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).

Yes / The mental health benefits of physical activity and exercise are well-documented and asylum seekers who may have poor mental health could benefit from undertaking recommended levels of physical activity or exercise. Digital mobile applications are increasingly seen as feasible to precipitate behaviour change and could be a means to encourage asylum seekers to increase their levels of physical activity and exercise. This paper reports on a study that aimed to assess the feasibility of asylum seekers using the digital animation as a tool to change behaviour and increase their physical activity and exercise levels. A feasibility study underpinned by the principles of the COM-B behaviour change model was undertaken in West Yorkshire, UK, in 2019. Thirty participants were purposively recruited and interviewed. Peer interpreters were used as necessary. Deductive thematic analysis was undertaken to analyse the data. Overall, participants were positive about the feasibility of asylum seekers using the application as a behaviour change intervention. All expressed the view that it was easy to follow and would motivate them to increase their physical activity levels. Participants identified facilitators to this as the simplicity of the key messages, the cultural neutrality of the graphics and the availability of the mobile application in different languages. Identified barriers related to the dialect and accents in the translations and the over-simplicity of the application. This study has identified that a targeted digital animation intervention could help asylum seekers change their behaviour and hence improve their health and well-being. In designing such interventions, however, researchers must strongly consider co-design from an early stage as this is an important way to ensure that the development of an intervention is fit for purpose for different groups. / University of Bradford Research Development Fund

Background: Adults benefit from participating in physical activity (PA) for chronic disease prevention and treatment. Postnatal women are encouraged to commence a gradual return to PA 4-6 weeks after giving birth, with participation in line with PA guidelines. The potential benefits of postnatal PA include weight management, improvements in cardiovascular fitness and psychological wellbeing. There has been limited high-quality information about the efficacy, feasibility and acceptability of PA interventions in postnatal women and few studies in the UK. Behavioural counselling interventions informed by behaviour change theory have been shown to successfully increase PA in low-active adults. Physical activity consultations (PACs) use structured and individualised behavioural counselling to enhance individuals’ motivation for change, and improve self-management skills. This approach may support adoption of PA in low-active postnatal women with research demonstrating that modifiable socio-cognitive factors influence PA behaviour. This thesis reports on the efficacy of a postnatal PA intervention, the More Active MuMs in Stirling (MAMMiS) study on change in PA behaviour. Efficacy of the intervention was tested in a randomised controlled trial. The effect on secondary health and wellbeing outcomes and PA cognitions targeted by the intervention and feasibility results are also reported. Methods: The intervention comprised a face-to-face PAC of around 35-45 minutes and 10-week group pramwalking programme. Non-attenders to the pramwalking group received a support telephone call. A follow-up PAC (15-20 minutes) was delivered after three month assessments. The first PAC involved raising awareness about benefits of PA, developing self-efficacy for change, setting goals and action planning PA, developing strategies for overcoming barriers, encouraging self-monitoring, prompting social support and selecting/changing the environment to support PA. The second PAC involved feedback about changes and preventing a return to sedentary habits. The pramwalking group met weekly for 6 walks of 30-55 minutes at a brisk pace, providing opportunities to demonstrate moderate-intensity walking and to encourage and support PA behaviour change. The control group received an NHS leaflet, which encouraged PA after childbirth. Postnatal women (six weeks to 12 months after childbirth) were identified through a variety of NHS-based and community-based strategies plus local advertisements and word-of-mouth. The primary outcome measure was evaluation of PA behaviour change using the Actigraph GT3X/GT3X+ accelerometer, an objective measure of PA behaviour; self-reported moderate-vigorous physical activity (MVPA) was measured using a recall questionnaire (Seven-Day Physical Activity Recall) and cardiovascular fitness using a submaximal step-test (Chester step-test). Secondary health and wellbeing measures