Defining the content and delivery of an intervention to Change AdhereNce to treatment in BonchiEctasis (CAN-BE): a qualitative approach incorporating the Theoretical Domains Framework, behavioural change techniques and stakeholder expert panels

Background
Low patient adherence to treatment is associated with poorer health outcomes in bronchiectasis. We sought to use the Theoretical Domains Framework (TDF) (a framework derived from 33 psychological theories) and behavioural change techniques (BCTs) to define the content of an intervention to change patients’ adherence in bronchiectasis (Stage 1 and 2) and stakeholder expert panels to define its delivery (Stage 3).

Methods
We conducted semi-structured interviews with patients with bronchiectasis about barriers and motivators to adherence to treatment and focus groups or interviews with bronchiectasis healthcare professionals (HCPs) about their ability to change patients’ adherence to treatment. We coded these data to the 12 domain TDF to identify relevant domains for patients and HCPs (Stage 1). Three researchers independently mapped relevant domains for patients and HCPs to a list of 35 BCTs to identify two lists (patient and HCP) of potential BCTs for inclusion (Stage 2). We presented these lists to three expert panels (two with patients and one with HCPs/academics from across the UK). We asked panels who the intervention should target, who should deliver it, at what intensity, in what format and setting, and using which outcome measures (Stage 3).

Results
Eight TDF domains were perceived to influence patients’ and HCPs’ behaviours: Knowledge, Skills, Beliefs about capability, Beliefs about consequences, Motivation, Social influences, Behavioural regulation and Nature of behaviours (Stage 1). Twelve BCTs common to patients and HCPs were included in the intervention: Monitoring, Self-monitoring, Feedback, Action planning, Problem solving, Persuasive communication, Goal/target specified:behaviour/outcome, Information regarding behaviour/outcome, Role play, Social support and Cognitive restructuring (Stage 2). Participants thought that an individualised combination of these BCTs should be delivered to all patients, by a member of staff, over several one-to-one and/or group visits in secondary care. Efficacy should be measured using pulmonary exacerbations, hospital admissions and quality of life (Stage 3).

Conclusions
Twelve BCTs form the intervention content. An individualised selection from these 12 BCTs will be delivered to all patients over several face-to-face visits in secondary care. Future research should focus on developing physical materials to aid delivery of the intervention prior to feasibility and pilot testing. If effective, this intervention may improve adherence and health outcomes for those with bronchiectasis in the future.

Cues to action : do they result in belief and behavioural change in women?

