1
|
Del-Valle-Soto C, López-Pimentel JC, Vázquez-Castillo J, Nolazco-Flores JA, Velázquez R, Varela-Aldás J, Visconti P. A Comprehensive Review of Behavior Change Techniques in Wearables and IoT: Implications for Health and Well-Being. Sensors (Basel) 2024; 24:2429. [PMID: 38676044 PMCID: PMC11054424 DOI: 10.3390/s24082429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
This research paper delves into the effectiveness and impact of behavior change techniques fostered by information technologies, particularly wearables and Internet of Things (IoT) devices, within the realms of engineering and computer science. By conducting a comprehensive review of the relevant literature sourced from the Scopus database, this study aims to elucidate the mechanisms and strategies employed by these technologies to facilitate behavior change and their potential benefits to individuals and society. Through statistical measurements and related works, our work explores the trends over a span of two decades, from 2000 to 2023, to understand the evolving landscape of behavior change techniques in wearable and IoT technologies. A specific focus is placed on a case study examining the application of behavior change techniques (BCTs) for monitoring vital signs using wearables, underscoring the relevance and urgency of further investigation in this critical intersection of technology and human behavior. The findings shed light on the promising role of wearables and IoT devices for promoting positive behavior modifications and improving individuals' overall well-being and highlighting the need for continued research and development in this area to harness the full potential of technology for societal benefit.
Collapse
Affiliation(s)
- Carolina Del-Valle-Soto
- Facultad de Ingeniería, Universidad Panamericana, Álvaro del Portillo 49, Zapopan 45010, Mexico;
| | | | - Javier Vázquez-Castillo
- Department of Informatics and Networking, Universidad Autónoma del Estado de Quintana Roo, Chetumal 77019, Mexico;
| | | | - Ramiro Velázquez
- Facultad de Ingeniería, Universidad Panamericana, Aguascalientes 20296, Mexico;
| | - José Varela-Aldás
- Centro de Investigaciones de Ciencias Humanas y de la Educación—CICHE, Universidad Indoamérica, Ambato 180103, Ecuador;
| | - Paolo Visconti
- Department of Innovation Engineering, University of Salento, 73100 Lecce, Italy;
| |
Collapse
|
2
|
Harakeh Z, Preuhs K, Eekhout I, Lanting C, Klein Velderman M, van Empelen P. Behavior Change Techniques That Prevent or Decrease Obesity in Youth With a Low Socioeconomic Status: A Systematic Review and Meta-Analysis. Child Obes 2024; 20:128-140. [PMID: 37204322 DOI: 10.1089/chi.2022.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Background: Interventions, targeting youth, are necessary to prevent obesity later in life. Especially youth with low socioeconomic status (SES) are vulnerable to develop obesity. This meta-analysis examines the effectiveness of behavioral change techniques (BCTs) to prevent or reduce obesity among 0 to 18-year-olds with a low SES in developed countries. Method: Intervention studies were identified from systematic reviews or meta-analyses published between 2010 and 2020 and retrieved from PsycInfo, Cochrane systematic review, and PubMed. The main outcome was body mass index (BMI), and we coded the BCTs. Results: Data from 30 studies were included in the meta-analysis. The pooled postintervention effects of these studies indicated a nonsignificant decrease in BMI for the intervention group. Longer follow-up (≥12 months) showed favorable differences for intervention studies, although that BMI change was small. Subgroup analyses showed larger effects for studies with six or more BCTs. Furthermore, subgroup analyses showed a significant pooled effect in favor of the intervention for the presence of a specific BCT (problem-solving, social support, instruction on how to perform the behavior, identification of self as role model, and demonstration of the behavior), or absence of a specific BCT (information about health consequences). The intervention program duration and age group of the study population did not significantly influence the studies' effect sizes. Conclusions: Generally, the effects of interventions on BMI change among youth with low SES are small to neglectable. Studies with more than six BCTs and/or specific BCTs had a higher likelihood of decreasing BMI of youth with low SES.
Collapse
Affiliation(s)
- Zeena Harakeh
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Katharina Preuhs
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Iris Eekhout
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Caren Lanting
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Mariska Klein Velderman
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Pepijn van Empelen
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| |
Collapse
|
3
|
Jäger M, Zangger G, Bricca A, Dideriksen M, Smith SM, Midtgaard J, Taylor RS, Skou ST. Mapping interventional components and behavior change techniques used to promote self-management in people with multimorbidity: a scoping review. Health Psychol Rev 2024; 18:165-188. [PMID: 36811829 PMCID: PMC7615688 DOI: 10.1080/17437199.2023.2182813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
Ageing populations and improved survival, have contributed to a rise in the number of people living with multimorbidity, raising issues related to polypharmacy, treatment burden, competing priorities and poor coordination of care. Self-management programs are increasingly included as an essential component of interventions to improve outcomes in this population. However, an overview of how interventions supporting self-management in patients with multimorbidity is missing. This scoping review focused on mapping the literature on patient-centered interventions for people living with multimorbidity. We searched several databases, clinical registries, and grey literature for RCTs published between 1990-2019 describing interventions that supported self-management in people with multimorbidity. We included 72 studies that were found to be very heterogeneous when it comes to the population, delivery modes and modalities, intervention elements and facilitators. The results pointed to an extensive use of cognitive behavioral therapy as a basis for interventions, as well as behavior change theories and disease management frameworks. The most coded behavior change techniques stemmed from the categories Social Support, Feedback and monitoring and Goals and Planning. To allow for implementation of effective interventions in clinical practice, improved reporting of intervention mechanisms in RCTs is warranted.
Collapse
Affiliation(s)
- Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Danish Centre for Motivation and Behaviour Science, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Graziella Zangger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Mette Dideriksen
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Susan M. Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Rod S. Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, Scotland
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| |
Collapse
|
4
|
Shi Y, Ma Z, Yao S, Lu N, Wu Y, Cheng F. Effects of interventions on the screening behavior in female first-degree relatives of breast cancer patients: A systematic review. Public Health Nurs 2024; 41:22-36. [PMID: 37712430 DOI: 10.1111/phn.13252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Women are more likely to develop breast cancer if their first-degree relatives (FDRs) have the disease, but they are often unaware of their individual risk and conduct screening behaviors. OBJECTIVE This study aimed to evaluate the effectiveness of interventions in increasing breast self-examination, clinical breast examination, and mammography rates in FDRs of breast cancer patients. METHODS We selected randomized clinical trials and quasi-experimental studies in eight databases. Interventions in each study were categorized as "promising", or "non-promising" according to whether they led to a positive change in screening behaviors. Interventions were also coded using the Behavioral Change Techniques (BCTs) Taxonomy and a promise ratio calculated for each. BCTs with a promise ratio ≥2 was classified as "promising". RESULTS Thirteen studies with 21 different BCTs were included. The most frequent BCTs were "Prompts/cues", "Credible source", and "Instructions on how to perform the behavior". Seven BCTs had a promise ratio of ≥2 and the four most promising were "Information about health consequences" (promise ratio = 6), "Problem solving" (promise ratio = 4), "Demonstration of the behavior" (promise ratio = 4), and "Adding objects to the environment" (promise ratio = 4). CONCLUSIONS This review indicated an overall weak use of theory, and an insufficient description of several interventions to support the assessment of how specific BCTs were activated.
Collapse
Affiliation(s)
- Yanyan Shi
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Zhuyue Ma
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Shanshan Yao
- Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Institute of Cancer Research, Nanjing, China
| | - Ningning Lu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yuqing Wu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Fang Cheng
- School of Nursing, Nanjing Medical University, Nanjing, China
- Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Institute of Cancer Research, Nanjing, China
| |
Collapse
|
5
|
Marin-Farrona M, Wipfli B, Thosar SS, García-Unanue J, Gallardo L, Felipe JL, López-Fernández J. UCLMuevete: Increasing the amount of physical activity, work-ability, and cardiorespiratory fitness capacity in university workers through active breaks. Work 2024; 77:263-273. [PMID: 37638465 DOI: 10.3233/wor-230062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Active break programs at the workplace are a promising initiative for increasing workers' physical activity (PA) levels, health, work-ability (WA), and social relationship. OBJECTIVE To determine the impact of an Active Breaks workplace program based on Bandura's Social Cognitive Theory (SCT) aligned with Behavior Change Techniques (BCT) on PA levels, cardiorespiratory fitness (CRF), WA, and social relationships among university workers. METHODS #UCLMuévete is a quasi-experimental, 12-week intervention designed according to the TREND and TIDieR-PHP checklists. Sixty-nine university workers were recruited and placed into 17 teams of 3 to 5 people. Participants were instructed to take a 20-min active break every working day (walking, cycling, and functional training). The following variables were measured before and after the 12-week intervention: (1) Amount of PA with accelerometers, (2) CRF through the 6 Min-Walking Test (m), (3) Body composition (fat mass (gr), muscle mass (gr), and bone mineral content (g/cm3) through densitometry), (4) Stress with the BodyGuard2 device, (5) WA through Work Ability Index (WAI), and (6) Social relationships through an ad-hoc questionnaire. Part-time workers, pregnant women, and workers with physical disability were excluded. RESULTS Significant improvements were observed in the amount of daily moderate-to-vigorous PA (Difference (Dif)., women +8.05 and men +12.31 minutes; p < 0.05; ES = 0.224; 0.379), CRF (Dif., women +52.98 and men +25.53 meters; p < 0.05; ES = 0.578; 0.209), and (Dif., women +2.16 and men +2.39; p < 0.05; ES = 0.150; 0.177). No significant changes were observed in body composition and stress. CONCLUSION 20 min/day of aerobic and strength active breaks, based on SCT aligned to BCTs, improves university workers' amount of PA, CRF, WAI, and social relationships.
Collapse
Affiliation(s)
- Maria Marin-Farrona
- Department of Physical Activity and Sport Sciences, IGOID Research Group, University of Castilla-La Mancha, Toledo, Spain
| | - Brad Wipfli
- OHSU-PSU School of Public Health, Portland State University, Portland, OR, USA
| | - Saurabh S Thosar
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Jorge García-Unanue
- Department of Physical Activity and Sport Sciences, IGOID Research Group, University of Castilla-La Mancha, Toledo, Spain
| | - Leonor Gallardo
- Department of Physical Activity and Sport Sciences, IGOID Research Group, University of Castilla-La Mancha, Toledo, Spain
| | - Jose Luis Felipe
- Department of Physical Activity and Sport Sciences, IGOID Research Group, University of Castilla-La Mancha, Toledo, Spain
| | | |
Collapse
|
6
|
Singh T, Truong M, Roberts K, Myneni S. Sequencing conversational turns in peer interactions: An integrated approach for evidence-based conversational agent for just-in-time nicotine cravings intervention. Digit Health 2024; 10:20552076241228430. [PMID: 38357587 PMCID: PMC10865956 DOI: 10.1177/20552076241228430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
Background Risky health behaviors place an enormous toll on public health systems. While relapse prevention support is integrated with most behavior modification programs, the results are suboptimal. Recent advances in artificial intelligence (AI) applications provide us with unique opportunities to develop just-in-time adaptive behavior change solutions. Methods In this study, we present an innovative framework, grounded in behavioral theory, and enhanced with social media sequencing and communications scenario builder to architect a conversational agent (CA) specialized in the prevention of relapses in the context of tobacco cessation. We modeled peer interaction data (n = 1000) using the taxonomy of behavior change techniques (BCTs) and speech act (SA) theory to uncover the socio-behavioral and linguistic context embedded within the online social discourse. Further, we uncovered the sequential patterns of BCTs and SAs from social conversations (n = 339,067). We utilized grounded theory-based techniques for extracting the scenarios that best describe individuals' needs and mapped them into the architecture of the virtual CA. Results The frequently occurring sequential patterns for BCTs were comparison of behavior and feedback and monitoring; for SAs were directive and assertion. Five cravings-related scenarios describing users' needs as they deal with nicotine cravings were identified along with the kinds of behavior change constructs that are being elicited within those scenarios. Conclusions AI-led virtual CAs focusing on behavior change need to employ data-driven and theory-linked approaches to address issues related to engagement, sustainability, and acceptance. The sequential patterns of theory and intent manifestations need to be considered when developing effective behavior change CAs.
Collapse
Affiliation(s)
- Tavleen Singh
- McWilliams School of Biomedical Informatics, The University of Texas Health Science Center, Houston, Texas, USA
| | - Michael Truong
- McWilliams School of Biomedical Informatics, The University of Texas Health Science Center, Houston, Texas, USA
| | - Kirk Roberts
- McWilliams School of Biomedical Informatics, The University of Texas Health Science Center, Houston, Texas, USA
| | - Sahiti Myneni
- McWilliams School of Biomedical Informatics, The University of Texas Health Science Center, Houston, Texas, USA
| |
Collapse
|
7
|
Xu J, Hoover RL, Woodard N, Leeman J, Hirschey R. A Systematic Review of Dietary Interventions for Cancer Survivors and Their Families or Caregivers. Nutrients 2023; 16:56. [PMID: 38201886 PMCID: PMC10780967 DOI: 10.3390/nu16010056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Family or caregiver engagement has the potential to support healthy dietary changes among cancer survivors. However, little is known about these family- or caregiver-involved dietary interventions and their effects. This systematic review aimed to identify the behavior change techniques (BCTs) used in dietary interventions for cancer survivors and their families or caregivers and to synthesize intervention effects on dietary and health outcomes. Following the PRISMA guidelines, we conducted systematic searches in three databases and identified 12 trials (16 peer-reviewed manuscripts) for inclusion in this review. Data were extracted from these manuscripts and the BCT taxonomy was used to identify the BCTs. A total of 38 BCTs were identified from 12 trials, 13 of which were used in at least half of the 12 trials. Ten studies reported significant intervention effects on health outcomes (e.g., adiposity) and six suggested significant improvements in dietary behaviors (e.g., fruit and vegetable intake). Overall, this review found that family- or caregiver-involved interventions for cancer survivors significantly improved dietary and health outcomes. Future research should identify BCTs particularly for dietary changes and develop effective dyadic strategies to facilitate diet-related interactions between survivors and their families or caregivers to enhance their engagement in healthy diets.
Collapse
Affiliation(s)
- Jingle Xu
- School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, 120 N. Medical Dr., Chapel Hill, NC 27599, USA; (R.L.H.); (J.L.); (R.H.)
| | - Rebecca L. Hoover
- School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, 120 N. Medical Dr., Chapel Hill, NC 27599, USA; (R.L.H.); (J.L.); (R.H.)
| | - Nathaniel Woodard
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Dr., Chapel Hill, NC 27599, USA;
| | - Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, 120 N. Medical Dr., Chapel Hill, NC 27599, USA; (R.L.H.); (J.L.); (R.H.)
