A meta-analysis of self-determination theory-informed intervention studies in the health domain: effects on motivation, health behavior, physical, and psychological health

The Influence of Environmental Exposure to Heavy Metals on the Occurrence of Selected Elements in the Maxillary Bone

The elemental composition of the body's calcified tissues may reflect the environmental exposure of the population to heavy metals. The aim of the study was to assess whether the elemental composition of the maxillary bone from individuals belonging to a given population reflects the environmental exposure of this population to lead and cadmium. The research material consisted of cortical bone from the anterolateral walls of the maxilla collected from 126 patients during Caldwell-Luc maxillary sinus surgery on residents of two cities differing in terms of the lead and cadmium pollution of the natural environment. The content levels of lead, cadmium, iron, manganese, chromium, copper, and iron were determined by using atomic absorption spectrophotometry. The content levels of lead and cadmium in the samples of the maxillary bones of residents of Bielsko-Biala were 3.26 ± 2.42 µg/g and 0.74 ± 0.38 µg/g, respectively, whereas in the samples from the residents of Katowice, they were 7.66 ± 2.79 µg/g and 1.12 ± 0.08 µg/g, respectively. It was found that the lead and cadmium levels in the maxillary bone corresponded to the environmental exposure to these heavy metals in the place of residence, which was proven here via the example of the residents of two cities with different concentrations of these heavy metals in the air over long time periods. Additionally, higher content levels of essential metals such as manganese, chromium, copper, and iron are characteristic of the maxillary bone samples of residents of the area that is more polluted with heavy metals.

How Does the Level of Physical Activity Influence Eating Behavior? A Self-Determination Theory Approach

Physical activity and diet are two predominant determinants of population health status that may influence each other. Physical activity has been identified as a behavior that may lead to a healthier diet and regulates eating behaviors. This research aimed to investigate how the level of physical activity is associated with the motivation related to eating behaviors and, consequently, the eating style individuals have on a daily basis. This was a cross-sectional study in which participants completed an online questionnaire that assessed the following variables: the level of physical activity, the motivation toward eating behavior, and the type of eating behavior. In total, 440 individuals (180 men and 260 women) who regularly exercised in gyms and fitness centers aged between 19 and 64 years (M = 33.84; SD = 10.09) took part in the study. The data were collected following the Declaration of Helsinki and with the approval of the Ethics Committee of the Polytechnic of Leiria. For the statistical analysis, mean and standard deviations were first calculated, as well as bivariate correlations between all the variables of interest. Then, structural equation model analyses were performed considering the levels of physical activity as the independent variable, motivations toward eating behavior as the mediators, and eating styles as the dependent variables. It was concluded that a greater level of physical activity leads to a more self-determined type of eating regulation, which in turn results in less constricted eating behaviors that are influenced by external factors and emotional factors.

A brief self-persuasion intervention to strengthen health-promoting dietary intentions through autonomous motivation

Given the prevalence in obesity and other diet-related chronic diseases among adults in America, methods targeting dietary behavior change are essential. Interventions that aim to increase individuals' autonomous (i.e., self-driven) motivation to engage in health-promoting behaviors are highly effective, however, such interventions are difficult to scale. Thus, the current study tested the efficacy of a brief self-persuasion intervention to change participants' dietary goal content and increase intentions to make healthy dietary decisions, through autonomous motivation. The study also investigated the assumption that appearance-based goals decrease health-promoting behavior. The intervention was administered online to female college students (N = 300). Results showed that inspiring health-based and appearance-based goal content led to higher intentions compared to gaining others' approval-based goals, indirectly through higher autonomous motivation. Appearance-based goal content also led to higher intentions compared to a control condition. Results imply that there is promise in using a brief, easily administrable, self-persuasion intervention to increase health-promoting dietary behaviors. Additionally, results reflect that bolstering appearance-based goal content can promote health-promoting behaviors, however, more research is necessary to delineate the parameters of the finding.

"A source of empowerment and well-being": Experiences of a dance and yoga intervention for young girls with functional abdominal pain disorders

Background

Functional abdominal pain disorders are common among children and adolescents worldwide and effective treatments are needed to alleviate suffering for these children and their families. This study aimed to explore the experience of participating in a combined dance and yoga intervention from the perspectives of girls aged 9-13 years with functional abdominal pain disorders.

Materials and Methods

A randomized controlled trial called Just in TIME (Try, Identify, Move and Enjoy) recruited 121 girls aged 9-13 years with functional abdominal pain disorders. The eight-month intervention combined dance and yoga twice a week, focusing on enjoyment, socialization and playful creativity in an undemanding and non-judgemental environment. The intervention group comprised 64 girls, of whom 25 were purposefully selected for this qualitative interview study. Semi-structured interviews were conducted and analysed using qualitative content analysis with an inductive approach.

Results

The girls' experiences of the Just in TIME intervention can be described as "A source of empowerment and well-being which facilitated personal growth and new ways of engaging in life". The main category was derived from six generic categories: "A sense of belonging", "Joy and emotional expression through movement", "Relief from pain", "More self-confident", "More active in daily life" and "A sense of calm."

Conclusions

Regular participation in an eight-month intervention with combined dance and yoga in a supportive and non-judgemental atmosphere can ease pain and strengthen inner resources, resulting in empowerment, well-being and a more active life for girls with functional abdominal pain disorders.

Trial registration

The Just in TIME study is available online at clinicaltrials.gov, ID: NCT02920268.

Examining the Role of Autonomy Support, Goal Setting, and Care Coordination Quality on HIV PrEP Adherence in Black Men Who Have Sex with Men: HPTN 073

Autonomy support is a concept that is derived from self-determination theory. Autonomy refers to the freedom to act as one chooses. The current study aimed to examine if autonomy support was associated with dried blood spot validated pre-exposure prophylaxis (PrEP) adherence, and whether the association was mediated by PrEP adherence goal setting and progress toward PrEP adherence goals. Our sample was drawn from Black men who have sex with men (MSM) from across three cities (Chapel Hill, NC; Los Angeles, CA; and Washington, DC) in the United States between February 2013 and September 2014. We used logistic regression to evaluate associations between study variables and path analysis to test mediation effects. Participants were, on average, 28 [standard deviation (SD) = 1.12] years old and 25% were unemployed. We found that MSM who experienced high autonomy support were more likely to adhere to PrEP [odds ratio (OR) = 1.17; 95% confidence interval: 1.00-1.38]. MSM who set PrEP adherence goals were more likely to adhere to PrEP. Moreover, MSM who reported making progress toward their goals were also more likely to adhere to PrEP. Finally, client perception of coordination quality enhanced the magnitude of the association between goal setting and goal progress and the effect size of goal progress on PrEP adherence. Autonomy support, goal setting, goal monitoring/evaluation, and care coordination quality influenced PrEP adherence among Black MSM. Our findings indicate that while it is important to set goals for PrEP adherence, goal setting may need to be accompanied by progress monitoring to achieve the maximal effect.

The impact of adolescents' health motivation on the relationship among mental stress, physical exercise, and stress symptoms during COVID-19: A dual moderation model

Objective

Many Chinese teenagers are experiencing high mental stress levels due to epidemic-related restrictions and closures. Mental stress can induce numerous associated symptoms, and physical exercise is considered to buffer mental stress. However, it remains unclear whether health motivation regulates the relationships among mental stress, physical exercise, and stress symptoms. This study examined whether mental stress events during the epidemic can predict stress symptoms, whether physical exercise can buffer mental stress, and whether the mental stress buffer effect is enhanced when health motivation regarding physical exercise is high.

Methods

In total, 2,420 junior high school students (1,190 boys and 1,230 girls; 826 seventh-grade students, 913 eighth-grade students, and 681 ninth-grade students) from nine provinces nationwide were selected to investigate mental stress events, symptoms, health motivation, and physical exercise in adolescents. The hypothesis was tested with a multiple regression analysis.

Results

A positive relationship between adolescent mental stress events and stress symptoms was observed, and an interactive relationship was found among health motivation, physical exercise, and mental stress factors. Specifically, the mental stress-buffering effect of physical exercise was significant only when health motivation was high.

Conclusion

In the post-epidemic period, the influence of mental stress events on stress symptoms in adolescents was found to be buffered by physical exercise only in terms of high health motivation. This result highlighted the role of health motivation in the buffering effect of physical exercise on mental stress during an epidemic.

