Social-Cognitive Factors in Changing Health-Related Behaviors

Health, coping and subjective well-being: results of a longitudinal study of elderly Israelis

OBJECTIVES

The aim of this study was to test a conceptual model designed to promote the understanding of factors influencing subjective well-being (SWB) in old age. Within this framework, we evaluated the relative influences on elderly Israelis' SWB of health and/or function, personal resources, coping behaviors (reactive and proactive), and changes in all of these factors over time.

METHOD

At baseline, 1216 randomly selected elderly persons (75+) were interviewed at home (T1) and 1019 one year later (T2). The conceptual model was evaluated by Structural Equation Modeling (SEM) analysis using AMOS 18.

RESULTS

After one year, a relatively high percentage of participants reported decline in health/function (DHF) and in personal resources. The effects of the study variables on T2-SWB were evaluated by a SEM analysis, resulting in a satisfying fit: χ² = 279.5 (df = 102), p < .001, CFI = .970, NFI = .954, TLI = .955, RMSEA = .046. In addition to significant direct effects of health/function on T2-SWB, health/function was found to indirectly influence T2-SWB. Our analysis showed that health/function had a negative influence on the positive effects of personal resources (function self-efficacy, social support) and the diverse effects of the coping patterns (goal-reengagement - positive; expectations for future care needs - negative; having concrete plans for future care - positive).

CONCLUSION

Personal resources and use of appropriate coping behaviors enable elderly people to control their well-being even in the presence of DHF. Evidence-based interventions can help older people to acquire and/or strengthen effective personal resources and coping patterns, thus, promoting their SWB.

Creating an upward spiral: A qualitative study of caregivers' experience of participating in a structured physical activity programme

Family caregivers' physical and emotional well-being may be negatively impacted while in the caregiver role. Interventions to support caregiver health have largely focused on psychological support, with only a few studies to date evaluating the role of exercise. Of the exercise studies conducted, there has been one qualitative study examining caregivers' perspectives on the value and impact of this type of intervention. This qualitative study was part of a larger mixed methods investigation including a randomised controlled trial investigating the effects of a 24-week exercise programme for cancer caregivers conducted in western Canada. We aimed to explore cancer family caregivers' experience of participating in a structured exercise programme. We conducted face-to-face interviews with 20 of the participants from the exercise intervention and analysed transcribed data using Thorne's interpretive description as a guiding framework. Two main patterns characterised the experiences of the caregivers. The metaphor of a downward spiral represented the experience of being in the caregiver role, while the metaphor of an upward spiral represented the experience of participating in the exercise programme. Our findings highlight that caregivers valued the exercise programme, experienced positivity through exercise and the group-based format, and noticed improvements to their physical and emotional well-being.

Using an Internet-Based Breast Cancer Risk Assessment Tool to Improve Social-Cognitive Precursors of Physical Activity

BACKGROUND

Internet-based cancer risk assessment tools might serve as a strategy for translating epidemiological risk prediction research into public health practice. Understanding how such tools affect key social-cognitive precursors of behavior change is crucial for leveraging their potential into effective interventions.

PURPOSE

To test the effects of a publicly available, Internet-based, breast cancer risk assessment tool on social-cognitive precursors of physical activity.

METHODS

Women (N = 132) aged 40-78 with no personal cancer history indicated their perceived risk of breast cancer and were randomly assigned to receive personalized ( www.yourdiseaserisk.wustl.edu ) or nonpersonalized breast cancer risk information. Immediately thereafter, breast cancer risk perceptions and physical activity-related behavioral intentions, self-efficacy, and response efficacy were assessed.

RESULTS

Personalized information elicited higher intentions, self-efficacy, and response efficacy than nonpersonalized information, P values < 0.05. Self-efficacy and response efficacy mediated the effect of personalizing information on intentions. Women who received personalized information corrected their inaccurate risk perceptions to some extent, P values < 0.05, but few fully accepted the information.

CONCLUSION

Internet-based risk assessment tools can produce beneficial effects on important social-cognitive precursors of behavior change, but lingering skepticism, possibly due to defensive processing, needs to be addressed before the effects can be maximized.

Self-management education interventions for patients with cancer: a systematic review

PURPOSE

This systematic review was intended to identify the effectiveness and inclusion of essential components of self-management education interventions to support patients with cancer in developing the skills needed for effective self-management of their disease and the acute or immediate, long-term, and late harmful effects of treatments.

METHODS

Self-management education interventions were included if they were randomized controlled trials (RCTs) containing at least one of the eight core elements outlined by the research team. A systematic search was conducted in Ovid MEDLINE (2005 through April 2015), Embase (2005 to 2015, week 15), the Cochrane Database of Systematic Reviews (Issue 4, April 2015), CINAHL (2005 to 2015) and PsychINFO (2005 to 2015). Keywords searched include 'self-management patient education' or 'patient education'.

RESULTS

Forty-two RCTs examining self-management education interventions for patients with cancer were identified. Heterogeneity of interventions precluded meta-analysis, but narrative qualitative synthesis suggested that self-management education interventions improve symptoms of fatigue, pain, depression, anxiety, emotional distress and quality of life. Results for specific combinations of core elements were inconclusive. Very few studies used the same combinations of core elements, and among those that did, results were conflicting. Thus, conclusions as to the components or elements of self-management education interventions associated with the strength of the effects could not be assessed by this review.

CONCLUSION

Defining the core components of cancer self-management education and the fundamental elements for inclusion in supporting effective self-management will be critical to ensure consistent and effective provision of self-management support in the cancer system.

