Framework Development for Reducing Attrition in Digital Dietary Interventions: Systematic Review and Thematic Synthesis.

BACKGROUND: Dietary behaviors significantly influence health outcomes across populations. Unhealthy diets are linked to serious diseases and substantial economic burdens, contributing to approximately 11 million deaths and significant disability-adjusted life years annually. Digital dietary interventions offer accessible solutions to improve dietary behaviors. However, attrition, defined as participant dropout before intervention completion, is a major challenge, with rates as high as 75%-99%. High attrition compromises intervention validity and reliability and exacerbates health disparities, highlighting the need to understand and address its causes. OBJECTIVE: This study systematically reviews the literature on attrition in digital dietary interventions to identify the underlying causes, propose potential solutions, and integrate these findings with behavior theory concepts to develop a comprehensive theoretical framework. This framework aims to elucidate the behavioral mechanisms behind attrition and guide the design and implementation of more effective digital dietary interventions, ultimately reducing attrition rates and mitigating health inequalities. METHODS: We conducted a systematic review, meta-analysis, and thematic synthesis. A comprehensive search across 7 electronic databases (PubMed, MEDLINE, Embase, CENTRAL, Web of Science, CINAHL Plus, and Academic Search Complete) was performed for studies published between 2013 and 2023. Eligibility criteria included original research exploring attrition in digital dietary interventions. Data extraction focused on study characteristics, sample demographics, attrition rates, reasons for attrition, and potential solutions. We followed ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used RStudio (Posit) for meta-analysis and NVivo for thematic synthesis. RESULTS: Out of the 442 identified studies, 21 met the inclusion criteria. The meta-analysis showed mean attrition rates of 35% for control groups, 38% for intervention groups, and 40% for observational studies, with high heterogeneity (I²=94%-99%) indicating diverse influencing factors. Thematic synthesis identified 15 interconnected themes that align with behavior theory concepts. Based on these themes, the force-resource model was developed to explore the underlying causes of attrition and guide the design and implementation of future interventions from a behavior theory perspective. CONCLUSIONS: High attrition rates are a significant issue in digital dietary interventions. The developed framework conceptualizes attrition through the interaction between the driving force system and the supporting resource system, providing a nuanced understanding of participant attrition, summarized as insufficient motivation and inadequate or poorly matched resources. It underscores the critical necessity for digital dietary interventions to balance motivational components with available resources dynamically. Key recommendations include user-friendly design, behavior-factor activation, literacy training, force-resource matching, social support, personalized adaptation, and dynamic follow-up. Expanding these strategies to a population level can enhance digital health equity. Further empirical validation of the framework is necessary, alongside the development of behavior theory-guided guidelines for digital dietary interventions. TRIAL REGISTRATION: PROSPERO CRD42024512902; https://tinyurl.com/3rjt2df9.

Evaluating the Need for Competency-Based Pharmacy Education (CBPE): The Report of the 2023-2024 Academic Affairs Standing Committee.

The 2023-2024 Academic Affairs Committee was charged to create a sense of urgency around the concept of Competency-Based Pharmacy Education and develop a "readiness for change" instrument that is based on the 5 essential elements that make up the definition of Competency-Based Pharmacy Education. This report describes the process undertaken by the committee to determine the societal needs of pharmacists and current state of pharmacy practice and pharmacy education. The practice gaps in pharmacy education and the key drivers needed to close these gaps are evaluated. To complete the charges, the committee conducted evidence-based literature reviews and completed a series of focus groups with stakeholders and thought leaders with experience in competency-based education.

A Nutrition-Focused Approach During Continuous Glucose Monitoring Initiation in People With Type 2 Diabetes: Using a Theoretical Framework to Unite Continuous Glucose Monitoring and Food Choices.

