Background: In Canada, only 15% of adults meet the physical activity guidelines (Colley et al., 2011). As regular physical activity has been demonstrated to substantially improve physical and mental health (Naci & Ioannidis, 2013; Schuch et al., 2016), a wealth of physical activity promoting interventions have been developed and evaluated (Kahn et al., 2002; Prince et al., 2014). Physical Activity Counselling (PAC) is one of these and has been shown effective in increasing physical activity motivation and behaviour (Fortier et al., 2011). However, the active ingredients of PAC have never been reported in detail, thus limiting our potential for understanding its effectiveness and to allow for its replication. Recently, taxonomies have been published for characterizing behaviour change techniques (BCTs) and Motivational Interviewing (MI) techniques in interventions (Hardcastle et al., 2017; Michie et al., 2013). Due to its novelty, no studies to date have used the MI technique taxonomy to report interventions. Purpose: To investigate the behaviour change techniques (BCTs) and Motivational Interviewing (MI) techniques applied in PAC sessions delivered by student-counsellors. Methods: PAC 1 and PAC 2 sessions delivered by 11 student-counsellors were double coded for identification of BCTs and MI techniques, for a total of 22 video recorded sessions. Two trained coders rated the presence of BCTs and MI techniques using the Behaviour Change Technique Taxonomy v1 (BCTTv1) and the table of MI techniques. Inter coder agreement was assessed using Cohen’s kappa and the prevalence- and bias-adjusted kappa (PABAK) statistic. Results: Overall, 29 BCTs (on 93) and 27 MI techniques (on 38) were reliably coded across the sampled PAC sessions (Cohen’s k =.81, PABAK=.91). Popular BCTs included 3.1 Social support (unspecified), 1.1 Goal setting (behaviour), 1.4 Action planning, whereas OARS skills (i.e., open-ended questions, affirmations, reflective and summary statements) and 24. Emphasize autonomy were the predominating MI techniques. On average, 5.7 BCTs and 9.5 MI techniques were recorded per session. Conclusions: Findings of this study provide a first detailed report of a PAC intervention and have important implications for PAC training and replication. Future research in this area specifically looking at the quality of application of the techniques and the influence of use and quality on physical activity behaviour over time is recommended.

Klimatet har på senare tid blivit en av de mest omdiskuterade och viktigaste frågorna i samhället. Om Parisavtalets mål om att hålla den globala temperaturökningen under 2 grader skall lyckas, måste utsläppen av växthusgaser att minska. Det finns ett flertal sätt till att minska växthusgasutsläppen, och ett av sättet är med hjälp av ett minskat matsvinn från hushåll, vilket bland annat är något FN uppmärksammat bland sina 17 hållbarhetsmålet satta till år 2030. I dagsläget slängs en ohållbar mängd mat, och en av anledningarna är av bortglömde matlådor vars innehåll har behövt slängas på grund av att bäst före-datumet passerats. Den här studien kommer att undersöka om det går, med en framtagen intervention designad med utgångspunk i beteendeförädringsramverket The Behaviour Change Wheel, att uppmuntra till ett beteende för ett minskat matsvinn. Interventionen kommer att innefatta ett inläsningssystem för matlådor, vars syfte är att hjälpa dess användare att hålla koll på sina matlådor. Sex deltagare blev rekryterade till studien utifrån en enkät, och fick under en tvåveckorsperiod testa på att använda inläsningssystemet. Resultatet skulle indikera på att inläsningssystemet fungerade som tänkt för vissa av deltagarna, men att den för andra deltagare inte gjorde det. Detta berodde emellertid inte på systemet i sig, utan istället till vilken grad deltagaren hade använt matlådor. / The climate debate has recently become one of the most discussed and important topics. If the Paris Agreement's goal of keeping the increase in global temperature below 2 degrees, the reduction of greenhouse gas emission is vital. There are several ways to reduce greenhouse gas emissions, and one of the ways is throughout a reduced food waste. This is also a topic that the UN has taken notice of among its 17 sustainable development goals set by 2030. At present, an unsustainable amount of food is thrown away, and one of the reasons is because of forgotten food boxes whose content has had to be thrown away because the expiration date has passed. This study will investigate if it is possible, with an intervention designed based on The Behavior Change Wheel framework, to encourages a behavior for a reduced food waste. The intervention will consist of a scanning system for food boxes, whose purpose is to help its user to keep track of their food boxes. Six participants were recruited to the study based on a questionnaire and got to test the scanning system for a two-week period. The result would indicate that the system worked as intended for some of the participants, but not for some others. This was not due to the system itself, but instead to what extent the participant had used food boxes.

