Translational Behavioral Medicine最新文献

Background: School-based interventions improve healthy eating, physical activity, and reduce tobacco, and/or alcohol use in students. While strategies supporting their implementation have been found effective, a comprehensive understanding of the active ingredients [e.g. behavior change techniques (BCTs)] remains unclear.

Purpose: To describe and examine which BCTs within implementation strategies are associated with increased implementation of school-based interventions targeting healthy eating, physical activity, tobacco, and/or alcohol use in students aged 5-18.

Methods: A secondary analysis was conducted on 39 randomized controlled trials (RCTs) from a 2024 Cochrane review. Individual BCTs within implementation strategies were coded using the BCT taxonomy v1 and mapped to the Behavior Change Technique Ontology (BCTO). Mode of delivery, setting, and source were coded. Meta-regressions using random-effect models assessed the associations between identified BCTs (at the highest level of aggregation of the BCTO) and effective implementation of policies and/or practice (e.g. number of curriculum lessons taught).

Results: Eighty-four independent BCTs were identified and meta-regression analysis revealed that out of 14 highest level of aggregation BCTs, "Associative learning" (e.g. Prompt intended action) had a statistically significant association with increased implementation (standard mean difference 0.90, 95% confidence interval 0.08, 1.72; 30 trials), which were primarily delivered face to face and by teachers or researchers.

Conclusions: Our findings suggest that "Associative learning BCTs" should be prioritized in future school-based interventions to address implementation barriers and increase implementation of policies and/or practices. Opportunities remain to operationalize and evaluate underrepresented BCTs amenable to school settings in future implementation studies.

Background: Few weight loss interventions have isolated the use of gamification through points to incentivize the social support needed for successful weight loss during a mobile intervention.

Purpose: To compare a group that receives points [mLife (mobile Lifestyle Intervention for Food and Exercise)+points] vs. a group that did not receive points (mLife) for completing social support activities. Differences in social support perceptions, provision, and receipt were examined as part of a 12-month weight loss intervention. The mediating role of these activities with weight loss was also examined.

Methods: Participants with overweight/obesity (n = 243 enrolled) were recruited to participate in a 12-month randomized trial delivered via the mLife app. Perceived social support was measured via survey [Multidimensional Scale of Perceived Social Support (MSPSS)] and by ratings of support received in the app. Social support provision was assessed via the number of social support activities completed in the mLife app over 12 months, and social support receipt was assessed as the number of social support activities a participant received over 12 months.

Results: At 12 months, mLife+points participants had greater perceived social support (difference between groups: total MSPSS 0.52 ± 0.16, P < .01; ratings of support via app: 0.17 ± 0.07, P = .02) and greater rate ratio (RR) of providing social support (RR = 2.23, P < .001) and receiving social support (RR = 2.4, P < .001) as compared to mLife participants. Both social support receipt and provision mediated the relationship between group and 12-month weight loss.

Conclusions: Incentivizing social support provision during a weight loss intervention via points is a potential way to increase social support perceptions, provision, and receipt.

Clinical trial information: The Clinical Trials Registration #NCT05176847.

Background: Mothers experience increased risk of obesity due to pregnancy and caregiving demands. Maternal obesity influences women's health, pregnancy outcomes, and children's obesity risk. Effective obesity prevention interventions rely on participant engagement. Research suggests that social determinants of health (SDOH) influence intervention engagement; however, research is limited on how SDOH influence engagement and ways interventions may help mothers navigate SDOH.

Purpose: Understand how SDOH influence mothers' obesity risk and participation in the 24-month Healthy Eating and Active Living Taught at Home (HEALTH) intervention delivered by parent educators (PEs) through the Parents as Teachers home visiting organization.

Methods: Semistructured interviews were conducted with participants (mothers) from the HEALTH Dissemination and Implementation study. Interviews were recorded, transcribed, and analyzed in NVivo using a priori codes and a dual nonindependent approach.

Results: Thirteen mothers (five Spanish-speaking, eight English-speaking) were interviewed. The most common SDOH influencing health behaviors were neighborhood physical activity environment, food environment, and community/social context. Mothers felt that HEALTH was needed, available (PEs flexibility to meet in-person at home/other locations; virtual meetings), fit their needs/strengths (adapted to mothers' health behaviors; motivation for change), and provided actionable steps for navigating SDOH (incorporating short walks or stretching at home to overcome childcare/time demands). Spanish-speaking mothers benefited from shared language and community with PEs.

Conclusions: Obesity prevention interventions for mothers may help minimize negative SDOH and leverage positive SDOH for health behaviors. Interventions delivered through community-based home visiting organizations may overcome SDOH barriers to intervention engagement through availability and relational connections with providers.

Clinical trial information: The Clinical Trials Registration #NCT03758638.

Background: Schools are ideal settings for implementing evidence-based physical activity interventions at scale due to their wide reach. However, dissemination strategies used to achieve scale are rarely reported.

Purpose: This study aimed to describe the strategy type, frequency, intensity, temporality, and pathways used in disseminating the TransformUs Secondary initiative across Australia over the first 16 months of national scale-up.

