This systematic review and meta-regression analysis examined behavioural correlates of plasma donation intention and behaviour, employing the Theoretical Domains Framework (TDF) to categorise associated factors. From 53 included studies (n = 3,282,755 participants), we identified 56 unique factors spanning 11 TDF domains. Meta-regression revealed significant correlations between plasma donation intention and six domains, including beliefs about capabilities, social influences, and emotions. Meta-regression of factors associated with behaviour did not identify any significant associations. This review highlights key theoretically informed correlates of plasma donation intention but reveals a lack of evidence on predictors of actual donation behaviour. Addressing this intention-behaviour gap through robust, longitudinal research will be critical to informing effective plasma donation interventions.

BACKGROUND:Healthcare professionals' (HCPs) routinely engage in multiple different clinical actions. We aimed to identify and synthesize the characteristics of multiple behavior change interventions in HCPs. METHODS:Five electronic databases were searched up to June 2025 for randomized trials of interventions aiming to change more than one clinical behavior, including behavior change advice. Two reviewers independently screened and extracted 20 % of the data. Quality was assessed using Cochrane's Risk of Bias 2 tool and content of interventions was coded using Behavior Change Ontologies. Evidence was narratively synthesized. RESULTS:Seventeen studies were included, most targeting physicians. Clinical behaviors varied in type and specificity and were inductively categorized into seven upper-level domains: 'provision of behavior change advice', 'screening/assessment/measurement', 'prescription of medication', 'referrals', 'treatment', 'diagnosis' and 'medical history taking'. Interventions were mostly brief (median = 5 days) and delivered through a combination of face-to-face and at-a-distance modes of delivery (41 %) and in group settings (47 %). Only 3 trials reported using theory to inform intervention development (18 %). Each intervention used at least one behavior change technique (BCT; 22 BCTs identified). The most frequent BCTs were 'set behavior goal' (90 %), 'add objects to the environment' and 'present information from credible influence'(63 % each). CONCLUSIONS:Current interventions are highly heterogeneous in the clinical behaviors targeted for change and approaches to their measurement. Greater recognition of the multiple behavior nature of such interventions, and on reporting their content accordingly, may contribute to understanding whether and how best to intervene on more than one clinical behavior. REGISTRATION:PROSPERO (CRD42022327108) and Open Science Framework (https://osf.io/g7mwf/files/yfqrt).

Background: The aim of this study was to examine the temporal dynamics of health behaviours (e.g., physical activity, alcohol consumption) and pandemic related health behaviours (e.g., hand washing, physical distancing) using network psychometrics. Methods: This hypothesis-generating analysis used temporal network models to fit temporal net-works, contemporaneous networks, and between-subject networks from items within the International COVID-19 Awareness and Responses Evaluation (iCARE) survey. The iCARE study is a multi-wave observational cohort study of public awareness, attitudes, and responses to public health policies implemented to reduce the spread of COVID-19 on people around the world. Results: Descriptive statistics revealed that over six months, adherence to mask wearing, social distancing, hand washing, physical activity, and alcohol consumption remained generally stable. People reported a decrease in healthy diet before this be-haviour returned to pre-pandemic levels. Between February and May respondents to the iCARE survey also reported smoking cigarettes, using recreational drugs, and vaping ‘a lot more’ since the start of the pandemic; however, this pattern reversed abruptly from May to July with most participants reporting they engage in these behaviours ‘a lot less’ than be-fore the pandemic or ‘not at all’. Temporal associations were observed between physical activity and health eating, and a bi-directional relationship was evident between outdoor mask use and vaping. A contemporaneous network revealed associations between vice behaviours (drugs, vaping, cigarettes, and alcohol), and within person associations between drug use, physical activity, and healthy eating. Conclusions: The application of temporal network analysis to the study of multiple health behaviours is well suited to address key re-search questions in the field such as ‘how to multiple health behaviours co-vary with one another over time’. Future research employing intensive time series data and measuring affective and cognitive mediators of behaviour, in addition to health behaviours, has the potential to contribute valuable hypothesis generating insights to the basic science of multiple health behaviour research.

