Abstract 13773: Applied Behavior Change Techniques in Self-care Interventions for Patients With a Chronic Condition

Introduction: Self-care requires behavior change in patients and healthcare providers play a pivotal role in supporting those changes. Examination of the behavior change techniques used by providers in self-care interventions can provide insights into how self-care behavior is enhanced in patients with a chronic condition. Objective: To quantify the behavior change techniques used to enhance healthy behavior in self-care interventions for patients with a chronic condition. Methods: Studies from a scoping review (n=233) were reviewed to identify behavior change techniques used in studies testing self-care interventions in adults with nine chronic conditions, most of which were CVDs. All studies were published between January 2008 and January 2019. Nine techniques from the Behavior Change Technique Taxonomy V1 (with 93 consensually agreed, distinct techniques) were selected for review because they are commonly used by a broad range of disciplines and have previously been shown to influence behavior change. Results: The 233 studies represent 59,950 patients, mean age 59.5 (±8.3) years, 44% female. Study sample sizes ranged from 24 to 2,445 patients. Most studies focused on DM2 (n=85; 36%), HTN (n=32; 14%) or HF (n=27; 12%). Most interventions targeted only patients (n=207; 89%). Goal setting (n=113; 48%) and problem solving (n=92; 40%) were the behavior change techniques used predominantly. Action planning, feedback and review of behavioral goals were used in 46-60 (20%-26%) studies and most commonly in patients with DM2 or CAD and rarely in patients with HTN or HF. Information about health consequences was used in 46 (20%) studies. Social support (n=17; 7%) and reminders (n=13; 6%) were rarely used. Conclusions: Few behavior change techniques were specified in the published self-care intervention trials. In future research, behavior change techniques and the associated mechanisms of actions need to be specified to support self-care intervention research.

Download Full-text

Behavior change techniques in mobile apps targeting self-harm in young people: a systematic review

Translational Behavioral Medicine ◽

10.1093/tbm/ibaa131 ◽

2021 ◽

Author(s):

Elena Panagiotopoulou ◽

Celeste Peiris ◽

Daniel Hayes

Keyword(s):

Young People ◽

Behavior Change ◽

Dialectical Behavior Therapy ◽

Mobile Apps ◽

Mental Healthcare ◽

Future Research ◽

Active Components ◽

Behavior Change Techniques ◽

Other Information ◽

Self Harm

Abstract Despite the high prevalence of self-harm among young people, as well as their extensive use of mobile apps for seeking support with their mental healthcare, it is unclear whether the design of mobile apps aimed at targeting self-harm is underpinned by behavior change techniques (BCTs). To systematically analyze and identify (a) what BCTs and (b) what theories are present in self-harm apps for young people in an attempt to understand their active components. Systematic searches in Apple store, followed by thorough screening, were conducted to identify free mobile apps targeting self-harm in young people. Five apps met the inclusion criteria and were used by trained researchers, who coded identified features against the BCT Taxonomy V1. Despite the majority of apps being underpinned by principles of Dialectical Behavior Therapy (DBT), no other information is available about specific theories underpinning these apps. Nineteen of the 93 BCTs were identified across the five apps. The most frequently used BCT was “Distraction” (54.2%), offering ideas for activities to distract users from self-harming. Other techniques that were used often were “Social Support (unspecified)” (27.0%) and “Behavior Substitution” (10.6%). This study provides the first analysis of BCTs present in mental health apps which are designed to target the reduction of self-harm in young people. Future research is needed to evaluate the effectiveness of the apps, as well as assess the effectiveness of the BCTs present.

Download Full-text

The Effects of Gamification and Oral Self-Care on Oral Hygiene in Children: Systematic Search in App Stores and Evaluation of Apps (Preprint)

10.2196/preprints.16365 ◽

2019 ◽

Author(s):

Nino Fijačko ◽

Lucija Gosak ◽

Leona Cilar ◽

Alenka Novšak ◽

Ruth Masterson Creber ◽

...

