A machine learning analysis of the relationship of demographics and social gathering attendance from 41 countries during pandemic

Knowing who to target with certain messages is the prerequisite of efficient public health campaigns during pandemics. Using the COVID-19 pandemic situation, we explored which facets of the society—defined by age, gender, income, and education levels—are the most likely to visit social gatherings and aggravate the spread of a disease. Analyzing the reported behavior of 87,169 individuals from 41 countries, we found that in the majority of the countries, the proportion of social gathering-goers was higher in male than female, younger than older, lower-educated than higher educated, and low-income than high-income subgroups of the populations. However, the data showed noteworthy heterogeneity between the countries warranting against generalizing from one country to another. The analysis also revealed that relative to other demographic factors, income was the strongest predictor of avoidance of social gatherings followed by age, education, and gender. Although the observed strength of these associations was relatively small, we argue that incorporating demographic-based segmentation into public health campaigns can increase the efficiency of campaigns with an important caveat: the exploration of these associations needs to be done on a country level before using the information to target populations in behavior change interventions.

“Sometimes You Get Good Ones, and Sometimes You Get Not-so-Good Ones”: Vendors’ and Consumers’ Strategies to Identify and Mitigate Food Safety Risks in Urban Nigeria

This paper uses detailed data from in-depth interviews with consumers (n = 47) and vendors (n = 37) in three traditional markets in Birnin Kebbi, Nigeria. We used observations from those markets to examine how consumers and vendors identify and avoid or manage food safety risks and whom they hold responsible and trust when it comes to ensuring food safety. At the level of the vendor, consumers mentioned seeking “clean” or “neat” vendors or stalls. Cleanliness was primarily related to the appearance of the vendor, stall, and surroundings; reliance on trusted, known vendors was also noted. Food products themselves were largely evaluated based on visual cues: insects, holes, and colors—with some reliance on smell, also. Similarly, vendors assessed safety of food from suppliers based on a visual assessment or reliance on trusted relationships. On the second research question, both consumers and vendors largely placed responsibility for ensuring food safety on government; when asked specifically, consumers also named specific steps that vendors could take to ensure food safety. Consumers and vendors also generally felt that they could limit many food safety risks through identifying the “good” products in the market or from suppliers. The paper discusses the implications of these results for behavior change interventions.

Effective Techniques in Coronary Heart Disease Interventions: A meta-analysis (Preprint)

BACKGROUND Coronary heart disease (CHD) is a major cause of death worldwide. OBJECTIVE In this research, we investigated the effectiveness of digital interventions designed for the prevention and management of CHD. METHODS We searched three academic databases for scientific papers on CHD and digital interventions from 2004 to 2020, yielding 1706 papers and 1556 papers after deduplication. We further screened the titles and abstracts, excluding irrelevant papers, leaving 28 papers. A further nine papers were retrieved and included in the analysis through forward and backward referencing. We conducted meta-analysis using 13 of the 37 papers that fit the criteria for meta-analysis. We identified and classified intervention features using the Persuasive Systems Design model. Our findings show that digital health interventions had an impact on all clinical outcomes except Body Mass Index. RESULTS We present (1) intervention features that were associated with positive clinical outcomes, and (2) successful and unsuccessful interventions and the persuasive software features incorporated in them. Reminders, verifiability, social role, expertise, authority, tailoring, personalization, self-monitoring, praise, suggestion, and social learning principles were incorporated in interventions that succeeded in improving clinical outcomes. CONCLUSIONS Our research provides insights into persuasive software features that maintain powers to influence the effectiveness of CHD behavior change interventions.

Understanding Farmers' Behavior and Their Decision-Making Process in the Context of Cattle Diseases: A Review of Theories and Approaches

Understanding farmers' behavior regarding disease control is essential to successfully implement behavior change interventions that improve uptake of best practices. A literature review was conducted to identify theoretical underpinnings, analytical methodologies, and key behavioral determinants that have been described to understand farmers' behavior in disease control and prevention on cattle farms. Overall, 166 peer-reviewed manuscripts from studies conducted in 27 countries were identified. In the past decade, there were increasing reports on farmers' motivators and barriers, but no indication of application of appropriate social science methods. Furthermore, the majority (58%) of reviewed studies lacked a theoretical framework in their study design. However, when a theoretical underpinning was applied, the Theory of Planned Behavior was most commonly used (14% of total). The complexity of factors impacting farmers' behavior was illustrated when mapping all described key constructs of the reviewed papers in behavior change frameworks, such as the socioecological framework and the Capability, Opportunity and Motivation Behavior (COM-B) model. Constructs related to personal influences and relationships between farmers and veterinarians were overrepresented, whereas constructs related to other interpersonal and contextual environments were not extensively studied. There was a general lack of use of validated scales to measure constructs and empirically validated theoretical frameworks to understand and predict farmers' behavior. Furthermore, studies mainly focused on measurements of intention of stakeholder behavior rather than actual behavior, although the former is a poor predictor of the latter. Finally, there is still a lack of robust evidence of behavior change interventions or techniques that result in a successful change in farmers' behavior. We concluded that for a sustainable behavior change, studies should include wider constructs at individual, interpersonal, and contextual levels. Furthermore, the use of empirically validated constructs and theoretical frameworks is encouraged. By using coherent frameworks, researchers could link constructs to design interventions, and thereby take the first step toward theory-driven, evidence-based interventions to influence farmers' behavior for disease control.

