Facilitators and barriers to behavior change in overweight and obesity management using the COM-B model

Introduction

Increasing overweight and obesity rates represent one of the global public health challenges. COM-B is a theoretical model used to identify areas to target to achieve behavior change. It identifies three factors that are needed for any behavior to occur: capability, opportunity, and motivation. We aimed to assess the potential facilitators and barriers to behavior change in weight management using the COM-B.

Methods

The study included 139 people with overweight and obesity (mean age 48.81 ± 14.49 years; 64.5% female; body mass index 32.64 ± 6.51 kg/m2; waist-to-height ratio 0.62 ± 0.10) from primary care settings. All participants completed the Brief Measure of Behavior Change (COM-B), the General Self-Efficacy Scale (GSE), the Rosenberg Self-esteem Scale (RSE), and the Overall Evaluation of Health (OEH). Multiple linear regression was performed to analyse the data.

Results

The associations between sociodemographic and clinical variables and COM-B domains attenuated or were no longer significant when psychological resources were added to the regression models. Self-efficacy was identified as a stronger facilitator of health behavior change (p < 0.001) when compared to self-esteem (p < 0.05). No associations between automatic motivation and psychological resources were identified, however. Automatic motivation was found to be associated with higher age, being in a relationship, and better health.

Discussion

Behavioral interventions for weight management should specifically target different components of COM-B. Self-efficacy and self-esteem may play a significant role in individual capabilities, opportunities, and reflective motivation and should be included in tailored public health interventions. Health programs targeting younger and single people, and people with chronic conditions may help to promote sustainable behavior change.

Behavioral innovations in the management of obesity and overweight using the COM-B model

Background

Increasing overweight and obesity rates represent one of the global health challenges in the 21st century. Obesity is a gateway to many non-communicable diseases and shorter life expectancy. Understanding individual capability, opportunity, and motivation for health behavior change (COM-B) may help to develop effective public health interventions. However, so far, only a very few studies examined interventions based on behavior change theories. Thus, we aimed to assess the potential facilitators and barriers to behavior change in weight management using the COM-B model.

Methods

We included 146 people with overweight and obesity (66.7% female; mean age 46.62±14.51 years; body mass index 32.46±6.51 kg/m2) from primary care settings. All participants completed the Brief Measure of Behavior Change (COM-B), the General Self-Efficacy Scale (GSE), the Rosenberg Self-esteem Scale (RSE), and the Self-Rated Heath scale (SRH). Multiple linear regression analyses were used to analyze the data.

Results

In univariate analyses COM-B domains were positively associated with female gender, living with a partner, lower body mass index, and higher SRH. However, the associations between sociodemographic and clinical variables and COM-B domains were no longer significant when self-esteem and general self-efficacy were added to the multivariate regression models. Self-efficacy was associated with reflective motivation (β: 0.53; p &lt; 0.001), physical capability (β: 0.43; p &lt; 0.001), and psychological capability (β: 0.44; p &lt; 0.001) the most significantly. Self-esteem was strongly associated with physical capability (β: 0.41; p &lt; 0.01). Total explained variances in the final models varied from 17.7% to 25.0%.

Conclusions

Personal resources may play a significant role in weight management and should be included in tailored public health interventions (Grant support: VEGA: 1/0748/22).

Key messages

• Interventions focused on the enhancement of personal resources may improve weight management.

• Behavioral and cultural aspects should be considered when designing effective public health interventions.

Greek Translation and Cultural Adaptation of the Short Version of the Maastricht Utrecht Adherence in Hypertension Questionnaire

BACKGROUND

The recently published short version of the Maastricht Utrecht Adherence in Hypertension (MUAH) questionnaire (MUAH-16) suggests that MUAH-16 better represents a patient's adherence to antihypertensive medication than the original MUAH questionnaire.

OBJECTIVE

The aim of our study was the cultural adaptation and validation of the short MUAH-16 questionnaire in the Greek population.

