scholarly journals Gauging the impact of behavior change interventions: A tutorial on the Numbers Needed to Treat

2017 ◽  
Author(s):  
Stefan L.K. Gruijters ◽  
Gjalt - Jorn Ygram Peters
Keyword(s):  
Behavior Change ◽  
Effect Size ◽  
Population Level ◽  
Applied Psychology ◽  
Behavior Change Intervention ◽  
Behavior Change Interventions ◽  
Effect Size Index ◽  
Numbers Needed To Treat ◽  
Explained Variance ◽  
The Impact

Effect size indices are valuable to research in applied psychology, but traditional measures (e.g. Cohen’s d or Pearson’s r) are limited by their ability to convey practical information about intervention effectiveness. Researchers rely on concepts such as ‘standardized mean difference’ or ‘explained variance’ to express effectiveness. Practitioners, policymakers, and lay-people prefer concepts such as frequencies. Partial solutions have been offered by rules-of-thumb (e.g. Cohen’s categories of ‘small’, ‘moderate’ and ‘large’), but such pigeon-holing is somewhat arbitrary and of little nuance. We review, and provide a tutorial on, the Numbers Needed for Treat (NNT) statistic—an effect size index that originated in the medical literature. NNT fills the communicative gap between research and practice, and is particularly suited to gauge the impact of a behavior change intervention on a population level. NNT is defined as the number of people who need to be exposed to an intervention to achieve the desired change in one more individual, relative to a control condition. NNT has informational advantages: 1) it communicates effect magnitude in a frequency-format (number of people) making the impact of an intervention on a population transparent, and 2) it considers the population behavior base-rate to estimate this number. We adapt and extend the NNT index to suit applied psychology endeavors, and argue that the measure can strengthen the translation of intervention research to practice. The statistical procedure to estimate the NNT is explained, illustrated with concrete examples, and supplemented by script and functions to calculate the index in the R - environment.

scholarly journals Norms and Social Network–Centric Behavior Change Intervention (Nam Nalavazhvu) for Improved Toilet Usage in Peri-Urban Communities of Tamil Nadu: Protocol for a Cluster-Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Sania Ashraf ◽  
Cristina Bicchieri ◽  
Maryann G Delea ◽  
Upasak Das ◽  
Kavita Chauhan ◽  
...  
Keyword(s):  
Behavior Change ◽  
Low Income ◽  
Tamil Nadu ◽  
Controlled Trial ◽  
Well Being ◽  
Baseline Survey ◽  
Behavior Change Intervention ◽  
Behavior Change Interventions ◽  
Cluster Randomized ◽  
The Impact

BACKGROUND Inconsistent toilet usage is a continuing challenge in India. Despite the impact of social expectations on toilet usage, few programs and studies have developed theoretically grounded norm-centric behavior change interventions to increase toilet use in low-income settings. OBJECTIVE The objective of this paper is to detail the rationale and design of an ex ante, parallel cluster-randomized trial evaluating the impact of a demand-side, norm-centric behavior change intervention on exclusive toilet use and maintenance in peri-urban Tamil Nadu, India. METHODS Following formative research, we developed an evidence-based norm-centric behavior change intervention called Nam Nalavazhvu (Tamil for “our well-being”). The multilevel intervention aims to improve toilet usage by shifting empirical expectations or beliefs about other relevant people’s sanitation practices. It also provides action-oriented information to aid individuals to set goals and overcome barriers to own, consistently use, and maintain their toilets. This trial includes 76 wards in the Pudukkottai and Karur districts, where half were randomly assigned to receive the intervention and the remaining served as counterfactuals. RESULTS We enrolled wards and conducted a baseline survey among randomly selected individuals in all 76 wards. The 1-year behavior change intervention is currently ongoing. At the endline, we will collect relevant data and compare results between study arms to determine the impacts of the Nam Nalavazhvu intervention on sanitation-related behavioral, health, and well-being outcomes and potential moderators. This study is powered to detect differences in the prevalence of exclusive toilet use between study arms. We are also conducting a process evaluation to understand the extent to which the intervention was implemented as designed, given the special pandemic context. CONCLUSIONS Findings from this trial will inform norm-centric behavior change strategies to improve exclusive toilet usage. CLINICALTRIAL ClinicalTrials.gov NCT04269824; https://www.clinicaltrials.gov/ct2/show/NCT04269824 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/24407

scholarly journals Norms and Social Network–Centric Behavior Change Intervention (Nam Nalavazhvu) for Improved Toilet Usage in Peri-Urban Communities of Tamil Nadu: Protocol for a Cluster-Randomized Controlled Trial