A meta-theoretical framework for organizing and integrating theory and research on motivation for health-related behavior

The concept of motivation is broad and multi-faceted. In health psychology, motivation has been conceptualized as cravings, urges, or desires for unhealthy behaviors, such as consumption of alcohol, cigarettes, or calorie-dense foods; or as behavioral intentions or proximal goals for healthy behaviors, such as smoking cessation, physical activity, or condom use. Because of the differences in terminology and associated theoretical underpinnings, it is difficult to characterize the state of the science or integrate research findings on motivation for health-related behavior. The present paper introduces a meta-theoretical Automatic-Reflective Motivation Framework (ARM-F) with the goals of organizing and integrating theory and research on motivation for health-related behaviors. At the first and broadest level, the ARM-F defines general motivation as a wanting or desire to do something. At the second level, it distinguishes between automatic and reflective motivation types, consistent with emerging perspectives in health psychology, historical and contemporary philosophical views on desire, and dual-processing perspectives in psychology. At the third level, the ARM-F preserves the nuanced terminologies and conceptualizations within the automatic (e.g., craving, urge, desire) and reflective (e.g., behavioral intention) motivation categories. The ARM-F has potential utility for organizing and integrating theory and research on motivation for health-related behavior, with implications for future research.

A self-support approach to satisfy basic psychological needs during difficult situations

We tested whether a self-support approach to satisfy basic psychological needs to increase students' basic need satisfaction, mindfulness, and subjective vitality, and decrease their need frustration, coronavirus, and test anxiety during the novel coronavirus and university final exams. Three hundred and thirty students (M _age = 21.45, SD = 2.66) participated in this 6-day long experimental study and they were randomly allocated to either experimental (self-support approach, n = 176) or control (no-intervention) condition. Students completed the targeted questionnaires at the beginning (first day of the university final exams, Time 1) middle (3 days after the beginning of the study, Time 2), and the end of study (6 days after the beginning of the study, Time 3). Compared to students in the control condition, students in the experimental condition reported higher need satisfaction, mindfulness, subjective vitality, and lower need frustration, coronavirus, and test anxiety. Through a path analysis, the experimental condition predicted positively students higher need satisfaction, which in turn, predicted their higher subjective vitality, and lower coronavirus and test anxiety at Time 3. Results highlighted the importance of a self-support approach on students' outcomes during difficult situations, that have implications for theory and practice.

Development of a tool for quantifying need-supportive coaching in technology-mediated exercise classes

Technology-mediated interventions to promote physical activity are growing in popularity and appear to be effective for supporting continued adherence for some people. Some of this efficacy may be related to the cultivation of motivation that is self-determined (i.e., autonomous), which is posited to arise from the satisfaction of three basic psychological needs: competence, relatedness, and autonomy. We developed an observational coding tool for quantifying the frequency of needs-supportive and needs-indifferent coaching during technology-mediated exercise classes. The Peloton Instructor Needs-Supportive Coaching (PINC) tool shows evidence of reliability (average kappa = .91). We also demonstrated the utility of the PINC for characterizing needs-supportive coaching profiles across 4 different types of classes (Beginner, Power Zone, Groove, and High-Intensity Interval Training) and the construct validity of the PINC with respect to examining the relationship of needs-supportive coaching to intrinsic motivation. The PINC offers a useful tool with which future studies could evaluate whether and how instructor coaching impacts self-determined motivation to exercise within a technology-mediated context.

Concepts from behavioral theories can guide clinicians in coaching for behavior change

OBJECTIVES

Many patients do not engage in health behaviors that can control common, chronic illnesses. Clinicians have opportunities to promote health behaviors yet may lack skills for coaching effectively about health behaviors. Our aims are to: present definitions of coaching, propose concepts for coaching about behavior change from two theories, share theory-guided research on behavior change relevant to ambulatory care settings, and delineate how concepts from these theories can guide coaching.

METHODS

In our discussion, we explain how two behavioral theories are complementary and applicable to coaching, present empirical support for these theories, and describe applications of these concepts for practice.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Self-determination theory can guide clinicians in how to interact with patients to meet patients' psychological needs, to promote health behaviors, and subsequent health status. Self-regulation theory can guide coaches in what concepts to address for behavior change. These complementary theories have been supported in rigorous research with adult populations in ambulatory care settings.

The Role of Health Education, Policies, and Services on College Students' Health Behavior

Objective: In this study, we aimed to define the role of health education, health policies, and health service as factors in the health behavior of Chinese college students. It is critical to understand that there is an important role of health behavior in the life of college students in any society because the survival of society is dependent on better health status. Methods: We used SPSS software for analysis to test our hypotheses.Results: We found an important role for health education, health policies, and health services as determinants of health behavior. Conclusion: The focus of healthcare organizations must be to focus on health education, health policies, and health services by creating awareness in college students that ensures they are provided with the appropriate health sector solutions. Additionally, we found theoretical and practical implications to improve the health behavior of Chinese college students via a moderating role of information technology, because, in modern times, the role of information technology is critical to convey information productively.

Culture in Physical Activity: The Contribution of Basic Psychological Needs and Goal Orientation

Numerous variables affect motivation in physical activity (PA) with culture being an understudied variable. Self-determination theory's basic psychological needs (BPN) includes a combination of autonomy, competence, and relatedness in PA; however, cultural definitions pit autonomy and relatedness against each other. Thus, this study aims to investigate the moderating role of culture on relationships between BPN, goal orientations (ego, task) for PA, and PA behavior. A survey was implemented to 168 participants (109 females, 59 males; 92 Turks, 76 Americans) investigating students' self-construal type, their basic psychological needs in exercise (BPNES), PA levels (Godin Leisure-Time Exercise Questionnaire/GLTEQ), and goal orientation types (Task and Ego Orientation in Sport Questionnaire/TEOSQ). Turks (n = 92) and Americans (n = 76) demonstrated distinct cultural differences in terms of the study variables. American students were more autonomous, task-oriented, and physically active than Turkish students. Results from the multi-group path analysis showed that there was a moderating role of culture between predictors (i.e., BPN Autonomy, BPN Relatedness, BPN Competence, Ego Orientation, and Task Orientation) and Physical Activity. Such that, the paths from predictors (i.e., BPNT Autonomy, BPNT Relatedness, BPNT Competence, Ego Orientation, and Task Orientation) to PA was not significant in Turkish cultural context. Results suggest that culturally tailored approaches to PA interventions are critical in supporting motivation for physical activity and further research is needed to explore different culturally relevant motivational drivers for PA among adults.

What Influences Children's Physical Activity? Investigating the Effects of Physical Self-Concept, Physical Self-Guides, Self-Efficacy, and Motivation

Physical fitness self-concept (PFSC) is an important predictor of motivation and physical activity in children. Recent studies revealed that not only PFSC but also its interplay with perceptions of one's ideal and ought physical fitness self are related to motivation and physical activity. As the meaning of ideal and ought selves in children is yet unclear, this study aimed to investigate how PFSC, ideal physical fitness self, and ought physical fitness self are related to children's motivation and physical activity. Six hundred forty-five children (Mage = 8.87 years) filled out questionnaires twice with an interval of approximately 8 months. Polynomial regression with response surface analyses and mediation analyses was conducted. Results showed that PFSC, rather than ideal and ought self-perceptions, is associated with autonomous motivation, self-efficacy, and physical activity. The relationship between PFSC and physical activity was mediated by self-efficacy. Findings indicate that physical activity promotion programs should include PFSC and self-efficacy enhancement in childhood.

Freedom as Prevention: Mechanisms of Autonomy Support for Promoting HIV Pre-Exposure Prophylaxis Use and Condom Use among Black MSM in 3 US Cities-HPTN 073

Healthcare providers who use controlling or coercive strategies may compel short-term enactment of HIV and sexually transmitted infection prevention behaviors but may inadvertently undermine their client's motivation to maintain those behaviors in the absence of external pressure. Autonomous motivation refers to the self-emanating and self-determined drive for engaging in health behaviors. It is associated with long-term maintenance of health behaviors. We used structural equation modeling to investigate whether autonomy support was associated with increased odds of therapeutic serum levels of pre-exposure prophylaxis, through a pathway that satisfies basic psychological needs for autonomous self-regulation and competence regarding pre-exposure prophylaxis use. We also investigated whether autonomy support was associated with decreased odds of condomless anal intercourse via the same psychological needs-satisfaction pathway of autonomous self-regulation and competence regarding condom use. We tested these two theorized pathways using secondary data from a longitudinal sample of Black men who have sex with men from across three cities in the US (N = 226). Data from the sample fit the theorized models regarding the pathways by which autonomy support leads to the presence of therapeutic PrEP levels in serum (χ2 = 0.56; RMSEA = 0.04; CFI = .99, TLI = 0.98) and how it also leads to decreased odds of condomless anal intercourse (χ2 = 0.58; RMSEA = 0.03; CFI = 0.99; TLI = 0.98). These findings provide scientific evidence for the utility of self-determination theory as a model to guide intervention approaches to optimize the implementation and impact of PrEP for Black men who have sex with men.

