Background: Public health recommendations and governmental measures during the COVID-19 pandemic have resulted in numerous restrictions on daily living including social distancing, isolation and home confinement. While these measures are imperative to abate the spreading of COVID-19, the impact of these restrictions on health behaviours and lifestyles at home is undefined. Therefore, an international online survey was launched in April 2020, in seven languages, to elucidate the behavioural and lifestyle consequences of COVID-19 restrictions. This report presents the results from the first thousand responders on physical activity (PA) and nutrition behaviours. Methods: Following a structured review of the literature, the “Effects of home Confinement on multiple Lifestyle Behaviours during the COVID-19 outbreak (ECLB-COVID19)” Electronic survey was designed by a steering group of multidisciplinary scientists and academics. The survey was uploaded and shared on the Google online survey platform. Thirty-five research organisations from Europe, North-Africa, Western Asia and the Americas promoted the survey in English, German, French, Arabic, Spanish, Portuguese and Slovenian languages. Questions were presented in a differential format, with questions related to responses “before” and “during” confinement conditions. Results: 1047 replies (54% women) from Asia (36%), Africa (40%), Europe (21%) and other (3%) were included in the analysis. The COVID-19 home confinement had a negative effect on all PA intensity levels (vigorous, moderate, walking and overall). Additionally, daily sitting time increased from 5 to 8 h per day. Food consumption and meal patterns (the type of food, eating out of control, snacks between meals, number of main meals) were more unhealthy during confinement, with only alcohol binge drinking decreasing significantly. Conclusion: While isolation is a necessary measure to protect public health, results indicate that it alters physical activity and eating behaviours in a health compromising direction. A more detailed analysis of survey data will allow for a segregation of these responses in different age groups, countries and other subgroups, which will help develop interventions to mitigate the negative lifestyle behaviours that have manifested during the COVID-19 confinement.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Blended care, a combination of online and face-to-face therapy, is increasingly being applied in mental health care to obtain optimal benefit from the advantages these two treatment modalities have. Promising results have been reported, but a variety in descriptions and ways of operationalizing blended care exists. Currently, what type of “blend” works for whom, and why, is unclear. Furthermore, a rationale for setting up blended care is often lacking. In this viewpoint paper, we describe postulates for blended care and provide an instrument (Fit for Blended Care) that aims to assist therapists and patients whether and how to set up blended care treatment. A review of the literature, two focus groups (n=5 and n=5), interviews with therapists (n=14), and interviews with clients (n=2) were conducted to develop postulates of eHealth and blended care and an instrument to assist therapists and clients in setting up optimal blended care. Important postulates for blended care are the notion that both treatment modalities should complement each other and that set up of blended treatment should be based on shared decision making between patient and therapist. The “Fit for Blended Care” instrument is presented which addresses the following relevant themes: possible barriers to receiving blended treatment such as the risk of crisis, issues in communication (at a distance), as well as possible facilitators such as social support. More research into the reasons why and for whom blended care works is needed. To benefit from blended care, face-to-face and online care should be combined in such way that the potentials of both treatment modalities are used optimally, depending on patient abilities, needs, and preferences. To facilitate the process of setting up a personalized blended treatment, the Fit for Blended Care instrument can be used. By applying this approach in research and practice, more insight into the working mechanisms and optimal (personal) “blends” of online and face-to-face therapy becomes within reach.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Maintaining weight after weight loss is a major health challenge, and eHealth solutions may be one way to meet this challenge. Application of behavior change techniques (BCTs) and persuasive system design (PSD) principles in eHealth development may contribute to design of technologies that positively influence behavior and motivation to support the sustainable health behavior change needed. Objective: To identify BCTs and PSD principles stimulating motivation and adherence in eHealth interventions supporting weight maintenance following weight loss. Methods: A systematic literature search was performed in the databases: PsycInfo, Ovid Medline, Embase, Scopus, Web of Science, and Amed, from January 1, 2007 to June 30, 2018. Arksey and O’Malley scoping review methodology was applied, using Michie´s Behavior Change Taxonomy and the Persuasive System Design-model to identify techniques and principles used. Publications on eHealth interventions were included if focused on weight loss or weight loss maintenance, in combination with motivation or adherence and behavior change. The main focus of this review was on weight loss maintenance. However, eHealth interventions targeting weight loss were also examined, particularly for weight loss maintenance related factors. Results: The search identified 317 publications, of which 45 met the inclusion criteria. Eleven focused on weight loss maintenance and 34 on weight loss. Smartphone (n=28) was the most frequently used technology. Frequently used wearables or sensors were activity trackers or step-counters (n=14), as well as other monitoring technologies such as wireless or digital scales (n=8). Several interventions had a human support component in a blended care format (n=27). Feedback and monitoring and goals and planning were core BCT clusters applied in the majority of included publications. Social support and associations through prompts and cues to support and maintain new habits were more frequently used in weight loss maintenance than weight loss interventions. In both types of interventions, frequently applied PSD principles were self-monitoring, goal-setting and feedback. Tailoring, reminders, personalization and rewards were additional principles frequently applied in weight loss maintenance interventions. Results did not reveal an “ideal” combination of BCTs or PSD principles to stimulate motivation, adherence and weight loss maintenance. The most frequently mentioned individual BCTs and PSD principles applied to stimulate motivation were however personalization, praise and feedback, while associations were frequently mentioned to stimulate adherence. eHealth interventions that found significant effects for weight loss maintenance all applied self-monitoring, feedback, goal-setting, and shaping knowledge, combined with a human social support component. Conclusions: To our knowledge, this is the first review examining key BCTs and PSD principles applied in weight loss maintenance interventions compared with those of weight loss interventions. The most successful eHealth weight loss maintenance interventions entailed a combination of BCTs and PSD principles, including tailoring, self-monitoring, feedback, goals and planning, and shaping knowledge to support creation and establishment of healthy habits and behaviors. The current review identified several techniques and principles applied to stimulate motivation and adherence. Future research should however aim to examine which eHealth design combinations can be the most effective in support of long-term behavior change and weight loss maintenance.