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While behavioural change interventions are utilized in low- and lower-middle-income countries and may be essential in reducing maternal and child mortality, evidence on the effectiveness of such interventions is lacking. This review provides evidence on the effectiveness of behavioural change interventions designed to improve maternal and child healthcare-seeking behaviour in low- and lower-middle-income countries. We searched three electronic databases (PUBMED, EMBASE, and PsycINFO) for articles published in English and French between January 2013 and December 2022. Studies that evaluated interventions to increase maternal and child healthcare utilization, including antenatal care, skilled birth care, postnatal care, immunization uptake, and medication or referral compliance, were included. We identified and included 17 articles in the review. Overall, 11 studies found significant effects of the behavioural change interventions on the desired healthcare outcomes, 3 found partially significant effects, and 3 did not observe any significant impact. A major gap identified in the literature was the lack of studies reporting the effect of behavioural change interventions on women's non-cognitive and personality characteristics, as recent evidence suggests the importance of these factors in maternal and child healthcare-seeking behaviour in low-resource settings. This review highlights some intervention areas that show encouraging trends in maternal and child healthcare-seeking behaviours, including social influence, health education, and nudging through text message reminders. Bien que les interventions visant à modifier les comportements soient utilisées dans les pays à faibles et moyens revenus et qu'elles pourraient être essentielles pour réduire la mortalité maternelle et infantile, les preuves de l'efficacité de telles interventions font défaut. Cette revue synthétise les preuves de l'efficacité des interventions de changement de comportement conçues pour améliorer le recours aux soins maternels et infantiles dans les pays à faibles et moyens revenus. Nous avons identifiés dans trois bases de données électroniques (PUBMED, EMBASE et PsycINFO) les articles publiés en anglais et en français entre janvier 2013 et décembre 2022. Les études qui évaluaient les interventions visant à accroître l'utilisation des soins de santé maternelle et infantile, y compris les soins prénatals, les soins d'accouchement par du personnel qualifié, les soins postnatals, la vaccination et l'observance des traitements médicamenteux ou de référence, ont été incluses. Nous avons identifié et inclus 17 articles dans la revue. Dans l'ensemble, 11 études mettent en évidence des effets significatifs des interventions visant à modifier les comportements en matière de soins de santé, 3 mettent en évidence des effets partiellement significatifs et 3 n'observent pas d'impact significatif. Une lacune majeure dans la littérature est le manque d'études rapportant l'effet des interventions de changement de comportement sur les caractéristiques non cognitives et de personnalité des femmes, alors que des travaux récents suggèrent l'importance de ces facteurs pour le recours aux soins de santé pour la mère et l'enfant dans les environnements à faibles ressources. Cette étude met en lumière certains domaines d'interventions qui encourageraient les comportements de recours aux soins des mères et des enfants, notamment l'influence sociale, l'éducation à la santé et l'incitation par le biais de rappels par SMS.

Objective: This research aims to address the challenges of just-in-time adaptive interventions (JITAIs) in behaviour change by introducing an architecture that integrates both the tailoring of the message to the user profile and context, and the timing of the intervention by detecting the trigger of the behaviour. Methods: We designed a system that integrates trigger detection to determine optimal intervention moments and uses prompt engineering on a large language model (LLM) to give personalised support based on the detected trigger, the context, and personal information of the person. As a proof of concept, we applied this intervention to the domain of smoking cessation. We conducted an in-depth semi-structured interview with a domain expert to evaluate the correctness, relevancy and personalisation of the chatbot’s responses. Results: An expert indicated that the support given by the chatbot is correct, personal, and tailored to the trigger and circumstances. While some suggestions were provided to further enhance the chatbot, its current capabilities were deemed effective and acceptable as a supportive tool for smoking cessation. Conclusions: An LLM with prompt engineering can be used to create a chatbot that can react to a trigger in a personalised way. Integrating both trigger detection and a generative chatbot into a JITAI is possible while ensuring privacy of the individual’s personal information and circumstances.

