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Introduction: Health partnerships in global health aim to build capacity by strengthening training and education. Health psychology has an important role to play, as traditionally health partnerships focus upon increasing capability such as increasing knowledge but do not tackle opportunity and motivation. The Change Exchange recruits applied psychologist volunteers to utilize health psychology in global health partnerships, which is a novel approach. This study aimed to understand the experiences of applied psychologist volunteers working in health partnerships and how such interventions were implemented. Methods: Semi-structured interviews were carried out. Interviews were analysed using inductive thematic analysis to explore the translation and implementation of health psychology in health partnerships. A deductive approach was then taken using the higher level constructs of the Normalization Process Theory to inform and interpret the themes into recommendations. Results: Fifteen applied psychologists, all of whom were from the UK and had volunteered in health partnerships between the UK and low- to middle-income countries participated. Key themes and sub-themes were identified: (1) The challenges of the application of behavioural science within the health partnerships, (2) Building relationships within the health partnership, (3) Exploring the communal and individual effort carried out within the health partnership and (4) Reflecting on the work carried out within the health partnership. Discussion: Barriers exist in regards to the implementation of health psychology in health partnerships but capacity building is possible. Recommendations suggest, future work should establish clear roles for applied psychologists in health partnerships and critical evaluation of current psychological models, methods and measures for use outside of Western, Educated, Industrialized, Rich and Democratic societies.

Background: The COVID-19 pandemic exacerbated vulnerabilities and inequalities in children’s oral health and treatment activity virtually ceased during periods of lockdown. Primary care dentistry is still in the post-pandemic recovery phase and it may be some years before normal service is resumed in NHS dentistry. However, opportunities to support the dental workforce through offering some preventative care in outreach settings may exist. This has the additional benefit of potentially reaching children who do not routinely see a dentist. The aim of this research was therefore to explore views around upskilling practitioners working in strategic community settings to support families of pre-school aged children to adopt and maintain preventative oral health behaviours. Methods: Using the Capability, Opportunity and Motivation model of behaviour (COM-B) to structure our data collection and analysis, we conducted semi-structured interviews with 16 practitioners (dental and non-dental) and analysed the data using deductive framework analysis. Results: The data was a good fit with the COM-B model and further themes were developed within each construct, representing insights from the data. Conclusion: Early years practitioners can reach vulnerable children who are not usually brought to see a dentist and have capability, opportunity and motivation to support the oral health behaviours of families of children in their care. Further research is needed to identify training needs (oral health and behaviour change knowledge and skills), acceptability to parents, and supporting dental practice teams to work in partnership with early years settings.

BackgroundAntimicrobial stewardship (AMS) interventions promote optimised use of antimicrobials by healthcare professionals. In 2019-2020, the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) supported twelve global health partnerships in low-and-middle-income countries to co-develop education and training interventions to improve AMS practices among hospital staff. MethodThis study aimed to describe 6 of the CwPAMS health partnerships’ target behaviours and behaviour change techniques (BCTs) within their planned AMS interventions. Content analysis extracted behaviours and BCTs from partnership materials. Techniques used by partnerships with (n=2) and without (n=4) an embedded behavioural scientist were compared, to understand their added value.ResultsNineteen AMS related behaviours for hospital staff were targeted; most commonly hand hygiene and antibiotic prescribing behaviours. Twenty-three BCTs were coded, with instructing participants on how to perform the behaviours the most prominent across all, including partnerships with a behavioural scientist. Intervention materials did not always report the context of the intervention being delivered, including who was delivering it and the target. Behaviours for change were also often not specified. ConclusionPartnerships varied in reporting their content and specific behaviours, impacting replicability of their interventions, and limiting knowledge exchange. An AMS behaviour change intervention resource is recommended to support clear specification of prospective AMS interventions.

