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

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.

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

JMIR mhealth and uhealth ◽

10.2196/25668 ◽

2021 ◽

Vol 9 (4) ◽

pp. e25668

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.

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Informing a PCOS Lifestyle Program: Mapping Behavior Change Techniques to Barriers and Enablers to Behavior Change Using the Theoretical Domains Framework

Seminars in Reproductive Medicine ◽

10.1055/s-0041-1735456 ◽

2021 ◽

Vol 39 (03/04) ◽

pp. 143-152

Author(s):

Stephanie Pirotta ◽

A.E. Joham ◽

L.J. Moran ◽

H. Skouteris ◽

S.S. Lim

Keyword(s):

Behavior Change ◽

Polycystic Ovary ◽

Intervention Development ◽

Theoretical Domains Framework ◽

Behavioral Model ◽

Future Research ◽

Positive Health ◽

Behavior Change Techniques ◽

Lifestyle Management ◽

Barriers And Enablers

AbstractThis article aimed to identify the behavior change techniques (BCTs) based on facilitators and barriers to lifestyle management in women with polycystic ovary syndrome (PCOS) according to the behavior change wheel (BCW). This qualitative study design using inductive thematic analysis following semistructured interviews (n = 20) identified barriers and enablers to lifestyle management. These were then mapped to Capability, Opportunity, Motivation—Behavioral Model (COM-B) constructs and the corresponding Theoretical Domains Framework (TDF) domains. This study included women with PCOS residing in Australia. Main outcome measures include intervention functions, policy categories, and BCTs described in the BCW. Twenty-three BCTs were recognized to influence behavior change in women with PCOS. Factors were categorized into the subcomponents of the COM-B: psychological capability (e.g., lack of credible information), physical capability (e.g., managing multiple health conditions), physical opportunity (e.g., limited access to resources), social opportunity (e.g., adequate social support), reflective motivation (e.g., positive health expectancies following behavior change), and automatic motivation (e.g., emotional eating). Future research should use this work to guide PCOS lifestyle intervention development and then test intervention effectiveness through an experimental phase to provide empirical evidence for wider use and implementation of tailored, theory-informed PCOS lifestyle programs as part of evidence-based PCOS management.

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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.

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Adults’ Preferences for Behavior Change Techniques and Engagement Features in a Mobile App to Promote 24-Hour Movement Behaviors: Cross-Sectional Survey Study (Preprint)

10.2196/preprints.15707 ◽

2019 ◽

Author(s):

Ann DeSmet ◽

Ilse De Bourdeaudhuij ◽

Sebastien Chastin ◽

Geert Crombez ◽

Ralph Maddison ◽

...

Keyword(s):

Behavior Change ◽

Repeated Measures ◽

Self Regulation ◽

Mobile App ◽

User Preferences ◽

Movement Behavior ◽

Survey Study ◽

User Engagement ◽

Behavior Change Techniques ◽

Self Monitoring

BACKGROUND There is a limited understanding of components that should be included in digital interventions for 24-hour movement behaviors (physical activity [PA], sleep, and sedentary behavior [SB]). For intervention effectiveness, user engagement is important. This can be enhanced by a user-centered design to, for example, explore and integrate user preferences for intervention techniques and features. OBJECTIVE This study aimed to examine adult users’ preferences for techniques and features in mobile apps for 24-hour movement behaviors. METHODS A total of 86 participants (mean age 37.4 years [SD 9.2]; 49/86, 57% female) completed a Web-based survey. Behavior change techniques (BCTs) were based on a validated taxonomy v2 by Abraham and Michie, and engagement features were based on a list extracted from the literature. Behavioral data were collected using Fitbit trackers. Correlations, (repeated measures) analysis of variance, and independent sample <italic>t</italic> tests were used to examine associations and differences between and within users by the type of health domain and users’ behavioral intention and adoption. RESULTS Preferences were generally the highest for information on the health consequences of movement behavior self-monitoring, behavioral feedback, insight into healthy lifestyles, and tips and instructions. Although the same ranking was found for techniques across behaviors, preferences were stronger for all but one BCT for PA in comparison to the other two health behaviors. Although techniques fit user preferences for addressing PA well, supplemental techniques may be able to address preferences for sleep and SB in a better manner. In addition to what is commonly included in apps, sleep apps should consider providing tips for sleep. SB apps may wish to include more self-regulation and goal-setting techniques. Few differences were found by users’ intentions or adoption to change a particular behavior. Apps should provide more self-monitoring (<italic>P</italic>=.03), information on behavior health outcome (<italic>P</italic>=.048), and feedback (<italic>P</italic>=.04) and incorporate social support (<italic>P</italic>=.048) to help those who are further removed from healthy sleep. A virtual coach (<italic>P</italic><.001) and video modeling (<italic>P</italic>=.004) may provide appreciated support to those who are physically less active. PA self-monitoring appealed more to those with an intention to change PA (<italic>P</italic>=.03). Social comparison and support features are not high on users’ agenda and may not be needed from an engagement point of view. Engagement features may not be very relevant for user engagement but should be examined in future research with a less reflective method. CONCLUSIONS The findings of this study provide guidance for the design of digital 24-hour movement behavior interventions. As 24-hour movement guidelines are increasingly being adopted in several countries, our study findings are timely to support the design of interventions to meet these guidelines.

