Learning from the COVID-19 pandemic to combat climate change: comparing drivers of individual action in global crises

The COVID-19 pandemic and climate change are two global crises that require collective action. Yet, the inertia typically associated with behavior change to limit climate change stands in contrast to the speed associated with behavior change to stop the spread of COVID-19. Identifying the roots of these differences can help us stimulate climate-friendly behaviors. We assessed the extent to which a number of theory-based drivers underlie behaviors aiming to counter COVID-19 and climate change with an online survey (N = 534). We focused on the role of a number of drivers derived from prominent behavior change theories and meta-analyses in the field, namely, personal threat, threat to close others, threat to vulnerable others, fear, participative efficacy, injunctive and descriptive social norms, and governmental policy perceptions. We investigated (1) what drivers people perceived as most important to engage in behaviors that limit the spread of the COVID-19 pandemic and climate change and (2) the strength of the associations between these drivers and engaging in behaviors that limit the spread of the pandemic and climate change. Results highlight three key drivers for climate change action: changing perceptions of governmental policy and perceptions of threat to close others and priming participative efficacy beliefs.

Behavior change factors and retention in dietary interventions for older adults: scoping review

Background and Objectives Although poor diet is a major driver of morbidity and mortality in people 60 and older, few dietary interventions are widely implemented for this population. We mapped behavior change theories, agents, and techniques in dietary interventions for adults 60+ and explored relationships between these factors and ability to retain at least 80% of the study participants. Research Design and Methods We conducted a scoping review using MEDLINE, CINAHL, and Web of Science through April 2021 for dietary interventions in adults 60 and older. We collated, summarized, and calculated frequency distributions of behavior change theories, behavior change agents, and behavior change techniques (BCTs) using BCTv1 taxonomy with regard to participant retention across 43 studies. Results Only 49% and 30% of the studies reported behavior theory and change agents respectively. Of the studies reporting on theory and agents, the most common were social cognitive theory and the related mechanism of self-efficacy. The most common BCTv1 were “shaping knowledge” and “goals and planning.” Several BCTv1 such as “antecedents” and “reward and threat” and evidence for concordance between BCTs and change agents were more common in interventions with higher retention rates. Discussion and Implications Mechanistically concordant studies with BCTs that involve resource allocation and positive reinforcement through rewards may be advantageous for retention in dietary intervention for older adults. Future studies should continue developing theory and mechanism-oriented research. Furthermore, future studies should consider diversifying the portfolio of currently deployed BCTs and strengthening a concordance between BCTs and mechanisms of change.

The design, implementation, and effectiveness of intervention strategies aimed at improving genetic referral practices: a systematic review of the literature

Purpose Despite rapid advancements in genetics and genomics, referral practices remain suboptimal. This systematic review assesses the extent to which approaches from implementation science have been applied to address suboptimal genetic referral practices. Methods A search of MEDLINE, EMBASE, and PsycINFO generated 7,794 articles, of which 28 were included. Lay barriers were mapped to the Theoretical Domains Framework (TDF) and interventions mapped to behavior change techniques. Use of implementation and behavior change frameworks was assessed, and the Theory and Techniques Tool used to determine theoretical alignment. Results Knowledge was the most frequent retrospectively TDF-coded barrier, followed by environmental context and resources, and skills. Significant referral improvements occurred in 56% of studies. Among these, the most frequent interventions were clinical data review systems, family history collection and referral tools, and embedding genetics staff into nongenetic specialties. Few studies used implementation frameworks or reported implementation outcomes, though some deployed intuitive strategies that aligned with theory. Conclusion Genetic referral interventions are rarely informed by implementation and/or behavior change theories, limiting opportunities for learning across contexts. Retrospective coding has provided a suite of theoretically linked strategies, which may be useful for informing future efforts. Incorporating these strategies into clinical guidelines may facilitate operationalization within the system.

The necessity of examining patients’ social behavior and teaching behavior change theories: curricular innovations induced by the COVID-19 pandemic

During the COVID-19 pandemic, despite many widespread calls for social distancing, recommendations have not been followed by some people and the high rate of non-compliance has significantly affected lives all around the world. It seems that the rate of non-compliance with the recommendations among medical students has been as high as the rest of the other youth. In the time that students are removed from clinical environments and most physician teachers are strained in providing services to patients, medical students can be trained in interdisciplinary behavior change counseling programs and they can be employed in delivering virtual consultations to the patients referred to medical centers.In this quick review, we provide an argument regarding the importance of integrating the topic of patients’ social history into the undergraduate medical curriculum and the necessity of teaching theories of behavior change to medical students. Hypotheses are proposed that focus on the importance of integrating behavioral and social sciences into the medical curriculum and to teach theories or models of behavior change to students. Health professions educators can design and implement interventions to teach hypothesized models of behavioral change to medical students and evaluate the effectiveness of those interventions. The impacts of such educational interventions on increasing people’s compliance with recommendations to improve public health can be evaluated as well.

