Prospective prediction of health-related behaviours with the Theory of Planned Behaviour: a meta-analysis

Drinker prototype alteration and cue reminders as strategies in a tailored web-based intervention reducing adults' alcohol consumption: randomized controlled trial

BACKGROUND

Excessive alcohol use is a prevalent and worldwide problem. Excessive drinking causes a significant burden of disease and is associated with both morbidity and excess mortality. Prototype alteration and provision of a cue reminder could be useful strategies to enhance the effectiveness of online tailored interventions for excessive drinking.

OBJECTIVE

Through a Web-based randomized controlled trial, 2 strategies (ie, prototype alteration and cue reminders) within an existing online personalized feedback intervention (Drinktest) aimed to reduce adults' excessive drinking. It was expected that both strategies would add to Drinktest and would result in reductions in alcohol consumption by intrinsic motivation and the seizure of opportunities to act.

METHODS

Participants were recruited online and through printed materials. Excessive drinking adults (N=2634) were randomly assigned to 4 conditions: original Drinktest, Drinktest plus prototype alteration, Drinktest plus cue reminder, and Drinktest plus prototype alteration and cue reminder. Evaluation took place at 1-month posttest and 6-month follow-up. Differences in drinking behavior, intentions, and behavioral willingness (ie, primary outcomes) were assessed by means of longitudinal multilevel analyses using a last observation carried forward method. Measures were based on self-reports.

RESULTS

All conditions showed reductions in drinking behavior and willingness to drink, and increased intentions to reduce drinking. Prototype alteration (B=-0.15, P<.05) and cue reminder usage (B=-0.15, P<.05) were both more effective in reducing alcohol consumption than when these strategies were not provided. Combining the strategies did not produce a synergistic effect. No differences across conditions were found regarding intentions or willingness.

CONCLUSIONS

Although individuals' awareness of their cue was reasonable, their reported alcohol consumption was nevertheless reduced. Individuals appeared to distance their self-image from heavier drinking prototypes. Thus, prototype alteration and cue reminder usage may be feasible and simple intervention strategies to promote reductions in alcohol consumption among adults, with an effect up to 6 months.

TRIAL REGISTRATION

Nederlands Trial Register (NTR): 4169; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4169 (Archived by WebCite at http://www.webcitation.org/6VD2jnxmB).

Knowledge, attitudes, beliefs and behaviour intentions for three bowel management practices in intensive care: effects of a targeted protocol implementation for nursing and medical staff

BACKGROUND

Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians' intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs' knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices.

METHODS

A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May - June 2008; post: Feb - May 2009).

RESULTS

Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema.

CONCLUSION

This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians' knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management practices. Further research is required to explore the influence of opinion leaders and organizational culture on clinicians' behaviour intentions related to bowel management for intensive care patients.

Psychosocial determinants of physicians' intention to practice euthanasia in palliative care

BACKGROUND

Euthanasia remains controversial in Canada and an issue of debate among physicians. Most studies have explored the opinion of health professionals regarding its legalization, but have not investigated their intentions when faced with performing euthanasia. These studies are also considered atheoretical. The purposes of the present study were to fill this gap in the literature by identifying the psychosocial determinants of physicians' intention to practice euthanasia in palliative care and verifying whether respecting the patient's autonomy is important for physicians.

METHODS

A validated anonymous questionnaire based on an extended version of the Theory of Planned Behavior was mailed to a random sample of 445 physicians from the province of Quebec, Canada.

RESULTS

The response rate was 38.3% and the mean score for intention was 3.94 ± 2.17 (range: 1 to 7). The determinants of intention among physicians were: knowing patients' wishes (OR = 10.77; 95%CI: 1.33-86.88), perceived behavioral control-physicians' evaluation of their ability to adopt a given behavior-(OR = 4.35; 95%CI: 1.44-13.15), moral norm-the appropriateness of adopting a given behavior according to one's personal and moral values-(OR = 3.22; 95%CI: 1.29-8.00) and cognitive attitude-factual consequences of the adoption of a given behavior-(OR = 3.16; 95%CI: 1.20-8.35). This model correctly classified 98.8% of physicians. Specific beliefs that might discriminate physicians according to their level of intention were also identified. For instance, physicians' moral norm was related to the ethical principle of beneficence.

CONCLUSIONS

Overall, physicians have weak intentions to practice euthanasia in palliative care. Nevertheless, respecting patients' final wishes concerning euthanasia seems to be of particular importance to them and greatly affects their motivation to perform euthanasia.

