Design of a Planner-Based Intervention to Facilitate Diet Behaviour Change in Type 2 Diabetes
Kevin A. CradockLeo R. QuinlanFrancis FinucaneHeather L. GainforthKathleen A. Martin GinisElizabeth SandersGearóid ÓLaighin
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Diet behaviour is influenced by the interplay of the physical and social environment as well as macro-level and individual factors. In this study, we focus on diet behaviour at an individual level and describe the design of a behaviour change artefact to support diet behaviour change in persons with type 2 diabetes. This artefact was designed using a human-centred design methodology and the Behaviour Change Wheel framework. The designed artefact sought to support diet behaviour change through the addition of healthy foods and the reduction or removal of unhealthy foods over a 12-week period. These targeted behaviours were supported by the enabling behaviours of water consumption and mindfulness practice. The artefact created was a behaviour change planner in calendar format, that incorporated behaviour change techniques and which focused on changing diet behaviour gradually over the 12-week period. The behaviour change planner forms part of a behaviour change intervention which also includes a preparatory workbook exercise and one-to-one action planning sessions and can be customised for each participant.Keywords:
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“There’s many a slip twixt cup and lip.” In interventions to change health behavior, even the most carefully crafted interventions can be undermined by a lack of fidelity in intervention delivery [1], or by a lack of ‘enactment’ (the degree to which participants engage with and use the intended behavior change techniques) [2]. The article by Hankonen and colleagues in this issue [3] describes a novel method for exploring the mechanisms of change in behavioral interventions. The authors measured the level of enactment of behavior change techniques by 210 participants in the intervention arm of a lifestyle intervention for people with newly diagnosed type 2 diabetes (the ADDITION-Plus trial). They found that increased use of the targeted behavior change techniques was associated with an increase in weight loss. Although the intervention overall did not generate weight loss, individuals who reported using all 16 of the intervention’s intended behavior change techniques lost significantly more weight than those who used 10 or less. This suggests that the intervention model and selected behavior change strategies may have been valid (when the techniques were used, change occurred), but that the lack of overall weight loss may have stemmed from suboptimal promotion of the use of these strategies (participants were not inspired to use the techniques suggested). The picture is limited to some extent by the sensitivity and precision of the measures used for enactment and for dietary and physical activity behaviors. However, the analyses suggest that some specific behavior change techniques were associated with changes in diet and physical activity. A particularly interesting aspect of this type of process analysis is that it prompts us to consider the use of behavior change techniques as a behavioral target in itself. This introduces a ‘second order’ question to the field—how can we increase the uptake and use of behavior change techniques? What ‘meta behavior change techniques’ (MBCTs) or intervention-delivery techniques (IDTs) are effective in motivating, supporting, and maintaining the use of the BCTs targeted by the intervention? For instance, to prompt selfmonitoring of physical activity, is it sufficient to simply give people a pedometer and some instructions? Can we use existing techniques, such as ‘prompting practice’ or encouraging social support (e.g., asking partners to remind or encourage the participant to use the pedometer)? Or, do we need novel techniques to promote the uptake and maintenance of BCTs (e.g., explaining the process of behavior change [4]; providing evidence on the link between use of the technique and successful behavior change)? Hakonen et al.’s article demonstrates that enactment-based process evaluation can add considerable explanatory value to the evaluation of behavior change interventions. It also prompts deeper thinking about how we can best promote the uptake and sustained use of behavior change techniques. This is a major contribution to the field.
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Even through the health benefits of regular exercise and physical activity are well documented, most people are inadequately active or completely inactive.Designing interventions to enhance the adoption and maintenance of a physically active lifestyle continues to be a challenge, given that the majority of individuals are not considering becoming more active, and that over half of those who decide to become more physically active return to a sedentary lifestyle within three to six months.It has been recommended that research on exercise adherence be conducted utilizing models of behavioral science.One of the most effective models is the transtheoretical model of behavior change(TTM).The TTM has been used to explain both the stages and processes people go through when trying to eliminate a negative form of behavior(e.g., smoking)and when trying to acquire a positive form of behavior(e.g., exercise).The model consists of various stages of change, processes of change, decisional balance, and self-efficacy.The TTM suggests that individuals attempting to change exercise behavior move through five stages of change.In addition, individuals experience different congnitive and behavioral processes of change as they move from one stage to another.As people change, decisional balance and self-efficacy are employed uniquely at each stage.According to this model, tailoring interventions to match a person's readiness(stage of change)is essential.Although research on exercise adherence utilizing the TTM has been actively conducted in Western countries, this area of research is yet to be advanced in Japan.This article reviews research on exercise adherence utilizing the TTM, and discusses the applicability of the TTM to understanding physical activity and exercise behavior in the Japanese population.
