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Background: Effective infection prevention and control (IPC) practices among healthcare workers are crucial to prevent the spread of COVID-19 and other infections in healthcare settings. Aim: To synthesise evidence on behaviour change theories, models, or frameworks applied to understand healthcare workers' IPC practices during the COVID-19 pandemic. Methods: PubMed, EBSCOhost interface, ProQuest interface, MEDLINE (Ovid), and grey literature were searched for primary studies published between December 2019 and May 2023. The Mixed Method Appraisal Tool evaluated the methodological quality of the studies. Two reviewers independently completed study selection, data extraction, and quality assessment. Results: The search yielded 2110 studies, of which 19 were included. Seven behaviour change theories, models, and frameworks were identified, with the Health Belief Model and Theoretical Domains Framework being the most employed. Based on these theories, models, and frameworks, the included studies identified cognitive, environmental, and social factors influencing healthcare workers' compliance with COVID-19 IPC practices. Discussion: This review offers insights into the critical role of behavioural change theories, models, or frameworks in understanding the factors influencing healthcare workers' compliance with IPC practices during COVID-19. It also highlights the potential of these theories in guiding the development of evidence-based interventions to improve healthcare workers' compliance with IPC practices. [ABSTRACT FROM AUTHOR]

BACKGROUND: Southeast Asia is making tremendous progress towards their 2030 malaria elimination goal but needs new interventions to stop forest malaria. This study trials two new vector control tools, a volatile pyrethroid spatial repellent (VPSR) and insecticide-treated clothing (ITC), amongst forest-exposed populations in Mondulkiri Province Cambodia to inform their potential use for eliminating forest malaria. METHODS: 21 forest-exposed individuals were given a questionnaire on their perceptions of malaria and preventive practices used, after which they trialed two products sequentially. Clothes was treated with ITC by the study team. Mixed methods were used to understand their experience, attitudes, and preferences regarding the products trialed. Quantitative data was summarized and qualitative insights were analysed using thematic analysis, applying the Capability, Opportunity, and Motivation Behaviour Change (COM-B) model and Behaviour Change Wheel Framework to identify intervention functions to support tailored product rollout amongst these populations. RESULTS: Study participants reported a need for protection from mosquito bites in outdoor and forest-exposed settings and perceived both products trialed to be effective for this purpose. The VPSR product was preferred when travel was not required, whereas ITC was preferred for ease of use when going to the forest, especially in rainy conditions. COM-B analysis identified that key enablers for use of both products included their perceived efficacy and ease of use, which required no skill or preparation. For barriers to use, the odour of ITC was sometimes perceived as being toxic, as well as its inability to protect uncovered skin from mosquito bites, while the perceived usefulness of the VPSR product trialed was limited by its water sensitivity in rainy forest settings. Intervention components to encourage appropriate and sustained use of these products include education about how to use these products and what to expect, persuasion to use them from community leaders and targeted channels, and enablement to facilitate convenient and affordable access. CONCLUSION: The rollout of VPSRs and ITC amongst forest-exposed populations can be useful for eliminating malaria in Southeast Asia. Study findings can be applied to increase product uptake among forest exposed populations in Cambodia, while manufacturers can aim to develop products that are rainproof, easy to use in forest settings, and have favourable odour profiles to target users.

Purpose: Optometrists are well positioned to help expand low vision (LV) services and improve their availability and accessibility. Determinants of participation in LV service provision must be well understood to facilitate successful service expansion. This survey aimed to investigate optometrists' professional confidence in the delivery of LV services and attitudes towards further learning. Methods: An online survey was emailed to a sample of College of Optometrists members. Respondents rated their confidence in different areas of core optometric practice; confidence in LV was compared with confidence in other areas. Respondents also rated their confidence in undertaking multiple tasks involved in LV service delivery and in routine optometric practice; confidence was compared between optometrists who do and do not work in a LV service. Attitudes towards learning more about assessing and supporting patients with a vision impairment (VI) were recorded. Results: The survey received 451 recorded responses (15.1% response rate). Optometrists who do not work in a LV service reported significantly lower confidence in LV than in other areas of core optometric practice, whereas optometrists who work in a LV service reported significantly higher confidence in LV than in other areas. Additionally, optometrists who do not work in a LV service reported significantly lower confidence in all tasks involved in LV service delivery than optometrists who work in a LV service (p < 0.001 for all tasks). Approximately 80% of respondents were interested in learning more about assessing and supporting patients with a VI. Conclusions: Optometrists who do not work in a LV service have relatively low confidence in LV, which could contribute to low motivation to participate in LV service provision. There is sizeable interest in learning more about assessing and supporting patients with a VI, which could help to increase motivation to participate in LV service provision. [ABSTRACT FROM AUTHOR]

Background: As reproductive genetic carrier screening (RGCS) becomes more widely accessible, ensuring uptake by primary healthcare professionals (HCPs) is essential to equitable service provision. This study aimed to identify and prioritise implementation strategies to reduce barriers and support HCPs to routinely offer RGCS in Australia. Methods: HCPs (n = 990) involved in a large national research study, offering couples-based RGCS, were surveyed at three time points: prior to offering RGCS through the study (Survey 1: Barriers); 8+ weeks after offering to their patients (Survey 2: Possible supports); and towards the end of the study (Survey 3: Prioritised supports). HCPs were from primary care (e.g. general practice, midwifery) and tertiary care (e.g. fertility, genetics) settings. Results were analysed via a novel approach of using behaviour change theory (Capability, Opportunity and Motivation – COM.B) to align theory to practice. Results: Survey 1 (n = 599) identified four barrier themes: time constraints, lack of HCP knowledge and skill, patient receptivity, and HCP's perceived value of RGCS. Survey 2 (n = 358) identified 31 supports that could facilitate HCPs offering RGCS. Survey 3 (n = 390) was analysed separately by speciality and clinic location. Prioritised supports for primary care HCPs were 'regular continuing professional development activities' and 'a comprehensive website to direct patients for information'. There was general accordance with the perceived importance of the supports, although some difference in relation to funding between professional groups and clinic locations. Conclusion: This study identified a range of supports acceptable to HCPs across specialties and geographic locations that policymakers may use to direct efforts to ensure the roll out of RGCS is equitable across Australia. As reproductive genetic carrier screening becomes more widely accessible, ensuring uptake by primary health care professionals (HCPs) is essential to equitable service provision. We surveyed HCPs offering reproductive genetic carrier screening and identified a range of priorities to address barriers to and support for routine offering of screening. Top supports included patient resources, funding, and ongoing education. Policymakers may use these findings to direct their future efforts. [ABSTRACT FROM AUTHOR]