Motivating playgrounds: understanding how school playgrounds support autonomy, competence, and relatedness of tweens

Purpose

Physical activity (PA) is an important factor contributing to general health. PA declines rapidly during tween years (9–12 years) when children’s social world changes. School playgrounds can contribute substantially to children’s PA, but little is known about how to motivate tweens to use school playgrounds. Using the three basic psychological needs (autonomy, competence, and relatedness) proposed by the Self-Determination Theory, this qualitative study aimed to investigate how school playgrounds can support tweens’ needs.

Methods

Tweens (n = 56) participated in focus group go-along interviews in their school playground.

Results

We found that tweens needed a variety of play possibilities (autonomy) that challenged their skills (competence) as well as areas to retract and be with friends (relatedness).

Conclusion

This research highlights the importance of incorporating tweens’ perspectives in playground design to attract and retain them in play and PA in school playgrounds.

A group-based exercise and behavioural maintenance intervention for adults over 65 years with mobility limitations: the REACT RCT

Background

Mobility limitation in older age reduces quality of life, generates substantial health- and social-care costs, and increases mortality.

Objective

The REtirement in ACTion (REACT) trial aimed to establish whether or not a community-based active ageing intervention could prevent decline in physical functioning in older adults already at increased risk of mobility limitation.

Design

A multicentre, pragmatic, two-arm, parallel-group randomised controlled trial with parallel process and health economic evaluations.

Setting

Urban and semi-rural locations across three sites in England.

Participants

Physically frail or pre-frail older adults (aged ≥ 65 years; Short Physical Performance Battery score of 4–9). Recruitment was primarily via 35 primary care practices.

Interventions

Participants were randomly assigned to receive brief advice (three healthy ageing education sessions) or a 12-month, group-based, multimodal exercise and behavioural maintenance programme delivered in fitness and community centres. Randomisation was stratified by site and used a minimisation algorithm to balance age, sex and Short Physical Performance Battery score. Data collection and analyses were blinded.

Main outcome measures

The primary outcome was change in lower limb physical function (Short Physical Performance Battery score) at 24 months, analysed using an intention-to-treat analysis. The economic evaluation adopted the NHS and Personal Social Services perspective.

Results

Between June 2016 and October 2017, 777 participants (mean age 77.6 years, standard deviation 6.8 years; 66% female; mean Short Physical Performance Battery score 7.37, standard deviation 1.56) were randomised to the intervention arm (n = 410) or the control arm (n = 367). Data collection was completed in October 2019. Primary outcome data at 24 months were provided by 628 (80.8%) participants. At the 24-month follow-up, the Short Physical Performance Battery score was significantly greater in the intervention arm (mean 8.08, standard deviation 2.87) than in the control arm (mean 7.59, standard deviation 2.61), with an adjusted mean difference of 0.49 (95% confidence interval 0.06 to 0.92). The difference in lower limb function between intervention and control participants was clinically meaningful at both 12 and 24 months. Self-reported physical activity significantly increased in the intervention arm compared with the control arm, but this change was not observed in device-based physical activity data collected during the trial. One adverse event was related to the intervention. Attrition rates were low (19% at 24 months) and adherence was high. Engagement with the REACT intervention was associated with positive changes in exercise competence, relatedness and enjoyment and perceived physical, social and mental well-being benefits. The intervention plus usual care was cost-effective compared with care alone over the 2 years of REACT; the price year was 2019. In the base-case scenario, the intervention saved £103 per participant, with a quality-adjusted life-year gain of 0.04 (95% confidence interval 0.006 to 0.074) within the 2-year trial window. Lifetime horizon modelling estimated that further cost savings and quality-adjusted life-year gains were accrued up to 15 years post randomisation.

Conclusion

A relatively low-resource, 1-year multimodal exercise and behavioural maintenance intervention can help older adults to retain physical functioning over a 24-month period. The results indicate that the well-established trajectory of declining physical functioning in older age is modifiable.

Limitations

Participants were not blinded to study arm allocation. However, the primary outcome was independently assessed by blinded data collectors. The secondary outcome analyses were exploratory, with no adjustment for multiple testing, and should be interpreted accordingly.

Future work

Following refinements guided by the process evaluation findings, the REACT intervention is suitable for large-scale implementation. Further research will optimise implementation of REACT at scale.

Trial registration

This trial is registered as ISRCTN45627165.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 14. See the NIHR Journals Library website for further project information.

Motivation and anxiety during the second COVID-19 lockdown in gym exercisers: The mediating role of affects and satisfaction with life

The present study aimed to analyze the association between motivation (self-determined and non-self-determined motivation), positive and negative affect, life satisfaction and state-anxiety in a sample of gym exercisers, during the 2nd COVID-19 lockdown in Portugal. Also, we aimed to analyze the possible mediating role of positive and negative affect and life satisfaction in the relationship between motivation and levels of state-anxiety. A total of 201 gym participants (30.42 ± 11.22) were enrolled in the present study, of which 116 (57.7%) were women and 85 (42.3%) were men. The survey included sociodemographic data as well as the subsequently validated instruments: the State-Trait Anxiety Inventory, the Positive and Negative Affect Schedule, and the Satisfaction with Life Scale. The results revealed a positive association between state-anxiety and negative affect (r = .69), controlled motivation (r = .33), and autonomous motivation (r = .25). Still, state-anxiety was negatively associated with positive affect (r = -.40) and with satisfaction with life (r = -.43),. In addition, the results of mediation analysis, revealed inconsistent mediation of positive affect and life satisfaction in the relationship between autonomous motivation and state-anxiety. However, a total mediation was observed through negative affect and life satisfaction in the relationship between controlled motivation and anxiety since the indirect effect (β = .27) is higher than the direct effect (β = .06). Overall, the results reinforce that positive affect and satisfaction with life could act as a possible buffer against state-anxiety in gym exercisers and, thus, should be considered in future interventions and studies.

Changes in Health-Promoting Behaviors and Their Association with Weight Loss, Retention, and Engagement on a Digital Program: Prospective Study

Health-promoting lifestyle behaviors (e.g., as measured by the HPLP-II) are associated with reductions in lifestyle disease mortality, as well as improved well-being, mental health, and quality of life. However, it is unclear how a weight-management program relates to a broad range of these behaviors (i.e., health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management), especially a fully digital program on which individuals have to self-manage their own behaviors in their daily lives (with assistance from a virtual human coach). In the context of a digital setting, this study examined the changes in health-promoting behaviors over 12 months, as well as the associations between health-promoting behaviors and weight loss, retention, and engagement, among participants who self-enrolled in a mobile CBT-based nutritionally focused behavior change weight management program (n = 242). Participants lost a statistically significant amount of weight (M = 6.7 kg; SD = 12.7 kg; t(80) = 9.26, p < 0.001) and reported significantly improved overall health-promoting lifestyle behaviors (i.e., HPLP-II summary scores), as well as, specifically, health responsibility, physical activity, nutrition, spiritual growth, stress management, and interpersonal relations behaviors from baseline to 6 months and from 6 months to 12 months (all ps < 0.008). Health-promoting behaviors at 6 months (i.e., learned health-promoting behaviors) compared to baseline were better predictors of retention and program engagement. A fully digital, mobile weight management intervention can improve HPLP-II scores, which, in turn, has implications for improved retention, program engagement, and better understanding the comprehensive effects of weight management programs, particularly in a digital setting.

Validation of the motivation scale towards Health-Oriented physical activity (EMAPS) in Spanish Population

The aim of the present study was to examine the psychometric properties of the motivation scale towards health-oriented physical activity (EMAPS) in the Spanish Population. A sample of 808 participants (Mage = 33.90; SD = 12.91; 366 men and 440 women), participated to ensure the structural, methodological, and external correlates of EMAPS scale validation. Results of the structural stage of analyses confirmed 6 dimensions of EMAPS (i.e., intrinsic motivation, integrated regulation, identified regulation, introjected regulation, external regulation and amotivation). In conclusion, results provided evidence for the reliability and validity of the Spanish version of the EMAPS scores. Thus, this instrument may serve to provide a measure of the motivation towards health-oriented physical activity purposes in the Spanish population.

