Falko F Sniehotta

Heidelberg University · Faculty of Medicine Mannheim and Clinic Mannheim

Population health and health inequalities are best conceptualised in a complex systems model with interdependent elements at various levels within a connected whole. 1 This perspective suggests that wide effects on health, such as socioeconomic, cultural, and environmental factors as well as social, behavioural, and biological effects, interact in...

N-of-1 studies test hypotheses within individuals based on repeated measurement of variables within the individual over time. Intra-individual effects may differ from those found in between-participant studies. Using examples from a systematic review of n-of-1 studies in health behaviour research, this article provides a state of the art overview o...

N-of-1 studies are based on repeated observations within an individual or unit over time and are acknowledged as an important research method for generating scientific evidence about the health or behaviour of an individual. Statistical analyses of n-of-1 data require accurate modelling of the outcome while accounting for its distribution, time-rel...

Background: Behaviour change interventions are effective in supporting individuals in achieving temporary behaviour change. Behaviour change maintenance, however, is rarely attained. The aim of this review was to identify and synthesise current theoretical explanations for behaviour change maintenance to inform future research and practice. Metho...

http://www.tandfonline.com/doi/full/10.1080/17437199.2013.869710

Optimizing vaccine uptake is a public health challenge that requires the implementation of effective strategies. The asymmetric dominance (or decoy) effect describes the increasing likelihood of selecting an option when a clearly inferior alternative is offered. Therefore, we aimed to test the impact of offering decoy alternatives—less convenient v...

Background Severe and multiple disadvantage (SMD) is the combined effect of experiencing homelessness, substance use and repeat offending. People experiencing SMD have high burden of physical and mental health issues. Oral health is one of the most common health problems in people experiencing SMD which interacts with substance use, smoking, and un...

Background Cancer-related fatigue (CRF) is the most prevalent, distressing, and quality of life disturbing symptom during and after cancer treatment for many cancer types including breast cancer. The experience and burden of this symptom can induce a cognitive bias towards fatigue or a fatigue-related self-image, which can further increase the fati...

Background Patient complaints in healthcare settings can provide feedback for monitoring and improving healthcare services. Behavioural responses to complaints (e.g., talking or apologising to a patient) can influence the trajectory of a complaint for instance, whether a complaint is escalated or not. We aimed to explore healthcare professional (HC...

BACKGROUND Digital approaches to weight management have potential to produce cost-effective and scalable weight management solutions. OBJECTIVE The core components of effective weight management interventions encourage self-regulation of energy balance behaviors which could be enhanced using aspects of emotion regulation. METHODS The NoHoW trial...

Regular testing using rapid antigen lateral flow tests (LFTs) was an important prevention strategy during the COVID-19 pandemic. However, falsification of home LFTs was a concern. Using a large quota-representative sample of adults ( n = 1295) in England, we conducted a vignette survey consisting of four hypothetical scenarios of LFT falsification...

Understanding the behavioural factors influencing flu vaccination is crucial for mitigating seasonal infection outbreaks. This study utilised the Precaution Adoption Process Model (PAPM) to examine the public’s decision-making about seasonal flu vaccination through an online cross-sectional survey with 2004 participants in England, UK. Results show...

Background Poor adherence to photoprotection in Xeroderma Pigmentosum (XP) increases morbidity and shortens lifespan due to skin cancers. Objective To test a highly personalised intervention (XPAND) to reduce the dose of ultraviolet radiation (UVR) reaching the face in adults with XP, designed using known psychosocial determinants of poor photopro...

Background It is challenging to predict long-term outcomes of interventions without understanding how they work. Health economic models of public health interventions often do not incorporate the many determinants of individual and population behaviours that influence long term effectiveness. The aim of this paper is to draw on psychology, sociolog...

Background The path of a complaint and patient satisfaction with complaint resolution is often dependent on the responses of healthcare professionals (HCPs). It is therefore important to understand the influences shaping HCP behaviour. This systematic review aimed to (1) identify the key actors, behaviours and factors influencing HCPs’ responses to...

Background UK local authority public health teams (LAPHT) supported delivery of the Covid-19 vaccination programme, particularly to disadvantaged populations. We explored the challenges encountered and lessons learnt by LAPHTs in tackling low Covid-19 vaccine uptake. The aim of this study was to understand what works, and how, in addressing local i...

Objectives Behaviour change theories have extensively been used in health behaviour change interventions and their programme theories. However, they are rarely evaluated in randomized field studies. The Let's Move It intervention targeted various psychosocial constructs to increase adolescents' physical activity. A theory‐based process evaluation a...