Continuous glucose monitoring (CGM) has transformed diabetes care, yet opportunities for further innovations still exist. Some research suggests CGM could be an ideal tool to guide food choices and other healthy lifestyle behaviors, especially for people with type 2 diabetes (T2D). Behavior change theories can be used to understand and describe how CGM users make food-related decisions, which could ultimately lead to the design of more tailored and effective interventions. In this commentary, we describe what it looks like to use the behavior change wheel-a theory-based intervention development framework-to design an intervention for people with T2D who will use CGM data to guide food choices aligned with evidence-based nutrition recommendations. Such frameworks may be beneficial when designing or evaluating future technology-focused behavior change interventions.

A Framework for Implementing Disease Prevention and Behavior Change Evidence at Scale.

The current corpus of evidence-based information for chronic disease prevention and treatment is vast and growing rapidly. Behavior change theories are increasingly more powerful but difficult to operationalize in the current healthcare system. Millions of Canadians are unable to access personalized preventive and behavior change care because our in-person model of care is running at full capacity and is not set up for mass education and behavior change programs. We propose a framework to utilize data from electronic medical records to identify patients at risk of developing chronic disease and reach out to them using digital health tools that are overseen by the primary care team. The framework leverages emerging technologies such as artificial intelligence, digital health tools, and patient-generated data to deliver evidence-based knowledge and behavior change to patients across Canada at scale. The framework is flexible to enable new technologies to be added without overwhelming providers, patients or implementers.

Understanding Physical Distancing and Face Mask Use Across High-Risk African American Subgroups During the COVID-19 Pandemic: Application of Health Belief Model.

Physical distancing and face masks remain frontline prevention strategies due to suboptimal vaccine uptake and the highly infectious COVID-19 variants. Communities of color are disproportionately impacted by a chronic disease burden that places them at higher risk of severe COVID-19 disease. Therefore, they can greatly benefit from face mask use and physical distancing, especially if the individual(s) have not received the vaccine. We applied the Health Belief Model to explore barriers and motivators influencing physical distancing and face mask use among high-risk, Black American subgroups during the early COVID-19 pandemic stages. We conducted 62 semi-structured interviews among four Black American subgroups: young adults, individuals with underlying medical conditions, essential workers, and parents. Thematic analysis, guided by the Health Belief Model, yielded six themes: (1) Knowledge on Face Mask Use and Physical Distancing, (2) Perceived Susceptibility and Severity Varies by Subgroup, (3) Experience with and Perceived Self-Efficacy to Engage in Preventive Behavior, (4) Perceived Benefits to engaging in preventive behaviors, (5) Perceived Barriers to engage in preventive behaviors, and (6) Cues to action to increase participation. Each subgroup's unique experience informed multilevel, tailored approaches that can be used by health promotion practitioners to improve face mask use and physical distancing among uniquely vulnerable Black American subgroups in the current and future pandemic.

Developing the capability of digital financial literacy in developing countries: A Case of online loan for small entrepreneurs.

The rapid growth of digital financial services especially during the COVID-19 outbreak, is a factor accelerating the use of online loan applications that inevitably require the knowledge of digital finance. This study used the behavior change theory and digital financial literacy to identify relevant and correlated variables to confirm positive motivational factors on digital financial skills and capability. Structure equation modeling (SEM) and path analysis were applied to find the correlation and confirm the proposed hypotheses presented. There were 400 samples of small entrepreneurs from different provinces, and online questionnaires were used for data collection. The findings showed that the knowledge and motivation variables were related and had a positive effect. It contributes to continuously building up the skills and capabilities of small entrepreneurs who need to develop their capabilities in digital financial literacy adequately in line with the changes in business and technology after the outbreak of COVID-19. This concept can apply to online loan policy for small entrepreneurs trained with motivating courses who accepted digital finance literacy's usefulness.

Supporting meaningful research partnerships: an interview study applying behavior change theory to develop relevant recommendations for researchers.