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Dr., Chapel Hill, NC 27599, USA;
| | - Rachel Hirschey
- School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, 120 N. Medical Dr., Chapel Hill, NC 27599, USA; (R.L.H.); (J.L.); (R.H.)
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Dr., Chapel Hill, NC 27599, USA;
| |
Collapse
|
8
|
Montilva-Monsalve J, Dimantas B, Perski O, Gutman LM. Barriers and Enablers to the Adoption of a Healthier Diet Using an App: Qualitative Interview Study With Patients With Type 2 Diabetes Mellitus. JMIR Diabetes 2023; 8:e49097. [PMID: 38113087 PMCID: PMC10762608 DOI: 10.2196/49097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/28/2023] [Accepted: 10/26/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Adopting a healthy diet is one of the cornerstones of type 2 diabetes (T2D) management. Apps are increasingly used in diabetes self-management, but most studies to date have focused on assessing their impact in terms of weight loss or glycemic control, with limited evidence on the behavioral factors that influence app use to change dietary habits. OBJECTIVE The main objectives of this study were to assess the enablers and barriers to adopting a healthier diet using the Gro Health app in 2 patient groups with T2D (patients with recently diagnosed and long-standing T2D) and to identify behavior change techniques (BCTs) to enhance enablers and overcome barriers. METHODS Two semistructured qualitative interview studies were conducted; the first study took place between June and July 2021, with a sample of 8 patients with recently diagnosed (<12 mo) T2D, whereas the second study was conducted between May and June 2022 and included 15 patients with long-standing (>18 mo) T2D. In both studies, topic guides were informed by the Capability, Opportunity, Motivation, and Behavior model and the Theoretical Domains Framework. Transcripts were analyzed using a combined deductive framework and inductive thematic analysis approach. The Behavior Change Wheel framework was applied to identify appropriate BCTs that could be used in future iterations of apps for patients with diabetes. Themes were compared between the patient groups. RESULTS This study identified similarities and differences between patient groups in terms of enablers and barriers to adopting a healthier diet using the app. The main enablers for recently diagnosed patients included the acquired knowledge about T2D diets and skills to implement these, whereas the main barriers were the difficulty in deciding which app features to use and limited cooking skills. By contrast, for patients with long-standing T2D, the main enablers included knowledge validation provided by the app, along with app elements to help self-regulate food intake; the main barriers were the limited interest paid to the content provided or limited skills engaging with apps in general. Both groups reported more enablers than barriers to performing the target behavior when using the app. Consequently, BCTs were selected to address key barriers in both groups, such as simplifying the information hierarchy in the app interface, including tutorials demonstrating how to use the app features, and redesigning the landing page of the app to guide users toward these tutorials. CONCLUSIONS Patients with recently diagnosed and long-standing T2D encountered similar enablers but slightly different barriers when using an app to adopting a healthier diet. Consequently, the development of app-based approaches to adopt a healthier diet should account for these similarities and differences within patient segments to reduce barriers to performing the target behavior.
Collapse
Affiliation(s)
- Jonas Montilva-Monsalve
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Bruna Dimantas
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Olga Perski
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Leslie Morrison Gutman
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| |
Collapse
|
9
|
Kuru H. Identifying Behavior Change Techniques in an Artificial Intelligence-Based Fitness App: A Content Analysis. Health Educ Behav 2023:10901981231213586. [PMID: 38054236 DOI: 10.1177/10901981231213586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
In the field of artificial intelligence-based fitness apps, the effective integration of behavior change techniques (BCTs) is critical for promoting physical activity and improving health outcomes. However, the specific BCTs employed by apps and their impact on user engagement and behavior change are not explored sufficiently. This study investigates the Freeletics fitness app through a mixed-methods approach to evaluate the use of BCTs. In the quantitative analysis, fifteen unique BCTs were identified based on the Behavior Change Technique Taxonomy (V1). In the qualitative analysis, user reviews (n=400) were examined to understand perspectives on the app's effectiveness in promoting behavior change. Goal setting, action planning, self-monitoring of behavior, and social support were among the most prevalent BCTs identified in the Freeletics app, and their effectiveness in enhancing user engagement and promoting behavior change was also highlighted by user reviews. Among the areas of improvement identified in the study were the need for simplifying personalization options and addressing user concerns regarding the specificity of feedback. The study underscores the importance of integrating BCTs effectively within AI-based fitness apps to drive user engagement and facilitate behavior change. It contributes valuable insights into the design and implementation of BCTs in fitness apps and offers recommendations for developers, emphasizing the significance of goal setting, feedback mechanisms, self-monitoring, and social support. By understanding the impact of specific BCTs on user behavior and addressing user concerns, developers can create more effective fitness apps, ultimately promoting healthier lifestyles and positive behavior change.
Collapse
Affiliation(s)
- Hakan Kuru
- İstanbul Rumeli University, İstanbul, Turkey
- Middle East Technical University, Ankara, Turkey
| |
Collapse
|
10
|
Mokaya M, Kyallo F, Yiga P, Koole JL, Boedt T, Vangoitsenhoven R, Matthys C. Designing Mobile Phone Text Messages Using the Behavior Change Wheel Framework to Influence Food Literacy in Adults With Type 2 Diabetes in Kenya: Protocol for a Systematic Development Study. JMIR Res Protoc 2023; 12:e48271. [PMID: 38048150 PMCID: PMC10728794 DOI: 10.2196/48271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The worldwide prevalence of type 2 diabetes (T2D) has increased in the past decade, and it is projected to increase by 126% by 2045 in Africa. At the same time, mobile phone use has increased in Africa, providing a potential for innovative mobile health interventions to support diabetes care. OBJECTIVE This study aimed to apply the Behavior Change Wheel (BCW) framework to develop text messages to influence food literacy in adults with T2D in urban Kenya. METHODS The 8 steps of the BCW framework guided the development of text messages: (1) Define the problem in behavioral terms; (2) select target behaviors; (3) specify the target behaviors based on who needs to perform the behaviors, what needs to change, and when, where, how often, and with whom; (4) identify what needs to change; (5) identify intervention functions; (6) select policy categories; (7) select behavior change techniques (BCTs); and (8) select the mode of delivery. Recent exploratory studies in Kenya and other low- and middle-income countries provided information that was used to contextualize the intervention. RESULTS In step 1, the behavioral problem was defined as unhealthy dietary patterns among adults with T2D. In step 2, based on a qualitative study in the target population, the target behavior was selected to be evaluation of reliable sources of information, and selection and preparation of healthy food. In step 3, unhealthy dietary patterns were selected. In step 4, 10 domains of the Theoretical Domains Framework were identified, and in step 5, 5 intervention functions were linked to the domains and unhealthy dietary patterns were specified. In step 6, communication and regulations were identified as policy categories, while in step 7, 9 BCTs were selected from the Behavior Change Technique Taxonomy version 1. In step 8, the most suitable mode of delivery was determined to be mobile text messages. A total of 36 mobile text messages were developed based on the 9 BCTs. CONCLUSIONS This study shows the step-by-step application of the BCW framework to develop mobile text messages to influence food literacy in adults with T2D. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/48271.
Collapse
Affiliation(s)
- Moses Mokaya
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Experimental and Clinical Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Florence Kyallo
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Peter Yiga
- Mildmay Research Centre, Kampala, Uganda
| | - Janna Lena Koole
- Experimental and Clinical Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Tessy Boedt
- Experimental and Clinical Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Roman Vangoitsenhoven
- Experimental and Clinical Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals, Leuven, Belgium
| | - Christophe Matthys
- Experimental and Clinical Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| |
Collapse
|
11
|
Struik L, Sharma RH, Rodberg D, Christianson K, Lewis S. A Content Analysis of Behavior Change Techniques Employed in North American Vaping Prevention Interventions. AJPM Focus 2023; 2:100126. [PMID: 37790953 PMCID: PMC10546602 DOI: 10.1016/j.focus.2023.100126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Vaping among North American youth has surfaced as a concerning public health epidemic. Increasing evidence of harms associated with E-cigarette use, especially among the young, has prompted urgency in addressing vaping. Although a number of individual behavior change campaigns have arisen as a result, little is known about which behavior change techniques are being employed to influence youth vaping behavior. In this study, we aimed to code all North American vaping prevention campaigns using the behavior change technique taxonomy (Version 1) to determine which behavior change techniques are being used. Methods We identified the sample of campaigns through systematic searches using Google. After applying the exclusion criteria, the campaigns were reviewed and coded for behavior change techniques. Results In total, 46 unique vaping prevention campaigns were identified, including 2 federal (1 from Canada, 1 from the U.S.), 43 U.S. state-level, and 1 Canadian provincial-level campaign(s). The number of behavior change technique categories and behavior change techniques in a campaign ranged from 0 to 5 (mean=1.56) and 0 to 6 (mean=2.13), respectively. Of the 16 possible behavior change technique categories, 4 were utilized across the campaigns, which included 5. Natural consequences (89%), 6. Comparison of behavior (22%), 13. Identity (20%), and 3. Social support (11%). Conclusions Only a small number of behavior change techniques were used in North American vaping prevention campaigns, with a heavy and often sole reliance on communicating the health consequences of use. Incorporating other promising behavior change techniques into future campaigns is likely a productive way forward to tackling the complex and multifaceted issue of youth vaping.
Collapse
Affiliation(s)
- Laura Struik
- Department of Health and Exercise Sciences, School of Nursing, The University of British Columbia Okanagan Campus, Kelowna, British Columbia, Canada
| | - Ramona H. Sharma
- Department of Health and Exercise Sciences, School of Social Work, The University of British Columbia Okanagan Campus, Kelowna, British Columbia, Canada
| | - Danielle Rodberg
- Department of Health and Exercise Sciences, School of Nursing, The University of British Columbia Okanagan Campus, Kelowna, British Columbia, Canada
| | - Kyla Christianson
- Department of Health and Exercise Sciences, School of Nursing, The University of British Columbia Okanagan Campus, Kelowna, British Columbia, Canada
| | - Shannon Lewis
- Department of Health and Exercise Sciences, School of Social Work, The University of British Columbia Okanagan Campus, Kelowna, British Columbia, Canada
| |
Collapse
|
12
|
Simao SC, Bartlett YK, French DP. The state of knowledge regarding delivering behavior change techniques via short text messages is already quite advanced: A response to "Can behavior change techniques be delivered via short text messages?". Transl Behav Med 2023:ibad071. [PMID: 38016181 DOI: 10.1093/tbm/ibad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Doğru et al. recent study reported developing text messages that attempted to capture each of 93 behavior change techniques (BCTs) in a standardized taxonomy. They found that a panel of experts identified the majority of the messages developed as having good fidelity to the intended BCTs. While this work has clear merit, we do not believe it accurately reflects the large body of existing research in this area. A process of producing text messages to address BCTs that yielded high fidelity has previously been reported. Furthermore, this work showed that messages developed for one behavior can be modified to address another behavior with similarly good fidelity. Importantly, these messages have been shown to successfully change target constructs in an experimental study and are being used in a randomized trial that has recently completed recruitment of over 1000 people with Type 2 diabetes.
Collapse
Affiliation(s)
- Sara Correia Simao
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Yvonne Kiera Bartlett
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - David P French
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
13
|
Meloncelli N, O’Connor H, Wilkinson SA, Nitert MD, Kearney L, de Jersey S. Preventing Gestational Diabetes with a Healthy Gut Diet: Protocol for a Pilot, Feasibility Randomized Controlled Trial. Nutrients 2023; 15:4653. [PMID: 37960306 PMCID: PMC10649061 DOI: 10.3390/nu15214653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/18/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
Around 14% of pregnancies globally are affected by gestational diabetes mellitus (GDM), making it one of the most common disorders experienced by women in pregnancy. While dietary, physical activity and supplement interventions have been implemented to prevent GDM, with varying levels of success, altering the gut microbiota through diet is a promising strategy for prevention. Several studies have demonstrated that women with GDM likely have a different gut microbiota to pregnant women without GDM, demonstrating that the gut microbiota may play a part in glycemic control and the development of GDM. To date, there have been no randomized controlled trials using diet to alter the gut microbiota in pregnancy with the aim of preventing GDM. Here, we present the study protocol for a single-blind randomized controlled trial which aims to determine the effectiveness of the Healthy Gut Diet on reducing the diagnosis of GDM in pregnant women with one or more risk factors. Consenting women will be randomized into either the Healthy Gut Diet intervention group or the usual care (control) group after 11 weeks gestation. The women in the intervention group will receive three telehealth counseling appointments with an Accredited Practicing Dietitian with the aim of educating and empowering these women to build a healthy gut microbiota through their diet. The intervention was co-designed with women who have lived experience of GDM and incorporates published behavior change techniques. The control group will receive the usual care and will also be shown a brief (3 min) video on general healthy eating in pregnancy. The primary outcome is the diagnosis of GDM at any stage of the pregnancy. Secondary outcomes include changes to gut microbiota composition and diversity; gestational weight gain; maternal and infant outcomes; management of GDM (where relevant); dietary quality and intake; physical activity; and depression scoring. We aim to recruit 120 women over 16 months. Recruitment commenced in January 2023. The trial has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622001285741).