Training a skilled healthcare workforce is an essential part in reaching the United Nations Sustainable Development Goal to end preventable deaths in children and neonates. The greatest burden of mortality lies in low and lower-middle income countries (LLMIC). Short term, in-service courses have been implemented in many LLMIC to improve the quality of care delivered, but the evaluation methods of these courses are inconsistent.Studies describing evaluations of course and outcome measures were included if the course lasted seven days or less with postgraduate participants, included paediatric or neonatal acute or emergency training and was based in a LLMIC. This narrative review provides a detailed description of evaluation methods of course content, delivery and outcome measures based on 'Context, Input, Process and Product' (CIPP) and Kirkpatrick models.5265 titles were screened with 93 articles included after full-text review and quality assessment. Evaluation methods are described: context, input, process, participant satisfaction, change in learning, behaviour, health system infrastructure and patient outcomes.Outcomes, including mortality and morbidity, are rightly considered the fundamental aim of acute-care courses in LLMIC. Course evaluation can be difficult, especially with low resources, but this review outlines what can be done to guide future course organisers in providing well-conducted courses with consistent outcome measures for maximum sustainable impact.

ObjectivesPhysical distancing, defined as keeping 1–2m apart when co-located, can prevent cases of droplet or aerosol transmitted infectious diseases such as SARS-CoV2. During the COVID-19 pandemic, distancing was a recommendation or a requirement in many countries. This systematic review aimed to determine which interventions and behavior change techniques (BCTs) are effective in promoting adherence to distancing and through which potential mechanisms of action (MOAs).MethodsSix databases were searched. The review included studies that were (a) conducted on humans, (b) reported physical distancing interventions, (c) included any comparator (e.g., pre-intervention versus post-intervention; randomized controlled trial), and (d) reported actual distancing or predictors of distancing behavior. Risk of bias was assessed using the Mixed Methods Appraisal Tool. BCTs and potential MoAs were identified in each intervention.ResultsSix reports (with seven studies and 19 comparisons) indicated that distancing interventions could successfully change MoAs and behavior. Successful BCTs (MoAs) included feedback on behavior (e.g., motivation); information about health consequences, salience of health consequences (e.g., beliefs about consequences), demonstration (e.g., beliefs about capabilities), and restructuring the physical environment (e.g., environmental context and resources). The most promising interventions were proximity buzzers, directional systems, and posters with loss-framed messages that demonstrated the behaviors.ConclusionsThe evidence indicates several BCTs and potential MoAs that should be targeted in interventions and highlights gaps that should be the focus of future research.

The COVID-19 pandemic exacerbated vulnerabilities and inequalities in children’s oral health and treatment activity virtually ceased during periods of lockdown. However, opportunities to support the dental workforce through offering some preventative care in outreach settings may exist. This has the additional benefit of potentially reaching children who do not routinely see a dentist. The aim of this study was therefore to investigate views around upskilling practitioners working in strategic community settings to support families of pre-school aged children to adopt and maintain preventative oral health behaviours. Using the Capability, Opportunity and Motivation model of behaviour (COM-B) to structure our research, we conducted semi-structured interviews with 16 practitioners (dental and non-dental) and analysed the data using deductive framework analysis. The data was a good fit with the COM-B model and further themes were developed within each construct, representing insights from the data. Early years practitioners can reach vulnerable children who are not usually brought to see a dentist. Staff have the capability, opportunity and motivation to support the oral health behaviours of families. Further research is needed to identify training needs, acceptability to parents, and supporting dental practice teams to work in partnership with early years settings. In brief: · Preventative dental activity was greatly diminished during the COVID-19 pandemic however there may be opportunities for professionals based outside general dental practice to have oral health behaviour change conversations with parents· Early years practitioners in particular can potentially reach vulnerable children who are not routinely brought to dental check-ups and have the capability, opportunity and motivation to have oral health behaviour change conversations with parents.· Further research is needed to identify training requirements and how to develop supportive relationships with NHS dental teams

Interactions about children’s weight and weight-related behaviours occur from an early stage in school settings between various stakeholders, and are often intended to facilitate weight-related behavioural change in children and/or families. This meta-synthesis (PROSPERO - CRD42019133231) aimed to investigate stakeholder reported experiences and challenges of these encounters. Studies were eligible if they included school stakeholders (teaching or non-teaching staff, parents, caregivers or children), explored communication topics related to child obesity (weight, diet or activity), were conducted within an early school setting (primary school stage or international equivalent), and used qualitative methods. Database searches conducted March - July 2019 (updated November 2020), identified 40 studies (2,324 participants) from seven countries. Included studies were assessed for quality using the Critical Appraisal Skills Programme. Using inductive thematic analysis, we identified four core themes across this database: (1) ‘Conversation characteristics and consequences’, (2) ‘Missing components’, (3) ‘Avoiding stigma’, and (4) ‘School responsibilities’. Overall, stakeholders recognised that schools are well-positioned to provide positive influential messages about childhood obesity and reported that discussions on this topic do occur in early school settings but that stakeholders find them difficult, complex, and lack the necessary skills to deliver the non-judgemental, consistent and tailored support that they desire.

