on enhancing treatment adherence by integrating the key adherence factors identified. The third phase revolves around the evaluation of the serious game. These phases are underpinned by 2 overarching themes, namely, a user-centered design and the GameFlow model.

CONCLUSIONS

The conceptual framework offers a detailed, step-by-step guide for creating serious games that incorporate essential adherence factors, thereby contributing to improved adherence in the physical rehabilitation process. To establish its validity, further evaluations of this framework across various physical rehabilitation programs and user groups are necessary.

A Systematic Review of Workplace Physical Activity Coaching

Aim Studies show that about 60 min of moderate physical activity (PA) per day compensate for sitting all day at work. However, the workplace offers an ideal setting for health-promoting interventions such as PA coaching as a person-centered intervention aimed at achieving lasting health behavior changes. Given a good evidence base of health coaching studies in general, this systematic review aims to provide an overview of workplace PA coaching interventions. Methods This review was conducted according to PRISMA guidelines. Studies published up to July 2021 were considered based on the following inclusion criteria: (1) longitudinal intervention studies, (2) analysis of PA at work, (3) sedentary employees, (4) PA coaching in the workplace as intervention, (5) increasing workplace PA. Results Of 4323 studies found, 14 studies with 17 interventions met inclusion criteria. All 17 interventions indicated an increase in at least one PA outcome. Twelve interventions indicated significant improvements in at least one workplace or total PA outcome. There is a high variation within the different coaching parameters, such as behavior change techniques and communication channels. The study quality showed a moderate to high risk of bias. Conclusions The majority of interventions provided evidence for the effectiveness of workplace PA coaching. Nevertheless, the results are inconclusive with regard to the variety of coaching parameters and thus no general statement can be made about the effectiveness of individual parameters. However, this variety of parameters also leads to a high degree of individualization of workplace PA coaching interventions to increase PA for different groups of employees and different types of workplaces.

Coaction of Exercise and Eating Improvements Within a Behavioral Obesity Treatment: Directionality and Psychological Mechanisms

Purpose: Because coaction (a favorable change in one behavior increasing the probability of a similarly favorable change in another behavior) associated with health behaviors has been identified, directionalities of such relationships within weight-loss behaviors (e.g., exercise, healthy eating) and their theory-based psychological mechanisms requires more investigation. Method: Women with obesity and either disturbed mood (n = 61) or normal mood (n = 58) participated in a cogntive-behavioral weight-management treatment within a community setting. Analyses of both group differences, and mediation models using aggregate data of behavioral and psychological variables, were conducted. Results: Improvements in measures of self-regulation, self-efficacy, mood, exercise, and fruit/vegetable intake were significant overall; with fruit/vegetable increase greater in the disturbed mood group. The prediction of increase in fruits/vegetables from baseline-Month 6 by increase in exercise from bascline-Month 3 (β = .24) was stronger than effects of change in fruit/vegetabe intake on exercise (β = .16). Overall mediation models were significant where changes in self-regulation and self-efficacy were entered as serial mediators of predictions of fruit/vegetable change by change in exercise (R2= .35 and .32), and vice versa (R2= .24 and .23). Paths demonstrating effects through self-regulation change and self-efficacy change were significant in the prediction of eating and exercise changes, respectively. Conclusion: Contributions to advancements in behavioral theory and treatment curricula targeting self-regulation and self-efficacy to improve exercse-eating change relationships were suggested.  .

Scope, Characteristics, Behavior Change Techniques, and Quality of Conversational Agents for Mental Health and Well-Being: Systematic Assessment of Apps

BACKGROUND

Mental disorders cause substantial health-related burden worldwide. Mobile health interventions are increasingly being used to promote mental health and well-being, as they could improve access to treatment and reduce associated costs. Behavior change is an important feature of interventions aimed at improving mental health and well-being. There is a need to discern the active components that can promote behavior change in such interventions and ultimately improve users' mental health.

OBJECTIVE

This study systematically identified mental health conversational agents (CAs) currently available in app stores and assessed the behavior change techniques (BCTs) used. We further described their main features, technical aspects, and quality in terms of engagement, functionality, esthetics, and information using the Mobile Application Rating Scale.

