What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol

Evaluating the effectiveness of mindfulness alone compared to exercise and mindfulness on fatigue in women with gynaecology cancer (GEMS): Protocol for a randomised feasibility trial

BACKGROUND

In 2020 Globocan reported nearly 1.4 million new cases of gynaecology cancer worldwide. Cancer related fatigue has been identified as a symptom that can be present for gynaecology cancer patients many years after treatment. The current evidence around the management of this symptom suggests that exercise has the most positive outcome. However, some ambiguity remains around the evidence and whether it can address all areas of fatigue effectively. More recently, other interventions such as mindfulness have begun to show a favourable response to the management of symptoms for cancer patients. To date there has been little research that explores the feasibility of using both these interventions together in a gynaecology cancer population. This study aims to explore the feasibility of delivering an intervention that involves mindfulness and mindfulness and exercise and will explore the effect of this on fatigue, sleep, mood and quality of life.

METHODS/DESIGN

This randomised control trial will assess the interventions outcomes using a pre and post design and will also include a qualitative process evaluation. Participants will be randomised into one of 2 groups. One group will undertake mindfulness only and the other group will complete exercise and mindfulness. Both groups will use a mobile application to complete these interventions over 8 weeks. The mobile app will be tailored to reflect the group the participants have drawn during randomisation. Self-reported questionnaire data will be assessed at baseline prior to commencing intervention and at post intervention. Feasibility will be assessed through recruitment, adherence, retention and attrition. Acceptability and participant perspective of participation (process evaluation), will be explored using focus groups.

DISCUSSION

This trial will hope to evidence and demonstrate that combination of two interventions such as mindfulness and exercise will further improve outcomes of fatigue and wellbeing in gynaecology cancer. The results of this study will be used to assess (i) the feasibility to deliver this type of intervention to this population of cancer patients using a digital platform; (ii) assist this group of women diagnosed with cancer to manage fatigue and other symptoms of sleep, mood and impact their quality of life.

TRIAL REGISTRATION

NCT05561413.

An Evolving Model of Best Practice in a Community Physical Activity Program: A Case Study of "Active Herts"

BACKGROUND

Community-based physical activity programs typically evolve to respond to local conditions and feedback from stakeholders. Process evaluations are essential for capturing how programs are implemented, yet often fail to capture delivery evolution over time, meaning missed opportunities for capturing lessons learned.

METHODS

This research paper reports on a staged approach to a process evaluation undertaken within a community-based UK 12-month physical activity program that aimed to capture change and adaptation to program implementation. Twenty-five one-to-one interviews and 12 focus groups took place over the 3 years of program delivery. Participants included program participants, management, and service deliverers.

RESULTS

Program adaptations that were captured through the ongoing process evaluation included changes to the design of promotional material, program delivery content, ongoing training in behavior change, and the addition of regular participant community events. The authors address how these strands evolved over program delivery, and how the process evaluation was able to capture them.

CONCLUSION

The pragmatic evaluation approach enabled changes in response to the local context, as well as improvements in the program to be captured in a timely manner, allowing the delivery to be responsive and the evaluation flexible.

Physical distancing messages targeting youth on the social media accounts of Canadian public health entities and the use of behavioral change techniques

Introduction

Physical distancing (PD) is an important public health strategy to reduce the transmission of COVID-19 and has been promoted by public health authorities through social media. Although youth have a tendency to engage in high-risk behaviors that could facilitate COVID-19 transmission, there is limited research on the characteristics of PD messaging targeting this population on social media platforms with which youth frequently engage. This study examined social media posts created by Canadian public health entities (PHEs) with PD messaging aimed at youth and young adults aged 16–29 years and reported behavioral change techniques (BCTs) used in these posts.

Methods

A content analysis of all social media posts of Canadian PHEs from Facebook, Twitter, Instagram and YouTube were conducted from April 1st to May 31st, 2020. Posts were classified as either implicitly or explicitly targeting youth and young adults. BCTs in social media posts were identified and classified based on Behavior Change Technique Taxonomy version 1 (BCTTv1). Frequency counts and proportions were used to describe the data.

Results

In total, 319 youth-targeted PD posts were identified. Over 43% of the posts originated from Ontario Regional public health units, and 36.4 and 32.6% of them were extracted from Twitter and Facebook, respectively. Only 5.3% of the total posts explicitly targeted youth. Explicit posts were most frequent from federal PHEs and posted on YouTube. Implicit posts elicited more interactions than explicit posts regardless of jurisdiction level or social media format. Three-quarters of the posts contained at least one BCT, with a greater portion of BCTs found within implicit posts (75%) than explicit posts (52.9%). The most common BCTs from explicit posts were instructions on how to perform a behavior (25.0%) and restructuring the social environment (18.8%).