Research partnerships, while promising for ensuring translation of relevant and useable findings, are challenging and need support. This study aimed to apply behavior change theory to understand and support researchers' adoption of a research partnership approach and the Integrated Knowledge Translation (IKT) Guiding Principles for conducting and disseminating spinal cord injury (SCI) research in partnership. Using an IKT approach, SCI researchers across Canada and the USA completed a survey (n = 22) and were interviewed (n = 13) to discuss barriers and facilitators to deciding to partner and follow the IKT Guiding Principles. The Behaviour Change Wheel, Theoretical Domains Framework (TDF), and Mode of Delivery Ontology were used to develop the survey, interview questions, and guided analyses of interview data. COM-B and TDF factors were examined using descriptive statistics and abductive analyses of barriers and facilitators of decisions to partner and/or use the IKT Guiding Principles. TDF domains from the interview transcripts were then used to identify intervention, content, and implementation options. 142 factors (79 barriers, 63 facilitators) related to deciding to partner, and 292 factors (187 barriers, 105 facilitators) related to deciding to follow the IKT Guiding Principles were identified. Barriers to partnering or use the IKT Guiding Principles were primarily related to capability and opportunity and relevant intervention options were recommended. Interventions must support researchers in understanding how to partner and use the IKT Guiding Principles while navigating a research system, which is not always supportive of the necessary time and costs required for meaningful research partnerships.

Research partnerships, which expand beyond researchers solely working with other researchers, are said to be promising for helping to move research into practice. However, there is a lack in understanding of how to support meaningful research partnerships with those who are not part of academia. This study interviewed spinal cord injury researchers to understand what helps and prevents them from deciding to partner when conducting research projects. Results suggest that researchers do not lack motivation to partner; however, their ability and opportunity to do so is lacking. Overall, support is needed to help researchers understand how to work in partnership within the research system.

Preschool- and childcare center-based interventions to increase fruit and vegetable intake in preschool children in the United States: a systematic review of effectiveness and behavior change techniques.

BACKGROUND: Fruit and vegetable (FV) consumption in children in the United States (US) is very low. Adequate FV consumption is required for proper development during childhood, and dietary habits are established during preschool-age and tend to persist into adulthood. As most U.S. preschool-aged children attend childcare or preschool, this may be an opportune time and setting to conduct interventions to improve FV intake. These interventions should be based in theory and use behavior change techniques (BCTs) to explain mechanisms for expected change. To date, no published reviews have examined the effectiveness of childcare- or preschool-based FV interventions in preschoolers and their use of theoretical frameworks and BCTs. METHODS: This systematic review was completed adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were randomized controlled trials (RCTs) published between 2012 and 2022 of interventions to improve diet or FV intake in preschoolers (aged 2-5 years) in childcare or preschool-settings. A search of four databases was conducted between in September 2022 using search terms pertaining to the study's primary aim (FV consumption), age group (preschool-aged), settings (US childcare or preschool settings), and study design (RCT). Additional criteria were objective measures of FV consumption or skin carotenoids, as a proxy for FV intake. Included studies were narratively synthesized based on intervention type, measured effect, and use of theory and BCTs. RESULTS: The search resulted in six studies that reported on nine interventions. Overall, six interventions increased FV intake, of which five used nutrition education and one manipulated the feeding environment. Among the three interventions with no measured effect, two manipulated the feeding environment and one used peer modeling. Effective studies used at least three BCTs, though no pattern was observed between use of theory or BCTs and intervention effect. CONCLUSIONS: While several studies have shown promising results, the limited number of studies identified in this review highlights key gaps in this field: there is a need for studies to test FV interventions in US childcare settings that use objective measures of FV intake, directly compare intervention components and BCTs, are theory-based, and assess long-term behavior change.

Using Behavior Change Theory to Identify Drivers and Barriers for Antifungal Treatment Decisions: A Case Study in a Large Teaching Hospital in the East of England, UK.

