The prevention of arboviral diseases using mobile devices: a preliminary study of the attitudes and behaviour change produced by educational interventions.

OBJECTIVES: In Brazil, the National Policy for Dengue Control seeks to incorporate the lessons of national and international experience in dengue control, emphasising the need for health education activities. The objective of this study was to evaluate and compare knowledge, attitudes and behaviours related to the prevention of arboviruses before and after a two-month educational intervention using a learning platform on mobile devices. METHODS: This quasi-experimental study corresponds to the first phase of the project 'Impact of mobile learning in the prevention and management of complications caused by arboviruses (Zika, Dengue, Chikungunya) - ZIKAMOB', sponsored as part of the British Council Newton Fund. RESULTS: Thirty of the 93 participants were first-year undergraduate university students (36.7% male), and 63 were police officers (84.1% male). The pattern of attitudes and behaviour was very similar in both groups before the intervention. The students changed their attitudes and behaviour (P = 0.032) in relation to their engagements in actions for the prevention of arboviral diseases and several other activities related to house inspections and precautions with water tanks (P < 0.01). However, recycling and surveillance activities were not as effective in changing behaviour. Female participants showed more motivation to participate in preventive activities, but living alone and working were barriers to participation. Individuals who already perform selective waste collection and are cultivating gardens demonstrated both a positive attitude and a positive behaviour towards actions for the prevention of arboviral diseases. CONCLUSION: Mobile learning and behaviour change theories might be successful as the basis for school-based and community-based interventions to avoid arboviruses. These outcomes need to be confirmed in broader future studies.

OBJECTIFS: Au Brésil, la politique nationale de lutte contre la dengue cherche à intégrer les leçons tirées des expériences nationales et internationales en matière de lutte contre la dengue, en insistant sur la nécessité d'activités d'éducation sur la santé. L'objectif de cette étude était d'évaluer et de comparer les connaissances, les attitudes et les comportements liés à la prévention des arbovirus avant et après une intervention éducative de deux mois à l'aide d'une plate-forme d'éducation basée sur des appareils mobiles. MÉTHODES: Cette étude quasi expérimentale correspond à la première phase du projet "Impact de l'éducation mobile dans la prévention et la prise en charge des complications causées par les arbovirus (Zika, Dengue, Chikungunya) - ZIKAMOB", parrainé dans le cadre du British Council Newton Fund. RÉSULTATS: Trente des 93 participants étaient des étudiants de première année d'université (36,7% d'hommes) et 63 étaient des agents de police (84,1% d'hommes). Le modèle des attitudes et de comportement était très similaire dans les deux groupes avant l'intervention. Les étudiants ont changé leurs attitudes et comportements (P = 0,032) en ce qui concerne leur participation à des actions de prévention des maladies à arbovirus et à plusieurs autres activités liées aux inspections des maisons et aux précautions d'utilisation des réservoirs d'eau (P < 0,01). Cependant, les activités de recyclage et de surveillance n'étaient pas aussi efficaces pour le changement de comportement. Les participantes étaient plus motivées à participer aux activités de prévention, mais le fait de vivre seul et de travailler constituait un obstacle à la participation. Les personnes qui effectuent déjà une collecte sélective des déchets et cultivent des jardins ont démontré à la fois une attitude positive et un comportement positif à l'égard des actions de prévention des maladies à arbovirus. CONCLUSION: Les théories sur l'éducation mobile et le changement de comportement pourraient être couronnées de succès en tant que base d'interventions en milieu scolaire et communautaire visant à éviter les arbovirus. Ces résultats doivent être confirmés dans des études supplémentaires plus larges.

[Nursing students, key players in health services]. / Les étudiants en soins infirmiers, acteurs clés du service sanitaire.

The health service, which came into effect in September 2018, concerns all health-care students. Nursing students were among the first to get involved in nursing fields in a variety of settings where the population could get involved in raising awareness of healthy behaviours. A group of nursing students from a school in Île-de-France attests to their involvement in this innovation.

Comparing the behavioural impact of a nudge-based handwashing intervention to high-intensity hygiene education: a cluster-randomised trial in rural Bangladesh.