Influence of Hearing Risk Information on the Motivation and Modification of Personal Listening Device Use

PURPOSE

The purpose of this study was (a) to investigate the behaviors, knowledge, and motivators associated with personal listening device (PLD) use and (b) to determine the influence of different types of hearing health risk education information (text with or without visual images) on motivation to modify PLD listening use behaviors in young adults.

METHOD

College-age students (N = 523) completed a paper-and-pencil survey tapping their behaviors, knowledge, and motivation regarding listening to music or media at high volume using PLDs. Participants rated their motivation to listen to PLDs at lower volume levels following each of three information sets: text only, behind-the-ear hearing aid image with text, and inner ear hair cell damage image with text.

RESULTS

Acoustically pleasing and emotional motives were the most frequently cited (38%-45%) reasons for listening to music or media using a PLD at high volume levels. The behind-the-ear hearing aid image with text information was significantly (p < .0001) more motivating to participants than text alone or the inner ear hair cell damage image with text.

CONCLUSIONS

Evocative imagery using hearing aids may be an effective approach in hearing protective health campaigns for motivating safer listening practices with PLDs in young adults.

Randomised controlled trial of a digitally assisted low intensity intervention to promote personal recovery in persisting psychosis: SMART-Therapy study protocol

BACKGROUND

Psychosocial interventions have an important role in promoting recovery in people with persisting psychotic disorders such as schizophrenia. Readily available, digital technology provides a means of developing therapeutic resources for use together by practitioners and mental health service users. As part of the Self-Management and Recovery Technology (SMART) research program, we have developed an online resource providing materials on illness self-management and personal recovery based on the Connectedness-Hope-Identity-Meaning-Empowerment (CHIME) framework. Content is communicated using videos featuring persons with lived experience of psychosis discussing how they have navigated issues in their own recovery. This was developed to be suitable for use on a tablet computer during sessions with a mental health worker to promote discussion about recovery.

METHODS/DESIGN

This is a rater-blinded randomised controlled trial comparing a low intensity recovery intervention of eight one-to-one face-to-face sessions with a mental health worker using the SMART website alongside routine care, versus an eight-session comparison condition, befriending. The recruitment target is 148 participants with a schizophrenia-related disorder or mood disorder with a history of psychosis, recruited from mental health services in Victoria, Australia. Following baseline assessment, participants are randomised to intervention, and complete follow up assessments at 3, 6 and 9 months post-baseline. The primary outcome is personal recovery measured using the Process of Recovery Questionnaire (QPR). Secondary outcomes include positive and negative symptoms assessed with the Positive and Negative Syndrome Scale, subjective experiences of psychosis, emotional symptoms, quality of life and resource use. Mechanisms of change via effects on self-stigma and self-efficacy will be examined.

DISCUSSION

This protocol describes a novel intervention which tests new therapeutic methods including in-session tablet computer use and video-based peer modelling. It also informs a possible low intensity intervention model potentially viable for delivery across the mental health workforce.

TRIAL REGISTRATION

NCT02474524 , 24 May 2015, retrospectively registered during the recruitment phase.

Renewing caregiver health and wellbeing through exercise (RECHARGE): A randomized controlled trial

BACKGROUND

Family caregivers (FCs) to cancer patients are at increased risk for physical and emotional health problems as a result of being in the caregiver role. Current research on interventions for FCs has focused on psychological support or educational interventions, with very little investigation of exercise in maintaining or improving health. Based on our preliminary survey, participation in regular exercise to improve health was noted as a priority for FCs. The purpose of the study described in this protocol is to examine the impact of a 12-week structured exercise program on physical functioning (primary outcome), physical activity levels and psychological well-being (secondary outcomes), in FCs caring for adult cancer patients. In addition, the trial described here will examine the outcomes from a 12-week maintenance program, immediately following the initial program.

METHODS/DESIGN

A mixed methods design using a randomized control trial (RCT) with a 50/50 allocation ratio for the quantitative portion, followed by face to face interviews and qualitative data analysis. Approximately 86 participants will be enrolled over a 10 month period. The intervention will consist of a structured exercise program of aerobic and resistance training. An intention to treat principle using mixed effects modeling will guide data analysis.

DISCUSSION

FCs will continue to play a pivotal role in the care of cancer patients as the incidence and chronicity of cancer increases. The research described in this protocol will provide information about the impact of an exercise program in supporting FC health.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02580461.

PREVIEW Behavior Modification Intervention Toolbox (PREMIT): A Study Protocol for a Psychological Element of a Multicenter Project

BACKGROUND

Losing excess body weight and preventing weight regain by changing lifestyle is a challenging but promising task to prevent the incidence of type-2 diabetes. To be successful, it is necessary to use evidence-based and theory-driven interventions, which also contribute to the science of behavior modification by providing a deeper understanding of successful intervention components.

OBJECTIVE

To develop a physical activity and dietary behavior modification intervention toolbox (PREMIT) that fulfills current requirements of being theory-driven and evidence-based, comprehensively described and feasible to evaluate. PREMIT is part of an intervention trial, which aims to prevent the onset of type-2 diabetes in pre-diabetics in eight clinical centers across the world by guiding them in changing their physical activity and dietary behavior through a group counseling approach.

METHODS

The program development took five progressive steps, in line with the Public Health Action Cycle: (1) Summing-up the intervention goal(s), target group and the setting, (2) uncovering the generative psychological mechanisms, (3) identifying behavior change techniques and tools, (4) preparing for evaluation and (5) implementing the intervention and assuring quality.