Background Southeast Asia is making tremendous progress towards their 2030 malaria elimination goal but needs new interventions to stop forest malaria. This study trials two new vector control tools, a volatile pyrethroid spatial repellent (VPSR) and insecticide-treated clothing (ITC), amongst forest-exposed populations in Mondulkiri Province Cambodia to inform their potential use for eliminating forest malaria. Methods 21 forest-exposed individuals were given a questionnaire on their perceptions of malaria and preventive practices used, after which they trialed two products sequentially. Clothes was treated with ITC by the study team. Mixed methods were used to understand their experience, attitudes, and preferences regarding the products trialed. Quantitative data was summarized and qualitative insights were analysed using thematic analysis, applying the Capability, Opportunity, and Motivation Behaviour Change (COM-B) model and Behaviour Change Wheel Framework to identify intervention functions to support tailored product rollout amongst these populations. Results Study participants reported a need for protection from mosquito bites in outdoor and forest-exposed settings and perceived both products trialed to be efective for this purpose. The VPSR product was preferred when travel was not required, whereas ITC was preferred for ease of use when going to the forest, especially in rainy conditions. COM-B analysis identifed that key enablers for use of both products included their perceived efcacy and ease of use, which required no skill or preparation. For barriers to use, the odour of ITC was sometimes perceived as being toxic, as well as its inability to protect uncovered skin from mosquito bites, while the perceived usefulness of the VPSR product trialed was limited by its water sensitivity in rainy forest settings. Intervention components to encourage appropriate and sustained use of these products include education about how to use these products and what to expect, persuasion to use them from community leaders and targeted channels, and enablement to facilitate convenient and afordable access. Conclusion The rollout of VPSRs and ITC amongst forest-exposed populations can be useful for eliminating malaria in Southeast Asia. Study fndings can be applied to increase product uptake among forest exposed populations in Cambodia, while manufacturers can aim to develop products that are rainproof, easy to use in forest settings, and have favourable odour profles to target users. [ABSTRACT FROM AUTHOR]

Abstract Background Changing people’s behaviour by giving advice and instruction, as traditionally provided in healthcare consultations, is usually ineffective. Healthy Conversation Skills (HCS) training enhances health professionals’ communication skills and ability to empower and motivate people in health behaviour change. Guided by the Theoretical Domains Framework (TDF), this study examined the impact of HCS training on health professional barriers to conducting behaviour change conversations in both clinical and non-clinical settings. Secondary aims were to i) identify health professionals’ barriers to having behaviour change conversations, and explore the ii) effect of HCS training on health professionals’ competence and attitudes to adopting HCS, iii) feasibility, acceptability and appropriateness of using HCS in their clinical and non-clinical roles, and iv) acceptability and quality of HCS training. Methods HCS training was conducted in October-November 2019 and February 2020. Pre-training (T1), post-training (T2) and follow-up (T3; 6-10 weeks post-training) surveys collected data on demographics and changes in competence, confidence, importance and usefulness (10-point Likert scale, where 10 = highest score) of conducting behaviour change conversations. Validated items assessing barriers to having these conversations were based on eight TDF domains. Post-training acceptability and quality of training was assessed. Data were summarised using descriptive statistics, and differences between TDF domain scores at the specific time points were analysed using Wilcoxon matched-pairs signed-rank tests. Results Sixty-four participants consented to complete surveys (97% women; 16% identified as Aboriginal), with 37 employed in clinical settings and 27 in non-clinical settings. The training improved scores for the TDF domains of skills (T1: median (interquartile range) = 4.7(3.3-5.3); T3 = 5.7(5.3-6.0), p

Plain language summary Family planning (FP) programmes aim to enable people to achieve their desired family size. Successful programmes are essential for encouraging better health outcomes for individuals and families. Historically, FP programmes have focused on the sexual and reproductive health and rights of women and girls, and while this is necessary, it has also contributed to the exclusion of men and boys from FP programmes. There is growing evidence to suggest, however, that involving men and boys in FP may increase its uptake and improve health outcomes for all. However, we still know relatively little about the best ways to involve men and boys in FP programmes in order to ensure success. Research is ongoing to rectify this. When we look at public health behaviour change programmes in general, we find that many successful programmes incorporate theories of behaviour change into their design. These theories guide the kinds of activities and materials that the programme employs in order to promote behaviour change. In the field of FP, there is little information about the kinds of behaviour change theories that might be used to design programmes. This review aimed to address this by reviewing the global literature on FP programmes that involved men and boys to identify relevant behaviour-change theories. We found a range of theories that will be of use to programme planners. We also found, however, that there was lots of variability in the way theories were reported. We make recommendations for how this problem might be resolved.

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Background: Infection prevention and control (IPC) practices performed by healthcare workers are key to the prevention and management of infections. Compliance with IPC practices is often low, they are therefore commonly the focus of improvement interventions. Designing interventions that are based on behaviour change theories may help to improve compliance to practice. The aim of this review is to synthesise the evidence on the application of behaviour change theories to interventions to improve IPC practice in healthcare settings. Methods: A scoping review was conducted following the Joanna Briggs Institute methodological framework. The theories of focus were the Theoretical Domains Framework (TDF), Capability, Opportunity, Motivation, Behaviour (COM-B) and Behaviour Change Wheel (BCW). Studies which applied these theories to any IPC practice were included. Results: Eleven studies were identified which met the inclusion criteria. The IPC behaviours investigated were hand hygiene (7), antimicrobial stewardship (3), and MRSA screening (1). Nine studies explored barriers and facilitators to existing IPC practice; three used their findings to design a behaviour change intervention or tool. Domains of 'beliefs about consequences', 'environmental context/resources', and 'social/professional role and identity' were identified as key across all three IPC behaviours. Discussion: This review has demonstrated the use of behavioural theories to understand determinants of behaviour related to IPC practice. Currently, there are few published examples of interventions to improve IPC practice that have been underpinned by behavioural theory. Practitioners in IPC should consider the use of these methods to enhance the efficacy of strategies to change healthcare worker behaviour. [ABSTRACT FROM AUTHOR]

