Co-Developing a Culturally Responsive, Theory-Informed Dyadic Mind-Body Intervention to Improve Sleep and Wellbeing in People with Dementia and Their Caregivers in the UK.

Despite growing evidence of the positive impact of public involvement, formally referred to as patient and public involvement (PPI), in research, this remains rare in Singapore. The potential of PPI in the Singapore-Asia context has to be explored. I conducted a three-phased exploratory study aiming to: 1) set the background through a mapping review of published articles and grey literature, including media reports, 2) provide a national perspective through a qualitative study guided by thematic framework analysis and 3) provide a study perspective through a case study of involvement in a local biobank study using the Theoretical Domains Framework. An iterative research process was adopted throughout all phases, enabling findings from each phase to be integrated. Phase 1 highlighted a shift towards patient-centeredness in Singapore, both in clinical curriculum and practices, and a desire to continue the road of patient activation and engagement. The shift for the clinical aspect could facilitate a shift in research-oriented tasks. Phase 2 revealed that most interviewees (n = 40) expressed a lack of experience with PPI, which was perceived as a beneficial strategy, both by researchers and by lay members. Whilst highlighting both utilitarian and ethical reasons for implementing PPI, challenges specific to the Singapore-Asia context made involvement at an individual level less likely to be successful. Interviewees - researchers from diverse disciplines and levels of experience, and with roles in funding panels and ethics boards, and lay members of diverse background and ages - identified formal and informal strategies to overcome barriers, favouring an asset-based, more community-oriented approach. In Phase 3 biobank researchers’ attitudes were best described through the theoretical domains of knowledge, skills, professional role, professional identity, environmental context and resources, and goals. Sometimes, PPI was simply seen as a middle “nice to have” element, but not one to be considered before other priorities were resolved. Researchers’ experiences of collaborating with the public during this case study were described as a motivation for further involvement. A cultural reluctance of individuals to question perceived authority figures, such as health professionals, clinical scientists and researchers was noted in both Phases 2 and 3 of this study. It may be overcome by adopting an approach to PPI that is closer to local community values, and which facilitates patients and the public collectively engaging in research. Careful consideration needs to be given to issues of resource and support to enable members of the public to engage in meaningful ways that will deliver research best placed to improve patient outcomes. The project’s findings have been used to develop a useful framework to develop and support PPI in the Singapore-Asia context: the supported model of involvement. In the Singaporean context, the timeliness of involvement implementation will heavily rely on political opportunities, as central coordination and support appears to be a decisive factor for many. Despite not having a recipe for involvement, successful work with members of the public is more likely if adhering to four sets of basic principles: adapted to the local context, diverse and inclusive, timely and purposeful and reciprocal and respectful. Preparing fertile ground for collaboration will also require planning and early work building relationships and trust.

IntroductionOnly 6% of UK memory services meet Alzheimer’s disease (AD) biomarker access guidelines, limiting psychiatrists’ experience. Emerging AD blood biomarker (BBM) tests will potentially expand access. Exploring implementation barriers and enablers a priori can inform rollout strategies. This study examined current clinical practises, barriers and enablers to implementation and potential interventions to support implementation.MethodsIn November 2024, Royal College of Psychiatrists Old Age Psychiatry Faculty members (n = 172) participated in an online survey and four focus groups (n = 16 participants), informed by the Theoretical Domains Framework (TDF) and Behaviour Change Wheel. Demographic data were summarised descriptively. Mean (SD) belief statement scores for TDF domains and percentage agreement were calculated. Multiple linear regression examined associations between TDF domains and intention to use BBMs.ResultsRespondents were mainly consultants in England; <33% had used biomarkers. Key barriers to use were: ‘Knowledge,’ ‘Environmental Context and Resources’ and ‘Goals.’ Enablers included: ‘Behavioural Regulation,’ ‘Social Influences’ and ‘Intention.’ Mixed enablers/barriers included: ‘Beliefs about Consequences’, ‘Optimism’ and ‘Social/Professional Role & Identity’. In regression analyses, ‘Memory, Attention and Decision Processes’ (B = 0.44, 95%CI 0.20–0.68), ‘Beliefs about Consequences’(B = 0.45, 95%CI 0.11–0.78), and ‘Social Influences’ (B = 0.24, 95%CI 0.04–0.44) were positively associated with intention, while ‘Optimism’ (B = -0.31,95% CI-0.58 to-0.04) and ‘Emotion’ (B = -0.33, 95%CI -0.60 to-0.06) were negatively associated. Key interventions were ‘Guidelines’ (e.g. appropriate use criteria) and ‘Environmental Restructuring’ to expand resources and re-organise pathways.DiscussionA complex interplay of barriers and enablers influences AD BBM implementation. Interventions targeting clinician, service and policy levels are required to support their introduction.