RESULTS

PREMIT is based on a trans-theoretical approach referring to valid behavior modification theories, models and approaches. A major "product" of PREMIT is a matrix, constructed for use by onsite-instructors. The matrix includes objectives, tasks and activities ordered by periods. PREMIT is constructed to help instructors guide participants' behavior change. To ensure high fidelity and adherence of program-implementation across the eight intervention centers standardized operational procedures were defined and "train-the-trainer" workshops were held. In summary PREMIT is a theory-driven, evidence-based program carefully developed to change physical activity and dietary behaviors in pre-diabetic people.

Physical Exercise and Experienced Bodily Changes: The Emergence of Benefits and Limits on Benefits

Self-reports of levels of physical exercise, experienced bodily changes, and attitudinal and well-being variables were obtained from 407 adults, aged 26 to 95 years. The purpose was to assess the relative magnitudes of the experienced benefits of exercise across the exercise continuum. Cluster analyses identified three groups at each of four age levels: a) sedentary people who experienced negative bodily changes; b) modest exercisers who reported the most positive bodily changes; and c) high exercisers who reported only minimal bodily changes. Psychological barriers to exercise among sedentary people included negative exercise attitudes, attributions of negative bodily changes to aging, and low levels of exercise motivation and self-efficacy. Modest and high exercisers both scored high on attitude and well-being variables.

Multidimensional Health Locus of Control: Comments on the Construct and its Measurement

In the present commentary, the theoretical construct of Multidimensional Health Locus of Control (MHLC) is described and evaluated in terms of its contributions to health psychology. This concept is compared to other control beliefs, in particular to perceived self-efficacy. It is argued that MHLC has supplied health psychology with essential insights and has offered a great deal of intellectual stimulation. Nevertheless, for some applications, different constructs might be more promising, in particular when it comes to predicting health behavior change. MHLC measurement, specifically its factorial structure, its proximity to health outcomes and health behaviors and its cultural sensitivity are addressed. Further refinement of the instrument is recommended, and the range of promising applications needs to be clearly defined.

Validation and psychometric evaluation of physical activity belief scale among patients with type 2 diabetes mellitus: an application of health action process approach

BACKGROUND

Moderate increase in physical activity (PA) may be helpful in preventing or postponing the complications of type 2 diabetes mellitus (T2DM). The aim of this study was to assess the psychometric properties of a health action process approach (HAPA)-based PA inventory among T2DM patients.

METHODS

In 2015, this cross-sectional study was carried out on 203 participants recruited by convenience sampling in Isfahan, Iran. Content and face validity was confirmed by a panel of experts. The comments noted by 9 outpatients on the inventory were also investigated. Then,the items were administered to 203 T2DM patients. Construct validity was conducted using exploratory and structural equation modeling confirmatory factor analyses. Reliability was also assessed with Cronbach alpha and interclass correlation coefficient (ICC).

RESULTS

Content validity was acceptable (CVR = 0.62, CVI = 0.89). Exploratory factor analysis extracted seven factors (risk- perception, action self-efficacy, outcome expectancies, maintenance self-efficacy, action and coping planning, behavioral intention, and recovery self-efficacy) explaining 82.23% of the variation. The HAPA had an acceptable fit to the observations (χ2 = 3.21, df = 3, P = 0.38; RMSEA = 0.06; AGFI = 0.90; PGFI = 0.12). The range of Cronbach alpha and ICC for the scales was about 0.63 to 0.97 and 0.862 to 0.988, respectively.

CONCLUSION

The findings of the present study provided an initial support for the reliability and validity of the HAPA-based PA inventory among patients with T2DM.

Self-Monitoring Using Continuous Glucose Monitors with Real-Time Feedback Improves Exercise Adherence in Individuals with Impaired Blood Glucose: A Pilot Study

BACKGROUND

Exercise helps individuals with prediabetes or type 2 diabetes (T2D) manage their blood glucose (BG); however, exercise adherence in this population is dismal. In this pilot study we tested the efficacy of a self-monitoring group-based intervention using continuous glucose monitors (CGMs) at increasing exercise adherence in individuals with impaired BG.

MATERIALS AND METHODS

Thirteen participants with prediabetes or T2D were randomized to an 8-week standard care exercise program (CON condition) (n = 7) or self-monitoring exercise intervention (SM condition) (n = 6). Participants in the SM condition were taught how to self-monitor their exercise and BG, to goal set, and to use CGM to observe how exercise influences BG. We hypothesized that compared with the CON condition, using a real-time CGM would facilitate self-monitoring behavior, resulting in increased exercise adherence.

RESULTS

Repeated-measures analysis of variance revealed significant Condition × Time interactions for self-monitoring (P < 0.01), goal setting (P = 0.01), and self-efficacy to self-monitor (P = 0.01), such that the SM condition showed greater increases in these outcomes immediately after the program and at the 1-month follow-up compared with the CON condition. The SM condition had higher program attendance rates (P = 0.03), and a greater proportion of participants reregistered for additional exercise programs (P = 0.048) compared with the CON condition. Participants in both conditions experienced improvements in health-related quality of life, waist circumference, and fitness (P values <0.05).

CONCLUSIONS

These findings provide promising initial support for the use of a real-time CGM to foster self-monitoring and exercise behavior in individuals living with prediabetes or T2D.