METHODS

10 patients were involved in the process of translation and cultural adaptation of MUAH-16, providing feedback on the final version, which was then administered to 100 patients. All patients received at least one antihypertensive drug during the last three months and were followed in the Hypertension-24h ABPM ESH Center of Excellence, Outpatient Clinic for the Treatment of Hypertension in the 3rd Internal Medicine Department of Papageorgiou General Hospital of Thessaloniki.

RESULTS

A factor analysis revealed a similar internal structure with four subscales that closely resembled the subscales in the original version of the questionnaire. Internal reliability indexes are equal or better than those of the original subscale structure.

CONCLUSIONS

The Greek translation of the MUAH-16 is a good match for the original version with small, cultural differences. More research is needed in order to validate the proposed revised internal structure with a larger sample.

Community pharmacy customer segmentation based on factors influencing their selection of pharmacy and over-the-counter medicines

Background

Within the competitive pharmacy market environment, community pharmacies are required to develop efficient marketing strategies based on contemporary information about consumer behavior in order to attract clients and develop customer loyalty.

Objectives

This study aimed to investigate the consumers' preferences concerning the selection of pharmacy and over-the-counter (OTC) medicines, and to identify customer segments in relation to these preferences.

Methods

A cross-sectional study was conducted between February and March 2016 on a convenient quota sample of 300 participants recruited in the metropolitan area of Thessaloniki, Greece. The main instrument used for data collection was a structured questionnaire with close-ended, multiple choice questions. To identify customer segments, Two-Step cluster analysis was conducted.

Results

Three distinct pharmacy customer clusters emerged. Customers of the largest cluster (49%; 'convenience customers') were mostly younger consumers. They gave moderate to positive ratings to factors affecting the selection of pharmacy and OTCs; convenience, and previous experience and the pharmacist's opinion, received the highest ratings. Customers of the second cluster (35%; 'loyal customers') were mainly retired; most of them reported visiting a single pharmacy. They gave high ratings to all factors that influence pharmacy selection, especially the pharmacy's staff, and factors influencing the purchase of OTCs, particularly previous experience and the pharmacist's opinion. Customers of the smallest cluster (16%; 'convenience and price-sensitive customers') were mainly retired or unemployed with low to moderate education, and low personal income. They gave the lowest ratings to most of the examined factors; convenience among factors influencing pharmacy selection, whereas previous experience, the pharmacist's opinion and product price among those affecting the purchase of OTCs, received the highest ratings.

Conclusions

The community pharmacy market comprised of distinct customer segments that varied in the consumer preferences concerning the selection of pharmacy and OTCs, the evaluation of pharmaceutical services and products, and demographic characteristics.

Significance of qualitative PCR detection method for preemptive therapy of cytomegalovirus infection in patients after allogeneic hematopoietic stem cell transplantation -- single-centre experience

Both early cytomegalovirus (CMV) monitoring and prophylactic antiviral therapy can decrease clinical complications or can prevent them in patients after allogeneic hematopoietic stem cell transplantation (HSCT). Presented paper summarizes experiences with using regular monitoring of reactivation of CMV after allogeneic HSCT by qualitative polymerase chain reaction (PCR) method to prevent the development of symptomatic CMV disease. Samples of peripheral blood leukocytes (PBL) in 71 patients were monitored. Because of retransplantation in two patients, 73 transplantations, each followed by the monitoring, were performed. Patients were monitored weekly after the transplantation for CMV DNA-emia in PBL. An episode of CMV infection representing an indication for preemptive ganciclovir (GCV) or foscarnet (FOS) therapy was defined as two consecutive positive PCR results in 4-7 days. Median time of monitoring was 313 days. The CMV infection was found in 28/73 monitorings (38.4%) and always was followed by preemptive therapy. One recurrence of CMV infection was observed in 4/28 (14.3%) monitorings and two recurrences in 1/28 (3.6%) monitorings. Presented approach resulted in complete prevention of overt CMV disease and this study enable to show that qualitative PCR method for determination of incipient CMV infection followed by preemptive therapy is suitable for preventing patients after allogeneic transplantation from CMV disease.