Table 1 Behavior change techniques used in our intervention

Education and Awareness

Educational information is included to raise the participants’ awareness of specific factors that are influencing their weight and to provide examples of solutions for behaviour change.

Stimulus Control

Stimuli or cues are triggers to eating/sedentary behaviours e.g. feeling down, easy access to food, celebration events, hunger, and peer pressure. We help participants to appreciate that it is therefore important to reduce unhealthy food and sedentary cues and create an environment more conducive to long term weight management. Examples of this technique include shopping online to prevent being tempted by offers or energy dense foods; only having fruit snacks in the house; and having trainers easily accessible/visible to keep up the walking to work or school routine. Advising Qatari schools to offer healthy foods and provide shopping healthy foods tips for students. QU Human Nutrition Program students can help with this effort.

Monitoring / Journaling (starts session 1)

Monitoring of behaviours is one of the strongest behaviour change tools, as it provides feedback on progress to date. We encourage participants to monitor their behaviours regularly. The greater the detail provided, the greater the information available to make small and sustainable changes. Where feasible we shall use mobile technology tools to facilitate self-monitoring; for example, a physical activity device worn on the belt or wrist, that communicates via the family computer.

Behaviour Shaping

This involves coaching participants to help them understand how they can influence their behaviour, which is important. Examples include taking the stairs instead of escalators and lifts and/or encouraging eating a new vegetable or food at mealtimes or a different piece of fruit at snack time. Also, providing such alternative responses with positive outcomes is critical to helping behaviour change, because most behaviours tend to be a formed by previous experiences.

Goal Setting and Planning (starts session 1)

Goal-setting is an initial priority. Without a goal, an individual will be unclear about their weight loss journey. End and journey goals provide the direction of the weight management programme. Planning ensures the steps to these goals are clear and owned by the individual. In fact, all sessions involve the review and development of goals. Goals should be SMART (Specific, Measurable, Achievable, Realistic, and Time-specific):

Specific: Specific and detailed: for example, rather than writing ‘I am not going to miss meals’ participants are encouraged to write ‘I will not miss breakfast’.

Measurable: Participants are shown how to measure their progress and make appropriate changes. Instead of writing ‘I will walk 3 miles in 4 months.’ they are encouraged to state ‘I will walk 2 miles in 1 h in the first month increasing to 3 miles in an hour at the end of 4 months’.

Achievable: This ensures that their goals are in reach and they have a good chance of achieving them. Instead of writing “I want to be a size 10” they would be encouraged to write “I would like to lose 3–4 pounds a week during the programme”. This is much safer and much more achievable. If goals are not achievable then they run the risk of setting themselves up to fail. This is also forgiving as it specifies “3–4 pounds” not “4 pounds” therefore if they lose 3 pounds they have still met their goal.

Realistic: Instead of “I will give up chocolate for the rest of my life” they will be encouraged to state “This week I will cut down from a snickers bar every day to 2 snickers bars during the week.” It isn’t realistic to give up chocolate for the rest of a person’s life, and neither is it necessary.

Time specific: Here they will be shown how to arrive at realistic time frames for goals. In weight management we should think about months and years rather than days and weeks. Instead of writing “I want to lose a stone” they will be encouraged to write “I want to lose 1–2 pounds a week for the next 12 weeks”.

Problem Solving

Weight management is difficult because life has a nasty habit of getting in the way. Each participant will be shown how to have a plan B, or a set of ready-made solutions to common barriers, as an effective way of keeping them on track. During each session, participants will be asked to consider what challenges they might face and how they can plan to overcome them. What if they forget their healthy packed lunch? What if their bike isn’t working? What if they have a bad day at work? Do they have a plan B in place for each?

Time Management

We observe in many of the individuals we work with that they have difficulty in managing their time; the outcome of this is they make rash decisions especially around eating and activity. To help, we encourage them to think about priority management rather than time management. This helps the participant think of their behaviours rather than the specific units of time they may have. This strategy is linked with monitoring, goal setting and planning so that the participant can continually manage their weight.

Social Support

This is the support provided by peers and other family member during and following attendance of the service. The majority of participants will access group support as part of their weight loss journey and during these sessions peer support should be strongly encouraged. The online community provides a further mechanism to encourage access to social support. We encourage the group to pass on details with each other so that they can have ‘support buddies’ available; and also make it clear within the sessions that building up social networks is a key objective of the programme.

Motivational Interviewing

Prompting the person to provide self-motivating statements and evaluations of their own behaviour to minimize resistance to change. Project trainers and parents play a key role in this.

Incentives

Behavior change is more likely to occur when it is immediately rewarded. Therefore, the children earned points during their time at the camp for effort, good behavior, and achievements, especially those relating to conduction of healthy behaviors.

Norms

We are strongly influenced by what others do, therefore the children were made aware of peers who had earned large numbers of points through use of leaderboards.

Salience

Our attention is drawn to what is novel and seems relevant to us. During one of the lifestyle education lessons, the children used a ‘mental contrasting’ technique, which involves being prompted to imagine a desirable outcome, to mentally contrast this outcome with their present situation, and to focus on things that they may need to change to achieve the outcome. There is evidence that using this technique can increase likelihood of positive behavior change being achieved. Specifically, the attendees of the camp wrote: (1) An aim for them to achieve relating to health (e.g. to eat more fruit and vegetables); (2), the most positive outcome of achieving their aim, and events and experiences they associate with this positive outcome (e.g. to feel happier); and (3) the most critical obstacle to their achieving this aim, together with events and experiences associated with this obstacle (e.g. no fruit at home).

Commitments

Behavior change research evidence indicates we are likely to behave in ways consistent to our public promises, therefore the children signed contracts to declare their intentions to behave in healthy ways. At the start of the camp, contracts between participants, their parents or guardians and the project team were created and signed. These outlined the goals of the three parties; these goals related to supporting the child to conduct healthy behaviors. At the start of individual daily activities at the camp, ‘group contract’ agreements were signed by all of the camp attendees involved, on a single piece of paper, to encourage them to adhere to behavioral recommendations when taking part in certain lifestyle or activity sessions.