Development and Psychometric Properties of the Yoga Self-Efficacy Scale (YSES)

BACKGROUND

Yoga is a behavioral practice that uses physical movement, breathing, and meditation to improve health and promote personal transformation. Ancient yoga philosophy proposed that an individual's confidence about yoga, a concept similar to self-efficacy, will affect the likelihood of improved health from yoga practice. The purpose of this study was to develop and examine the psychometric properties of a self-efficacy measure for yoga practice (the Yoga Self-Efficacy Scale; YSES).

METHODS

Yoga practitioners were recruited to evaluate the psychometric properties of YSES via a secure online survey. We collected data on additional measures to further examine construct validity. After two weeks, participants were invited to complete YSES items again to assess test-retest reliability.

RESULTS

A majority of participants (N = 309) were White (85%), female (82%), and yoga instructors (56%). The 12-item YSES is unidimensional with a Cronbach's alpha of 0.93. Test-retest reliability is r = 0.79 (n = 170). YSES scores are positively correlated with health competence, health-related quality of life, and years practicing yoga, supporting construct validity. Also, yoga teachers scored significantly higher on the YSES than non-teachers (p < 0.001). Non-significant relationships with education, income and sex supported discriminant validity. YSES maintained internal consistency and construct validity for all yoga styles surveyed.

CONCLUSION

YSES is a reliable and valid measure of self-efficacy for yoga practice that may provide insight into barriers to adopting and maintaining yoga as a health behavior.

[Risk of contamination from exposure to Rio Doce water: a case study on the population's perceptions in Tumiritinga, Minas Gerais State, Brazil]

The close relationship between local residents and the Rio Doce and the river's recurrent flooding lead to continuous exposure of the population to waterborne diseases. Given the epidemiological importance of such diseases in the region, this study analyzes the association between risk perception of contamination and river water use, as well as the heuristic mechanisms used by individuals to shape their personal perception of risk. Regression models coupled with thematic network analysis were applied to primary data from 352 households in 2012. The data are representative of urban residents of Tumiritinga, Minas Gerais State, Brazil. The results show that while 92.6% of respondents perceived high risk of waterborne diseases, only 11.4% reported not making direct use of the river. This apparent paradox is explained by the lack of information on transmission mechanisms, underestimating the perception of contamination. Public campaigns to promote preventive behavior should stress how waterborne diseases are transmitted, using simple examples to reach a wider local audience.

The effects of a peer modeling intervention on cardiorespiratory fitness parameters and self-efficacy in obese adolescents

Inconsistencies exist in the assessment and interpretation of peak VO2 in the pediatric obese population, as cardiorespiratory fitness assessments are effort-dependent and psychological variables prevalent in this population must be addressed. This study examined the effect of a peer modeling intervention on cardiorespiratory fitness performance and task self-efficacy in obese youth completing a maximal treadmill test. Forty-nine obese (BMI ≥ 95th percentile for age and sex) youth were randomized to an experimental (received an intervention) or to a control group. The outcome variables were mean and variability cardiorespiratory fitness (peak VO2, heart rate, duration, respiratory exchange ratio), rating of perceived exertion, and task self-efficacy scores. Irrespective of whether a mean or variability score was used, receiving the intervention was associated with non-significant trends in fitness parameters and task self-efficacy over time, favoring the experimental group. Cardiorespiratory fitness and task self-efficacy were moderately correlated at both time points. To elucidate the aforementioned findings, psychosocial factors affecting obese youth and opportunities to modify the peer modeling intervention should be considered. Addressing these factors has the potential to improve standard of care in a clinical setting regarding pretest patient education.

Executive function moderates the intention-behavior link for physical activity and dietary behavior

Dominant theories of health behavior posit that social-cognitive and conative variables are sufficient to explain health behavior tendencies. The current studies challenge this assumption in two ways: (1) by demonstrating that unique variance in health protective behavior is predictable by knowing about individual differences in executive functioning, and (2) by demonstrating that executive function moderates the association between intention and behavior. In Studies 1 and 2, participants completed a computer-based task of executive function (Go/NoGo task) and articulated 1-week behavioral intentions for physical activity (Study 1) and dietary behavior (Study 2). Hierarchical regression analyses revealed that executive function predicts unique variance in both behaviors, and strongly moderates the association between behavioral intention and behavioral performance. Together behavioral intention and executive function explain more variance in health protective behavior than 'rational actor' models that have been widely adopted and disseminated.

Psychometric validity of the parent's outcome expectations for children's television viewing (POETV) scale

Background

TV and other screen use are common among elementary school aged children with both potential benefits and harms. It is not clear why some parents restrict their children’s screen use and others do not. Parent’s outcome expectations for allowing their child to watch TV and other screen media, i.e. the perceived ‘costs’ and ‘benefits,’ may be influential. Our objective was to develop a measure of Parent’s Outcome Expectations for Children’s TV Viewing (POETV) and test the psychometrics of the resulting instrument among parents with children 6-12 years old.

Methods

An ethnically diverse sample (n = 311) of parents from Harris County, Texas completed measures for POETV, demographics, and parent and child TV viewing and other screen media use via an internet survey. The sample was randomly split and an exploratory factor analysis (EFA) was conducted among the first half of the sample separately for Positive and Negative POETV. A confirmatory factor analysis (CFA) assessed the fit of the resulting factors with the data in the second half of the sample. Internal reliabilities and Spearman partial correlations (controlling for confounders) of children’s TV and other screen use with the resulting POETV factors were calculated for the full sample.

