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Chen RT, Nelson AJ, Tan S, Clark RA, Zoungas S, Nicholls SJ. The effectiveness of visualising plaque on cardiac computed tomography in modifying risk factors for cardiovascular disease: A systematic review. J Cardiovasc Comput Tomogr 2024; 18:223-232. [PMID: 38467535 DOI: 10.1016/j.jcct.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/30/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
Cardiovascular disease (CVD) is the leading cause of disease burden worldwide, with a significant proportion of cases and deaths attributable to modifiable risk factors. Recent interest has emerged in using cardiac computed tomography (CT) imaging as a tool to enhance motivation and drive positive behavioural changes. However, the impact of providing visual feedback of plaque from CT on risk factor control and individual health behaviours remains understudied. This study aimed to assess the effects of visual feedback from cardiac CT imaging on health-related behaviours and risk factor control. A systematic search of electronic databases was conducted, yielding nine studies (five randomised controlled trials and four observational studies) for analysis. The results varied, but based on the limited low-quality data, CT imaging appears to have short-term favourable effects on cholesterol levels and systolic blood pressure reductions, and positive dietary behavioural changes. Further research is warranted to better understand the long-term impact of cardiac CT imaging on health behaviours and risk factor modification.
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Affiliation(s)
- Ruofei Trophy Chen
- Monash Victorian Heart Institute, Monash University, 631 Blackburn Road, Clayton VIC 3168, Australia.
| | - Adam J Nelson
- Monash Victorian Heart Institute, Monash University, 631 Blackburn Road, Clayton VIC 3168, Australia.
| | - Sean Tan
- Monash Victorian Heart Institute, Monash University, 631 Blackburn Road, Clayton VIC 3168, Australia.
| | - Robyn A Clark
- College of Nursing and Health Sciences, Flinders University, Level 1, Room N103, Sturt North Sturt Rd, Bedford Park SA 5042, Australia.
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne VIC 3004, Australia.
| | - Stephen J Nicholls
- Monash Victorian Heart Institute, Monash University, 631 Blackburn Road, Clayton VIC 3168, Australia.
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2
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St Quinton T, Morris B, Lithopoulos A, Norman P, Conner M, Rhodes RE. Self-efficacy and alcohol consumption: Are efficacy measures confounded with motivation? COGENT PSYCHOLOGY 2023. [DOI: 10.1080/23311908.2023.2180872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Affiliation(s)
- Tom St Quinton
- School of Psychology & Therapeutic Studies, Leeds Trinity University, Leeds, UK
| | - Ben Morris
- School of Psychology & Therapeutic Studies, Leeds Trinity University, Leeds, UK
| | - Alexander Lithopoulos
- School of Exercise Science, Physical & Health Education, University of Victoria, BC, Canada
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
| | - Ryan E. Rhodes
- School of Exercise Science, Physical & Health Education, University of Victoria, BC, Canada
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3
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Berry MP, Chwyl C, Metzler AL, Sun JH, Dart H, Forman EM. Associations between behaviour change technique clusters and weight loss outcomes of automated digital interventions: a systematic review and meta-regression. Health Psychol Rev 2023; 17:521-549. [PMID: 36102170 DOI: 10.1080/17437199.2022.2125038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/09/2022] [Indexed: 11/04/2022]
Abstract
Automated digital interventions for weight loss represent a highly scalable and potentially cost-effective approach to treat obesity. However, current understanding of the active components of automated digital interventions is limited, hindering efforts to improve efficacy. Thus, the current systematic review and meta-analysis (preregistration: PROSPERO 2021-CRD42021238878) examined relationships between utilisation of behaviour change techniques (BCTs) and the efficacy of automated digital interventions for producing weight loss. Electronic database searches (December 2020 to March 2021) were used to identify trials of automated digital interventions reporting weight loss as an outcome. BCT clusters were coded using Michie's 93-item BCT taxonomy. Mixed-effects meta-regression was used to examine moderating effects of BCT clusters and techniques on both within-group and between-group measures of weight change. One hundred and eight conditions across sixty-six trials met inclusion criteria (13,672 participants). Random-effects meta-analysis revealed a small mean post-intervention weight loss of -1.37 kg (95% CI, -1.75 to -1.00) relative to control groups. Interventions utilised a median of five BCT clusters, with goal-setting, feedback and providing instruction on behaviour being most common. Use of Reward and Threat techniques, and specifically social incentive/reward BCTs, was associated with a higher between-group difference in efficacy, although results were not robust to sensitivity analyses.