were; anthropometric (i.e. weight and body mass index (BMI)) and body composition (measured using a bioelectrical impedance), psychological wellbeing (measured using the Adapted General Wellbeing Index) and fatigue (measured on a 100-point visual analogue scale). PA cognitions were measured via a questionnaire with constructs adapted from previous studies. All were taken at baseline (prior to randomisation), three and six months follow-up from baseline. Process measures were used to investigate intervention fidelity and feasibility. Acceptability was investigated in a post-trial interviews, conducted by a researcher not involved in the trial. RESULTS: Sixty-five postnatal women (average 33 years old with an infant 24 weeks old) were recruited (77% of those eligible). There was a 91% rate of retention at six months; participants who missed a follow-up assessment were younger (30 versus 34 years old) and had younger infants (21 versus 34 weeks old). Participants were less deprived and older compared with postnatal women in Scotland. Objectively measured PA behaviour did not change in response to the intervention. There was no between-groups difference in change in mean counts/minute from baseline to three months (p=0.35, 95% CI -73.50, 26.17, d=0.22) or three to six months (p=0.57, 95% CI -39.46, 71.18, d=0.13). There was no change in MVPA 7 minutes/day in either group from baseline to three (intervention =-0.70, IQR -9.86, 8.36; control =1.65, IQR -4.79, 8.21) or three to six months (intervention =0, IQR -1.13, 1.10; control =0, IQR -9.86, 8.23), with no between-groups difference baseline to three (p=0.43; r=0.10) or three to six months (p=0.75, r=0.09). Results for relative MVPA were similar. Median steps/day from baseline to three months did not change in the intervention group (0, IQR –1619.44, 1047.94) and increased by 195.95 (IQR -1519.55, 1691.03) among controls. The between-groups difference was non-significant (p=0.37, r=0.18). From three to six month follow-up steps/day increased in the intervention group and not in controls (0, IQR -1147.50, 1303.52), this between-groups difference was also non-significant (p=0.35, r=0.16). From baseline to three months self-reported MVPA declined in the intervention group (15 minutes/week; IQR -111, 15) and increased in the control group (30 minutes/week; IQR –68, 75): a non-significant between-groups difference, with a small effect size (p=0.71, r=0.22). From three to six months a decline in self-reported MVPA was found in controls (53 minutes/week; IQR -41,-101) and no change among the intervention group (0, IQ range -26, 71); a significant between-groups difference with a small effect size (p=0.04, r=0.26). There were no differences between the groups for the change in aerobic capacity from baseline to three months or three to six months with no evidence for change over time in aerobic capacity or fitness category in either group. Change in secondary outcomes did not differ between the groups from baseline to three or three to six months (although fatigue did improve in the intervention group relative to controls from baseline to three months). Considering PA cognitions, outcome expectancies declined in both groups from baseline to three months and continued to decline only in the intervention group from three to six months, a between-groups difference with a small effect size (p=0.03, r=0.26). Self-efficacy increased in the intervention group from baseline to three months and declined in the control group with a small effect size for the between-groups difference (p=0.03, r=-0.27). An increase in action 8 planning was seen among the intervention group but not controls from baseline to three months (p<0.01, r=-0.34). Both groups showed an increase in coping planning and action control; the change was larger among the intervention group relative to controls (i.e. p<0.01, r=0.44, r=0.43, respectively). Increased self-efficacy and action control were maintained from three to six months in the intervention group. Coping planning increased relative to controls (p<0.01, r=0.41) and action planning increased among controls from three to six months (p<0.01, r=0.39). Intervention fidelity and feasibility was good. All intervention participants received the initial PAC and adoption of self-management strategies was high for ‘thinking about the benefits of PA’, ‘action planning’ and ‘self-monitoring’, between baseline and three months. Most participants attended at least one walk (61% attended five or more), 89% of planned walks were conducted with no evidence of poor attendance due to season. Walks were conducted at a brisk pace and met moderate-intensity thresholds. DISCUSSION: MAMMiS aimed to recruit low-active healthy postnatal women to test the efficacy of a PAC and group pramwalking intervention. There was no evidence for an intervention effect on PA or on secondary health and wellbeing outcomes.