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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.

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Applying the Behaviour Change Wheel: insights into the development of the breastfeeding component of the Baby Buddy smartphone app

10.21203/rs.3.rs-33159/v1 ◽

2020 ◽

Author(s):

Loretta Musgrave ◽

Alison Baum ◽

Nilushka Perera ◽

Caroline SE Homer ◽

Adrienne Gordon

Keyword(s):

Behaviour Change ◽

Self Efficacy ◽

World Health Organisation ◽

World Health ◽

Future Research ◽

Behaviour Change Techniques ◽

Clear Understanding ◽

Younger Women ◽

Breastfeeding Knowledge ◽

Behaviour Change Wheel

Abstract BackgroundBreastfeeding 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), despite around 81% of women initiating breastfeeding, only 1% of women breastfeed exclusively to 6 months as recommended by the World Health Organisation (WHO). Women who are socially disadvantaged and younger, are less likely to breastfeed at 6-8 weeks postpartum. One strategy that aims to improve these statistics is the Baby Buddy app which has been designed, developed and implemented by the UK charity Best Beginnings to be a universal intervention to help reduce health inequalities, including breastfeeding. The aim was this study was to retrospectively examine the development of Baby Buddy as a Digital Behaviour Change Intervention (DBCI) that may increase breastfeeding self-efficacy, knowledge and confidence to positively impact breastfeeding rates and duration.MethodsThe study used a three-stage process evaluation, triangulation methods and formalised tools. A retrospective evaluation was done after the app was developed and embedded. The app development process and content were reviewed by applying the Behaviour Change Wheel (BCW), Capability, Opportunity and Motivation-Behaviour (COM-B) system and Behaviour Change Techniques Taxonomy (BCTTv1). A clear understanding of behaviours that need to change in pregnancy to improve breastfeeding knowledge, self-efficacy and confidence was sought. ResultsRetrospective application of the BCW, COM-B and BCTTv1 confirmed that the Baby Buddy app is a well-designed DBCI, appealing particularly to younger women and women for whom English is not their first language. The Best Beginnings charity used several frameworks and guidelines and the use of these instruments contributed to the good design and development of Baby Buddy. Content analysis verified that the resources developed could affect attitudes and assist women to make decisions, and perceptions of self-efficacy in relation to breastfeeding. ConclusionsBaby Buddy has the potential to improve breastfeeding knowledge, confidence and self-efficacy. Future research should assess which components of the app are most effective on breastfeeding and whether it has an impact on clinical health outcomes for mothers and babies.

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A Facilitated Web-Based Self-Management Tool for People With Type 1 Diabetes Using an Insulin Pump: Intervention Development Using the Behavior Change Wheel and Theoretical Domains Framework (Preprint)

10.2196/preprints.13980 ◽

2019 ◽

Author(s):

Claire Reidy ◽

Claire Foster ◽

Anne Rogers

Keyword(s):