With incidence rates of osteoporosis increasing (Osteoporosis Canada, 2007), preventative efforts to minimize costs associated with condition diagnosis are a public health priority. Cues to action are specific internal (e.g., physical symptoms, family member with a condition) or external stimuli (e.g., public service announcements, health education campaigns) that are necessary to trigger appropriate health behaviours and serve to create an awareness of the health threat (Mattson, 1999). To date, limited understanding of the scope of influence cues to action have on health beliefs and behaviour associated with osteoporosis is known. The present investigation was designed to address this gap in the literature. More specifically, the influence of cues to action, a public service announcement (PSA) developed by Osteoporosis Canada and a bone screening by way of Quantitative Ultrasound, on health beliefs and health-enhancing physical activity (HEPA) across a four week period was investigated. Peri-and postmenopausal women (N= 174) were randomly assigned to one of three conditions 1) an osteoporosis public service announcement (PSA) condition; 2) a bone screening condition via quantitative ultrasound techniques, and 3) a PSA attention control condition. Health beliefs associated with osteoporosis were taken at three time points: prior to the cue to action intervention, immediately following the intervention, and four weeks post intervention. Knowledge of osteorporosis risk factors and HEP A were assessed pre and post-intervention only. Results of a regression analysis suggested that baseline health beliefs predicted baseline HEPA (R2 adj = .24; F (9, 161) = 6.49,p = .000; 95% CI = .12 - .35) with exercise barriers (p = -.33) being a negative predictor and health motivation (p = .21) being a positive predictor of HEP A. Baseline health beliefs predicted With incidence rates of osteoporosis increasing (Osteoporosis Canada, 2007), preventative efforts to minimize costs associated with condition diagnosis are a public health priority. Cues to action are specific internal (e.g., physical symptoms, family member with a condition) or external stimuli (e.g., public service announcements, health education campaigns) that are necessary to trigger appropriate health behaviours and serve to create an awareness of the health threat (Mattson, 1999). To date, limited understanding of the scope of influence cues to action have on health beliefs and behaviour associated with osteoporosis is known. The present investigation was designed to address this gap in the literature. More specifically, the influence of cues to action, a public service announcement (PSA) developed by Osteoporosis Canada and a bone screening by way of Quantitative Ultrasound, on health beliefs and health-enhancing physical activity (HEPA) across a four week period was investigated. Peri-and postmenopausal women (N= 174) were randomly assigned to one of three conditions 1) an osteoporosis public service announcement (PSA) condition; 2) a bone screening condition via quantitative ultrasound techniques, and 3) a PSA attention control condition. Health beliefs associated with osteoporosis were taken at three time points: prior to the cue to action intervention, immediately following the intervention, and four weeks post intervention. Knowledge of osteorporosis risk factors and HEP A were assessed pre and post-intervention only. Results of a regression analysis suggested that baseline health beliefs predicted baseline HEPA (R2 adj = .24; F (9, 161) = 6.49,p = .000; 95% CI = .12 - .35) with exercise barriers (p = -.33) being a negative predictor and health motivation (p = .21) being a positive predictor of HEP A. Baseline health beliefs predicted

The effectiveness of a goal-setting model on behavioural change

To evaluate the effectiveness of a goal-setting model on behavioural change, thirty nine adults between the ages of23 and 73 years who were in a weight loss program were assigned to one oftwo groups. One group was taught to change eating behaviour using a weight-reducing diet. The other group was taught to use a goal-setting model to change behaviour. Pretest and posttest surveys were completed by all participants, and a callback survey by theexperimentals. The PET Type Check and Kolb's Learning Style Inventory were administered to all participants. As well, five ofthe experimentals were interviewed. Results of qualitative analyses showed no significant difference between the two groups, but qualitative research suggested that experimentals were more likely to use the goal-setting model to make behavioural changes, and that being successful increased their self-efficacy.

Ubiquitous monitoring and behavioural change: a semiotic perspective

We are soon approaching the pervasive-era ofcomputing, where computers are embedded intoobjects and the environment in order to provide newservices to users. Significant levels of data arerequired in order for these services to function asintended, and it is this collection of data which werefer to as ubiquitous monitoring. Existing monitoringtechniques have often been known to cause undesirableeffects, and it is anticipated that ubiquitousmonitoring, with its increased coverage, will lead toincreases in their occurrence and impact. To date, theeffects of ubiquitous monitoring on human behaviourhave not been sufficiently investigated, furtherincreasing the risk of undesirable effects. We propose apreliminary model consisting of a series of factorsbelieved to influence human behavior and augmentedby the Theory of Planned Behaviour. This model mayallow us to understand, predict, and therefore preventany undesirable effects caused by ubiquitousmonitoring.

Exploring behavioural change through an agent-oriented system dynamics model: the use of personal protective equipment among pesticide applicators in Colombia

The misuse of Personal Protective Equipment results in health risk among smallholders in developing countries, and education is often proposed to promote safer practices. However, evidence point to limited effects of education. This paper presents a System Dynamics model which allows the identification of risk-minimizing policies for behavioural change. The model is based on the IAC framework and survey data. It represents farmers' decision-making from an agent-oriented standpoint. The most successful intervention strategy was the one which intervened in the long term, targeted key stocks in the systems and was diversified. However, the results suggest that, under these conditions, no policy is able to trigger a self sustaining behavioural change. Two implementation approaches were suggested by experts. One, based on constant social control, corresponds to a change of the current model's parameters. The other, based on participation, would lead farmers to new thinking, i.e. changes in their decision-making structure.