Background: The prevalence of disability increases with age; therefore with an aging population, interventions to reduce disability are crucial. This thesis adopts a behavioural conceptualisation of disability. The theoretical frameworks of the International Classification of Functioning, Disability and Health (ICF), the Theory of Planned Behaviour (TPB) and the integrated ICF/TPB model are applied to investigate disability and physical activity (PA) behaviours. The thesis aims to: (1) identify the factors involved in the prioritisation of patients for total joint replacement; (2) classify patient pre-operative expectations of total hip replacement (THR) and investigate the relationship between expectations and recovery after surgery, and; (3) test whether the TPB and theory-based interventions can predict and explain PA within individuals. Method: Five studies were conducted. In the first study, health professionals judged whether the items from two prioritisation tools measured each of the ICF constructs. In the second study, surgeons ranked patient vignettes, which differed by constructs from the integrated model, in order of priority for THR. In the third study, a large cohort of THR patients reported expectations of surgery pre-operatively. Health and functioning were also reported pre-operatively and 1-year post-operatively. The fourth and fifth studies were a series of experimental n-of-1 studies using diary methods assessing TPB cognitions and PA behaviours. Results: There is a lack of agreement between judges in relation to the content of many of the items from prioritisation tools. Behavioural and psychological factors can influence prioritisation for THR. The majority of patient expectations of THR addressed activities and social participation; however, the evidence for a relationship between expectations and recovery was limited. The TPB can predict PA within some individuals but the evidence in support of interventions to increase PA was limited. Discussion: The findings provide important clinical and theoretical implications for understanding disability and physical activity behaviours.

Background: Cigarette smoking is a leading preventable factor associated with complications in pregnancy including preterm birth and low birthweight. Past interventions have raised cessation rates by approximately 6% overall (Lumley et al. 2009). Methods: A three-part literature review, two qualitative studies with a total of 36 participants, and the development of an intervention to promote smoking cessation during pregnancy were completed. Central to the design of the research was the creation of the theoretical basis which was developed in line with recommendations from the MRC Framework for Complex Interventions (Craig et al. 2008, Campbell et al. 2000). For part one of the literature review, 24 qualitative and 44 quantitative studies were re-analysed to complete a mixed-methods secondary analysis of the active ingredients in interventions to promote smoking cessation during pregnancy. Part two consisted of an exploration of psychological models and constructs which are likely to predict or influence smoking behaviour during pregnancy. The final part was a discussion regarding the modes of delivery by which an intervention could feasibly be delivered. Qualitative interviews were carried out with participants from stakeholder groups to fill in gaps in literature and determine the acceptability and feasibility of the proposed intervention. The intervention was created using the theoretical basis developed from the findings. Further qualitative interviews, a focus group, and heuristic evaluation were used to determine the acceptability and usability of the intervention for the target group of pregnant smokers. Results and Conclusions: Findings from this work are potentially relevant for a wide range of behaviours and behavioural interventions. An intervention which has a strong grounding in theory and evidence, and is acceptable and feasible for the target group and in clinical practice was developed using evidence gathered in this thesis.