METHODS

The search, selection, and assessment of apps were adapted from a systematic review methodology and included a search, 2 rounds of selection, and an evaluation following predefined criteria. We conducted a systematic app search of Apple's App Store and Google Play using 42matters. Apps with CAs in English that uploaded or updated from January 2020 and provided interventions aimed at improving mental health and well-being and the assessment or management of mental disorders were tested by at least 2 reviewers. The BCT taxonomy v1, a comprehensive list of 93 BCTs, was used to identify the specific behavior change components in CAs.

RESULTS

We found 18 app-based mental health CAs. Most CAs had <1000 user ratings on both app stores (12/18, 67%) and targeted several conditions such as stress, anxiety, and depression (13/18, 72%). All CAs addressed >1 mental disorder. Most CAs (14/18, 78%) used cognitive behavioral therapy (CBT). Half (9/18, 50%) of the CAs identified were rule based (ie, only offered predetermined answers) and the other half (9/18, 50%) were artificial intelligence enhanced (ie, included open-ended questions). CAs used 48 different BCTs and included on average 15 (SD 8.77; range 4-30) BCTs. The most common BCTs were 3.3 "Social support (emotional)," 4.1 "Instructions for how to perform a behavior," 11.2 "Reduce negative emotions," and 6.1 "Demonstration of the behavior." One-third (5/14, 36%) of the CAs claiming to be CBT based did not include core CBT concepts.

CONCLUSIONS

Mental health CAs mostly targeted various mental health issues such as stress, anxiety, and depression, reflecting a broad intervention focus. The most common BCTs identified serve to promote the self-management of mental disorders with few therapeutic elements. CA developers should consider the quality of information, user confidentiality, access, and emergency management when designing mental health CAs. Future research should assess the role of artificial intelligence in promoting behavior change within CAs and determine the choice of BCTs in evidence-based psychotherapies to enable systematic, consistent, and transparent development and evaluation of effective digital mental health interventions.

The AHAWOMEN project: study protocol of a multi-design research for exploring HAPA predictors of exercise in postmenopausal women

BACKGROUND

The postmenopausal period can represent an opportunity for women to improve their health and well-being. The Active and Healthy Ageing in Women during early postmenopause (AHAWOMEN) study aims to identify the key determinants of an active lifestyle among middle-aged women, with a focus on the stages and the social-cognitive variables outlined in the Health Action Process Approach (HAPA) model, a theoretical framework for understanding health behaviour change. We expected that HAPA factors and processes of intention creation (motivational phase) and action adoption (volitional phase) will be significant predictors of exercise initiation and maintenance, supporting both the HAPA tenets and the efficacy of HAPA-based interventions.

METHODS/DESIGN

This study was approved by the authors' Institutional Review Committee. Postmenopausal women aged between 45 and 65 years will voluntarily participate. The participants will be allocated to one of three groups: Intervention-Initiators (n = 100, random allocation), Control-Sedentary (n = 100, random allocation) or Control-Active (n = 100, non-random allocation). The intervention group will engage in a supervised exercise programme lasting at least 3 months, supplemented with a HAPA-based intervention for behaviour change. The sedentary control group will not receive any intervention to change their physical activity, while the active control group will consist of women who are already regularly adhering to an active lifestyle. Study variables will be measured at baseline and postintervention phases, as well as at 1, 3, 6 and 12-month follow-ups. The predictors of exercise behaviour in the different phases of the behavioural change process will be explored and compared within and between groups throughout the study. These analyses will help identify the factors that determine the adoption of a healthy active behaviour. Additionally, the effectiveness of the model and the intervention for changing active behaviour will be evaluated.

DISCUSSION

This paper describes the rationale, development and methods used in the AHAWOMEN project. Supporting women who intend to become active can help them to translate their goals into sustainable action. Verifying that the HAPA predictions are applicable to postmenopausal women's adoption of exercise would provide the basis for designing effective interventions for promoting healthy and active ageing that are also tailored to the experiences of middle-aged women.

TRIAL REGISTRATION

ISRCTN16251361. Registration date: 01/06/2023 (retrospectively registered).