Interventions addressing more than one health behavior at a time could be an efficient way of intervening to manage chronic conditions. Within a systematic review of multiple health behavior change (MBHC) interventions, we identified key components of interventions in patients with chronic conditions, assessed how they are linked to theory, behavior change techniques implemented, and evaluated their impact on intervention effectiveness. Studies were identified by systematically searching five electronic databases. Subgroup analyses and meta-regressions were conducted to analyze the association between intervention components and behavioral changes. In total, 61 studies were included spanning different chronic conditions. Most interventions sought to change behaviors simultaneously (72%), often targeting the ‘physical activity, diet and smoking’ cluster of behaviors (33%), and were not theory informed (55%). A total of 36 behavior change techniques were identified. Subgroup analyses indicated that MHBC interventions delivered entirely face-to-face might not be as effective for physical activity outcomes, and not using goal setting (behavior) might be more effective for smoking cessation outcomes. Meta-regressions indicated that longer intervention duration may work best to achieve better physical activity outcomes. This review provides a comprehensive understanding of interventions and contributes to the field of MHBC by facilitating data-driven insights for future optimization and dissemination.

Background: Health behaviors play a significant role in chronic disease management. Rather than being independent of one another, health behaviors often co-occur, suggesting that targeting more than one health behavior in an intervention has the potential to be more effective in promoting better health outcomes. Purpose: We aimed to conduct a systematic review and meta-analysis of randomized trials of interventions that target more than one behavior to examine the effectiveness of multiple health behavior change interventions in patients with chronic conditions.Methods: Five electronic databases (Web of Science, PubMed, CINAHL, EMBASE and Cochrane) were systematically searched in November 2023, and studies included in previous reviews were also consulted. We included randomized trials of interventions aiming to change more than one health behavior in individuals with chronic conditions. Two independent reviewers screened and extracted data, and used Cochrane’s Risk of Bias 2 tool. Meta-analyses were conducted to estimate the effects of interventions on change of health behaviors. Results were presented as Cohen’s d for continuous data, and risk ratio for dichotomous data. Results: Sixty-one studies were included spanning a range of chronic diseases: cardiovascular (k = 25), type 2 diabetes (k = 15), hypertension (k = 10), cancer (k = 7), multiple conditions (k = 3). Most interventions aimed to change more than one behavior simultaneously (rather than in sequence) and most targeted three particular behaviors at once: ‘physical activity, diet and smoking’ (k = 20). Meta-analysis of 43 eligible studies showed for continuous data (k = 29) a small to substantial positive effect on behavior change for all health behaviors (d = .081 to 2.003) except for smoking (d = -.019). For dichotomous data (k = 23) all analyses showed positive effects of targeting more than one behavior on all behaviors (RR = 1.026 to 2.247). Conclusions: Targeting more than one behavior at a time is effective in chronic disease management and more research should be directed into developing the science of multiple behavior change.

Background Hepatitis C virus (HCV) infection is a significant global health burden, particularly among people who inject drugs. Rapid point-of-care HCV testing has emerged as a promising approach to improve HCV detection and linkage to care in harm reduction organizations such as needle and syringe programs. The objective of this study was to use an intersectionality lens to explore the barriers and enablers to point-of-care HCV testing in a needle and syringe program.Methods A qualitative study was conducted using semi-structured interviews with clients (people who inject drugs) and service providers in a large community organization focused on the prevention of sexually transmitted and blood borne infections and harm reduction in Montreal, Canada. An intersectionality lens was used alongside the Theoretical Domains Framework to guide the formulation of research questions as well as data collection, analysis, and interpretation.Results We interviewed 27 participants (15 clients, 12 providers). For clients, four themes emerged: (1) understanding and perceptions of HCV testing, (2) the role of an accessible and inclusive environment, (3) the interplay of emotions and motivations in decision-making, and (4) the impact of intersectional stigma related to HCV, behaviors, and identities. For providers, five themes emerged: (1) knowledge, skills, and confidence for HCV testing, (2) professional roles and their intersection with identity and lived experience, (3) resources and integration of services, (4) social and emotional factors, and (5) behavioral regulation and incentives for HCV testing. Intersectional stigma amplified access, emotional and informational barriers to HCV care for clients. In contrast, identity and lived experience acted as powerful enablers for providers in the provision of HCV care.Conclusion The application of an intersectionality lens provides a nuanced understanding of multilevel barriers and enablers to point-of-care HCV testing. Findings underscore the need for tailored strategies that address stigma, improve provider roles and communication, and foster an inclusive environment for equitable HCV care. Using an intersectionality lens in implementation research can offer valuable insights, guiding the design of equity-focused implementation strategies.