Results

EFA identified two factors for Positive POETV (Parent Centered; Child Centered) and two factors for Negative POETV (TV & Content Exposure; Prevent Other Activities). Follow up CFA confirmed moderate to good psychometric properties for both factor structures with the addition of four correlated errors in the Positive POETV model. Internal reliabilities were appropriate (Cronbach’s alpha >0.7). Parent Centered Positive POETV and Child Centered Positive POETV were correlated with children’s TV viewing on weekdays (0.14, p < 0.05) and weekends (0.17, p < 0.01) respectively. Both also correlated with other screen media use on weekends (0.20 and 0.21, p < 0.001). Prevent Other Activities Negative POETV was negatively correlated with children’s TV viewing on weekdays (-0.16, p < 0.01), weekends (-0.14, p < 0.05) and other screen media on weekends (-0.14, p < 0.05).

Conclusions

The Positive and Negative POETV scales offer a new tool to better define predictors of screen media parenting practices and child screen media use behaviors.

Development of the Parental Self-Efficacy Scale for Child Autonomy toward Minor Surgery (PSESCAMS): based on results of questionnaire surveys of parents raising children between 3 and 6 years old

AIM

The aim of this study is to prepare the Parental Self-Efficacy Scale for Child Autonomy toward Minor Surgery (PSESCAMS) and verify its reliability and validity.

METHODS

The PSESCAMS was developed based on the findings of previous qualitative studies on preschool children aged 3-6 years who were undergoing day surgery and their parents. The Generalized Self-Efficacy Scale, Maternal Self-Accomplishment Scale (MSAS), and Japanese-language version of the State-Trait Anxiety Inventory A-trait subscale (STAI: A-trait) were used to examine the criterion-related validity of the PSESCAMS. In addition, the test-retest method was utilized for the PSESCAMS.

RESULTS

The number of valid responses was 586. A principle component analysis of the PSESCAMS was conducted of 18 items, extracting two factors. As a result of factor analysis that assumed two factors, the two factors were named "self-efficacy for support related to child's emotional control for minor surgery" and "self-efficacy for support related to child's understanding of minor surgery". A structural equation model having high goodness of fit for the PSESCAMS was shown by a covariance structure analysis. The correlations between GSES, MSAS, STAI: A-trait and the PSESCAMS were r = 0.323 (P < 0.001), r = 0.370 (P < 0.001), and r = -0.248 (P < 0.001), respectively. Cronbach's alpha of both the initial test and the test-retest for the PSESCAMS were 0.9 and the correlation between both was significant.

CONCLUSION

The PSESCAMS consists of two categories and includes 18 items. The reliability and validity of the PSESCAMS were proved.

Social support and functional outcome in severe mental illness: the mediating role of proactive coping

Individuals with Severe Mental Illness (SMI) are faced with wide-spread social and occupational impairment, yet some are able to achieve a meaningful degree of functional improvement. A structural model based on Proactive Coping Theory was developed and tested in a longitudinal context to better understand: (1) the impact of proactive processes on functioning for people with SMI, and (2) the stability of the theoretical framework over time for this population. A latent path analysis examining social support, positive reappraisal, intrinsic motivation, and role functioning was tested with 148 severely mentally ill individuals receiving psychosocial rehabilitation treatment at baseline. An observed path analysis of the model was examined at six months post-baseline with 102 people. The baseline model displayed an excellent fit to the data and accounted for 54% of the variance in role functioning. Results at time 2 also suggest the empirical promise and potential longitudinal viability of the model. In line with Proactive Coping Theory and a social resources model of coping, social support may facilitate proactive coping processes to enhance role functioning, and these processes may be stable over time for people with SMI.

Development of a behaviour change communication tool for medical students: the 'Tent Pegs' booklet

OBJECTIVE

To describe the development and validation of a behaviour change communication tool for medical students.

METHODS

Behaviour change techniques (BCTs) were identified within the literature and used to inform a communication tool to support medical students in discussing health-related behaviour change with patients. BCTs were organized into an accessible format for medical students (the 'Tent Pegs' booklet) and validated using discriminant content validity methods with 11 expert judges.

RESULTS

One-sample t-tests showed that judges reliably mapped BCTs onto six of the seven Tent Pegs domains (confidence rating means ranged from 4.0 to 5.1 out of 10, all p≤0.002). Only BCTs within the 'empowering people to change' domain were not significantly different from the value zero (mean confidence rating=1.2, p>0.05); these BCTs were most frequently allocated to the 'addressing thoughts and emotions' domain instead.

CONCLUSION

BCTs within the Tent Pegs booklet are reliably allocated to corresponding behaviour change domains with the exception of those within the 'empowering people to change' domain.

PRACTICE IMPLICATIONS

The existing evidence-base on BCTs can be used to directly inform development of a communication tool to support medical students facilitate health behaviour change with patients.

Understanding Activity Limitations in Depression

Behavioral activation plays an important role in the treatment of depression. Although the development of activation treatments has made important progress in the past decades, effects are still low to moderate. This paper illustrates how the understanding and treatment of activity limitations in depression can be improved through the integration of theories from health psychology. One of the leading theories is the health action process approach (HAPA; Schwarzer, Lippke, & Luszczynska, 2011 ). In accordance with the HAPA, we argue that reasons for activity limitations can be divided into problems of intention formation (motivational problems) and problems of intention implementation (volitional problems). To date, depression research has primarily focused on motivational deficits. With regard to the HAPA, we discuss different aspects of motivational deficits by reviewing common constructs such as negative thoughts, learned helplessness, loss of reinforcers, or self-efficacy. In addition, we demonstrate that volitional deficits are also important for explaining activity limitations and should be taken into account more. Volitional deficits in depression are documented by behavior studies focusing on self-regulation and procrastination; additionally, evidence of volitional deficits has been found in research on executive functions and in neurobiology. In conclusion, the HAPA contributes to a better understanding of activity limitations in depression: The reviewed literature demonstrates that depression is associated with motivational and volitional deficits. Each of these two kinds of deficits should be treated with a different intervention technique (e.g., values assessment vs. activity scheduling). Beyond this relevance for clinical psychology, implications for health psychology are discussed.