Background: Accrual of continuing medical education credits is part of licensure in family medicine but opinions are mixed as to whether the training has an impact on clinical practice. Literature does suggest that practice change is most likely when training involves multiple interactive exposures, and when the benefit to patients is apparent. Aim: To determine whether an interactive peer-lead educational intervention for General Practitioners in British Columbia, the Practice Support Program Mental Health Module, resulted in measureable change in clinical practice of the Vancouver Island participants. Method: Administrative information from British Columbia Ministry of Health databases was obtained for analysis regarding physician billing and prescribing, and hospitalizations on Vancouver Island. Paired t-tests were used to compare physician-patient interactions among module participants before and after the training regarding a) initiation of antidepressants and anti-anxiety medication, and b) use of the mental health plan billing code, used to support patients who struggle with activities of daily living. In addition, mental health hospitalizations among participants' patients before and after training were used to measure its impact on patient outcomes. Results: One-hundred and ninety-seven General Practitioners on Vancouver Island completed the mental health module between 2008 and 2011. While no significant difference was found in the numbers of mental health patients seen during the pre- and post- periods (M=142.06, SD=97.45) and (M=144.44, SD=103.00); t(196)=-0.679, p=0.498, α=.05, the change in the proportion of new prescriptions between pre-period mean (M=0.0796, SD=.06527) and post-period means (M=.0530, SD=.03877); t(195)=6.668, p<0.001 was found to be significant and indicative of a relative decrease between 31.2 and 33.4%. The change in the proportion of mental health plans was also found to be significant between pre-period (M=0.1142, SD=.018598) and post-period means (M=.1674, SD=.23973); t(180)=-3.586, p<0.001. This indicated a relative increase between 42.0 and 46.6%. No significant change in patient hospitalizations was found between the pre- and post-period means: (M=0.039, SD=.0612) and (M=.0392, SD=.0978); t(192)=-0.055, p=0.956. Conclusion: This educational intervention appears to have resulted in significant changes in the practice patterns of the physician participants. Future research using better indicators may reveal more about the impact of physician training on patient outcomes. / Graduate

O objetivo deste trabalho foi investigar barreiras, motivações e estratégias que apresentam potencial para promover a mobilidade sustentável de alunos de graduação, pós-graduação, servidores técnico- administrativos e servidores docentes no campus da Universidade de São Paulo em São Carlos. O método utilizado para atingir o objetivo foi dividido em três etapas: i. desenvolvimento de ferramenta para coleta de dados; ii. análise dos dados por meio do modelo transteórico de mudança comportamental; iii. análise de estratégias visando a mobilidade sustentável. O questionário on-line desenvolvido e aplicado para o estudo forneceu uma taxa de resposta robusta e bem distribuída dos principais usuários do campus (25,5% da população do campus total). Percentagens consideráveis de usuários em todos os grupos investigados manifestaram a intenção de mudar para outro modo de transporte. Entre aqueles que mudariam para modos de transporte sustentáveis, 27,1% mudariam para o modo a pé, enquanto que 46,2% mudariam para o modo bicicleta. No entanto, 13,6% dos entrevistados declararam que mudariam para o automóvel, o que representa uma demanda adicional de cerca de 300 lugares de estacionamento no campus. Em relação às barreiras para a adoção de modos de transporte sustentáveis, a posse de um veículo motorizado foi o principal obstáculo identificado (independentemente do modo a ser adotado como uma alternativa). Duas alternativas foram classificadas como as melhores estratégias para promoção da mobilidade sustentável no contexto estudado: a construção de ciclovias que ligam o campus com a rede viária urbana e estacionamento para bicicletas dentro do campus. Uma avaliação adicional da primeira alternativa demonstrou significativo potencial para servir a usuários de vários modos de transporte, com grande impacto positivo sobre o modo a pé. Outra estratégia também testada foi a abertura de novos pontos de acesso para pedestres no campus. Estimou-se que sua implantação resultaria em uma redução de 20% nas distâncias de viagem a pé dos alunos. / The objective of this study was to investigate barriers, motivators and strategies with potential to promote sustainable mobility for graduate and undergraduate students, staff and faculty at the campus of the University of São Paulo at São Carlos. The method used to reach the objective had three steps: i. development of a data collection tool; ii. analysis of the data with the transtheoretical model of behavior change; iii. analysis of strategies aiming at sustainable mobility. The online questionnaire developed and applied for the study provided a robust and well-distributed response rate of the main users (25.5% of the total campus population). Considerable percentages of users in all groups investigated have declared that would eventually change to another travel mode. Among those who would change to sustainable modes, 27.1% would change to the walking mode, whereas 46.2% would change to the cycling mode. However, 13.6% of the respondents declared they would change to the automobile, what represents an additional demand of approximately 300 parking spaces in the campus. Regarding the barriers to the adoption of sustainable modes, owning a motorized vehicle was identified as the main obstacle (regardless of the mode to be adopted as an alternative). Two alternatives have been rated as the best strategies for promoting sustainable mobility in the studied context: the construction of cycling paths connecting the campus with the urban street network and parking facilities for bicycles within the campus. An additional evaluation of the first alternative has shown a significant potential to serve users of several transport modes, with a large positive impact on pedestrians. Another strategy also tested was the opening of new access points to pedestrians in the campus. This strategy could reduce the total walking distance travelled by the students in 20%.

