Oral health care of older people in long-term care facilities is insufficient, stressing the need for clear evidence-based implementation strategies to improve oral care. In 2013, a systematic review was performed and new evidence was published. This study aimed to gain insights into implementation strategies used to promote or improve oral health care for older people in long-term care facilities, explore their effectiveness and uncover strategy content in behavioral change techniques, and report the differences between the current results and those of the 2013 study.

A systematic review of the literature according to PRISMA guidelines and meta-analyses of implementation strategies were performed. Cochrane Library, PubMed, and CINAHL databases were searched for papers published between 2011 and 2023. Strategies were identified using the Coding Manual for Behavioral Change Techniques. Meta-analyses of oral health outcomes ("plaque" and "denture plaque") were performed with random-effects models using R language for statistical computing.

16 studies were included in the current results; 20 studies were included in the 2013 findings. More high-quality studies (67 %) were included in this review than in 2013 (47 %). Dental care professionals were involved in 14 of the 16 studies. Fourteen of the 16 studies used and/ or combined five or more different implementation strategies: knowledge, intention, awareness, self-efficacy, attitude, and facilitation of behavior. Implementation positively affected the knowledge and attitudes of the nursing staff; however, the oral health of older people did not necessarily improve. In the 2013 review, more studies indicated combined oral health measurements were effective (71 %) than in the current review (20 %-33 %). Meta-analysis of four studies on dental plaque (0-3 scale) showed a significant, statistically small mean difference of -.21 (CI -.36; -.07, Cohen's d -.29) between the control and treatment group. Meta-analysis of three studies on denture plaque (0-4 scale), showed a significant, statistically large mean difference of -.76 (CI -1.48; -.05, Cohen's d -.88).

In this review, more implementation strategies and combinations were used to implement oral care in long-term care. Implementation strategies positively affected the knowledge and attitudes of nursing staff; however, the oral health of older people did not necessarily improve. Meta-analyses on plaque showed that oral care implementations are effective; for denture plaque, the effect size was large and thus may have more clinical value than for dental plaque.

The effectiveness of pelvic floor muscle training is limited by insufficient human resource and low adherence to the exercise.

Group-based pelvic floor muscle training provides a possible way to implement pelvic floor muscle training for more women. However, the feasibility and effectiveness of group-based pelvic floor muscle training still needs to be evaluated.

This study aimed to co-design a group-based programme to facilitate adherence to pelvic floor muscle training in pregnant women.

The study involved a systematic review, a survey, behaviour change theory identification and stakeholder engagement to co-design the programme.

The stakeholders discussed the barriers and mapped them to the capability, opportunity, motivation and behaviour model. The main barriers are increased cost and time for receiving the pelvic floor muscle training supervision and lack of knowledge about the importance of doing pelvic floor muscle training. Six intervention functions were identified to facilitate behaviour change in pregnant women. Then, 18 behaviour change techniques were identified and used to develop a facilitated group-based pelvic floor muscle training programme for pregnant women.

This study has shown the importance of addressing barriers to adhere to the resulting programme. However, how to ensure the pregnant women to attend the sessions still need to be discussed.

Through the use of the behaviour change wheel approach, this paper describes a transparent process of translating current evidence and theoretical understanding to the co-design of a complex intervention to improve adherence to a group-based pelvic floor muscle training programme.

This study has been registered with ClinicalTrials.gov under NCT05242809.

Mental health problems, self-harm and suicide are major public health concerns. Following national strategic commitments to improve the response and follow-up support for adults in Scotland presenting to frontline services in emotional distress, this study describes the development of the first national Distress Brief Intervention, a multi-agency service to provide connected, compassionate support for people in distress.

The six step Intervention Mapping protocol was used to account for the complexity of the intervention and to guide development, testing and implementation. Data/information sources comprised: literature and evidence review; delivery partner and stakeholder consultations (n = 19); semi-structured interviews and/or focus-groups with frontline services staff experienced in responding to distress (n = 8); interviews and/or focus groups with adults with experience of distress (n = 9); feedback from test training for staff (n = 16); self-assessed confidence ratings provided by staff immediately before and following training (n = 388).

We developed a time-limited, two-level, complex intervention for adults experiencing emotional distress, provided by 'frontline' statutory services (primary and acute healthcare, police, ambulance) and third-sector community organisations in Scotland. Intervention components included competency-based training programmes for staff, information, protocols and guidance for providers, personalised distress management planning and behaviour change tools. During the development phase, 525 intervention providers (n = 472 frontline statutory service staff; n = 53 third-sector community organisation staff) completed training programmes in four pilot areas in Scotland. Training evaluations from 388 providers (74%) indicated significantly greater confidence following training on key competencies.

A multi-agency national Distress Brief Intervention was systematically developed and implemented in a range of non-specialist frontline and community settings in Scotland. Up-take of training and evaluations of training indicate it is highly acceptable to potential providers and improves key competencies. Following independent evaluation, the Distress Brief Intervention has been rolled out nationally across the whole of Scotland, and has significant potential as a model of care and prevention internationally, including countries with low statutory health resources.

Many interventions aiming to improve medication adherence in primary open-angle glaucoma (POAG) have yielded equivocal findings. This equivocacy has been attributed to several factors, including limited incorporation of health behavior theory and patient preference into intervention design. In this study, we performed a literature review of interventions aiming to improve medication adherence in POAG to develop a taxonomy of behavior change techniques (BCTs). Eligible studies measured medication adherence using electronic monitors for a minimum of 3 months. For each study, we evaluated the effectiveness of the BCTs, their basis in health behavior theory, and their usefulness in day-to-day management of POAG by surveying a sample of patients and providers. Twelve studies were included. BCTs included knowledge shaping (education), prompts (reminders), behavioral rehearsal (eye drop instillation training), and pharmacological support (combination monotherapy vs. polytherapy). Knowledge shaping, prompts, health coaching, and motivational interviewing led to an improvement in medication adherence and were perceived as being most useful in day-to-day management of POAG. Taxonomies of BCTs can help researchers to improve the design and effectiveness of interventions for improving medication adherence in POAG.

Corporate wellness programs are increasingly using digital technologies to promote employee health. Digital wellness programs (DWPs) refer to initiatives that deliver health interventions through digital tools. Despite a growing body of evidence on DWPs, the literature remains fragmented across multiple health domains.

This study aims to provide a comprehensive synthesis of existing research on the efficacy (eg, impact on employee's physical health, mental well-being, behavioral changes, and absenteeism) and acceptability (eg, engagement, perceived usefulness, and adoption) of employer-provided DWPs. Specifically, we aim to map the extent, range, and nature of research on this topic; summarize key findings; identify gaps; and facilitate knowledge dissemination.

We conducted a meta-review of studies published between 2000 and 2023. We adopted a database-driven search approach, including the MEDLINE, PsycINFO, ProQuest Central, and Web of Science Core Collection databases. The inclusion criteria consisted of (1) review articles; (2) publications in English, French, or German; (3) studies reporting on digital health interventions implemented in organizations; (4) studies reporting on nonclinical or preclinical employee populations; and (5) studies assessing the efficacy and acceptability of employer-provided DWPs. We performed a descriptive numerical summary and thematic analysis of the included studies.

Out of 593 nonduplicate studies screened, 29 met the inclusion criteria. The most investigated health domains included mental health (n=19), physical activity (n=8), weight management (n=6), unhealthy behavior change (n=4), and sleep management (n=2). In total, 24 reviews focused on the efficacy of DWPs, primarily in relation to health-related outcomes (eg, stress and weight), while fewer reviews addressed organization-related outcomes (eg, burnout and absenteeism). Four reviews explored the mechanisms of action, and 3 assessed the acceptability of DWPs using various measures. Overall, the findings support the efficacy and acceptability of DWPs, although significant gaps persist, particularly regarding the durability of outcomes, the role of technology, and the causal mechanisms underlying behavioral change.

While DWPs show promise across a variety of health domains, several aspects of their effectiveness remain underexplored. Practitioners should capitalize on existing evidence of successful DWPs while acknowledging the limitations in the literature.

