Introduction

'This is essential reading for social marketing practitioners, researchers and students. the book describes a comprehensive range of behavior change theories of relevance to social marketing and is complemented with illustrative case ...

Theories and their uses in social marketing

'This is essential reading for social marketing practitioners, researchers and students. the book describes a comprehensive range of behavior change theories of relevance to social marketing and is complemented with illustrative case ...

Rational economic models (cognitive models)

'This is essential reading for social marketing practitioners, researchers and students. the book describes a comprehensive range of behavior change theories of relevance to social marketing and is complemented with illustrative case ...

Buying’ or ‘consumer’ behaviour decision models

'This is essential reading for social marketing practitioners, researchers and students. the book describes a comprehensive range of behavior change theories of relevance to social marketing and is complemented with illustrative case ...

Healthy weight regulation and eating disorder prevention in high school students: a universal and targeted web-based intervention

Background: Given the rising rates of obesity in children and adolescents, developing evidence-based weight loss or weight maintenance interventions that can be widely disseminated, well implemented, and are highly scalable is a public health necessity. Such interventions should ensure that adolescents establish healthy weight regulation practices while also reducing eating disorder risk.

Objective: This study describes an online program, StayingFit, which has two tracks for universal and targeted delivery and was designed to enhance healthy living skills, encourage healthy weight regulation, and improve weight/shape concerns among high school adolescents.

Methods: Ninth grade students in two high schools in the San Francisco Bay area and in St Louis were invited to participate. Students who were overweight (body mass index [BMI] >85th percentile) were offered the weight management track of StayingFit; students who were normal weight were offered the healthy habits track. The 12-session program included a monitored discussion group and interactive self-monitoring logs. Measures completed pre- and post-intervention included self-report height and weight, used to calculate BMI percentile for age and sex and standardized BMI (zBMI), Youth Risk Behavior Survey (YRBS) nutrition data, the Weight Concerns Scale, and the Center for Epidemiological Studies Depression Scale.

Results: A total of 336 students provided informed consent and were included in the analyses. The racial breakdown of the sample was as follows: 46.7% (157/336) multiracial/other, 31.0% (104/336) Caucasian, 16.7% (56/336) African American, and 5.7% (19/336) did not specify; 43.5% (146/336) of students identified as Hispanic/Latino. BMI percentile and zBMI significantly decreased among students in the weight management track. BMI percentile and zBMI did not significantly change among students in the healthy habits track, demonstrating that these students maintained their weight. Weight/shape concerns significantly decreased among participants in both tracks who had elevated weight/shape concerns at baseline. Fruit and vegetable consumption increased for both tracks. Physical activity increased among participants in the weight management track, while soda consumption and television time decreased.

Conclusions: Results suggest that an Internet-based, universally delivered, targeted intervention may support healthy weight regulation, improve weight/shape concerns among participants with eating disorders risk, and increase physical activity in high school students. Tailored content and interactive features to encourage behavior change may lead to sustainable improvements in adolescent health.

Influence of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: outcomes of the Supermarket Healthy Eating for Life randomized controlled trial

BACKGROUND: Fiscal strategies are increasingly considered upstream nutrition promotion measures. However, few trials have investigated the effectiveness or cost effectiveness of pricing manipulations on diet in real-world settings. OBJECTIVE: We assessed the effects on fruit, vegetable, and beverage purchasing and consumption of a 20% price-reduction intervention, a tailored skills-based behavior-change intervention, and a combined intervention compared with a control condition. DESIGN: The Supermarket Healthy Eating for Life trial was a randomized controlled trial conducted over 3 mo [baseline (time 1) to postintervention (time 2) with a 6-mo follow-up (time 3)]. Female primary household shoppers in Melbourne, Australia, were randomly assigned to a 1) skill-building (n = 160), 2) price-reduction (n = 161), 3) combined skill-building and price-reduction (n = 160), or 4) control (n = 161) group. Supermarket transaction data and surveys were used to measure the following study outcomes: fruit, vegetable, and beverage purchases and self-reported fruit and vegetable consumption at each time point. RESULTS: At 3 mo (time 2), price reduction-alone participants purchased more total vegetables and frozen vegetables than did controls. Price reduction-alone and price reduction-plus-skill-building participants purchased more fruit than did controls. Relative to controls, in the price-reduction group, total vegetable consumption increased by 233 g/wk (3.1 servings or 15% more than at baseline), and fruit purchases increased by 364 g/wk (2.4 servings; 35% more than at baseline). Increases were not maintained 6 mo postintervention (time 3). Price reduction-alone participants showed a tendency for a slight increase in fruit consumption at time 2 (P = 0.09) that was maintained at time 3 (P = 0.014). No intervention improved purchases of bottled water or low-calorie beverages. CONCLUSIONS: A 20% price reduction in fruit and vegetables resulted in increased purchasing per household of 35% for fruit and 15% for vegetables over the price-reduction period. These findings show that price modifications can directly increase produce purchases. The Supermarket Healthy Eating for Life trial was registered at Current Controlled Trials Registration as ISRCTN39432901.

