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Semin Reprod Med 2021; 39(03/04): 143-152
DOI: 10.1055/s-0041-1735456
Review Article

Informing a PCOS Lifestyle Program: Mapping Behavior Change Techniques to Barriers and Enablers to Behavior Change Using the Theoretical Domains Framework

Stephanie Pirotta 
1   Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
,
A.E. Joham 
1   Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
2   Department of Diabetes, Monash Health, Clayton, Victoria, Australia
,
L.J. Moran 
1   Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
,
H. Skouteris 
1   Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
3   Warwick Business School, Warwick University, Coventry, United Kingdom
,
S.S. Lim 
1   Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
› Institutsangaben Funding This study received funding from the Collier Charitable Fund and the NHMRC Partnership Grant. S.P. was funded by a Monash University Post Graduate Publication Award, A.E.J. and S.S.L. by an NHMRC Early Career Fellowship, L.J.M. by a National Heart Foundation Future Leader Fellowship, and H.S. by a NHMRC Medical Research Future Fund (MRFF) Fellowship.
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Abstract

This article aimed to identify the behavior change techniques (BCTs) based on facilitators and barriers to lifestyle management in women with polycystic ovary syndrome (PCOS) according to the behavior change wheel (BCW). This qualitative study design using inductive thematic analysis following semistructured interviews (n = 20) identified barriers and enablers to lifestyle management. These were then mapped to Capability, Opportunity, Motivation—Behavioral Model (COM-B) constructs and the corresponding Theoretical Domains Framework (TDF) domains. This study included women with PCOS residing in Australia. Main outcome measures include intervention functions, policy categories, and BCTs described in the BCW. Twenty-three BCTs were recognized to influence behavior change in women with PCOS. Factors were categorized into the subcomponents of the COM-B: psychological capability (e.g., lack of credible information), physical capability (e.g., managing multiple health conditions), physical opportunity (e.g., limited access to resources), social opportunity (e.g., adequate social support), reflective motivation (e.g., positive health expectancies following behavior change), and automatic motivation (e.g., emotional eating). Future research should use this work to guide PCOS lifestyle intervention development and then test intervention effectiveness through an experimental phase to provide empirical evidence for wider use and implementation of tailored, theory-informed PCOS lifestyle programs as part of evidence-based PCOS management.