Coronary heart disease (CHD) is a leading cause of death in the UK. Clinical guidelines recommend cardiac rehabilitation (CR), including health education, cardiovascular risk reduction advice, physical activity and stress management components. However, uptake of standard in-person, group-based CR is only around 50%. Hybrid cardiac rehabilitation (CR), combining in-person and remote service delivery, may improve CR uptake and reduce inequalities in service access. This study used focus groups and semi-structured interviews to explore staff and patient experiences of using the Active+me REMOTE hybrid CR app, a cloud-based platform providing access to education modules, behaviour change support, live exercise classes, physical activity and health monitoring across three sites in the East of England. Twelve staff and six patients participated. Topic guides explored participants' experiences of delivering or receiving hybrid CR, barriers and facilitators associated with the hybrid CR pathway, and implications for future implementation of Active+me REMOTE. Qualitative data were collected remotely, audio-recorded and independently transcribed. Staff data were analysed deductively, using the Consolidated Framework for Implementation Research (CFIR). Patient data were analysed inductively using thematic analysis. Despite some technical issues and governance delays, Active+me REMOTE was perceived as acceptable, convenient and allowed tailoring of support to meet patients' needs and circumstances. Data upload from wearable devices (blood pressure monitors) allowed staff to monitor patients' progress and empowered patients to direct their recovery. Staff initially felt they should screen patients to ensure that hybrid CR was offered to digitally literate, physically active individuals, although screening became less common as staff familiarity with the app increased. Findings suggest that effective implementation of hybrid CR requires system-level resource to facilitate governance approvals and embed hybrid CR delivery as standard care. Sufficient time must be allowed for staff training and to support patient enrolment to hybrid services. The study was registered on 3/7/2023 (ISRCTN320764).

We aimed to evaluate the effects of obesity treatment with behavioral therapy (BT) and cognitive behavioral therapy (CBT) interventions compared with multiple comparators and find effective techniques or combinations of techniques in BT and CBT interventions for weight loss. We systematically searched electronic databases and selected randomized controlled trials using CBT or BT intervention for obesity treatment in overweight adults or adults with obesity without psychological symptoms. Both pairwise meta-analysis and network meta-analysis were performed to comprehensively evaluate the comparative effects between interventions. We classified the techniques used in BT and CBT interventions and compared the treatment effects between techniques. Compared with no treatment as a common comparator, CBT was most effective for weight loss, followed by BT, usual care (UC), and minimal care (MC). CBT was a more effective intervention than BT, but the effect of CBT compared to BT was not remarkable in network estimates. The most used BT techniques were feedback and monitoring, and the most used CBT technique was cognitive restructuring. Our results indicated that CBT and BT are effective interventions for weight loss, and that successful weight loss requires more aggressive interventions such as BT or CBT than MC and UC.

METHODS: A structured search strategy encompassing databases including MEDLINE, Embase, CINAHL Plus, PsycINFO and Cochrane Library was implemented from inception to October 2023. Included studies focused on interventions targeting opioid reduction in adults following major surgeries. The risk of bias was evaluated using Cochrane risk-of-bias tool V.2 (RoB 2) and non-randomised studies of interventions (ROBINS-I) tools, and Cohen's d effect sizes were calculated. BCTs were identified using a validated taxonomy.

22 studies, comprising 7 clinical trials and 15 cohort studies, were included, with varying risks of bias. Educational (n=12), guideline-focused (n=3), multifaceted (n=5) and pharmacist-led (n=2) interventions demonstrated diverse effect sizes (small-medium n=10, large n=12). A total of 23 unique BCTs were identified across studies, occurring 140 times. No significant association was observed between the number of BCTs and effect size, and interventions with large effect sizes predominantly targeted healthcare professionals. Key BCTs in interventions with the largest effect sizes included behaviour instructions, behaviour substitution, goal setting (outcome), social support (practical), social support (unspecified), pharmacological support, prompts/cues, feedback on behaviour, environmental modification, graded tasks, outcome goal review, health consequences information, action planning, social comparison, credible source, outcome feedback and social reward.

Understanding the dominant BCTs in highly effective interventions provides valuable insights for future opioid tapering strategy implementations. Further research and validation are necessary to establish associations between BCTs and effectiveness, considering additional influencing factors.

CRD42022290060.

Antimicrobial resistance (AMR) is a critical global health threat, partly driven by the overuse of antimicrobials in livestock production. Addressing this issue requires targeted interventions to influence behavioral drivers behind AMU practices. Behavior change techniques (BCTs) offer a structured approach to designing such interventions, yet their application in reducing AMU on farms remains underexplored. This scoping review systematically maps the current applications of the Behavior Change Techniques Taxonomy version 1 (BCTTv1) in interventions aimed at reducing AMU in livestock, while also identifying gaps in the literature and opportunities for future research. A comprehensive search across academic databases identified 23 relevant studies. Findings revealed the use of 37 BCTs, with commonly applied techniques including goal setting, instruction on behavior, credible sources, problem-solving, feedback on behavior, and self-monitoring. While some studies explicitly referenced BCTs, many applied them implicitly, without alignment with standardized frameworks. Intervention outcomes were influenced by contextual factors including financial, logistical, cultural, and technical challenges. This review underscores the importance of explicitly integrating and systematically reporting BCTs to enhance transparency, replicability, and scalability. Future interventions should adopt tailored, context-specific approaches to address regional and sectoral challenges, ultimately contributing to global efforts in combating AMR through improved antimicrobial stewardship.

Audit and group feedback (A&F) is an instrument used to encourage healthcare professionals to improve the quality of care. Clinical practice was audited against a set of criteria and fed back to a group by a facilitator. The aim of this study was to gain a better understanding of how physician group feedback sessions in nursing homes were conducted and to what extent they resulted in action planning.

Fifteen group feedback sessions of the antibiotic A&F program within a nursing home network were audio-recorded, transcribed, and analyzed via the Framework Method for thematic analysis. The coding was performed using the existing Calgary A&F Framework and Cooke's conceptual model of physician behaviors, and open inductive codes were added.

Elements of the conceptual model and the Calgary A&F Framework occurred within all group feedback sessions. The relationships within the group and with the facilitators were important elements when moving a group from interpreting the results to formulating action plans. Physician groups responded positively to the audit data, particularly if they were among the best performing. The data were met with doubt by physicians who did not recognize their own practice. When exploring potential reasons for lower guideline adherence, groups often considered data quality or external factors such as the choice of non-adherent treatment by locum staff. The degree of reflection on personal factors as explanations for low adherence and the extent to which groups identified learning and improvement opportunities varied: some groups were able to formulate action plans to address data problems and knowledge gaps, whereas others scheduled a follow-up meeting to develop action plans for treatment or prescribing practice changes.

The facilitator was crucial in supporting the group in interpreting the results, steering the conversation towards sharing change cues, and helping the physician group in developing action plans. The degree of reflection and action planning varied by group. By implementing the lessons learned from this study, group feedback sessions can be refined, supporting participants in action planning.

This paper proposes a taxonomy for Community Health Workers (CHWs) and others engaged in front-line community health activities, encompassing formally-employed workers extending government primary health care (PHC) service delivery as well as a range of other actors with roles at the nexus of government PHC and communities. The taxonomy is grounded in current definitions from the World Health Organization and the International Labor Organization, and proposes some refinements for future iterations of guidance from these agencies. The designation, "Community Health Worker" is currently used to cover a broad range of roles. Furthermore, there are programs engaging workers or community members in roles closely adjacent to those generally recognized as CHWs that use other designations, not commonly included under the rubric of "CHW". This potentially confusing range of roles and nomenclature leads at times to over-generalizations, applying insights and principles relevant for one type of worker or community member that are not necessarily relevant for another. It also leads to a failure to consider occupational groups not commonly thought of as CHWs-but engaged in PHC service delivery at the most peripheral level-in community-based-PHC planning and management arrangements. Building on ILO and WHO classifications and standards, a further clarification of terms and a taxonomy is proposed, with the intention of contributing to clearer communication and shared understanding and, ultimately, sounder community health policy, program planning, and implementation; and more substantial progress towards Universal Health Coverage.

