Patterns and Correlates of Participation in a Weekly Mass Participation Physical Activity Event, parkrun, in Australia, 2011-2020.

BACKGROUND: Studying effective interventions already operating at scale is critical to improving physical activity intervention research translation. The free, weekly, timed 5-km run or walk parkrun represents a unique opportunity to examine successful organic dissemination. We conducted an ecological analysis to identify patterns of growth in Australian parkrun participation and their correlates from 2011 to 2020. METHOD: Outcome variables were (1) weekly counts of walkers/runners and (2) monthly number of new parkrun registrants. We used latent class analysis to characterize growth trajectories followed by logistic regression on class membership. Covariates included parkrun course characteristics (eg, surface type and route), site-level aggregate participant profile (eg, proportion women and mean age), and surrounding area characteristics (eg, population density and physical activity norm). RESULTS: Three hundred and sixty-three parkruns were included (n = 8,388,695 participation instances). Sixty-nine percent followed a low-growth and 31% a high-growth participation pattern. High growth was associated with greater participation by women, concrete/bitumen surface type, lower area socioeconomic status, and greater volunteer heterogeneity. Odds of being in the slow-growth class were higher if the course contained >1 km of repetition, higher average age of participants, better average parkrun performance, and higher running group membership. Two patterns of new registration were identified: high start followed by steep decline; and low start, slow decline with similar correlates to participation. CONCLUSIONS: Parkruns with a less competitive social milieu may have more rapid dissemination. As a free and regular event, parkruns in low socioeconomic areas have the potential to improve the activity levels of those with fewer resources.

Junior parkrun pilot in Australia: A real world evaluation.

ISSUE ADDRESSED: Regular physical activity is important for children's health. Parkrun supports communities to deliver free, weekly, 5 km events in 22 countries around the world and is the largest physical activity model delivered at scale in the world. Junior parkrun aims to encourage children aged 4-14 years to be active outdoors through providing safe, cost-free and non-competitive weekly timed walk, run or jog over a 2-km distance. The aim of this study is to evaluate the junior parkrun pilot in Australia. METHODS: A process evaluation was conducted using routinely collected data of junior parkrun participants, as well as a self-completed questionnaire. RESULTS: A total of 1827 children had registered and participated in at least one junior parkrun over the course of the pilot period. Participants had, on average, attended 10% of the junior parkrun events including and subsequent to their first participation by the end of the study period. Majority of parents (61%) said that junior parkrun had increased their child's physical activity either a little or a lot, and most agreed or strongly agreed that junior parkrun was fun (90%), enjoyable (91%), energising (85%) and challenging (70%). CONCLUSION: The junior parkrun pilot appears to show promise in Australia for enabling children to engage in physical activity, in their local communities in a fun and inclusive way. SO WHAT: Parkrun junior can co-exist with other organised sports programs; however, it can also specifically target those not participating in any sports, given the high levels of enjoyment in a non-competitive, non-team environment.

The psychometric properties of a novel task-based dance self-efficacy measure for older adult dance program participants.

BACKGROUND: Self-efficacy for dance may reflect individual differences in factors likely to influence dance program participation. This study investigated the psychometric properties of six novel task-based dance self-efficacy (t-bDSE) questions for older adults participating in two large-scale dance intervention trials (N1 = 530; N2 = 131). METHODOLOGY: Internal consistency of t-bDSE was assessed and items validated according to age, gender, physical ability, cognitive status, psychosocial wellbeing, dance experience and exercise behaviour. Responsiveness of t-bDSE was investigated by comparing dance program participants to control groups. RESULTS: Internal consistency was high (Cronbach's α = .88). Dance self-efficacy was weaker in participantswith less dance experience, poorer mental health, poorer cognitive and physical abilities, and insufficiently active. t-bDSE scores improved in aged-care trial participants (ηp2 = .05, a moderate effect). CONCLUSIONS: The dance self-efficacy measure demonstrated good criterion and construct validity and can be included in future dance interventions to improve understanding of outcome variability and inform program evaluation.

Designing physical activity interventions for women aged 50+: a qualitative study of participant perspectives.

