Translating promoting factors and behavior change principles into the blended and technology supported intervention “Foxfit” to stimulate physical activity in children with asthma: Design study (Preprint)

BACKGROUND Children with asthma can decrease the impact of their disease by improving their physical activity (PA). However, healthcare providers lack in interventions for children with asthma that effectively increase their PA levels and achieve behavior change regarding PA. A technology supported approach can positively influence PA and physical functioning in children. OBJECTIVE The aim of this study was to develop a technology supported intervention that facilitates healthcare providers in promoting PA for children with asthma and to systematically describe this developmental process. METHODS Intervention mapping (IM) was applied to develop a blended and technology supported intervention in co-creation with children with asthma, their parents, and healthcare providers. According to the IM framework, the following steps were performed: 1) conduct a needs assessment; 2) define the intervention outcome, performance objectives, and change objectives; 3) select theory based intervention methods and strategies; 4) create components of the intervention and conduct pilot tests; 5) create an implementation plan; and 6) create an evaluation plan. RESULTS We developed the blended intervention “Foxfit” that consists of an app with a physical activity monitor (PAM) for children with asthma, and a web-based dashboard for their healthcare provider. The intervention focusses on PA in everyday life to improve social participation. Foxfit contains components based on behavior change principles and gamification: goal setting, rewards, action planning, (self-)monitoring, shaping knowledge, a gamified story, personal coaching and feedback, and a tailored approach. CONCLUSIONS The IM framework was very useful to systematically develop a technology supported intervention and to describe the translational process from scientific evidence, the needs and wishes of future users, and behavior change principles into this intervention. This has led to the technology supported intervention Foxfit that facilitates healthcare providers in promoting PA in children with asthma. The structured description of the development process and functional components shows the way behavior change techniques are incorporated in the intervention. CLINICALTRIAL Dutch Trial Register: NTR6658

A model of integrated remote monitoring and behaviour change for osteoarthritis

Background The National Institute for Health and Care Excellence recommends the use of digital and mobile health technologies to facilitate behaviour change interventions. Due to its high prevalence and dependence upon patient self-management strategies, osteoarthritis is one musculoskeletal condition which may benefit from such approaches. This is particularly pertinent due to the increasing use of remote monitoring technologies to collect patient data and facilitate self-management in individuals outside of hospital clinics. In practice however, application of digital behaviour change interventions is difficult due to insufficient reporting of behaviour change theories in the current literature. When digital technologies are employed to alter behaviour change in osteoarthritis, they often focus on physical activity. Currently, such interventions focus of self-efficacy but do not often explicitly report the behaviour change techniques they use to facilitate these changes. Methods This paper proposes a new model of integrating specific behaviour change principles (persuasive design) in an integrated model of remote monitoring and digital behaviour change interventions for osteoarthritis. Results There is potential to combine remote monitoring systems of patient data through digital and mobile technologies with behaviour change principles to improve physical activity behaviours in individuals with osteoarthritis. The use of persuasive design principles (e.g. prompts or nudges) through mobile notifications and strategic system design can be directed to enhance behaviour change. A validated measure of behaviour change, such as the patient activation measure, will allow effective evaluation of such systems. Conclusions Digital behaviour change interventions should be directed towards the underlying principles of behaviour change they employ, although this is not commonly reported in practice. Such interventions can be integrated within remote monitoring pathways using persuasive design techniques to enhance patient activation. This approach can enhance self-management in individuals with musculoskeletal conditions, such as osteoarthritis.

Antimicrobial stewardship and infection prevention interventions targeting healthcare-associated Clostridioides difficile and carbapenem-resistant Klebsiella pneumoniae infections: a scoping review

ObjectivesThis study assessed antimicrobial stewardship (AMS) and infection prevention (IP) interventions targeting healthcare-associated Clostridioides difficile and carbapenem-resistant Klebsiella pneumoniae (CRKP) infections, their key outcomes and the application of behaviour change principles in these interventions.DesignThis scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines while focusing on acute healthcare settings in both low-to-middle income and high-income countries.Data sourcesThe databases searched were MEDLINE, PubMed, Web of Science and CINAHL between 22 April 2020 and 30 September 2020.EligibilityThe review included peer-reviewed articles published in English language between 2010 and 2019. Studies that focussed on IP and/or AMS interventions primarily targeting C. difficile or CRKP were included. Studies that assessed effectiveness of diagnostic devices or treatment options were excluded from this review.Data extraction and synthesisAn abstraction sheet calibrated for this study was used to extract data on the main study characteristics including the population, intervention and outcomes of interest (antimicrobial use, compliance with IP interventions and risk for C. difficile and CRKP). A narrative synthesis of the results is provided.ResultsThe review included 34 studies. Analysis indicates that interventions targeting C. difficile and CRKP include Education, Surveillance/Screening, Consultations, Audits, Policies and Protocols, Environmental measures, Bundles, Isolation as well as Notifications or alerts (represented using the ESCAPE-BIN acronym). The identified outcomes include antimicrobial use, resistance rates, risk reduction, adherence to contact precautions, hospital stay and time savings. AMS and IP interventions tend to be more adhoc with limited application of behaviour change principles.ConclusionThis scoping review identified the AMS and IP interventions targeting C. difficile and CRKP in healthcare settings and described their key outcomes. The application of behaviour change principles in AMS and IP interventions appears to be limited.

Can incorporating behaviour change principles make clinical practice guidelines and health policies more impactful in change public health?

