Social-Cognitive Factors in Changing Health-Related Behaviors

Predictors of child pornography offenses and child sexual abuse in a community sample of pedophiles and hebephiles

Little is known about factors that distinguish men who act upon their self-identified sexual interest in prepubescent or pubescent children from those who do not. Even less is known about pedophiles or hebephiles who are not involved with the criminal justice system. In this study, a sample of 155 self-referred pedophiles and hebephiles was recruited from the community. All participants met DSM-IV-TR criteria for pedophilia (or paraphilia not otherwise specified for those who were sexually attracted to pubescent children). Two sets of group comparisons were conducted on sociodemographic variables and measures of dynamic risk factors. The first set was based on recent activity and compared men who had committed child pornography only or child sexual abuse offenses in the past six months with men who remained offense-free during the same period. The second set was based on lifetime offense history (excluding the most recent six months) and compared child pornography offenders with child sexual abuse offenders and men who had committed both kinds of offenses. Overall, there were more similarities than differences between groups.

Psychological science on pregnancy: stress processes, biopsychosocial models, and emerging research issues

Psychological science on pregnancy is advancing rapidly. A major focus concerns stress processes in pregnancy and effects on preterm birth and low birth weight. The current evidence points to pregnancy anxiety as a key risk factor in the etiology of preterm birth, and chronic stress and depression in the etiology of low birth weight. Key mediating processes to which these effects are attributed, that is neuroendocrine, inflammatory, and behavioral mechanisms, are examined briefly and research on coping with stress in pregnancy is examined. Evidence regarding social support and birth weight is also reviewed with attention to research gaps regarding mechanisms, partner relationships, and cultural influences. The neurodevelopmental consequences of prenatal stress are highlighted, and resilience resources among pregnant women are conceptualized. Finally, a multilevel theoretical approach for the study of pregnancy anxiety and preterm birth is presented to stimulate future research.

Discontinuity patterns in stages of the precaution adoption process model: Meat consumption during a livestock epidemic

OBJECTIVES

Patterns of changes in social-cognitive variables were investigated in order to test selected stages of the precaution adoption process model (PAPM). It was hypothesized that non-linear trends (discontinuity patterns) in perceived vulnerability, positive and negative outcome expectancies, procrastination, and self-efficacy might be observed across the stages.

DESIGN

Cross-sectional data from 808 respondents were employed.

METHOD

Questionnaire data were collected in an on-line study on meat consumption during a livestock epidemic in Germany. Polynomial trends and analyses of variance with post-hoc-contrasts were used to examine the patterns of change.

RESULTS

Discontinuity patterns were found for perceived vulnerability, negative outcome expectancies, and procrastination. The data provided partial support for discontinuity patterns in self-efficacy. Continuity patterns were found for positive outcome expectancies.

CONCLUSIONS

Results provide support for a stage model rather than a pseudo-stage model.

Social cognitive theory as a predictor of dietary behavior and leisure time physical activity behavior in middle-aged Asian Indian women residing in United States

The purpose of the study was to determine to what extent expectations, self-control, and self-efficacy from the social cognitive theory account for variance in the dietary behaviors and leisure time physical activity of middle-aged Asian Indian women residing in Chicago. Dietary behavior was broken down into fruit and vegetable consumption and number of portions consumed. Data was collected from a sample of 200 participants in Chicago over a span of 1 month. Valid and reliable subscales were developed for the study. Descriptive statistics, stepwise multiple regressions, and Pearson correlations were used to analyze the data. Results indicated expectations for leisure time physical activity and self-control as predictive for leisure time physical activity (adjusted R² = 0.14). No relationships were seen with the constructs of the social cognitive theory with number of portions and fruit and vegetable consumption. Recommendations have been included for future studies.

Effects of upward and downward social comparison information on the efficacy of an appearance-based sun protection intervention: a randomized, controlled experiment

This experiment examined the impact of adding upward and/or downward social comparison information on the efficacy of an appearance-based sun protection intervention (UV photos and photoaging information). Southern California college students (N = 126) were randomly assigned to one of four conditions: control, intervention, intervention plus upward social comparison, intervention plus downward social comparison. The results demonstrated that all those who received the basic UV photo/photoaging intervention reported greater perceived susceptibility to photoaging (d = .74), less favorable tanning cognitions (d = .44), and greater intentions to sun protect (d = 1.32) relative to controls. Of more interest, while the basic intervention increased sun protective behavior during the subsequent 5 weeks relative to controls (d = .44), the addition of downward comparison information completely negated this benefit. Upward comparison information produced sun protection levels that were only slightly (and nonsignificantly) greater than in the basic intervention condition and, as such, does not appear to be a cost-effective addition. Possible mechanisms that may have reduced the benefits of upward comparison information and contributed to the undermining effects of downward comparison information are discussed.

