Cross cultural “behavioural diagnosis” examining the uptake of the MIND diet, using the COM-B model to inform an intervention.

Abstract Background: The aim of this study was to develop a “behavioural diagnosis” of factors influencing the uptake of the MIND diet in 40-55-year olds according to the COM-B model, in order to reduce the risk of cognitive decline in later life. Comparing a Mediterranean (Italy) and non-Mediterranean (Northern Ireland) country to inform an intervention. This study also sought to identify intervention functions and behaviour change techniques (BCTs) that are likely to be effective in changing MIND diet behaviour. Methods: This was a qualitative study that was used to elicit beliefs surrounding Capability, Opportunity, Motivation and Behaviour (COM-B) with adhering to a diet associated with a reduced risk of cognitive decline, the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND diet). This study further elaborated the COM-B components into the 14 domains of the Theoretical Domains Framework (TDF) to further understand behaviour. Twenty-five Northern Irish (NI) and Italian participants were recruited onto the study, to take part in either a focus group or an interview. Participants were both male and female aged between 40-55 years. Results: Thematic analysis revealed that the main barriers to the uptake of the MIND diet were; time, work environment (opportunity), taste preference and convenience (motivation). Culture (motivation), seasonal foods and lack of family support (opportunity) to be a barrier to the Italian sample only. The main facilitators reported were; improved health, memory, planning and organisation (motivation) and access to good quality food (opportunity). Cooking skills, knowledge (capability) and heathy work lunch (opportunity) being a facilitator to the Italian sample only. Five intervention functions and fifteen BCTs were identified for possible inclusion in intervention development. Conclusions: The “behavioural diagnosis” provides comparisons and valuable insight into the personal, social and environmental factors that participants report as barriers and facilitators to the uptake of the MIND diet in the two samples. More barriers to healthy dietary change were found than facilitators. There is a need for interventions that increase capability, opportunity and motivation to aid behaviour change. The “behavioural diagnosis” from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel (BCW).

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Comparison of barriers and facilitators of MIND diet uptake among adults from Northern Ireland and Italy

BMC Public Health ◽

10.1186/s12889-021-10307-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Deirdre Timlin ◽

Barbara Giannantoni ◽

Jacqueline M. McCormack ◽

Angela Polito ◽

Donatella Ciarapica ◽

...

Keyword(s):

Northern Ireland ◽

Behaviour Change ◽

Theoretical Domains Framework ◽

Taste Preference ◽

Later Life ◽

Barriers And Facilitators ◽

Cross Cultural Differences ◽

The Mind ◽

Italian Sample ◽

Mind Diet

Abstract Background The aim of the study was to identify and compare components of the COM-B (capability, opportunity, motivation and behaviour) model, that influences behaviour to modify dietary patterns in 40–55-year olds living in Northern Ireland (NI) and Italy, in order to reduce the risk of cognitive decline in later life. Methods This was a qualitative study examining factors influencing Mediterranean-DASH (Dietary Approaches to Stop Hypertension) Intervention for Neurodegenerative Delay (MIND) diet behaviour. This study further elaborated the COM-B components into the 14 domains of the Theoretical Domains Framework to further understand behaviour. Twenty-five Northern Irish and Italian participants were recruited onto the study, to take part in either a focus group or an interview. Participants were both male and female aged between 40 and 55 years. Results Thematic analysis revealed that the main barriers to the uptake of the MIND diet were; time, work environment (opportunity), taste preference and convenience (motivation). Culture (motivation), seasonal foods and lack of family support (opportunity) to be a barrier to the Italian sample only. The main facilitators reported were; improved health, memory, planning and organisation (motivation) and access to good quality food (opportunity). Cooking skills, knowledge (capability) and heathy work lunch (opportunity) reported as a facilitator to the Italian sample only. Conclusions Cross-cultural differences in relation to psychosocial barriers and facilitators were found in both samples. More barriers than facilitators towards uptake of the MIND diet were found. There is a need for interventions that increase capability, opportunity, and motivation to aid behaviour change. The findings from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.