OBJECTIVE: To determine the impact of environmental nudges on handwashing behaviours among primary school children as compared to a high-intensity hygiene education intervention. METHODS: In a cluster-randomised trial (CRT), we compared the rates of handwashing with soap (HWWS) after a toileting event among primary school students in rural Bangladesh. Eligible schools (government run, on-site sanitation and water, no hygiene interventions in last year, fewer than 450 students) were identified, and 20 schools were randomly selected and allocated without blinding to one of four interventions, five schools per group: simultaneous handwashing infrastructure and nudge construction, sequential infrastructure then nudge construction, simultaneous infrastructure and high-intensity hygiene education (HE) and sequential handwashing infrastructure and HE. The primary outcome, incidence of HWWS after a toileting event, was compared between the intervention groups at different data collection points with robust-Poisson regression analysis with generalised estimating equations, adjusting for school-level clustering of outcomes. RESULTS: The nudge intervention and the HE intervention were found to be equally effective at sustained impact over 5 months post-intervention (adjusted IRR 0.81, 95% CI 0.61-1.09). When comparing intervention delivery timing, the simultaneous delivery of the HE intervention significantly outperformed the sequential HE delivery (adjusted IRR 1.58 CI 1.20-2.08), whereas no significant difference was observed between sequential and simultaneous nudge intervention delivery (adjusted IRR 0.75, 95% CI 0.48-1.17). CONCLUSION: Our trial demonstrates sustained improved handwashing behaviour 5 months after the nudge intervention. The nudge intervention's comparable performance to a high-intensity hygiene education intervention is encouraging.

Effect of hygiene interventions on acute respiratory infections in childcare, school and domestic settings in low- and middle-income countries: a systematic review.

OBJECTIVES: Acute respiratory infections (ARIs) disproportionately affect those living in low- and middle-income countries (LMICs). We aimed to determine whether hygiene interventions delivered in childcare, school or domestic settings in LMICs effectively prevent or reduce ARIs. METHODS: We registered our systematic review with PROSPERO (CRD42017058239) and searched MEDLINE, EMBASE, CENTRAL, and Scopus from inception to 17 October 2017 for randomised controlled trials (RCTs) examining the impact of hygiene interventions on ARI morbidity in adults and children in community-based settings in LMICs. We stratified data into childcare, school and domestic settings and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess evidence quality. RESULTS: We identified 14 cluster RCTs evaluating hand-hygiene interventions in LMICs with considerable heterogeneity in setting, size, intervention delivery and duration. We found reduced ARI-related absenteeism and illness in childcare settings (low- to moderate-quality evidence). In school settings, we found reduced ARI-related absenteeism and laboratory-confirmed influenza (moderate- to high-quality evidence), but no reduction in ARI illness (low-quality evidence). In domestic settings, we found reduced ARI illness and pneumonia amongst children in urban settlements (high-quality evidence) but not in rural settlements (low-quality evidence), and no effect on secondary transmission of influenza in households (moderate-quality evidence). CONCLUSIONS: Evidence suggests that hand-hygiene interventions delivered in childcare, school and domestic settings can reduce ARI morbidity, but effectiveness varies according to setting, intervention target and intervention compliance. Further studies are needed to develop, deliver and evaluate targeted and sustainable hygiene interventions in LMICs.

Behaviour change intervention to improve shared toilet maintenance and cleanliness in urban slums of Dhaka: a cluster-randomised controlled trial.