Introduction: As the delivery of continuing medical education moves towards digital modes, determining how to embed and capitalise on the skills of specialised educators in digital modalities is critical. Drawing on social theories of adult learning and behaviour change, this study trialled multiple delivery modes of education about reproductive genetic 'carrier screening' with varying levels of specialised educator (genetic counsellors) input to examine clinical effectiveness, and health care practitioners and educator preferences., Methods: A subset of health care practitioners (n = 209) interested in offering carrier screening through a large study were randomly allocated to receive education via face-to-face, a pre-recorded video or an online module, with active or passive educator input. The modes were evaluated using four levels of behaviour-linked outcomes., Findings: The results of our study show that although face-to-face and a video modality with active educator input had the highest completion rates and impact on clinical practice, there was little difference across modes on self-reported behaviour change outcomes. The educators observed that there was no one-size-fits-all approach to education delivery and reported benefits and drawbacks to each. Going forward, 56% of health care practitioners considered an online mode of education delivery, such as videos, written material or both, to be viable approaches with options for ongoing educator support., Conclusion: Embedding highly specialised educators with ongoing support and incorporating aspects of social learning within functional digital platforms should be considered in the development of continuing medical education, especially for health care practitioners who may work in smaller and isolated clinics., (© 2024 Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Abstract Background Brief messaging interventions, including Short Message Service (SMS) text-messages, delivered via mobile device platforms, show promise to support and improve treatment adherence. To understand how these interventions work, and to facilitate transparency, we need clear descriptions of the intervention development process. Method We describe and reflect on the process of designing and pretesting an evidence- and theory-informed brief messaging intervention, to improve diabetes treatment adherence in sub-Saharan Africa. We followed the stepwise approach recommended by the Medical Research Council, United Kingdom (MRC UK) Framework for Development and Evaluation of Complex Health Interventions and guidance for mobile health intervention development. Results We used a four-phase, iterative approach that first generated primary and secondary evidence on the lived experience of diabetes, diabetes treatment services and mobile-phone use. Second, we designed a type 2 diabetes-specific, brief text-message library, building on our previous hypertension text-message library, as well as drawing on the primary and secondary data from phase one, and on expert opinion. We then mapped the brief text-messages onto behaviour change (COM-B) theoretical constructs. Third, we refined and finalised the newly developed brief text-message library through stakeholder consultation and translated it into three local languages. Finally, we piloted the intervention by pre-testing the automated delivery of the brief text-messages in the trial sites in Malawi and South Africa. The final SMS text Adherence suppoRt for people with type 2 diabetes (StAR2D) intervention was tested in a randomised controlled trial in Malawi and South Africa (trial registration: ISRCTN70768808 ). Conclusion The complexity of public health interventions requires that we give more attention to intervention development work. Our documentation and reflection on the StAR2D intervention development process promotes transparency, replicability, assessment of intervention quality, and comparison with other studies.

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. [ABSTRACT FROM AUTHOR]

The aim of this study was to review the intervention components of school‐based oral health‐related behavioural interventions using the Theoretical Domains Framework (TDF). We identified relevant papers from the review of Cooper et al., and these papers came from both the original inclusion and exclusion article lists. We also modified and updated their search strategies (2013 – April 2019). The 53 included papers reported on 79 interventions (experimental groups = 57 interventions, control groups = 22 interventions). Most of the papers used three to nine domains (average = 5.6) in their experimental interventions, and the most commonly used domains were 'knowledge,' 'skills,' 'social influences,' and 'environmental context and resources.' Considering the complexity of intervention components in one programme, there is no one specific domain or domain set that can determine the success of behavioural interventions. The design of future programmes should be guided by a complex intervention methodology. However, the best combination set might not exist, and the choice of domains should depend on local context or resources. This study can be used as a resource for identifying previous papers, which have used the same domains. [ABSTRACT FROM AUTHOR]

Aim: This systematic review aimed to describe behaviour change theories and techniques used to inform nutrition interventions for adults undergoing bariatric surgery. Methods: A systematic search was conducted across PubMed, PsycInfo, CENTRAL, EMBASE and CINAHL from inception until 09 March 2021. Eligible studies were randomised controlled trials involving nutrition interventions performed by a healthcare provider, to adults that were waitlisted or had undergone bariatric surgery and received a nutrition intervention explicitly informed by one or more behaviour change theories or behaviour change techniques. Screening was conducted independently by two authors. Behaviour change techniques were examined using the behaviour change technique taxonomy version one which includes 93 hierarchical techniques clustered into 16 groups. Quality of included studies was assessed using Cochrane risk of bias 2.0. Results: Twenty‐one publications were included, involving 15 studies and 14 interventions, with 1495 participants. Bias was low or had some concerns. Two interventions reported using behaviour change theories (transtheoretical model and self‐determination theory). Thirteen behaviour change technique taxonomy groupings and 29 techniques were reported across 14 interventions. Common techniques included '1.2 Problem solving' (n = 9 studies), '3.1 Social support (unspecified)' (n = 9 studies), '1.1 Goal setting (behaviour)' (n = 6 studies) and '2.3 Self‐monitoring of behaviour' (n =‐ 6 studies). Conclusion: While behaviour change techniques have been included, behaviour change theory is not consistently reported and/or adopted to inform nutrition interventions for adults undergoing bariatric surgery. Integrating behaviour change theory and techniques in nutrition interventions is important for researchers and bariatric surgery teams, including dietitians, to effectively target behaviours for this population. [ABSTRACT FROM AUTHOR]

This systematic review provides an overview of the unique challenges allied health professions face in the translation and implementation of evidence into practice, which remain relatively under reported and uninformed by a theoretical basis of behaviour change. MEDLINE, EMBASE, CINAHL and Scopus databases from 2010 to 2022 were searched for primary study designs resulting in 21 articles included in this review (PROSPERO: 2022 CRD42022314996). Allied health disciplines reported in the review were mainly from occupational therapy, physiotherapy, dietetics, and speech pathology. The most frequently reported implementation determinants across the Theoretical Domains Framework were identified as 'environmental context and resources', and 'knowledge'. The results also identified a greater influence of 'social influences' and 'beliefs about consequences' in implementation. Implementing evidence into clinical practice is a multifaceted, complex process, and the use of the Theoretical Domains Framework provided a systematic approach to understanding the drivers behind the target behaviours. However, there is a paucity of studies across the allied health professions that describe implementation strategies used and their impact. Many of the studies focused on implementation by the individual clinician rather than the role organizations can play in the translation of evidence into practice., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Programme interventionists often determine best practices from systematic reviews of the literature. Interpretations of findings from systematic reviews, however, are susceptible to subjective decisions of the authors. Replication of systematic reviews by different authors on the same topic can increase the authenticity of findings, analysis, and interpretations. The purposes of the current paper were to (a) replicate a systematic literature review using the theory of planned behaviour (TPB) to understand the intention of adults living with physical disabilities to participate in PA, and (b) compare the findings with a published systematic literature review on the same topic. CINAHL, ERIC, SPORTDiscus, Medline, Psycinfo, and Pubmed databases were searched for eligible studies. A total of 11 articles were included for the current review. Intention was the strongest predictor for PA behaviour, with attitude and perceived behavioural control were also significant predictors for intention. Subjective norm had less influence but a distinct role shaping intention. A total of six of 11 studies overlapped with the comparison review. Selection of different studies were due to differences in search databases, search strategy, and inclusion and exclusion criteria. Inconsistency was also found in relationships among other components in the theory, with different interpretations made between the two reviews. The current replication review provides practical and research related implications that add to the understanding of the TBP for persons living with physical disabilities and the findings of the comparative review. [ABSTRACT FROM AUTHOR]