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Using the COM-B model to identify barriers and facilitators towards adoption of a diet associated with cognitive function (MIND diet)

Public Health Nutrition ◽

10.1017/s1368980020001445 ◽

2020 ◽

pp. 1-14

Author(s):

Deirdre Timlin ◽

Jacqueline M McCormack ◽

Ellen EA Simpson

Keyword(s):

Behaviour Change ◽

Theoretical Domains Framework ◽

Taste Preference ◽

Later Life ◽

Barriers And Facilitators ◽

Face To Face ◽

Time Work ◽

The Uk ◽

The Mind ◽

Mind Diet

Abstract Objective: The aim of the study was to identify components of the COM-B (capability, opportunity, motivation and behaviour) model that influences behaviour to modify dietary patterns in 40–55-year-olds living in the UK, in order to influence the risk of cognitive decline in later life. Design: This is a qualitative study using the COM-B model and theoretical domains framework (TDF) to explore beliefs to adopting the Mediterranean-DASH Intervention for Neurodegenerative delay (MIND) diet. Setting: Northern Ireland. Participants: Twenty-five participants were recruited onto the study to take part in either a focus group or an interview. Participants were men and women aged between 40 and 55 years. Participants were recruited via email, Facebook and face to face. Results: Content analysis revealed that the main perceived barriers to the adoption of the MIND diet were time, work environment, taste preference and convenience. The main perceived facilitators reported were improved health, memory, planning and organisation, and access to good quality food. Conclusions: This study provides insight into the personal, social and environmental factors that participants report as barriers and facilitators to the adoption of the MIND diet among middle-aged adults living in the UK. More barriers to healthy dietary change were found than facilitators. Future interventions that increase capability, opportunity and motivation may be beneficial. The results from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.

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Identifying barriers, facilitators and behaviour change techniques to the adoption of the full scope of pharmacy practice among pharmacy professionals: Using the Theoretical Domains Framework

Research in Social and Administrative Pharmacy ◽

10.1016/j.sapharm.2020.10.003 ◽

2020 ◽

Author(s):

Rand Hussein ◽

Colin R.J. Whaley ◽

Esther C.J. Lin ◽

Kelly Grindrod

Keyword(s):

Behaviour Change ◽

Pharmacy Practice ◽

Theoretical Domains Framework ◽

Behaviour Change Techniques

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Breaking barriers: using the Behavior Change Wheel to develop a tailored intervention to overcome workplace inhibitors to breaking up sitting time

10.21203/rs.2.10405/v2 ◽

2019 ◽

Author(s):

Samson O Ojo ◽

Daniel P. Bailey ◽

Marsha L. Brierley ◽

David J. Hewson ◽

Angel M. Chater

Keyword(s):

Behaviour Change ◽

Theoretical Domains Framework ◽

Office Workers ◽

Sitting Time ◽

Mental Wellbeing ◽

Behaviour Change Techniques ◽

Tailored Intervention ◽

Structured Interviews ◽

Behaviour Change Technique ◽

Break Up

Abstract Background: The workplace is a prominent domain for excessive sitting. The consequences of increased sitting time include adverse health outcomes such as cardiovascular disease and poor mental wellbeing. There is evidence that breaking up sitting could improve health, however, any such intervention in the workplace would need to be informed by a theoretical evidence-based framework. The aim of this study was to use the Behaviour Change Wheel (BCW) to develop a tailored intervention to break up and reduce workplace sitting in desk-based workers. Methods: The BCW guide was followed for this qualitative, pre-intervention development study. Semi-structured interviews were conducted with 25 office workers (26-59 years, mean age 40.9 [SD=10.8] years; 68% female) who were purposively recruited from local council offices and a university in the East of England region. The interview questions were developed using the Theoretical Domains Framework (TDF). Transcripts were deductively analysed using the COM-B (Capability, Opportunity, Motivation – Behaviour) model of behaviour. The Behaviour Change Technique Taxonomy Version 1 (BCTv1) was thereafter used to identify possible strategies that could be used to facilitate change in sitting behaviour of office workers in a future intervention. Results: Qualitative analysis using COM-B identified that participants felt that they had the physical Capability to break up their sitting time, however, some lacked the psychological Capability in relation to the knowledge of both guidelines for sitting time and the consequences of excess sitting. Social and physical Opportunity was identified as important, such as a supportive organisational culture (social) and the need for environmental resources (physical). Reflective and automatic Motivation was highlighted as a core target for intervention. Seven intervention functions and three policy categories from the BCW were identified as relevant. Finally, 39 behaviour change techniques (BCTs) were identified as potential active components for an intervention to break up sitting time in the workplace. Conclusions: The TDF, COM-B model and BCW can be successfully applied through a systematic process to understand the drivers of behaviour of office workers to develop a co-created intervention that can be used to break up and decrease prolonged sitting in the workplace.

