The Adaptive Behavioral Components (ABC) Model for Planning Longitudinal Behavioral Technology-Based Health Interventions: A Theoretical Framework

Novel behaviour change frameworks for digital health interventions: A critical review

Digital health interventions - interventions delivered over digital media to support the health of users - are becoming increasingly prevalent. Utilising an intervention development framework can increase the efficacy of digital interventions for health-related behaviours. This critical review aims to outline and review novel behaviour change frameworks that guide digital health intervention development. Our comprehensive search for preprints and publications used PubMed, PsycINFO, Scopus, Web of Science and the Open Science Framework repository. Articles were included if they: (1) were peer-reviewed; (2) proposed a behaviour change framework to guide digital health intervention development; (3) were written in English; (4) were published between 1/1/19 and 1/8/2021; and (5) were applicable to chronic diseases. Intervention development frameworks considered the user, intervention elements and theoretical foundations. However, the timing and policy of interventions are not consistently addressed across frameworks. Researchers should deeply consider the digital applicability of behaviour change frameworks to improve intervention success.

A Qualitative Exploration of the Potential Role of Using Online Social Media Support Communities to Increase Initiation of Medications for Opioid Use Disorder (MOUD)

Objectives

This study sought to explore the potential role of peer-led online communities to increase use of medications for opioid use disorder.

Methods

From January through March 2020, participants with opioid use disorder and their family members/friends were recruited from paid Facebook ads; public health key stakeholders were recruited from referrals from the study team and opioid experts. Thirty participants from California were interviewed; 23 persons reporting opioid misuse, 3 family members/friends of persons misusing opioids, and 4 public health key stakeholders. We conducted semi-structured interviews asking about preferences, barriers and facilitators of treatment options for opioid use disorder, and perspectives around the use of digital/online communities. The categories of participants interviewed were each asked slightly different questions depending upon their role.

Results

Results suggest that participants who misuse opioids (1) may prefer to engage in online communities rather than in-person meetings to discuss their opioid use, (2) generally prefer to receive opioid-related information from other patients with opioid use disorder and/or those in recovery rather than from health providers or other individuals, and (3) thought that an online community could be beneficial for helping address their opioid use.

Conclusion

Results suggest an openness and interest in a peer-led online community to discuss opioid use and treatment among people who misuse opioids.

Applying Cultural Intelligence to Improve Vaccine Hesitancy Among Black, Indigenous, and People of Color

Despite the overwhelming evidence to support the benefits of vaccines for preventable diseases and improving health outcomes throughout the world, vaccine hesitancy and resistance continues to be a concern during the COVID-19 pandemic. Although Black, Indigenous, and People of Color (BIPOC) experience the highest rates of morbidity and mortality from COVID-19, mistrust and historical unethical research and medical practices continue to preclude this population from getting the vaccine. This article urges clinicians to subscribe to development and application of cultural intelligence to understand the impact of structural racism and cultural considerations of BIPOC to partner in strategy development.

Antifragile Behavior Change Through Digital Health Behavior Change Interventions

Digital health behavior change interventions (DHBCIs) offer users accessible support, yet their promise to improve health behaviors at scale has not been met. One reason for this unmet potential may be a failure to offer users support that is tailored to their personal characteristics and goals. We apply the concept of antifragility to propose how DHBCIs could be better designed to support diverse users’ behavior change journeys. We first define antifragility as a feature of an individual’s relationship to a particular challenge such that if one is antifragile to a challenge, one is well positioned to benefit from facing that challenge. Second, we introduce antifragile behavior change to describe behavior change processes that leverage person-specific antifragilities to maximize benefits and minimize risk in the behavior change process. While most existing behavior change models focus on improving one’s motivation and ability to face challenges, antifragile behavior change complements these models by helping to select challenges that are most likely to produce desired outcomes. Next, we propose three principles by which DHBCIs can help users to develop antifragile behavior change strategies: providing personalized guidance, embracing variance and exploration in choosing behaviors, and prioritizing user agency. Finally, we offer an example of how a DHBCI could be designed to support antifragile behavior change.