OBJECTIVES: Shared toilets in urban slums are often unclean and poorly maintained, discouraging consistent use and thereby limiting impacts on health and quality of life. We developed behaviour change interventions to support shared toilet maintenance and improve user satisfaction. We report the intervention effectiveness on improving shared toilet cleanliness. METHODS: We conducted a cluster-randomised controlled trial among users of 1226 shared toilets in 23 Dhaka slums. We assessed baseline toilet cleanliness in January 2015. The six-month intervention included provision of hardware (bin for solid waste, 4 l flushing bucket, 70 l water reservoir), and behaviour change communication (compound meetings, interpersonal household sessions, signs depicting rules for toilet use). We estimated the adjusted difference in difference (DID) to assess outcomes and accounted for clustering effects using generalised estimating equations. RESULTS: Compared to controls, intervention toilets were more likely to have water available inside toilet cubicles (DID: +4.7%, 95% CI: 0.2, 9.2), access to brush/broom for cleaning (DID: +8.4%, 95% CI: 2, 15) and waste bins (DID: +63%, 95% CI: 59, 66), while less likely to have visible faeces inside the pan (DID: -13%, 95% CI: -19, -5), the smell of faeces (DID: -7.6%, 95% CI: -14, -1.3) and household waste inside the cubicle (DID: -4%, 95% CI: -7, -1). CONCLUSIONS: In one of few efforts to promote shared toilet cleanliness, intervention compounds were significantly more likely to have cleaner toilets after six months. Future research might explore how residents can self-finance toilet maintenance, or employ mass media to reduce per-capita costs of behaviour change.

Does targeting children with hygiene promotion messages work? The effect of handwashing promotion targeted at children, on diarrhoea, soil-transmitted helminth infections and behaviour change, in low- and middle-income countries.

OBJECTIVES: To synthesise evidence on the effect of handwashing promotion interventions targeting children, on diarrhoea, soil-transmitted helminth infection and handwashing behaviour, in low- and middle-income country settings. METHODS: A systematic review of the literature was performed by searching eight databases, and reference lists were hand-searched for additional articles. Studies were reviewed for inclusion according to pre-defined inclusion criteria and the quality of all studies was assessed. RESULTS: Eight studies were included in this review: seven cluster-randomised controlled trials and one cluster non-randomised controlled trial. All eight studies targeted children aged 5-12 attending primary school but were heterogeneous for both the type of intervention and the reported outcomes so results were synthesised qualitatively. None of the studies were of high quality and the large majority were at high risk of bias. The reported effect of child-targeted handwashing interventions on our outcomes of interest varied between studies. Of the different interventions reported, no one approach to promoting handwashing among children appeared most effective. CONCLUSION: Our review found very few studies that evaluated handwashing interventions targeting children and all had various methodological limitations. It is plausible that interventions which succeed in changing children's handwashing practices will lead to significant health impacts given that much of the attributable disease burden is concentrated in that age group. The current paucity of evidence in this area, however, does not permit any recommendations to be made as to the most effective route to increasing handwashing with soap practice among children in LMIC.

If I do not have enough water, then how could I bring additional water for toilet cleaning?! Addressing water scarcity to promote hygienic use of shared toilets in Dhaka, Bangladesh.

OBJECTIVES: Provision of toilets is necessary but not sufficient to impact health as poor maintenance may impair toilet function and discourage their consistent use. Water in urban slums is both scarce and a prerequisite for toilet maintenance behaviours. We describe the development of behaviour change communications and selection of low-cost water storage hardware to facilitate adequate flushing among users of shared toilets. METHODS: We conducted nine focus group discussions and six ranking exercises with adult users of shared toilets (50 females, 35 males), then designed and implemented three pilot interventions to facilitate regular flushing and improve hygienic conditions of shared toilets. We conducted follow-up assessments 1 and 2 months post-pilot including nine in-depth interviews and three focus group discussions with adult residents (23 females, 15 males) and three landlords in the pilot communities. RESULTS: Periodic water scarcity was common in the study communities. Residents felt embarrassed to carry water for flushing. Reserving water adjacent to the shared toilet enabled slum residents to flush regularly. Signs depicting rules for toilet use empowered residents and landlords to communicate these expectations for flushing to transient tenants. Residents in the pilot reported improvements in cleanliness and reduced odour inside toilet cubicles. CONCLUSIONS: Our pilot demonstrates the potential efficacy of low-cost water storage and behaviour change communications to improve maintenance of and user satisfaction with shared toilets in urban slum settings.

Can gossip change nutrition behaviour? Results of a mass media and community-based intervention trial in East Java, Indonesia.