Computer-assisted dieting: effects of a randomised controlled intervention

In this pilot study, the effects of two computer-assisted dieting (CAD) interventions on weight loss and blood chemistry were examined among overweight and obese adults. Participants (91 community members, average age 42.6 years) were randomly assigned to CAD-only (a single-session introduction and provision of a dieting software, n = 30), CAD plus an additional four-session self-management group training (CAD+G, n = 31) and a waitlist control group whose members were randomised into the two interventions at the 3-month follow-up (n = 30). A three (group)-by-two (time) repeated measures ANOVA revealed no significant group by time interaction during the initial 3-month period. However, the two intervention groups combined showed a significant, though moderate weight loss relative to the control group. Further, although a general improvement was found with regard to the lipid panel results during the first 3 months of the trial, the treatment by time interaction was not significant. A comparison of the developments in the two intervention groups during the 3- to 6-month follow-up time period revealed a tendency towards greater weight regain in the CAD-only condition. The evidence suggests that CAD supports initial weight loss; however, additional self-management training might be necessary to support maintenance.

People Use Self-Control to Risk Personal Harm: An Intra-Interpersonal Dilemma

People will smoke cigarettes, drink alcohol, binge eat, drink coffee, eat chili peppers, fail tests, steal, ingest illicit drugs, engage in violent and sadistic actions including killing, have sex, and seek to become HIV positive for the sake of interpersonal acceptance. The self-control for personal harm model reconceptualizes behaviors that have both urge and control components as demonstrating either successful or failed self-control, depending on the incipient urge. The model underscores the role of expected social rewards as an important incentive for which people sometimes engage in personally risky and aversive behaviors despite feeling that they would rather avoid the behaviors and attendant harm. Research from diverse perspectives converges to show that risky behaviors, which might on the surface appear to be self-control failures, can in fact require self-control exertion.

Drug offenders' perceptions of motivation: the role of motivation in rehabilitation and reintegration

This article presents a qualitative analysis of participants' perceptions of the importance of motivation in the detoxification and rehabilitation process. As part of an outcome evaluation of recovering drug addicts who participated in a prison-based therapeutic community, 39 participants (a nonrandomized subsample) are interviewed regarding their rehabilitation and reintegration experiences. Although many studies show that participation in prison-based drug treatment programs reduces the likelihood of recidivism, clients in this study suggest that other factors might be equally important, and in particular clients' own motivation to change their lives. This study raises some questions about the true ability of drug treatment programs to treat and rehabilitate drug-abusing offenders, diverting the emphasis from the treatment program itself to the participants' motivation to change. Findings are discussed in regard to prison-based drug treatment programs, after-release impediments encountered by inmates, and inmates' expectations of successful reintegration into the normative noncriminal society.

Development and exploratory cluster-randomised opportunistic trial of a theory-based intervention to enhance physical activity among adolescents

This article reports the development and exploratory testing of a school-based intervention programme designed to enhance levels of physical activity in adolescents. The intervention is based on social cognitive theory (SCT), self-regulation theory (SRT) and planning as evidence-based mediators of physical activity changes. Two classes, paired on socio-economic variables, were selected from each of eight Portuguese schools and randomly assigned to an intervention or control group (N = 291). Primary outcome was 'moderate to vigorous physical activity' (International Physical Activity Questionnaire) measured pre and post intervention and at three and nine months follow-up. SCT, SRT and planning variables were secondary outcomes measured pre and post intervention. At post test, participants in the intervention group reported 18 min per week more physical activity (PA), adjusted for pre-intervention, age and sex, than those in the control group (95% confidence interval -10 to 46; p = 0.249). This difference increased to 33 min (95% CI-4 to 71; p = 0.082) at three months and to 57 min (95% CI 13 to 101, p = 0.008) at nine month follow-up. Moreover, the intervention resulted in changes of some of the theoretical target variables, including outcome expectancies and coping planning. However, no evidence was found for the changes in theoretical moderators to mediate the intervention effects on behaviour. Implications for theory and for future research are discussed.