INTRODUCTION: Antifungal stewardship (AFS) programs are recognized to contribute to optimizing antifungal prescribing for treatment and prophylaxis. However, only a small number of such programs are implemented. Consequently, evidence on behavioral drivers and barriers of such programs and learnings from existing successful AFS programs is limited. This study aimed to leverage a large AFS program in the UK and derive learnings from it. The objective was to (a) investigate the impact of the AFS program on prescribing habits, (a) use a Theoretical Domains Framework (TDF) based on the COM-B (Capability, Opportunity, and Motivation for Behavior) to qualitatively identify drivers and barriers for antifungal prescribing behaviors across multiple specialties, and (c) semiquantitatively investigate trends in antifungal prescribing habits over the last 5 years. METHODS: Qualitative interviews and a semiquantitative online survey were conducted across hematology, intensive care, respiratory, and solid organ transplant clinicians at Cambridge University Hospital. The discussion guide and survey used were developed to identify drivers of prescribing behavior, based on the TDF. RESULTS: Responses were received from 21/25 clinicians. Qualitative outcomes demonstrated that the AFS program was effective in supporting optimal antifungal prescribing practices. We found seven TDF domains influencing antifungal prescribing decisions-five drivers and two barriers. The key driver was collective decision-making among the multidisciplinary team (MDT) while key barriers were lack of access to certain therapies and fungal diagnostic capabilities. Furthermore, over the last 5 years and across specialties, we observed an increasing tendency for prescribing to focus on more targeted rather than broad-spectrum antifungals. CONCLUSIONS: Understanding the basis for linked clinicians' prescribing behaviors for identified drivers and barriers may inform interventions on AFS programs and contribute to consistently improving antifungal prescribing. Collective decision-making among the MDT may be leveraged to improve clinicians' antifungal prescribing. These findings may be generalized across specialty care settings.

Self-Monitoring of Physical, Cognitive, and Social Activities and 2-Year Disability Onset in Community-Dwelling Older Adults.

OBJECTIVES: Self-monitoring of physical, cognitive, and social activities may be a means of helping older adults to adopt or maintain an active lifestyle, but its effect on disability onset is unknown. This study aimed to examine the association between self-monitoring of the activities and disability onset in older adults. DESIGN: Longitudinal, observational study. SETTING AND PARTICIPANTS: General community setting. Participants were 1399 older adults aged ≥75 years (mean age: 79.3 ± 3.6 years; 48.1% female). METHODS: Participants conducted self-monitoring of physical, cognitive, and social activities using a specialized booklet and a pedometer. Level of engagement in self-monitoring was assessed based on the percentage of days in a year for which activities were recorded: no-engagement group (0% of days recorded; n = 438), midlevel-engagement group (0.1-89.9% of days recorded; n = 416), and high-engagement group (≥90% of days recorded; n = 545). Disability onset was determined by whether the participants were awarded a long-term care insurance certification over the 2 years after the explanation of the booklet and pedometer. RESULTS: Cox proportional hazard regression models showed that the high-engagement group, when compared to the no-engagement group, had a significantly reduced hazard ratio (HR) for disability onset, after adjustment for covariates (HR 0.54, 95% CI 0.34-0.86, P = .010). After propensity score adjustment through inverse probability of treatment weighting (IPTW) and propensity score matching (PSM), the high-engagement group's HR remained significantly lower (IPTW: HR 0.54, 95% CI 0.34-0.86, P = .010; PSM: HR 0.58, 95% CI 0.35-0.96, P = .032). CONCLUSIONS AND IMPLICATIONS: Self-monitoring of physical, cognitive, and social activities reduces the risk of 2-year disability onset in community-dwelling older adults. Further studies in other settings are needed to examine whether self-monitoring of activities can be a population approach for the primary prevention of disability in other settings.

Developing a Suite of Resources to Improve Patient Adherence to Compression Stockings: Application of Behavior Change Theory.