BACKGROUND:Access to hepatitis C care within harm reduction community organizations for people who inject drugs is crucial for achieving hepatitis C elimination. However, there is a lack of data on how perceptions of hepatitis C and treatment have changed among individuals visiting these organizations during the era of direct-acting antivirals (DAAs). This study aimed to explore the perceptions of hepatitis C and treatment access for (re)infection among individuals visiting a needle and syringe program in Canada. METHODS:Eighteen semi-structured interviews were conducted with individuals who recently injected drugs and visited a needle and syringe program. The interviews were guided by the Common-Sense Self-Regulation Model (CS-SRM) and aimed to explore cognitive and emotional representations of hepatitis C, perceptions of treatment, coping strategies and sources of information. Interviews were audio recorded, transcribed, and coded using thematic analysis. RESULTS:Most of the participants identified as male, were of white ethnicity and had a median age of 45. While most underscored the therapeutic advancements and the effectiveness of DAAs, they expressed confusion regarding the mechanisms of access to treatment, especially in cases of reinfection. Perceptions of the controllability of hepatitis C were significantly influenced by the stigmatizing discourse surrounding treatment access, cost, and public coverage. This influence extended to their intentions for seeking treatment. Participants emphasized the social consequences of hepatitis C, including stigma. Emotional representations of hepatitis C evolved along the care cascade, encompassing initial shock at diagnosis and later fear of reinfection following successful treatment. CONCLUSION:Nearly a decade after the advent of DAAs, misinformation about treatment access persists. Findings underscore a nexus of internalized and institutionalized stigma associated with hepatitis C, drug use, and the challenges of cost and access to treatment, pointing to a clear need for education and service delivery optimisation in harm reduction community organizations.

Background Health behaviors such as physical inactivity, unhealthy eating, smoking tobacco, and alcohol use are leading risk factors for noncommunicable chronic diseases and play a central role in limiting health and life satisfaction. To date, however, health behaviors tend to be considered separately from one another, resulting in guidelines and interventions for healthy aging siloed by specific behaviors and often focused only on a given health behavior without considering the co-occurrence of family, social, work, and other behaviors of everyday life. Objective The aim of this study is to understand how behaviors cluster and how such clusters are associated with physical and mental health, life satisfaction, and health care utilization may provide opportunities to leverage this co-occurrence to develop and evaluate interventions to promote multiple health behavior changes. Methods Using cross-sectional baseline data from the Canadian Longitudinal Study on Aging, we will perform a predefined set of exploratory and hypothesis-generating analyses to examine the co-occurrence of health and everyday life behaviors. We will use agglomerative hierarchical cluster analysis to cluster individuals based on their behavioral tendencies. Multinomial logistic regression will then be used to model the relationships between clusters and demographic indicators, health care utilization, and general health and life satisfaction, and assess whether sex and age moderate these relationships. In addition, we will conduct network community detection analysis using the clique percolation algorithm to detect overlapping communities of behaviors based on the strength of relationships between variables. Results Baseline data for the Canadian Longitudinal Study on Aging were collected from 51,338 participants aged between 45 and 85 years. Data were collected between 2010 and 2015. Secondary data analysis for this project was approved by the Ottawa Health Science Network Research Ethics Board (protocol ID #20190506-01H). Conclusions This study will help to inform the development of interventions tailored to subpopulations of adults (eg, physically inactive smokers) defined by the multiple behaviors that describe their everyday life experiences. International Registered Report Identifier (IRRID) DERR1-10.2196/24887

Objectives: Vaccinating healthcare workers (HCWs) against COVID-19 has been a public health priority since rollout began in late 2020. Promoting COVID-19 vaccination among HCWs would benefit from identifying modifiable behavioural determinants. We sought to identify and categorize studies looking at COVID-19 vaccination acceptance to identify modifiable factors to increase uptake in HCWs. Study design: Rapid evidence review.Methods: We searched MEDLINE and Cochrane databases until May 2021 and conducted a grey literature search to identify cross-sectional, cohort, and qualitative studies. Key barriers to, and enablers of, vaccine acceptance were categorized using the Theoretical Domains Framework (TDF), a comprehensive theo-retical framework comprising 14 behavioural domains.Results: From 19,591 records, 74 studies were included. Almost two-thirds of responding HCWs were willing to accept a COVID-19 vaccine (median = 64%, interquartile range = 50-78%). Twenty key barriers and enablers were identified and categorized into eight TDF domains. The most frequently identified barriers to COVID-19 vaccination were as follows: concerns about vaccine safety, efficacy, and speed of development (TDF domain: Beliefs about consequences); individuals in certain HCW roles (Social/profes-sional role and identity); and mistrust in state/public health response to COVID-19 (Social influences). Routinely being vaccinated for seasonal influenza (Reinforcement), concerns about contracting COVID-19 (Beliefs about consequences) and working directly with COVID-19 patients (Social/professional role and identity) were key enablers of COVID-19 vaccination among HCWs.Discussion: Our review identified eight (of a possible 14) behavioural determinants of COVID-19 vaccine acceptance among HCWs that, if targeted, could help design tailored vaccination messaging, policy, campaigns, and programs to support HCWs vaccination uptake.(c) 2022 Published by Elsevier Ltd on behalf of The Royal Society for Public Health.

