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Background: Telephone support services are a viable means of providing population-level support to reduce health risk behaviours. While research exists on the effectiveness of Quitlines to reduce smoking, there is limited other research investigating whether telephone services can provide effective behaviour change support for people with a mental health condition for behaviours including physical activity, healthy eating, and weight management. The aims of this trial were to evaluate the effectiveness of referral of people with a mental health condition to a population-level telephone coaching service to improve health risk behaviours and increase attempts to do so. Methods: A parallel-group randomised controlled trial was conducted. Participants with a mental health condition (N = 681) were assigned to a control (health information pack) or intervention group (information pack and referral by the research team to a coaching program). Data were collected via telephone surveys at baseline and six months post-recruitment. Primary outcomes were: (1) weekly minutes of moderate-to-vigorous physical activity, (2) daily fruit serves, (3) daily vegetable serves, and (4) attempted behaviour change/weight loss (yes/no; composite measure). Secondary outcomes included weight, Body Mass Index (BMI), and attempts to change each health behaviour individually. Results: Intention-to-treat analyses found no significant differential change between groups from baseline to six months for primary or secondary outcomes. By follow-up, 242/549 (44%) of intervention participants had enrolled in coaching and completed at least one call, with 16/242 having completed the program, 79 ongoing, and 147 withdrawn. Per-protocol analyses found attempting to improve at least one health behaviour/lose weight was significantly greater in enrolees (OR = 3.7, 95% CI 1.03—13.23) than the control group. Conclusions: Referral to the program did not improve risk behaviours or weight/BMI but did support behaviour change attempts. Contributing factors may include low program completion by follow-up and impact of COVID-19. Further research is required to better understand participation in and benefits of telephone coaching services for people with a mental health condition. Trial registration: Registered retrospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12620000351910). [ABSTRACT FROM AUTHOR]

Background: Behaviour change interventions delivered in real-world settings could be vulnerable to threats to internal and external validity if methodological considerations are overlooked. The primary dental care setting is a difficult environment within which to deliver research protocols presenting unique challenges for robust scientific research delivery. Intervention fidelity strategies are an important mechanism to improve the scientific rigor of such studies. Feasibility studies provide a vital opportunity to refine and optimise research processes and implementation strategies before embarking on larger scale projects. This paper sets out the development of a comprehensive intervention fidelity strategy guided by The National Institutes of Health Behavior Change Consortium.(BCC) recommendations. Method: Using observations (53 h) and qualitative interviews (17 patient interviews and 2 staff interviews) conducted during the delivery of the RETURN feasibility study (InteRventions to rEduce inequaliTies in the Uptake of Routine deNtal care), an intervention fidelity strategy was developed for use in the RETURN main trial. Results: A comprehensive intervention fidelity strategy was developed, structured around the five domains of the BCC's recommendations (design, training, delivery, receipt, enactment) and attending to the goals pertaining to each of those domains. This paper sets out the fidelity strategy implemented in the RETURN main trial. Implications and conclusions: The RETURN fidelity strategy was influenced by the unique research environment the primary dental care setting presents. The strategy could serve as a blueprint to other researchers conducting research in similar settings. It is also intended that this strategy is read alongside the RETURN results upon their publication. Trial registration: ISRCTN10853330, registered: 07/10/2019. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes (T2D) is up to three times more common in people of Black African and Black Caribbean heritage living in the UK, compared to their White British counterparts. Structured education is the cornerstone of care but is less successful for people from minority ethnic groups. Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) was developed to support diabetes self-management in people of Black African and Caribbean heritage living with T2D in the UK. The intervention was designed using COM-B/behaviour change wheel methodology to specify the theory of change. In a process evaluation study, we explored how the selected behaviour change techniques (BCTs) supported behaviour change in the intervention. Methods: Focus groups and interviews were conducted with participants who were randomised to receive the HEAL-D intervention in a feasibility trial. A topic guide directed discussions to explore experiences of HEAL-D, key learnings and impact, and behaviour change; the interviews gave the opportunity to probe further the focus group themes and areas requiring clarification. Sessions were audio-recorded and transcribed. Framework analysis was used to explore how the selected BCTs supported behaviour change in those attending HEAL-D. Results: Thirty-six participants took part in one or both activities (44% Black African, 50% Black Caribbean, 6% Mixed race; 61% female, 83% first-generation; mean age 59.5 years, SD 10.02). Participants reported increased physical activity, reduced carbohydrate portion size and engagement in weight monitoring behaviour. BCTs to increase social opportunity (social comparison, social support) and overcome motivational barriers (credible sources and modelling) were effective in addressing cultural barriers relating to diet, stigma and health beliefs. BCTs to develop capability (demonstration, instruction, information on health consequences) were effective because of the cultural salience of the developed components. Less impactful BCTs were problem solving, graded tasks, goal setting, and feedback on outcomes. Conclusions: BCTs in the HEAL-D intervention were effective in supporting behaviour change, particularly those promoting social opportunity, as normative cultural habits and beliefs can conflict with diabetes self-management guidance. In addition, lifestyle interventions should include opportunity for experiential learning alongside culturally salient information provision. Trial registration: number: NCT03531177, May 18th 2018. [ABSTRACT FROM AUTHOR]

