Barriers and enablers to influenza vaccination uptake in adults with chronic respiratory conditions: applying the behaviour change wheel to specify multi-levelled tailored intervention content

AbstractObjectivesTo specify future intervention content to enhance influenza vaccination uptake using the Behaviour Change Wheel (BCW).DesignCross-sectional, multi-modal data collection and subsequent behaviourally informed analysis and expert stakeholder engagement.MethodsContent analysis was initially used to identify barriers and enablers to influenza vaccination from nine semi-structured focus groups, 21 individual interviews and 101 open-ended survey responses. Subsequently, the Theoretical Domains Framework (TDF) and the BCW were used to specify evidence-based and theoretically-informed future intervention content in the form of preliminary recommendations. Finally, drawing on the APEASE criteria, expert stakeholders refined our recommendations to yield a range of multi-levelled potentially actionable ideas.ResultsThe TDF domain of ‘Beliefs about Consequences’ was the most frequently mapped domain with themes relating to ‘perceptions of side effects (barrier)’ and ‘feeling protected from catching flu (enabler)’. The next most important domain was ‘Environmental Context and Resources’ with themes relating to ‘time constraints (barrier)’ and ‘receiving reminders to vaccinate (enabler)’. Next, ‘Social Influences’ was identified with themes relating to ‘encouragement from others (enabler)’, followed by ‘Emotion’ with themes relating to ‘fear of needles (barrier)’. These factors mapped to seven of the nine intervention functions and 22 identified behaviour change techniques (BCTs). Stakeholders reduced an initial 26 recommendations to 21.ConclusionsOur comprehensive analyses showed that the factors affecting vaccine uptake were multifaceted and multileveled. The study suggested a suite of complementary multi-level intervention components may usefully be combined to enhance vaccination uptake involving a range of diverse actors, intervention recipients and settings.Statement of ContributionWhat is already known on this subject?Uptake of the influenza vaccination in those with an “at-risk” health condition is low and has been decreasing year on year.The reasons for vaccine hesitancy are complex and involve psychological, social and contextual factors.There is a lack of theory-based intervention content aimed at increasing influenza vaccination uptake.What does this study add?This study showed that the factors affecting vaccine uptake were multifaceted and multileveled. They could be theorised as relating to the TDF domains of ‘Beliefs about Consequences’, ‘Environmental Context and Resources’, ‘Social Influences’ and ‘Emotion’.With the help of key stakeholders the study suggested a suite of complementary multi-level intervention components may be most useful to enhance vaccination compliance involving a range of diverse actors, intervention recipients and settings.Mass and social media interventions, and interactions between recipients and healthcare providers should include clear and concise information about vaccine side-effects and directly address misinformation. Community-based vaccination delivery methods should be enhanced by modifying traditional and adopting novel approaches.

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Designing interventions to change eating behaviours

Proceedings of The Nutrition Society ◽

10.1017/s0029665115000075 ◽

2015 ◽

Vol 74 (2) ◽

pp. 164-170 ◽

Cited By ~ 31

Author(s):

Lou Atkins ◽

Susan Michie

Keyword(s):

Behaviour Change ◽

Design Process ◽

Theoretical Domains Framework ◽

Research Literature ◽

Intervention Design ◽

Eating Behaviours ◽

Behavioural Science ◽

Behaviour Change Technique ◽

Behaviour Change Wheel ◽

Intervention Content

Understanding and changing eating behaviours are central to the work of Nutrition Society members working in both research and applied settings. The present paper describes a recently published resource to guide the design of interventions to change behaviour, The Behaviour Change Wheel: A Guide to Designing Interventions (BCW Guide). This is a practical guide to intervention design that brings together recently-developed theory-based tools in behavioural science into a coherent step-by-step design process. It is based on the BCW, a synthesis of nineteen frameworks of behaviour change found in the research literature. The BCW has at its core a model of behaviour known as ‘capability’, ‘opportunity’, ‘motivation’ and ‘behaviour’. The model recognises that behaviour is part of an interacting system involving all these components. The BCW identifies different intervention options that can be applied to changing each of the components and policies that can be adopted to deliver those intervention options. The book shows how the BCW links to theory-based frameworks to understand behaviour such as the Theoretical Domains Framework and the recently developed Behaviour Change Technique Taxonomy v1 for specifying intervention content. In essence, it shows how to link what is understood about a given behaviour to types of intervention likely to be effective and then translate this into a locally relevant intervention. In addition, the present paper sets out some principles of intervention design.

