Facilitators and barriers of technology adoption and social connectedness among rural older adults: a qualitative study.

Background: Social disconnection is a public health concern among rural Australian older adults. While research suggests technology can enhance social wellbeing and protect against social disconnection, many older adults are not digitally literate, and little is known as to why and how technology adoption could be promoted in rural contexts. This study aimed to (1) explore the barriers and facilitators of technology adoption among rural older adults and (2) determine the potential utility of technology to promote social connectedness in the aged population. The Theoretical Domains Framework and the Behaviour Change Wheel (BCW) were employed to gain a comprehensive understanding of the digital and social behaviours of rural Australian older adults. Methods: Semi-structured interviews were conducted with a convenience sample of 33 rural older adults aged between 65 and 87 years. Interviews were conducted over the phone, audio-recorded, and transcribed. Interview transcripts were coded and analysed using thematic analysis and the BCW. Results: Numerous barriers and facilitators of technology adoption were identified, with the most prominent being knowledge, perceived value, perceived self-efficacy, and social support. Findings suggest that older adults' technology adoption is not simply a technical matter, but influenced by various individual, social, and environmental contexts. Consideration of these factors during development, marketing, training and implementation may facilitate technology adoption among older adults. With regard to social connectedness, several rural barriers emerged, including low population density, geographic isolation, limited community opportunities and poor public transport infrastructure. Conclusion: Technology was consistently identified as a facilitator of the social experience, indicating that technology is a promising tool to enhance social connectedness among older adults, particularly those living in rural areas. Future research should focus on enhancing the capability, opportunity and motivation of older adults in technology adoption, with reference to the rural contexts.

Co-designing planning interventions to facilitate participation in mail-out bowel cancer screening.

BACKGROUND: Population mail-out bowel cancer screening programs save lives through prevention and early detection; however, their effectiveness is constrained by low participation rates. Many non-participants are "intenders"; that is, they intend to screen but fail to do so, often forgetting or procrastinating. This study aimed to co-design interventions to increase screening participation among intenders in the Australian National Bowel Cancer Screening Program. METHODS: Three semi-structured interviews, and one online cross-sectional survey, were conducted between August 2021 and December 2022. Interviews with people who had completed and returned their latest screening kit ("completers") were first conducted to identify the planning strategies they had used. Using survey data, logistic regressions were conducted to analyse strategies predictive of participants having returned their latest bowel cancer screening kit. Then, intenders were interviewed to explore their opinions of these strategies and worked with researchers to adapt these strategies into prototype interventions to facilitate screening participation. All interviews were analysed using the framework approach of codebook thematic analysis. RESULTS: Interview participants who returned their kit shared their effective planning strategies, such as putting the kit in a visible place or by the toilet, planning a time at home to complete the kit, and using reminders. Survey participants who reported using such strategies were more likely to have completed their screening kit compared to those who did not. Prototype interventions developed and endorsed by intenders included providing a prompt to place the kit or a sticker near the toilet as a reminder, a deadline for kit return, the option to sign up for reminders, and a bag to store the sample in the fridge. CONCLUSIONS: These novel, consumer-led interventions that are built upon the needs and experience of screening invitees provide potential solutions to improve participation in population bowel cancer screening.

Road to referral success in COPD: Enhancing patient engagement through dedicated conversations about pulmonary rehabilitation programs.

RESEARCH QUESTION: From the perspectives of healthcare professionals (HCPs) and people with chronic obstructive pulmonary disease (COPD) known to tertiary care, what influences successful referrals to a pulmonary rehabilitation program (PRP)? METHODS: This cross-sectional qualitative study was informed by a critical realist perspective. We purposively sampled people with COPD and HCPs who deliver COPD care and used semi-structured interviews and focus groups to explore determinants of a successful referral to a PRP. Interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis. RESULTS: Data were available on 38 HCPs and 15 people with COPD. We generated three core themes pertaining to successful referrals. The first theme was that HCPs should be mindful of how professional responsibilities (such as their personal value and interest in a PRP, their degree of understanding of PRPs, and the organisational culture the PRPs are embedded within) shape decision-making during a therapeutic interaction. The second theme, there's more to me than my COPD, characterised psychological perceptions that shape a person's readiness to engage in a PRP. The third theme, communication is a two-way street that requires careful navigation, characterised the interpersonal dynamic between HCP and patient, and how dedicated conversations about PRPs can encourage successful referrals. CONCLUSION: Therapeutic interactions that include dedicated conversations about PRPs can foster successful referrals among people with COPD. During these interactions, HCPs should take the time to understand and carefully unpack psychological perceptions whilst imparting value, interest and enthusiasm for PRPs. Doing so can shape patient engagement toward referral success.