Understanding feedback report uptake: process evaluation findings from a 13-month feedback intervention in long-term care settings

BACKGROUND: Long-term care settings provide care to a large proportion of predominantly older, highly disabled adults across the United States and Canada. Managing and improving quality of care is challenging, in part because staffing is highly dependent on relatively non-professional health care aides and resources are limited. Feedback interventions in these settings are relatively rare, and there has been little published information about the process of feedback intervention. Our objectives were to describe the key components of uptake of the feedback reports, as well as other indicators of participant response to the intervention. METHODS: We conducted this project in nine long-term care units in four facilities in Edmonton, Canada. We used mixed methods, including observations during a 13-month feedback report intervention with nine post-feedback survey cycles, to conduct a process evaluation of a feedback report intervention in these units. We included all facility-based direct care providers (staff) in the feedback report distribution and survey administration. We conducted descriptive analyses of the data from observations and surveys, presenting this in tabular and graphic form. We constructed a short scale to measure uptake of the feedback reports. Our analysis evaluated feedback report uptake by provider type over the 13 months of the intervention. RESULTS: We received a total of 1,080 survey responses over the period of the intervention, which varied by type of provider, facility, and survey month. Total number of reports distributed ranged from 103 in cycle 12 to 229 in cycle 3, although the method of delivery varied widely across the period, from 12% to 65% delivered directly to individuals and 15% to 84% left for later distribution. The key elements of feedback uptake, including receiving, reading, understanding, discussing, and reporting a perception that the reports were useful, varied by survey cycle and provider type, as well as by facility. Uptake, as we measured it, was consistently high overall, but varied widely by provider type and time period. CONCLUSIONS: We report detailed process data describing the aspects of uptake of a feedback report during an intensive, longitudinal feedback intervention in long-term care facilities. Uptake is a complex process for which we used multiple measures. We demonstrate the feasibility of conducting a complex longitudinal feedback intervention in relatively resource-poor long-term care facilities to a wider range of provider types than have been included in prior feedback interventions.

Culture, lifestyle and diabetes in Indonesia

Diabetes is an increasing concern worldwide, including in developing countries such as Indonesia. It has often been suggested that the rise in this condition is associated with a “westernization” of behavior in developing societies as well as social change that is tending away from traditional lifestyles. In many cases, however, the nature and extent of such behavior change, as well as the segment of the population likely to be affected, is unclear. In Indonesia, for example, there is evidence that certain aspects of traditional behavior and food preferences are, in fact, likely to increase risk for diabetes, suggesting that factors such as increased life expectancy and increased standard of living are more significant in the rise in this illness than the adoption of an outside way of life. This paper will discuss the relationship of traditional behaviorand food preferences in the context of recent social and economic change to rising incidence of diabetes in Indonesia. Specifically, the situation in the province of West Sumatra will be considered as a case study of social change and cultural context in relation to diabetes.

Mobile phone app aimed at improving iron intake and bioavailability in premenopausal women: a qualitative evaluation

BACKGROUND: Low iron intake can lead to iron deficiency, which can result in impaired health and iron-deficiency anemia. A mobile phone app, combining successful dietary strategies to increase bioavailable iron with strategies for behavior change, such as goal setting, monitoring, feedback, and resources for knowledge acquisition, was developed with the aim to increase bioavailable iron intake in premenopausal women.

OBJECTIVE: To evaluate the content, usability, and acceptability of a mobile phone app designed to improve intake of bioavailable dietary iron.

METHODS: Women aged 18-50 years with an Android mobile phone were invited to participate. Over a 2-week period women were asked to interact with the app. Following this period, semistructured focus groups with participants were conducted. Focus groups were audio recorded and analyzed via an inductive open-coding method using the qualitative analysis software NVivo 10. Themes were identified and frequency of code occurrence was calculated.

RESULTS: Four focus groups (n=26) were conducted (age range 19-36 years, mean 24.7, SD 5.2). Two themes about the app's functionality were identified (frequency of occurrence in brackets): interface and design (134) and usability (86). Four themes about the app's components were identified: goal tracker (121), facts (78), photo diary (40), and games (46). A number of suggestions to improve the interface and design of the app were provided and will inform the ongoing development of the app.

CONCLUSIONS: This research indicates that participants are interested in iron and their health and are willing to use an app utilizing behavior change strategies to increase intake of bioavailable iron. The inclusion of information about the link between diet and health, monitoring and tracking of the achievement of dietary goals, and weekly reviews of goals were also seen as valuable components of the app and should be considered in mobile health apps aimed at adult women.