Collapse
Affiliation(s)
- Nina Meloncelli
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia
- Office of the Chief Allied Health Practitioner, Metro North Hospital and Health Service, Brisbane, QLD 4029, Australia
| | - Hannah O’Connor
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Shelley A. Wilkinson
- Department of Obstetric Medicine, Mater Mothers Hospital, South Brisbane, QLD 4101, Australia;
- Faculty of Health and Behavioural Sciences, School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Marloes Dekker Nitert
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia;
| | - Lauren Kearney
- Women’s and Newborn Service Group, Royal Brisbane and Women’s Hospital, Metro North Health, Brisbane, QLD 4029, Australia;
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Susan de Jersey
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia
- Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Metro North Health, Brisbane, QLD 4029, Australia
| |
Collapse
|
14
|
Bentlage E, Nyamadi JJ, Dubbeldam R. The Importance of Activating Factors in Physical Activity Interventions for Older Adults Using Information and Communication Technologies: Systematic Review. JMIR Mhealth Uhealth 2023; 11:e42968. [PMID: 37933182 PMCID: PMC10644949 DOI: 10.2196/42968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/14/2023] [Accepted: 08/04/2023] [Indexed: 11/08/2023] Open
Abstract
Background In an aging population, it is important to activate older adults in taking care of their own health. Increasing physical activity is one way to avoid or lessen age-related physical and mental impairments. Interest in the use of information and communication technology (ICT) tools to promote physical activity among older adults is growing considerably. Such tools are suitable for communicating activation factors-skills, knowledge, and motivation-by integrating a variety of behavior change techniques (BCTs) to enhance physical activity. Although activation factors have been incorporated into physical activity interventions using ICT, little is known about the actual integration methods used in such interventions or about the effects of activation factors on influencing behavior change. Objective The first aim of this study was to identify which of the activation factors were covered in physical activity-promoting ICT interventions for older adults and which BCTs were used to address them. The second objective was to classify the user interaction interfaces and delivery modes that were used to promote these activation factors. Methods The search engines of PubMed, Web of Science, and ScienceDirect were used to search for and identify articles examining the effectiveness of ICT interventions for promoting physical activity in older adults. References and related data were selected, extracted, and reviewed independently by 2 reviewers. The risk of bias was assessed, and any conflict was addressed by a third separate reviewer. Selected articles included older adults aged ≥55 years without pre-existing medical diseases and other physical or mental conditions that could hinder movement. Results In total, 368 records were retrieved, and 13 studies met all inclusion criteria. Articles differed in terms of themes, timescales, user interaction interfaces, and outcome measures; therefore, a quantitative data synthesis was not feasible. Motivation was the most promoted activation factor among all trials (33 times). An app and a smartwatch were used in the majority of intervention groups (7/20, 35%) for tracking physical activity and receiving personalized feedback based on the individual goals. Skills (25 times) and knowledge (17 times) were the next most commonly addressed activation factors. Face-to-face interaction was the most used approach to targeting users' skills, including providing instructions on how to perform a behavior and exchanging knowledge via education on the health consequences of insufficient physical activity. Overall, integrating all 3 activation factors and using multiple user interaction interfaces with a variety of delivery modes proved the most effective in improving physical activity. Conclusions This study highlights commonly used BCTs and preferred modes of their delivery. So far, only a limited number of available BCTs (21/99, 21%) have been integrated. Considering their effectiveness, a larger variety of BCTs that address skills, knowledge, and motivation should be exploited in future ICT interventions.
Collapse
Affiliation(s)
- Ellen Bentlage
- Department of Movement Science, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
| | - John Jnr Nyamadi
- Department of Movement Science, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
| | - Rosemary Dubbeldam
- Department of Movement Science, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
| |
Collapse
|
15
|
Liu X, Zhao W, Qi Q, Luo X. A Survey on Autism Care, Diagnosis, and Intervention Based on Mobile Apps Focusing on Usability and Software Design. Sensors (Basel) 2023; 23:6260. [PMID: 37514555 PMCID: PMC10384173 DOI: 10.3390/s23146260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
This article presents a systematic review on autism care, diagnosis, and intervention based on mobile apps running on smartphones and tablets. Here, the term "intervention" means a carefully planned set of activities with the objective of improving autism symptoms. We guide our review on related studies using five research questions. First, who benefits the most from these mobile apps? Second, what are the primary purposes of these mobile apps? Third, what mechanisms have been incorporated in these mobiles apps to improve usability? Fourth, what guidelines have been used in the design and implementation of these mobile apps? Fifth, what theories and frameworks have been used as the foundation for these mobile apps to ensure the intervention effectiveness? As can be seen from these research questions, we focus on the usability and software development of the mobile apps. Informed by the findings of these research questions, we propose a taxonomy for the mobile apps and their users. The mobile apps can be categorized into autism support apps, educational apps, teacher training apps, parental support apps, and data collection apps. The individuals with autism spectrum disorder (ASD) are the primary users of the first two categories of apps. Teachers of children with ASD are the primary users of the teacher training apps. Parents are the primary users of the parental support apps, while individuals with ASD are usually the primary users of the data collection apps and clinicians and autism researchers are the beneficiaries. Gamification, virtual reality, and autism-specific mechanisms have been used to improve the usability of the apps. User-centered design is the most popular approach for mobile app development. Augmentative and alternative communication, video modeling, and various behavior change practices have been used as the theoretical foundation for intervention efficacy.
Collapse
Affiliation(s)
- Xiongyi Liu
- Department of Curriculum and Foundations, Cleveland State University, Cleveland, OH 44115, USA
| | - Wenbing Zhao
- Department of Electrical and Computer Engineering, Cleveland State University, Cleveland, OH 44115, USA
| | - Quan Qi
- College of Information Science and Technology, Shihezi University, Shihezi 832003, China
| | - Xiong Luo
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, China
| |
Collapse
|
16
|
Almutairi N, Vlahu-Gjorgievska E, Win KT. Persuasive features for patient engagement through mHealth applications in managing chronic conditions: A systematic literature review and meta-analysis. Inform Health Soc Care 2023; 48:267-291. [PMID: 36650714 DOI: 10.1080/17538157.2023.2165083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Patient engagement is currently considered the cornerstone of a revolution in healthcare for its positive impact on health outcomes, health behaviors and healthcare costs. Patient engagement is focused on personalized care to consumers through providing knowledge, skills and confidence. Mobile health (mHealth) applications are an innovative means to facilitate patient engagement. Nevertheless, the extent to which the current mHealth applications are designed to engage patients in managing their chronic diseases is unclear. This paper aims to identify the Persuasive System Design (PSD) features present in current mHealth applications that increased the engagement of patients with chronic diseases. This review also aims to identify patient engagement-related outcomes of these features. This paper conducted a systematic literature review and meta-analysis to find relevant studies published from all years up to 2020 through six databases: PubMed, Scopus, Web of Science, Cinahl plus with full text, MEDLINE with full text, and Cochrane Library (Central register of controlled trials). The database search returned 4939 articles; after applying the inclusion and exclusion criteria, the number of included articles for the final review was 13. A qualitative content analysis was performed to identify PSD model features and their patient engagement-related outcomes. The quality assessment has been done through the Cochrane Risk of Bias tool for RCTs. The systematic literature review and meta-analysis identified eleven PSD features that can increase patient engagement through using mHealth applications. The identified PSD features have been shown to have various patient engagement-related outcomes. Behavior Change Techniques (BCTs) were combined with the identified PSD features. This paper identified persuasive features of mHealth application design that influence the engagement of patients with chronic diseases toward changing their behavior. The impact of these features is also analyzed in this review. The results show that an mHealth technology-mediated patient engagement model is needed.
Collapse
Affiliation(s)
- Nawaf Almutairi
- Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
- Faculty of Public Health and Health Informatics, University of Hail, Hail, Saudi Arabia
| | - Elena Vlahu-Gjorgievska
- Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Khin Than Win
- Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| |
Collapse
|
17
|
Friel CP, Robles PL, Butler M, Pahlevan-Ibrekic C, Duer-Hefele J, Vicari F, Chandereng T, Cheung K, Suls J, Davidson KW. Testing Behavior Change Techniques to Increase Physical Activity in Middle-Aged and Older Adults: Protocol for a Randomized Personalized Trial Series. JMIR Res Protoc 2023; 12:e43418. [PMID: 37314839 PMCID: PMC10337349 DOI: 10.2196/43418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Being physically active is critical to successful aging, but most middle-aged and older adults do not move enough. Research has shown that even small increases in activity can have a significant impact on risk reduction and improve quality of life. Some behavior change techniques (BCTs) can increase activity, but prior studies on their effectiveness have primarily tested them in between-subjects trials and in aggregate. These design approaches, while robust, fail to identify those BCTs most influential for a given individual. In contrast, a personalized, or N-of-1, trial design can assess a person's response to each specific intervention. OBJECTIVE This study is designed to test the feasibility, acceptability, and preliminary effectiveness of a remotely delivered personalized behavioral intervention to increase low-intensity physical activity (ie, walking) in adults aged 45 to 75 years. METHODS The intervention will be administered over 10 weeks, starting with a 2-week baseline period followed by 4 BCTs (goal-setting, self-monitoring, feedback, and action planning) delivered one at a time, each for 2 weeks. In total, 60 participants will be randomized post baseline to 1 of 24 intervention sequences. Physical activity will be continuously measured by a wearable activity tracker, and intervention components and outcome measures will be delivered and collected by email, SMS text messages, and surveys. The effect of the overall intervention on step counts relative to baseline will be examined using generalized linear mixed models with an autoregressive model that accounts for possible autocorrelation and linear trends for daily steps across time. Participant satisfaction with the study components and attitudes and opinions toward personalized trials will be measured at the intervention's conclusion. RESULTS Pooled change in daily step count will be reported between baseline and individual BCTs and baseline versus overall intervention. Self-efficacy scores will be compared between baseline and individual BCTs and between baseline and the overall intervention. Mean and SD will be reported for survey measures (participant satisfaction with study components and attitudes and opinions toward personalized trials). CONCLUSIONS Assessing the feasibility and acceptability of delivering a personalized, remote physical activity intervention for middle-aged and older adults will inform what steps will be needed to scale up to a fully powered and within-subjects experimental design remotely. Examining the effect of each BCT in isolation will allow for their unique impact to be assessed and support design of future behavioral interventions. In using a personalized trial design, the heterogeneity of individual responses for each BCT can be quantified and inform later National Institutes of Health stages of intervention development trials. TRIAL REGISTRATION clinicaltrials.gov NCT04967313; https://clinicaltrials.gov/ct2/show/NCT04967313. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/43418.
Collapse
Affiliation(s)
- Ciaran P Friel
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
| | - Patrick L Robles
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
| | - Mark Butler
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
| | - Challace Pahlevan-Ibrekic
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
| | - Joan Duer-Hefele
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
| | - Frank Vicari
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
| | - Thevaa Chandereng
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
| | - Ken Cheung
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Jerry Suls
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
| | - Karina W Davidson
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
| |
Collapse
|
18
|
Conroy DE, Wu J, Lee AM, Brunke-Reese D, Lagoa CM. Dose-response relations between the frequency of two types of momentary feedback prompts and daily physical activity. Health Psychol 2023; 42:151-160. [PMID: 36862471 PMCID: PMC10015600 DOI: 10.1037/hea0001271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE Self-monitoring and behavioral feedback are widely used to help people monitor progress toward daily physical activity goals. Little information exists about the optimal dosing parameters for these techniques or if they are interchangeable in digital physical activity interventions. This study used a within-person experimental design to evaluate associations between the frequency of two different prompt types (one for each technique) and daily physical activity. METHOD Insufficiently active young adults were assigned monthly physical activity goals and wore smartwatches with activity trackers for 3 months. They received zero to six randomly selected and timed watch-based prompts each day, with individual prompts either providing behavioral feedback or prompting the participant to self-monitor. RESULTS Physical activity increased significantly over the 3-month period (step counts d = 1.03; moderate-to-vigorous physical activity duration d = 0.99). Mixed linear models revealed that daily step counts were positively associated with the frequency of daily self-monitoring prompts up to approximately three prompts/day (d = 0.22) after which additional prompts provided minimal or reduced benefit. Daily step counts were not associated with the frequency of behavioral feedback prompts. Daily moderate-to-vigorous physical activity was not associated with the frequency of either prompt. CONCLUSIONS Self-monitoring and behavioral feedback are not interchangeable behavior change techniques in digital physical activity interventions, and only self-monitoring prompts show signs of a dose-response association with physical activity volume. Activity trackers, such as smartwatches and mobile apps, should provide an option to replace behavioral feedback prompts with self-monitoring prompts to promote physical activity among insufficiently active young adults. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- David E Conroy
- Department of Kinesiology, The Pennsylvania State University
| | - Jingchuan Wu
- Department of Kinesiology, The Pennsylvania State University
| | - Alexandra M Lee
- Department of Kinesiology, The Pennsylvania State University
| | | | - Constantino M Lagoa
- School of Electrical Engineering & Computer Science, The Pennsylvania State University
| |
Collapse
|
19
|
Vlahu-Gjorgievska E, Burazor A, Win KT, Trajkovik V. mHealth Apps Targeting Obesity and Overweight in Young People: App Review and Analysis. JMIR Mhealth Uhealth 2023; 11:e37716. [PMID: 36656624 PMCID: PMC9896356 DOI: 10.2196/37716] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/15/2022] [Accepted: 11/22/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Overweight and obesity have been linked to several serious health problems and medical conditions. With more than a quarter of the young population having weight problems, the impacts of overweight and obesity on this age group are particularly critical. Mobile health (mHealth) apps that support and encourage positive health behaviors have the potential to achieve better health outcomes. These apps represent a unique opportunity for young people (age range 10-24 years), for whom mobile phones are an indispensable part of their everyday living. However, despite the potential of mHealth apps for improved engagement in health interventions, user adherence to these health interventions in the long term is low. OBJECTIVE The aims of this research were to (1) review and analyze mHealth apps targeting obesity and overweight and (2) propose guidelines for the inclusion of user interface design patterns (UIDPs) in the development of mHealth apps for obese young people that maximizes the impact and retention of behavior change techniques (BCTs). METHODS A search for apps was conducted in Google Play Store using the following search string: ["best weight loss app for obese teens 2020"] OR ["obesity applications for teens"] OR ["popular weight loss applications"]. The most popular apps available in both Google Play and Apple App Store that fulfilled the requirements within the inclusion criteria were selected for further analysis. The designs of 17 mHealth apps were analyzed for the inclusion of BCTs supported by various UIDPs. Based on the results of the analysis, BCT-UI design guidelines were developed. The usability of the guidelines was presented using a prototype app. RESULTS The results of our analysis showed that only half of the BCTs are implemented in the reviewed apps, with a subset of those BCTs being supported by UIDPs. Based on these findings, we propose design guidelines that associate the BCTs with UIDPs. The focus of our guidelines is the implementation of BCTs using design patterns that are impactful for the young people demographics. The UIDPs are classified into 6 categories, with each BCT having one or more design patterns appropriate for its implementation. The applicability of the proposed guidelines is presented by mock-ups of the mHealth app "Morphe," intended for young people (age range 10-24 years). The presented use cases showcase the 5 main functionalities of Morphe: learn, challenge, statistics, social interaction, and settings. CONCLUSIONS The app analysis results showed that the implementation of BCTs using UIDPs is underutilized. The purposed guidelines will help developers in designing mHealth apps for young people that are easy to use and support behavior change. Future steps involve the development and deployment of the Morphe app and the validation of its usability and effectiveness.