OBJECTIVE: It is unclear how best to go about improving child feeding practices. We studied the effect of a novel behaviour change intervention, Gerakan Rumpi Sehat (the Healthy Gossip Movement), on infant and young child feeding practices in peri-urban Indonesia. METHODS: The pilot intervention was designed based on the principles of a new behaviour change theory, Behaviour Centred Design (BCD). It avoided educational messaging in favour of employing emotional drivers of behaviour change, such as affiliation, nurture and disgust and used television commercials, community activations and house-to-house visits as delivery channels. The evaluation took the form of a 2-arm cluster randomised trial with a non-randomised control arm. One intervention arm received TV only, while the other received TV plus community activations. The intervention components were delivered over a 3-month period in 12 villages in each arm, each containing an average of 1300 households. There were two primary outcomes: dietary diversity of complementary food and the provision of unhealthy snacks to children aged 6-24 months. RESULTS: Dietary diversity scores increased by 0.8 points in the arm exposed to TV adverts only (95% CI: 0.4-1.2) and a further 0.2 points in the arm that received both intervention components (95% CI: 0.6-1.4). In both intervention arms, there were increases in the frequency of vegetable and fruit intake. We found inconsistent evidence of an effect on unhealthy snacking. CONCLUSION: The study suggests that novel theory-driven approaches which employ emotional motivators are capable of having an effect on improving dietary diversity and the regularity of vegetable and fruit intake among children aged 6-24 months. Mass media can have a measurable effect on nutrition-related behaviour, but these effects are likely to be enhanced through complementary community activations. Changing several behaviours at once remains a challenge.

Behaviour Change to Promote Diabetes Outcomes: Getting More From What We Have Through Dissemination and Scalability.

The potential benefits of advanced medical treatments (pharmacotherapies) and technologies (diagnostics, devices and apps) are unrealized due to lack of sustained behaviour change in individuals living with type 2 diabetes. The lack of scale-up of effective health behaviour change interventions limits health improvement. Identification of mediators of behaviour change (adherence, self-efficacy, intrinsic motivation) can address this limitation by shifting the focus of behaviour change from input (which behaviour change strategy to choose) to output (what can the person adhere to and sustain). Technology and accessing the workplace environment to promote change offer scalable opportunities for facilitating health behaviour change in populations.

MoveStrong at home: a feasibility study of a model for remote delivery of functional strength and balance training combined with nutrition education for older pre-frail and frail adults.

Exercise and nutrition interventions are often recommended for frailty; however, effective strategies are required for real-world implementation. Our primary aim was to assess the feasibility and acceptability of telephone and virtual delivery of MoveStrong, an 8-week exercise and nutrition program with a 4-week follow-up for older pre-frail and frail adults. A priori criteria for success included: recruitment (≥25/12 weeks), retention at follow-up (≥80%), and adherence to exercise and nutrition sessions (≥70%). We recruited community-dwelling Ontario residents; ≥60 years, ≥1 chronic condition, ≥1 FRAIL scale score. Participants received mailed materials, a personalized exercise program, 11 remote one-on-one training sessions with an exercise physiologist and 3 online dietitian-led nutrition education sessions. We completed exploratory analyses of secondary outcomes including physical function and dietary protein intake. Semi-structured interviews supported program evaluation. In total, 30 participants were enrolled. 28 (93%) participants completed program and follow-up assessments. Adherence to exercise and nutrition sessions (CI) was 84% (77%-91%) and 82% (70%-93%) respectively. At program end and follow-up [mean change (CI)], significant improvements were measured in 30-second chair stand test [3.50 (1.12-5.86), 4.54 (1.94-7.13) chair stands] and dietary protein intake [12.9 (5.7-20.0), 9.2 (0.4-18.1) g]. Overall, participants were satisfied with program delivery. Trial registration number: NCT04663685.

Persons With Diabetes and General/Family Practitioner Perspectives Related to Therapeutic Inertia in Type 2 Diabetes Mellitus Using Qualitative Focus Groups and the Theoretical Domains Framework: Results From the MOTION Study.