Personalized nutrition (PN) delivers tailored dietary guidance by integrating health, lifestyle, and behavioral data to improve individual health outcomes. Recent technological advances have enhanced access to diverse data sources, yet challenges remain in collecting, integrating, and analyzing complex datasets. To address these, the Personalized Nutrition Initiative at Illinois organized a workshop titled "Personalized Nutrition Data: Challenges & Opportunities," which gathered experts to explore three essential data domains in PN: 1) health and biological, 2) social, behavioral, and environmental, and 3) consumer purchasing data. Discussions underscored the importance of cross-disciplinary collaboration to standardize data collection, enable secure data sharing, and develop data fusion techniques that respect privacy and build trust. Participants emphasized the need for representative datasets that include underserved populations, ensuring that PN services are accessible and equitable. Key principles for responsible data integration were proposed, alongside strategies to overcome barriers to effective data use. By addressing these challenges, PN can enhance health outcomes through precise, personalized recommendations tailored to diverse population needs.

The global environmental issues require that we redesign food systems. Transitioning towards more plant-based diets is crucial, but there is a gap observed between consumers' intention and behaviour. We propose that businesses in the food sector can play a role by challenging their potential customers to overcome the gap. Drawing on the holistic COM-B model of behaviour change as well as the concept of self-nudging, we conduct an intervention study that shows how a business-driven marketing campaign that mimics challenges in the style of Veganuary could provide an opportunity for change. The mixed methods evaluation reveals that participants significantly reduced meat consumption frequency and maintained this at two months after the challenge. Perceived barriers to eating more plant-based food decreased, while perceived capability to reduce meat consumption increased. Participants talk about health and environment as motives as well as social eating contexts as barriers. We discuss implications for the role of businesses and their marketing activities in the transition to a more sustainable food system.

Engaging in regular exercise is essential for managing knee osteoarthritis (KOA) symptoms. Despite the established findings, sustained exercise adoption remains a challenge for KOA patients, with notable disparities among Hispanic patients, warranting a need to identify determinants that explain the racial discrepancy in exercise participation. The purpose of this study was to employ a biopsychosocial model to identify determinants of exercise participation and highlight racial disparities. Patients (n = 163) from a university hospital clinic were medically examined to be considered eligible for the study based on radiographs. Eligible participants completed validated survey measures that assessed exercise participation over the past two weeks, along with measures from biological, psychological and social domains to predict future intention exercise. Structural equation modelling tested hypothesized the paths. Past exercise behavior predicted attitudes, self-efficacy, and future exercise intentions. Pain catastrophizing correlated with exercise participation, but the competing effects of physician and (personal) social support on exercise nullified the significance of pain catastrophizing to exercise participation. Significant ethnicity comparisons found non-Hispanic white patients to have higher education, income, lower BMI, stronger scores on attitudes and self-efficacy, and greater exercise participation time. Non-significant effects between the two ethnicities include intention, physician support, and social support. Designing an intervention that helps foster support from the patient's physician and proximal friends/family members can play a vital role in exercise participation for both ethnicities. Additional focus on developing attitudes and self-efficacy among Hispanics can address some disparities. Further notes on promoting exercise equity using a biopsychosocial approach are provided.

Fruit and vegetable intake (FVI), moderate-to-vigorous physical activity (MVPA), and sleep duration are each independently associated with cancer-related and general health outcomes among cancer survivors. Past research suggests that health behaviors cluster among cancer survivors, with caregivers demonstrating similar patterns. This analysis examined co-occurrence of FVI, MVPA, and sleep duration among cancer survivors and informal cancer caregivers and identified sociodemographic and clinical correlates of health behavior engagement. Using data from the Health Information National Trends Survey (HINTS), an exploratory latent profile analysis (LPA) was conducted among those self-reporting a history of cancer or identifying as a cancer caregiver. The LPA model was fit with daily self-reported FVI (cups/d), MPVA (minutes/d) and sleep duration (hours/d). Multinomial logistic regression models were used to predict profile membership based on sociodemographic and clinical characteristics. Four health behavior profiles were identified (Least Engaged-No MVPA, Least Engaged-Low MVPA, Moderately Engaged, and Highly Engaged). The largest profile membership was Least Engaged-No MVPA, capturing 37% of the sample. Profiles were most distinguished by MVPA, with the lowest variance in sleep duration. Participants reporting higher FVI also often reported greater MVPA and longer sleep duration. Profile membership was significantly associated with age, relationship status, education, income, rurality, alcohol use, self-efficacy, psychological distress, BMI, and cancer type. This study identified four health behaviors patterns and sociodemographic correlates that distinguished those patterns among cancer survivors and caregivers drawn from a nationally representative sample. Results may help identify for whom health behavior interventions could be of greatest benefit.

Theoretically, self-control can be considered as both a facilitator of habit development and a moderator of whether behavior occurs habitually. However, debate remains on the contexts in which such relationships are likely to occur. The current study tested whether self-control, conceptualized into inhibitory and initiatory facets, would predict healthy behavior via habits or moderate the habit-behavior relationship, and whether these effects differed across complex (bootcamp attendance N = 69, physical activity in pregnant women N = 115) and simple (flossing N = 254) behaviors. Three independent samples completed measures of self-control and habit, followed by a prospective measure of behavior. Data were fitted to PLS-SEM models. Inhibitory and initiatory self-control predicted habit in all three samples, and habit in turn predicted each health behavior. Inhibitory self-control only moderated the effect of habit in the bootcamp and physical activity samples. Initiatory self-control did not moderate effects in any sample. Findings indicate that both initiatory and inhibitory self-control are associated with habit. Further, as the moderating effect of inhibitory self-control was only present in the complex behavior samples, results suggest the moderating effects of self-control on the habit-behavior relationship may be best represented by the effect of inhibiting competing cues from disrupting automatically activated behavioral sequences.

Dementia is a growing public health issue. Non-drug interventions targeting individuals before the onset of overt cognitive decline may be effective. Subjective cognitive decline (SCD) is present in > 50% of older adults and associated with progression to dementia. Here, we tested the compliance and effectiveness of a Multidomain Lifestyle Intervention Program using the mini-program, Cognitive Evergreenland, (MLIP-CE), based on the Health Action Process Approach model to support home-based intervention in older adults with SCD.

Cognitive Evergreenland was designed to improve cognitive reserve and maintain brain function in people at high risk of dementia and included: cognitive stimulation, cognitive training, health education, vascular risk monitoring, social support, and functional assessment, among other features. This was an exploratory trial designed to examine participant compliance with the mobile lifestyle intervention and its effectiveness, as well as changes in health-related indicators and cognitive function of older adults with SCD from baseline to 12 and 24 weeks post-intervention.

The retention rate for MLIP-CE was 90.2% (37/41). Mean participant age was 70.93 ± 6.91 years, 73.2% of participants were female, and mean Montreal Cognitive Assessment score was 24.51 ± 2.87. Throughout the 24 weeks of the prescribed intervention, app usage remained consistently high, with over 92% of participants using the mini-program at least once a week and successfully completing corresponding health management tasks. In terms of average usage, cognitive training emerged as the most frequently used functional module (95.73%), closely followed by health education (95.02%). The health behavior levels of older adults with SCD, measured in terms of ability, opportunity, and motivation, were significantly increased relative to baseline (p < 0.001). Regarding cognitive function, Mini-Mental State Examination scores were significantly improved post-intervention, with a moderate effect size (Hedges' g = 0.60).

These findings suggest that MLIP-CE, which was designed based on a theoretical framework, has potential for implementation, and support ongoing research into use of MLIP-CE for individuals at high risk of SCD or other dementia conditions.

The trial was prospectively registered at the Chinese Clinical Trials Registry with the registration number ChiCTR2200058665 on 13 April 2022.

Mobile sensing technology allows automated behavior shaping routines to be incorporated into health behavior interventions and other settings. In previous work, a computational model was built to investigate how to best arrange automatic behavior shaping procedures, but the degree to which this model reflects actual human behavior is not known.

To translate a previously developed computational model of automatic behavior shaping into an experimental setting.

