Understanding the impact of distance and disadvantage on lung cancer care and outcomes: a study protocol.

BACKGROUND: Lung cancer is the third most common cancer in the UK and the leading cause of cancer mortality globally. NHS England guidance for optimum lung cancer care recommends management and treatment by a specialist team, with experts concentrated in one place, providing access to specialised diagnostic and treatment facilities. However, the complex and rapidly evolving diagnostic and treatment pathways for lung cancer, together with workforce limitations, make achieving this challenging. This place-based, behavioural science-informed qualitative study aims to explore how person-related characteristics interact with a person's location relative to specialist services to impact their engagement with the optimal lung pathway, and to compare and contrast experiences in rural, coastal, and urban communities. This study also aims to generate translatable evidence to inform the evidence-based design of a patient engagement intervention to improve lung cancer patients' and informal carers' participation in and experience of the lung cancer care pathway. METHODS: A qualitative cross-sectional interview study with people diagnosed with lung cancer < 6 months before recruitment (in receipt of surgery, radical radiotherapy, or living with advanced disease) and their informal carers. Participants will be recruited purposively from Barts Health NHS Trust and United Lincolnshire Hospitals NHS Trusts to ensure a diverse sample across urban and rural settings. Semi-structured interviews will explore factors affecting individuals' capability, opportunity, and motivation to engage with their recommended diagnostic and treatment pathway. A framework approach, informed by the COM-B model, will be used to thematically analyse facilitators and barriers to patient engagement. DISCUSSION: The study aligns with the current policy priority to ensure that people with cancer, no matter where they live, can access the best quality treatments and care. The evidence generated will be used to ensure that lung cancer services are developed to meet the needs of rural, coastal, and urban communities. The findings will inform the development of an intervention to support patient engagement with their recommended lung cancer pathway. PROTOCOL REGISTRATION: The study received NHS Research Ethics Committee (Ref: 23/SC/0255) and NHS Health Research Authority (IRAS ID 328531) approval on 04/08/2023. The study was prospectively registered on Open Science Framework (16/10/2023; https://osf.io/njq48 ).

Are the physical activity habits of healthcare professionals associated with their physical activity promotion and counselling?: A systematic review.

OBJECTIVE: Healthcare professionals (HCPs) play an important role in conducting brief physical activity counselling during consultations, representing one of the population's most cost-effective interventions for its promotion. Despite this, their clinical practice often falls short in addressing physical activity with the necessary depth and frequency. This study aimed to synthesise the literature concerning the association between the physical activity habits of HCPs and their attitudes toward physical activity promotion and counselling. METHODS: The systematic review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Its protocol was registered in PROSPERO under ID: CRD42023408302. In March 2023, a comprehensive search was conducted using key terms related to physical activity levels and HCPs counselling practices across the Web of Science, Scopus, PubMed, SPORTDiscus, APA PsycInfo, and CINAHL databases. Registered HCPs classified under the International Standard Classification of Occupations (ISCO) were included. The Newcastle-Ottawa Scale was used for assessing articles quality. RESULTS: The search yielded 6618 articles, with 51 meeting the inclusion criteria after filtering and cross-referencing. Predominantly cross-sectional studies were included, mainly involving HCPs responding to questionnaires regarding their physical activity habits and promotion and counselling practices. Heterogeneous results were found. CONCLUSION: High-quality studies mainly concluded that higher physical activity levels among HCPs were associated with more physical activity promotion and counselling practices. These findings are an important contribution to the relevance of the physical activity practice by HCPs and highlighting the importance of promoting its counselling in clinical practice.

To Improve Motivational Barriers to Retention in High Resolution Anoscopy, Patients and Providers Recommend Social and Environmental Changes: A Sequential Explanatory Mixed-Methods Pilot Study in a Federally Qualified Health Center.

Loss to follow-up (LTFU) in high-resolution anoscopy (HRA) programs jeopardizes the procedure's potential to help prevent anal cancer. We explored quality improvement factors to understand how to address this LTFU. Using the transtheoretical COM-B Model (Capability, Opportunity, Motivation, and Behavior) and a sequential explanatory mixed-methods design, we surveyed and interviewed 13 patients who remained engaged in HIV care but who delayed their HRA monitoring or treatment visits in the same community clinic, and 6 HRA clinicians and medical assistants. Analyses involved descriptive statistics and rapid qualitative analysis. Patients were racially, ethnically, and economically representative of the LTFU population, and were generally experienced with HRA (Mean HRA visits = 4.6, SD = 2.8, mdn = 3). Providers were experienced clinicians and medical assistants (Mean years providing HRA = 6.0, SD = 2.2). Analyses revealed two primary, related barriers: (A) motivational barriers such as physical pain, discomfort, embarrassment, and anxiety; which were largely borne from (B) opportunity barriers such as difficulties with scheduling, inconsistent after-care (particularly for pain and discomfort), anxiety-inducing exam rooms and equipment, and internalized and anticipated stigma. Capability barriers, such as limited health literacy about HRA, were less common and, like motivational barriers, linked to opportunity barriers. Participants recommended potential facilitators, including easier scheduling, standardization of pain management and after-care services, and examination room modifications to reduce anxiety. To retain HRA patients in community settings, interventions should address social and physical opportunity barriers that strongly determine motivational and capability barriers. Improving convenience, standardizing pain management, and introducing stigma interventions specific to HRA, could alleviate both motivational and capability barriers.