Beyond good intentions: The role of proactive coping in achieving sustained behavioural change in the context of diabetes management

This study examines the effectiveness of a brief self-management intervention to support patients recently diagnosed with type-2 diabetes to achieve sustained improvements in their self-care behaviours. Based on proactive coping, the intervention emphasizes the crucial role of anticipation and planning in maintaining self-care behaviours. In a randomised controlled trial among recent screen-detected patients, participants who received the intervention were compared with usual-care controls, examining changes in proximal outcomes (intentions, self-efficacy and proactive coping), self-care behaviour (diet, physical activity and medication) and weight over time (0, 3 and 12 months). Subsequently, the contribution of proactive coping in predicting maintenance of behavioural change was analysed using stepwise hierarchical regression analyses, controlling for baseline self-care behaviour, patient characteristics, and intentions and self-efficacy as measured after the course. The intervention was effective in improving proximal outcomes and behaviour with regard to diet and physical activity, resulting in significant weight loss at 12 months. Furthermore, proactive coping was a better predictor of long-term self-management than either intentions or self-efficacy. Proactive coping thus offers new insights into behavioural maintenance theory and can be used to develop effective self-management interventions.

Determinants of awareness, initiation and maintenance of physical activity among the over-fifties: a Delphi study

To develop effective interventions to stimulate physical activity (PA), insight into its underlying variables is needed. The aim of this study was to obtain an overview of the most relevant determinants of awareness, initiation and maintenance of PA among the over-fifties by means of a three-round Delphi study. In the first round, 17 key-experts outlined possible relevant determinants into an open-ended electronic questionnaire. In the second round, 118 experts completed a structured electronic questionnaire that was based on the first round results, in which they scored each determinant on its relevance. In the third round, experts were asked to re-rate the relevance of each determinant, after feedback was given about the group median relevance score. After three rounds, the experts agreed on 30 relevant determinants of the three phases of PA. When compared with longitudinal studies, the Delphi study pointed out new concepts, such as several post-motivational and social and environmental determinants as possible relevant determinants, suggesting that this method has the potential to trace new and promising determinants. The results further showed that next to similarities, much dissimilarity in relevant determinants of awareness, initiation and maintenance of PA was found, suggesting that most determinants could be phase specific.

Multifaceted determinants for achieving glycemic control: the International Diabetes Management Practice Study (IDMPS)

OBJECTIVE

The International Diabetes Mellitus Practice Study is a 5-year survey documenting changes in diabetes treatment practice in developing regions.

RESEARCH DESIGN AND METHODS

Logistic regression analysis was used to identify factors for achieving A1C <7% in 11,799 patients (1,898 type 1 diabetic and 9,901 type 2 diabetic) recruited by 937 physicians from 17 countries in Eastern Europe (n = 3,519), Asia (n = 5,888), Latin America (n = 2,116), and Africa (n = 276).

RESULTS

Twenty-two percent of type 1 diabetic and 36% of type 2 diabetic patients never had A1C measurements. In those with values for A1C, blood pressure, and LDL cholesterol, 7.5% of type 1 diabetic (n = 696) and 3.6% of type 2 diabetic (n = 3,896) patients attained all three recommended targets (blood pressure <130/80 mmHg, LDL cholesterol <100 mg/dl, and A1C <7%). Self-monitoring of blood glucose was the only predictor for achieving the A1C goal in type 1 diabetes (odds ratios: Asia 2.24, Latin America 3.55, and Eastern Europe 2.42). In type 2 diabetes, short disease duration (Asia 0.97, Latin America 0.97, and Eastern Europe 0.82) and treatment with few oral glucose-lowering drugs (Asia 0.64, Latin America 0.76, and Eastern Europe 0.62) were predictors. Other region-specific factors included lack of microvascular complications and old age in Latin America and Asia; health insurance coverage and specialist care in Latin America; lack of obesity and self-adjustment of insulin dosages in Asia; and training by a diabetes educator, self-monitoring of blood glucose in patients who self-adjusted insulin, and lack of macrovascular complications in Eastern Europe.

CONCLUSIONS

In developing countries, factors pertinent to patients, doctors, and health care systems all impact on glycemic control.

