This is he pos p in e sion o he a icle, which has been published in Pa ien Educa ion and
Counseling Janua y 2020, 103(1), 234-239. A ailable online 16 Augus 2019.
h ps://doi.o g/10.1016/j.pec.2019.08.015
De eloping heo y- and e idence-based counseling o a heal h p omo ion
in e en ion: A discussion pape
Sanni Tii inen1, Saka i Ilomäki1, Jaana Lai inen2, E eliina Ko kiakangas2, Heli Hannonen2, Johanna
Ruusu uo i1
1 Tampe e Uni e si y, Tampe e, Finland
2 Finnish Ins i u e o Occupa ional Heal h, Oulu, Finland
Abs ac
Al hough he use o heo ies and e idence is o en s essed in he de elopmen o heal h
p omo ion in e en ions, his does no gua an ee he success o an in e en ion. Thus, we
need o e lec on in e en ion de elopmen p ocesses ha use di e en ypes o heo ies
and e idence. In his pape , we p o ide a e lec i e discussion on how we iden i ied e idence-
based beha io change echniques and counseling hemes o a heal h p omo ion
in e en ion. In addi ion, we discuss he challenges ha we encoun e ed and wha we
lea ned du ing he p ocess: a) a lack o p e ious esea ch and me a-analyses, b)
inconsis encies in e idence, c) in eg a ing e idence and heo ies ha ha e di e en s a ing
poin s, and d) collabo a ing wi h esea che s who ep esen di e en e idence and heo ies.
Du ing he p ocess, we bene i ed om ha ing he clea goal o conduc ing e idence- and
heo y-based wo k. We sol ed he challenges by, o example, u ilizing di e en ypes o
e idence and being e lec i e abou he easons behind any inconsis encies in he e idence.
In e ospec , we would ha e bene i ed om close collabo a ion be ween he eams ha
wo ked sepa a ely wi h di e en e idence. These kinds o e lec i e desc ip ions o
de elopmen p ocesses and he challenges encoun e ed du ing hem may help o he
esea che s and p o essionals a oid encoun e ing he same challenges.
1. In oduc ion
Theo ies and e idence play a key ole in designing heal h p omo ion in e en ions. A heo y is de ined
as a “se o in e ela ed concep s, de ini ions, and p oposi ions ha explain o p edic e en s o
si ua ions by speci ying ela ions among a iables” [1]. By he e m e idence, we e e o knowledge
ha can be easoned wi h some scien i ic p oo . When an in e en ion is designed, heo ies and
e idence can help iden i y ele an de e minan s o heal h ou comes and selec deli e y me hods
o he in e en ion [2].
Al hough he u iliza ion o heo ies and e idence is one ac o ha has been associa ed wi h he
e ec i eness o heal h p omo ion in e en ions [3-4], i does no au oma ically gua an ee
e ec i eness [5]. Thus, we need e lec i e desc ip ions o he in e en ion de elopmen p ocesses
ha use di e en ypes o heo ies and e idence in o de o be e unde s and wha kind o u iliza ion
o hese heo ies and e idence can be bene icial o de eloping e ec i e in e en ions.
The ecen de elopmen o ca ego iza ion ools o heo y u iliza ion [6], he ac i e componen s o
in e en ions – beha io change echniques (BCT) [7] – and hei mechanisms o ac ion [8] ha e been
impo an s eps owa d sys ema izing he u iliza ion o heo ies and e idence o e alua e and epo
in e en ion me hods in e ospec . In addi ion, ools such as In e en ion Mapping [9] ha e been
de eloped o highligh he heo e ical assump ions in he design o in e en ions. Howe e , each
p ocess o designing an in e en ion is unique, and esea che s doing his need o e lec upon wha
applying e idence and heo ies mean in hei speci ic case.
In his pape , we p o ide a e lec i e discussion on ou p ocess o de eloping ac i e componen s and
con en s o a heal h p omo ion in e en ion. The in e en ion is conduc ed h ough a mobile
applica ion and aims o p omo e mic o-en ep eneu s’ wo k abili y and eco e y om wo k
1
[12]. The
heo e ical amewo k o he in e en ion leans on he Sel -de e mina ion Theo y (SDT) [13] and he
Beha io Change Wheel [14].