Background:Despite the importance of medication counselling for patients, it is commonknowledge that it is often sub-optimally carried out by pharmacy staff.While some interventions have been designed to help improve counselling, nostudy till date has used the Capability Opportunity and Motivation behaviormodel (COM-B) or Theoretical Domains Framework (TDF) as a basis foridentifying evidence-based intervention strategies to improve medicationcounselling.Objective:To understand barriers/facilitators to optimal medication counselling byconducting a behavioral analysis using the COM-B model and TDF, and use theBehavior Change Wheel (BCW) as a basis for identifying evidence-basedintervention strategies and policy categories that could be used to improveoutpatient medication counselling by pharmacy staff in hospital settingslocated within Northwest Nigeria.Methods:Semi-structured interviews were used to collect data from 25 purposivelysampled pharmacy staff working at eight major public hospitals, from Januarytill March 2020. Data from the interviews were then transcribed anddeductively coded using the COM-B model and TDF. These findings were thenused to identify areas requiring change, as well as the intervention typeand policy functions required to support these changes.Results:Findings from the behavioral analysis revealed shortfalls in pharmacy staffcapability, opportunity and motivation with respect to outpatient medicationcounselling. To improve their counselling behaviors, change was identifiedas necessary in eight TDF domains namely ‘knowledge’,‘interpersonal skills’, ‘memory’‘environmental context’, ‘social influences’,‘intentions’, ‘reinforcement’ and‘beliefs about capabilities’. Seven intervention functionsincluding ‘education’, ‘training’,‘modelling’, ‘enablement’ and‘environmental restructuring’, in addition to three policycategories (‘guidelines’, ‘regulations’ and‘environmental/social planning’) were also identified asrelevant to future intervention design.Conclusions:Various factors were identified as affecting medication counselling by thepharmacy staff, with several of them requiring changes if counselling was tobe improved upon. Multi-component interventions combining several of theseintervention functions are recommended for hospital authorities and otherrelevant stakeholders to improve outpatient medication counselling.

The aim of this study was to identify potential implementation interventions to increase the uptake of shared decision making (SDM) in clinical practice in New South Wales (NSW) Health. The Agency for Clinical Innovation hosted a full-day SDM masterclass in May 2017 and 53 attendees completed a survey to identify barriers to implementing SDM. The Theoretical Domains Framework, COM-B ('capability', 'opportunity', motivation' and 'behaviour') Model and Behaviour Change Wheel were used to conduct a theoretical analysis of the barriers and identify potential interventions to increase the uptake of SDM. This was supplemented by a purposive review of articles about current international efforts to facilitate SDM. From the theoretical analysis, 9 of the 14 theoretical domains were considered relevant to implementing SDM in the NSW Health context. Multi-faceted interventions including education, training, enablement, modelling, incentivisation, persuasion and environmental restructuring were identified as potential ways to increase SDM. The review of international articles identified communication and marketing, patient and public involvement, research, training, legislation, patient decision aids, service provision, clinical champions, financial incentives and policy as interventions being used to increase the uptake of SDM internationally. Based on current perceptions about barriers for SDM implementation in NSW Health, initial efforts should focus on workforce skills development, motivation, communication and marketing, service provision and creating receptive work environments. Investments into facilitating SDM will require an ongoing commitment to enhancing patient experience, evidence translation and reducing unwarranted variations in care.