RESUMEN: La pérdida de seguimiento (LTFU) en los programas de anoscopia de alta resolución (HRA) pone en peligro el potencial del procedimiento para ayudar a prevenir el cáncer anal. Exploramos factores de mejora de la calidad para comprender cómo abordar este LTFU. Utilizando el modelo COM-B transteórico (Capacidad, Oportunidad, Motivación y Comportamiento) y un diseño de métodos mixtos explicativos secuenciales, encuestamos y entrevistamos a 13 pacientes que permanecieron involucrados en la atención del VIH pero que retrasaron sus visitas de seguimiento o tratamiento de la HRA en la misma clínica comunitaria y 6 médicos y asistentes médicos de la HRA. Los análisis involucraron estadísticas descriptivas y análisis cualitativo rápido. Los pacientes eran representativos de la población LTFU en cuanto a raza, etnia, y estatus económico. En general, tenían experiencia con HRA (visitas HRA media = 4,6, DE = 2,8, mdn = 3). Los proveedores eran médicos y asistentes médicos con experiencia (promedio de años proporcionando HRA = 6,0, DE = 2,2). Los análisis revelaron dos barreras principales relacionadas: (A) barreras motivacionales como el dolor físico, la incomodidad, la vergüenza y la ansiedad; que se debieron en gran medida a (B) barreras de oportunidad, como dificultades con la programación, cuidados posteriores inconsistentes (particularmente para el dolor y el malestar), salas de examen y equipos que inducen ansiedad, y estigma internalizado y anticipado. Las barreras a la capacidad, como la limitada alfabetización sanitaria sobre la HRA, fueron menos comunes y, al igual que las barreras motivacionales, estaban vinculadas a las barreras de oportunidades. Los participantes recomendaron posibles facilitadores, incluida una programación más sencilla, la estandarización del manejo del dolor y los servicios de cuidados posteriores, y modificaciones en la sala de examen para reducir la ansiedad. Para retener a los pacientes de HRA en entornos comunitarios, las intervenciones deben abordar las barreras de oportunidades sociales y físicas que determinan fuertemente las barreras motivacionales y de capacidad. Mejorar la conveniencia, estandarizar el manejo del dolor e introducir intervenciones de estigma específicas para la HRA podría aliviar las barreras tanto motivacionales como de capacidad.

Use of consumer insights to inform behavior change interventions aimed at illegal pet turtle trade in China.

Illegal poaching and overexploitation for the international pet trade are among the greatest threats to freshwater turtles in Southeast Asia. Expanding consumer research in China is crucial to filling knowledge gaps about the scale and structure of illegal trade and developing audience-targeted and relevant interventions that may reduce demand for illegal turtles as pets. We applied mixed methods to provide a detailed understanding of the consumer side of the illegal pet turtle trade in China. We conducted 30 interviews with key stakeholders and online surveys (n = 2456) of turtle keepers via community forums. From these, we identified 3 core consumer groups based on their prior turtle-keeping experience, species exposure, and potential for future purchases. We conducted a thematic qualitative analysis of concepts related to the capability, opportunity, motivation, and behavior (COM-B) model to determine the factors influencing the illegal pet turtle trade and to identify barriers to illegal purchases. Specifically, we identified purchasers' capabilities, opportunities, and motivations in the context of legality, enforcement risk, captive breeding, and impacts on wild population. We developed consumer journey maps (i.e., visual representations of customer's experiences throughout their buying journey) for core consumer groups. These maps illustrate the sequential behaviors and processes that consumers undertake when purchasing turtles, from initial exposure to sourcing, keeping, and providing a new home. Key factors influencing illegal purchases included convenient purchase channels, misguided cognition and motivations for pet keeping, and weak law enforcement. Effective interventions included messages focusing on shifting cognition and beliefs, increasing legal risk perception, and emphasizing stringent law enforcement, primarily delivered through online channels. Our results underscore the necessity for adaptable, audience-tailored interventions to reduce consumer demand for illegal wildlife products. The mixed-methods approach, combining quantitative and qualitative data, provided a comprehensive understanding of the target behavior and can inform the development of effective intervention strategies.