Yes / Background: Interpreting evaluations of complex interventions can be difficult without sufficient description of key intervention content. We aimed to develop an implementation package for primary care which could be delivered using typically available resources and could be adapted to target determinants of behaviour for each of four quality indicators: diabetes control, blood pressure control, anticoagulation for atrial fibrillation and risky prescribing. We describe the development and prospective verification of behaviour change techniques (BCTs) embedded within the adaptable implementation packages. Methods: We used an over-lapping multi-staged process. We identified evidence-based, candidate delivery mechanisms—mainly audit and feedback, educational outreach and computerised prompts and reminders. We drew upon interviews with primary care professionals using the Theoretical Domains Framework to explore likely determinants of adherence to quality indicators. We linked determinants to candidate BCTs. With input from stakeholder panels, we prioritised likely determinants and intervention content prior to piloting the implementation packages. Our content analysis assessed the extent to which embedded BCTs could be identified within the packages and compared them across the delivery mechanisms and four quality indicators. Results: Each implementation package included at least 27 out of 30 potentially applicable BCTs representing 15 of 16 BCT categories. Whilst 23 BCTs were shared across all four implementation packages (e.g. BCTs relating to feedback and comparing behaviour), some BCTs were unique to certain delivery mechanisms (e.g. ‘graded tasks’ and ‘problem solving’ for educational outreach). BCTs addressing the determinants ‘environmental context’ and ‘social and professional roles’ (e.g. ‘restructuring the social and ‘physical environment’ and ‘adding objects to the environment’) were indicator specific. We found it challenging to operationalise BCTs targeting ‘environmental context’, ‘social influences’ and ‘social and professional roles’ within our chosen delivery mechanisms. Conclusion: We have demonstrated a transparent process for selecting, operationalising and verifying the BCT content in implementation packages adapted to target four quality indicators in primary care. There was considerable overlap in BCTs identified across the four indicators suggesting core BCTs can be embedded and verified within delivery mechanisms commonly available to primary care. Whilst feedback reports can include a wide range of BCTs, computerised prompts can deliver BCTs at the time of decision making, and educational outreach can allow for flexibility and individual tailoring in delivery / UK National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (Grant Reference Number RP-PG-1209-10040).

The first part of the report reads up on food waste and makes account for how to reduce food waste in households by documenting it. The goal of this project is to examine how a measure of method consisting of voice commands is working as compared to a classic method of measurement with paper and pen. Food waste is a big issue and to decrease food waste, it is important to document this waste in several ways. Since food waste can include different kinds of food depending on how it’s phrased, the concept of food waste is described as both food that could have been eaten but also food that could not be eaten. In studies of food waste, taking notes is a common method of measurement – but it has couple of flaws. In example subjects often forget to take notes when this is required. In this study we are investigating how voice control could be a new alternative to log food waste. The problem statement is based on whether households find easier to log something with the help of voice commands rather than writing it down with paper and pen. We have built a system that will be tested on five subjects. The subjects of the study will use voice commands with a Google Home Mini. In this study they will use voice commands while documenting food waste in each subject’s household, this will be going on in single households. To analyse the data there will be a trashcan prototype created which counts each time something is thrown in the bin. With the help of the counter there will be a possibility to examine if more food waste is thrown than being logged. Furthermore, every interaction with the voice control that is related to food waste will be saved in a spreadsheet. In the method section, an analysis of how the five subjects will be tested is done. The first week the subjects will log food waste by voice commands and will only be using the prototype that was created as the designated food waste bin. The second week, subjects will log on to paper and pen instead. Finally, the prototypes are collected to analyse the data on the microcontroller as well as the logged data collected in a spreadsheet. Qualitative data is gathered through a survey. The result indicated that the majority preferred voice control as a measurement method once it worked, deficiencies such as communication problems were a major reason why this method was not the most optimal. One subject preferred the measurement method with paper and pen over voice control. Several test subjects thought it was difficult to keep track of paper and pencil but appreciated that it was a safe method of measurement in which they could see what was on the paper. This study is of interest to systems where voice control is used in, for example smart homes but also a contribution to the development of measurement methods. One conclusion in the study is that voice control is a possible measurement method but that more studies are needed in the subject. / Matsvinn är ett stort problem och för att minska matsvinn är det viktigt att öka medvetenhet och kunskap om vad som slängs och varför. Eftersom matsvinn kan omfatta olika typer av livsmedel definieras begreppen matsvinn som mat som hade kunnat ätas och matavfall definieras som matsvinn samt oundvikligt matavfall. Vid forskning om matsvinn är anteckningar en vanlig datainsamlingsmetod, men den lider av brister där exempelvis testpersoner glömmer bort att anteckna. I denna studie undersöker vi möjligheterna att använda röststyrning som ett nytt alternativ till att logga matsvinn. Problemformuleringen grundar sig i att undersöka om hushåll anser att det är enklare att logga något med hjälp av röstkommandon jämfört med att skriva ned det med papper och penna. Vi har byggt ett system som testas på fem testpersoner. För att använda sig av röststyrning blev testpersonerna i studien tilldelade varsin Google Home Mini. I denna studie appliceras denna mätmetod på att mäta matsvinn i singelhushåll. För att analysera datan byggde varsin kompostpåsehållare som räknar varje gång svinn slängs i papperskorgen. Genom räknaren kan det undersökas om det slängs mer än det antecknas. Dessutom loggas allt testpersonerna säger till röstassistenten som har med matsvinn att göra. Första veckan under undersökningen loggades deltagarna allt de slängde med röstkommandon samt använder sig enbart av den givna prototypen för att slänga matsvinn. Andra veckan loggade deltagarna istället på papper och penna. Slutligen samlades prototyperna för att analysera datan på mikrokontrollern samt den loggade datan som samlades i ett kalkylark. Kvalitativ data samlades genom en enkät. Resultatet tyder på att majoriteten föredrog röststyrning som mätmetod när det väl fungerade, brister som kommunikationsproblem med röstassistenten var en stor anledning till varför denna metod inte var den mest optimala. En testperson föredrog mätmetoden med papper och penna framför röststyrning. Flera testpersoner tyckte att det var jobbigt att ha koll på papper och penna men uppskattade att det var en säker mätmetod då de kunde se vad som stod på pappret. Studien är av intresse för system där röststyrning används i exempelvis smarta hem men även ett bidrag till utveckling av mätmetoder. En slutsats i studien är att röststyrning är en möjlig mätmetod men att fler studier behövs göras i ämnet.