Keywords

polycystic ovary syndrome - behavior change techniques - lifestyle management

Supplementary Material



Publikationsverlauf

Artikel online veröffentlicht:
25. August 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 March WA, Moore VM, Willson KJ, Phillips DIW, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 2010; 25 (02) 544-551
    CrossrefPubMedGoogle Scholar
  • 2 Garad R, Shorakae S, Teede H. Assessment and management of women with polycystic ovary syndrome (PCOS). Adv Prac Endo Nurs 2019; 753-769
    CrossrefPubMedGoogle Scholar
  • 3 Domecq JP, Prutsky G, Mullan RJ. et al. Lifestyle modification programs in polycystic ovary syndrome: systematic review and meta-analysis. J Clin Endocrinol Metab 2013; 98 (12) 4655-4663
    CrossrefPubMedGoogle Scholar
  • 4 Haqq L, McFarlane J, Dieberg G, Smart N. Effect of lifestyle intervention on the reproductive endocrine profile in women with polycystic ovarian syndrome: a systematic review and meta-analysis. Endocr Connect 2014; 3 (01) 36-46
    CrossrefPubMedGoogle Scholar
  • 5 Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2011; (02) CD007506
    PubMedGoogle Scholar
  • 6 Thomson RL, Buckley JD, Lim SS. et al. Lifestyle management improves quality of life and depression in overweight and obese women with polycystic ovary syndrome. Fertil Steril 2010; 94 (05) 1812-1816
    CrossrefPubMedGoogle Scholar
  • 7 Khatlani K, Njike V, Costales VC. Effect of lifestyle intervention on cardiometabolic risk factors in overweight and obese women with polycystic ovary syndrome: a systematic review and meta-analysis. Metab Syndr Relat Disord 2019; 17 (10) 473-485
    CrossrefPubMedGoogle Scholar
  • 8 Monash University. International Evidence Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Melbourne: Monash University; 2018
    Google Scholar
  • 9 Teede HJ, Joham AE, Paul E. et al. Longitudinal weight gain in women identified with polycystic ovary syndrome: results of an observational study in young women. Obesity (Silver Spring) 2013; 21 (08) 1526-1532
    CrossrefPubMedGoogle Scholar
  • 10 Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med 2010; 8 (01) 41
    CrossrefPubMedGoogle Scholar
  • 11 Albarracín D, Gillette JC, Earl AN, Glasman LR, Durantini MR, Ho MH. A test of major assumptions about behavior change: a comprehensive look at the effects of passive and active HIV-prevention interventions since the beginning of the epidemic. Psychol Bull 2005; 131 (06) 856-897
    CrossrefPubMedGoogle Scholar
  • 12 Noar SM, Zimmerman RS. Health Behavior Theory and cumulative knowledge regarding health behaviors: are we moving in the right direction?. Health Educ Res 2005; 20 (03) 275-290
    CrossrefPubMedGoogle Scholar
  • 13 Dyson J, Lawton R, Jackson C, Cheater F. Does the use of a theoretical approach tell us more about hand hygiene behaviour? The barriers and levers to hand hygiene. J Infect Prev 2011; 12 (01) 17-24
    CrossrefPubMedGoogle Scholar
  • 14 Albarracín D, Johnson BT, Fishbein M, Muellerleile PA. Theories of reasoned action and planned behavior as models of condom use: a meta-analysis. Psychol Bull 2001; 127 (01) 142-161
    CrossrefPubMedGoogle Scholar
  • 15 Taylor N, Conner M, Lawton R. The impact of theory on the effectiveness of worksite physical activity interventions: a meta-analysis and meta-regression. Health Psychol Rev 2012; 6 (01) 33-73
    CrossrefPubMedGoogle Scholar
  • 16 Baker R, Camosso-Stefinovic J, Gillies C. et al. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2010; (03) CD005470
    PubMedGoogle Scholar
  • 17 Michie S, Richardson M, Johnston M. et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 2013; 46 (01) 81-95
    CrossrefPubMedGoogle Scholar
  • 18 Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 2011; 6 (01) 42
    CrossrefPubMedGoogle Scholar
  • 19 Timlin D, McCormack JM, Simpson EE. Using the COM-B model to identify barriers and facilitators towards adoption of a diet associated with cognitive function (MIND diet). Public Health Nutr 2021; 24 (07) 1657-1670
    CrossrefPubMedGoogle Scholar
  • 20 Michie S, Johnston M, Francis J, Hardeman W, Eccles M. From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol 2008; 57 (04) 660-680
    CrossrefPubMedGoogle Scholar
  • 21 Cane J, O'Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci 2012; 7 (01) 37
    CrossrefPubMedGoogle Scholar
  • 22 Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Medical Research Council Guidance. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008; 337: a1655
    Google Scholar
  • 23 National Institute of Health and Care Excellence. Behaviour Change: general approaches public health guideline [PH6]. Published 2007. Accessed July 26, 2020 at: https://www.nice.org.uk/Guidance/PH6
