Evidencing the logic model of behaviour change underpinning a personalised and tailored app for the self-management of musculoskeletal conditions (Preprint)

2021 ◽  
Author(s):  
Alice Berry ◽  
Carey McClellan ◽  
Ben Wanless ◽  
Nicola Walsh
Keyword(s):  
Behaviour Change ◽  
Digital Health ◽  
Systems Design ◽  
Logic Model ◽  
Self Management ◽  
Behaviour Change Techniques ◽  
Design Framework ◽  
Management Tools ◽  
Change Models ◽  
The Uk

BACKGROUND Musculoskeletal (MSK) conditions such as back and joint pain are a growing problem, affecting 18.8 million people in the UK. Digital health interventions (DHIs) are a potentially effective way to deliver information and to support self-management. It is vital that the development of such interventions is transparent, can illustrate how individual components work, how they link back to the theoretical constructs they are attempting to change, and how this might influence outcomes. getUBetter is a DHI developed to address the lack of personalised supported self-management tools available to patients with MSK conditions, by providing knowledge, skills and confidence to navigate through a self-management journey. OBJECTIVE The aim of this project was to map a logic model of behaviour change for getUBetter, to illustrate how content and functionality of the DHI is aligned with recognised behavioural theory, effective behaviour change techniques (BCTs), and clinical guidelines. METHODS A range of behaviour change models and frameworks were used including the behaviour change wheel and persuasive systems design framework to map the logic model of behaviour change underpinning getUBetter. Three main stages included: 1) understanding the behaviour the intervention is attempting to change, 2) identifying which elements of the intervention might bring about the desired change in behaviour, and 3) describing intervention content and how this can be optimally implemented. RESULTS The content mapped to 25 BCTs, including: information about health consequences, instruction on how to perform a behaviour, reducing negative emotions, and verbal persuasion about capability. Mapping to the persuasive system design framework illustrated the use of a number of persuasive design principles, including: tailoring, personalisation, simulation, and reminders. CONCLUSIONS This process enabled the proposed mechanisms of action and theoretical foundations of getUBetter to be comprehensively described, highlighting the key techniques utilised to support patients to self-manage their condition. These findings provide guidance for the on-going evaluation of effectiveness (including quality of engagement) of the intervention, and highlight areas which might be strengthened in future iterations.

scholarly journals Evidence-Based Digital Tools for Weight Loss Maintenance: The NoHoW Project

Obesity Facts ◽  
2021 ◽  
pp. 1-14
Author(s):  
R. James Stubbs ◽  
Cristiana Duarte ◽  
António L. Palmeira ◽  
Falko F. Sniehotta ◽  
Graham Horgan ◽  
...  
Keyword(s):  
Weight Loss ◽  
Behaviour Change ◽  
Digital Health ◽  
Self Regulation ◽  
Self Management ◽  
Behaviour Change Techniques ◽  
Evidence Based ◽  
Behavioural Science ◽  
Digital Architecture

<b><i>Background:</i></b> Effective interventions and commercial programmes for weight loss (WL) are widely available, but most people regain weight. Few effective WL maintenance (WLM) solutions exist. The most promising evidence-based behaviour change techniques for WLM are self-monitoring, goal setting, action planning and control, building self-efficacy, and techniques that promote autonomous motivation (e.g., provide choice). Stress management and emotion regulation techniques show potential for prevention of relapse and weight regain. Digital technologies (including networked-wireless tracking technologies, online tools and smartphone apps, multimedia resources, and internet-based support) offer attractive tools for teaching and supporting long-term behaviour change techniques. However, many digital offerings for weight management tend not to include evidence-based content and the evidence base is still limited. <b><i>The Project:</i></b> First, the project examined why, when, and how many European citizens make WL and WLM attempts and how successful they are. Second, the project employed the most up-to-date behavioural science research to develop a digital toolkit for WLM based on 2 key conditions, i.e., self-management (self-regulation and motivation) of behaviour and self-management of emotional responses for WLM. Then, the NoHoW trial tested the efficacy of this digital toolkit in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial BMI ≥25). The primary outcome was change in weight (kg) at 12 months from baseline. Secondary outcomes included biological, psychological, and behavioural moderators and mediators of long-term energy balance (EB) behaviours, and user experience, acceptability, and cost-effectiveness. <b><i>Impact:</i></b> The project will directly feed results from studies on European consumer behaviour, design and evaluation of digital toolkits self-management of EB behaviours into development of new products and services for WLM and digital health. The project has developed a framework and digital architecture for interventions in the context of EB tracking and will generate results that will help inform the next generation of personalised interventions for effective self-management of weight and health.

scholarly journals A modified Delphi study to gain consensus for a taxonomy to report and classify physical activity referral schemes (PARS)

