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A cross-sectional analysis of motivation and decision-making in referrals to lifestyle interventions by primary care general practitioners: a call for guidance

Aim: To explore 1) GPs´ motivation to refer to lifestyle interventions and to investigate the association between GPs’ own lifestyle-behaviors and their referral behavior, and 2) patient indicators in the decision-making process of the GPs’ referral to lifestyle interventions. Method: A cross-sectional study was conducted among 99 Dutch primary care GPs. Their motivation to refer was assessed by beliefs regarding lifestyle interventions. GPs’ referral behaviors were assessed - considering referral and self-reported actual referral - and their own lifestyle behaviors - physical activity, dieting, being overweight). Decision-making regarding referring patients to lifestyle interventions was assessed by imposed patient indicators, spontaneously suggested decisive patient indicators, and by case-based referring (vignettes).Results: A substantial group of GPs was not motivated for referral to lifestyle interventions. GPs’ refer behavior was significantly associated with their perceived subjective norm, behavioral control, and their own physical activity and diet. Most important patient indicators in referral to lifestyle interventions were somatic indicators, and patients’ motivation for lifestyle interventions.Conclusions: GPs motivation and referral behavior might be improved by providing them with tailored resources about evidence based lifestyle interventions, with support from allied health professionals, and with official guidelines for a more objective and systematic screening of patients.

The effect of a non-talking rule on the sound level and perception of patients in an outpatient infusion center

Noise is a common problem in hospitals, and it is known that social behavior can influence sound levels. The aim of this naturally-occurring field experiment was to assess the influence of a non-talking rule on the actual sound level and perception of patients in an outpatient infusion center. In a quasi-randomized trial two conditions were compared in real life. In the control condition, patients (n = 137) were allowed to talk to fellow patients and visitors during the treatment. In the intervention condition patients (n = 126) were requested not to talk to fellow patients and visitors during their treatment. This study measured the actual sound levels in dB(A) as well as patients’ preferences regarding sound and their perceptions of the physical environment, anxiety, and quality of health care. A linear-mixed-model showed a statistically significant, but rather small reduction of the non-talking rule on the actual sound level with an average of 1.1 dB(A). Half of the patients preferred a talking condition (57%), around one-third of the patients had no preference (36%), and 7% of the patients preferred a non-talking condition. Our results suggest that patients who preferred non-talking, perceived the environment more negatively compared to the majority of patients and perceived higher levels of anxiety. Results showed no significant effect of the experimental conditions on patient perceptions. In conclusion, a non-talking rule of conduct only minimally reduced the actual sound level and did not influence the perception of patients.

Greening the city : how to get rid of garden pavement!

The Steenbreek program is a private Dutch program which aims to involve citizens, municipalities and other stakeholders in replacing pavement with vegetation in private gardens. The Dutch approach is characterized by minimal governmental incentives or policy, which leaves a niche for private initiatives like Steenbreek, that mainly work on behavioural change. The aim of this paper is to build a model based on theory that can be used to improve and better evaluate depaving actions that are based on behavioural change. We tested this garden greening behaviour model in the Steenbreek program. The main result is that the model provides an understanding of the ‘how and why’ of the Steenbreek initiatives. Based on this we are able to provide recommendations for the improvement of future initiatives. Steenbreek covers a wide range of projects that together, in very different ways, take into account elements of the theoretical framework; either more on information factors, or on supporting factors, sometimes taking all elements together in a single action. This focus is sometimes understandable when just one element is needed (e.g., support), sometimes more elements could be taken into account to be more effective. If a certain element of the framework is lacking, the change of behaviour will not (or will only partly) take place. The model also gives insight into a more specific approach aimed at the people most susceptible to changing their behaviour, which would make actions more effective.

