Using an Analysis of Behavior Change to Inform Effective Digital Intervention Design: How Did the PRIMIT Website Change Hand Hygiene Behavior Across 8993 Users?
Using an Analysis of Behavior Change to Inform Effective Digital Intervention Design: How Did the PRIMIT Website Change Hand Hygiene Behavior Across 8993 Users?
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DOI：
10.1007/s12160-016-9866-9
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发表时间：
2017-06
期刊：
影响因子：
--
通讯作者：
Yardley L
中科院分区：
文献类型：
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作者：
Ainsworth B;Steele M;Stuart B;Joseph J;Miller S;Morrison L;Little P;Yardley L
在为医疗保健设计数字干预措施时，重要的是不仅要了解干预措施是否奏效，还要了解干预措施如何以及对谁有效--包括个别干预措施是否具有不同的影响，是否需要特定的使用阈值来改变每次干预的行为，以及不同人群的使用情况是否有所不同。我们使用基于网站的感染控制干预措施以修改流感样疾病和呼吸道感染传播(PRIMIT)干预措施的数字初级保健试验的大型试验的数据来调查这些问题，该干预措施旨在通过增加手卫生行为来减少呼吸道感染(RTI)。基线和跟踪调查问卷测量了手部卫生方面的行为、意图和态度。结合对四次PRIMIT会议使用情况的客观测量，我们分析了这些观察数据，以检查8993名干预使用者的行为变化机制。我们发现，PRIMIT干预改变了行为、意图和态度，这种变化与RTI的减少有关。最大的手部卫生变化发生在第一次会议之后，在随后的每一次会议之后变化逐渐变小，这表明参与第一次会议中包括的核心行为改变技术对于行为改变是必要的和充分的。这项干预对男性和女性、老年人和年轻人都同样有效，对受教育程度较低的人尤其有效。我们有力的分析对干预发展具有启示意义。我们能够确定手卫生变化所需的干预参与的“最低阈值”，并讨论了这一(以及其他类型的分析)可能对进一步干预发展产生的潜在影响。我们还讨论了类似分析在其他干预措施中的应用。
In designing digital interventions for healthcare, it is important to understand not just whether interventions work but also how and for whom—including whether individual intervention components have different effects, whether a certain usage threshold is required to change behavior in each intervention and whether usage differs across population subgroups. We investigated these questions using data from a large trial of the digital PRimary care trial of a website based Infection control intervention to Modify Influenza-like illness and respiratory tract infection Transmission) (PRIMIT) intervention, which aimed to reduce respiratory tract infections (RTIs) by increasing hand hygiene behavior. Baseline and follow-up questionnaires measured behaviors, intentions and attitudes in hand hygiene. In conjunction with objective measures of usage of the four PRIMIT sessions, we analysed these observational data to examine mechanisms of behavior change in 8993 intervention users. We found that the PRIMIT intervention changed behavior, intentions and attitudes, and this change was associated with reduced RTIs. The largest hand hygiene change occurred after the first session, with incrementally smaller changes after each subsequent session, suggesting that engagement with the core behavior change techniques included in the first session was necessary and sufficient for behavior change. The intervention was equally effective for men and women, older and younger people and was particularly effective for those with lower levels of education. Our well-powered analysis has implications for intervention development. We were able to determine a ‘minimum threshold’ of intervention engagement that is required for hand hygiene change, and we discuss the potential implications this (and other analyses of this type) may have for further intervention development. We also discuss the application of similar analyses to other interventions.