Participants (n = 54) operated a computer mouse and attempted to locate a hidden, randomly-placed target circle on a blank computer screen and clicks within some threshold distance of the target circle were reinforced by a pleasant auditory tone. As the trial progressed, the threshold distance narrowed according to a shaping function until eventually only clicks within the target circle were reinforced. Accumulated Area Under Trajectory Curves and Time Until 10 Consecutive Target Clicks were used to quantify the probability of the target behavior. Linear mixed effects models were used to assess differential outcomes for concave up, concave down, and linear shaping functions.

In congruence with the computational model, concave-up functions most effectively shaped participants' behavior, with linear and then concave-down shaping functions producing the next best outcomes.

Concave-up shaping routines most effectively generated target behavior, which should be confirmed in health behavior trials. The automatic shaping routines that this study helps develop can be applied in a number of domains, including exercise intensity and duration, tobacco/cannabis smoking, caloric intake, and screen time.

Despite the benefits of physical activity (PA), cancer survivors report engagement barriers, and existing interventions often lack comprehensive solutions. Theory-based interventions using evidence-based behavior change techniques (BCTs) have been shown to be effective in promoting PA for breast cancer survivors, although their feasibility and acceptability lack evidence. The PAC-WOMAN trial is a three-arm randomized controlled trial aimed at promoting short- and long-term PA and improving the quality of life of breast cancer survivors. This study describes the development of a brief counseling theory-based motivational intervention from the PAC-WOMAN trial, assessing its feasibility and acceptability.

A broad search of theory-based interventions for people with chronic diseases was conducted. Key strategies from each intervention helped shape the main components and BCTs used in the eight bimonthly sessions of the PAC-WOMAN brief counseling intervention, which was based on self-determination theory principles and aimed at empowering participants to develop self-regulation resources for PA through basic psychological needs satisfaction. A toolkit and manuals for intervention facilitators and participants were developed. A feasibility study was conducted to monitor implementation fidelity, acceptability, adherence, and participants' experiences (via a focus group).

Twelve women (mean age 55.9 ± 6.7 years) participated. Implementation monitoring indicated that the intervention was feasible. The attrition rate was 25%. Focus-group discussion suggested that weekly sessions would increase attendance, highlighted the helpfulness of self-monitoring and the importance of role models for PA, and identified the session on safely exercising at home as key in improving PA levels.

This research aims to enhance systematic reporting in intervention development by detailing the specific BCTs used, translating them into implementation strategies, providing comprehensive resources for facilitators/participants, and supporting the implementation, dissemination, and adoption of a theory-based intervention informed by previous research. Feasibility testing suggests that the intervention was well accepted by participants and feasible, although it could benefit from adjustments in format to increase compliance.

NCT05860621, registered 20 April 2023 - retrospectively registered, https://clinicaltrials.gov/study/NCT05860621 . Registered 21 April 2023 - retrospectively registered, https://doi.org/10.17605/OSF.IO/ZAQ9N . UMIN000050945, registered 27 April 2023 - retrospectively registered, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000058070 .

The popularization of mobile health (mHealth) apps for public health or medical care purposes has transformed human life substantially, improving lifestyle behaviors and chronic condition management. The objective of this study is to evaluate the effect of gamification features in a mHealth app that includes the most common categories of behavior change techniques for the self-report of lifestyle data. The data reported by the user can be manual (i.e., diet, activity, and weight) and automatic (Fitbit wearable devices). As a secondary objective, this work aims to explore the differences in the adherence when considering a longer study duration and make a comparative analysis of the gamification effect.

In this study, the effectiveness of various behavior change techniques strategies is evaluated through the analysis of two user groups. With a first group of users, we perform a comparative analysis in terms of adherence and system usability scale of two versions of the app, both including the most common categories of behavior change techniques but the second version having added gamification features. Then, with a second group of participants and the best mHealth app version, a longer study is carried out and user adherence, the system usability scale and user feedback are analyzed.

In the first stage study, results have shown that the app version with gamification features has achieved a higher adherence, as the percentage of days active was higher for most of the users and the system usability scale score is 80.67, which is categorized as rank A. The app also exceeded the expectations of the users by about 70% for the app version with gamification functionalities. In the second stage of the study, an adherence of 76.25% is reported after 8 weeks and 58% at the end of the pilot for the mHealth app. Similarly, for the wearable device, an adherence of 74.32% is achieved after 8 weeks and 81.08% is obtained at the end of the pilot. We hypothesize that these specific wearable devices have contributed to a decreased system usability scale score, reaching 62.89 which is ranked as C.

This study evidences the effectiveness of the gamification category of behavior change techniques in increasing the overall user adherence, expectations, and perceived usability. In addition, the results provide quantitative results on the effect of the most common categories of behavior change techniques for the self-report of lifestyle data. Therefore, a higher duration in the study has shown several limitations when capturing lifestyle data, especially when including wearable devices such as Fitbit.

Dutch adolescents predominantly purchase unhealthy snacks in supermarkets, which negatively influence their health. The aim of this study was to investigate the short- and longer-term effects of a nutrition peer-education intervention in supermarkets on food purchases and determinants of food purchase behaviour among adolescents of different education levels.

We performed a quasi-experimental study in three supermarkets (two intervention and one comparison school) in Amsterdam, the Netherlands. The intervention schools received a 45-min peer-education workshop in the supermarket near their school, and the comparison school received no intervention. The workshops also included a 2-week 'healthy snacking challenge' and were led by two young supermarket employees. Measurements were performed 2 weeks before the intervention (T0) 2 weeks after (T1) and 3 months (T2) after the intervention. Cash receipts were used to examine food purchases (n = 458) and questionnaires to examine determinants of food purchase behaviour (n = 463).

The nutrition peer-education intervention did not improve food purchases but did improve several determinants of food purchase behaviour. Adolescents from the intervention schools reported improved nutritional knowledge (β = 0.38, 95% CI: 0.04-0.72) at T1, more favourable attitudes (β = 0.21, 95% CI: 0.00-0.42) and stronger social support (β = 0.27, 95% CI: 0.02-0.53) for healthy food purchases at T2 compared to those from the comparison schools. Adolescents with a low level of education reported more short- and longer-term improvements of determinants of food purchase behaviour compared to those with a higher level of education.

While nutrition peer education in supermarkets did not improve adolescents' food purchases in the supermarket, determinants of food purchase behaviour did improve. The intervention was especially effective among adolescents with a low level of education. Nevertheless, to promote healthy food purchases of adolescents in supermarkets, more efforts are needed.

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, though it may be prevented by increasing physical activity (PA). When behaviour change techniques (BCTs) are bundled together, they increase PA, though which individual BCTs increase PA (and the behavioural mechanism of action (MoA) responsible for said increase) have not been studied. The aim of this study is to conduct a randomised factorial experiment to determine which of four BCTs significantly engage the proposed MoA-self-efficacy for PA-in adults at risk for CVD.

Eight hundred and twenty sedentary adults (18-74 years old) at risk for CVD will be recruited between September 2022 and June 2025 to a fully remote, 24-week randomised BCT intervention. To identify those who might benefit from this intervention, we define self-reported walking <7500 steps per day as 'sedentary'. Following a 4-week run-in period to confirm sedentary behaviour and adherence to the study protocol, 624 eligible participants will be randomised to an 8-week intervention period. A full factorial randomised experiment will be conducted with 16 possible conditions: one will receive no BCTs (no-BCT condition), another will receive all four, and 14 will receive a unique combination of BCTs. During the intervention, participants will receive their randomised daily BCT(s) via text message. Daily steps will be continuously measured using an activity tracker. Self-efficacy for PA will be assessed bi-weekly via the Self-Efficacy for Walking Scale-Duration. Participants will complete a 12-week post-intervention follow-up period where steps will be monitored despite no BCTs being delivered. BCT(s) associated with increased daily step counts and increased self-efficacy for PA between run-in and study completion (week 12 of follow-up) will be determined alongside whether or not self-efficacy for PA mediates the association between each BCT and increased walking.