Background: Performance management (PM) systems in healthcare consist of many interacting interventions, such as contracts, scorecards and incentives. The diversity, complexity and poor description of PM interventions hampers replication in research, standardized comparative analysis and accumulation of evidence. Specifying PM systems and interventions in terms of their behaviour change techniques (BCTs) using standardized language can address these challenges and clarify the mechanisms linking system-level PM with individual behaviours. Methods: We conducted an analysis of BCTs in a PM system in Ontario, Canada using a modified behaviour change technique taxonomy (BCTT). We reviewed 64 documents, observed 15 meetings and conducted 4 semi-structured interviews with key informants to map the PM interventions on to the taxonomy. Results: We identified 54 BCTs spanning 13 taxonomy domains in the PM system. BCTs were concentrated in four domains: (1) goals and planning, (2) reward and threat, (3) feedback and monitoring and (4) identity. The BCTs coded most often included: (1) discrepancy between current behaviour and goal, (2) feedback on outcome(s) of behaviour, (3) social comparison and (4) social incentive/reward. These BCTs suggest that this PM system seeks to change behaviour primarily by directing programme attention to their current performance in relation to the target and in relation to other programs across the province, and by acknowledging good performance with praise or recognition. A total of five PM interventions accounted for 58% of identified BCTs – the scorecard, quarterly performance review reports, quarterly performance review meetings, escalation letter for poor or declining performance and the improvement action plan. Conclusions: The results provide a unique analytical and evaluative characterization of the PM system, revealing how a behaviour-change lens on health systems PM can support the (re)design, standardized comparison, and evaluation of PM systems in research and in practice. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONLow back pain (LBP) poses global health management and economic challenges. Self-management of LBP is critical, and smartphone apps have great potential to facilitate LBP self-management. This study aimed to co-design a LBP Self-Management App Review Tool (LBP-SMART) for consumers to assess the quality, behaviour change and self-management potential of LBP self-management apps for LBP rehabilitation.Two-phase prospective cross-sectional design. Consumers and health professionals participated in four online co-design workshops, underpinned by the Co-KT framework, to develop a consumer-level assessment tool for LBP self-management smartphone apps. User evaluation of the tool (LBP-SMART) was then undertaken.Four stakeholders (consumers n = 2, health professionals n = 2) with the guidance of researchers (n = 3) participated in the workshops. The LBP-SMART was developed, consisting of seven categories: 1)Safety; 2)Download process; 3)Look, function and feel; 4)Customisation; 5)Goals and self-monitoring; 6)Enabling sharing and 7)Additional features. Five additional participants undertook user evaluation. All reported that the tool was easy to use/understand, and the order/sequencing was appropriate. The LBP-SMART has content validity based on evidence, stakeholder and expert views.The LBP-SMART guides consumers and health professionals on appropriate app choice with quality, and self-management and behaviour change potential features that may improve LBP rehabilitation outcomes.Low back pain (LBP) poses global health management, rehabilitation and economic challenges.Self-management of LBP is critical, and smartphone apps have great potential to facilitate LBP rehabilitation via self-management.The LBP-SMART guides consumers to choose apps with appropriate quality, and self-management and behaviour change potential features that may improve their LBP rehabilitation outcomes.The tool also may provide a guide for health professionals working with people with LBP to offer an alternative rehabilitation option.Low back pain (LBP) poses global health management, rehabilitation and economic challenges.Self-management of LBP is critical, and smartphone apps have great potential to facilitate LBP rehabilitation via self-management.The LBP-SMART guides consumers to choose apps with appropriate quality, and self-management and behaviour change potential features that may improve their LBP rehabilitation outcomes.The tool also may provide a guide for health professionals working with people with LBP to offer an alternative rehabilitation option. [ABSTRACT FROM AUTHOR]

