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Adapting behavioural interventions for a changing public health context: A worked example of implementing a digital intervention during a global pandemic using rapid optimisation methods

Adapting behavioural interventions for a changing public health context: A worked example of implementing a digital intervention during a global pandemic using rapid optimisation methods
Adapting behavioural interventions for a changing public health context: A worked example of implementing a digital intervention during a global pandemic using rapid optimisation methods

Background: A rigorous approach is needed to inform rapid adaptation and optimisation of behavioral interventions in evolving public health contexts, such as the Covid-19 pandemic. This helps ensure that interventions are relevant, persuasive, and feasible while remaining evidence-based. This paper provides a set of iterative methods to rapidly adapt and optimize an intervention during implementation. These methods are demonstrated through the example of optimizing an effective online handwashing intervention called Germ Defense. Methods: Three revised versions of the intervention were rapidly optimized and launched within short timeframes of 1–2 months. Optimisations were informed by: regular stakeholder engagement; emerging scientific evidence, and changing government guidance; rapid qualitative research (telephone think-aloud interviews and open-text surveys), and analyses of usage data. All feedback was rapidly collated, using the Table of Changes method from the Person-Based Approach to prioritize potential optimisations in terms of their likely impact on behavior change. Written feedback from stakeholders on each new iteration of the intervention also informed specific optimisations of the content. Results: Working closely with clinical stakeholders ensured that the intervention was clinically accurate, for example, confirming that information about transmission and exposure was consistent with evidence. Patient and Public Involvement (PPI) contributors identified important clarifications to intervention content, such as whether Covid-19 can be transmitted via air as well as surfaces, and ensured that information about difficult behaviors (such as self-isolation) was supportive and feasible. Iterative updates were made in line with emerging evidence, including changes to the information about face-coverings and opening windows. Qualitative research provided insights into barriers to engaging with the intervention and target behaviors, with open-text surveys providing a useful supplement to detailed think-aloud interviews. Usage data helped identify common points of disengagement, which guided decisions about optimisations. The Table of Changes was modified to facilitate rapid collation and prioritization of multiple sources of feedback to inform optimisations. Engagement with PPI informed the optimisation process. Conclusions: Rapid optimisation methods of this kind may in future be used to help improve the speed and efficiency of adaptation, optimization, and implementation of interventions, in line with calls for more rapid, pragmatic health research methods.

COVID-19, adaptation, behavior change, intervention - behavioral, optimisation, rapid research methods
2296-2565
1-11
Morton, Kate
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Ainsworth, Benjamin
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Miller, Sascha
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Rice, Cathy
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Bostock, Jennifer
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Denison-Day, James
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Towler, Lauren
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Groot, Julia
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Moore, Michael
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Willcox, Merlin
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Chadborn, Tim
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Amlot, Richard
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Gold, Natalie
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Little, Paul
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Yardley, Lucy
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Morton, Kate
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Ainsworth, Benjamin
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Miller, Sascha
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Rice, Cathy
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Bostock, Jennifer
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Denison-Day, James
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Towler, Lauren
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Groot, Julia
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Moore, Michael
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Willcox, Merlin
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Chadborn, Tim
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Amlot, Richard
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Gold, Natalie
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Little, Paul
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Yardley, Lucy
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Morton, Kate, Ainsworth, Benjamin, Miller, Sascha, Rice, Cathy, Bostock, Jennifer, Denison-Day, James, Towler, Lauren, Groot, Julia, Moore, Michael, Willcox, Merlin, Chadborn, Tim, Amlot, Richard, Gold, Natalie, Little, Paul and Yardley, Lucy (2021) Adapting behavioural interventions for a changing public health context: A worked example of implementing a digital intervention during a global pandemic using rapid optimisation methods. Frontiers in Public Health, 9, 1-11, [668197]. (doi:10.3389/fpubh.2021.668197).

Record type: Article

Abstract

Background: A rigorous approach is needed to inform rapid adaptation and optimisation of behavioral interventions in evolving public health contexts, such as the Covid-19 pandemic. This helps ensure that interventions are relevant, persuasive, and feasible while remaining evidence-based. This paper provides a set of iterative methods to rapidly adapt and optimize an intervention during implementation. These methods are demonstrated through the example of optimizing an effective online handwashing intervention called Germ Defense. Methods: Three revised versions of the intervention were rapidly optimized and launched within short timeframes of 1–2 months. Optimisations were informed by: regular stakeholder engagement; emerging scientific evidence, and changing government guidance; rapid qualitative research (telephone think-aloud interviews and open-text surveys), and analyses of usage data. All feedback was rapidly collated, using the Table of Changes method from the Person-Based Approach to prioritize potential optimisations in terms of their likely impact on behavior change. Written feedback from stakeholders on each new iteration of the intervention also informed specific optimisations of the content. Results: Working closely with clinical stakeholders ensured that the intervention was clinically accurate, for example, confirming that information about transmission and exposure was consistent with evidence. Patient and Public Involvement (PPI) contributors identified important clarifications to intervention content, such as whether Covid-19 can be transmitted via air as well as surfaces, and ensured that information about difficult behaviors (such as self-isolation) was supportive and feasible. Iterative updates were made in line with emerging evidence, including changes to the information about face-coverings and opening windows. Qualitative research provided insights into barriers to engaging with the intervention and target behaviors, with open-text surveys providing a useful supplement to detailed think-aloud interviews. Usage data helped identify common points of disengagement, which guided decisions about optimisations. The Table of Changes was modified to facilitate rapid collation and prioritization of multiple sources of feedback to inform optimisations. Engagement with PPI informed the optimisation process. Conclusions: Rapid optimisation methods of this kind may in future be used to help improve the speed and efficiency of adaptation, optimization, and implementation of interventions, in line with calls for more rapid, pragmatic health research methods.

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GD Rapid opt paper 10.03.21 clean - Accepted Manuscript
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Accepted/In Press date: 19 March 2021
Published date: 26 April 2021
Keywords: COVID-19, adaptation, behavior change, intervention - behavioral, optimisation, rapid research methods

Identifiers

Local EPrints ID: 448106
URI: http://eprints.soton.ac.uk/id/eprint/448106
ISSN: 2296-2565
PURE UUID: 9327965a-e274-41e8-b2e2-f9621ed07ec9
ORCID for Kate Morton: ORCID iD orcid.org/0000-0002-6674-0314
ORCID for Benjamin Ainsworth: ORCID iD orcid.org/0000-0002-5098-1092
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Merlin Willcox: ORCID iD orcid.org/0000-0002-5227-3444
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

Catalogue record

Date deposited: 01 Apr 2021 15:59
Last modified: 10 Jan 2022 05:51

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Contributors

Author: Kate Morton ORCID iD
Author: Benjamin Ainsworth ORCID iD
Author: Sascha Miller
Author: Cathy Rice
Author: Jennifer Bostock
Author: Lauren Towler
Author: Julia Groot
Author: Michael Moore ORCID iD
Author: Merlin Willcox ORCID iD
Author: Tim Chadborn
Author: Richard Amlot
Author: Natalie Gold
Author: Paul Little
Author: Lucy Yardley ORCID iD

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