• Academic achievement
• Adolescence
• Health
• Well-being

• adolescents
• health promotion strategies
• physical activity
• qualitative methods
• sports

• analytical
• business growth
• entrepreneurial competency
• innovative
• locus of control
• opportunity-seeking
• quality of life
• sustainable entrepreneurial intention

• Causal relationship
• Posttraumatic growth
• Random intercept cross-lagged panel model
• Social support

• Active learning
• Escape room
• Game-based learning
• Laboratory
• Student engagement

• Adherence
• Antiretroviral therapy
• Game-based education
• Young people infected with HIV

•

Justice-involved young adults are in need of tailored substance use interventions.

Readiness to change is a key component of substance use behavioral change; yet little is known about readiness to change among justice-involved young adults. This study 1) describes readiness to change alcohol and drug use and 2) examines predictors of readiness to change alcohol and drug use among justice-involved young adults.

Justice-involved young adults (18–24 years; n = 137) who were positive on a validated alcohol and/or drug screening tool completed an interview assessing substance use, readiness to change, and reasons to quit. A multivariable linear regression model examined whether reasons to change and substance use severity, and interactions between these, predicted readiness.

More than half of participants were contemplating or had decided to quit/cut down substance use. Personal reasons to quit were positively related to readiness to change; interpersonal reasons were negatively associated.

This study contributes information needed to design motivational interventions for substance use among justice-involved young adults. Personal reasons to quit using drugs are a potential intervention target.

• Alcohol use
• Criminal justice
• Drug use
• Emerging adults
• Justice-involved
• Motivation to change
• Readiness to change
• Substance Use
• Young adults

• Attention
• ESM
• Instagram
• Media effects
• N = 1 research

• NWO

• controlled interventional study
• emotional exhaustion
• empowering leadership
• hospital management
• systemic intervention

• COVID-19
• nurses
• phenomenology
• recovery experiences

• AUD
• Fitbit
• alcohol use disorder
• feasibility study
• mobile phone
• physical activity
• smartphone app

For several decades, there has been an increase in studies on second language motivation, one of the most salient topics in individual difference research in second language acquisition, guided by theories and methods from related fields. Self-determination theory (SDT) is one of the most influential theories to provide a comprehensive framework for investigating language learning motivation. To date, numerous SDT-related studies have been performed to explore ways to develop more self-determined types of motivation. However, research on the relationship between self-determined types of motivation and other psychological variables has been limited. To address this gap, the present study investigated the complex relationships between autonomous motivation, buoyancy, boredom, and engagement in a sample of 561 Chinese senior high school English as a foreign language (EFL) learners. Data were collected through a composite questionnaire measuring students’ autonomous motivation, buoyancy, boredom, and engagement in EFL learning. Chain mediation analysis was used to test the complex relationships among these variables. The results show that autonomous motivation directly affected student engagement in EFL learning and autonomous motivation also indirectly affected student engagement in EFL learning through the separate mediation of buoyancy and boredom in EFL learning as well as the chain mediation of both mediators. The results support SDT and offer some pedagogical implications for teachers and educators.

• Beijing Foreign Studies University
• Northeast Normal University

• Complexity
• Homecare
• Leadership anxiety
• Motivation
• Person-centredness
• Purchaser-provider split
• Service innovation
• Trust-based management

Many cancer survivors do not meet recommended levels of exercise, despite the benefits physical activity offers. This study aimed to understand experiences of insufficiently active overweight/obese breast or colorectal cancer survivors, in efforts to (1) examine regular physical activity barriers, and (2) determine perceptions and acceptability of a remotely delivered physical activity intervention utilizing wearable sensors and personalized feedback messages.

In-person and virtual small group interviews were conducted engaging overweight/obese cancer survivors (n = 16, 94% female, 94% breast cancer survivors) in discussions resulting in 314 pages of transcribed data analyzed by multiple coders.

All participants expressed needing to increase physical activity, identifying lack of motivation centering on survivorship experiences and symptom management as the most salient barrier. They indicated familiarity with activity trackers (i.e., Fitbit) and expressed interest in biosensors (i.e., continuous glucose monitors [CGMs]) as CGMs show biological metrics in real-time. Participants reported (1) personalized feedback messages can improve motivation and accountability; (2) CGM acceptability is high given survivors’ medical history; and (3) glucose data is a relevant health indicator and they appreciated integrated messages (between Fitbit and CGM) in demonstrating how behaviors immediately affect one's body.

This study supports the use of wearable biosensors and m-health interventions to promote physical activity in cancer survivors. Glucose-based biofeedback provides relevant and motivating information for cancer survivors regarding their daily activity levels by demonstrating the immediate effects of physical activity. Integrating biofeedback into physical activity interventions could be an effective behavioral change strategy to promote a healthy lifestyle in cancer survivors.

• behavioral interventions
• biosensors
• cancer survivors
• exercise
• mobile health
• physical activity

Previous studies have shown that academic procrastination not only affects middle school students’ academic performance but also causes them physical and psychological stress, as well as negative emotions. Therefore, it is necessary to explore the influencing factors of academic procrastination and its internal mechanisms. This study aims to explore the relationship between perceived parental autonomy support and academic procrastination, as well as the role of autonomous motivation and time management disposition.

Cross-sectional data from 662 middle school students were collected using the Parental Autonomy Support Scale, Academic Procrastination Inventory for Middle School Students, Academic Self-Regulation Questionnaire and Adolescence Time Management Disposition Scale. SPSS and its PROCESS macro were used for data analysis.

After gender and age were controlled, the results showed that perceived parental autonomy support could not only directly predict middle school students’ academic procrastination but also predict three paths of procrastination: (1) the mediating role of autonomous motivation, (2) the mediating role of time management disposition, and (3) the chain mediating role of autonomous motivation and time management disposition.

Autonomous motivation and time management disposition played a chain mediating role in the relationship between perceived parental autonomy support and academic procrastination in middle school students.

• academic procrastination
• autonomous motivation
• middle school students
• perceived parental autonomy support
• time management disposition

• Community health workers
• Community-based participatory research
• Dyadic intervention
• Family support
• Latino/a
• Peer support
• Self-management interventions
• Social support
• Type 2 diabetes

• Adult
• COVID-19
• Community Health Workers
• Diabetes Mellitus, Type 2/diagnosis
• Diabetes Mellitus, Type 2/therapy
• Glycated Hemoglobin/analysis
• Humans
• Pandemics
• Randomized Controlled Trials as Topic

• P30 DK092926 NIDDK NIH HHS
• R01 DK116733 NIDDK NIH HHS
• R01DK116733 NIDDK NIH HHS
• National Institute of Diabetes and Digestive and Kidney Diseases

• Aging
• Chronic pain
• Fibromyalgia
• Interventions
• Mindfulness
• Review

Empirical evidence shows that leadership style is a job resource that promotes employee subjective well-being among workers of value-based organizations. These organizations try to create cultures with strong values to which employees adhere, increasing their subjective well-being and transmitting the identity values. Concretely, religious organizations are characterized by transmitting their values while they perform their services. The value-based management model of religious entities is an appropriate setting for studying the effects that this style based on values has on subjective well-being.

In organizations with strong value-based cultures, the most appropriate styles are moral leadership and, among them, servant and authentic leadership; thus, this research contributes from the theoretical framework of job demands-resources (JD-R) model to the open debate on leadership as job resource to promote subjective well-being and the common characteristics of these leadership styles.

To reach the aim of this research, a sample of workers in Catholic organizations located in Spain was used. The data was processed using partial least squares (PLS) technique.

The results show that while authentic leadership is a job resource to achieving greater well-being among workers of value-based organizations, servant leadership is merely a resource in the presence of a perceived authentic leadership. In other words, authentic leadership exerts a total mediation in the relationship between servant leadership and subjective well-being.

The main contribution of this research lies in demonstrating that servant and authentic leadership are job resources that together promote subjective well-being among workers of religious organizations. This result rejects the previous theory that defend the redundant outcomes of these leadership styles, what undoubtedly constitutes an interesting finding for the academy. These findings also complement the social identity theory, as the identity of a service entity could justify that servant leadership generates higher levels of perceived authentic leadership.

• JD-R model
• authentic leadership
• governance
• servant leadership
• subjective well-being
• value-based organizations

Autonomy is recognized as important for individual well-being and constitutes one dimension in the KIDSCREEN-instrument measuring health related quality of life (HRQoL) in children and adolescents. However, the autonomy questions in KIDSCREEN are restricted to opportunities to influence leisure time activities, which is a form of autonomy as volition. Yet, there are other aspects of autonomy that might be related to adolescent’s HRQoL. The aims of the present study were first to investigate the psychometric properties of a scale measuring autonomy in adolescence from a control perspective (AAC) including its relation to the autonomy dimension in KIDSCREEN, and second; to investigate AACs ability to predict each of the 10 dimensions constituting KIDSCREEN.

Students (n = 154) aged 15–16 years who were recruited from schools located in both low (two schools) and high (two schools) socioeconomic status (SES) areas in Sweden participated in a cross-sectional study. The adolescents answered a questionnaire including a new 6-item scale measuring perceived autonomy and HRQoL assessed by the KIDSCREEN-52 instrument. A factor analyses was computed to investigate the relation between the items in the AAC scale and the autonomy items in the KIDSCREEN instrument. Hierarchical regression analyses were computed to investigate if the AAC scale predicted HRQoL in any of the 10 dimensions in KIDSCREEN after controlling for gender, SES and the original autonomy scale included in KIDSCREEN.

The factor analysis showed that all the items from the autonomy scale loaded in one factor and that all the items from the AAC scale loaded in another dimension. The hierarchical regression models showed that the AAC scale uniquely predicted HRQoL in all dimensions of the KIDSCREEN instrument after controlling for gender, SES and the original autonomy scale included in KIDSCREEN-52. A high level of perceived autonomy was associated with a high level of HRQoL for both scales.

A new scale for measuring autonomy from a control perspective has been presented and shown to differ from autonomy as volition. Both forms of autonomy are positively related to HRQoL in adolescence 15–16 years old.

The online version contains supplementary material available at 10.1186/s12887-022-03607-5.

• Adolescents
• Autonomy
• Health-related quality of life
• KIDSCREEN

In Canada, stroke survivors have difficulty accessing community-based rehabilitation services because of a lack of resources. VirTele, a personalized remote rehabilitation program combining virtual reality exergames and telerehabilitation, was developed to provide stroke survivors an opportunity to pursue rehabilitation of their chronic upper extremity (UE) deficits at home while receiving ongoing follow-up from a clinician.

We aimed to identify the behavioral and motivational techniques used by clinicians during the VirTele intervention, explore the indicators of empowerment among stroke survivors, and investigate the determinants of VirTele use among stroke survivors and clinicians.

This multiple case study involved 3 stroke survivors with chronic UE deficits and their respective clinicians (physiotherapists) who participated in the VirTele intervention, a 2-month remote rehabilitation intervention that uses nonimmersive virtual reality exergames and telerehabilitation aimed at improving UE deficits in stroke survivors. Study participants had autonomous access to Jintronix exergames and were asked to use them for 30 minutes, 5 times a week. The VirTele intervention included 1-hour videoconference sessions with a clinician 1 to 3 times a week, during which the clinician engaged in motivational interviewing, supervised the stroke survivors’ use of the exergames, and monitored their use of the affected UE through activities of daily living. Semidirected interviews were conducted with the clinicians and stroke survivors 4 to 5 weeks after the end of the VirTele intervention. All interviews were audiorecorded and transcribed verbatim. An abductive thematic analysis was conducted to generate new ideas through a dynamic interaction between data and theory.

Three stroke survivors (n=2, 67%, women and n=1, 33%, man), with a mean age of 58.8 (SD 19.4) years, and 2 physiotherapists participated in the study. Five major determinants of VirTele use emerged from the qualitative analyses, namely technology performance (usefulness and perception of exergames), effort (ease of use), family support (encouragement), facilitators (considerations of the stroke survivors’ safety as well as trust and understanding of instructions), and challenges (miscommunication and exergame limits). During the VirTele intervention, both clinicians used motivational and behavioral techniques to support autonomy, competence, and connectivity. All these attributes were reflected as empowerment indicators in the stroke survivors. Lessons learned from using telerehabilitation combined with exergames are provided, which will be relevant to other researchers and contexts.

This multiple case study provides a first glimpse into the impact that motivational interviewing can have on adherence to exergames and changes in behavior in the use of the affected UE in stroke survivors. Lessons learned regarding the supportive role caregivers play and the new responsibilities clinicians have when using the VirTele intervention may inform the use of exergames via telerehabilitation. These lessons will also serve as a model to guide the implementation of similar interventions.

RR2-10.2196/14629

Interventions to support physical activity participation among individuals with spinal cord injury (SCI) are required given this population’s low levels of physical activity and extensive barriers to quality physical activity experiences.

This study aimed to develop a mobile health intervention, called SCI Step Together, to improve the quantity and quality of physical activity among individuals with SCI who walk.

Our overarching methodological framework was the Person-Based approach. This included the following 4 steps: conduct primary and secondary research (step 1); design intervention objectives and features (step 2a); conduct behavioral analysis and theory (step 2b); create a logic model (step 3); and complete the SCI Step Together program content and integrated knowledge translation (IKT; step 4), which occurred throughout development. The partnership approach was informed by the SCI IKT Guiding Principles. Three end users pilot-tested the app and participated in the interviews.

Step 1 identified issues to be addressed when designing intervention objectives and features (step 2a) and features were mapped onto the Behavior Change Wheel (step 2b) to determine the behavior change techniques (eg, action planning) to be included in the app. The logic model linked the mechanisms of action to self-determination theory (steps 2/3). Interviews with end users generated recommendations for the technology (eg, comparing physical activity levels with guidelines), trial (eg, emailing participants’ worksheets), and intervention content (eg, removing graded tasks; step 4).

Using the SCI IKT Guiding Principles to guide partner engagement and involvement ensured that design partners had shared decision-making power in intervention development. Equal decision-making power maximizes the meaningfulness of the app for end users. Future research will include testing the acceptability, feasibility, and engagement of the program. Partners will be involved throughout the research process.

ClinicalTrials.gov: NCT05063617; https://clinicaltrials.gov/ct2/show/NCT05063617

• exercise
• mobile apps
• mobile phone
• spinal cord injuries
• stakeholder participation
• telemedicine

• COVID-19
• employees’ innovation behavior
• inclusive leadership
• innovation performance
• psychological empowerment

This study examined the contextual factors associated with psychological need satisfaction (PNS) and the predictability of the PNS components, together with the contextual factors, on the developmental outcomes of elite young athletes in the Ethiopian sports academies, and further identified differences in perception of PNS from a comparative perspective. The study used a cross-sectional survey design applying developmental and PNS theories as guiding frameworks. Samples of elite young Ethiopian athletes participated (n = 257, 47.47% were women with a mean age of 17.44 years and SD = 0.87, and 52.53% were men with a mean age of 18.25 years and SD = 1.14).

Structural equation modeling showed that the three PNS domains, together with the five contextual factors positively predicted the three developmental outcomes measured (41–54% explained variance). Moreover, there were higher differences in PNS (0.55 ≤ Cohen’s d ≥ 0.71) among young athletes classified by the sport types.

As per the findings of this study, young athletes may differ in the levels of PNS they obtained depending on the type of sports enrolled in sports academies. Also, the results of this study indicated that PNS attained may be modestly influenced by some contextual factors. It also evidenced that those developmental outcomes in elite young athletes are significantly positively associated with contextual and PNS factors. Stakeholders such as young athlete coaches, parents, sports psychologists, and administrators must consider the differing implications of program type during the elite young athletes’ participation in sports academics and the significant positive association between contextual factors, PNS, and developmental outcomes of elite young athletes.

In sum, the PNS of youth athletes may differ across sports types and the talent development of elite young athletes should emphasize the individual nature of the processes. Also, it can be concluded that the PNS components than the contextual factors had higher predictions of developmental outcomes.

• Contextual environment
• Developmental outcome
• Ethiopia
• Psychological needs satisfaction
• Sports academy

The COVID-19 pandemic caused an abrupt change in higher education that had a profound impact on students. Pandemic distance learning required students to regulate their learning more independently and to find new ways of communicating with their peers and instructors. This study focused on how students perceived the learning conditions that they encountered during the first semester that took place online compared to the time before distance learning. The primary aim of this study was to determine whether students’ internal resource management strategies, intrinsic motivation, and instruction format (synchronous, asynchronous, and face-to-face) preferences were associated with the perceived changes of the learning conditions. Students enrolled in a German university (N = 330) answered an online questionnaire at the end of the summer term in 2020. Findings from structural equation modeling showed that the regulative resources of attention and intrinsic motivation were significant factors that predicted how students perceived changes in relevance, quality, and support of online instruction compared to the time before distance learning. However, our results show that these factors did not impact perceived changes in social relatedness. Moreover, the results demonstrate that preferences for digital formats were significant related to student perceptions of changes in relevance, quality, and support, whereas preferences for the face-to-face format had significant negative effects on these factors. Only the face-to-face preference had a significant (negative) effect on social relatedness. Finally, the study revealed an indirect effect of attention on students’ perceived changes of learning conditions through preferences for lesson formats. This study has important implications for digital integration in higher education and suggests that institutions should implement various methods that foster social interaction and internal regulation strategies.

• Federal Ministry of Education and Research

Research about using physical activity (PA) to improve health, quality of life, and participation after moderate-to-severe traumatic brain injury (TBI) is receiving growing attention. However, best-practices for maintaining PA participation after TBI have yet to be defined. In this context, a team of researchers and stakeholders with a moderate-to-severe TBI (including program participants and peer mentors) participated in a co-creation process to optimize a 9-month, 3-phased, community-based, adapted PA program named TBI-Health.

The study aimed to provide a detailed account of the participation in and co-creation of a new TBI-Health Program to enhance sport and exercise participation for adults with moderate-to-severe TBI. Specifically, we carried out an in-depth exploration of the perceived experiences and outcomes of users over one cycle of the program to assist the co-creation process.

An interpretive case study approach was used to explore the experiences and outcomes of the participatory co-creation within and across phases of the TBI-Health program. A purposeful sample of fourteen adults with moderate-to-severe TBI (program participants n = 10; peer mentors n = 4) were involved in audio-recorded focus groups after each program phase. Reflexive thematic analyses within and across the phases identified three higher-order themes.

Program Participation included barriers, facilitators, sources of motivation and suggested modifications to optimize the program; Biopsychosocial Changes highlighted perceived physical, psychological, and social outcomes, by self and others, that resulted from program participation; PA Autonomy emphasized transitions in knowledge, sex- and gender-related beliefs, and abilities related to exercise and sport participation.

Study findings suggest the TBI-Health program can increase autonomy for and reduce barriers to PA for adults with moderate-to-severe TBI, which results in increased PA participation and important physical, psychological, and social benefits. More research is needed about the TBI-Health program with larger samples.

• Social Sciences and Humanities Research Council of Canada

• brand dissatisfaction
• brand hate
• brand retaliation
• consumer wellbeing
• quality of life
• self-incongruity
• young consumers

• Medical staff
• Public service motivation
• Task performance
• Turnover intention
• Work stress

• decision aid
• decision support
• decision support technique
• decision support tool
• decision-making
• digital health
• eHealth
• evidence-based medicine
• informed decision-making
• smoking
• smoking cessation
• value clarification method

• Computers
• Decision Support Techniques
• Humans
• Internet
• Smoking
• Smoking Cessation/methods

• awe
• connectedness to nature
• leisure
• solitude
• urban parks

• National Science Foundation

• Goal-setting
• Implementation evaluation
• Pediatrics
• Pragmatic trial
• Rehabilitation

• Activities of Daily Living
• Child
• Child, Preschool
• Goals
• Humans
• Motivation
• Multicenter Studies as Topic
• Parents
• Quality of Life
• Randomized Controlled Trials as Topic

• Maternal Newborn Child and Youth Strategic Clinical Network

• BC
• acceptability
• breast cancer
• mHealth
• mobile app
• mobile phone
• physical activity
• user experience

• brand loyalty
• brand personality appeal
• brand-based self-realization
• idol worship
• perceived emotional value
• relatedness needs satisfaction

• employee green behavior
• positive organizational psychology
• positive predictors
• positive psychology
• systematic review

• health care
• risk factors

• Behavior, Addictive
• Humans
• Motivation
• Muscular Diseases
• Neural Networks, Computer
• Video Games/adverse effects

• creative self-efficacy
• employee innovative behavior
• job control
• mindfulness
• moderated mediation model

Voice-controlled smart speakers and displays have a unique but unproven potential for delivering eHealth interventions. Many laptop- and smartphone-based interventions have been shown to improve multiple outcomes, but voice-controlled platforms have not been tested in large-scale rigorous trials. Older adults with multiple chronic health conditions, who need tools to help with their daily management, may be especially good candidates for interventions on voice-controlled devices because these patients often have physical limitations, such as tremors or vision problems, that make the use of laptops and smartphones challenging.

The aim of this study is to assess whether participants using an evidence-based intervention (ElderTree) on a smart display will experience decreased pain interference and improved quality of life and related measures in comparison with participants using ElderTree on a laptop and control participants who are given no device or access to ElderTree.

A total of 291 adults aged ≥60 years with chronic pain and ≥3 additional chronic conditions will be recruited from primary care clinics and community organizations and randomized 1:1:1 to ElderTree access on a smart display along with their usual care, ElderTree access on a touch screen laptop along with usual care, or usual care alone. All patients will be followed for 8 months. The primary outcomes are differences between groups in measures of pain interference and psychosocial quality of life. The secondary outcomes are between-group differences in system use at 8 months, physical quality of life, pain intensity, hospital readmissions, communication with medical providers, health distress, well-being, loneliness, and irritability. We will also examine mediators and moderators of the effects of ElderTree on both platforms. At baseline, 4 months, and 8 months, patients will complete written surveys comprising validated scales selected for good psychometric properties with similar populations. ElderTree use data will be collected continuously in system logs. We will use linear mixed-effects models to evaluate outcomes over time, with treatment condition and time acting as between-participant factors. Separate analyses will be conducted for each outcome.

Recruitment began in August 2021 and will run through April 2023. The intervention period will end in December 2023. The findings will be disseminated via peer-reviewed publications.

To our knowledge, this is the first study with a large sample and long time frame to examine whether a voice-controlled smart device can perform as well as or better than a laptop in implementing a health intervention for older patients with multiple chronic health conditions. As patients with multiple conditions are such a large cohort, the implications for cost as well as patient well-being are significant. Making the best use of current and developing technologies is a critical part of this effort.

ClinicalTrials.gov NCT04798196; https://clinicaltrials.gov/ct2/show/NCT04798196

PRR1-10.2196/37522

• aged
• chronic pain
• eHealth
• geriatrics
• health expenditures
• mobile phone
• multiple chronic conditions
• primary care
• quality of life
• smart displays
• smart speakers

The present study aimed at investigating the motivational factors affecting Iranian learners’ learning of English as a Foreign Language across differing levels of language proficiency. To this end, 110 males and 70 females with an age range of 18–31 took part in the study and a mixed-methods approach was adopted. First, the researchers administered Oxford Placement Test (OPT) to determine the proficiency level of the participants and placed them into three levels of language proficiency. Elementary, intermediate, and advanced. Next, as for the quantitative part of the study, the Attitude/Motivation Test Battery (AMBT) questionnaire was distributed among all the participants to delve into the motivational factors. Finally, a semi-structured interview was conducted to qualitatively probe into EFL learners’ motivational factors affecting their learning of English. It was found that the motivational factors which encouraged EFL learners resulted from either intrinsic or extrinsic tendencies. The recognized intrinsically-based motivational factors were personal enjoyment, social prestige, and being challenged. The extrinsically-oriented factors as the source of motivation to learn English were getting a job, pursuing education, earning more money, traveling to foreign countries, pursuing academic careers, making efficient use of technology, and effectively interacting with native speakers. It was concluded that beginner and intermediate English language learners tended to learn English more based on extrinsic factors whereas advanced learners were found to be more intrinsically motivated.

• EFL learners
• extrinsic motivation
• intrinsic motivation
• learning English
• motivational factors
• proficiency level

• corporate social responsibility
• employee creativity
• extra roles
• hotel
• social identity theory
• work engagement

The National Health Service (NHS) Diabetes Prevention Program is a behavior change intervention for adults in England who are identified as being at high risk of developing type 2 diabetes. The face-to-face service was launched in 2016, followed by a digital service (NHS Digital Diabetes Prevention Program [NHS-DDPP]) in 2019. A total of 4 service providers were commissioned to deliver the NHS-DDPP and were required to deliver the digital service in line with a program specification detailing the key intervention content. The fidelity of the behavior change content in the digital service (ie, the extent to which the program is delivered as intended) is currently unknown. Digital interventions may allow higher fidelity as staff do not have to be trained to deliver all intervention content. Assessing fidelity of the intervention design is particularly important to establish the planned behavior change content in the NHS-DDPP and the extent to which this adheres to the program specification. This is the first known independent assessment of design fidelity in a large-scale digital behavior change intervention.

This study aims to assess the fidelity of the behavior change content in each of the 4 NHS-DDPP providers’ intervention designs to the full program specification.

We conducted a document review of each provider’s NHS-DDPP intervention design, along with interviews with program developers employed by the 4 digital providers (n=6). Providers’ intervention design documents and interview transcripts were coded for behavior change techniques (BCTs; ie, the active ingredients of the intervention) using the Behavior Change Technique Taxonomy version 1 and underpinning theory using the Theory Coding Scheme framework. The BCTs identified in each digital provider’s intervention design were compared with the 19 BCTs included in the program specification.

Of the 19 BCTs specified in the program specification, the 4 providers planned to deliver 16 (84%), 17 (89%), 16 (84%), and 16 (84%) BCTs, respectively. An additional 41 unspecified BCTs were included in at least one of the 4 digital providers’ intervention designs. By contrast, inconsistent use of the underpinning theory was apparent across providers, and none of the providers had produced a logic model to explain how their programs were expected to work. All providers linked some of their planned BCTs to theoretical constructs; however, justification for the inclusion of other BCTs was not described.

The fidelity of BCT content in the NHS-DDPP was higher than that previously documented for the face-to-face service. Thus, if service users engage with the NHS-DDPP, this should increase the effectiveness of the program. However, given that a clear theoretical underpinning supports the translation of BCTs in intervention designs to intervention delivery, the absence of a logic model describing the constructs to be targeted by specific BCTs is potentially problematic.

• behavior change
• diabetes prevention
• digital interventions
• fidelity