An Integrated Model for Evaluating the Sustainability of Gamified Mobile Health Apps: An Instrument Development and Validation

Mobile health (mHealth) apps are designed to support health behavior outcomes and improve well-being. The existing body of literature confirms mHealth’s overall efficacy in promoting physical activity; however, more research on its utility in sustaining user engagement is needed. Understanding the determinants of an individual’s willingness to continue using mHealth is vital to improving the intervention’s success. This study developed a unified model and survey instrument adapted from extant literature while introducing new constructs to predict the sustained use of gamified mHealth. A pilot study was conducted to validate the survey instrument using 48 gamified fitness app users in Malaysia. The survey instrument was tested following rigorous guidelines for quantitative research in the information system context. According to the findings, the reliabilities of most measurement items met the criterion, and those items were retained. Overall, this paper contributes by integrating social comparison theory and the self-determination theory for sustaining user engagement with gamified mHealth through an extrinsic and intrinsic motivation perspective.

Effect of In-Person Delivered Behavioural Interventions in People with Multimorbidity: Systematic Review and Meta-analysis

BACKGROUND

To investigate the effect of in-person delivered behavioural interventions in people with multimorbidity and which behaviour change techniques (BCTs), targeting lifestyle behaviours, are associated with better outcomes.

METHODS

Systematic review of randomised controlled trials. We searched MEDLINE, EMBASE, CENTRAL, and CINAHL and screened reference list of reviews including people with multimorbidity, registries, and citation tracking of included studies. Meta-analyses using random-effects model to assess the effect of behavioural interventions and meta-regression analyses and effectiveness ratios to investigate the impact of mediators on effect estimates. Cochrane 'Risk of Bias Tool' 2.0 and the GRADE assessment to evaluate the overall quality of evidence.

RESULTS

Fourteen studies involving 1,378 people. Behavioural interventions had little to no effect on physical activity (standardised mean difference 0.38, 95% CI -0.12-0.87) and the effect on weight loss was uncertain (BMI mean difference -0.17, 95% CI -1.1-0.83) at the end-treatment follow-up. Small improvements were seen in health-related quality of life (SMD 0.29, 95% CI 0.17-0.42) and physical function (SMD 0.42, 95% CI 0.12-0.73), and moderate improvements were seen for depression symptoms (SMD -0.70, 95% CI -0.97-0.42). Studies using the BCTs 'action planning' and 'social support (practical)' reported greater physical activity and weight loss.

CONCLUSIONS

Behavioural interventions targeting lifestyle behaviours may improve health-related quality of life and physical function, and reduce depression, whereas little to no effect was achieved on physical activity and weight loss in people with multimorbidity. However, the evidence for physical activity and weight loss were of low quality and the end-treatment benefits diminished over time.

Advancing Health Equity Efforts to Reduce Obesity: Changing the Course

Population-based solutions are needed to stabilize and then reverse the continued upward trends in obesity prevalence in the US population and worldwide. This review focuses on the related, urgent issue of disparities in obesity prevalence affecting US racial/ethnic minority and other socially marginalized populations. The review provides background on these disparities from a health equity perspective and highlights evidence of progress in equity-focused obesity efforts. Five recommendations for advancing equity efforts are offered as potential approaches to build on progress to date: (a) give equity issues higher priority, (b) adopt a health equity lens, (c) strengthen approaches by using health equity frameworks, (d) broaden the types of policies considered, and (e) emphasize implementation science concepts and tools. Potential challenges and opportunities are identified, including the prospect of longer-term, transformative solutions that integrate global and national initiatives to address obesity, undernutrition, and climate change.

Key process features of personalized diet counselling in metabolic syndrome: secondary analysis of feasibility study in primary care

BACKGROUND

Personalized diet counselling, as part of lifestyle change programs for cardiometabolic risk conditions (combinations of prediabetes or type 2 diabetes, hypertension, dyslipidemia and high waist circumference) has been shown to reduce progression to type 2 diabetes overall. To identify key process of care measures that could be linked to changes in diet, we undertook a secondary analysis of a Canadian pre-post study of lifestyle treatment of metabolic syndrome (MetS). Diet counselling process measures were documented and association with diet quality changes after 3 months were assessed. Results of the primary study showed 19% reversal of MetS after 1 year.

METHODS

Registered dietitians (RDs) reported on contact time, specific food behaviour goals (FBG), behaviour change techniques (BCT; adapted from the Michie CALO-RE taxonomy) and teaching resources at each contact. Diet quality was measured by 2005 Canadian Healthy Eating Index (HEI-C) and assessed for possible associations with individual BCT and FBG.

