Developing the Choosing Health digital weight loss and maintenance intervention using an Intervention Mapping approach (Preprint)

BACKGROUND Digital health promotion programs tailored to the individual are a potential cost-effective and scalable solution to enable self-management and provide support to people with excess body weight. However, solutions that are personalised, theory- and evidence- based and widely accessible are still limited. OBJECTIVE This study aimed to develop a digital behaviour change program, Choosing Health, that could identify modifiable predictors of weight loss and maintenance for each individual and utilise these to provide tailored support. METHODS We applied an Intervention Mapping protocol to design the program. This systematic approach to develop theory- and evidence-based health promotion programs consisted of 6 steps: development of (1) a logic model of the problem, (2) model of change, (3) intervention design and (4) production, (5) the implementation plan, and (6) evaluation plan. The decisions made during the Intervention Mapping process were guided by theory, existing evidence, and our own research (including four focus groups, N=40, expert consultations, N=12 and interviews, N=11). The stakeholders included researchers, public representatives (including individuals with overweight and obesity), and experts from the variety of relevant backgrounds (including nutrition, physical activity, and healthcare sector). RESULTS Following a structured process, we developed a tailored intervention that has potential to reduce excess body weight and support behaviour changes in people with overweight and obesity. The Choosing Health intervention consists of tailored personalised text messages and email support that correspond with theoretical domains potentially predictive of weight outcomes for each participant. Intervention content includes behaviour change techniques to support motivation maintenance, self-regulation, habit formation, environmental restructuring, social support and addressing physical and psychological resources. CONCLUSIONS Use of an Intervention Mapping protocol enabled the systematic development of the Choosing Health intervention and guided the implementation and evaluation of the program. Through the involvement of different stakeholders, including representatives of general public, we were able to map out program facilitators and barriers while increasing ecological validity of the program, to ensure that we build an intervention that is useful, user friendly, and informative. We also summarised lessons learnt for the Choosing Health intervention development and for other health promotion programs. CLINICALTRIAL This is an Intervention Mapping study which is currently evaluated through a Randomised Controlled Trial. This trial was registered with www.clinicaltrials.gov; registration number NCT04291482. INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2020-040183

Design of a Digital Game Intervention to Promote Socio-Emotional Skills and Prosocial Behavior in Children

In emergency contexts such as the COVID-19 pandemic, mental health risk factors affect children and may affect behavioral and emotional problems including anxiety, self-blame, emotional disturbance, and stress. Preventive measures are crucial to address these health risks. Research highlights strength-based factors, such as socio-emotional skills and prosocial behaviors, as important for childhood development and socio-emotional wellbeing. Yet, the initial evidence base shows mixed effectiveness and insufficient behavior change theory application into socio-emotional and prosocial digital game interventions. Additionally, few interventions are designed with a clear process to convert theory into practical game solutions and very limited guidance on the digital game development process exists. This study describes the Intervention Mapping Protocol (IMP) and theory application in the design of a digital game intervention which aims to strengthen social-emotional skills development and promote prosocial behavior in 8–11-year-old children. The method systematically describes the steps of the IMP process in detail to guide future theory-based game design. The results explain the final digital game prototype that was co-designed with continuous input and insights provided by stakeholders and feedback from children. This paper contributes to our understanding of theory application in the design of digital game interventions focused on health and behavior change and provides much needed guidance on how theory and stakeholder input can be incorporated into a final game design.

Development of a School-Based Physical Activity Intervention Using an Integrated Approach: Project SMART

Physical activity (PA) is a health-protective factor with multiple benefits for school-age children, yet only 22% of children and adolescents living in the United States (United States) accrue the recommended amount of moderate to vigorous PA. Given the prevalence of insufficient PA among children, promoting and providing PA opportunities during the school day, especially when integrated into the curriculum and linked to the learning standards, is essential for children. The purpose of this paper is to describe the procedure for the development of a school-based PA program using an integrated approach through the modified intervention mapping protocol (IMP). A total of 22 physical education teachers and 167 children from five different elementary schools were involved in the process. The procedure includes the Self-Determination Theory (SDT) that provides a theoretical framework that plays a vital role in motivating students to have a physically active lifestyle. This study applied SDT and IMP to develop and pilot a PA intervention called Project SMART using an integrative community participatory approach. As a pilot PA intervention, Project SMART is an online educational game where the students navigate a virtual journey across the United States A class’s aggregate PA propels the students on their journey, where standards-based modules are unlocked to achieve STEM (science, technology, engineering, and math) and social-emotional learning outcomes while gaining an understanding of the importance of health behaviors and opportunities to habitually engage in healthy decision-making with the support of their peers. Although initially labor intensive for the researchers, the process of tailoring the intervention to the children’s contextual and cultural needs has implications for all theoretically grounded and evidence-based PA interventions.