Clinicians can use behaviour change techniques effectively in routine consultations in healthcare settings, including dentistry. Professional guidelines support their use for preventing and managing a range of dental diseases. Theory and evidence from behavioural science can inform effective behaviour change interventions. This article examines the relevance of these techniques to the whole dental team and how they can be implemented within routine dental consultations. CPD/Clinical Relevance: Guidance and recommendations on how to support patients to change behaviours to promote oral (and general) health.

In March 2020 the president of the British Psychological Society (BPS) reached out to member networks to join forces on a BPS Covid-19 co-ordinating group. Members of this group were tasked to lead different work-streams highlighting psychology’s role during the pandemic. One workstream focused on ‘Behavioural Science and Disease Prevention’. It was clear that understanding behaviour and anticipating public responses to changes in policies, public messaging and guidelines would be key to improving health outcomes. This workstream focused on developing clear guidance to prevent the spread of Covid-19 and identifying psychological evidence to promote best practice in the design of sustainable behavioural interventions. This includes both immediate infection control behaviours aimed at reducing virus transmission, such as hand washing, physical-distancing and self-isolation, and behaviours that may have been influenced during the pandemic, such as physical activity, eating behaviour, substance use and healthcare use, which will have far reaching impacts on future health. This article provides an overview of the core guidance and practical examples of its application in a public health setting.

BackgroundIndividual behaviour changes, such as hand hygiene and physical distancing, are required on a population scale to reduce transmission of infectious diseases such as COVID-19. However, little is known about effective methods of communicating risk reducing information, and how populations might respond.ObjectiveTo synthesise evidence relating to what (1) characterises effective public health messages for managing risk and preventing infectious disease and (2) influences people’s responses to messages.DesignA rapid systematic review was conducted. Protocol is published on Prospero CRD42020188704.Data sourcesElectronic databases were searched: Ovid Medline, Ovid PsycINFO and Healthevidence.org, and grey literature (PsyarXiv, OSF Preprints) up to May 2020.Study selectionAll study designs that (1) evaluated public health messaging interventions targeted at adults and (2) concerned a communicable disease spread via primary route of transmission of respiratory and/or touch were included. Outcomes included preventative behaviours, perceptions/awareness and intentions. Non-English language papers were excluded.SynthesisDue to high heterogeneity studies were synthesised narratively focusing on determinants of intentions in the absence of measured adherence/preventative behaviours. Themes were developed independently by two researchers and discussed within team to reach consensus. Recommendations were translated from narrative synthesis to provide evidence-based methods in providing effective messaging.ResultsSixty-eight eligible papers were identified. Characteristics of effective messaging include delivery by credible sources, community engagement, increasing awareness/knowledge, mapping to stage of epidemic/pandemic. To influence intent effectively, public health messages need to be acceptable, increase understanding/perceptions of health threat and perceived susceptibility.DiscussionThere are four key recommendations: (1) engage communities in development of messaging, (2) address uncertainty immediately and with transparency, (3) focus on unifying messages from sources and (4) frame messages aimed at increasing understanding, social responsibility and personal control. Embedding principles of behavioural science into public health messaging is an important step towards more effective health-risk communication during epidemics/pandemics.