Hand Washing and Related Cognitions Following a Brief Behavior Change Intervention During the COVID-19 Pandemic: a Pre-Post Analysis

Background Effective hand washing (for at least 20 s, with water and soap) is one of the health behaviors protecting against infection transmissions. Behavior change interventions supporting the initiation and maintenance of hand washing are crucial to prevent infection transmissions. Based on the Health Action Process Approach, the aim of this research was to conduct a pre-post analysis of hand washing and related cognitions (i.e., intention, self-efficacy, self-monitoring), measured up to 100 days following an intervention. Methods A convenience sample of N = 123 participants (age: M = 23.96 years; SD = 5.82; 80% women) received a brief intervention (key behavior change techniques: information about health consequences of hand washing; action planning) and responded to daily diaries and questionnaires up to a 100-day follow-up. Two-level models were used to analyze data of n = 89 participants who provided longitudinal data. Results Hand washing and self-monitoring increased, whereas intention and self-efficacy decreased over time. Only self-monitoring was a consistent positive correlate of hand washing on a between-person level. Conclusions Hand washing and self-monitoring considerably increased over several weeks following the intervention. Future research testing the intervention against a control condition is needed to rule out that changes in behavior and cognitions might have been prompted by completing the daily diaries. Trial Registration German Clinical Trials Register; https://www.drks.de; registration number: DRKS00022067.

#LetsUnlitterUK: A demonstration and evaluation of the Behavior Change Wheel methodology

The Behavior Change Wheel is the most comprehensive and practically useful methodology available for developing behavior change interventions. The current article demonstrates how it can be applied to optimize pro-environmental behaviors and, in so doing, give interventionists access to a rigorous set of theories and techniques for systematically developing pro-environmental interventions. Section 1 describes the development of an intervention to increase people’s intentions to post anti-littering messages on social media. Study 2 describes the development and evaluation of an intervention to increase people’s actual anti-littering posts. Both evaluations are randomized controlled trials that compare the effectiveness of the developed intervention with interventions less informed by the Wheel. We found interventions completely informed by the Wheel to be more effective than interventions less (or not at all) informed by the Wheel. The discussion explores how the Behavior Change Wheel methodology can be used to design future pro-environment interventions.

Let’s build an app for that

The promotion of physical activity behavior change among adults with cancer is a research priority. Within this field, increasing attention is being devoted to the use of health technology, which includes mobile phones and applications, or apps, to support and deliver physical activity behavior change interventions. While building a mobile app is a popular proposal among exercise oncology researchers, little practical information exists on how this process should be done or what considerations researchers should take in collaboration with participants and industry. The present article provides an overview of recent experiences with app development in exercise oncology and outlines several recommendations for future research. Methods and Results: After forming an interdisciplinary team of researchers, industry partners, and exercise oncology program participants, an iterative, user-centered app improvement process was followed to collect feedback and make meaningful changes to an existing mobile health app for its use in exercise oncology. Participant feedback was summarized and addressed collaboratively via open discussion and detailed action plans. Changes made include enhanced introductory materials for the app and improvements to usability and personalization. Some requests remain to be addressed in future updates. Two challenges identified during the app improvement process were balancing the unique needs and priorities of all parties, as well as addressing the variable feedback from a variable population of adults with cancer. Conclusions and significance: A multidisciplinary participant-oriented app improvement process led to meaningful updates to the mobile application of interest, preparing researchers to carry out an evaluation of its effectiveness within exercise oncology. Furthermore, based on lessons learned, the research team present key recommendations to consider in future mobile app research before, during, and after the development process.