A web-based, social networking physical activity intervention for insufficiently active adults delivered via Facebook app: randomized controlled trial

BACKGROUND: Online social networks offer considerable potential for delivery of socially influential health behavior change interventions. OBJECTIVE: To determine the efficacy, engagement, and feasibility of an online social networking physical activity intervention with pedometers delivered via Facebook app. METHODS: A total of 110 adults with a mean age of 35.6 years (SD 12.4) were recruited online in teams of 3 to 8 friends. Teams were randomly allocated to receive access to a 50-day online social networking physical activity intervention which included self-monitoring, social elements, and pedometers ("Active Team" Facebook app; n=51 individuals, 12 teams) or a wait-listed control condition (n=59 individuals, 13 teams). Assessments were undertaken online at baseline, 8 weeks, and 20 weeks. The primary outcome measure was self-reported weekly moderate-to-vigorous physical activity (MVPA). Secondary outcomes were weekly walking, vigorous physical activity time, moderate physical activity time, overall quality of life, and mental health quality of life. Analyses were undertaken using random-effects mixed modeling, accounting for potential clustering at the team level. Usage statistics were reported descriptively to determine engagement and feasibility. RESULTS: At the 8-week follow-up, the intervention participants had significantly increased their total weekly MVPA by 135 minutes relative to the control group (P=.03), due primarily to increases in walking time (155 min/week increase relative to controls, P<.001). However, statistical differences between groups for total weekly MVPA and walking time were lost at the 20-week follow-up. There were no significant changes in vigorous physical activity, nor overall quality of life or mental health quality of life at either time point. High levels of engagement with the intervention, and particularly the self-monitoring features, were observed. CONCLUSIONS: An online, social networking physical activity intervention with pedometers can produce sizable short-term physical activity changes. Future work is needed to determine how to maintain behavior change in the longer term, how to reach at-need populations, and how to disseminate such interventions on a mass scale. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614000488606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366239 (Archived by WebCite at http://www.webcitation.org/6ZVtu6TMz).

Mixed method evaluation of a community-based physical activity program using the RE-AIM framework: practical application in a real-world setting

BACKGROUND: Communities are a pivotal setting in which to promote increases in child and adolescent physical activity behaviours. Interventions implemented in these settings require effective evaluation to facilitate translation of findings to wider settings. The aims of this paper are to i) present findings from a RE-AIM evaluation of a community-based physical activity program, and ii) review the methodological challenges faced when applying RE-AIM in practice.

METHODS: A single mixed-methods case study was conducted based on a concurrent triangulation design. Five sources of data were collected via interviews, questionnaires, archival records, documentation and field notes. Evidence was triangulated within RE-AIM to assess individual and organisational-level program outcomes.

RESULTS: Inconsistent availability of data and a lack of robust reporting challenged assessment of all five dimensions. Reach, Implementation and setting-level Adoption were less successful, Effectiveness and Maintenance at an individual and organisational level were moderately successful. Only community-level Adoption was highly successful, reflecting the key program goal to provide community-wide participation in sport and physical activity.

CONCLUSIONS: This research highlighted important methodological constraints associated with the use of RE-AIM in practice settings. Future evaluators wishing to use RE-AIM may benefit from a mixed-method triangulation approach to offset challenges with data availability and reliability.

Implementation of clinical guidelines on diabetes and hypertension in urban Mongolia: a qualitative study of primary care providers' perspectives and experiences

BACKGROUND: Hypertension and diabetes, key risk factors for cardiovascular disease, are significant health problems globally. As cardiovascular disease is one of the leading causes of mortality in Mongolia since 2000, clinical guidelines on arterial hypertension and diabetes were developed and implemented in 2011. This paper explores the barriers and enablers influencing the implementation of these guidelines in the primary care setting.

METHODS: A phenomenological qualitative study with semi-structured interviews was conducted to explore the implementation of the diabetes and hypertension guidelines at the primary care level, as well as to gain insight into how practitioners view the usability and practicality of the guidelines. Ten family health centres were randomly chosen from a list of all the family health centres (n = 136) located in Ulaanbaatar City. In each centre, a focus group discussion with nurses (n = 20) and individual interviews with practice doctors (n = 10) and practice managers (n = 10) were conducted. Data was analysed using a thematic approach utilising the Theoretical Domains Framework.

RESULTS: The majority of the study participants reported being aware of the guidelines and that they had incorporated them into their daily practice. They also reported having attended guideline training sessions which were focused on practice skill development. The majority of participants expressed satisfaction with the wide range of resources that had been supplied to them by the Mongolian Government to assist with the implementation of the guidelines. The resources, supplied from 2011 onwards, included screening devices, equipment for blood tests, medications and educational materials. Other enablers were the participants' commitment and passion for guideline implementation and their belief in the simplicity and practicality of the guidelines. Primary care providers reported a number of challenges in implementing the guidelines, including frustration caused by increased workload and long waiting times, time constraints, difficulties with conflicting tasks and low patient health literacy.