In response to increasing emergency department presentations and wait times in Australia, multiple strategies and models of care have been implemented with varying results. One effective strategy has been the implementation of pre-hospital blood collection by paramedics when they insert an intravenous cannula. This research aims to determine the efficiency of and barriers to wider implementation of a pre-hospital blood collection trial in a regional context. In particular, to evaluate the impact of the pre-hospital blood collection on time to pathology results and error rates, and paramedic opinion. This retrospective controlled cohort study was conducted over 12 months from August 2018. Emergency and pathology data were used to determine the haemolysis and error rates, as well as the time to result availability of pre-hospital blood collection samples compared to in hospital samples arrived by ambulance. To determine the facilitators and barriers to wider implementation a survey of 48 paramedics was conducted following completion of the 12-month trial. The survey was informed by the Theoretical Domains Framework, a behavior change theory associated with improved uptake when applied. Overall 237 samples were collected. There was a 65% (51 min) reduction in time taken for samples to be received at pathology and a 38% (50 min) improvement in time taken for results to return from pathology for patients arrived by ambulance. There were no labelling errors in the pre-hospital blood collection group or change in haemolysis rates. The majority (79%) of paramedics who completed the survey were optimistic about the protocol improving patient outcomes and 89% regarded the change in practice as acceptable. Three main themes emerged: 1. Training, environmental challenges and adequate equipment; 2. increased efficiency and improved patient care and 3. Prerequisites to implementing a new practice. Integration of Quantitative and Qualitative data resulted in 10 key influencers of behavior that need to be addressed in any future implementation. The introduction of pre-hospital phlebotomy reduced the time to blood results availability by 38% and resulted in fewer labelling errors. Wider implementation is supported by paramedics, but more training is required. [ABSTRACT FROM AUTHOR]

Background: Changing people's behaviour by giving advice and instruction, as traditionally provided in healthcare consultations, is usually ineffective. Healthy Conversation Skills (HCS) training enhances health professionals' communication skills and ability to empower and motivate people in health behaviour change. Guided by the Theoretical Domains Framework (TDF), this study examined the impact of HCS training on health professional barriers to conducting behaviour change conversations in both clinical and non-clinical settings. Secondary aims were to i) identify health professionals' barriers to having behaviour change conversations, and explore the ii) effect of HCS training on health professionals' competence and attitudes to adopting HCS, iii) feasibility, acceptability and appropriateness of using HCS in their clinical and non-clinical roles, and iv) acceptability and quality of HCS training.Methods: HCS training was conducted in October-November 2019 and February 2020. Pre-training (T1), post-training (T2) and follow-up (T3; 6-10 weeks post-training) surveys collected data on demographics and changes in competence, confidence, importance and usefulness (10-point Likert scale, where 10 = highest score) of conducting behaviour change conversations. Validated items assessing barriers to having these conversations were based on eight TDF domains. Post-training acceptability and quality of training was assessed. Data were summarised using descriptive statistics, and differences between TDF domain scores at the specific time points were analysed using Wilcoxon matched-pairs signed-rank tests.Results: Sixty-four participants consented to complete surveys (97% women; 16% identified as Aboriginal), with 37 employed in clinical settings and 27 in non-clinical settings. The training improved scores for the TDF domains of skills (T1: median (interquartile range) = 4.7(3.3-5.3); T3 = 5.7(5.3-6.0), p < 0.01), belief about capabilities (T1 = 4.7(3.3-6.0); T3 = 5.7(5.0-6.0), p < 0.01), and goals (T1 = 4.3(3.7-5.0); T3 = 4.7(4.3-5.3), p < 0.01) at follow-up. Competence in using 'open discovery questions' increased post-training (T1 = 25% of responses; T2 = 96% of responses; T3 = 87% of responses, p < 0.001), as did participants' confidence for having behaviour change conversations (T1 = 6.0(4.7-7.6); T2 = 8.1(7.1-8.8), p < 0.001), including an increased confidence in having behaviour change conversations with Aboriginal clients (T1 = 5.0(2.7-6.3); T2 = 7.6(6.4-8.3), p < 0.001).Conclusions: Provision of additional support strategies to address intentions; memory, attention and decision processes; and behavioural regulation may enhance adoption and maintenance of HCS in routine practice. Wider implementation of HCS training could be an effective strategy to building capacity and support health professionals to use a person-centred, opportunistic approach to health behaviour change. [ABSTRACT FROM AUTHOR]

Background: There is growing recognition of the need for interventions that effectively involve men and boys to promote family planning behaviours. Evidence suggests that the most effective behavioural interventions in this field are founded on theoretical principles of behaviour change and gender equality. However, there are few evidence syntheses on how theoretical approaches are applied in this context that might guide best practice in intervention development. This review addresses this gap by examining the application and reporting of theories of behaviour change used by family planning interventions involving men and boys. Methods: We adopted a systematic rapid review approach, scoping findings of a previously reported evidence and gap map of intervention reviews (covering 2007–2018) and supplementing this with searches of academic databases and grey literature for reviews and additional studies published between 2007 and 2020. Studies were eligible for inclusion if their title, abstract or keywords referred to a psychosocial or behavioural intervention targeting family planning behaviours, involved males in delivery, and detailed their use of an intervention theory of change. Results: From 941 non-duplicate records identified, 63 were eligible for inclusion. Most records referenced interventions taking place in low- and middle-income countries (65%). There was a range of intervention theories of change reported, typically targeting individual-level behaviours and sometimes comprising several behaviour change theories and strategies. The most commonly identified theories were Social Cognitive Theory, Social Learning Theory, the Theory of Planned Behaviour, and the Information-Motivation-Behaviour Skills (IMB) Model. A minority of records explicitly detailed gender-informed elements within their theory of change. Conclusion: Our findings highlight the range of prevailing theories of change used for family planning interventions involving men and boys, and the considerable variability in their reporting. Programmers and policy makers would be best served by unified reporting and testing of intervention theories of change. There remains a need for consistent reporting of these to better understand how complex interventions that seek to involve men and boys in family planning may lead to behaviour change. Plain language summary: Family planning (FP) programmes aim to enable people to achieve their desired family size. Successful programmes are essential for encouraging better health outcomes for individuals and families. Historically, FP programmes have focused on the sexual and reproductive health and rights of women and girls, and while this is necessary, it has also contributed to the exclusion of men and boys from FP programmes. There is growing evidence to suggest, however, that involving men and boys in FP may increase its uptake and improve health outcomes for all. However, we still know relatively little about the best ways to involve men and boys in FP programmes in order to ensure success. Research is ongoing to rectify this. When we look at public health behaviour change programmes in general, we find that many successful programmes incorporate theories of behaviour change into their design. These theories guide the kinds of activities and materials that the programme employs in order to promote behaviour change. In the field of FP, there is little information about the kinds of behaviour change theories that might be used to design programmes. This review aimed to address this by reviewing the global literature on FP programmes that involved men and boys to identify relevant behaviour-change theories. We found a range of theories that will be of use to programme planners. We also found, however, that there was lots of variability in the way theories were reported. We make recommendations for how this problem might be resolved. [ABSTRACT FROM AUTHOR]