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Breaking barriers: using the Behavior Change Wheel to develop a tailored intervention to overcome workplace inhibitors to breaking up sitting time

10.21203/rs.2.10405/v4 ◽

2019 ◽

Author(s):

Samson O Ojo ◽

Daniel P. Bailey ◽

Marsha L. Brierley ◽

David J. Hewson ◽

Angel M. Chater

Keyword(s):

Behaviour Change ◽

Theoretical Domains Framework ◽

Office Workers ◽

Sitting Time ◽

Mental Wellbeing ◽

Behaviour Change Techniques ◽

Tailored Intervention ◽

Structured Interviews ◽

Behaviour Change Technique ◽

Break Up

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A pilot study of the S-MAP (Solutions for Medications Adherence Problems) intervention for older adults prescribed polypharmacy in primary care: study protocol

Pilot and Feasibility Studies ◽

10.1186/s40814-019-0506-6 ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 3

Author(s):

D. E. Patton ◽

J. J. Francis ◽

E. Clark ◽

F. Smith ◽

C. A. Cadogan ◽

...

Keyword(s):

Pilot Study ◽

Process Evaluation ◽

Behaviour Change ◽

Older Patients ◽

Controlled Trial ◽

Theoretical Domains Framework ◽

Self Report ◽

Community Pharmacies ◽

Behaviour Change Techniques ◽

Limited Effectiveness

Abstract Background Adhering to multiple medications as prescribed is challenging for older patients (aged ≥ 65 years) and a difficult behaviour to improve. Previous interventions designed to address this have been largely complex in nature but have shown limited effectiveness and have rarely used theory in their design. It has been recognised that theory (‘a systematic way of understanding events or situations’) can guide intervention development and help researchers better understand how complex adherence interventions work. This pilot study aims to test a novel community pharmacy-based intervention that has been systematically developed using the Theoretical Domains Framework (12-domain version) of behaviour change. Methods As part of a non-randomised pilot study, pharmacists in 12 community pharmacies across Northern Ireland (n = 6) and London, England (n = 6), will be trained to deliver the intervention to older patients who are prescribed ≥ 4 regular medicines and are non-adherent (self-reported). Ten patients will be recruited per pharmacy (n = 120) and offered up to four tailored one-to-one sessions, in the pharmacy or via telephone depending on their adherence, over a 3–4-month period. Guided by an electronic application (app) on iPads, the intervention content will be tailored to each patient’s underlying reasons for non-adherence and mapped to the most appropriate solutions using established behaviour change techniques. This study will assess the feasibility of collecting data on the primary outcome of medication adherence (self-report and dispensing data) and secondary outcomes (health-related quality of life and unplanned hospitalisations). An embedded process evaluation will assess training fidelity for pharmacy staff, intervention fidelity, acceptability to patients and pharmacists and the intervention’s mechanism of action. Process evaluation data will include audio-recordings of training workshops, intervention sessions, feedback interviews and patient surveys. Analysis will be largely descriptive. Discussion Using pre-defined progression criteria, the findings from this pilot study will guide the decision whether to proceed to a cluster randomised controlled trial to test the effectiveness of the S-MAP intervention in comparison to usual care in community pharmacies. The study will also explore how the intervention components may work to bring about change in older patients’ adherence behaviour and guide further refinement of the intervention and study procedures. Trial registration This study is registered at ISRCTN: 10.1186/ISRCTN73831533

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Perceived Barriers and Facilitators to Breaking Up Sitting Time among Desk-Based Office Workers: A Qualitative Investigation Using the TDF and COM-B

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16162903 ◽

2019 ◽

Vol 16 (16) ◽

pp. 2903 ◽

Cited By ~ 6

Author(s):

Samson O. Ojo ◽

Daniel P. Bailey ◽

David J. Hewson ◽

Angel M. Chater

Keyword(s):

