Identification of behaviour change techniques and engagement strategies to design a smartphone app to reduce alcohol consumption using a formal consensus method

Background: Digital interventions to reduce excessive alcohol consumption have the potential to have a broader reach and be more cost-effective than traditional brief interventions. However, there is not yet a strong evidence base on their ability to engage users or on their effectiveness. Objective: This study aimed to identify the behaviour change techniques (BCTs) and engagement strategies most worthy of further study by inclusion in a smartphone application (app) to reduce alcohol consumption, using formal expert consensus methods. Methods: The first phase of the study consisted of a Delphi exercise with three rounds. It was conducted with seven international experts in the field of alcohol and/or behaviour change. In the first round, experts identified BCTs most likely to be effective at reducing alcohol consumption and strategies most likely to engage users with an app; these were rated in the second round; and those rated as effective by at least four out of seven participants were ranked in the third round. The rankings were analysed using Kendall’s W coefficient of concordance, which indicates consensus between participants. The second phase consisted of a new, independent group of experts (n=43) ranking the BCTs that were identified in the first phase. The correlation between the rankings of the two groups was assessed using Spearman’s rank correlation coefficient. Results: Twelve BCTs were identified as likely to be effective. There was moderate agreement among the experts over their ranking (W=.465, χ2(11)=35.77, P<.001) and the BCTs receiving the highest mean rankings were self-monitoring, goal-setting, action planning, and feedback in relation to goals. There was a significant correlation between the ranking of the BCTs by the group of experts who identified them and a second independent group of experts (Spearman’s rho=.690, P=.01). Seventeen responses were generated for strategies likely to engage users. There was moderate agreement among experts on the ranking of these engagement strategies (W=.563, χ2(15)=59.16, P<.001) and those with the highest mean rankings were ease of use, design – aesthetic, feedback, function, design – ability to change design to suit own preferences, tailored information, and unique smartphone features. Conclusions: The BCTs with greatest potential to include in a smartphone app to reduce alcohol consumption were judged by experts to be self-monitoring, goal-setting, action planning, and feedback in relation to goals. The strategies most likely to engage users were ease of use, design, tailoring of design and information, and unique smartphone features

A Mobile App to Aid Smoking Cessation: Preliminary Evaluation of SmokeFree28

Background: Little is known about the effectiveness of mobile apps in aiding smoking cessation or their validity for automated collection of data on smoking cessation outcomes. Objective: We conducted a preliminary evaluation of SF28 (SF28 is the name of the app, short for SmokeFree28)—an app aimed at helping smokers to be smoke-free for 28 days. / Methods: Data on sociodemographic characteristics, smoking history, number of logins, and abstinence at each login were uploaded to a server from SF28 between August 2012 and August 2013. Users were included if they were aged 16 years or over, smoked cigarettes at the time of registration, had set a quit date, and used the app at least once on or after their quit date. Their characteristics were compared with data from a representative sample of smokers trying to stop smoking in England. The percentage of users recording 28 days of abstinence was compared with a value of 15% estimated for unaided quitting. Correlations were assessed between recorded abstinence for 28 days and well-established abstinence predictors. / Results: A total of 1170 users met the inclusion criteria. Compared with smokers trying to quit in England, they had higher consumption, and were younger, more likely to be female, and had a non-manual rather than manual occupation. In total, 18.9% (95% CI 16.7-21.1) were recorded as being abstinent from smoking for 28 days or longer. The mean number of logins was 8.5 (SD 9.0). The proportion recording abstinence for 28 days or longer was higher in users who were older, in a non-manual occupation, and in those using a smoking cessation medication. / Conclusions: The recorded 28-day abstinence rates from the mobile app, SF28, suggest that it may help some smokers to stop smoking. Further evaluation by means of a randomized trial appears to be warranted

Pandora's box and the delphic oracle : EU cohesion policy and state aid compliance

The relationship between EU Competition policy and EU Cohesion policy is at best one of ambiguity and at worst one of direct conflict. While EU Cohesion policy explicitly intervenes to alter economic outcomes, EU Competition policy aims to ensure that State intervention does not interfere with the smooth functioning of the internal market or distort competition to an extent contrary to the common interest. EU Competition policy predates EU Cohesion policy by several decades. EU Cohesion policy in its current form dates back to the end of the 1980s, which saw the radical restructuring and upgrading of a policy that had until then largely been an adjunct to national regional policies. By contrast, EU Competition policy was enshrined in the Treaty from the outset. It is clear that, back in the 1950s, the authors of the Treaty perceived the risks to the common market that lay in allowing Member States unfettered use of subsidies. Moreover, although the original provisions have been subject to extensive interpretation, the fundamental principle has remained unchanged since the outset: State aid which distorts or threatens to distort competition in the EU is prohibited, subject to certain exceptions. Given this context, EU-sponsored intervention in the form of the Structural Funds arguably sits uneasily with the precepts of State aid control, and there remain significant conceptual and practical difficulties in reconciling EU Cohesion and Competition policies, especially given that the Structural Funds Regulations impose specific requirements on the Member States which make State aid compliance issues of particular relevance to Structural Fund Managing Authorities. The aim of this article is to explore those issues and examine how they have been addressed in practice. It draws on a mix of desk research and interviews with staff working on the implementation of Structural Funds programmes and in State aid compliance. The article starts with an examination of definitional issues associated with State aid and briefly reviews the scope of admissible aid. It then covers the institutional and procedural arrangements for ensuring compliance with the State aid rules, and concludes by highlighting some key areas of difficulty where tensions remain unresolved