OBJECTIVES: Therapeutic inertia in type 2 diabetes (T2DM) is the failure to receive timely treatment intensification as indicated according to T2DM treatment guidelines. Multifactorial causes of therapeutic inertia in T2DM have been documented at the level of persons with diabetes (PwD), health-care providers and health-care systems. METHODS: We developed a 3-part mixed-methods research program, called the Moving to Overcome Therapeutic Inertia Obstacles Now in T2DM (MOTION) study, to inform the development of strategies to address therapeutic inertia in T2DM. We present the results from focus groups with the following objectives: 1) understanding PwD and general practitioner/family practitioner (GPFP) determinants of behaviour related to treatment intensification using the Theoretical Domains Framework (TDF); and 2) identifying the sources of behaviours contributing to therapeutic inertia in T2DM, as proposed by the Behaviour Change Wheel (BCW). Two focus groups with PwD and 4 with GPFPs were conducted. Transcripts from the focus groups were coded independently by 2 investigators to identify themes, then mapped to TDF domains and linked using the BCW. RESULTS: For PwD, the most commonly coded TDF domains were intentions, goals, knowledge, beliefs about consequences and social influences. For GPFPs, the most common domains were intentions, environmental context and resources and social/professional role and identity. The BCW identified that PwD interventions should include reflective motivation, psychological capability and social opportunity; GPFP interventions should include physical opportunity, social opportunity and reflective motivation. CONCLUSIONS: Comprehensive strategies that target both PwD and GPFP barriers would encourage a more collaborative approach toward treatment intensification decisions and reducing therapeutic inertia.

Video for Knowledge Translation: Engaging Older Adults in Social and Physical Activity.

Une vaste majorité des Canadiens âgés ne pratiquent pas suffisamment d'activité physique. Le développement de stratégies originales et innovantes encourageant et appuyant les modes de vie actifs est donc urgent. La vidéo est un outil prometteur pour l'application de connaissances (AC) visant l'engagement de divers publics dans la discussion et l'adoption de comportements favorisant la santé. L'Approche systématique pour les vidéos fondées sur des données probantes (Systematic Approach to Evidence-informed Video, SAEV), qui fournit un cadre pour guider et structurer le développement de vidéos ayant pour objectif l'AC, a été utilisée pour la création et la diffusion d'un documentaire de 19 minutes, I'd Rather Stay (https://vimeo.com/80503957). Quarante-huit participants âgés de 60 ans et plus ont visionné la vidéo, participé à des groupes de discussion et rempli des questionnaires concernant cette vidéo. Les données ont été recueillies après le visionnement et lors d'un suivi organisé six mois plus tard. La vidéo a éduqué, encouragé et mobilisé les personnes âgées sur les questions liées à l'autonomie, à l'activité physique et aux liens sociaux. Nous encourageons les chercheurs à adopter des stratégies d'AC auxquelles les personnes âgées peuvent s'identifier, qui sont accessibles et par lesquelles elles peuvent s'engager à un niveau critique, autant sur le plan émotionnel qu'intellectuel, comme les vidéos basées sur des preuves scientifiques.Most older Canadians do not engage in sufficient physical activity. There is an urgent need for outside-the-box strategies that encourage and sustain active lifestyles. Video is a promising knowledge translation (KT) tool to engage diverse audiences in discussion and action around health promoting behaviours. We adopted a KT framework to inform a structured process of video development we have named systematic approach to evidence-informed video (SAEV). This guided the creation and dissemination of a 19-minute documentary video: I'd Rather Stay (https://vimeo.com/80503957). Following screenings, we collected focus group and questionnaire data from 48 participants aged 60 years and older at baseline and 6-month follow-up. The video educated, encouraged, and activated older people around issues such as independence, physical activity and social connectedness. We encourage researchers to adopt KT strategies ­ and to use evidence-informed video ­ that older adults can relate to and critically engage with on an accessible, emotional, and intellectual level.

Développement et implantation d'une intervention ciblée encourageant le dépistage régulier du VIH chez les travailleuses du sexe au Bénin : application du protocole d' intervention mapping.