BACKGROUND: The Active Women over 50 trial tested a scalable program for increasing physical activity among women aged 50+. The program included information, activity tracker and email support. This study sought to describe the participant perspectives of the Active Women over 50 program and considerations for designing physical activity interventions for this demographic. METHODS: Women who completed the Active Women over 50 trial were purposively recruited for maximum variation in age, employment, carer responsibility, medical conditions and physical activity. Individual semi-structured interviews explored their perspectives on physical activity, Active Women over 50 program components and suggestions for future iterations. Data were thematically analysed. RESULTS: Participants' capacity to be physically active was shaped by an interplay of factors. Our analysis generated four main themes relating to physical activity in general and to the program: Age and gender matters, Physical activity is social, Strategising for physical activity and the Self-responsibility discourse. At this midlife stage, physical activity participation was challenged by personal, life-stage and cultural factors, alongside a tension of the self-responsibility discourse which also impacted the program experience. Social factors and finding a suitable strategy for motivation were deemed integral aspects of being active. Future programs could consider facilitation of social networks and accountability, life-stage health information and positive framing to support self-responsibility. CONCLUSION: A range of strategies is key to supporting women over 50 to be more physically active due to the variety of circumstances and levels of agency experienced. We offer suggestions that do not need to be resource intensive but could be incorporated into a scaled program.

Instabrand courtside: a content analysis of marketing strategies by food and beverage brands during the 2021 Australian Open tennis tournament.

OBJECTIVE: To examine the marketing techniques food and beverage brands use on Instagram, as part of their sport sponsorship strategy. METHODS: We conducted a qualitative content analysis of 31 Instagram accounts during the 2021 Australian Open tennis tournament. Branded food and beverage posts with tennis-linked content were coded based on an initial screening and previously published frameworks. RESULTS: Of the 152 included posts, 92% were made by food and beverage companies that were official 'partners' of the Australian Open. Products in posts were mostly discretionary foods and alcohol. The most frequently used strategies were 'Engagement' (89%) and 'Branding' (80%) and nearly half (45%) of alcohol posts invited direct consumption of their product. CONCLUSIONS: The powerful combination of sport and social media are utilised by brands to interact and build relationship with consumers while promoting the consumption of alcohol and discretionary foods - products which impede rather than promote health. The indirect marketing techniques favoured by brands make this form of advertising difficult to identify and control. IMPLICATIONS FOR PUBLIC HEALTH: These results highlight the need for counter-marketing, policy and regulatory actions to remove unhealthy food and alcohol from sport and reorient sponsorship of sporting events towards products that promote health.

Co-Produce, Co-Design, Co-Create, or Co-Construct-Who Does It and How Is It Done in Chronic Disease Prevention? A Scoping Review.

Co-production in health literature has increased in recent years. Despite mounting interest, numerous terms are used to describe co-production. There is confusion regarding its use in health promotion and little evidence and guidance for using co-produced chronic disease prevention interventions in the general population. We conducted a scoping review to examine the research literature using co-production to develop and evaluate chronic disease prevention programs. We searched four electronic databases for articles using co-production for health behaviour change in smoking, physical activity, diet, and/or weight management. In 71 articles that reported using co-production, co-design, co-create, co-develop, and co-construct, these terms were used interchangeably to refer to a participatory process involving researchers, stakeholders, and end users of interventions. Overall, studies used co-production as a formative research process, including focus groups and interviews. Co-produced health promotion interventions were generally not well described or robustly evaluated, and the literature did not show whether co-produced interventions achieved better outcomes than those that were not. Uniform agreement on the meanings of these words would avoid confusion about their use, facilitating the development of a co-production framework for health promotion interventions. Doing so would allow practitioners and researchers to develop a shared understanding of the co-production process and how best to evaluate co-produced interventions.

Changes in Australian community perceptions of non-communicable disease prevention: a greater role for government?

