Abstract: Combined lifestyle interventions (CLI) are focused on guiding clients with weight-related health risks into a healthy lifestyle. CLIs are most often delivered through face-to-face sessions with limited use of eHealth technologies. To integrate eHealth into existing CLIs, it is important to identify how behavior change techniques are being used by health professionals in the online and offline treatment of overweight clients. Therefore, we conducted online semi-structured interviews with providers of online and offline lifestyle interventions. Data were analyzed using an inductive thematic approach. Thirty-eight professionals with (n = 23) and without (n = 15) eHealth experience were interviewed. Professionals indicate that goal setting and action planning, providing feedback and monitoring, facilitating social support, and shaping knowledge are of high value to improve physical activity and eating behaviors. These findings suggest that it may be beneficial to use monitoring devices combined with video consultations to provide just-in-time feedback based on the client’s actual performance. In addition, it can be useful to incorporate specific social support functions allowing CLI clients to interact with each other. Lastly, our results indicate that online modules can be used to enhance knowledge about health consequences of unhealthy behavior in clients with weight-related health risks.
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Behavior change is a topic that is of great interest to many people. People can use apps to exercise more, eat healthier, or learn a new skill, but and digital interventions and games are also used by policy makers and companies to create a safe environment for the general public or to increase sales. Given this interest in behavior change, it is not surprising that this topic has seen a lot of interest from the scientific community. This has resulted in a wide range of theories and techniques to bring about behavior change. However, maintaining behavior change is rarely addressed, and as a result poorly understood. In this paper, we take a first step in the design of digital interventions for long-term behavior change by placing a range of behavior change techniques on a long-term behavior change timeline.
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Introduction Physical activity levels of children with disabilities are low, as these children and their parents face a wide variety of both personal and environmental barriers. Behavior change techniques support pediatric physical therapists to address these barriers together with parents and children. We developed the What Moves You?! intervention Toolkit (WMY Toolkit) filled with behavioral change tools for use in pediatric physical therapy practice. Objective To evaluate the feasibility of using the WMY Toolkit in daily pediatric physical therapy practice. Methods We conducted a feasibility study with a qualitative approach using semi-structured interviews with pediatric physical therapists (n = 11). After one day of training, the pediatric physical therapists used the WMY Toolkit for a period of 9 weeks, when facilitating physical activity in children with disabilities. We analyzed the transcripts using an inductive thematic analysis followed by a deductive analysis using a feasibility framework. Results For acceptability, pediatric physical therapists found that the toolkit facilitated conversation about physical activity in a creative and playful manner. The working mechanisms identified were in line with the intended working mechanisms during development of the WMY Toolkit, such as focusing on problem solving, self-efficacy and independence. For demand, the pediatric physical therapists mentioned that they were able to use the WMY Toolkit in children with and without disabilities with a broad range of physical activity goals. For implementation, education is important as pediatric physical therapists expressed the need to have sufficient knowledge and to feel confident using the toolkit. For practicality, pediatric physical therapists were positive about the ease of which tools could be adapted for individual children. Some of the design and materials of the toolkit needed attention due to fragility and hygiene. Conclusion The WMY Toolkit is a promising and innovative way to integrate behavior change techniques into pediatric physical therapy practice.
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To improve people’s lives, human-computer interaction researchers are increasingly designing technological solutions based on behavior change theory, such as social comparison theory (SCT). However, how researchers operationalize such a theory as a design remains largely unclear. One way to clarify this methodological step is to clearly state which functional elements of a design are aimed at operationalizing a specific behavior change theory construct to evaluate if such aims were successful. In this article, we investigate how the operationalization of functional elements of theories and designs can be more easily conveyed. First, we present a scoping review of the literature to determine the state of operationalizations of SCT as behavior change designs. Second, we introduce a new tool to facilitate the operationalization process. We term the tool blueprints. A blueprint explicates essential functional elements of a behavior change theory by describing it in relation to necessary and sufficient building blocks incorporated in a design. We describe the process of developing a blueprint for SCT. Last, we illustrate how the blueprint can be used during the design refinement and reflection process.
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Behaviour Change Support Systems (BCSS), already running for the 10th time at Persuasive Technology, is a workshop that builds around the concept of systems that are specifically designed to help and support behaviour change in individuals or groups. The highly multi-disciplinary nature of designing and implementing behaviour change strategies and systems for the strategies has been in the forefront of this workshop from the very beginning. The persuasive technology field is becoming a linking pin connecting natural and social sciences, requiring a holistic view on persuasive technologies, as well as multi-disciplinary approach for design, implementation, and evaluation. So far, the capacities of technologies to change behaviours and to continuously monitor the progress and effects of interventions are not being used to its full potential. The use of technologies as persuaders may shed a new light on the interaction process of persuasion, influencing attitudes and behaviours. Yet, although human- computer interaction is social in nature and people often do see computers as social actors, it is still unknown how these interactions re-shape attitude, beliefs, and emotions, or how they change behaviour, and what the drawbacks are for persuasion via technologies. Humans re-shape technology, changing their goals during usage. This means that persuasion is not a static ad hoc event but an ongoing process. Technology has the capacity to create smart (virtual) persuasive environments that provide simultaneously multimodal cues and psycho-physiological feedback for personal change by strengthening emotional, social, and physical presence. An array of persuasive applications has been developed over the past decade with an aim to induce desirable behaviour change. Persuasive applications have shown promising results in motivating and supporting people to change or adopt new behaviours and attitudes in various domains such as health and wellbeing, sustainable energy, education, and marketing. This workshop aims at connecting multidisciplinary researchers, practitioners and experts from a variety of scientific domains, such as information sciences, human-computer interaction, industrial design, psychology and medicine. This interactive workshop will act as a forum where experts from multiple disciplines can present their work, and can discuss and debate the pillars for persuasive technology.
