Detecting and Treating Psychosocial and Lifestyle-Related Difficulties in Chronic Disease: Development and Treatment Protocol of the E-GOAL eHealth Care Pathway
Abstract
:1. Introduction
2. Development
2.1. Screening Tool
2.2. Screening Questionnaires: Increased-Risk Profile Identification and Intervention Tailoring
2.2.1. Development Screening Questionnaires Stage 1: Developing Initial Version
Part 1: Questionnaires for Increased-Risk Profile Identification
Part 2: Questionnaires for Intervention-Tailoring
2.2.2. Development Screening Questionnaires Stage 2: Acquiring User Feedback
2.2.3. Development Screening Questionnaires Stage 3: Revising and Refining
2.3. Personal Profile Charts to Visualize Screening Results
2.3.1. Development Personal Profile Charts Stage 1: Developing Initial Version
2.3.2. Development Personal Profile Charts Stage 2: Acquiring User Feedback
2.3.3. Development Personal Profile Charts Stage 3: Revising and Refining
2.4. iCBT Treatment
2.5. Treatment: Lifestyle Modules
2.5.1. Development Treatment Stage 1: Developing Initial Version
2.5.2. Development Treatment Stage 2: Acquiring User Feedback
2.5.3. Development Treatment Stage 3: Revising and Refining
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Key Behavioral Problem | Unhealthy Lifestyle Behaviors (Leading to Poor Health Outcomes) |
---|---|
What (target behavior) | Physical activity: moderate-to-vigorous intensity ≥150 min per week in multiple sessions Healthy weight: BMI 18.5 to 24.9 Healthy diet: Adherence to dietary prescriptions (e.g., low sodium) Smoking: No tobacco smoking Medication: Adherence to medication prescriptions |
Who (target group) | Individuals with lifestyle-related chronic diseases |
When/where/how often | Regularly, i.e., on a weekly to daily basis, embedded in daily schedule |
With whom | With support from health professionals and social environment |
COM-B Component (Step 4) | Main TDF Barriers and Facilitators (Step 4) | Selected Intervention Functions (Step 5) | Selected BCTs (Step 7) | Description of BCTs within the Intervention | Lifestyle iCBT Module (Based on Stages of Behavior Change) |
---|---|---|---|---|---|
Capability | Knowledge (How to engage in a healthy lifestyle) | Education, Persuasion | Instruction on how to perform the behavior; Information about antecedents; Information about health consequences; Feedback on behavior | Guidelines on what, how, and why to engage in healthy lifestyle behaviors; Instruction to keep a record of (unhealthy) behaviors and of events, emotions, and cognitions occurring prior to it; Information about advantages of healthy behaviors; Evaluative feedback on monitored behavior. | 1: Goals Exploration (contemplation and decision) |
Opportunity | Social influences (Support by professionals and social environment) | Enablement | Social support (unspecified); social support (practical); social support (emotional) | Exercise to discuss personal strengths with important others and how to implement them in behavior change; Exercise to think about ways in which social support is received and about emotional and practical support the person would (not) like to receive; Prompt to ask for support. | 3: Goals Persistence (evaluation and maintenance) |
Environmental context and resources (Disease symptoms and material support tools) | Enablement | Restructuring the physical environment; Avoidance/changing exposure to cues for the behavior | Advice and prompt to think about how to avoid exposure to environmental cues for unhealthy behavior and to make adaptations to the environment that facilitate the wanted behavior. | 2: Goals in Action (planning and action) | |
Motivation | Role and identity (Personality characteristics) | Persuasion | Valued self-identity | Exercise to list personal strengths. | 3: Goals Persistence (evaluation and maintenance) |
Beliefs about capabilities (Self-efficacy, locus of control) | Persuasion | Focus on past success | Exercise to list previous successes in behavior change. | 3: Goals Persistence (evaluation and maintenance) | |
Optimism (Acceptance, focusing on possibilities vs. limitations) | Persuasion | Problem solving | Exercise to identify barriers for behavior change and explore ways to overcome them. | 1: Goals Exploration (contemplation and decision) | |
Emotion (Depression, stress, anxiety) | Education, Persuasion, Enablement | Education, Persuasion: Information on emotional consequences; Self-assessment of affective consequences Enablement: Reduce negative emotions | Information about emotional advantages of healthy lifestyle behaviors; Instruction to keep a record of feelings after performing unhealthy vs. healthy behaviors; Exercise to identify positive self-talk and images to promote positive emotions that facilitate maintenance of the wanted behavior; Exercise to identify ways to reduce negative and stressful emotions. | 1: Goals Exploration (contemplation and decision) 3: Goals Persistence (evaluation and maintenance) | |
Reinforcement (Noticeable effects of healthy behavior, rewards) | Incentivization | Self-reward, material reward | Prompt to use a personally relevant reward if there has been progress in the wanted behavior. | 2: Goals in Action (planning and action) | |
Intentions (Intrinsic motivation, joy, higher-order purposes) | Incentivization, Enablement | Pros and cons; Commitment | Exercise to identify and compare reasons for wanting and not wanting to change behavior; Exercise to link the wanted behavior to personally relevant higher-order values; Instruction to write down a decision statement indicating commitment to change behavior. | 1: Goals Exploration (contemplation and decision) | |
Goals (Concrete and feasible goals) | Enablement | Goal setting (outcome); Goal setting (behavior); Review of outcome goals; Review of behavior goals; Action planning | Exercise to set weekly goals; Instruction to create a daily action (implementation intentions); Prompt to reflect on behavior and correspondence with goals and action plans, leading to re-setting or adapting. | 2: Goals in Action (planning and action) 3: Goals Persistence (evaluation and maintenance) | |
Beliefs about Consequences (Beliefs about and experiences with consequences of behavior) | Enablement | Pros and cons | Exercise to identify and compare reasons for wanting and not wanting to change behavior. | 1: Goals Exploration (contemplation and decision) |
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Cardol, C.K.; Tommel, J.; van Middendorp, H.; Ciere, Y.; Sont, J.K.; Evers, A.W.M.; van Dijk, S. Detecting and Treating Psychosocial and Lifestyle-Related Difficulties in Chronic Disease: Development and Treatment Protocol of the E-GOAL eHealth Care Pathway. Int. J. Environ. Res. Public Health 2021, 18, 3292. https://doi.org/10.3390/ijerph18063292
Cardol CK, Tommel J, van Middendorp H, Ciere Y, Sont JK, Evers AWM, van Dijk S. Detecting and Treating Psychosocial and Lifestyle-Related Difficulties in Chronic Disease: Development and Treatment Protocol of the E-GOAL eHealth Care Pathway. International Journal of Environmental Research and Public Health. 2021; 18(6):3292. https://doi.org/10.3390/ijerph18063292
Chicago/Turabian StyleCardol, Cinderella K., Judith Tommel, Henriët van Middendorp, Yvette Ciere, Jacob K. Sont, Andrea W. M. Evers, and Sandra van Dijk. 2021. "Detecting and Treating Psychosocial and Lifestyle-Related Difficulties in Chronic Disease: Development and Treatment Protocol of the E-GOAL eHealth Care Pathway" International Journal of Environmental Research and Public Health 18, no. 6: 3292. https://doi.org/10.3390/ijerph18063292