BACKGROUND: Monitoring trends in community opinion can identify critical opportunities to implement upstream health policies or interventions. Our study examines change and demographic modifiers of change in community perceptions of government intervention for prevention of lifestyle-related chronic disease across two time points in Australia. METHODS: Data were drawn from the 2016 (n = 2052) and 2018 (n = 2601) waves of a nationally representative cross-sectional telephone survey, 'AUSPOPS'. Survey questions gauged perceptions of government intervention for health in general, peoples'/organizations' role in maintaining health (e.g., parents, government) and support for specific health interventions (e.g., taxing soft drink). Bivariate and multivariate regression models tested for change between the two surveys, adjusted for demographic characteristics. Models with interactions between survey wave and demographic variables tested for differential change. One-tailed variance ratio tests examined whether opinions had become more polarized in 2018 compared with 2016. RESULTS: The large, significant increase observed in the perceived size of the role that government has in maintaining people's health was uniform across demographic subpopulations. The role for employers and private health insurers was also perceived to be larger in 2018 compared with 2016, but the degree of change varied by gender, age and/or socioeconomic status. Support for some government interventions (e.g., taxing soft drinks) increased among specific demographic subgroups whilst exhibiting no overall change. Opinion was more polarized on general attitudes to government intervention for population health in 2018 compared to 2016, despite little change in central tendency. CONCLUSIONS: Opportunities may exist to implement government health-promoting policies (e.g., taxing soft drinks), although advocacy may be needed to address the concerns of less supportive subpopulations. Attitudes on government intervention in general may be becoming more polarized; future research examining the association of such changes with exposure to different information sources could inform communication strategies for future health policy change.

Service provider perspectives on implementing the NSW Get Healthy at Work program.

Purpose: One approach increasingly used by governments to deliver on public initiatives is to partner with private enterprise through public-private partnerships. This study is a qualitative process evaluation of an Australian state-wide workplace health programme "Get Healthy at Work" from the currently under-researched perspective of the private service providers. Methods: Semi-structured interviews were conducted with nine service providers. Interviews were transcribed and analysed inductively. Results: Service providers reported an alignment of motives and skills between the programme and their organizations as a benefit of the partnership. However, they also described misalignments: between the potential and realized value of the programme to businesses and service providers; the programme cycle and business operational processes; and the capacity building approach and businesses' expectations of the service.Conclusions: Although several hallmarks of a well-functioning private-public partnership were evident, misalignments of process and expectations challenged sustained partnership involvement by providers. Careful consideration must be given to the ongoing management functioning of cross-sector engagement and partnering in health promotion practice in order to ensure public health goals are being met, but also that the model is mutually sustainable.

Are perceptions of government intervention for prevention different by gender and age? Results from the AUStralian Perceptions Of Prevention Survey (AUSPOPS).

OBJECTIVES: Understanding public opinion and community attitudes is needed to help the implementation of chronic disease prevention policies that are acceptable to the population. The AUStralian Perceptions Of Prevention Survey ('AUSPOPS') is a national survey designed to provide evidence on the views of Australians regarding government intervention for prevention. However there is limited evidence whether age and gender have modifying effects on attitudes about prevention. METHODS: Using results from the 2018 AUSPOPS dataset, this study examines whether the effect of age on attitudes about prevention is modified by the effect of gender. Survey questions included views about statements for government intervention and whether government had gone far enough for thirteen different preventive interventions. RESULTS: 2601 Australian residents aged 18 years or older participated in the survey (response rate 16.7%). Results showed strong support for prevention framed as a shared responsibility between governments and individuals. Interventions where >50% of respondents felt the government had not gone far enough in prevention were restricting unhealthy food advertising for children and setting salt limits on processed food. There were significant age by gender interactions in a small number (n = 4) of questions examining support for government intervention for prevention, suggesting young men were least in favour of more action by government. CONCLUSIONS: There is general support in the Australian community for government intervention for prevention. Policymakers could capitalize on this sentiment by prioritizing policies with high levels of support across all groups, and target population subgroups on issues where acceptability appears to be heterogenous.

Yoga-based exercise to prevent falls in community-dwelling people aged 60 years and over: study protocol for the Successful AGEing (SAGE) yoga randomised controlled trial.