This trial was approved by the Northwell Health Institutional Review Board. The full factorial experimental trial results will be published in a peer-reviewed journal. Data from this clinical trial will be made available on reasonable request.

clinicaltrials.gov; Identifier: NCT05425641, 06/21/2022.

Hypertension has become a major public problem. One of every 4 adults has hypertension. Medications are critical in controlling blood pressure, but patient medication adherence is low. Therefore, it is very crucial to promote medication adherence. However, the complexity and variety of interventions cause clinical decision-making difficulties for health managers and patients.

The aim of this study was to compare the effectiveness of different interventions to improve medication adherence in patients with hypertension.

We searched PubMed, Cochrane Library, Web of Science, EMBASE, Wan Fang, China National Knowledge Infrastructure, China Science and Technology Journal Database, and China Biology Medicine disc databases for eligible studies. Medication adherence rate and medication adherence difference were assessed as outcomes. Sensitivity analysis and inconsistency detection were performed to evaluate whether the exclusion of high-risk studies affected the validity. The risk of bias was assessed using the risk of bias table in Review Manager 5.4. The surface under the cumulative ranking curve was used to estimate the rankings among different interventions.

Twenty-seven randomized controlled trials were included, and the interventions involved were categorized into 8 different categories. The network meta-analysis showed that the health intervention was the best to promote medication compliance in patients with hypertension.

Health intervention is recommended to improve medication adherence in patients with hypertension.

Health managers are recommended to provide health intervention to patients with hypertension to improve their medication adherence. This approach reduces morbidity, mortality, and healthcare costs for patients with cardiovascular disease.

Digital health technologies offer a more equitable way of providing access to health education. This study engaged consumers and clinicians from two Australian regions with a high burden of oral disease to develop a digital oral health resource called "TOOTH" tailored for adults.

A total of three focus groups (one clinician and two consumers) were conducted to identify themes that were used to draft text message content. The study team reviewed, refined, and mapped these messages to behaviour change techniques and developed videos to support key concepts.

Eight multidisciplinary clinicians (dentist, oral health therapist, dietician, cardiac nurse, and dental nurse), 75% female with a mean age of 48 ± 10 years, and seven consumers from a metropolitan and a regional area in New South Wales, 43% female with a mean age 62 ± 11.6 years participated in the focus groups. Key themes identified by clinicians included (1) limited support from medical and allied health teams for integrating oral health care into the healthcare system, (2) government-supported measures enable prevention, and (3) poor oral health of Australians. Consumers highlighted (1) barriers to accessing oral health care, (2) negative attitudes towards oral health, and (3) limited oral health-related knowledge. The final resource developed includes 81 text messages sequenced to ensure a gradual increase in knowledge and skill and five supporting videos.

The TOOTH resource has the potential to improve awareness and knowledge regarding oral disease prevention, enabling more equitable access to oral health education and better self-management of oral health.

This paper outlines the protocol for the ecofit implementation-effectiveness trial, a multi-component mobile Health (mHealth) intervention that aims to increase resistance and aerobic physical activity in primary care-based adults with type 2 diabetes (T2D). This study will be conducted as part of the Diabetes Alliance Program Plus (DAP+), a large-scale integrated health service intervention in a large health district in Australia. The ecofit program has previously demonstrated efficacy and effectiveness in insufficiently active people with (or at risk of) T2D and community dwelling-adults, respectively. The aim of this study is to assess the reach (primary outcome), adoption, appropriateness, feasibility and fidelity of the implementation of ecofit and the overall effectiveness of the intervention.

Prospective participants are adults diagnosed with T2D, who attend primary care settings enrolled in DAP+, and are identified and referred to ecofit by a primary care clinician. To support the implementation of ecofit a host of strategies will be utilised, which includes the education and upskilling of primary care clinicians enrolled in DAP+ using brief training sessions, the supply of an information package and access to professional development. The co-primary outcomes of reach will be defined as the number of participant registrations on the ecofit platform and the number of primary care clinicians who have been introduced to ecofit.

This study will evaluate the implementation of ecofit among adults with T2D within the primary care setting. The results may help improve T2D lifestyle interventions in primary care settings across Australia.

This review examined the effectiveness of mobile-health (m-health) app-supported interventions in improving patient health outcomes. It also sought to describe the behavior change techniques (BCTs) used in these interventions and identify effective BCTs or combinations of BCTs to facilitate glycemic control.

MEDLINE, EMBASE, and Web of Science databases were searched for relevant studies published until November 2024. Forty-three randomized controlled trials (RCTs) examining the effects of m-health app on glycemic control were identified and included in the analysis. The BCTs utilized in each intervention were coded based on a widely used BCT taxonomy. Health outcomes (e.g. change in hemoglobin A1c [HbA1c]) were meta-analyzed using random effect models. Meta-regression models were used to examine associations between the use of BCTs and HbA1c improvements. Cochrane Collaboration's tool was used for the evaluation of the risk of bias.

Using m-health app-supported interventions significantly reduced HbA1c, fasting blood glucose, systolic and diastolic blood pressure, low-density lipoprotein cholesterol, triglycerides, weight, and waist circumference. The examined interventions utilized 5.77 BCTs on average. The most frequently used BCTs included "credible source," followed by "social support (general)," "self-monitoring of outcome(s) of behavior," "biofeedback," "self-monitoring of behavior," and "instruction on how to perform a behavior (skills training)." Interventions that utilized "problem solving" and "reward and threat" were associated with greater HbA1c improvement than those did not. Using BCTs in groupings of "feedback and monitoring," "social support," and "comparison of outcomes" formed the simplest and most effective combination.

Our study provides evidence about effective BCTs and combinations for better glycemic control. However, optimal BCT combinations warrant further examination. Future RCTs that clearly report the BCTs used are recommended. Experimental designs such as a multiphase optimization strategy should be used to examine the effects of single BCTs and their interactions.

Increasing digital technology and media use among young people has raised concerns about problematic use and negative consequences. The formal recognition of a technology addiction (eg, gaming disorder) requires an understanding of the landscape of interventions designed to prevent this disorder and related technology addictions.

We conducted a rapid systematic review to investigate the current evidence on approaches to prevent problematic technology use and promote digital well-being, defined as the healthy use of digital media and technology and the absence of problems resulting from excessive use.

We used a pragmatic and rapid approach to systematically review and synthesize recent literature with a focus on contextual factors that can aid in understanding translatability, making trade-offs appropriate for rapid reviews per the Cochrane Collaboration guidelines. We searched multiple databases, including gray literature, for primary studies and systematic reviews of prevention interventions targeting children, adolescents, and youth. We extracted data on study characteristics, quality, and translatability and synthesized evidence through narrative description and vote counting of controlled trials. Data are openly available on our Open Science Framework website.

We found 6416 citations, of which 41 (0.64%) were eligible for inclusion (6 reviews and 35 primary studies of 33 interventions). Most interventions (26/33, 79%) combined intervention approaches and included an education component. Synthesis through vote counting showed benefits for all forms of digital well-being. Both included meta-analyses reported small positive effects on reductions of screen time. However, study reporting was overall lacking, impairing the ability to draw conclusions.

As digital technology use increases, interventions to prevent problematic technology use and promote digital well-being continue to proliferate. Understanding context factors that influence healthy technology use and understanding the limitations of the current evidence are vital for informing future research. This review demonstrates positive findings for the effectiveness of prevention interventions and describes factors that may contribute to translation and implementation. Future research would benefit from following appropriate reporting guidelines, reporting both the benefits and harms of interventions, and including greater detail on factors informing translation.

PROSPERO CRD42023444387; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=444387.