A Peer-Led Online Community to Increase HIV Self-Testing Among African American and Latinx MSM: A Randomized Controlled Trial

OBJECTIVE

We sought to assess the effectiveness of using a peer-led online community to increase HIV self-testing among Latinx and African American men who have sex with men (MSM).

DESIGN

Randomized controlled trial.

METHODS

Throughout 6 waves, between February 18, 2017, and January 8, 2021, 900 HIV negative and/or serostatus unknown Los Angeles-based MSM (68.9% Latinx, 16.0% African American, and 7.4% White) participated in an online 12-week HIV prevention randomized controlled trial. A total of 79 trained role models (peer leaders) were randomly assigned to participants within clusters to build trust and deliver HIV testing information on Facebook groups. Participants in control groups were assigned to groups without peer leaders. Participants were not required to respond to peer leaders or to remain group members. Participants completed self-report assessments at baseline and 12-week follow-up and could receive a free HIV self-testing kit during the study period.

RESULTS

Compared with control group participants, intervention group participants were significantly more likely to accept the offer for the HIV self-testing kit (intervention 130 of 450, 29%; control 102 of 450, 22.7%; odds ratio = 1.43, 95% confidence interval: 1.04 to 1.95, P = 0.03), report having taken an HIV self-test within the past 3 months (odds ratio = 1.47, 95% confidence interval: 1.01 to 2.13, P = 0.04), and report drinking fewer glasses of alcohol in an average week (P = 0.01). Effects seemed concentrated within later study waves. Study retention was greater than 93%.

CONCLUSIONS

A peer-led online community seems to be an effective method of increasing HIV self-testing among MSM of color. We discuss the implications of the wave effects on public health research and policy.

Technology-Delivered Intervention Strategies to Bolster HIV Testing

Since the beginning of the HIV epidemic, there have been more than 75 million cases. Currently, there about 1.2 million living with HIV in the USA. Despite current testing recommendations, test rates continue to be suboptimal. Investigators have studied the use of digital technology to promote HIV testing, especially among high-risk populations. PURPOSE OF REVIEW: This non-systematic review provides an overview of the scientific research between 2015 and 2020 focused on the use of digital technology to bolster HIV testing and suggests novel technologies for exploration. RECENT FINDINGS: A total of 40 studies were included in the review that span a wide range of available technology. Studies effectively increased HIV testing among study participants. Generally, participants in the intervention/exposure groups had significantly higher rates of HIV test uptake compared to participants in the comparison groups at study follow-up. For a variety of reasons (e.g., differences in ways the technologies were used and study design), no digital tool clearly performed better than others, but each have the capacity to increase outreach and self-testing. An exploration of the potential use of nascent technologies is also discussed, as well as the authors' experiences using a number of these technologies in our research.

Facilitators and Inhibitors of Lifestyle Modification and Maintenance of KOREAN Postmenopausal Women: Revealing Conversations from FOCUS Group Interview

Modifiable lifestyle behaviors, such as lack of physical activity, smoking, and unhealthy diet, are associated with the risk of cardiovascular diseases in postmenopausal women, in addition to other risk factors, such as aging and physiological changes. Therefore, it is necessary to emphasize the importance of encouraging healthy lifestyles and health-promoting behaviors among postmenopausal women, to achieve a better health status. However, it is difficult to modify lifestyle and maintain that change. This study was aimed at identifying the factors that affect the maintenance of healthy lifestyle habits in postmenopausal women, using various theoretical models. This qualitative study included focus-group interviews with 21 Korean postmenopausal women aged 54 to 69 years. A theory-guided thematic analysis was performed based on the Health Belief Model, Self-Determination Theory, Social Cognitive Theory, and Theory of Planned Behavior. As a result, facilitators and inhibitors to healthy lifestyle modification and maintenance are identified. Various sources of motivation and reinforcement are important for menopausal women to maintain a healthy lifestyle. Autonomy support and self-regulation strategies play an important role in integrating health-promoting behaviors into a daily routine. In addition to personal effort, a social support system is also important to help individuals maintain a healthy lifestyle