BackgroundInappropriate use of antibiotics is a major contributing factor to the emergence of antimicrobial resistance globally, including in Sudan.ObjectivesThe project aimed to develop a theory-driven behaviour change strategy addressing both prescribers and patients based on factors that are driving antibiotic use in primary healthcare settings in Gezira state in Sudan.MethodsThe strategy was designed based on the Theoretical Domains Framework (TDF) to identify behavioural domains and the Behaviour Change Wheel (BCW) to select appropriate intervention functions. The process included (1) a formative qualitative research study and (2) a knowledge co-production workshop that utilized the results of the qualitative study to design a salient, appropriate, and credible behaviour change strategy.ResultsThe TDF domains related to prescribers that emerged from the study included knowledge, skills, and intention. The selected BCW intervention functions included education, training, modelling, and persuasion. The main TDF domains related to patients included social influences and intention. The selected BCW intervention functions included enablement and education.ConclusionUsing the TDF and BCW intervention functions, the study identified behavioural domains that influence antibiotic prescription and consumption in rural primary healthcare settings in Gezira state in Sudan and appropriate intervention functions to modify these behaviours. Knowledge co-production ensured that the evidence-based strategy was acceptable and practical in the local context.

Purpose This study aims to develop a digital nutrition intervention for individuals with severe mental illness (SMI) using a theoretically informed co-design approach. Design/methodology/approach This study will use a participatory, mixed-methods approach, incorporating public and patient involvement (PPI) to ensure user-centred intervention design. The behaviour change wheel (BCW) guides the selection of intervention functions, behaviour change techniques and delivery methods. The study will consist of three phases: (1) preparation, (2) co-design and (3) finalisation. Findings Data collection is expected to commence in March 2025. The co-design findings will directly inform the refinement of the digital nutrition intervention. Originality/value This study contributes to digital health research by outlining a structured methodology for designing a digital nutrition intervention for individuals with SMI. By integrating the BCW with PPI principles, the intervention will be theoretically robust and user-centred, addressing a gap in nutrition-focused digital interventions.

Background: Antimicrobial resistance, exacerbated by antibiotic misuse, poses a global threat. Though delayed antibiotic prescribing (DAP) can mitigate antibiotic overuse, its adoption in developing nations, such as China, is limited. This study probed barriers and facilitators to DAP in Xinjiang, characterized by extensive rural landscapes and primary care institutions (PCIs). Methods: Adopting a qualitative methodology, we conducted key informant interviews with thirty participants across six county hospitals in Xinjiang using VooV Meeting. Employing a two-stage sampling method targeting economically diverse areas, our interviews spanned physicians, pharmacists, patients, and caregivers. We organized the data according to the Theoretical Domains Framework (TDF) and the Behavior Change Wheel (BCW), spotlighting behavioral and policy elements impacting DAP. Results: Our research included thirty interviewees. Twelve physicians contemplated delayed prescriptions, while five adult patients and six caregivers encountered recommendations for delayed antibiotic prescriptions. Six patients sought pharmacists’ advice on antibiotic necessity. Prominent TDF domains were memory, attention, and beliefs about consequences. Critical intervention functions included education and environmental restructuring, while vital policy categories encompassed communication/marketing and guidelines. Conclusions: Countering antibiotic misuse and resistance in China necessitates overcoming barriers through strategic resource distribution, comprehensive education, rigorous training, and consistent monitoring, thereby promoting DAP adoption. The adoption of DAP in rural healthcare settings in China has the potential to significantly reduce antibiotic misuse, thereby mitigating the global threat of antimicrobial resistance.