Using Normalisation Process Theory to explore the contribution of stakeholder workshops to the development and refinement of a complex behavioural intervention: the STAMINA lifestyle intervention.

BACKGROUND: The National Institute for Health and Care Excellence (NICE) recommend that men with prostate cancer on androgen deprivation therapy (ADT) are offered twice weekly supervised aerobic and resistance exercise to address side effects of treatment. However, supervised exercise is not routinely offered in standard clinical practice. The STAMINA programme grant for applied research (PGfAR) has been designed to evaluate whether this recommendation can be delivered within standard NHS care. This paper describes how future implementation of NICE recommendations within the NHS was explored during complex intervention development to enable evaluation of a lifestyle intervention. METHODS: Two stakeholder workshops were conducted to explore factors pertinent to future implementation of the STAMINA Lifestyle intervention (SLI). Normalisation Process Theory (NPT) provided the theoretical framework for discussion and analysis. Stakeholder workshop 1 focussed on intervention coherence and buy-in. Stakeholder workshop 2 explored barriers and facilitators for embedding SLI into the context of the NHS, with delivery partner Nuffield Health, in the future. RESULTS: Workshops were attended by healthcare professionals (n = 16), exercise professionals (n = 17), members of public involved in PPI including patients (n = 12), health psychologists (n = 2), clinical commissioners (n = 4), cancer charities (n = 3), a cancer alliance (n = 1) and health economist (n = 1). Stakeholders agreed that professional training packages should emphasise the uniqueness of the SLI and underpinning theory and evidence (Coherence). To further engagement, the use of STAMINA champions and information about the delivery partner were recommended to enhance confidence and knowledge (Cognitive participation). Furthermore, a simple communication (Collective Action) and progress reporting system (Reflexive Monitoring) was suggested to fit into existing infrastructure within the NHS and community partner. CONCLUSIONS: Application of NPT within two stakeholder workshops enhanced complex intervention development. Context-specific strategies to support implementation of SLI within the context of a trial were proposed, sensed-checked, and considered acceptable. The organisational implications of embedding and sustaining the intervention in preparation for wider NHS roll-out were considered (if proven to be effective) and will be explored in the qualitative component of a process evaluation underpinned by NPT. TRIAL REGISTRATION: (ISRCTN: 46385239 ). Registered on July 30, 2020.

Identifying motivational interviewing techniques in Quitline smoking cessation counselling sessions from Queensland, Australia.

Motivational interviewing (MI) is a common approach for smoking cessation counselling, yet little is known about the use of MI techniques in practice. This qualitative content analysis applied a published classification of content and relational MI techniques to a sample of 30 Quitline transcripts (January-March 2019) from Queensland, Australia. Overall, 36 MI techniques (94.7%) were identified at least once within the total sample. On average, 20 techniques (52.6%) were used in an individual conversation with a small difference observed between initial and follow-up calls. Techniques most frequently applied across conversations were largely relational, while techniques addressing client ambivalence/resistance were less frequently/never applied. Variability in techniques between individual initial and follow-up calls highlights the high degree of personalisation when applying MI to smoking cessation. Further investigations exploring associations of individual techniques and cessation outcomes are warranted. The classification may prove useful for assessments of fidelity for training and monitoring activities.

Remote physical activity intervention to promote physical activity and health in adolescent girls (the HERizon project): a multi-arm, pilot randomised trial.

BACKGROUND: Engaging in physical activity (PA) during adolescence is beneficial for health and positive development. However, most adolescent girls have low PA levels, and there is a need for interventions outside of school hours. This pilot randomised controlled trial aimed to explore the preliminary effectiveness of three different remote PA interventions in increasing adolescent girls' moderate-to- vigorous PA (MVPA), fitness and psychosocial outcomes. METHODS: Girls living in the UK or Ireland, aged between 13 and 16 years old, who wished to increase their activity levels, were eligible for the study. Using a random number generator, participants (n = 153; 14.8y ± 1.4) were randomised into one of three 12-week intervention groups (i) PA programme, (ii) Behaviour change support, or (iii) Combined PA programme and Behaviour change support, or (iv) a Comparison group. Outcome measures included accelerometer and self-reported PA, physical fitness (cardiorespiratory fitness; 20 m shuttle run, muscular endurance; push up, muscular strength; long jump), and psychosocial assessments (perceived competence; body appreciation; self-esteem; behavioural regulation). Linear mixed models were used to analyse differences between each intervention arm and the comparison group immediately postintervention (12 weeks) and at follow up (3-months post-intervention), while adjusting for potential confounders. RESULTS: Participation in the PA programme group was associated with higher perceived competence (0.6, 95% CI 0.1 to 1.2), identified regulation (0.7, 95% CI 0.2 to 1.1) and intrinsic motivation (0.9, 95% CI 0.2 to 1.6) at post-intervention. Participation in the Behaviour change group was associated with higher perceived competence at post-intervention (0.6, 95% CI 0.1 to 1.2), and higher push-up scores at the 3-month follow-up (4.0, 95% CI 0.0 to 7.0). Participation in the Combined group was also associated with higher perceived competence at post-intervention (0.8, 95% CI 0.2 to 1.4), and higher push-up scores at the 3-month follow-up (5.0, 95% CI 1.0 to 8.0). No other significant differences were found between the intervention arms and the comparison group. CONCLUSION: Results suggest perceived competence increased across all intervention arms, while the PA programme group enhanced autonomous motivation in the short term. Intervention arms with behaviour change support appear most promising in improving muscular endurance. However, a larger scale trial is needed for a better understanding of between-group differences and the impact of intervention arms on MVPA and fitness, given the small sample size and short-term follow-up.

Patient experiences and desires for recovery after ankle fracture surgery.

OBJECTIVE: This study investigates patients' experiences of commencing weight-bearing after ankle fracture surgery and their recovery priorities to inform a new rehabilitation intervention. METHODS: Embedded within the Weight bearing in Ankle Fractures (WAX) trial, this qualitative study conducted semi-structured interviews with patients following ankle fracture surgery. The Behaviour Change Wheel (BCW) framework guided the interview questions to ensure comprehensive domain coverage. A purposive, maximum variation sampling strategy was used for participant selection. Data analysis employed a combined deductive and inductive approach. RESULTS: A total of 29 patients were interviewed, revealing five key themes: understanding the recovery journey, navigating the healthcare system, understanding personal physical capabilities, building confidence for weight-bearing, and resuming daily activities. Themes emphasised the variability in healthcare access, the impact of non-weight-bearing on independence, and the role of self-efficacy in recovery. CONCLUSIONS: The study highlighted the diversity in patient experiences and recovery challenges post-ankle fracture surgery. Patients' recovery was influenced by access to consistent healthcare advice, self-efficacy, and the physical and psychological impact of non-weight-bearing. The findings suggest a need for tailored, patient-centred rehabilitation interventions that consider individual recovery trajectories and promote self-management. These insights provide a foundational understanding for developing interventions that more effectively address patient priorities and barriers to recovery.

"I don't really know how to help her." Family caregivers' capabilities, opportunities and motivations to provide hearing support to long-term care home residents with dementia.