Evidence that implementation intentions reduce drivers' speeding behavior: testing a new intervention to change driver behavior

Implementation intentions have the potential to break unwanted habits and help individuals behave in line with their goal intentions. We tested the effects of implementation intentions in the context of drivers' speeding behavior. A randomized controlled design was used. Speeding behavior, goal intentions and theoretically derived motivational pre-cursors of goal intentions were measured at both baseline and follow-up (one month later) using self-report questionnaires. Immediately following the baseline questionnaire, the experimental (intervention) group (N=117) specified implementation intentions using a volitional help sheet, which required the participants to link critical situations in which they were tempted to speed with goal-directed responses to resist the temptation. The control group (N=126) instead received general information about the risks of speeding. In support of the hypotheses, the experimental group reported exceeding the speed limit significantly less often at follow-up than did the control group. This effect was specific to 'inclined abstainers' (i.e., participants who reported speeding more than they intended to at baseline and were therefore motivated to reduce their speeding) and could not be attributed to any changes in goal intentions to speed or any other measured motivational construct. Also in line with the hypotheses, implementation intentions attenuated the past-subsequent speeding behavior relationship and augmented the goal intention - subsequent speeding behavior relationship. The findings imply that implementation intentions are effective at reducing speeding and that they do so by weakening the effect of habit, thereby helping drivers to behave in accordance with their existing goal intentions. The volitional help sheet used in this study is an effective tool for promoting implementation intentions to reduce speeding.

False alarms and missed events: the impact and origins of perceived inaccuracy in tornado warning systems

Theory and conventional wisdom suggest that errors undermine the credibility of tornado warning systems and thus decrease the probability that individuals will comply (i.e., engage in protective action) when future warnings are issued. Unfortunately, empirical research on the influence of warning system accuracy on public responses to tornado warnings is incomplete and inconclusive. This study adds to existing research by analyzing two sets of relationships. First, we assess the relationship between perceptions of accuracy, credibility, and warning response. Using data collected via a large regional survey, we find that trust in the National Weather Service (NWS; the agency responsible for issuing tornado warnings) increases the likelihood that an individual will opt for protective action when responding to a hypothetical warning. More importantly, we find that subjective perceptions of warning system accuracy are, as theory suggests, systematically related to trust in the NWS and (by extension) stated responses to future warnings. The second half of the study matches survey data against NWS warning and event archives to investigate a critical follow-up question--Why do some people perceive that their warning system is accurate, whereas others perceive that their system is error prone? We find that subjective perceptions are--in part-a function of objective experience, knowledge, and demographic characteristics. When considered in tandem, these findings support the proposition that errors influence perceptions about the accuracy of warning systems, which in turn impact the credibility that people assign to information provided by systems and, ultimately, public decisions about how to respond when warnings are issued.

Evidence that attitude accessibility augments the relationship between speeding attitudes and speeding behavior: a test of the MODE model in the context of driving

According to the MODE model of attitude-to-behavior processes, attitude accessibility augments attitude-behavior correspondence, reflecting an automatic influence of attitudes on behavior. We therefore tested whether attitude accessibility moderates the attitude-behavior relationship in a context that is governed by characteristically automatic behavior, namely driving. In study 1 (correlational design), participants (N=130) completed online questionnaire measures of the valences and accessibilities of their attitudes towards speeding. Two weeks later, online questionnaire measures of subsequent speeding behavior were obtained. Attitude valence was a significantly better predictor of behavior at high (mean+1SD) versus low (mean-1SD) levels of attitude accessibility. In study 2 (experimental design), attitude accessibility was manipulated with a repeated attitude expression task. Immediately after the manipulation, participants (N=122) completed online questionnaire measures of attitude valence and accessibility, and two weeks later, subsequent speeding behavior. Increased attitude accessibility in the experimental (versus control) condition generated an increase in attitude-behavior correspondence. The findings are consistent with the MODE model's proposition that attitudes can exert an automatic influence on behavior. Interventions to reduce speeding could usefully increase the accessibility of anti-speeding attitudes and reduce the accessibility of pro-speeding attitudes.

Predicting actual weight loss: A review of the determinants according to the theory of planned behaviour

Weight reduction that corresponds with lifestyle modification is difficult to foster. The theory of planned behaviour has been actively cited in explaining health-related behaviour. This review evaluated the application of the theory of planned behaviour to weight-loss behaviour. Among the three reviewed papers, cross-sectional survey designs and subjective outcome measurements were commonly applied. All of the studies recruited obese female adults as participants, limiting the generalisability of the studies' findings. The theory of planned behaviour can be effectively applied in weight-reduction programmes targeting female obese patients. This review confirmed critiques citing the limitations of experimental studies, the subjective measurement of behaviour and short follow-up periods.

Psychosocial determinants of nurses’ intention to practise euthanasia in palliative care

Background:

Most studies on euthanasia fail to explain the intentions of health professionals when faced with performing euthanasia and are atheoretical.

Research objective:

The purpose of this study was to identify the psychosocial determinants of nurses’ intention to practise euthanasia in palliative care if it were legalised.