RESULTS

Food behaviour goals associated with improved HEI-C at 3 months were: poultry more than red meat, increased plant protein, increased fish, increased olive oil, increased fruits and vegetables, eating breakfast, increased milk and alternatives, healthier fats, healthier snacks and increased nuts, with an adverse association noted for more use (> 2 times/ 3 months) of the balanced meal concept (F test; p < 0.001). Of 16 BCT, goal setting accounted for 15% of all BCT recorded, yet more goal setting (> 3 times/3 months) was associated with poorer HEI-C at 3 months (F test; p = 0.007). Only self-monitoring, feedback on performance and focus on past success were associated with improved HEI-C.

CONCLUSIONS

These results identify key aspects of process that impact diet quality. Documentation of both FBG and BCT is highly relevant in diet counselling and a summary diet quality score is a promising target for assessing short-term counselling success.

Environments and situations as correlates of eating and drinking among women living with obesity and urban poverty

Objective

One path to improving weight management may be to lessen the self-control burden of physical activity and healthier food choices. Opportunities to lessen the self-control burden might be uncovered by assessing the spatiotemporal experiences of individuals in daily context. This report aims to describe the time, place, and social context of eating and drinking and 6-month weight change among 209 midlife women (n = 113 African-American) with obesity receiving safety-net primary care.

Methods

Participants completed baseline and 6-month weight measures, observations and interviews regarding obesogenic cues in the home environment, and up to 12 ecological momentary assessments (EMA) per day for 30 days inquiring about location, social context, and eating and drinking.

Results

Home was the most common location (62%) at times of EMA notifications. Participants reported "yes" to eating or drinking at the time of nearly one in three (31.1% ± 13.2%) EMA notifications. Regarding social situations, being alone was significantly associated with less frequent eating and drinking (OR = 0.75) unless at work in which case being alone was significantly associated with a greater frequency of eating or drinking (OR = 1.43). At work, eating was most common late at night, whereas at home eating was most frequent in the afternoon and evening hours. However, eating and drinking frequency was not associated with 6-month weight change.

Conclusions

Home and work locations, time of day, and whether alone may be important dimensions to consider in the pursuit of more effective weight loss interventions. Opportunities to personalize weight management interventions, whether digital or human, and lessen in-the-moment self-control burden might lie in identifying times and locations most associated with caloric consumption.

Clinical trial registration: NCT03083964 in clinicaltrials.gov.

Effectiveness, Moderators and Mediators of Self-regulation Intervention on Older Adults' Exercise Behavior: a Randomized, Controlled Crossover Trial

Background

Although self-regulation interventions are effective in promoting exercise behaviors, moderators and mediators of interventions among older adults are not well established. This study aimed to examine whether (1) self-regulation intervention promoted exercise behavior, (2) health literacy and habit strength moderated the intervention effect, and (3) self-regulation and habit strength mediated the intervention effect among older adults.

Methods

This study was a randomized, non-blinded, controlled crossover trial. The baseline questionnaire survey assessed the average amount of exercise time per day, self-regulation, habit strength, health literacy, and socio-demographic factors. After the baseline survey, 393 community-dwelling older adults were randomly assigned to either the immediate intervention or the delayed intervention group. For the immediate group, print-based materials were provided once a week for 7 weeks before a second questionnaire survey. For the delayed group, the materials were provided only after the second survey. Finally, a third survey was conducted for both groups.

Results

The mixed models showed that the average exercise time was increased after the intervention in both groups. Multiple regression analyses revealed that no factor moderated the intervention effect. From the path analyses, the mediating effect of self-regulation on the relationship between intervention and changes in average exercise time was supported, but the mediating role of habit strength was not clearly indicated.

Conclusions

Although the mediating roles of habit strength for the intervention effects are still inconclusive, self-regulation intervention can promote exercise behavior among older adults, regardless of their health literacy level, habit strength, and socio-demographic characteristics.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12529-021-10049-3.

Behaviour Change Techniques in Weight Gain Prevention Interventions in Adults of Reproductive Age: Meta-Analysis and Meta-Regression

Weight gain prevention interventions are likely to be more effective with the inclusion of behaviour change techniques. However, evidence on which behaviour change techniques (BCT) are most effective for preventing weight gain and improving lifestyle (diet and physical activity) is limited, especially in reproductive-aged adults. This meta-analysis and meta-regression aimed to identify BCT associated with changes in weight, energy intake and physical activity in reproductive-aged adults. BCT were identified using the BCT Taxonomy (v1) from each intervention. Meta-regression analyses were used to identify BCT associated with change in weight, energy intake and physical activity. Thirty-four articles were included with twenty-nine articles for the meta-analysis. Forty-three of the ninety-three possible BCT listed in the taxonomy were identified in the included studies. Feedback on behaviour and Graded tasks were significantly associated with less weight gain, and Review behaviour goals was significantly associated with lower energy intake. No individual BCT were significantly associated with physical activity. Our analysis provides further evidence for which BCT are most effective in weight gain prevention interventions. The findings support that the use of key BCT within interventions can contribute to successful weight gain prevention in adults of reproductive age.