Social Support ◽

Type 1 Diabetes ◽

Behavior Change ◽

Insulin Pump ◽

Theoretical Domains Framework ◽

Self Management ◽

Web Based ◽

Barriers And Enablers ◽

Behavior Change Wheel

BACKGROUND Type 1 diabetes (T1D) requires intensive self-management (SM). An insulin pump is designed to better support personal T1D management, but at the same time, it exacerbates the complexity and requirements of SM. Research shows that people with diabetes are likely to benefit from navigating and connecting to local means of social support and resources through web-based interventions that offer flexible, innovative, and accessible SM. However, questions remain as to which behavior change mechanisms within such resources benefit patients most and how to foster engagement with and endorsement of SM interventions. OBJECTIVE The aim of this study was to evaluate the perspectives and experiences of people with T1D using an insulin pump and specialist health care professionals (HCPs) and determine what behavior change characteristics and strategies are required to inform the optimization of an existing web-based social network (SN) intervention to support SM. METHODS Focus groups with insulin pump users (n=19) and specialist HCPs (n=20) in 6 National Health Service (NHS) trusts across the south of England examined the barriers and enablers to incorporating and self-managing an insulin pump. An analysis was undertaken using the Behavior Change Wheel and Theoretical Domains Framework, followed by a taxonomy of behavior change techniques (BCTs) to identify the contents of and strategies for the implementation of a complex health intervention. RESULTS A total of 4 themes represent the SM perspectives and experiences of stakeholders: (1) a desire for access to tailored and appropriate resources and information—the support and information required for successful SM are situational and contextual, and these vary according to time and life circumstances, and therefore, these need to be tailored and appropriate; (2) specific social support preferences—taking away isolation as well as providing shared learnings and practical tips, but limitations included the fear of judgment from others and self-pity from peers; (3) the environmental context, that is, capacity and knowledge of pump clinic HCPs—HCPs acknowledge the patient’s need for holistic support but lack confidence in providing it; and (4) professional responsibility and associated risks and dangers, whereas HCPs are fearful of the consequences of promoting non-NHSSM support, and they question whether SM support fits into their role. BCTs were identified to address these issues. CONCLUSIONS The use of behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers and enablers of self-managing T1D with an insulin pump. A web-based SN intervention appears to offer additional forms of SM support while complementing NHS services. However, for intervention implementation, HCPs’ apprehensions about responsibility when signposting to non-NHS SM support would need to be addressed, and opportunistic features would need to be added, through which pump users could actively engage with other people living with T1D.

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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.

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

Circulation ◽

10.1161/circ.142.suppl_3.13773 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Barbara Riegel ◽

Heleen Westland ◽

Paolo Iovino ◽

Ingrid Barelds ◽

Joyce Bruins Slot ◽

...

Keyword(s):

Behavior Change ◽

Chronic Condition ◽

Healthcare Providers ◽

Self Care ◽

Action Planning ◽

Future Research ◽

Behavior Change Techniques ◽

Care Intervention ◽

Intervention Trials ◽

Behavior Change Technique

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.

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Supporting Occupational Physicians in the Implementation of Workers’ Health Surveillance: Development of an Intervention Using the Behavior Change Wheel Framework

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041939 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1939

Author(s):

Felicia S. Los ◽

Henk F. van der Molen ◽

Carel T. J. Hulshof ◽

Angela G. E. M. de Boer

Keyword(s):

Behavior Change ◽

Action Planning ◽

Health Surveillance ◽

Survey Study ◽

Behavior Change Techniques ◽

Occupational Physicians ◽

Target Behavior ◽

Work Related ◽

Behavior Change Wheel ◽

E Learning

Workers’ health surveillance (WHS) is an important preventive activity aimed at prevention of work-related diseases. However, WHS is not regularly implemented in some EU-countries. As occupational physicians (OPs) have to play an important role in implementation of WHS, this study aimed to develop an intervention to support OPs in implementation of WHS. The behavior change wheel framework (BCW) was used to develop the intervention. First, the problem was defined, and target behavior was selected by using results from a survey study among OPs. Subsequently, change objectives in target behavior were specified. Finally, appropriate intervention functions, behavior change techniques, and modes of delivery were identified to develop the intervention. Target behaviors were (1) OPs initiate WHS, and (2) OPs conduct preventive consultations with workers. OPs’ capabilities, and experienced opportunities were identified as change objectives. Intervention functions (education, training, enablement) and behavior change techniques (information about consequences, demonstration, instructions, behavioral practice, feedback on behavior, goal setting, action planning, reviewing goals) were selected to develop the intervention, delivered by face-to-face group training and e-learning. The proposed intervention consists of training and e-learning to support OPs in implementing WHS. Feasibility and effect of the intervention will be evaluated in future studies.

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