Application, understanding, and appropriation of the Montessori method for persons with dementia: A qualitative pilot study.

BackgroundWhile there is strong support for the benefits of working in multi-professional teams in health care, the implementation of multi-professional teamwork is reported to be complex and challenging. Implementation strategies combining multiple behavior change interventions are recommended, but the understanding of how and why the behavior change interventions influence staff behavior is limited. There is a lack of studies focusing on the functions of different behavior change interventions and the mechanisms driving behavior change. In this study, applied behavior analysis is used to analyze the function and impact of different behavior change interventions when implementing multi-professional teamwork.MethodsA comparative case study design was applied. Two sections of an emergency department implemented multi-professional teamwork involving changes in work processes, aimed at increasing inter-professional collaboration. Behavior change interventions and staff behavior change were studied using observations, interviews and document analysis. Using a hybrid thematic analysis, the behavior change interventions were categorized according to the DCOM® model. The functions of the behavior change interventions were then analyzed using applied behavior analysis.ResultsThe two sections used different behavior change interventions, resulting in a large difference in the degree of staff behavior change. The successful section enabled staff performance of teamwork behaviors with a strategy based on ongoing problem-solving and frequent clarification of directions. Managerial feedback initially played an important role in motivating teamwork behaviors. Gradually, as staff started to experience positive outcomes of the intervention, motivation for teamwork behaviors was replaced by positive task-generated feedback.ConclusionsThe functional perspective of applied behavior analysis offers insight into the behavioral mechanisms that describe how and why behavior change interventions influence staff behavior. The analysis demonstrates how enabling behavior change interventions, managerial feedback and task-related feedback interact in their influence on behavior and have complementary functions during different stages of implementation.

The pathway through which behavior change techniques have an effect on the behavior of an individual is referred to as the Mechanism of Action (MoA). Digitally enabled behavior change interventions could potentially benefit from explicitly modelling the MoA to achieve more effective, adaptive, and personalized interventions. For example, if ‘motivation’ is proposed as the targeted construct in any behavior change intervention, how can a model of this construct be used to act as a mechanism of action, mediating the intervention effect using various behavior change techniques? This article discusses a computational model for motivation based on the neural reward pathway with the aim to make it act as a mediator between behavior change techniques and target behavior. This model’s formal description and parametrization are described from a neurocomputational sciences prospect and elaborated with the help of a sub-question, i.e., what parameters/processes of the model are crucial for the generation and maintenance of motivation. An intervention scenario is simulated to show how an explicit model of ‘motivation’ and its parameters can be used to achieve personalization and adaptivity. A computational representation of motivation as a mechanism of action may also further advance the design, evaluation, and effectiveness of personalized and adaptive digital behavior change interventions.