Background Selenium has potential safeguarding properties against cognitive decline, because of its role in protecting DNA, proteins, and lipids in the brain from oxidative damage. However, acute and chronic overexposure to selenium can be neurotoxic. Objective The aim of this analysis was to explore the association between selenium status [serum...

Background Difficulties identifying anxiety disorders in primary‐school aged children present significant barriers to timely access to support and intervention. This study aimed to develop a brief assessment tool that can identify children with anxiety disorders in community settings, with a high level of sensitivity and specificity. Methods Child...

Optimising vaccine uptake is a public health challenge and requires effective strategies. The asymmetric dominance (or decoy) effect describes the increasing likelihood of choosing an alternative when an inferior alternative is offered. Therefore, we aimed to test the impact of offering decoy alternatives, less convenient vaccination appointments,...

The trace element selenium is known to protect against oxidative damage which is known to contribute to cognitive impairment with ageing (1,2) . The aim of this study was to explore the association between selenium status (serum selenium and selenoprotein P (SELENOP)) and global cognitive performance at baseline and after 5 years in 85-year-olds li...

Amidst the global momentum of behavioral insights (BI), there has been a shift from mostly nudge-based BI applications to systemic approaches. This is particularly pressing in public health, where interacting issues regularly produce unanticipated consequences. Regardless, little is known about adopting complex systems approaches in behavioral publ...

Background Populations facing severe and multiple disadvantage (SMD), co-occurring homelessness, substance use and repeat offending have high levels of physical and mental ill-health. Poor oral health is one of the most common health problems in this population and is closely linked with substance use, smoking and poor diet. Issues related to the i...

Background People experiencing homelessness co-occurring with substance use or offending (‘severe and multiple disadvantage’ SMD) often have high levels of poor oral health and related health behaviours (particularly, substance use, smoking, poor diet). This systematic review aimed to assess the effectiveness and cost-effectiveness of interventions...

Background Pregnancy weight management interventions can improve maternal diet, physical activity, gestational weight gain, and postnatal weight retention. UK guidelines were published in 2010 but health professionals report multiple complex barriers to practice. GLOWING used social cognitive theory to address evidence-based barriers to midwives’ i...

Objectives To examine the effectiveness of shared medical appointments (SMAs) compared with one-to-one appointments in primary care for improving health outcomes and reducing demand on healthcare services by people with one or more long-term conditions (LTCs). Design A systematic review of the published literature. Data sources Six databases, inc...

Background NULevel was a randomized control trial to evaluate a technology-assisted weight loss maintenance (WLM) program in the UK. The program included: (a) a face-to-face goal-setting session; (b) an internet platform, a pedometer, and wirelessly connected scales to monitor and report diet, physical activity, and weight, and; (c) regular automat...

During the COVID-19 pandemic, lateral flow tests (LFTs) were used to regulate access to work, education, social activities, and travel. However, falsification of home LFT results was a concern. Falsification of test results during an ongoing pandemic is a sensitive issue. Consequently, respondents may not answer truthfully to questions about LFT fa...

Background The Identifying Child Anxiety Through Schools-identification to intervention (iCATS-i2i) trial is being conducted to establish whether ‘screening and intervention’, consisting of usual school practice plus a pathway comprising screening, feedback and a brief parent-led online intervention (OSI: Online Support and Intervention for child a...

BACKGROUND Virtual wards (VWs) are being introduced in England as a new way of delivering care to patients who would otherwise be hospitalised. Using digital technologies, patients can receive acute care, remote monitoring, and treatment in their own homes. Integrated Care System commissioners have an important role in the adoption and implementati...

Background Virtual wards (VWs) are being introduced within the National Health Service (NHS) in England as a new way of delivering care to patients who would otherwise be hospitalized. Using digital technologies, patients can receive acute care, remote monitoring, and treatment in their homes. Integrated care system commissioners are employees invo...

Objectives Among people experiencing severe and multiple disadvantage (SMD), poor oral health is common and linked to smoking, substance use and high sugar intake. Studies have explored interventions addressing oral health and related behaviours; however, factors related to the implementation of these interventions remain unclear. This mixed-method...

Background: Low levels of physical activity (PA), more prevalent among those with low education, require effective interventions. Fewer trials have tested interventions to decrease sedentary behaviour (SB). No school-based interventions have shown lasting effects on PA or sedentary behaviour in vocational schools. Purpose: To examine whether the Le...

Background Cancer related fatigue (CRF) is the most prevalent, distressing and quality of life disturbing symptom during and after cancer treatment for many cancer types including breast cancer. The experience and burden of this symptom can induce a cognitive bias towards fatigue or a fatigue related self-image, which can further increase the fatig...