Research design:

A cross-sectional study using a validated anonymous questionnaire based on an extended version of the Theory of Planned Behaviour.

Participants and research context:

A random sample of 445 nurses from the province of Quebec, Canada, was selected for participation in the study.

Ethical considerations:

The study was reviewed and approved by the Ethics Committee of the Centre hospitalier universitaire de Québec.

Findings:

The response rate was 44.2% and the mean score for intention was 4.61 ± 1.90 (range: 1–7). The determinants of intention were the subjective (odds ratio = 3.08; 95% confidence interval: 1.50–6.35) and moral (odds ratio = 2.95; 95% confidence interval: 1.58–5.49) norms. Specific beliefs which could discriminate nurses according to their level of intention were identified.

Discussion:

Overall, nurses have a slightly positive intention to practise euthanasia. Their family approval seems particularly important and also the approval of their medical colleagues. Nurses’ moral norm was related to beneficence, an ethical principle.

Conclusion:

To our knowledge, this is the first study to identify nurses’ motivations to practise euthanasia in palliative care using a validated psychosocial theory. It also has the distinction of identifying the ethical principles underlying nurses’ moral norm and intention.

Social cognitive theory and physical activity: a systematic review and meta-analysis

This review investigated three research questions (i) What is the utility of social cognitive theory (SCT) to explain physical activity (PA)?; (ii) Is the effectiveness of SCT moderated by sample or methodological characteristics? and (iii) What is the frequency of significant associations between the core SCT constructs and PA? Ten electronic databases were searched with no date or sample restrictions. Forty-four studies were retrieved containing 55 SCT models of PA. Methodological quality was assessed using a standardized tool. A random-effects meta-analysis revealed that SCT accounted for 31% of the variance in PA. However, methodological quality was mostly poor for these models. Methodological quality and sample age moderated the PA effect size, with increases in both associated with greater variance explained. Although self-efficacy and goals were consistently associated with PA, outcome expectations and socio-structural factors were not. This review determined that SCT is a useful framework to explain PA behaviour. Higher quality models explained more PA variance, but overall methodological quality was poor. As such, high-quality studies examining the utility of SCT to explain PA are warranted.

Testing the bi-dimensional effects of attitudes on behavioural intentions and subsequent behaviour

Attitudes are typically treated as unidimensional predictors of both behavioural intentions and subsequent behaviour. On the basis of previous research showing that attitudes comprise two independent, positive and negative dimensions, we hypothesized that attitudes would be bi-dimensional predictors of both behavioural intentions and subsequent behaviour. We focused on health-risk behaviours. We therefore also hypothesized that the positive dimension of attitude (evaluations of positive behavioural outcomes) would better predict both behavioural intentions and subsequent behaviour than would the negative dimension, consistent with the positivity bias/offset principle. In Study 1 (cross sectional design), N = 109 university students completed questionnaire measures of their intentions to binge-drink and the positive and negative dimensions of attitude. Consistent with the hypotheses, both attitude dimensions independently predicted behavioural intentions and the positive dimension was a significantly better predictor than was the negative dimension. The same pattern of findings emerged in Study 2 (cross sectional design; N = 186 university students) when we predicted intentions to binge-drink, smoke and consume a high-fat diet. Similarly, in Study 3 (prospective design; N = 1,232 speed limit offenders), both the positive and negative dimensions of attitude predicted subsequent (6-month post-baseline) speeding behaviour on two different road types and the positive dimension was the better predictor. The implications for understanding the motivation of behaviour and the development of behaviour-change interventions are discussed.

African American organ donor registration: a mixed methods design using the theory of planned behavior

CONTEXT

A large racial disparity exists in organ donation.

OBJECTIVE

To identify factors associated with becoming a registered organ donor among African Americans in Alabama.

METHODS

Concurrent mixed methods design guided by the Theory of Planned Behavior to analyze African Americans' decisions to become a registered organ donor by using both qualitative (focus groups) and quantitative (survey) methods.

RESULTS

The sample consisted of 22 registered organ donors and 65 non registered participants from 6 focus groups completed in urban (n = 3) and rural (n = 3) areas. Participants emphasized the importance of the autonomy to make one's own organ donation decision and have this decision honored posthumously. One novel barrier to becoming a registered organ donor was the perception that organs from African Americans were often unusable because of the high prevalence of chronic medical conditions such as diabetes and hypertension. Another novel theme discussed as an advantage to becoming a donor was the subsequent motivation to take responsibility for one's health. Family and friends were the most common groups of persons identified as approving and disapproving of the decision to become a donor. The most common facilitator to becoming a donor was information, whereas fear and the lack of information were the most common barriers. In contrast, religious beliefs, mistrust, and social justice themes were infrequently referenced as barriers to becoming a donor.