BackgroundMultiple health behaviour change (MHBC) interventions are proposed to be an effective and efficient way of intervening to manage and/or prevent chronic conditions, both with patients (targeting health-related behaviours, e.g. diet, smoking) and healthcare professionals (targeting clinical behaviours, e.g. advice, examine). However, their effectiveness is still unclear. Therefore, a review of these interventions in this context is warranted. Two interrelated systematic reviews of MHBC interventions will be conducted, one targeting health-related behaviours of patients with chronic conditions and another one targeting clinical behaviours of healthcare professionals.Materials and methods These systematic reviews will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search for MHBC interventions for patients will be performed in Web of Science, PubMed, CINAHL, EMBASE and Cochrane, and a systematic search for healthcare professionals will be conducted in the same databases. Studies from previous reviews will also be consulted. We will include randomised trials, in which interventions aim to change more than one behaviour (health-related for patients, clinical for HCPs). Components of the interventions will be extracted by using existing standardised classifications, such as ontologies (e.g. mode of delivery) and taxonomies (e.g. behaviour change techniques taxonomy v1), and the Cochrane Collaboration revised tool of Risk of Bias will be applied to perform risk of bias assessment. The components of included interventions will be synthesised and links between them will be mapped to identify trends and gaps. If sufficient comparable studies are included, a meta-analysis will be performed in both reviews. Systematic reviews registrationsCRD42022327085 and CRD42022327108

Lab-based experiments and observational data have consistently shown that extraverted behavior is associated with elevated levels of positive affect. This association typically holds regardless of one’s dispositional level of trait extraversion, and individuals who enact extraverted behaviors in laboratory settings do not demonstrate costs associated with acting counter-dispositionally. Inspired by these findings, we sought to test the efficacy of week-long ‘enacted extraversion’ interventions. In three studies, participants engaged in fifteen minutes of assigned behaviors in their daily life for five consecutive days. Studies 1 and 2 compared the effect of adding more introverted or extraverted behavior (or a control task). Study 3 compared the effect of adding social extraverted behavior or non-social extraverted behavior (or a control task). We assessed positive affect and several indicators of well-being during pretest (day 1) and post-test (day 7), as well as ‘in-the-moment’ (days 2-6). Participants who engaged in extraverted behavior reported greater levels of positive affect ‘in-the-moment’ when compared to introverted and control behaviors. We did not observe strong evidence to suggest that this effect was more pronounced for dispositional extraverts. The current research explores the effects of extraverted behavior on other indicators of well-being and examines the effectiveness of acting extraverted (both socially and non-socially) as a well-being strategy.

Health risk behaviours such as physical inactivity, unhealthy eating, smoking tobacco, and alcohol use are each leading risk factors for non-communicable chronic disease and each play a central role in limiting health and life satisfaction. However, much less is known about how co-occurring behaviours are associated with health outcomes. Understanding which behaviours tend to co-occur (i.e., cluster together), and how such clusters are associated with physical and mental health, life satisfaction, and health care utilization may provide novel opportunities to leverage this co-occurrence to develop and evaluate interventions to promote multiple health behaviour change. Using cross-sectional baseline data (N=40,268) from the Canadian Longitudinal Study of Aging, we performed a pre-defined set of analyses to examine the co-occurrence of health behaviours. We used agglomerative hierarchical cluster analysis to cluster individuals based on their behavioural tendencies and multinomial logistic regression to examine how these clusters are associated with demographic characteristics, healthcare utilization, and general health and life satisfaction, and assess whether sex and age moderate these relationships. Seven clusters were identified with clusters differentiated by six of the seven health behaviours included in the analysis. Variability between clusters was observed in frequencies of weekly walking, strenuous exercise, and alcohol consumption. Sociodemographic characteristics varied across several clusters while self-reported physical/mental health showed less variation across clusters. The seven identified clusters of health behaviours allow for contrasts to be made with comparable analyses in other countries and will help inform the development of future health behaviour change interventions tailored to sub-populations and their sociodemographic profiles.