BACKGROUND There is a critical need to support patients with congenital heart disease (CHD), especially during their young adulthood, to help maintain lifelong care with adult CHD specialists. To achieve this, effective, scalable, accessible, and sustainable strategies are needed. Digital health offers potential solutions but require a rigorous scientific approach in its design to address the needs of the target population. OBJECTIVE To use a theory-based and person-centered approach to developing and adapting a digital intervention that improves lifelong CHD care. METHODS The intervention planning included the combination of theory-based behavioral framework, semi-structured qualitative interviews with patients and clinicians, and community-based participatory research (CBPR). The primary behavioral target was patients’ activation skills; skills that promote patient engagement with CHD care. We used the Capability, Opportunity, and Motivation (COM) and Theoretical Domains Framework (TDF) of the Behavior Change Wheel (BCW) theoretical model to identify determinants of the target behavior and design intervention components. To make the interventions equitable and relevant to diverse patients, we incorporated the principles of digital health equity, diffusion of innovation, and behavioral economics. RESULTS We interviewed 54 participants (37 diverse patients with CHD and 17 clinicians) and engaged 21 community partners representing 4 advocacy organizations. The COM- and TDF-guided CHD patient engagement framework identified the design objectives and key features of the digital intervention to address challenges uniquely faced by patients with CHD. Four emerging hopes for the digital tool included providing easy access to credible resources, uplifting patient voices, customizing to patient needs, and centering positivity and joy. The digital tool, named by community partners as Empower My Congenital Heart (EmpowerMyCH), was implemented within the web- and mobile-based, Apple- and Android-compatible, Eureka Digital Research platform (University of California, San Francisco). Key intervention components include a digital medical passport, expert and peer guidance, and peer connections and support. Six intervention functions from the BCW (education, training, modeling, enablement, persuasion, and environmental restructuring) were mapped to the intervention components. “Empowerment” and “Peer Empowerment” quotes are used as motivational, confidence-building messages from clinicians and patients, respectively, to reinforce the patient’s role as an active participant in their care. CONCLUSIONS The EmpowerMyCH digital tool, developed using behavior change theories and CBPR approaches, offers rapidly scalable intervention components (digital medical passport, education on managing CHD, and community support) that can be delivered outside the clinic visits. EmpowerMyCH redefines how we support adults with chronic conditions, such as CHD, to be actively involved in their care and could potentially improve outcomes. CLINICALTRIAL The National Clinical Trial number for this study is NCT06581484.

This study aimed to better understand the factors influencing the provision of sexuality-related post-stroke rehabilitation services by clinicians on different sites and to explore strategies to improve post-stroke rehabilitation services with stakeholders. A qualitative study with co-design methods was conducted with 20 clinicians from five post-stroke rehabilitation centers in Canada, 1 manager and 1 patient-partner. Participants either took part in a focus group or in sessions of an adapted version of the LEGO Serious Play method to explore influencing factors and strategies of improvement in relation to post-stroke sexual rehabilitation services. Thematic analysis was conducted semi-deductively using the Theoretical Domains Framework (TDF), the Capability, Opportunity, Motivation and Behaviour (COM-B) system and the Behaviour Change Wheel (BCW). A total of twenty factors pertaining either to the categories of Capability (n = 8; e.g., Sexual rehabilitation procedural knowledge), Motivation (n = 4; e.g., Professional boundaries) or Opportunity (n = 8; e.g., Workload) were perceived as influencing provision of sexual rehabilitation services by participants. A theoretical model was conceptualized. Strategies (n = 10) were categorized in concordance with the BCW as Training (n = 1), Enablement (n = 5) or Environmental restructuring (n = 4). This study showed that factors influencing provision of post-stroke rehabilitation services were numerous and interrelated, and that various strategies aiming either clinicians or the rehabilitation environment would be relevant to improve services. This study will help guide the design and implementation of future interventions studies aiming at improving post-stroke sexual rehabilitation services.

Although the HPV vaccine is highly safe and effective, its uptake is sub-optimal in many countries, including Ireland. There is therefore a need to identify appropriate interventions that will increase HPV vaccine acceptance by parents. In this study, we took a systematic approach to understand the factors that influence HPV vaccine uptake by parents of adolescent girls in Ireland to define suitable behaviour change interventions that would support positive vaccine decision-making in the future. Specifically, we conducted semi-structured interviews, used a Theoretical Domains Framework (TDF)-based topic guide, to gain insight into the knowledge, beliefs, attitudes and current behaviours of parents with respect to their HPV vaccine decision. Transcripts were analysed using the TDF. The Behaviour Change Wheel (BCW) was used to identify relevant intervention functions and the Behaviour Change Technique Taxonomy version 1 (BCTTv1), to identify relevant intervention techniques. All parents discussed the essential role of healthcare providers in vaccine decision-making. Complacency and confidence were important factors in decision-making by vaccine hesitant parents. Five BCW intervention functions were identified as appropriate, namely; education; persuasion; environmental restructuring; modelling and enablement. To our knowledge, this is the first study to systematically evaluate HPV vaccine decision-making using behaviour change theory and identify suitable intervention strategies to promote positive vaccine decision-making using this approach.