Background Many global health challenges may be targeted by changing people’s behaviour. Behaviours including cigarette smoking, physical inactivity and alcohol misuse, as well as certain dietary behaviours, contribute to deaths and disability by increasing the risk of cancers, cardiovascular diseases and diabetes. Interventions have been designed to change these health behaviours with a view to reducing these health risks. However, the effectiveness of these interventions has been quite variable and further information is needed to enhance their success. More information is needed about the specific processes that underlie the effectiveness of intervention strategies. Aim Researchers have developed a taxonomy of 93 behaviour change techniques (i.e. the active components of an intervention that bring about behavioural change), but little is known regarding their potential mechanisms of action (i.e. the processes through which a behaviour change technique affects behaviour). We therefore aimed to examine links between behaviour change techniques and mechanisms of action. Method First, we conducted a literature synthesis study of 277 behaviour change intervention studies, from which we extracted information on links, described by authors, between behaviour change techniques and mechanisms of action, and identified an average of 10 links per intervention report. Second, behaviour change experts (n = 105) were engaged in a three-round consensus study in which they discussed and rated their confidence in the presence/absence of ‘links’ and ‘non-links’ between commonly used behaviour change techniques (n = 61) and a set of mechanisms of action (n = 26). Ninety links and 460 ‘non-links’ reached the pre-set threshold of 80% agreement. To enhance the validity of these results, a third study was conducted that triangulated the findings of the first two studies. Discrepancies and uncertainties between the studies were included in a reconciliation consensus study with a new group of experts (n = 25). The final results identified 92 definite behaviour change technique–mechanism of action links and 465 definite non-links. In a fourth study, we examined whether or not groups of behaviour change techniques used together frequently across interventions revealed shared theoretical underpinnings. We found that experts agreed on the underlying theory for three groups of behaviour change techniques. Results Our results are potentially useful to policy-makers and practitioners in selecting behaviour change techniques to include in behaviour change interventions. However, our data do not demonstrate that the behaviour change techniques are effective in targeting the mechanism of action; rather, the links identified may be the ‘best bets’ for interventions that are effective in changing mechanisms of action, and the non-links are unlikely to be effective. Researchers examining effectiveness of interventions in either primary studies or evidence syntheses may consider these links for further investigation. Conclusion To make our results usable by researchers, practitioners and policy-makers, they are available in an online interactive tool, which enables discussion and collaboration (https://theoryandtechniquetool.humanbehaviourchange.org/); accessed 1 March 2020. This work, building on previous work to develop the behaviour change technique taxonomy, is part of an ongoing programme of work: the Human Behaviour Change Project (www.humanbehaviourchange.org/; accessed 1 March 2020). Funding This project was funded by the Medical Research Council via its Methodology Panel: ‘Developing methodology for designing and evaluating theory-based complex interventions: an ontology for linking behaviour change techniques to theory’ (reference MR/L011115/1).

Latrine cleanliness is important to ensure the beneficial effects of access to sanitation on health and well-being. Behavior change interventions may be necessary to enhance the regular cleaning of facilities and therefore it is necessary to understand what influences cleanliness. Three empirical studies were conducted in rural Burundi to find contextual and psychosocial factors influencing latrine cleanliness, to plan and evaluate an intervention based on these findings, and to understand how general hygiene practice influences latrine cleanliness. Overall, the results emphasize the importance of psychosocial and contextual factors for latrine cleanliness. It makes sense to promote behavior change, as habitual latrine cleaning was the most important predictor of latrine cleanliness. Latrine cleanliness was also related to characteristics of the quality of latrine construction and encouraging households to improve the quality of their latrines could further enhance cleanliness. Psychosocial factors, especially commitment strength and positive emotions towards cleaning, and satisfaction with latrine cleanliness were important predictors for habitual latrine cleaning and should therefore be targeted by behavior change promotions. Moreover, the results for general hygiene practice suggest that it is important to examine latrine cleanliness not in isolation but within the broader perspective of general hygiene as all kind of different hygiene behaviors were interrelated.

