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Background Older adults are the fastest-growing and most sedentary group in society. As sedentary behaviour is associated with deleterious health outcomes, reducing sedentary time may improve overall well-being. This mixed-methods systematic review aimed to systematically review quantitative and qualitative studies examining interventions to reduce sedentary behaviour in community-dwelling older adults (aged ≥ 65 years). Methods Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Cinahl, SportDiscus, and PEDRO were searched from inception to July 2025. We included quantitative studies (randomised-controlled trials (RCTs) and cluster RCTs), qualitative studies (semi-structured interviews or focus groups), and mixed-method studies exploring interventions to reduce sedentary behaviour in community-dwelling older adults. Studies were appraised using the Mixed Method Appraisal Tool. Quantitative evidence was meta-analysed; qualitative evidence was thematically synthesised, with both combined in a mixed-method synthesis. The Behaviour Change Techniques employed were charted and analysed. Results Fifty-six studies (16 RCTs, 30 qualitative, and 10 mixed-method studies) were included. When pooled, interventions reduced sedentary behaviour by 27.53 min/day (95% CI: − 57.43 to 2.37), with greater reductions observed via self-report (–83.65 min/day) than device measures (–11.61 min/day). Using ≥ 11 BCTs (-24.01 min/day) was more effective than using 1–10 ( 9.24 min/day). Analytical themes included what sitting means to older adults, expectations of ageing, and social influence in older adults. The mixed-method synthesis identified that existing interventions are limited by recruited samples that are not representative of the wider population of older adults, and intervention design and outcome measurement selection that is not consistent with older adults’ priorities. Conclusions Interventions to reduce sedentary behaviour in community-dwelling older adults are somewhat effective at reducing sedentary time. Future research should focus on inclusive recruitment strategies to recruit underrepresented populations, incorporate outcome measures valued by older adults, and align intervention content with their preferences. PROSPERO registration number CRD42021264954.

Mental health first aid (MHFA) has gained popularity over the years. This study retrospectively maps the MHFA intervention to characterise its content using the Behavioural Change Wheel to identify the active ingredients and mechanisms of action. Three data sources formed the data for the current study. Namely, the MHFA training manual, a roleplay video demonstrating how to implement the intervention, and interviews with six participants of whom five were MHFAers and five were MHFA recipients, on their experiences of the MHFA intervention. The interview data source formed part of the EMPOWER trial. The study presented here utilised a two-step approach: a) The MHFA intervention was described using the Template for Intervention Description and Replication (TIDieR) framework, and b) the content was analysed to identify the behavioural change techniques (BCTs) using the behavioural change techniques taxonomy version 1 and intervention functions using the behavioural change wheel. The mechanisms of action were specified using the capability, opportunity, motivation model of behaviour and theoretical domains framework. Twelve BCTs and four intervention functions were identified across the three data sources. Only social support BCTs and the intervention functions of enablement and persuasion were consistently identified across the three data sources in the MHFA. The most frequent mechanisms of action were reflective motivation (particularly 'beliefs about capabilities' and 'goals') and social opportunity (particularly 'social influences'). The MHFA intervention incorporates BCTs to increase reflective motivation and social opportunity to seek help for mental health concerns. However, psychological capability and physical opportunity need to be addressed to enhance help-seeking behaviours in those experiencing mental health difficulties. Future research should evaluate the impact of integrating additional BCTs and intervention functions into the MHFA programme to determine the most effective combination for promoting help-seeking behaviour and improving mental health outcomes.

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.