Background: Public health emergencies require rapid responses from experts. Differing viewpoints are common in science, however, “mixed messaging” of varied perspectives can undermine credibility of experts, reduce trust in guidance, and act as a barrier to changing public health behaviours. Collation of a unified voice for effective knowledge creation and translation can be challenging. This work aimed to create a method for rapid psychologically-informed expert guidance during the COVID-19 response. Method: TRICE (Template for Rapid Iterative Consensus of Experts) brings structure, peer-review and consensus to the rapid generation of expert advice. It was developed and trialled with 15 core members of the British Psychological Society COVID-19 Behavioural Science and Disease Prevention Taskforce. Results: Using TRICE, we have produced 18 peer-reviewed COVID-19 guidance documents, based on rapid systematic reviews, co-created by experts in behavioural science and public health, taking 4–156 days to produce, with approximately 18 experts and a median of 7 drafts per output. We provide worked-examples and key considerations, including a shared ethos and theoretical/methodological framework, in this case, the Behaviour Change Wheel and COM-B. Conclusion: TRICE extends existing consensus methodologies and has supported public health collaboration, co-creation of guidance and translation of behavioural science to practice through explicit processes in generating expert advice for public health emergencies.

International audience; The COVID-19 pandemic has impacted individuals, communities, and whole populations. Experts across many different fields contributed their time and efforts in different ways to respond to the pandemic. Psychologists working in healthcare provided support and led many initiatives, both regionally and nationally. However, it is unknown how this has differed across Europe and its full range of activities and contributions. Aim: The current study is a survey of European member associations of EFPA, carried out to understand the current contributions and the impact those psychology contributions have had on the COVID-19 pandemic response, to share lessons learned, and to propose a roadmap for the future. Results: Overall, our study highlights how psychological expertise was integrated into many countries’ policy/decision-making, action-planning, caregiving, and the promotion of health and well-being to health professionals and the general public. Even in places where psychologists were not directly integrated into governmental systems, they played an important role in responding to this pandemic by providing their services and empirical knowledge. Discussion: Many psychologists possess the skills and tools to adapt their practice to the digital provision of services and to provide a continuity of care during the pandemic. Research carried out by psychologists has contributed important and new knowledge on pandemic effects, consequences, and interventions; yet, more research financial support is needed. We make recommendations for augmenting psychologists’ contributions in the future. In a global health crisis, where the main possible treatment is a preventive approach concentrated on sustainable behavior change, psychologists should be included every step of the way – they can make a difference.

ObjectivesPhysical distancing, that is keeping 1-2m apart when co-located, can prevent cases of droplet or aerosol transmitted infectious diseases such as SARS-COV2. During the COVID-19 pandemic, distancing was a recommendation or a requirement in many countries. This systematic review aimed to determine which interventions and behaviour change techniques (BCTs) are effective in promoting adherence to distancing and through which potential mechanisms of action (MOAs). MethodsSix databases were searched. The review included studies that were (a) conducted on humans, (b) reported physical distancing interventions, (c) included any comparator (e.g., pre-intervention versus post-intervention; randomised controlled trial) and (d) reported actual distancing or predictors of distancing behaviour. Risk of bias was assessed using the Mixed Methods Appraisal Tool. BCTs and potential MoAs were identified in each intervention. ResultsSix moderate or high quality papers indicated that distancing interventions could successfully change MoAs and behaviour. Successful BCTs (MoAs) included feedback on behaviour (e.g., motivation); information about health consequences, salience of health consequences (e.g., beliefs about consequences), demonstration (e.g., beliefs about capabilities) and restructuring the physical environment (e.g., environmental context and resources). The most promising interventions were proximity buzzers, directional systems and posters with loss-framed messages that demonstrated the behaviours. ConclusionsThe evidence indicates several BCTs and potential MoAs that should be targeted in interventions and highlights the gaps that should be focused on in future research.

In order of first author surname

Introduction Health behaviours result in oral health problems. Behaviour change techniques, informed by behaviour science, are rarely utilised by dental care professionals (DCPs) within routine care.Aim To develop a theory-informed intervention to support DCPs' behaviour change conversations and evaluate its feasibility and acceptability.Intervention A behaviour change toolkit (Toothpicks) comprising 33 behaviour change techniques relevant to dentistry, delivered within an interactive online course.Design Development and mixed-methods evaluation of the intervention.Materials and methods Participants' motivation to discuss behaviour change with patients was measured before and after training using a validated questionnaire. Acceptability was assessed through semi-structured interviews.Results DCPs' (N = 32) motivation increased significantly post-training. Participants found the training acceptable and reported subsequently implementing techniques into their practice. Potential barriers preventing implementation to clinical practice include perceived lack of opportunities to effect change within the constraints of the clinical context.Conclusions Acceptable theory-informed training that is acceptable and accessible can be developed that increases DCPs' motivation to discuss behaviour change with patients. Further research is necessary to establish the longer-term impact of brief behaviour change training on DCPs' clinical practice and patient health behaviours.