Behaviour Change ◽

Theoretical Domains Framework ◽

Perceived Barriers ◽

Barriers And Facilitators ◽

Office Workers ◽

Sitting Time ◽

Future Research ◽

Behaviour Change Techniques ◽

Organisational Support ◽

Sitting Behaviour

High amounts of sedentary behaviour, such as sitting, can lead to adverse health consequences. Interventions to break up prolonged sitting in the workplace have used active workstations, although few studies have used behaviour change theory. This study aimed to combine the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation to Behaviour system (COM-B) to investigate perceived barriers and facilitators to breaking up sitting in desk-based office workers. Semi-structured interviews with 25 desk-based employees investigated barriers and facilitators to breaking up sitting in the workplace. Seven core inductive themes were identified: ‘Knowledge-deficit sitting behaviour’, ‘Willingness to change’, ‘Tied to the desk’, ‘Organisational support and interpersonal influences’, ‘Competing motivations’, ‘Emotional influences’, and ‘Inadequate cognitive resources for action’. These themes were then deductively mapped to 11 of the 14 TDF domains and five of the six COM-B constructs. Participants believed that high amounts of sitting had adverse consequences but lacked knowledge regarding recommendations and were at times unmotivated to change. Physical and social opportunities were identified as key influences, including organisational support and height-adjustable desks. Future research should identify intervention functions, policy categories and behaviour change techniques to inform tailored interventions to change sitting behaviour of office workers.

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Towards Implementing Exercise Into the Prostate Cancer Care Pathway: Development of a Theory and Evidence-Based Intervention to Change Healthcare Professional Behaviour

10.21203/rs.3.rs-129003/v1 ◽

2021 ◽

Author(s):

Rebecca Turner ◽

Madelynne Arden ◽

Sophie Reale ◽

Eileen Sutton ◽

Stephanie Taylor ◽

...

Keyword(s):

Prostate Cancer ◽

Healthcare Professional ◽

Behaviour Change ◽

Cancer Care ◽

Healthcare Professionals ◽

Randomised Trial ◽

Complex Interventions ◽

Theoretical Domains Framework ◽

Behaviour Change Techniques ◽

Training Package

Abstract BackgroundTwice-weekly supervised aerobic and resistance exercise for 12 weeks reduces fatigue and improves quality of life in men on Androgen Deprivation Therapy for prostate cancer. Despite the National Institute for Health and Care Excellence (NICE) proposing this as standard of care, it does not routinely take place in practice. Healthcare professionals are in a prime position to deliver and integrate these recommendations. A change in the behaviour of clinical teams is therefore required.In this paper, we describe the development of a training package for healthcare professionals using theory and evidence to promote delivery of such recommendations as standard care.MethodsThe intervention development process was guided by the Medical Research Council guidance for complex interventions and the Behaviour Change Wheel. Target behaviours were identified from the literature and thirty-five prostate cancer care healthcare professionals were interviewed to understand influences on these behaviours. The Theoretical Domains Framework was used to identify theoretical constructs for change. Behaviour change techniques were selected based on theory and evidence and were translated into intervention content. The intervention was refined with the input of stakeholders including healthcare professionals, patients, and exercise professionals in the form of rehearsal deliveries, focus groups and a workshop.ResultsSeven modifiable healthcare professional target behaviours were identified to support the delivery of the NICE recommendations including identifying eligible patients suitable for exercise, recommending exercise, providing information, exercise referral, providing support and interpret and feedback on progress. Ten domains from the Theoretical Domain’s Framework were identified as necessary for change, including improving knowledge and skills, addressing beliefs about consequences, and targeting social influences. These were targeted through twenty-two behaviour change techniques delivered in a half-day, interactive training package. Based on initial feedback from stakeholders, the intervention was refined in preparation for evaluation.ConclusionsWe designed an intervention based on theory, evidence, and stakeholder feedback to promote and support the delivery of NICE recommendations. Future work will aim to test this training package in a multi-centre randomised trial. If proven effective, the development and training package will provide a template for replication in other clinical populations, where exercise has proven efficacy but is insufficiently implemented.Trial registrationN/A

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Implementing the use of objective medication adherence data in routine clinical practice via the digital CFHealthHub platform: situation analysis and strategy development using the theoretical domains framework

10.21203/rs.3.rs-847358/v1 ◽

2021 ◽

Author(s):

Carla Girling ◽

Anna Packham ◽

Louisa Robinson ◽

Madelynne A Arden ◽

Daniel Hind ◽

...