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Affiliation(s)
- Michael P Berry
- Center for Weight, Eating & Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Christina Chwyl
- Center for Weight, Eating & Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Abigail L Metzler
- Center for Weight, Eating & Lifestyle Science, Drexel University, Philadelphia, PA, USA
| | - Jasmine H Sun
- Center for Weight, Eating & Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Hannah Dart
- Center for Weight, Eating & Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Evan M Forman
- Center for Weight, Eating & Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Department of Psychology, Drexel University, Philadelphia, PA, USA
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Michaelsen MM, Esch T. Understanding health behavior change by motivation and reward mechanisms: a review of the literature. Front Behav Neurosci 2023; 17:1151918. [PMID: 37405131 PMCID: PMC10317209 DOI: 10.3389/fnbeh.2023.1151918] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/22/2023] [Indexed: 07/06/2023] Open
Abstract
The global rise of lifestyle-related chronic diseases has engendered growing interest among various stakeholders including policymakers, scientists, healthcare professionals, and patients, regarding the effective management of health behavior change and the development of interventions that facilitate lifestyle modification. Consequently, a plethora of health behavior change theories has been developed with the intention of elucidating the mechanisms underlying health behavior change and identifying key domains that enhance the likelihood of successful outcomes. Until now, only few studies have taken into account neurobiological correlates underlying health behavior change processes. Recent progress in the neuroscience of motivation and reward systems has provided further insights into the relevance of such domains. The aim of this contribution is to review the latest explanations of health behavior change initiation and maintenance based on novel insights into motivation and reward mechanisms. Based on a systematic literature search in PubMed, PsycInfo, and Google Scholar, four articles were reviewed. As a result, a description of motivation and reward systems (approach/wanting = pleasure; aversion/avoiding = relief; assertion/non-wanting = quiescence) and their role in health behavior change processes is presented. Three central findings are discussed: (1) motivation and reward processes allow to distinguish between goal-oriented and stimulus-driven behavior, (2) approach motivation is the key driver of the individual process of behavior change until a new behavior is maintained and assertion motivation takes over, (3) behavior change techniques can be clustered based on motivation and reward processes according to their functional mechanisms into facilitating (= providing external resources), boosting (= strengthening internal reflective resources) and nudging (= activating internal affective resources). The strengths and limitations of these advances for intervention planning are highlighted and an agenda for testing the models as well as future research is proposed.
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5
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Sillice MA, Dunsiger S, Bock BC. Exploring Factors Associated with Dietary Improvement Among Participants Who Completed a Randomized Controlled Trial for Physical Activity: Evidence of a Transfer Effect. Int J Behav Med 2023:10.1007/s12529-023-10186-x. [PMID: 37308771 DOI: 10.1007/s12529-023-10186-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND This research aimed at understanding how changes in one behavior affect other behaviors, known as "transfer effect," could extend knowledge of shared constructs among compound health risk behaviors, and improve methods for promoting simultaneous behavior changes. The current study explored whether participants who completed a randomized controlled trial for physical activity (PA) improved their diet with no intervention in diet or nutrition. METHODS US adults (N = 283) were randomly assigned to 12 weeks of either exercise videogames, standard exercise, or an attention control. Secondary analyses were conducted to examine a possible transfer effect of the intervention on diet at end of intervention (EOT) and 6-month follow-up. Assessments of potential PA constructs (i.e., exercise enjoyment, self-efficacy) and demographics (e.g., age, gender) were conducted. PA, specifically moderate-to-vigorous levels of physical activity (MVPA), was measured using a self-report measure. Diet was measured using the Rate Your Plate dietary assessment. RESULTS Findings support that a randomization effect was associated with a higher likelihood of increasing MVPA (β = 30.00, 95% CI = 4.46, 64.46) and dietary improvement at EOT (β = 1.48, SE = .83, P = .01) and follow-up (β = 1.74, SE = .52, P = .02). At EOT, changes in diet were associated with higher PA enjoyment (β = 0.41, SE = 0.15, P = .01). This intervention effect on diet was moderated by gender, with women showing more dietary improvement than men (β = - .78, SE = 13, P = .03). At 6 months, dietary improvement was associated with greater self-efficacy (β = .04, SE = .01, P = .01). CONCLUSION This study shows evidence of a transfer effect among two synergistic behaviors and expands understanding of factors that predict the occurrence of this type of behavior change.
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Affiliation(s)
- Marie Aline Sillice
- Center for Systems and Community Design, Department of Health Policy and Management, City University of New York School of Public & Health Policy, 55 W. 125 Street, Room 842, NY, 10027, New York, USA.
