Group-based interventions are widely used to promote health-related behaviour change. While processes operating in groups have been extensively described, it remains unclear how behaviour change is generated in group-based health-related behaviour-change interventions. Understanding how such interventions facilitate change is important to guide intervention design and process evaluations. We employed a mixed-methods approach to identify, map and define change processes operating in group-based behaviour-change interventions. We reviewed multidisciplinary literature on group dynamics, taxonomies of change technique categories, and measures of group processes. Using weight-loss groups as an exemplar, we also reviewed qualitative studies of participants' experiences and coded transcripts of 38 group sessions from three weight-loss interventions. Finally, we consulted group participants, facilitators and researchers about our developing synthesis of findings. The resulting 'Mechanisms of Action in Group-based Interventions' (MAGI) framework comprises six overarching categories: (1) group intervention design features, (2) facilitation techniques, (3) group dynamic and development processes, (4) inter-personal change processes, (5) selective intra-personal change processes operating in groups, and (6) contextual influences. The framework provides theoretical explanations of how change occurs in group-based behaviour-change interventions and can be applied to optimise their design and delivery, and to guide evaluation, facilitator training and further research. ARTICLE HISTORY
Background: Small groups are used to promote health, well-being, and personal change by altering members' perceptions, beliefs, expectations, and behaviour patterns. An extensive cross-disciplinary literature has articulated and tested theories explaining how such groups develop, function, and facilitate change. Yet these theoretical understandings are rarely applied in the development, description, and evaluation of health-promotion, group-based, behaviour-change interventions. Methods: Medline database, library catalogues, search engines, specific journals and reference lists were searched for relevant texts. Texts were reviewed for explanatory concepts or theories describing change processes in groups, which were integrated into the developing conceptual structure. This was designed to be a parsimonious conceptual framework that could be applied to design and delivery. Results: Five categories of interacting processes and concepts were identified and defined: (1) group development processes, (2) dynamic group processes, (3) social change processes, (4) personal change processes, and (5) group design and operating parameters. Each of these categories encompasses a variety of theorised mechanisms explaining individual change in small groups. Conclusion: The final conceptual model, together with the design issues and practical recommendations derived from it, provides a practical basis for linking research and theory explaining group functioning to optimal design of group-based, behaviour-change interventions.
BackgroundPublished descriptions of group-based behaviour-change interventions (GB-BCIs) often omit design and delivery features specific to the group setting. This impedes the ability to compare behaviour-change interventions, synthesise evidence on their effectiveness and replicate effective interventions. The aim of this study was to develop a checklist of elements that should be described to ensure adequate reporting of GB-BCIs.MethodsA range of characteristics needed to replicate GB-BCIs were extracted from the literature and precisely defined. An abbreviated checklist and a coder manual were developed, pilot tested and refined. The final checklist and coder manual were used to identify the presence or absence of specified reporting elements in 30 published descriptions of GB-BCIs by two independent coders. Reliability of coding was assessed.ResultsThe checklist comprises 26 essential reporting elements, covering intervention design, intervention content, participant characteristics, and facilitator characteristics. Inter-rater reliability for identification of reporting elements was high (95 % agreement, Mean AC1 = 0.89).ConclusionThe checklist is a practical tool that can be used, alongside other reporting guidelines, to ensure comprehensive description and to assess reporting quality of GB-BCIs. It can also be helpful for designing group-based health interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2300-6) contains supplementary material, which is available to authorized users.
Diet and physical activity interventions delivered in groups are effective in promoting clinically meaningful weight loss at 12 months. Intervention design and effectiveness vary considerably between studies, and evidence on what optimises the effectiveness of group-based weight-loss interventions remains limited.
BackgroundParent carers of disabled children report poor physical health and mental wellbeing. They experience high levels of stress and barriers to engagement in health-related behaviours and with ‘standard’ preventive programmes (e.g. weight loss programmes). Interventions promoting strategies to improve health and wellbeing of parent carers are needed, tailored to their specific needs and circumstances.MethodsWe developed a group-based health promotion intervention for parent carers by following six steps of the established Intervention Mapping approach. Parent carers co-created the intervention programme and were involved in all stages of the development and testing. We conducted a study of the intervention with a group of parent carers to examine the feasibility and acceptability. Standardised questionnaires were used to assess health and wellbeing pre and post-intervention and at 2 month follow up. Participants provided feedback after each session and took part in a focus group after the end of the programme.ResultsThe group-based Healthy Parent Carers programme was developed to improve health and wellbeing through engagement with eight achievable behaviours (CLANGERS – Connect, Learn, be Active, take Notice, Give, Eat well, Relax, Sleep), and by promoting empowerment and resilience. The manualised intervention was delivered by two peer facilitators to a group of seven parent carers. Feedback from participants and facilitators was strongly positive. The study was not powered or designed to test effectiveness but changes in measures of participants’ wellbeing and depression were in a positive direction both at the end of the intervention and 2 months later which suggest that there may be a potential to achieve benefit.ConclusionsThe Healthy Parent Carers programme appears feasible and acceptable. It was valued by, and was perceived to have benefited participants. The results will underpin future refinement of the intervention and plans for evaluation.
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