Cardiovascular diseases (CVD) caused 17.9 million deaths worldwide in 2019. General CVD prevention should be developed whilst controlling health expenditure. The aim of the SPICES project was to assess the efficacy of a community support intervention for adults with intermediate CVD risk at 24 months, compared to repeated brief advice alone. A randomised, controlled study was conducted in a poor, medically underserved, rural area in France from November 2019 to November 2021. Community champions lead small group sessions. They were specifically trained in behavioural change techniques and CVD prevention. Participants chose their own small, feasible cardiovascular health goals. The primary outcome was the difference in the Non-laboratory Interheart risk score (INL) in intention-to-treat at 24 months. Quality of life was assessed using the WHOQOL-BREF, diet using the DASH-questionnaire, physical activity using the IPAQ-short. Changes in BMI, smoking level, and self-declared alcohol consumption were recorded as health goals in the intervention group.1309 participants were eligible. 536 people were analysed. At 24 months, the difference Intervention-Control = -0.12 INL (95% CI -0.80 to 1.04) was not significant (p = 0.76). 257 people remained in the study. Most participants chose weight-loss as their objective. Although this study was impacted by the Covid-19 pandemic, pertinent observations were made. Participants spontaneously chose to lose weight, which was not an effective goal. The study was neglected by participants which suggests this population felt little concerned about CVD-prevention. Other awareness strategies should be developed. Public policies should be developed as individuals currently fail to improve their health. Trial registration: This trial is registered at clinicaltrials.gov (NCT0388606).

Participation in cardiac rehabilitation (CR) reduces risk of cardiovascular mortality, improves functional capacity and enhances quality of life in patients with coronary artery disease (CAD). eHealth-based CR can increase participation rates, but research into effective components is necessary. The objective of this systematic review was to identify effective behavior change techniques (BCTs) used in eHealth-based CR interventions.

A search of four databases (CINAHL, PubMed, PsychINFO, and MEDLINE) was conducted until January 10, 2023. Randomized controlled trials investigating eHealth-based interventions for patients with CAD were included. Risk of bias was assessed using the Effective Public Healthcare Practice Project tool. BCTs were coded following the Behavior Change Taxonomy. A best-evidence synthesis was conducted to determine the effectiveness of BCTs, with ratings ranging from A (strong evidence indicating either a positive effect (+) or no effect (-)) to D (no data collected).

A total of 88 studies (25,007 participants) met the eligibility criteria. The interventions in these studies used 31 different BCTs. The most common BCTs were instructions on how to perform the behavior (k = 86), social support (k = 69) and and information about health consequences (k = 56). The evidence for action planning was rated as A+ for medication adherence and diet. Conversely, for systematically decreasing the number of prompts/cues sent during an intervention, the evidence was rated as A- for physical activity, medication adherence and smoking cessation. The evidence for feedback on behavior was rated as A+ for medication adherence and A- for smoking cessation.

Action planning is effective as a BCT in eHealth-based CR, whereas reducing prompts/cues is not. Feedback on behavior may, depending on the behavior targeted, exert both positive and no effect, suggesting that BCT-behavior matching is important to optimize effectiveness of eHealth-based CR.

To develop and evaluate an intervention tailored to patients' needs to increase the rate of positive airway pressure (PAP) adherence in patients afflicted with obstructive sleep apnea (OSA), who undergo PAP therapy.

A multi-center, 3 parallel-arm, randomized, controlled trial was conducted. Participants with OSA who undergo a PAP therapy were randomized to one of three groups: control arm (usual care), educational booklet arm, and mobile-based application arm. PAP usage, the percentage of days using the device for more than 4 h, change in knowledge, risk perception, outcome expectancy, self-efficacy, and ESS were assessed before and one month after interventions in the three groups. Also, the application usage data were analyzed.

The result showed the change in average PAP usage, knowledge, risk perception, and self-efficacy in the application group was significantly higher than the control and booklet groups. Also, the change in use for more than 4 h in the application group was significantly higher than the control group. Comparing the actual and patients' self-report PAP use indicated patients' self-report about the use of the device is about 50 min (0.8 h) more than the actual amount of use.

The study results indicated that the improvement of primary and secondary outcomes in adherence to PAP was significantly higher in the application group than in other study groups. Given the increasingly penetrating influence of smartphone-based technologies, it seems that mobile-based applications could potentially be adopted in the population of patients with OSA.

IRCT2017092236314N1; https://en.irct.ir/trial/27185.

Experimental research has established the benefits of interrupting prolonged periods of sedentary behaviour in the evening with regular activity breaks. Research should now focus on how people can be encouraged and supported to engage in this behaviour. This study explores the barriers and facilitators unique to performing regular activity breaks in the evening mapped to the Capability Opportunity and Motivation model of Behaviour (COM-B), to inform future free-living intervention development.

Individual, face-to-face, semi-structured interviews were conducted with 28 participants (female n = 20, mean (SD) age 25.4 (5.5) years) who had participated in a laboratory-based, evening regular activity breaks intervention. Questions explored barriers and facilitators to incorporating regular activity breaks into their everyday lives at home in the evening. The interview transcripts were analyzed inductively first using thematic analysis, and then mapped, where relevant, to the COM-B model to link the themes to theoretical factors influencing behaviour change.

'Awareness of the benefits' of performing regular activity breaks, along with having the 'Memory and attention required to change behaviour' (e.g., reminders to overcome forgetfulness) influenced participant's psychological capability to perform this behaviour in the evening at home. 'Characteristics of the regular activity break exercises' enhanced physical capability as the exercises were easy and simple. The theme 'Social influences on behaviour' was mapped to social opportunity and described that others present in their home environment could support or hinder the behaviour, dependent on whether they were also taking regular activity breaks or not. 'Motivation' such as working towards a goal (facilitator) or not wanting to interrupt current sedentary behaviours (barrier) explained how reflective motivation, could influence taking regular activity breaks. Additionally, this theme explained how laziness, tiredness and reinforcement of sedentary behaviour via the nature of streaming services could hinder individuals' automatic motivation to perform regular activity breaks in their habitual evening routines.

Capability, opportunity and motivation were all perceived to influence individuals' ability to interrupt habitual evening sedentary behaviour by performing regular activity breaks. To encourage people to perform this behaviour, a multicomponent intervention is required to improve capability by understanding the benefits, opportunity by utilizing social support and motivation by creating goals and action planning.

The objective of this best practice implementation project was to improve dieticians' professional practice and dietary care through the use of counseling strategies.

Improving the design and implementation of evidence-based practice depends on successful behavior change interventions. This requires an appropriate method for designing the interventions and then analyzing the targeted behavior. Behavior change techniques (BCTs) have been demonstrated to improve the patient-dietitian relationship and patient treatment outcomes.

This evidence-based quality improvement project used the JBI Evidence Implementation Framework to identify gaps in clinical practice and barriers to changing practice. We recruited 20 dietitians and conducted a baseline audit to determine their level of knowledge of BCTs, the extent to which they applied BCTs in their practice, and barriers to using BCTs. To address the identified barriers, a 5-hour training session was conducted by a dietitian with psychological training. A follow-up audit was then conducted to measure improvements in compliance with best practice.

The baseline audit revealed that 80% of participants used some of the targeted counseling strategies. The most common barriers were lack of guidance on the use of BCTs or insufficient knowledge of BCTs. The follow-up audit revealed that 93% of participants used some counseling strategies, representing a 13% improvement from baseline.

Applying BCTs is a challenge in dietary practice. The results indicate that education about these techniques is needed. As the next step, we suggest disseminating the relevant recommendations among dietitians in Poland and providing education about the use of these methods.

http://links.lww.com/IJEBH/A289.

To identify the most commonly reviewed behaviour change techniques (BCTs) and their effectiveness based on consistency across reviews for lifestyle interventions of non-communicable diseases.

Umbrella review of systematic reviews.

PubMed, Embase, PsycINFO, Cochrane CENTRAL, Global Health.

A narrative synthesis of extracted findings was conducted. The Behaviour Change Technique v1 Taxonomy was used to identify and code behaviour change techniques (e.g., goal setting) in a standardised manner, which were independently assessed by two reviewers. Study quality was independently assessed by two reviewers using the assessment of multiple systematic review tools.

26 reviews were included with a total of 72 BCT labels evaluated across the different lifestyle interventions and non-communicable diseases. A total of 13 BCT clusters were identified to be reported as effective. The most commonly reviewed BCTs and their effectiveness/ineffectiveness were as follows: 'Goals and Planning' (12 effective/1 ineffective), 'Feedback and monitoring' (9 effective/3 ineffective), 'Social support' (9 effective/1 ineffective), 'Shaping knowledge' (11 effective/1 ineffective), and 'Natural consequences' (6 effectiveness/ 2 ineffective). The vast majority of the studies were conducted in high-income and a few in upper middle-income countries, with hardly any studies from lower middle-income and lower income studies.