The art of forming habits: applying habit theory in changing physical activity behaviour

Background

Habits are obtained as a consequence of cue-contingent behavioural repetition. Context cues stimulate strong habits without an individual contemplating that action has been initiated. Because of its health-enhancing effects, making physical activity a part of one’s life is essential. This study examined the associations of physical activity (PA) behaviours with PA habits and the role of autonomous motivation in developing PA habits.

Methods

This study used a cross-sectional design. A structured questionnaire was implemented through emails to 226 university students, where PA levels, habits and autonomous motivation were self-reported.

Results

Binary logistic regression identified age groups, gender and participants who were trying to lose weight as the significant predictors in meeting physical activity guidelines. Path analysis showed that moderate-intensity physical activity (β = 0.045, CI = 0.069–0.248) and strength training exercises (β = 0.133, CI = 0.148–0.674) were significantly associated with PA habits (p < 0.01). Autonomous motivation was directly associated with PA habits (β = 0.062, CI = [0.295–0.541], p < 0.01) and was also significantly related to moderate-intensity physical activity (β = 0.243, CI = [0.078–0.266], p < 0.01) and strength training exercises (β = 0.202, CI = [0.033–0.594], p < 0.05).

Conclusions

The emphasis on experiment-based logic and interest in habit formation in the research community is extensive. As the college years offer an excellent opportunity to establish healthy behavioural interventions, encouraging students in regular PA and exhibiting an autonomous motivation towards PA may be necessary.

Self-Determination Theory and Preventive Medication Adherence: Motivational Considerations to Support Historically Marginalized Adolescents With Asthma

INTRODUCTION

Using self-determination theory, we explored relationships between autonomous motivation (AM) and perceived competence (PC) with previously validated measures of motivation and adolescent-reported asthma medication adherence.

METHOD

Data were from adolescents (n = 260) enrolled in the School-Based Asthma Care for Teens study and taking preventive medication at baseline. Eligible adolescents (aged 12-16 years) had physician-diagnosed persistent asthma or poor control.

RESULTS

Adolescents taking daily preventive medicine reported higher AM and PC for adherence, whereas adolescents likely to miss ≥1 dose in the next 2 weeks had lower AM and PC. Adolescents taking medicines as prescribed, with plans to continue, and those feeling able to follow provider care plans, had higher AM and PC. Findings remained significant in regressions with control variables.

DISCUSSION

Many factors interfere with adolescent medication-taking. Clinicians' efforts to build AM and PC with patients and caregivers may be key to promoting adherence in this group.

Self-determination theory guided oral self-care training for adolescents-A cluster randomised controlled trial

Quality oral self-care is a key element in maintaining oral health, which is important for students' general health, their overall well-being and learning. The cluster randomised controlled trial tested the following hypotheses: (1) self-determination theory (SDT)-guided dental education is superior to conventional dental instruction in modifying oral self-care in adolescents; (2) after the discontinued dental education, improved oral self-care is only maintained for short rather than long term and (3) multiple predictors explain variations in adolescents' oral self-care at different observation periods. The intervention group (N = 97) received three face-to-face educational sessions to facilitate adolescents' intrinsic motivation, while the control group (N = 99) had one conventional dental instruction session. Dental plaque scores (% of tooth area covered by dental plaque) indicated a lack of oral self-care. Linear multivariable models tested the following predictors of oral self-care at different observation periods: socio-demographics (sex, socio-economic status, school) and self-determination attributes (autonomy, relatedness, competence). Results indicated that from baseline to the 6-month follow-up, dental plaque scores decreased (oral self-care improved) in the intervention group but not in the control group. At the 12-month follow-up point, there were no significant differences in mean plaque scores between the study groups. Baseline plaque levels (β = 0.807), the type of dental instruction (theory guided vs. conventional) (β = 0.208), relatedness (β = 0.106) and competence (β = 0.102) were significant predictors that explained 67.6% of the variance in dental plaque scores at the 12-month follow-up point. The theory-guided education was superior to conventional verbal instruction in improving adolescent oral self-care; however, this improvement was only maintained short term. Variations in adolescent oral self-care at short- and long-term observation points were explained by baseline oral self-care levels and two SDT components: relatedness and competence.

Parental Autonomy Support and Mental Health among Chinese Adolescents and Emerging Adults: The Mediating Role of Self-Esteem

Guided by the dual-factor model and self-determination theory, this study explored the relationship between parental autonomy support and mental health (i.e., life satisfaction and emotional problems) in adolescents and emerging adults, with a focus on the mediating role of self-esteem. We conducted two studies among independent samples in China, including 1617 adolescents aged 10 to 17 years (Mage =12.79, SD = 1.63; 50.7% girls; Study 1) and 1274 emerging adults aged 17 to 26 years (Mage = 20.31, SD = 1.63; 56.6% women; Study 2). All participants completed a set of self-reported questionnaires. The results of both studies validated our hypothesis; specifically, parental autonomy support was positively associated with life satisfaction, but negatively associated with emotional problems (emotional symptoms in Study 1 and depressive symptoms in Study 2). Meanwhile, self-esteem partially mediated the positive relationship between parental autonomy support and life satisfaction (R² = 0.33 in Study 1; R² = 0.38 in Study 2), and partially mediated the negative relationship between parental autonomy support and emotional problems (R² = 0.16 in Study 1; R² = 0.42 in Study 2). In summary, this suggests that the common antecedents of positive and negative indicators of mental health addressed in this study are prevalent in adolescents and emerging adults. These findings have important implications for preventive and interventional efforts aimed at mental health problems in both demographics.

Psychometric Parameters of the Intrinsic Motivation Inventory Adapted to Physical Education in a Sample of Active Adults from Austria

Introduction. Intrinsic motivation is essential for establishing life-long positive behaviors. In Physical Education (PE), this variable may have a significant impact on students’ choice of adhering to an active lifestyle both in the short and long term. Many tools have been developed for the assessment of intrinsic motivation, among which the Intrinsic Motivation Inventory (IMI) was built based on the Self-Determination Theory. The aim of this study is to examine a version of the IMI adapted to PE (IMI-PE). Methods. A total of 660 customers of a Sports Service Center responded to the IMI-PE and 39 individuals carried out a test–retest of the tool within two weeks. Results. The initial model including the original pool of items showed low indexes of goodness of fit. However, the removal of item 6, 8, 13, and 14 led to excellent parameters for the four-factor model (CFI = 0.96, and SRMR = 0.0420). Internal consistency and reliability analyses confirmed the robustness of such model. The final IMI-PE, comprising 14 items distributed into four factors, represents a robust assessment tool for the analysis of intrinsic motivation in PE.

Reliability and validity of the Japanese treatment self-regulation questionnaire for Japanese workers

BACKGROUND

Motivational interventions are used as preventive measures in occupational health. However, existing studies primarily focus on motivation methods and not the stage of motivation-the process from extrinsic to intrinsic motivation. The treatment self-regulation questionnaire (TSRQ) can predict workers' health at each motivational stage. Accordingly, this study examined the reliability and validity of the Japanese version of the TSRQ (Diet and Exercise) in occupational health settings.

METHODS

Responses of 912 workers were analyzed. In this study, the Cronbach's alphas were 0.85 for Diet and 0.84 for Exercise after excluding items with low Item-Total correlations. Regarding convergent validity, there was a weak correlation between behavior modification stages and the TSRQ. Regarding structural validity, confirmatory factor analysis was performed assuming a four-factor structure.

RESULTS

The goodness-of-fit indices were: Comparative Fit Index (CFI) = 0.94, Tucker Lewis Index (TLI) = 0.92, and Root Mean Square Error of Approximation (RMSEA) = 0.07 for Diet and CFI = 0.92, TLI = 0.91, and RMSEA = 0.08 for Exercise.

CONCLUSION

The Japanese version of the TSRQ has a certain degree of reliability and validity. It can measure motivation for Diet and health-related behaviors in occupational health settings. The findings of this study may serve as a basis for promoting primary and secondary prevention.

Effectiveness of Digital Interventions for Deficit-Oriented and Asset-Oriented Psychological Outcomes in the Workplace: A Systematic Review and Narrative Synthesis

BACKGROUND

Digital psychological interventions can target deficit-oriented and asset-oriented psychological outcomes in the workplace. This review examined: (a) the effectiveness of digital interventions for psychological well-being at work, (b) associations with workplace outcomes, and (c) associations between interventions' effectiveness and their theory-base.

METHODS

six electronic databases were searched for randomised controlled trials (RCT) and quasi-experimental studies. The methodological quality of studies that used randomisation was conducted with the "Cochrane Collaboration's Risk of Bias" tool, while the "JBI Critical Appraisal Checklist" was used for non-randomised studies. Studies' theory-base was evaluated using an adaptation of the "theory coding scheme" (TSC). Due to heterogeneity, narrative synthesis was performed.