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Background Rates of noncommunicable diseases continue to rise worldwide. Many of these diseases are a result of engaging in risk behaviors. Without lifestyle and behavioral intervention, noncommunicable diseases can worsen and develop into more debilitating diseases. Behavioral interventions are an effective strategy to reduce the burden of disease. Behavior change techniques can be described as the “active ingredients” in behavior change and address the components that need to be altered in order for the target behavior to change. Health professionals, such as pharmacists and nurses, can engage in opportunistic behavior change with their patients, to encourage positive health behaviors. Objective We aimed to develop, implement, and evaluate a behavior change workshop targeted at health professionals in Australia, with the goal of increasing knowledge of behavior change techniques and psychological variables. Methods A prospective study design was used to develop and evaluate a 2-hour behavior change workshop targeted at health professionals. The workshop was developed based on the Capability, Opportunity, Motivation, and Behavior Model and had five core objectives: (1) to detail the role of health professionals in delivering optimal care, (2) to demonstrate opportunities to change behavior, (3) to describe principles of behavior change, (4) to explain behavior change techniques, and (5) to determine the most appropriate behavior change techniques to use and when to use them. A total of 10 workshops were conducted. To evaluate the workshops and identify any potential long-term changes in behavior, we collected pre- and postworkshop data on knowledge and psychological constructs from the attendees. Results A final sample of 41 health professionals comprising general practitioners, nurses, and pharmacists completed the pre- and postworkshop surveys. Following the workshops, there were significant improvements in knowledge of behavior change techniques (t40=–5.27, P<.001), subjective norms (t40=–3.49, P=.001), descriptive norms (t40=–3.65, P<.001), perceived behavioral control (t40=–3.30, P=.002), and intention (t36=–3.32, P=.002); each had a large effect size. There was no significant difference in postworkshop attitude (t40=0.78, P=.44). The participants also found the workshops to be highly acceptable. Conclusions A 2-hour, theoretically informed workshop designed to facilitate the use of behavior change techniques by health professionals was shown to be largely effective. The workshops resulted in increases in knowledge, descriptive and subjective norms, perceived behavioral control, and intention, but not in attitude. The intervention was also shown to be highly acceptable, with the large majority of participants deeming the intervention to be needed, useful, appropriate, and applicable, as well as interesting and worth their time. Future research should examine the lasting impacts of the workshop on health professionals’ practices.
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Despite the current popularity and potential use of mobile applications (apps) in the area of behaviour change, health promotion, and well-being for young people, it is unclear whether their design is underpinned by theory-based behaviour change techniques. Understanding the design of these apps may improve the way they can be used to support young people’s well-being.The objectives of this study were to investigate what behaviour change techniques are included in the content of health and lifestyle apps, and determine which of these are prominent in app design. Thirty of the top-listed health and lifestyle apps across three categories (physical activity, diet, and sleep) were freely downloaded from the two most popular app stores (GooglePlay™ and AppStore™). Selected apps were used by trained researchers and the features identified coded against the Behaviour Change Techniques Taxonomy 1, a systematic classification of techniques used in behaviour change interventions. It was found that 9 of the 93 behaviour change techniques listed in the Behaviour Change Techniques Taxonomy 1 were common across the chosen health and lifestyle apps. The app found to include the most behaviour change techniques had 20 (21%), while the app found to include the least had 1 behaviour change technique (1%). The most frequently used behaviour change techniques were related to goal setting and feedback. Entire categories in the Behaviour Change Techniques Taxonomy 1 were absent in the design of the selected apps.
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