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Using the Behaviour Change Wheel to identify barriers and enablers to the delivery of webchat counselling for young people

Counselling and Psychotherapy Research ◽

10.1002/capr.12410 ◽

2021 ◽

Author(s):

Maria Giulia Richiello ◽

Geoffrey Mawdsely ◽

Leslie Morrison Gutman

Keyword(s):

Young People ◽

Behaviour Change ◽

Barriers And Enablers ◽

Behaviour Change Wheel

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A mixed methods study of seasonal influenza vaccine hesitancy in adults with chronic respiratory conditions

10.1101/2021.03.01.21252674 ◽

2021 ◽

Author(s):

Lynn Williams ◽

Karen Deakin ◽

Allyson Gallant ◽

Susan Rasmussen ◽

David Young ◽

...

Keyword(s):

Mixed Methods ◽

Side Effects ◽

Influenza Vaccination ◽

Thematic Analysis ◽

Psychological Factors ◽

Seasonal Influenza ◽

Collective Responsibility ◽

Mixed Methods Study ◽

Barriers And Enablers ◽

Respiratory Conditions

AbstractBackgroundSeasonal influenza vaccination is recommended for patients with chronic respiratory conditions, but uptake is suboptimal. We undertook a comprehensive mixed methods study in order to examine the barriers and enablers to influenza vaccination in patients with chronic respiratory conditions.MethodsMixed methods including a survey (n=429) which assessed socio-demographics and the psychological factors associated with vaccine uptake (i.e. confidence, complacency, constraints, calculation and collective responsibility) with binary logistic regression analysis. We also undertook focus groups and interviews (n=59) to further explore barriers and enablers to uptake using thematic analysis.ResultsThe survey analysis identified that older participants were more likely to accept the vaccine, as were those with higher perceptions of collective responsibility around vaccination, lower levels of complacency, and lower levels of constraints. Thematic analysis showed that concerns over vaccine side effects, lack of tailored information and knowledge, and a lack of trust and rapport with healthcare professionals were key barriers. In contrast, the importance of feeling protected, acceptance of being part of an at-risk group, and feeling a reduced sense of vulnerability after vaccination were seen as key enablers.ConclusionsOur findings showed that the decision to accept a vaccine against influenza is influenced by multiple sociodemographic and psychological factors. Future interventions should provide clear and transparent information about side effects and be tailored to patients with chronic respiratory conditions. Interactions between patients and their healthcare providers have a particularly important role to play in helping patients address their concerns and feel confident in vaccination.

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Breaking through the barriers to recruit research participants in community settings: a qualitative exploration using the Theoretical Domains Framework and Behaviour Change Wheel

10.21203/rs.3.rs-16188/v1 ◽

2020 ◽

Author(s):

Jennie Rose ◽

Jane Akister ◽

Fiona Maxton ◽

Sarah Anne Redsell

Keyword(s):