Background: Public health teams need to understand how the public responds to vaccination messages in a pandemic or epidemic to inform successful campaigns encouraging the uptake of new vaccines as they become available. Methods: A rapid systematic review was performed by searching PsycINFO, MEDLINE, healthevidence.org, OSF Preprints and PsyArXiv Preprints in May 2020 for studies including at least one health message promoting vaccine uptake of droplet spread viruses. Non-English language studies and dissertations were excluded in line with using rapid review methodology. Included studies were assessed for quality using the MMAT or AMSTAR, and for patient and public involvement (PPI) in designing and/or conducting the research. Results: Thirty-five articles were included. Most reported messages for seasonal influenza (n=11; 31%) or H1N1 (n = 11; 31%) and only seven studies (20%) sampled vulnerable populations at higher risk of mortality/morbidity from viruses, e.g. older adults. Evidence from moderate to high quality studies for improving vaccine uptake included providing: information about virus risks, vaccination safety, and addressing misunderstandings about vaccination, vaccination reminders, detail about vaccination clinics and their locations, and mixed media campaigns at scale across hospitals or communities. Behavioural influences (beliefs and intentions) were improved when shorter messages, risk-reducing, or relative risk framing was used, the benefits of vaccination to society were emphasised, and beliefs about capability to be vaccinated and concerns among target populations (e.g. about vaccine safety) were addressed. Clear, credible, messages in language target groups can understand were found acceptable. Two studies (6%) described PPI in the research process. Conclusions: This review has identified effective messages to encourage vaccination and improve vaccination beliefs and intentions. Future campaigns should consider the beliefs and information needs of target populations in their design. Findings were inconclusive whether the medium through which the message was delivered, e.g. text message, affected outcomes. More high quality research is needed to demonstrate the behavioural outcomes of messaging interventions.

Abstract. Introduction: The COVID-19 pandemic has impacted individuals, communities, and whole populations. Experts across many different fields contributed their time and efforts in different ways to respond to the pandemic. Psychologists working in healthcare provided support and led many initiatives, both regionally and nationally. However, it is unknown how this has differed across Europe and its full range of activities and contributions. Aim: The current study is a survey of European member associations of EFPA, carried out to understand the current contributions and the impact those psychology contributions have had on the COVID-19 pandemic response, to share lessons learned, and to propose a roadmap for the future. Results: Overall, our study highlights how psychological expertise was integrated into many countries’ policy/decision-making, action-planning, caregiving, and the promotion of health and well-being to health professionals and the general public. Even in places where psychologists were not directly integrated into governmental systems, they played an important role in responding to this pandemic by providing their services and empirical knowledge. Discussion: Many psychologists possess the skills and tools to adapt their practice to the digital provision of services and to provide a continuity of care during the pandemic. Research carried out by psychologists has contributed important and new knowledge on pandemic effects, consequences, and interventions; yet, more research financial support is needed. We make recommendations for augmenting psychologists’ contributions in the future. In a global health crisis, where the main possible treatment is a preventive approach concentrated on sustainable behavior change, psychologists should be included every step of the way – they can make a difference.