PURPOSE: Hearing loss is highly prevalent in long-term care home (LTCH) residents with dementia ("residents") and exacerbates confusion and communication difficulties. Residents rely on caregivers, including family, for hearing-related care. This study aims to understand the drivers of family caregivers' provision of hearing support to LTCH residents using the Behaviour Change Wheel. MATERIALS AND METHODS: This exploratory two-stage study was guided by the Capability, Opportunity, Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). A self-report survey (N = 87) and interviews (N = 6) explored drivers behind the provision of hearing support. Quantitative data were analysed using descriptive statistics and a within-participants ANOVA. Deductive coding of TDF domains alongside thematic analysis was used for qualitative data. RESULTS: Provision of hearing support was variable. Gaps in family caregivers' psychological capability, reflective motivation and physical opportunity were identified. Barriers included lacking knowledge, unclear caregiver responsibilities, deprioritising hearing support, COVID-19 restrictions and fragmented collaborations with audiology services. CONCLUSIONS: Future behaviour-change interventions to facilitate family caregivers' provision of hearing support to LTCH residents should include: Improving knowledge of how to provide effective hearing support, establishing caregiver responsibilities and increasing the resources for hearing support within LTCHs.

Interventions to aid family caregivers in providing hearing support for their relative with dementia should be designed to address gaps in capabilities, opportunities and motivations, as barriers are present in all three constructs.Audiologists should signpost family caregivers to educational resources about traditional hearing aids and assistive listening devices to be used within the long-term care homes (LTCH) and understand the benefits of domiciliary audiology appointments for LTCH residents.Care staff and family to discuss roles and responsibilities for hearing support and document these in care plans when the resident first moves to the LTCH e.g., accompanying resident to external audiology appointments.

Reconceiving Domestic Burning Controls: Air Quality Alerts, Behavioural Responsive Regulation, and Designing for Compliance.

Domestic combustion emissions pose a growing risk to public health, especially in the UK. Existing responses are polarised, with government advocating use of lower emission fuels and stoves while clean air campaigners call for blanket bans on burning. However, each approach is limited in its ability to control these emissions. An alternative can be found in the U.S.A., where 'burn alert' systems require stove and fireplace users to avoid lighting during periods of actual or projected poor air quality. Given the effectiveness of these regimes, the current study designs and evaluates the effectiveness and acceptability of a burn alert system in the UK for the first time, drawing on the theoretical perspective of behavioural responsive regulation. Fifty participants were recruited to use the system over 2 weeks in winter. The findings illustrate that a voluntary burn alert system can dissuade burning among users. Of those in receipt of an alert, 74% reduced burning frequency or burned for a shorter duration. In total, the alert system prevented at least 178 hours of burning for this group. Qualitative findings show that the consistency of the behavioural response is influenced by technical, structural, and environmental factors, providing key insight into how UK-based burn alert systems could be modified to increase the consistency of compliance in future. The overall conclusion is that burn alerts could be introduced in the UK and beyond, as a means of reducing domestic combustion emissions and their associated public health risks.

Enhancing making every contact count (MECC) training and delivery for the third and social economy (TSE) sector: a strategic behavioural analysis.

OBJECTIVE: To enhance Making Every Contact Count (MECC, an opportunistic approach to health promotion), training in the Third and Social Economy (TSE, all groups and organisations primarily working towards social justice, outside of the government or household) by examining the degree to which the behavioural content of MECC training tackled significant factors influencing MECC delivery. METHODS AND MEASURES: A strategic behavioural analysis design. Semi-structured interviews with service providers (n = 15) and users (n = 5) were coded for barriers and facilitators of MECC delivery using the Theoretical Domains Framework (TDF). Existing MECC training was coded for behaviour change techniques (BCTs) and intervention functions (IFs). The degree to which BCTs and IFs addressed the key TDF domains of influences on MECC delivery in the TSE were examined using prespecified tools. RESULTS: Seven key TDF domains of influences in MECC delivery were identified. Overall, only 9/31 linked BCTs were utilised within MECC training, with percentage utilisation of relevant BCTs for each domain ranging from 0% to 66.7%. Training adequately addressed 2/7 key domains. CONCLUSION: The TSE and healthcare share many common key TDF domains, although there are differences in how each are relevant. Limitations and recommendations for MECC training are discussed.

A Healthy Conversation Skills intervention to support changes to physical activity and dietary behaviours in community-dwelling older adults during the COVID-19 pandemic.