Physical inactivity is a growing public health problem in the 21st century. A large proportion of the adult and adolescent population is not achieving recommended levels of physical activity which has significant consequences for both the individual and our society. With no evidence that the levels of physical inactivity will improve in the future, traditional methods of addressing this problem have evidently proven ineffective. A relatively new and promising approach to this problem that has become increasingly important in recent years is smartphone-based behavioral interventions to promote physical activity and other health-related behaviors. While several studies have shown many positive and promising results with this approach, other studies have also shown that the method is not completely understood. For instance, research shows that many of the health and fitness applications available today do not adequately adhere to behavior change strategies or health-related research, suggesting that these applications are not reaching their fullest potential. The goal of this study was to develop and evaluate an application to promote physical activity that was aligned with such research. A high-fidelity prototype based on the Behaviour Change Wheel was developed in Adobe XD and later evaluated by four participants. The outcome of the evaluation indicated that the developed prototype was well received overall, and participants believed it would trigger the desired behavior change of an increase in physical activity. However, due to the study limitations of unrepresentative participants and evaluation environment, time frame and application levels, nothing was truly proven in this regard. Further improvement of the prototype and future studies are needed to evaluate the prototype more accurately. / Fysisk inaktivitet är ett växande hälsoproblem för vårt samhälle under 2000-talet. En stor andel av vuxna och ungdomar uppnår inte rekommenderade hälsonivåer för fysiska aktivitet vilket har påtagliga konsekvenser för både individ och samhälle. Utan några forskningsbevis på att nivåerna för fysisk inaktivitet kommer att förbättras i framtiden har traditionella metoder för att motverka detta problem skenbarligen visats sig vara ineffektiva. Ett relativt nytt och lovande tillvägagångssätt för problemet som blivit alltmer relevant under de senaste åren är smartphonebaserade beteendeinterventioner för att främja fysisk aktivitet och andra hälsorelaterade beteenden. Medan ett flertal studier visat många positiva påföljder och lovande resultat med detta tillvägagångssätt, har andra studier samtidigt visat att metoden inte är helt förstådd och otillräckligt efterforskad. Bland annat visar forskning att många av dagens tillgängliga hälso- och träningsapplikationer inte optimalt följer riktlinjer för vare sig beteendeförändringsstrategier eller hälsorelaterad forskning, vilket antyder att dessa applikationer inte uppnår sin fulla potential. Målet med denna studie var att utveckla och utvärdera en applikation för att främja fysisk aktivitet som var baserad på sådan forskning. En prototyp av hög funktionsnivå baserad på The Behaviour Change Wheel utvecklades i Adobe XD och utvärderades av fyra deltagare. Resultatet från utvärderingen pekade mot att den utvecklade prototypen var väl uppskattad av deltagarna som även ansåg att prototypen skulle framkalla den önskade beteendeförändringen för ökad fysisk aktivitet. Emellertid, på grund av studiebegränsningarna med bland annat icke-representativa deltagare och utvärderingsförhållanden, tidsram samt applikationens funktionsnivå, kunde inte något absolut bevis framläggas i detta avseende. Ytterligare förbättringar av prototypen och framtida studier är nödvändiga för att utvärdera prototypen mer exakt.

After cancer patients have completed active cancer treatment, they have specific follow-up care needs. These needs include ongoing surveillance for new and recurring cancers, managing the side effects of cancer treatment, and psychosocial concerns (Rushton et al., 2015). In the past, cancer centres and oncology specialists provided follow-up care; however, new models of care are needed because cancer centres can no longer provide treatment and follow-up care to all cancer survivors (Jefford et al., 2022). To allocate health care resources, low risk cancer survivors (i.e., breast and colorectal cancer survivors) are being discharged from cancer centres after primary treatment back to their primary care provider (PCP) for follow-up care. Survivorship care plans (SCPs) have been identified as a tool to help survivors and their PCPs with this transition (Rushton et al., 2015). SCPs generally consist of a treatment summary, a schedule for follow-up and surveillance tests, and general health recommendations (i.e., diet and exercise; Howell et al., 2011; Ruston et al., 2015). While SCPs are widely accepted, research on their effectiveness as transition tools has been inconclusive (Hill et al., 2019; Jacobsen et al., 2018). Some studies show positive, neutral, and negative impacts of SCP use, and there are three potential reasons for these mixed findings: 1) there is wide variety in the content, format, delivery, and timing of SCPs which adds considerable variance when studying the impact of SCPs; 2) the use of outcomes to measure the usefulness of SCPs as transition tools that are beyond the scope that information about treatment history and follow-up guidelines could impact and; 3) that SCPs are not effective as transition tools (Hill et al., 2019; Jacobsen et al., 2018). An important first step in clarifying whether SCPs are effective transition tools is to understand how SCPs are being used in real world practice (Hill et al., 2019; Jacobsen et al., 2018). The