Uso de las percepciones del consumidor para guiar las intervenciones de cambio conductual enfocadas en el mercado ilegal de tortugas en China Resumen La caza furtiva y la sobreexplotación por el comercio internacional de mascotas son algunas de las mayores amenazas para las tortugas de agua dulce del sudeste asiático. Es esencial conocer más sobre los consumidores en China para llenar los vacíos en el conocimiento sobre la escala y la estructura del comercio ilegal y desarrollar intervenciones pertinentes y dirigidas al público que puedan reducir la demanda de tortugas como mascotas ilegales. Aplicamos métodos mixtos para conocer en detalle la percepción del consumidor del comercio ilegal de tortugas como mascotas en China. Realizamos 30 entrevistas a actores clave y encuestas en línea (n=2456) a cuidadores de tortugas a través de foros comunitarios. A partir de ellas, identificamos tres grupos principales de consumidores en función de su experiencia previa en la cría de tortugas, su exposición a las especies y su potencial para futuras compras. Realizamos un análisis cualitativo temático de conceptos relacionados con el modelo de capacidad, oportunidad, motivación y comportamiento (COM­B) para determinar los factores que influyen en el comercio ilegal de tortugas e identificar las barreras para las compras ilegales. En concreto, identificamos las capacidades, oportunidades y motivaciones de los compradores en el contexto de la legalidad, el riesgo de aplicación de la ley, la cría en cautiverio y el impacto sobre la población silvestre. Elaboramos mapas de viaje del consumidor (representaciones visuales de las experiencias del cliente a lo largo de su compra) para los principales grupos de consumidores. Estos mapas ilustran los comportamientos y procesos secuenciales que llevan a cabo los consumidores cuando compran tortugas, desde la exposición inicial hasta la adquisición, el mantenimiento y la asignación de un nuevo hogar. Entre los factores clave que influyen en las compras ilegales se encuentran la conveniencia de los canales de compra, los conocimientos y motivaciones erróneos para mantener mascotas y la debilidad de la aplicación de la ley. Las intervenciones eficaces incluyeron mensajes centrados en cambiar los conocimientos y las creencias, aumentar la percepción del riesgo legal y hacer hincapié en la aplicación rigurosa de la ley, principalmente a través de canales virtuales. Nuestros resultados destacan la necesidad de intervenciones adaptables y adaptadas al público para reducir la demanda de productos ilegales de fauna silvestre por parte de los consumidores. El enfoque de métodos mixtos, que combina datos cuantitativos y cualitativos, proporcionó una comprensión exhaustiva del comportamiento objetivo y puede servir de base para el desarrollo de estrategias de intervención eficaces.

How Do Australians Manage Diagnostic Testing Risks? Focus Groups Linked to a Model of Behaviour Change.

BACKGROUND: Diagnostic tests carry significant risks, and communications are needed to help lay people consider these. The development of communications has been hindered by poor knowledge about how lay people understand and negotiate testing risks. We examined lay Australians' perceptions of diagnostic testing risks and how these risks are managed. METHOD: We completed 12 semistructured online focus groups with 61 Australian adults (18+) between April and June 2022. Participants were divided into younger/older (> 50 years) and male/female groups. Using semistructured discussion and exploring two hypothetical scenarios, we examined attitudes to diagnostic tests, their risks and how test risks were managed. Themes were identified, subanalysed to identify age and gender differences and mapped to the COM-B model of behaviour change. RESULTS: The six themes provided detailed accounts of how participants considered themselves able, empowered and assertive when negotiating testing risks and of complex ways in which relationships with health workers, personal experiences and structural factors influenced negotiating testing risks. COM-B identified multiple opportunities for leveraging these lay beliefs in health promotion. It also identified barriers, including narrow concepts of testing risks, challenges during shared decision-making and overestimation of personal influence on testing decisions. SIGNIFICANCE: Our findings matter because they are a novel, detailed account of testing risk beliefs, linked to a model for behaviour change. This will directly inform development of test risk/benefit communications, which are a research priority. PUBLIC CONTRIBUTION: The study design enabled participants to influence the discussion agenda, and they could comment on the analysis. Participants contributed insights about their needs, beliefs and experiences related to medical testing, and these will be used to shape future patient-centred decision tools.

Barriers and facilitators to providing rehabilitation for long-term care residents with dementia: a qualitative study.

BACKGROUND: Rehabilitation can help long-term care (LTC) residents with dementia maintain their independence. However, many residents do not receive rehabilitation. This study aimed to identify the barriers and facilitators to providing rehabilitation for LTC residents with dementia and propose practical interventions for overcoming them. METHODS: Using a phenomenological research design, we conducted a qualitative study involving 17 privately owned LTC homes in Nova Scotia, Canada. Data were collected through individual interviews and a focus group with residents with dementia (n = 3), family members (n = 4), rehabilitation providers (n = 6), and other staff (n = 3). We analyzed the data using inductive thematic content analysis and mapped the results onto the socioecological framework and the Behaviour Change Wheel (BCW) to classify and analyze barriers and facilitators to rehabilitation. The APEASE criteria (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) in the BCW were used to identify feasible interventions and policies linked to the identified barriers and facilitators. RESULTS: Barriers at the intrapersonal level included communication difficulties, comorbidities, and lack of motivation among residents. Interpersonal factors encompassed the availability of family support and lack of interdisciplinary practice. Policy/environmental factors involved limited resources, complex admission processes, low staff ratios, and restrictive restraint policies. Enhancing communication, reducing the use of restraints, promoting interdisciplinary practice, and increasing accessibility to activity spaces and equipment will improve the provision of rehabilitation for the residents. CONCLUSION: Enhancing the capabilities, opportunities, and motivations of all actors in LTC homes can potentially minimize these barriers. Interventions such as staff training on effective communication and dementia care, promoting person-centred and meaningful activities, and improving interdisciplinary collaboration are crucial. Policy measures to improve hospital-to-LTC transitions, increase volunteer involvement, educate families and communities, and recruit more staff are recommended. Addressing these barriers through targeted interventions and policy changes can significantly improve rehabilitation provision for residents with dementia in LTC settings.