| | - Shira Dunsiger
- Department of Psychiatry & Human Behavior , Warren Alpert Medical School of Brown University, RI, 02906, Providence, USA
| | - Beth C Bock
- Department of Psychiatry & Human Behavior , Warren Alpert Medical School of Brown University, RI, 02906, Providence, USA
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He F, Qi Y, Zhou Y, Cao A, Yue X, Fang S, Zheng Y. Meta-analysis of the efficacy of digital therapies in children with attention-deficit hyperactivity disorder. Front Psychiatry 2023; 14:1054831. [PMID: 37260755 PMCID: PMC10228751 DOI: 10.3389/fpsyt.2023.1054831] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/26/2023] [Indexed: 06/02/2023] Open
Abstract
Background Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that commonly occurs in childhood. The aim of this meta-analysis was to summarize the available evidence for the efficacy of digital therapeutics in children and adolescents with ADHD. Methods We searched the MEDLINE, EMBASE, Cochrane Library (Cochrane Database of Systematic Reviews), and Web of Science (science and social science citation index) databases for relevant studies and used Stata 15.0 software to carry out the meta-analysis. Results A total of 31 studies involving 2169 participants (1665 boys and 504 girls) aged 4-17 years old were included in the final analysis. The meta-analysis results showed that digital interventions improved the symptoms of inattention with an effect value of -0.20 (95% confidence interval [CI] -0.36, -0.04) and decreased the continuous performance task (CPT) reaction time (effect, -0.40, 95% CI -0.73, -0.07) in ADHD patients. The score for impulsive hyperactivity was slightly decreased (effect, -0.07, 95% CI -0.23, 0.09). Moreover, executive function was improved (effect, 0.71, 95% CI 0.37, 1.04). The capability of working memory appeared to be increased (effect, 0.48, 95% CI 0.21, 0.76) between the two groups. Visual appraisal of the sensitivity analysis suggested the absence of heterogeneity, and no obvious publication bias was detected. Discussion Based on the existing literature evidence, we conclude that digital therapy can be a promising therapeutic strategy for ADHD patients.
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Affiliation(s)
- Fan He
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yanjie Qi
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yuanyue Zhou
- Department of Medical Psychology, The First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China
| | - Aihua Cao
- Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Xin Yue
- MaiDeHaiKe Technology, Beijing, China
| | - Shuanfeng Fang
- Children's Hospital Affiliated, Zhengzhou University, Zhengzhou, Henan, China
| | - Yi Zheng
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
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Coteur K, Van Nuland M, Schoenmakers B, Van den Broeck K, Anthierens S. "At the time I only wanted to relieve stress": Exploring motivation for behaviour change in long-term hypnotic users. Heliyon 2023; 9:e16215. [PMID: 37234622 PMCID: PMC10205632 DOI: 10.1016/j.heliyon.2023.e16215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/07/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Background Motivating patients to discontinue long-term benzodiazepine receptor agonist (BZRA) use for insomnia remains an important challenge in primary care because of the medication's unfavourable risk-benefit profile. Previous studies have shown that understanding the complexity of patients' motivation is crucial to the primary care physician for providing effective interventions efficiently. Theoretical frameworks about behaviour change show that motivation is a multi-layered concept that interacts with other concepts, which aligns with a holistic perspective or implementation of the biopsychosocial model. Aim Exploring primary care patients' views and ideas on what factors helped or hindered them in discontinuing long-term BZRA use, in relation to motivation as conceptualised in the Behaviour Change Wheel, and associated domains of the Theoretical Domains Framework. Design and setting A qualitative study with semi-structured interviews in primary care in Belgium between September 2020 and March 2021. Method Eighteen interviews with long-term hypnotic users were audio recorded, transcribed and thematically analyzed, using the Framework Method. Results The success of discontinuation interventions does not solely rely on patients' spontaneous sense of striving for improvement. Reinforcement and identity were found to be important domains for motivation. Beliefs about personal capabilities, and about consequences of both BZRA intake and discontinuation, differed between previous and current users. Conclusion Motivation is a multi-layered concept which is not fixed in time. Patient empowerment and goal setting could help long-term BZRA users to lower their intake. As well as public health interventions that might change social attitudes towards the use of hypnotic medication.
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Affiliation(s)
- Kristien Coteur
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Belgium
| | - Marc Van Nuland
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Belgium
| | - Birgitte Schoenmakers
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Belgium
| | - Kris Van den Broeck
- Department of Family Medicine and Population Health, University of Antwerp, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health, University of Antwerp, Belgium
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8
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Wallbank G, Haynes A, Tiedemann A, Sherrington C, Grunseit AC. Designing physical activity interventions for women aged 50+: a qualitative study of participant perspectives. BMC Public Health 2022; 22:1855. [PMID: 36195939 PMCID: PMC9531643 DOI: 10.1186/s12889-022-14237-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Active Women over 50 trial tested a scalable program for increasing physical activity among women aged 50+. The program included information, activity tracker and email support. This study sought to describe the participant perspectives of the Active Women over 50 program and considerations for designing physical activity interventions for this demographic. METHODS Women who completed the Active Women over 50 trial were purposively recruited for maximum variation in age, employment, carer responsibility, medical conditions and physical activity. Individual semi-structured interviews explored their perspectives on physical activity, Active Women over 50 program components and suggestions for future iterations. Data were thematically analysed. RESULTS Participants' capacity to be physically active was shaped by an interplay of factors. Our analysis generated four main themes relating to physical activity in general and to the program: Age and gender matters, Physical activity is social, Strategising for physical activity and the Self-responsibility discourse. At this midlife stage, physical activity participation was challenged by personal, life-stage and cultural factors, alongside a tension of the self-responsibility discourse which also impacted the program experience. Social factors and finding a suitable strategy for motivation were deemed integral aspects of being active. Future programs could consider facilitation of social networks and accountability, life-stage health information and positive framing to support self-responsibility. CONCLUSION A range of strategies is key to supporting women over 50 to be more physically active due to the variety of circumstances and levels of agency experienced. We offer suggestions that do not need to be resource intensive but could be incorporated into a scaled program.
