Co-Produce, Co-Design, Co-Create, or Co-Construct—Who Does It and How Is It Done in Chronic Disease Prevention? A Scoping Review

Co-production in health literature has increased in recent years. Despite mounting interest, numerous terms are used to describe co-production. There is confusion regarding its use in health promotion and little evidence and guidance for using co-produced chronic disease prevention interventions in the general population. We conducted a scoping review to examine the research literature using co-production to develop and evaluate chronic disease prevention programs. We searched four electronic databases for articles using co-production for health behaviour change in smoking, physical activity, diet, and/or weight management. In 71 articles that reported using co-production, co-design, co-create, co-develop, and co-construct, these terms were used interchangeably to refer to a participatory process involving researchers, stakeholders, and end users of interventions. Overall, studies used co-production as a formative research process, including focus groups and interviews. Co-produced health promotion interventions were generally not well described or robustly evaluated, and the literature did not show whether co-produced interventions achieved better outcomes than those that were not. Uniform agreement on the meanings of these words would avoid confusion about their use, facilitating the development of a co-production framework for health promotion interventions. Doing so would allow practitioners and researchers to develop a shared understanding of the co-production process and how best to evaluate co-produced interventions

Acceptability of financial incentives for maintenance of weight loss in mid-older adults: a mixed methods study

Abstract Background Health insurers worldwide implement financial incentive schemes to encourage health-related behaviours, including to facilitate weight loss. The maintenance of weight loss is a public health challenge, and as non-communicable diseases become more prevalent with increasing age, mid-older adults could benefit from programs which motivate weight loss maintenance. However, little is understood about their perceptions of using financial incentives to maintain weight loss. Methods We used mixed methods to explore the attitudes and views of participants who had completed an Australian weight loss and lifestyle modification program offered to overweight and obese health insurance members with weight-related chronic diseases, about the acceptability and usefulness of different types of financial incentives to support weight loss maintenance. An online survey was completed by 130 respondents (mean age = 64 years); and a further 28 participants (mean age = 65 years) attended six focus groups. Results Both independent samples of participants supported a formalised maintenance program. Online survey respondents reported that non-cash (85.2%) and cash (77%) incentives would be potentially motivating; but only 40.5% reported that deposit contracts would motivate weight loss maintenance. Results of in-depth discussions found overall low support for any type of financial incentive, but particularly deposit contracts and lotteries. Some participants expressed that improved health was of more value than a monetary incentive and that they felt personally responsible for their own health, which was at odds with the idea of financial incentives. Others suggested ongoing program and peer support as potentially useful for weight loss maintenance. Conclusions If financial incentives are considered for mid-older Australian adults in the health insurance setting, program planners will need to balance the discordance between participant beliefs about the individual responsibility for health and their desire for external supports to motivate and sustain weight loss maintenance

Effectiveness of Australia’s Get Healthy Information and Coaching Service®: maintenance of self-reported anthropometric and behavioural changes after program completion

BACKGROUND: The Get Healthy Information and Coaching Service® (GHS) is a population-wide telephone-based program aimed at assisting adults to implement lifestyle improvements. It is a relatively uncommon example of the translation of efficacious trials to up-scaled real-world application. GHS participants who completed the 6-month coaching program made significant initial improvements to their weight, waist circumference, Body Mass Index (BMI), physical activity and nutrition behaviours. This study examines the maintenance of anthropometric and behaviour change improvements 6-months after program completion. METHODS: GHS coaching participants (n=1088) were recruited between February 2009 and June 2011. Participants were eligible if they completed the 6-month coaching program and had available data at 12-month follow-up (n=277). Weight, waist circumference, BMI, fruit and vegetable consumption and physical activity were collected at baseline and 6-months by GHS coaches and 12-months (6-months post program) by independent evaluators. Matched pair t-tests, mixed linear regression and logistic regression analyses were performed to assess maintenance of program effects. RESULTS: Improvements in weight (−2.9 kg, 95% CI: -3.6, -2.1), waist circumference (−5.4 cm, 95% CI: -6.7, -4.1), BMI (−1.1units, 95% CI: -1.5, -0.8), and fruit (+0.3 serves per day, 95% CI: 0.2, 0.3) and vegetable (+0.5 serves per day 95% CI: 0.3, 0.6) consumption were observed from baseline to 12-months. Apart from vegetable consumption, there were no significant differences between 6-month and 12-month changes from baseline, indicating these risk factor improvements were maintained from the end of the coaching program. There were also improvements in the proportion of participants undertaking recommended levels of physical activity from baseline to 12-months (increase of 5.2%), however the improvements made at end of the coaching program were not maintained at the 6-month follow up. CONCLUSIONS: This study provides preliminary evidence that the GHS has potential to contribute to substantial improvements in the chronic disease risk factor profile of program completers and facilitates sustained maintenance six months after completing the coaching program

supplementary_material - Are Financial Incentives for Lifestyle Behavior Change Informed or Inspired by Behavioral Economics? A Mapping Review

<p>supplementary_material for Are Financial Incentives for Lifestyle Behavior Change Informed or Inspired by Behavioral Economics? A Mapping Review by Bronwyn McGill, Blythe J O’Hara, Adrian Bauman, Anne C Grunseit, and Philayrath Phongsavan in American Journal of Health Promotion</p

Unweighted demographic characteristics and (weighted) distribution of BMI in post-campaign sample.

<p>Notes</p><p>¹ Secondary campaign target group aged 45–65 years.</p><p>² Income was collected as: <$AUD30,000;$AUD30,000–49,999; $AUD50,000–69,999;$AUD70,000–99,999; $AUD100,000+. The categories <$50k, $50k—<$100k, $100k+ approximate to: low income (below the 40^th percentile), middle income (between 40^th and 70^th percentile) and high income (70^th percentile and above) gross annual income for the Australian population.[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121387#pone.0121387.ref040" target="_blank">40</a>]</p><p>³ Missing 9.2% (n = 259) for self-reported height/weight, weighted percentages</p><p>Unweighted demographic characteristics and (weighted) distribution of BMI in post-campaign sample.</p

Demographic profile for each level of <i>Measure-Up</i> campaign awareness (n = 2812).

<p>† Weighted percentages</p><p>* Category significantly different from Unprompted Recallers at. 05,</p><p>** at. 01 in regression analysis</p><p>¹ Secondary campaign target group</p><p>² Primary target group are aged 25–49 with children younger than 17 years</p><p>Demographic profile for each level of <i>Measure-Up</i> campaign awareness (n = 2812).</p

<i>Measure-Up</i> campaign-related knowledge, behaviours, and intentions for each campaign recall group, with tests for trend.

<p>* Category significantly different from Unprompted Recallers at. 05,</p><p>** at. 01</p><p><i>Measure-Up</i> campaign-related knowledge, behaviours, and intentions for each campaign recall group, with tests for trend.</p