10.2196/24407 ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. e24407
Author(s):  
Sania Ashraf ◽  
Cristina Bicchieri ◽  
Maryann G Delea ◽  
Upasak Das ◽  
Kavita Chauhan ◽  
...  
Keyword(s):  
Behavior Change ◽  
Low Income ◽  
Tamil Nadu ◽  
Controlled Trial ◽  
Well Being ◽  
Baseline Survey ◽  
Behavior Change Intervention ◽  
Behavior Change Interventions ◽  
Cluster Randomized ◽  
The Impact

Background Inconsistent toilet usage is a continuing challenge in India. Despite the impact of social expectations on toilet usage, few programs and studies have developed theoretically grounded norm-centric behavior change interventions to increase toilet use in low-income settings. Objective The objective of this paper is to detail the rationale and design of an ex ante, parallel cluster-randomized trial evaluating the impact of a demand-side, norm-centric behavior change intervention on exclusive toilet use and maintenance in peri-urban Tamil Nadu, India. Methods Following formative research, we developed an evidence-based norm-centric behavior change intervention called Nam Nalavazhvu (Tamil for “our well-being”). The multilevel intervention aims to improve toilet usage by shifting empirical expectations or beliefs about other relevant people’s sanitation practices. It also provides action-oriented information to aid individuals to set goals and overcome barriers to own, consistently use, and maintain their toilets. This trial includes 76 wards in the Pudukkottai and Karur districts, where half were randomly assigned to receive the intervention and the remaining served as counterfactuals. Results We enrolled wards and conducted a baseline survey among randomly selected individuals in all 76 wards. The 1-year behavior change intervention is currently ongoing. At the endline, we will collect relevant data and compare results between study arms to determine the impacts of the Nam Nalavazhvu intervention on sanitation-related behavioral, health, and well-being outcomes and potential moderators. This study is powered to detect differences in the prevalence of exclusive toilet use between study arms. We are also conducting a process evaluation to understand the extent to which the intervention was implemented as designed, given the special pandemic context. Conclusions Findings from this trial will inform norm-centric behavior change strategies to improve exclusive toilet usage. Trial Registration ClinicalTrials.gov NCT04269824; https://www.clinicaltrials.gov/ct2/show/NCT04269824 International Registered Report Identifier (IRRID) DERR1-10.2196/24407

scholarly journals The Importance of Studying Health Behavior in Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 827-827
Author(s):  
Jaime Hughes ◽  
Susan Hughes ◽  
Mina Raj ◽  
Janet Bettger
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Behavior Change ◽  
Chronic Conditions ◽  
Population Level ◽  
Multiple Chronic Conditions ◽  
Prior Work ◽  
Time Changes ◽  
The Impact ◽  
Over Time

Abstract Behavior change is an inherent aspect of routine geriatric care. However, most research and clinical programs emphasis how to initiate behavior change with less emphasis placed on skills and strategies to maintain behaviors over time, including after an intervention has concluded. This presentation will provide an introduction to the symposium, including a review of prior work and our rationale for studying the critical yet overlooked construct of maintenance in older adults. Several key considerations in our work include the impact of multiple chronic conditions, declines in cognitive and functional capacity over time, changes in environmental context and/or social support, and sustainability of community and population-level programs and services.

scholarly journals Design and rationale of the Longitudinal Evaluation of Norms and Networks Study (LENNS): A cluster-randomized trial assessing the impact of a norms-centric intervention on exclusive toilet use and maintenance in peri urban communities of Tamil Nadu

2020 ◽  
Author(s):  
Sania Ashraf ◽  
Cristina Bicchieri ◽  
Maryann G. Delea ◽  
Upasak Das ◽  
Kavita Chauhan ◽  
...  
Keyword(s):  
Behavior Change ◽  
Randomized Trial ◽  
Low Income ◽  
Tamil Nadu ◽  
Cluster Randomized Trial ◽  
List Type ◽  
Behavior Change Intervention ◽  
Ex Ante ◽  
Cluster Randomized ◽  
The Impact