Evaluating Experiences in a Digital Nutrition Education Program for People With Multiple Sclerosis: A Qualitative Study.

BACKGROUND: Multiple sclerosis (MS) is a complex immune-mediated disease with no currently known cure. There is growing evidence to support the role of diet in reducing some of the symptoms and disease progression in MS, and we previously developed and tested the feasibility of a digital nutrition education program for people with MS. OBJECTIVE: The aim of this study was to explore factors that influenced engagement in the digital nutrition education program, including features influencing capability, opportunity and motivation to change their dietary behaviours. METHODS: Semi-structured interviews were conducted with people who had MS, and who completed some or all of the program until data saturation was reached. Interviews were analysed inductively using thematic analysis. Themes were deductively mapped against the COM-B (Capability, Opportunity, Motivation, Behaviour) behaviour change model. RESULTS: Sixteen interviews were conducted with participants who completed all (n = 10) or some of the program (n = 6). Four themes emerged: (1) acquiring and validating nutrition knowledge; (2) influence of time and social support; (3) getting in early to improve health and (4) accounting for food literacy experiences. DISCUSSION: This is the first online nutrition program with suitable behavioural supports for people with MS. It highlights the importance of disease-specific and evidence-based nutrition education to support people with MS to make dietary changes. Acquiring nutrition knowledge, coupled with practical support mechanisms, such as recipe booklets and goal setting, emerged as crucial for facilitating engagement with the program. CONCLUSIONS: When designing education programs for people with MS and other neurological conditions, healthcare professionals and program designers should consider flexible delivery and building peer support to address the needs and challenges faced by participants. PATIENT OR PUBLIC CONTRIBUTION: Members of the MS Nutrition Research Program Stakeholder Reference Group, which includes people with MS and MS health professionals, provided input during the development of the nutrition education program and study design stages.

Physical activity from the perspective of older adults: a convergent mixed-method study.

BACKGROUND: Older adults are insufficiently physically active, despite its importance for healthy aging. To develop appropriate physical activity interventions, it is necessary to understand their physical activity. This study applies a theoretical perspective, the COM-B model, and a mixed-method design to examine what influences older adults' physical activity levels with three questions: (1) What individual and external factors predict older adults' physical activity levels? (2) What do older adults perceive as influencing their levels of physical activity? (3) To what extent do the quantitative results on older adults' physical activity levels agree and disagree with the qualitative findings on older adults' physical activity levels? METHODS: A convergent mixed-method design was used with questionnaire (n = 334) and interview (n = 14) data from adults 65 years and older. Regression analyses were used for quantitative measurements: physical activity, age, subjective socioeconomic status, health status, capability, opportunity, motivation, and depression. Content analysis was applied to the qualitative data. The two forms of data were then integrated to provide greater insights than would be obtained by either dataset separately. RESULTS: The regression analyses showed that previous physical activity, current motivation, health status, and age significantly predicted older adults' physical activity levels. The content analysis revealed that participants addressed all subcomponents of the COM-B model, indicating its pertinence in understanding how older adults discuss their current physical activity levels. The integrated findings showed convergent and divergent results. Overall results indicated that previous physical activity engagement, present motivation, capability, and opportunity influenced older adults' physical activity levels. CONCLUSIONS: This study is the first to use this mixed-methods design to examine factors influencing physical activity levels among older adults living in rental apartments with community hosts. The integrated result reveals convergence for findings on motivation and physical capability but divergence on psychological capability, opportunity, and previous physical activity. The findings underscore a complex interplay of factors influencing older adults' physical activity levels and indicate relevance for the COM-B model. The results can guide future research on theoretically informed interventions to promote physical activity and healthy aging. Future research should clarify the role of opportunity for older adults' physical activity.

Behavioral, cognitive and emotional determinants of getting vaccinated for COVID-19 and the mediating role of institutional trust among young adults in Cyprus.