BackgroundIncreased accessibility to the internet and mobile devices has seen a rapid expansion in electronic health (eHealth) behavior change interventions delivered to patients with cancer and survivors using synchronous, asynchronous, and combined delivery methods. Characterizing effective delivery methods of eHealth interventions is required to enable improved design and implementation of evidence-based health behavior change interventions.ObjectiveThis study aims to systematically review the literature and synthesize evidence on the success of eHealth behavior change interventions in patients with cancer and survivors delivered by synchronous, asynchronous, or combined methods compared with a control group. Engagement with the intervention, behavior change, and health outcomes, including quality of life, fatigue, depression, and anxiety, were examined.MethodsA search of Scopus, Ovid MEDLINE, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature Plus, PsycINFO, Cochrane CENTRAL, and PubMed was conducted for studies published between March 2007 and March 2019. We looked for randomized controlled trials (RCTs) examining interventions delivered to adult cancer survivors via eHealth methods with a measure of health behavior change. Random-effects meta-analysis was performed to examine whether the method of eHealth delivery impacted the level of engagement, behavior change, and health outcomes.ResultsA total of 24 RCTs were included predominantly examining dietary and physical activity behavior change interventions. There were 11 studies that used a synchronous approach and 11 studies that used an asynchronous approach, whereas 2 studies used a combined delivery method. Use of eHealth interventions improved exercise behavior (standardized mean difference [SMD] 0.34, 95% CI 0.21-0.48), diet behavior (SMD 0.44, 95% CI 0.18-0.70), fatigue (SMD 0.21, 95% CI −0.08 to 0.50; SMD change 0.22, 95% CI 0.09-0.35), anxiety (SMD 1.21, 95% CI: 0.36-2.07; SMD change 0.15, 95% CI −0.09 to 0.40), depression (SMD 0.15, 95% CI 0.00-0.30), and quality of life (SMD 0.12, 95% CI −0.10 to 0.34; SMD change 0.14, 95% CI 0.04-0.24). The mode of delivery did not influence the amount of dietary and physical activity behavior change observed.ConclusionsPhysical activity and dietary behavior change eHealth interventions delivered to patients with cancer or survivors have a small to moderate impact on behavior change and a small to very small benefit to quality of life, fatigue, depression, and anxiety. There is insufficient evidence to determine whether asynchronous or synchronous delivery modes yield superior results. Three-arm RCTs comparing delivery modes with a control with robust engagement reporting are required to determine the most successful delivery method for promoting behavior change and ultimately favorable health outcomes.

Often parents are concerned that their child is not being treated as an individual and that its particular needs and requirements are not recognised, or, in the case of children with SEND, ignored by the specialist professionals involved (Zablotsky et al, 2014), and in some cases by the School as a whole (Carpenter et al, 2015). Therefore, parents feel that it is necessary to pay for any extra private support their child needs, and in the case of SEND even opt for home education in order to escape the structures of a formalised, generalised education system (Badman, 2009; Parsons et al, 2009; Parsons & Lewis, 2010; Kendell & Taylor, 2016). The present study investigates two play-based approaches and how they impact upon the learning and development of children with and without SEND. These two play-based approaches have their roots in the constructivist epistemology that characterises the approach developed and advocated by Maria Montessori. The study was qualitative in nature and was itself underpinned by a social constructionist epistemological position. I chose to use three data collection methods: observation, questionnaires and semi-structured interviews. These were carried out over a series of visits to the settings. Using thematic analysis and an inductive approach (Swain, 2018), I investigated the similarities and differences in the way the two settings taught children aged between two and three (without SEND) and four and seven (with SEND). The specific SEND of the children under consideration in this study was Autism Spectrum Condition. I examined a range of factors that could affect the learning and development of the children. These included the learning environment; pedagogy; methods that facilitated positive relationships between staff and children - including the key element of communication; and peer-teacher and peer-peer interactions. The impact on the children’s development is critically discussed and analysed in relation to acquisition of knowledge and play-based curricula; curriculum adaptability and flexibility, autonomy-supportive teaching and freedom of choice; independent learning and development of life skills; and physical development. This approach allowed me to gather in-depth information and to investigate group processes in detail, from a micro-perspective (Klonek et al, 2016). Based on the evidence presented in this thesis, my conclusion is that play-based approaches can be highly effective in facilitating children’s overall learning and development. They respond to the children’s interests, allow them to work at their own pace and do not pressure them to achieve learning that is beyond their capability to grasp at any particular stage.