overall purpose of this study was to develop best practice recommendations for implementing SCPs. This was achieved through three study objectives: 1) to comprehensively identify barriers and facilitators perceived to influence SCP use among cancer survivors and primary care providers (PCPs); 2) to identify evidence-based approaches to address barriers and enhance facilitators of SCP use; and 3) to develop best practice recommendations that can be used by implementors of SCPs that are adaptable across different contexts. Article 1 presents the results of semi-structured interviews with breast and colorectal cancer survivors who had received a SCP at least 12 months prior to the interview. The interviews were based on the Theoretical Domains Framework, version two (TDF-2; Cane et al., 2012) and comprehensively identified barriers and facilitators of SCP use amongst breast and colorectal cancer survivors. Thirty cancer survivors (17 female, 13 male) participated in the 30–45-minute interviews, which were then analyzed using content and thematic analysis. Survivors who had received education about the purpose of SCPs and how to use them reported finding their SCP helpful and that they used it to schedule appointments and communicate with their healthcare providers. Barriers to SCP use that were reported by cancer survivors included having lost or not remembering receiving a SCP, not understanding the importance of their SCP, and wanting information about additional supports to be able to follow the SCP (e.g., regular contact from the cancer centre, avenues for peer support). Overall, study 1 found that in order to SCPs to be used as intended transition tools, survivors benefit from receiving education about how to use them and be informed of the expectation that they be actively involved in their follow-up care. Article 2 presents the TDF-based semi-structured interviews with primary care providers (PCPs). Thirteen PCPs completed 15-20 minute interviews, and content and thematic analysis was conducted. PCPs reported finding SCPs helpful and that they contained relevant information to provide follow-up care. A key facilitator of using the SCP was the table of follow-up tasks (e.g., mammography, colonoscopy) and their frequencies included in the SCP. Two significant barriers for PCPs using SCPs were: a) logistical issues with ordering follow-up tests and receiving results; and b) a lack of clear avenues to consult with oncology specialists (e.g., managing side effects of medications, actions that need to be taken when follow-up tests are abnormal). Overall, article 2 showed that PCPs appreciate and readily use SCPs, and contextual changes to facilitate clear avenues of communication between primary and tertiary care may be beneficial when implementing SCPs. Article 3 is a methodology article that presents a detailed explanation and rationale for the implementation science frameworks used and the data analysis chosen. The TDF-2 and Behaviour Change Techniques Taxonomy (BCTTv1; Michie, et al., 2008; Michie et al., 2013). The Human Behaviour Change Project researchers have empirically linked the 14 TDF domains to behaviour change techniques (BCTs), which allowed for multiple options to be developed to address barriers (and promote facilitators) of SCP use among breast and colorectal cancer survivors and PCPs (https://theoryandtechniquetool.humanbehaviourchange.org/tool; Michie et al., 2021). Using the TDF and BCTTv1 showed a dynamic between oncology specialists (e.g., oncologists, oncology nurses), cancer survivors, and PCPs that is involved in ensuring SCPs are implemented in an optimal way. A logic model was used to organize the barriers and enablers into different phases of SCP development, content, delivery, and use by PCPs and cancer survivors in their follow-up care (Mills et al., 2019). A flowchart organizing the recommendations of implementing SCPs was developed, and comprised 10 steps representing interrelationships between cancer centers, PCPs, and cancer survivors. The detailed methodology article also includes lessons learned and suggestions for implementation science researchers using the TDF and BCTTv1. Finally, article 4 is written for anyone looking for guidance implementing SCPs or improving upon how SCPs have been implemented already. It differs from article 3 in that it provides practical solutions for implementers. Because this work generated many recommendations, article 4 provides a worked example of how to use the results of this study. It is written in a way that outlines who would benefit from using the recommendations, and how to use the flow chart to narrow down the recommendation to those most relevant to implementors. The recommendations are organized into one of the 10 relationships in the flow chart, along with the purpose of the recommendations, how to implement it, to whom the recommendation targets, and those responsible for enacting the recommendations. The core factors associated with facilitating SCP use by PCPs and cancer survivors were: a) a treatment summary and follow-up guidelines included in the SCP; b) SCP provided to both cancer survivors and their PCP; and c) educating cancer survivors about their role as self-managers of their own care and the expectation that they participate in their follow-up cancer care. Future research on the usefulness of SCPs in follow-up care should include detailed information about the content, format, and receivers of SCPs and the outcomes most realistically influenced by the information included in SCPs. Before throwing the proverbial baby out with the bathwater, the implementation of SCPs requires additional standardization before meaningful investigation of their effectiveness as transition tools can be conducted.