Bakgrund: Personer med funktionsnedsättning är mindre fysiskt aktiva, upplever sämre livsvillkor och mindre delaktighet än övriga befolkningen. Fysisk aktivitet på recept (FaR) uppvisar evidens och utvecklingspotential för att öka fysisk aktivitet hos personer med funktionsnedsättningar. Enligt Socialstyrelsen behöver antalet förskrivna FaR öka för särskilda utsatta grupper. Således behövs mer kunskap om fysioterapeuters erfarenheter av att förskriva av FaR till personer med funktionsnedsättningar och därigenom stödja beteendeförändring. Syfte: Att undersöka fysioterapeuters erfarenheter av att förskriva fysisk aktivitet på recept (FaR) till personer med funktionsnedsättning med fokus på hur de stödjer beteendeförändring av fysisk aktivitetsnivå. Metod: Kvalitativ semistrukturerad intervjustudie och deskriptiv design, där induktiv kvalitativ innehållsanalys användes vid analys av materialet. Resultat: Analysen gav tolv underkategorier fördelade på fyra kategorier: Att beakta skäl till förskrivning och beteendeförändring, Att skapa förståelse för förskrivningen hos brukare och nätverk, Att hitta fungerande aktivitet samt Att stödja en beteendeförändring. Genom dessa beskrev fysioterapeuterna sina erfarenheter. Slutsats: Fysioterapeuternas erfarenheter av att förskriva FaR till personer med funktionsnedsättning och därigenom stödja beteendeförändring av fysisk aktivitetsnivå, beskrev en utmanande och komplex uppgift. Omgivningsrelaterade faktorer som ekonomi och aktivitetsutbud kan ibland hindra förskrivning och beteendeförändring hos brukare, trots att fysioterapeuterna skapat förutsättningar. Detta kan försvåra uppgiften att stödja en marginaliserad grupp till ökad fysisk aktivitet. / Background: Individuals with disabilities are less physically active, report lower  life conditions and a lower participation then the rest of the population. Physical activity on prescription (PAP) show a high degree of evidence and potential for development to improve the physical activity among people with disabilities. The amount of PAP within vulnerable groups needs to increase according to the National guidelines from the National board of Health &amp; Welfare. Therefore more knowledge are needed about physiotherapist’s experiences of prescribing PAP to support behavior change for individuals with disabilities. Aim: The aim was to explore physiotherapist’s experiences of prescribing physical activity on prescription (PAP) for individuals with disabilities with the focus on behavior change towards increased physical activity. Method: A qualitative, semi structured interview study with descriptive design. An inductive, qualitative content analysis were used when analyzing the material. Result: The analysis resulted in twelve subcategories divided into four main categories: Reasons considered when prescribing and for behavior change, To create understanding among patients and their community about the prescription, To find a suitable activity and last To support behavior change. The physiotherapist’s within the study used these categories to depict their experiences. Conclusion: The physiotherapist’s experiences when prescribing physical activity on prescription for individuals with disabilities and to support their behavior change towards increased physical activity depicted a challenging and complex task. Environment-related factors such as economy and the availability of activities could hinder the prescription and patient’s behavior change despite preconditions created by the physiotherapist’s. This could hinder the task of supporting a marginalized group towards improvements in physical activity.