INTRODUCTION: Falls significantly reduce independence and quality of life in older age. Balance-specific exercise prevents falls in people aged 60+ years. Yoga is growing in popularity and can provide a high challenge to balance; however, the effect of yoga on falls has not been evaluated. This trial aims to establish the effect on falls of a yoga exercise programme compared with a yoga relaxation programme in community-dwellers aged 60+ years. METHOD AND ANALYSIS: This randomised controlled trial will involve 560 community-dwelling people aged 60+ years. Participants will be randomised to either: (1) the Successful AGEing (SAGE) yoga exercise programme or (2) a yoga relaxation programme. Primary outcome is rate of falls in the 12 months post randomisation. Secondary outcomes include mental well-being, physical activity, health-related quality of life, balance self-confidence, physical function, pain, goal attainment and sleep quality at 12 months after randomisation. The number of falls per person-year will be analysed using negative binomial regression models to estimate between-group difference in fall rates. Generalised linear models will assess the effect of group allocation on the continuously scored secondary outcomes, adjusting for baseline scores. An economic analysis will compare the cost-effectiveness and cost-utility of the two yoga programmes. ETHICS AND DISSEMINATION: Protocol was approved by the Human Research Ethics Committee at The University of Sydney, Australia (approval 2019/604). Trial results will be disseminated via peer-reviewed articles, conference presentations, lay summaries. TRIAL REGISTRATION NUMBER: The protocol for this trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001183178).

Ecological study of playground space and physical activity among primary school children.

OBJECTIVES: To examine the relationship between school playground size and total physical activity (PA), fitness and fundamental movement skills (FMS) of primary school students. DESIGN: Cross-sectional ecological analysis. SETTING: 43 primary schools in New South Wales, Australia. PARTICIPANTS: Data were from 5238 students, aged 5 to 12 years, participating in the Schools Physical Activity and Nutrition Survey. OUTCOME MEASURES: Self (for age ≥11 years) and parent (for age <11 years) report of PA (meeting PA recommendations and number of days meeting recommendations), objectively measured FMS and cardiorespiratory and muscular fitness. RESULTS: Associations between playground space and measures of PA and fitness were mostly non-linear and moderated by loose equipment. Students in schools with no loose equipment showed a weak association between space and meeting PA recommendations (self-report). In schools with equipment, students' predicted probability of meeting PA recommendations increased sharply between 15 m2 and 25 m2 per student from 0.04 (95% CI: 0.01 to 0.08) to 0.30 (95% CI: 0.14 to 0.46), but at 30 m2 returned to levels comparable to students in schools with no equipment (0.18, 95% CI: 0.07 to 0.28). For cardiorespiratory fitness, in schools with no loose equipment, probabilities for being in the healthy cardiovascular fitness zone varied between 0.66 and 0.77, showing no consistent trend. Students in schools with loose equipment had a predicted probability of being in the healthy fitness zone of 0.56 (95% CI: 0.41 to 0.71) at 15 m2 per student, which rose to 0.75 (95% CI: 0.63 to 0.86) at 20 m2 per student. There was no relationship between space and FMS. CONCLUSIONS: School space guidelines need to incorporate sufficient playground space for students. Our study provides evidence supporting better PA outcomes with increasing space up to 25 m2 per student, and access to loose equipment, however further research is required to determine precise thresholds for minimum space. Intersectoral planning and cooperation is required to meet the needs of growing school populations.

Weight change among repeat participants of an Aboriginal community-based weight loss program.

BACKGROUND: Community-based weight loss programs may have potential to address overweight and obesity at the population level. However, participation patterns and individual outcomes from these programs are understudied. This study examined repeat participation patterns and participant weight change between contests over seven years of an Aboriginal Australian team-based program in order to identify (1) predictors of repeat participation and (2) associations with weight change between contests. METHODS: Data for the 12 contests from 2012 to 2018 were merged, with probabilistic record matching. A total of 7510 enrolments were registered for the 12 contests, representing 4438 unique people. Contest lengths varied from 10 to 16 weeks in duration. Non-repeat participants were those who only competed once in the program by the end of 2018, and repeaters were those who competed in at least two contests. Associations between repeat participation and participant baseline (i.e., first participation occasion) characteristics, change in diet and physical activity and percent change in weight during the first participation occasion were examined using crossed random effects (for person and team) regression adjusted for exposure to the program. Weight percentage change between contests was calculated for consecutive participation occasions occurring at least three months apart, converted to percent change per month. Weight change was regressed on number of repeat participation occasions adjusted for age, gender, baseline weight at first participation occasion, and weight percent change in the immediately preceding contest. RESULTS: One-third of the 4433 participants participated more than once, with women more likely than men to repeat. A 1% reduction in weight during a competition was associated with an increase in weight of 0.05% per month between competition end and subsequent participation. Regain was smaller the heavier participants were at their first participation. CONCLUSIONS: While individuals benefit from weight loss through program participation, strengthening strategies for weight loss maintenance within or following the program could improve long-term weight outcomes and reduce weight cycling.