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Affiliation(s)
- Geraldine Wallbank
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, Australia. .,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. .,, Missenden Road, PO Box M179, 2050, Camperdown, NSW, Australia.
| | - Abby Haynes
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Anne C Grunseit
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Cullen L, Laures E, Hanrahan K, Edmonds S. The Coat Hook Analogy and the Precision Implementation Approach® Solution. J Perianesth Nurs 2022; 37:732-736. [PMID: 36182248 DOI: 10.1016/j.jopan.2022.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Laura Cullen
- Nursing Research and Evidence-Based Practice, Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, Iowa City, IA.
| | - Elyse Laures
- Nursing Research and Evidence-Based Practice, Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Kirsten Hanrahan
- Nursing Research and Evidence-Based Practice, Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Stephanie Edmonds
- Nursing Research and Evidence-Based Practice, Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, Iowa City, IA
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10
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Harrison D, Wilson R, Graham A, Brown K, Hesselgreaves H, Ciesielska M. Making every contact count with seldom-heard groups? A qualitative evaluation of voluntary and community sector (VCS) implementation of a public health behaviour change programme in England. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3193-e3206. [PMID: 35218264 PMCID: PMC9544506 DOI: 10.1111/hsc.13764] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/19/2021] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
Making Every Contact Count (MECC) is a national, long-term public health strategy in England. It supports public-facing workers to use opportunities during routine contacts to enable healthy lifestyle changes. This paper reports the findings from an external evaluation of voluntary and community sector (VCS) delivery of MECC in the North East of England, which focused on engaging under-represented client groups. The study aimed to (a) Establish if (and how) MECC had impacted the workforce, including changes to staff knowledge, confidence and behaviour; (b) Identify benefits, challenges and unintended consequences; and (c) Explore outcomes for service users. A multi-stage qualitative design focused on understanding both process and outcomes. The study utilised three data collection methods, including a journey mapping workshop (n = 20), semi-structured interviews with delivery leads, VCS workers and volunteers who had accessed MECC training (n = 11), and focus group discussions with clients (n = 22). The findings illustrated positive early outcomes, including improvements in self-reported staff knowledge and confidence as well as emerging examples of organisational culture shift and individual behaviour change. Alongside this, the data provided a rich picture of barriers and challenges which are examined at different levels-national programme, local programme, VCS sector, partner organisation, worker and client. The research highlights clear successes of the VCS delivery model. However, it is presented as a 'double-edged sword,' in light of associated challenges such as sector-level funding uncertainty and accessibility of MECC resources to diverse client groups. The discussion considers issues related to the measurement and attribution of behaviour change outcomes for brief interventions, as well as fidelity, legacy and long-term sustainability challenges. The recommendations call for system-level analysis and comparison of different MECC implementation models, to improve our understanding of challenges, opportunities and programme reach for behaviour change intervention programmes-particularly in relation to seldom-heard client groups.
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Affiliation(s)
- Deborah Harrison
- Newcastle Business SchoolNorthumbria UniversityNewcastle‐upon‐TyneUK
| | - Rob Wilson
- Newcastle Business SchoolNorthumbria UniversityNewcastle‐upon‐TyneUK
| | - Andy Graham
- Public Health ConsultantLocal GovernmentNorth East EnglandUK
| | - Kristina Brown
- Newcastle Business SchoolNorthumbria UniversityNewcastle‐upon‐TyneUK
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11
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Burke MV, Cha S, Shumaker TM, LaPlante M, McConahey L, Graham AL. Delivery of smoking cessation treatment via live chat: An analysis of client-centered coaching skills and behavior change techniques. PATIENT EDUCATION AND COUNSELING 2022; 105:2183-2189. [PMID: 34887156 DOI: 10.1016/j.pec.2021.11.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/14/2021] [Accepted: 11/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This qualitative study explored whether evidence-based tobacco cessation treatment components can be deployed via web-based live chat coaching. METHODS N = 100 randomly selected chats were coded. Researchers used a structured coding guide to note the presence of 3 Motivational Interviewing (MI) skills and 61 behavior change techniques (BCTs). RESULTS MI skills were observed in 86% of chats: 31 chats incorporated one skill, 31 incorporated two, and 24 incorporated all three. Open-ended questions were most common (76%), followed by affirmations (47%) and reflective listening statements (38%). BCTs were observed in 100% of chats: 21% involved one-five BCTs, 69% involved six-10 BCTs, and 10% involved 11 or more BCTs. Mean number of BCTs per chat was 7.25 (SD=2.5; range 2-17). The most common BCTs were Social Support (99%), Reward/Threat (95%), Natural Consequences (82%), Regulation (82%), Goals/Planning (64%), and Self Belief (42%). CONCLUSIONS Tobacco cessation coaching using MI skills and evidence-based BCTs can be delivered via live chat. This synchronous modality allows the delivery of an intervention tailored to the user's motivations and goals. PRACTICE IMPLICATIONS Web-based live chat can broaden the reach of tobacco treatment specialists to deploy evidence-based counseling skills and behavior change techniques in personalized, accessible coaching.