Introduction Prehabilitation aims to improve physiological reserve and psychological resilience, enabling patients to better tolerate the physiological stress of major surgery, thereby reducing the risk of complications and improving surgical outcomes. In this review, we provide an update of the development of prehabilitation in patients having cancer surgery. Methods We searched databases of peer-reviewed research to identify appropriate papers. Keywords comprised 'prehabilitation', 'cancer surgery' and associated synonyms (prehab; pre-operative rehabilitation; cancer). The results were combined with articles identified by reviewing the references of key papers and the use of the grey literature to develop our discussion. Results We detail the different elements of prehabilitation (exercise, nutrition, psychological support) relevant to patients with cancer undergoing surgery, focusing on the recent evidence base and ongoing challenges. Within this, we consider the role of behaviour change in enabling patients to undertake prehabilitation interventions and reflect on the different models of prehabilitation that have been utilised. Facilitators and barriers to implementation of prehabilitation are explored. Key findings include positioning prehabilitation as an integral part of the oncological surgical pathway which includes, but is discrete from, medical optimisation. Discussion Prehabilitation has the potential to improve surgical outcomes for patients undergoing cancer surgery. Further evidence is needed to understand how and what we provide to patients as optimal exercise, nutrition and psychological interventions as part of their surgical care, and how we improve long-term lifestyle using behaviour change methodology. Digital technology offers the opportunity for scaling and greater personalisation of prehabilitation but needs to be deliberately fashioned to ensure equitable access. [ABSTRACT FROM AUTHOR]

Objective: Lifestyle is an important determinant of health. The Live Well intervention allows mental health clinicians to address lifestyle during routine mental health encounters. Method: Clinicians were taught how to encourage consumers to learn more about lifestyle and health; consider their own lifestyle and health using a self-rated health and wellness questionnaire (HAWQ) and helped them decide which out of six health domains (physical, mental and social activity, healthy eating, mental wellbeing and positive thinking) should be improved in small, sustainable steps using a SMART (specific, measurable, achievable, relevant and timed) goal-setting template. Results: Out of 65 enrolled consumers, 52 completed pre-intervention, 6-week and 12-week post-assessment assessments. There were improvements in all self-rated health domains except for heathy eating. At 12-week, consumers also recorded significant satisfaction with the Live Well program, goal achievement and wellbeing. Clinicians' feedback was positive about using this intervention with their consumers. Conclusions: Live Well is a feasible and effective way to engage consumers on positive lifestyle changes in routine mental health care encounters. [ABSTRACT FROM AUTHOR]