Using Intervention Mapping to Develop a Media Literacy-Based Smoking Prevention Program for Female Adolescents

Smoking prevalence among female adolescents in South Korea has increased gradually, despite a decreasing trend seen for male adolescents. Smoking scenes or cigarette advertisements in the media have influenced female adolescents’ initiation into smoking. It is therefore crucial to develop a smoking prevention program to enhance female adolescents’ smoking media literacy by implementing gender-specific interventions. The purpose of this study is to describe how intervention mapping protocol (IMP) was used to develop a media literacy-based smoking prevention program (MLSP) for female adolescents. The IMP was used in six steps: needs assessment (literature review and focus groups comprising 24 female adolescents and 12 teachers), program goal setting, selection of intervention methods, production of program components and materials, program implementation planning, and program evaluation by ten experts and three adolescents. Six performance objectives and 14 change objectives were generated. Each module consisted of theory-based methods such as raising consciousness. Half of the modules covered topics regarding smoking media literacy, while half covered topics related to gender-specific intervention. The major advantages of utilizing IMP are that MLSP has been developed to reflect multiple perspectives, including of adolescents, teachers, and professors through a systematic process, and identified to be acceptable and valid.

Design of an Online Initiative to Promote Water Consumption in Mexican Adolescents

Objectives To describe the development of an initiative for water consumption in Mexican adolescents of public secondary schools. Methods Based on a diagnosis in adolescents 11 to 16 years from public secondary schools we developed an initiative following the Intervention Mapping protocol: (1) Logic model of the problem, (2) Logic model of change, (3) Program design, (4) Program production, (5) Program implementation plan, and (6) Evaluation plan. We established behavioral outcomes for the next levels: Intrapersonal (adolescents), Interpersonal (mothers and fathers), Organizational (principals and teachers) and Social (authorities of the respective Ministries of Education and Health). At Intrapersonal and Interpersonal levels, we based on the Health Belief Model and the Social Cognitive Theory. For Organizational and Social levels, we considered the Stage Theory of Organizational Change. Results We developed a comprehensive initiative with a gender perspective entitled EPCA (for its acronym in Spanish of Schools Promoting Water Consumption). It includes an online course for adolescents, which shows the benefits of water and the health risks of sugary drinks, it guides adolescents to identify their water requirement and gives them tips to achieve it. The course presents funny challenges and healthy advices in audiovisual materials. For principals, teachers, mothers, and fathers there are digital resources available on the Facebook page of the EPCA initiative, which aim to help adults guide adolescents to take the course online, in addition, the resources motivate them to consume water. For the implementation of the EPCA initiative we developed a manual and planned online workshops with authorities of the Ministries of Education and Health, principals, and parents. We developed a process and impact evaluation plan, in which we considered to make a randomized controlled trial. Conclusions The EPCA initiative is a multilevel online intervention that was developed in accordance with a systematic protocol grounded in theory and scientific evidence, which will be implemented in a pilot manner in a random sample of Mexican adolescents to evaluate their impact on water consumption. Funding Sources This study was financed by the United Nations Children's Fund, UNICEF-Mexico.

Family-Centered Social Cognitive Factors Preventing Primary Tooth Caries in Children Based on Intervention Mapping Approach

Background. Given the increasing prevalence of primary tooth caries in Iran and the importance of providing evidence- and theory-based family-centered prevention programs, the present study is aimed at determining the family-centered social cognitive factors preventing deciduous tooth caries among children using the intervention mapping protocol. Methods. This cross-sectional study was performed on 240 Iranian mothers in Ilam who were randomly selected to participate in the study. The data were collected using a self-designed questionnaire including items on demographic information and social cognitive constructs (knowledge, attitude, perceived severity, perceived benefits, perceived barriers, practice guidance, perceived self-efficacy, behavior intention, subjective norms, and social norms). The questionnaire was completed by mothers, and the data were analyzed by performing one-way analysis of variance and linear regression. Results. The results obtained from linear regression analysis showed that perceived self-efficacy ( B = 0.295 , p < 0.001 ), perceived barriers ( B = 0.084 , p < 0.028 ), practice guidance ( B = 0.774 , p < 0.001 ), and social norms ( B = 0.137 , p < 0.020 ) accounted for 71% of the behavioral intention variance and were the most important predictors for preventing primary tooth caries among children. Conclusion. The findings suggest that perceived self-efficacy, perceived barriers, practice guidance, and social norms are essential for developing family-centered programs to prevent primary tooth caries in children.

Preconception Care Program for Women with Inflammatory Bowel Disease Using Intervention Mapping: A Protocol for Program Development

The prevalence of inflammatory bowel disease in Korea is rapidly increasing. Women with inflammatory bowel disease have a higher risk of adverse birth outcomes than healthy women, and the magnitude of this risk is related to the severity of the disease at the time of pregnancy. For a woman with inflammatory bowel disease to have a healthy pregnancy, interventions are needed to manage the disease before pregnancy—implying a need for pregnancy planning. In this study, the intervention mapping protocol was used to develop a program for this purpose. This protocol contains the following stages: needs assessment, setting of program outcomes and performance objectives, selection of methods and strategies based on theory, and development of the program and its materials. Through individual in-depth interviews and a literature review, individual and environmental determinants were assessed and six change objectives of the program were set. The methods and practical strategies were developed based on the information-motivation-behavioral skills model, self-efficacy theory, and social support theory. The final program, consisting of four sessions and the corresponding materials, was completed by making revisions based on a content validity assessment by experts and a pilot test. Follow-up studies on the implementation of this program will be conducted in the future.