Evidence-Based and Theoretically-Driven Behaviour Change Interventions for Physical Activity to Enhance Health and Wellbeing

There are high rates of inactivity in UK adults, which can lead to a range of health problems. The main aims of this thesis were: first to review existing behaviour change intervention design, delivery, evaluation, and reporting frameworks to gauge the most effective process and/or combination; second to review the existing literature on physical activity and sedentary behaviour interventions, to see whether they work, what techniques might be effective, and how well they were reported; third to review theories of behaviour (change) in terms of completeness and suitability for physical activity and sedentary behaviour; fourth to test the chosen theory (COM-B model) in terms of the relevant components of the three constructs (Capability, Opportunity, Motivation) and how well they predicted moderate-to-vigorous physical activity (MVPA) and sedentary behaviour (in comparison to the Theory of Planned Behaviour); last to design, implement, and evaluate (including from the deliverers’ perspective) a community physical activity programme, with the techniques highlighted in the review included in the content and the behavioural drivers from the theory analysis as secondary outcomes. The exploration of behaviour change intervention design frameworks concluded by summarising a nine-step process covering the most important elements from needs assessment to dissemination. The systematic review showed physical activity interventions to be effective at changing behaviour and maintaining those changes, and pointed towards behaviour change techniques that were associated with effectiveness. The theory review concluded that the COM-B contained the most comprehensive range of behavioural determinants and was ideally situated within the Behaviour Change Wheel for designing interventions. The COM-B analysis showed a strong prediction of MVPA and highlighted Psychological Capability and Reflective Motivation as important drivers. Sedentary behaviour was also predicted relatively strongly with Psychological Capability the most important driver. The Active Herts programme was then detailed and evaluated, showing improvements in physical activity, health, life satisfaction, and wellbeing at 3 and 6 months. COM-B measures predicted MVPA more strongly after intervention at 3 and 6 months, than at baseline, and were better at predicting MVPA performance than change over this period. Interviews with the Get Active Specialists delivering the programme reflected positively on the training, materials, and overall programme. Key lessons to take forward were extra support at the start with supervision and engaging referrers, and limiting the length and complexity of outcomes measures. The discussion explored the need to measure long-term outcomes of behaviour change, difficulties in measuring the constructs of the COM-B, the balance between standardisation and tailoring of interventions, and adopting a transdisciplinary approach to programme design

The influence of clothing on first impressions : Rapid and positive responses to minor changes in male attire

Clothing communicates information about the wearer and first impressions can be heavily influenced by the messages conveyed by attire. The purpose of this paper is to investigate the effect of minor changes in clothing on the perception of a male model, in the absence of facial information with limited time exposurePeer reviewe

A prospective study exploring the construct and predictive validity of the COM-B model for physical activity

The final, definitive version of this paper has been published in Journal of Health Psychology, November 2017, doi: https://doi.org/10.1177/1359105317739098, published by SAGE Publishing, All rights reserved.This study examined the constructs of Capability, Opportunity, and Motivation from the COM-B model and their influence on moderate-to-vigorous physical activity (MVPA). Using a prospective survey design, 186 healthy adults completed measures representing the Theoretical Domains Framework mapped to the COM-B, and MVPA one week later. The main indicators for the COM constructs were ‘habits’ (Capability), ‘subjective norms’ (Opportunity), and ‘exercise self-identity’ (Motivation). Motivation (77%) and MVPA (50%) were strongly predicted, with Capability and Motivation as key drivers of behaviour. Motivation was a strong mediator for Capability on behaviour. Future research should consider this approach for other populations and behaviours.Peer reviewe

How effective is community physical activity promotion in areas of deprivation for inactive adults? A pragmatic observational evaluation of the 'Active Herts' physical activity programme