Introduction: Traditional approaches to supporting older adults in adopting and maintaining an active lifestyle have largely failed. The previously proposed "Staircase Approach" offers a new foundation for developing interventions and public health strategies; this approach includes Step 1 (changing sedentary behaviour) and Steps 2 to 4 (incorporating more physical activity of increasing levels of intensity). In this systematic search and review, we aimed to inform the co-creation of a novel Staircase Approach intervention for community-dwelling, inactive older adults, primarily focussed on Step 1. Methods: A systematic search was performed across six databases (MEDLINE, PsycInfo, CINAHL, Cochrane CENTRAL, SPORTDiscus and Scopus). Results: After duplicates were removed, 3427 titles and abstracts were screened. Fourteen articles (including 17 intervention groups) were included after full-text review. Five were randomized controlled trials, three compared two interventions and six were single-arm studies. Sample sizes ranged from 9 to 176 participants, and included 617 older adults at baseline. Mean age of samples ranged from 64.3 (standard deviation [SD] 3.8) to 85.1 (SD 6.2) years, while the intervention length ranged from less than one day to 6 months. Sedentary time interventions are well accepted; most studies had completion rates above 80%. Based on findings from within-group comparisons, half of the studies showed a reduction in sedentary time (6/12 groups) and half showed an increase in physical activity (6/12 groups). Based on findings from between-group comparisons, 2 out of 5 intervention groups showed improvements in sitting time and physical activity outcomes compared to controls. Satisfaction and adherence to interventions were generally high. Conclusion: Sedentary time interventions for older adults show promise and point to several components that may be included in an intervention focussed on Step 1 of the Staircase Approach. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to investigate perceived determinants of physical activity (PA) maintenance following supervised exercise oncology rehabilitation and the acceptability of a remote coaching intervention during this period. Methods: A phenomenological qualitative study with semi-structured interviews was conducted. Nineteen participants (16 women, 3 men) were recruited from the intervention (n = 12) and control group (n = 7) of a randomized controlled trial on the effectiveness of remote coaching following hospital-based, supervised exercise oncology rehabilitation. Participants in the intervention group received a 6-month remote coaching intervention after completing the exercise program, aimed at stimulating PA maintenance. The interviews were based on the Capability, Opportunity, and Motivation model of Behaviour (COM-B model) and the framework of acceptability (TFA) and were coded using template analysis. Results: Key themes regarding determinants of PA maintenance were self-efficacy, PA habits, accountability, physical complaints, and facilities. Remote coaching was perceived acceptable because it stimulated PA maintenance by offering a source of structure and social support and thereby increased accountability. Moreover, it improved confidence to perform PA, leading to increased levels of self-efficacy. The remote nature of the intervention was perceived as convenient by some of the participants, while others would have preferred additional physical appointments. Conclusions: Cancer survivors considered remote coaching acceptable to stimulate PA maintenance following supervised rehabilitation. Interventions should focus on increasing accountability, self-efficacy, forming habits, and helping cancer survivors to overcome barriers. Implications for Cancer Survivors: The ability to maintain PA beyond supervised exercise oncology programs depends on many determinants. Remote coaching interventions have potential to target individually relevant determinants following exercise programs in cancer survivors. [ABSTRACT FROM AUTHOR]

AbstractSuicide is a complex phenomenon because in addition to the individual who is impacted, its effects seep into many lives including caregivers of the individual experiencing suicidal thoughts and those who die by suicide. Often, caregivers seek help everywhere, but face various challenges including long wait times, difficulty accessing resources quickly, personal struggles with mental health, and time sensitivity. Mobile-health interventions are a promising solution for this, as they are easily accessible, available, geographic location independent and affordable. Many mobile apps for suicide prevention exist. However, not much is known about their design and efficacy, and if these apps address the unique mental health needs of caregivers dealing with suicidal individuals. To address these gaps, we designed LifeLink, a persuasive mobile application (app) specifically for supporting caregivers of individuals experiencing suicidal thoughts. Firstly, we reviewed 25 studies to determine risk factors that are most strongly associated with suicide and considerations for developing technological interventions for suicide prevention. Secondly, we reviewed 80 suicide prevention apps from app stores and academic literature to identify gaps and different persuasive strategies’ implementations using the Persuasive System Design (PSD) model. Thirdly, using the findings from the two systematic reviews, we designed a low-fidelity prototype of LifeLink app, implementing various evidence-based persuasive strategies. Next, using a user-centered design approach, 45 caregivers evaluated the user experience of LifeLink. Finally, we conducted a survey and semi-structured interviews to understand caregivers’ needs when supporting an individual, their assessment of perceived persuasiveness of the app and implemented strategies. Our results reveal that all the persuasive strategies were effective and significantly persuasive. LifeLink was found to be easy to use, engaging, useful, easy to navigate, elicited positive user experience, was helpful and impactful for caregivers. We also conducted a thematic analysis of participants’ qualitative feedback to uncover more insights. Findings from our evaluation demonstrate the potential of LifeLink as a valuable tool for caregivers that can increase mental health literacy and foster a supportive environment. [ABSTRACT FROM AUTHOR]