CONCLUSION

Findings from this study may be useful for prioritizing organ donation community-based educational interventions in campaigns to increase donor registration.

Driving under the influence among frequent ecstasy consumers in Australia: trends over time and the role of risk perceptions

BACKGROUND

Driving under the influence (DUI) of alcohol and illicit drugs is a serious road safety concern. This research aimed to examine trends in DUI across time and changes in attitudes towards the risks (crash and legal) associated with DUI among regular ecstasy users (REU) interviewed in Australia.

METHODS

Participants were regular (at least monthly) ecstasy users surveyed in 2007 (n=573) or 2011 (n=429) who had driven a car in the last six months. Face to face interviews comprised questions about recent engagement of DUI and roadside breath (alcohol) and saliva (drug) testing. Participants also reported the risk of crash and of being apprehended by police if DUI of alcohol, cannabis, ecstasy, and methamphetamine.

RESULTS

There were significant reductions in DUI of psychostimulants (ecstasy, methamphetamine, cocaine, LSD) but not alcohol or cannabis between 2007 and 2011. This was accompanied by increased experience of roadside saliva testing and increases in crash and legal risk perceptions for ecstasy and methamphetamine, but not alcohol or cannabis. When the relationship between DUI and risk variables was examined, low crash risk perceptions were associated with DUI of all substances and low legal risk perceptions were associated with DUI of ecstasy.

CONCLUSIONS

The observed reduction in DUI of psychostimulants among frequent ecstasy consumers may be related to increased risk awareness stemming from educational campaigns and the introduction of saliva testing on Australian roads. Such countermeasures may be less effective in relation to deterring or changing attitudes towards DUI of cannabis and alcohol among this group.

Investigating driver willingness to drive through flooded waterways

Approximately 40% of all drowning deaths involve a motor vehicle. Regardless of its significance as a cause of flood-related mortality, there is continued prevalence of driving through flooded waterways in Australia and worldwide. We aimed to understand the motivational determinates of driving through flooded waterways in low and high-risk scenarios by utilizing an augmented theory of planned behaviour (TPB) with behavioural willingness as the outcome variable as well as the influence of additional predictors; namely perceived risk and past behaviour. Participants (n=174; Mage=27.43, SD=10.76) answered standard TPB-based questions in regards to attitudes, subjective norm, and perceived behavioural control (PBC), as well as additional variables of perceived risk (i.e., perceived susceptibility and perceived severity) and past behaviour. Support was found for the augmented TPB as attitude, subjective norm, and PBC predicted behavioural willingness. Support was also found for perceived severity in the high-risk but not the low-risk scenario. No support was found for perceived susceptibility. Past behaviour emerged as a significant predictor of willingness in the low and high-risk scenario. The findings provide support for an augmented TPB in understanding individuals' willingness to drive through flooded waterways, suggesting that a multi-strategy approach may be critical in attempts to reduce the incidence of such risky driving behaviour.

Using the intervention mapping protocol to develop a maintenance programme for the SLIMMER diabetes prevention intervention

Background

Although lifestyle interventions have shown to be effective in reducing the risk for type 2 diabetes mellitus, maintenance of achieved results is difficult, as participants often experience relapse after the intervention has ended. This paper describes the systematic development of a maintenance programme for the extensive SLIMMER intervention, an existing diabetes prevention intervention for high-risk individuals, implemented in a real-life setting in the Netherlands.

Methods

The maintenance programme was developed using the Intervention Mapping protocol. Programme development was informed by a literature study supplemented by various focus group discussions and feedback from implementers of the extensive SLIMMER intervention.

Results

The maintenance programme was designed to sustain a healthy diet and physical activity pattern by targeting knowledge, attitudes, subjective norms and perceived behavioural control of the SLIMMER participants. Practical applications were clustered into nine programme components, including sports clinics at local sports clubs, a concluding meeting with the physiotherapist and dietician, and a return session with the physiotherapist, dietician and physical activity group. Manuals were developed for the implementers and included a detailed time table and step-by-step instructions on how to implement the maintenance programme.

Conclusions

The Intervention Mapping protocol provided a useful framework to systematically plan a maintenance programme for the extensive SLIMMER intervention. The study showed that planning a maintenance programme can build on existing implementation structures of the extensive programme. Future research is needed to determine to what extent the maintenance programme contributes to sustained effects in participants of lifestyle interventions.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-1108) contains supplementary material, which is available to authorized users.

Consumer purchasing behaviour towards fish and seafood products. Patterns and insights from a sample of international studies

The present systematic review was performed to assess consumer purchasing behaviour towards fish and seafood products in the wide context of developed countries. Web of Science, Scopus, ScienceDirect and Google Scholar engines were used to search the existing literature and a total of 49 studies were identified for inclusion. These studies investigated consumer purchasing behaviour towards a variety of fish and seafood products, in different countries and by means of different methodological approaches. In particular, the review identifies and discusses the main drivers and barriers of fish consumption as well as consumers' preferences about the most relevant attributes of fish and seafood products providing useful insights for both practitioners and policy makers. Finally, main gaps of the existing literature and possible trajectories for future research are also discussed.

