A multi-methods, multi-actor exploration of the benefits and barriers to milk recording on Irish farms using the COM-B model

Milk recording is a critical tool in dairy farming, providing individual cow information. When used effectively, this data contributes to on-farm productivity, herd health management decisions and supports prudent veterinary prescribing of antimicrobials. Although an industry and government priority, uptake has been relatively slow in Ireland. This multi-methods, three-part study aimed to gain a comprehensive understanding of the benefits to farm performance, and factors driving uptake of milk recording on Irish dairy farms. It involved an economic analysis of N=516 farms from 2008-2019, a workshop with N=26 stakeholders and an online survey of N=197 non-milk-recording farmers. Quantitative and qualitative data were analysed using econometric models and thematic analysis respectively. Results were synthesised using the COM-B model to gain a deeper understanding of what drives the target behaviour. The study revealed that agricultural education, farm location, farm specialisation in dairy and membership of a farmer discussion group were the main factors influencing uptake of milk recording. Milk recording was associated with a €39.04/cow increase in gross margin, a 177.58 litres/cow increase in milk yield and a reduction of 13,450 cells/ml in bulk milk tank somatic cell count readings. Infrastructural constraints, cost, lack of benefits and workload were the most reported perceived barriers to milk recording by farmers. The Behaviour Change Wheel illustrates how to utilise findings and systematically develop future interventions to increase milk recording uptake. This study highlights the importance of a multi-methods approach to agricultural technology adoption and the need for evidence-based methodology when developing behaviour change interventions.

Impacts of the COVID-19 public health emergency on healthcare professional delivery of opportunistic behaviour change interventions: a retrospective cohort study

BACKGROUND

The public health policy "Making Every Contact Count" (MECC) compels healthcare professionals to deliver health behaviour change interventions during routine consultations. As healthcare systems continue their recovery from the impacts of the COVID-19 public health emergency, supporting people to modify health behaviours is more important now than when the policy was introduced. The present study aims to: (a) examine changes in healthcare professionals' awareness of, and engagement with the policy over a five-year period, (b) examine the psychosocial drivers associated with delivering behaviour change interventions, and (c) identify targets to increase healthcare professionals' delivery of interventions.

METHODS

Comparison of data from two independent representative surveys of NHS healthcare professionals working in the UK. In both surveys (July-September 2017; N = 1387, and February-March 2022; N = 1008), participants were asked to report: (1) awareness of the MECC policy, (2) the prevalence of MECC-related practice (perceived patient benefit, how often interventions were delivered, and time spent delivering interventions), and (3) perceptions of capabilities, opportunities and motivations to deliver behaviour change interventions. T- tests (independent-samples), MANOVA, multiple linear regression, and chi-square analyses were used to generate comparisons between the surveys.

RESULTS

Awareness of the policy increased from 2017 (31.4%) to 2022 (52.0%). However, in 2022 compared with 2017, healthcare professionals reported (a) fewer patients would benefit from behaviour change interventions (49.1% versus 55.9%), (b) they delivered behaviour change interventions to a lower proportion of patients (38.0% versus 50.0%), and (c) they spent a lower proportion of the consultation time delivering interventions (26.5% versus 35.3%). Further, in 2022, compared with 2017, healthcare professionals reported fewer physical opportunities, fewer social opportunities, and fewer psychological capabilities to deliver behaviour change interventions. In the 2022 survey, perceptions of patient benefit and delivery of interventions was associated with greater perceptions of opportunities and motivations.

CONCLUSIONS

Health behaviour change interventions remain an important part of routine healthcare in the continued recovery from COVID-19 public health emergency, however reported engagement with MECC-related practices appears to have reduced over time. Future research should consider how healthcare professionals identify patients who might benefit from opportunistic behaviour change interventions, and to increase capabilities, opportunities, and motivations to deliver interventions during routine consultations.

