Influences on Pregnant Women’s and Health Care Professionals’ Behaviour Regarding Maternal Vaccinations: A Qualitative Interview Study

The uptake of maternal influenza and pertussis vaccinations is often suboptimal. This study explores the factors influencing pregnant women’s and health care professionals’ (HCPs) behaviour regarding maternal vaccinations (MVs). Pregnant/recently pregnant women, midwives, pharmacists and general practice staff in Waikato, New Zealand, were interviewed. The analysis used the behaviour change wheel model. Interviews of 18 women and 35 HCPs revealed knowledge about MVs varied with knowledge deficiencies hindering the uptake, particularly for influenza vaccination. HCPs, especially midwives, were key in raising women’s awareness of MVs. Experience with vaccinating, hospital work (for midwives) and training increased HCPs’ knowledge and proactivity about MVs. A “woman’s choice” philosophy saw midwives typically encouraging women to seek information and make their own decision. Women’s decisions were generally based on knowledge, beliefs, HCPs’ emphasis and their perceived risk, with little apparent influence from friends, family, or online or promotional material. General practice’s concentration on children’s vaccination and minimal antenatal contact limited proactivity with MVs. Busyness and prioritisation appeared to affect HCPs’ proactivity. Multi-pronged interventions targeting HCPs and pregnant women and increasing MV access are needed. All HCPs seeing pregnant women should be well-informed about MVs, including how to identify and address women’s questions or concerns about MVs to optimise uptake.

Using the Behaviour Change Wheel to Design an App to Change Tourist Behaviour and Increase Dispersal into Regional Areas

Currently, many tourism destinations are experiencing greatly reduced tourism due to COVID-19. In order to ensure that regions that wish to engage in tourism can share the benefits of it more equally, and to prevent the predicted future problem of overuse of popular areas once pre-COVID visitor numbers resume, an app to encourage tourists and leisure-seekers to change their behaviour and disperse into regional areas has been developed. The Behaviour Change Wheel was used to define the problem, find suitable intervention functions and design methods of delivery that could increase tourists’ capability, opportunity and motivation to disperse farther into regions. The Huon Valley of Tasmania, Australia, was used as a research area. Our application of the Behaviour Change Wheel methodology determined that active engagement in logistic, value-based, and social information has the greatest chance of changing behaviour in this region and a list of Behaviour Change Techniques has been developed and considered in the design of a gamified travel app.

Gay, Bisexual and other Men who have Sex with Men (GBMSM) remote mental health help-seeking during Covid-19

Gay, bisexual and other men who have sex with men (GBMSM) experience far worse mental health (MH) than wider society. This disparity was exacerbated by additional ‘unique to sexual minority status’ COVID-19 stressors. This sequential, mixed-methods study examined MH help-seeking among GBMSM in the UK and Ireland during the first COVID-19 lockdown. Quantitative survey data (n=1,368), analysed with logistic regression, suggested GBMSM experiencing moderate-to-severe anxiety and those with a past MH diagnosis were most likely to seek MH support. Thematic analysis of qualitative interview (n=18) data identified multiple barriers and enablers to GBMSM seeking MH help, who focused on GBMSM-facing organisations and population-wide online resources. Finally, the behaviour change wheel was used to generate theoretically informed recommendations to promote MH help-seeking among GBMSM in Scotland. We discuss how applying these recommendations in the short, medium and long term will begin to address GBMSM’s MH needs, post COVID-19.

A theory-based exploration of antibiotic use in primary healthcare in Gezira state, Sudan

Background Inappropriate use of antibiotics is a major contributing factor to the emergence of antimicrobial resistance globally, including in Sudan. Objectives The project aimed to develop a theory-driven behaviour change strategy addressing both prescribers and patients based on factors that are driving antibiotic use in primary healthcare settings in Gezira state in Sudan. Methods The strategy was designed based on the Theoretical Domains Framework (TDF) to identify behavioural domains and the Behaviour Change Wheel (BCW) to select appropriate intervention functions. The process included (1) a formative qualitative research study and (2) a knowledge co-production workshop that utilized the results of the qualitative study to design a salient, appropriate, and credible behaviour change strategy. Results The TDF domains related to prescribers that emerged from the study included knowledge, skills, and intention. The selected BCW intervention functions included education, training, modelling, and persuasion. The main TDF domains related to patients included social influences and intention. The selected BCW intervention functions included enablement and education. Conclusion Using the TDF and BCW intervention functions, the study identified behavioural domains that influence antibiotic prescription and consumption in rural primary healthcare settings in Gezira state in Sudan and appropriate intervention functions to modify these behaviours. Knowledge co-production ensured that the evidence-based strategy was acceptable and practical in the local context.

Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: a qualitative secondary analysis guided by the Behaviour Change Wheel

Background The purpose of this study is to develop a theory-driven understanding of the barriers and facilitators underpinning physicians’ attitudes and capabilities to implementing SARS-CoV-2 point-of-care (POC) testing into primary care practices. Methods We used a secondary qualitative analysis approach to re-analyse data from a qualitative, interview study of 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify the barriers to implementing SARS-CoV-2 POC testing and identified strategies to address these challenges. Results Several factors underpinned primary care physicians’ attitudes and capabilities to implement SARS-CoV-2 POC testing into practice. First, limited knowledge of the SARS-CoV-2 POC testing landscape and a demanding workload affected physicians’ willingness to use the tests. Second, there was scepticism about the insufficient evidence pertaining to the clinical efficacy and utility of POC tests, which affected physicians’ confidence in the accuracy of tests. Third, physicians would adopt POC tests if they were prescribed and recommended by authorities. Fourth, physicians required professional education and training to increase their confidence in using POC tests but also suggested that healthcare assistants should administer the tests. Fifth, physicians expressed concerns about their limited workload capacity and that extra resources are needed to accommodate any anticipated changes. Sixth, information sharing across practices shaped perceptions of POC tests and the quality of information influenced physician perceptions. Seventh, financial incentives could motivate physicians and were also needed to cover the associated costs of testing. Eighth, physicians were worried that society will view primary care as an alternative to community testing centres, which would change perceptions around their professional identity. Ninth, physicians’ perception of assurance/risk influenced their willingness to use POC testing if it could help identify infectious individuals, but they were also concerned about the risk of occupational exposure and potentially losing staff members who would need to self-isolate. Conclusions Improving primary care physicians’ knowledgebase of SARS-CoV-2 POC tests, introducing policies to embed testing into practice, and providing resources to meet the anticipated demands of testing are critical to implementing testing into practice.

Using the Behaviour Change Wheel (BCW) to Characterise Parenting Interventions to Prevent Intergenerational Child Abuse

Research shows that parents with a history of child abuse are at risk of perpetuating the cycle of abuse; however, exploration of intervention content is still a neglected area. This qualitative study identifies intervention components and corresponding mechanisms of change of parenting interventions to prevent intergenerational child abuse. Interviews with ten heads of interventions from the UK and USA were coded using deductive framework analysis. The Behaviour Change Technique (BCT) Taxonomy and Behaviour Change Wheel were used to code intervention components including BCTs and intervention functions. Mechanisms of change were coded using the Theoretical Domains Framework. Twelve BCTs and eight intervention functions were identified including education, enablement and training delivered through BCTs of instruction on how to perform a behaviour, restructuring the environment and social support. Corresponding mechanisms of change include behaviour regulation, knowledge and social influences, among others. This study offers insight into targeting and tailoring services to improve outcomes for parents with a history of child abuse. Findings suggest that there are possible mechanisms through which vulnerable parents can be helped to break the cycle of abuse including promoting social support, regulating parents’ behaviour through trauma-informed approaches and enhancing knowledge, self-esteem and confidence in parenting.

Enabling women to access preferred methods of contraception: a rapid review and behavioural analysis

Background Many pregnancies in the UK are either unplanned or ambivalent. This review aimed to (i) explore barriers and facilitators to women choosing and accessing a preferred method of contraception in the United Kingdom, and (ii) identify opportunities for behavioural interventions based on examination of interventions that are currently available nationally. Methods Three databases were searched, and experts contacted to identify grey literature for studies presenting barriers and facilitators to women choosing and accessing a preferred method of contraception, conducted in the UK and published between 2009 and October 2019. Information on barriers and facilitators were coded into overarching themes, which were then coded into Mechanisms of Actions (MoAs) as listed in the Theory and Techniques Tool. National interventions were identified by consulting stakeholders and coded into the Behaviour Change Wheel. The match between barriers/facilitators and intervention content was assessed using the Behaviour Change Wheel. Results We included 32 studies and identified 46 barrier and facilitator themes. The most cited MoA was Environmental Context and Resources, which primarily related to the services women had access to and care they received. Social Influences, Beliefs about Consequences (e.g., side effects) and Knowledge were also key. The behavioural analysis highlighted four priority intervention functions (Modelling, Enablement, Education and Environmental Restructuring) that can be targeted to support women to choose and access their preferred method of contraception. Relevant policy categories and behaviour change techniques are also highlighted. Conclusions This review highlights factors that influence women’s choices and access to contraception and recommends opportunities that may be targeted for future interventions in order to support women to access preferred contraception. Registration Protocol was registered with PROSPERO (an international database of prospectively registered systematic reviews in health and social care) in December 2019, CRD42019161156.