The contributions of behaviour change science towards dental public health practice: a new paradigm

Conventional behavioural models, such as social cognition models, to improve oral health have been proposed for a long time but have failed to consistently explain reliable amounts of variability in human behaviours relevant to oral health. This paper introduces current work from the behavioural sciences aiming to better understand the process through which behaviour change may take place. Given the shortcomings seen so far in attempts to explain behaviour through traditional models it is proposed that a new approach is adopted. This commentary outlines this new approach, grounded in current work by mainstream behaviour change experts. We propose that attempts to use unreliable theoretical models to explain and predict oral health behaviour should now be replaced by work following this new paradigm.

Doing more than Just Acknowledging Attrition at Follow-Up: A Comment on Lu, Cheng, and Chen (2013)

Lu, Cheng, and Chen (2013) faced one of the most common challenges encountered in longitudinal studies: follow-up attrition. Using a correlational prospective design, 464 volunteers completed a questionnaire that measured the constructs of the theory of planned behavior, and subsequently 154 of them provided physical activity data at a 6-month follow-up. The proportion of participants (66.8%) for whom the investigators were not able to gather information on the behavioral outcome at follow-up may reflect a form of selection bias that may affect both the validity and generalizability of study results. Lu, et al.'s (2013) study is used here to explore the implication of follow-up attrition on the results and inference, to review what information should be reported in a scientific paper in such situations, and to give practical tips to handle follow-up attrition.

How well does the theory of planned behaviour predict alcohol consumption? A systematic review and meta-analysis

This study aimed to quantify correlations between theory of planned behaviour (TPB) variables and (i) intentions to consume alcohol and (ii) alcohol consumption. Systematic literature searches identified 40 eligible studies that were meta-analysed. Three moderator analyses were conducted: pattern of consumption, gender of participants and age of participants. Across studies, intentions had the strongest relationship with attitudes (r₊ = .62), followed by subjective norms (r₊ = .47) and perceived behavioural control (PBC; r₊ = .31). Self-efficacy (SE) had a stronger relationship with intentions (r₊ = .48) compared with perceived control (PC; r₊ = −.10). Intention had the strongest relationship with alcohol consumption (r₊ = .54), followed by SE (r₊ = .41). In contrast, PBC and PC had negative relationships with alcohol consumption (r₊ = −.05 and −.13, respectively). All moderators affected TPB relationships. Patterns of consumption with clear definitions had stronger TPB relations, females reported stronger attitude–intention relations than males, and adults reported stronger attitude–intention and SE–intention relations than adolescents. Recommendations for future research include targeting attitudes and intentions in interventions to reduce alcohol consumption, using clear definitions of alcohol consumption in TPB items to improve prediction and assessing SE when investigating risk behaviours.

Association of implementation of a public bicycle share program with intention and self-efficacy: The moderating role of socioeconomic status

This natural experiment examines the effect of a public bicycle share program on cognitions and investigates the moderating influence of socioeconomic status on this effect. Two cross-sectional population-based surveys were conducted. Intention and self-efficacy to use the public bicycle share program were assessed by questionnaire. A difference-in-differences approach was adopted using logistic regression analyses. A significant effect of the public bicycle share program was observed on intention (exposure × time; odds ratio = 3.41; 95% confidence interval: 1.50-7.73) and self-efficacy (exposure; odds ratio = 1.61; 95% confidence interval: 1.28-2.01). A positive effect on intention was observed among individuals with low income (exposure × time; odds ratio = 27.85; 95% confidence interval: 2.51-309.25). Implementing a public bicycle share program is associated with increases in intention and self-efficacy for public bicycle share use, although some social inequalities persist.

'My health is not a job': a qualitative exploration of personal health management and imperatives of the 'new public health'

BACKGROUND

There is an increasing push in Western healthcare for people to 'manage' their health, a key aspect of what has been called the 'new public health'. It has been argued that this 'personal health management' - informal work done to monitor, inform, or influence one's health - may be a burden, with potential to contribute to poor health outcomes. However, there is little research actually examining perceptions of personal health management and the 'burden' of these activities, particularly for generally healthy individuals.

METHODS

We conducted exploratory qualitative interviews with 30 generally healthy men and women about their perceptions and experiences of personal health management. Questions focused on health behaviours (e.g., information seeking), as well as feelings about these behaviours and perceptions of the time dedicated to health. Audio-recorded interviews were transcribed and analyzed qualitatively using NVivo 10. Where appropriate, quantitative codes were applied and descriptive statistics are reported alongside qualitative findings.