The most common BCTs were 'Goals and Planning', 'Feedback and Monitoring', 'Shaping Knowledge', 'Social Support', and 'Natural Consequence'. Based on consistency across reviews, several BCTs such as 'Goals and Planning', Feedback and Monitoring', 'Shaping Knowledge', and 'Social Support' have demonstrated effectiveness (Recommendation Grade A) in improving health behaviours across a limited range of NCDs. The evidence is less clear for other BCT techniques. It is also likely that not all BCTs will be transferable across different settings. There is a need for more research in this area, especially in low-middle-income countries.

Registered on the International Prospective Register of Systematic Reviews; PROSPERO (CRD42020222832).

Lower socioeconomic status (SES) is associated with poorer dietary habits and fewer family meals. Therefore, initiatives to empower families with a lower SES to adopt healthier meal practices are employed. The objective of this study was to evaluate a nationwide intervention "Dinner is served at 1-2-3 euros", developed by a Belgian retailer in collaboration with social organizations. It targets families with a lower SES and aims to promote more balanced and freshly cooked meals by providing recipe booklets of affordable meals at a guaranteed price of 1, 2, or 3 euros per portion. The process evaluation aimed to gain insight into the implementation process (Reach, Recruitment, Dose-delivered, Context), the satisfaction with the intervention (Dose-received), and the perceived impact of intervention participation.

A mixed-methods study combining qualitative (i.e., focus groups and individual interviews) and quantitative research (i.e., surveys) was conducted. An interview with the retailer (n = 1), three focus group interviews with the involved social organizations (n = 15), and interviews with participants of "Dinner is served at 1-2-3 euros" (n = 26) were carried out, as well as surveys among these social organizations and participants.

Social organizations were generally satisfied with the project and appreciated the collaboration with the retailer. The main barrier to implement the project was a lack of time to help participants subscribing. Participants appreciated the inspiration from the recipe booklets, and the recipes' ease of preparation, their healthiness, and the variety. However, the recipes were sometimes deemed too exotic for participants' children. Participants also appreciated the budget friendliness, although the price guarantee mechanism of 1, 2 or 3 euros per portion was not always clear. Positive effects were mentioned in areas such as perceived healthy cooking and eating, improved cooking skills and ideas, and reduced financial concerns.

In general, participants and social organizations were satisfied with the delivery and implementation of the intervention. Participants also noted some positive effects on their meal practices. Future research should provide insight into the intervention's effectiveness and impact on the healthiness of participants' dietary choices.

The study protocol was pre‑registered prior to data collection at Clinicaltrials.gov (NCT05595551-27/10/2022).

Understanding users' acceptance of smoking cessation interventions features is a precursor to mobile cessation apps' uptake and use. We gauged perceptions of three features of smoking cessation mobile interventions (self-monitoring, tailored feedback and support, educational content) and their design in two smoking cessation apps, Quit Journey and QuitGuide, among young adults with low socioeconomic status (SES) who smoke. A convenience sample of 38 current cigarette smokers 18-29-years-old who wanted to quit and were non-college-educated nor currently enrolled in a four-year college participated in 12 semi-structured virtual focus group discussions on GoTo Meeting. Discussions were audio recorded, transcribed verbatim, and coded using the second Unified Theory of Acceptance and Use of Technology (UTAUT2) constructs (i.e., performance and effort expectancies, hedonic motivation, facilitating conditions, social influence), sentiment (i.e., positive, neutral, negative), and app features following a deductive thematic analysis approach. Participants (52.63% female, 42.10% non-Hispanic White) expressed positive sentiment toward self-monitoring (73.02%), tailored feedback and support (70.53%) and educational content (64.58%). Across both apps, performance expectancy was the dominant theme discussed in relation to feature acceptance (47.43%). Features' perceived usefulness centered on the reliability of apps in tracking smoking triggers over time, accommodating within- and between-person differences, and availability of on-demand cessation-related information. Skepticism about features' usefulness included the possibility of unintended consequences of self-monitoring, burden associated with user-input and effectiveness of tailored support given the unpredictable timing of cravings, and repetitiveness of cessation information. All features were perceived as easy to use. Other technology acceptance themes (e.g., social influence) were minimally discussed. Acceptance of features common to smoking cessation mobile applications among low socioeconomic young adult smokers was owed primarily to their perceived usefulness and ease of use. To increase user acceptance, developers should maximize integration within app features and across other apps and mobile devices.

Athletes display a high prevalence of undesired sleep characteristics that may affect both performance and wellbeing.

This scoping review aimed to identify and map the existing evidence of behavioral sleep interventions and their effects on sleep outcomes in athletes, and retrospectively code the behavior change techniques (BCTs) implemented using the Behavior Change Technique Taxonomy (BCTTv1).

Conducted following the JBI methodology for scoping reviews, four online databases were used to identify prospective interventions with at least one behavioral component in competitive athletes, and reporting a sleep outcome pre- and post-intervention.

Thirty-three studies met the inclusion criteria, encompassing 892 participants with a median age of 23. Five intervention categories were identified (education, mind-body practices, direct, multi-component, and other), with each demonstrating mixed efficacy but the potential to improve sleep outcomes. The BCTs varied in type and frequency between each category, with only 18 unique BCTs identified across all studies.

The varied efficacy of previous studies at improving sleep outcomes may be attributed to the lack of behavior change theory applied during intervention development. Designing interventions following a targeted specification of the behavioral problem, and the integration of corresponding BCTs should be considered in future research.

Working in healthcare often involves stressful situations and a high workload, and many healthcare workers experience burnout complaints or suffer from mental or physical problems. This also affects the overall quality of health care. Many previous workplace interventions focused on knowledge exchange instead of other health cognitions, and were not particularly effective. Multicomponent lifestyle interventions may offer the potential in improving lifestyle and well-being of healthcare professionals. This study aims to evaluate the impact of a multicomponent lifestyle intervention "Healthy and Vital" for healthcare professionals on several health-related outcomes.

A pre- (multiple) post-pilot study has been conducted using data from 2012 to 2018 to evaluate the lifestyle intervention in 126 female healthcare professionals. Measurements were conducted before, directly after the intervention (at 3 months), and 6 months after finishing the intervention (at 9 months). Participants filled out questionnaires and anthropometrics measurements were conducted by a dietitian. The intervention is based on the ASE-model, theory of planned behavior, and motivational interviewing techniques. The intervention included workshops related to stress, eating, sleep, and individual meetings with a dietitian. Multilevel linear mixed models with a random intercept and fixed slope were used to evaluate the impact on lifestyle self-efficacy, eating behavior, anthropometric outcomes and quality of life.

Improvements were observed for lifestyle self-efficacy (total: beta= 1.32 95%CI 0.94;1.48, I know: beta= 1.19 95%CI 0.92;1.46, and I can: beta= 1.46 95%CI 1.19;1.73), eating behavior (emotional eating: beta=-0.33 95%CI-0.44;-0.23, external eating: beta=-0.35 95%CI -0.44;-0.26, and diet/restrictive behavior: beta= 0.41 95%CI 0.30;0.51), anthropometric outcomes (weight: beta=-5.03 95%CI -5.93;-4.12, BMI: beta=-1.873 95%CI -2.06;-1.41, waist circumference: beta=-6.83 95%CI -8.00;-5.65, and body fat percentage: beta=-1.80 95%CI -2.48;-1.17) and multiple outcomes of quality of life (physical functioning: beta= 4.43 95%CI 1.98;6.88, vitality: beta= 7.58 95%CI 4.74;10.42, pain: beta=4.59 95%CI 0.91;1.827, general health perception: beta= 7.43 95%CI 4.79;10.07, and health change: beta= 21.60 95%CI 16.41;28.80) directly after the intervention. The improvements remained after a six-month follow-up.

