Empiric validation of a process for behavior change

Abstract

Most behavior change trials focus on outcomes rather than deconstructing how those outcomes related to programmatic theoretical underpinnings and intervention components. In this report, the process of change is compared for three evidence-based programs' that shared theories, intervention elements and potential mediating variables. Each investigation was a randomized trial that assessed pre-and post-intervention variables using survey constructs with established reliability. Each also used mediation analyses to define relationships. The findings were combined using a pattern matching approach. Surprisingly, knowledge was a significant mediator in each program (a and b path effects [p<0.01]). Norms, perceived control abilities, and self-monitoring were confirmed in at least two studies (p<0.01 for each). Replication of findings across studies with a common design but varied populations provides a robust validation of the theory and processes of an effective intervention. Combined findings also demonstrate a means to substantiate process aspects and theoretical models to advance understanding of behavior change. KeywordsBehavior change, Mediation, Peer-led INTRODUCTION Knowledge about how healthy lifestyles can prevent illness has outpaced effective means to assist people in living health lives [1]. That limitation is not due to lack of research, and contributions have come from diverse disciplines, such as health promotion, behavioral economics, psychology, decision analysis, and sociology. However, progress may have been constrained due to a focus on outcomes rather than deconstructing how change occurred [2][3][4]. Our group has studied a series of behavior change interventions that use a shared format and theoretical structure. All had documented efficacy in randomized controlled trials [5][6][7][8][9][10], and for each, specific program components were related to behavioral endpoints [11][12][13]. Comparing their observed patterns of findings presents a means to assess theories of behavior change and validate an effective intervention format.

A Mediation Analysis of Mothers’ Dietary Intake: TheEntre Familia: Reflejos de SaludRandomized Controlled Trial

“…Despite the availability of the mediation analysis framework to explore mediating effects in interventions, focus is more often placed on outcomes rather than understanding how changes were made (Elliot et al, 2016). In a meta-analysis of eating norms on eating behaviors, Robinson, Thomas, Aveyard, and Higgs (2014) found no studies conducting mediation analysis.…”

Nutrition Education and Dietary Behavior Change Games: A Scoping Review

“…47 Research from three large behavior change trials (not using games) used mediating variable analyses to validate a multi-theoretical model to specify the conceptual framework for the design of health behavior change interventions that are likely to be effective. 48 Several conceptual models have been advanced to account for how games may influence diet-related outcomes. [49][50][51] Some of these models interrelate game elements and behavior change principles, 50,51 while others emphasize the relevance of food cues and individual predisposing factors (e.g., impulsivity).…”

Incorporating Positive Youth Development into the Therapeutic Model for Incarcerated Young Woman

“…A hypothesized model of a PYD program for incarcerated young women is shown in Figure 2 . It begins with our established model of similar peer-led, group-centered curricula, including an analysis of the original ATHENA intervention [ 85 , 88 ]. And, it includes superimposed features from processes of PYD programs and the focused self-efficacy behaviors related to achieving appropriate sleep and attending a program of regular exercise tailored to the setting ( Figure 2 ).…”

“…Mediation analysis is a means to assess the hypothetical relationships among intervention components, targeted variables, and outcomes. It provides an explicit check on whether a program affected the intermediate variables and whether the purported theoretical relationship of those variables to outcomes holds [83][84][85]. In our prior randomized trials of school [including the ATHENA program] and worksite-based health promotion/harm reduction interventions, we have applied mediation analysis to establish a model of behavior change [85].…”

“…It provides an explicit check on whether a program affected the intermediate variables and whether the purported theoretical relationship of those variables to outcomes holds [83][84][85]. In our prior randomized trials of school [including the ATHENA program] and worksite-based health promotion/harm reduction interventions, we have applied mediation analysis to establish a model of behavior change [85]. To date mediation analysis has not been applied to PYD programs, and the mechanisms of action are based on existing theories and identification of shared features of effective interventions [86] In 2016, Bonell and colleagues reviewed 16 PYD programs relating to substance abuse and violence, with the goal of identifying the theoretical underpinnings of programs' positive outcomes [86].…”