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Coral L. Hanson ◽  
Emily J. Oliver ◽  
Caroline J. Dodd-Reynolds ◽  
Alice Pearsons ◽  
Paul Kelly
Keyword(s):  
Physical Activity ◽  
Behaviour Change ◽  
Delphi Study ◽  
Policy Research ◽  
Monitoring And Evaluation ◽  
Health Improvement ◽  
Behaviour Change Techniques ◽  
Policy And Practice ◽  
Modified Delphi ◽  
The Uk

Abstract Background Physical Activity Referral Schemes (PARS), including exercise referral schemes, are a popular approach to health improvement, but understanding of effectiveness is limited by considerable heterogeneity in reporting and evaluation. We aimed to gain consensus for a PARS taxonomy as a comprehensive method for reporting and recording of such schemes. Methods We invited 62 experts from PARS policy, research and practice to complete a modified Delphi study. In round one, participants rated the need for a PARS taxonomy, the suitability of three proposed classification levels and commented on proposed elements. In round two, participants rated proposed taxonomy elements on an 11-point Likert scale. Elements scoring a median of ≥7, indicating high agreement, were included in the final taxonomy. Results Of those invited, 47 (75.8%) participated in round one, with high retention in round two (n = 43; 91.5%). 42 were UK-based, meaning the resultant taxonomy has been scrutinised for fit to the UK context only. The study gained consensus for a three-level taxonomy: Level 1: PARS classification (primary classification, provider, setting, conditions accepted [have or at risk of], activity type and funding). Level 2: scheme characteristics (staff structure, staff qualifications, behaviour change theories, behaviour change techniques, referral source, referrers, referral process, scheme duration, session frequency, session length, session times, session type, exit routes, action in case of non-attendance, baseline assessment, exit assessment, feedback to referrer and exclusion criteria) and Level 3: participant measures (demographics, monitoring and evaluation, and measures of change). Conclusion Using a modified Delphi method, this study developed UK-based consensus on a PARS classification taxonomy. We encourage PARS practitioners and public health colleagues, especially those working with similar service models internationally, to test, refine and use this taxonomy to inform policy and practice.

scholarly journals The impact of nature-based interventions on public health: a review using pathways, mechanisms and behaviour change techniques from environmental social science and health behaviour change

2021 ◽  
Vol 9s7 ◽  
pp. 33-61
Author(s):  
Stephanie Wilkie ◽  
Nicola Davinson
Keyword(s):  
Public Health ◽  
Social Science ◽  
Health Outcomes ◽  
Behaviour Change ◽  
Health Behaviour ◽  
Behaviour Change Techniques ◽  
Change Models ◽  
Health Behaviour Change ◽  
The Impact ◽  
Environmental Social Science

The aim of this narrative review is to explore whether nature-based interventions improved individual public health outcomes and health behaviours, using a conceptual framework that included pathways and pathway domains, mechanisms, and behaviour change techniques derived from environmental social science theory and health behaviour change models. A two-stage scoping methodology was used to identified studies published between 2000 and 2021. Peer reviewed, English-language reports of nature-based interventions with adults (N = 9) were included if the study met the definition of a health�behaviour change intervention and reported at least one measured physical/mental health outcome. Interventions focused on the restoring or building capacities pathway domains as part of the nature contact/experience pathway; varied health behaviour change mechanisms and techniques were present but environmental social-science-derived mechanisms to influence health outcomes were used less. Practical recommendations for future interventions include explicit statement of the targeted level of causation, as well as utilisation of both environmental social science and health behaviour change theories and varied public health outcomes to allow simultaneously testing of theoretical predictions.

scholarly journals Development of a European competency framework for health and other professionals to support behaviour change in persons self-managing chronic disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mara Pereira Guerreiro ◽  
Judith Strawbridge ◽  
Afonso Miguel Cavaco ◽  
Isa Brito Félix ◽  
Marta Moreira Marques ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Chronic Diseases ◽  
Behaviour Change ◽  
Competency Framework ◽  
Strategic Partnership ◽  
Self Management ◽  
Delphi Panel ◽  
Behaviour Change Techniques ◽  
Core Set ◽  
Preparatory Work

Abstract Background Healthcare and other professionals are expected to support behaviour change in people living with chronic disease. However, effective behaviour change interventions are largely absent in routine encounters. The Train4Health project, a European strategic partnership for higher education, sought to address this problem. The primary aim of this study, which is part of an early work package, was to develop an interprofessional competency framework for health and other professions to support behaviour change for the self-management of chronic disease at a European level. A secondary aim was to derive a set of behaviour change techniques (BCTs) from an established taxonomy to link with framework competencies. Methods The study comprised two interlinked parts. Part 1 involved a two-round e-Delphi study with an interprofessional panel of 48 experts across 12 European countries to develop the behaviour change competency framework. Preparatory work included drafting a list of competency statements based on seven existing frameworks. Part 2 involved an expert panel of six behavioural psychologists deriving a set of BCTs to link with framework competencies. Their feedback was based on preparatory work, which focused on seven high priority chronic diseases for self-management, identified through European projects on self-management and identifying five relevant target behaviours from key clinical guidelines. A literature search yielded 29 effective BCTs for the target behaviours in the selected chronic diseases. Results Twenty-seven competency statements, were presented in Round 1 to the Delphi panel. Consensus was achieved for all statements. Based on comments, two statements were removed, one was added, and 14 were modified. All 15 statements subjected to Round 2 were consensus-approved, yielding a total of 12 foundational competencies for behaviour change in self-management of chronic disease and 14 behaviour change competencies. Four behaviour change competencies related to BCTs. Behavioural psychologists’ feedback led to a core set of 21 BCTs deemed applicable to the five target behaviours across the seven chronic diseases. Conclusions A behaviour change competency framework comprising 26 statements for European health and other professionals to support self-management of chronic disease was developed, linked with a core set of 21 BCTs from an established taxonomy.

scholarly journals The theoretical basis of a nationally implemented type 2 diabetes prevention programme: how is the programme expected to produce changes in behaviour?

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Rhiannon E. Hawkes ◽  
Lisa M. Miles ◽  
David P. French
Keyword(s):  
Type 2 Diabetes ◽  
Behaviour Change ◽  
Staff Training ◽  
Diabetes Prevention ◽  
Logic Model ◽  
Prevention Programme ◽  
Behaviour Change Techniques ◽  
Behavioural Changes ◽  
Diabetes Prevention Programme

Abstract Background It is considered best practice to provide clear theoretical descriptions of how behaviour change interventions should produce changes in behaviour. Commissioners of the National Health Service Diabetes Prevention Programme (NHS-DPP) specified that the four independent provider organisations must explicitly describe the behaviour change theory underpinning their interventions. The nationally implemented programme, launched in 2016, aims to prevent progression to Type 2 diabetes in high-risk adults through changing diet and physical activity behaviours. This study aimed to: (a) develop a logic model describing how the NHS-DPP is expected to work, and (b) document the behaviour change theories underpinning providers’ NHS-DPP interventions. Methods A logic model detailing how the programme should work in changing diet and activity behaviours was extracted from information in three specification documents underpinning the NHS-DPP. To establish how each of the four providers expected their interventions to produce behavioural changes, information was extracted from their programme plans, staff training materials, and audio-recorded observations of mandatory staff training courses attended in 2018. All materials were coded using Michie and Prestwich’s Theory Coding Scheme. Results The NHS-DPP logic model included information provision to lead to behaviour change intentions, followed by a self-regulatory cycle including action planning and monitoring behaviour. None of the providers described an explicit logic model of how their programme will produce behavioural changes. Two providers stated their programmes were informed by the COM-B (Capability Opportunity Motivation – Behaviour) framework, the other two described targeting factors from multiple theories such as Self-Regulation Theory and Self-Determination Theory. All providers cited examples of proposed links between some theoretical constructs and behaviour change techniques (BCTs), but none linked all BCTs to specified constructs. Some discrepancies were noted between the theory described in providers’ programme plans and theory described in staff training. Conclusions A variety of behaviour change theories were used by each provider. This may explain the variation between providers in BCTs selected in intervention design, and the mismatch between theory described in providers’ programme plans and staff training. Without a logic model describing how they expect their interventions to work, justification for intervention contents in providers’ programmes is not clear.

Promoting health behaviour change in the preconception period: An Intervention Mapping approach (Preprint)

2021 ◽  
Author(s):  
Jodie Scott ◽  
Melissa Oxlad ◽  
Jodie Dodd ◽  
Claudia Szabo ◽  
Andrea Deussen ◽  
...  
Keyword(s):  
Weight Management ◽  
Behaviour Change ◽  
Intervention Mapping ◽  
Idea Generation ◽  
Systems Design ◽  
Behaviour Change Techniques ◽  
Healthy Weight ◽  
Weight Range ◽  
Mapping Approach ◽  
Ehealth Intervention