BACKGROUND: Vaccination uptake is a complex behavior, influenced by numerous factors. Behavioral science theories are commonly used to explain the psychosocial determinants of an individual's health behavior. This study examined the behavioural, cognitive, and emotional determinants of COVID-19 vaccination intention based on well-established theoretical models: Acceptance and Commitment Therapy (ACT), Capability, Opportunity, Motivation, and Behaviour (COM-B) and the Health Belief Model (HBM). Additionally, it examined the mediating role of institutional trust in the relationship between determinants of these models and vaccination intentions. METHODS: A cross-sectional study was conducted from January to May 2022, where university students in Cyprus completed an online survey. RESULTS: A total of 484 university students completed the online survey, with 23.8% reporting being vaccinated with fewer than three vaccination doses and/or no intention to vaccinate further. Hierarchical logistic regression analysis showed that higher scores in institutional trust, perceived severity, motivation, physical and psychological capability were significantly associated with higher odds of intending to vaccinate. Higher psychological flexibility and not being infected with COVID-19 were also associated with higher odds of vaccination intention, but not in the final model when all determinants were included. Additionally, significant indirect effects of psychological and physical capability, motivation and perceived severity on vaccination intention were found to be mediated by institutional trust. CONCLUSIONS: When tackling COVID-19 vaccination hesitancy, behavioural, cognitive, and emotional aspects should be considered. Stakeholders and policymakers are advised to implement targeted vaccination programs in young people while at the same time building trust and improving their capabilities and motivation towards getting vaccinated.

"Are we working (too) comfortably?": a focus group study to understand sedentary behaviour when working at home and identify intervention strategies.

BACKGROUND: The Covid-19 pandemic initiated an enduring shift in working patterns, with many employees now working at home (w@h). This shift has exacerbated existing high levels of occupational sedentary behaviour (SB) in office workers, which is a recognised risk to health and well-being. This study aimed to use the Capability-Opportunity-Motivation-Behaviour (COM-B) model to better understand both employees' SB, and line managers behaviour to assist employees to reduce SB when w@h, and identify how employees can best be supported to reduce SB. METHODS: Three online focus groups with employees aged 18-40 working in desk-based roles (e.g. administrative / sales / customer services) (n = 21), and three with line managers (n = 21) were conducted. The focus groups facilitated discussion regarding participants' current behaviour, what impacts it, and what could be done to reduce employee SB when w@h. The focus group data were thematically analysed guided by the COM-B framework to understand influences on behaviour, and to identify promising intervention strategies. RESULTS: Most participants recognised that w@h had elevated employee occupational SB, and line managers reported the importance of supporting employees to manage their workload, and encouraging and modelling taking breaks. There were multiple influences on both employee and line manager behaviour with capability, opportunity and motivation all perceived as influential, although not equally. For example, a major theme related to the reduced physical opportunities for employees to reduce their SB when w@h, including blurred work-life boundaries. Changes in physical opportunities also made supporting employees challenging for line managers. Additionally, the w@h environment included unique social opportunities that negatively impacted the behaviour of both groups, including an expectation to always be present online, and social norms. A range of strategies for reducing SB when w@h at both individual and organisational level were suggested. CONCLUSIONS: It was evident that SB when w@h is influenced by a range of factors, and therefore multi-component intervention strategies are likely to be most effective in reducing SB. Future intervention research is a priority to evaluate and refine strategies, and inform w@h guidance to protect both the short-term and long-term health consequences of elevated SB for those who continue to w@h.

Factors affecting the readiness for hospital discharge of initially treated pulmonary tuberculosis patients in China: a phenomenological study.

BACKGROUND: Despite readiness for hospital discharge widespread popularity since readiness for hospital discharge introduction in 1979 and extensive study, readiness for hospital discharge among pulmonary tuberculosis (PTB) patients has not yet been investigated. Moreover, the factors influencing this process remain unclear. OBJECTIVE: The objective of this study was to investigate the factors influencing readiness for hospital discharge in initially treated PTB patients using the capability, opportunity, motivation-behavior (COM-B) model. METHODS: This phenomenological study was conducted from December 2023 to March 2024. Face-to-face individual interviews were conducted with 18 initially treated patients with PTB according to a semistructured interview guide developed on the basis of the COM-B model. The interview data were subjected to analysis using NVivo 14 software and Colaizzi's method. RESULTS: As a result, 6 themes and 14 subthemes were identified. Physical capability for readiness for hospital discharge (subthemes included poor health status, early acquisition of adequate knowledge about PTB, inadequate knowledge about readiness for hospital discharge), psychological capability for readiness for hospital discharge(subthemes included false perceptions about readiness for hospital discharge, high treatment adherence), physical opportunity for readiness for hospital discharge (subthemes included high continuity of transition healthcare, insufficient financial support, insufficient informational support), social opportunity for readiness for hospital discharge (subthemes included stigmatization, inadequate emotional support), reflective motivation for readiness for hospital discharge (subthemes included lack of reflection on coping with difficulties, intention to develop a readiness for hospital discharge plan), and automatic motivation for readiness for hospital discharge (subthemes included strong desire to be cured, negative emotions). CONCLUSION: We established factors related to readiness for hospital discharge in initially treated PTB patients in terms of capability, opportunity and motivation, which can inform the future development of readiness for hospital discharge plans. To improve patients' readiness for hospital discharge, patients need to be motivated to plan and desire readiness for hospital discharge, patients' knowledge and treatment adherence should be improved, and patients' transition healthcare continuity and emotional support should be focused on. Moreover, the quality of readiness for hospital discharge and discharge education should be assessed in a timely manner to identify impeding factors and provide interventions.

Developing the PEAK mood, mind, and marks program to support university students' mental and cognitive health through physical exercise: a qualitative study using the Behaviour Change Wheel.