Anthropogenic climate change is a global problem that affects every country and each individual. The UK introduced its own carbon budgets, aiming to reduce its GHGs by 80% by 2050 compared with 1990 levels. The United Nations Conference of the Parties in Paris in 2015 came to an agreement on limiting the global average temperature rise to "well below 2oC". It has been argued that the Paris Agreement requires deeper and more rapid emission reductions than current UK targets. The CO2 emissions from energy use by households account for almost a third of total CO2 emissions in the UK in recent years. The research aims to explore drivers of high energy consumption in order to identify where there may be intervention points that can achieve a greater level of emission reductions than conventional policy tools in the short to medium term. Previous studies have focused on either socioeconomic factors or practices to explore household energy consumption and CO2 emissions, but have not integrated both aspects to identify drivers behind high energy consumption. To address this gap in the literature, the research applies an interdisciplinary approach to analyse the interconnected factors impacting on household energy consumption and CO2 emissions. Socioeconomic characteristics and practice theory are combined in order to understand how and why energy is consumed at home, and specifically to explore high energy consumption and related CO2 emissions at the household level. Both quantitative cluster analyses based on household socioeconomic factors and qualitative data collection and thematic analyses on energy-related practices at home have been conducted in the research. Results indicate that various combinations of socioeconomic factors and dwelling-related characteristics can collectively lead to high CO2 emissions from energy use at home. Nonetheless, these characteristics cannot fully explain why some households are high emitters, as they still share a variety of similar characteristics with average households in the UK. Besides household socioeconomic factors and dwelling-related characteristics, the materials, procedure and meanings of practices; people's discursive and practical consciousness; and dominant meanings of the home, also collectively influence energy use at home. Policymakers should consider not only improving the energy efficiency of the dwelling and appliances, but also how people's hidden knowledge and routines allow or constrain the performance of energy-related practices, as well as how the existing meanings of practices and dominant meanings of the home can be supported with less energy input and associated CO2 emissions. Energy efficiency related policies could focus more on how to reduce the interruption to people's everyday lives and the level of space loss. Policymakers could also work with different stakeholders, such as local authorities and community groups to tackle the challenges of installation of double gazing, cavity wall and roof insulation in the private rented sector. Policies for promoting renewable electricity micro-generation in the UK can target more effectively the high emitters who are at home most weekdays, as they can be more flexible in rearranging their use of appliances in daily routines and potentially reduce energy consumption during the peak time. In addition to combining a novel range of approaches and perspectives to understanding energy use at home, the research makes a contribution to achieving deeper and more rapid emission reductions in the short to medium term in the UK by focusing on the drivers behind high energy consumption at home than average energy consumption in general.

This thesis investigates the acceptability and efficacy of Functional Imagery Training (FIT), a motivational intervention for weight-management. FIT is based on Elaborated Intrusion Theory, delivered in the style of Motivational interviewing (MI), and designed to promote sustained behaviour change and address cravings. It trains the habitual use of affective, goal-directed mental imagery of personal incentives, using imagery to plan behaviours, anticipate obstacles, and mentally try out solutions from previous successes. Participants are taught to update their imagery from their experience, and to generalise their imagery skills to new goals. In study 1, focus groups explored problems and wishes in regards to weight-management, including reactions to Functional Imagery Training (FIT) as a possible intervention. The issue of waning motivation and the desire for motivational app support was expressed in all groups. Participants were positive about FIT. Study 2 was an uncontrolled pilot trial of FIT. Eleven out of 17 participants (65%) lost 5% body weight or more by three months. Participants continued to lose weight during an unsupported 12-month period and experienced mean weight loss of 6kg (SD= 5.7; d=1.06) and mean waistline reduction of 11.5 cm (SD= 7.4; d=1.56) at 15 months. Study 3 compared the impact of FIT with MI on motivation and self-efficacy, over the first month of a randomised controlled trial (RCT) for weight-loss. Structured elicitation and training in goal-related imagery, i.e., FIT, increased motivation and self-efficacy for weight-loss relative to MI. Study 4 was the RCT for weight-loss, comparing FIT and MI over an intervention-supported six-month period, followed by six months unsupported. The FIT group achieved clinically meaningful weight-loss at 6 months (M kg-loss=4.11) and continued weight-loss at 12 months (M kg-loss=6.44); the MI group stabilised by 12 months (M kg-loss=.67), after minimal weight loss at 6 months (M kg-loss=.74). Study 5 qualitatively explored experiences of MI and FIT RCT participants, upon completing the 6-month intervention phase. MI participants wished for continued therapist- support and feared relapse. FIT participants described a mind-set-change and were confident they could maintain changes and overcome challenges using imagery techniques. Given the demonstrated benefit of motivational imagery in weight-control, FIT should be considered and further tested as an intervention for health behaviour change.