Nutrition Concepts for the Treatment of Obesity in Adults

Obesity caused by a positive energy balance is a serious health burden. Studies have shown that obesity is the major risk factor for many diseases like type 2 diabetes mellitus, coronary heart diseases, or various types of cancer. Therefore, the prevention and treatment of increased body weight are key. Different evidence-based treatment approaches considering weight history, body mass index (BMI) category, and co-morbidities are available: lifestyle intervention, formula diet, drugs, and bariatric surgery. For all treatment approaches, behaviour change techniques, reduction in energy intake, and increasing energy expenditure are required. Self-monitoring of diet and physical activity provides an effective behaviour change technique for weight management. Digital tools increase engagement rates for self-monitoring and have the potential to improve weight management. The objective of this narrative review is to summarize current available treatment approaches for obesity, to provide a selective overview of nutrition trends, and to give a scientific viewpoint for various nutrition concepts for weight loss.

Reciprocal relationship of mood and emotional eating changes through self-regulation of weight-loss behaviors

Emotional eating is a considerable problem in women, and holds a great risk for obesity. Negative mood has been identified as a predictor of emotional eating, and vice versa. However, associated research has generally been cross-sectional, lacking sensitivity to dynamic changes and interactions occurring in psychological variables during a behavioral obesity treatment. The aim of the present study was to assess if physical activity-associated improvement in mood is significantly related to a subsequent reduction in emotional eating in women, and whether a reciprocal relationship is also present. Because improved mood has been posited to positively impact self-regulation, and physical activity-related self-regulation has been shown to transfer to eating-related self-regulation, they were also tested as possible mediators of mood-emotional eating relationships. A treatment focused on physical activity and self-regulation (n = 57) demonstrated greater improvements in mood, emotional eating, physical activity- and eating-related self-regulation, and physical activity than a treatment with a more typical focus on primarily providing information on healthy eating (n = 57). Reduction in negative mood over 3 months significantly predicted a 6-month reduction in emotional eating, and vice versa (i.e., a reciprocal relationship). Models with sequential entry of changes in physical activity-related self-regulation, then eating-related self-regulation, as mediators were significant. However, paths through the self-regulation changes were significant only in the model where change in mood predicted emotional eating change. Findings supported the role of physical activity in mood change, and the benefits of also addressing self-regulatory skills development within behavioral obesity treatments so that emotional eating is reduced.

Linking Emotional Intelligence, Physical Activity and Aggression among Undergraduates

Several indicators are strongly related to health and well-being in university students, such as emotional intelligence and physical activity. At the same time, some qualities threaten it and are incompatible with students’ adaptation to society in general, such as aggressive behaviours. The aim of this research is to analyse the relationship established between emotional intelligence using TMMS-24, physical activity, using IPAQ, and aggression behaviours in university students. For this purpose, a descriptive, cross-sectional and non-experimental study was developed with 932 undergraduates (M = 20.55; SD = 3.673). The findings highlight how emotional intelligence and physical activity practice decrease violent behaviour in university students. In addition, men tend to have more aggressive behaviours than women as well as the relation between physical activity and emotional intelligence is stronger in all its dimensions. Results highlight the importance of including emotional intelligence programs in order to enable undergraduate well-being.

Older Women's Experiences of a Community-Led Walking Programme Using Activity Trackers

Promoting physical activity amongst older adults represents a major public health goal and community-led exercise programmes present benefits in promoting active lifestyles. Commercial activity trackers potentially encourage positive behaviour change with respect to physical exercise. This qualitative study investigated the experiences and attitudes of older adults following a 6-week community-led walking programme utilising activity trackers. Eleven community-dwelling older women aged 60+ completed individual phone interviews following their involvement in the programme. The programme, codesigned with a group of senior citizens, equipped participants with wrist-worn activity trackers and included biweekly check-in sessions with a researcher to monitor progress and support motivation. Interviews explored participants’ experiences of the programme and of using activity trackers for the purpose of becoming more active. A thematic analysis produced three main themes: ‘programme as a source of motivation’, ‘user experiences with the technology’ and ‘views on social dimension of the programme’. Overall, participants highlighted the self-monitoring function of activity trackers as most beneficial for their exercise levels. This study provides insights into the personal and social factors perceived by older adults in relation to being part of a community-led programme using activity trackers. It highlights the role of the programme and trackers in maintaining motivation to stay active.