Collapse
Affiliation(s)
- Elena Vlahu-Gjorgievska
- School of Computing and Information Technology, University of Wollongong, Wollongong, Australia
| | - Andrea Burazor
- School of Computing and Information Technology, University of Wollongong, Wollongong, Australia
| | - Khin Than Win
- School of Computing and Information Technology, University of Wollongong, Wollongong, Australia
| | - Vladimir Trajkovik
- Faculty of Computer Science and Engineering, Ss Cyril and Methodius University, Skopje, Republic of North Macedonia
| |
Collapse
|
20
|
McCleary N, Laur C, Presseau J, Dobell G, Lam JM, Gushue S, Hagel K, Bevan L, Salach L, Desveaux L, M. Ivers N. Surfacing the causal assumptions and active ingredients of healthcare quality improvement interventions: An application to primary care opioid prescribing. Implement Res Pract 2023; 4:26334895231206569. [PMID: 37936967 PMCID: PMC10624081 DOI: 10.1177/26334895231206569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Efforts to maximize the impact of healthcare improvement interventions are hampered when intervention components are not well defined or described, precluding the ability to understand how and why interventions are expected to work. Method We partnered with two organizations delivering province-wide quality improvement interventions to establish how they envisaged their interventions lead to change (their underlying causal assumptions) and to identify active ingredients (behavior change techniques [BCTs]). The interventions assessed were an audit and feedback report and an academic detailing program. Both focused on supporting safer opioid prescribing in primary care in Ontario, Canada. Data collection involved semi-structured interviews with intervention developers (n = 8) and a content analysis of intervention documents. Analyses unpacked and articulated how the interventions were intended to achieve change and how this was operationalized. Results Developers anticipated that the feedback report would provide physicians with a clear understanding of their own prescribing patterns in comparison to others. In the feedback report, we found an emphasis on BCTs consistent with that assumption (feedback on behavior; social comparison). The detailing was designed to provide tailored support to enable physicians to overcome barriers to change and to gradually enact specific practice changes for patients based on improved communication. In the detailing materials, we found an emphasis on instructions on how to perform the behavior, for a range of behaviors (e.g., tapering opioids, treating opioid use disorder). The materials were supplemented by detailer-enacted BCTs (e.g., social support [practical]; goal setting [behavior]; review behavioral goal[s]). Conclusions The interventions included a small range of BCTs addressing various clinical behaviors. This work provides a methodological example of how to apply a behavioral lens to surface the active ingredients, target clinical behaviors, and causal assumptions of existing large-scale improvement interventions that could be applied in other contexts to optimize effectiveness and facilitate scale and spread.
Collapse
Affiliation(s)
- Nicola McCleary
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Justin Presseau
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - Gail Dobell
- Health System Performance & Support, Ontario Health, Toronto, Canada
| | - Jonathan M.C. Lam
- Health System Performance & Support, Ontario Health, Toronto, Canada
| | - Sharon Gushue
- Population Health & Prevention, Ontario Health, Toronto, Canada
| | - Katie Hagel
- Centre for Effective Practice, Toronto, Canada
| | | | - Lena Salach
- Centre for Effective Practice, Toronto, Canada
| | - Laura Desveaux
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada
| | - Noah M. Ivers
- Women's College Hospital Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| |
Collapse
|
21
|
Worthington A, Gillies N, Roy R, Braakhuis A. Development of eHealth-Based Behavior Change Support for Young Adults Using the Nine Principles Framework. J Nutr Educ Behav 2023; 55:38-47. [PMID: 36372660 DOI: 10.1016/j.jneb.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Implementing behavior strategies into nutrition research requires consideration. The Nine Principles framework was used to develop an eHealth behavior change support (BCS) program to enhance young adults' adherence to (1) eating healthily and (2) recording dietary intake when participating in a randomized control trial. The Theory of Planned Behavior and qualitative focus group data informed a 10-week pilot of the BCS delivered on Facebook and texts. The BCS appeared to support optimal dietary recording and maintained dietary behaviors, suggesting using a framework underpinned by theory and user-centered design may be a promising avenue to enhance adherence in randomized control trials.
Collapse
Affiliation(s)
- Anna Worthington
- Discipline of Nutrition, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.
| | - Nicola Gillies
- Discipline of Nutrition, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Rajshri Roy
- Discipline of Nutrition, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Andrea Braakhuis
- Discipline of Nutrition, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
22
|
Jacobs C, Turbitt E, McEwen A, Atkins L. Australasian Genetic Counselors' Perceptions of Their Role in Supporting Clients' Behavior Change. J Pers Med 2022; 13. [PMID: 36675691 DOI: 10.3390/jpm13010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/09/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Genetic testing does not always change health behavior. Effective behavior change requires a theory-driven coordinated set of activities (behavior change techniques). Genetic counselors are ideally positioned to facilitate behavior change. We aimed to explore genetic counselors' perceptions of their role in supporting clients' behavior change to inform the design of an intervention. Recruitment was via a professional organization and genetics services. Data were collected from 26 genetic counselors via qualitative focus groups/interview. Transcripts were analyzed using thematic analysis and mapped to the COM-B model. We identified three behaviors genetic counselors wanted clients to change: attend appointments, access information, and share information with family members. Strategies for changing clients' behavior included: assessing needs and capabilities, providing information and support, enabling and monitoring behavior change. Barriers included lack of behavior change skills and knowledge, lack of time, and beliefs about ownership of healthcare, directiveness of behavior change, and scope of practice. Equipping genetic counselors to deliver behavior change requires (i) education in behavior change theory and behavior change techniques, (ii) integration of capability, opportunity and motivation assessment into existing practice, and (iii) development of evidence-based strategies using behavior change tools to focus discussions and promote clients' agency to change their behavior.
Collapse
|
23
|
Sun Y, Gao Y, Yu S, Wang A, Ou X, Tao D, Baker JS. Promoting Physical Activity among Workers: A Review of Literature and Future Directions on Developing Theory-Based Interventions. Int J Environ Res Public Health 2022; 19:13594. [PMID: 36294174 PMCID: PMC9602512 DOI: 10.3390/ijerph192013594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/15/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
Insufficient physical activity (PA) has been identified as a leading risk factor for premature and all-cause death, as well as non-communicable diseases. Employees, especially those with low occupational PA, are more vulnerable to physical inactivity, and studies in this population are scarce. However, employees may receive benefits for both health and work productivity from PA. Therefore, well-designed behavior change studies to promote PA in employees are urgently needed, especially during the COVID-19 pandemic. Literature was searched before 30 July 2022, and updated evidence was summarized. This review elaborates on the evidence related to insufficient PA and further provides an overview of theory-based interventions for promoting PA. Evidence indicates that intervention mapping (IM) was a useful tool to develop, implement, and evaluate behavior change interventions. Based on the IM framework, reviewing the theory- and evidence-based change methods and delivery modes, and further identifying the research gaps and limitations of existing interventions could provide promising suggestions and directions for development of well-founded interventions promoting PA among employees. The updated knowledge base for developing future interventions may boost efficacy and provide firm conclusions for researchers in this area.
Collapse
Affiliation(s)
- Yan Sun
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong 999077, China
| | - Yang Gao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong 999077, China
- Centre for Health and Exercise Science Research, Hong Kong Baptist University, Hong Kong 999077, China
| | - Siyue Yu
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Aiwei Wang
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong 999077, China
- College of Physical Education, Yangzhou University, Yangzhou 225012, China
| | - Xiaoting Ou
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong 999077, China
| | - Dan Tao
- Department of Government and International Studies, Hong Kong Baptist University, Hong Kong 999077, China
| | - Julien S. Baker
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong 999077, China
- Centre for Health and Exercise Science Research, Hong Kong Baptist University, Hong Kong 999077, China
| |
Collapse
|
24
|
Pimenta N, Félix IB, Monteiro D, Marques MM, Guerreiro MP. Promoting Physical Activity in Older Adults With Type 2 Diabetes via an Anthropomorphic Conversational Agent: Development of an Evidence and Theory-Based Multi-Behavior Intervention. Front Psychol 2022; 13:883354. [PMID: 35903740 PMCID: PMC9315349 DOI: 10.3389/fpsyg.2022.883354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Anthropomorphic conversational agents (ACA) are a promising digital tool to support self-management of type 2 diabetes (T2D), albeit little explored. There is a dearth of literature on the detailed content of these interventions, which may limit effectiveness and replication. Our aim is to describe the development of an evidence and theory-based intervention to improve physical activity in older adults with T2D, subsumed in a multi-behavior intervention via a mobile application with an ACA. Methods Overall decisions on the multi-behavior intervention design, such as the use of standardized behavior change techniques (BCTTv1), guided the development of the physical activity component. Firstly, recommendations on ambulatory activity were used to select the target behavior (walking). Meta-research on effective behavior change techniques (BCTs) was then identified. One meta-analysis linked effective BCTs with the three basic psychological needs of the self-determination theory (SDT). This meta-analysis, taken together with additional evidence on SDT, led to the selection of this theory to inform the design. BCTs were extracted from meta-research; we selected the most appropriate to be operationalized via the conversational agent through multidisciplinary discussions. Rules governing the dialogue flow and BCTs tailoring, taking the form "if some conditions hold then execute some action," were derived based on the Basic Psychological in Exercise Scale (competence, autonomy, and relatedness scores), in conjunction with published evidence and multidisciplinary discussions. Results Thirteen BCTs were implemented in the prototype via the ACA (e.g., goal setting behavior 1.1). Six if-then rules were derived and depicted in the dialogue steps through process flow diagrams, which map how the system functions. An example of a rule is "If competence score ≤ 10 then, apply BCT 1.1 with 500 steps increments as options for the daily walking goal; If competence score > 10 then, apply BCT 1.1 with 1,000 steps increments as options for the daily walking goal." Conclusion Evidence and SDT were translated into a mobile application prototype using an ACA to promote physical activity in older adults with T2D. This approach, which includes 13 BCTs and six if-then rules for their tailoring, may leverage the efforts of others in developing similar interventions.
Collapse
Affiliation(s)
- Nuno Pimenta
- Sport Sciences School of Rio Maior, Polytechnic Institute of Santarém, Santarém, Portugal
- Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, Cruz-Quebrada, Portugal
- Centro de Investigação Interdisciplinar em Saúde, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Isa Brito Félix
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisbon, Portugal
| | - Diogo Monteiro
- ESECS – Polytechnic of Leiria, Leiria, Portugal
- Research Centre in Sport, Health and Human Development (CIDESD), Vila Real, Portugal
- Life Quality Research Centre (CIEQV), Leiria, Portugal
| | - Marta Moreira Marques
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Mara Pereira Guerreiro
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisbon, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Monte de Caparica, Portugal
| |
Collapse
|
25
|
Gervais-Hupé J, Filleul A, Perreault K, Hudon A. Implementation of a biopsychosocial approach into physiotherapists' practice: a review of systematic reviews to map barriers and facilitators and identify specific behavior change techniques. Disabil Rehabil 2022:1-10. [PMID: 35790490 DOI: 10.1080/09638288.2022.2094479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Our first objective was to map the barriers and facilitators to the implementation of a biopsychosocial approach into physiotherapists' practice within the Theoretical Domains Framework (TDF). Our second objective was to identify the specific behavior change techniques (BCT) that could facilitate this implementation. MATERIALS AND METHODS We conducted a review of systematic reviews to identify barriers and facilitators to the use of a biopsychosocial approach by physiotherapists and we mapped them within the TDF domains. We then analyzed these domains using the Theory and Techniques tool (TaTT) to identify the most appropriate BCTs for the implementation of a biopsychosocial approach into physiotherapists' practice. RESULTS The barriers and facilitators to the use of a biopsychosocial approach by physiotherapists were mapped to 10 domains of the TDF (Knowledge; skills; professional role; beliefs about capabilities; beliefs about consequences; intentions; memory, attention and decision processes; environmental context; social influences; emotion). The inclusion of these domains within the TaTT resulted in the identification of 33 BCTs that could foster the use of this approach by physiotherapists. CONCLUSIONS Investigating the implementation of a biopsychosocial approach into physiotherapists' practice from a behavior change perspective provides new strategies that can contribute to successfully implement this approach.Implications for RehabilitationThe implementation of a biopsychosocial approach into physiotherapists' practice is a complex process which involves behavior changes influenced by several barriers and facilitators.Barriers and facilitators reported by physiotherapists when implementing a biopsychosocial approach can be mapped within 10 domains of the Theoretical Domain Framework.Thirty-three behavior change techniques (e.g., verbal persuasion about capability, problem solving, restructuring the physical environment, etc.) were identified to foster the implementation of a biopsychosocial approach and specifically target barriers and facilitators.By using a behavior change perspective, this study highlights new strategies and avenues that can support current efforts to successfully implement the use of a biopsychosocial approach into physiotherapists' practice.
Collapse
Affiliation(s)
- Jonathan Gervais-Hupé
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré de services sociaux et de santé du Centre-Sud-de-l'Ile-de-Montréal, Centre de recherche en éthique (CRÉ), Montreal, Canada
| | | | - Kadija Perreault
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, Québec, Canada
| | - Anne Hudon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré de services sociaux et de santé du Centre-Sud-de-l'Ile-de-Montréal, Centre de recherche en éthique (CRÉ), Montreal, Canada
| |
Collapse
|
26
|
Hughes CM. One size fits all? How to optimize the prescribing of appropriate polypharmacy in chronic diseases, using a behavioral approach - a United Kingdom perspective. Expert Rev Clin Pharmacol 2022; 15:497-499. [PMID: 35762041 DOI: 10.1080/17512433.2022.2094767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Carmel M Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland
| |
Collapse
|
27
|
Wu B, Plassman BL, Poole P, Siamdoust S, Bunn M, Burwell B, Pei Y, Downey C, Gomes D, Kamer A, Yu G, Leak Bryant A, Anderson RA. Study protocol for a randomised controlled trial of a care partner assisted intervention to improve oral health of individuals with mild dementia. BMJ Open 2022; 12:e057099. [PMID: 35732396 PMCID: PMC9226943 DOI: 10.1136/bmjopen-2021-057099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Individuals with mild dementia are at high risk of poor oral health outcomes. To address this issue, we describe an intervention to teach care partners skills to guide individuals with mild dementia in proper oral hygiene techniques and provide reminders to practice oral hygiene care. By providing support to perform these tasks successfully, we aim to delay oral health decline among this vulnerable population. METHODS AND ANALYSIS This multisite study is a three-arm randomised controlled trial. The primary objective is to evaluate the efficacy of an intervention to improve oral hygiene outcomes by promoting positive oral hygiene behaviours and skills among individuals with mild dementia. Care partners' behaviour factors, such as oral care self-efficacy and implementation of the care plan, serve as mediators of the intervention. Participant-care partner dyads will be randomly assigned to either Treatment Group 1, Treatment Group 2 or the Control Group. All groups will receive an educational booklet. Treatment Group 1 and Treatment Group 2 will receive a smart electronic toothbrush. Treatment Group 2 (the intervention group) will also receive an oral hygiene care skill assessment, personalised oral hygiene instruction and treatment plan; and care partners will receive in-home and telephone coaching on behaviour change. Oral health outcomes will be compared across the three groups. The duration of the active intervention is 3 months, with an additional 3-month maintenance phase. Data collection will involve three home visits: baseline, 3 months and 6 months. The study enrollment started in November 2021, and the data collection will end in Spring 2024. ETHICS AND DISSEMINATION The study has been approved by the Institutional Review Board of the NYU Grossman School of Medicine and Duke University, and is registered at Clinicaltrials.gov. A Data Safety Monitoring Board has been constituted. The study findings will be disseminated via peer-reviewed publications, conference presentations and social media. TRIAL REGISTRATION NUMBER NCT04390750.