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BackgroundCombined lifestyle interventions (CLI) aim to help clients with weight-related health risks to change their physical activity levels and dietary behaviors. These long-term (2 year) interventions are mostly delivered through face-to-face sessions with limited use of eHealth technologies. To integrate eHealth into existing CLIs, it is important to determine how behavior change techniques (BCTs) are being used by health professionals in the online and offline treatment of overweight clients. Therefore, we conducted semi-structured interviews with providers and developers of online and offline CLIs.MethodsDue to the COVID-19 restrictions all semi-structured interviews were organized online. We recruited professionals who had experience with the (1) provision of the traditional ‘offline’ CLIs, (2) provision of online CLIs and (3) the development of (online) CLIs. The interview guide contained topics about the use and requirements of online and offline BCTs in practice. The data were analyzed through an inductive thematic approach.Findings Thirty-eight lifestyle professionals were interviewed. Professionals who work online use diary apps, smartwatches or smartphone-based accelerometers to support clients in changing their dietary and physical activity behavior. These tools help professionals in the provision of specific BCTs, including monitoring, feedback and shaping knowledge. Monitoring is seen as a starting point for feedback. Professionals use online modules to enhance knowledge about health consequences of unhealthy behavior. Coaches who work predominantly offline use goal setting and action planning techniques. Although online contact can be a quick and easy way to interact, physical meetings are seen as the best way to enhance social support.ConclusionThese Findings suggest that it may be beneficial to use monitoring devices to provide just-in-time feedback based on the client’s actual performance. Based on the Findings we are now developing an online platform with instructions for lifestyle coaches how to integrate online BCTs into practice.
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Background: Behaviour change techniques (BCTs) can be employed to support a healthy lifestyle for people with intellectual disabilities. The aim of this study is to determine whether and which BCTs are used by direct support professionals (DSPs) for supporting healthy lifestyle behaviour of people with moderate to profound intellectual disabilities. Method: Direct support professionals (n = 18) were observed in their daily work using audio-visual recordings. To code BCTs, the Coventry Aberdeen London Refined (CALO-RE-NL) taxonomy was employed. Results: Direct support professionals used 33 BCTs out of 42. The most used BCTs were as follows: ‘feedback on performance’, ‘instructions on how to perform the behaviour’, ‘doing together’, ‘rewards on successful behaviour’, ‘reward effort towards behaviour’, ‘DSP changes environment’, ‘graded tasks’, ‘prompt practice’ and ‘model/demonstrate behaviour’. Conclusions: Although a variety of BCTs is used by DSPs in their support of people with moderate to profound intellectual disabilities when facilitating healthy lifestyle behaviour, they rely on nine of them.
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Chronic diseases represent a significant burden for the society and health systems; addressing this burden is a key goal of the European Union policy. Health and other professionals are expected to deliver behaviour change support to persons with chronic disease. A skill gap in behaviour change support has been identified, and there is room for improvement. Train4Health is a strategic partnership involving seven European Institutions in five countries, which seeks to improve behaviour change support competencies for the self-management of chronic disease. The project envisages a continuum in behaviour change support education, in which an interprofessional competency framework, relevant for those currently practising, guides the development of a learning outcomes-based curriculum and an educational package for future professionals (today’s undergraduate students).
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Blended behavior change interventions combine therapeutic guidance with online care. This new way of delivering health care is supposed to stimulate patients with chronic somatic disorders in taking an active role in their disease management. However, knowledge about the effectiveness of blended behavior change interventions and how they should be composed is scattered. This comprehensive systematic review aimed to provide an overview of characteristics and effectiveness of blended behavior change interventions for patients with chronic somatic disorders.
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BackgroundPhysical activity can prevent or delay age-related impairments and prolong the ability of older adults to live independently. Community-based programs typically offer classes where older adults can exercise only once a week under the guidance of an instructor. The health benefits of such programs vary. Exercise frequency and the duration of the program play a key role in realizing effectiveness. An auxiliary home-based exercise program can provide older adults the opportunity to exercise more regularly over a prolonged period of time in the convenience of their own homes. Furthermore, mobile electronic devices can be used to motivate and remotely guide older adults to exercise in a safe manner. Such a blended intervention, where technology is combined with personal guidance, needs to incorporate behavior change principles to ensure effectiveness.ObjectiveThe aim of this study was to identify theory-based components of a blended intervention that supports older adults to exercise at home.MethodsThe Medical Research Council framework was used to develop the blended intervention. Insights from focus group, expert panels, and literature were combined into leading design considerations.ResultsA client-server system had been developed that combined a tablet app with a database in the cloud and a Web-based dashboard that can be used by a personal coach to remotely monitor and guide older adults. The app contains several components that facilitate behavior change—an interactive module for goal setting, the ability to draw up a personal training schedule from a library containing over 50 exercise videos, progress monitoring, and possibilities to receive remote feedback and guidance of a personal coach.ConclusionsAn evidence-based blended intervention was designed to promote physical activity among older adults. The underlying design choices were underpinned by behavior change techniques that are rooted in self-regulation. Key components of the tablet-supported intervention were a tailored program that accommodates individual needs, demonstrations of functional exercises, monitoring, and remote feedback. The blended approach combines the convenience of a home-based exercise program for older adults with the strengths of mobile health and personal guidance.
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