Beyond weight loss: Impact of a weight management programme for mid-older Australians in private health insurance.

Weight-loss maintenance and lifestyle behaviour necessary to manage weight are undisputedly challenging. We evaluated a secondary prevention weight-loss maintenance programme for participants (n = 490) with weight-related chronic disease in the Australian private health insurance setting. This study investigated the impact of the maintenance programme on anthropometric and lifestyle risk behaviour changes after 6 and 12 months, and trends in weight-loss maintenance after 1 year. Using a pre- and post-test design, data were analysed with generalized linear mixed models for repeated measures to determine the effect of the programme on weight loss and lifestyle behaviour outcomes. After initially losing a clinically significant amount of weight (mean 9.1 kg), maintenance-programme participants maintained clinically significant weight loss (mean 7.6 kg) at 12 months. Rates of discontinuation in the programme were high (47% at 6 months and 73% at 12 months). Weight-loss maintenance was achieved by 76% of participants at 3 months and 62% at 6 months, stabilizing at 55% and 56% at 9 and 12 months, respectively. Greater initial weight loss was associated with weight-loss maintenance at 12 months. Participants <55 years demonstrated consistent weight-loss maintenance over this time but the odds for successful weight-loss maintenance for those ≥55 years continued to decrease over time. At maintenance-baseline, 68.3% of participants had sufficient physical activity for health; 61.4% and 19.8% met recommended fruit and vegetable consumption, respectively. All lifestyle risk behaviours were maintained at 12 months. A programme extending support strategies for maintaining weight-related behaviour shows promise to successfully support these changes over 12 months. There is a potentially important opportunity for targeted intervention at 6 to 9 months.

Sociodemographic and health risk profile associated with participation in a private health insurance weight loss maintenance and chronic disease management program.

Objective Identifying who participates in chronic disease management programs yields insights into program reach and appeal. This study investigated sustained participation in a remotely delivered weight loss maintenance program offered to Australian private health insurance members. Methods All participants completing an initial 18-week weight loss program were eligible for a maintenance phase. A pre-post test design was used and sociodemographic and anthropometric characteristics of those who did and did not opt in to the maintenance phase were compared using binary logistic regression. Results Maintenance phase participants lost more weight during the initial weight loss program (-2.2kg (P<0.001); body mass index -0.8kg/m2 (P<0.001)) than those who did not opt in. Participants who were obese (v. overweight) upon completion of the initial weight loss program were less likely to opt in to the maintenance phase (adjusted odds ratio (aOR) 1.76, 95% confidence interval (CI) 1.35-2.30, P<0.001) and participants aged ≥55 years were more likely to opt in (aOR 0.59, 95% CI 0.44-0.80, P<0.001) than those aged <55 years. Conclusions Understanding why health insurance members opt in to maintenance programs can assist the development of strategies to improve program reach. Younger participants and those who remain obese following a weight loss program may be targeted by private health insurers and service providers to increase weight loss maintenance program participation. What is known about the topic? Australian private health insurers offer chronic disease management programs to support members to manage obesity-related chronic disease. An 18-week weight loss and lifestyle modification program was extended to assist participants maintain weight loss and health benefits resulting from the initial program. This weight loss maintenance phase is novel in the private health insurance setting and is thought to be important to sustained health improvement. Although program reach is important to benefit those most in need, little is known about who sustains the use (or does not) of such programs. What does this paper add? This study provides an insight to the characteristics of participants more likely to opt in to a weight loss maintenance program. It highlights the sociodemographic and anthropometric characteristics associated with maintenance program uptake, identifying the subgroups less likely to opt in. These study findings are novel because they report on participation in a chronic disease management program with a focus on maintenance of weight loss. What are the implications for practitioners? These results will benefit private health insurers and service providers implementing maintenance programs for weight loss, providing an awareness of which participant groups to target to increase maintenance and reach. In addition, they offer avenues for future exploration, such as the generalisability and sustainability of chronic disease management programs. Although those not opting in are a difficult-to-access group, a qualitative study of reasons for not opting in to such a program would provide further information for program design, recruitment and retention.