Collapse
Affiliation(s)
- Bei Wu
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Brenda L Plassman
- Departments of Psychiatry and Neurology, Duke University, Durham, North Carolina, USA
| | - Patricia Poole
- Departments of Psychiatry and Neurology, Duke University, Durham, North Carolina, USA
| | - Shahrzad Siamdoust
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Melanie Bunn
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bobbi Burwell
- Departments of Psychiatry and Neurology, Duke University, Durham, North Carolina, USA
| | - Yaolin Pei
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Christine Downey
- Adams School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Danni Gomes
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Angela Kamer
- Department of Periodontology and Implant Dentistry, New York University, New York, New York, USA
| | - Gary Yu
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - A Leak Bryant
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
28
|
Faessen JPM, Lucassen DA, Buso MEC, Camps G, Feskens EJM, Brouwer-Brolsma EM. Eating for 2: A Systematic Review of Dutch App Stores for Apps Promoting a Healthy Diet during Pregnancy. Curr Dev Nutr 2022; 6:nzac087. [PMID: 35711572 PMCID: PMC9197571 DOI: 10.1093/cdn/nzac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
A healthy diet during pregnancy has been associated with beneficial child and maternal health outcomes but is challenging to achieve. Recent technological advances offer new opportunities to support pregnant women in their food choices-for instance, via apps. This is already reflected by a wide availability of pregnancy-related apps, but health care professionals feel unsure about their potential. Therefore, the Dutch Google Play Store and Apple App Store were reviewed to identify existing apps on diet and pregnancy. App quality was assessed using the 1) Mobile App Rating Scale (MARS; i.e., assessing functionality, aesthetics, engagement, information quality), 2) Dutch dietary guidelines for pregnant women, and 3) App Behavior Change Scale (ABACUS). Fifty-seven unique apps were identified with an average star rating of 4.2 ± 0.6 and MARS quality score of 3.2 ± 0.3, indicating a moderate quality. Most apps scored best in terms of functionality and aesthetics (4.0 ± 0.4 and 3.3 ± 0.6), but lowest in terms of engagement (2.5 ± 0.6). Regarding nutrition information provision, most apps were incomplete or deviated from the Dutch guidelines. Folic acid supplementation (91%), hygiene (81%), caffeine (79%), and alcohol (77%) were the most commonly addressed nutrition aspects, whereas licorice (11%), iodine (19%), and soy (18%) were only addressed in a few apps. Moreover, a median of 2 out of 21 ABACUS behavior change items were identified per app, which were predominantly related to the category "knowledge and information." Thus, despite the abundance of apps supporting a healthy diet during pregnancy in the Dutch app stores, there is an urgent need for apps with complete and scientifically sound dietary information that is supported by effective behavior change techniques.
Collapse
Affiliation(s)
- Janine P M Faessen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Desiree A Lucassen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
- Systematic Change Group, Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marion E C Buso
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Guido Camps
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
- OnePlanet Research Center, Plus Ultra II, Wageningen, The Netherlands
| | - Edith J M Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Elske M Brouwer-Brolsma
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| |
Collapse
|
29
|
Bartlett YK, Farmer A, Newhouse N, Miles L, Kenning C, French DP. Effects of Using a Text Message Intervention on Psychological Constructs and the Association Between Changes to Psychological Constructs and Medication Adherence in People With Type 2 Diabetes: Results From a Randomized Controlled Feasibility Study. JMIR Form Res 2022; 6:e30058. [PMID: 35486430 PMCID: PMC9107060 DOI: 10.2196/30058] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/10/2021] [Accepted: 10/24/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Poor adherence to oral medications is common in people with type 2 diabetes and can lead to an increased chance of health complications. Text messages may provide an effective delivery method for an intervention; however, thus far, the majority of these interventions do not specify either a theoretical basis or propose specific mechanisms of action. This makes it hard to determine how and whether an intervention is having an effect. The text messages included in the current intervention have been developed to deliver specific behavior change techniques. These techniques are the "active ingredients" of the intervention and were selected to target psychological constructs identified as predictors of medication adherence. OBJECTIVE There are 2 aims of this study: (1) to assess whether a text message intervention with specified behavior change techniques can change the constructs that predict medication adherence behaviors in people with type 2 diabetes and (2) to assess whether changes to psychological constructs are associated with changes in self-reported medication adherence. METHODS We conducted a randomized controlled, 6-month feasibility trial. Adults prescribed oral medication for type 2 diabetes (N=209) were recruited from general practice and randomized to either receive a text message-based intervention or care as usual. Data were analyzed with repeated measures analysis of covariance and Spearman rho correlation coefficients. RESULTS For 8 of the 14 constructs that were measured, a significant time-by-condition interaction was found: necessity beliefs, intention, maintenance self-efficacy, recovery self-efficacy, action control, prompts and cues, social support, and satisfaction with experienced consequences all increased in the intervention group compared to the control group. Changes in action self-efficacy, intention, automaticity, maintenance self-efficacy, and satisfaction with experienced consequences were positively associated with changes in self-reported medication adherence. CONCLUSIONS A relatively low-cost, scalable, text message-only intervention targeting medication adherence using behavior change techniques can influence psychological constructs that predict adherence. Not only do these constructs predict self-reported medication adherence, but changes in these constructs are correlated with changes in self-reported medication adherence. These findings support the promise of text message-based interventions for medication adherence in this population and suggest likely mechanisms of action. TRIAL REGISTRATION ISRCTN Registry ISRCTN13404264; https://www.isrctn.com/ISRCTN13404264.
Collapse
Affiliation(s)
- Yvonne Kiera Bartlett
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Nikki Newhouse
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Lisa Miles
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Cassandra Kenning
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - David P French
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
30
|
Milne-Ives M, Homer S, Andrade J, Meinert E. Associations Between Behavior Change Techniques and Engagement With Mobile Health Apps: Protocol for a Systematic Review. JMIR Res Protoc 2022; 11:e35172. [PMID: 35348460 PMCID: PMC9006128 DOI: 10.2196/35172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background Digitally enabled care along with an emphasis on self-management of health is steadily growing. Mobile health apps provide a promising means of supporting health behavior change; however, engagement with them is often poor and evidence of their impact on health outcomes is lacking. As engagement is a key prerequisite to health behavior change, it is essential to understand how engagement with mobile health apps and their target health behaviors can be better supported. Although the importance of engagement is emphasized strongly in the literature, the understanding of how different components of engagement are associated with specific techniques that aim to change behaviors is lacking. Objective The purpose of this systematic review protocol is to provide a synthesis of the associations between various behavior change techniques (BCTs) and the different components and measures of engagement with mobile health apps. Methods The review protocol was structured using the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) and the PICOS (Population, Intervention, Comparator, Outcome, and Study type) frameworks. The following seven databases will be systematically searched: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, APA PsycInfo, ScienceDirect, Cochrane Library, and Web of Science. Title and abstract screening, full-text review, and data extraction will be conducted by 2 independent reviewers. Data will be extracted into a predetermined form, any disagreements in screening or data extraction will be discussed, and a third reviewer will be consulted if consensus cannot be reached. Risk of bias will be assessed using the Cochrane Collaboration Risk of Bias 2 and the Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tools; descriptive and thematic analyses will be conducted to summarize the relationships between BCTs and the different components of engagement. Results The systematic review has not yet started. It is expected to be completed and submitted for publication by May 2022. Conclusions This systematic review will summarize the associations between different BCTs and various components and measures of engagement with mobile health apps. This will help identify areas where further research is needed to examine BCTs that could potentially support effective engagement and help inform the design and evaluation of future mobile health apps. Trial Registration PROSPERO CRD42022312596; https://tinyurl.com/nhzp8223 International Registered Report Identifier (IRRID) PRR1-10.2196/35172
Collapse
Affiliation(s)
- Madison Milne-Ives
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Sophie Homer
- School of Psychology, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Jackie Andrade
- School of Psychology, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Edward Meinert
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.,Harvard T H Chan School of Public Health, Harvard University, Boston, MA, United States
| |
Collapse
|
31
|
Bossen D, Bak M, Braam K, Wentink M, Holla J, Visser B, Dallinga J. Online and Offline Behavior Change Techniques to Promote a Healthy Lifestyle: A Qualitative Study. Int J Environ Res Public Health 2022; 19:ijerph19010521. [PMID: 35010781 PMCID: PMC8744993 DOI: 10.3390/ijerph19010521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/17/2021] [Accepted: 12/27/2021] [Indexed: 02/04/2023]
Abstract
Combined lifestyle interventions (CLI) are focused on guiding clients with weight-related health risks into a healthy lifestyle. CLIs are most often delivered through face-to-face sessions with limited use of eHealth technologies. To integrate eHealth into existing CLIs, it is important to identify how behavior change techniques are being used by health professionals in the online and offline treatment of overweight clients. Therefore, we conducted online semi-structured interviews with providers of online and offline lifestyle interventions. Data were analyzed using an inductive thematic approach. Thirty-eight professionals with (n = 23) and without (n = 15) eHealth experience were interviewed. Professionals indicate that goal setting and action planning, providing feedback and monitoring, facilitating social support, and shaping knowledge are of high value to improve physical activity and eating behaviors. These findings suggest that it may be beneficial to use monitoring devices combined with video consultations to provide just-in-time feedback based on the client's actual performance. In addition, it can be useful to incorporate specific social support functions allowing CLI clients to interact with each other. Lastly, our results indicate that online modules can be used to enhance knowledge about health consequences of unhealthy behavior in clients with weight-related health risks.
Collapse
Affiliation(s)
- Daniël Bossen
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands; (M.B.); (K.B.); (M.W.); (B.V.); (J.D.)
- Correspondence:
| | - Monique Bak
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands; (M.B.); (K.B.); (M.W.); (B.V.); (J.D.)
| | - Katja Braam
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands; (M.B.); (K.B.); (M.W.); (B.V.); (J.D.)
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 2015 CE Haarlem, The Netherlands;
| | - Manon Wentink
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands; (M.B.); (K.B.); (M.W.); (B.V.); (J.D.)
| | - Jasmijn Holla
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 2015 CE Haarlem, The Netherlands;
- Amsterdam Rehabilitation Research Center, Reade, 1054 HW Amsterdam, The Netherlands
| | - Bart Visser
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands; (M.B.); (K.B.); (M.W.); (B.V.); (J.D.)
| | - Joan Dallinga
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands; (M.B.); (K.B.); (M.W.); (B.V.); (J.D.)
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 2015 CE Haarlem, The Netherlands;
| |
Collapse
|
32
|
Bezabih AM, Gerling K, Abebe W, Abeele VV. Behavioral Theories and Motivational Features Underlying eHealth Interventions for Adolescent Antiretroviral Adherence: Systematic Review. JMIR Mhealth Uhealth 2021; 9:e25129. [PMID: 34890353 PMCID: PMC8709919 DOI: 10.2196/25129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/06/2021] [Accepted: 09/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background eHealth systems provide new opportunities for the delivery of antiretroviral therapy (ART) adherence interventions for adolescents. They may be more effective if grounded in health behavior theories and behavior change techniques (BCTs). Prior reviews have examined the effectiveness, feasibility, and acceptability of these eHealth systems. However, studies have not systematically explored the use of health behavior theories and BCTs in the design of these applications. Objective The purpose of this review was to explore whether health behavior theories and BCTs were considered to ground designs of eHealth systems supporting adolescents’ (10-24 years) ART adherence. More specifically, we examined which specific theories and BCTs were applied, and how these BCTs were implemented as design features. Additionally, we investigated the quality and effect of eHealth systems. Methods A systematic search was performed on IEEE Xplore, ACM, ScienceDirect, PubMed, Scopus, and Web of Science databases from 2000 to 2020. Theory use and BCTs were coded using the Theory Coding Scheme and the Behavior Change Technique Taxonomy version 1 (BCTTv1), respectively. Design features were identified using the lenses of motivational design for mobile health (mHealth). The number of BCTs and design features for each eHealth system and their prevalence across all systems were assessed. Results This review identified 16 eHealth systems aiming to support ART adherence among adolescents. System types include SMS text message reminders (n=6), phone call reminders (n=3), combined SMS text message and phone call reminders (n=1), electronic adherence monitoring devices (n=3), smartphone apps (n=1), smartphone serious games (n=1), gamified smartphone apps (n=1), leveraging existing social media (n=2), web-based applications (n=1), videoconferencing (n=1), and desktop applications (n=1). Nine were grounded in theory, of which 3 used theories extensively. The impact of adolescent developmental changes on ART adherence was not made explicit. A total of 42 different BCTs and 24 motivational design features were used across systems. Ten systems reported positive effects on 1 or more outcomes; however, of these ten systems, only 3 reported exclusively positive effects on all the outcomes they measured. As much as 6 out of 16 reported purely no effect in all the outcomes measured. Conclusions Basic applications (SMS text messaging and phone calls) were most frequent, although more advanced systems such as mobile apps and games are also emerging. This review indicated gaps in the use of theory and BCTs, and particularly the impact of developmental changes on ART adherence was not adequately considered. Together with adopting a developmental orientation, future eHealth systems should effectively leverage health theories and consider developing more advanced systems that open the door to using BCTs more comprehensively. Overall, the impact of eHealth systems on adolescent ART adherence and its mediators is promising, but conclusive evidence on effect still needs to be provided.