Background Physical activity (PA) can play an important role in optimizing metabolic/bariatric surgery (MBS) outcomes. However, many MBS patients have difficulty increasing PA, necessitating the development of theory-driven counseling interventions. This study aimed to (1) assess the feasibility and acceptability of the TELEhealth BARIatric behavioral intervention (TELE-BariACTIV) trial protocol/methods and intervention, which was designed to increase moderate-to-vigorous intensity physical activity (MVPA) in adults awaiting MBS and (2) estimate the effect of the intervention on MVPA. Methods This trial used a repeated single-case experimental design. Twelve insufficiently active adults awaiting MBS received 6 weekly 45-min PA videoconferencing counseling sessions. Feasibility and acceptability data (i.e., refusal, recruitment, retention, attendance, and attrition rates) were tracked and collected via online surveys, and interviews. MVPA was assessed via accelerometry pre-, during, and post-intervention. Results Among the 24 patients referred to the research team; five declined to participate (refusal rate = 20.8%) and seven were ineligible or unreachable. The recruitment rate was 1.2 participants per month between 2021–09 and 2022–07. One participant withdrew during the baseline phase, and one after the intervention (retention rate = 83.3%). No participant dropouts occurred during the intervention and 98.6% of sessions were completed. Participants’ anticipated and retrospective acceptability of the intervention was 3.2/4 (IQR, 0.5) and 3.0/4 (IQR, 0.2), respectively. There was a statistically significant increase in MVPA [Tau-U = 0.32(0.11; 0.51)] from pre- to post-intervention. Conclusion Despite a low recruitment rate, which could be explained by circumstances (COVID-19 pandemic), results support feasibility, acceptability, and preliminary efficacy of the TELE-Bari-ACTIV intervention for increasing MVPA in patients awaiting MBS. Graphical Abstract

Background The purpose of this 6-month intervention pilot feasibility randomised trial was to test sending brief messages using mobile phones to promote self-management through taking medication as prescribed to people with type 2 diabetes. This was to inform the design and conduct of a future large-scale United Kingdom-based clinical trial and establish the feasibility of recruitment, the technology used, follow-up, and data collection. Methods A multicentre individually randomised, controlled parallel group trial in primary care, recruiting adults (≥ 35 years) with type 2 diabetes in England. Consenting participants were randomly allocated to receive short message system text messages up to four times a week, or usual care, for a period of 6 months; messages contained behavioural change techniques targeting medication use. The primary outcome was the rate of recruitment to randomisation of participants to the trial with a planned rate of 22 participants randomised per month. The study also aimed to establish the feasibility of follow-up at 6 months, with an aim of retaining more than 80% of participants. Data, including patient-reported measures, were collected at baseline and the end of the 6-month follow-up period, and a notes review was completed at 24 months. Results The trial took place between 26 November 2018 and 30 September 2019. In total 209 participants were randomly allocated to intervention ( n  = 103) or usual care ( n  = 106). The maximum rate of monthly recruitment to the trial was 60–80 participants per month. In total, 12,734 messages were sent to participants. Of these messages, 47 were identified as having failed to be sent by the service provider. Participants sent 2,864 messages to the automated messaging system. Baseline data from medical records were available for > 90% of participants with the exception of cholesterol (78.9%). At 6 months, a further HbA1c measurement was reported for 67% of participants. In total medical record data were available at 6 months for 207 (99.0%) of participants and completed self-report data were available for 177 (84.7%) of participants. Conclusion The feasibility of a large-scale randomised evaluation of brief message intervention for people with type 2 diabetes appears to be high using this efficient design. Failure rate of sending messages is low, rapid recruitment was achieved among people with type 2 diabetes, clinical data is available on participants from routine medical records and self-report of economic measures was acceptable. Trial registration ISCTRN ISRCTN13404264. Registered on 10 October 2018.

IntroductionType 2 diabetes is common, affecting over 400 million people worldwide. Risk of serious complications can be reduced through use of effective treatments and active self-management. However, people are often concerned about starting new medicines and face difficulties in taking them regularly. Use of brief messages to provide education and support self-management, delivered through mobile phone-based text messages, can be an effective tool for some long-term conditions. We have developed messages aiming to support patients’ self-management of type 2 diabetes in the use of medications and other aspects of self-management, underpinned by theory and evidence. The aim of this trial is to determine the feasibility of a large-scale clinical trial to test the effectiveness and cost-effectiveness of the intervention, compared with usual care.Methods and analysisThe feasibility trial will be a multicentre individually randomised, controlled trial in primary care recruiting adults (≥35 years) with type 2 diabetes in England. Consenting participants will be randomised to receive short text messages three times a week with messages designed to produce change in medication adherence or non-health-related messages for 6 months. The aims are to test recruitment methods, retention to the study, the feasibility of data collection and the mobile phone and web-based processes of a proposed definitive trial and to refine the text messaging intervention. The primary outcome is the rate of recruitment to randomisation of participants to the trial. Data, including patient reported measures, will be collected online at baseline and the end of the 6-month follow-up period. With 200 participants (100 in each group), this trial is powered to estimate 80% follow-up within 95% CIs of 73.8% to 85.3%. The analysis will follow a prespecified plan.Ethics and disseminationEthics approval was obtained from the West of Scotland Research Ethics Committee 05. The results will be disseminated through conference presentations, peer-reviewed journals and will be published on the trial website: www.summit-d.org (SuMMiT-D (SUpport through Mobile Messaging and digital health Technology for Diabetes)).Trial registration number ISRCTN13404264.