BACKGROUND: Concerns about mental and cognitive health are common among university students. Engaging in regular physical exercise has been shown to enhance both mental health and cognitive performance, yet most students are not participating in the level of exercise required to obtain these benefits. The Behaviour Change Wheel (BCW) provides a framework for developing behavioural interventions that are informed by theory, evidence, and stakeholder perspectives. The current study aimed to apply the BCW to develop the PEAK Mood, Mind, and Marks program (i.e., PEAK), a behaviour change intervention designed to increase university students' exercise engagement for the benefit of their mental and cognitive health. METHODS: PEAK was developed across three stages of the BCW: (1) understand the target behaviour, (2) identify intervention options, and (3) identify intervention content and delivery mode. Development was informed by triangulated data from a systematic literature review, co-design consultations with key stakeholders, and knowledge of relevant experts. Consultations with stakeholders involved focus groups with 25 university students and individual interviews with 10 university leaders and staff to identify barriers and facilitators to students' exercise engagement and the adoption and implementation of PEAK by universities. Template analysis was used to code transcripts to the capability, opportunity, and motivation (COM-B) model of behaviour. The BCW was applied to identify the most appropriate intervention types and behaviour change techniques (BCTs). RESULTS: Thirty-one barriers and facilitators were identified and mapped to seven intervention types (Education; Modelling; Persuasion; Environmental Restructuring; Incentivisation; Training; and Enablement) and 26 BCTs, which were delivered across digital channels and in-person. The final intervention consisted of multiple components targeting students' capability (e.g., increasing knowledge about the mental and cognitive health benefits of exercise), opportunity (e.g., providing a flexible range of accessible exercise options and social support), and motivation (e.g., increasing the perceived importance of exercise) to exercise. CONCLUSIONS: University students and staff describe a need and appetite for more empowering, scalable solutions to support students' mental and cognitive health. Exercise-based approaches that are informed by behaviour change frameworks, evidence, and stakeholder perspectives, such as PEAK, have the potential to address this need. Current findings will inform a pilot of PEAK to evaluate its efficacy and implementation.

Key influences on university students' physical activity: a systematic review using the Theoretical Domains Framework and the COM-B model of human behaviour.

BACKGROUND: Physical activity is important for all aspects of health, yet most university students are not active enough to reap these benefits. Understanding the factors that influence physical activity in the context of behaviour change theory is valuable to inform the development of effective evidence-based interventions to increase university students' physical activity. The current systematic review a) identified barriers and facilitators to university students' physical activity, b) mapped these factors to the Theoretical Domains Framework (TDF) and COM-B model, and c) ranked the relative importance of TDF domains. METHODS: Data synthesis included qualitative, quantitative, and mixed-methods research published between 01.01.2010-15.03.2023. Four databases (MEDLINE, PsycINFO, SPORTDiscus, and Scopus) were searched to identify publications on the barriers/facilitators to university students' physical activity. Data regarding study design and key findings (i.e., participant quotes, qualitative theme descriptions, and survey results) were extracted. Framework analysis was used to code barriers/facilitators to the TDF and COM-B model. Within each TDF domain, thematic analysis was used to group similar barriers/facilitators into descriptive theme labels. TDF domains were ranked by relative importance based on frequency, elaboration, and evidence of mixed barriers/facilitators. RESULTS: Thirty-nine studies involving 17,771 participants met the inclusion criteria. Fifty-six barriers and facilitators mapping to twelve TDF domains and the COM-B model were identified as relevant to students' physical activity. Three TDF domains, environmental context and resources (e.g., time constraints), social influences (e.g., exercising with others), and goals (e.g., prioritisation of physical activity) were judged to be of greatest relative importance (identified in > 50% of studies). TDF domains of lower relative importance were intentions, reinforcement, emotion, beliefs about consequences, knowledge, physical skills, beliefs about capabilities, cognitive and interpersonal skills, social/professional role and identity, and behavioural regulation. No barriers/facilitators relating to the TDF domains of memory, attention and decision process, or optimism were identified. CONCLUSIONS: The current findings provide a foundation to enhance the development of theory and evidence informed interventions to support university students' engagement in physical activity. Interventions that include a focus on the TDF domains 'environmental context and resources,' 'social influences,' and 'goals,' hold particular promise for promoting active student lifestyles. TRIAL REGISTRATION: Prospero ID-CRD42021242170.

Development and feasibility testing of a time-restricted eating intervention for women living with overweight/obesity and HIV in a resource-limited setting of South Africa.