We ocus he e on he p ocess o de eloping he in e en ion’s counseling con en , in which he
hemes o counseling we e in eg a ed wi h BCTs. By beha io change echnique we e e o “an
obse able, eplicable, and i educible componen o an in e en ion designed o al e o edi ec
causal p ocesses ha egula e beha io ” as de ined by Michie [7]. By counseling hemes, we e e o
opics and ac o s ha a e ele an o wo k abili y and eco e y om wo k. The p ocess o
in e en ion design also includes adap ing he con en o sui he so wa e h ough which he con en
is deli e ed o he in e en ion pa icipan s, bu he so wa e design p ocess is p esen ed in a
sepa a e publica ion [15].
We ocus on he ollowing aspec s o he p ocess o de eloping he counseling con en :
1. How we iden i ied he e idence-based a) BCTs and b) counseling hemes ele an o he
in e en ion.
2. The challenges we encoun e ed when iden i ying and in eg a ing e idence-based BCTs and
counseling hemes wi h each o he and wi h he in e en ion’s heo e ical amewo k, and
wha we lea ned om he challenges.
1
Wo k abili y can be de ined as he balance be ween a pe son’s esou ces and he demands o
hei wo k [10]. Reco e y om wo k e e s o ac i i ies ha aim o eplenish esou ces and o
enable he con inua ion o wo k ac i i ies [11].
2. The p ocesses o iden i ying e idence-based beha io change echniques and counseling
hemes
We iden i ied e idence-based BCTs and counseling hemes using wo eams: one om Tampe e
Uni e si y, ep esen ed by Sanni Tii inen, Saka i Ilomäki and Johanna Ruusu uo i; and he o he om
he Finnish Ins i u e o Occupa ional Heal h (FIOH), ep esen ed by Jaana Lai inen, E eliina
Ko kiakangas and Heli Hannonen.
2.1 Iden i ying e idence-based beha io change echniques
To iden i y e idence-based BCTs, Tampe e Uni e si y’s eam conduc ed sys ema ic li e a u e
sea ches o e iews and me a-analyses o heal h beha io change. We chose e iews and me a-
analyses as sou ces o e idence because hey a e ypically seen as p o iding a high-quali y le el o
e idence [16] as compa ed wi h single s udies, which always include mul iple elemen s ha can
explain he e ec i eness o he echniques.
Table 1. Selec ed BCTs and s udies sugges ing hei e ec i eness. Me a-analyses and me a-
eg essions a e ma ked wi h *. An in e en ion s udy ma ked wi h **.
Beha io change
echnique
E ec i eness iden i ied in a s udy
ocusing on ace- o- ace o all
ypes o in e en ions
E ec i eness iden i ied in a
s udy ocusing on echnology-
based in e en ions
Goals and planning
Hankonen e al., 2015** [20]
Bo -Roig e al., 2014 [25]
McEwan e al., 2016* [21]
Nou e al., 2016* [26]
Michie e al., 2009* [22]
Schoeppe e al., 2016 [19]
Shil s e al., 2004 [23]
Webb e al., 2010* [4]
Williams & F ench, 2011* [24]
Sel -moni o ing
Bi d e al., 2013 [27]
Schoeppe e al., 2016 [19]
Ga dne e al., 2016 [28]
Michie e al., 2009* [22]
Olande e al., 2013* [29]
Feedback
Michie e al., 2009* [22]
Bo -Roig e al., 2014 [25]
Nou e al., 2016* [26]
Schoeppe e al., 2016 [19]
Webb e al., 2010* [4]
Social suppo
Hankonen e al., 2015** [20]
Bo -Roig e al., 2014 [25]
G ea es e al., 2011 [30]
Olande e al., 2013* [29]
Shaping knowledge &
Na u al consequences
McDe mo e al., 2016* [31]
Nou e al., 2016* [26]
Williams & F ench, 2011* [24]
Social compa ison
Ha mann-Boyce e al., 2014* [32]
Webb e al., 2010* [4]
Regula ion
Webb e al., 2010* [4]
In he p elimina y phase, we concen a ed on mul i-beha io al, echnology-based in e en ions ha
a ge ed he die a y habi s, physical ac i i y and sleep o wo king-age people wi h no pa icula
diagnoses. We ocused on hese h ee a ge beha io s because, a he poin o conduc ing he
li e a u e sea ches, hese had been selec ed o inclusion in he in e en ion. We conduc ed sea ches
in PubMed, Medline, Coch ane, CINAHL and PsycINFO, and a e excluding duplica es, we had 705
e e ences. As we ound only h ee s udies ha ocused on e iewing he e ec i eness o he
echniques and he ea u es o in e en ions [17-19], we decided o ex end ou ocus and conduc ed
addi ional sea ches on me a-analyses and e iews ha ocused speci ically on BCTs in bo h single-
and mul i-beha io , as well as bo h echnology-based and ace- o- ace in e en ions. Finally, based
on 15 p e ious s udies, e iews and me a-analyses, we chose se en BCTs o a close analysis o hei
po en ial in he in e en ion de elopmen . We p io i ized e idence p o ided by me a-analyses and
me a- eg essions and supplemen ed i wi h e idence om sys ema ic e iews. Table 1 p esen s he
BCTs and s udies acco ding o he basis on which hey we e selec ed. To ca ego ize he BCTs, we used
Michie e al.’s [7] axonomy.
