Developing a theory and evidence-based intervention for black African women using the COM-B model and behaviour change wheel: BALANCED programme

Abstract

Background: Obesity is a major global health issue, increasing morbidity and mortality through its association with non communicable diseases. Black African women experience disproportionately high obesity rates, reaching 37 percent in the UK. They face cultural, social, and systemic barriers to achieving sustainable lifestyle changes. To address these disparities, the Black African Lifestyle and Nutrition Change for Empowerment and Development (BALANCED) intervention was developed. This paper describes the development of the BALANCED intervention and the evidence, theory, and community informed processes that shaped its design. Methods: A stepwise approach guided by the Behaviour Change Wheel and COM B model (Capability, Opportunity, Motivation Behaviour) was used. Formative research, including a systematic review, dietary pattern analysis, and qualitative interviews, identified key behavioural determinants and barriers to healthy eating among Black African women with overweight and obesity in the UK. These insights informed the selection of intervention functions and behaviour change techniques (BCTs). Intervention components were co designed with key stakeholders to support acceptability and feasibility. Results: Formative research showed that Black African women face barriers to adopting healthy behaviours, including limited access to culturally appropriate dietary guidance, time constraints, and systematic healthcare challenges. In response, the intervention addressed these barriers through educational and training modules, culturally tailored counselling, and structured peer support, focusing on dietary and physical activity behaviours. Seven Behaviour Change Wheel intervention functions were applied, incorporating BCTs aligned with identified determinants. Conclusion: The BALANCED intervention offers an innovative, culturally tailored approach to supporting sustainable behaviour change among Black African women living with overweight and obesity. Grounded in behavioural theory and informed by empirical evidence, it addresses multidimensional barriers and supports engagement. Future research will pilot the intervention and evaluate its effectiveness and scalability to inform public health strategies to reduce health disparities in this population.

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