AbstractIntroductionInconsistent toilet usage is a continuing challenge in India. Despite the impact of social expectations on toilet usage, few programs and studies have developed theoretically grounded norms-centric behavior change interventions to increase toilet use in low-income settings. This protocol details the rationale and design of an ex-ante, parallel cluster-randomized trial evaluating the impact of a demand-side, norms-centric behavior change intervention on exclusive toilet use and maintenance in peri-urban Tamil Nadu, India.Methods and AnalysisFollowing two years of formative research, we developed an evidence-based norm-centric behavior change intervention called Nam Nalavazhvu (Tamil for “Our wellbeing”). The multi-level intervention aims to shift collective beliefs by shifting empirical expectations or beliefs about other relevant people’s sanitation practices. It also provides action-oriented information to aid individuals to set goals and overcome barriers to build, consistently use and maintain their toilets. This trial includes 76 wards in Pudukkottai and Karur districts, where half were randomly assigned to receive the intervention and the remaining serve as counterfactuals. During baseline and endline (conducted one year after the initiation of intervention) assessments, we collect relevant data and compare results between study arms to determine the impacts of the Nam Nalavazhvu intervention on sanitation-related behavioral, health, wellbeing outcomes and potential moderators. This study is powered to detect differences in the prevalence of exclusive toilet use between study arms. We will also conduct a process evaluation to understand the extent to which the intervention was implemented, as designed.Ethics and DisseminationThe study protocol has been reviewed and approved by the ethics board at the University of Pennsylvania, USA and the Catalyst Foundation, India. Research findings will be disseminated through open access peer reviewed publications and presentations to stakeholders, government officials and conferences.Trial registrationNCT04269824.Strengths and limitations of this studyThis ex-ante, parallel cluster randomized trial assesses the impact of a norm-centric behavior change intervention strategy to improve sanitation practices. These behavior change techniques are novel to the sanitation sector but has been effective in changing a variety of behaviors, such as water use, drinking behavior, and energy consumption.The study outcomes include health, wellbeing outcomes, and a careful assessment of changes in social beliefs, expectations, and social determinants of collective sanitation behaviors.This study is being rolled out during the ongoing COVID-19 pandemic. This can potentially impact the effectiveness of this intervention package that uses community and network-based group activities. However, through a detailed process monitoring and evaluation we will be able to assess the impact on delivery, and subsequent behavior change in this unique setting.

scholarly journals Understanding Health Behavior Technology Engagement: Pathway to Measuring Digital Behavior Change Interventions

10.2196/14052 ◽  
2019 ◽  
Vol 3 (4) ◽  
pp. e14052 ◽  
Author(s):  
Heather Cole-Lewis ◽  
Nnamdi Ezeanochie ◽  
Jennifer Turgiss
Keyword(s):  
Health Behavior ◽  
Behavior Change ◽  
User Experience ◽  
User Engagement ◽  
User Interactions ◽  
Behavior Change Intervention ◽  
Behavioral Determinants ◽  
Behavior Change Interventions ◽  
Frequency Of Use ◽  
Measurement And Evaluation

Researchers and practitioners of digital behavior change interventions (DBCI) use varying and, often, incongruent definitions of the term “engagement,” thus leading to a lack of precision in DBCI measurement and evaluation. The objective of this paper is to propose discrete definitions for various types of user engagement and to explain why precision in the measurement of these engagement types is integral to ensuring the intervention is effective for health behavior modulation. Additionally, this paper presents a framework and practical steps for how engagement can be measured in practice and used to inform DBCI design and evaluation. The key purpose of a DBCI is to influence change in a target health behavior of a user, which may ultimately improve a health outcome. Using available literature and practice-based knowledge of DBCI, the framework conceptualizes two primary categories of engagement that must be measured in DBCI. The categories are health behavior engagement, referred to as “Big E,” and DBCI engagement, referred to as “Little e.” DBCI engagement is further bifurcated into two subclasses: (1) user interactions with features of the intervention designed to encourage frequency of use (ie, simple login, games, and social interactions) and make the user experience appealing, and (2) user interactions with behavior change intervention components (ie, behavior change techniques), which influence determinants of health behavior and subsequently influence health behavior. Achievement of Big E in an intervention delivered via digital means is contingent upon Little e. If users do not interact with DBCI features and enjoy the user experience, exposure to behavior change intervention components will be limited and less likely to influence the behavioral determinants that lead to health behavior engagement (Big E). Big E is also dependent upon the quality and relevance of the behavior change intervention components within the solution. Therefore, the combination of user interactions and behavior change intervention components creates Little e, which is, in turn, designed to improve Big E. The proposed framework includes a model to support measurement of DBCI that describes categories of engagement and details how features of Little e produce Big E. This framework can be applied to DBCI to support various health behaviors and outcomes and can be utilized to identify gaps in intervention efficacy and effectiveness.

scholarly journals Evaluation of a Package of Behaviour Change Interventions (Baduta Program) to Improve Maternal and Child Nutrition in East Java, Indonesia: Protocol for an Impact Study

10.2196/18521 ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. e18521 ◽  
Author(s):  
Michael John Dibley ◽  
Ashraful Alam ◽  
Umi Fahmida ◽  
Iwan Ariawan ◽  
Christiana Rialine Titaley ◽  
...  
Keyword(s):  
Behavior Change ◽  
Pregnant Women ◽  
Child Nutrition ◽  
Health System Strengthening ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Child Stunting ◽  
Maternal And Child Nutrition ◽  
Behavior Change Interventions ◽  
The Impact