Background There is a high prevalence of inactivity in UK adults and many suffer from comorbid conditions. These frequently co-exist in areas of higher socio-economic deprivation. There is a need to test the effectiveness, acceptability, and sustainability of physical activity programmes in this population. Method Active Herts recruited inactive adults (N=435) with one or more risk factors for cardiovascular disease and/or mild-to-moderate mental health conditions, and followed up at 3 and 6 months after baseline. In two areas programme-users received a behaviour change technique booklet, consultations, a booster phone call, motivational text messages, and signposting to 12 weeks of exercise classes (standard intervention). In another two areas programme-users also received 12 weeks of free tailored exercise classes, with optional exercise ‘buddies’ (enhanced intervention). Mixed ANOVAs analysed changes in physical activity, sporting participation, sitting (primary outcomes), mental wellbeing, health perception, and COM-B measures (secondary outcomes). Secondary analyses explored whether COM-B measures predicted moderate-to-vigorous physical activity (MVPA) at baseline, 3, and 6 months, and changes at 3 and 6 months using path analyses. Results At both timepoints, physical activity (3 months, η2 = .17; 6 months, η2 = .18), sporting participation (3 months, η2 = .22; 6 months, η2 = .17), sitting time (3 months, η2 = .08; 6 months, η2 = .06), and several secondary outcomes (e.g. wellbeing) improved regardless of group. COM-B related indicators explained MVPA performance better after 3 (R2=18%) and 6 (R2=15%) months than at baseline (R2=8%), but changes in MVPA were weakly predicted (3 months, R2=5%; 6 months, R2=7%). Self-monitoring was key in driving MVPA performance and change. Conclusions and Implications Active Herts improved activity levels at 3 and 6 months providing preliminary evidence that such interventions, delivered in real world settings, can change the behaviour and wellbeing of residents living in areas of deprivation.Peer reviewedFinal Published versio

Unbuttoned: : The interaction between provocativeness of female work attire and occupational status

This document is the Accepted Manuscript. The final publication is available at Springer via https://doi.org/10.1007/s11199-015-0450-8.Gender-biased standards in United Kingdom (UK) workplaces continue to exist. Women experience gender discrimination in judgements of competence, even by other women. Clothing cues can subtly influence professional perceptions of women. The aim of this study was to investigate how minor manipulations to female office clothing affect the judgements of competence of them by other UK females and to examine whether such effects differ with occupational status. One group of female university students (n = 54) and one group of employed females (n = 90), all from London and the East of England, rated images of faceless female targets, on a global competence measure derived from six competence ratings (of intelligence, confidence, trustworthiness, responsibility, authority, and organisation). The dress style was conservative but varied slightly by skirt length and the number of buttons unfastened on a blouse. The female targets were ascribed different occupational roles, varying by status (high – senior manager, or low - receptionist). Participants viewed the images for a maximum of 5 s before rating them. Overall participants rated the senior manager less favourably when her clothing was more provocative, but more favourably when dressed more conservatively (longer skirt, buttoned up blouse). This interaction between clothing and status was not present for the receptionist. Employed participants also rated females lower than did student participants. We conclude that even subtle changes to clothing style can contribute towards negative impressions of the competence of women who hold higher status positions in a UK cultural contextPeer reviewedFinal Accepted Versio

Can an established preschool obesity prevention programme (HENRY) be successfully delivered by trained volunteers?

Abstract IntroductionAlmost a quarter of 4-5 year olds are overweight. HENRY (Health, Exercise, Nutrition for the Really Young) delivers evidence-based interventions with consistently positive results when delivered by trained staff. This study tested whether this intervention could also be successfully delivered by trained volunteers.MethodThe programme was delivered one-to-one over eight 1-hour sessions. Baseline and post programme data was analysed for 87 parents and, for a sub-sample, at 6 months follow-up. Delivery was at the parent's home or community venue according to parent preference in four London boroughs. Approximately 80% of programmes were delivered by volunteers with a similar demographic profile to target parents and 20% by staff to enable a comparative evaluation.ResultsProgrammes provided by volunteers and staff showed similar statistically significant improvements in self-reported parent and child emotional wellbeing, parenting efficacy, and fruit and vegetable consumption. Additional benefits were seen in family eating (e.g. eating healthy meals and eating with others) and food purchasing (e.g. reading labels on food packaging) behaviours. Follow-up data showed that some changes were maintained six months later. Parent and volunteer ratings of the programme and training were very positive, with high retention (mean attendance of 7.2 out of 8 sessions).ConclusionVolunteers from similar backgrounds to target families can be recruited and trained to deliver structured obesity prevention programmes, resulting in the same positive lifestyle changes as those delivered by paid staff. External funding details Department of Health: Health and Social Care Volunteering Fund grant (Ref: 2013/National/055).Peer reviewe

Does image congruence impact the effectiveness of a gain-framed physical activity message?