Collapse
Affiliation(s)
- Alemitu Mequanint Bezabih
- Department of Computer Science, e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kathrin Gerling
- Department of Computer Science, e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Workeabeba Abebe
- Department of Pediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Vero Vanden Abeele
- Department of Computer Science, e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| |
Collapse
|
33
|
Thurzo A, Kurilová V, Varga I. Artificial Intelligence in Orthodontic Smart Application for Treatment Coaching and Its Impact on Clinical Performance of Patients Monitored with AI-TeleHealth System. Healthcare (Basel) 2021; 9:healthcare9121695. [PMID: 34946421 PMCID: PMC8701246 DOI: 10.3390/healthcare9121695] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 11/27/2021] [Accepted: 12/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Treatment of malocclusion with clear removable appliances like Invisalign® or Spark™, require considerable higher level of patient compliance when compared to conventional fixed braces. The clinical outcomes and treatment efficiency strongly depend on the patient's discipline. Smart treatment coaching applications, like strojCHECK® are efficient for improving patient compliance. PURPOSE To evaluate the impact of computerized personalized decision algorithms responding to observed and anticipated patient behavior implemented as an update of an existing clinical orthodontic application (app). MATERIALS AND METHODS Variables such as (1) patient app interaction, (2) patient app discipline and (3) clinical aligner tracking evaluated by artificial intelligence system (AI) system-Dental monitoring® were observed on the set of 86 patients. Two 60-day periods were evaluated; before and after the app was updated with decision tree processes. RESULTS All variables showed significant improvement after the update except for the manifestation of clinical non-tracking in men, evaluated by artificial intelligence from video scans. CONCLUSIONS Implementation of application update including computerized decision processes can significantly enhance clinical performance of existing health care applications and improve patients' compliance. Using the algorithm with decision tree architecture could create a baseline for further machine learning optimization.
Collapse
Affiliation(s)
- Andrej Thurzo
- Department of Stomatology and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava, 81250 Bratislava, Slovakia
- Correspondence: ; Tel.: +421-903-110-107
| | - Veronika Kurilová
- Faculty of Electrical Engineering and Information Technology, Slovak University of Technology, 81219 Bratislava, Slovakia;
| | - Ivan Varga
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, 81372 Bratislava, Slovakia;
| |
Collapse
|
34
|
Marques MM, Matos M, Mattila E, Encantado J, Duarte C, Teixeira PJ, Stubbs RJ, Sniehotta FF, Ermes M, Harjumaa M, Leppänen J, Välkkynen P, Silva MN, Ferreira C, Carvalho S, Palmeira L, Horgan G, Heitmann BL, Evans EH, Palmeira AL. A Theory- and Evidence-Based Digital Intervention Tool for Weight Loss Maintenance (NoHoW Toolkit): Systematic Development and Refinement Study. J Med Internet Res 2021; 23:e25305. [PMID: 34870602 PMCID: PMC8686406 DOI: 10.2196/25305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/08/2021] [Accepted: 03/16/2021] [Indexed: 12/18/2022] Open
Abstract
Background Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult to achieve. Digital technologies offer a promising means of delivering behavior change approaches at low costs and on a wide scale. The Navigating to a Healthy Weight (NoHoW) project, which was funded by the European Union’s Horizon 2020 research and innovation program, aimed to develop, test, and evaluate a digital toolkit designed to promote successful long-term weight management. The toolkit was tested in an 18-month, large-scale, international, 2×2 factorial (motivation and self-regulation vs emotion regulation) randomized controlled trial that was conducted on adults with overweight or obesity who lost ≥5% of their body weight in the preceding 12 months before enrollment into the intervention. Objective This paper aims to describe the development of the NoHoW Toolkit, focusing on the logic models, content, and specifications, as well as the results from user testing. Methods The toolkit was developed by using a systematic approach, which included the development of the theory-based logic models, the selection of behavior change techniques, the translation of these techniques into a web-based app (NoHoW Toolkit components), technical development, and the user evaluation and refinement of the toolkit. Results The toolkit included a set of web-based tools and inputs from digital tracking devices (smart scales and activity trackers) and modules that targeted weight, physical activity, and dietary behaviors. The final toolkit comprised 34 sessions that were distributed through 15 modules and provided active content over a 4-month period. The motivation and self-regulation arm consisted of 8 modules (17 sessions), the emotion regulation arm was presented with 7 modules (17 sessions), and the combined arm received the full toolkit (15 modules; 34 sessions). The sessions included a range of implementations, such as videos, testimonies, and questionnaires. Furthermore, the toolkit contained 5 specific data tiles for monitoring weight, steps, healthy eating, mood, and sleep. Conclusions A systematic approach to the development of digital solutions based on theory, evidence, and user testing may significantly contribute to the advancement of the science of behavior change and improve current solutions for sustained weight management. Testing the toolkit by using a 2×2 design provided a unique opportunity to examine the effect of motivation and self-regulation and emotion regulation separately, as well as the effect of their interaction in weight loss maintenance.
Collapse
Affiliation(s)
- Marta M Marques
- CIPER -Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.,Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Marcela Matos
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Elina Mattila
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Jorge Encantado
- CIPER -Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Cristiana Duarte
- School of Education, Language and Psychology, York St John University, York, United Kingdom
| | - Pedro J Teixeira
- CIPER -Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - R James Stubbs
- School of Education, Language and Psychology, York St John University, York, United Kingdom
| | - Falko F Sniehotta
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom.,NIHR Policy Research Unit Behavioural Science, Newcastle University, Newcastle Upon Tyne, United Kingdom.,Faculty of Behavioural, Management and Social Sciences, University of Twente, Twente, Netherlands
| | - Miikka Ermes
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Marja Harjumaa
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Juha Leppänen
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Pasi Välkkynen
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Marlene N Silva
- Centro de Investigação em Desporto, Educação Física e Saúde, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal
| | - Cláudia Ferreira
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Sérgio Carvalho
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,HEI-Lab: Digital Human-Environment Interaction Lab, School of Psychology and Life Sciences, Lusófona University, Lisbon, Portugal
| | - Lara Palmeira
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Graham Horgan
- Biomathematics and Statistics Scotland, Aberdeen, United Kingdom
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Denmark.,Department of Public Health, Section for General Practice, University of Copenhagen, Copenhagen, Denmark
| | | | - António L Palmeira
- Centro de Investigação em Desporto, Educação Física e Saúde, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal
| |
Collapse
|
35
|
Lewkowicz D, Slosarek T, Wernicke S, Winne A, Wohlbrandt AM, Bottinger E. Digital Therapeutic Care and Decision Support Interventions for People With Low Back Pain: Systematic Review. JMIR Rehabil Assist Technol 2021; 8:e26612. [PMID: 34807837 PMCID: PMC8663573 DOI: 10.2196/26612] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/26/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
Background Low back pain (LBP) is the leading cause of worldwide years lost because of disability, with a tremendous economic burden for health care systems. Digital therapeutic care (DTC) programs provide a scalable, universally accessible, and low-cost approach to the multidisciplinary treatment of LBP. Moreover, novel decision support interventions such as personalized feedback messages, push notifications, and data-driven activity recommendations amplify DTC by guiding the user through the program while aiming to increase overall engagement and sustainable behavior change. Objective This systematic review aims to synthesize recent scientific literature on the impact of DTC apps for people with LBP and outline the implementation of add-on decision support interventions, including their effect on user retention and attrition rates. Methods We searched bibliographic databases, including MEDLINE, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database, from March 1, 2016, to October 15, 2020, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and conducted this review based on related previously published systematic reviews. Besides randomized controlled trials (RCTs), we also included study designs with the evidence level of at least a retrospective comparative study. This enables the consideration of real-world user-generated data and provides information regarding the adoption and effectiveness of DTC apps in a real-life setting. For the appraisal of the risk of bias, we used the Risk of Bias 2 Tool and the Risk of Bias in Non-Randomized Studies of Interventions Tool for the RCTs and nonrandomized trials, respectively. The included studies were narratively synthesized regarding primary and secondary outcome measures, DTC components, applied decision support interventions, user retention, and attrition rates. Results We retrieved 1388 citations, of which 12 studies are included in this review. Of the 12 studies, 6 (50%) were RCTs and 6 (50%) were nonrandomized trials. In all included studies, lower pain levels and increased functionality compared with baseline values were observed in the DTC intervention group. A between-group comparison revealed significant improvements in pain and functionality levels in 67% (4/6) of the RCTs. The study population was mostly homogeneous, with predominantly female, young to middle-aged participants of normal to moderate weight. The methodological quality assessment revealed moderate to high risks of biases, especially in the nonrandomized trials. Conclusions This systematic review demonstrates the benefits of DTC for people with LBP. There is also evidence that decision support interventions benefit overall engagement with the app and increase participants’ ability to self-manage their recovery process. Finally, including retrospective evaluation studies of real-world user-generated data in future systematic reviews of digital health intervention trials can reveal new insights into the benefits, challenges, and real-life adoption of DTC programs.
Collapse
Affiliation(s)
- Daniel Lewkowicz
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Tamara Slosarek
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Sarah Wernicke
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Antonia Winne
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Attila M Wohlbrandt
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Erwin Bottinger
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany.,Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| |
Collapse
|
36
|
McHale F, Ng K, Taylor S, Bengoechea E, Norton C, O'Shea D, Woods C. A Systematic Literature Review of Peer-led Strategies for Promoting Physical Activity Levels of Adolescents. Health Educ Behav 2021; 49:41-53. [PMID: 34628981 PMCID: PMC8892039 DOI: 10.1177/10901981211044988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background. Low levels of physical activity (PA) in adolescents highlight the necessity for effective intervention. During adolescence, peer relationships can be a fundamental aspect of adopting and maintaining positive health behaviors. Aim. This review aims to determine peer-led strategies that showed promise to improve PA levels of adolescents. It will also identify patterns across these interventions, including training provided and the behavior change techniques (BCTs) employed. Method. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, PsychINFO, and Scopus were searched using key concepts of peer, PA and adolescent for articles that examined interventions that had a peer-led component and reported on at least one PA outcome in 12- to 19-year-olds. Following title and abstract screening of 1,509 studies, and full text review stage, 18 progressed to data synthesis. Methodological quality was assessed using an adapted scale. Results. Quality assessment identified 11 studies as high quality. Half of the included studies (n = 9) reported improved PA outcomes in the school setting. The most prominent behavioral change techniques were social support, information about health consequences, and demonstration of the behavior. Older adolescents leading younger peers and younger adolescents leading those of the same age showed potential. Seldom have older adolescents been targeted. Gender-specific interventions showed the most promise. Conclusion. Peer leadership requires careful planning and in the school setting can be a resourceful way of promoting adolescent PA.
Collapse
Affiliation(s)
| | - Kwok Ng
- University of Limerick, Limerick, Ireland.,University of Eastern Finland, Joensuu, Finland
| | | | | | | | - Donal O'Shea
- St. Vincent's University Hospital, Dublin, Ireland
| | | |
Collapse
|
37
|
Chan J, McMahon E, Brimblecombe J. Point-of-sale nutrition information interventions in food retail stores to promote healthier food purchase and intake: A systematic review. Obes Rev 2021; 22:e13311. [PMID: 34254422 DOI: 10.1111/obr.13311] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 12/01/2022]
Abstract
Providing simple information that identifies healthier/less healthy products at the point-of-sale has been increasingly recognized as a potential strategy for improving population diet. This review evaluated the effect on healthiness of food purchasing/intake of interventions that identify specific products as healthier/less healthy at the point-of-sale in food retail settings. Five databases were searched for peer-reviewed randomized controlled or quasi-experimental trials published 2000-2020. Effects on primary outcomes of the 26 eligible studies (322 stores and 19,002 participants) were positive (n = 14), promising (effective under certain conditions; n = 3), mixed (different effect across treatment arms/outcomes; n = 4), null (n = 3), negative (n = 1), or unclear (n = 1). Shelf-label studies (three studies of two rating systems across all products) were positive. Technology-delivered (mobile applications/podcast/kiosk) interventions were positive (n = 3/5) or promising/mixed (n = 2/5). In-store displays (n = 16) had mixed effectiveness. Interventions provided information on targeted healthier products only (n = 17), unhealthy products only (n = 1), both healthy and unhealthy (n = 2), and across all products (n = 5). No patterns were found between behavior change technique used and effectiveness. Study quality was mixed. These findings indicate that point-of-sale interventions identifying healthy/unhealthy options can lead to healthier customer purchasing behavior, particularly those delivered using shelf-labels or technology. Further research on discouraging unhealthy foods is needed.
Collapse
Affiliation(s)
- Jasmine Chan
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia.,Global Obesity Centre, Deakin University, Burwood, Victoria, Australia
| | - Emma McMahon
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| |
Collapse
|
38
|
Subramaniam S, Dhillon JS, Wan Ahmad WF. Behavioral Theory-Based Framework for Prediabetes Self-Care System-Design Perspectives and Validation Results. Int J Environ Res Public Health 2021; 18:ijerph18179160. [PMID: 34501750 PMCID: PMC8430489 DOI: 10.3390/ijerph18179160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/28/2022]
Abstract
Type 2 diabetes (T2D) is a chronic condition that can lead to many life-threatening diseases. Prediabetes is defined as a state in which blood glucose levels are elevated but not high enough to be diagnosed as diabetes. This stage can be reversible with appropriate lifestyle and dietary modifications. Existing solutions are mostly developed to deal with T2D instead of preventing it in the first place. In this study, we propose a framework to aid in the development of self-care systems to prevent T2D, which integrates behavioral change theories and techniques and offers features, such as goal setting, activity planning, and health monitoring. We then assessed the feasibility of a prediabetes self-care system designed based on the proposed framework. Quantitative and qualitative methods were adopted in evaluating i-PreventDiabetes, a prototype. Numerous aspects of the prototype were evaluated, including (1) its effectiveness in assisting individuals with prediabetes in improving their health management behaviors, (2) its effect on users’ attitudes toward diabetes prevention, (3) users’ motivation levels, (4) user acceptability of the system, and (5) user experience. Users viewed i-PreventDiabetes positively and experienced a positive change in their attitude toward their health. Diabetes prevention systems, such as i-PreventDiabetes, have the potential to increase self-care behaviors among individuals with prediabetes, enabling them to manage their lifestyle and nutrition more effectively to avert a variety of potentially fatal conditions.