Towards a theory of intentional behaviour change: plans, planning, and self-regulation

PURPOSE

Briefly review the current state of theorizing about volitional behaviour change and identification of challenges and possible solutions for future theory development.

METHOD

Review of the literature and theoretical analysis.

RESULTS

Reasoned action theories have made limited contributions to the science of behaviour change as they do not propose means of changing cognitions or account for existing effective behaviour change techniques. Changing beliefs does not guarantee behaviour change. The implementation intentions (IMPs) approach to planning has advanced theorizing but the applications to health behaviours often divert substantially from the IMPs paradigm with regard to interventions, effects, mediators and moderators. Better construct definitions and differentiations are needed to make further progress in integrating theory and understanding behaviour change.

CONCLUSIONS

Further progress in theorizing can be achieved by (a) disentangling planning constructs to study their independent and joint effects on behaviour, (b) progressing research on moderators and mediators of planning effects outside the laboratory and (c) integrating planning processes within learning theory and self-regulation theory.

The Active plus protocol: systematic development of two theory- and evidence-based tailored physical activity interventions for the over-fifties

Background

Limited data are available on the development, implementation and evaluation processes of physical activity promotion programmes among older adults. More integrative insights into interventions describing the planned systematic development, implementation and evaluation are needed.

Methods and design

The purpose of this study is to give an integrative insight into the development of the Active plus programme applying the six-step Intervention Mapping protocol. The Active plus programme consisted of two theory- and evidence-based tailored physical activity promotion interventions, both comprising three tailored letters delivered over four months and aimed at raising awareness of insufficient physical activity, and stimulating physical activity initiation and maintenance among the over-fifties.

The first intervention, the basic tailored intervention, provided tailored letters that intervened on the psychosocial determinants of physical activity. The second intervention, the intervention plus, provided the same tailored information but additionally provided tailored information about physical activity opportunities in the specific environment in which the older adults lived. This environment-based component also provided access to a forum and e-buddy system on a website. A plan for implementation and evaluation is also described.

Discussion

The planned development of the Active plus programme resulted in two theory- and evidence-based tailored physical activity interventions targeted at the over-fifties.

Trial Registration

Dutch Trial Register NTR 920

Systematic Self-Monitoring and Reflection of Health Behavior in Widely Differing Preventive Settings

Effects of a group health promotion program were tested in widely differing preventive settings. The objectives of the SySeRe program are systematic self-monitoring and reflection on everyday life health behavior as well as the promotion of health- and development-related cognitions and personal well-being. Randomized group designs were employed to evaluate effects on health locus of control, health value, personal developmental control, personal self-regulation of development, well-being, and psychosomatic complaints. Program effects were confirmed with reference to outcome measures administered at the end of the treatment and at 2-month follow-ups in samples of 56 aged individuals (Study 1), 50 adolescents (Study 2), and 53 inpatients on a psychosomatic rehabilitation hospital program (Study 3). Results demonstrate effectiveness and usability of the SySeRe program as an economical health promotion treatment in different primary and tertiary preventive settings.

Perceptions of risk in adults with a low or high risk profile of developing type 2 diabetes; a cross-sectional population-based study

OBJECTIVE

To compare the perceived seriousness and risk of type 2 diabetes among low risk with high risk profile non-diabetic subjects and examine the relationship of perceived risk with multiple self-reported risk indicators.

METHODS

A cross-sectional population-based study among 4435 low risk profile and 2607 high risk profile non-diabetic residents of the Hoorn region, participating in a stepwise type 2 diabetes screening study. Main outcome measures were perceived seriousness and risk of diabetes in subjects categorized (low vs. high risk profile) using the Symptom Risk Questionnaire.

RESULTS

85.0% of the low risk and 81.2% of the high risk profile subjects perceived diabetes as a moderate to very serious disease. About half (43.0%) of all 7042 subjects reported that they do not know their risk of having diabetes. The mean perceived risk of having diabetes was slightly lower for the low risk compared with the high risk profile subjects (difference = 2.8%; 95% confidence interval [CI] = 1.8% to 3.8%; P < 0.001). This difference was mostly explained by having a parent or sibling with diabetes, frequent thirst and claudication (difference = 0.6%; 95% CI = -0.7% to 1.9%). Interestingly, perceived risk decreased with increasing age within both groups (P for trend < 0.001).