RESULTS

51 studies were included in a synthesis describing four clusters of digital interventions: (a) cognitive behavioural therapy, (b) stress-management interventions and workplace well-being promotion, (c) meditation training and mindfulness-based interventions, and (d) self-help interventions. Studies demonstrated a high risk of contamination effects and high attrition bias. Theory-informed interventions demonstrated greater effectiveness. Cognitive behavioural therapy demonstrated the most robust evidence for reducing depression symptoms among healthy employees. With the exception of the Headspace application, there was weak evidence for meditation training apps, while relaxation training was a key component of effective stress-management interventions.

Losing sleep over work: A self-determination theory view on need frustration, sleep disturbance, and mental ill health

Given the centrality of sleep and work in most individuals' lives, it is interesting to note that an empirical understanding of the association between what happens in the workplace and how well people sleep is in an early stage of development, at least relative to other topics that are of interest in the literature on stress and health. Using self-determination theory, the current study examined how maladaptive motivational processes at work relate to sleep disturbance and mental ill health. In line with hypotheses, the results of a cross-sectional analysis and analyses using data from two time points over 15 months revealed that employees are more likely to report sleep disturbance, anxiety, and depressive symptoms when they experience frustration of the basic psychological needs for autonomy, competence, and relatedness in the workplace. Additional results revealed an indirect effect of change in basic psychological need frustration on change in anxiety-but not on change in depressive symptoms-through change in sleep disturbance. Taken together, these findings add to the burgeoning literature on the maladaptive motivational origins of ill health and dysfunction in the workplace.

A process evaluation, with mediation analysis, of a web-based intervention to augment primary care exercise referral schemes: the e-coachER randomised controlled trial

Background

The e-coachER trial aimed to determine whether adding web-based behavioural support to exercise referral schemes (ERS) increased long-term device-measured physical activity (PA) for patients with chronic conditions, compared to ERS alone, within a randomised controlled trial. This study explores the mechanisms of action of the e-coachER intervention using measures of the behaviour change processes integral to the intervention’s logic model.

Methods

Four hundred fifty adults with obesity, diabetes, hypertension, osteoarthritis or history of depression referred to an ERS were recruited in Plymouth, Birmingham and Glasgow. The e-coachER intervention comprising 7-Steps to Health was aligned with Self-Determination Theory and mapped against evidence-based behaviour change techniques (BCTs). Participants completed questionnaires at 0, 4, and 12 months to assess PA and self-reported offline engagement with core BCTs in day-to-day life (including action planning and self-monitoring) and beliefs relating to PA (including perceived importance, confidence, competence, autonomy and support). We compared groups at 4 and 12 months, controlling for baseline measures and other covariates. Mediation analysis using the product of coefficients method was used to determine if changes in process variables mediated intervention effects on moderate to vigorous physical activity (MVPA) recorded by accelerometer and self-report at 4- and 12-months.

Results

The internal reliability (Cronbach’s alpha) for all multi-item scales was > 0.77. At 4-months, those randomised to e-coachER reported higher levels of PA beliefs relating to importance (1.01, 95% confidence interval (CI): 0.42 to 1.61, p = 0.001), confidence (1.28, 95% CI: 0.57 to 1.98, p < 0.001), competence (1.61, 95% CI: .68 to 2.54, p = 0.001), availability of support (0.77, 95% CI: 0.07 to 1.48, p = 0.031), use of action planning (1.54, 95% CI: 0.23 to 2.85, p = 0.021) and use of self-monitoring (0.76, 95% CI: 0.19 to 1.32, p = 0.009) compared to ERS alone. There were no intervention effects on autonomous beliefs or perceived frequency of support, compared to ERS alone. At the 12-month follow-up, participants belief in the importance of PA was the only process measure to remain significantly higher in the e-coachER group when compared to ERS alone (0.75, 95% CI: 0.05 to 1.45). Intervention effects on perceived importance (2.52, 95% CI: 0.45 to 5.39), action planning (1.56, 95% CI: 0.10 to 3.54) and self-monitoring (1.92, 95% CI: 0.21 to 4.33) at 4-months significantly mediated change in accelerometer measured MVPA at 12-months (recorded in ≥ 10-min bouts).

Conclusions

e-coachER led to some short-term changes in most process outcomes. Some of these processes also appeared to mediate e-coachER effects on changes in accelerometer measured MVPA. Further work should be carried out to understand how best to design and implement theoretically underpinned web-based physical activity promotion interventions within ERS.

Trial registration

ISRCTN, ISRCTN15644451. Registered 12 February 2015.

Eating Choices—The Roles of Motivation and Health Literacy: A Cross-Sectional Study

Food choices are determined by intrinsic and extrinsic product characteristics, biological and physiological features, psychological factors, and situational and socio-cultural factors. Self-determination theory offers the explanation of health behavior change identifying motivations located along a continuum of autonomy. Another approach to the motivations guiding health behaviors, including food choices, relies on distinguishing thematic categories. Health motivations seem to be an obvious determinant of health behaviors, but final decisions regarding health are also the effect of other types of motivations such as economic, cultural, or emotional. The role of marketing pressure in modern society is perceived to be an important source of motivation for purchasing food and other products. The Motivation–Opportunity–Ability (MOA) framework was initially proposed in order to explain the processing of brand information from advertisements and was later expanded to other areas, including health and nutritional behaviors. The aim of this study was the analysis of determinants of food choices. We have developed a common regression model including six categories of motivations addressed by the Eating Motivations Scale and three health literacy types corresponding with element of ability from the MOA framework, adjusted for socio-demographic factors, health status, and the use of the Internet and TV. The analysis was performed on data from a computer-assisted web-based interviewing (CAWI) survey among 2008 adult Internet users completed in May 2022. The uni- and multivariate linear regression models were developed with the Index of Unhealthy Food Choices (IUFC), calculated based on the responses to items asking about the frequency of the consumption of twelve food categories. Univariate modeling revealed that IUFC is significantly associated with health, food, and e-health literacies and with five out of six eating motivations. However, the multivariate regression model yielded significant associations only for eating motivations but not for the three literacy scores. Health motivation was negatively associated with IUFC (B, standard error (SE): 0.83, 0.07; 95% confidence interval (95% CI): 0.98–0.69), but positively with emotional (B, SE: 0.22, 0.04; 95% CI: 0.14–0.3), economic (B, SE: 0.41, 0.08; 95% CI: 0.25–0.56), and marketing (B, SE: 0.62, 0.08; 95% CI: 0.47–0.78) motivations. Our findings suggest that motivations guiding food choices may prevail over the element of ‘ability’ distinguished in the frameworks and models that explain people’s behaviors, including behaviors relating to health. Thus, it is essential to emphasize development of appropriate motivations and not only to provide knowledge and skills. Furthermore, one should also remember motivations other than health motivations when searching for the determinants of health behaviors.

Drinking water behavior and willingness to use filters by middle-aged and elderly residents in rural areas: A cross-sectional study in Tengchong, China

Access to safe drinking water is critical to health and development issues, and residents' drinking behavior reflects their awareness of health and water hygiene. Random sampling and face-to-face questionnaires were used to investigate the drinking water behavior, sanitation and perceptions of drinking water among middle-aged and elderly residents in Tengchong, southwest Yunnan from July 1 to July 28, 2021. Differences between groups were assessed using the Chi-square test and t-test. Two binary logistic regression analyses were conducted to explore the influencing factors of drinking unboiled tap water and willingness to use filters. Results show that 35% of residents drink unboiled tap water, and 29.8% of respondents indicated a willingness to use filters. The model results showed a strong correlation between 60 and 79 years old (OR: 0.510, 95% CI: 0.303-0.858), 80 and above years old (OR: 0.118, 95% CI: 0.038-0.365), drinking water at a regular interval (OR: 0.397, 95% CI: 0.257-0.612), wanting to gain knowledge about drinking water (OR: 0.198, 95% CI: 0.099-0.395), Perceived health risks (PHR) (OR: 0.847, 95% CI: 0.771-0.929), having kidney stones (OR: 2.975, 95% CI: 1.708-5.253) and drinking unboiled tap water (p < 0.05). 60-79 years old (OR: 0.446, 95% CI: 0.244-0.815), 80 and above years old (OR: 0.228, 95% CI: 0.064-0.812), water storage (OR: 0.088, 95% CI: 0.026-0.300), middle school and above (OR: 2.238, 95% CI: 1.289-3.883), household water treatment (HWT) (OR: 33.704, 95% CI: 9.726-116.791), Perceived health risks (PHR) (OR:1.106, 95% CI: 1.009-1.213), water authority satisfaction (WAT) (OR:0.857, 95% CI: 0.769-0.956) and willingness to use filters were correlated (p < 0.05). Our findings suggested that a certain proportion of permanent middle-aged and elderly residents in rural areas still drink unboiled tap water, and residents are less willing to use filters. Residents' perception of drinking water can reflect residents' drinking water behavior and willingness to a certain extent. It is recommended that the government and Centers for Disease Control (CDC) should strengthen relevant measures such as knowledge popularization and health education, and regulate the water use behavior of middle-aged and elderly residents. Promote safe, economical and effective household water filtration facilities to ensure public health safety.