Methods: TransformUs Secondary is a whole-of-school initiative that targets behavioral, environmental, and pedagogical strategies inside and outside the classroom to reduce sedentary behavior and increase physical activity among adolescents aged 12-18 years. Since October 2023, the TransformUs team and 16 partner organizations collaboratively disseminated the initiative nationally. A dissemination activity log was used to record dissemination strategies, which were subsequently mapped post hoc to existing frameworks to categorize type, frequency, intensity, temporality, and pathways. Data are reported descriptively and graphically.

Results: Between October 2023 and February 2025, 10 discrete strategies were identified, with the most frequent and intensive strategies being "Promotion via mass media" (33.2%, 110 person-hours), "Develop educational materials" (20.8%, 48 person-hours), and "Maintain partner engagement" (12.4%, 20 person-hours). Strategy frequency and intensity fluctuated and increased after the initiative launch, shifting the focus from targeting partner organizations to targeting school staff. Notably, 54.3% of dissemination strategies occurred via direct pathways to school staff.

Conclusion: Reporting dissemination strategies and pathways clarifies how school-based interventions are scaled in practice, providing evidence to inform research, guide policy, and support effective implementation in schools.

Clinical trial information: The Clinical Trials Registration #ACTRN12622000600741.

Background: Translating public health research into practice remains challenging despite ongoing focus on evidence-based approaches. This study profiles the scope of research undertaken by the Prevention Research Collaboration (PRC), a university based applied public health research organization, with funding from both traditional academic sources and from policy agencies, and examines how it contributed to a translational, evidence-building approach in chronic disease prevention.

Methods: We analyzed PRC's research output using two complementary approaches: (i) a review of journal articles published from 2018 to 2024 where PRC researchers were lead or senior authors; and (ii) an examination of annual reports and workplans from 2013 to 2023 to identify major research programs. Research was classified according to public health evidence-building typology and whether it was investigator-initiated or policy-initiated.

Results: Overall, investigator-initiated research was dominant amongst journal publications, and particularly showcased problem definition studies. Intervention evaluation, as identified in journal publications and internal documents, was more likely to be policy-initiated. PRC demonstrated a high degree of collaboration with policy and practice professionals (42.5% of investigator-initiated and 50% of policy-initiated publications included policy co-authors). Key research areas across chronic disease prevention included physical activity (40.4% of publications), obesity prevention (14.2%), and tobacco control (12.8%).

Conclusion: This case study demonstrates that a small public health research group can successfully navigate the research-policy interface over a sustained period. PRC's continuity of management, staffing and funding arrangements, plus shared agenda and strong partnership with government, are considered to be key enabling factors for this collaborative evidence-building public health approach.

Sleep is a major health issue for young adults. While sleep hygiene interventions have small-to-moderate effects, better outcomes might be achieved by delivering interventions individually to those reporting sleep difficulties, or in the presence of a supportive other or companion. To examine the feasibility, acceptability, and initial effects of an adapted sleep hygiene intervention for young adults with poor sleep, we conducted an ORBIT Phase IIb pilot randomized controlled trial (n = 51). Young adults with poor sleep were randomized to receive a sleep hygiene intervention individually or with a companion. Sleep patterns were measured at baseline and 4 weeks. Participants completed daily dairies and wore wearable devices for the month following the intervention. Attrition at follow-up was minimal (3.9%), and missing rates were low for diary data (8%), and in line with prior studies for wearable devices (14%). Participants expressed high levels of satisfaction with the study, with no differences between study arms. Significant effects were found postintervention for all participants, indicating improved sleep quality (t = 6.14, P < .001), greater sleep duration (t = 3.8, P < .001), and reduced daytime sleepiness (t = 2.13, P = .039). There were no significant differences in sleep efficiency pre and postintervention, or between study arms for any sleep outcome based on self-reported and objective data. Results from this pilot provide evidence for the feasibility and acceptability of a sleep hygiene intervention for young adults and lay the groundwork for a larger, fully powered study.

Background: The increase in food insecurity (FI) during the COVID-19 pandemic resulted in greater demand for food- and nutrition-related services. Yet, little is known about the experiences of local food- and nutrition-related agencies and how they responded to address the increased need.

Purpose: We aimed to elucidate the perspectives and experiences of key informants from diverse food- and nutrition-related stakeholder agencies in addressing FI in San Diego County, CA during the COVID-19 pandemic.

Methods: The Socioecological Model and a capacity-oriented approach informed this qualitative study. Trained researchers conducted semi-structured interviews virtually on Zoom with 20 key informants from 14 food- and nutrition-related stakeholder agencies and analyzed data using thematic content analysis.

Results: Three linked themes emerged relating to how agencies addressed FI during the COVID-19 pandemic: (i) the pandemic uniquely influenced the agencies and the services they provided by presenting both challenges (e.g. limited in-person contact created distinct barriers) and opportunities (e.g. charitable contributions and federal funding increased); (ii) agencies leveraged new and existing within-agency capacities (e.g. adaptability, volunteers) and across-agency partnerships to address the increased demand; and (iii) agencies became forward-thinking as a result of the pandemic (e.g. focused on intentional and innovative strategic goals).