BACKGROUND Half of women begin pregnancy above the healthy weight range, increasing the risk of complications and adversely affecting the lifelong health of their baby. Maternal obesity remains the strongest risk factor for offspring obesity across childhood, adolescence and adulthood. Previous research suggests that women should be encouraged to be within a healthy weight range before conception in order to improve health outcomes. OBJECTIVE We outline the application of the Intervention Mapping (IM) approach in developing an evidence-informed eHealth intervention to promote weight management. The intervention, based on psychological theories and behaviour change techniques, was developed for women with overweight or obesity who intend to become pregnant. The “Begin Better” eHealth intervention is part of an integrated program being evaluated in a clinical trial to assess if weight management before pregnancy can influence clinical outcomes for mother and baby. METHODS The current study documents steps 2 to 5 of a 6-step iterative intervention mapping approach informed by the Information-Motivation-Behavioural Skills (IMB) model and the findings of a previous interview study. We defined behaviour change objectives for each of the IMB behavioural determinants as well as theory-based behaviour change techniques (BCT) and practical strategies. We also utilised Persuasive Systems Design (PSD) principles to assist in translating these strategies to a digital environment. RESULTS The resultant intervention comprises nutrition and physical activity content, along with psychological strategies, which are notably absent from mainstream weight management programs. Strategies to increase motivation, garner social support and promote self-care are integral to maintaining engagement with the intervention, which aims to improve lifestyle behaviours and enhance wellbeing. Important elements include: tracking mechanisms for percentage progress towards goals to enable feedback on behaviours and outcomes; in-app messages of praise on entry of goals or habits; strategies to prompt habit formation and action planning via small, easily achievable steps toward positive change. CONCLUSIONS Design decisions and processes for idea generation about intervention content, format and delivery are often not reported. This study we respond to this gap in the literature and outline a process that is potentially transferable to the development of other interventions.

A Framework to Assist School Psychologists and Counsellors in Recommending Quality Apps for Supporting Diabetes Self-Management: An Illustrative Assessment Using Content Analysis

2018 ◽  
Vol 29 (01) ◽  
pp. 82-97
Author(s):  
Brett Furlonger ◽  
Marko Ostojic ◽  
Jasmine Chung ◽  
Katrina Philips ◽  
Margherita Busacca ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Content Analysis ◽  
School Psychologists ◽  
Behaviour Change ◽  
Mental Health Professionals ◽  
The Self ◽  
Self Management ◽  
Behaviour Change Techniques ◽  
Change Strategies

A framework was examined to assist school psychologists and counsellors in recommending quality apps for supporting diabetes self-management. A content analysis was undertaken to assess behaviour change strategies in Apple and Android smartphone apps for the self-management of type 2 diabetes. The Behaviour Change Technique Taxonomy was used to assess the presence of behaviour change strategies, while the Mobile App Rating Scale was used to assess overall app quality. Raters found, on average, 7.13 behaviour change techniques out of a possible 93, indicating few behaviour change techniques in apps for the self-management of Type 2 diabetes. Analysis indicated that apps of a higher overall quality tended to incorporate more behaviour change strategies. It was concluded that mental-health professionals are advantaged if they are able to assess and refine selection tools for matching apps with the needs of students with diabetes.

scholarly journals Applying translational behavioural science to improve people’s health

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
I Nagyova
Keyword(s):  
Public Health ◽  
Behaviour Change ◽  
Positive Impact ◽  
Behaviour Change Techniques ◽  
Knowledge Mobilization ◽  
Behavioural Science ◽  
Holistic View ◽  
Change Models ◽  
The Individual ◽  
Behavioural Aspects

Abstract Background The rising burden of chronic diseases poses a challenge for the whole public health system, and to deal with this we need to address the socioeconomic, cultural, and behavioural aspects of health and its determinants. While a change in individual 'lifestyle' factors, such as diet, exercise, smoking, and alcohol are often the target of intervention design, there needs to be an acknowledgement that behavioural science is much more than just 'lifestyle choice' on the individual level. Governments worldwide are increasingly incorporating the behavioural insights approach into policymaking. There has been an increasing interest in 'choice architecture' and 'nudging' to facilitate behaviour (change), often by manipulating elements of the environment. Designing interventions that target the most important determinants of behaviour, based on research evidence in the field of behavioural science, provide the best chance of changing behaviour and demonstrating a positive impact in terms of health outcomes and cost-effectiveness. However, knowing what works and how to apply it presents an ongoing challenge. Results The COM-B, EAST, and MOST are behaviour change models that were built on an impressive effort to synthesize available evidence regarding intervention development frameworks, behaviour change theories, and behaviour change techniques. They tackle determinants of behaviour in terms of capability, opportunity, and motivation on the level of the individual (micro level), alongside ways in which to intervene, at mezzo level (intervention functions) and macro level (policy categories). Conclusions These approaches take a holistic view of interventions and can contribute to the development of new scientific knowledge regarding mechanisms underlying effective knowledge mobilization in behaviour change. They are also expected to further support the adoption of the evidence-based practices within the field of public health.

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