Environmental and public health co-benefits of consumer switches to immunity-supporting food

During COVID-19, there has been a surge in public interest for information on immunity-boosting foods. There is little scientific support for immunity-supporting properties of specific foods, but strong evidence for food choice impacts on other health outcomes (e.g. risk of non-communicable disease) and environmental sustainability. Here, we relate online recommendations for "immunity-boosting" foods across five continents to their environmental and human health impacts. More frequently recommended food items and groups are plant based and have lower land use and greenhouse gas emission impacts plus more positive health outcomes (reducing relative risks of mortality or chronic diet-related diseases) per serving of food. We identify trade-offs between environmental outcomes of increasing consumption of recommended food items, with aquatic environment impacts increasing with food recommendation frequency. People's reliance on the Internet for health information creates an opportunity to consolidate behaviour change towards consuming foods with multiple co-benefits. Our study identifies win-win options for nudging online information-seeking behaviour towards more sustainable choices for terrestrial biodiversity conservation and human health.

Integrating behaviour change interventions and patient decision aids: How to accomplish synergistic effects?

People make numerous health-related choices each day: For example, deciding to brush one's teeth or to eat well and healthy - or not to do these activities. To support complex decisions and subsequent behaviour change, both Behaviour Change Interventions (BCIs) and Patient Decision Aids (PtDAs) have been developed and evolved independently to support people in health-related decision making. In this paper, we critically review BCIs and PtDAs, examine their similarities and differences, and identify potential for integration of expertise to increase the benefits for people engaging with healthcare and health behaviours. The two approaches appear to mainly differ in terms of their (1) goals and foci, (2) theoretical basis, (3) development frameworks, (4) active ingredients and (5) effect evaluation. To facilitate the integration of scientific insights from these two fields, we recommend to (1) bring both fields together and promote interprofessional discussions, (2) train (health) professionals to recognise strengths of both approaches, (3) investigate the synergy of the two fields, (4) be prepared for and try to mitigate a culture shock when the fields start to interact. Knowledge generated by researching PtDAs could be used to facilitate decisional processes that enable patients to choose goals that are in line with their values and preferences, while insights from researching BCIs could be used to facilitate engagement with, and implementation of those goals. This integration could allow researchers and intervention providers to increase the benefits for people engaging with healthcare and health behaviours.

Changing Health-Related Behaviours 5: On Interventions to Change Physician Behaviours

In many countries, there is a large amount of public money spent on health care. Some patient tests and treatments are not only unnecessary but also may be harmful, leading health researchers to look for the most effective interventions to change physician behaviour. The purpose of this chapter is to describe some of the interventions used to modify physician behaviour and highlight their challenges observed in a Canadian provincial context. We begin with a brief description of the increasing interest in behaviour change interventions in recent years and their theoretical basis. We then describe several interventions used to change physician behaviour ranging from nudges to choice restriction and the available evidence on their effectiveness. We provide examples of interventions and their challenges as we've experienced them in our research program, Quality of Care NL. We conclude with a summary of what the evidence tells us about interventions to change physicians' behaviours.

What Competences Are Required to Deliver Person-Person Behaviour Change Interventions: Development of a Health Behaviour Change Competency Framework

BACKGROUND

The competence of the person delivering person-to-person behaviour change interventions may influence the effectiveness of the intervention. However, we lack a framework for describing the range of competences involved. The objective of the current work was to develop a competency framework for health behaviour change interventions.

METHOD

A preliminary framework was developed by two judges rating the relevance of items in the competency framework for cognitive behaviour therapies; adding relevant items from reviews and other competency frameworks; and obtaining feedback from potential users on a draft framework. The Health Behaviour Change Competency Framework (HBCCF) was used to analyse the competency content of smoking cessation manuals.

RESULTS

Judges identified 194 competency items as relevant, which were organised into two domains: foundation (12 competency topics comprising 56 competencies) and behaviour change (12 topics, 54 competencies); several of the 54 and 56 competencies were composed of sub-competencies (84 subcompetencies in total). Smoking cessation manuals included 14 competency topics from the foundation and behaviour change competency domains.