Introduction and Objective: Evidence suggests that modulating the gut microbiota during pregnancy through dietary interventions may reduce gestational diabetes mellitus (GDM) risk. To improve acceptability and reduce research waste, co-designing interventions with consumers has emerged as a powerful method of meaningful consumer engagement. This study aimed to co-design the Healthy Gut Diet, a complex dietary behavior change intervention for preventing GDM, with women who had previously experienced GDM. Methods: Co-design used a range of participatory methods with 6 researchers and 12 consumer participants across 3 online workshops. A 'behavior diagnosis' explored barriers and enablers of two dietary behaviors: increasing plant food intake and reducing ultra-processed food consumption. The COM-B model of behavior, the Theoretical Domains Framework (TDF) and the Behavior Change Wheel were used to select Behavior Change Techniques, embedded in all components of the intervention. Results: Barriers and enablers were mapped across six COM-B components and 10 TDF domains. Five intervention functions—education, enablement, environmental restructuring, persuasion, and incentivization—were employed, integrating 40 behavior change techniques. The intervention comprises telehealth dietitian sessions, participant handbooks, text messages, and social media support groups. Conclusion: The Healthy Gut Diet is the result of understanding consumer education and support preferences as well as targeting barriers to changing dietary behavior. This co-design process provided unique insights into what women want and need from dietary interventions with individualization and flexibility being perceived as key factors for success. Disclosure N.J.L. Meloncelli: None. S. Wilkinson: None. A. Rushton: None. K. Pateman: None. S. Gallaher: None. H.M. O'Connor: None. S.J. de Jersey: None. Funding Office of Research and Innovation, Queensland HealthThe University of Queensland, Faculty of Medicine

BackgroundThree billion people use solid cooking fuels, and 4 million people die from household air pollution annually. Shifting households to clean fuels, like liquefied petroleum gas (LPG), may protect health only if stoves are consistently used. Few studies have used an implementation science framework to systematically assess “de-implementation” of traditional stoves, and none have done so with pregnant women who are more likely to adopt new behaviors. We evaluated an introduced LPG stove coupled with a phased behavioral intervention to encourage exclusive gas stove use among pregnant women in rural Guatemala.MethodsWe enrolled 50 women at < 20 weeks gestation in this prospective cohort study. All women received a free 3-burner LPG stove and ten tank refills. We conducted formative research using COM-B Model and Theoretical Domains Framework (TDF). This included thematic analysis of focus group findings and classes delivered to 25 pregnant women (Phase 1). In Phase 2, we complemented classes with a home-based tailored behavioral intervention with a different group of 25 pregnant women. We mapped 35 TDF constructs onto survey questions. To evaluate stove use, we placed temperature sensors on wood and gas stoves and estimated fraction of stove use three times during pregnancy and twice during the first month after infant birth.ResultsClass attendance rates were above 92%. We discussed feasible ways to reduce HAP exposure, proper stove use, maintenance and safety. We addressed food preferences, ease of cooking and time savings through cooking demonstrations. In Phase 2, the COM-B framework revealed that other household members needed to be involved if the gas stove was to be consistently used. Social identity and empowerment were key in decisions about stove repairs and LPG tank refills. The seven intervention functions included training, education, persuasion, incentivization, modelling, enablement and environmental restructuring. Wood stove use dropped upon introduction of the gas stove from 6.4 h to 1.9 h.ConclusionsThis is the first study using the COM-B Model to develop a behavioral intervention that promotes household-level sustained use of LPG stoves. This study lays the groundwork for a future LPG stove intervention trial coupled with a behavioral change intervention.Trial registrationNCT02812914, registered 3 June 2016, retrospectively registered.