Lessons Learned From Clinicians and Stroke Survivors About Using Telerehabilitation Combined With Exergames: Multiple Case Study

Background

In Canada, stroke survivors have difficulty accessing community-based rehabilitation services because of a lack of resources. VirTele, a personalized remote rehabilitation program combining virtual reality exergames and telerehabilitation, was developed to provide stroke survivors an opportunity to pursue rehabilitation of their chronic upper extremity (UE) deficits at home while receiving ongoing follow-up from a clinician.

Objective

We aimed to identify the behavioral and motivational techniques used by clinicians during the VirTele intervention, explore the indicators of empowerment among stroke survivors, and investigate the determinants of VirTele use among stroke survivors and clinicians.

Methods

This multiple case study involved 3 stroke survivors with chronic UE deficits and their respective clinicians (physiotherapists) who participated in the VirTele intervention, a 2-month remote rehabilitation intervention that uses nonimmersive virtual reality exergames and telerehabilitation aimed at improving UE deficits in stroke survivors. Study participants had autonomous access to Jintronix exergames and were asked to use them for 30 minutes, 5 times a week. The VirTele intervention included 1-hour videoconference sessions with a clinician 1 to 3 times a week, during which the clinician engaged in motivational interviewing, supervised the stroke survivors’ use of the exergames, and monitored their use of the affected UE through activities of daily living. Semidirected interviews were conducted with the clinicians and stroke survivors 4 to 5 weeks after the end of the VirTele intervention. All interviews were audiorecorded and transcribed verbatim. An abductive thematic analysis was conducted to generate new ideas through a dynamic interaction between data and theory.

Results

Three stroke survivors (n=2, 67%, women and n=1, 33%, man), with a mean age of 58.8 (SD 19.4) years, and 2 physiotherapists participated in the study. Five major determinants of VirTele use emerged from the qualitative analyses, namely technology performance (usefulness and perception of exergames), effort (ease of use), family support (encouragement), facilitators (considerations of the stroke survivors’ safety as well as trust and understanding of instructions), and challenges (miscommunication and exergame limits). During the VirTele intervention, both clinicians used motivational and behavioral techniques to support autonomy, competence, and connectivity. All these attributes were reflected as empowerment indicators in the stroke survivors. Lessons learned from using telerehabilitation combined with exergames are provided, which will be relevant to other researchers and contexts.

Conclusions

This multiple case study provides a first glimpse into the impact that motivational interviewing can have on adherence to exergames and changes in behavior in the use of the affected UE in stroke survivors. Lessons learned regarding the supportive role caregivers play and the new responsibilities clinicians have when using the VirTele intervention may inform the use of exergames via telerehabilitation. These lessons will also serve as a model to guide the implementation of similar interventions.

International Registered Report Identifier (IRRID)

RR2-10.2196/14629

Patient life aspirations in the context of Duchenne Muscular Dystrophy: a mixed-methods case–control study

Background

Aspirations refer to wishes, ways of defining quality of life (QOL), and life goals. Living with chronic illness likely impacts a person’s life aspirations. Duchenne Muscular Dystrophy (DMD) is an inherited disorder characterized by the inevitable and progressive loss of ambulation and independence. The present cross-sectional case–control study investigated how aspirations differed between people with DMD and a stratified comparison group of nationally representative children/adults.

Methods

A web-based survey was administered October through December 2020. Recruitment was stratified by age group: 8–12, 13–17, and >  = 18, reflecting the DMD disability trajectory. Aspirations were measured using qualitative (open-ended) and quantitative (closed-ended) questions. Qualitative prompts asked participants about wishes, how they would define “QOL”; and goals; answers to the prompts were then coded by six trained raters. Quantitative questions included 29 closed-ended goal-delineation items from the QOL Appraisal Profilev2. These data were analyzed using multivariate models adjusting for propensity scores (demographic differences), and testing for the effects of role (patient or comparison), age, and role-by-age interactions.

Results

The study sample of DMD (n = 285) and comparison (n = 292) participants provided open-text data: 577 wishes statements, 283 QOL-definition statements, and 149 goals statements. Inter-rater reliability (kappa = 0.77) reflected good agreement between different raters’ codes. Results suggested that people with DMD have aspirations that differ from their peers in several important ways. Both open-text and closed-ended data in both unadjusted and adjusted analyses generally showed that people with DMD were more focused on intrinsic aspirations such as health, healthcare, and independence than their peers. Compared to non-DMD persons, DMD individuals were much less focused on financial or housing concerns, community contributions, or spiritual growth. With age, patients’ aspirations focused less on extrinsic aspirations such as careers and work and increasingly emphasized emotion-oriented goals. Patients were markedly less likely to give a direct answer to the open-ended goals question.

Conclusion

There were important differences in aspirations between people with DMD and their peers. These findings may be helpful for developing psychosocial interventions.

Siblings’ life aspirations in the context of Duchenne muscular dystrophy: a mixed-methods case-control study

Background

The inevitable and progressive loss of independence in Duchenne Muscular Dystrophy (DMD) patients may have an impact on their siblings’ life aspirations. The present cross-sectional case-control study investigated how aspirations differed between brothers and sisters of people with DMD and a stratified comparison group of nationally representative children/adults.

Methods

A web-based survey was administered October through December 2020. Aspirations were measured using qualitative (open-ended) and quantitative (closed-ended) questions. Qualitative prompts asked participants about wishes, goals, and how they define quality of life (QOL) and were coded by six trained raters. Quantitative questions included 29 closed-ended goal-delineation items from the QOL Appraisal Profile_v2. These data were analyzed using multivariate models adjusting for propensity scores (demographic differences) and testing for the effects of role (sibling or comparison), age, and role-by-age interactions.

Results

The study sample of DMD sibling (n = 349) and comparison (n = 619) participants provided open-ended data on 968 wishes statements, 390 QOL-definition statements, and 328 goals statements. Inter-rater reliability (kappa = 0.77) reflected good agreement between raters. Results of both open-ended and closed-ended data, and of both unadjusted and adjusted analyses suggested that DMD siblings, with age, were more focused on DMD-related, family/community, intimacy, and work concerns than their peers. They were less focused on improving mood, independence, pragmatics, or subtle fine-tuning of problem-solving in life. In contrast, the comparison group was more focused on goals related to growth, purpose, and reflection. Some group differences were amplified amongst older siblings.

Conclusion

This is the first study to evaluate DMD siblings’ aspirations in comparison to their peers. While there were many similarities between groups, the differences in aspirations between DMD siblings and their peers encompassed not just DMD, family/community, and intimacy, but also more work concerns. Directions for future quantitative and qualitative research are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-022-00501-7.

Is a female physical empowerment campaign effective in improving positive body image, motivation for physical activity, and physical activity behavior in young female adults? A two-study experimental test of "This Girl Can"

This Girl Can is a campaign designed to empower women to increase physical activity. The campaign uses images/videos of women of diverse body weights/shapes, ages and ethnicities being physically active, emphasizing body functionality. First, we examined the effects of multi-session (N = 3) exposures to This Girl Can on body functionality, body appreciation and self-compassion (Study 1). Second, we explored if autonomous motivation for physical activity mediated effects of This Girl Can on physical activity (Study 2). Women (Study 1: N = 186, M (SD) age = 27.55 (14.01); Study 2: N = 153, M (SD) age = 28.31 (11.70)) were randomized to This Girl Can, or control videos/images depicting idealized women of thin/athletic body types being physically active (Study 1), or control videos highlighting physical activity benefits (Study 2). Outcomes were measured at baseline, post-test and 1-week follow-up. Study 1 results showed significant group by time interactions for body functionality (decreasing in the control group), body appreciation and self-compassion (both increased only in the experimental conditions). In Study 2, path analysis revealed no statistically significant mediation effect (ab = 13.18, 95 % CI [-107.92, 152.59]) of autonomous motivation. Future interventions designed to promote positive body image and self-compassion should incorporate media focusing on diverse women engaging in self-chosen physical activity.