CO2 reduction through shared mobility: A review of psychological factors for the switch from a private car to shared transport

Behavioural perspective on car owners’ uptake of shared e-mobility

In the Interreg Smart Shared Green Mobility Hubs project, electric shared mobility is offered through eHUBs in the city. eHUBs are physical places inneighbourhoods where shared mobility is offered, with the intention of changing citizens’ travel behaviour by creating attractive alternatives to private car use.In this research, we aimed to gain insight into psychological factors that influence car owners’ intentions to try out shared electric vehicles from an eHUB in order to ascertain:1. The psychological factors that determine whether car owners are willing to try out shared electric modalities in the eHUBs and whether these factors are identical for cities with different mobility contexts.2. How these insights into psychological determinants can be applied to entice car owners to try out shared electric modalities in the eHUBs.Research was conducted in two cities: Amsterdam (the Netherlands) and Leuven (Belgium). An onlinesurvey was distributed to car owners in both cities inSeptember 2020 and, additionally, interviews wereheld with 12 car owners in each city.In general, car owners from Amsterdam and Leuven seem positive about the prospect of having eHUBs in their cities. However, they show less interest inusing the eHUBs themselves, as they are satisfied with their private car, which suits their mobility needs. Car owners mentioned the following reasons for notbeing interested in trying out the eHUBs: they simply do not see a need to do so, the costs involved with usage, the need to plan ahead, the expected hasslewith registration and ‘figuring out how it works’, having other travel needs, safety concerns, having to travel a distance to get to the vehicle, and a preferencefor ownership. Car owners who indicated that they felt neutral, or that they were likely to try out an eHUB, mentioned the following reasons for doing so:curiosity, attractive pricing, convenience, not owning a vehicle like those offered in an eHUB, environmental concerns, availability nearby, and necessity when theirown vehicle is unavailable.In both cities, the most important predictor determining car owners’ intention to try out an eHUB is the perceived usefulness of trying out an eHUB.In Amsterdam, experience with shared mobility and familiarity with the concept were the second and third factors determining car owners’ interest in tryingout shared mobility. In Leuven, pro-environmental attitude was the second factor determining car owners’ openness to trying out the eHUBs, and agewas the third factor, with older car owners being less likely to try one out.Having established that perceived usefulness was the most important determinant for car owners to try out shared electric vehicles from an eHUB, weconducted additional research, which showed that, in both cities, three factors contribute to perceived usefulness, in order of relevance: (1) injunctive norms(e.g., perceiving that society views trying out eHUBs as correct behaviour); (2) trust in shared electric mobility as a solution to problems in the city (e.g., expecting private car owners’ uptake of eHUBs to contributeto cleaner air, reduce traffic jams in city, and combat climate change); and (3) trust in the quality and safety of the vehicles, including the protection of users’privacy. In Amsterdam specifically, two additional factors contributed to perceived usefulness of eHUBs: drivers’ confidence in their capacity to try out anunfamiliar vehicle from the eHUB and experience of travelling in various modes of transport.Drawing on the relevant literature, the results of our research, and our behavioural expertise, we make the following recommendations to increase car users’ uptake of shared e-mobility:1. Address car owners’ attentional bias, which filters out messages on alternative transport modes.2. Emphasise benefits of (trying out) shared mobility from different perspectives so that multiple goals can be addressed.3. Change the environment and the infrastructure, as infrastructure determines choice of transport.4. For Leuven specifically: target younger car owners and car owners with high pro-environmental attitudes.5. For Amsterdam specifically: provide information on eHUBs and opportunities for trying out eHUBs.

The power of persuasive communication to influence sustainable holiday choices : appealing to self-benefits and norms

Messages with a clear focus on personal benefits and social and personal norms could impact holidaymakers' preferences towards opting for sustainability actions. This argument was explored using a three stage, sequential, mixed methods study. Firstly, analysis of current sustainability messages from three responsible tour operators revealed a low likelihood of them influencingcustomer preferences towards sustainability actions. An online survey of consumer beliefs and values proved that a manipulated message was more persuasive than the real messages used by the tour operators. This informed an experiment in message design that showed preferences for: i) obtaining individual gains from acting pro-sustainability (the importance of self-benefit), ii) doing what others are doing (the appeal of conforming to the descriptive norm), and iii) doing what others think one should do (the appeal of conforming to the injunctive norm). The findings have led the ANVR to relaunch their sustainability programme, focusing on customer benefits.