AIMS: Physical activity (PA) and nutrition are important determinants of health in late adulthood. However, low levels of PA and poor nutrition are common in older adults and have become more prevalent during the COVID-19 pandemic. We hypothesised that Healthy Conversation Skills could be used to support health behaviour changes beneficial for health in older adults and thus conducted a study nested within the UK Hertfordshire Cohort Study. METHODS: Between November 2019 and March 2020, 176 participants were visited at home. A trained researcher administered a questionnaire and undertook anthropometric and physical performance tests. A total of 89 participants were randomised to the control group and received a healthy living leaflet; 87 participants in the intervention group were interviewed using Healthy Conversation Skills at the initial visit with follow-up telephone calls at 1, 3, 6 and 9 months. Follow-up at 1 year by postal questionnaire assessed change in PA and diet. In total, 155 participants (79 control and 76 intervention) completed the baseline and 1-year follow-up. RESULTS: At baseline, median (lower quartile, upper quartile) age (years) was 83.1 (81.5, 85.5) and median PA time (min/day) from walking, cycling and sports was 30.0 (15.0, 60.0). In total, 95% of participants completed the intervention; the total response rate for postal questionnaires was 94%. There were no statistically significant differences in outcomes between the trial arms. In women, there was a tendency for greater increases in diet quality in the intervention group compared to the control group (p = 0.075), while among men, there was a tendency for reduced decline in self-reported physical function in the intervention group compared to the control group (p = 0.081). CONCLUSION: We have shown that it is viable to utilise Healthy Conversation Skills via telephone to promote healthier lifestyles in older adults. Larger appropriately powered studies to determine the efficacy of such an intervention are now warranted.

Mindfulness improves psychological health and supports health behaviour cognitions: Evidence from a pragmatic RCT of a digital mindfulness-based intervention.

BACKGROUND: Mindfulness-based interventions can improve psychological health; yet the mechanisms of change are underexplored. This pre-registered remote RCT evaluated a freely accessible digital mindfulness programme aiming to improve well-being, mental health and sleep quality. Health behaviour cognitions were explored as possible mediators. METHODS: Participants from 91 countries (N = 1247, Mage = 27.03 [9.04]) were randomized to 30 days of mindfulness practice or attention-matched control condition. Measures of well-being, depression, anxiety, stress, sleep quality, barriers self-efficacy, self-regulation and behavioural predictors (e.g., attitudes and behavioural intentions) were taken at baseline, 1-month (post-intervention) and 2-months (follow-up). Linear regression examined intervention effects between and within groups. Longitudinal mediation analyses explored indirect effects through health behaviour cognitions. RESULTS: Three hundred participants completed post-intervention measures. Those receiving mindfulness training reported significantly better well-being (Mdifference = 2.34, 95%CIs .45-4.24, p = .016), lower depression (Mdifference = -1.47, 95%CIs -2.38 to -.56, p = .002) and anxiety symptoms (Mdifference = -.77, 95%CIs -1.51 to -.02, p = .045) than controls. Improvements in well-being and depression were maintained at follow-up. Intervention effects on primary outcomes were mediated by attitudes towards health maintenance and behavioural intentions. Mediating effects of attitudes remained when controlling for prior scores in models of depression and well-being. CONCLUSIONS: Digital, self-administered mindfulness practice for 30 days meaningfully improved psychological health, at least partially due to improved attitudes towards health behaviours and stronger behavioural intentions. This trial found that digital mindfulness is a promising and scalable well-being tool for the general population, and highlighted its role in supporting health behaviours.

The influence of life transitions on Danish adults' physical activity beliefs and behaviour: A qualitative study.

Using a qualitative design, we explored how life transitions influence Danish adults' physical activity beliefs and behaviour adopting the Theory of Planned Behaviour as a guiding framework. Life story interviews with 42 participants revealed 6 salient life transition periods which affected physical activity behaviour, either in a disruptive way resulting in decreased activity levels or in a facilitative manner, providing opportunities for increased activity engagement. The identified life transition periods uniquely influenced individuals' attitudes, subjective norms and perceived behavioural control (PBC) beliefs, thus affecting motivations toward physical activity. Specifically, starting primary school or a career, forming a romantic relationship, and having a child primarily shaped subjective norm and PBC, while leaving home was especially influential on PBC and retirement on attitudes and PBC. Consistent themes across the transition periods included time constraints and opportunities to be active, supportive social contexts, access to facilities and having a need to be active.