Additional Effects of Reduced Emotional Eating on Associations of Weight Loss via Changes in Social Cognitive Theory Variables

BACKGROUND

Improvements in the theory-based psychosocial variables of eating self-regulation, mood, and self-efficacy for controlled eating significantly predicted weight loss in community-based obesity treatments. However, in women, additional effects from reductions in emotional eating, and age and race/ethnicity are unclear.

METHODS

Women (N = 130) participating in a community-based cognitive-behavioral obesity treatment were assessed on changes in theory-based psychosocial variables and weight.

RESULTS

Treatment-associated improvements in self-regulation, mood, and self-efficacy over 3 months significantly predicted 6-month weight loss (R² = 0.26), with self-regulation change being the strongest individual predictor. Entry of change in emotional eating into the prediction model significantly added to the variance in weight change explained. Age and race/ethnicity did not further improve the predictive strength.

CONCLUSIONS

In addition to targeting self-regulation skill development and, to a lesser extent addressing mood and self-efficacy improvements, behavioral obesity treatments should focus on emotional eating to maximize their large-scale effects on excess weight.

A Clinician-Led, Experience-Based Co-Design Approach for Developing mHealth Services to Support the Patient Self-management of Chronic Conditions: Development Study and Design Case

BACKGROUND

Despite the increasing use of mobile health (mHealth) services, such as mHealth apps or SMS text messaging services, that support the patient self-management of chronic conditions, many existing mHealth services lack theoretical guidance. In addition, although often the target audience for requirement acquisition at the initial mHealth app design stage, it is a common challenge for them to fully conceptualize their needs for mHealth services that help self-manage chronic conditions.

OBJECTIVE

This study proposes a novel co-design approach with the initial requirements for mHealth services proposed by clinicians based on their experiences in guiding patients to self-manage chronic conditions. A design case is presented to illustrate our innovative approach to designing an mHealth app that supports the self-management of patients with obesity in their preparation for elective surgery.

METHODS

We adopted a clinician-led co-design approach. The co-design approach consisted of the following four cyclic phases: understanding user needs, identifying an applicable underlying theory, integrating the theory into the prototype design, and evaluating and refining the prototype mHealth services with patients. Expert panel discussions, a literature review, intervention mapping, and patient focus group discussions were conducted in these four phases.

RESULTS

In stage 1, the expert panel proposed the following three common user needs: motivational, educational, and supportive needs. In stage 2, the team selected the Social Cognitive Theory to guide the app design. In stage 3, the team designed and developed the key functions of the mHealth app, including automatic push notifications; web-based resources; goal setting and monitoring; and interactive health-related exchanges that encourage physical activity, healthy eating, psychological preparation, and a positive outlook for elective surgery. Push notifications were designed in response to a patient's risk level, as informed by the person's response to a baseline health survey. In stage 4, the prototype mHealth app was used to capture further requirements from patients in the two focus group discussions. Focus group participants affirmed the potential benefits of the app and suggested more requirements for the function, presentation, and personalization needs. The app was improved based on these suggestions.

CONCLUSIONS

This study reports an innovative co-design approach that was used to leverage the clinical experiences of clinicians to produce the initial prototype app and the approach taken to allow patients to effectively voice their needs and expectations for the mHealth app in a focus group discussion. This approach can be generalized to the design of any mHealth service that aims to support the patient self-management of chronic conditions.