Background Over the past decade, the prevalence of stunting has been close to 37% in children aged <5 years in Indonesia. The Baduta program, a multicomponent package of interventions developed by the Global Alliance for Improved Nutrition, aims to improve maternal and infant nutrition in Indonesia. Objective This study aims to assess the impact of the Baduta program, a package of health system strengthening and behavior change interventions, compared with the standard village health services on maternal and child nutrition. Methods The impact evaluation uses a cluster randomized controlled trial design with 2 outcome assessments. The first uses cross-sectional surveys of mothers of children aged 0-23 months and pregnant women before and after the interventions. The second is a cohort study of pregnant women followed until their child is 18 months from a subset of clusters. We will also conduct a process evaluation guided by the program impact pathway to assess coverage, fidelity, and acceptance. The study will be conducted in the Malang and Sidoarjo districts of East Java, Indonesia. The unit of randomization is the subdistricts. As random allocation of interventions to only 6 subdistricts is feasible, we will use constrained randomization to ensure balance of baseline covariates. The first intervention will be health system strengthening, including the Baby-Friendly Hospital Initiative, and training on counseling for appropriate infant and young child feeding (IYCF). The second intervention will be nutrition behavior change that includes Emo-Demos; a national television (TV) advertising campaign; local screening TV spots; a free, text message service; and promotion of low-cost water filters and hygiene practices. The primary study outcome is child stunting (low length-for-age), and secondary outcomes include length-for-age Z scores, wasting (low weight-for-length), anemia, child morbidity, IYCF indicators, and maternal and child nutrient intakes. The sample size for each cross-sectional survey is 1400 mothers and their children aged <2 years and 200 pregnant women in each treatment group. The cohort evaluation requires a sample size of 340 mother-infant pairs in each treatment group. We will seek Gatekeeper consent and written informed consent from the participants. The intention-to-treat principle will guide our data analysis, and we will apply Consolidated Standards of Reporting Trials guidelines for clustered randomized trials in the analysis. Results In February 2015, we conducted a baseline cross-sectional survey on 2435 women with children aged <2 years and 409 pregnant women. In February 2017, we conducted an end-line survey on 2740 mothers with children aged <2 years and 642 pregnant women. The cohort evaluation began in February 2015, with 729 pregnant women, and was completed in December 2016. Conclusions The results of the program evaluation will help guide policies to support effective packages of behavior change interventions to prevent child stunting in Indonesia. International Registered Report Identifier (IRRID) RR1-10.2196/18521

scholarly journals Different Combinations of Behavior Change Interventions and Frequencies of Interpersonal Contacts Are Associated with Infant and Young Child Feeding Practices in Bangladesh, Ethiopia, and Vietnam

2019 ◽  
Vol 4 (2) ◽  
Author(s):  
Sunny S Kim ◽  
Phuong Hong Nguyen ◽  
Lan Mai Tran ◽  
Silvia Alayon ◽  
Purnima Menon ◽  
...  
Keyword(s):  
Young Child ◽  
Mass Media ◽  
Behavior Change ◽  
Dietary Diversity ◽  
Child Feeding ◽  
Factors Associated ◽  
Young Child Feeding ◽  
Behavior Change Interventions ◽  
Infant And Young Child ◽  
The Impact

ABSTRACT Background Social and behavior change communication interventions are integral to improving dietary and care practices, but evidence on the impact of the combination and intensity of these interventions in different contexts is scarce. Objectives We examined the extent of and factors associated with intervention exposure: interpersonal communication (IPC) alone or with other interventions (i.e., mass media, community mobilization, or nutrition-sensitive agricultural activities), number of and factors associated with IPC contacts, and combinations of intervention components and number of contacts associated with infant and young child feeding (IYCF) practices. Methods We used endline survey data from impact evaluations in Bangladesh, Ethiopia, and Vietnam (n = 1001, 1720, and 1001 mothers with children aged &lt;2 y, respectively). Multivariable regression models were used for analyses. Results Exposure to the interventions varied in all 3 countries. On average, mothers received 8 visits in the last 6 mo in Bangladesh, 2 visits in the last 3 mo in Ethiopia, and 1 visit in the last 6 mo in Vietnam. Across countries, the factors associated with intervention exposure and number of IPC contacts differed. In Ethiopia, exposure to IPC with other interventions was associated with higher odds of achieving minimum meal frequency (OR: 1.6), minimum dietary diversity (OR: 1.8), and consumption of iron-rich foods (OR: 4.7). In Vietnam, exposure to IPC alone or with mass media was associated with higher odds of exclusive breastfeeding (EBF; OR: 2.8–3.7). Near-monthly visits were associated with 2–3 times higher odds of IYCF practices in Bangladesh and Ethiopia. In Vietnam, even 1 IPC visit was associated with 2 times higher odds of EBF. Conclusions Exposure matters for impact, but the combination of behavior change interventions and number of IPC contacts required to support IYCF behavior change are context specific. This trial was registered at www.clinicaltrials.gov as NCT01678716 (Bangladesh), NCT02775552 (Ethiopia), and NCT01676623 (Vietnam).

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