Malnutrition is a serious and widespread health problem in community-dwelling older adults who receive care in hospital and at home. Hospital and home care nurses and nursing assistants have a key role in the delivery of high-quality multidisciplinary nutritional care. Nursing nutritional care in current practice, however, is still suboptimal, which impacts its quality and continuity. There appear to be at least two reasons for this. First, there is a lack of evidence for nutritional care interventions to be carried out by nurses. Second, there are several factors, that influence nurses’ and nursing assistants’ current behaviour, such as lack of knowledge, moderate awareness of the importance and neutral attitudes. This results in a lack of attention towards nutritional care. Therefore, there is a need to generate more evidence and to focus on targeting the factors that influence nurses’ and nursing assistants’ current behaviour to eventually promote behaviour change. To increase the likelihood of successfully changing their behaviour, an evidence-based educational intervention is appropriate. This might lead to enhancing nutritional care and positively impact nutritional status, health and well-being of community-dwelling older adults. The general objectives of this thesis are: 1) To understand the current state of evidence regarding nutrition-related interventions and factors that influence current behaviour in nutritional care for older adults provided by hospital and home care nurses and nursing assistants to prevent and treat malnutrition. 2) To develop an educational intervention for hospital and home care nurses and nursing assistants to promote behaviour change by affecting factors that influence current behaviour in nutritional care for older adults and to describe the intervention development and feasibility.
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Background: Self-management interventions are considered effective in patients with chronic disease, but trials have shown inconsistent results, and it is unknown which patients benefit most. Adequate self-management requires behaviour change in both patients and health care providers. Therefore, the Activate intervention was developed with a focus on behaviour change in both patients and nurses. The intervention aims for change in a single self-management behaviour, namely physical activity, in primary care patients at risk for cardiovascular disease. The aim of this study is to evaluate the effectiveness of the Activate intervention. Methods/design: A two-arm cluster randomised controlled trial will be conducted to compare the Activate intervention with care as usual at 31 general practices in the Netherlands. Approximately 279 patients at risk for cardiovascular disease will participate. The Activate intervention is developed using the Behaviour Change Wheel and consists of 4 nurse-led consultations in a 3-month period, integrating 17 behaviour change techniques. The Behaviour Change Wheel was also applied to analyse what behaviour change is needed in nurses to deliver the intervention adequately. This resulted in 1-day training and coaching sessions (including 21 behaviour change techniques). The primary outcome is physical activity, measured as the number of minutes of moderate to vigorous physical activity using an accelerometer. Potential effect modifiers are age, body mass index, level of education, social support, depression, patient-provider relationship and baseline number of minutes of physical activity. Data will be collected at baseline and at 3 months and 6 months of follow-up. A process evaluation will be conducted to evaluate the training of nurses, treatment fidelity, and to identify barriers to and facilitators of implementation as well as to assess participants’ satisfaction. Discussion: To increase physical activity in patients and to support nurses in delivering the intervention, behaviour change techniques are applied to change behaviours of the patients and nurses. Evaluation of the effectiveness of the intervention, exploration of which patients benefit most, and evaluation of our theory-based training for primary care nurses will enhance understanding of what works and for whom, which is essential for further implementation of self-management in clinical practice.
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Equestrianism is currently facing a range of pressing challenges. These challenges, which are largely based on evolving attitudes to ethics and equine wellbeing, have consequences for the sport’s social licence to operate. The factors that may have contributed to the current situation include overarching societal trends, specific aspects of the equestrian sector, and factors rooted in human nature. If equestrianism is to flourish, it is evident that much needs to change, not the least,human behaviour. To this end, using established behaviour change frameworks that have been scientifically validated and are rooted in practice — most notably, Michie et al.’s COM-B model and Behaviour Change Wheel — could be of practical value for developing and implementing equine welfare strategies. This review summarises the theoretical underpinnings of some behaviour change frameworks and provides a practical, step-by-step approach to designing an effective behaviour change intervention. A real-world example is provided through the retrospective analysis of an intervention strategy that aimed to increase the use of learning theory in (educational) veterinary practice. We contend that the incorporation of effective behaviour change interventions into any equine welfare improvement strategy may help to safeguard the future of equestrianism.