Keyword(s):

Public Health ◽

Behavior Change ◽

Oral Hygiene ◽

Rating Scale ◽

Self Care ◽

Public Health Problem ◽

Mobile App ◽

Evidence Based ◽

Behavior Change Techniques ◽

Evidence Based Dentistry

BACKGROUND Poor oral hygiene is a great public health problem worldwide. Oral health care education is a public health priority as the maintenance of oral hygiene is integral to overall health. Maintaining optimal oral hygiene among children is challenging and can be supported by using relevant motivational approaches. OBJECTIVE The primary aim of this study was to identify mobile smartphone apps that include gamification features focused on motivating children to learn, perform, and maintain optimal oral hygiene. METHODS We searched six online app stores using four search terms (“oral hygiene game,” “oral hygiene gamification,” “oral hygiene brush game,” and “oral hygiene brush gamification”). We identified gamification features, identified whether apps were consistent with evidence-based dentistry, performed a quality appraisal with the Mobile App Rating Scale user version (uMARS), and quantified behavior scores (Behavior Change score, uMARS score, and Coventry, Aberdeen, and London-Refined [CALO-RE] score) using three different instruments that measure behavior change. RESULTS Of 612 potentially relevant apps included in the analysis, 17 met the inclusion criteria. On average, apps included 6.87 (SD 4.18) out of 31 possible gamification features. The most frequently used gamification features were time pressure (16/17, 94%), virtual characters (14/17, 82%), and fantasy (13/17, 76%). The most common oral hygiene evidence-based recommendation was brushing time (2-3 minutes), which was identified in 94% (16/17) of apps. The overall mean uMARS score for app quality was high (4.30, SD 0.36), with good mean subjective quality (3.79, SD 0.71) and perceived impact (3.58, SD 0.44). Sufficient behavior change techniques based on three taxonomies were detected in each app. CONCLUSIONS The majority of the analyzed oral hygiene apps included gamification features and behavior change techniques to perform and maintain oral hygiene in children. Overall, the apps contained some educational content consistent with evidence-based dentistry and high-quality background for oral self-care in children; however, there is scope for improvement.

Download Full-text

Caring for the Family Caregiver

Caring for the Family Caregiver ◽

10.1093/med/9780190055233.003.0013 ◽

2020 ◽

pp. 200-214

Author(s):

Elaine Wittenberg ◽

Joy V. Goldsmith ◽

Sandra L. Ragan ◽

Terri Ann Parnell

Keyword(s):

Health Literacy ◽

Family Caregiver ◽

Contextual Factors ◽

Healthcare Providers ◽

Self Care ◽

Future Research ◽

Disease Information ◽

The Family ◽

Caregiver Needs ◽

Literacy Framework

There is little evidence for caregiver assessment and interventions based on unique social and contextual factors of caregiving. Current approaches to caring for the family caregiver involve a “one size fits all” approach where caregiver assessment may or may not occur, and there is no link between identification of caregiver needs and recommended resources. When caregiver assessment does occur, it does not involve unique caregiving characteristics that positively impact communication and health literacy. Caring for the Family Caregiver, a communication and health literacy framework, is introduced and consists of teaching healthcare providers to address caregiving types by finding disease information, assessing and integrating information, partnering with the caregiver, finding support, talking with the caregiver, and planning for caregiver self-care. Directions for future research are also summarized.

Download Full-text

Cardiovascular Disease Self-Care Interventions

Nursing Research and Practice ◽

10.1155/2013/407608 ◽

2013 ◽

Vol 2013 ◽

pp. 1-16 ◽

Cited By ~ 8

Author(s):

Victoria Vaughan Dickson ◽

Jill Nocella ◽

Hye-Won Yoon ◽

Marilyn Hammer ◽

Gail D’Eramo Melkus ◽

...

Keyword(s):

Cardiovascular Disease ◽

Intervention Studies ◽

Self Care ◽

Future Research ◽

Inclusion Criteria ◽

Care Intervention ◽

Rigorous Study ◽

Study Designs ◽

Combined Interventions

Background. Cardiovascular disease (CVD) is a major cause of increased morbidity and mortality globally. Clinical practice guidelines recommend that individuals with CVD are routinely instructed to engage in self-care including diet restrictions, medication adherence, and symptom monitoring.Objectives. To describe the nature of nurse-led CVD self-care interventions, identify limitations in current nurse-led CVD self-care interventions, and make recommendations for addressing them in future research.Design. Integrative review of nurse-led CVD self-care intervention studies from PubMed, MEDLINE, ISI Web of Science, and CINAHL. Primary studies (n=34) that met the inclusion criteria of nurse-led RCT or quasiexperimental CVD self-care intervention studies (years 2000 to 2012) were retained and appraised. Quality of the review was assured by having at least two reviewers screen and extract all data.Results. A variety of self-care intervention strategies were studied among the male (57%) and Caucasian (67%) dominated samples. Combined interventions were common, and quality of life was the most frequent outcome evaluated. Effectiveness of interventions was inconclusive, and in general results were not sustained over time.Conclusions. Research is needed to develop and test tailored and inclusive CVD self-care interventions. Attention to rigorous study designs and methods including consistent outcomes and measurement is essential.