Background: The 'Ottawa Depression Algorithm' is an evidence-based online tool developed to support primary care professionals care for adults with depression. Uptake of such tools require provider behaviour change. Identifying issues which may impact use of an innovation in routine practice (i.e. barriers to and enablers of behaviour change) informs the selection of implementation strategies that can be deployed with the tool to support use. However, established theory-informed barriers/enablers assessment methods may be less well suited to identifying issues with tool usability. User testing methods can help to determine whether the tool itself is optimally designed. We aimed to integrate these two methodological approaches to i) identify issues impacting the usability of algorithm; and ii) identify barriers to and enablers of algorithm use in routine practice. Methods: We conducted semi-structured interviews with primary care professionals in Ottawa, Canada. To evaluate usability, participants used a written patient scenario to work through the algorithm while verbalizing their thoughts ('Think Aloud'). Participants were then asked about factors influencing algorithm use in routine practice (informed by the Theoretical Domains Framework). We used the codebook approach to thematic analysis to assign statements to pre-specified codes and develop themes pertaining to usability and routine use. Results: We interviewed 20 professionals from seven practices. Usability issues were summarised within five themes: Optimizing content and flow to align with issues faced in practice, Enhancing the most useful algorithm components, Interactivity of the algorithm and embedded tools, Clarity of presence, purpose, or function of components, and Navigational challenges and functionality of links. Barriers to and enablers of routine use were summarised within five themes: Getting to know the algorithm, Alignment with roles and pathways of influence, Integration with current ways of working, Contexts for use, and Anticipated benefits and concerns about patient communication. Conclusions: Whilst the Ottawa Depression Algorithm was viewed as a useful tool, specific usability issues and barriers to use were identified. Supplementing a theory-based barriers/enablers assessment with usability testing provided enhanced insights to inform optimization and implementation of this clinical tool. We have provided a methods guide for others who may wish to apply this approach. [ABSTRACT FROM AUTHOR]

Background: The beneficial role of physical activity for people living with cancer is well established. However, the importance of physical activity to women living with metastatic breast cancer is not known. As motivations and perceptions around physical activity influence behavioural uptake, a qualitative study was undertaken to explore the motivations and perceptions towards physical activity of this group. Methods: Women living with metastatic breast cancer were recruited through a metropolitan cancer centre in Australia to participate in semi-structured interviews about their physical activity. Open-ended questions explored health-specific factors, goals, barriers, enablers, and interests. Interviews were recorded, transcribed and thematically analysed. Results: Twenty-three women participated; median age was 60 years (IQR: 20) and median time since metastatic diagnosis was 3.3 years (IQR: 3.0). Twelve women were engaged with physical activity, seven reported intentions to be active but found it challenging, and four reported nominal interest in physical activity. Four categories, covering nine themes, were identified: (i) predispositions towards physical activity, incorporating themes on enjoyment and energy, and positivity and mental resilience; (ii) health-related motivations behind physical activity, incorporating themes on physical and mental health benefits; (iii) social motivations behind physical activity, incorporating themes on enjoying exercise with others, role models and social support, and others' negative perceptions of metastatic breast cancer; and (iv) connections between physical activity and metastatic breast cancer, incorporating themes on prognosis uncertainty, and reframing limiting perceptions. Conclusions: Participants described a wide-ranging spectrum of experiences and perceptions toward physical activity. Whilst most women perceived improved physical and mental well-being from being physically active, some women were not engaged in being physically active. Behaviour change strategies that target both their attitudes and those around them may address this gap. [ABSTRACT FROM AUTHOR]