CONCLUSIONS

Both low risk and high risk profile subjects perceive diabetes as a serious disease. Even among those at high risk profile for type 2 diabetes, almost half appeared not to know their risk. Perceived risk of having diabetes was slightly lower for the low risk compared with the high risk profile subjects. Furthermore, perceived risk decreases with increasing age.

PRACTICE IMPLICATIONS

This study points to a greater need to effectively address people's (mis)perceptions, and how to raise the awareness and understanding of type 2 diabetes and its risk factors in the general population in order to influence early detection and healthy lifestyle changes.

'Feeling' Risk and Seeing Solutions

This study assessed cognitive and affective predictors of intention to obtain vaccination against the hepatitis B virus (HBV) among men who have sex with men (MSM), based on leading social cognitive models of health behavior. The key predictors of vaccination intention were perceived risk of contracting HBV, expectancies regarding the outcome of vaccination, and the interaction between risk perception and outcome expectancies. Negative affect increased risk perceptions, which, in turn, positively affected vaccination intention. It is concluded that MSM should feel they are at risk for HBV, and see solutions to this risk.

Predicting utilization of formal and informal help among general hospital inpatients with alcohol use disorders

AIM

The aim of this prospective study was to identify predictors of utilizing formal and informal help among currently non-help-seeking individuals with alcohol use disorders.

METHODS

Data was based on 197 general hospital inpatients with alcohol dependence or abuse. Using multivariable logistic regression analyses, intention to utilize formal help was tested in addition to evidence based predictors of utilization of help.

RESULTS

Intention to seek help and prior help-seeking were identified as central predictors for formal and informal help-seeking.

CONCLUSIONS

The lack of utilization of formal help among persons with alcohol use disorders may be reduced by focusing professional interventions on enhancing help-seeking motivation.

Translating concern into action: HIV care providers' views on counseling patients about HIV prevention in the clinical setting

Recent Centers for Disease Control (CDC) guidelines recommend that HIV care practitioners provide HIV prevention counseling to patients at routine medical visits. However, research shows that HIV care practitioners provide such counseling infrequently, presenting a challenge for clinics implementing these guidelines. Our qualitative study of 19 HIV care providers at an infectious diseases clinic in the southeastern US explored providers' beliefs about their patients' HIV transmission behaviors, expected outcomes of conducting HIV prevention counseling, and perceived barriers and facilitators to counseling. Providers' concern about HIV transmission among their patients was high but did not "translate into action" in the form of counseling. They anticipated poor outcomes from counseling, including harm to patient-provider relationships, and failure of patients to change their behavior. They also listed barriers and facilitators to counseling, most importantly time, state reporting policies, and conversational triggers. Implications for implementation of CDC guidelines and clinic-based "Prevention with Positives" programs are discussed.

The effectiveness of a motivation programme for lifestyle change in the course of aortocoronary bypass graft surgery

Objective: To evaluate the effectiveness of a motivation programme the motivation for lifestyle change in patients was measured before and after coronary artery bypass graft (CABG) surgery by comparing a usual care group with a group attending a motivation programme.

Design: Prospective controlled study.

Setting: University hospital cardiothoracic surgery department.

Subjects: One hundred and forty patients (mean age 64.9; SD 8.5 years) who had an elective CABG surgery.

Interventions: Each patient was evaluated regarding his or her motivation for lifestyle change two days before and 10 days after CABG surgery. Between January and May 2002 patients in usual care were investigated as a control group (n=70). From January to May 2003 patients had the opportunity to take part in a motivation programme that was provided by a trained clinical psychologist (n = 70). The programme consists of both personalized single sessions and group lectures.

Measures: A 30-item questionnaire measuring the six factors Vulnerability, Intention, Social expectation, Outcome expectation, Self-efficacy expectation, and Perceived severity was developed.

Results: ANOVA procedures with repeated measurements indicate significant effects in terms of higher motivation for lifestyle change in the treatment group in Vulnerability (F(1, 138) = 4.04; P=0.04), Intention (F(1, 138) = 19.81; P<0.001), Social expectation (F(1, 138)=21.97; P<0.001), Outcome expectation (F(1, 138) =17.95; P<0.001), and Self-efficacy expectation (F(1, 138) =14.31; P<0.001).

Conclusions: This motivation programme performed in a cardiac surgery hospital after CABG may increase the motivation for a positive lifestyle change.

