Methods of Health Behavior Change

People’s behavior influences health, for example, in the prevention, early detection, and treatment of disease, the management of illness, and the optimization of healthcare professionals’ behaviors. Behaviors are part of a system of behaviors within and between people in that any one behavior is influenced by others. Methods for changing behavior may be aimed at individuals, organizations, communities, and/or populations and at changing different influences on behavior, e.g., motivation, capability, and the environment. A framework that encapsulates these influences is the Behavior Change Wheel, which links an understanding of behavior in its context with methods to change behavior. Within this framework, methods are conceptualized at three levels: policies that represent high-level societal and organizational decisions, interventions that are more direct methods to change behavior, and behavior change techniques that are the smallest components that on their own have the potential to change behavior. In order to provide intervention designers with a systematic method to select the policies, interventions, and/or techniques relevant for their context, a set of criteria can be used to help select intervention methods that are likely to be implemented and effective. One such set is the “APEASE” criteria: affordability, practicability, effectiveness, acceptability, safety, and equity

Does non-smoker identity following quitting predict long-term abstinence? Evidence from a population survey in England

Aims: ‘Categorical self-labels’ (e.g. thinking of oneself as a smoker or non-smoker) are important aspects of identity that can have a fundamental influence on behaviour. To explore the role identity aspects relating to smoking can play in smoking cessation and relapse, this study assessed the prospective associations between taking on a non-smoker identity following quitting and long-term abstinence.  Methods: A representative sample of 574 ex-smokers in England who quit smoking in the past year was followed-up at three (N=179) and six months (N=163). Post-quit identity relating to smoking (‘I still think of myself as a smoker’ or ‘I think of myself as a nonsmoker’), and demographic and smoking-related characteristics were assessed at baseline. Self-reported smoking abstinence was assessed at follow-ups.  Results: Non-smoker identity was reported by 80.3% (95%CI 76.8-83.4) of recent exsmokers. Younger age (p=0.017) and longer abstinence (p<0.001) were independently associated with a post-quit non-smoker identity. After adjusting for covariates, non-smoker identity (p=0.032) and length of abstinence at baseline (p<0.001) were associated with continued abstinence at three months follow-up, and baseline length of abstinence (p=0.003) predicted continued abstinence at six months.  Conclusions: The majority of people who quit smoking recently consider themselves as nonsmokers. Younger people and those who have been abstinent for longer are more likely to take on a non-smoker identity. Ex-smokers who make this mental transition following a quit attempt appear more likely to remain abstinent in the medium term than those who still think of themselves as smokers

Development of a smoking cessation smartphone application for pregnant smokers focusing on the role of identity

This thesis reports two strands of work leading to the creation of a smartphone application harnessing identity change to promote smoking cessation during pregnancy. The first strand studied the role of smoker identity in smoking cessation. Using data from a national prospective study of smokers in England, Study 1 found that most young women do not have a positive smoker identity but that those who do are less likely to try to quit smoking, independent of other smoking-related attitudes. Study 2 used prospective national survey data and showed that adopting a non-smoker identity after a quit attempt predicts medium-term abstinence. Study 3 was a meta-ethnography of smoker identity in young adults and found that multiple smoker identities evolve depending on the context and that these do appear to play a role in cessation. The second strand related to the development of the application itself. Using interviews with pregnant smokers, Study 4 found that, from their perspective, stopping smoking would require strong enough motivation, improved ability and a supportive social and physical environment. Study 5 involved focus groups of health professionals working with pregnant smokers and solicited recommendations regarding the design and delivery of digital cessation aids in pregnancy. Study 6 used data from a pilot randomised controlled trial of the smoking cessation website, MumsQuit, to assess associations between exposure to particular components and four-week continuous abstinence. Six behaviour change techniques were associated with abstinence: promoting problem solving, providing feedback on behaviour, promoting self-monitoring of outcomes of the behaviour, providing feedback on outcomes of the behaviour, providing social reward, and promoting self-reward. The thesis concludes with a description of the development of a smartphone application, SmokeFree Baby, based on preceding work

Positive smoker identity as a barrier to quitting smoking: findings from a national survey of smokers in England

It has been proposed that positive smoker identity may be an important factor undermining smoking cessation but very little research exists on this. This study tested the hypothesis that a simple measure of positive smoker identity would predict quit attempts over and above other known predictors in a population sample. More tentatively it explored whether this measure would also predict quit success

Usability testing of a smoking cessation smartphone application ('SmokeFree Baby'): a think-aloud study with pregnant smokers

BACKGROUND: Only a few digital interventions have been developed for pregnant smokers, and little is known about the acceptability and usability of smartphone apps to aid cessation in pregnancy. This study aimed to explore pregnant smokers’ views on the design, content and usability of a pregnancy-specific smoking cessation app in order to inform intervention development and optimisation. METHODS: Ten interviews were conducted and the ‘think-aloud’ protocol was used in order to explore participants’ views about a smoking cessation smartphone app (‘SmokeFree Baby’). The data were subsequently thematically analysed. Participants were 18 and over, pregnant, and daily or weekly cigarette smokers. RESULTS: Three main themes were identified: views about the design elements, mode of delivery and content of the intervention. App design was considered as an important element that might influence potential users’ engagement with the intervention. Participants felt that the intervention content was educational, motivational and non-judgemental. However, it was emphasised that the app should provide further options for personalisation and include more practical features. CONCLUSIONS: Delivering smoking cessation support via a smartphone app can be feasible and acceptable for pregnant smokers. They appear to value content that is motivational, educational and personalised, and meeting these requirements may be important for user experience and promoting engagement with the intervention