A Conceptual Model Map on Health and Nutrition Behavior (CMMHB/NB)

The Conceptual Model Map (CMM) presented here is intended to show the connections between different theories and constructs in the field of health and nutrition behavior (including literacy models, the knowledge–attitude(s)–practice(s) survey structure (KAP), behavior change theories, and Maslow’s pyramid of needs). The CMM can be used as a map to locate existing and future studies, to show their range of effect as well as their limitations. In this context, the CMM also reveals reasons for the attitude/intention–behavior gap.

Transtheoretical model-based nutritional interventions in adolescents: a systematic review

Background Literature has shown a tendency of inadequate dietary intake among youth, consequently, nutritional interventions are required. The transtheoretical model (TTM) classifies individuals based on their readiness to change. This model is widely used for health education interventions with proven efficacy. Purpose This review aimed to weigh the strength of evidence about the TTM usage in nutritional interventions for adolescents and its effectiveness regarding dietary intake. Methods This study followed the PRISMA guidelines. Eligible studies were input into Mendeley software. The Adolec, Google Scholar, LILACS, PsycINFO, PubMed, Science Direct and Web of Science databases were searched. Only full original articles written in English, Spanish or Portuguese on randomized controlled trials and quasi-experimental designs that applied the TTM in the design of nutritional interventions targeting adolescents were included, with no restrictions on publication date. The quality and risk of bias was evaluated with the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Results The initial search yielded 3779 results. Three studies were rated as strong, six as moderate and five as weak. The final sample of 14 articles included adolescents that were mostly recruited from schools, with interventions ranging from one month to three years. The TTM was used alone or combined with other behavior-change theories and most of the interventions involved digital technology. The nutritional topics covered included fruit and vegetable consumption, low-fat diet, and cooking skills. Four studies presented improvement in fruit and vegetable consumption and four progressed through stages of change. Participants from two interventions reduced fat intake. At the end of one intervention, all the participants were in action and maintenance stages. Conclusion The TTM seems to be a successful strategy for nutritional intervention aiming at improving dietary intake in adolescents. Its application in different contexts shows that the TTM is flexible and possible to be implemented in many settings. The use of the model is shown to be restricted to the stage of change’ construct. Further studies should use all constructs of the TTM in the design and compare the TTM with other behavior-change theories to better understand its effectiveness.

Enhancing Influenza Vaccination of Hospital Workers from 30% to 80% Through Application of Behavior Change Theories

Background: Historically, influenza vaccination coverage among Norwegian healthcare workers has been low. In 2014–2015 and 2015–2016 the national averages were 9% and 12%, respectively, Although the Fig.s for Oslo University Hospital were higher (30% in 2015–2016), we were still far from the goal of 75% set by the WHO. The same year, <10% of employees at Vestre Viken Hospital Trust were vaccinated. Before the 2016–2017 influenza season, we therefore launched a campaign using methods based on behavior change theories and social marketing to enhance vaccination coverage. Methods: In May–June 2016 a questionnaire was sent by e-mail to all employees at Oslo University Hospital (n = ~25,000) and Vestre Viken Hospital Trust (n = 9,000). The questionnaire was structured according to the theory of planned behavior, asking questions related to attitude, subjective norms, and perceived control. The respondents were asked to grade each answer from 1 to 5, and we could then calculate a score for each question based on the proportion (%) of respondents across the 5 grades. Thus a score between 0 and 500 was possible. We then selected the questions with the highest and lowest scores for intervention, and applied stages of change principles and social marketing for implementation. In May–June 2017, the same questionnaire was sent to all employees and the procedure was repeated before the 2017–2018 influenza season. Finally, for the third time, the procedure was repeated before the 2019–2020 season. This time some additional questions were added, about which sources the employees were using for information on influenza vaccination. Results: In 2017–2018 vaccination coverage increased from 30% to 54%. The year after we reached 73%, and at the time of abstract submission (November 12, 2019) we have passed 80% for the 2019–2020 season, still with more vaccines to be given. Among Norwegian healthcare workers, attitudes and perceived control seemed to have a stronger impact on behavior (vaccination) than subjective norms. Conclusions: We were able to significantly increase voluntary influenza vaccination, reaching the WHO goal of at least 75%, by the application of behavior change theories and social marketing.Funding: NoneDisclosure: Egil Lingaas, Salary - 3M Healthcare

Do Combinations of Behavior Change Techniques That Occur Frequently in Interventions Reflect Underlying Theory?