Purpose: Poor patient adherence to compression stockings remains a difficult and pervasive problem for clinicians, with costly repercussions for patients and health-care systems. The purpose of this paper was to describe the application of behavior change theory to the systematic development of a suite of resources, aimed at improving patient adherence to wearing compression stockings. Methods: Employing a non-empirical approach, behavior-change theory was used to develop an innovative intervention as part of a multi-phase project. Target behaviors, barriers and potential enablers were identified in relation to stocking adherence. An impact-likelihood matrix for behavior prioritization was used to identify possible areas for intervention within occupational therapy outpatient clinics. Selection of suitable resources and their consequent development were based on a narrative and problem-solving process by a panel of clinical experts. Results: Of 14 potential domains embedded in the Theoretical Domains Framework, the key target behaviors and barriers were associated with eight domains. Michie's Behavior Change Wheel revealed recommendations in six subdivisions and of these, four intervention functions were selected by the panel, based on their potential impact and likelihood of adoption in clinical practice. Findings led to the development of a suite of resources comprising a new questionnaire, a clinical decision tree, augmented by clinical answer sheets corresponding to each of the barriers. Conclusion: Application of behavior change theory informed the design of a behavior change intervention comprising an integrated suite of resources for novice and experienced clinicians. Practice Implications: These novel resources have potential to improve patient adherence to compression stockings and consequently generate health-care savings through reduced need for wound care products, and medical interventions with translation to other settings and conditions requiring compression stockings. Patient outcomes will likely be improved with reduced pain, improved quality of life and earlier resumption of usual occupations.

Personalization of Mobile Apps for Health Behavior Change: Protocol for a Cross-sectional Study.

BACKGROUND: Mobile health apps have the potential to motivate people to adopt healthier behavior, but many fail to maintain this behavior over time. However, it has been suggested that long-term adherence can be improved by personalizing the proposed interventions. Based on the literature, we created a conceptual framework for selecting appropriate functionalities according to the user's profile. OBJECTIVE: This cross-sectional study aims to investigate if the relationships linking functionalities and profiles proposed in our conceptual framework are confirmed by user preferences. METHODS: A web-based questionnaire comprising several sections was developed to determine the mobile app functionalities most likely to promote healthier behavior. First, participants completed questionnaires to define the user profile (Big Five Inventory-10, Hexad Scale, and perception of the social norm using dimensions of the Theory of Planned Behavior). Second, participants were asked to select the 5 functionalities they considered to be the most relevant to motivate healthier behavior and to evaluate them on a score ranging from 0 to 100. We will perform logistic regressions with the selected functionalities as dependent variables and with the 3 profile scales as predictors to allow us to understand the effect of the participants' scores on each of the 3 profile scales on the 5 selected functionalities. In addition, we will perform logistic ordinal regressions with the motivation score of the functionalities chosen as dependent variables and with scores of the 3 profile scales as predictors to determine whether the scores on the different profile scales predict the functionality score. RESULTS: Data collection was conducted between July and December 2021. Analysis of responses began in January 2022, with the publication of results expected by the end of 2022. CONCLUSIONS: This study will allow us to validate our conceptual model by defining the preferred functionalities according to user profiles. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/38603.

Evaluation of a Healthy Checkout Lane "Nudge" on Grocery and Convenience Store Sales of a Price-Promoted Nutritious Food.

Grocery store intervention trials, including trials testing behavioral economics "nudges," may change food-purchasing behaviors and improve diet quality. This study aimed to design and evaluate a grocery store healthy checkout lane "nudge" intervention on sales of a targeted healthy item. We conducted a randomized controlled trial based on the behavioral economic concept of cognitive fatigue and the marketing concept of impulse buying. Six grocery stores from one North Carolina-based chain were randomized to the intervention (n = 3) or control (n = 3) condition. Researchers tested a 4-week healthy checkout lane intervention, in which intervention stores moved 6-ounce cans of peanuts to the cash registers. Cashiers were instructed to upsell the peanuts to all shoppers at checkout. While not a component of the intervention, the retailer decreased the price of the peanuts from $1.99 to $1.50 during the first 2 weeks of the intervention. Fidelity to the checkout display was high. Fidelity to the upsell was low. The main outcome measure was aggregated store-level sales of the promoted peanuts for 4 weeks before the intervention and during the 4-week intervention period. On average, sales increased by 10 units/week in intervention stores (5.83 vs. 15.83 units, p = .04) with no significant change in control stores (1.42 vs. 1.17 units, p = .64). The difference (10 vs. -0.25 units, p = .02) was likely due to displaying the peanuts at checkout combined with the price promotion. Larger randomized controlled trials should examine whether healthy checkout lane interventions are effective "nudges" for promoting purchases of healthier foods in grocery stores.