This is a pre-publication version of the following article: Neil Howlett, Joanne Gardiner & Abbie Foster, 'Does image congruence impact the effectiveness of gain-framed physical activity message? ', Health Psychology Update, Vol. 26 (1): Spring 2017. The version of record is available online at https://shop.bps.org.uk/publications/publication-by-series/health-psychology-update/health-psychology-update-vol-26-no-1-spring-2017.html. Published by the British Psychological Society.Background: Gain-framed messages can improve processing and physical activity, however inconsistency remains about the merits of using different accompanying images. This study explored whether gain-framed messages alongside positive images (congruent) were more effective than negative (incongruent) images at increasing Social Cognitive Theory (SCT) constructs and moderate-to-vigorous physical activity (MVPA). Method: Using a mixed design participants (N=110) were randomly assigned to read a gain-framed physical activity booklet containing either congruent or incongruent images. Data were collected at two time points (baseline and one week later) using online questionnaires assessing SCT constructs and interviews about MVPA over the previous seven days. Results: A time by condition interaction showed that intentions (p=.039, η2=.04) and self-efficacy (p=.005, η2=.07) increased in the congruent condition only. There was a time main effect for self-regulation (p=.001, η2=.09) and MVPA (p=.011, η2=.06), but no difference between conditions. Changes in self-regulation predicted changes in MVPA in both conditions (congruent, p=.003; incongruent, p=.030). Conclusions: Congruence between message content and images increased intentions and self-efficacy, but not MVPA. Improving self-regulation may increase physical activity levels regardless of message congruence.Peer reviewedFinal Accepted Versio

How effective is community physical activity promotion in areas of deprivation for inactive adults with cardiovascular disease risk and/or mental health concerns? Study protocol for a pragmatic observational evaluation of the ’Active Herts' physical activity programme

Introduction: There is a high prevalence of inactive adults in the UK, and many suffer from conditions such as cardiovascular disease (CVD) or poor mental health. These coexist more frequently in areas of higher socioeconomic deprivation. There is a need to test the effectiveness, acceptability and sustainability of physical activity programmes. Active Herts uses novel evidence-based behaviour change techniques to target physical inactivity. Methods and analysis: Active Herts is a community physical activity programme for inactive adults aged 16+ with one or more risk factors for CVD and/or a mild to moderate mental health condition. This evaluation will follow a mixed-methods longitudinal (baseline, and 3-month, 6-month and 12-month follow-ups) design. Pragmatic considerations mean delivery of the programme differs by locality. In two areas programme users will receive a behaviour change technique booklet, regular consultations, a booster phone call, motivational text messages and signposting to 12 weeks of exercise classes. In another two areas programme users will also receive 12 weeks of free tailored exercise classes, with optional exercise ‘buddies’ available. An outcome evaluation will assess changes in physical activity as the primary outcome, and sporting participation, sitting, well-being, psychological capability and reflective motivation as secondary outcomes. A process evaluation will explore the views of stakeholders, delivery staff and programme leads. Economic evaluation will examine the programme costs against the benefits gained in terms of reduced risk of morbidity. Ethics and dissemination: This study was been approved by the Faculty of Medicine and Health Sciences Research Ethics Committee at the University of East Anglia. Informed written consent will be obtained from programme users in the evaluation. Results will be published in peer-reviewed journals, presented at conferences, and shared through the study website and local community outlets

Believe it or not:Exploring the relationship between dogmatism and openness within non-religious samples

Personality and dogmatic thinking within religious individuals have been examined by previous research, but neglected for non-religious individuals. In this experiment, we distinguish between two types of non-religious groups; those who ascribe themselves to an identity (atheists) and those who do not (no beliefs in particular). A total of 103 non-religious individuals (36% atheists and 64% with no particular beliefs) completed an online questionnaire measuring dogmatism and openness traits, with an additional Christian group (n = 91) serving as a control. After confirming a relationship between identity salience and dogmatism, and validating a measure of dogmatism (DOG) in both non-religious groups, we note key personality differences between the two. Those with no beliefs in particular demonstrated a traditional negative correlation between openness and dogmatism (along with Christians) while these variables correlated positively for atheists (in particular, on ‘unconventionality’). This study is the first to establish differences between the relationship of dogmatism and openness within non-religious populations and explain these differences through group identity. Thus, identity strength and group belief systems are suggested to be key contributors to observed group differences between non-religious individualsPeer reviewe

A nod in the wrong direction : Does nonverbal feedback affect eyewitness confidence in interviews?

Eyewitnesses can be influenced by an interviewer's behaviour and report information with inflated confidence as a result. Previous research has shown that positive feedback administered verbally can affect the confidence attributed to testimony, but the effect of non-verbal influence in interviews has been given little attention. This study investigated whether positive or negative non-verbal feedback could affect the confidence witnesses attribute to their responses. Participants witnessed staged CCTV footage of a crime scene and answered 20 questions in a structured interview, during which they were given either positive feedback (a head nod), negative feedback (a head shake) or no feedback. Those presented with positive non-verbal feedback reported inflated confidence compared with those presented with negative non-verbal feedback regardless of accuracy, and this effect was most apparent when participants reported awareness of the feedback. These results provide further insight into the effects of interviewer behaviour in investigative interviewsPeer reviewedFinal Accepted Versio