2.2 Iden i ying e idence-based counseling hemes o he a ge g oup
When iden i ying e idence-based counseling hemes o he a ge g oup – mic o-en ep eneu s –
we ocused on beha io s ha p omo e wo k abili y and eco e y om wo k, ha is, he ac o s ha
had been chosen as he a ge ed long- e m ou comes o he in e en ion [12].
FIOH’s eam ga he ed p e ious esea ch e idence on wo k abili y and eco e y om wo k in bo h
small and la ge wo kplaces – and la e sys ema ized he li e a u e in o sys ema ic and scoping e iews
[11,33-36]. Based on p e ious esea ch, we concluded ha when enhancing wo k abili y and eco e y
om wo k i is impo an o 1) p omo e wo k- ela ed esou ces, such as social suppo , job con ol
and b eaks a wo k [37]; 2) dec ease high demands and cogni i e wo kload [37] and 3) p omo e
pe sonal esou ces h ough imp o ing heal h- ela ed habi s and li es yle a eas such as physical
ac i i y, sleep and die a y habi s [38-39]. Fu he , we obse ed ha e ec i e heal h p omo ion a
wo k equi es conside ing occupa ion- ela ed ac o s, because 1) hese ac o s se speci ic demands
and condi ions o heal h beha io [40] and 2) he e ec i eness o in e en ions has shown o
inc ease when he ac ions a e ailo ed acco ding o occupa ion and wo k asks [36].
In o de o ailo he counseling hemes o he a ge g oup, we examined ea lie su eys by he
Fede a ion o Finnish En e p ises, e e ed o as FIOH’s eam’s expe ience in heal h p omo ion
p ojec s among mic o-en ep eneu s [41], and e e enced wo kshop discussions wi h bo h
en ep eneu s hemsel es and ep esen a i es o he Fede a ion o Finnish En e p ises. These
sou ces o e idence highligh ed ha ime managemen and s ess managemen a e ele an hemes
o mic o-en ep eneu s. I also became e iden ha he social con ex o heal h p omo ion is
di e en o mic o-en ep eneu s han o wo ke s a la ge wo kplaces; mic o-en ep eneu s may
lack social con ac s wi h co-wo ke s. Acco ding o Finnish legisla ion, mic o-en ep eneu s a e no
obliged o a ange occupa ional heal h se ices o hemsel es, no o ha e o ganiza ions o sa e y
o human esou ces.
As a esul o combining he di e en ypes o e idence on ele an hemes o he a ge ed long-
e m ou comes, counseling ocused on he ollowing hemes: wo k abili y, sleep, physical ac i i y and
seden a y beha io , eco e y om wo k, s ess managemen , ime managemen and die a y habi s.
Each o he hemes o med an independen hema ic module in he mobile applica ion.
3. Challenges and lea ning om he p ocess o iden i ying and in eg a ing heo ies and
e idence
Nex , we e lec on he challenges ha we encoun e ed du ing he p ocess and wha we lea ned om
hem in ela ion o iden i ying and in eg a ing heo ies and e idence in he de elopmen o a heal h
p omo ion in e en ion.