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Affiliation(s)
- Michael V Burke
- Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - Sarah Cha
- Innovations Center, Truth Initiative, Washington, DC, USA.
| | | | | | - Laura McConahey
- Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA.
| | - Amanda L Graham
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Innovations Center, Truth Initiative, Washington, DC, USA.
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12
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Evidence Into Practice: Journal Clubs as an Implementation Strategy. J Perianesth Nurs 2022; 37:411-415. [PMID: 35667816 DOI: 10.1016/j.jopan.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/28/2021] [Indexed: 11/21/2022]
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13
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Cullen L, Hanrahan K, Edmonds SW, Reisinger HS, Wagner M. Iowa Implementation for Sustainability Framework. Implement Sci 2022; 17:1. [PMID: 34983585 PMCID: PMC8725573 DOI: 10.1186/s13012-021-01157-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background An application-oriented implementation framework designed for clinicians and based on the Diffusion of Innovations theory included 81 implementation strategies with suggested timing for use within four implementation phases. The purpose of this research was to evaluate and strengthen the framework for clinician use and propose its usefulness in implementation research. Methods A multi-step, iterative approach guided framework revisions. Individuals requesting the use of the framework over the previous 7 years were sent an electronic questionnaire. Evaluation captured framework usability, generalizability, accuracy, and implementation phases for each strategy. Next, nurse leaders who use the framework pile sorted strategies for cultural domain analysis. Last, a panel of five EBP/implementation experts used these data and built consensus to strengthen the framework. Results Participants (n = 127/1578; 8% response) were predominately nurses (94%), highly educated (94% Master’s or higher), and from across healthcare (52% hospital/system, 31% academia, and 7% community) in the USA (84%). Most (96%) reported at least some experience using the framework and 88% would use the framework again. A 4-point scale (1 = not/disagree to 4 = very/agree) was used. The framework was deemed useful (92%, rating 3–4), easy to use (72%), intuitive (67%), generalizable (100%), flexible and adaptive (100%), with accurate phases (96%), and accurate targets (100%). Participants (n = 51) identified implementation strategy timing within four phases (Cochran’s Q); 54 of 81 strategies (66.7%, p < 0.05) were significantly linked to a specific phase; of these, 30 (55.6%) matched the original framework. Next, nurse leaders (n = 23) completed a pile sorting activity. Anthropac software was used to analyze the data and visualize it as a domain map and hierarchical clusters with 10 domains. Lastly, experts used these data and implementation science to refine and specify each of the 75 strategies, identifying phase, domain, actors, and function. Strategy usability, timing, and groupings were used to refine the framework. Conclusion The Iowa Implementation for Sustainability Framework offers a typology to guide implementation for evidence-based healthcare. This study specifies 75 implementation strategies within four phases and 10 domains and begins to validate the framework. Standard use of strategy names is foundational to compare and understand when implementation strategies are effective, in what dose, for which topics, by whom, and in what context. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01157-5.
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Affiliation(s)
- Laura Cullen
- Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
| | - Kirsten Hanrahan
- Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, 200 Hawkins Dr., Iowa City, IA, 52242, USA
| | - Stephanie W Edmonds
- Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, 200 Hawkins Dr., Iowa City, IA, 52242, USA
| | - Heather Schacht Reisinger
- Department of Internal Medicine, University of Iowa, 200 Hawkins Dr., Iowa City, IA, 52242, USA.,Institute for Clinical and Translational Science, University of Iowa, 200 Hawkins Dr., Iowa City, IA, 52242, USA
| | - Michele Wagner
- Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, 200 Hawkins Dr., Iowa City, IA, 52242, USA
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Michie S, West R, Pidgeon N, Reicher S, Amlôt R, Bear L. Staying 'Covid-safe': Proposals for embedding behaviours that protect against Covid-19 transmission in the UK. Br J Health Psychol 2021; 26:1238-1257. [PMID: 34463407 PMCID: PMC8646269 DOI: 10.1111/bjhp.12557|] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/11/2021] [Indexed: 12/29/2023]
Abstract
OBJECTIVES The Scientific Pandemic Insights group on Behaviours (SPI-B) as part of England's Scientific Advisory Group on Emergencies (SAGE), were commissioned by the UK Cabinet Office to identify strategies to embed infection control behaviours to minimize Covid-19 transmission in the long term. METHODS With minimal direct evidence available, three sources of information were used to develop a set of proposals: (1) a scoping review of literature on sustaining behaviour change, (2) a review of key principles used in risk and safety management, and (3) prior reports and reviews on behaviour change from SPI-B. The information was collated and refined through discussion with SPI-B and SAGE colleagues to finalize the proposals. RESULTS Embedding infection control behaviours in the long-term will require changes to the financial, social, and physical infrastructure so that people in all sections of society have the capability, opportunity, and motivation needed to underpin those behaviours. This will involve building Covid-safe educational programmes, regulating to ensure minimum standards of safety in public spaces and workspaces, using communications and social marketing to develop a Covid-safe culture and identity, and providing resources so that all sections of society can build Covid-safe behaviours into their daily lives. CONCLUSIONS Embedding 'Covid-safe' behaviours into people's everyday routines will require a co-ordinated programme to shape the financial, physical, and social infrastructure in the United Kingdom. Education, regulation, communications, and social marketing, and provision of resources will be required to ensure that all sections of society have the capability, opportunity, and motivation to enact the behaviours long term.