BACKGROUND: Human Immunodeficiency Virus (HIV) and type 2 diabetes (T2D) are amongst the leading causes of death in South Africa. The preferred first-line anti-retroviral treatment contains dolutegravir (DTG), shown to increase body weight, may compound the already high rates of obesity and associated risk for T2D. South Africa has widespread food insecurity, making traditional dietary strategies difficult to implement. Time-restricted eating (TRE) may be an appropriate intervention in resource-limited communities. METHODS: This article outlines the development and feasibility testing of a TRE intervention to inform the design of a TRE randomised controlled trial in women (20-45 years old) living with overweight/obesity and HIV, receiving DTG-based treatment from a resource-limited community in Cape Town, South Africa. Factors influencing TRE adoption were identified using the Capability, Opportunity, Motivation - Behaviour model and the Theoretical Domains Framework, combining in-depth interviews (IDIs) and focus group discussions. Participants from the IDIs went on to participate in a single arm 4-week TRE pilot trial where feasibility was explored in terms of reach, acceptability, applicability, and implementation integrity. An iterative, thematic analysis approach was employed to analyse the qualitative data. RESULTS: Participants included 33 isiXhosa-speaking women (mean age 37.1 years, mean BMI 35.9 kg/m2). Thematic analysis identified psychological capability (knowledge of fasting), social influences (cultural preferences, family support), and reflective motivation (awareness of weight, health impact, motivation for TRE) as key factors influencing adoption of TRE for weight management. In a 4-week TRE pilot trial (n = 12), retention was 100%. Positive outcomes perceived included improved energy, appetite control and weight loss. TRE was perceived as acceptable, easy, and enjoyable. Family support facilitated adherence, while habitual and social eating and drinking practices were barriers. Compliance was high, aided by self-selected eating times, reminders, and weekly calls. Recommendations included the incorporation of dietary education sessions and text messages to provide additional support and reminders. CONCLUSIONS: This study indicates that TRE is a feasible weight management strategy in women living with overweight/obesity and HIV, receiving DTG-based treatment in a resource-limited community. These findings will ensure that the forthcoming TRE randomised controlled trial is adapted and optimised to the local South African context.

Use of the Capability, Opportunity and Motivation Behaviour model (COM-B) to Understand Interventions to Support Physical Activity Behaviour in People with Stroke: An Overview of Reviews.

OBJECTIVE: Physical activity in people with stroke remains low despite considerable research. This overview aimed to provide high-level synthesis and aid clinical decision-making. The Capability, Opportunity, Motivation-Behaviour (COM-B) model was used to classify interventions to understand which components improve physical activity behaviour in people with stroke. DATA SOURCES: CINAHL, Cochrane Database, MEDLINE, PEDro, PsychINFO, SPORTDiscus. REVIEW METHODS: A systematic search was conducted (November 2023) to identify reviews of interventions to improve physical activity in people with stroke. Results were screened and assessed for eligibility. Participant characteristics, intervention classification using COM-B, and effect of intervention were extracted. Quality was assessed using AMSTAR2, and Corrected Cover Analysis for study overlap. Narrative synthesis was used to understand components of interventions to improve physical activity behaviour. RESULTS: 1801 references were screened and 29 full-text references assessed for eligibility. Twenty reviews were included. Quality ranged from critically low (n = 3) to high (n = 10). Study overlap calculated using corrected cover area indicated slight overlap (0.028) and minimal reporting bias.The majority of participants were mobile with mild stroke and community dwelling. Twenty-three interventions were classified using COM-B. Three of twelve interventions classified to one aspect of the COM-B were effective. Fourteen of sixteen effective interventions combined at least two COM-B elements, ten of these combined capability and motivation. CONCLUSION: Interventions including at least two elements of the COM-B are most likely to improve physical activity in mobile stroke survivors. Further research is needed to understand physical activity behaviour in those with moderate to severe stroke.

A qualitative exploration of mothers' perspectives on infant formula use in Uruguay.

The transformation of the first-food systems and the widespread availability and marketing of breastmilk substitutes undermine efforts to promote adequate breastfeeding practices. The objective of the present research was to explore mothers' perspectives on infant formula use in Montevideo, the capital of Uruguay. A generic qualitative design was used to explore mothers' perspectives on the factors that act as enablers or barriers for infant formula use. Semi-structured interviews with thirty-four mothers of 0-23 months old children, aged between 25- and 40-years old, were conducted. The interview transcripts were analyzed using content analysis based on inductive-deductive coding considering the framework of the Capability, Opportunity, Motivation, and Behavior (COM-B) model. The discourse of the interviewees enabled the identification of a wide range of barriers and enablers for the use of infant formula, which were related to the three components of the model: capabilities, opportunity, and motivation. The health system emerged as the key determinant of infant formula use. Most of the participants who used infant formula referred to medical indication when explaining the reasons underlying their infant feeding decisions. The working status of the mother and emotional aspects of the child feeding experience were also identified as key enablers of infant formula use, whereas knowledge about health benefits and breastfeeding techniques, support from families and health-professionals, and motivation to breastfeed were key barriers. Taken together, these results suggest that strategies to reduce the use of infant formula in Uruguay should mainly focus on providing opportunities to breastfeed by improving the quality of the support and guidance provided to families in the health system and facilitating greater balance between breastfeeding and work.

Exploring factors influencing late evening eating and barriers and enablers to changing to earlier eating patterns in adults with overweight and obesity.

