Creative Technologies for Behaviour Change

behaviour change; motivational interviewing; motivation; physical activity; exercise; qualitative research; computer-assisted therapy; robotics; social robotics; virtual coaching; video coaching; functional imagery trainingThis thesis presents innovative uses of technology to support motivation, using motivational interviewing (MI) and functional imagery training (FIT) scripts developed specifically for remote delivery. MI scripts aimed to develop discrepancy, evoke solutions and promote self-efficacy. FIT scripts included multi-sensory mental imagery exercises at key points in the MI scripts. Four methods of delivery were developed: a human video-counsellor, a NAO robot programmed with Choregraphe software, a video robot counsellor for comparison with the human video-counsellor, and a life-sized two dimensional 'holographic' projection. Four empirical studies tested these developments in participants wanting to become more physically active. Study 1 (N=18) and Study 2 (N=20) used qualitative methods to explore the usability and acceptability of MI delivered by a pre-recorded human video counsellor and NAO robot respectively. Analysis of participants' verbal dialogue with the video counsellor in Study 1 showed high levels of change talk, an important ingredient of effective MI. In both studies, participants reported that voicing their goals aloud was helpful but they were somewhat frustrated by the lack of personalised response. Participants positively appraised the non-judgemental aspect of the interview with the robot. Study 3 tested if virtual FIT would be more acceptable and effective than virtual MI. Ninety-eight participants received FIT or MI delivered by a video robot, and compared to a wait-list control group. In Study 4, 104 participants were randomized to a monologue version of FIT delivered by a human counsellor projected as a two-dimensional life-size hologram, or on a computer screen, or a wait-list control condition. Neither Study 3 or 4 found any quantitative effect of virtual counselling on physical activity, self-efficacy, or motivation. As in studies 1 and 2, although participants found the technological interaction somewhat impersonal, qualitative responses were largely positive: participants liked the opportunity to voice their goals, reported a motivational boost, and perceived the virtual coaches as non-judgmental. This research has shown that people perceive benefits from speaking aloud about their goals and problems, and even engaging silently in imagery-based counselling. There is potential to deliver a brief motivational intervention that is fully-automated and acceptable to participants

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease