Background: Recent empirical research and theoretical models acknowledge that impulsive processes, can often undermine peoples’ attempts to lose weight despite currently available and effective support (Chapter 2). Aim: To develop, deliver, and evaluate an impulse management intervention to support weight loss in adults. Methods: A systematic review was conducted to identify available impulse management techniques for influencing eating behaviour (Chapter 3). Intervention Mapping was used to develop the intervention (Chapter 4) which drew on various sources including the findings from the systematic review, stakeholder consultations, existing guidance, and qualitative interviews. A two-arm randomised controlled feasibility trial (Chapter 5), with nested mixed-methods process evaluation and two cycles of intervention delivery and data collection (Chapter 6), was conducted. This assessed the feasibility and acceptability of, and informed refinements to, both the intervention and trial procedures in preparation for a full-scale effectiveness evaluation. Weight was measured as the proposed primary outcome for a full-scale trial at baseline, one-month, and three-months of follow-up, app usage data were collected at both follow-up time points, and semi-structured interviews were conducted at one-month with a subsample of intervention group participants only. Results: The systematic review critically appraised and synthesised evidence on 17 identified techniques which were categorised as Impulse-focused or Reflective techniques. Promising changes in eating behaviour and craving were found for the techniques of visuospatial loading, physical activity, and implementation intentions. Intervention Mapping resulted in development of a novel smartphone app-based intervention (ImpulsePal) aimed to reduce unhealthy snacking, overeating, and alcoholic and sugary drink consumption using impulse management techniques identified in the systematic review. Eighty-eight adults with a Body Mass Index of ≥25kg/m2 and wishing to lose weight, were recruited and randomised in a 2:1 ratio to use ImpulsePal (n=58) or to a waiting list control (n=30) group. Data were available for 74 participants (84%) at one-month and 67 (76%) at three months. Exploratory analyses suggest that the ImpulsePal group (n=43) lost 1.03kg (95% CI 0.33 to 1.74) more than controls (n=26) at one-month, and 1.01kg (95% CI -0.45 to 2.47) more at three months. Participants reported high satisfaction with the intervention and trial procedures. The process evaluation suggests that ImpulsePal and the impulse management techniques are feasible to deliver and acceptable to users. Interviews with twenty-two participants suggest that they valued having access to in-the-moment support, felt more aware of their own eating behaviour and influences on it, and felt an increased ability to resist temptations. Conclusions: This work has developed a novel, theory- and evidence-informed, person-centred app which showed potential to improve impulse management, promote healthier eating, and support weight loss. ImpulsePal is acceptable to overweight and obese adults who want to lose weight and is now ready for evaluation in a full-scale trial. The thesis discusses theoretical, methodological, and practical implications for the future development, evaluation, and implementation of digital behaviour change interventions.

Bakgrund: Många personer med schizofreni lider av fysisk ohälsa som övervikt, hjärt-kärlsjukdomar och diabetes, med risk för en för tidig död som följd. För att förbättra den fysiska hälsan hos personer med schizofreni behövs mer kunskap om vilka insatser sjuksköterskan kan vidta beträffande levnadsvaneförändringar. Närståendes erfarenheter gällande levnadsvaneinterventioner ger en ökad förståelse och ett viktigt komplement för att kunna utveckla omvårdnaden. Syfte: Syftet med studien var att beskriva närståendes erfarenheter av levnadsvaneinterventioner för personer med schizofreni. Metod: Studien genomfördes som en beskrivande kvalitativ intervjustudie med induktiv ansats. Tio närstående till personer med schizofreni intervjuades och textmaterialet analyserades med metoden kvalitativ innehållsanalys. Resultat: Resultatet formade tre kategorier: Fysisk hälsa nedprioriterades, Patientens behov av motiverande stöd och Närståendes begränsade medverkan. Slutsats: Resultatet visade att patientens fysiska hälsa nedprioriterades. Närstående var inte involverade i patienternas levnadsvaneinterventioner. Närstående betonade att patienterna skulle behöva mer motiverande stöd. Omvårdnaden ska ha holistisk syn på människan, och inte särskilja den fysiska hälsan från den psykiska. Specialistsjuksköterskestudenter inom psykiatrisk vård ska få kunskap om fysisk ohälsa hos patienter med schizofreni, för att sedan kunna informera närstående, och individanpassa omvårdnadsåtgärder gällande levnadsvanor. Regelbundna levnadsvaneinterventioner ska vara en rutin i vårdprocessen från början, och fortlöpa genom hela vårdkedjan. Ytterligare studier behövs om närståendes och den psykiatriska vårdens syn på och värderingar av fysisk ohälsa i denna patientgrupp. / Background: Many people with schizophrenia suffer from physical disorder such as obesity, cardiovascular disease and diabetes, at risk of premature death. In order to improve the physical health of people with schizophrenia, more knowledge is needed about the types of interventions the nurse can take regarding lifestyle changes. Relatives' experiences regarding lifestyle change interventions provide increased understanding and an important complement to developing nursing care. Purpose: The purpose of the study was to describe the relatives' experiences of lifestyle change interventions for people with schizophrenia. Method: The study was conducted as a descriptive qualitative interview study with inductive approach. Ten relatives to people with schizophrenia were interviewed and the text material was analyzed using the qualitative content analysis method. Results: The result formed three categories: Physical health was down prioritized, Patient's need for motivational support and Relatives’ limited contribution. Conclusion: The results showed that the patients' physical health was down prioritized. Relatives were not involved in the patients' lifestyle change interventions. Relatives stressed that patients would need more motivational support. Nursing should have a holistic view of man and should not distinguish physical health from the mental. Specialist Nursing students in psychiatric care should gain knowledge about physical illness in patients with schizophrenia, to then be able to inform their relatives, and to personalize nursing measures regarding living habits. Regular lifestyle change interventions should be a routine in the care process from the outset and continue throughout the care chain. Further studies are needed on the relatives’ and psychiatric care's views on and values of physical illness in this patient group. / Liv-projektet

No description available.

This study has focused on investigating the perceived effect on knowledge, retention and engagement from using a gamified app developed to reduce employee greenhouse emissions. Data was gathered using a “deed-based” mobile application at a large nordic commercial IT company. The employees of the company entered a month-long campaign commitment to try and improve their knowledge of sustainable emission behavior. After completing the campaign period we conducted interviews with select people to gather qualitative insight of their experience. The results found indicate that participants do not conclusively perceive a knowledge increase of sustainability and greenhouse emissions after the campaign ended. Participants generally enjoyed the competitive aspect of the gamified app, often referring to it as fun and engaging. In some cases, participants became very engaged and initiated deeper sustainability discussions with their teammates during the campaign. / Denna studie har fokuserat på att undersöka upplevd påverkan på kunskap, bibehållande av kunskap och engagemang från att använda en spelapp utvecklad för att minska anställdas CO2-utsläpp. Denna uppdragsbaserade mobilapp användes som utgångspunkt för den här studien på ett stort nordiskt IT-företag. De anställda i företaget gick in i en månadslång kampanj för att försöka förbättra sina kunskaper om hållbart utsläppsbeteende. Efter att ha slutfört kampanjperioden genomfördes intervjuer med utvalda personer för att få insikt i deras erfarenheter från kampanjen. Resultaten indikerar att deltagarna inte upplevde en kunskapsökning inom hållbarhet och växthusgasutsläpp efter kampanjens slut. Deltagarna uppskattade i allmänhet tävlingsmomentet i appen, som ofta ansågs rolig och engagerande. I i vissa fall blev deltagarna väldigt engagerade i djupare hållbarhetsdiskussioner inom laget.

A helpful tool in forming, breaking, and maintaining habits and behaviors is a digital behavior change intervention (DBCI). These are interventions that leverage digital technologies to help their users to either take on or avoid certain behaviors. A common problem is a lack of user engagement with the interventions’ content, which is key for its effectiveness. It has however been shown that gamified content and using prompts—such as push notifications—may have the effect of increasing user engagement, for both DBCIs and other applications. Furthermore, two commonly occurring game concepts are competition and cooperation, each with different influences on engagement which in turn may vary depending on the context and the user. Therefore, this thesis set out to examine how push notifications can be used to increase user engagement with a gamified DBCI by making its gamified elements more salient. Additionally, it will investigate if there is any difference in influence on engagement of notifications that either promote competition or cooperation. This was evaluated by deploying two different push notification strategies on Deedster—a gamified mobile DBCI with the aim to get its users to reduce their personal CO2-emissions—and tracking user behavior. The results of the evaluation showed that users who received push notifications were more engaged—started more sessions and spent more time—with the application than users who did not receive any. They also performed a significantly higher amount of target behaviors. There was no difference in the influence on performed target behaviors between the notifications promoting competition or cooperation, and only one significant difference—usage of intervention features—regarding user engagement. The gender of the user was also found to be a considerable factor in the influence of the push notifications. Competition increased engagement more than cooperation for male users, but not for female users. / Ett effektivt verktyg för att forma, bryta eller bibehålla vanor och beteenden är en så kallad digital beteendeförändrings-intervention (eng. digital behavior change intervention eller DBCI). Dessa interventioner använder digital teknik för att hjälpa deras användare att antingen påbörja eller undvika särskilda beteenden. Ett vanligt problem med dessa är att användarna ofta inte är särskilt engagerade i interventionernas innehåll eller funktioner, vilket är viktigt för deras effektivitet. Emellertid har det visats att spelifierat innehåll och användandet av notiser—såsom push-notiser—kan ha en ökande effekt på engagemanget. Två vanligt förekommande spelkoncept är tävling och samarbete, båda med sina olika effekter på engagemang vilket också skiftar beroende på kontexten och användaren. Därför ska detta examensarbete undersöka hur push-notiser kan användas för att öka användar-engagemanget i en spelifierad och mobil beteendeförändrings-intervention genom att göra dess spelifierade element mer framträdande. Dessutom kommer det även undersökas om det är någon skillnad i effekt mellan notiser som antingen främjar tävling eller samarbete. Detta var utvärderat genom att använda två olika push-notis-strategier på Deedster—en spelifierad, mobil intervention som syftar till att minska dess användares CO2-utsläpp—och sedan följa användarnas beteende. Resultaten visade att användare som fick push-notiser var mer engagerade—startade mer sessioner och spenderade mer tid—inom applikationen jämfört med användare som inte fick några notiser. De utförde också signifikant fler önskade beteenden. Det var ingen skillnad i effekt på antalet önskade beteende utförda mellan att främja tävling eller samarbete och endast några få skillnader i engagemang. Dock visade det sig att användarens kön var en betydande faktor i effekten av notiserna. Notiserna som främjade tävling var mer effektiva för manliga användare jämfört med de som främjade samarbete. Denna effekt syntes inte bland kvinnliga användare. / Designing digital technologies for supporting energy-related behavior change in the kitchen

The thesis describes and analyses a long-term transformative change program conducted at ICI (Australia) Botany Site between the years 1987 - 1997. The change program is unusual in that, after a massive and destructive confrontation between management and the unions, a new collaborative approach to change was developed which led to significant organisational renewal. Change interventions developed in the program have diffused through Australian industry over the decade. The program is analysed within the framework of a theoretical model which describes a path taken towards achieving a capable organisation which can sustain productive performance. The thesis uses evidence from the case to investigate issues of management style, governance, flexibility, 'bundled interventions', productivity, work organisation, downsizing, reward systems, skills acquisition and self-managed teams. A theoretical model of organisational change is developed which suggests how the treatment of these contingencies can lead to organisational capability.

Background The Swedish population is ageing quickly and the system for elderly home care is under increasing pressure. Staff turnover is high, nursing assistants are reporting stress, and employers have to recruit staff lacking sufficient experience. These factors are barriers to empathic care, considered essential to patient health outcomes. Elderly care should rely on cognitive empathy, be other-oriented and improve the client’s situation based on contextual understanding. There is a need for education and support for nursing assistants, so that they can provide empathic care. Purpose The thesis explores empathy as a skill in elderly home care to identify opportunities of promoting empathy in the client-nursing assistant interaction, by means of behaviour change interventions delivered through an mHealth application that nursing assistants already use at work. Method A group interview was conducted with six nursing assistants from four elderly home care organisations in a Swedish municipality, to learn about their experience of empathy at work, and factors affecting their ability to give empathic care. The respondents were using the same mHealth application to get and provide information about client visits. The Behaviour Change Wheel framework was used to analyze behavioural drivers of empathic care in elderly home care. Results Influences on empathic behaviour was identified in all 14 domains in the Theoretical Domains Framework. 13 target behaviours, 7 Intervention Functions and 45 Behaviour Change Techniques were suggested as suitable candidates to investigate for intervention development. Conclusion Empathy seems possible to promote through resource-efficient digital behaviour change interventions. Future studies may use this work as a starting point for development of interventions to promote empathic behaviour in elderly care.