Download Full-text

Identifying Effective Behavior Change Techniques for Alcohol and Illicit Substance Use During Pregnancy: A Systematic Review

Annals of Behavioral Medicine ◽

10.1093/abm/kay085 ◽

2018 ◽

Vol 53 (8) ◽

pp. 769-781 ◽

Cited By ~ 5

Author(s):

Libby Fergie ◽

Katarzyna A Campbell ◽

Tom Coleman-Haynes ◽

Michael Ussher ◽

Sue Cooper ◽

...

Keyword(s):

Substance Use ◽

Alcohol Consumption ◽

Behavior Change ◽

Pregnant Women ◽

Illicit Drugs ◽

Illicit Drug ◽

Action Planning ◽

Intervention Design ◽

Behavior Change Techniques ◽

Cochrane Reviews

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.

Download Full-text

Effective behavior change techniques in asthma self-care interventions: Systematic review and meta-regression.

Health Psychology ◽

10.1037/a0033080 ◽

2014 ◽

Vol 33 (7) ◽

pp. 577-587 ◽

Cited By ~ 24

Author(s):

Sarah Denford ◽

Rod S. Taylor ◽

John L. Campbell ◽

Colin J. Greaves

Keyword(s):

Systematic Review ◽

Behavior Change ◽

Self Care ◽

Behavior Change Techniques ◽

Meta Regression ◽

Effective Behavior

Download Full-text

Behavior Change Techniques in Wrist-Worn Wearables to Promote Physical Activity: Content Analysis (Preprint)

10.2196/preprints.20820 ◽

2020 ◽

Author(s):

Peter Düking ◽

Marie Tafler ◽

Birgit Wallmann-Sperlich ◽

Billy Sperlich ◽

Sonja Kleih

Keyword(s):

Physical Activity ◽

Content Analysis ◽

Behavior Change ◽

Goal Setting ◽

Wearable Sensors ◽

Action Planning ◽

Noncommunicable Diseases ◽

Behavior Change Techniques ◽

Self Monitoring ◽

Current Behavior

BACKGROUND Decreasing levels of physical activity (PA) increase the incidences of noncommunicable diseases, obesity, and mortality. To counteract these developments, interventions aiming to increase PA are urgently needed. Mobile health (mHealth) solutions such as wearable sensors (wearables) may assist with an improvement in PA. OBJECTIVE The aim of this study is to examine which behavior change techniques (BCTs) are incorporated in currently available commercial high-end wearables that target users’ PA behavior. METHODS The BCTs incorporated in 5 different high-end wearables (Apple Watch Series 3, Garmin Vívoactive 3, Fitbit Versa, Xiaomi Amazfit Stratos 2, and Polar M600) were assessed by 2 researchers using the BCT Taxonomy version 1 (BCTTv1). Effectiveness of the incorporated BCTs in promoting PA behavior was assessed by a content analysis of the existing literature. RESULTS The most common BCTs were goal setting (behavior), action planning, review behavior goal(s), discrepancy between current behavior and goal, feedback on behavior, self-monitoring of behavior, and biofeedback. Fitbit Versa, Garmin Vívoactive 3, Apple Watch Series 3, Polar M600, and Xiaomi Amazfit Stratos 2 incorporated 17, 16, 12, 11, and 11 BCTs, respectively, which are proven to effectively promote PA. CONCLUSIONS Wearables employ different numbers and combinations of BCTs, which might impact their effectiveness in improving PA. To promote PA by employing wearables, we encourage researchers to develop a taxonomy specifically designed to assess BCTs incorporated in wearables. We also encourage manufacturers to customize BCTs based on the targeted populations.

Download Full-text

Baby Buddy App for Breastfeeding and Behavior Change: Retrospective Study of the App Using the Behavior Change Wheel (Preprint)

10.2196/preprints.25668 ◽

2020 ◽

Author(s):

Loretta M Musgrave ◽

Alison Baum ◽

Nilushka Perera ◽

Caroline SE Homer ◽

Adrienne Gordon

Keyword(s):