CONCLUSION

The HBCCF provides a structured method for assessing and reporting competency to deliver behaviour change interventions. It can be applied to assess a practitioner's competency and training needs and to identify the competencies needed for a particular intervention. To date, it has been used in self-assessments and in developing training programmes. We propose the HBCCF as a practical tool for researchers, employers, and those who design and provide training. We envisage the HBCFF maturing and adapting as evidence that identifies the essential elements required for the effective delivery of behaviour change interventions emerges.

Protective sexual behaviours among young adults in Nigeria: influence of family support and living with both parents

Background

Many studies have focused on risky sexual behaviour among adolescents and young adults; however, literature on protective sexual practices among this age cohort is still evolving. Since young adults are disproportionately burdened by sexually transmissible infections, including HIV, understanding factors that influence protective sexual behaviour among the age group is crucial in developing age-appropriate interventions. Drawing from a cross-sectional survey conducted among adolescents and young adults in two Nigerian universities, we examined gender differences in protective sexual behaviours and the influence of family support and living with both parents on these behaviours.

Methods

A total of 800 male and female university students in two Nigerian universities were recruited using stratified random sampling between February and April 2018. Analysis was, however, based on 599 participants aged between 15 and 24 . Adjusted and unadjusted multinomial logistic regression models were used to examine the influence of family support, and living with both parents on protective sexual behaviours at a 95% confidence interval.

Results

Findings show that the largest proportion of our participants engaged in protective sexual behaviours. We found no gender differences in protective sexual behaviours, including sexual abstinence, consistent condom use, and sexual fidelity. Family support and living with both parents were positively associated with protective sexual behaviours among adolescents and young adults.

Conclusion

This study found that a majority of adolescents and young adults in Nigerian Universities engage in protective sexual behaviours. Adequate family support and living with both parents are positively associated with protective sexual behaviours. The study however revealed that about one-fifth of our participants engaged in high-risk sexual behaviour. This suggests a need for behavioural change interventions, provision of sexual health services and empowerment of students who receive inadequate family support.

Implementing multiple health behaviour change interventions for cardiovascular risk reduction in primary care: a qualitative study

Background

The implementation of multiple health behaviour change interventions for cardiovascular risk reduction in primary care is suboptimal. This study aimed to identify barriers and facilitators to implementing multiple health behaviour change interventions for cardiovascular disease (CVD) risk reduction in primary care.

Methods

Qualitative study using semi-structured interviews informed by the Theoretical Domains Framework. Interviews were conducted with a purposive sample of healthcare professionals working in the implementation of the NHS Health Check programme in London. Data were analysed using the Framework method.

Results

Thirty participants were recruited including ten general practitioners, ten practice nurses, seven healthcare assistants and three practice managers from 23 practices. Qualitative analysis identified three main themes: healthcare professionals’ conceptualising health behaviour change; delivering multiple health behaviour change interventions in primary care; and delivering the health check programme. Healthcare professionals generally recognised the importance of health behaviour change for CVD risk reduction but were more sceptical about the potential for successful intervention through primary care. Participants identified the difficulty of sustained behaviour change for patients, the lack of evidence for effective interventions and limited access to appropriate resources in primary care as barriers. Discussing changing multiple health behaviours was perceived to be overwhelming for patients and difficult to implement for healthcare professionals with current primary care resources. The health check programme consists of several components that are difficult to fully complete in limited time.

Conclusions

Advancing the prevention agenda will require strategies to support the delivery of behaviour change interventions in primary care. Greater emphasis needs to be given to promoting behaviour change through supportive environmental context. Further research is needed to evaluate current external lifestyle services to improve the intervention outcomes.

Electronic supplementary material

The online version of this article (10.1186/s12875-018-0860-0) contains supplementary material, which is available to authorized users.