Este artículo se encuentra disponible en la siguiente URL: https://recyt.fecyt.es/index.php/ASSN/article/view/83163 Background. The TEnT PEGS framework is a behavior change communication toolkit which has been shown to be useful in increasing health professional trainees’ skills and knowledge about obesity-related behavior change techniques. There is no version of the behavioral change intervention toolkit in Spanish. Therefore, the objectives of this study were 1) to translate the TEnT PEGS framework into Spanish and apply it to a Spanish nursing student population; 2) To analyze whether training with the Spanish toolkit (DEPREMIO) had a positive impact on students’ skills in encouraging obesity-related behavioral change. Methods. First year nursing students (n=95) attended two face-to-face (2 hours per session) obesity management training sessions. A specifically designed pre-post test was carried out. Data were collected using an ad-hoc questionnaire of fourteen items, ten of them evaluated the student’s knowledge and attitude about behavior change techniques, and four evaluated the student’s perception of their skills in developing different strategies. Results. Training significantly increased most students’ knowledge and attitudes with a 0.05 level of significance and effect sizes were between 0.36 and 0.77. It also increased students’ skills, although not to any significant extent. Conclusion. The DEPREMIO toolkit helped nursing students to acquire more knowledge, attitudes and skills in obesity management. It therefore seems that this adaptation is an acceptable and feasible training tool for the Spanish nursing student population. Fundamento. El programa TEnT PEGS es un conjunto de herramientas de comunicación para el cambio de comportamiento que se ha demostrado útil para aumentar las habilidades y conocimiento de los profesionales de la salud sobre técnicas de cambio de comportamiento relacionadas con la obesidad. No existe ningún manual de intervención para cambiar la conducta en español. Por lo tanto, los objetivos de este estudio fueron 1) traducir TEnT PEGS al español y aplicarlo en una población de estudiantes de enfermería españoles; 2) Analizar si este programa en español (DEPREMIO) tuvo un impacto positivo en las habilidades de los estudiantes para fomentar el cambio de comportamiento relacionado con la obesidad. Metodología. Los estudiantes de primer año de enfermería (n = 95) asistieron a dos sesiones presenciales (2 horas por sesión) de control de la obesidad. Se utilizó un diseño prepost. Los datos se recogieron a través de un cuestionario ad-hoc de catorce ítems, diez de ellos evaluaban los conocimientos y actitudes de los estudiantes sobre técnicas de cambio de conducta y cuatro evaluaban la percepción de los estudiantes sobre sus habilidades para desarrollar diferentes técnicas. Resultados. La intervención aumentó significativamente la mayoría de los conocimientos y actitudes de los estudiantes con un nivel de significación de 0,05 y tamaños de efecto entre 0,36 y 0,77. También aumentaron las habilidades de los estudiantes, aunque no significativamente. Conclusión. La herramienta DEPREMIO ayudó a los estudiantes de enfermería a alcanzar mayores habilidades y actitudes en el manejo de la obesidad, por lo que sería una intervención aceptable y factible para la población española de estos estudiantes.

© 2020 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society Objectives: To investigate the general public’s source credibility attitudes towards health and social care professionals when giving advice associated with their ‘traditional role’ versus an ‘expanded health behaviour change’ role, to facilitate the implementation of the health behaviour change agenda. Design: A 3x3 experimental between-subjects vignette questionnaire study with nine scenarios in which a general practitioner (GP), health visitor, or firefighter offered advice on either stopping smoking, preventing cot death, or fire safety. Combinations were either congruent with a traditional role (e.g., health visitor and cot death) or an expanded role (e.g., firefighter and stopping smoking). Methods: Adults were recruited from metropolitan locations in northern England. Participants were randomized to one scenario and complete a validated 18-item source credibility questionnaire. Factor analysis explored source credibility components; ratings for traditional and expanded role scenarios were compared using Mann–Whitney tests. Results: 369 participants completed the questionnaire (49.3% women, 64% White British, age range: 16–83). Factor analysis confirmed three source credibility dimensions: competence, caring, and trustworthiness. Ratings were generally high across professions and scenarios; participants rated professionals as significantly more ‘competent’ where scenarios related to their traditional roles than expanded roles (U 9778.5, p

BACKGROUND Digital contact tracing apps have been proposed as a method of controlling the spread of Covid-19. The effectiveness of this tool depends largely on adequate levels of uptake (e.g. whether the user downloads and registers on the application) and engagement (e.g. the extent of usage of the application or its components over time). It has been estimated that approximately 60% of the population would need to use the NHSX application in order for it to be effective in reducing the spread of COVID-19. It is therefore crucial that we understand the level of, and factors influencing, uptake and engagement with digital tracing applications in order to put appropriate measures in place to mitigate those issues. AIMS 1. To quantify the current data on COVID-19 digital contact tracing applications a. Uptake and engagement of COVID-19 digital contact tracing applications b. Examine whether uptake differs between countries c. Identify any predictors or correlates of uptake and engagement 2. To conduct two scoping reviews to identify key barriers and facilitators influencing engagement and uptake of a. COVID-19 digital contact tracing applications b. Health behaviour change applications, including government approved applications, from academic literature and behaviour change guidelines CONCLUSIONS • There is no evidence on the level of uptake and engagement with COVID-19 digital contact tracing applications. • There is a dearth of evidence regarding the barriers and facilitators to uptake and engagement with COVID-19 digital contact tracing applications. • The health behaviour change literature suggests a number of barriers and facilitators associated with uptake and engagement with applications.