"I'm Still on Track": A Qualitative Exploration of Participant Experiences of a Weight Loss Maintenance Program.

Qualitative evidence of participants' experiences of real-life weight loss maintenance programs is important for ongoing participant engagement and can inform program improvements. The purpose of this study was to understand how participants account for their engagement with a weight loss maintenance program and the role of the program in their weight management. A qualitative study using semi-structured interviews with 17 participants of a weight loss maintenance program was conducted; common themes were identified using a thematic inductive approach. Many participant narratives incorporated recurrent descriptions of their program experiences as a weight management journey. Our analysis generated four themes: returning to real life as a threat, the personal responsibility imperative, the program supporting agency and the program supporting self-regulation. The program, which provides external support and strategies, overlapped with the context of returning to real life and the personal responsibility imperative. Participant accounts of their journey at this intersection include the program supporting both agency and self-regulation which influences ongoing weight management. The interplay between themes identified and the maintenance program services allows compatibility between participants' sense of personal responsibility and the program components to help participants to 'stay on track' or 'get back on track'. In providing sufficient structure, opportunities to revisit successful strategies, and accountability, participants are empowered to overcome real-life threats and make positive health choices.

Healthy Weight for Life programme: Evaluating the practice and effectiveness of a weight loss maintenance programme in the private health insurance setting.

BACKGROUND: Australian private health insurers are increasingly involved in the delivery of chronic disease management programmes to their members, recognising the importance of decreasing and managing lifestyle risk factors and the impact such factors have on health service utilisation. One such secondary prevention programme is the Healthy Weight for Life programme, an intensive weight loss and lifestyle modification programme that has been designed for overweight and obese private health insurance members in Australia. Together with the insurer, the Healthy Weight for Life service provider developed and implemented a long-term maintenance programme that supports participants who complete the Healthy Weight for Life programme to maintain the weight loss they achieved during the programme. Various studies have shown that evidence-based weight management programmes can be effective; however, the results may vary in different contexts. OBJECTIVE: This article presents the evaluation rationale and framework designed to assess the process and impact of the long-term maintenance programme on weight loss maintenance, other health-related benefits and participants' experience with the programme. METHODS: The evaluation will comprise a number of inter-related sub-studies balancing evaluation of programme effectiveness and implementation. The maintenance programme presented a unique opportunity for researchers to partner with private health insurance and a service provider to assess a real-world programme in the under-researched area of weight loss maintenance in this setting and emphasises the importance of evaluating such programmes given the potential the private health insurance context has in the future delivery of health care.

Participant profile and impacts of an Aboriginal healthy lifestyle and weight loss challenge over four years 2012-2015.

OBJECTIVE: To explore participation, consistency of demographic and health profiles, and short-term impacts across six Aboriginal Knockout Health Challenge (KHC) team-based weight loss competitions, 2012 to 2015. METHODS: Data comprised one competition each from 2012 and 2013 and two per year in 2014 and 2015. We compared baseline and change (pre- to post-competition) in weight, fruit and vegetable consumption, physical activity and waist circumference (baseline only) across competitions using mixed models. RESULTS: Numbers of teams and participants increased from 2012 to 2015 from 13 and 324 to 33 and 830, respectively. A total of 3,625 participants registered, representing 2,645 unique people (25.4% repeat participation). Participants were mainly female and >90% were classified obese at baseline. Baseline weight and weight lost (between 1.9% and 2.5%) were significantly lower in subsequent competitions compared with the first. Improvements in fruit and vegetable consumption and physical activity were comparable across competitions. CONCLUSION: The KHC has increasing and sustained appeal among Aboriginal communities, attracting those at risk from lifestyle-associated chronic disease and effectively reducing weight and promoting healthy lifestyles in the short term. Implications for public health: Community-led programs generated by, and responsive to, Aboriginal Australians' needs can demonstrate consistent community reach and sustained program-level lifestyle improvements.