RESULTS

Participants were generally satisfied with the amount of time spent on their health and few perceived personal health management as a burden. Many participants took issue with the concept of 'work' being associated with health and stressed the importance of taking personal responsibility for health.

CONCLUSIONS

Our findings suggest that generally healthy people have internalised the notion of the 'new public health' and accepted the imperative of personal health responsibility. On the one hand, this bodes well for healthy individuals; their positive attitude may lead to better health outcomes, and the manageable amount of time spent suggests personal health management is unlikely to cause negative health consequences associated with stress. On the other hand, our findings may indicate that other factors, such as social determinants of health, are ignored in health promotion efforts and that those who cannot manage their own health may fall further behind. Future research should continue to explore the time people spend 'working' for their health, and how they perceive and respond to 'new public health' imperatives.

Predicting use of ineffective vegetable parenting practices with the Model of Goal Directed Behavior

OBJECTIVE

Increasing a parent's ability to influence a child's vegetable intake may require reducing the parent's use of ineffective vegetable parenting practices. The present study was designed to understand the psychosocial influences on ineffective vegetable parenting practices.

DESIGN

A cross-sectional web-based survey was conducted to model use of ineffective vegetable parenting practices using validated scales from a Model of Goal Directed Vegetable Parenting Practices.

SETTING

The dependent variable was a composite ineffective vegetable parenting practices index. The independent variables included validated subscales of intention, habit, perceived barriers, desire, competence, autonomy, relatedness, attitudes, norms, perceived behavioural control and anticipated emotions. Models were analysed using block regression with backward deletion.

SUBJECTS

Parents of 307 pre-school children (3-5 years old).

RESULTS

Variables significantly positively related to ineffective vegetable parenting practices in order of relationship strength included habit of controlling vegetable practices (standardized β=0·349, P<0·0001) and desire (standardized β=0·117, P=0·025). Variables significantly negatively related to ineffective vegetable parenting practices in order of relationship strength included perceived behavioural control of negative parenting practices (standardized β=-0·215, P<0000), the habit of active child involvement in vegetable selection (standardized β=-0·142, P=0·008), anticipated negative parent emotional response to child vegetable refusal (standardized β=-0·133, P=0·009), autonomy (standardized β=-0·118, P=0.014), attitude about negative effects of vegetables (standardized β=-0·118, P=0·015) and descriptive norms (standardized β=-0·103, P=0·032). The model accounted for 40·5 % of the variance in use of ineffective vegetable parenting practices.

CONCLUSIONS

The present study is the first report of psychometrically tested scales to predict use of ineffective vegetable parenting practices. Innovative intervention procedures will need to be designed and tested to reduce ineffective vegetable parenting practices.

Predicting Australian adults' sun-safe behaviour: examining the role of personal and social norms

OBJECTIVES

To address the scarcity of comprehensive, theory-based research in the Australian context, this study, using a theory of planned behaviour (TPB) framework, investigated the role of personal and social norms to identify the key predictors of adult Australians' sun-safe intentions and behaviour.

DESIGN

The study used a prospective design with two waves of data collection, 1 week apart.

METHODS

Participants were 816 adults (48.2% men) aged between 18 and 88 years recruited from urban, regional, and rural areas of Australia. At baseline, participants completed a questionnaire assessing the standard TPB predictors (attitude, subjective norm, and perceived behavioural control [PBC]), past behaviour, behavioural intention, and additional measures of group norm for the referent groups of friends and family, image norm, personal norm, personal choice/responsibility, and Australian identity. Seventy-one per cent of the participants (n = 577) reported on their sun-safe behaviour in the subsequent week.

RESULTS

Via path modelling, past behaviour, attitude, group norm (friends), personal norm, and personal choice/responsibility emerged as independent predictors of intentions which, in turn, predicted sun-safe behaviour prospectively. Past behaviour, but not PBC, had direct effects on sun-safe behaviour. The model explained 61.6% and 43.9% of the variance in intention and behaviour, respectively.

CONCLUSIONS

This study provides support for the use of a comprehensive theoretical decision-making model to explain Australian adults' sun-safe intentions and behaviours and identifies viable targets for health-promoting messages in this high-risk context. Statement of contribution What is already known on this subject? Identifying determinants of sun-safe behaviour is vital in high-risk cancer areas like Australia. For young Australians, friendship group norm is a key influence of intentions and behaviour. Little is known about drivers of sun safety, especially norms, among Australian adults in general. What does this study add? This study drew on qualitative data and reconceptualized norms for Australians' sun-safe decisions. Friendship group norm and personal norm, not family group norm, influence sun-safe intentions. Perceived responsibility and choice to be sun safe also impact on people's intentions.