CONCLUSIONS: This study provides evidence that comprehensive and rigorous dissemination and implementation strategies increase the likelihood of successful implementation of new guidelines in low resource primary care settings. It also offers some key lessons that might be carefully considered when other evidence-based clinical guidelines are to be put into effect in low resource settings and elsewhere.

A mudança de comportamento do setor público após o choque mundial de 1975 como resultado de conflitos sociais

O objetivo deste trabalho é duplo: verificar se a mudança de comportamento do setor público foi afetada pelo processo de ajuste que a economia mundial passou após o choque de 1975 e se a mesma foi explicada por variáveis macroeconomicamente pouco convencionais como distribuição de renda e eficiência da burocracia. Os resultados mostram que a mudança estrutural da economia em 1975 não foi significativa enquanto que a distribuição de renda e eficiência da burocracia foram: pior (melhor) distribuição de renda e melhor (pior) eficiência da burocracia levaram o setor público a um ajustamento (expansão). Testou-se ainda um 'mix' entre as variáveis usadas para representar a mudança estrutural, distribuição de renda e eficiência da burocracia. Fez-se isto para ver se esta mudança estrutural, combinada a estas variáveis, que seriam mais estáveis ao longo do tempo, influenciariam o resultado deste comportamento. Viu-se que variáveis de mudança estrutural combinadas com distribuição de renda e eficiência da burocracia foram significativas para explicar a mudança de comportamento do setor público sem alterar o sinais dos resultados obtidos pelas variáveis que foram significativas isoladamente. O 'mix' de variáveis de mudança estrutural e cada uma das variáveis alternadamente não foi: seu resultado não foi significativo ou foi de intuição não muito simples.

A experiência da mudança: de Gregory Bateson aos alcoólicos anônimos

Mudança de comportamento: eis um fenômeno que suscita dúvidas, polêmicas e toda sorte de questionamentos. Por que ele se dá, por que não se dá, como fazer para que ocorra, como compreendê-la quando se dá de forma autônoma - essas são perguntas presentes na prática de muitos profissionais e no dia a dia mesmo das pessoas. Algumas destas perguntas fazem parte deste estudo, que tem como objetivo examinar o processo de mudança de comportamento diante de uma situação problemática. Para isso,tomaremos como base teórica os pressupostos oferecidos pela epistemologia ecossistêmica de Bateson, visto que esta se apresenta como uma perspectiva fértil para a compreensão dos fenômenos ao encará-los sob um ponto de vista relacional. A dinâmica da mudança será investigada a partir de experiências de membros de grupos AA relatadas em entrevistas. A razão pela qual escolhemos falar do tema a que nos propomos através da situação específica do alcoolismo e daqueles que passam a frequentar o AA deve ser clarificada. Sendo a síndrome de dependência do álcool uma condição que traz problemas de grande gravidade àqueles que a apresentam, e sendo o AA uma forma de tratamento que tem se mostrado muito eficaz, ambos merecem ser investigados, pois podem trazer luz à compreensão do processo de mudança. E é a isto que nos propomos neste estudo. Mais que apresentar conclusões fechadas, desejamos abrir caminhos a questionamentos sobre a mudança, sobre o alcoolismo e a prática do AA, a qual parece oferecer uma sistemática para aquilo que a visão teórica ecossistêmica apresenta.

Technologies that motivates healthy toothbrushing: practices through social translucence

Fifty percent of the European Union’s population suffers from an oral disease. Studies have repeatedly shown that while acquiring healthy toothbrushing practices early on in one’s life is of significance, children and adults often fail to adhere to those. In this thesis we attempt to design and prototype interactive technologies that motivate healthy tooth brushing habits on individuals. Rather than focusing on the technologies’ persuasive power over individuals, we tap on the social mechanisms employed by families. In this sense, we think of these technologies as social translucent rather than persuasive, whose goal is to raise awareness within the family on each other’s habits and that aim at leveraging families’ existing social mechanisms for behavior change, rather than replacing them. More specifically, we aim to gain insights with respect to the following questions: a) What are the drivers and barriers towards adhering to healthy tooth brushing behaviors? b) Can we effectively measure toothbrushing behaviors? c) How can technologies leverage family communication practices in motivating proper toothbrushing behaviors? First, we present two studies about children and adults’ tooth brushing behaviors and how these are influenced by social interactions within the family. Secondly, we present the design and prototyping of two systems that sense toothbrushing practices and provide feedback, using the Social Translucence Framework as a design lens. We conclude with an overview of lessons learnt from the prototyping of these systems supported by an analysis of the strengths and pitfalls of the developed technologies.