3.1 U ilizing di e en ypes o e idence due o a lack o p e ious esea ch and me a-analyses
The i s challenge ha we aced in ela ion o iden i ying e idence-based counseling hemes and
BCTs was a gene al lack o e idence. Al hough me a-analyses a e adi ionally conside ed o p o ide
conclusi e e idence [16], we we e unable o ga he all he ele an in o ma ion om he me a-
analyses. In ela ion o iden i ying e idence-based counseling hemes, FIOH’s eam ound ha
p e ious scien i ic li e a u e has nei he b oadly no sys ema ically add essed he wo k abili y and
eco e y om wo k o mic o-en ep eneu s [11]. Fu he , in ela ion o iden i ying e idence-based
BCTs, ea lie e iew a icles ha e poin ed ou ha he same BCTs a e o en used in bo h in e en ion
and con ol g oups [42], ha no signi ican di e ences ha e been ound be ween e ec i e and
ine ec i e echniques [43], and ha in e en ion and con ol se ings a y eno mously [17]. All hese
ea u es ha e con ibu ed o he di icul y o conduc ing me a-analyses ha p o ide sys ema ic
e idence o he e ec i eness o BCTs.
We also no iced ha i is di icul o ind e idence o he e ec i eness o BCTs because some o hem
ha e been u ilized in in e en ions so in equen ly. Fo example, he me a-analyses and e iews ha
we had ga he ed as he sou ces o iden i ying e idence-based BCTs did no highligh echniques
ela ed o es uc u ing one’s physical and social en i onmen , al hough we had hypo hesized on he
basis on he Beha io Change Wheel [14] ha hey could be ele an o ensu ing oppo uni ies o
beha io change. Howe e , i was c ucial o s udy he me a-analyses ca e ully, and we ound ha
Webb e al.’s [4] me a-analysis o 85 in e en ions included only wo, and ha Williams and F ench’s
[24] me a-analysis o 27 in e en ions included no in e en ions ha used echniques ela ed o
es uc u ing an eceden s o he en i onmen .
Ou solu ion o he lack o e idence p o ided by me a-analyses was o use mul iple o ms o e idence,
such as di e en ypes o scien i ic li e a u e, and expe iences o using mic o-en ep eneu s as a
a ge g oup gained om ea lie esea ch and de elopmen p ojec s. We also aimed o ake in o
accoun he limi s o di e en ypes o e idence. Fo example, we ecognized ha mic o-
en ep eneu s a e a he e ogeneous a ge g oup whose iewpoin s he pa icipan s o p e ious
p ojec s do no comp ehensi ely ep esen and hus, we aimed o u ilize wide- anging p e ious
li e a u e on he heal h p omo ion o all wo king-age adul s. In e ospec , i would ha e been use ul
o ga he he a ge g oup’s expe iences mo e sys ema ically and comp ehensi ely, as i u ned ou
ha we did no ully unde s and he p e equisi es o success ul in e en ions among mic o-
en ep eneu s.
3.2 Highligh ing heo y-based ope a ionaliza ion o BCTs due o inconsis encies in e idence
The second challenge ha we encoun e ed in ela ion o iden i ying e idence-based BCTs in pa icula
was he inconsis encies in he exis ing e idence. Fo example, Michie e al. [22] epo ed ha he
e ec i eness o sel -moni o ing is enhanced when i is combined wi h, o example, eedback in ace-
o- ace in e en ions, and Webb e al. [4] iden i ied eedback as an e ec i e echnique in echnology-
based in e en ions. On he o he hand, McDe mo e al. [31] demons a ed a nega i e associa ion
be ween a ge beha io and eedback on pe o mance. Simila inconsis encies we e obse able in
ela ion o he e ec i eness o social suppo [20,24,29-30]. Thus, we had o e lec upon no only
which BCTs we e e ec i e, bu on he social mechanisms h ough which hey could be e ec i e, in
which con ex s and unde which condi ions [44-45].
Tampe e Uni e si y’s eam’s expe ise in social in e ac ion was e y use ul when dealing wi h hese
kinds o inconsis encies in e idence. We leaned on he unde s anding ha people co-cons uc he
meanings o e e y u e ance and ac i i y in he minu e p ac ices o social in e ac ion [46]. Thus, as
we unde s ood ha he echniques o p o iding eedback and social suppo a e undamen ally based
on he logic o social in e ac ions, we we e able o see ha he inconsis encies we e unde s andable
because he way in which he echniques a e pu in o p ac ice a he de ailed le el o ( ace- o- ace
and echnology-based) in e ac ion is c ucial o how hey a e expe ienced.