Background Smoking cessation during pregnancy and the postpartum period by both women and their partners offers multiple health benefits. However, compared to pregnant/postpartum women, their partners are less likely to actively seek smoking cessation services. There is an increased recognition about the importance of tailored approaches to smoking cessation for expectant and new fathers. While Behavior Change Interventions (BCIs) are a promising approach for smoking cessation interventions, evidence on effectiveness exclusively among expectant and new fathers are fragmented and does not allow for many firm conclusions to be drawn. Methods We conducted a systematic review on effectiveness of BCIs on smoking cessation outcomes of expectant and new fathers both through individual and/or couple-based interventions. Peer reviewed articles were identified from eight databases without any date or language restriction.Two independent reviewers screened studies for relevance, assessed methodological quality of relevant studies, and extracted data from studies using a predeveloped data extraction sheet. Results We retrieved 1222 studies, of which 39 were considered for full text screening after reviewing the titles and abstracts. An additional eight studies were identified from reviewing the reference list of review articles picked up by the databases search. A total of nine Randomised Control Trials were included in the study. Six studies targeted expectant/new fathers, two targeted couples and one primarily targeted women with an intervention component to men. While the follow-up measurements for men varied across studies, the majority reported biochemically verified quit rates at 6 months. Most of the interventions showed positive effects on cessation outcomes. BCI were heterogenous across studies. Findings are suggestive of gender targeted interventions being more likely to have positive cessation outcomes. Conclusions This systematic review found limited evidence supporting the effectiveness of BCI among expectant and new fathers, although the majority of studies show positive effects of these interventions on smoking cessation outcomes. There remains a need for more research targeted at expectant and new fathers. Further, there is a need to identify how smoking cessation service delivery can better address the needs of (all) gender(s) during pregnancy.

Behavioral change interventions promoting the reduction of animal product consumption are valuable tools to improve ecological sustainability as well as public health and help the mitigation of climate change. Recent findings revealed improved efficacy of interventions targeted at barriers (e.g., self-efficacy) of three different types of meat consumers over non-targeted interventions (e.g., completion of unrelated surveys). However, such interventions have yet to factor in the role of individual differences in personality. Therefore, in a first step, we performed segmentation analysis on barriers and benefits of reducing animal product consumption (e.g., meat attachment, environmentalism) with the inclusion of personality. In an online sample of N=1135 participants, latent profile analysis revealed five distinct dietary groups: “plant-based eaters”, “meat-reducers”, “medium-hindrance meat eaters”, “medium strong-hindrance meat eaters, and “strong-hindrance meat eaters”, based on inhibitors and facilitators of meat reduction. Groups differed in terms of consumption of different animal products (η2=0.08 to η2=0.80) as well as the Big Five (η2=0.08 to η2=0.80) and Dark Triad (η2=0.08 to η2=0.80). Strong-hindrance meat eaters were characterized by low Conscientiousness, Agreeableness, and Openness as well as high dark trait expression, implying new targets for future intervention design.

Background Open burning of household waste, especially plastics, is a major but unaddressed environmental and health hazard in countries that lack infrastructure to properly manage waste. This study will implement village-level community working groups that aim to reduce household plastic waste burning and improve health-related quality of life in women of reproductive age in rural Guatemala. Methods Using a type 1 hybrid-effectiveness-implementation study design, we will randomize 16 matched-pair rural villages in Jalapa, Guatemala, and randomly select 400 women of reproductive age (25 in each village) who report burning plastic waste as a primary form of waste disposal to participate in the trial. In eight intervention villages, we will conduct 12-week community working groups to implement alternatives to burning plastic that are achievable over the subsequent 9 months. We will use the Behavior Change Wheel and RE-AIM, two implementation science frameworks, and a mixed-methods approach to refine, implement, and evaluate community-initiated interventions that address plastic waste. At baseline, 4 and 12 months, we will measure personal exposures to fine particulate matter and black carbon, and urinary biomarkers of exposure (e.g., bisphenols, phthalates, polycyclic aromatic hydrocarbons, and volatile organic compounds). We will use filter-based 1,3,5-Triphenylbenzene, a known tracer of plastic incineration, to quantify emissions estimates of air pollutants due to plastic burning. Based on plastic waste reductions in intervention villages, we will assess regional impacts of pollutant emissions reduction using a 3D chemical transport model. Discussion Our findings will inform community-driven public health actions to develop programs that address this environmental and health hazard. This project has direct benefit not only to those residing in Guatemala, but potentially in other areas where open waste burning contributes to air pollutants both regionally and globally. Trial Registration ClinicalTrials.gov NCT05130632 (Trial registration date 10/20/2021).