Background: The UK has low levels of breastfeeding initiation and continuation, with evident socioeconomic disparities. To be inclusive, peer-support interventions should be woman-centred rather than breastfeeding-centred. Assets-based approaches to public health focus on the positive capabilities of individuals and communities, rather than their deficits and problems. The Assets-based feeding help Before and After birth (ABA) intervention offers an assets-based approach based on behaviour change theory. Objective: To investigate the feasibility of delivering the ABA infant feeding intervention in a randomised controlled trial. Design: This was an individually randomised controlled feasibility trial; women were randomised in a 1 : 1 ratio to either the intervention group or the comparator (usual care) group. Setting: Two separate English sites were selected because they had an existing breastfeeding peer support service, relatively high levels of socioeconomic disadvantage and low rates of breastfeeding. Participants: Women aged ≥ 16 years who were pregnant with their first child, irrespective of feeding intention (n = 103), were recruited by researchers in antenatal clinics. Interventions: Proactive, woman-centred support, using an assets-based approach and including behaviour change techniques, was provided by an infant-feeding helper (a breastfeeding peer supporter trained in the ABA intervention) and delivered through face-to-face contact, telephone conversations and text messages. The intervention commenced at around 30 weeks’ gestation and could continue until 5 months postnatally. Main outcome measures: The main outcome measures were feasibility of intervention delivery with the requisite intensity and duration; acceptability to women, infant-feeding helpers and maternity services; and feasibility of a future randomised controlled trial. Outcomes included recruitment rates and follow-up rates at 3 days, 8 weeks and 6 months postnatally, and outcomes for a future full trial were collected via participant questionnaires. A mixed-methods process evaluation included qualitative interviews with women, infant-feeding helpers and maternity services; infant-feeding helper logs; and audio-recordings of antenatal contacts to check intervention fidelity. Results: Of the 135 eligible women approached, 103 (76.3%) agreed to participate. The study was successful in recruiting teenagers (8.7%) and women living in areas of socioeconomic disadvantage (37.3% resided in the most deprived 40% of small areas in England). Postnatal follow-up rates were 68.0%, 85.4% and 80.6% at 3 days, 8 weeks and 6 months, respectively. Feeding status at 8 weeks was obtained for 95.1% of participants. Recruitment took place from February 2017 until August 2017. It was possible to recruit and train existing peer supporters to the infant-feeding helper role. The intervention was delivered to most women with relatively high fidelity. Among the 50 women in the intervention group, 39 received antenatal visits and 40 received postnatal support. Qualitative data showed that the intervention was acceptable. There was no evidence of intervention-related harms. Limitations: Birth notification delays resulted in delays in the collection of postnatal feeding status data and in the offer of postnatal support. In addition, the intervention needs to better consider all infant-feeding types and did not adequately accommodate women who delivered prematurely. Conclusion: It is feasible to deliver the intervention and trial. Future work: The intervention should be tested in a fully powered randomised controlled trial. Trial registration: Current Controlled Trials ISRCTN14760978. Funding: This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 7. See the NIHR Journals Library website for further project information.

Background: Brief messaging interventions, including Short Message Service (SMS) text-messages, delivered via mobile device platforms, show promise to support and improve treatment adherence. To understand how these interventions work, and to facilitate transparency, we need clear descriptions of the intervention development process.Method: We describe and reflect on the process of designing and pretesting an evidence- and theory-informed brief messaging intervention, to improve diabetes treatment adherence in sub-Saharan Africa. We followed the stepwise approach recommended by the Medical Research Council, United Kingdom (MRC UK) Framework for Development and Evaluation of Complex Health Interventions and guidance for mobile health intervention development.Results: We used a four-phase, iterative approach that first generated primary and secondary evidence on the lived experience of diabetes, diabetes treatment services and mobile-phone use. Second, we designed a type 2 diabetes-specific, brief text-message library, building on our previous hypertension text-message library, as well as drawing on the primary and secondary data from phase one, and on expert opinion. We then mapped the brief text-messages onto behaviour change (COM-B) theoretical constructs. Third, we refined and finalised the newly developed brief text-message library through stakeholder consultation and translated it into three local languages. Finally, we piloted the intervention by pre-testing the automated delivery of the brief text-messages in the trial sites in Malawi and South Africa. The final SMS text Adherence suppoRt for people with type 2 diabetes (StAR2D) intervention was tested in a randomised controlled trial in Malawi and South Africa (trial registration: ISRCTN70768808 ).Conclusion: The complexity of public health interventions requires that we give more attention to intervention development work. Our documentation and reflection on the StAR2D intervention development process promotes transparency, replicability, assessment of intervention quality, and comparison with other studies. [ABSTRACT FROM AUTHOR]

Objective: A taxonomy of ninety-three functionally different behaviour change techniques (BCTs) has been identified. However, it is not fully clear how these and other theory-based techniques are applied in the day-to-day practice of people delivering health behaviour change interventions. This study examines feedback provided by expert health coaches in a behavioural weight-loss intervention, to describe; a) what theory-based techniques are used in sessions, b) which techniques are used most frequently, c) what occurs in sessions, beyond existing theory-based techniques. Main Outcome Measures: Theory-based techniques (BCTs/tailoring strategies); relational/content-based techniques. Design: 10 tailored feedback videos from two health coaches were coded using a hybrid thematic analysis approach. Theory-based techniques were coded deductively; content not matching definitions of theory-based techniques but that addressed a determinant of behaviour change were coded inductively and relational codes were connected into themes. Results: Seventeen BCTs were coded M = 20.88 times (range:1–109). Eight tailoring techniques were coded M = 25.25 times (range:1–91). Relational themes included; 'Autonomous interpersonal coaching style,' 'Supportive accountability,' and 'Coach as expert'. Additional behavioural techniques were also identified. Conclusion: This work highlights what and how theory-based techniques are implemented in a weight-loss intervention, drawing attention to the role of tailoring techniques and health coaches in supporting behaviour change. [ABSTRACT FROM AUTHOR]

The rising use of the Internet and information technology has made computerized interventions an attractive channel for providing advice and support for behaviour change. Health behaviour and behaviour change theories are a family of theories which aim to explain the mechanisms by which human behaviours change and use that knowledge to promote change. Among the best-known of these theories are the Social Learning and Social Cognitive theories, the Health Belief Model, the Theory of Reasoned Action and its successors the Theory of Planned Behaviour and the Reasoned Action Approach, and the Transtheoretical model. We discuss three examples of how behaviour change theories have been applied in computer-based interventions: a system to aid users to quit smoking, a decision aid for choice of breast cancer therapy, and an internet-based exercise program for reducing cardiovascular risk. We also discuss misapplication of theory, and reflect on how these theories can best be used. Behaviour change theory can be applied in health informatics interventions in several ways; for example, to select participants for a particular intervention, to shape the content of the intervention to effectively influence behaviour, or to tailor content to individual needs. Application of these theories to provide personalized advice ("decision support") is a young but promising area of research, and could inform other decision support interventions, including those that provide support for clinicians. [ABSTRACT FROM AUTHOR]

