A digital intervention to increase motivation and access to NHS Stop Smoking Services: Applying the Behaviour Change Wheel to develop the ‘Stop-app’.

Background: Smokers are four times more likely to stop smoking with the help of an NHS Stop Smoking Service (SSS). However attendance is in decline, possibly due to the increase in popularity of e-cigarettes. SSS’s will support smokers who choose to use e-cigarettes as part of a quit attempt, therefore interventions are needed to encourage continued access and uptake of SSS. Aim: To design an evidence based intervention (Stop-app) to increase referrals, 4 week quit rates and reduce ‘did not attend’ (DNA) rates within SSS. Methods/Results: In Phase 1 we collected data to explore the barriers and facilitators to people using SSS. Smokers and ex-smokers identified a number of barriers, including a lack of knowledge about what happens at the service; the belief that there would be ’scare tactics’, ‘nagging’, that the service would be unfriendly and clinical; and a lack of perceived efficacy of the service. In Phase 2, data from extant literature and phase 1 were subject to behavioural analysis as outlined by the Behaviour Change Wheel framework. A range of factors were identified as needing to change. These aligned with capability (e.g. a lack of knowledge about the benefits of SSS), opportunity (e.g. beliefs that SSS are not easy to access) and to motivation to act (e.g. beliefs that they did not need and would not benefit from SSS). We describe the content development process, illustrating the choice of 19 ‘Behaviour Change Techniques’ included in our digital intervention. In Phase 3 we assessed the acceptability of the proposed intervention by interviewing stop smoking service advisors and non-NHS provider sites (e.g. library services and children’s centres). Findings from interviews are presented and have been used to consider the best path for implementation of the web-app within service provision. Conclusion: The ‘Stop –app’ is in development and will be accessible online, linking with the SSS booking system used by Public Health Warwickshire, and other local authorities nationally for NHS and non-NHS providers. Stop-app incorporates a brief behaviour change intervention to increase motivation to attend SSS, along with an e-referral system for instant appointment booking. Examples of content and functionality of the app are outlined. Usability and feasibility testing are planned for Phase 4; and a pilot efficacy trial protocol is in development

Stop-app: Using the Behaviour Change Wheel to develop an app to increase uptake and attendance at NHS Stop Smoking Services.

Smokers who attend NHS Stop Smoking Services (SSS) are four times more likely to stop smoking; however, uptake has been in decline. We report the development of an intervention designed to increase uptake of SSS, from a more motivated self-selected sample of smokers. In Phase 1 we collected data to explore the barriers and facilitators to people using SSS. In Phase 2, data from extant literature and Phase 1 were subject to behavioural analysis, as outlined by the Behaviour Change Wheel (BCW) framework. Relevant Behaviour Change Techniques (BCTs) were identified in order to address these, informing the content of the StopApp intervention. In Phase 3 we assessed the acceptability of the StopApp. Smokers and ex-smokers identified a number of barriers to attending SSS, including a lack of knowledge about what happens at SSS (Capability); the belief that SSS is not easy to access (Opportunity); that there would be ’scare tactics’ or ‘nagging’; and not knowing anyone who had been and successfully quit (Motivation). The ‘StopApp’ is in development and will link in with the commissioned SSS booking system. Examples of the content and functionality of the app are outlined. The next phase will involve a full trial to test effectiveness

Facing up to New Realism: The case of using the Target Cost Management approach in healthcare delivery Management

This study emerged out of the difficulties to identify the type of management model(s) used by the NHS to manage it care delivery portfolios. Amidst a period of persistent negative returns on care delivery output, questionable quality issues, shrinking resources, public outcry about hospital performances and management distress, this study set up to identify and examine three aspects within operations management and strategy related to the healthcare in general and NHS healthcare delivery management system in particular. The first is to determine the type of strategic management model deployed by the NHS. Being the principal healthcare deliverer in the UK, the study initially assumes that the NHS deployed a robust cost management model which is hypothetically holistic and runs through the entire care delivery value chain. Investigation presented in this thesis shows that such a model is not in use within the NHS management framework. This vacuum led to the proposal that Target Cost Management (TCM) model could be adopted by the NHS. The main reason for this is that the TCM system will fits well within the NHS benchmarking operation and care delivery requirements. The second aspect of the study seeks to understand what the TCM model is all about plus the reasons why it is being considered as a more superior system than other costing methods. When compared with the popular cost–plus or the traditional costing system, TCM is identified as being ex–ante, price based, dynamic and strategic, meeting modern cost management needs while others are more ex–post and cost – based and considered outdated. Seeking whether TCM could be applied in the NHS, a case study is designed to test the hypothesis thereby justifying such proposition since there is limited implementation of this phenomenon of interest in other studies

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