Pre-drinking and alcohol-related harm in undergraduates: the influence of explicit motives and implicit alcohol identity

The present study investigated how pre-drinking could be explained using a model based on dual-systems theory, incorporating measures of explicit and implicit constructs. Undergraduate students (N = 144; 44 male; 100 female; M age = 20.1 years), completed an online survey comprising measures of pre-drinking motives, a measure of pre-drinking cost motives, and an alcohol identity implicit association test. Variance-based structural equation modelling revealed that the predictors explained 34.8% of the variance in typical pre-drinking alcohol consumption and 25% of the variance in alcohol-related harm. Cost, interpersonal enhancement, and barriers to consumption motives predicted higher typical pre-drinking alcohol consumption and greater alcohol-related harm. Higher situational control scores predicted lower typical pre-drinking alcohol consumption, and lower alcohol-related harm. Positive implicit alcohol identity predicted alcohol-related harm, but not typical alcohol consumption. Results indicate that a dual-systems approach to pre-drinking has utility in predicting alcohol-related harm and may inform interventions to reduce excessive alcohol consumption and associated harm.

Explaining young adults' drinking behaviour within an augmented Theory of Planned Behaviour: temporal stability of drinker prototypes

OBJECTIVES

Prototypes (i.e., social images) predict health-related behaviours and intentions within the context of the Theory of Planned Behaviour (TPB). This study tested the moderating role of temporal stability of drinker prototype perceptions on prototype-intentions and prototype-behaviour relationships, within an augmented TPB. The study examined abstainer, moderate drinker, heavy drinker, tipsy, and drunk prototypes.

DESIGN AND METHODS

An online prospective study with 1-month follow-up was conducted among 410 young adults (18-25 years old, Mage = 21.0, SD = 2.14, 21.7% male). Assessed were prototype perceptions (favourability and similarity, T1, T2), stability of prototype perceptions, TPB variables (T1), intentions (T2), and drinking behaviour (T2). Intention analyses were corrected for baseline behaviour; drinking behaviour analyses were corrected for intentions and baseline behaviour.

RESULTS

Hierarchical regressions showed that prototype stability moderated the relationships of drunk and abstainer prototype similarity with intentions. Similarity to the abstainer prototype explained intentions to drink sensibly more strongly among individuals with stable perceptions than among those with unstable perceptions. Conversely, intentions were explained stronger among individuals with stable perceptions of dissimilarity to the drunk prototype than among those with unstable perceptions. No moderation effects were found for stability of favourability or for relationships with behaviour.

CONCLUSIONS

Stable prototype similarity perceptions were more predictive of intentions than unstable perceptions. These perceptions were most relevant in enhancing the explanation of young adults' intended drinking behaviour. Specifically, young adults' health intentions seem to be guided by the dissociation from the drunk prototype and association with the abstainer prototype. Statement of contribution What is already known on this subject? Prototypes have augmented the Theory of Planned Behaviour in explaining risk behaviour. Temporal stability has been shown to successfully extend the TPB in explaining intentions. Temporal stability of TPB variables can moderate the relationships with behaviour and intentions. What does this study add? Stability of prototype perceptions moderates the prototype-intentions relationship. Stability of abstainer and drunk prototype similarity enhances the explanation of (intentional) drinking. Stable prototype perceptions are more explanatory than unstable perceptions.

Perceived behavioural control, subjective norms, attitudes and intention to use condom: a longitudinal cross-lagged design

Based on the Theory of Planned Behaviour (TPB), the purpose of this investigation was to examine the directionality of the association among condom use, intention, attitudes, subjective norms and perceived behavioural control. The present study investigated the nature of these relationships using a longitudinal cross-lagged design applied to data from a cohort of 958 randomly selected Italian adults. Using structural equation modelling, two cross-lagged panel analyses revealed reciprocal relationships between intention and attitudes and between intention and condom use. Contrary to expectations, baseline subjective norms and perceived behavioural control did not predict subsequent intention to use condom when controlled for the autoregressive effect of intention at T1 on the same variable at T2. Also, perceived behavioural control at T1 did not influence condom use at T2 after controlling for the effect of baseline intention. The possibility of reciprocity was also tested for all relations and significant results were found. The moderation effect of perceived behavioural control on the relationship between intention and condom use was not significant. The differences in age, gender and partnership status were taken into account in the analyses.

Modeling mental health information preferences during the early adult years: a discrete choice conjoint experiment

Although most young adults with mood and anxiety disorders do not seek treatment, those who are better informed about mental health problems are more likely to use services. The authors used conjoint analysis to model strategies for providing information about anxiety and depression to young adults. Participants (N = 1,035) completed 17 choice tasks presenting combinations of 15 four-level attributes of a mental health information strategy. Latent class analysis yielded 3 segments. The virtual segment (28.7%) preferred working independently on the Internet to obtain information recommended by young adults who had experienced anxiety or depression. Self-assessment options and links to service providers were more important to this segment. Conventional participants (30.1%) preferred books or pamphlets recommended by a doctor, endorsed by mental health professionals, and used with a doctor's support. They would devote more time to information acquisition but were less likely to use Internet social networking options. Brief sources of information were more important to the low interest segment (41.2%). All segments preferred information about alternative ways to reduce anxiety or depression rather than psychological approaches or medication. Maximizing the use of information requires active and passive approaches delivered through old-media (e.g., books) and new-media (e.g., Internet) channels.