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Human behaviour change is necessary to meet targets set by the Paris Agreement to mitigate climate change. Restrictions and regulations put in place globally to mitigate the spread of COVID-19 during 2020 have had a substantial impact on everyday life, including many carbon-intensive behaviours such as transportation. Changes to transportation behaviour may reduce carbon emissions. Behaviour change theory can offer perspective on the drivers and influences of behaviour and shape recommendations for how policy-makers can capitalise on any observed behaviour changes that may mitigate climate change. For this commentary, we aimed to describe changes in data relating to transportation behaviours concerning working from home during the COVID-19 pandemic across the Netherlands, Sweden and the UK. We display these identified changes in a concept map, suggesting links between the changes in behaviour and levels of carbon emissions. We consider these changes in relation to a comprehensive and easy to understand model of behaviour, the Opportunity, Motivation Behaviour (COM-B) model, to understand the capabilities, opportunities and behaviours related to the observed behaviour changes and potential policy to mitigate climate change. There is now an opportunity for policy-makers to increase the likelihood of maintaining pro-environmental behaviour changes by providing opportunities, improving capabilities and maintaining motivation for these behaviours.
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Residential public charging points are shared by multiple electric vehicle drivers, often neighbours. Therefore, charging behaviour is embedded in a social context. Behaviours that affect, or are influenced by, other publiccharging point users have been sparsely studied and lack an overarching and comprehensive definition. Consequently, very few measures are applied in practice to influence charging behaviour. We aim to classify and define the social dimension of charging behaviour from a social-psychological perspective and, using a behaviour change framework, identify and analyse the measures to influence this behaviour. We interviewed 15 experts onresidential public charging infrastructure in the Netherlands. We identified 17 charging behaviours rooted in interpersonal interactions between individuals and interactions between individuals and technology. These behaviours can be categorised into prosocial and antisocial charging behaviours. Prosocial charging behaviour provides or enhances the opportunity for other users to charge their vehicle at the public charging point, for instance by charging only when necessary. Antisocial charging behaviour prevents or diminishes this opportunity, for instance by occupying the charging point after charging, intentionally or unintentionally. We thenidentified 23 measures to influence antisocial and prosocial charging behaviours. These measures can influence behaviour through human–technology interaction, such as providing charging etiquettes to new electric vehicle drivers or charging idle fees, and interpersonal interaction, such as social pressure from other charging point users or facilitating social interactions to exchange requests. Our approach advocates for more attention to the social dimension of charging behaviour.
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There is a groundswell of opinion in tourism, transport and cognate academic fields, that the travel and tourism industry is profoundly environmentally flawed (Gössling et al., 2010; Wheeller, 2012). Deeply embedded in neoliberal consumer society and entrenched in the structures of late-capitalism (Harvey, 2011), efforts to address the environmental failures of global tourism have, for the time being, rested largely with the consumer. This edited book has interrogated the behavioural and psychological dimensions of (tourist) mobility consumption, highlighted the complexity of consumer decision-making and drawn into question the efficacy of a consumer-led industry response to the climate crisis. The chapters in the first part of the book explored psychological understandings of climate change and tourism mobilities. These chapters unpack some of the key barriers to behaviour change in sustainable mobility, focusing on the attitude-behaviour gap as a significant hurdle to actualising behavioural change, the importance of identity and emotions to consumer decision-making in tourism and transport contexts, and how the hedonic and affective representations surrounding tourism spaces make them particular tricky settings for enacting sustained positive behaviour change. The chapters show that the barriers to unlocking behavioural change amongst consumers are considerable, and that the