Background: Healthcare worker (HCW) hand hygiene compliance is key to patient safety; however, compliance is suboptimal. Nevertheless hand hygiene compliance is not well studied in the long-term care setting.Aim: To apply a behaviour change framework, the Theoretical Domains Framework (TDF), to identify modifiable facilitators and barriers for HCW hand hygiene compliance in long-term care settings.Methods: HCW hand hygiene compliance facilitators and barriers were examined using a questionnaire for HCWs from long-term care homes in Ontario, Canada. The questionnaire was informed by the TDF, which is based on a synthesis of constructs from a number of relevant psychological theories of behaviour change.Findings: Barriers identified from the questionnaire aligned with the TDF domain environmental context and resources (time pressure, workload, and environmental controls). Facilitators identified from questionnaire results aligned with the TDF domains social/professional role and identity (it is what is expected of HCWs), and beliefs about consequences (risk of transmission of micro-organisms to self or others).Conclusion: There are several barriers to hand hygiene compliance that persist in long-term care. A behaviour change theory-informed framework such as the TDF can be helpful to identify those barriers. This study identified several key behavioural constructs aligned with the TDF that can be targeted when developing novel hand hygiene interventions. [ABSTRACT FROM AUTHOR]

Peer-led education has been shown to be an effective approach for raising community-dwelling older adults' beliefs, knowledge and intention to engage in falls prevention strategies in a recent intervention trial. This article outlines the design and development of the intervention, which was a peer-led falls prevention education programme designed to promote older adult's motivation to change their behaviour in the area of falls prevention. The elements of the programme that contributed to its efficacy are also described. The programme was designed using a four-step approach and was based on the constructs of a theoretical framework (the COM-B model). Feedback from older adults was also incorporated into the programme development. Programme components developed were a workshop to train older adult peer educators to deliver falls prevention education, a one-hour peer-led falls prevention presentation, and supporting resources to aid programme delivery. A questionnaire measuring older adults' responses to the presentation was concurrently developed and pilot-tested prior to implementation of the education programme. Finally, resources to monitor and evaluate fidelity at five points in the programme were developed. It was found that seeking older adult consumer involvement, and adopting a theoretical framework-driven approach contributes to effective design and delivery of falls prevention education programmes. This ensured that the programme was acceptable to older adults, feasible to deliver and allowed robust measurement of the effect of the education programme on important behavioural change components. [ABSTRACT FROM AUTHOR]

Rationale Persons with physical disabilities report higher cigarette smoking rates and a lower likelihood of accessing health services (e.g., smoking cessation services). Explicit and systematic application of behaviour change theory may be a promising approach to addressing these inequities and developing impactful smoking cessation interventions for persons with physical disabilities. This scoping review aimed to explore how behaviour change theory and intervention components have been used to design smoking cessation interventions for persons with physical disabilities. Electronic databases (Medline, Embase, PsycINFO, CINAHL, Web of Science) were systematically searched. Smoking cessation interventions for persons with physical disabilities were identified. Behaviour change theory and intervention components, including behaviour change techniques, intervention functions, mode of delivery, intervention source, and setting, were extracted from the included articles. Among the eleven included articles, there were nine unique smoking cessation interventions for persons with physical disabilities. Three interventions mentioned theory, but none of these articles explicitly applied or tested the theory. Intervention components were consistently combined to deliver pharmacotherapy and behavioural counselling-based interventions. The results of this review highlight the scarcity of theory-based smoking cessation interventions for persons with physical disabilities. While the interventions were not theory-based, they were evidence-based and aligned with recommendations for smoking cessation treatment (i.e., behavioural counselling plus pharmacotherapy). Future research should take a theory-based approach to intervention development to enhance the likelihood that smoking cessation interventions for persons with physical disabilities are effective, replicable, and equitable. [ABSTRACT FROM AUTHOR]

To assess the wider application of the SHARP (Stretching whilst moving, High repetition of skills, Accessibility, Reducing sitting and standing, and Promotion of physical activity) Principles intervention on children’s moderate to vigorous physical activity (MVPA) in physical education (PE), when applied by teachers and coaches. A quasi-experimental intervention was employed in nine primary schools (experimental, n = 6: control, n = 3) including teachers (n = 10), coaches (n = 4), and children (aged 5 to 11 years, n = 84) in the West Midlands, UK. Practitioners applied the SHARP Principles to PE lessons, guided by an innovative behaviour change model. The System for Observing Fitness and Instruction Time (SOFIT) was used to measure children’s MVPA in 111 lessons at pre- (n = 60) and post-intervention (n = 51). Seven interviews were conducted post-intervention to explore practitioners’ perceptions. Two-way ANOVA (Analysis of Variance) revealed that teachers increased children’s MVPA by 27.7%. No statistically significant change in children’s MVPA was observed when taught by the coaches. The qualitative results for teachers were ‘children’s engagement’, a ‘pedagogical paradigm shift’, and ‘relatedness’; and for coaches ‘organisational culture’ and ‘insufficient support and motivation’. The SHARP Principles intervention is the most effective teaching strategy at increasing MVPA in primary PE when taught by school based staff (rather than outsourced coaches), evidencing increases almost double that of any previously published study internationally and demonstrating the capacity to influence educational policy and practice internationally.

Aims and objectives To determine potential facilitators and barriers and tailor interventions to optimise future implementation of a patient-assessment framework into emergency nursing practice. Background An evidence-informed patient-assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) improves the quality of patient assessments performed by emergency nurses. Facilitators and barriers must be understood and tailored interventions selected to optimise implementation. Design A mixed-method convergent study design was used. Methods Thirty eight early career emergency nurses from five Australian hospitals participated in an education workshop on the HIRAID assessment framework. Simulated clinical scenarios enabled participants to experience conducting a patient assessment with and without using the framework. All participants completed surveys, interviews and focus groups to identify potential facilitators and barriers. Twenty three participants completed follow-up telephone surveys 4-6 months later. Quantitative and qualitative data were analysed separately using descriptive statistics and inductive content analysis, prior to integration. Implementation interventions were selected using the Behaviour Change Wheel. Results Nine facilitators and nine barriers were identified to potentially effect implementation of the HIRAID assessment framework. Twelve of the 23 participants (52.2%) who completed follow-up surveys reported using the framework in the clinical setting. To optimise future implementation, the education workshop needs refinement, and environmental restructuring, modelling and social support are required. Conclusion A multimodal strategy is needed to promote future successful implementation of the HIRAID assessment framework into emergency nursing practice. Relevance for clinical practice The successful implementation of the HIRAID assessment framework has the potential to improve nursing assessments of patients in emergency and other acute care settings. This study demonstrates how to systematically identify facilitators and barriers to behaviour change and select interventions to optimise implementation of evidence-informed nursing practices. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Pregnant women benefit from completing pelvic floor muscle exercises (PFMEs). The aims of the study were to evaluate pregnant women's levels of awareness, knowledge, and beliefs about the pelvic floor muscles (PFMs) and PFMEs. Methods: A cross-sectional survey was conducted. Respondents were pregnant women over the age of 18 years who attended antenatal clinics in Western Australia (WA). Questionnaire items measured awareness and knowledge about PFMs, confidence and beliefs about engaging in PFMEs, and attendance at antenatal education (ANE) classes. Chi-squared tests examined potential associations between questionnaire items and respondent characteristics. Results: Mean gestation of respondents ( n = 633 out of 850; 74% response rate) was 28.7 (+7.8) weeks and 50% were giving birth for the first time. Although 76% of respondents knew that PFMs can prevent urinary incontinence, only 27% knew that they prevented faecal incontinence and 41% thought it was normal to leak urine when pregnant. Only n = 72 (11%) were practicing PFMEs. Respondents who had attended ANE (28%) were significantly more knowledgeable about pelvic floor function ( p < .001) and significantly less likely to believe that leaking urine during pregnancy was normal ( p = 0.02), compared with those who had not attended ANE. Respondents who did not speak English at home (18%) were significantly less knowledgeable about PFMs and PFMEs, and significantly less likely to have attended, or planned to attend, ANE classes. Conclusion: Pregnant women require more health education regarding PFMs. Education should be provided using diverse modes, especially for women from migrant backgrounds and women who do not plan to attend formal ANE classes. [ABSTRACT FROM AUTHOR]