Late evening eating is a potential risk factor for overconsumption and weight gain. However, there is limited qualitative research investigating the complex factors that influence late evening eating in adults living with obesity. Identifying the factors that influence late evening eating can inform interventions to reduce late evening eating and associated health risks. Therefore, this study aimed to: i) explore factors that contribute to eating late, and ii) apply the Capability, Opportunity, and Motivation Behaviour (COM-B) model to understand the barriers and enablers to changing to earlier food intake timings in UK adults who report eating late. Semi-structured interviews with seventeen participants [32.47 ± 6.65 years; 34.68 ± 7.10 kg/m2; 71% female (n = 12); 41% White (n = 7)] investigated reasons for late evening eating and the potential barriers and enablers to changing to earlier eating patterns. Thematic analysis identified four main contributors to late evening eating: 1) internal signals (e.g., feeling hungry in the evening); 2) external and situational factors (e.g., work schedules and the food-rich environment); 3) social factors (e.g., interactions with family) and 4) behavioural and emotional factors (e.g., personal preferences and negative feelings in the evening). Time constraints and work schedules were identified as main barriers to changing to earlier eating patterns. Whereas, having high motivation (e.g., contentment with eating earlier in the evening) and interpersonal support were identified as main enablers to eating earlier. This study provides in-depth insights into the psychological, social, and environmental factors contributing to late evening eating. The findings highlight potential targets for future interventions to facilitate earlier eating times in individuals at risk of overweight and obesity.

Behavioural determinants of healthy and environmentally friendly diets in French university students.

Although encouraging the shift toward sustainable diets in young adults is a major challenge to preserve population and planet health, the precursors of sustainable diets in this population remain unknown. This study aimed to identify the behavioural determinants of healthier and more environmentally friendly diets among university students. A sample of 582 French university students reported their food consumption using an online 125-item food frequency questionnaire. The nutritional quality (adherence to French recommendations, sPNNS-GS2) and the greenhouse gas emissions (GHGE) of students' diets were calculated for an isocaloric diet. Behavioural determinants were measured based on a literature review and classified into the Capability, Opportunity, Motivation Behaviour (COM-B) framework. Linear models, adjusted for socioeconomic characteristics, were run to identify the most prominent behavioural predictors of nutritional quality and GHGE of students' diets. Higher cooking skills (ß = 0.38, p = 0.01) and health motives (ß = 0.91, p < 0.001) were associated with higher nutritional quality. Greater environmental knowledge was linked to lower GHGE (ß = -0.07, p = 0.002), while health and weight control motives were associated with higher GHGE (ß = 0.26, p = 0.02 and ß = 0.39, p < 0.001). Enhancing cooking skills and environmental knowledge could enable healthy and environmentally friendly diets, but health-based motives can act as a lever and as a barrier.

Streamlining COM-B model: Insights from the Healthy Eating Context.

The global rise in diet-related diseases highlights the urgent need for effective behavioural interventions. While theoretical frameworks like the Capability, Opportunity, Motivation-Behaviour (COM-B) model are valuable for understanding and influencing healthy eating behaviours, their practical application is often hindered by complexity and extensive measurement demands. This study addresses these challenges by testing a simplified version of the COM-B model, focusing on a select set of items representing seven core constructs. We conducted a cross-sectional survey with 347 Australian young adults to validate this streamlined model, making it more accessible for researchers and practitioners. Our findings underscore the importance of automatic motivation, the physical environment, and physical capability as critical factors in promoting healthy eating behaviours. By simplifying the COM-B model, this research contributes to developing more practical and effective strategies for healthier eating, addressing a critical public health issue.

Understanding family food purchasing behaviour of low-income urban UK families: An analysis of parent capability, opportunity and motivation.

OBJECTIVE: Family food purchasing decisions have a direct influence on children's food environments and are powerful predictors of obesity and dietary quality. This study explored parents' capability, opportunities, and motivations regarding food purchasing for their families, as well as barriers and facilitators of healthy food purchasing behaviour, in an ethnically diverse, low-income area. DESIGN: Semi-structured interviews with parents of under-11-year-old children were conducted to investigate family food purchases, both when eating inside and outside the home. Interviews were analysed using framework analysis mapped against the COM-B model (Michie et al., 2011). SETTING: An ethnically diverse, low-income area in Birmingham, UK. PARTICIPANTS: Sixteen parents (13F, 3M) of under-11-year-old children. 75% Pakistani, 12.5% White British, 6.3% White and Black Caribbean, and 6.3% "Other". RESULTS: Four themes were identified: i) I know how to provide healthy meals for my family, ii) Family food purchase decisions are complex, iii) I want what they are eating and iv) Healthy eating is important but eating outside of the home is a treat. The barriers of healthy family food purchasing were predominantly at family and community levels, including time, cost, and both parents' and children's food enjoyment and preferences. Facilitators of healthy family food purchasing were primarily identified at an individual level, with high levels of capability and motivation for healthy food provision. CONCLUSIONS: Attempts to enhance parental capability to improve healthy food purchasing through nutrition education is not likely to be a useful intervention target in this group. Emphasis on enjoyment, palatability and value for money could be key to increasing parental motivation to purchase healthy family foods.