Background: Understanding ethnic differences in factors influencing healthy lifestyles postpartum is vital for informing effective lifestyle engagement strategies for women from specific ethnic groups. We aimed to explore ethnic differences in facilitators and barriers to lifestyle management among women after childbirth. Methods: In this multi-methods study, women within 5 years of childbirth in Australia were recruited in a cross-sectional survey (n = 478) and semi-structured interviews (n = 17). Ethnicity was categorised as Oceanian, Asian and Other, according to the Australian Bureau of Statistics. Chi-square tests were used to compare the survey responses between groups. Qualitative data were thematically analysed, with identified themes mapped to the Theoretical Domains Framework (TDF) and Capability, Opportunity, Motivation and Behaviour (COM-B) model. Results: Both Oceanian and Asian women had a range of facilitators and barriers to lifestyle management relating to capability (e.g., knowledge of a healthy lifestyle), opportunity (e.g., time availability) and motivation (e.g., enjoyment in exercise). However, Asian women were more likely to report knowing the importance of a healthy lifestyle (p = 0.026), having better practical skills (p = 0.004), having a flexible work arrangement (p = 0.008) and being able to access a conducive environment (p = 0.040) as important factors to maintain a healthy lifestyle, compared with Oceanian women. In addition, Asian women suggested a need to address cultural barriers around parenting and postpartum practices. Conclusions: Asian women encountered additional barriers to lifestyle management after childbirth compared with Oceanian women. Future interventions should integrate strategies corresponding to these challenges to improve lifestyle engagement in Asian women. [ABSTRACT FROM AUTHOR]

Background: Women living with metastatic breast cancer can benefit from physical activity. Presently, there is an absence of research outside of quantitative investigations on the benefits of structured programs. To enable effective physical activity advice and services, it is important to understand factors that may facilitate or prevent engagement. We therefore explored with women with metastatic breast cancer: (i) personal and behavioural factors that influenced physical activity, and (ii) the role of healthcare services in influencing engagement in being physically active. Methods: Recruitment took place at a metropolitan cancer centre from November 2019 to January 2020. Women living with metastatic breast cancer were asked to participate in semi-structured interviews about physical activity, covering health-specific factors, goals, barriers, enablers, and interests. Interviews were recorded, transcribed and thematically analysed. Results: Twenty-three women completed the interview, with a median age of 60 years (IQR: 20) and median time since metastatic diagnosis of 3.3 years (IQR: 3.0). Physical activity ranged from regular participation in structured exercise to simple incidental activity. Seven themes organised into three categories were identified. The category 'personal context' incorporated themes on: (1) both cancer and non-cancer related health factors; (2) time, work and family factors; and (3) exercise history and preferences. The category 'strategies for physical activity' incorporated themes on: (4) self-efficacy, and (5) routine and incidental activity. The category 'role of health and physical activity services' incorporated themes on: (6) tailored education and services, and (7) specific metastatic cancer services and considerations. Conclusions: Participants expressed diverse experiences with physical activity, with common notions on how physical activity is beneficial but difficult in which to adhere. Whilst some barriers to engagement in physical activity were unique to having cancer, many were not specific to metastatic breast cancer. For example, some participants emphasised specific considerations resulting from their disease, while others primarily reported on general factors such as being time-poor or having conflicting priorities. A patient-centred approach tailored to this group's health and behavioural context may be effective for women who are currently inactive to engage in physical activity. [ABSTRACT FROM AUTHOR]

This study investigates the effectiveness of an Optimal Time Recommendation model (OTR) in encouraging citizens to shift the usage of their home appliances, such as dishwasher to off-peak hours. The research was conducted at the HSB Living Lab + in Gothenburg city, involving 74 participants from diverse social groups, including students, one-person households, couples, and families with kids. The study employed a mixed-methods approach, combining surveys, interviews, and data from self-reporting QR-code or iPad-based web-interface. Participants were provided with personalised recommendations generated by the OTR model, which considered factors such as energy demand, grid load, electricity pricing and level of CO2. The recommendations aimed to assist users in identifying the optimal time slots for operating their home appliances during off-peak, motivated by the lower price, lower CO2 emission or both. Results indicated a positive response from participants across all social groups. Most participants reported an increased awareness of their energy consumption patterns and a willingness to adopt delay shifting practices. However, some frictions and obstacles to adopt shifting time of the behaviour were highlighted as well. The findings from this case study contribute to the existing knowledge on flexibility and Demand-Side Management (DSM). These findings can inform home appliances producers to increase the delay start function usability, policymakers to emphasise the eco-design of the white goods, and researchers in developing effective strategies to encourage energy conservation practices on a larger scale. [ABSTRACT FROM AUTHOR]