Behaviour Change ◽

Service User ◽

Theoretical Domains Framework ◽

Professional Role ◽

Service Users ◽

Barriers And Enablers ◽

Behaviour Change Wheel ◽

Health Visitors ◽

Community Midwives ◽

Specific Barriers

Abstract Background Recruitment of pregnant or postnatal women and young families into health research is a challenge. Community midwives and health visitors are well placed to invite service users to participate, but evidence suggests that they do not always invite all potentially eligible service users. Our aim was to use the Theoretical Domains Framework to explore health visitors’ and community midwives’ perceived barriers and enablers to approaching service users about participation in research and to use the Behaviour Change Wheel to suggest theory-based strategies to improve future recruitment. Methods Health visitors and community midwives working in four NHS Trusts and one community partnership in England were invited to complete an anonymous, online survey. The sample comprised health visitors (n=39) and community midwives (n=22). Qualitative data from open-ended questions about recruitment behaviour informed by the Theoretical Domains Framework were analysed using directed content analysis and inductive coding to identify salient Theoretical Domains Framework domains and specific barriers and enablers. Strategies to address these barriers and enablers were identified using the Behaviour Change Wheel. Results Six key Theoretical Domains Framework domains were identified as salient to service user approach: (a) environmental context and resources; (b) social/professional role and identity; (c) social influences; (d) goals; (e) beliefs about capabilities; (f) knowledge. Intervention strategies were identified to address specific barriers (insufficient time and staff capacity, inadequate study materials, rejection of the study’s relevance to practitioners’ role, negative influence of researchers and managers, and competing priorities) and to leverage specific enablers (additional staff resource, the relevance of service user approach to professional role, positive influence of team members, managers and researchers, and a belief in the link between service user approach and improvements in healthcare). Conclusions This study provides new insights into why community midwives and health visitors do, and do not, invite service users to participate in research. Using the Theoretical Domains Framework and the Behaviour Change Wheel we identified that resourcing and social support for staff together with education and communication about the health benefits of approaching service users about research participation are key to improving research recruitment involving these health professionals.

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Coverage and Timing of Influenza Vaccination Among Privately Insured Pregnant Women in the United States, 2010-2018

Public Health Reports ◽

10.1177/00333549211026779 ◽

2021 ◽

pp. 003335492110267

Author(s):

Kai Hong ◽

Megan C. Lindley ◽

Fangjun Zhou

Keyword(s):

Influenza Vaccination ◽

Pregnant Women ◽

Vaccination Coverage ◽

Influenza Season ◽

The United States ◽

Metropolitan Statistical Area ◽

Provider Education ◽

Vaccination Uptake ◽

Increased Risk ◽

Privately Insured

Objective Pregnant women are at increased risk of serious complications from influenza and are recommended to receive an influenza vaccination during pregnancy. The objective of this study was to assess trends, timing patterns, and associated factors of influenza vaccination among pregnant women. Methods We used 2010-2018 MarketScan data on 1 286 749 pregnant women aged 15-49 who were privately insured to examine trends and timing patterns of influenza vaccination coverage. We examined descriptive statistics and identified factors associated with vaccination uptake by using multivariate log-binomial and Cox proportional hazard models. Results In-plan influenza vaccination coverage before delivery increased from 22.0% during the 2010-2011 influenza season to 33.2% during the 2017-2018 influenza season. About two-thirds of vaccinated women received the vaccine in September or October during each influenza season. For women who delivered in September through May, influenza vaccination coverage increased rapidly at the beginning of influenza season and flattened after October. For women who delivered in June through August, influenza vaccination coverage increased gradually until February and flattened thereafter. Most vaccinated women who delivered before January received the vaccine in the third trimester. Increased likelihood of being vaccinated was associated with age 31-40, living in a metropolitan statistical area, living outside the South, enrollment in a consumer-driven or high-deductible health plan, being spouses or dependents of policy holders, and delivery in November through January. Conclusions Despite increases during the past several years, vaccination uptake is still suboptimal, particularly after October. Health care provider education on timing of vaccination and recommendations throughout influenza seasons are needed to improve influenza vaccination coverage among pregnant women.