Understanding the Components in Social Behavioural Change: Implications for Non-profit Organisations

In this paper we investigate the relationship between intrinsic motivation, extrinsic motivation and government influence with the over riding objective of developing more effective and efficient social behavioural change programs that have been instigated by public sector environmental management organisations. Based on the notion of intrinsic and extrinsic motivation, which has previously been shown to explain altitudes and behaviour associated with environmental issues, we extend the analysis in this paper to include the influence of government. A survey of a random sample of 566 landmanagers in South-eastern Australia was conducted and the data collected subsequently analysed using a structural equation modelling approach. The model that was developed identified the relationship between intrinsic motivation, extrinsic motivation and government influence.

Contribution of Australian cardiologists, general practitioners and dietitians to adult cardiac patients’ dietary behavioural change

Aim:  To investigate the use of behavioural change techniques by cardiologists, general practitioners and dietitians in adult cardiac patients within 12 months of their cardiac event.
Method:  Quantitative cross-sectional surveys. Frequency analyses were conducted on the respondents' answers to questionnaire items. Chi-squared test of independence compared responses of the three professional groups on the questionnaire items. Analyses of variance were conducted to explore the impact of the independent variables: age, sex and time worked on the behavioural change techniques used by the respondents.
Results:  The respondents included 248 general practitioners (30% response), 189 cardiologists (47% response) and 180 dietitians (60% response). General practitioners and cardiologists acted mainly as advocates for dietary change in the dietary management process. Dietitians provided nutrition knowledge and a range of techniques to assist dietary behavioural change. Cardiologists and dietitians shared little nutrition information with general practitioners (cardiologists with general practitioners = 8%, dietitians with general practitioners = 49%).
Conclusion:  The present study shows that cardiac patients may have insufficient access to knowledge of nutrition and techniques to assist them with dietary behavioural change.

Influence operations and behavioural change

The intended outcome of Information Operations appears to be a favourable change (to the instigator) in attitudes or belief systems of the target, however, the relationship between attitude and behaviour is tenuous. Propaganda and other methods of ‘influence’ are difficult to assess as the cause and effect relationship is complicated. The short term effects of psychological warfare where force is used in conjunction with influence techniques can be easily assessed; at least at a superficial level. Even in the latter case, the actual causes and effects could be solely the force used or some other factors rather than the psychological techniques per se. Influence Operations attempt to win the hearts and minds of the target audience but, even if successful, the lasting effects of a campaign are problematic. It is further complicated because if a person has a particular view, it does not mean that the ensuing behaviours will reflect that view. Also, there is evidence that the use of force on one set of people produces attitudes and behaviours that instigate radical beliefs and behaviours in another set. So psychological warfare techniques on one group that may or may not produce compliant behaviour stimulates another group to empathise with the victims thus producing an overall practical negative influence. Influence campaigns cannot be separated from the physical environment in which they are executed. If good politics requires good influence campaigns then good influence campaigns require good politics to back them up. This paper will examine the relationships between short term influence campaigns and compare them with the more long term socialising effects such as early education, family and physical attributes that have on attitudes and beliefs which result in the development of such behaviours as terrorism.

Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS) : multicentre, three arm, cluster-randomised controlled trial

Funding and trial registration: Scottish Government Chief Scientist Office grant CZH/3/17. ClinicalTrials.gov registration NCT01602705.

Designing motivation or motivating design? Exploring Service Design, motivation and behavioural change

Motivation researcher Edward Deci has suggested that if we want behavioural change to be sustainable, we have to move past thinking of motivation as something that we ‘do’ to other people and see it rather as something that we as Service Designers can enable service users to ‘do’ by themselves. In this article, Fergus Bisset explores the ways in which Service Designers can create more motivating services. Dan Lockton then looks at where motivating behaviour via Service Design often starts, with the basic ‘pinball’ and ‘shortcut’ approaches. We conclude by proposing that if services are to be sustainable in the long term, we as Service Designers need to strive to accommodate humans' differing levels of motivation and encourage and support service users' sense of autonomy within the services we design.