    Google Scholar
  • 24 National Institute for Health and Care Excellence. Behaviour change: individual approaches Public health guideline [PH49] National Institute for Health and Care Excellence. Published 2004. Accessed July 27, 2020 at: https://www.nice.org.uk/Guidance/PH49
    Google Scholar
  • 25 Atkins L, Francis J, Islam R. et al. A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implement Sci 2017; 12 (01) 77
    CrossrefPubMedGoogle Scholar
  • 26 Fleming A, Bradley C, Cullinan S, Byrne S. Antibiotic prescribing in long-term care facilities: a qualitative, multidisciplinary investigation. BMJ Open 2014; 4 (11) e006442
    CrossrefPubMedGoogle Scholar
  • 27 Squires JE, Grimshaw JM, Taljaard M. et al. Design, implementation, and evaluation of a knowledge translation intervention to increase organ donation after cardiocirculatory death in Canada: a study protocol. Implement Sci 2014; 9 (01) 80
    CrossrefPubMedGoogle Scholar
  • 28 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151 (04) 264-269 , W64
    Google Scholar
  • 29 Martin R, Murtagh EM. An intervention to improve the physical activity levels of children: design and rationale of the ‘Active Classrooms’ cluster randomised controlled trial. Contemp Clin Trials 2015; 41: 180-191
    CrossrefPubMedGoogle Scholar
  • 30 McEachan RRC, Santorelli G, Bryant M. et al; BiB childhood obesity scientific group. The HAPPY (Healthy and Active Parenting Programme for early Years) feasibility randomised control trial: acceptability and feasibility of an intervention to reduce infant obesity. BMC Public Health 2016; 16 (01) 211
    CrossrefPubMedGoogle Scholar
  • 31 Tombor I, Shahab L, Brown J, Crane D, Michie S, West R. Development of SmokeFree Baby: a smoking cessation smartphone app for pregnant smokers. Transl Behav Med 2016; 6 (04) 533-545
    CrossrefPubMedGoogle Scholar
  • 32 van Agteren JEM, Lawn S, Bonevski B, Smith BJ. Kick.it: the development of an evidence-based smoking cessation smartphone app. Transl Behav Med 2018; 8 (02) 243-267
    CrossrefPubMedGoogle Scholar
  • 33 Webster R, Michie S, Estcourt C, Gerressu M, Bailey JV. MenSS Trial Group. Increasing condom use in heterosexual men: development of a theory-based interactive digital intervention. Transl Behav Med 2016; 6 (03) 418-427
    CrossrefPubMedGoogle Scholar
  • 34 Jansink R, Braspenning J, van der Weijden T, Elwyn G, Grol R. Primary care nurses struggle with lifestyle counseling in diabetes care: a qualitative analysis. BMC Fam Pract 2010; 11: 41
    CrossrefPubMedGoogle Scholar
  • 35 Campbell K, Engel H, Timperio A, Cooper C, Crawford D. Obesity management: Australian general practitioners' attitudes and practices. Obes Res 2000; 8 (06) 459-466
    CrossrefPubMedGoogle Scholar
  • 36 Epling JW, Morley CP, Ploutz-Snyder R. Family physician attitudes in managing obesity: a cross-sectional survey study. BMC Res Notes 2011; 4: 473
    CrossrefPubMedGoogle Scholar
  • 37 Salinas GD, Glauser TA, Williamson JC, Rao G, Abdolrasulnia M. Primary care physician attitudes and practice patterns in the management of obese adults: results from a national survey. Postgrad Med 2011; 123 (05) 214-219
    CrossrefPubMedGoogle Scholar
  • 38 Nicholas LG, Pond CD, Roberts DC. Dietitian-general practitioner interface: a pilot study on what influences the provision of effective nutrition management. Am J Clin Nutr 2003; 77 (4, Suppl): 1039S-1042S
    CrossrefPubMedGoogle Scholar
  • 39 Boote J, Telford R, Cooper C. Consumer involvement in health research: a review and research agenda. Health Policy 2002; 61 (02) 213-236
    CrossrefPubMedGoogle Scholar
  • 40 Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19 (06) 349-357
    CrossrefPubMedGoogle Scholar
  • 41 Strauss AL. Qualitative Analysis for Social Scientists. New York, NY: Cambridge University Press; 1987
    CrossrefGoogle Scholar
  • 42 Hoffmann TC, Glasziou PP, Boutron I. et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 2014; 348: g1687
    Google Scholar
  • 43 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3 (02) 77-101
    CrossrefPubMedGoogle Scholar
  • 44 Michie S, Atkins L, West R. The behaviour change wheel. A guide to designing interventions. London: Silverback Publishing; 2014
    Google Scholar
  • 45 Benton MR, Tape N, Deussen AR, Turnbull D, Dodd JM. Barriers to and facilitators for addressing overweight and obesity before conception: a qualitative study. Women Birth 2020; ; (epub ahead of print) DOI: 10.1016/j.wombi.2020.09.025.
    CrossrefPubMedGoogle Scholar