Behavior Change ◽

Self Efficacy ◽

Mobile App ◽

World Health ◽

Future Research ◽

Potential Health ◽

Behavior Change Techniques ◽

Barriers And Enablers ◽

Behavior Change Wheel ◽

The Uk

BACKGROUND Breastfeeding plays a major role in the health of mothers and babies and has the potential to positively shape an individual’s life both in the short and long term. In the United Kingdom (UK), although 81% of women initiate breastfeeding, only 1% of women breastfeed exclusively to 6 months as recommended by the World Health Organization. In the UK, women who are socially disadvantaged and younger are less likely to breastfeed at 6 to 8 weeks postpartum. One strategy that aims to improve these statistics is the Baby Buddy app, which has been designed and implemented by the UK charity Best Beginnings to be a universal intervention to help reduce health inequalities, including those in breastfeeding. OBJECTIVE This study aimed to retrospectively examine the development of Baby Buddy by applying the Behavior Change Wheel (BCW) framework to understand how it might increase breastfeeding self-efficacy, knowledge, and confidence. METHODS Retrospective application of the BCW was completed after the app was developed and embedded into maternity services. A three-stage process evaluation used triangulation methods and formalized tools to gain an understanding of the potential mechanisms and behaviors used in apps that are needed to improve breastfeeding rates in the UK. First, we generated a behavioral analysis by mapping breastfeeding barriers and enablers onto the Capability, Opportunity, and Motivation-Behavior (COM-B) system using documents provided by Best Beginnings. Second, we identified the intervention functions and policy categories used. Third, we linked these with the behavior change techniques identified in the app breastfeeding content using the Behavior Change Techniques Taxonomy (BCTTv1). RESULTS Baby Buddy is a well-designed platform that could be used to change breastfeeding behaviors. Findings from stage one showed that Best Beginnings had defined breastfeeding as a key behavior requiring support and demonstrated a thorough understanding of the context in which breastfeeding occurs, the barriers and enablers of breastfeeding, and the target actions needed to support breastfeeding. In stage two, Best Beginnings had used intervention and policy functions to address the barriers and enablers of breastfeeding. In stage three, Baby Buddy had been assessed for acceptability, practicability, effectiveness, affordability, safety, and equity. Several behavior change techniques that could assist women with decision making around breastfeeding (eg, information about health consequences and credible sources) and possibly affect attitudes and self-efficacy were identified. Of the 39 videos in the app, 19 (49%) addressed physical capabilities related to breastfeeding and demonstrated positive breastfeeding behaviors. CONCLUSIONS Applying a theoretical framework retrospectively to a mobile app is possible and results in useful information to understand potential health benefits and to inform future development. Future research should assess which components and behavioral techniques in the app are most effective in changing behavior and supporting breastfeeding.

Download Full-text

Online and Offline Behavior Change Techniques to Promote a Healthy Lifestyle: A Qualitative Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19010521 ◽

2022 ◽

Vol 19 (1) ◽

pp. 521

Author(s):

Daniël Bossen ◽

Monique Bak ◽

Katja Braam ◽

Manon Wentink ◽

Jasmijn Holla ◽

...

Keyword(s):

Social Support ◽

Behavior Change ◽

Health Risks ◽

Healthy Lifestyle ◽

Action Planning ◽

Lifestyle Interventions ◽

Structured Interviews ◽

Support Functions ◽

Behavior Change Techniques ◽

Actual Performance

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.

Download Full-text

Known Knowns and Known Unknowns on Behavior Change Interventions and Mechanisms of Action

10.31234/osf.io/djbvy ◽

2020 ◽

Author(s):

Martin S Hagger ◽

Susette Moyers ◽

Kaylyn McAnally ◽

Lauren Mckinley

Keyword(s):

Behavior Change ◽

Behavioral Intervention ◽

Mechanisms Of Action ◽

Intervention Research ◽

Current Evidence ◽

Future Research ◽

Study Quality ◽

Behavior Change Techniques ◽

Behavior Change Interventions ◽

Known Unknowns

Systematic reviews and meta-analyses play an important role in summarizing current research on the efficacy of behavior change interventions and their mechanisms of action. The reviews in this special issue represent a ‘step change’ in evaluating current evidence on behavior change interventions and mechanisms. This article outlines the findings and emerging issues identified in the reviews (‘known knowns’), and summarizes evidence gaps to be addressed in future research (‘known unknowns’). Findings indicate that tests of mechanisms of behavior change interventions are not routinely conducted in primary studies and research syntheses; reviews and studies do not sufficiently account for study quality; substantive variability exists in descriptions of intervention content and putative mediators implicated in their mechanisms of action; limited data is available on the efficacy of many behavior change techniques; and moderators of intervention effects and mechanisms are seldom taken into account. Possible solutions include testing effects of isolated behavior change techniques and mechanisms of action; routine evaluation of study quality in behavioral intervention research; development of an evidence base linking behavior change techniques with theory-based constructs that comprise mechanisms of action; adoption of fit-for-purpose methods for synthesizing behavioral intervention mechanisms of action; and routine testing of moderators in intervention research.

Download Full-text