Background Over the past two decades, the population of Malaysia has grown rapidly and the prevalence of diabetes mellitus in Malaysia has dramatically increased, along with the frequency of obesity, hyperlipidaemia and hypertension. Early-life influences play an important role in the development of non-communicable diseases. Indeed, maternal lifestyle and conditions such as gestational diabetes mellitus or obesity can affect the risk of diabetes in the next generation. Lifestyle changes can help to prevent the development of type 2 diabetes mellitus. This is a protocol for an unblinded, community-based, randomised controlled trial in two arms to evaluate the efficacy of a complex behavioural change intervention, combining motivational interviewing provided by a community health promoter and access to a habit formation mobile application, among young Malaysian women and their spouses prior to pregnancy. Method/design Eligible subjects will be Malaysian women in the age group 20 to 39 years, who are nulliparous, not diagnosed with diabetes and own a smartphone. With an alpha-value of 0.05, a statistical power of 90 %, 264 subjects will need to complete the study. Subjects with their spouses will be randomised to either the intervention or the control arm for an 8-month period. The primary endpoint is change in waist circumference from baseline to end of intervention period and secondary endpoints are changes in anthropometric parameters, biochemical parameters, change in health literacy level, dietary habits, physical activity and stress level. Primary endpoint and the continuous secondary endpoints will be analysed in a linear regression model, whereas secondary endpoints on an ordinal scale will be analysed by using the chi-squared test. A multivariate linear model for the primary endpoint will be undertaken to account for potential confounders. This study has been approved by the Medical Research and Ethics Committee of the Ministry of Health Malaysia (protocol number: NMRR-14-904-21963) on 21 September 2015. Discussion This study protocol describes the first community-based randomised controlled trial, to examine the efficacy of a complex intervention in improving the pre-pregnancy health of young Malaysian women and their spouses. Results from this trial will contribute to improve policy and practices regarding complex behavioural change interventions to prevent diabetes in the pre-conception period in Malaysia and other low- and middle-income country settings. Trial registration This trial is registered with ClinicalTrials.gov (www.clinicaltrials.gov) on 30 November 2015, Identifier: NCT02617693 .

Employees in an office setting are more likely to remain physically inactive. Physical inactivity has become one of the major barriers to overcoming the risk factors for anxiety, depression, coronary heart disease, certain cancers, and type 2 diabetes. Currently, there is a gap in mobile health (mHealth) apps to promote physical activity (PA) for workers in the workplace. Studies on behavior change theories have concluded that health apps generally lack the use of theoretical constructs. The objective of this study was to study the feasibility of a persuasive app aimed at encouraging PA among employees and to understand the motivational aspects behind the implementation of mHealth apps among office workers. A 4-week study using a mixed methods (quantitative and qualitative) design was conducted with office-based employees in cities in 4 countries: Oulu, Finland; Carlow, Ireland; London, United Kingdom; and Dhaka, Bangladesh. Of the 220 invited participants (experimental group, n=115; control group, n=105), 84 participated (experimental group, n=56; control group, n=28), consisting of working-age volunteers working in an office setting. Participants used 2 different interventions: The experimental group used an mHealth app for PA motivation, and the control group used a paper diary. The purpose was to motivate employees to engage in healthier behavior regarding the promotion of PA in the workplace. A user-centered design process was followed to design, develop, and evaluate the mHealth app, incorporating self-determination theory (SDT) and using game elements. The paper diary had no specific theory-driven approach, design technique, nor game elements. Compliance with app usage remained relatively low, with 27 participants (experimental group, n=20; control group, n=7) completing the study. The results support the original hypothesis that the mHealth app would help increase PA (ie, promoting daily walking in the workplace) in comparison to a paper diary (P=.033). The mHealth app supported 2 of the basic SDT psychological needs, namely autonomy (P=.004) and competence (P=.014), but not the needs of relatedness (P=.535). The SDT-based mHealth application motivated employees to increase their PA in the workplace. However, compliance with app usage remained low. Future research should further develop the app based on user feedback and test it in a larger sample.