The Human Behaviour-Change Project: harnessing the power of artificial intelligence and machine learning for evidence synthesis and interpretation

BACKGROUND

Behaviour change is key to addressing both the challenges facing human health and wellbeing and to promoting the uptake of research findings in health policy and practice. We need to make better use of the vast amount of accumulating evidence from behaviour change intervention (BCI) evaluations and promote the uptake of that evidence into a wide range of contexts. The scale and complexity of the task of synthesising and interpreting this evidence, and increasing evidence timeliness and accessibility, will require increased computer support. The Human Behaviour-Change Project (HBCP) will use Artificial Intelligence and Machine Learning to (i) develop and evaluate a 'Knowledge System' that automatically extracts, synthesises and interprets findings from BCI evaluation reports to generate new insights about behaviour change and improve prediction of intervention effectiveness and (ii) allow users, such as practitioners, policy makers and researchers, to easily and efficiently query the system to get answers to variants of the question 'What works, compared with what, how well, with what exposure, with what behaviours (for how long), for whom, in what settings and why?'.

METHODS

The HBCP will: a) develop an ontology of BCI evaluations and their reports linking effect sizes for given target behaviours with intervention content and delivery and mechanisms of action, as moderated by exposure, populations and settings; b) develop and train an automated feature extraction system to annotate BCI evaluation reports using this ontology; c) develop and train machine learning and reasoning algorithms to use the annotated BCI evaluation reports to predict effect sizes for particular combinations of behaviours, interventions, populations and settings; d) build user and machine interfaces for interrogating and updating the knowledge base; and e) evaluate all the above in terms of performance and utility.

DISCUSSION

The HBCP aims to revolutionise our ability to synthesise, interpret and deliver evidence on behaviour change interventions that is up-to-date and tailored to user need and context. This will enhance the usefulness, and support the implementation of, that evidence.

Development of SmokeFree Baby: a smoking cessation smartphone app for pregnant smokers

Pregnant smokers may benefit from digital smoking cessation interventions, but few have been designed for this population. The aim was to transparently report the development of a smartphone app designed to aid smoking cessation during pregnancy. The development of a smartphone app (‘SmokeFree Baby’) to help pregnant women stop smoking was guided by frameworks for developing complex interventions, including the Medical Research Council (MRC), Multiphase Optimization Strategy (MOST) and Behaviour Change Wheel (BCW). Two integrative behaviour change theories provided the theoretical base. Evidence from the scientific literature and behaviour change techniques (BCTs) from the BCT Taxonomy v1 informed the intervention content. The app was developed around five core modules, each with a distinct intervention target (identity change, stress management, health information, promoting use of face-to-face support and behavioural substitution) and available in a ‘control’ or ‘full’ version. SmokeFree Baby has been developed as part of a multiphase intervention optimization to identify the optimum combination of intervention components to include in smartphone apps to help pregnant smokers stop smoking.

Characterising smoking cessation smartphone applications in terms of behaviour change techniques, engagement and ease-of-use features

The aim of this study was to assess whether or not behaviour change techniques (BCTs) as well as engagement and ease-of-use features used in smartphone applications (apps) to aid smoking cessation can be identified reliably. Apps were coded for presence of potentially effective BCTs, and engagement and ease-of-use features. Inter-rater reliability for this coding was assessed. Inter-rater agreement for identifying presence of potentially effective BCTs ranged from 66.8 to 95.1 % with ‘prevalence and bias adjusted kappas’ (PABAK) ranging from 0.35 to 0.90 (p < 0.001). The intra-class correlation coefficients between the two coders for scores denoting the proportions of (a) a set of engagement features and (b) a set of ease-of-use features, which were included, were 0.77 and 0.75, respectively (p < 0.001). Prevalence estimates for BCTs ranged from <10 % for medication advice to >50 % for rewarding abstinence. The average proportions of specified engagement and ease-of-use features included in the apps were 69 and 83 %, respectively. The study found that it is possible to identify potentially effective BCTs, and engagement and ease-of-use features in smoking cessation apps with fair to high inter-rater reliability.