Facilitators and barriers to fitness bootcamp participation using the Behaviour Change Wheel

Objective: Despite its importance for mental and physical health, many adults fail to meet current physical activity recommendations. Furthermore, most adults who begin a physical activity programme revert to being less active or even inactive within the first 6 months. Fitness bootcamps represent a potential intervention for improving physical activity in healthy adults. However, no study to date has examined the influences on long-term participation in fitness bootcamps, which is the first step to developing an effective intervention. Using the Behaviour Change Wheel (BCW) framework, this study identified the facilitators and barriers to long-term (1 year or more) fitness bootcamp participation, which were then linked to behaviour change techniques (BCTs) to facilitate intervention development. Design: Qualitative research design. Setting: Data collection occurred in England. Method: Interviews were conducted with 15 long-term fitness bootcamp participants. Results: Thematic analysis revealed 17 facilitators and 6 barriers to long-term fitness bootcamp participation. Participants highlighted the importance of facilitators such as convenience, being outdoors and enjoyment. The social environment, including having a positive instructor and supportive group members, was further noted as a key influence on participation. While long-term participants faced occasional barriers to their routine such as physical injury, bad weather and competing events, the impact of these could be minimised through appropriate BCTs such as ‘demonstration of the behaviour’ and ‘restructuring the social/physical environment’. Conclusion: Findings from this study highlight the importance of social and environmental factors to promoting long-term fitness bootcamp participation and the inclusion of social and physical environmental restructuring as key intervention components.

Orthodontic apps: an assessment of quality (using the Mobile App Rating Scale (MARS)) and behaviour change techniques (BCTs)

Background Apps have been shown to be an effective tool in changing patients’ behaviours in orthodontics and can be used to improve their compliance with treatment. The Behaviour Change Techniques (BCTs) and quality (using MARS) within these apps have previously not been published. Objectives To evaluate the quality of these apps aiming to change behaviour. To assess BCTs used in patient focused orthodontic apps. Methods The UK Google Play and Apple App Stores were searched to identify all orthodontic apps and 305 apps were identified. All 305 apps were assessed for the presence of BCTs using an accepted taxonomy of BCTs (Behaviour Change Wheel (BCW)), widely utilised in healthcare. Of those containing BCTs, the quality was assessed using the Mobile App Rating Scale (MARS), a validated and multi-dimensional tool which rates apps according to 19 objective criteria. Data collection was carried out by two calibrated, independent assessors and repeated after 6 weeks for 25% of the apps by both assessors. Results BCTs were found in 31 apps, although only 18 of them were analysed for quality and 13 apps were excluded. Six different BCTs were identified: these were most commonly ‘prompts/cues’, and ‘information about health consequences’. All apps were shown to be of moderate quality (range 3.1–3.7/5). Inter-rater and intra-rater reliability for BCT and quality assessment were excellent. Conclusions The current availability of orthodontic apps of sufficient quality to recommend to patients is very limited. There is therefore a need for high-quality orthodontic apps with appropriate BCTs to be created, which may be utilised to improve patients’ compliance with treatment.

Understanding behaviour change to promote regular dental attendance

Regular dental attendance is a key oral health behaviour. Behaviour change interventions are increasingly being used to promote positive oral health behaviours. A systematic approach to understanding behaviour has led to the development of frameworks which aim to guide the process of designing behaviour change interventions. One such framework is the Behaviour Change Wheel (BCW). This article aims to explore and identify barriers to regular dental attendance which may be targeted using behaviour change interventions based on the Capability, Opportunity and Motivation Behaviour model (COM-B) and the BCW, and suggests potential behaviour change techniques which could be utilised into a behaviour change intervention with the aim to promote regular dental attendance.