A randomised controlled trial of a theory of planned behaviour to increase fruit and vegetable consumption. Fresh Facts

Young adults are less likely than other adults to consume fruit and vegetables. Fresh Facts is a theory of planned behaviour based intervention designed to promote fruit and vegetable consumption. The present study sought to evaluate Fresh Facts using a randomised controlled trial. Australian young adults (n = 162) were allocated to the Fresh Facts intervention or to the control group in 2011. Intervention participants received automated email messages promoting fruit and vegetable consumption every 3 days over the course of the 1 month intervention. Messages targeted attitude, subjective norm, and perceived behavioural control. Theory of planned behaviour variables and fruit and vegetable intake were measured at baseline and post-intervention (Day 30). Significant increases in attitude and subjective norm relative to control were found among Fresh Facts participants. However, intention, perceived behavioural control and fruit and vegetable consumption did not change as a result of the intervention. Changes in intention reported by each participant between baseline and follow-up were not correlated with corresponding changes in fruit and vegetable consumption. Fresh Facts was not successful in increasing fruit and vegetable consumption. Current evidence does not support the use of the theory of planned behaviour in the design of interventions to increase fruit and vegetable intake in this population.

Development of theory-based health messages: three-phase programme of formative research

Online health behaviour interventions have great potential but their effectiveness may be hindered by a lack of formative and theoretical work. This paper describes the process of formative research to develop theoretically and empirically based health messages that are culturally relevant and can be used in an online intervention to promote healthy lifestyle behaviours among new university students. Drawing on the Theory of Planned Behaviour, a three-phase programme of formative research was conducted with prospective and current undergraduate students to identify (i) modal salient beliefs (the most commonly held beliefs) about fruit and vegetable intake, physical activity, binge drinking and smoking, (ii) which beliefs predicted intentions/behaviour and (iii) reasons underlying each of the beliefs that could be targeted in health messages. Phase 1, conducted with 96 pre-university college students, elicited 56 beliefs about the behaviours. Phase 2, conducted with 3026 incoming university students, identified 32 of these beliefs that predicted intentions/behaviour. Phase 3, conducted with 627 current university students, elicited 102 reasons underlying the 32 beliefs to be used to construct health messages to bolster or challenge these beliefs. The three-phase programme of formative research provides researchers with an example of how to develop health messages with a strong theoretical- and empirical base for use in health behaviour change interventions.

Theory of planned behaviour variables and objective walking behaviour do not show seasonal variation in a randomised controlled trial

BACKGROUND

Longitudinal studies have shown that objectively measured walking behaviour is subject to seasonal variation, with people walking more in summer compared to winter. Seasonality therefore may have the potential to bias the results of randomised controlled trials if there are not adequate statistical or design controls. Despite this there are no studies that assess the impact of seasonality on walking behaviour in a randomised controlled trial, to quantify the extent of such bias. Further there have been no studies assessing how season impacts on the psychological predictors of walking behaviour to date. The aim of the present study was to assess seasonal differences in a) objective walking behaviour and b) Theory of Planned Behaviour (TPB) variables during a randomised controlled trial of an intervention to promote walking.

METHODS

315 patients were recruited to a two-arm cluster randomised controlled trial of an intervention to promote walking in primary care. A series of repeated measures ANCOVAs were conducted to examine the effect of season on pedometer measures of walking behaviour and TPB measures, assessed immediately post-intervention and six months later. Hierarchical regression analyses were conducted to assess whether season moderated the prediction of intention and behaviour by TPB measures.

RESULTS

There were no significant differences in time spent walking in spring/summer compared to autumn/winter. There was no significant seasonal variation in most TPB variables, although the belief that there will be good weather was significantly higher in spring/summer (F = 19.46, p < .001). Season did not significantly predict intention or objective walking behaviour, or moderate the effects of TPB variables on intention or behaviour.

CONCLUSION

Seasonality does not influence objectively measured walking behaviour or psychological variables during a randomised controlled trial. Consequently physical activity behaviour outcomes in trials will not be biased by the season in which they are measured. Previous studies may have overestimated the extent of seasonality effects by selecting the most extreme summer and winter months to assess PA. In addition, participants recruited to behaviour change interventions might have higher levels of motivation to change and are less affected by seasonal barriers.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN95932902.