Using an Analysis of Behavior Change to Inform Effective Digital Intervention Design: How Did the PRIMIT Website Change Hand Hygiene Behavior Across 8993 Users?

Ainsworth, B.; Steele, M.; Stuart, B.; Joseph, J.; Miller, S.; Morrison, L.; Little, P.; Yardley, L.

doi:10.1007/s12160-016-9866-9

Cited by 41Behavioral Health and InterventionsMobile Health and mHealth ApplicationsInfection Control in Healthcare

Using an Analysis of Behavior Change to Inform Effective Digital Intervention Design: How Did the PRIMIT Website Change Hand Hygiene Behavior Across 8993 Users?

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Ainsworth, B., Steele, M., Stuart, B., Joseph, J., Miller, S., Morrison, L., Little, P., Yardley, L.·2017·Annals of Behavioral Medicine

DOI 10.1007/s12160-016-9866-9PMC PMC5440485

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Abstract

BACKGROUND: In designing digital interventions for healthcare, it is important to understand not just whether interventions work but also how and for whom-including whether individual intervention components have different effects, whether a certain usage threshold is required to change behavior in each intervention and whether usage differs across population subgroups. PURPOSE: We investigated these questions using data from a large trial of the digital PRimary care trial of a website based Infection control intervention to Modify Influenza-like illness and respiratory tract infection Transmission) (PRIMIT) intervention, which aimed to reduce respiratory tract infections (RTIs) by increasing hand hygiene behavior. METHOD: Baseline and follow-up questionnaires measured behaviors, intentions and attitudes in hand hygiene. In conjunction with objective measures of usage of the four PRIMIT sessions, we analysed these observational data to examine mechanisms of behavior change in 8993 intervention users. RESULTS: We found that the PRIMIT intervention changed behavior, intentions and attitudes, and this change was associated with reduced RTIs. The largest hand hygiene change occurred after the first session, with incrementally smaller changes after each subsequent session, suggesting that engagement with the core behavior change techniques included in the first session was necessary and sufficient for behavior change. The intervention was equally effective for men and women, older and younger people and was particularly effective for those with lower levels of education. CONCLUSIONS: Our well-powered analysis has implications for intervention development. We were able to determine a 'minimum threshold' of intervention engagement that is required for hand hygiene change, and we discuss the potential implications this (and other analyses of this type) may have for further intervention development. We also discuss the application of similar analyses to other interventions.

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The threshold of engagement with the digital component that successfully facilitates the "non-digital target behaviour" can demonstrably vary between individuals, supporting a shift toward patient-treatment matching and person-centered care.
“Notably, the threshold of engagement with the digital component that successfully facilitates the “non-digital target behaviour” can demonstrably vary between individuals [71], supporting a shift toward patient-treatment matching and person-centered care [72]”
From Experiences of Using Digital Mindfulness-Based Interventions: Rapid Scoping Review and Thematic Synthesis (2023) · cites this paper as [71]
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Additional file 1 of Implementing Germ Defence digital behaviour change intervention via all primary care practices in England to reduce respiratory infections during the COVID-19 pandemic: an efficient cluster randomised controlled trial using the OpenSAFELY platform
Ainsworth, B., Horwood, J., Walter, S. R., Miller, S., Chalder, M., de Vocht, F., Denison‐Day, J., Elwenspoek, M. M. C., Curtis, H. J., Bates, C., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26649237
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Additional file 4 of Implementing Germ Defence digital behaviour change intervention via all primary care practices in England to reduce respiratory infections during the COVID-19 pandemic: an efficient cluster randomised controlled trial using the OpenSAFELY platform
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Additional file 3 of Implementing Germ Defence digital behaviour change intervention via all primary care practices in England to reduce respiratory infections during the COVID-19 pandemic: an efficient cluster randomised controlled trial using the OpenSAFELY platform
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Additional file 2 of Implementing Germ Defence digital behaviour change intervention via all primary care practices in England to reduce respiratory infections during the COVID-19 pandemic: an efficient cluster randomised controlled trial using the OpenSAFELY platform
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Authors: Ainsworth, B., Steele, M., Stuart, B., Joseph, J., Miller, S., Morrison, L., Little, P., & Yardley, L.
Affiliations: University of Southampton (GB)
Corresponding author: Ainsworth, B.
ORCID: Ainsworth, B.
Steele, M.
Stuart, B.
Joseph, J.
Miller, S.
Morrison, L.
Little, P.
Yardley, L.
Venue: Annals of Behavioral Medicine
Publisher: Oxford University Press (OUP)
Published: 2016-12-01
Volume: 51
Issue: 3
Pages: 423-431
ISSN: 0742-5554 (ISSN-L)
0883-6612
1532-4796
DOI: 10.1007/s12160-016-9866-9
PMC: PMC5440485
OpenAlex: W2558876944
Cited by: 41
References: 49
Citations by year: 2025: 2 · 2024: 7 · 2023: 7 · 2022: 3 · 2021: 10 · 2020: 4 · 2019: 2 · 2018: 5 · 2017: 1
FWCI: 4.11
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0 (unspecified)
Locations: Annals of Behavioral Medicine (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Explore Bristol Research (publishedVersion, cc-by)
ePrints Soton (University of Southampton) (acceptedVersion)
Bristol Research (University of Bristol) (submittedVersion, cc-by)
Funders: Medical Research Council (09/800/22)
Engineering and Physical Sciences Research Council (GB) (EP/I032673/1)
Topics: Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
Keywords: hand hygiene, behavior change, digital interventions, infection control, respiratory infections, influenza-like illness, primary care, intervention engagement, behaviour change techniques, behavior change mechanisms, educational level differences, gender differences, age differences
MeSH terms: Adult, Behavior Therapy, Female, Humans, Influenza, Human, Male, Middle Aged, Surveys and Questionnaires, Intention, Hand Hygiene

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Using an Analysis of Behavior Change to Inform Effective Digital Intervention Design: How Did the PRIMIT Website Change Hand Hygiene Behavior Across 8993 Users?

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