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AimsNHS England commissioned independent service providers to deliver the NHS Low‐Calorie Diet Programme pilot. Previous research has illustrated a drift in the fidelity of behaviour change techniques (BCTs) during the delivery of the programme provided through face‐to‐face group or one‐to‐one behavioural support. The aim of this study was to assess the delivery fidelity of the BCT content in the digital delivery of the programme.MethodsOnline, app chat and phone call support content was coded using The Behaviour Change Technique Taxonomy. BCTs delivered by each service provider (N = 2) were calculated and compared to the BCTs specified in the NHS service specification and those specified in the providers' programme plans.ResultsBetween 78% and 83% of the BCTs identified in the NHS service specification were delivered by the service providers. The fidelity of BCT delivery to those specified in providers' programme plans was 60%–65% for provider A, and 82% for provider B.ConclusionsThe BCT content of the digital model used in the NHS‐LCD programme adhered well to the NHS service specification and providers' plans. It surpassed what has been previously observed in face‐to‐face services provided through group or one‐on‐one behavioural support models.
AimsNHS England commissioned independent service providers to deliver the NHS Low‐Calorie Diet Programme pilot. Previous research has illustrated a drift in the fidelity of behaviour change techniques (BCTs) during the delivery of the programme provided through face‐to‐face group or one‐to‐one behavioural support. The aim of this study was to assess the delivery fidelity of the BCT content in the digital delivery of the programme.MethodsOnline, app chat and phone call support content was coded using The Behaviour Change Technique Taxonomy. BCTs delivered by each service provider (N = 2) were calculated and compared to the BCTs specified in the NHS service specification and those specified in the providers' programme plans.ResultsBetween 78% and 83% of the BCTs identified in the NHS service specification were delivered by the service providers. The fidelity of BCT delivery to those specified in providers' programme plans was 60%–65% for provider A, and 82% for provider B.ConclusionsThe BCT content of the digital model used in the NHS‐LCD programme adhered well to the NHS service specification and providers' plans. It surpassed what has been previously observed in face‐to‐face services provided through group or one‐on‐one behavioural support models.
BackgroundAdvance care planning (ACP) has been reconceptualized as a health behavior. Action plans (APs), or patient‐directed mini contracts, improve behavior change. However, no prior studies have assessed whether APs can increase ACP documentation and engagement.MethodsWe included English and Spanish‐speaking primary care patients from San Francisco, ≥55 years of age, with ≥2 serious or chronic illnesses. Participants were in the intervention arm of the PREPAREforYOURcare.org trial and asked at baseline to choose 1 of 5 actions (e.g., choose a surrogate). At 6 months, we assessed whether participants completed their AP and if completion was associated with demographics, electronic health record (EHR) ACP documentation, and five‐point ACP Engagement Survey scores. We used t‐tests, chi‐squared, multivariate analysis adjusted for baseline ACP and clustering by physician, and qualitative thematic analysis to explore reasons for non‐completion.ResultsThe mean age of 586 participants was 65 ± 10 years; 44.0% women, 45.9% Spanish‐speaking, 31.4% had limited health literacy, and 43% completed an AP at 6 months; surrogate‐related (47.4%), tell others about medical wishes (33.7%), ask clinicians questions (13.7%), and decide what matters most in life (5.2%). Participants with limited versus adequate health literacy were less likely to complete an AP (25.4% vs 35.9%, p = 0.01). Completing an AP was associated with greater ACP EMR documentation 49.8% vs 35.6%, p < 0.001 (adjusted odds ratio: 2.06; 95% CI [1.43–2.97]) and engagement (adjusted five‐point scores [3.69; 95% CI 3.57–3.81 vs 3.10; 95% CI: 2.98–3.21], p < 0.001). Themes for non‐completion included not being ready and logistical issues (e.g., surrogate deceased).ConclusionsAmong English and Spanish‐speaking older adults, creating an ACP AP resulted in greater documentation and engagement. APs may help facilitate ACP behavior change as part of effective ACP interventions. Additional support may be needed for patients with limited health literacy and those facing logistical barriers.
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