Behaviour setting transformation methodology, filling in the gaps of the conventional architectural design process.

This article recounts 6 years of empirical research in a humanitarian context on spatial behaviour using the behaviour settings theory. This research journey details the shortcomings of conventional architectural processes and the subsequent development of a human-centred behaviour setting methodology that drives behaviour change for adaptable spaces. The research work puts Barker's theory of behaviour settings into practice to show its significant methodological abilities in shaping behaviours through spaces. While the original theory was solely an analytical account of existing behaviours in certain settings, this study marks the first pragmatic exploration of the theory into both residential and refugee contexts. The methodology that is subsequently proposed is a complementary tool to account for the deficiencies of conventional architectural design processes. A method that enables one to fully immerse themselves in the environment, recognize specific architectural interventions, assess their effects and reiterate. It is a proposal for humanizing architecture, sympathizing its processes and personalizing its results for the users of any space. This article is part of the theme issue 'People, places, things, and communities: expanding behaviour settings theory in the twenty-first century'.

Expert consensus on multilevel implementation hypotheses to promote the uptake of youth care guidelines: a Delphi study.

BACKGROUND: The implementation of youth care guidelines remains a complex process. Several evidence-based frameworks aid the identification and specification of implementation determinants and strategies. However, the influence of specific strategies on certain determinants remains unclear. Therefore, we need to clarify which active ingredients of strategies, known as behaviour change techniques (BCTs), elicit behaviour change and improve implementation outcomes. With this knowledge, we are able to formulate evidence-based implementation hypotheses. An implementation hypothesis details how determinants and in turn, implementation outcomes might be influenced by specific implementation strategies and their BCTs. We aimed to identify (1) determinants relevant to the implementation of youth care guidelines and (2) feasible and potentially effective implementation hypotheses. METHODS: A four-round online modified Delphi study was conducted. In the first round, experts rated the implementation determinants based on their relevance. Next, experts formulated implementation hypotheses by connecting BCTs and implementation strategies to determinants and were asked to provide a rationale for their choices. In round three, the experts reconsidered and finalised their hypotheses based on an anonymous overview of all formulated hypotheses, including rationales. Finally, the experts rated the implementation hypotheses based on their potential effectiveness and feasibility. RESULTS: Fourteen experts completed the first, second, and third rounds, with 11 completed the final round. Guideline promotion, mandatory education, presence of an implementation leader, poor management support, knowledge regarding guideline use, and a lack of communication skills were reported as most relevant determinants. In total, 46 hypotheses were formulated, ranging from 6 to 9 per determinant. For each determinant, we provide an overview of the implementation hypotheses that were most commonly deemed feasible and potentially effective. CONCLUSION: This study offers valuable insights into youth care guideline implementation by systematically identifying relevant determinants and formulating hypotheses based on expert input. Determinants related to engagement and to knowledge and skills were found to be relevant to youth care guideline implementation. This study offers a set of hypotheses that could help organisations, policymakers, and professionals guide the implementation process of youth care guidelines to ultimately improve implementation outcomes. The effectiveness of these hypotheses in practice remains to be assessed.

Physical activity maintenance in colorectal cancer survivors after an exercise intervention applying behaviour change techniques: a systematic review and meta-analysis.