Associations between Perceived Teacher Autonomy Support, Self-Determined Motivation, Physical Activity Habits and Non-Participation in Physical Education in a Sample of Lithuanian Adolescents

In this cross-sectional study, we tested the associations between teacher autonomy support, self-determined motivation for physical education (PE), physical activity habits and non-participation in physical education in a sample of adolescents. A total of 715 adolescents (of whom 371 (51.89%) were girls) participated. The ages ranged from 14 to 18 years, with mean ages of 16.00 (SD = 0.79) for girls and 15.99 (SD = 0.75) for boys. The study questionnaire consisted of demographic questions and the Learning Climate Questionnaire, Revised Perceived Locus of Causality in Physical Education Questionnaire, Behavioural Regulation in Exercise Questionnaire 2, Self-Report Habit Index for Physical Activity, Godin Leisure-Time Exercise Questionnaire, Rosenberg Self-Esteem Scale, perceived physical fitness and frequency of non-participation in PE classes. The results showed that perceived teacher autonomy support was directly positively associated with physical activity habits and negatively with non-participation in physical education classes. Autonomous motivation for PE was a mediator between perceived teacher autonomy support and physical activity habits, meaning that higher autonomous motivation was related to higher physical activity habits. Motivation for PE was also a mediator between teacher autonomy support and non-participation in PE. Higher autonomous motivation for PE was associated with less frequent non-participation in PE classes. The findings can inform PE teachers' practice by showing that supporting students' autonomy and strengthening their self-determined motivation can facilitate increased participation in PE classes and the formation of students' physical activity habits.

Analysis of the Effect of Mindfulness Behavior Intervention Combined with Progressive Breathing Training on Pulmonary Function Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease

Purpose

Studies have shown that 50%-70% of patients with chronic obstructive pulmonary disease (COPD) have fatigue in addition to respiratory symptoms, so relieving respiratory symptoms and reducing fatigue are the main treatment objectives for COPD patients. This study focuses on the effect of positive behavioral intervention combined with progressive breathing training on pulmonary function rehabilitation in patients with COPD.

Methods

86 patients who underwent COPD treatment in our hospital between August 2020 and December 2021 were selected as study subjects and were divided into control (n = 43) and study groups (n = 43) using the random number table method. Patients in the control group were given conventional care, treatment, and health guidance, while patients in the study group were given positive behavioral intervention combined with progressive breathing training on this basis. Patients in both groups were compared on the basis of Multidimensional Fatigue Inventory 20 (MFI-20) score, the Medical Coping Questionnaire (MCMQ score), the Massive Attentional Awareness Scale (MAAS) score, and pulmonary function indicators (including the percentage of forced expiratory volume one second (FEV1%), peak expiratory flow (PEF), forced vital capacity (FVC), and 6-min walk distance (6MWD)) and quality of life (MCMQ) scores before and after 12 weeks of intervention.

Results

After 12 weeks of intervention, the study group had higher MFI-20 scores (comprehensive fatigue, physical fatigue, reduced activity, decreased power, and mental fatigue), confrontation scores on the MCMQ scale, MAAS scores (observation, description, nonjudgmental to intrinsic experience, nonresponsiveness to intrinsic experience, and perceived behavior), FEV1%, PEF, FVC, and 6MWD levels than the control group (P < 0.05). The scores of avoidance and submission on the MCMQ scale, and all scores of quality of life (cough, expectoration, shortness of breath, chest tightness, housework, going out, sleep, and energy) were lower than those of the control group (P < 0.05).

Conclusion

Positive behavioral interventions combined with progressive breathing training have a strengthening effect on the clinical treatment of COPD patients. Positive behavioral interventions combined with progressive breathing training are simple to implement as individual self-regulation methods and can be practiced on their own after being familiar with certain methods and techniques, and long-term adherence helps individuals cope with the stimulation of adverse events. Trail Registration. The clinical registration number for this research is L2020083.

The role of irrational beliefs and motivation regulation in worker mental health and work engagement: A latent profile analysis

Research concerning rational emotive behaviour therapy (REBT) and autonomous and controlled motivation within athletic settings is burgeoning. It is proposed that irrational beliefs (i.e., illogical, rigid, and extreme) together with controlled forms of motivation, can determine psychological well-being and physical health in these contexts. For example, research indicates that extreme negative self-evaluation (i.e., self-depreciation) is related to more controlled (less autonomous) motivation regulation, which may underpin poorer health. Though, research is yet to understand the concomitant influence of both irrational beliefs and motivation regulation on work related variables such as presenteeism, persistence and turnover intention, as well as non-work-related variables such as life satisfaction and mental-wellbeing. The present two study paper examines the latent profile structure of irrational beliefs and motivation regulation, and how these latent profiles relate to health and work-related variables. Across studies 1 and 2, results indicated a two-class profile whereby class 1 is characterised by low irrational beliefs and high self-determined motivation (low irrational engagement), and class 2 is characterised by high irrational beliefs and low self-determined motivation (high irrational engagement). Those in Class 2 reported poorer life satisfaction, persistence, and presenteeism, as well as greater depression, anxiety, stress, intention to quit, and absenteeism than those in class 1. Thus, findings indicate that poorer work and health outcomes are associated with greater irrational work engagement. The findings are discussed in relation to the practical implications for occupational workers.

Basic Psychological Needs and Agency and Communion During the COVID-19 Pandemic

Abstract. Despite the conceptual proximity between the basic needs and agency and communion and their similar function for psychological functioning, studies investigating their interplay are scarce. This study aims to investigate their joint role in hedonic and eudaimonic well-being in light of the COVID-19 pandemic. Self-reports were collected from 13,313 adolescents (Sample 1) and 1,707 young adults (Sample 2) from Austria. The results show the importance of both agency and communion for the fulfillment of different basic needs and their role in well-being, with a universal interaction effect between communion and perceived competence on intrinsic motivation (eudaimonic aspect) in both gender groups in adolescence, as well as on positive emotions (hedonic aspect) among young women. Theoretical and practical implications are discussed.

Children's Motivation Profiles in Sports and Physical Activities: A Latent Profile Analysis and Self-Determination Theory Approach

Using latent profile analysis and self-determination theory, the present study aimed to examine younger children's motivation profiles in sports and physical activities and the relations of those profiles to various predictors and achievement outcomes. A total of 1,116 German children from Grade 2 participated in this study. Latent-profile-analysis solutions based on five behavioral-regulation types covered in self-determination theory (i.e., intrinsic, identified, introjected, external, amotivation) were tested. Results favored a three-profile solution, showing three theoretically meaningful and distinct motivation profiles labeled "amotivated," "non-self-determined," and "self-determined." Older children and children with a lower physical self-concept were more likely to be members of the amotivated profile relative to the other profiles than younger children and children with a higher physical self-concept. Furthermore, children of the self-determined profile demonstrated the best physical performance in various motor-skills tests.

Cardiology clinic patient attitudes toward and potential personal utility of genetic testing: Findings from a unique multiracial clinical sample

As more is understood about the hereditary nature of disease risk, the utility of genetic testing within cardiovascular medicine is increasingly being explored. Although testing may afford more personalized risk stratification, there is a paucity of information regarding patient knowledge, attitudes, and beliefs toward genetic testing among cardiology patients. Participants (n = 530) recruited primarily from a cardiology clinic filled out a 41-item written questionnaire assessing knowledge, beliefs, and attitudes toward genetic testing, motivators and detractors for considering genetic testing, and perceived likelihood for behavior change after hypothetical genetic testing risk stratification. Path analysis was used to test the hypothetical models predicting the likelihood of getting a genetic test and making behavior changes following genetic testing. The patient population was late-middle-aged (59.0 ± 14.5 years), majority women (61.5%), and about half reported having a bachelor's degree. 58.1% of participants self-identified as White, 25.7% as African American or Black, 6.8% as Spanish, Latino, or Hispanic, 3.0% as Asian or Pacific Islander, and 0.5% as Native American. Gender (being a woman) and more years of education were related to greater knowledge about genetic testing. Racial identity and years of education were related to beliefs about genetic testing. Beliefs, but not knowledge, were related to more positive attitudes and a higher likelihood of pursuing genetic testing. Positive attitudes were related to greater perceived personal control (PPC). Furthermore, attitudes and PPC were related to higher likelihood of lifestyle change after genetic testing. These results highlight the need to integrate the experiences of racialized communities into education/counseling efforts. Most educational counseling efforts lack a nuanced discussion of social determinants of health or beliefs. In addition to factual information, educational counseling must also address people's beliefs, concerns, and the intersecting experiences and identities, which shape patients' relationships with the evolving landscape of healthcare and personalized medicine.