Collapse
Affiliation(s)
- Suthashini Subramaniam
- Faculty of Information and Communication Technology, Universiti Tunku Abdul Rahman (UTAR), Kampar 31900, Malaysia;
| | - Jaspaljeet Singh Dhillon
- College of Computing & Informatics, Universiti Tenaga Nasional (UNITEN), Kajang 43000, Malaysia
- Correspondence:
| | - Wan Fatimah Wan Ahmad
- Computer & Information Sciences Department, Universiti Teknologi Petronas (UTP), Seri Iskandar 32610, Malaysia;
| |
Collapse
|
39
|
Meyer-Schwickerath C, Morawietz C, Baumann FT, Huber G, Wiskemann J. Efficacy of face-to-face behavior change counseling interventions on physical activity behavior in cancer survivors - a systematic review and meta-analysis. Disabil Rehabil 2021; 44:5386-5401. [PMID: 34261403 DOI: 10.1080/09638288.2021.1938247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE This systematic review and meta-analysis of randomized controlled trials determines the efficacy of face-to-face behavior change counseling (BCC) interventions on physical activity (PA) behavior in adult cancer survivors at least pre-and immediately post-intervention compared to usual care. Additionally, this review aims to answer the question which behavior change techniques (BCTs) are most effective. MATERIALS AND METHODS A structured search of the databases Medline, OTseeker, PEDro, the Cochrane Library, and article reference lists was conducted. All trials were critically appraised for methodological quality using the PEDro scale. The BCC interventions were coded using the BCT Taxonomy (v1). Random effect meta-analysis explored between group differences in PA behavior post intervention. Standardized mean differences (SMD) describe effect sizes. RESULTS Fourteen studies were included, 12 effect sizes within 11 trials were pooled in meta-analysis. The SMD between groups favored the intervention group with a small effect (SMD 0.22; 95% CI 0.11, 0.33; p < 0.0001). The BCTs "graded tasks", "self-monitoring of behavior", "action planning" and "habit reversal" were more frequently coded in more efficacious interventions. CONCLUSION BCC interventions are effective in increasing PA behavior in cancer survivors. Further research is needed providing details of fidelity assessment and structuring the intervention description by using a BCT taxonomy. Health care professionals should consider our results while awaiting further trial evaluation.Implications for RehabilitationFace-to-face behavior change counseling interventions can significantly increase physical activity behavior in cancer survivors.Although small differences are evident, included trials presented with a broad variety of study components, and characteristics, which limits the interpretation of effective components.The behavior change techniques "Graded tasks", "Action planning", "Habit reversal", and "Credible Source" were used in the trials with a positive effect, but not in the ineffective ones.
Collapse
Affiliation(s)
- Corinna Meyer-Schwickerath
- Institute of Sports and Sports Sciences, University of Heidelberg, Heidelberg, Germany.,Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - Christina Morawietz
- Institute of Sports and Sports Sciences, University of Duisburg-Essen, Essen, Germany
| | - Freerk T Baumann
- Department of Internal Medicine, Center for Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany
| | - Gerhard Huber
- Institute of Sports and Sports Sciences, University of Heidelberg, Heidelberg, Germany
| | - Joachim Wiskemann
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
40
|
Dieberger AM, van Poppel MNM, Watson ED. Baby Steps: Using Intervention Mapping to Develop a Sustainable Perinatal Physical Activity Healthcare Intervention. Int J Environ Res Public Health 2021; 18:5869. [PMID: 34070723 PMCID: PMC8198094 DOI: 10.3390/ijerph18115869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 12/16/2022]
Abstract
While the benefits of physical activity (PA) during and after pregnancy have been established, many women do not reach the recommended PA levels during this time. A major barrier found in the literature is a lack of counselling by healthcare providers (HCPs), which is partly caused by the limited knowledge on the topic. The aim of this study was to develop an intervention to improve the promotion of PA by HCPs. We used Intervention Mapping (IM), a theory-based framework to develop an intervention, called "Baby steps", in a high-income (Austria) and a low-to-middle-income country (South Africa). We applied the following IM steps: (1) A needs assessment to determine the barriers and enablers of PA promotion by HCPs, including a scoping literature review and community needs assessments (qualitative interviews, questionnaires, and focus groups with midwives, obstetricians, and community health workers) to determine the desired outcomes of the intervention. (2) Performance and change objectives were formulated, describing the behaviors that need to change for the intervention to succeed. (3) Based on these objectives, theory-based behavior change techniques were selected, and practical applications were developed. (4) The applications were combined into two evidence-based interventions tailored to each country's needs. Step (5) and (6) consist of an implementation and evaluation plan, respectively. The intervention is aimed at HCPs, such as midwives and community health workers, consisting of a two-day training course, including practical resources. Combining didactic and interactive education, it addresses both PA knowledge and the skills needed to transfer knowledge and facilitate behavior change. In the future, the intervention's effect on women's activity levels during and after pregnancy needs to be studied.
Collapse
Affiliation(s)
- Anna M. Dieberger
- Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - Mireille N. M. van Poppel
- Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14, 8010 Graz, Austria;
| | - Estelle D. Watson
- Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, 27 St. Andrews Road, Parktown, Johannesburg 2193, South Africa;
- Department of Exercise Sciences, Faculty of Science, The University of Auckland, Building 907, Suiter Street, Newmarket, Auckland 1142, New Zealand
| |
Collapse
|
41
|
Hayman M, Alfrey KL, Cannon S, Alley S, Rebar AL, Williams S, Short CE, Altazan A, Comardelle N, Currie S, Denton C, Harrison CL, Lamerton T, Mena GP, Moran L, Mottola M, Nagpal TS, Vincze L, Schoeppe S. Quality, Features, and Presence of Behavior Change Techniques in Mobile Apps Designed to Improve Physical Activity in Pregnant Women: Systematic Search and Content Analysis. JMIR Mhealth Uhealth 2021; 9:e23649. [PMID: 33825693 PMCID: PMC8060865 DOI: 10.2196/23649] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/21/2020] [Accepted: 01/17/2021] [Indexed: 12/18/2022] Open
Abstract
Background Physical activity during pregnancy is associated with several health benefits for the mother and child. However, very few women participate in regular physical activity during pregnancy. eHealth platforms (internet and mobile apps) have become an important information source for pregnant women. Although the use of pregnancy-related apps has significantly increased among pregnant women, very little is known about their theoretical underpinnings, including their utilization of behavior change techniques (BCTs). This is despite research suggesting that inclusion of BCTs in eHealth interventions are important for promoting healthy behaviors, including physical activity. Objective The aim of this study was to conduct a systematic search and content analysis of app quality, features, and the presence of BCTs in apps designed to promote physical activity among pregnant women. Methods A systematic search in the Australian App Store and Google Play store using search terms relating to exercise and pregnancy was performed. App quality and features were assessed using the 19-item Mobile App Rating Scale (MARS), and a taxonomy of BCTs was used to determine the presence of BCTs (26 items). BCTs previously demonstrating efficacy in behavior changes during pregnancy were also identified from a literature review. Spearman correlations were used to investigate the relationships between app quality, app features, and number of BCTs identified. Results Nineteen exercise apps were deemed eligible for this review and they were accessed via Google Play (n=13) or App Store (n=6). The MARS overall quality scores indicated moderate app quality (mean 3.5 [SD 0.52]). Functionality was the highest scoring MARS domain (mean 4.2 [SD 0.5]), followed by aesthetics (mean 3.7 [SD 0.6]) and information quality (mean 3.16 [SD 0.42]). Subjective app quality (mean 2.54 [SD 0.64]) and likelihood for behavioral impact (mean 2.5 [SD 0.6]) were the lowest scoring MARS domains. All 19 apps were found to incorporate at least two BCTs (mean 4.74, SD 2.51; range 2-10). However, only 11 apps included BCTs that previously demonstrated efficacy for behavior change during pregnancy, the most common being provide opportunities for social comparison (n=8) and prompt self-monitoring of behavior (n=7). There was a significant positive correlation between the number of BCTs with engagement and aesthetics scores, but the number of BCTs was not significantly correlated with functionality, information quality, total MARS quality, or subjective quality. Conclusions Our findings showed that apps designed to promote physical activity among pregnant women were functional and aesthetically pleasing, with overall moderate quality. However, the incorporation of BCTs was low, with limited prevalence of BCTs previously demonstrating efficacy in behavior change during pregnancy. Future app development should identify and adopt factors that enhance and encourage user engagement, including the use of BCTs, especially those that have demonstrated efficacy for promoting physical activity behavior change among pregnant women.
Collapse
Affiliation(s)
- Melanie Hayman
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| | - Kristie-Lee Alfrey
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| | - Summer Cannon
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| | - Stephanie Alley
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| | - Amanda L Rebar
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| | - Susan Williams
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| | - Camille E Short
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Abby Altazan
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Natalie Comardelle
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Sinead Currie
- Division of Psychology, Stirling University, Scotland, United Kingdom
| | - Caitlin Denton
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Cheryce L Harrison
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tayla Lamerton
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Gabriela P Mena
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Lisa Moran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michelle Mottola
- Faculty of Health Sciences in Kinesiology, University of Western Ontario, London, ON, Canada
| | - Taniya S Nagpal
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Lisa Vincze
- School of Allied Health Sciences - Nutrition and Dietetics, Griffith University, Gold Coast, Australia
| | - Stephanie Schoeppe
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| |
Collapse
|
42
|
Lee D. Knowledge Gaps in Mobile Health Research for Promoting Physical Activity in Adults With Autism Spectrum Disorder. Front Psychol 2021; 12:635105. [PMID: 33841267 PMCID: PMC8024466 DOI: 10.3389/fpsyg.2021.635105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/01/2021] [Indexed: 12/27/2022] Open
Abstract
A growing body of research highlights that adults with autism spectrum disorder (ASD) have poor health outcomes, yet effective health interventions are lacking for this population. While mobile health applications demonstrate potential for promoting physical activity (PA) in adults with ASD, scientific evidence for supporting this tool’s long-term effectiveness on PA behavior change remains inconclusive. This study aimed to provide the latest information on PA research and the prospective role of mobile health applications for promoting PA in adults with ASD. A literature review demonstrated that a few available studies show contradictory results regarding PA levels in adults with ASD, and behavior change techniques and gamification-guided mobile health applications can be promising tactics to leverage autism’s strengths and increase PA in these individuals. Optimizing design decisions based on needs analysis and user feedback is crucial to identifying and developing a sustainable mobile health intervention for PA promotion in adults with ASD.
Collapse
Affiliation(s)
- Daehyoung Lee
- Department of Applied Human Sciences, University of Minnesota Duluth, Duluth, MN, United States
| |
Collapse
|
43
|
Gamwell KL, Kollin SR, Gibler RC, Bedree H, Bieniak KH, Jagpal A, Tran ST, Hommel KA, Ramsey RR. Systematic evaluation of commercially available pain management apps examining behavior change techniques. Pain 2021; 162:856-865. [PMID: 33003110 PMCID: PMC9152920 DOI: 10.1097/j.pain.0000000000002090] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/17/2020] [Indexed: 12/13/2022]
Abstract
ABSTRACT Mobile health (mHealth) apps have the potential to enhance pain management through the use of daily diaries, medication and appointment reminders, education, and facilitating communication between patients and providers. Although many pain management apps exist, the extent to which these apps use evidence-based behavior change techniques (BCTs) remains largely unknown, making it nearly impossible for providers to recommend apps with evidence-based strategies. This study systematically evaluated commercially available pain management apps for evidence-based BCTs and app quality. Pain management apps were identified using the search terms "pain" and "pain management" in the App and Google Play stores. Reviewed apps were specific to pain management, in English, for patients, and free. A total of 28 apps were coded using the taxonomy of BCTs. App quality was assessed using the Mobile App Rating Scale. Apps included 2 to 15 BCTs (M = 7.36) and 1 to 8 (M = 4.21) pain management-specific BCTs. Prompt intention formation, instruction, behavioral-health link, consequences, feedback, and self-monitoring were the most common BCTs used in the reviewed apps. App quality from the Mobile App Rating Scale ranged from 2.27 to 4.54 (M = 3.65) out of a possible 5, with higher scores indicating better quality. PainScale followed by Migraine Buddy demonstrated the highest number of overall and pain management BCTs as well as good quality scores. Although existing apps should be assessed through randomized controlled trials and future apps should include capabilities for electronic medical record integration, current pain management apps often use evidence-based pain management BCTs.
Collapse
Affiliation(s)
- Kaitlyn L. Gamwell
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Sophie R. Kollin
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Robert C. Gibler
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Helen Bedree
- Department of Psychology, DePaul University, Chicago, IL, United States
| | - Keely H. Bieniak
- Department of Psychology, DePaul University, Chicago, IL, United States
| | - Anjana Jagpal
- Department of Psychology, DePaul University, Chicago, IL, United States
| | - Susan T. Tran
- Department of Psychology, DePaul University, Chicago, IL, United States
| | - Kevin A. Hommel
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Rachelle R. Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| |
Collapse
|
44
|
Fergie L, Campbell KA, Coleman-Haynes T, Ussher M, Cooper S, Coleman T. Identifying Effective Behavior Change Techniques for Alcohol and Illicit Substance Use During Pregnancy: A Systematic Review. Ann Behav Med 2020; 53:769-781. [PMID: 30379989 PMCID: PMC6636888 DOI: 10.1093/abm/kay085] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background During pregnancy, consuming alcohol and using illicit drugs can have serious health implications for both mother and child. Behavioral change interventions, especially those underpinned by theoretical constructs, can be effective in reducing harmful substance use among pregnant women. Purpose To understand what type of behavior change mechanisms could be useful in reducing alcohol consumption or achieving abstinence from illicit drug use during pregnancy, this review aimed to identify behavior change techniques (BCTs), the smallest, active components of interventions that may be effective. It also aimed to establish the extent that psychosocial-based theories were used to inform intervention design. Methods To identify eligible randomized controlled trials (RCTs), five databases were searched electronically from the end search dates of the most recent Cochrane systematic reviews on behavioral interventions for each behavior, until March 2018. Within the RCTs, intervention descriptions were analyzed for BCT content and extent of theory use in the intervention design process and outcome measurements, in each trial, was established. “Effectiveness percentages,” the number of times a BCT had been a component of an effective intervention divided by the total number of interventions it had been used in, were calculated for BCTs used in two or more trials. Results Including all RCTs from the Cochrane reviews, and those published subsequently, nine alcohol and six illicit drug trials were identified. Interventions tested in four alcohol RCTs and no illicit drugs RCTs showed positive results. Subsequent data were extracted for alcohol consumption trials only. Thirteen BCTs showed “potential effectiveness” for alcohol consumption. Six of nine included alcohol trials reported using theory but not extensively. Conclusions Action planning, behavioral contract, prompts/cues, self-talk, offer/direct toward written material, problem solving, feedback on behavior, social support (unspecified), information about health consequences, behavior substitution, assess current readiness and ability to reduce excess alcohol consumption, goal setting (behavior), and tailor interactions appropriately are BCTs that could be useful in helping reduce alcohol consumption among pregnant women.