Mediators of relations of obesity treatment-associated changes in mood and weight: extending cross-sectional research

Significant cross-sectional associations between mood and weight have been made in women; however, data on associated longitudinal effects and their psychological and behavioral mechanisms are required to inform obesity treatments that mostly have limited success beyond the very short term. Women participating in behavioral obesity treatments were assessed on psychological and behavioral measures, and weight change over 12 months. A treatment focused on physical activity and self-regulation (n = 67) had significantly better improvements than a treatment centered around weight-loss education (n = 64) on measures of mood (overall mood, depression, anxiety), self-regulation, emotional eating, eating behaviors, physical activity, and weight in women with obesity. Incorporating a lagged variable design, 12-month weight loss was significantly predicted (separately) by changes in overall negative mood, depression, and anxiety. When changes in measures of self-regulation, emotional eating, and eating behaviors were sequentially entered as mediators, mood change-weight change relationships were rendered non-significant. Significant mediation paths were: mood change→self-regulation change→weight change, and mood change→self-regulation change→eating behavior change→weight change. They were unaffected by the treatment group. Findings contributed to both theory and obesity intervention architectures via a design sensitive to the dynamic psychological and behavioral changes occurring within weight-loss processes.

Effective behavior change techniques to promote physical activity in adults with overweight or obesity: A systematic review and meta-analysis

Multicomponent behavior change interventions are typically used in weight management, but results are largely heterogeneous and modest. Determining which techniques (behavior change technique [BCTs]) are more effective in changing behavior is thus required. This study aimed to identify the most effective BCTs for increasing physical activity (PA) in digital and face-to-face behavior change interventions in adults with overweight/obesity. Four databases were searched for eligible studies until October 2019. BCTs were coded using BCTTv1 and MBCT taxonomies. Sixty-two RCTs were included. Meta-regressions were performed to explore BCTs' moderating role. Five BCTs showed significant moderator effects on PA in digital interventions: goal setting behavior, goal setting outcome, graded tasks, social incentive, and self-monitoring of behavior (adjusted R² 's = 0.15-0.51). One BCT showed significant moderator effects on PA in face-to-face interventions, behavioral practice and rehearsal (adjusted R²  = 0.22). Multivariate and sensitivity analysis generally led to similar findings. Effective BCTs for increasing PA in adults with overweight/obesity in digital and face-to-face interventions seem to differ. Evidence suggests that using goal setting, social incentive, and graded tasks might help improve PA in digital interventions while avoiding inconsistent self-monitoring of behavior. In face-to-face interventions, prompting behavioral practice and rehearsal might lead to better PA outcomes. Still, further studies are needed. Implications of the current findings are discussed.

Occupational outcomes of a physical activity intervention for post-secondary student mental health

BACKGROUND.

Physical activity (PA) is a therapeutic approach to address post-secondary student mental health, yet the effect of PA on occupational outcomes has been understudied among students.

PURPOSE.

This study (1) identified and described occupational performance issues (OPIs) among post-secondary students seeking mental health support and (2) assessed pre- and post-intervention differences in occupational performance and performance satisfaction.

METHOD.

Using a single group pre-test post-test pilot study design, participants (N = 20) completed a 6-week, 1-hour PA intervention. The Canadian Occupational Performance Measure was administered pre- and post-intervention.

FINDINGS.

The most commonly reported OPIs included academics, PA, and sleep hygiene. There were significant improvements in participants' occupational performance (mean change: 2.7, p < .001; d_z = 2.28) and performance satisfaction (mean change: 3.7, p < .001; d_z = 3.04).

IMPLICATIONS.

Results provide an initial demonstration of the benefits of PA for occupational outcomes within a post-secondary mental health context.

Evidence-Based Digital Tools for Weight Loss Maintenance: The NoHoW Project

BACKGROUND

Effective interventions and commercial programmes for weight loss (WL) are widely available, but most people regain weight. Few effective WL maintenance (WLM) solutions exist. The most promising evidence-based behaviour change techniques for WLM are self-monitoring, goal setting, action planning and control, building self-efficacy, and techniques that promote autonomous motivation (e.g., provide choice). Stress management and emotion regulation techniques show potential for prevention of relapse and weight regain. Digital technologies (including networked-wireless tracking technologies, online tools and smartphone apps, multimedia resources, and internet-based support) offer attractive tools for teaching and supporting long-term behaviour change techniques. However, many digital offerings for weight management tend not to include evidence-based content and the evidence base is still limited. The Project: First, the project examined why, when, and how many European citizens make WL and WLM attempts and how successful they are. Second, the project employed the most up-to-date behavioural science research to develop a digital toolkit for WLM based on 2 key conditions, i.e., self-management (self-regulation and motivation) of behaviour and self-management of emotional responses for WLM. Then, the NoHoW trial tested the efficacy of this digital toolkit in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial BMI ≥25). The primary outcome was change in weight (kg) at 12 months from baseline. Secondary outcomes included biological, psychological, and behavioural moderators and mediators of long-term energy balance (EB) behaviours, and user experience, acceptability, and cost-effectiveness.