Managers of marine protected areas (MPAs) are constantly challenged to encourage positive user behaviour to minimise impacts on marine ecosystems while allowing recreational use. Yet, some marine users continue to act in ways that diminish conservation values of the area. Drawing on social psychological theories, this paper presents a case for informed behaviour change strategies to reduce problem behaviours in MPAs and contribute to conservation efforts. Social psychological drivers of behaviour are explained and applied to an MPA context to demonstrate how they can inform strategies for predicting and changing behaviour using persuasive communication. As behavioural and persuasive communication theories are seldom invoked and almost never rigorously applied to MPAs, the review offers new theoretical and practical insights into how they can assist MPA management to target and shift specific behaviours that ultimately support marine park values. [ABSTRACT FROM AUTHOR]

This review investigated the effectiveness of behaviour-change interventions to improve physical activity (PA) participation in individuals with a spinal cord injury. Additionally, the review sought to analyse the change in PA behaviour that might be expected by utilising behaviour change in PA interventions and what specific intervention characteristics, application of behaviour change theories, and behaviour change techniques are most efficacious. The protocol was prospectively registered on PROSPERO: CRD42021252744, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed in this review. Eight databases were comprehensively searched using a well-defined strategy developed in collaboration with an academic liaison librarian. Randomised, non-randomised controlled, and non-controlled studies were included in this review; however, controlled and non-controlled studies were analysed separately. Studies were included if participants were older than 16 years and had an SCI of any cause, level or severity, regardless of the time since injury. The behaviour change technique taxonomy version 1 was used to code the intervention characteristics for behaviour modification. The combined effects across studies were pooled in a meta-analysis, and the risk of bias was assessed using the Cochrane Risk of Bias 2 tool. The search retrieved 10,155 titles and abstracts. After duplicate removal and screening against the eligibility criteria, 23 studies were included. The overall effect estimate of the change in PA participation in the controlled trials post-intervention was medium (d = 0.50, 95% CI = 0.31–0.70) in favour of behaviour-targeted interventions. The mean difference in PA volume between pre- and post-intervention was an increase of 22 minutes per week (95% CI = 5.96–38.90). Interventions that provided practical support (d = 0.81, 95% CI = 0.46–1.16), which were individualised (d = 0.62, 95% CI = 0.34–0.90) and that utilised monitoring (d = 0.59, 95% CI = 0.34–0.83) had a greater effect on change to PA than those that were group-based and did not utilise those specific techniques. Interventions that target behaviour change to increase PA in people with SCI appear effective. Utilising behaviour change frameworks and specific behaviour change techniques augments PA uptake and levels, and interventions aimed at improving PA in people with SCI should incorporate a behaviour modification component. More research is needed on the isolated effect of intervention structure parameters and specific behaviour change techniques. • Interventions that utilise behaviour-change techniques alter physical activity (PA) behaviour in people with a spinal cord injury. • Targeting PA behaviour change and maximising the application of behaviour change frameworks can increase the amount of PA performed per week. • Individualising programs and providing practical support elicit the most significant PA change. [ABSTRACT FROM AUTHOR]

Behaviour change interventions offer clinical pharmacists many opportunities to optimise the use of medicines. 'MINDSPACE' is a framework used by a Government-affiliated organisation in the United Kingdom to communicate an approach to changing behaviour through policy. The Theoretical Domains Framework (TDF) organises constructs of psychological theories that are most relevant to behaviour change into 14 domains. Both frameworks offer a way of identifying what drives a change in behaviour, providing a target for an intervention. This article aims to compare and contrast MINDSPACE and the TDF, and serves to inform pharmacy practitioners about the potential strengths and weaknesses of using either framework in a clinical pharmacy context. It appears that neither framework can deliver evidence-based interventions that can be developed and implemented with the pace demanded by policy and practice-based settings. A collaborative approach would ensure timely development of acceptable behaviour change interventions that are grounded in evidence. [ABSTRACT FROM AUTHOR]

Background Medical Research Council (MRC) guidelines recommend applying theory within complex interventions to explain how behaviour change occurs. Guidelines endorse self-management of chronic low back pain (CLBP) and osteoarthritis (OA), but evidence for its effectiveness is weak. Objective This literature review aimed to determine the use of behaviour change theory and techniques within randomised controlled trials of group-based self-management programmes for chronic musculoskeletal pain, specifically CLBP and OA. Methods A two-phase search strategy of electronic databases was used to identify systematic reviews and studies relevant to this area. Articles were coded for their use of behaviour change theory, and the number of behaviour change techniques (BCTs) was identified using a 93-item taxonomy, Taxonomy (v1). Results 25 articles of 22 studies met the inclusion criteria, of which only three reported having based their intervention on theory, and all used Social Cognitive Theory. A total of 33 BCTs were coded across all articles with the most commonly identified techniques being ‘ instruction on how to perform the behaviour ’, ‘ demonstration of the behaviour ’, ‘ behavioural practice ’, ‘ credible source ’, ‘ graded tasks ’ and ‘ body changes ’. Conclusion Results demonstrate that theoretically driven research within group based self-management programmes for chronic musculoskeletal pain is lacking, or is poorly reported. Future research that follows recommended guidelines regarding the use of theory in study design and reporting is warranted. [ABSTRACT FROM AUTHOR]

