Background SMS text messaging is a low-cost and far-reaching modality that can be used to augment existing diabetes prevention programs and improve long-term diet and exercise behavior change adherence. To date, little research has been published regarding the process of SMS text message content development. Understanding how interventions are developed is necessary to evaluate their evidence base and to guide the implementation of effective and scalable mobile health interventions in public health initiatives and in future research. Objective This study aims to describe the development and refinement of a bank of SMS text messages targeting diet and exercise behavior change to be implemented following a diabetes prevention program. Methods A bank of 124 theory-based SMS text messages was developed using the Behaviour Change Wheel and linked to active intervention components (behavior change techniques [BCTs]). The Behaviour Change Wheel is a theory-based framework that provides structure to intervention development and can guide the use of evidence-based practices in behavior change interventions. Once the messages were written, 18 individuals who either participated in a diabetes prevention program or were a diabetes prevention coach evaluated the messages on their clarity, utility, and relevance via survey using a 5-point Likert scale. Messages were refined according to participant feedback and recoded to obtain an accurate representation of BCTs in the final bank. Results 76/124 (61.3%) messages were edited, 4/124 (3.2%) were added, and 8/124 (6.5%) were removed based on participant scores and feedback. Of the edited messages, 43/76 (57%) received minor word choice and grammar alterations while retaining their original BCT code; the remaining 43% (33/76, plus the 4 newly written messages) were recoded by a reviewer trained in BCT identification. Conclusions This study outlines the process used to develop and refine a bank of SMS text messages to be implemented following a diabetes prevention program. This resulted in a bank of 120 theory-based, user-informed SMS text messages that were overall deemed clear, useful, and relevant by both individuals who will be receiving and delivering them. This formative development process can be used as a blueprint in future SMS text messaging development to ensure that message content is representative of the evidence base and is also grounded in theory and evaluated by key knowledge users.

Research suggests that the inclusion of dogs in the delivery of psychotherapy for adolescents might have a positive effect on outcomes. This evaluation explores the impact of introducing a dog to CBT based anxiety management groups for young people aged 11 to 14. 35 young people attended these groups which ran either with or without a dog present. The results suggest that the presence of a therapy dog significantly reduced young peoples' anxiety ratings in 5 out of 6 sessions and contributed to a higher discharge rate after completing the group therapy (44% with vs 28% without the dog). Qualitative feedback indicates that the presence of a therapy dog improved the young people's experiences by reporting feeling more relaxed and more confident in the group. Findings suggest that a therapy dog can enhance young people's experiences in group therapy, especially at early stages, and increase discharge rates.

Background Infectious diarrhea is a common cause of emergency department (ED) visits and hospital admissions. Polymerase chain reaction (PCR) testing allows for quick and expansive pathogen identification and facilitates earlier targeted treatment. We implemented a multiplex gastrointestinal (GI) PCR panel in 2014. In collaboration with the Antimicrobial and Diagnostic Advisement Program (ADAP), post-launch optimization strategies have changed test use. We evaluate the impact of diagnostic stewardship initiatives. Methods GI PCR testing was initially unrestricted for ED or inpatients within 72 hours of admission. After fielding many questions regarding interpretation, the ADAP developed a guidance document in June 2019 regarding treatment considerations for all potential organisms detected. In January 2020, organism-specific treatment considerations were embedded in the test results real-time treatment guidance (figure 1). A pre-post quality improvement assessment of the changes was performed. In August 2021, individual GI PCR panel orders were replaced with an order set containing a decision tree to provide passive guidance evaluating acute vs chronic diarrhea, assessing recent antibiotic use (to consider C. difficile testing), no testing scenarios, and avoiding repeat testing (figure 2). Figure 1Example of templated comments for Norovirus embedded within GI PCR panel results. Figure 2 GI PCR panel order set Results GI PCR panel use peaked in 2019 with 3,142 tests processed. The guidance document was less helpful, requiring an external site link. Embedding organism-specific GI PCR guidance significantly improved appropriate antibiotic prescribing (77.9 vs 89.1%, p=0.001). A precipitous drop off in GI PCR test orders occurred after the COVID-19 pandemic began (1,774 in 2020), partly attributed to supply chain issues. When comparing intra-pandemic years (2020 vs 2021), implementation of a smart order set was associated with a 51.3% reduction in orders (1,774 vs 864) and $131,000 in savings despite significant patient volume increases in 2021. Low use rates have persisted into the first quarter of 2022 (n=229). Conclusion Diagnostic stewardship changes should be proactive and contextually relevant at the time of result interpretation. Antimicrobial stewardship programs are uniquely positioned to lead optimization initiatives and drive clinical and cost-effective solutions. Disclosures All Authors: No reported disclosures.

BACKGROUND Text messaging presents a low-cost and far-reaching modality which can be used to augment existing diabetes prevention programs and improve long-term diet and exercise behaviour change adherence. To date, little research has been published regarding the process of text message content development. Understanding how interventions are developed is necessary to evaluate their evidence base, and to guide implementation of effective and scalable mHealth interventions in public health initiatives and in future research. OBJECTIVE This paper describes the development and refinement of a bank of text messages targeting diet and exercise behaviour change to be implemented following a diabetes prevention program. METHODS A bank of 124 theory-based text messages was developed using the Behaviour Change Wheel and linked to active intervention components (behaviour change techniques OR BCTs). The Behaviour Change Wheel is a theory-based framework which provides structure to intervention development, and can guide the use of evidence-based practices in behaviour change interventions. Once messages were written, 18 individuals who either took part in a diabetes prevention program or were a diabetes prevention coach evaluated the messages on their clarity, utility, and relevance using a 5-point Likert scale. Messages were refined according to participant feedback and re-coded to have an accurate representation of BCTs in the final bank. RESULTS Seventy-six messages (61%) were edited, four were added, and 8 were removed based on participant scores and feedback. Of the 76 messages edited, 43 received minor word choice and grammar alterations while retaining their original BCT code; the remaining 33 (plus the four newly written messages) were re-coded by a reviewer trained in BCT identification. CONCLUSIONS This study outlines the process used to develop and refine a bank of text messages to be implemented following a diabetes prevention program. This resulted in a bank of 120 theory-based, user-informed text messages which were overall deemed clear, useful, and relevant by both individuals who will be receiving and delivering them. This formative development process can be used as a blueprint in future text messaging development to ensure that message content is representative of the evidence base and is also grounded in theory and evaluated by key knowledge users.