Cet article présente le processus suivi pour développer et implanter une intervention ciblée encourageant les femmes travailleuses du sexe (TS) à se faire dépister régulièrement pour le virus de l'immunodéficience humaine (VIH) dans les services de santé adaptés au Bénin. Le modèle de planification d' intervention mapping (IM) de Bartholomew et al. (2006), structuré en six étapes, a servi de référence pour guider le développement et l'implantation de l'intervention. Une analyse des besoins a été réalisée à partir d'une revue de littérature et d'une étude basée sur la théorie du comportement planifié, d'Ajzen (1991). Cette analyse a permis d'identifier les déterminants associés au comportement sur lesquels ont porté les actions de changement. Les méthodes et stratégies d'intervention ont été basées sur des théories et adaptées aux besoins des femmes TS. Les résultats consistent en une intervention de neuf mois visant à couvrir plus de 1200 femmes TS, en impliquant divers acteurs (intervenants communautaires, agents de santé et pairs éducatrices). La perception de contrôle comportemental, la norme descriptive, les connaissances, l'attitude et l'intention d'adopter le dépistage régulier du VIH constituent les cibles d'action. L'intervention comporte des activités visant des changements individuels et environnementaux à travers diverses méthodes comme le counseling motivationnel, l'éducation par les pairs, le modeling, la communication persuasive, le renforcement de capacités et la réorganisation des services cliniques. L'IM a permis de structurer et d'implanter avec transparence une intervention ciblée visant l'adoption d'un comportement favorable à la santé chez les femmes TS. Les enjeux rencontrés et les leçons tirées de l'application de l'IM en contexte africain francophone peuvent inspirer les planificateurs et professionnels pour améliorer leurs interventions en promotion de la santé.

Psychosocial Constructs as Possible Moderators of Self-Reported Driving Restrictions.

To date, associations between psychosocial driving variables and behaviour have been examined only cross-sectionally. Using three waves of data collected annually from 928 older drivers (mean age = 76.21 years; 62% male) enrolled in the Candrive II cohort, we examined in this study whether changes in attitudes and perceptions towards driving (decisional balance and day and night driving comfort) were associated with changes in older adults' reported restrictions in driving practices and perceived driving abilities. Multi-level models revealed that older adults who showed an increase in negative attitudes towards driving over time were more likely to report more-restricted practices (greater avoidance of challenging driving situations) and perceived declines in driving abilities compared to individuals whose attitudes towards driving remained stable across two years. This work supports previous findings and offers a new understanding of how attitudes relate to driving perceptions (e.g., comfort) and self-regulation in older adults over time.

Preventing diabetes in primary care: a feasibility cluster randomized trial.

OBJECTIVE: To determine the feasibility of implementing a large-scale primary care-based diabetes prevention trial. METHODS: A feasibility cluster randomized controlled trial was conducted in British Columbia, Canada, amongst adults with prediabetes using the Facilitated Lifestyle Intervention Prescription (FLIP) vs. usual care. FLIP included lifestyle advice, a pedometer, and telephone support from a lifestyle facilitator for 6 months. Indicators of feasibility included recruitment rates of family practices, participants and facilitators, as well as feasibility and retention rates in the FLIP program and study protocols. RESULTS: Six family practices participated; 59 patients were enrolled between October 2012 and March 2013. The trial protocol was acceptable to practices and participants and had a 95% participant retention rate over the 6 months (56/59). Adherence to the intervention was high (97%), with 34 of 35 patients continuing to receive telephone calls from the facilitator for 6 months. The mean cost of the intervention was C$144 per person. Compared with control, intervention participants significantly reduced weight by 3.2 kg (95% CI, 1.7 to 4.6); body mass index by 1.2 (95% CI, 0.7 to 1.7) and waist circumference by 3 cm (95% CI, 0.3 to 5.7). CONCLUSIONS: It is feasible to implement FLIP and to conduct a trial to assess effectiveness. A larger trial with longer follow up to assess progression to diabetes is warranted.

Assessing intentions to eat low-glycemic index foods by adults with diabetes using a new questionnaire based on the theory of planned behaviour.