Background Behavioral interventions typically include multiple behavior change techniques (BCTs). The theory informing the selection of BCTs for an intervention may be stated explicitly or remain unreported, thus impeding the identification of links between theory and behavior change outcomes. Purpose This study aimed to identify groups of BCTs commonly occurring together in behavior change interventions and examine whether behavior change theories underlying these groups could be identified. Methods The study involved three phases: (a) a factor analysis to identify groups of co-occurring BCTs from 277 behavior change intervention reports; (b) examining expert consensus (n = 25) about links between BCT groups and behavioral theories; (c) a comparison of the expert-linked theories with theories explicitly mentioned by authors of the 277 intervention reports. Results Five groups of co-occurring BCTs (range: 3–13 BCTs per group) were identified through factor analysis. Experts agreed on five links (≥80% of experts), comprising three BCT groups and five behavior change theories. Four of the five BCT group–theory links agreed by experts were also stated by study authors in intervention reports using similar groups of BCTs. Conclusions It is possible to identify groups of BCTs frequently used together in interventions. Experts made shared inferences about behavior change theory underlying these BCT groups, suggesting that it may be possible to propose a theoretical basis for interventions where authors do not explicitly put forward a theory. These results advance our understanding of theory use in multicomponent interventions and build the evidence base for further understanding theory-based intervention development and evaluation.

Transtheoretical model-based nutritional interventions in adolescents: a systematic review

Background: Literature has shown a tendency of inadequate dietary intake among youth, consequently, nutritional interventions are required. The transtheoretical model (TTM) classifies individuals based on their readiness to change. This model is widely used for health education interventions with proven efficacy. Purpose: This review aimed to weigh the strength of evidence about the TTM usage in nutritional interventions for adolescents and its effectiveness regarding dietary intake.Methods: This study followed the PRISMA guidelines. Eligible studies were input into Mendeley software. The Adolec, Google Scholar, LILACS, PsycINFO, PubMed, Science Direct and Web of Science databases were searched. Only full original articles written in English, Spanish or Portuguese on randomized controlled trials and quasi-experimental designs that applied the TTM in the design of nutritional interventions targeting adolescents were included, with no restrictions on publication date. The quality and risk of bias was evaluated with the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies.Results: The initial search yielded 3779 results. Three studies were rated as strong, six as moderate and five as weak. The final sample of 14 articles included adolescents that were mostly recruited from schools, with interventions ranging from one month to three years. The TTM was used alone or combined with other behavior-change theories and most of the interventions involved digital technology. The nutritional topics covered included fruit and vegetable consumption, low-fat diet, and cooking skills. Four studies presented improvement in fruit and vegetable consumption and four progressed through stages of change. Participants from two interventions reduced fat intake. At the end of one intervention, all the participants were in action and maintenance stages. Conclusion: The TTM seems to be a successful strategy for nutritional intervention aiming at improving dietary intake in adolescents. Its application in different contexts shows that the TTM is flexible and possible to be implemented in many settings. The use of the model is shown to be restricted to the stage of change’ construct. Further studies should use all constructs of the TTM in the design and compare the TTM with other behavior-change theories to better understand its effectiveness.

Transtheoretical model-based nutritional interventions in adolescents: a systematic review

Background: Literature has shown a tendency of inadequate dietary intake among youth, consequently, nutritional interventions are required. The transtheoretical model (TTM) classifies individuals based on their readiness to change. This model is widely used for health education interventions with proven efficacy. Purpose: This review aimed to weigh the strength of evidence about the TTM usage in nutritional interventions for adolescents and its effectiveness regarding dietary intake.Methods: This study followed the PRISMA guidelines. Eligible studies were input into Mendeley software. The Adolec, Google Scholar, LILACS, PsycINFO, PubMed, Science Direct and Web of Science databases were searched. Only full original articles written in English, Spanish or Portuguese on randomized controlled trials and quasi-experimental designs that applied the TTM in the design of nutritional interventions targeting adolescents were included, with no restrictions on publication date. The quality and risk of bias was evaluated with the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies.Results: The initial search yielded 3779 results. Three studies were rated as strong, six as moderate and five as weak. The final sample of 14 articles included adolescents that were mostly recruited from schools, with interventions ranging from one month to three years. The TTM was used alone or combined with other behavior-change theories and most of the interventions involved digital technology. The nutritional topics covered included fruit and vegetable consumption, low-fat diet, and cooking skills. Four studies presented improvement in fruit and vegetable consumption and four progressed through stages of change. Participants from two interventions reduced fat intake. At the end of one intervention, all the participants were in action and maintenance stages. Conclusion: The TTM seems to be a successful strategy for nutritional intervention aiming at improving dietary intake in adolescents. Its application in different contexts shows that the TTM is flexible and possible to be implemented in many settings. The use of the model is shown to be restricted to the stage of change’ construct. Further studies should use all constructs of the TTM in the design and compare the TTM with other behavior-change theories to better understand its effectiveness.