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Affiliation(s)
- Susan Michie
- Centre for Behaviour ChangeUniversity College LondonUK
| | - Robert West
- Institute of Epidemiology and HealthUniversity College LondonUK
| | - Nick Pidgeon
- Understanding Risk Research GroupSchool of PsychologyCardiff UniversityUK
| | - Stephen Reicher
- School of Psychology and NeuroscienceUniversity of St. AndrewsUK
| | - Richard Amlôt
- Behavioural Science and Insights UnitPublic Health EnglandUK
| | - Laura Bear
- Department of Social AnthropologyLondon School of Economics and Political ScienceUK
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Rantala E, Vanhatalo S, Tilles-Tirkkonen T, Kanerva M, Hansen PG, Kolehmainen M, Männikkö R, Lindström J, Pihlajamäki J, Poutanen K, Karhunen L, Absetz P. Choice Architecture Cueing to Healthier Dietary Choices and Physical Activity at the Workplace: Implementation and Feasibility Evaluation. Nutrients 2021; 13:nu13103592. [PMID: 34684592 PMCID: PMC8538928 DOI: 10.3390/nu13103592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 01/14/2023] Open
Abstract
Redesigning choice environments appears a promising approach to encourage healthier eating and physical activity, but little evidence exists of the feasibility of this approach in real-world settings. The aim of this paper is to portray the implementation and feasibility assessment of a 12-month mixed-methods intervention study, StopDia at Work, targeting the environment of 53 diverse worksites. The intervention was conducted within a type 2 diabetes prevention study, StopDia. We assessed feasibility through the fidelity, facilitators and barriers, and maintenance of implementation, building on implementer interviews (n = 61 informants) and observations of the worksites at six (t1) and twelve months (t2). We analysed quantitative data with Kruskall-Wallis and Mann-Whitney U tests and qualitative data with content analysis. Intervention sites altogether implemented 23 various choice architectural strategies (median 3, range 0-14 strategies/site), employing 21 behaviour change mechanisms. Quantitative analysis found implementation was successful in 66%, imperfect in 25%, and failed in 9% of evaluated cases. These ratings were independent of the ease of implementation of applied strategies and reminders that implementers received. Researchers' assistance in intervention launch (p = 0.02) and direct contact to intervention sites (p < 0.001) predicted higher fidelity at t1, but not at t2. Qualitative content analysis identified facilitators and barriers related to the organisation, intervention, worksite environment, implementer, and user. Contributors of successful implementation included apt implementers, sufficient implementer training, careful planning, integration into worksite values and activities, and management support. After the study, 49% of the worksites intended to maintain the implementation in some form. Overall, the choice architecture approach seems suitable for workplace health promotion, but a range of practicalities warrant consideration while designing real-world implementation.
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Affiliation(s)
- Eeva Rantala
- VTT Technical Research Centre of Finland, Tietotie 2, P.O. Box 1000, 02044 Espoo, Finland; (S.V.); (M.K.); (K.P.)
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
- Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland;
- Correspondence:
| | - Saara Vanhatalo
- VTT Technical Research Centre of Finland, Tietotie 2, P.O. Box 1000, 02044 Espoo, Finland; (S.V.); (M.K.); (K.P.)
| | - Tanja Tilles-Tirkkonen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
| | - Markus Kanerva
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
- D Department, Tikkurila Campus, Laurea University of Applied Sciences, Ratatie 22, 01300 Vantaa, Finland
| | - Pelle Guldborg Hansen
- Department of Communication, Business & Information Technologies, Universitetsvej 1, Roskilde University, 4000 Roskilde, Denmark;
| | - Marjukka Kolehmainen
- VTT Technical Research Centre of Finland, Tietotie 2, P.O. Box 1000, 02044 Espoo, Finland; (S.V.); (M.K.); (K.P.)
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
| | - Reija Männikkö
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
| | - Jaana Lindström
- Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland;
| | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, P.O. Box 100, 70029 Kuopio, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland, Tietotie 2, P.O. Box 1000, 02044 Espoo, Finland; (S.V.); (M.K.); (K.P.)