Purpose Preventing weight regain can only be achieved by sustained changes in energy balance-related behaviors that are associated with weight, such as diet and physical activity. Changes in motivation and self-regulatory skills can support long-term behavioral changes in the context of weight loss maintenance. We propose that experiencing a suppor...

Background: The Identifying Child Anxiety Through Schools – identification to intervention (iCATS-i2i) trial is being conducted to establish whether ‘screening and intervention’, consisting of usual school practice plus a pathway comprising screening, feedback and a brief parent-led online intervention (OSI: Online Support and Intervention for chil...

Background There has been a rapid increase in the number of, and demand for, organisations offering behavioural science advice to government over the last ten years. Yet we know little of the state of science and the experiences of these evidence providers. Aims and objectives To identify current practice in this emerging field and the factors tha...

During the COVID-19 pandemic, lateral flow tests (LFTs) were used in England to regulate access to work, education, social activities, and travel. However, falsification of home LFT results was a concern. This study estimated the prevalence of LFT falsification behaviours (FBs) in a representative sample of adults living in England (n=1577) who hav...

The effectiveness and cost of a public health intervention is dependent on complex human behaviors, yet health economic models typically make simplified assumptions about behavior, based on little theory or evidence. This paper reviews existing methods across disciplines for incorporating behavior within simulation models, to explore what methods c...

Preconception obesity is associated with adverse pregnancy outcomes and deprivation. The postnatal period provides an opportunity for preconception intervention. There is a lack of published postnatal behaviour and weight data to inform intervention needs. Secondary analysis of the GLOWING study explored postnatal diet, physical activity (PA) and w...

Background Avoidable hospital admissions and prolonged in-patient stays cause patients distress, limit hospital bed capacity, and are costly to the NHS. Virtual wards are being introduced in Integrated Care Systems in England as a new way of delivering care to patients who would otherwise be in hospital. Using digital technologies, patients can rec...

Background As regular testing using rapid lateral flow device (LFD) tests became common practice during the COVID-19 pandemic, there was concern that some individuals were falsifying at-home test results. Falsification behaviours run counter to moral and ethical obligations of preventing harm, collective responsibility, and adherence to behavioural...

Background Populations facing severe and multiple disadvantage (SMD) – co-occurring homelessness, substance misuse and repeat offending, have high level of physical and mental ill-health. Poor oral health is one of the three most common physical health problems among this population, and it is closely linked with high levels of drug and alcohol use...

Background Severe and multiple disadvantage (SMD) includes overlapping issues of homelessness, substance misuse or repeated offending. Among this population, poor oral health is common and is caused by health risk behaviours, including smoking, substance misuse and high sugar intake. Studies have explored interventions addressing to improve these b...

Background Local Authority Public Health Teams (LAPHT) were crucial to the Covid-19 vaccination programme. Although the vaccine was delivered by NHS staff, LAPHT endeavoured to increase uptake in disadvantaged groups, namely those who found it difficult to, or may not routinely, engage with health services. We describe how LAPHT engaged with disadv...

Background A key component for control of COVID-19 transmission was regular testing using lateral flow device (LFD) tests. However , as home self-testing using LFDs became common practice, there was concern that some people were falsifying test results. Responses to direct questioning surveys that probe sensitive behaviours are often compromised b...

Background The path of a complaint and patient satisfaction with complaint resolution is often dependent on healthcare professionals’ (HCPs) first response. It is therefore important to understand the influences shaping HCP behaviour. This systematic review aimed to (1) identify the key actors, behaviours and factors influencing HCPs’ responses to...

Behaviour change interventions for weight management have found varied effect sizes and frequent weight re-gain after weight loss. There is interest in exploring whether differences in eating behaviour can be used to develop tailored weight management programs. This secondary analysis of an 18-month weight maintenance randomised controlled trial (R...

Introduction Place-based public health evaluations are increasingly making use of natural experiments. This scoping review aimed to provide an overview of the design and use of natural experiment evaluations (NEEs), and an assessment of the plausibility of the as-if randomization assumption. Methods A systematic search of three bibliographic datab...

Background There is limited evidence on what shapes the acceptability of population level dietary and active-travel policies in England. This information would be useful in the decision-making process about which policies should be implemented and how to increase their effectiveness and sustainability. To fill this gap, we explored public and polic...

Aims: The aim of this narrative review was to identify important knowledge gaps in behavioural science relating to type 2 diabetes prevention, to inform future research in the field. Methods: Seven researchers who have published behaviour science research applied to type 2 diabetes prevention independently identified several important gaps in kn...