Foreground-background salience effect in traffic risk communication

Pie charts are often used to communicate risk, such as the risk of driving. In the foreground-background salience effect (FBSE), foreground (probability of bad event) has greater salience than background (no bad event) in such a chart. Experiment 1 confirmed that the displays format of pie charts showed a typical FBSE. Experiment 2 showed that the FBSE resulted from a difference in cognitive efforts in processing the messages and that a foreground-emphasizing display was easier to process. Experiment 3 manipulated subjects’ information processing mindset and explored the interaction between displays format and information processing mindset. In the default mindset, careless subjects displayed a typical FBSE, while those who were instructed to be careful reported similar risk-avoidant behavior preference reading both charts. Suggestions for improving risk communication are discussed.

Body-Efficacy Expectation: Assessment of Beliefs concerning Bodily Coping Capabilities with a Five-Item Scale

Background. Expectancies regarding a treatment play an important role in recovery as has been shown in placebo research. The role of expectations regarding the bodily capability to overcome illness is less investigated although in complementary and alternative medicine (CAM) such capability is the target of interventions. We introduced a new construct, body-efficacy expectation, defined as the conviction that one's body is able to deal with health-threatening factors by itself, and developed and validated a scale for its measurement. Methods. The scale was developed following expert recommendations. Using online survey data from 1054 participants an exploratory factor analysis was conducted and psychometric properties of the scale were examined (item characteristics, reliability, and validity). Results. The exploratory factor analysis yielded a one-factor solution explaining 51.96% of total variance (Cronbach's α = 0.77). One of the originally six items was removed due to poor item characteristics. Correlations with several validation measures were in line with the theoretical background of the construct. Most importantly, participants with better general health showed higher body-efficacy expectation than participants with poorer health status. Conclusions. Further studies confirming the factor structure and using clinical samples are recommended. Also, the relations with the appraisal of CAM and CAM use warrant further research.

Implementation intention and action planning interventions in health contexts: state of the research and proposals for the way forward

The purpose of this paper is to provide an overview of the literature on two planning intervention techniques in health behaviour research, implementation intentions and action planning, and to develop evidence-based recommendations for effective future interventions and highlight priority areas for future research. We focused our review on four key areas: (1) definition and conceptualisation; (2) format and measurement; (3) mechanisms and processes; and (4) design issues. Overall, evidence supports the effectiveness of planning interventions in health behaviour with advantages including low cost and response burden. There is, however, considerable heterogeneity in the effects across studies and relatively few registered randomised trials that include objective behavioural measures. Optimally effective planning interventions should adopt "if-then" plans, account for salient and relevant cues, include examples of cues, be guided rather than user-defined, and include boosters. Future studies should adopt randomised controlled designs, report study protocols, include fidelity checks and relevant comparison groups, and adopt long-term behavioural follow-up measures. Priority areas for future research include the identification of the moderators and mediators of planning intervention effects. Future research also needs to adopt "best practice" components of planning interventions more consistently to elucidate the mechanisms and processes involved.

Self-Management of Wellness and Illness in an Aging Population

In this chapter, we review the last 10 years of literature on self-management of illnesses (acute/episodic and chronic) and wellness (e.g., health promotion). We focus on health self-management in the context of an aging population, wherein middle-aged adults are more likely to be managing wellness activities and older adults are often managing both maintenance of health and chronic illnesses. The critical issues related to self-management of health are discussed, including those imposed by health care demands and those stemming from individual differences in general abilities (e.g., motor, perception, cognition) and socioemotional characteristics. The dynamic relationship between theory and practice is highlighted. Health care demands reflect the nature of the illness or wellness activity and include managing comorbidities, symptoms, and medications; engaging in health promotion activities (e.g., exercise, diet); the required use of health technologies; the need for health-related information; and coordination of the care network. Individual differences in motor, perceptual, and cognitive abilities, as well as in the severity and complexity of the illness and the consequent demands, also impact how a person self-manages health. Cognitive abilities, such as decision making, knowledge, literacy (i.e., general, health, and e-health literacy), and numeracy are particularly implicated in the process of managing one’s own health and are especially important in the context of an aging population; therefore we give these cognitive abilities special attention in this chapter. Socioemotional characteristics, and attitudes and beliefs about one’s health, impact an individual’s self-management of health as well, impacting his or her motivation and goal-setting behaviors. Moreover, we discuss literature on interventions that have been used to improve self-management of health, and we examine the potential for technology. We conclude with guidelines for technology design and instruction, and discuss emerging themes.

The Reasoning and Regulating Medication Adherence Instrument for patients with coronary artery disease: development and psychometric evaluation

BACKGROUND

Many patients experience difficulty taking medications resulting in suboptimal adherence. Ambiguity surrounding adherence issues in chronic illness has been exacerbated by a lack of patient-centered, medication-specific, and theoretically integrative measurement instruments.

AIM

To develop a reliable and valid instrument to measure the factors that influence adherence in patients prescribed pharmacotherapy for coronary artery disease.