This unde s anding o he easons behind he inconsis encies led us o ea he lis o e ec i e BCTs
iden i ied on he basis o p e ious me a-analyses and e iews as a me e s a ing poin o a heo y-
based ope a ionaliza ion o he echniques. As we had decided o base he in e en ion on SDT [12],
we used his in he ope a ionaliza ion o he selec ed BCTs. Acco ding o SDT, he building blocks o
mo i a ion a e he needs o au onomy, compe ence and ela edness, and ha o be mo i a ed, one
should eel ha one is a olun a y sou ce as well as a capable and app ecia ed agen o change [47].
Table 2 p esen s e lec ions on he selec ed BCTs om he pe spec i e o SDT.
Table 2. Re lec ions om pe spec i e o SDT on selec ed BCTs (in alphabe ical o de ). An as e isk
(*) indica es ha p e ious me a-analyses o e iews iden i ied he BCT as po en ially bene icial (as
desc ibed in Sec ion 2).
BCT
Re lec ions om pe spec i e o SDT
Feedback and moni o ing*
To suppo compe ence, eedback should be in o ma i e and non-
judgmen al; o suppo ela edness, i should be empa he ic [48]. Rewa ds
we e seen as unsui able, as hey would ca y he isk o ex e nalizing
mo i a ion [13]. Compe ence can also be suppo ed h ough eedback and
sel -moni o ing, which gene a e e lec ion and enable con ol o one’s own
beha io [49].
Goals and planning*
To suppo au onomy, use s should be able o se hei own goals; ones ha
a e ele an o hem; o suppo compe ence, he goals should be ealis ic
[48].
Iden i y
No iden i ied as an e ec i e/ine ec i e BCT in p e ious me a-analyses o
e iews because o sca ce u iliza ion in in e en ions. F om he pe spec i e
o SDT, iden i ica ion o one’s own alues and in eg a ing hem in o one's
own iden i y suppo s au onomy and in e nalized mo i a ion [50].
Regula ion*
Enhancing egula ion can be seen as suppo ing compe ence.
Sel -belie
Ambiguous and sca ce e idence on e ec i eness [see 32,51,4]. F om he
pe spec i e o SDT, sel -belie should be suppo ed in ways ha suppo
compe ence and au onomy.
Shaping knowledge &
Na u al consequences*
To suppo compe ence, use s should eel hey ha e su icien knowledge
and skills o achie e hei goals; o suppo au onomy, knowledge should be
ele an o he use s [48].
Social compa ison*
The s uc u e o a use ’s mo i a ion a ec s he way in which hey
expe ience social compa ison [52]. As social compa ison can be use ul o
some use s bu no o he s, cau ion should be aken when implemen ing i .
Social suppo *
To suppo ela edness, social suppo should enhance he eeling o being
hea d and app ecia ed; i mus no unde mine compe ence and social
suppo should a oid pa onizing.
3.3 The challenge o in eg a ing e idence and heo ies wi h di e en s a ing poin s
The hi d challenge we encoun e ed, speci ically a he poin a which we s a ed o in eg a e he
BCTs and counseling hemes in o he counseling con en s, was ha he di e en ypes o e idence
we e based on di e en s a ing poin s ha we e incompa ible.
As p e ious li e a u e o ou heo e ical amewo k did no p o ide s aigh o wa d insigh s in o
s uc u ing he counseling con en s, he s uc u e and ma e ials o each hema ic module we e
d a ed on he basis o a success ul in e en ion o ace- o- ace and ideo-media ed counseling o
mic o-en ep eneu s and wo king-age people a a high isk o ype 2 diabe es, a anged by FIOH [41].
The exis ing ma e ials included in o ma ion on and assignmen s o p omo e wo k abili y.
In gene al, he u iliza ion o he exis ing s uc u e and ma e ials signi ican ly acili a ed he d a ing
o he p elimina y counseling con en s. Howe e , some unexpec ed inconsis encies ensued. Namely,
he p e ious p ojec s had been based on cons uc i is heo y, and i became appa en ha his was
no ully compa ible wi h he elemen s highligh ed om he pe spec i e o SDT. The unc ionali y and
appa en neu ali y o he s uc u e made i di icul o e lec upon he di icul ies in ela ion o his
inconsis ency. As he s uc u e and ma e ials om he p e ious p ojec had con ibu ed o he e y
beginning o he in eg a ion p ocess, i was p ac ically impossible o modi y hem la e wi hou
changing he counseling con en s. Thus, we lea ned ha o ensu e compa ibili y, i is essen ial o
e lec i ely plan he u iliza ion o di e en ypes o e idence be o ehand.