PURPOSE: The purpose of this systematic review and meta-analysis is to determine the long-term effect of combined physical activity (PA) and behaviour change techniques (BCT) interventions in PA maintenance of colorectal cancer survivors (CRCS) and identify the most frequent BCT implemented in them. METHODS: PRISMA recommendations were followed. Databases were searched for randomized controlled trials up to October 2023. Studies in which CRCS completed a PA intervention based on any Theoretical Model of Behaviour Change (TMBC) and a subsequent follow-up period were included. Between-group differences at baseline and after follow-up were pooled for meta-analysis. BCT codification was performed using the BCT taxonomy v1. Methodological quality and evidence certainty were also assessed. RESULTS: Five studies involving 906 CRCS met the inclusion criteria. PA interventions applying BCT showed a significant change with a small positive effect (pooled SMD = 0.22 (0.09, 0.35)) on the PA after a follow-up period between 3 and 12 months. Twenty-two different BCTs were identified (mean 17.2, range 15-19) of which 12 were common across all interventions. CONCLUSIONS: PA and BCT interventions have been found to be effective in improving the long-term maintenance of PA in CRCS. Further studies with higher methodological quality are needed to confirm these findings. IMPLICATIONS FOR CANCER SURVIVORS: Aerobic exercise, pedometers, PA diaries and educational materials seem to be important aspects to achieve sustainable adherence to an active lifestyle over time. Supervision, access to fitness areas and applying some BCT appear to be differentiating features to obtain more successful PA maintenance.

Unravelling interacting barriers and facilitators to adherence and delivery of exercise-based care in the treatment of Subacromial Pain Syndrome - an exploratory qualitative study.

PURPOSE: Subacromial Pain Syndrome (SAPS) is a common persistent pain condition. Exercise-based care is first-line recommendation, but an insufficient exercise dose hampers effectiveness. This study explores individual and contextual barriers and facilitators for delivery of and adherence to exercise-based care in people with SAPS. MATERIALS AND METHODS: Participants in this exploratory qualitative study were involved in the management of SAPS in Denmark. Triangular interviews and analyses were conducted within 3 themes (delivery of recommended services, adherence to recommendations, and frames of the clinical pathways) using the Theoretical Domains Framework (TDF) and the Behavioural Change Wheel model (BCW) to map barriers and facilitators into the Capability, Opportunity, Motivation and Behaviour (COM-B) model. RESULTS: From interviews with 10 persons with SAPS and 37 healthcare practitioners and double-deductive analyses, 30 subjects of target behaviour within 13 TDF domains emerged across perspectives and COM-B components. Central barriers to delivery and adherence were inconsistencies in diagnostic terminology, cross-professional disagreements, beliefs, and expectations towards pathway services. CONCLUSION: We identified interrelated individual and contextual barriers to delivery and adherence across all aspects of the BCW, underpinning the complexity of the subject. Findings support that effectiveness of exercise-based care is linked to contextual barriers to delivery and adherence.

Exercise-based care is the recommended first-line care for Subacromial Pain Syndrome (SAPS), but an insufficient exercise dose hampers effectiveness.Inconsistencies in terminology and care, diverging beliefs and cross-professional disagreements, and varying expectations of pathway services are the main challenges to delivery of and adherence to recommended exercise-based care.Easy access to key information, examination and treatment suggestions, a person-centred approach, and alignment in patient information between HCPs facilitate adherence to clinical recommendations.

Using the behaviour change wheel to develop a tailored intervention to overcome general practitioners' perceived barriers to referring insomnia patients to digital therapeutic sleepio.

BACKGROUND: Digital therapeutic Sleepio has proven effective in improving sleep quality and decreasing symptoms of anxiety. The National Institute for Health and Care Excellence (NICE) guidance recommends Sleepio as an alternative treatment to usual sleep hygiene education and hypnotic medications. General practitioners (GPs) play a critical role in the adoption of digital therapeutics in patient care. Previous interventions did not adopt theoretical frameworks to systematically understand GPs behaviour toward referring patients to digital therapeutics. OBJECTIVES: This study aimed to report the systematic and comprehensive development of an intervention to encourage GPs to refer insomnia patients to Sleepio, using the Behaviour Change Wheel (BCW). METHODS: The eight steps outlined in the BCW were followed to develop an intervention. The Capability Opportunity Motivation-Behaviour Self-Evaluation Questionnaire (COM-B-Qv1) was adopted to understand GPs perceived facilitators and barriers to refer insomnia patients to Sleepio. The Behaviour Change Technique Taxonomy Version 1 (BCTv1) was thereafter used to identify possible strategies that could be used to facilitate changes in GPs' behaviour in relation to Sleepio. RESULTS: The BCW design process resulted in the identification of five intervention functions, three policy categories and five behaviour change techniques (BCTs) as potential active components for an intervention. The intervention includes providing GPs with an orientation about using Sleepio to improve their knowledge and confidence, sending visual reminders to GPs to recommend Sleepio to their patients, providing ongoing technical support. CONCLUSION: The BCW can be successfully applied through a systematic process to understand the drivers of GPs' behaviour and to develop an intervention that can encourage them to refer insomnia patients to Sleepio.