Participatory Development and Pilot Testing of an Adolescent Health Promotion Chatbot

Background: The use of chatbots may increase engagement with digital behavior change interventions in youth by providing human-like interaction. Following a Person-Based Approach (PBA), integrating user preferences in digital tool development is crucial for engagement, whereas information on youth preferences for health chatbots is currently limited.Objective: The aim of this study was to gain an in-depth understanding of adolescents' expectations and preferences for health chatbots and describe the systematic development of a health promotion chatbot.Methods: Three studies in three different stages of PBA were conducted: (1) a qualitative focus group study (n = 36), (2) log data analysis during pretesting (n = 6), and (3) a mixed-method pilot testing (n = 73).Results: Confidentiality, connection to youth culture, and preferences when referring to other sources were important aspects for youth in chatbots. Youth also wanted a chatbot to provide small talk and broader support (e.g., technical support with the tool) rather than specifically in relation to health behaviors. Despite the meticulous approach of PBA, user engagement with the developed chatbot was modest.Conclusion: This study highlights that conducting formative research at different stages is an added value and that adolescents have different chatbot preferences than adults. Further improvement to build an engaging chatbot for youth may stem from using living databases.

Nudges as Behavior Change Interventions to Improve Health and Well-Being. Protocol for a scoping review (Preprint)

UNSTRUCTURED Objective Our objective is to map and summarize the evidence on nudges that assess behavior change interventions to improve health and well-being. Design This is the protocol for a scoping review Data source A comprehensive search will be conducted on Cochrane database of systematic reviews (CDSR); Database of Abstracts of Reviews of Effectiveness (DARE); HTA Database; PubMed; LILACS; CINAHL; PsyclNFO; EMBASE; EPPI-Centre Evidence Library; WHO institutional Repository for information Sharing; NICE public health guidelines and systematic reviews; through an advanced search in the Epistemonikos platform. The search will cover the period until the day before this protocol is submitted to a journal. Eligibility criteria for study selection and methods Only systematic reviews (SR) will be included, which are operationally defined as any secondary research that includes only primary clinical studies, with the above search strategy applied in at least two databases that have assessed the use of nudges related to health, including SR of broader scope. Primary studies, clinical practice guides, abstracts and other evidence summary designs will be excluded. The electronic search results will be added according to the inclusion criteria. This manuscript will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) [10] Ethics and Dissemination Ethical approval is deemed unnecessary. The results of this review will be widely disseminated through peer reviewed publications, social networks and traditional media.

Psychoeducational Messaging to Reduce Alcohol Use for College Students With Type 1 Diabetes: Internet-Delivered Pilot Trial

Background College environments promote high-volume or binge alcohol consumption among youth, which may be especially harmful to those with type 1 diabetes (T1D). Little is known about the acceptability and effectiveness of interventions targeting reduced alcohol use by college students with T1D, and it is unclear whether intervention framing (specifically, the narrator of intervention messages) matters with respect to affecting behavior change. Interventions promoted by peer educators may be highly relatable and socially persuasive, whereas those delivered by clinical providers may be highly credible and motivating. Objective The aim of this study is to determine the acceptability and impacts of an alcohol use psychoeducational intervention delivered asynchronously through web-based channels to college students with T1D. The secondary aim is to compare the impacts of two competing versions of the intervention that differed by narrator (peer vs clinician). Methods We recruited 138 college students (aged 17-25 years) with T1D through web-based channels and delivered a brief intervention to participants randomly assigned to 1 of 2 versions that differed only with respect to the audiovisually recorded narrator. We assessed the impacts of the exposure to the intervention overall and by group, comparing the levels of alcohol- and diabetes-related knowledge, perceptions, and use among baseline, immediately after the intervention, and 2 weeks after intervention delivery. Results Of the 138 enrolled participants, 122 (88.4%) completed all follow-up assessments; the participants were predominantly women (98/122, 80.3%), were White non-Hispanic (102/122, 83.6%), and had consumed alcohol in the past year (101/122, 82.8%). Both arms saw significant postintervention gains in the knowledge of alcohol’s impacts on diabetes-related factors, health-protecting attitudes toward drinking, and concerns about drinking. All participants reported significant decreases in binge drinking 2 weeks after the intervention (21.3%; odds ratio 0.48, 95% CI 0.31-0.75) compared with the 2 weeks before the intervention (43/122, 35.2%). Changes in binge drinking after the intervention were affected by changes in concerns about alcohol use and T1D. Those who viewed the provider narrator were significantly more likely to rate their narrator as knowledgeable and trustworthy; there were no other significant differences in intervention effects by the narrator. Conclusions The intervention model was highly acceptable and effective at reducing self-reported binge drinking at follow-up, offering the potential for broad dissemination and reach given the web-based format and contactless, on-demand content. Both intervention narrators increased knowledge, improved health-protecting attitudes, and increased concerns regarding alcohol use. The participants’ perceptions of expertise and credibility differed by narrator. Trial Registration ClinicalTrials.gov NCT02883829; https://clinicaltrials.gov/ct2/show/NCT02883829 International Registered Report Identifier (IRRID) RR2-10.1177/1932296819839503