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Improving centre-based group exercise participation of older adults using the behaviour change wheel

BMJ Open Quality ◽

10.1136/bmjoq-2020-001078 ◽

2021 ◽

Vol 10 (1) ◽

pp. e001078

Author(s):

Boon Chong Kwok ◽

Wai Pong Wong ◽

Louisa Remedios

Keyword(s):

Older Adults ◽

Behaviour Change ◽

Participation Rate ◽

Community Dwelling ◽

Participation Rates ◽

Group Exercise ◽

Exercise Participation ◽

Behaviour Change Wheel ◽

Wheel Model ◽

Community Dwelling Older Adults

An emphasis on active ageing could help to delay the onset of frailty. In Singapore, Senior Activity Centres provide free and guided group exercise sessions for older adults. However, one such centre had very low participation rates among community-dwelling older adults despite running standardised programmes. Based on a needs analysis from a prior project, this paper reports on strategies implemented to improve the daily centre-based group exercise participation rate among community-dwelling older adults. Using the behaviour change wheel model, participant motivation domains were identified as primary gaps, while the psychological capability and physical opportunity were categorised as secondary gaps. A logic model was used to design a project to respond to these identified gaps and guide the evaluation approach. Three strategies were implemented over a 4-week period and reviewed at 6 months: (1) promotion of the exercise classes, (2) delayed rewards for participation and (3) health ambassadors. Evaluation findings highlighted that more resources were needed for the training of community-dwelling older adult healthcare ambassadors in the use of motivational interviewing. The interventions were found to be efficacious in increasing daily group exercise participation rate at the centre, from an average of three to nine participants per day over the 4 weeks. Furthermore, more than 60% of these participants achieved the WHO’s weekly minimum exercise recommendation for older adults (150 min moderate-intensity physical activity). To increase the engagement of older adults in physical activity or exercise participation, we recommend the use of behaviour change wheel model and the use of community-based health ambassadors. In conclusion, the project found improved daily centre-based group physical exercise participation rates when all the domains in the behaviour change wheel model were addressed.

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An organisational participatory research study of the feasibility of the behaviour change wheel to support clinical teams implementing new models of care

BMC Health Services Research ◽

10.1186/s12913-019-3885-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Eleanor R Bull ◽

Joanne K Hart ◽

Juliette Swift ◽

Kirstie Baxter ◽

Neil McLauchlan ◽

...

Keyword(s):

Participatory Research ◽

Behaviour Change ◽

Research Study ◽

Models Of Care ◽

Behaviour Change Wheel ◽

New Models

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‘No one ever asked us’: a feasibility study assessing the co-creation of a physical activity programme with adolescent girls

Global Health Promotion ◽

10.1177/1757975919853784 ◽

2019 ◽

Vol 27 (3) ◽

pp. 34-43

Author(s):

Méabh Corr ◽

Elaine Murtagh

Keyword(s):

Physical Activity ◽

Data Collection ◽

Behaviour Change ◽

Adolescent Girls ◽

Retention Rate ◽

Controlled Trial ◽

Activity Level ◽

Health Concern ◽

Post Intervention ◽

Behaviour Change Wheel

Background: Globally, the poor activity level of adolescent girls is a public health concern. Little research has involved adolescents in the design of interventions. This study assessed the feasibility of involving girls in the co-creation of an activity programme. Methods: Thirty-one students (15–17 years old) were recruited from a post-primary school. The Behaviour Change Wheel guided intervention design, providing insights into participants’ capability, opportunity and motivation for change. Step counts and self-reported physical activity levels were recorded pre- and post-intervention. Feasibility benchmarks assessed recruitment, data collection, acceptability and adherence. Results: Activity and educational sessions were delivered for six weeks during physical education class. Average attendance was 87% (benchmark = 80%). Eligibility was 61% (benchmark = 60%). There was a 100% retention rate (benchmark = 90%). All participants ( n = 31) completed baseline measures and 71% ( n = 22) completed post-measures. 54% ( n = 17) of students completed pedometer measurements, with 32% ( n = 10) having complete data. Average daily steps were 13,121 pre-intervention and 14,128 post-intervention ( p > 0.05). Data collection was feasible, receiving a mean score > 4/5 (benchmark > 3.5/5). Conclusions: The Behaviour Change Wheel can be used to co-create an activity programme with adolescent girls. Predetermined benchmarks, except for pedometer recordings, were reached or exceeded, providing evidence for the need of a randomised controlled trial to test effectiveness.

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