BackgroundMind-body interventions have the potential to positively impact the symptom burden associated with primary biliary cholangitis (PBC). Interventions are more likely to be effective if they are informed by a theoretical framework. The Behaviour Change Wheel (BCW) and the behaviour change technique taxonomy version 1 (BCTv1) provide frameworks for intervention development.ObjectiveThis study describes how theory has guided the development of a 12-week multicomponent mind-body wellness intervention for PBC.MethodsThe steps involved in developing the BCW intervention included specifying the target behavior; explaining barriers and facilitators using the Capability, Opportunity, Motivation, and Behaviour and the theoretical domains framework; identifying intervention functions to target explanatory domains; and selecting relevant behavior change techniques to address intervention functions. Qualitative data from patients with inflammatory bowel disease using an earlier version of the program and feedback from a PBC patient advisory team were used to guide intervention development.ResultsBarriers and facilitators to intervention participation associated with capability, opportunity, and motivation were identified. Intervention functions and behavior change techniques were identified to target each barrier and facilitator.ConclusionsThe Peace Power Pack PBC intervention was developed to help individuals with PBC manage their symptom burden. The theoretical frameworks employed in this intervention provide direction on targeting antecedents of behavior and allow standardized reporting of intervention components.Trial RegistrationClinicalTrials.gov NCT04791527; https://clinicaltrials.gov/ct2/show/NCT04791527

ObjectiveMajor trauma 'Rehabilitation Prescriptions' aim to facilitate continuity of care and describe patient needs following discharge from UK Major Trauma Centre (MTCs), however research suggests rehabilitation prescriptions are not being implemented as intended. We aimed to identify factors influencing completion and use of rehabilitation prescriptions using the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF). DesignOnline survey informed by the TDF and BCW. SettingUK trauma rehabilitation pathway. PopulationRehabilitation and trauma service providers involved in completing and/or using rehabilitation prescriptions (n = 78). AnalysisMean scores were calculated for TDF behavioural domains, identifying facilitators (score ≥5) and barriers (≤3.5) to rehabilitation prescription implementation. Thematic analysis of free text data informed by the BCW/TDF identified further facilitators and barriers, plus potential behaviour change strategies. ResultsMost respondents worked in UK MTCs (n = 63) and were physiotherapists (n = 34), trauma rehabilitation coordinators (n = 16) or occupational therapists (n = 15). ‘Social/professional role and identity’, 'knowledge’ and ‘emotion’ (the highest-scoring TDF domains) were facilitators to implementing rehabilitation prescriptions. Qualitative data identified barriers to rehabilitation prescription completion, including ‘seen as tick-box exercise’,‘not a priority’, lack of resources (IT and workforce), poor inter-service communication, limited knowledge/training. Facilitators included therapist buy-in, standardised training, easy inter-service rehabilitation prescription transfer, usefulness for sharing patient needs. ConclusionsAlthough rehabilitation prescriptions are valued by some service providers, their effectiveness is hindered by negative attitudes, limited knowledge and poor communication. Uncertainties exist about whether rehabilitation prescriptions achieve their goals, particularly in documenting patient needs, engaging patients in rehabilitation, and informing onward referrals following MTC discharge. Improving IT systems, empowering patients, redirecting funding, and providing training might improve their usage. Further research should explore service provider and patient perspectives, and prospective long-term follow-up on outcomes of rehabilitation prescription recommendations.

IntroductIonDespite being at higher risk for chronic disorders, the South Asian population remains largely under-represented in clinical and applied health research or service design, 1,2 and is less likely to access or be referred to relevant services compared with the white population. 3This adds to the multiple disadvantages faced by some ethnic minority communities. 4ainstream research practices that elicit the participation of the majority population can sometimes exclude minority populations because the nature of the methods used are not always culturally appropriate. 5Given the prevalence and consequences of overweight/obesity in the South Asian population in the UK, it is important to identify strategies for raising the issue of overweight/obesity with this group, although there is little evidence on raising this sensitive issue with patients generally.