Intervention science faces a hazardous paradox: on the one hand, vulnerable populations (eg, patients, people from low socioeconomic background, older adults) are those for whom adoption of healthy behaviors is most urgent; on the other hand, behavior change models are less predictive, and interventions less successful, in these populations. This c...

Background: Behavioral weight management programs (BWMPs) enhance weight loss in the short term, but longer term cardiometabolic effects are uncertain as weight is commonly regained. We assessed the impact of weight regain after BWMPs on cardiovascular risk factors, diabetes, and cardiovascular disease. Methods: Trial registries, 11 databases, a...

Background: NULevel was a randomized control trial to evaluate a technology-assisted weight loss maintenance (WLM) program in the UK [1,2]. The program included: (a) a face-to-face goal-setting session; (b) an internet platform, a pedometer, and wirelessly connected scales to monitor and report diet, physical activity, and weight, and; (c) regular...

Understanding what predicts behavior change is a hot topic in health psychology, especially with regard to physical activity. While existing research has revealed key factors of physical activity ( e.g. , reasoned cognitions, automatic processes), it fails to accurately identify those that are specific to the most inactive populations ( e.g. , olde...

Background Increasing physical activity and limiting sedentary time may minimize weight recurrence after bariatric surgery. However, few studies have evaluated potential associations of objectively-measured physical activity and sedentary time with post-surgical weight recurrence over time. Aims To evaluate associations of change in physical activ...

Background: COVID-19 continues to pose a threat to public health. Booster vaccine programmes are critical to maintain population-level immunity. Stage theory models of health behaviour can help our understanding of vaccine decision-making in the context of perceived threats of COVID-19. Purpose: To use the Precaution Adoption Process Model (PAPM...

Background Maternal weight management is a priority due to pregnancy risks for women and babies. Interventions significantly improve maternal diet, physical activity, weight, and pregnancy outcomes. There are complex barriers to midwives’ implementation of guidelines; low self-efficacy is a core implementation barrier. The GLOWING intervention uses...

Background Anxiety problems are extremely common and have an early age of onset. We previously found, in a study in England, that fewer than 3% of children with an anxiety disorder identified in the community had accessed an evidence‐based treatment (Cognitive Behavioural Therapy; CBT). Key ways to increase access to CBT for primary school‐aged chi...

Aims: As sustained weight loss is vital for achieving remission of type 2 diabetes we explored whether randomisation to weight loss plus maintenance in the DiRECT trial was associated with physical activity, inactivity or sleep. Methods: Participants were randomised to either a dietary weight management programme or best-practice care. The weigh...

Intervention science faces a hazardous paradox: on the one hand, vulnerable populations (e.g., patients, people from low socio-economic background, older adults) are those for whom adoption of healthy behaviours is most urgent; on the other hand, behaviour change models are less predictive, and interventions less successful, in these populations. T...

Objective: To identify the core components of digital behaviour change interventions for weight loss maintenance targeting physical activity, in terms of: (i) behaviour change techniques, (ii) mechanisms of action, (iii) modes of delivery, (iv) dose and (v) tailoring/personalization. In addition, the links between these components were investigate...

Objectives Achieving high vaccination coverage is vital to the efforts of curbing the impact of the COVID-19 pandemic on public health and society. This study tested whether communicating the social benefit through community protection for friends and family members versus overall society, affects vaccination intention and perception among a sample...

Background Maternal weight management increases risks for women and babies and is a public health priority. Interventions can substantially improve maternal diet and physical activity behaviours and pregnancy outcomes. Low self-efficacy is a core barrier to midwives' implementation of guidelines. GLOWING used social cognitive theory to address evid...

Background Systematically screening for child anxiety problems, and offering and delivering a brief, evidence-based intervention for children who are identified as likely to benefit would minimise common barriers that families experience in accessing treatment. We have developed a short parent-report child anxiety screening questionnaire, and proce...

Aims: We used data from a recent systematic review to investigate weight regain after behavioural weight management programmes (BWMPs, sometimes referred to as lifestyle modification programmes) and its impact on quality-of-life and cost-effectiveness. Materials and methods: Trial registries, databases, and forward-citation searching (latest sea...

Background The high prevalence of childhood obesity is a concern for public health policy and practitioners, leading to a focus on early prevention. UK health visitors (HVs) are well-positioned to prevent excessive weight gain trends in pre-school children but experience barriers to implementing guideline recommended practices. This research engage...

Background Systematically screening for child anxiety problems, and offering and delivering a brief, evidence-based intervention for children who are identified as likely to benefit would minimise common barriers that families experience in accessing treatment. We have developed a short parent-report child anxiety screening questionnaire, and proce...