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
| | - Pilvikki Absetz
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
- Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
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Michie S, West R, Pidgeon N, Reicher S, Amlôt R, Bear L. Staying 'Covid-safe': Proposals for embedding behaviours that protect against Covid-19 transmission in the UK. Br J Health Psychol 2021; 26:1238-1257. [PMID: 34463407 PMCID: PMC8646269 DOI: 10.1111/bjhp.12557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/11/2021] [Indexed: 01/04/2023]
Abstract
Objectives The Scientific Pandemic Insights group on Behaviours (SPI‐B) as part of England’s Scientific Advisory Group on Emergencies (SAGE), were commissioned by the UK Cabinet Office to identify strategies to embed infection control behaviours to minimize Covid‐19 transmission in the long term. Methods With minimal direct evidence available, three sources of information were used to develop a set of proposals: (1) a scoping review of literature on sustaining behaviour change, (2) a review of key principles used in risk and safety management, and (3) prior reports and reviews on behaviour change from SPI‐B. The information was collated and refined through discussion with SPI‐B and SAGE colleagues to finalize the proposals. Results Embedding infection control behaviours in the long‐term will require changes to the financial, social, and physical infrastructure so that people in all sections of society have the capability, opportunity, and motivation needed to underpin those behaviours. This will involve building Covid‐safe educational programmes, regulating to ensure minimum standards of safety in public spaces and workspaces, using communications and social marketing to develop a Covid‐safe culture and identity, and providing resources so that all sections of society can build Covid‐safe behaviours into their daily lives. Conclusions Embedding ‘Covid‐safe’ behaviours into people’s everyday routines will require a co‐ordinated programme to shape the financial, physical, and social infrastructure in the United Kingdom. Education, regulation, communications, and social marketing, and provision of resources will be required to ensure that all sections of society have the capability, opportunity, and motivation to enact the behaviours long term.
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Affiliation(s)
- Susan Michie
- Centre for Behaviour Change, University College London, UK
| | - Robert West
- Institute of Epidemiology and Health, University College London, UK
| | - Nick Pidgeon
- Understanding Risk Research Group, School of Psychology, Cardiff University, UK
| | - Stephen Reicher
- School of Psychology and Neuroscience, University of St. Andrews, UK
| | - Richard Amlôt
- Behavioural Science and Insights Unit, Public Health England, UK
| | - Laura Bear
- Department of Social Anthropology, London School of Economics and Political Science, UK
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Beard E, Lorencatto F, Gardner B, Michie S, Owen L, Shahab L. Behavioral Intervention Components Associated With Cost-effectiveness: A Comparison of Six Domains. Ann Behav Med 2021; 56:176-192. [PMID: 34114597 PMCID: PMC8832109 DOI: 10.1093/abm/kaab036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background To help implement behavior change interventions (BCIs) it is important to be able to characterize their key components and determine their effectiveness. Purpose This study assessed and compared the components of BCIs in terms of intervention functions identified using the Behaviour Change Wheel Framework (BCW) and in terms of their specific behavior change techniques (BCTs) identified using the BCT TaxonomyV1, across six behavioral domains and the association of these with cost-effectiveness. Methods BCIs in 251 studies targeting smoking, diet, exercise, sexual health, alcohol and multiple health behaviors, were specified in terms of their intervention functions and their BCTs, grouped into 16 categories. Associations with cost-effectiveness measured in terms of incremental cost-effectiveness ratio (ICER) upper and lower estimates were determined using regression analysis. Results The most prevalent functions were increasing knowledge through education (72.1%) and imparting skills through training (74.9%). The most prevalent BCT groupings were shaping knowledge (86.5%), changing behavioral antecedents (53.0%), supporting self-regulation (47.7%), and providing social support (44.6%). Intervention functions associated with better cost-effectiveness were those based on training (βlow = −15044.3; p = .002), persuasion (βlow = −19384.9; p = .001; βupp = −25947.6; p < .001) and restriction (βupp = −32286.1; p = .019), and with lower cost-effectiveness were those based on environmental restructuring (β = 15023.9low; p = .033). BCT groupings associated with better cost-effectiveness were goals and planning (βlow = −8537.3; p = .019 and βupp = −12416.9; p = .037) and comparison of behavior (βlow = −13561.9, p = .047 and βupp = −30650.2; p = .006). Those associated with lower cost-effectiveness were natural consequences (βlow = 7729.4; p = .033) and reward and threat (βlow = 20106.7; p = .004). Conclusions BCIs that focused on training, persuasion and restriction may be more cost-effective, as may those that encourage goal setting and comparison of behaviors with others.