Digital lifestyle interventions hold promise in supporting healthy gestational weight gain (GWG) during pregnancy. However, clarity on their key design and implementation features remains limited. The prevalence of excessive GWG and its associated maternal and infant health risks makes understanding the landscape of digital intervention characteristics critical. This scoping review aimed to map current literature on digital lifestyle interventions designed to promote healthy GWG and to identify intervention characteristics, including behavior change techniques (BCTs), used across these interventions, with particular attention to patterns in design and implementation features across studies reporting positive outcomes. We systematically searched PubMed, Embase, Cochrane, and Web of Science for peer-reviewed studies published between 2014 and 2024. Studies were included if they described interventions with at least 1 digital component targeting GWG. Studies on high-risk pregnancies, nonhuman participants, protocols without results, abstracts, gray literature, and non-English publications were excluded. Data extraction covered study characteristics, theoretical frameworks, timing, duration, frequency, delivery modes, and BCTs applied. The landscape of intervention characteristics was mapped, including descriptive analysis of features that appeared across different study outcomes. A total of 44 studies met the inclusion criteria: 23 primary data articles (pilot studies, randomized controlled trials, etc) and 21 secondary data articles (meta-analyses, systematic reviews, etc). Primary studies showed that interventions were more likely to achieve intended outcomes when they started earlier, lasted longer, and combined digital and in-person components. Five BCTs were commonly present across interventions achieving positive outcomes: goal setting (outcome; 71%), discrepancy between current behavior and goal (43%), self-monitoring of behavior (86%), social support (unspecified; 71%), and credible source (71%). Secondary studies supported these findings, identifying several helpful features: starting before midpregnancy, long duration with high intensity, in-person contact, and BCTs related to goal setting, action planning, feedback on, and monitoring of behavior. However, primary studies showed gaps in reporting practices, with many details lacking about design and implementation features, such as BCTs. This converged with secondary studies reporting insufficient detail in the reviewed primary literature, limiting interpretation and replication potential. This scoping review maps digital interventions for GWG and identifies key patterns in intervention design and implementation. Evidence suggests that interventions may be more promising when combining digital delivery with in-person components and incorporating BCTs related to goal setting, self-monitoring, and social support. This review provides a comprehensive mapping of BCT usage and other intervention features, highlighting approaches associated with positive outcomes. However, significant gaps in reporting practices limit evidence synthesis. The findings can inform the design of digital interventions for managing GWG by identifying potentially successful design and implementation features. Future research should prioritize standardized reporting practices and evaluate interventions in underserved populations, including health care desert communities, to enhance the evidence base.

ObjectivesThe quality and safety of drug therapy in primary care are global concerns. The Pharmacist and Data-Driven Quality Improvement in Primary Care (P-DQIP) intervention aims to improve prescribing safety via an informatics tool, which facilitates proactive management of drug therapy risks (DTRs) by health-board employed pharmacists with established roles in general practices. Study objectives were (1) to identify and prioritise factors that could influence P-DQIP implementation from the perspective of practice pharmacists and (2) to identify potentially effective, acceptable and feasible strategies to support P-DQIP implementation.DesignSemistructured face-to-face interviews using a Theoretical Domains Framework informed topic guide. The framework method was used for data analysis. Identified implementation factors were prioritised for intervention based on research team consensus. Candidate intervention functions, behavioural change techniques (BCTs) and policies targeting these were identified from the behavioural change wheel. The final intervention content and modes of delivery were agreed with local senior pharmacists.SettingGeneral practices from three Health and Social Care Partnerships in National Health Service (NHS) Tayside.Participants14 NHS employed practice pharmacists.ResultsIdentified implementation factors were linked to thirteen theoretical domains (all except intentions) and six (skill, memory/attention/decision making, behavioural regulation, reinforcement, environmental context/resources, social influences) were prioritised. Three intervention functions (training, enablement and environmental restructuring) were relevant and were served by two policy categories (guidelines, communication/marketing) and eight BCTs (instructions on how to perform a behaviour, problem solving, action planning, prompt/cues, goal setting, self-monitoring, feedback and restructuring the social environment). Intervention components encompass an informatics tool, written educational material, a workshop for pharmacists, promotional activities and small financial incentives.ConclusionsThis study explored pharmacists’ perceptions of implementation factors which could influence management of DTRs in general practices to inform implementation of P-DQIP, which will initially be implemented in one Scottish health board with parallel evaluation of effectiveness and implementation.