Background We now live in world of ever-increasing amounts of evidence and information. In spite of the use of high-quality methods to synthesise this information, clinical practice guidelines and health policies often fail to impact public health. Canada has started to develop a series of guidelines and policies which have incorporated a behaviour change perspective into their development to fast track their implementability and their impact on public health. For example, the Canadian Association of Cardiovascular Prevention and Rehabilitation (CACPR)'s new Cardiovascular Rehabilitation Guidelines are being built using key integrated knowledge translation and behaviour change theories to develop recommendations which not only target the what to do but, who, and how this needs to be done. Another example is Canada's new Food Guide, which is unique in the fact that it has taken a behaviour-oriented perspective, rather than a macro and micronutrient path. Both of these examples leverage basic behaviour change principles to get multiple stakeholders to increase their uptake and usage of these knowledge products. Results Both the CACPR guidelines and the Food Guide are still relatively new, so their uptake and impact is not currently measurable. However, there is a monitoring plan which will evaluate these aspects. That being said, there is some evidence that both of these products have been well received by their respective communities. Conclusions Taking a behaviour change perspective in the development and delivery of guidelines and policy, especially health policy, has the potential to positively engage more stakeholders in the process, and fast track their impact on public's health. Ultimately, more evidence is needed to define the optimal way to do this.

Sustaining Sustainability: Lessons from the Psychology of Habits

Recent dramatic shifts in pro-environmental attitudes have not been accompanied by similar increases in sustainable behavior. We propose that this attitude-behavior gap is partly driven by unsustainable habits. Policies can reduce this gap by enacting structural changes based on insights from habit psychology and behavioral economics. We outline three behavior change principles: First, policies can leverage friction to encourage repetition of sustainable actions and impede unsustainable ones. Second, policies can set up action cues for sustainable actions and disrupt existing cues for unsustainable habits. Finally, policies can encourage sustainable habits by using psychologically-informed incentives. We then describe how even initially-unpopular policies can become acceptable through habitual repetition. Habit psychology represents a promising but currently unrealized part of the policymaker's toolbox.

Workshop: Behaviour change and knowledge translation: The unlocked potential to improve people’s health

Background Despite the complexities of modern healthcare it remains the case that human behaviour plays a critical role in health outcomes and in the efficacy of most treatments. We know that people get sick because of unhealthy behaviours. We know that the success of most healthcare interventions is highly dependent on patients’ willingness to adhere to self-care activities such as taking medications or performing self-examinations. Over the last decades well-validated, cost-effective behavioural medicine interventions have been developed. The field has contributed to strategies in health education, with techniques for modifying behaviour, and enhancing motivation and learning for health. More recently, multilevel intervention models, including environmental and policy variables, are being increasingly proposed and tested. Yet, for several reasons, only few such interventions have been translated into policy recommendations or implemented successfully in clinical practice. Through highlighting critical gaps in knowledge translation that can be addressed by integrating modern theoretical and methodological approaches across disciplines we hope to contribute to the development of effective and implementable behaviour change interventions for optimal population and individual health and well-being. Aim The aim of this workshop is to broaden our understanding of measures that have originated from behavioural sciences and have a lot to offer to public health. This workshop also seeks to contribute to capacity building in knowledge translation and evidence-informed decision-making in public health. Workshop structure The workshop will consist of five presentations providing an overview of topical issues in the field of behaviour change and knowledge translation, followed by an interactive audience discussion. The first presentations will introduce the most recent challenges in knowledge translation from the WHO/Europe perspective. The second presentation will discuss the possibilities of using behaviour change principles in the development and adoption of health policies showcasing the Canada’s newly adopted Food Guide. The third presentation will highlight the challenges in tackling physician’s ability to effectively conduct behaviour change counselling with their patients in the context of chronic disease prevention. The fourth presentation will make the link between the knowledge translation theory and practice, using the Behaviour Change Wheel theory. The fifth presentation will introduce the free academic meta-search engine - Motrial, which has a great potential in evaluating the randomized controlled trials and fuelling meta-analyses and systematic reviews in return of better quality. Further to the reflexion on the current knowledge base, an audience discussion will give attendees the opportunity to share their opinions regarding challenges and opportunities in knowledge translation to improve people’s health and well-being. Key messages Policy development and adoption can be considered as a behaviour change process. The application of behaviour change principles to the policy process may lead to greater stakeholder engagement and faster policy implementation.

Using behaviour change principles in the development and adoption of health policies

Issue/problem We now live in world of ever-increasing amounts of evidence and information. Unfortunately, high quality evidence is not always incorporated into policy documents and can be ignored by policy makers when making decisions. Description of the problem Canada recently released its Healthy Eating Strategy, a comprehensive policy which covers a number of aspects, including Canada’s new Food Guide. The Food Guide is rooted in both nutritional and behavioural evidence. It is unique in the fact that it has taken a behaviour-oriented perspective, rather than a macro and micronutrient path. In addition, to incorporating a behavioural perspective into the policy there is a concerted effort to leverage basic behaviour change principles to get the healthcare community to increase their uptake and usage of the food guide. Furthermore, the same principles are being leveraged to ensure that policy makers and members of the government continually reinvest and push the food guide forward as new evidence is generated. Results Though the Healthy Eating Strategy is still relatively new, there has been substantial policy movement on a number of the areas it will tackle. For the Food Guide, this was only released at the start of 2019, so its uptake and impact is not currently measurable. However, there is a monitoring plan which will evaluate these aspects. That being said, there is some evidence that the Food Guide, and the messaging around it, has been well received. Lessons Taking a behaviour change perspective in the development and delivery of policy, especially health policy, has the potential to positively engage more stakeholders in the process. Ultimately, more evidence is needed to define the optimal way to do this.

Behaviour Change for Open Science

This Editorial presents a discussion of behaviour change strategies that could be used to increase uptake of Open Science behaviours. It explores what we mean by behaviour in Open Science, barriers and facilitators of Open Science behaviours and the potential for intervention development using behaviour change principles using a case-study of the Behaviour Change Wheel.