Reverse Coding of a Common-Sense Physical Activity Intervention for Older Adults Using Elements of the Behaviour Change Wheel Framework.

"Common-sense" physical activity (PA) interventions for older adults may be more effective if developed in accordance with behavior change theory. One way to achieve this is through retrospectively applying a theoretical behavior change framework to "reverse code" an existing intervention and guide its ongoing development. This study aimed to detail a clear and systematic procedure that applied elements of the Behaviour Change Wheel (BCW) framework to reverse code the Active Ageing Pathway (AAP) intervention. The objectives of the procedure were to characterize the content of the AAP and its links to behavior change theory. The content of the AAP was first deconstructed through the examination of "standard operating procedures" documents, in-person observation, and a series of face-to-face discussions with AAP management. Then, the behavior change techniques (BCT) and BCW intervention functions associated with the AAP's content were identified and coded using the BCT Taxonomy version 1. Forty-one active components were identified within the AAP, which involved numerous professionals, and pertained to a diverse and interlinked range of factors, across various modes of delivery. The components were classified under 20 separate BCT labels, which related to eight of the nine BCW intervention functions. These outcomes were demonstrated to have practical applications for identifying gaps in intervention content as well as for guiding future intervention evaluation. This study supports previous work detailing the usefulness of reverse coding procedures as a tool for developing common-sense interventions, and is the first to do so in the context of a PA intervention for older adults.

Returning complex genetic risk information to promote better health-related behaviors: a commentary of the literature and suggested next steps.

Genome-wide association studies aim to identify genetic variants that are associated with a disease phenotype in order to enhance precision medicine efforts. Despite the excitement surrounding the promise of precision medicine and interest among the public in accessing personalized genetic information, there has been little effort dedicated to understanding how complex genetic risk information could be incorporated into clinical practice to inform prevention, screening, and treatment. In this article, we briefly summarize the literature on the impact of receiving genetic risk information on health-related behavior, discuss the limitations of these studies, and outline the challenges that will need to be overcome, along with suggested next steps for future studies, to understand the true promise of precision medicine. The current literature demonstrates that there is no consistent or strong evidence that receiving complex genetic risk information, such as polygenic risk scores, has an impact on behavior; however, there are a number of limitations that may impact the failure to find significant effects associated with receiving genetic feedback. Behavior change is a complex process and simply providing genetic risk information without incorporating a theoretical perspective on behavior change diminishes the potential impact of receiving genetic risk information on actual behavior change. Future studies and interventions which return genetic feedback should be designed using theoretical frameworks of behavior change models to improve the impact of receiving personalized genetic information.

The basis of precision medicine is to use an individual's personal genetic information, such as a polygenic risk score, along with lifestyle information and personal medical history, to promote better health outcomes. The utility of polygenic risk scores relies on the assumption that receiving complex genetic feedback will motivate changes in behavior that reduces one's risk for developing a medical condition. To date, there is no consistent or strong evidence that receiving complex genetic risk information, such as polygenic risk scores, influences behavior change. However, the literature on how to effectively deliver polygenic risk scores is small. Prior studies assessing the impact of receiving complex genetic risk information have several limitations that may impact the failure to find that individuals take action or change health behaviors after receiving genetic feedback. One way to address these limitations is to incorporate theories of behavior change, such as the Health Belief Model, into the way in which genetic risk information is returned. Designing intervention programs grounded in theories of behavior change and developing testable hypotheses related to theoretical mechanisms of change are important next steps.