Background This paper describes (the development of) an eHealth tool (dr. Bart app) to enhance self-management and to optimize non-surgical health care utilization in patients with knee and/or hip osteoarthritis (OA) and presents a study aiming 1) to study the effectiveness of the dr. Bart app on health care use 2) to explore differences in use, usability and the clinical outcomes of the dr. Bart app between the Netherlands and Germany. Methods The dr. Bart app is a fully automated eHealth application and is based on the Fogg model for behavioural change, augmented with reminders, rewards and self-monitoring to reinforce app engagement and health behaviour. The dr. Bart app propose goals to a healthier lifestyle based on machine learning techniques fed by data collected in a personal profile and choosing behaviour of the app user. Patients ≥50 years with self-reported knee and/or hip OA will be eligible to participate. Participants will be recruited in the community through advertisements in local newspapers and campaigns on social media. This protocol presents a study with three arms, aiming to include 161 patients in each arm. In the Netherlands, patients are randomly allocated to usual care or dr. Bart app and in Germany all patients receive the dr. Bart app. The primary outcome of the first research question is the number of self-reported consultations in secondary health care. The primary outcome of the second research question (comparison between the Netherlands and Germany) is self-management behaviour assessed by the patient activation measure (PAM-13) questionnaire. Secondary outcomes are costs, health-related quality of life, physical functioning and activity, pain, use and usability of the dr. Bart app. Data will be collected through three online questionnaires (at baseline and after 3 and 6 months after inclusion). Discussion This study will gain insight into the effectiveness of the dr. Bart app in the (conservative) treatment of patients with knee and/or hip OA and differences in the use and usability of the dr. Bart app between the Netherlands and Germany. Trial registration Dutch Trial Register (Trial Number NTR6693 / NL6505 ). Registration date: 4 September 2017.

Background Diabetes is a rising but preventable health concern in Latin America and the Caribbean, where healthy eating research and behavioral interventions are crucial to reducing its global health burden. This study aimed to explore perceived barriers and facilitators of healthy eating, explain their underlying psychosocial mechanisms with the Theoretical Domains Framework and identify relevant behavioral interventions. Methods A multimethod qualitative Photovoice study was conducted to identify themes related to healthy eating barriers and facilitators. The Theoretical Domains Framework was used to explain the psychosocial mechanisms explaining barrier and facilitator themes, and identify behavior change techniques. Results Thirteen participants contributed 48 photos for analysis. The multimethod triangulation between thematic and content analysis highlighted that barriers are concentrated around structural factors such as the socioeconomic context, while facilitator’s themes are less concentrated and have a higher code frequency supporting skills, knowledge and personal factors. The environmental context , social role and influences were core TDF domains explaining barriers. The TDF domains explaining facilitators were more heterogeneous with social influences and environmental context , knowledge and belief about consequences being the core psychosocial mechanisms explaining facilitators. Restructuring the physical and social environment where the main behavioral interventions relevant to the overall sample. Additionally, modelling the desired behavior and simultaneously providing instruction on how to perform the behaviour, especially by peers in the social network, were also relevant to the sample. Conclusion These findings unique to Latin America and the Caribbean reveal the potential of participatory research to provide insights into local healthy eating behavioral etiology to inform small-scale interventions and personalized behavioral interventions. Furthermore, primary health care teams conducting home visits could use this information to employ behavioral change techniques beyond providing or discussing information to community members.

Background Fundamental motor skills (FMSs) are crucial for children’s health and comprehensive development. Obese children often encounter a considerable challenge in the development of FMSs. School-family blended PA programs are considered a potentially effective approach to improve FMSs and health-related outcomes among obese children, however, empirical evidence is still limited. Therefore, this paper aims to describe the development, implementation, and evaluation of a 24-week school-family blended multi-component PA intervention program for promoting FMSs and health among Chinese obese children, namely the Fundamental Motor Skills Promotion Program for Obese Children (FMSPPOC) employing behavioral change techniques (BCTs) and building on the Multi-Process Action Control (M-PAC) framework as well as using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework for improving and evaluating the program. Methods Using a cluster randomized controlled trial (CRCT), 168 Chinese obese children (8–12 years) from 24 classes of six primary schools will be recruited and randomly assigned to one of two groups by a cluster randomization, including a 24-week FMSPPOC intervention group and a non-treatment waiting-list control group. The FMSPPOC program includes a 12-week initiation phase and a 12-week maintenance phase. School-based PA training sessions (2 sessions/week, 90 min each session) and family-based PA assignments (at least three times per week, 30 min each time) will be implemented in the initiation phase (semester time), while three 60-min offline workshops and three 60-min online webinars will be conducted in the maintenance phase (summer holiday). The implementation evaluation will be undertaken according to the RE-AIM framework. For intervention effectiveness evaluation, primary outcome (FMSs: gross motor skills, manual dexterity and balance) and secondary outcomes (health behaviors, physical fitness, perceived motor competence, perceived well-being, M-PAC components, anthropometric and body composition measures) will be collected at four time-points: at baseline, 12-week mid-intervention, 24-week post-intervention, and 6-month follow-up occasions. Discussion The FMSPPOC program will provide new insights into the design, implementation, and evaluation of FMSs promotion among obese children. The research findings will also supplement empirical evidence, understanding of potential mechanisms, and practical experience for future research, health services, and policymaking. Trial registration Chinese Clinical Trial Registry; ChiCTR2200066143; 25 Nov 2022.

