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      Developing Behavior Change Interventions for Self-Management in Chronic Illness : An Integrative Overview

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          Abstract

          Abstract. More people than ever are living longer with chronic conditions such as obesity, type 2 diabetes, and heart disease. Behavior change for effective self-management can improve health outcomes and quality of life in people living with such chronic illnesses. The science of developing behavior change interventions with impact for patients aims to optimize the reach, effectiveness, adoption, implementation, and maintenance of interventions and rigorous evaluation of outcomes and processes of behavior change. The development of new services and technologies offers opportunities to enhance the scope of delivery of interventions to support behavior change and self-management at scale. Herein, we review key contemporary approaches to intervention development, provide a critical overview, and integrate these approaches into a pragmatic, user-friendly framework to rigorously guide decision-making in behavior change intervention development. Moreover, we highlight novel emerging methods for rapid and agile intervention development. On-going progress in the science of intervention development is needed to remain in step with such new developments and to continue to leverage behavioral science’s capacity to contribute to optimizing interventions, modify behavior, and facilitate self-management in individuals living with chronic illness.

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          Most cited references94

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          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          The Lancet, 380(9859), 2224-2260
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            Depression, chronic diseases, and decrements in health: results from the World Health Surveys

            Depression is an important public-health problem, and one of the leading causes of disease burden worldwide. Depression is often comorbid with other chronic diseases and can worsen their associated health outcomes. Few studies have explored the effect of depression, alone or as a comorbidity, on overall health status. The WHO World Health Survey (WHS) studied adults aged 18 years and older to obtain data for health, health-related outcomes, and their determinants. Prevalence of depression in respondents based on ICD-10 criteria was estimated. Prevalence values for four chronic physical diseases--angina, arthritis, asthma, and diabetes--were also estimated using algorithms derived via a Diagnostic Item Probability Study. Mean health scores were constructed using factor analysis and compared across different disease states and demographic variables. The relation of these disease states to mean health scores was determined through regression modelling. Observations were available for 245 404 participants from 60 countries in all regions of the world. Overall, 1-year prevalence for ICD-10 depressive episode alone was 3.2% (95% CI 3.0-3.5); for angina 4.5% (4.3-4.8); for arthritis 4.1% (3.8-4.3); for asthma 3.3% (2.9-3.6); and for diabetes 2.0% (1.8-2.2). An average of between 9.3% and 23.0% of participants with one or more chronic physical disease had comorbid depression. This result was significantly higher than the likelihood of having depression in the absence of a chronic physical disease (p<0.0001). After adjustment for socioeconomic factors and health conditions, depression had the largest effect on worsening mean health scores compared with the other chronic conditions. Consistently across countries and different demographic characteristics, respondents with depression comorbid with one or more chronic diseases had the worst health scores of all the disease states. Depression produces the greatest decrement in health compared with the chronic diseases angina, arthritis, asthma, and diabetes. The comorbid state of depression incrementally worsens health compared with depression alone, with any of the chronic diseases alone, and with any combination of chronic diseases without depression. These results indicate the urgency of addressing depression as a public-health priority to reduce disease burden and disability, and to improve the overall health of populations.
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              Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health.

              To assess the utility of an acronym, place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital ("PROGRESS"), in identifying factors that stratify health opportunities and outcomes. We explored the value of PROGRESS as an equity lens to assess effects of interventions on health equity.
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                Author and article information

                Contributors
                Journal
                Eur Psychol
                Eur Psychol
                epp
                European Psychologist
                Hogrefe Publishing
                1016-9040
                1878-531X
                August 16, 2018
                2019
                : 24
                : 1 , Special Issue: Adjustment to Chronic Illness
                : 7-25
                Affiliations
                [ 1 ]Institute of Health & Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
                [ 2 ]School of Psychology, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
                [ 3 ]Faculty of Social Sciences, University of Tampere, Finland
                [ 4 ]Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
                [ 5 ]School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Canada
                [ 6 ]School of Psychology, University of Ottawa, Canada
                [ 7 ]Fuse. The UK Clinical Research Collaboration Centre for Translational Research in Public Health
                Author notes
                Vera Araújo-Soares, Institute of Health & Society, Faculty of Medical Sciences, Newcastle University, Baddiley-Clarke Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK, vera.araujo-soares@ 123456newcastle.ac.uk
                Article
                10.1027/1016-9040/a000330
                6727632
                31496632
                0e3e95f5-5cd3-48ae-9127-a1a8661db034
                © 2018 Hogrefe Publishing

                Distributed as a Hogrefe OpenMind article under the license CC BY 4.0 ( http://creativecommons.org/licenses/by/4.0)

                History
                : May 20, 2017
                : February 21, 2018
                : April 19, 2018
                Categories
                Original Articles and Reviews

                behavior change,intervention development,complex interventions

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