Feasibility of a Theory-Based, Online Tailored Message Program to Motivate Healthier Behaviors in College Women.

We aimed to test the feasibility of an online survey and tailored message program in young women. Recruited from college campuses, women (n = 189) completed an online survey assessing preference for and behaviors toward diet and physical activity as well as theory-based influencers of these behaviors (knowledge/information, motivation, and confidence). Health messages were tailored to the participant's survey responses and learning style to address misconceptions and motivate or reinforce healthy physical activity and dietary behaviors. Most women reported the survey as relevant (92%) and useful for reflecting on their health (83%), with survey responses variable in level of nutrition and physical activity knowledge, motivation, and confidence. Each woman received four tailored messages-most reported the messages as relevant (80%) and learning new information (60%). Across all messages, nearly half of the participants (~48%) reported willingness to try or maintain healthier behaviors and confidence in their ability. Body size discrepancy and dietary restraint had small effects message responses of information learned, and the motivation and confidence in trying healthier behaviors. In summary, these data support the feasibility of this online tailored message program. The college women found the tailored message program acceptable and useful to motivate healthier behaviors. The findings provide direction for behaviorally focused interventions to improve dietary and physical activity behaviors.

The COMPASS study: A prospective, randomized, multi-center trial testing the impact of a clinic-based intervention informing patients of colorectal cancer screening options on screening completion.

BACKGROUND: Colorectal cancer (CRC) screening is underutilized despite evidence that screening improves survival. Since healthcare provider recommendation is a strong predictor of CRC screening completion, providers are encouraged to engage eligible patients in collaborative decision-making that attends to patients' values, needs, and preferences for guideline-concordant screening modalities. METHODS: This three-arm randomized controlled trial is testing the effectiveness of an evidence-based video intervention informing patients of screening choices delivered in a clinic prior to a healthcare appointment. We hypothesize that participants randomized to watch a basic video describing CRC and screening in addition to an informed choice video showing the advantages and disadvantages of fecal immunochemical test (FIT), stool DNA FIT (s-DNA FIT), and colonoscopy (Arm 3) will exhibit a greater proportion of time adherent to CRC screening guidelines after 1, 3 and 6 years than those who only watch the basic video (Arm 2) or no video at all (Arm 1). Primary care and Obstetrician/Gynecology clinics across the United States are recruiting 5280 patients, half who have never been screened and half who previously screened but are currently not guideline adherent. Participants complete surveys prior to and following an index appointment to self-report personal, cognitive, and environmental factors potentially associated with screening. Proportion of time adherent to screening guidelines will be assessed using medical record data and supplemented with annual surveys self-reporting screening. CONCLUSION: Results will provide evidence on the effectiveness of informational and motivational videos to encourage CRC screening that can be easily integrated into clinical practice. CLINICALTRIALS: gov #NCT05246839.

Evaluation of Digital Interventions for Physical Activity Promotion: Scoping Review.

