Developing Behavior Change Interventions for Self-Management in Chronic Illness

Abstract

Abstract. More people than ever are living longer with chronic conditions such as obesity, type 2 diabetes, and heart disease. Behavior change for effective self-management can improve health outcomes and quality of life in people living with such chronic illnesses. The science of developing behavior change interventions with impact for patients aims to optimize the reach, effectiveness, adoption, implementation, and maintenance of interventions and rigorous evaluation of outcomes and processes of behavior change. The development of new services and technologies offers opportunities to enhance the scope of delivery of interventions to support behavior change and self-management at scale. Herein, we review key contemporary approaches to intervention development, provide a critical overview, and integrate these approaches into a pragmatic, user-friendly framework to rigorously guide decision-making in behavior change intervention development. Moreover, we highlight novel emerging methods for rapid and agile intervention development. On-going progress in the science of intervention development is needed to remain in step with such new developments and to continue to leverage behavioral science’s capacity to contribute to optimizing interventions, modify behavior, and facilitate self-management in individuals living with chronic illness.

Psychological correlates of adherence to photoprotection in a rare disease: International survey of people with Xeroderma Pigmentosum

“…Interventions showing improvements in photoprotection among individuals at elevated risk for melanoma highlight the potential for behaviour change (Wu et al, 2016 for a systematic review). Approaches to complex intervention design such as the Behaviour Change Wheel (Michie, van Stralen, & West, 2011) and Intervention Mapping (Eldredge, Markham, Kok, Ruiter, & Parcel, 2016) are theory agnostic, and recommend using broad frameworks based on multiple theories such as Theoretical Domains Framework (TDF) (Ara ujo- Soares, Hankonen, Presseau, Rodrigues, & Sniehotta, 2019). Given that this study is part of formative research informing an intervention for a complex set of behaviours and that recent reviews of adherence interventions conclude that no single theoretical model sufficiently incorporates all known determinants; >700 identified by a review of reviews (Kardas, Lewek, & Matyjaszczyk, 2013), we selected variables on the basis of the TDF (Cane, O'Connor, & Michie, 2012) and the updated Common-Sense Model of selfregulation (CSM) (Leventhal, Phillips, & Burns, 2016).…”

Changing activity behaviours in vocational school students: The stepwise development and optimised content of the ‘Let’s Move it’ intervention

“…Intervention development was an iterative process as usual (Bartholomew, Parcel, Kok, & Gottlieb, 2006;Michie, van Stralen, & West, 2011) with empirical data obtained at different steps from different sources, feeding back and shaping intervention decisions, and often determining going back a step in order to reach a final draft intervention. Figure 1 shows the main steps of the development process (For an in-depth introduction to the integrated steps, see Araújo-Soares et al, 2018).…”

“…The intervention development process was in line with the UK Medical Research Council Guidance recommendations (Campbell et al, 2000;Craig et al, 2008), using a phased approach to design and feasibility/pilot testing. For more specific guidance, we used the Behaviour Change Wheel (BCW) and the Intervention Mapping (IM) approach as integrated into four steps (for an analysis and integrative overview of frameworks, see Araujo-Soares et al (Araújo-Soares et al, 2018)), applying multiple theories and mixed methods. Four steps were followed in the development: In step 1 the problem was analysed and intervention objectives developed; step 2 allowed for the definition of the behavioural scientific core of the intervention; step 3 lead to the design/development of the intervention materials, and finally; step 4 consisted of an empirical optimization using a randomised feasibility study.…”

“…We report the stepwise development process, including four steps from problem analysis (Step 1) to definition of the scientific core (Step 2), the design of the intervention materials (Step 3) and empirical optimization of the program (Step 4) (Araújo-Soares, Hankonen, Presseau, Rodrigues, & Sniehotta, 2018). The full final intervention content is also presented.…”

Challenges and proposed solutions for formative research to inform systematic intervention development in rare and unstudied conditions: The case example of Xeroderma Pigmentosum

“…‘Best practice’ intervention development typically involves following a systematic approach (a review is beyond the scope of this editorial; Araujo‐Soares, Hankonen, Presseau, Rodrigues, & Sniehotta, unpublished data for a summary). Despite differences between approaches, the steps related to formative research – that is, questions about what needs to change (behaviour) and how such change might be achieved (mechanisms/theory) – are remarkably similar.…”