Sustained behavior change is key to preventing and tackling future pandemics

Investment in research and programs to discover and apply the principles that underpin sustained behavior change is needed to address the continuing threat from COVID-19 and future pandemics and will require collaboration among behavioral, social, biomedical, public-health and clinical scientists

Embedding Covid-safe behaviours into everyday life through an enhanced risk management approach

Covid-19 is likely to be with us for many years, and the threat of future pandemics is high. Societies worldwide need to develop policies to minimise the impact of Covid-19 and the risk of future pandemics, and mitigate the harm caused by those pandemics when they occur. These policies need to work alongside strategies for tackling climate change and other threats to the lives and wellbeing of the global population. They also need to facilitate rather than restrict progress in combating poverty and inequality

Increasing condom use in heterosexual men: development of a theory-based interactive digital intervention

Increasing condom use to prevent sexually transmitted infections is a key public health goal. Interventions are more likely to be effective if they are theory- and evidence-based. The Behaviour Change Wheel (BCW) provides a framework for intervention development. To provide an example of how the BCW was used to develop an intervention to increase condom use in heterosexual men (the MenSS website), the steps of the BCW intervention development process were followed, incorporating evidence from the research literature and views of experts and the target population. Capability (e.g. knowledge) and motivation (e.g. beliefs about pleasure) were identified as important targets of the intervention. We devised ways to address each intervention target, including selecting interactive features and behaviour change techniques. The BCW provides a useful framework for integrating sources of evidence to inform intervention content and deciding which influences on behaviour to target

From lists of behaviour change techniques (BCTs) to structured hierarchies: comparison of two methods of developing a hierarchy of BCTs

Objectives Behaviour change technique (BCT) Taxonomy v1 is a hierarchically grouped, consensus-based taxonomy of 93 BCTs for reporting intervention content. To enhance the use and understanding of BCTs, the aims of the present study were to (1) quantitatively examine the ‘bottom-up’ hierarchical structure of Taxonomy v1, (2) identify whether BCTs can be reliably mapped to theoretical domains using a ‘top-down’ theoretically driven approach, and (3) identify any overlap between the ‘bottom-up’ and ‘top-down’ groupings. Methods and design The ‘bottom-up’ structure was examined for higher-order groupings using a dendrogram derived from hierarchical cluster analysis. For the theory-based ‘top-down’ structure, 18 experts sorted BCTs into 14 theoretical domains. Discriminant Content Validity was used to identify groupings, and chi-square tests and Pearson's residuals were used to examine the overlap between groupings. Results Behaviour change techniques relating to ‘Reward and Punishment’ and ‘Cues and Cue Responses’ were perceived as markedly different to other BCTs. Fifty-nine of the BCTs were reliably allocated to 12 of the 14 theoretical domains; 47 were significant and 12 were of borderline significance. Thirty-four of 208 ‘bottom-up’ × ‘top-down’ pairings showed greater overlap than expected by chance. However, only six combinations achieved satisfactory evidence of similarity. Conclusions The moderate overlap between the groupings indicates some tendency to implicitly conceptualize BCTs in terms of the same theoretical domains. Understanding the nature of the overlap will aid the conceptualization of BCTs in terms of theory and application. Further research into different methods of developing a hierarchical taxonomic structure of BCTs for international, interdisciplinary work is now required. Statement of contribution What is already known on this subject? * Behaviour change interventions are effective in improving health care and health outcomes

The formation of ultra-compact dwarf galaxies and nucleated dwarf galaxies

Ultra compact dwarf galaxies (UCDs) have similar properties as massive globular clusters or the nuclei of nucleated galaxies. Recent observations suggesting a high dark matter content and a steep spatial distribution within groups and clusters provide new clues as to their origins. We perform high-resolution N-body / smoothed particle hydrodynamics simulations designed to elucidate two possible formation mechanisms for these systems: the merging of globular clusters in the centre of a dark matter halo, or the massively stripped remnant of a nucleated galaxy. Both models produce density profiles as well as the half light radii that can fit the observational constraints. However, we show that the first scenario results to UCDs that are underluminous and contain no dark matter. This is because the sinking process ejects most of the dark matter particles from the halo centre. Stripped nuclei give a more promising explanation, especially if the nuclei form via the sinking of gas, funneled down inner galactic bars, since this process enhances the central dark matter content. Even when the entire disk is tidally stripped away, the nucleus stays intact and can remain dark matter dominated even after severe stripping. Total galaxy disruption beyond the nuclei only occurs on certain orbits and depends on the amount of dissipation during nuclei formation. By comparing the total disruption of CDM subhaloes in a cluster potential we demonstrate that this model also leads to the observed spatial distribution of UCDs which can be tested in more detail with larger data sets.Comment: 8 pages, 8 figures, final version accepted for publication in MNRA