Conclusions

There is a need for more PD messaging that explicitly targets youth. BCTs should be used when designing posts to deliver public health messages and social media platforms should be selected depending on the target population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11659-y.

Interventions to improve physical activity in colorectal cancer survivors: protocol for a systematic review and meta-analysis of randomized controlled trials

AIM

To examine the effectiveness of physical activity (PA) interventions on changes in PA among colorectal cancer survivors, including an examination of theoretical versus atheoretical-driven approaches, with a special focus on their effectiveness across ethnic and racial minorities.

DESIGN

Systematic review with aggregated data meta-analyses.

DATA SOURCES

Using six databases (Cochrane Central Register of Controlled Trials, PubMed, PsycINFO, CINAHL with full text, Scopus and Web of Science), we will screen for randomized controlled trials written in English from May 1, 1993 up to December 31, 2020.

REVIEW METHODS

Dual study-selection and data abstraction will be performed. The Behavior Change Technique Taxonomy (v1) will be used to examine behavior change techniques among selected studies, while the Theory Coding Scheme will be used to assess the extent of theory use. Risk of bias will be assessed using the revised Cochrane risk-of-bias tool for randomized trials, while the strength of the evidence will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation instrument. In addition, intervention delivery will be appraised using the Template for Intervention Description and Replication. Changes in PA from each study will be calculated using the standardized mean difference effect size (Hedge's g). Results will be pooled using the inverse-variance heterogeneity model. Heterogeneity (Cochran's Q) and inconsistency (I² ) will be examined, while small-study effects (publication bias) will be evaluated using the Doi plot and LFK Index. Meta-regression will also be conducted to examine for potential associations between changes in physical activity and selected covariates (theoretical versus atheoretical-driven approaches, race/ethnicity).

DISCUSSION

This systematic review will identify specific racial/ethnic minorities for whom interventions are most effective and summarize the evidence of the effectiveness of theoretical vs. theoretical based intervention.

IMPACT

This systematic review can direct policymakers and practitioners towards actions that are likely to bring about positive physical activity behaviour change.

Substance use prevention interventions for children and young people in Sub-Saharan Africa: A systematic review

BACKGROUND

Different techniques and approaches have been used for substance use prevention worldwide. No reviews of prevention interventions in Africa exist; hence this study aimed to systematically review interventions undertaken in Sub-Saharan Africa to prevent substance use in children and young people.

METHODS

MEDLINE, EMBASE, Cochrane Central, CAB, PsycINFO, CINAHL, SCOPUS, ERIC, and Web of Science databases were searched. Studies were included if they evaluated a substance use prevention intervention for children and young people in a Sub-Saharan African Country between 2000 and 2020. A narrative synthesis was used to explore and describe the data.

RESULTS

Eighteen studies, mostly from South Africa, were included. Most (10/18) of the interventions were school-based. Only two of the included studies were considered having a strong quality concerning the risk of bias, and some studies poorly reported the interventions. School-based interventions, although successful in improving knowledge, had little or no effects on substance use. Overall, most studies that reported a statistically significant reduction in substance use-related outcomes were brief interventions, individual-focused, and involved participants who were already exposed to substance use. These were mostly delivered by trained professionals using motivational interviewing or cognitive behavioural therapy or both.

CONCLUSION

School-based programs present an opportunity for substance use prevention efforts in the Sub-Saharan region in Africa. Such programs may benefit from an improved focus on individual students. There is a need for improving the quality of design, implementation, and reporting of substance use interventions within the region.

Are physical activity interventions for healthy inactive adults effective in promoting behavior change and maintenance, and which behavior change techniques are effective? A systematic review and meta-analysis

Physical inactivity and sedentary behavior relate to poor health outcomes independently. Healthy inactive adults are a key target population for prevention. This systematic review and meta-analysis aimed to evaluate the effectiveness of physical activity and/or sedentary behavior interventions, measured postintervention (behavior change) and at follow-up (behavior change maintenance), to identify behavior change techniques (BCT) within, and report on fidelity. Included studies were randomized controlled trials, targeting healthy inactive adults, aiming to change physical activity and/or sedentary behavior, with a minimum postintervention follow-up of 6 months, using 16 databases from 1990. Two reviewers independently coded risk of bias, the "Template for Intervention Description and Replication" (TIDieR) checklist, and BCTs. Twenty-six studies were included; 16 pooled for meta-analysis. Physical activity interventions were effective at changing behavior (d = 0.32, 95% confidence intervals = 0.16-0.48, n = 2,346) and maintaining behavior change after 6 months or more (d = 0.21, 95% confidence intervals = 0.12-0.30, n = 2,190). Sedentary behavior interventions (n = 2) were not effective. At postintervention, physical activity intervention effectiveness was associated with the BCTs "Biofeedback," "Demonstration of the behavior," "Behavior practice/rehearsal," and "Graded tasks." At follow-up, effectiveness was associated with using "Action planning," "Instruction on how to perform the behavior," "Prompts/cues," "Behavior practice/rehearsal," "Graded tasks," and "Self-reward." Fidelity was only documented in one study. Good evidence was found for behavior change maintenance effects in healthy inactive adults, and underlying BCTs. This review provides translational evidence to improve research, intervention design, and service delivery in physical activity interventions, while highlighting the lack of fidelity measurement.