Collapse
Affiliation(s)
- Libby Fergie
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Katarzyna A Campbell
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tom Coleman-Haynes
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Michael Ussher
- Population Health Research Institute, St George's University of London, London, UK
| | - Sue Cooper
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tim Coleman
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
45
|
Atkins L, Chadborn T, Bondaronek P, Ashiru-Oredope D, Beech E, Herd N, de La Morinière V, González-Iraizoz M, Hopkins S, McNulty C, Sallis A. Content and Mechanism of Action of National Antimicrobial Stewardship Interventions on Management of Respiratory Tract Infections in Primary and Community Care. Antibiotics (Basel) 2020; 9:E512. [PMID: 32823693 DOI: 10.3390/antibiotics9080512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022] Open
Abstract
A major modifiable factor contributing to antimicrobial resistance (AMR) is inappropriate use and overuse of antimicrobials, such as antibiotics. This study aimed to describe the content and mechanism of action of antimicrobial stewardship (AMS) interventions to improve appropriate antibiotic use for respiratory tract infections (RTI) in primary and community care. This study also aimed to describe who these interventions were aimed at and the specific behaviors targeted for change. Evidence-based guidelines, peer-review publications, and infection experts were consulted to identify behaviors relevant to AMS for RTI in primary care and interventions to target these behaviors. Behavior change tools were used to describe the content of interventions. Theoretical frameworks were used to describe mechanisms of action. A total of 32 behaviors targeting six different groups were identified (patients; prescribers; community pharmacists; providers; commissioners; providers and commissioners). Thirty-nine interventions targeting the behaviors were identified (patients = 15, prescribers = 22, community pharmacy staff = 8, providers = 18, and commissioners = 18). Interventions targeted a mean of 5.8 behaviors (range 1–27). Influences on behavior most frequently targeted by interventions were psychological capability (knowledge and skills); reflective motivation (beliefs about consequences, intentions, social/professional role and identity); and physical opportunity (environmental context and resources). Interventions were most commonly characterized as achieving change by training, enabling, or educating and were delivered mainly through guidelines, service provision, and communications & marketing. Interventions included a mean of four Behavior Change Techniques (BCTs) (range 1–14). We identified little intervention content targeting automatic motivation and social opportunity influences on behavior. The majority of interventions focussed on education and training, which target knowledge and skills though the provision of instructions on how to perform a behavior and information about health consequences. Interventions could be refined with the inclusion of relevant BCTs, such as goal-setting and action planning (identified in only a few interventions), to translate instruction on how to perform a behavior into action. This study provides a platform to refine content and plan evaluation of antimicrobial stewardship interventions.
Collapse
|
46
|
Bearne LM, Sekhon M, Grainger R, La A, Shamali M, Amirova A, Godfrey EL, White CM. Smartphone Apps Targeting Physical Activity in People With Rheumatoid Arthritis: Systematic Quality Appraisal and Content Analysis. JMIR Mhealth Uhealth 2020; 8:e18495. [PMID: 32706727 PMCID: PMC7404016 DOI: 10.2196/18495] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/18/2020] [Accepted: 05/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a disabling, inflammatory joint condition affecting 0.5%-1% of the global population. Physical activity (PA) and exercise are recommended for people with RA, but uptake and adherence tend to be low. Smartphone apps could assist people with RA to achieve PA recommendations. However, it is not known whether high quality, evidence-informed PA apps that include behavior change techniques (BCTs) previously identified as effective for PA adherence are available for people with RA. OBJECTIVE This study aims to systematically identify apps that include goals to facilitate PA for adults with RA and assess app quality and content for the inclusion of relevant BCTs against recommendations for cardiorespiratory, resistance, flexibility, and neuromotor PA and exercise. METHODS A systematic search of the Apple App Store and Google Play Store in the United Kingdom was conducted to identify English language apps that promote PA for adults with RA. Two researchers independently assessed app quality (mobile app rating scale [MARS]; range 0-5) and content (BCT Taxonomy version 1, World Health Organization, the American College of Sports Medicine, and the European League against Rheumatism recommendations for PA). The completeness of reporting of PA prescription was evaluated using a modified version of the Consensus on Exercise Reporting Template (CERT; range 0-14). RESULTS A total of 14,047 apps were identified. Following deduplication, 2737 apps were screened for eligibility; 6 apps were downloaded (2 on the Apple App Store and 4 on the Google Play Store), yielding 4 unique apps. App quality varied (MARS score 2.25-4.17). Only 1 app was congruent with all aspects of the PA recommendations. All apps completely or partially recommended flexibility and resistance exercises, 3 apps completely or partially advised some form of neuromotor exercise, but only 2 offered full or partial guidance on cardiorespiratory exercise. Completeness of exercise reporting was mixed (CERT scores 7-14 points) and 3-7 BCTs were identified. Two BCTs were common to all apps (information about health consequences and instruction on how to perform behavior). Higher quality apps included a greater number of BCTs and were more closely aligned to PA guidance. No published trials evaluating the effect of the included apps were identified. CONCLUSIONS This review identifies 4 PA apps of mixed quality and content for use by people with RA. Higher quality apps were more closely aligned to PA guidance and included a greater number of BCTs. One high-quality app (Rheumatoid Arthritis Information Support and Education) included 7 BCTs and was fully aligned with PA and exercise guidance. The effect of apps on PA adherence should be established before implementation.
Collapse
Affiliation(s)
- Lindsay M Bearne
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Mandeep Sekhon
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | | | - Anthony La
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Mehrdad Shamali
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Aliya Amirova
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Emma L Godfrey
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Claire M White
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| |
Collapse
|
47
|
Rhodes A, Smith AD, Chadwick P, Croker H, Llewellyn CH. Exclusively Digital Health Interventions Targeting Diet, Physical Activity, and Weight Gain in Pregnant Women: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2020; 8:e18255. [PMID: 32673251 PMCID: PMC7382015 DOI: 10.2196/18255] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Interventions to promote a healthy diet, physical activity, and weight management during pregnancy are increasingly embracing digital technologies. Although some interventions have combined digital with interpersonal (face-to-face or telephone) delivery, others have relied exclusively on digital delivery. Exclusively digital interventions have the advantages of greater cost-effectiveness and broader reach and as such can be a valuable resource for health care providers. OBJECTIVE This systematic review aims to focus on exclusively digital interventions to determine their effectiveness, identify behavior change techniques (BCTs), and investigate user engagement. METHODS A total of 6 databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulated Index to Nursing and Allied Health Literature [CINAHL] Plus, Web of Science, and ProQuest) were searched for randomized controlled trials or pilot control trials of exclusively digital interventions to encourage healthy eating, physical activity, or appropriate weight gain during pregnancy. The outcome measures were gestational weight gain (GWG) and changes in physical activity and dietary behaviors. Study quality was assessed using the Cochrane Risk of Bias tool 2.0. Where possible, pooled effect sizes were calculated using a random effects meta-analysis. RESULTS In total, 11 studies met the inclusion criteria. The risk of bias was mostly high (n=5) or moderate (n=3). Of the 11 studies, 6 reported on GWG as the primary outcome, 4 of which also measured changes in physical activity and dietary behaviors, and 5 studies focused either on dietary behaviors only (n=2) or physical activity only (n=3). The meta-analyses showed no significant benefit of interventions on total GWG for either intention-to-treat data (-0.28 kg; 95% CI -1.43 to 0.87) or per-protocol data (-0.65 kg; 95% CI -1.98 to 0.67). Substantial heterogeneity in outcome measures of change in dietary behaviors and physical activity precluded further meta-analyses. BCT coding identified 7 BCTs that were common to all effective interventions. Effective interventions averaged over twice as many BCTs from the goals and planning, and feedback and monitoring domains as ineffective interventions. Data from the 6 studies reporting on user engagement indicated a positive association between high engagement with key BCTs and greater intervention effectiveness. Interventions using proactive messaging and feedback appeared to have higher levels of engagement. CONCLUSIONS In contrast to interpersonal interventions, there is little evidence of the effectiveness of exclusively digital interventions to encourage a healthy diet, physical activity, or weight management during pregnancy. In this review, effective interventions used proactive messaging, such as reminders to engage in BCTs, feedback on progress, or tips, suggesting that interactivity may drive engagement and lead to greater effectiveness. Given the benefits of cost and reach of digital interventions, further research is needed to understand how to use advancing technologies to enhance user engagement and improve effectiveness.
Collapse
Affiliation(s)
| | | | | | - Helen Croker
- University College London, London, United Kingdom
| | | |
Collapse
|
48
|
Sagar-Ouriaghli I, Godfrey E, Bridge L, Meade L, Brown JSL. Improving Mental Health Service Utilization Among Men: A Systematic Review and Synthesis of Behavior Change Techniques Within Interventions Targeting Help-Seeking. Am J Mens Health 2020; 13:1557988319857009. [PMID: 31184251 PMCID: PMC6560805 DOI: 10.1177/1557988319857009] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Compared to women, men are less likely to seek help for mental health
difficulties. Despite considerable interest, a paucity in evidence-based
solutions remains to solve this problem. The current review sought to synthesize the specific techniques within
male-specific interventions that may contribute to an improvement in
psychological help-seeking (attitudes, intentions, or behaviors). A systematic
review identified 6,598 potential articles from three databases (MEDLINE,
EMBASE, and PsycINFO). Nine studies were eligible. A meta-analysis was
problematic due to disparate interventions, outcomes, and populations. The
decision to use an innovative approach that adopted the Behavior Change
Technique (BCT) taxonomy to synthesize each intervention’s key features likely
to be responsible for improving help-seeking was made. Of the nine studies, four
were engagement strategies (i.e., brochures/documentaries), two randomized
controlled trials (RCTs), two pilot RCTs, and one retrospective review.
Regarding quality assessment, three were scored as “strong,” five as “moderate,”
and one as “weak.” Key processes that improved help-seeking attitudes,
intentions, or behaviors for men included using role models to convey
information, psychoeducational material to improve mental health knowledge,
assistance with recognizing and managing symptoms, active problem-solving tasks,
motivating behavior change, signposting services, and, finally, content that
built on positive male traits (e.g., responsibility and strength). This is the
first review to use this novel approach of using BCTs to summarize and identify
specific techniques that may contribute to an improvement in male help-seeking
interventions, whether engagement with treatment or the intervention itself.
Overall, this review summarizes previous male help-seeking interventions,
informing future research/clinical developments.
Collapse
Affiliation(s)
- Ilyas Sagar-Ouriaghli
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Emma Godfrey
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,2 School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Livia Bridge
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Laura Meade
- 2 School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
| | - June S L Brown
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| |
Collapse
|
49
|
Russell RD, Black LJ, Pham NM, Begley A. The effectiveness of emotional wellness programs on mental health outcomes for adults with multiple sclerosis: a systematic review and meta-analysis. Mult Scler Relat Disord 2020; 44:102171. [PMID: 32554283 DOI: 10.1016/j.msard.2020.102171] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND People with multiple sclerosis (MS) have a greater prevalence of depression and anxiety than the general population. Emotional wellness programs (any psychological or psychosocial interventions that focus on awareness, acceptance, managing, or challenging thoughts and feelings) could be important for people with MS. However, there have been no reviews on the effectiveness of emotional wellness programs for people with MS. The objective of this review was to determine the effectiveness of emotional wellness programs on mental health outcomes for adults with MS. INCLUSION CRITERIA Randomised controlled trials (RCTs) and quasi-experimental trials evaluating emotional wellness programs for adults with any form of MS were included. Mental health outcomes included were depression, anxiety, quality of life, and stress. The comparator groups were waitlist controls, usual care, or another intervention. METHODS This review was registered with PROSPERO (registration number CRD42019131082) and conducted in accordance with PRISMA guidelines. CINAHL, Cochrane, MEDLINE, PsycInfo, Web of Science, ProQuest Dissertations and Theses, Cochrane register of Controlled Trials, and Google Scholar were searched for English- language publications. Titles and abstracts were initially screened, followed by a screen of full text articles. Studies were critically appraised for methodological quality using the JBI standardised critical appraisal checklists. Data were extracted on intervention details, study outcome measures, behaviour change techniques, and results. Random effects meta-analyses were performed for outcomes assessed in at least five studies, with results reported as the standardised mean difference (SMD). RESULTS This review comprised 25 RCTs and four quasi-experimental studies (n participants=2323); 21 were included in meta-analyses. Meta-analyses produced statistically significant results favouring the interventions (SMD (95% CI) for depression -0.55 (-0.87, -0.24); anxiety -0.42 (-0.70, -0.14); quality of life 0.28 (0.14, 0.43); and stress -1.00 (-1.58, -0.43)). The most commonly used behaviour change techniques were behaviour practice/rehearsal, social comparison, and social support. CONCLUSIONS This review provides evidence to support the effectiveness of emotional wellness programs for improving mental health outcomes in adults with MS. However, these findings should be interpreted with caution given the high degree of heterogeneity between the studies, and potential for biases in analysis due to missing data and/or incomplete reporting.
Collapse
Affiliation(s)
- R D Russell
- School of Public Health, Curtin University, Perth, Australia
| | - L J Black
- School of Public Health, Curtin University, Perth, Australia
| | - N M Pham
- School of Public Health, Curtin University, Perth, Australia; Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - A Begley
- School of Public Health, Curtin University, Perth, Australia.
| |
Collapse
|
50
|
Bartlett YK, Farmer A, Rea R, French DP. Use of Brief Messages Based on Behavior Change Techniques to Encourage Medication Adherence in People With Type 2 Diabetes: Developmental Studies. J Med Internet Res 2020; 22:e15989. [PMID: 32401214 PMCID: PMC7254292 DOI: 10.2196/15989] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/25/2019] [Accepted: 12/16/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Brief messages are a promising way to improve adherence to medication for people with type 2 diabetes. However, it is often unclear how messages have been developed and their precise content, making it difficult to ascertain why certain messages are successful and some are not. OBJECTIVE The goal of the research was to develop messages that have proven fidelity to specified evidence-derived behavior change techniques (BCTs) and are acceptable to people with type 2 diabetes. METHODS Four studies were conducted: (1) a workshop (n=21) where behavioral change researchers and health care professionals developed messages based on specific BCTs or beliefs or concerns related to taking medication, (2) a focus group study with people with type 2 diabetes (n=23) to assess acceptability of the approach, (3) a survey to ascertain the acceptability of a subset of messages to people with type 2 diabetes (n=61) and, (4) a survey with behavior change researchers to assess the fidelity of a subset of messages to their intended BCT (n=18). RESULTS In study 1, 371 messages based on 38 BCTs and beliefs/concerns were developed. Workshop participants rated BCTs to be relevant to medication adherence (mean 7.12/10 [SD 1.55]) and messages to have good fidelity (mean 7.42/10 [SD 1.19]). In study 2, the approach of providing medication adherence support through text messages was found to be acceptable. In study 3, mean acceptability of all BCTs was found to be above the midpoint (mean 3.49/5 [SD 0.26]). In study 4, mean fidelity for all BCTs was found to be above the midpoint (mean 7.61/10 [SD 1.38]). CONCLUSIONS A library of brief messages acceptable to people with type 2 diabetes and representative of specific evidence-derived BCTs was developed. This approach allowed brief messages to be developed with known content that can be used to test theory.
Collapse
Affiliation(s)
- Yvonne Kiera Bartlett
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals Foundation Trust, Oxford, United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - David P French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| |
Collapse
|