The influence of psychological, social and contextual factors on recovery following a sport-related knee injury: a scoping review

The purpose of this study was to investigate the phytoremediation potential of two hyperaccumulator plants, Phytolacca americana L. and Polygonum hydropiper L., on manganese-contaminated paddy soils. The biomass growth, Mn concentrations in plant tissues, and potential Mn removal efficiency from soils of these two plants were studied with citric acid, and the mechanisms of citric acid on these two plants were analyzed by examining the root activity, the activities of superoxide dismutase (SOD), peroxidase (POD) and catalase (CAT) in leaves, as well as the concentrations of O2·- and H2O2 in leaves. The results showed that the biomass of these two plants were both promoted under low level of citric acid (3mmolkg-1). The concentration of Mn in the plants and the amount of Mn removed from the soil by the plants through harvesting were enhanced at low and intermediate (10mmolkg-1) citric acid application levels. The results also showed that root activity was enhanced at the low citric acid level and significantly inhibited under the intermediate and high levels (15mmolkg-1), which indicates the facilitative function of the low level of citric acid and the inhibitive function of the high level of citric acid application on plant biomass growth. Under the low and intermediate levels of citric acid application, O2·- in the plant leaves increased sharply, and the SOD, POD, and CAT activities also increased sharply, which made the level of H2O2 very similar to that of the control, ensuring the health of the plants. At the high level of citric acid application, however, the O2·- continued to rise sharply, while the activity of the three antioxidant enzymes declined sharply, causing the concentration of hydrogen peroxide to be much higher than that in the control, thus endangering the plants. The present study shows the potential of P. hydropiper for use in the phytoremediation of soil contaminated with a relatively low level of manganese.

Schistosomiasis is a public health problem and a social challenge, affecting over 240 million people globally, the majority of whom live in sub-Saharan Africa. In Uganda, despite mass drug administration (MDA) of praziquantel (PZQ) and health education and sensitization interventions, (re) infections persist, possibly due to behavioural and implementation factors. This study examined the application of citizen science, a bottom-up community-led approach to behaviour change intervention in Kagadi and Ntoroko districts. A three-phase quasi-experimental approach was employed. In the baseline phase, a cross-sectional mixed methods survey assessed knowledge, attitudes and practices, qualitative studies of lived experience and health-seeking behaviour regarding the disease. In the second phase, citizen science and participatory action research approaches were utilised to co-design and implement contextualised behaviour change interventions. Finally, a participatory evaluation of the CS approach to behaviour change intervention was conducted in phase three. Using Kish and Leslie's formula and estimation, a sample size of 613 was used for the study. Systematic random sampling and purposive sampling techniques were employed to select participants. Semi-structured survey questionnaires, in-depth and key informant interviews, focus group discussions, data party, prioritisation and ranking, world café and storytelling were used to collect data. Quantitative data underwent descriptive statistical analysis and chi-square tests for associations, while thematic analysis was applied to qualitative data. From the data, almost everyone had heard of schistosomiasis, and the majority knew its signs and symptoms, diagnosis, transmission modes and prevention. A majority recognised the disease’s severity and the importance of avoiding contact with contaminated water and open defecation. Misconceptions, limited access to safe water and latrines, open defecation, inadequate drugs, health workers’ negative attitudes, and poor infrastructure led some to go to witch doctors, herbalists, and prayers for treatment were barriers reported. Also, stigma, isolation, loneliness, and domestic violence were challenges mentioned by individuals suffering from schistosomiasis. Door-to-door visits by community volunteers, community radios, dialogue meetings, drama, songs, and football were preferred channels mentioned by participants. Over 9000 individuals in 18 villages were directly reached by the CSs through awareness raising about the disease in just one week. CSs reported increased respect, trust, discipline, social status, and knowledge, attitudes, and practices regarding schistosomiasis. They were also able to effectively communicate and engage with communities and stakeholders. The CS approach was appreciated by the communities for being participatory, transparent, engaging, and appropriate. High expectations from the project by the communities, differences in priorities between community needs and project priority, and a slow response to the awareness messages by the communities posed a challenge to the approach. Conclusively, there is adequate knowledge, and positive attitudes towards schistosomiasis prevention, but limited access to safe water, open defecation, myths and misconceptions, inadequate drugs, and ineffective communication which inhibit prevention and control efforts. Engaging communities in identifying schistosomiasis problems and co-designing and implementing contextualised behaviour change intervention can yield sustainable outcomes. CS as a bottom-up approach, has the potential for fostering community empowerment, ownership, transparency, inclusivity, and local leadership. For better outcomes, there is a need to address communities’ real needs and high expectations of WASH infrastructures and to ensure timely and in-depth community engagement and involvement. Government and development partners should consider integrating CS and PAR as community-led approaches into preventive health programs for more impactful interventions.