A prospective study exploring the construct and predictive validity of the COM-B model for physical activity

This study examined the constructs of capability, opportunity and motivation from the COM-B model and their influence on moderate-to-vigorous physical activity. Using a prospective survey design, 186 healthy adults completed measures representing the theoretical domains framework mapped to the COM-B, and moderate-to-vigorous physical activity 1 week later. The main indicators for the COM constructs were ‘habits’ (Capability), ‘subjective norms’ (Opportunity) and ‘exercise self-identity’ (Motivation). Motivation (77%) and moderate-to-vigorous physical activity (50%) were strongly predicted, with Capability and Motivation as key drivers of behaviour. Motivation was a strong mediator for Capability on behaviour. Future research should consider this approach for other populations and behaviours.

How effective is community physical activity promotion in areas of deprivation for inactive adults with cardiovascular disease risk and/or mental health concerns? Study protocol for a pragmatic observational evaluation of the 'Active Herts' physical activity programme

INTRODUCTION

There is a high prevalence of inactive adults in the UK, and many suffer from conditions such as cardiovascular disease (CVD) or poor mental health. These coexist more frequently in areas of higher socioeconomic deprivation. There is a need to test the effectiveness, acceptability and sustainability of physical activity programmes. Active Herts uses novel evidence-based behaviour change techniques to target physical inactivity.

METHODS AND ANALYSIS

Active Herts is a community physical activity programme for inactive adults aged 16+ with one or more risk factors for CVD and/or a mild to moderate mental health condition. This evaluation will follow a mixed-methods longitudinal (baseline, and 3-month, 6-month and 12-month follow-ups) design. Pragmatic considerations mean delivery of the programme differs by locality. In two areas programme users will receive a behaviour change technique booklet, regular consultations, a booster phone call, motivational text messages and signposting to 12 weeks of exercise classes. In another two areas programme users will also receive 12 weeks of free tailored exercise classes, with optional exercise 'buddies' available. An outcome evaluation will assess changes in physical activity as the primary outcome, and sporting participation, sitting, well-being, psychological capability and reflective motivation as secondary outcomes. A process evaluation will explore the views of stakeholders, delivery staff and programme leads. Economic evaluation will examine the programme costs against the benefits gained in terms of reduced risk of morbidity.

ETHICS AND DISSEMINATION

This study was been approved by the Faculty of Medicine and Health Sciences Research Ethics Committee at the University of East Anglia. Informed written consent will be obtained from programme users in the evaluation. Results will be published in peer-reviewed journals, presented at conferences, and shared through the study website and local community outlets.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov ID number: NCT03153098.

Self-management interventions to improve skin care for pressure ulcer prevention in people with spinal cord injuries: a systematic review protocol

BACKGROUND

Pressure ulcers are a serious, common, lifelong, and costly secondary complication of spinal cord injury (SCI). Community-dwelling people with a SCI can prevent them with appropriate skin care (i.e. pressure relieving activities, skin checks). Adherence to skin care remains suboptimal however, and self-management interventions that focus on improving this have been designed. Little is known on their content, effectiveness, or theoretical basis. The aim of the proposed systematic review is to synthesize the literature on self-management interventions to improve skin care in people with a SCI. Specific objectives are to describe these interventions in relation to their content, effectiveness, theory base, and adherence to reporting guidelines for intervention description.

METHODS

The search strategy will combine an electronic search of nine bibliographic databases (MEDLINE, Embase, PsycInfo, CENTRAL, CINAHL, Rehabdata, CIRRIE, PEDro, ERIC) and two trial registers with a manual search of relevant reference lists. Predefined eligibility criteria will be applied in a two-phase selection process involving title and abstract screening, followed by full-text screening. A data extraction spreadsheet will be applied to included papers. Intervention content will be coded using two taxonomies (behaviour change taxonomy; PRISMS self-management support taxonomy). A validated tool (Theory Coding Scheme) and the Template for Intervention Description and Replication (TIDieR) will be used to examine theoretical basis and assess adherence to reporting guidelines for intervention description. A small number of heterogeneous studies are likely to be included in this review therefore a narrative synthesis is planned.

DISCUSSION

This systematic review will help identify the gaps and priorities to guide future research activities in this area.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42016033191.