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. 2022 Jul 4;28:101880. doi: 10.1016/j.pmedr.2022.101880

Table 1.

Overview of summary statements from previous reviews, links to behavioural mechanisms and recommendations for future work.

Summary Statements Possible Behavioural Mechanism Recommendation
Environment
Poor physical design is a barrier to physical activity but many interventions involving changes to built environments are ineffective (Durand et al., 2011, Kramer et al., 2017, Olstad et al., 2017).
The environment subtly but often substantially influences behaviour. Environmental regeneration schemes should consider deliberately incorporating nudges into a design and testing these against control schemes.
Environmental changes alone are not effective without raising awareness of them or making them socially attractive (Hunter et al., 2019, Kramer et al., 2017). Behavioural interventions are most successful when they make the intended change frictionless, attractive, social and timely. Environmental regeneration schemes could test ways of removing all frictions, no matter how small, and drawing sufficient attention to the regeneration to make facilities attractive and socially acceptable to use.
How socially connected people feel to their environment is correlated with physical activity (Sawyer et al., 2017). 1. When people are more attached to their environment, they see it as safer and are more likely to look after it.
2. When people own something or have been involved in the creation of something, they value it more.
Environmental regeneration schemes could test whether actively involving communities in the regeneration and purposefully cultivating a sense of ownership and co-creation increases usage.




Information provision
Interventions that focus on one behaviour or fewer techniques tend to be more successful than those focussing on multiple behaviours or techniques (Bull et al., 2018, Craike et al., 2018, Michie et al., 2009). 1. Goals can motivate behaviour changes but having too many goals at one time can be de-motivating and stressful.
2. When strong arguments for doing something are combined with weaker arguments for doing it, it reduces the effectiveness of the strong arguments (Presenter’s Paradox).
Information provision interventions could test whether giving people one strong reason for changing their behaviour, or having them generate their own strong reason, is more effective at increasing physical activity than giving many reasons.
1. Providing information on the antecedents of exercise can decrease effectiveness (Bull et al., 2018).2. Giving opportunity to practice exercise or providing feedback through pedometers can increase effectiveness
(Bravata et al., 2007, Bull et al., 2018).
1. Feedback given too far in advance of a behaviour is not motivating.
2. When feedback is given immediately after a behaviour is carried out, it is motivating and increases likelihood of that behaviour being repeated.
Interventions that involve feedback from a practitioner could compare giving feedback prior to the intervention compared to during it. More work could be done on Just In Time Adaptive Interventions that are currently too underpowered to detect effects.
Information provision interventions are mostly ineffective but reports on the methods used are lacking in detail meaning analysis is difficult (Craike et al., 2018).
Information provision is not straightforward, its success may depend at least in part on how the information is framed. Information provision interventions could test different ways of framing information such as making the goal gain-framed rather than loss-framed to assess whether this changes outcomes overall and/or differs by subgroups.



Social Context
Group or community-focussed interventions are more effective than individually-targeted ones (Cleland et al., 2012, Cleland et al., 2013, Craike et al., 2018, Taylor et al., 1998). An individual’s behaviour is influenced by what they think other people are doing. Group-based interventions could test whether sharing information about the average levels of physical activity within the group during an intervention could help to change the social norm of inactivity and increase individuals’ own activity.
Interventions that promote group cohesiveness are most successful (Burke et al., 2006) (Note this is not a review of disadvantaged populations). Individuals incorporate the values of a group they affiliate with into their own sense of self and align their attitudes and behaviours to it Group-based interventions could test whether adding elements designed to build a team-like mentality during an intervention increases physical activity.
Incentives, particularly those that promote accountability if the behaviour is not achieved, can increase physical activity (Mitchell et al., 2013) (Note this is not a review of disadvantaged populations). Accountability can influence behaviour as individuals may wish to benefit a group they are part of, save face, gain status or avoid the regret of not doing something they intended to. Interventions involving non-financial forms of commitment contracts and incentives could be tested in socially disadvantaged groups.