Background: The Global Alliance for Chronic Diseases comprises the majority of the world's public research funding agencies. It is focussed on implementation research to tackle the burden of chronic diseases in low- and middle-income countries and amongst vulnerable populations in high-income countries. In its inaugural research call, 15 projects were funded, focussing on lowering blood pressure-related disease burden. In this study, we describe a reflexive mapping exercise to identify the behaviour change strategies undertaken in each of these projects.Methods: Using the Behaviour Change Wheel framework, each team rated the capability, opportunity and motivation of the various actors who were integral to each project (e.g. community members, non-physician health workers and doctors in projects focussed on service delivery). Teams then mapped the interventions they were implementing and determined the principal policy categories in which those interventions were operating. Guidance was provided on the use of Behaviour Change Wheel to support consistency in responses across teams. Ratings were iteratively discussed and refined at several group meetings.Results: There was marked variation in the perceived capabilities, opportunities and motivation of the various actors who were being targeted for behaviour change strategies. Despite this variation, there was a high degree of synergy in interventions functions with most teams utilising complex interventions involving education, training, enablement, environmental restructuring and persuasion oriented strategies. Similar policy categories were also targeted across teams particularly in the areas of guidelines, communication/marketing and service provision with few teams focussing on fiscal measures, regulation and legislation.Conclusions: The large variation in preparedness to change behaviour amongst the principal actors across these projects suggests that the interventions themselves will be variably taken up, despite the similarity in approaches taken. The findings highlight the importance of contextual factors in driving success and failure of research programmes. Forthcoming outcome and process evaluations from each project will build on this exploratory work and provide a greater understanding of factors that might influence scale-up of intervention strategies. [ABSTRACT FROM AUTHOR]

Introduction: maternal obesity [body mass index (BMI)≥30 kg/m2] is a cause for concern because of increasing rates and risk of associated complications. However, little is known about how to improve the health of women with a BMI≥30 kg/m2. Objective and methods: a 10-week antenatal lifestyle programme (The Lifestyle Course -- TLC), underpinned by behaviour change theory, was developed in a programme of research which included a prospective, multicentred, feasibility phase (n=227). Participants had a BMI≥30 kg/m2 at the start of their pregnancy, planned to deliver in two areas of Greater Manchester and were aged 18 or over. The objectives were to (1) assess the feasibility of the intervention and (2) to pilot the trial processes and outcome measures. Findings: (1) Trial intervention: only 22% of women in the feasibility phase had received gestational weight advice prior to the study. One or more TLC sessions were attended by 79% of women and 97% said they would recommend TLC to a friend due to the content suitability, perceived personal gains and extra care received. Changes to the TLC were suggested and implemented in the pilot phase. (2) Trial processes: recruitment rates (36%), retention rates (100%) and questionnaire completion rates up to one year (33%) were found. Daily general ‘lifestyle’ diaries and pedometers were not acceptable data collection tools (response rates of 32% and 16% respectively). However, specific food diaries were acceptable (response rates of 80–81%). The major challenge was the collection of maternal weight data at the follow-up points. Conclusions and implications: the antenatal intervention (TLC) designed for this programme of work appears to suit the needs of women with a BMI≥30 kg/m2. The need for an antenatal intervention is clear from this study and also highlights reflections on effective communication with pregnant women with a BMI≥30 kg/m2. Lessons learnt for designing a future trial include effective ways to communicate with pregnant women with a BMI≥30 kg/m2. Trial registration: ISRCTN29860479. [ABSTRACT FROM AUTHOR]

Background Parasitological confirmation is now recommended for all cases of suspected malaria. The roll-out of rapid diagnostic tests (RDTs) is hoped to enable this goal in low resource settings through point of care testing. However, simply making RDTs available has not led to high uptake of the tests or adherence to results by clinicians, with malaria continuing to be overdiagnosed in many settings. We undertook to design an evidence-based intervention package that would be sufficient to support the introduction of RDTs at dispensaries in Tanzania, to be evaluated through the Targeting Artemisinin Combination Therapy (TACT) cluster randomised controlled trial. Methods We describe five steps in our intervention design: formative research, review of existing evidence and theory, a workshop to define the intervention approach and content and results of formative research, engagement with behaviour change theory and literature, detailed design of intervention materials and piloting and pretesting of intervention materials. This involved fieldwork with a total of 19 health workers and 212 community members in northeast Tanzania. Results The formative research suggested that RDTs were a potential source of conflict in the health worker-patient interaction, but that health workers used various techniques to resolve this, including provision of antimalarial drugs for RDT-negative patients. Our reviews showed that evidence was mixed regarding the effectiveness of different methods and theories to support change in prescribing practice. Our design process is presented, drawing from this collective evidence. We describe the final TACT intervention package (including interactive small group workshops, feedback text messages, motivational text messages and patient information leaflets and posters) in terms of its programme theory and implementation theory. Conclusions Our study suggests that evidence-based design of complex interventions is possible. The use of formative research to understand malaria overdiagnosis in context was central to the design of the intervention as well as empirical research to test materials and methods prior to implementation. The TACT interventions may be appropriate for other settings where clinicians face similar challenges with malaria diagnostics. [ABSTRACT FROM AUTHOR]

This review presents a case study of Government policy in relation to behaviour change and suggests ways of strengthening it by drawing on theoretical and empirical approaches from health psychology. It aims to inform policy-makers and politicians about the value of behavioural science, and to provide psychologists with an example of engagement with Government. It is based on two Health Psychology submissions to the 2010 UK House of Lords' Science and Technology Select Committee inquiry into Behaviour Change. The Inquiry examined current knowledge about what interventions can effectively influence behaviour, how behaviour change interventions can be used to achieve policy goals and what factors should be taken into account by government in determining whether a particular behaviour change intervention is appropriate. The review critiques current UK Government thinking about behaviour change and presents a number of linked frameworks for determining which behaviour change interventions and policies it would be sensible to research and implement. These include the COM-B system, a systems approach to understanding behaviour in context; the PRIME Theory of motivation; the Behaviour Change Wheel, including a comprehensive listing of intervention functions and policy levers; and behaviour change techniques. We end with considerations of intervention development, effectiveness and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Finding effective ways to change healthcare workers’ (HCWs) behaviour while informing and empowering patients is challenging. Providing patient information at critical points of care delivery may empower them to address lapses and change HCWs’ behaviour. In this study, posters detailing standards required for five high impact interventions were displayed in patients’ rooms. Research groups were: ‘pre-poster’ (months 1–2; n=142 patients); ‘poster’ (months 3–4; n=59); ‘no-poster’ (months 3–4; n=52); and ‘no-poster’ (months 5–6; n=104). Poster effectiveness was evaluated by a quantitative questionnaire (n=357). Patients were asked if they identified lapses in five interventions by HCWs and whether patients had addressed them. Patient interviews (n=10 per group) explored patients’ knowledge of interventions. Only patients with posters addressed lapses. Poster presence was associated with significant increase in noticing lapses in the first two weeks but decreased incidence in noticing lapses in weeks 3–8. There was significant aversion to reporting doctors’ lapses. Interviews showed that posters significantly increased respondents’ knowledge, suggesting that lapses noticed in weeks 1–2 and not noticed in weeks 3–8 by the ‘poster’ group were genuine lapses followed by a change in HCWs’ behaviour. HCW self-interest in avoiding complaints from patients coincides with the aim of the posters in improving standards. [ABSTRACT FROM PUBLISHER]

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