3.4 The challenge o di e en esea che s ep esen ing di e en e idence and heo ies
The ou h challenge ha we encoun e ed was ela ed o ou wo king p ocess, in which di e en
esea che s ep esen ed di e en e idence and heo ies.
As we ha e desc ibed, Tampe e Uni e si y’s eam was esponsible o iden i ying e idence-based
BCTs and he FIOH’s eam o iden i ying e idence-based counseling hemes o he a ge g oup.
Fu he , o in eg a e heo y- and e idence-based BCTs and counseling hemes, he eams
collabo a ed in cyclical p ocesses. FIOH’s eam d a ed he p elimina y s uc u e and assignmen s o
hema ic modules. The d a s we e hen sc u inized by Tampe e Uni e si y’s eam, who iden i ied he
BCTs (u ilizing Michie e al.’s [7] axonomy) in hese d a s, analyzed hei o e all occu ence, and
compa ed hem wi h he e idence on e ec i e BCTs. In addi ion, Tampe e Uni e si y’s eam e lec ed
upon he ways in which he BCTs we e pu in o p ac ice om he iewpoin o ou heo e ical
amewo k, such as SDT. Based on his wo k, Tampe e Uni e si y’s eam sugges ed modi ica ions such
as including he BCT o goals and planning and pa ly eplacing gi ing in o ma ion wi h ins uc ions
on how o pe o m he a ge beha io .
A i s , he eams wo ked sepa a ely. In he in eg a ion phase, we no iced ha b inging he BCTs and
counseling hemes oge he was some imes di icul , as hese a e no sepa a e elemen s in he
counseling con en . This challenge was e lec ed in he di icul ies o dis ibu ing he wo k and making
decisions on he con en s. In e ospec , i is clea ha he wo eams should ha e collabo a ed mo e
om he beginning and p oceeded by p epa ing one module a a ime.
4. Conclusions and p ac ical implica ions
Ou aim in he de elopmen was o iden i y heo y- and e idence-based BCTs and counseling hemes
and o in eg a e hem in o counseling con en s o a heal h p omo ion in e en ion. Table 3 sums up
he logic model o de eloping he counseling con en s. He e, we ha e desc ibed one p ocess o
de eloping an in e en ion by looking a he challenges ha may be encoun e ed du ing he p ocess
and hei possible solu ions.
Table 3. Logic model o counseling con en s
Resou ces
Ac i i ies
Sho - e m ou comes
Medium- e m ou comes
Long- e m
ou comes
Funding o in e en ion
de elopmen
Resea che s wi h expe ise
in heal hy li es yles, wo k
abili y and eco e y om
wo k
Resea che s wi h expe ise
in beha io change and
mo i a ion
P e ious esea ch on heal h
beha io change and heal h
p omo ion
Insigh in o a ge g oup
gained h ough p e ious
esea ch and de elopmen
p ojec s a FIOH
Insigh in o a ge g oup
gained h ough wo kshops
De elopmen o
counseling con en s
o mobile
applica ion:
Iden i ying
e idence- and
heo y-based BCTs
Iden i ying
e idence-based
counseling hemes
o a ge g oup
In eg a ing heo y-
and e idence-based
BCTs and
counseling hemes
Re lec ing on one's own
cu en habi s and li e
si ua ion
Se ing ele an and
ealis ic goals h ough
e lec ion and/o beha io
change
Reading o lis ening o
ma e ials ha p o ide
ele an , new in o ma ion
Comple ing assignmen s
ha p omo e chosen goals
Ob aining suppo i e,
ele an and clea eedback
Con idence in applica ion's
subs ance and me hods
Enhanced au onomy,
compe ence and
ela edness in ela ion
o beha io change o
p omo e wo k abili y
and eco e y om
wo k
↓
Mo i a ion o e lec
upon one's wo k
p ac ices and li es yle
om he pe spec i es
o wo k abili y and
eco e y om wo k
Enhanced
oppo uni ies o lead
wo k p ac ices and
li es yles ha
p omo e wo k abili y
and eco e y om
wo k
Es ablishing new
wo k p ac ices and
li es yles ha
p omo e wo k
abili y and eco e y
om wo k (e.g.,
educing seden a y
beha io s, mo e
ene gy om
heal hy ood and
su icien amoun
o sleep du ing
nigh )
Main aining abo e
wo k p ac ices and
li es yles
Imp o ed eco e y
om wo k
Imp o ed wo k
abili y
Planned wo k
In ended esul s
Ou eam bene i ed om ha ing a clea goal o conduc ing e idence- and heo y-based wo k, as his
ga e us a sha ed s a ing poin agains which o measu e ou choices. Howe e , in his pape , we ha e
explained ha de eloping an in e en ion as e idence- and heo y-based is no a s aigh o wa d
ask. The lack o and inconsis encies in e idence may aise challenges ha equi e u ilizing di e en
ypes o e idence.