travelling public is unlikely to change “spontaneously” on the basis of environmental awareness alone. The socio-psychological insights in this part instead point towards increased governance as paramount in developing more sustainable mobility practices, if these changes are to be significant and in line with global climate policy. Part II of the book turned to behavioural aspects of climate change and tourism mobilities, and dealt with issues such as how carbon offsetting can ironically induce more travel rather than deter it, and the multiple ways in which time and distance are implicated in mobility decisions, including how changing information technologies can redefine these concepts. Longer-term planning horizons, and the impacts of individual lifestyles on demand modelling are explored, as well as how public transport can be promoted to visitors in urban destinations. The chapters in this part span a range of behavioural issues as they relate to (un)sustainable mobility, from localised ground transport and real-time travel information, to mega-events and the perceived cultural value of longdistance travel. The final part of the book focused on governance and policies based upon psychological, behavioural and social mechanisms. It commences with a comprehensive review of the cognitive, experiential and normative approaches to climate change communication before proposing an integrative conceptual framework for enhanced communication interventions. This aims to narrow the gap between awareness and attitudes on one hand, and behaviour on the other, that is evidenced in many of the other chapters. The part concludes with a challenge to move beyond socio/psychological approaches that attempt to foster sustainable mobility behaviour, such as nudging and social marketing, and question more seriously the systems of provision that perpetuate these practices. Significant structural change will require more radical approaches to governance, but the wheels of change turn slowly and in the case of anthropogenic climate change time is in limited supply. Overall, the chapters support earlier insights that increasing climate awareness and environmental concern has little bearing upon tourism consumption (Cohen et al., 2011; Eijgelaar et al., 2010; Hares et al., 2010; Higham and Cohen, 2011; McKercher et al., 2010), but they provide new perspectives as to why this might be the case. Travel decisions, the book shows, are deeply embedded socially and culturally, and intimately related to emotions, identity, time, happiness, performances of self or the attainment (or avoidance) of “possible selves”, all of which represent subconscious and little investigated psychological factors that bear upon travel decisions. The wide disparities that are apparent in domestic (“home”) and tourism (“away”) decision-making and behavioural contexts (Barr et al., 2010) cement the conclusion that the autonomy of individual pro-environmental response, when set within the systems of provision in latecapitalist consumer society, is fraught with challenge.
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Auxiliary reins (AR) such as draw- or side reins are commonly employed by equestrians but may cause equine welfare concerns. This study investigated behavioural factors underpinning AR usage and whether equestrians understand their biomechanical function. A mixed methods survey of 14–24 questions was circulated online via equestrian magazines and social media, collecting demographics, biomechanical knowledge, and behavioural factors relating to the use of AR. There were 570 responses from equestrians worldwide, with 344 (60.4 %) indicating that they had or would use AR. Univariable comparative statistics were performed between AR users and non-users. Participation in equestrian competition was significantly associated with the use of AR (X2(1, n = 570)= 20.42, p < 0.001). Equestrians who presently used or would use AR (n = 273) tended to have lower biomechanical knowledge scores than those who no longer used AR (n = 71), (W=11213, p = 0.029). Open text responses were analysed using thematic analysis, drawing on the Behaviour Change Wheel as a deductive framework. Most changes in a horse’s way of going in response to AR as reported by equestrians were not supported by scientific evidence. Social influence from those within an equestrian’s immediate environment and lack of physical riding or training skills were found to be primary drivers to start using AR. Once human behaviours were established, perceived horse characteristics and lack of rider ability were the most prominent barriers to reduced AR usage. Future research should focus on how to enhance rider knowledge and skill level, while creating a social environment that does not tolerate the inappropriate use of AR.