Intention to utilize formal help in a sample with alcohol problems: a prospective study

BACKGROUND

Studies investigating factors of treatment entry have predominantly focussed on persons that have already taken an initial step in the process of help-seeking. With particular emphasis on intention to utilize help, this study aims to detect predictors for alcohol-related help-seeking among a non-help-utilizing sample.

METHODS

Using 312 individuals with diverse alcohol problems (dependence, abuse, at-risk drinking), intention to utilize help was assessed in addition to evidence based predictors for utilization of help (e.g. severity of alcohol problem, prior help-seeking).

RESULTS

In addition to prior utilization of help (OR=9.76, CI: 4.60-20.74) and adverse consequences from drinking (OR=1.13, CI: 1.02-1.25), intention to utilize help (OR=4.84, CI: 2.04-11.51) was a central predictor for help-seeking. Among individuals who had not obtained prior help, individuals intending to seek help were 8.7 times more likely to utilize help than those not intending to seek help (CI: 1.05-72.2).

CONCLUSIONS

In the past, intention to utilize help has been neglected from models investigating treatment entry. This study's findings show that intention is a central factor for utilization of alcohol-specific formal help. Consequently, brief interventions focusing on enhancing motivation are expected to improve early help-seeking among general hospital patients with diverse alcohol problems.

Psychosoziale Aspekte und Gesundheitsverhalten bei Herzinsuffizienz

Zusammenfassung. Für die steigende Zahl von Patienten mit Herzinsuffizienz stehen verschiedene medizinische Behandlungsansätze zur Verfügung, darunter als letzte Option die Herztransplantation (HTX). Ergänzende psychosoziale und behaviorale Interventionen erscheinen aus verschiedenen Gründen auch für Patienten auf der HTX-Warteliste sinnvoll. Unser Literaturüberblick zeigt, dass bekannte psychosoziale koronare Risikofaktoren wie Depressivität und soziale Isolation auch bei Herzinsuffizienz Morbidität und Mortalität erhöhen. Körperliche Aktivität wirkt sich dagegen günstig auf subjektive und objektive Parameter aus. Diese Faktoren stellen erste Ansatzpunkte für verhaltensorientierte Interventionen dar. Welche Rolle andere koronare Risikofaktoren (z.B. Feindseligkeit, Ärger, Ernährung und Gewichtsreduktion) spielen, ist bislang ungeklärt. Ausblickend werden einige viel versprechende Forschungsansätze skizziert.

Assessing attention control in goal pursuit: a component of dispositional self-regulation

We examined the psychometric properties of the Self-Regulation Scale (SRS; Schwarzer, Diehl, & Schmitz, 1999), a measure of attention control in goal pursuit, in 2 independent studies. Study 1 included young adults (N = 443), whereas Study 2 included young, middle-aged, and older adults (N = 330). In both studies, the SRS showed good internal consistency. In Study 1, the SRS also showed satisfactory test-retest reliability over a 6-week period. We found support for the criterion validity of the SRS in terms of positive correlations with measures of general and domain-specific self-efficacy, proactive coping, and positive affect and in terms of negative correlations with depressive symptoms and negative affect. Hierarchical regression analyses showed that attention control accounted for unique portions of variance in relevant outcome variables above and beyond measures of self-efficacy and proactive coping.

Motives of Belgian Adolescents for Using Sunscreen: The Role of Action Plans

The first objective of this study was to analyze the differences between adolescents who use sunscreen frequently and those who do not. The second objective was to explore the importance of specific action plans when planning sunscreen use. Data was gathered among 602 Belgian secondary school students. Frequent and infrequent users of sunscreen were compared on several determinants related with sunscreen use, and a regression analysis on sunscreen use was done. Frequent users of sunscreen measures had significantly higher scores on attitudes, social influence, self-efficacy, some awareness factors, intention, and action plans. The integrated model for exploring motivational and behavioral change (I-Change model) explained 57% of the total variance of using sunscreen every 2 hours. Frequent sunscreen use was most strongly predicted by action plans, followed by positive intentions to use sunscreen, wearing protective clothing, seeking shade, attitude toward sunscreen use, education, social influence, and exposure to the sun. Our results suggest that skin cancer prevention programs aimed at promoting sunscreen use need to emphasize the advantages of sunscreen to infrequent users and to increase feelings of self-efficacy. Moreover, support by friends and parents should be stimulated. Finally, developing specific action plans for the use of sunscreen should be promoted to more effectively translate general intentions into actual sunscreen use.