  • 46 Poels M, van Stel HF, Franx A, Koster MPH. Actively preparing for pregnancy is associated with healthier lifestyle of women during the preconception period. Midwifery 2017; 50: 228-234
    CrossrefPubMedGoogle Scholar
  • 47 Vézina-Im LA, Perron J, Lemieux S, Robitaille J. Promoting fruit and vegetable intake in childbearing age women at risk for gestational diabetes mellitus: a randomised controlled trial. J Health Psychol 2019; 24 (05) 600-612
    CrossrefPubMedGoogle Scholar
  • 48 Lim S, Hill B, Pirotta S, O'Reilly S, Moran L. What are the most effective behavioural strategies in changing postpartum women's physical activity and healthy eating behaviours? A systematic review and meta-analysis. J Clin Med 2020; 9 (01) 237
    CrossrefPubMedGoogle Scholar
  • 49 Lavelle F, Hollywood L, Caraher M. et al. Increasing intention to cook from basic ingredients: a randomised controlled study. Appetite 2017; 116: 502-510
    CrossrefPubMedGoogle Scholar
  • 50 Taillie LS, Poti JM. Associations of cooking with dietary intake and obesity among supplemental nutrition assistance program participants. Am J Prev Med 2017; 52 (2S2) S151-S160
    CrossrefPubMedGoogle Scholar
  • 51 Wolfson JA, Bleich SN. Is cooking at home associated with better diet quality or weight-loss intention?. Public Health Nutr 2015; 18 (08) 1397-1406
    CrossrefPubMedGoogle Scholar
  • 52 Lim S, Smith CA, Costello MF, MacMillan F, Moran L, Ee C. Barriers and facilitators to weight management in overweight and obese women living in Australia with PCOS: a qualitative study. BMC Endocr Disord 2019; 19 (01) 106
    CrossrefPubMedGoogle Scholar
  • 53 Alvarado M, Murphy MM, Guell C. Barriers and facilitators to physical activity amongst overweight and obese women in an Afro-Caribbean population: a qualitative study. Int J Behav Nutr Phys Act 2015; 12: 97
    CrossrefPubMedGoogle Scholar
  • 54 Andajani-Sutjahjo S, Ball K, Warren N, Inglis V, Crawford D. Perceived personal, social and environmental barriers to weight maintenance among young women: a community survey. Int J Behav Nutr Phys Act 2004; 1 (01) 15
    CrossrefPubMedGoogle Scholar
  • 55 Monsivais P, Aggarwal A, Drewnowski A. Time spent on home food preparation and indicators of healthy eating. Am J Prev Med 2014; 47 (06) 796-802
    CrossrefPubMedGoogle Scholar
  • 56 Hammarström A, Wiklund AF, Lindahl B, Larsson C, Ahlgren C. Experiences of barriers and facilitators to weight-loss in a diet intervention - a qualitative study of women in northern Sweden. BMC Womens Health 2014; 14 (01) 59
    CrossrefPubMedGoogle Scholar
  • 57 Baruth M, Sharpe PA, Parra-Medina D, Wilcox S. Perceived barriers to exercise and healthy eating among women from disadvantaged neighborhoods: results from a focus groups assessment. Women Health 2014; 54 (04) 336-353
    CrossrefPubMedGoogle Scholar
  • 58 Eyler AA, Baker E, Cromer L, King AC, Brownson RC, Donatelle RJ. Physical activity and minority women: a qualitative study. Health Educ Behav 1998; 25 (05) 640-652
    CrossrefPubMedGoogle Scholar
  • 59 Lee AS, McInnes RJ, Hughes AR, Guthrie W, Jepson R. The effect of the More Active MuMs in Stirling Trial on body composition and psychological well-being among postnatal women. J Pregnancy 2016; 2016: 4183648-4183658
    PubMedGoogle Scholar
  • 60 Colangelo AM, Weissbrod CS. The role of social support, self-efficacy, and motivation in the exercise behavior of women. Exerc Med 2019; 3: 6
    CrossrefPubMedGoogle Scholar
  • 61 Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 2000; 55 (01) 68-78
    CrossrefPubMedGoogle Scholar
  • 62 Sheeran P, Wright CE, Avishai A. et al. Self-determination theory interventions for health behavior change: meta-analysis and meta-analytic structural equation modeling of randomized controlled trials. J Consult Clin Psychol 2020; 88 (08) 726-737
    CrossrefPubMedGoogle Scholar
  • 63 Teixeira PJ, Carraça EV, Marques MM. et al. Successful behavior change in obesity interventions in adults: a systematic review of self-regulation mediators. BMC Med 2015; 13 (01) 84
    CrossrefPubMedGoogle Scholar
  • 64 Executive Summary Trends in Women's Health. Results from the ALSWH—chronic conditions, risk factors and health behaviours. 2014 . Accessed December 1, 2014 at: www.alswh.org.au/Reports/other_reports.html
    Google Scholar
  • 65 Brennan L, Teede H, Skouteris H, Linardon J, Hill B, Moran L. Lifestyle and behavioral management of polycystic ovary syndrome. J Womens Health (Larchmt) 2017; 26 (08) 836-848
    CrossrefPubMedGoogle Scholar
  • 66 Moeller LV, Lindhardt CL, Andersen MS, Glintborg D, Ravn P. Motivational interviewing in obese women with polycystic ovary syndrome - a pilot study. Gynecol Endocrinol 2019; 35 (01) 76-80
    CrossrefPubMedGoogle Scholar