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Background: Collaboration between Speech and Language Therapists (SLTs) and parents is considered best practice for children with developmental disorders. However, such collaborative approach is not yet implemented in therapy for children with developmental language disorders (DLD) in the Netherlands. Improving Dutch SLTs’ collaboration with parents requires insight in factors that influence the way SLTs work with parents. Aims: To explore the specific beliefs of Dutch SLTs that influence how they collaborate with parents of children with DLD. Methods and procedures: We conducted three online focus groups with 17 SLTs using a reflection tool and fictional examples of parents to prompt their thoughts, feelings and actions on specific scenarios. Data were organised using the Theoretical Domains Framework (TDF). Outcomes and results: We identified 34 specific beliefs across nine TDF domains on how SLTs collaborate with parents of children with DLD. The results indicate that SLTs hold beliefs on how to support SLTs in collaborating with parents but also conflicting specific beliefs regarding collaborative work with parents. The latter relate to SLTs’ perspectives on their professional role and identity, their approach towards parents, and their confidence and competence in working collaboratively with parents.
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Background: The need for effective continuing education is especially high in in-hospital geriatric care, as older patients have a higher risk of complications, such as falls. It is important that nurses are able to prevent them. However, it remains unknown which interventions change the behavior of nurses. Therefore, the aim of this study is to identify intervention options to change the behavior of hospital nurses regarding fall prevention among older hospitalized patients. Methods: This study used a mixed method design. The Behavior Change Wheel (BCW) was used to identify intervention functions and policy categories to change the behavior of nurses regarding fall prevention. This study followed the eight steps of the BCW and two methods of data collection were used: five focus groups and three Delphi rounds. The focus groups were held with hospital nurses (n = 26). Geriatric experts (n = 11), managers (n = 13) and educators (n = 13) were included in the Delphi rounds. All data were collected within ten tertiary teaching hospitals in the Netherlands. All participants were included based on predefined in- and exclusion criteria and availability. Results: In Geriatric experts’ opinions interventions targeting behavior change of nurses regarding fall prevention should aim at ‘after-care’, ‘estimating fall risk’ and ‘providing information’. However, in nurses’ opinions it should target; ‘providing information’, ‘fall prevention’ and ‘multifactorial fall risk assessment’. Nurses experience a diversity of limitations relating to capability, opportunity and motivation to prevent fall incidents among older patients. Based on these limitations educational experts identified three intervention functions: Incentivisation, modelling and enablement. Managers selected the following policy categories; communication/marketing, regulation and environmental/social planning. Conclusions: The results of this study show there is a discrepancy in opinions of nurses, geriatric experts, managers and educators. Further insight in the role and collaboration of managers, educators and nurses is necessary for the development of education programs strengthening change at the workplace that enable excellence in nursing practice. DOI: https://doi.org/10.1186/s12912-021-00598-z
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Background: Nutritional care for older adults provided by hospital and home care nurses and nursing assistants is suboptimal. This is due to several factors including professionals' lack of knowledge and low prioritisation. Affecting these factors may promote nurses' and nursing assistants' behavioral change and eventually improve nutritional care. To increase the likelihood of successfully targeting these factors, an evidence-based educational intervention is needed. Objectives: To develop an educational intervention for hospital and home care nurses and nursing assistants to promote behaviour change by affecting factors that influence current behaviour in nutritional care for older adults. In this paper, we describe the intervention development process. Design: A multi-methods approach using literature and expert input. Settings: Hospital and home care. Participants: Older adults, nurses, nursing assistants, experts, and other professionals involved in nutritional care. Methods: The educational intervention was based on five principles: 1) interaction between intervention and users, 2) targeting users on both individual and team level, 3) supporting direct and easy transfer to the workplace, and continuous learning, 4) facilitating learning within an appropriate period, and 5) fitting with the context. Consistent with these principles, the research team focussed on developing a microlearning intervention and they established consensus on seven features of the intervention: content, provider, mode of delivery, setting, recipient, intensity, and duration. Results: The intervention consisted of 30 statements about nursing nutritional care for older adults, which nurses and nursing assistants were asked to confirm or reject, followed by corresponding explanations. These can be presented in a snack-sized way, this means one statement per day, five times a week over a period of six weeks through an online platform. Conclusions: Based on a well-founded and comprehensive procedure, the microlearning intervention was developed. This intervention has the potential to contribute to nursing nutritional care for older adults.
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