BACKGROUND: Digital interventions are interventions supported by digital tools or technologies, such as mobile apps, wearables, or web-based software. Digital interventions in the context of public health are specifically designed to promote and improve health. Recent reviews have shown that many digital interventions target physical activity promotion; however, it is unclear how such digital interventions are evaluated. OBJECTIVE: We aimed to investigate evaluation strategies in the context of digital interventions for physical activity promotion using a scoping review of published reviews. We focused on the target (ie, user outcomes or tool performance), methods (ie, tool data or self-reported data), and theoretical frameworks of the evaluation strategies. METHODS: A protocol for this study was preregistered and published. From among 300 reviews published up to March 19, 2021 in Medline, PsycINFO, and CINAHL databases, 40 reviews (1 rapid, 9 scoping, and 30 systematic) were included in this scoping review. Two authors independently performed study selection and data coding. Consensus was reached by discussion. If applicable, data were coded quantitatively into predefined categories or qualitatively using definitions or author statements from the included reviews. Data were analyzed using either descriptive statistics, for quantitative data (relative frequencies out of all studies), or narrative synthesis focusing on common themes, for qualitative data. RESULTS: Most reviews that were included in our scoping review were published in the period from 2019 to 2021 and originated from Europe or Australia. Most primary studies cited in the reviews included adult populations in clinical or nonclinical settings, and focused on mobile apps or wearables for physical activity promotion. The evaluation target was a user outcome (efficacy, acceptability, usability, feasibility, or engagement) in 38 of the 40 reviews or tool performance in 24 of the 40 reviews. Evaluation methods relied upon objective tool data (in 35/40 reviews) or other data from self-reports or assessments (in 28/40 reviews). Evaluation frameworks based on behavior change theory, including goal setting, self-monitoring, feedback on behavior, and educational or motivational content, were mentioned in 22 out of 40 reviews. Behavior change theory was included in the development phases of digital interventions according to the findings of 20 out of 22 reviews. CONCLUSIONS: The evaluation of digital interventions is a high priority according to the reviews included in this scoping review. Evaluations of digital interventions, including mobile apps or wearables for physical activity promotion, typically target user outcomes and rely upon objective tool data. Behavior change theory may provide useful guidance not only for development of digital interventions but also for the evaluation of user outcomes in the context of physical activity promotion. Future research should investigate factors that could improve the efficacy of digital interventions and the standardization of terminology and reporting in this field. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/35332.

Development and evaluation of the red flag campaign for the primary prevention of sexual and dating violence on college campuses.

Objective Sexual and dating violence (SV/DV) on college campuses is a pervasive problem with far-reaching implications for public health. This paper describes the development and evaluation of a widely disseminated SV/DV primary prevention program, the Red Flag Campaign (RFC). Participants and Methods: An online survey was administered to 203 freshmen at a southeastern US university, of whom 82% reported exposure to the RFC in the previous month. Results: College students exposed to the RFC reported greater efficacy for intervening as a bystander compared to those students who were not exposed. These results held when looking at exposure to RFC messages specifically, but not RFC events. Conclusions: This evaluation offers preliminary evidence that the RFC is effective at increasing determinants of prosocial bystander behavior, the enactment of which could reduce SV/DV on college campuses. Implications and recommendations for college personnel implementing the RFC are discussed.

Vaccine hesitancy and behavior change theory-based social media interventions: a systematic review.

It is widely acknowledged that vaccine hesitancy is a multifaceted problem that cannot be addressed by a single strategy. Behavior change theories and social media tools may together help to guide the design of interventions aimed at improving vaccination uptake. This systematic review aims to identify the breadth and effectiveness of such theories and tools. The systematic review search was performed in PubMed, Scopus, ACM, Cochrane Library, ProQuest, and Web of Science databases for studies between January 2011 and January 2021 that applied social media tools to increase vaccine confidence or improve vaccination uptake. The literature search yielded a total of 3,065 publications. Twenty articles met the eligibility criteria, 12 of which were theory-based interventions. The result shows that the Health Belief Model was the most frequently deployed theory, and the most common social media tool was educational posts, followed by dialogue-based groups, interactive websites, and personal reminders. Theory-based interventions were generally more measurable and comparable and had more evidence to trigger the positive behavior change. Fifteen studies reported the effectiveness in knowledge gain, intention increase, or behavior change. Educational messages were proved to be effective in increasing knowledge but less helpful in triggering behavior change. Dialogue-based social media intervention performed well in improving people's intention to vaccinate. Interventions informed by behavior change theory and delivered via social media platforms offer an important opportunity for addressing vaccine hesitancy. This review highlights the need to use a multitheory framework and tailoring social media interventions to the specific circumstances and needs of the target audience in future interventions. The results and insights gained from this review will be of assistance to future studies.