Al hough e idence is o en anked hie a chically in heal h sciences [16], we adop ed a c i ical and
ealis app oach [44-45] o he e idence by acknowledging he limi a ions o e idence hie a chies
[53]. Fo example, when ca ying ou e idence-based planning, ins ead o elying on only he ypes o
e idence ha ank high in he hie a chy, one should conside scien i ic adequacy, ele ance o
cu en needs, and he ways in which he e idence add esses di e en alues [54]. Thus, we u ilized
a a ie y o e idence (e.g., p e ious me a-analyses, expe iences om p e ious in e en ions, and
accumula ed knowledge on heal h p omo ion p o essionals and in e ac ion schola s) and e lec ed
on he na u e o his e idence and i s limi a ions.
Fu he mo e, as sugges ed by he ealis e alua ion pe spec i e, i is impo an o analyze no only
wha wo ks bu also how and why i wo ks (o does no wo k), in which con ex s and unde which
condi ions [44-45]. In de eloping counseling con en , he ealis e alua ion pe spec i e was especially
use ul when a) making in o med decisions when including BCTs wi h sca ce o inconsis en scien i ic
e idence, b) planning how e ec i e BCTs should be ope a ionalized in o de o align wi h SDT (see
Table 2), and c) applying e idence om di e en con ex s o he con ex a hand (e.g. aking in o
accoun he possibili y o limi ed social suppo o mic o-en ep eneu s).
In eg a ing di e en ypes o heo ies and e idence ela ed o beha io change enables planning
counseling con en s (BCTs and hemes) o heal h p omo ion in e en ions in such a way ha akes
mul iple pe spec i es in o accoun . Howe e , he p ocess o in eg a ion is no s aigh o wa d when
heo ies and e idence a e based on po en ially con lic ing backg ound assump ions. Fu he de ailed
e lec ions on he p ocesses o de eloping heo y- and e idence-based in e en ions a e equi ed
wi hin he ield o heal h- and well-being- ela ed counseling.
Resea che s and heal h p omo ion p o essionals need o be anspa en abou hei choices i hey
wan o plan c edible heo y- and e idence-based counseling o heal h p omo ion in e en ions.
Re lec i e desc ip ions o de elopmen p ocesses and he challenges encoun e ed du ing hese may
help o he esea che s and p o essionals a oid encoun e ing he same challenges.
Re e ences
[1] K. Glanz, D.B. Bishop, The ole o beha io al science heo y in de elopmen and
implemen a ion o public heal h in e en ions. Annu Re Public Heal h 31 (2010) 399–418.
h ps://doi.o g/10.1146/annu e .publheal h.012809.103604.
[2] L.K. Ba holomew, P.D. Mullen, Fi e oles o using heo y and e idence in he design and
es ing o beha io change in e en ions. J Public Heal h Den 71 (2011) 20–33.
h ps://doi.o g/10.1111/j.1752-7325.2011.00223.x.
[3] M. Gou lan, P. Be na d, C. Bo olon, A.J. Romain, O. La ey e, M. Ca ayol, G. Nino , J. Boiche.
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andomized con olled ials. Heal h Psychol Re 10 (2016) 50–66.
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[4] T.L. Webb, Y. Joseph, L. Ya dley, S. Michie, Using he in e ne o p omo e heal h beha io
change: a sys ema ic e iew and me a-analysis o he impac o heo e ical basis, use o beha io
change echniques, and mode o deli e y on e icacy. J Med In e ne Res 12 (2010) 1, e4.
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