Keyword(s):

Cystic Fibrosis ◽

Medication Adherence ◽

Behaviour Change ◽

Implementation Strategy ◽

Clinical Care ◽

Theoretical Domains Framework ◽

Behaviour Change Techniques ◽

Implementation Phase ◽

Adherence Data ◽

Healthcare Innovation

Abstract Background Preventative inhaled treatments preserve lung function and reduce exacerbations in Cystic Fibrosis (CF). Self-reported adherence to these treatments is over-estimated. An online platform (CFHealthHub) has been developed with patients and clinicians to display real-time objective adherence data from dose-counting nebulisers, so that clinical teams can offer informed treatment support. Methods In this paper, we identify pre-implementation barriers to healthcare practitioners performing two key behaviours: accessing objective adherence data through the website CFHealthHub and discussing medication adherence with patients. We aimed to understand barriers during the pre-implementation phase, so that appropriate strategy could be developed for the scale up of implementing objective adherence data in 19 CF centres. Thirteen semi-structured interviews were conducted with healthcare practitioners working in three UK CF centres. Qualitative data were coded using the Theoretical Domains Framework (TDF), which describes 14 validated domains to implementation behaviour change. Results Analysis indicated that an implementation strategy should address all 14 domains of the TDF to successfully support implementation. Participants did not report routines or habits for using objective adherence data in clinical care. Examples of salient barriers included skills, beliefs in consequences, and social influence and professional roles. The results also affirmed a requirement to address organisational barriers. Relevant behaviour change techniques were selected to develop implementation strategy modules using the behaviour change wheel approach to intervention development. ConclusionsThis paper demonstrates the value of applying the TDF at pre-implementation, to understand context and to support the development of a situationally relevant implementation strategy. Contribution to the literature· Research indicates that the implementation of healthcare innovations may be more likely to succeed when context and theory are taken into consideration. · In this study, healthcare professionals identified barriers to two behaviours that were key to the implementation of a national Cystic Fibrosis (CF) healthcare innovation. By coding barriers to the Theoretical Domains Framework (TDF), a contextually relevant implementation strategy was developed, with a focus on clinician behaviour change. · The study highlights the challenges CF teams face when implementing new remote monitoring of medication adherence, and provides an important opportunity to apply the TDF in the pre-implementation phase of a healthcare innovation.

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PARIS: protocol for a prospective single arm, theory-based, group-based feasibility intervention study to increase Physical Activity and reduce sedentary behaviouR after barIatric Surgery

BMJ Open ◽

10.1136/bmjopen-2021-051638 ◽

2021 ◽

Vol 11 (12) ◽

pp. e051638

Author(s):

Jennifer James ◽

Wendy Hardeman ◽

Helen Eborall ◽

Mark Goodall ◽

John Wilding

Keyword(s):

Physical Activity ◽

Bariatric Surgery ◽

Sedentary Behaviour ◽

Behaviour Change ◽

Feasibility Study ◽

Theoretical Domains Framework ◽

Comparative Approach ◽

Service Research ◽

Behaviour Change Techniques ◽

Behaviour Change Intervention

IntroductionIncreased physical activity and reduced sedentary behaviour can encourage favourable outcomes after bariatric surgery. However, there is a lack of evidence as to how to support patients with behaviour change. The aim of this study is to assess the feasibility of a physiotherapist led, online group-based behaviour change intervention to increase physical activity and reduce sedentary behaviour following bariatric surgery.Methods and analysisSingle arm feasibility study of a theory and evidence-based group behaviour change intervention based on the Behaviour Change Wheel and Theoretical Domains Framework using behaviour change techniques from the Behaviour Change Technique Taxonomy v1. The intervention has eight objectives and specifies behaviour change techniques that will be used to address each of these. Groups of up to eight participants who have had surgery within the previous 5 years will meet weekly over 6 weeks for up to 1½ hours. Groups will be held online led by a physiotherapist and supported by an intervention handbook. Feasibility study outcomes include: rate of recruitment, retention, intervention fidelity, participant engagement and acceptability. Secondary outcomes include: physical activity, sedentary behaviour, body composition, self-reported health status and will be analysed descriptively. Change in these outcomes will be used to calculate the sample size for a future evaluation study. Qualitative interviews will explore participants’ views of the intervention including its acceptability. Data will be analysed according to the constant comparative approach of grounded theory.Ethics and disseminationThis study has National Health Service Research Ethics Committee approval; Haydock 20/NW/0472. All participants will provide informed consent and can withdraw at any point. Findings will be disseminated through peer-reviewed journals, conference and clinical service presentations.Trial registration numberISRCTN31524689.

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