Sexual dysfunction and chronic illness: the role of flexibility in coping

Sexual dysfunction is common among individuals with chronic illnesses and is associated with distress and reduced quality of life. Because of the long-term, often irreversible nature of sexual dysfunction in chronic illness and limitations of pharmacological treatments, there is a need to understand cognitive and behavioral coping processes in this population. We present a model of coping with sexual dysfunction that focuses on the construct of flexibility, including the definition of sexual functioning and its centrality to overall self-concept. We describe how this model can be applied in a comprehensive approach to treating sexual dysfunction in individuals with chronic illnesses.

Selbstkonkordanz und Sportteilnahme

Zusammenfassung. Untersucht werden zwei Fragestellungen: Wie lässt sich die kontinuierliche Aufrechterhaltung einer Sportaktivität konzipieren? Und welche Rolle spielt dabei die Ziel-Selbstkonkordanz? In einer 13-Wochen-Längsschnittstudie mit Teilnehmern des Hochschulsports (N = 255) wurden die Skalen “Selbstbestimmung“ und “Introjektionsneigung“ (Selbststeuerungsinventar; Kuhl & Fuhrmann ) eingesetzt. Sie messen die Neigung zur Auswahl selbstkonkordanter Ziele. Das Kursteilnahmeverhalten wurde wöchentliche protokolliert (13 Messzeitpunkte). Clusteranalysen identifizierten vier Teilnehmergruppen: Dabeibleiber, Fluktuierer, Früh-Abbrecher und Spät-Abbrecher. Diese Gruppen unterscheiden sich hinsichtlich der Selbststeuerungsinventar-Skalen systematisch: Dabeibleiber weisen höhere Selbstbestimmung und niedrigere Introjektionsneigung auf als Spät-Abbrecher. Bei Früh-Abbrechern ist die psychologische Situation anders: Sie haben eine hohe Selbstbestimmung und niedrige Introjektionsneigung. Dropout ist hier weniger Ausdruck der Unfähigkeit, das, was man begonnen hat, zu Ende zu führen, als vielmehr der Fähigkeit, das, was man als falsch für sich erkannt hat, ohne Verzug zu beenden. Fazit: Non-Compliance ist nicht nur Folge fehlender Motivation oder Willenskraft, sondern oft Resultat einer an der Erfüllung selbstkonkordanter Ziele orientierten Selbstbestimmung.

Diagnostik von Ressourcen im Alter

Zusammenfassung: Als Ergänzung zur psychopathologisch orientierten Diagnostik zieht seit einiger Zeit die Beschäftigung mit Stärken, Kompetenzen und Ressourcen einer Person Aufmerksamkeit auf sich, zuletzt unter den Bemühungen der Positiven Psychologie. Gerade die Alterspsychotherapie kann von einer Ressourcenorientierung profitieren. Dieser Artikel verfolgt zum einen das Ziel, Instrumente zur Diagnostik verschiedener Ressourcen darzustellen, zum anderen Befunde zu positiven Konsequenzen dieser Ressourcen im Alter zusammenzufassen. Berücksichtigt werden emotionale Ressourcen (positiver Affekt, Lebenszufriedenheit, Selbstwerterleben), motivationale Ressourcen (Kontrollüberzeugung, Selbstwirksamkeitserwartung, dispositionaler Optimismus, optimistischer Attributionsstil, Hoffnung, intrinsische Lebensziele), volitionale Ressourcen (Handlungsorientierung, Selbstregulation und Selbstkontrolle, Aufmerksamkeitsregulation, Emotionsregulation), interpersonale Ressourcen (Bindung, Altruismus, soziale Verantwortung, Vergebung, Humor) und soziale Ressourcen (soziales Netzwerk, soziale Unterstützung, Partnerbeziehung). Diskutiert wird die Notwendigkeit einer Diagnostik der Ressourcen in der Psychotherapie, vorgeschlagene Änderungen am DSM-IV und Schlussfolgerungen für geplante Forschungsprojekte.

