Do automated digital health behaviour change interventions have a positive effect on self-efficacy? A systematic review and meta-analysis

© 2019 Taylor & Francis. This is an Accepted Manuscript of an article published by Taylor & Francis in Health Psychology Review on 20/01/2020, available online: https://doi.org/10.1080/17437199.2019.1705873.Self-efficacy is an important determinant of health behaviour. Digital interventions are a potentially acceptable and cost-effective way of delivering programmes of health behaviour change at scale. Whether behaviour change interventions work to increase self-efficacy in this context is unknown. This systematic review and meta-analysis sought to identify whether automated digital interventions are associated with positive changes in self-efficacy amongst non-clinical populations for five major health behaviours, and which BCTs are associated with that change. A systematic literature search identified 20 studies (n=5624) that assessed changes in self-efficacy and were included in a random effects meta-analysis. Interventions targeted: healthy eating (k=4), physical activity (k=9), sexual behaviour (k=3), and smoking (k=4). No interventions targeting alcohol use were identified. Overall, interventions had a small, positive effect on self-efficacy (푔 = 0.190, CI [0.078; 0.303]). The effect of interventions on self-efficacy did not differ as a function of health behaviour type (Qbetween = 7.3704 p = 0.061, df = 3). Inclusion of the BCT ‘information about social and environmental consequences’ had a small, negative effect on self-efficacy (Δ푔= - 0.297, Q=7.072, p=0.008). Whilst this review indicates that digital interventions can be used to change self-efficacy, which techniques work best in this context is not clear.Peer reviewedFinal Accepted Versio

Exploring perspectives of people with type-1 diabetes on goalsetting strategies within self-management education and care

Background. Collaborative goal-setting strategies are widely recommended for diabetes self-management support within healthcare systems. Creating self-management plans that fit with peoples’ own goals and priorities has been linked with better diabetic control. Consequently, goal-setting has become a core component of many diabetes selfmanagement programmes such as the ‘Dose Adjustment for Normal Eating (DAFNE) programme’. Within DAFNE, people with Type-1 Diabetes (T1D) develop their own goals along with action-plans to stimulate goal-achievement. While widely implemented, limited research has explored how goal-setting strategies are experienced by people with diabetes.Therefore, this study aims to explore the perspectives of people with T1D on theimplementation and value of goal-setting strategies within DAFNE and follow-up diabetes care. Furthermore, views on barriers and facilitators to goal-attainment are explored.Methods. Semi-structured interviews were conducted with 20 people with T1D who attended a DAFNE-programme. Following a longitudinal qualitative research design, interviews took place 1 week, and 6-8 months after completion of DAFNE. A recurrent cross-sectional approach is applied in which themes will be identified at each time-point using thematic analyses.Expected results. Preliminary identified themes surround the difference in value that participants place on goal-setting strategies, and the lack of support for goal-achievement within diabetes care.Current stage. Data collection complete; data-analysis ongoing.Discussion. Goal-setting strategies are increasingly included in guidelines for diabetes support and have become essential parts of many primary care improvement schemes. Therefore, exploring the perspectives of people with T1D on the value and implementation of goal-setting strategies is vital for their optimal application

The effect of Type 2 diabetes risk communication and risk perception on health behaviour intentions in a substance dependence population

Background: The risk and burden of diabetes is greatest among vulnerable populations such as people living with mental health and substance use disorders. However, there is a paucity of research examining Type 2 diabetes (T2D) risk in this population. There is a wealth of research in health risk communication which suggest the effectiveness of message framing and tailored risk feedback; however, little is known about their potential utility when used concurrently for T2D prevention in people with substance use problems. Methods: Study 1 was a systematic review, comprised of 5 empirical studies, that examined health risk communication in people who experience substance use problems. Study 2 was an online randomised controlled trial which evaluated the effects of message framing and tailored risk feedback on T2D risk perception and behavioural intentions, and if these effects were varied by level of alcohol consumption. Three hundred and forty-seven online participants were stratified by levels of alcohol consumption and subsequently randomised to receive T2D information, risk estimates, and lifestyle recommendations that were subjected to 4 different message framing and tailoring manipulations. Study 3 involved conducting a secondary data analysis, using both archival data from cross-sectional study and data from Study 4, to examine the risk and rates of T2D among people with alcohol and/or other drug (AOD) problems. A 2x2 ANCOVA, with gender and age as covariates, was used to assess if there was a significant interaction effect between alcohol consumption and mental health disorder (MHD) on T2D risk. Study 4 assessed the effectiveness of an online T2D risk communication intervention (T2D-RC) in a sample of 459 participants with AOD problems. Participants were randomized to either the intervention or a control (COVID-19 health message) group. The T2D-RC was developed based on findings from Study 1 and 2 and it incorporated the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK). Measures of T2D risk perception and behavioural intentions for physical activity and diet were assessed pre- and post-intervention for both Study 2 and 4. Results: Study 1 found that message framing, specifically gain-framed messages, had a positive impact on smoking cessation. However, the limited number of studies included were characterised by heterogeneous methods and measures. Study 2 did not find any significant differences in T2D risk perceptions or behavioural intentions by study arm. However, T2D risk perception scores and accuracies, and behavioural intentions significantly increased post-intervention across all conditions. In Study 3, the secondary data analysis of pooled participants with AOD problems indicated not only a high proportion of participants diagnosed with diabetes, but also an increased risk of T2D amongst the remaining participants despite their average age being lower than the typical age of T2D onset. After accounting for gender and age, there was no significant interaction effect but there were significant main effects of alcohol consumption and MHD on T2D risk. In Study 4, participants who received the T2D-RC reported a significantly greater increase in T2D risk perception. Additionally, there was a significantly larger proportion of participants who improved their T2D risk perception accuracy compared to the control group. Conclusion: This thesis highlights that people with AOD problems are an increased risk of developing T2D and that these individuals tend to not have an accurate perception of their risk. Health risk communication may be a viable intervention that can have positive implications on risk perception and behavioural intentions. Future research would benefit from a mixed methods approach and a greater focus on the subtle effects of message framing

Patterns of mental health symptoms, violence exposure, and health service utilization among adolescents: results from the healthy Allegheny teens survey

Introduction: Mental illness is widely known to be a serious public health concern. This study attempts to examine area-level differences in mental health symptoms, violence, and health utilization services. It also explores any demographic differences in the above measures across age, sex, and race. Method: The sample comprised 1813 teenagers aged 14-19 residing in Allegheny County completed the Healthy Allegheny Teens Survey via telephone interviews. Differences among variables of interest were examined using categorical data analyses. Binary and multivariate logistic regression models were used to test associations between variables of interest. Results: Significant differences across age, race, and sex were found for the above variables. For area-level differences, Medically Under-served Areas and municipalities with high homicide rates reported greater disparities in mental health symptoms, experiences with violence, and health service use. Measures of violence remained significant even after adjusting for age, race, and sex. Public Health Significance: This study is the first of its kind to examine adolescent mental health across Allegheny County using an area-level perspective. Future interventions can be designed to target specific areas of the County which report the greatest need. These findings can also guide the local health policy decision-making process and result in efficient distribution of public health resources