Exploring the Association Between Irrational Beliefs, Motivation Regulation and Anxiety in Ultra-Marathon Runners: A Mixed Methods Approach

Researchers are beginning to explore the antecedents to anxiety symptomology. Such antecedents to anxiety symptomology may be that of irrational beliefs and motivation regulation. It has been intimated that both irrational beliefs and motivation regulation can be risk factors for increased anxiety in athletes. Research is yet to explore the association between these two antecedents, and how and whether they interact in predicting anxiety symptomology. The present paper investigates such associations within two phases. In phase one, we identify the predictive capacity of irrational beliefs and motivation regulation on anxiety symptomology in 61 elite ultra-marathon runners. Results support intimated associations between irrational beliefs and motivation regulation, evidencing that irrational performance beliefs negatively associated with relative autonomous motivation. In addition, it was found that irrational performance beliefs positively associated with anxiety symptomology, whilst autonomous motivation negatively associated with anxiety symptomology in elite ultra-marathon runners. In phase two, we use a narrative approach to understand seven elite athletes’ stories surrounding their performance beliefs, motivation, and anxiety symptomology. Phase two supports findings in phase one, evidencing that the co-existence of both irrational performance beliefs and controlled motivation is an antecedent to anxiety symptomology and dysfunctional behaviours in ultra-marathon runners. The findings of both phase one and phase two are discussed in relation to the theoretical and practical implications for elite athletes.

Advances on Self-Regulation Models: A New Research Agenda Through the SR vs ER Behavior Theory in Different Psychology Contexts

The aim of this paper is to demonstrate how Bandura's Social Cognitive Theory (1986) influenced the development of several complementary models of the construct of Self-Regulation. Building on the foundation of Self-Determination Theory, SDT (2000), and Zimmerman's Self-Regulation Theory, SR (2001), with their assumptions, contributions, goddesses, and limitations, we come to the Self- vs. External Regulatory Theory, SR-ER (2021). Finally, we integrate recent evidence demonstrating the explanatory adequacy of the SR vs. ER model for different psychological constructions in different settings related to education, health, clinical practice and social work. Complementary, a new theoretical and empirical research agenda is presented, to continue testing the adequacy of SR vs. ER assumptions, and to better understand the behavioral variability of the different constructs studied.

Promoting Physical Activity in Older Adults With Type 2 Diabetes via an Anthropomorphic Conversational Agent: Development of an Evidence and Theory-Based Multi-Behavior Intervention

Introduction

Anthropomorphic conversational agents (ACA) are a promising digital tool to support self-management of type 2 diabetes (T2D), albeit little explored. There is a dearth of literature on the detailed content of these interventions, which may limit effectiveness and replication. Our aim is to describe the development of an evidence and theory-based intervention to improve physical activity in older adults with T2D, subsumed in a multi-behavior intervention via a mobile application with an ACA.

Methods

Overall decisions on the multi-behavior intervention design, such as the use of standardized behavior change techniques (BCTTv1), guided the development of the physical activity component. Firstly, recommendations on ambulatory activity were used to select the target behavior (walking). Meta-research on effective behavior change techniques (BCTs) was then identified. One meta-analysis linked effective BCTs with the three basic psychological needs of the self-determination theory (SDT). This meta-analysis, taken together with additional evidence on SDT, led to the selection of this theory to inform the design. BCTs were extracted from meta-research; we selected the most appropriate to be operationalized via the conversational agent through multidisciplinary discussions. Rules governing the dialogue flow and BCTs tailoring, taking the form "if some conditions hold then execute some action," were derived based on the Basic Psychological in Exercise Scale (competence, autonomy, and relatedness scores), in conjunction with published evidence and multidisciplinary discussions.

Results

Thirteen BCTs were implemented in the prototype via the ACA (e.g., goal setting behavior 1.1). Six if-then rules were derived and depicted in the dialogue steps through process flow diagrams, which map how the system functions. An example of a rule is "If competence score ≤ 10 then, apply BCT 1.1 with 500 steps increments as options for the daily walking goal; If competence score > 10 then, apply BCT 1.1 with 1,000 steps increments as options for the daily walking goal."

Conclusion

Evidence and SDT were translated into a mobile application prototype using an ACA to promote physical activity in older adults with T2D. This approach, which includes 13 BCTs and six if-then rules for their tailoring, may leverage the efforts of others in developing similar interventions.

Does the Weekly Practice of Recalling and Elaborating Episodes Raise Well-Being in University Students?

Increasing well-being is a prominent worldwide goal that can be achieved primarily through social support and environmental factors. However, in times of social distancing or isolation, it is important to also rely on self-managed activities. This study aimed to (a) test the effectiveness of a seven-week well-being intervention, in increasing need satisfaction, self-compassion, emotion regulation, and grateful disposition by curbing need frustration, self-derogation, and emotional suppression, and (b) examine the maintenance and long-term effects of the practices based on recall, elaboration, and writing. One hundred and twenty university students weekly recalled and elaborated for seven consecutive weeks on three recent episodes of gratitude, self-affirmation, goal setting, or meaningful things, according to the group to which they were assigned. Before the intervention, immediately after and one month later, they filled in questionnaires to assess need satisfaction/frustration, self-compassion/derogation, emotion regulation and grateful disposition. The results confirmed an increase in well-being and a decrease in ill-being for all groups (Cohen d for the significant differences ranging from 0.18 to 0.53). The effects were maintained one month later and even increased for self-compassion, self-derogation, need frustration, and emotional reappraisal. A follow-up assessment revealed that a third of the participants continued with the well-being practices. Implications and suggestions for future well-being interventions are discussed.

Evaluation of Normalization After Implementation of the Digital Dutch Obstetric Telephone Triage System: Mixed Methods Study With a Questionnaire Survey and Focus Group Discussion

Background

The Dutch Obstetric Telephone Triage System (DOTTS) was developed to improve the quality of acute obstetric care. To achieve optimal effect, the DOTTS should be adopted in the daily care process by triage staff.

Objective

The primary aim was to evaluate the degree of implementation (ie, normalization) of the DOTTS, and the secondary aim was to evaluate which lessons can be learned from its current implementation in Dutch hospitals.

Methods

An evaluation study with a mixed methods design was performed. All triage staff in 9 Dutch hospitals that implemented the DOTTS before September 1, 2019, were invited to complete the Normalization Measure Development (NoMAD) questionnaire between December 2019 and July 2020. The questionnaire is based on the Normalization Process Theory (NPT). This self-reported questionnaire provides insights into the work people do in order to integrate and embed new practice in routine care. The NPT is based on the following 4 constructs: coherence, cognitive participation, collective action, and reflexive monitoring. Within the questionnaire, each construct is represented by 4-7 questions. Questions are scored on a 5-point normalization process scale. Descriptive statistics were used for analysis of questionnaire scores. Subsequently, the questionnaire findings were discussed during a focus group. Template analysis following the 4 constructs was used for analyzing the results of the focus group.

Results

Overall, 173 of 294 (58.8%) triage staff members completed the NoMAD questionnaire, and 90.2% (156/173) of the participants had used the DOTTS for over 6 months. The digital application was used as much as possible or always by 137 of 173 (79.2%) participants. The overall normalization process score was 3.77 (SD 0.36). The constructs coherence, cognitive participation, collective action, and reflexive monitoring scored 4.01 (SD 0.47), 4.05 (SD 0.45), 3.5 (SD 0.45), and 3.72 (SD 0.47), respectively. Analysis of the focus group discussion showed that the added value of the DOTTS was seen as a quality improvement for the care of pregnant women. Dedication of the complete multidisciplinary implementation team was important for facilitating normalization. Support from the medical staff and proper use by all disciplines involved in the triage were seen as facilitating factors. Participants appreciated training and evaluation, and indicated a need for ongoing training and evaluation in relation to goal achievement.

Conclusions

The DOTTS has been integrated into normal care in daily practice. Evaluation by the NoMAD questionnaire provided a positive overall score. These results are in line with or, in some aspects, better than the results of other evaluation studies. Key factors in the normalization process of the DOTTS in obstetric triage are the shared added value for stakeholders, the dedication of the complete multidisciplinary implementation team, and implementation plans that are tailor made in the practical context of the hospital.