METHODS

Phase 1 involved the development of instrument structure and content. Constructs to be measured were defined through an analysis of adherence literature and qualitative interviews with patients. Phase 2 established the psychometric properties of the instrument. Exploratory factor analyses, reliability, and validity estimations were undertaken with a sample of patients (n = 404) from 3 tertiary cardiology referral centers.

RESULTS

Factor analyses resulted in a logically coherent, 16-item, three-factor solution that explained 50.5% variance. The factors were labelled: "Medication Planning Strategies," "Health Risk, and Health Protection." Internal consistency reliability met acceptable standards (alpha = .700 to alpha = .785). Fair to excellent intraclass correlations for temporal stability were demonstrated (.498-.882). Preliminary construct validity was supported by promising findings in relation to content validity results and factor structure stability.

CONCLUSIONS

A new adherence instrument for patients on pharmacotherapy for coronary artery disease has been developed and initial psychometric properties have been established. Additional instrument validation will be directed at further establishing construct and criterion-related validity. It is intended that this measure will be useful in identifying factors that impede or facilitate adherent behavior and contribute to advancing the science of instrument development within adherence research.

A structured intentions and action-planning intervention improves weight loss outcomes in a group weight loss program

PURPOSE

To assess whether forming general behavioral intentions and implementing intentions through action plans promotes weight loss and is moderated by weight loss goals and self-efficacy.

DESIGN

A quasi-experimental study comparing change in body mass index (BMI) for 15 months between a behavioral intentions condition (BIC), an implementation intentions condition (IIC), and a comparison condition (CC).

SETTING

Ten-week weight loss program delivered in weekly group meetings at community medical centers.

SUBJECTS

Six hundred thirty-two attendants at the weight loss program (80% of program attendants participated in the study).

INTERVENTION

Weight loss program focused on lifestyle changes, augmented by two experimental conditions (vs. a comparison condition): BIC, intended use of weight loss techniques; IIC, intended use and detailed plans for two techniques. Phone follow-up was conducted 3 and 12 months later.

MEASURES

MAIN OUTCOME

BMI during the program (computed on the basis of weight and height measured on a mechanical medical scale). Experimental manipulations included exposure to list of techniques (BIC/IIC) and structured planning form (IIC); independent variables were assessed with questionnaires (eating self-efficacy, weight loss goal, demographics).

ANALYSIS

Linear mixed models estimating changes in BMI and their interactions with the planning interventions, goals, and self-efficacy.

RESULTS

Participants in the BIC and IIC lost 40% more weight during the 10-week program than those in the CC (1.10 and 1.11 BMI points compared with .79; ts < -2.76, ps < .01). Weight loss goals interacted with implementation intentions (t = 2.98, p < .01). Self-efficacy was unrelated to weight loss. No differences were found between conditions at 3 and 12 months after the program.

CONCLUSION

Findings revealed that forming implementation intentions promotes weight loss within a weekly program at a field setting and that its effectiveness depends on initial high goals.

Family-based models for childhood-obesity intervention: a systematic review of randomized controlled trials

Effective interventions are needed to address the growing epidemic of childhood obesity. In the past 35 years, family-based approach has gradually developed as a preferred intervention. This review aimed to examine the methodological rigour and treatment effectiveness of family-based interventions according to intervention types and theoretical orientations. A total of 15 randomized controlled trials (RCTs) of family-based lifestyle interventions for children and adolescents aged 2-19 years were included. The adapted Methodological Quality Rating Scales (MQRS) and a four-grade qualitative scoring scheme were adopted to evaluate the methodological rigour and the effectiveness of treatment, respectively. The average MQRS score was 7.93 out of 14 points. Ten of the 15 RCTs had well aligned their research questions with appropriate research methods. The overall short-term outcome of the15 RCTs were satisfactory with an average score of 3.1. Family-based interventions rooted in behaviour theory achieved better results than those theoretically connected to family systems theory in terms of treatment effectiveness. Results suggest future studies to improve the methodological design and continue to explore the potential of the family systems approach.

Exercise: Why It is a Challenge for Both the Nonconscious and Conscious Mind

The epidemic of physical inactivity is an important societal and individual problem. Despite the well-documented health effects of physical activity, only 22% of the population exercises regularly enough to get the physiological and psychological benefits ( S. N. Blair, 1993 , Physical activity, physical fitness, and health. Research Quarterly for Exercise and Sport, Vol. 64, pp. 365–376.) Why does 78% fail to do so? The problem is largely psychological and attributable to the processes of nonconscious and conscious mind. This paper reviews research on how nonconscious and conscious processing affects human behavior in general and exercise behavior in particular. Although there generally is no question about the effect of the nonconscious mind on human behavior, “unconsciously operating motives” in and of themselves are incapable of igniting and sustaining this complex behavior—at least until the behavior has been repeated with regularity and long enough to become consistently prompted by situational cues (as is the case for 22% of the population). There is even some evidence to suggest that the nonconscious mind actually works against exercise by embracing cues and excuses for not exercising. A related problem for both the nonconscious and conscious mind, especially that of the occasional exerciser (54% of the population), is that exercise poses a threat to one's sense of freedom and choice (i.e., “you must do it or else”). The resultant psychological reactance leads to attempts to restore this freedom, but it is often accomplished by giving in to temptations (e.g., TV watching). Although people recognize fitness and health as important human conditions, they often pursue these goals by using exercise as a means toward another end (e.g., to lose weight). In doing so, they struggle cognitively with their need for autonomy while trying to balance it in interpersonal and leisure contexts. Such struggle depletes finite self-control resources and makes people more vulnerable to temptations. The net result is that both the nonconscious mind and the conscious mind fail to turn most people into rational thinkers and “self as doers,” who would do what is best for their health.