Multicomponent interventions such as "Healthy and Vital" for healthcare professionals may be useful for improving the health of healthcare workers. More research using other designs with a control group, such as a stepped-wedge or RCT, is needed to verify our findings.

Retrospectively registered on May 1 2024 at the Open Science Framework Registries ( https://doi.org/10.17605/OSF.IO/Z9VU5 ).

Growing evidence suggests cognitive and social health benefits can be derived from digital storytelling for older adults with cognitive impairment. Digital storytelling apps offer the potential to serve as an on-demand, easy-to-access platform for enhancing cognitive abilities and promoting social well-being. Yet, despite the increasing quantity of such apps being available on the market, there is a gap in research investigating their quality.

This app review aims to assess the digital storytelling apps available in the Chinese market and evaluate them in accordance with the Mobile Application Rating Scale (MARS). The goal was to identify key features and evaluate the overall quality in the context of cognitively impaired users.

A systematic search was conducted in both the Google Play store (Google LLC) and iTunes store (Apple Inc), using English and Chinese keywords. Apps were chosen according to specific criteria that included features, including (but not limited to) memory capture, story saving, cue-based reminiscing, and the ability to share stories or memories with others. The MARS was used by 3 individual researchers to independently assess app quality across several domains, such as engagement, functionality, aesthetics, and information quality, for both Android and iOS apps.

From an initial screening of 297 apps, only 9 (3%) met the criteria for detailed evaluation using MARS. The reviewed apps featured capture memory, save, reminisce, and share functions, which are critical in supporting cognitive functions and enhancing user engagement. The analysis revealed patterns in platform diversity and geographical distribution of developers, with apps available on both iOS and Android. Memoirs of Life and Memorize: Diaries, Memories, Notes, Ideas, Timelines, Categories (Fair Apps Mobile) had the highest mean MARS scores of 3.35, indicating strong engagement, functionality, and information quality, while the lowest score was 2.33. The overall mean score across all apps was only 3.03 (SD 0.60), highlighting significant variation, particularly in information quality. User feedback also showed considerable variability, ranging from 0 comments for apps such as Grand Storyteller (VarIT Inc) and PWI Storyteller (Project World Impact, LLC) to as many as 5361 comments for FamilySearch, which received extensive positive reviews. This wide range of user feedback underscores the importance of continuous improvement and user-centered design, particularly in enhancing information quality and content accuracy.

The systematic search and evaluation highlight the diverse capabilities yet variable quality of digital storytelling apps available within the Chinese market, reflecting user experiences, satisfaction levels, and efficacy in supporting cognitively impaired users. While some apps excel in engagement and functionality, others need significant improvements in information quality and user interface design to better serve those with cognitive impairments. Future research is recommended to investigate regional limitations and features that would result in more inclusive and effective digital storytelling apps.

The Thinking Healthy Program (THP) is a multicomponent low-intensity cognitive behavioral therapy-based psychosocial intervention. This intervention has been shown to be clinically effective in perinatal depression (PND) and feasible for implementation in low-resourced settings. It has also been shown to work universally for different phenotypes of PND. However, the mechanism through which THP resolves different phenotypes of PND are unclear. The present investigation presents secondary mediation analyses of a dataset curated from a cluster randomized controlled trial conducted in Pakistan assessing the effectiveness of the THP. Women aged 16-45 years in their third pregnancy trimester, with a diagnosis of PND, underwent 16 sessions of the intervention. The severity of depression was assessed using the Hamilton Depression Rating Scale (HDRS). 2-1-1 mediation models revealed that social support exerted significant mediation in driving the intervention effects for improving the severity of depressive symptoms on the HDRS [B (SE) = 0.45 (0.09), 95% CI: 0.30-0.60] and its symptom dimensions of core emotional symptoms [B (SE) = 0.27 (0.06), 95% CI: 0.18-0.37], somatic symptoms [B (SE) = 0.24 (0.04), 95% CI: 0.16-0.31] and insomnia symptoms [B (SE) = 0.04 (0.02), 95% CI: 0.02-0.07].

The benefits of healthy eating are well known, yet adolescent diet is often poor. School based interventions offer a promising option to promote healthy eating, however, evidence is unclear.

This umbrella review synthesised the current evidence on school-based interventions for healthy eating in adolescents (10-19 years old).

Using Joanna Briggs Institute (JBI) umbrella review guidelines, a systematic search was conducted on 11 electronic databases (PubMed, CINHAL, EMBASE, Science Direct, PsycINFO, MEDLINE, Scopus, ERIC, Web of Science, Cochrane Register of Systemic Review and JBI Evidence Synthesis) to identify reviews published between January 2000 and December 2023. Methodological quality was assessed using JBI critical appraisal tool. A narrative synthesis was conducted informed by the World Health Organisation's Health Promoting School (HPS) framework that categorises school-based interventions into three components i.e., health education, school environment changes, and family and community involvement.

Seventeen reviews were identified (including 347 unique primary studies) that were published between 2008 and 2023. 87% of the reviews were based on interventions in high- income countries, limiting applicability to low- and middle-income countries. Fourteen reviews were rated as high, two as moderate, and one was rated as low methodological quality. Evidence from 71% of the reviews (n = 14 reviews, 13 = high methodological quality) found that multi-component interventions (i.e., interventions incorporating more than two components of the HPS framework) improved adolescents' knowledge and behaviour concerning healthy eating. At the individual level, tech-driven healthy eating curricula effectively improved eating behaviours of adolescents. These individual-level interventions proved to be more effective and sustainable when supported by system-level changes, such as modifying school environments including increased availability of healthy foods and involving parents to promote healthy eating for adolescents. However, limited evidence from only three reviews suggests mixed feasibility for technology-based interventions and lower feasibility for multi-component interventions. The lack of information on stakeholder involvement in intervention design is another critical evidence gap.

School-based multi-component healthy eating interventions that combine individual-level interventions with system-level changes are effective in promoting healthy eating behaviours among adolescents. Future reviews should assess the effectiveness of participatory approaches in intervention design, feasibility and scale-up studies, and analysing evidence from low- and middle-income countries.

Digital interventions hold promise for improving physical activity in adolescents. However, a lack of empirical decision points (eg, timing of intervention prompts) is an evidence gap in the optimization of digital physical activity interventions.

The study examined the feasibility and acceptability, as well as the technical and functional reliability, of and participant engagement with a digital intervention that aligned its decision points to occur during times when adolescents typically exercise. This study also explored the impact of the intervention on adolescents' moderate to vigorous physical activity (MVPA) levels. Consistent with the Obesity-Related Behavioral Interventions Trials (ORBIT) model, the primary goal of the study was to identify opportunities to refine the intervention for preparation for future trials.

Ten adolescents completed a 7-day baseline monitoring period and Temporally Augmented Goal Setting (TAGS), a 20-day digital physical activity intervention that included a midday self-monitoring message that occurred when adolescents typically start to exercise (3 PM). Participants wore an accelerometer to measure their MVPA during the intervention. Participants completed questionnaires about the acceptability of the platform. Rates of recruitment and attrition (feasibility), user and technological errors (reliability), and engagement (average number of text message responses to the midday self-monitoring message) were calculated. The investigation team performed multilevel models to explore the effect of TAGS on MVPA levels from preintervention to intervention. In addition, as exploratory analyses, participants were matched to adolescents who previously completed a similar intervention, Network Underwritten Dynamic Goals Engine (NUDGE), without the midday self-monitoring message, to explore differences in MVPA between interventions.

The TAGS intervention was mostly feasible, acceptable, and technically and functionally reliable. Adolescents showed adequate levels of engagement. Preintervention to intervention changes in MVPA were small (approximately a 2-minute change). Exploratory analyses revealed no greater benefit of TAGS on MVPA compared with NUDGE.

TAGS shows promise for future trials with additional refinements given its feasibility, acceptability, technical and functional reliability, participants' rates of engagement, and the relative MVPA improvements. Opportunities to strengthen TAGS include reducing the burden of wearing devices and incorporating of other strategies at the 3 PM decision point. Further optimization of TAGS will inform the design of a Just-in-Time Adaptive Intervention for adolescent physical activity and prepare the intervention for more rigorous testing.