Development of an Aotearoa New Zealand adapted Mediterranean dietary pattern and Kai/food basket for the He Rourou Whai Painga randomised controlled trial.

Background: Following a Mediterranean diet (MedDiet) is associated with a lower risk of cardiovascular disease. He Rourou Whai Painga is a dietary intervention trial with behaviour change support that seeks to determine whether a MedDiet pattern can provide equivalent benefits in Aotearoa New Zealand (NZ), a country where cardiovascular disease is a leading cause of death. To do this, the MedDiet needs to be adapted in an acceptable way for NZ, with consideration of the Maori (indigenous) population. Methods: The MedDiet was defined using existing MedDiet scoring tools and adapted to the NZ context using local guidelines. The resulting NZ MedDiet pattern was used to develop a kai/food basket, including products from industry partners, for participants in He Rourou Whai Painga. Criteria set for the kai/food basket included providing up to 75% of energy requirements and falling within the Australia/NZ Acceptable Macronutrient Distribution Range to reduce risk of chronic disease. Maori researchers on the team provided support to ensure Matauranga Maori (Maori knowledge and values) was upheld through this process. Results: The NZ MedDiet pattern criteria was similar to the identified MedDiet scoring tools, with differences in recommendations for dairy, red meat, alcohol and olive oil. The resulting kai/food baskets were estimated to provide on average 73.5% of energy requirements for households, with 36% from fat, 8.6% from saturated fat, 17% protein, and 42% carbohydrate. Forty-two industry partners, including 3 Maori businesses, agreed to provide 22 types of food products towards the total. Conclusion: Small, feasible changes to the MedDiet can be made to align with the NZ guidelines and food environment. However, this eating pattern still differs from what the population, particularly Maori, are currently consuming. Continued partnership with Maori and additional behavioural support is important to facilitate adherence to this dietary pattern within He Rourou Whai Painga.Trial registration: https://www.anzctr.org.au/Default.aspx, identifier ACTRN12622000906752 and https://www.isrctn.com/, identifier ISRCTN89011056.

Factors associated with Edinburgh Cognitive and Behavioural ALS Screen (ECAS) alteration at time of diagnosis, in amyotrophic lateral sclerosis.

BACKGROUND: Edinburgh Cognitive and Behavioral ALS Screen (ECAS) is a validated assessment designed to screen cognitive functions and behavioral disorders in amyotrophic lateral sclerosis (ALS). Objective of this study is to determine the factors associated with ECAS impairment in a cohort of ALS patients without a co-morbid diagnosis of dementia, at the time of diagnosis. METHODS: We enrolled 71 non-demented ALS patient. We collected clinical and demographic data, ALS familiarity, analysis of the most commonly mutated genes in ALS, ALS Milano Torino Staging System and ALS Functional Rate Scale revised scores, progression rate; finally, we recorded whether symptoms onset involved spinal or bulbar area. The alteration of the ECAS was estimated based on age and education-adjusted-validated cut off for each of the items included in ECAS. A multivariable regression analysis was done. RESULTS: The significant determinants of ECAS alterations were: bulbar onset in both ALS-specific test and total ECAS score; bulbar onset and familiarity in ALS-non-specific test; finally, familiarity and diagnosis delay in ALS-behavioral test. All the subjects carrying C9orf72 mutations had alteration of both total ECAS score and ALS-specific tests. DISCUSSION: At diagnosis, bulbar-onset ALS, family history, diagnosis delay and C9orf72 hexanucleotide repeat expansion may contribute to impairment of ECAS.