IMPACT

The project will directly feed results from studies on European consumer behaviour, design and evaluation of digital toolkits self-management of EB behaviours into development of new products and services for WLM and digital health. The project has developed a framework and digital architecture for interventions in the context of EB tracking and will generate results that will help inform the next generation of personalised interventions for effective self-management of weight and health.

Key Factors Associated with Adherence to Physical Exercise in Patients with Chronic Diseases and Older Adults: An Umbrella Review

Physical inactivity is a major concern and poor adherence to exercise programs is often reported. The aim of this paper was to systematically review published reviews on the study of adherence to physical exercise in chronic patients and older adults and to identify those adherence-related key factors more frequently suggested by reviews for that population. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results were classified considering the target population and participants' characteristics to identify the most repeated factors obtained for each condition. Fifty-five articles were finally included. Fourteen key factors were identified as relevant to increase adherence to physical exercise by at least ten reviews: (a) characteristics of the exercise program, (b) involvement of professionals from different disciplines, (c) supervision, (d) technology, (e) initial exploration of participant's characteristics, barriers, and facilitators, (f) participants education, adequate expectations and knowledge about risks and benefits, (g) enjoyment and absence of unpleasant experiences, (h) integration in daily living, (i) social support and relatedness, (j) communication and feedback, (k) available progress information and monitoring, (l) self-efficacy and competence, (m) participant's active role and (n) goal setting. Therefore, adherence to physical exercise is affected by several variables that can be controlled and modified by researchers and professionals.

Enhancing the translation of health behaviour change research into practice: a selective conceptual review of the synergy between implementation science and health psychology

Health psychology is at the forefront of developing and disseminating evidence, theories, and methods that have improved the understanding of health behaviour change. However, current dissemination approaches may be insufficient for promoting broader application and impact of this evidence to benefit the health of patients and the public. Nevertheless, behaviour change theory/methods typically directed towards health behaviours are now used in implementation science to understand and support behaviour change in individuals at different health system levels whose own behaviour impacts delivering evidence-based health behaviour change interventions. Despite contributing to implementation science, health psychology is perhaps doing less to draw from it. A redoubled focus on implementation science in health psychology could provide novel prospects for enhancing the impact of health behaviour change evidence. We report a Health Psychology Review-specific review-of-reviews of trials of health behaviour change interventions published from inception to April 2020. We identified 34 reviews and assessed whether implementation readiness of behaviour change interventions was discussed. We then narratively review how implementation science has integrated theory/methods from health psychology and related discipline. Finally, we demonstrate how greater synergy between implementation science and health psychology could promote greater follow-through on advances made in the science of health behaviour change.

A Factorial Experiment to Optimize Remotely Delivered Behavioral Treatment for Obesity: Results of the Opt-IN Study

OBJECTIVE

Intensive behavioral obesity treatments face scalability challenges, but evidence is lacking about which treatment components could be cut back without reducing weight loss. The Optimization of Remotely Delivered Intensive Lifestyle Treatment for Obesity (Opt-IN) study applied the Multiphase Optimization Strategy to develop an entirely remotely delivered, technology-supported weight-loss package to maximize the amount of weight loss attainable for ≤$500.

METHODS

Six-month weight loss was examined among adults (N = 562) with BMI ≥ 25 who were randomly assigned to conditions in a factorial experiment crossing five dichotomous treatment components set to either low/high (12 vs. 24 coaching calls) or off/on (primary care provider reports, text messaging, meal replacements, and buddy training).

RESULTS

About 84.3% of participants completed the final assessment. The treatment package yielding maximum weight loss for ≤$500 included 12 coaching calls, buddy training, and primary care provider progress reports; produced average weight loss of 6.1 kg, with 57.1% losing ≥5% and 51.8% losing ≥7%; and cost $427 per person. The most expensive candidate-treatment component (24 vs. 12 coaching calls) was screened out of the optimized treatment package because it did not increase weight loss.

CONCLUSIONS

Systematically testing each treatment component's effect on weight loss made it possible to eliminate more expensive but less impactful components, yielding an optimized, resource-efficient obesity treatment for evaluation in a randomized controlled trial.