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Affiliation(s)
- E Beard
- Research Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - F Lorencatto
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, UK
| | - B Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S Michie
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, UK
| | - L Owen
- National Institute for Health and Care Excellence, NICE, UK
| | - L Shahab
- Research Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
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18
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Oliffe JL, Black N, Yiu J, Flannigan RK, McCreary DR, Goldenberg SL. Mapping Canadian Men's Recent and Intended Health Behavior Changes Through the Don't Change Much Electronic Health Program. J Med Internet Res 2020; 22:e16174. [PMID: 32412423 PMCID: PMC7260660 DOI: 10.2196/16174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/03/2020] [Accepted: 01/28/2020] [Indexed: 12/17/2022] Open
Abstract
Background Although evaluation studies confirm the strong potential of men’s electronic health (eHealth) programs, there have been calls to more fully understand acceptability, engagement, and behavior change to guide future work. Relatedly, mapping of behavior changes using health promotion theories including the transtheoretical model (or stages of change) has been recommended to build a translatable empirical base to advance design and evaluation considerations for men’s eHealth programs. Objective This study aimed to use a benchmark sample as a reference group to map the recent and intended health behavior changes in Canadian men who use the Don’t Change Much (DCM) eHealth program. The hypothesis being tested was that increased exposure to DCM would be positively associated with men’s recent and intended health behavior changes. Methods DCM users (n=863) were sampled for demographic data and self-reported recent and intended health behavior changes. Respondents also reported their usage (frequency and duration) for each of the 3 DCM components (web, newsletter, and social media) and were allocated to limited exposure (257/863, 29.8%), low exposure (431/863, 49.9%), and high exposure (175/863, 20.3%) subgroups. A benchmark sample (n=2000), comprising respondents who had not accessed DCM provided a reference group. Bivariate analysis of recent and intended health behavior changes and DCM exposure levels were used to compute the strength of association between the independent variables (exposure levels) and the 10 categorical dependent variables (recent and intended health behavior changes). Binary logistic regression models were computed for each of the 10 recent and intended health behavior changes. Linear regression was used to model the association between the number of recent and intended changes and the level of exposure to DCM. Results Compared with the benchmark reference group, DCM high-exposure respondents had significantly increased odds for 9 of the 10 health behavior changes, with the largest effect size observed for Changed diet or Improved eating habits (odds ratio [OR] 5.628, 95% CI 3.932-8.055). High-exposure respondents also had significantly increased odds for 9 intended health changes, with the largest effect sizes observed for Reduce stress level (OR 4.282, 95% CI 3.086-5.941). Moderate effect size (goodness of fit) was observed for increased total number of recent (F12,2850=25.52; P.001; adjusted R2=.093) and intended health behavior changes (F12,2850=36.30; P.001; adjusted R2=.129) among high-exposure respondents. Conclusions DCM respondents contrasted the predominately precontemplative benchmark sample mapping across the contemplative, preparation, and action stages of the transtheoretical health behavior change model. Almost 10% of variation in the recent and 13% of variation in the intended health behavior changes can be explained by DCM exposure and demographic factors, indicating the acceptability of this men’s eHealth resource.
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Affiliation(s)
- John L Oliffe
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, BC, Canada.,Department of Nursing, University of Melbourne, Melbourne, Australia
| | - Nick Black
- Intensions Consulting Inc, Vancouver, BC, Canada
| | - Jeffrey Yiu
- Intensions Consulting Inc, Vancouver, BC, Canada
| | - Ryan K Flannigan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.,Department of Urology, Weill Cornell Medicine, New York, NY, United States
| | - Donald R McCreary
- Department of Psychology, Brock University, St. Catharines, ON, Canada
| | - S Larry Goldenberg
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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19
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Heneghan MB, Hussain T, Barrera L, Cai SW, Haugen M, Duff A, Shoop J, Morgan E, Rossoff J, Weinstein J, Hijiya N, Cella D, Badawy SM. Applying the COM-B model to patient-reported barriers to medication adherence in pediatric acute lymphoblastic leukemia. Pediatr Blood Cancer 2020; 67:e28216. [PMID: 32068338 DOI: 10.1002/pbc.28216] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/10/2020] [Accepted: 01/28/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Adherence to oral chemotherapy, including 6-mercaptopurine (6-MP), is suboptimal in pediatric acute lymphoblastic leukemia (ALL), which is associated with increased risk of relapse. Study objectives were to examine self-reported adherence to 6-MP and related barriers to adherence, mapped to the capability, opportunity, motivation, and behavior (COM-B) model for behavior change. PROCEDURE Forty-nine parents (median, 39 years old; 76% females) and 15 patients (median, 17 years old, 20% females) completed the study survey. RESULTS Suboptimal adherence was reported in 43% of parents and 73% of patients. Most parents and patients (80% and 90%, respectively) reported ≥1 adherence barrier. Parents reported difficulty helping their child meet others with ALL (43%), contacting community organizations (39%), and meeting other parents (37%). Patients reported difficulty finding out what their medications are (40%), finding out what 6-MP does (47%), and meeting other patients (40%). Using the COM-B, we found that parents and patients endorsed barriers in multiple components, especially physical (55%, 67%) and social opportunity (56%, 47%), highlighting that barriers to adherence may be multifaceted. CONCLUSIONS Our results suggest that parents and patients with ALL face various prevalent barriers to medication adherence and provide insight into the development of behavioral interventions focused on promoting adherence, which is essential to prevent relapse and optimize health outcomes in ALL.
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Affiliation(s)
- Mallorie B Heneghan
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Tasmeen Hussain
- Division of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leonardo Barrera
- Mary Ann and J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Stephanie W Cai
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Maureen Haugen
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ashley Duff
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jenny Shoop
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Elaine Morgan
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jenna Rossoff
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Joanna Weinstein
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nobuko Hijiya
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - David Cella
- Northwestern University, Department of Medical Social Sciences, Feinberg School of Medicine, Chicago, Illinois
| | - Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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