Conclusions: The COVID-19 pandemic influenced how food- and nutrition-related stakeholder agencies provided services, leading agencies to create new and leverage existing within-agency capacities and across-agency partnerships and to prioritize forward-thinking goals. Future research should consider the long-term implications of the pandemic on the effectiveness of agency services.

Background: The Push-Pull-Infrastructure (PPI) model is proposed as a strategy for disseminating health innovations. Using a PPI model, we developed and examined the feasibility of a community-based intervention to disseminate oral human immunodeficiency virus (HIV) self-testing (OHST) to men who have sex with men in Portland, OR.

Methods: We disseminated OHST kits through a network of commercial businesses (n = 6) serving the Lesbian, Gay, Bisexual, Transgender, and Queer plus community. Data were collected weekly on the number of kits distributed. Street intercepts were conducted with customers to assess the impact of promotional efforts on intervention awareness. Using a quasi-experimental design, we examined variation in the intensity of the promotional component on OHST dissemination.

Results: Over a 24-week period, we disseminated 2698 OHSTs. Dissemination rates were found to vary significantly with the intensity of the promotional campaign in a dose-response manner (e.g. high intensity = more dissemination). Customer awareness of the campaign increased significantly in the first 9 weeks (from 22% to 60%, P < .001). Within the geographic area studied, we found our dissemination rate to be comparable to or in excess of rates obtained by other county-level HIV-testing programs (i.e. 2698 OHSTs vs. 2561 in-person clinic-based tests; vs. 78 OHSTs disseminated online).

Conclusions: A PPI model based on a community commercial network approach was highly successful. The promotional component successfully increased customers' awareness of the intervention. Formative work, using a single-case changing-intensity design, provided evidence that warrants more extensive research on strategies for mounting a promotional component that builds on the principle of "more for less."

Background: Despite the proven relationship between lifestyle and morbidity and mortality, rates of chronic disease (e.g. obesity) continue to rise in paradox to the myriad of studies supporting lifestyle behaviour change. Men have been less likely to seek out preventative care or lifestyle programs, putting them at risk. In response, Hockey Fans In Training (Hockey FIT) was developed as a group-based, lifestyle intervention leveraging the draw of hockey fandom to engage middle-aged men with overweight or obesity in lifestyle change. Encouraging pilot study results informed the optimization and delivery of the intervention through a cluster randomized controlled trial in 42 sites in Canada and the USA.

Methods: A process evaluation was conducted to evaluate intervention acceptability and fidelity and adaptations. Community-based sites were randomly allocated to Hockey FIT intervention (immediate program start) or wait-list control (12-month delay). Qualitative process evaluation data were collected from intervention sites and included seven virtual participant focus groups and one interview (n = 35 participants), open-ended participant feedback questionnaires (n = 316), interviews with program coaches (n = 22), post-session coach reflections (n = 233), and interviews with implementation partners (n = 16). A process of content analysis by question was performed and data saturation was reached.

Results: Themes fell into the following categories: (i) motivations for joining Hockey FIT; (ii) effective program components; and (iii) adaptations and suggested improvements.

Conclusions: The process evaluation detailed success engaging men in lifestyle change using sport fandom, and the importance of capitalizing further on competition within groups to drive behavioural change through user-friendly supports and greater engagement with hockey.

Clinical trial information: ClinicalTrials.gov. ID: NCT03636282.

Background: Vida Sana is an evidence-based, culturally adapted weight management program based on Social Cognitive Theory for Latino adults classified as overweight with metabolic syndrome or prediabetes. Few studies have evaluated the implementation potential of these types of interventions conducted in clinical settings that seek to support weight management and reduce metabolic risk among Latino adults.

Purpose: To use the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to understand implementation barriers and facilitators among multiple groups (patients, physicians, health coaches, recruiters) to guide future intervention refinement and delivery.

Methods: A longitudinal qualitative implementation evaluation was conducted to contextualize the results of the Vida Sana Hybrid Type 1 trial. Semistructured interviews were conducted with a subsample of 15% (n = 28) randomly selected main trial participants (patients) at baseline, 12 months (end of intervention), and 24 months (end of follow-up). Two health coaches and two physician champions were also interviewed. Four recruiters completed brief feedback forms. A framework analysis was conducted to analyze themes (RE-AIM domains) and deductive codes and to develop subthemes for each RE-AIM domain across time and group type.

Results: Analyses identified important implementation barriers and facilitators across RE-AIM domains potentially linked to Vida Sana's success. Patients indicated the intervention facilitated knowledge, skills, and self-monitoring for managing diet, physical activity, and weight. Barriers that may need to be addressed to increase effectiveness and sustainability include better health system supports. Although cultural adaptation was mentioned as supporting effectiveness, additional adaptations may be needed to maintain behavioral changes.

Conclusions: Vida Sana is implementable in primary care settings. Patients, clinicians, and study staff identified factors across RE-AIM dimensions that could increase the public health impact of the intervention by addressing barriers and building on facilitators.