BackgroundThe early language environment is important for language development and a child’s life-course trajectory. Risk factors associated with poor language development outcomes in children include maternal anxiety and depression, low educational attainment, substance misuse, and low socioeconomic status. Language Environment Analysis (LENA) is a wearable technology designed to promote caregivers’ engagement in supporting their children’s language development. LENA provides quantitative linguistic feedback, which has been shown to improve caregiver language output, thus enhancing a child’s language environment. There is limited research on the uptake of this technology by families with developmentally at-risk children.ObjectiveThis qualitative study aims to explore the conditions under which mothers with children at risk of poor developmental outcomes are willing to adopt the use of LENA to monitor and improve caregiver language output.MethodsUsing a qualitative interpretive design, semistructured, in-depth interviews were conducted with 8 mothers. Participants were recruited purposively to select the maximal variation of socioeconomic and ethnodemographic backgrounds. The transcribed interview data were analyzed thematically and interpretatively. Themes were mapped abductively to an extended Unified Theory of Acceptance and Use of Technology, which included contextual factors for LENA acceptance.ResultsFactors that influenced the intention to use LENA included both technology-specific acceptance factors and contextual factors. Technology acceptance themes included reassurance, feeling overwhelmed, and trust. These themes were mapped to performance expectancy, effort expectancy, and social influence. Contextual themes included emergent success and the intrusion of past difficulties. These were mapped to parenting self-efficacy and perceived risk. The theme of building on success described behavioral intention. Mothers were more likely to adopt LENA when the technology was viewed as acceptable, and this was influenced by parenting self-efficacy and perceived risk.ConclusionsLENA is a technology that is acceptable to mothers with children who are at risk of poor language development outcomes. Further studies are needed to establish LENA’s effectiveness as an adjunct to strategies to enrich a child’s early language environment.

Program Impact Pathway of the Positive Deviance/Hearth Interactive Voice Calling Program in a Peri-Urban Context of Cambodia

Introduction: Little is known about geosocial networking dating application use among young Black gay and bisexual men (YBGBM), a group severely affected by HIV in the United States. The purpose of this study was to explore: (1) How YBGBM describe motivations to use Jack’d; (2) How YBGBM describe and experience meeting romantic-sexual partners on Jack’d, including partner preferences and offline sexual encounters; and (3) How these descriptions and experiences reflect sexual risk behaviors?Methods: Between April and July 2015, we conducted 23 face-to-face semistructured interviews with self-identified Black gay (n = 15) and bisexual (n = 8) men (21–25 years) (M = 23.48, SD = 1.5) in Washington, DC. All interviews were audio-recorded, transcribed, and analyzed using thematic analysis methodology.Results: Motivations to use Jack’d included discomfort and challenges meeting men in open/public spaces that may lead to homophobic violence. Nearly half articulated distrust of HIV-negative disclosure from their Jack'd-met partner. Some participants reported inconsistent condom use when the insertive partner in anal sex, and several perceived Jack’d-met partners their own age to be less concerned about HIV than older men.Conclusion: HIV prevention strategies directed toward YBGBM should consider the role dating applications may play in either exacerbating or attenuating sexual risk.