"Doing a good thing for myself": a qualitative study of young adults' strategies for reducing takeaway food consumption.

BACKGROUND: Increasingly the population is eating meals and snacks prepared outside the home, especially younger adults. Takeaway foods can be energy-dense, high in saturated fat and sodium, and deleterious to health. Extending studies examining the barriers to healthy eating, this paper explores strategies employed by young adults who report reducing consumption of unhealthy takeaway foods. METHODS: Young adults aged 18 to 35 years in paid employment were recruited to participate in eight semi-structured focus groups. In response to initial findings, recruitment for the final four groups refocused on participants who either wanted, were in the process of, or had changed their takeaway food habits. Focus group recordings were transcribed verbatim and coded by two researchers for recurrent themes using an inductive method. RESULTS: Forty-eight participants with a mean BMI of 23.4 kg/m2 and mean age of 25 years took part, of which 34 were female, and 27 were born outside Australia. Four broad strategies emerged: altering cognitions about consumption/reduction of takeaway food; practical changes to behaviours; finding external support; and, reconfiguring social events. In detail, participants cognitively recast takeaway food consumption as negative (expensive and unhealthy) and reducing consumption of such foods or consuming healthy alternatives as a (positive) self-care action. Setting goals and making personal rules around consumption, and consciously making practical changes, such as planning for food shopping, were other strategies. Externally derived support including supportive food environments and friends and family passively reduced exposure to unhealthy takeaway food. Finally, some participants actively created social environments supportive of healthy choices. CONCLUSIONS: Our participants reported strategies they believed led to them successfully reduce their takeaway food consumption by matching the attractions (e.g., convenience) and countering apparent disincentives for reducing consumption (e.g., losing a reward) of takeaway food. They reported eschewing more short-term rewards and costs, to prioritise their health, believing that avoiding these foods would benefit them personally and financially. The identified strategies are consistent with documented techniques for successful behaviour change and corresponded to all levels in the social-ecological model from intrapersonal factors to public policy. The findings could underpin health promotion strategies to support this at-risk group.

Are Financial Incentives for Lifestyle Behavior Change Informed or Inspired by Behavioral Economics? A Mapping Review.

OBJECTIVE: To identify the behavioral economics (BE) conceptual underpinnings of lifestyle financial incentive (FI) interventions. DATA SOURCE: A mapping review of peer-reviewed literature was conducted by searching electronic databases. STUDY INCLUSION AND EXCLUSION CRITERIA: Inclusion criteria were real-world FI interventions explicitly mentioning BE, targeting individuals, or populations with lifestyle-related behavioral outcomes. Exclusion criteria were hypothetical studies, health professional focus, clinically oriented interventions. DATA EXTRACTION: Study characteristics were tabulated according to purpose, categorization of BE concepts and FI types, design, outcome measures, study quality, and findings. DATA SYNTHESIS AND ANALYSIS: Financial incentives were categorized according to type and payment structure. Behavioral economics concepts explicitly used in the intervention design were grouped based on common patterns of thinking. The interplay between FI types, BE concepts, and outcome was assessed. RESULTS: Seventeen studies were identified from 1452 unique records. Analysis showed 76.5% (n = 13) of studies explicitly incorporated BE concepts. Six studies provided clear theoretical justification for the inclusion of BE. No pattern in the type of FI and BE concepts used was apparent. CONCLUSIONS: Not all FI interventions claiming BE inclusion did so. For interventions that explicitly included BE, the degree to which this was portrayed and woven into the design varied. This review identified BE concepts common to FI interventions, a first step in providing emergent and pragmatic information to public health and health promotion program planners.