Type 2 diabetes mellitus (T2DM) is a highly prevalent chronic metabolic disease characterized by hyperglycemia and cardiovascular risks. Without proper treatment, T2DM can lead to long-term complications. Diabetes self-management is recognized as the cornerstone of overall diabetes management. Web-based self-management programs for T2DM patients can help to successfully improve patient health behaviors and health-related outcomes. Theories can help to specify key determinants of the target behaviors and behavior change strategies required to arrive at the desired health outcomes, which can then be translated into specific behavioral techniques or strategies that patients can learn to apply in their daily life. From previous reviews of a wide range of online diabetes self-management tools and programs, it appears that it is still unclear which behavioral change techniques (BCTs) are primarily used and are most effective when it comes to improving diabetes self-management behaviors and related health outcomes. We set out to identify which BCTs are being applied in online self-management programs for T2DM and whether there is indication of their effectiveness in relation to predefined health outcomes. Articles were systematically searched and screened on the mentioned use of 40 BCTs, which were then linked to reported statistically significant improvements in study outcomes. We found 13 randomized controlled trials reporting on 8 online self-management interventions for T2DM. The BCTs used were feedback on performance, providing information on consequences of behavior, barrier identification/problem solving, and self-monitoring of behavior. These BCTs were also linked to positive outcomes for health behavior change, psychological well-being, or clinical parameters. A relatively small number of theory-based online self-management support programs for T2DM have been reported using only a select number of BCTs. The development of future online self-management interventions should be based on the use of theories and BCTs and should be reported accurately.

Physical activity plays a central role in the course and progression of chronic conditions in older adults. However, individuals within this population tend to have an inactive lifestyle. Exergaming, which is defined as the integration of physical activity with game-based elements, offers a promising approach to promote physical activity in individuals with chronic conditions. Despite its potential, limited evidence exists on how specific game elements influence behavioral and psychological outcomes in this population. The aim of this study is to explore the behavioral and psychological change techniques experienced by individuals with chronic conditions using a walking-based mobile exergame, called Heart Farming. A cross-sectional qualitative design was used based on a gamification framework, using data from semistructured interviews with 14 participants aged 67 to 92 years who used the Heart Farming exergame for 3 months. Participants with chronic conditions, including heart failure, Parkinson disease, type 2 diabetes, stroke, or rheumatic disease, were recruited from 2 ongoing studies. Data were analyzed using deductive content analysis and presented based on the gamification framework. The data analysis revealed increased motivation to walk, which was facilitated by game elements such as goals, rewards, feedback, and planning. Participants valued not only the sense of progression and achievement within the game but also the real-world benefits, such as spending time in nature or feeling a sense of community with others. Exergaming was integrated into daily routines by supporting the planning and structuring of daily activities. It was also perceived as enjoyable, especially due to its farming theme and visual design. Behavioral change techniques such as goal setting, feedback, and social support were commonly experienced, whereas focus on past success (as described in the gamification framework) was not used as a technique by the exergame. Psychological techniques, including self-monitoring and stress management, were mentioned. A feeling of discomfort due to playing in public was reported, and participants varied in terms of the levels of digital literacy. Social interaction features were not adequately used, even though some participants created informal support groups to exergame. This study contributes to the exergaming literature by examining behavioral and psychological change techniques from the perspective of individuals with chronic conditions. Exergaming incorporates a variety of behavioral and psychological change techniques, which were experienced by the participants in various ways. Individuals' previous knowledge of exergaming, interests, and illness progression were mentioned as factors that can influence their experiences of exergaming. By increasing the understanding of how game elements are experienced and how they influence health-related behavior, the findings of this study may inform the development of exergames that are better tailored to users' needs. Further research is needed to refine behavioral change techniques and assess condition-specific adaptations to maximize engagement and health outcomes.