We sought to understand caregivers' experience of an education-based wellness program delivered using telehealth. In this qualitative pilot study, 4 caregivers participated in a focus group after completing a 6-wk telehealth program. Data analysis involved open coding, thematic analysis, and coding triangulation. Two major themes emerged. The first, "I feel like I am now prepared," included the subthemes of strategies for caregiver self-maintenance, the understanding that caregiving is a normal process, and the value of a group experience. The second theme, "It was just a good interaction," included the subthemes of benefits of telehealth, challenges of telehealth, and process of learning the technology. Participant discussion of the content learned and the value of group support indicated that telehealth was effective in both promoting learning and facilitating relationships. Even with challenges, participants reported an overall positive experience. Telehealth holds promise for increasing access to health promotion programs.

The coronavirus disease 2019 (COVID-19) pandemic inflicted deep wounds on the foodservice industry. Independent restaurants, like many counterparts within the larger foodservice industry, were not spared numerous unprecedented challenges, especially with limitations on dine-in services. Hence, this pilot study aims to explore the experiences of an independent restaurant owner in navigating food safety challenges during the COVID-19 pandemic in Malaysia. The study examines the strategies employed to overcome these challenges, focusing on assessing the efficacy of the approaches adopted in maintaining food safety. This pilot study employed a retrospective qualitative case study approach. Purposive sampling was used to select a single independent restaurant owner in Bandar Segamat, Johor, Malaysia. Data were collected through an in-depth, semi-structured interview utilising open-ended questions to explore the independent restaurant owner's experiences. Thematic analysis was used to identify recurring themes within the interview data. Correspondingly, the thematic analysis revealed four key themes, namely the challenges of compliance with evolving regulations, the impact of financial constraints on food safety practices, the adaptive capacity for strategy implementation, and the role of transformative learning in overcoming the impact of the pandemic. These findings suggest the need for coordinated efforts between the government, industry leaders, and education institutions so that the food industry in Malaysia can maintain its competitiveness, particularly post-pandemic. Hence, integrating digital tools, strategic agility, and continuous learning can position the Malaysian food industry as a resilient and forward-thinking sector capable of overcoming future uncertainties.

BackgroundAdolescent idiopathic scoliosis is a common spinal deformity typically treated with exercise therapy. Despite the increasing use of digital technologies in interventions, there remains a gap in understanding how to effectively integrate behavior change techniques (BCTs) and behavior theories within these digital solutions.ObjectiveThis review aims to identify the digital characteristics of interventions and the BCTs used, and to analyze potential theoretical mechanisms with the Theoretical Domains Framework and the capability, opportunity, motivation, and behavior model.MethodsWe conducted a scoping review according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A total of 5 databases, including PubMed, Web of Science, Embase, Cochrane Library, and CINAHL, were selected for screening eligible studies up to April 4, 2024. We included studies of any design type that involved patients with adolescent idiopathic scoliosis using digital interventions for exercise rehabilitation, including qualitative, quantitative, or mixed methods studies, and study protocols with detailed descriptions of digital interventions. Two researchers independently screened studies and extracted data into tables for descriptive analysis. The Mixed Methods Appraisal Tool was used to assess the quality of studies.ResultsOut of the 3267 identified papers, 21 (0.64%) studies were included. The most frequently used technologies were videoconferencing (n=7) and instructional videos (n=5). The three most common BCT clusters were “Shaping Knowledge” (n=19), “Social Support” (n=16), and “Antecedents” (n=16). “Knowledge” was the most used mechanism of action (n=21), followed by “Skills” (n=16), “Environmental Context and Resources” (n=16), and “Social Influences” (n=16). The studies primarily addressed “Capability” and “Opportunity,” with less emphasis on “Motivation,” particularly “Automatic Motivation.”ConclusionsThis review identified common digital technologies and their characteristics, analyzed potential mechanisms of behavior change in interventions, and provided recommendations for technology utilization. Future research should further evaluate the effectiveness of digital technologies while enhancing patient motivation and user experience.Trial RegistrationPROSPERO CRD42024530851; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024530851