OBJECTIVE: The Canadian Diabetes Association recommends that people with diabetes choose foods with low-glycemic index (GI). This study developed a questionnaire measuring Theory of Planned Behaviour (TPB) constructs relative to consuming a low-GI diet by people with diabetes so as to achieve a better understanding of which TPB constructs, demographic characteristics and diabetes-related variables best predict intention to consume a low-GI diet. METHOD: A questionnaire to measure intentions to consume a low-GI diet was developed based on TPB constructs and was administered to 369 adults (30 to 75 years) with type 1 or type 2 diabetes. Responses were analyzed using multiple linear regression. RESULTS: More than 90% of participants (mean age, 56.5±10.8 years; mean body mass index, 30.5±7.2 kg/m(2)) cited reduction and maintenance of healthy blood glucose levels as an advantage of eating low-GI foods. Older age, higher income, female gender, having type 2 diabetes, diabetes treatment (diet only) and understanding of the GI were positively associated with intention to eat a low-GI diet. TPB constructs that significantly predicted intentions to eat a low-GI diet were instrumental attitude (beta = 0.24, p<0.001); subjective norms (beta = 0.13, p=0.007); and perceived behavioural control (beta = 0.55, p<0.001). CONCLUSIONS: This new questionnaire is a valid tool to assess TPB constructs contributing to intentions to eat a low-GI diet by people with diabetes. Future studies that use this questionnaire can shed light on how TPB concepts in clinical practice can help people with diabetes to change their dietary intake.

Health coaching in diabetes: empowering patients to self-manage.

To effectively manage diabetes mellitus, patients must adhere to treatment recommendations and healthy lifestyle behaviors, but research shows many patients do not do this. Education is effective when combined with self-management support but peer-support programs do not lead to lasting changes. Health coaching, or professional support, can be highly effective if it focuses on developing self-efficacy and skills such as goal-setting, problem-solving and managing cognitive and emotional barriers. This overview discusses the benefits of patient self-management for chronic conditions such as diabetes, core competencies for health coaching, theoretical bases and principles of health coaching interventions, delivery methods and the evidence that health coaching works for diabetes self-management.

Behaviour change counselling--how do I know if I am doing it well? The development of the Behaviour Change Counselling Scale (BCCS).

OBJECTIVE: The purpose of this article is to operationalize behaviour change counselling skills (motivation enhancement, behaviour modification, emotion management) that facilitate self-management support activities and evaluate the psychometric properties of an expert rater scale, the Behaviour Change Counselling Scale (BCCS). METHODS: Twenty-one healthcare providers with varying levels of behaviour change counselling training interviewed a simulated patient. Videotapes were independently rated by 3 experts on 2 occasions over 6 months. Data on item/subscale characteristics, interrater and test-retest reliability, preliminary data on construct reliability, were reported. RESULTS: All items of the BCCS performed well with the exception of 3 that were dropped due to infrequent endorsement. Most subscales showed strong psychometric properties. Interrater and test-retest reliability coefficients were uniformly high. Competency scores improved significantly from pre- to posttraining. CONCLUSIONS: Behaviour change counselling skills to guide lifestyle interventions can be operationalized and assessed in a reliable and valid manner. PRACTICE IMPLICATIONS: The BCCS can be used to guide clinical training in lifestyle counselling by operationalizing the component skills and providing feedback on skill achieved. Further research is needed to establish cut scores for competency and scale construct and criterion validity.

The challenge of integrating self-management support into clinical settings.

Best practice diabetes mellitus clinical treatment and education takes place in the medical clinic, however, patient outcomes are largely mediated through their own behaviour and lifestyle that occurs after they leave the clinical setting. Once they return home, people usually continue to engage in the social, cultural and lifestyle behaviours that had contributed to having diabetes in the first place. Although a host of factors (e.g. economic, health care team and system, condition and client-related) can impact a client's capacity to self-manage, there are client, organizational and community level strategies that may partially mitigate these difficulties. To address client behaviour, clinicians are increasingly becoming skilled to incorporate self-management support including behavioural counselling interventions into routine practice. At the organizational level, the operation and structure of the clinical setting may create difficulty for staff to provide self-management support. Sustaining benefits on a day-to-day basis presents an additional challenge. This article will review several common implementation barriers to self-management support and describe strategies and techniques used elsewhere to successfully integrate self-management support as a core care component for persons with diabetes.