Maternal mortality rates in low-middle income countries remain high, with sub-Saharan Africa accounting for two-thirds of global maternal deaths. Inadequate staff training is one of the main contributors to anaesthesia-related deaths and the Association of Anaesthetists developed the Safe Anaesthesia from Education course in collaboration with the World Federation of Societies of Anaesthesiologists to address this training gap. We aimed to evaluate the impact of this course among Kenyan participants. Mixed methodologies and secondary analyses of anonymised data were used to study translation of learning into practice. In total, 103 participants from 66 facilities who attended courses between 2016 and 2017 were analysed. Ninety (87%) participants who were followed up completed knowledge tests. Baseline median (IQR [range]) knowledge test score was 41 (37-43 [21-46]). There was a significant improvement in median (IQR [range]) knowledge test score immediately post-course (43 (41-45 [33-48]); p

Background Action plans have been shown to be important in changing behaviour. In learners, action plans have been proposed as a mechanism by which feedback leads to an increase in expertise: feedback leads to action plans, which lead to changes in learning behaviours and finally to improvement. Little is known about the extent to which students are able to make specific actions plans that relate to the feedback they are given, however. We explored whether medical students created action plans after being given feedback, the quality of those plans and whether the action plans were related to the feedback given. Action plans have been shown to be important in changing behaviour METHODS: We collected data from a communication session for Year-1 medical students on the feedback they were given and the action plans they made for improvement. Results Most students (185/196, 94%) made one or more action plans, but only 31/196 (16%) made one or more action plans that were directly related to the feedback given to them. Conclusions Although educators may include action planning in education, students are not making specific enough action plans to effect change. Future work should include support for students in making better-quality action plans. …students are not making specific enough action plans to effect change.

Background: Understanding the drivers of ‘provider behaviour’ has been highlighted as one of the six domains of behaviour change in strengthening healthcare systems. Objectives: Our study sought to assess changes in healthcare provider behaviour i.e., the use of an ABCDE approach in acute illness management, after participating in a one-day course on the assessment and management of acutely ill patients. Further, we aimed to assess whether changes in psychological determinants of the ABCDE approach were associated with changes in the use of the approach. Methods: We used a pre-post design to study self-reported change in behaviour after a one-day training course from pre-course to follow-up one month later. We also measured psychological determinants of behaviour immediately pre- and post- and at one-month follow up. We explored if changes in psychological determinants were associated with change in practice one month later. Results: We found the following: Firstly, the use of the ABCDE approach increased at one-month post-course from a median percentage use of 50% to 90%. Secondly, the increase in the ABCDE approach was associated with a positive change in only one of the determinants of practice from pre- to post-course: perception of environmental determinants (r=0.323, p

There is an urgent need to improve access to safe surgical and anaesthetic care for children living in many low- and middle-income countries. Providing quality training for healthcare workers is a key component of achieving this. The three-day Safer Anaesthesia From Education (SAFE) paediatric anaesthesia course was developed to address the specific skills and knowledge required in this field. We undertook a project to expand this course across five East and Central African countries (Ethiopia, Kenya, Malawi, Uganda and Zambia) and train local faculty. This study reports the outcomes from course evaluation data, exploring the impact on knowledge, skills and behaviour change of participants. Eleven courses were conducted in a 15- month period, with 381 participants attending. Fifty-nine new faculty were trained. Knowledge scores (0 - 50 scale) increased significantly from mean (SD) 37.5 (4.7) pre-course to 43.2 (3.5) post-course (p < 0.0001). Skills scores (0 - 10 scale) increased significantly from 5.7 (2.0) pre-course to 8.0 (1.5) post-course (p < 0.0001). One hundred and twenty-six participants in Malawi, Uganda and Zambia were visited in their workplace three to six months later. Knowledge and skills were maintained at follow-up, with scores of 41.5 (5.0) and 8.3 (1.4) respectively (p < 0.0001 compared with pre-course scores). Content analysis from interviews with these participants highlighted positive behaviour changes in the areas of preparation, perioperative care, resuscitation, management of the sick child, communication and teaching. This study indicates that the Safer Anaesthesia From Education paediatric anaesthesia course is an effective way to deliver training, and could be used to help strengthen emergency and essential surgical care for children as a component of universal health coverage.