Adoption of self-management interventions for prevention and care

Seventy-five percent of health care costs can be attributed to chronic diseases, making prevention and management imperative. Collaborative patient self-management in primary care is efficacious in reducing symptoms and increasing quality of life. In this article, the authors argue that self-management interventions span the continuum of prevention and disease management. Self-management interventions rest on a foundation of 5 core actions: (1) activate motivation to change, (2) apply domain-specific information from education and self-monitoring, (3) develop skills, (4) acquire environmental resources, and (5) build social support. Several delivery vehicles are described and evaluated in terms of diffusion and cost-containment goals.

Enhanced medical rehabilitation increases therapy intensity and engagement and improves functional outcomes in postacute rehabilitation of older adults: a randomized-controlled trial

OBJECTIVES

For millions of disabled older adults each year, postacute care in skilled nursing facilities is a brief window of opportunity to regain enough function to return home and live independently. Too often this goal is not achieved, possibly because of therapy that is inadequately intense or engaging. This study tested Enhanced Medical Rehabilitation, an intervention designed to increase patient engagement in, and intensity of, daily physical and occupational therapy sessions in postacute-care rehabilitation.

DESIGN

Randomized controlled trial of Enhanced Medical Rehabilitation versus standard-of-care rehabilitation.

SETTING

Postacute care unit of a skilled nursing facility in St Louis, MO.

PARTICIPANTS

Twenty-six older adults admitted from a hospital for postacute rehabilitation.

INTERVENTION

Based on models of motivation and behavior change, Enhanced Medical Rehabilitation is a set of behavioral skills for physical and occupational therapists that increase patient engagement and intensity, with the goal of improving functional outcome, through (1) a patient-directed, interactive approach, (2) increased rehabilitation intensity, and (3) frequent feedback to patients on their effort and progress.

MEASUREMENTS

Therapy intensity: assessment of patient active time in therapy sessions. Therapy engagement: Rehabilitation Participation Scale. Functional and performance outcomes: Barthel Index, gait speed, and 6-minute walk.

RESULTS

Participants randomized to Enhanced Medical Rehabilitation had higher intensity therapy and were more engaged in their rehabilitation sessions; they had more improvement in gait speed (improving from 0.08 to 0.38 m/s versus 0.08 to 0.22 in standard of care, P = .003) and 6-minute walk (from 73 to 266 feet versus 40 to 94 feet in standard of care, P = .026), with a trend for better improvement of Barthel Index (+43 points versus 26 points in standard of care, P = .087), compared with participants randomized to standard-of-care rehabilitation.

CONCLUSION

Higher intensity and patient engagement in the postacute rehabilitation setting is achievable, with resultant better functional outcomes for older adults. Findings should be confirmed in a larger randomized controlled trial.

Harm reduction text messages delivered during alcohol drinking: feasibility study protocol

BACKGROUND

Recent research using mobile phone interventions to address public health issues such as smoking, obesity, depression, and diabetes provides a basis for trialing a similar approach toward reducing the negative consequences of risky drinking.

OBJECTIVE

This feasibility study aims to recruit drinkers between 18-34 years to a website where they will design and enter their own personal messages (repeating or one-off) to be sent to their mobile phones when they are drinking to remind them of their pre-drinking safety intentions.

METHODS/DESIGN

Participants in the treatment group will have access to the messaging function for 3 months and will be compared to a control group who will have 3 months access to a web chat site only. Data collection will occur at baseline, 3 months, and 6 months. The primary outcome is a change in unintended negative consequences from drinking at 3 months. Secondary outcomes include the acceptability of the intervention to this population, recruitment rate, participant retention, reduction in alcohol consumption, and the self-motivation discourse in participant messages.

DISCUSSION

Existing alcohol interventions in New Zealand attempt to reduce alcohol consumption in the population, but with little effect. This study aims to target unintended negative consequences resulting from drinking by empowering the drinkers themselves to deliver safety messages during the drinking session. If proven effective, this strategy could provide a cost-effective means of reducing the public health burden associated with risky drinking.

TRIAL REGISTRATION

Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000242921.

The Role of Self-Reflection, Emotional Management of Feedback, and Self-Regulation Processes in Self-Directed Leadership Development

This article presents and explores a framework of self-directed leadership development (SDLD) to advance conceptual understanding and practical applications for self-development approaches to development of leaders in organizations. Drawing on a diversified literature associated with experiential learning, emotion research, and social cognitive theories of change, the nature of self-development is explored. It is argued that underpinning effective self-development is the integrated operation of three metaskills—skills that are required for the development of other skills—relating to one’s ability to manage emotional reactions to feedback, to carry out effectively the practice of self-reflection, and to enact self-regulatory processes for development. The SDLD framework extends formal organization-based leadership-development practices and integrates multiple processes to aid leaders and human resource development (HRD) practitioners in the promotion and enactment of leadership self-development. The framework also provides guidance for HRD research on self-development and a number of research implications are presented.

The stress (of an) epidemic

We examined the consequences of being exposed to an outbreak of the Norwalk virus at a small university. Data from 422 undergraduates supported a model in which the experience of symptoms and perceptions of the university's response to the outbreak predicted fear of future contamination. In turn, fear predicted strain and enhanced hygiene practices. Results are consistent with a model of disease outbreak as a traumatic stressor, and implications for organizations dealing with disease outbreaks are discussed.