Optimism, abstinence self-efficacy, and self-mastery: a comparative analysis of cognitive resources

The relationship between optimism, abstinence self-efficacy, and self-mastery was examined by investigating levels of these cognitive resources among two samples of recovering substance abusers: Oxford House residents who attended twelve-step groups and twelve-step members who had never lived in an Oxford House. Participants 'levels of optimism were significantly and positively related to both abstinence self-efficacy and self-mastery scores, as abstinence self-efficacy was significantly and positively related to participants' number of days abstinent. Participants who reported having more than 180 days abstinent reported significantly higher levels of abstinence self-efficacy than participants who reported having less than 180 days abstinent. In addition, among participants who reported having less than 180 days abstinent, Oxford House residents reported significantly higher levels of abstinence self-efficacy than twelve-step members. Overall, findings suggest that cognitive resources facilitate substance abusers' recovery and that the Oxford House model might provide high levels of support in their ongoing abstinence.

Health policy perception and health behaviours: a multilevel analysis and implications for public health psychology

Associations of health policy perception with health behaviours are analysed. Policy perception is differentiated in information about programmes and appraisal of health policy's contribution to policy goals, and conceptualized on the level of: (1) individuals; and (2) populations (as a social climate indicator). Survey data from the Biomed2-Project MAREPS gathered in Belgium, Finland, Germany, The Netherlands, Spain and Switzerland (N= 3343) show that at the individual level, only policy information is associated with utilizing mammography, quitting smoking, physical activity and political participation in creating healthy environments. In contrast, multilevel regression analyses show that policy appraisal is related to physical activity and political participation as a social climate factor. Implications for integrating health psychology and public health within public health psychology are discussed.

Are current health behavioral change models helpful in guiding prevention of weight gain efforts?

Effective procedures are needed to prevent the substantial increases in adiposity that have been occurring among children and adults. Behavioral change may occur as a result of changes in variables that mediate interventions. These mediating variables have typically come from the theories or models used to understand behavior. Seven categories of theories and models are reviewed to define the concepts and to identify the motivational mechanism(s), the resources that a person needs for change, the processes by which behavioral change is likely to occur, and the procedures necessary to promote change. Although each model has something to offer obesity prevention, the early promise can be achieved only with substantial additional research in which these models are applied to diet and physical activity in regard to obesity. The most promising avenues for such research seem to be using the latest variants of the Theory of Planned Behavior and Social Ecology. Synergy may be achieved by taking the most promising concepts from each model and integrating them for use with specific populations. Biology-based steps in an eating or physical activity event are identified, and research issues are suggested to integrate behavioral and biological approaches to understanding eating and physical activity behaviors. Social marketing procedures have much to offer in terms of organizing and strategizing behavioral change programs to incorporate these theoretical ideas. More research is needed to assess the true potential for these models to contribute to our understanding of obesity-related diet and physical activity practices, and in turn, to obesity prevention.

Satisfaction with medication: an overview of conceptual, methodologic, and regulatory issues

OBJECTIVE

Patients' satisfaction with their medication or medical device has been of increasing interest over the past decade. This is reflective of the rise of the patient as consumer and the desire of pharmaceutical and device manufacturers to obtain feedback from the consumers about their products. Satisfaction with medication is more narrowly focused and should be distinguished from other aspects of satisfaction. The purpose of this article is to place the concept of patient satisfaction with medication in an appropriate theoretical context, to explore the challenges of performing this research, and to offer recommendations for the basis of satisfaction claims.

METHODS

We reviewed the literature on satisfaction with medication or medical devices. We summarize and discuss the background, conceptual issues, and theoretical justification for studying satisfaction with medication. We offer examples of domains to be included and suggestions on how to develop a psychometrically sound satisfaction measure. We also address additional issues for consideration.

RESULTS

Medication satisfaction is a type of patient-reported outcome, but is distinguished from other patient-reported outcomes-specifically health-related quality of life (HRQL) and self-reports of symptoms. The Theory of Reasoned Action provides one theoretical justification for the concept. The heuristic value of this theory leads to implications regarding the relation between satisfaction and adherence. In addition, the theory is consistent with the need to focus on the patient's beliefs and values concerning the impact of taking his/her medication. Although the beliefs will differ according to the specific drug-disease combination, the beliefs can often be categorized in several domains of satisfaction: symptom relief/efficacy, side effects, ease and convenience, impact on HRQL, general satisfaction, and additional domains specific to the given research question.

CONCLUSION

Patient satisfaction instruments should be subjected to the same psychometrically rigorous standards and procedures as any other patient-reported outcome and should also be subject to the same regulatory standards as other patient-reported outcomes with respect to advertising and promotion.