Health professional Continuing Professional Development (CPD) courses often aim to change practice; understanding which training techniques drive behavior change can help educators facilitate this. The 93-item Behaviour Change Technique Taxonomy (BCTT) describes behavior change techniques (BCTs) used in behavior change interventions but was not designed for understanding CPD; it is necessary to explore how best to use the BCTT in this context. This study aimed to explore the BCTs used by CPD course educators to change healthcare practice and to develop and pilot an e-tool, based on the BCTT, to enable course designers and educators to understand which BCTs are in their training. This understanding could lead to enhanced CPD and an experimental approach to assessing the benefits of including a variety of BCTs in CPD. Two psychologists, trained in using the BCTT, observed three postgraduate medical CPD courses. In Phase 1, the BCTT was used to code 26 hours of observations. An e-tool including observed BCTs was developed and used to code 35 hours of observations in Phase 2. Feedback was collected through short discussions with educators from each course. The tool was further refined in Phase 3. Thirty-seven BCTs were identified in Phase 1, a further four in Phase 2, and a further two in Phase 3. The final e-tool comprised 43 BCTs with examples of their use based on course observations to aid identification, since educators fed back that they would value an uncomplicated tool with practice-related examples. A coding tool to understand the active ingredients in health professional CPD could enable educators to maximize the impact of CPD on practice. Further work should explore whether educators themselves are able to use the tool to code their training interventions.

The objective was to explore the general public’s views on the role of health professionals in the management of weight with diet and the implementation of behaviour change. Semi-structured interviews were conducted. An inductive grounded theory approach utilised a coding framework; recurring concepts/themes explored in future interviews and thematic saturation achieved. Two themes summarised views on the role of health professionals in supporting dieting and weight management: responsibility to initiate talk and what patients expect. Individuals perceive health professionals as having a role in their weight management. Individuals have disparate views about responsibility for initiation of weight management talk.

Objective. (1) To identify whether an online training intervention could increase midwifery students’ knowledge of behaviour change techniques (BCTs) and intentions to use them in practice. (2) To identify students’ views and current experiences of talking to women about weight-related behaviour change. Design. Mixed methods study involving pre- and post-training assessments, and qualitative interviews with midwifery students. Setting. Online training course delivered at a University in the North of England, UK. Participants. Midwifery students in the third year of their undergraduate degree during 2015-16. Intervention. Online training focused on equipping students with knowledge of theoretically-informed BCTs, and the skills to use them opportunistically in existing practice settings. Measurements. Likelihood of discussing obesity with women was assessed via a 12-item, 7-point Likert scale assessing students’ attitudes, subjective norms, perceived behavioural control, and intentions. A 14-item checklist was used to assess BCT knowledge whereby students selected recognised BCTs (of 7 correct, 7 false). Students’ views and experiences of current practice was explored through in-depth, semi-structured one-on-one interviews with a member of the research team. Findings. Students’ subjective norms, perceived behavioural control, and knowledge of BCTs increased post-training but intention and attitudes did not. Interviews revealed three themes accounting for students experiences and views of behaviour change practice: (1) ‘How training fits with current encounters with maternal obesity in midwifery training’ (2) ‘TEnT PEGS prepares students for practice’, and (3) ‘Value of tailored training’.Key conclusions. Online BCT training can improve the midwifery students’ confidence, knowledge and beliefs that this is part of their role. They also reported finding the training helpful in better preparing them for this challenging element of their routine practice. Implications for practice. Online BCT training can be used to prepare undergraduate midwifery students for practice.