AIM:To identify barriers to/enablers of attendance at eye screening among three groups of immigrantsto Canada from cultural/linguistic minority groups living with diabetes.METHODS:Using a patient-oriented research approach leveraging Diabetes Action Canada's patient engagement platform, we interviewed a purposeful sample of people with type 2 diabetes who had immigrated to Canada from: Pakistan (interviews in Urdu), China (interviews in Mandarin) and French-speaking African and Caribbean nations (interviews in French). We collected and analysed data based on the Theoretical Domains Framework covering key modifiable factors that may operate as barriers to or enablers of attending eye screening. We used directed content analysis to code barrier/enabler domains. Barriers/enablers were mapped to behaviour change techniques to inform future intervention development.RESULTS:We interviewed 39 people (13 per group). Many barriers/enablers were consistent across groups, including views about harms caused by screening itself, practical appointment issues including forgetting, screening costs, wait times and making/getting to an appointment, lack of awareness about retinopathy screening, language barriers, and family and clinical support. Group-specific barriers/enablers included a preference to return to one's country of birth for screening, the impact of winter, and preferences for alternative medicine.CONCLUSION:Our results can inform linguistic and culturally competent interventions to support immigrants living with diabetes in attending eye screening to prevent avoidable blindness.

Health behaviours such as physical inactivity, unhealthy eating, smoking tobacco, and alcohol use are leading risk factors for non-communicable chronic disease and play a central role in limiting health and life satisfaction. To date, however, health behaviours tend to be considered separately from one another, resulting in guidelines and interventions for healthy aging siloed by specific behaviours and often focused only on a given health behaviour without considering the co-occurrence of family, social, work and other behaviours of everyday life. Understanding how behaviours cluster, and how such clusters are associated with physical and mental health, life satisfaction, and health care utilization may provide opportunities to leverage this co-occurrence to develop and evaluate interventions to promote multiple health behaviour change. Using cross-sectional baseline data from the Canadian Longitudinal Study of Aging, we will perform a pre-defined set of exploratory and hypothesis-generating analyses to examine the co-occurrence of health and everyday life behaviours. We will use agglomerative hierarchical cluster analysis to cluster individuals based on their behavioural tendencies. Multinomial logistic regression will then be employed to model the relationships between clusters and demographic indicators, healthcare utilization, and general health and life satisfaction, and assess whether sex and age moderate these relationships. Additionally, we will conduct network community detection analysis using the clique percolation algorithm to detect overlapping communities of behaviours based on the strength of relationships between variables. This study will help to inform the development of interventions tailored to sub-populations of adults (e.g., physically inactive smokers) defined by the multiple behaviours that describe their everyday life experience.

Background Immigrants to Canada belonging to ethnocultural minority groups are at increased risk of developing diabetes and complications, including diabetic retinopathy, and they are also less likely to be screened and treated. Improved attendance to retinopathy screening (eye tests) has the potential to reduce permanent complications, including blindness. Objective This study aims to identify the barriers and enablers of attending diabetic retinopathy screening among ethnocultural minority immigrants living with diabetes in Quebec and Ontario, Canada, to inform the development of a behavior change intervention to improve diabetic retinopathy screening attendance. Methods The research question draws on the needs of patients and clinicians. Using an integrated knowledge translation approach, the research team includes clinicians, researchers, and patient partners who will contribute throughout the study to developing and reviewing materials and procedures, helping to recruit participants, and disseminating findings. Using a convenience snowball strategy, we will recruit participants from three target groups: South Asian and Chinese people, and French-speaking people of African descent. To better facilitate reaching these groups and support participant recruitment, we will partner with community organizations and clinics serving our target populations in Ontario and Quebec. Data will be collected using semistructured interviews, using topic guides developed in English and translated into French, Mandarin, Hindi, and Urdu, and conducted in those languages. Data collection and analysis will be structured according to the Theoretical Domains Framework (TDF), which synthesizes predominant theories of behavior change into 14 domains covering key modifiable factors that may operate as barriers or enablers to attending eye screening. We will use directed content analysis to code barriers and enablers to TDF domains, then thematic analysis to define key themes within domains. Results This study was approved for funding in December 2017, and the research ethics board approved the conduct of the study as of January 13, 2018. Data collection then began in April 2018. As of August 28, 2018, we have recruited 22 participants, and analysis is ongoing, with results expected to be published in 2020. Conclusions Findings from this study will inform the codevelopment of theory-informed, culturally- and linguistically-tailored interventions to support patients in attending retinopathy screening. International Registered Report Identifier (IRRID) DERR1-10.2196/15109