Conceptualising engagement with digital behaviour change interventions: a systematic review using principles from critical interpretive synthesis

"Engagement" with digital behaviour change interventions (DBCIs) is considered important for their effectiveness. Evaluating engagement is therefore a priority; however, a shared understanding of how to usefully conceptualise engagement is lacking. This review aimed to synthesise literature on engagement to identify key conceptualisations and to develop an integrative conceptual framework involving potential direct and indirect influences on engagement and relationships between engagement and intervention effectiveness. Four electronic databases (Ovid MEDLINE, PsycINFO, ISI Web of Knowledge, ScienceDirect) were searched in November 2015. We identified 117 articles that met the inclusion criteria: studies employing experimental or non-experimental designs with adult participants explicitly or implicitly referring to engagement with DBCIs, digital games or technology. Data were synthesised using principles from critical interpretive synthesis. Engagement with DBCIs is conceptualised in terms of both experiential and behavioural aspects. A conceptual framework is proposed in which engagement with a DBCI is influenced by the DBCI itself (content and delivery), the context (the setting in which the DBCI is used and the population using it) and the behaviour that the DBCI is targeting. The context and "mechanisms of action" may moderate the influence of the DBCI on engagement. Engagement, in turn, moderates the influence of the DBCI on those mechanisms of action. In the research literature, engagement with DBCIs has been conceptualised in terms of both experience and behaviour and sits within a complex system involving the DBCI, the context of use, the mechanisms of action of the DBCI and the target behaviour.

General Practitioners' and patients' perceptions towards stratified care: a theory informed investigation

Background

Stratified primary care involves changing General Practitioners’ (GPs) clinical behaviour in treating patients, away from the current stepped care approach to instead identifying early treatment options that are matched to patients’ risk of persistent disabling pain. This article explores the perspectives of UK-based GPs and patients about a prognostic stratified care model being developed for patients with the five most common primary care musculoskeletal pain presentations. The focus was on views about acceptability, and anticipated barriers and facilitators to the use of stratified care in routine practice.

Methods

Four focus groups and six semi-structured telephone interviews were conducted with GPs (n = 23), and three focus groups with patients (n = 20). Data were analysed thematically; and identified themes examined in relation to the Theoretical Domains Framework (TDF), which facilitates comprehensive identification of behaviour change determinants. A critical approach was taken in using the TDF, examining the nuanced interrelationships between theoretical domains.

Results

Four key themes were identified: Acceptability of clinical decision-making guided by stratified care; impact on the therapeutic relationship; embedding a prognostic approach within a biomedical model; and practical issues in using stratified care. Whilst within each theme specific findings are reported, common across themes was the identified relationships between the theoretical domains of knowledge, skills, professional role and identity, environmental context and resources, and goals. Through analysis of these identified relationships it was found that, for GPs and patients to perceive stratified care as being acceptable, it must be seen to enhance GPs’ knowledge and skills, not undermine GPs’ and patients’ respective identities and be integrated within the environmental context of the consultation with minimal disruption.

Conclusions

Findings highlight the importance of taking into account the context of general practice when intervening to support GPs to make changes to their clinical behaviour. Findings will inform further stages of the research programme; specifically, the intervention format and content of support packages for GPs participating in a future randomised controlled trial (RCT). This study also contributes to the theoretical debate on how best to encourage clinical behaviour change in general practice, and the possible role of the TDF in that process.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-016-0511-2) contains supplementary material, which is available to authorized users.

A change in behaviour: getting the balance right for research and policy

Behaviour change interventions offer clinical pharmacists many opportunities to optimise the use of medicines. 'MINDSPACE' is a framework used by a Government-affiliated organisation in the United Kingdom to communicate an approach to changing behaviour through policy. The Theoretical Domains Framework (TDF) organises constructs of psychological theories that are most relevant to behaviour change into 14 domains. Both frameworks offer a way of identifying what drives a change in behaviour, providing a target for an intervention. This article aims to compare and contrast MINDSPACE and the TDF, and serves to inform pharmacy practitioners about the potential strengths and weaknesses of using either framework in a clinical pharmacy context. It appears that neither framework can deliver evidence-based interventions that can be developed and implemented with the pace demanded by policy and practice-based settings. A collaborative approach would ensure timely development of acceptable behaviour change interventions that are grounded in evidence.