This process makes the behaviours more likely through self-generation, 29 self-monitoring, 33 having a concrete meal plan, 34 tailoring, 35 achievability, 36 reinforcement and accountability; 37 all of which are CBT strategies that have been successful in nutritional behaviour change trials.
Rather than simply providing more evidence that tracking in any form supports behaviour change, this trial represents an important step forward in the challenging issue of physical activity promotion.
It has been argued that research is not being conducted to answer questions of importance to healthcare decision-makers; and, in particular, there is a dearth of high-quality economic analyses of health behaviour change intervention trials [12].
When possible, the trial design could use standard care as the basic treatment model, and limit the amount of clinical practice behaviour change which the trial would require [ 27, 39].
There was no objective measurement of behaviour change in this trial cohort and it was difficult to elucidate exactly which components of the intervention were associated with the observed improvements.
In future trials, it is crucial to conduct quantitative longitudinal studies to monitor possible post-trial behaviour change.
For example, Wilson et al. [ 59] recently argued for the inclusion of lifestyle behaviour change in antihypertensive drug trials, or at least control of lifestyle factors to tease out these relationships.
The study we describe in this paper is a small trial targeting behaviour change aimed at diabetes prevention.
It thus appears that in this trial, negative behaviour change (disinhibition or risk compensation) following circumcision, leading to higher risk taking, was not an important effect.
