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

Examining the impact of perceived behavioral control and planning on closing the exercise intention-behavior gap: Insights from a meta-analytic structural equation modeling study

OBJECTIVE

This study aims to investigate the roles of perceived behavioral control (PBC), action planning, and coping planning in bridging the gap between exercise intention and behavior. By using a Meta-Analytic Structural Equation Model (MASEM), we quantify the specific effects of these variables and explore their mediating roles in the relationships between intention, PBC, and behavior. The study provides insights into how these constructs contribute to informing effective behavioral intervention strategies.

METHODS

A meta-analysis was conducted to calculate the correlation effect sizes between variables in the model, and MASEM was employed to examine the interrelationships among multiple variables. Data from 57 samples across 49 studies, with a total sample size of 19,883, were analyzed. We constructed an aggregated correlation matrix and performed path analysis using structural equation modeling. AMOS 26.0 software was used to estimate model parameters, including path coefficients, standard errors, and various model fit indices.

RESULTS

The results indicate that behavioral intention serves as a key predictor of behavior, showing a significant positive direct effect (β = 0.416, p < 0.001). Intention also significantly predicts both action planning (β = 0.439, p < 0.001) and coping planning (β = 0.360, p < 0.001), though its impact on behavior is mediated differently by these two forms of planning. Mediation analysis further revealed that intention indirectly predicts behavior through coping planning (β = 0.067, p < 0.001), while the mediation effect through action planning was not significant (β = -0.001, p > 0.05). PBC played multiple roles: it directly predicts behavior (β = 0.106, p < 0.001), indirectly predicts behavior through intention (β = 0.282, p < 0.001), and further mediates behavior through intention and coping planning (β = 0.046, p < 0.001), as well as through coping planning alone (β = 0.032, p < 0.001). Additionally, the mediation effect of PBC on behavior through action planning was statistically significant but negligible (β = 0.000, p = 0.003), reinforcing the stronger role of coping planning in driving behavior change.

CONCLUSION

This study highlights the important roles of behavioral intention and perceived behavioral control in promoting physical activity while challenging the effectiveness of focusing solely on action planning. The findings suggest that although action planning does not significantly impact behavior, coping planning plays a critical role in behavior implementation. By integrating action planning and coping planning, comprehensive behavioral intervention strategies can more effectively bridge the intention-behavior gap and promote sustained physical activity.

Goal conflict and the physical activity intention-behavior relationship: Insights from a study of People's daily experiences

Although intention is a strong predictor of moderate-to-vigorous intensity physical activity (MVPA), several factors moderate the intention-behavior relationship. People experience goal conflict when one or more of their goals makes it more difficult to pursue other goals. Goal conflict was examined as a moderator of the intention-behavior relation using data from ecological momentary assessments and accelerometer-derived estimates of MVPA. Participants (N = 100; 22 males) wore an accelerometer and responded to digital surveys assessing MVPA intentions and goal conflict up to four times daily for seven consecutive days. MVPA in the 180-min epoch following each survey prompt was recorded. Multilevel modelling was used to analyze the data using the disaggregated between- and within-person effects. Results revealed an intention-behavior gap of 30% and significant within-person effects for intention and goal conflict. Within-person goal conflict moderated the intention-behavior relationship such that when people had stronger intentions to be active compared to their average level of intention, they engaged in more MVPA; and when goal conflict was higher, compared to their average level of goal conflict, people engaged in less MVPA. Findings suggest experiencing higher goal conflict about engaging in MVPA thwarts people's abilities to follow through with their intentions to be active throughout the day.

The influence of life transitions on Danish adults' physical activity beliefs and behaviour: A qualitative study

Using a qualitative design, we explored how life transitions influence Danish adults' physical activity beliefs and behaviour adopting the Theory of Planned Behaviour as a guiding framework. Life story interviews with 42 participants revealed 6 salient life transition periods which affected physical activity behaviour, either in a disruptive way resulting in decreased activity levels or in a facilitative manner, providing opportunities for increased activity engagement. The identified life transition periods uniquely influenced individuals' attitudes, subjective norms and perceived behavioural control (PBC) beliefs, thus affecting motivations toward physical activity. Specifically, starting primary school or a career, forming a romantic relationship, and having a child primarily shaped subjective norm and PBC, while leaving home was especially influential on PBC and retirement on attitudes and PBC. Consistent themes across the transition periods included time constraints and opportunities to be active, supportive social contexts, access to facilities and having a need to be active.

Polarizing Plates: Both Omnivores and Vegans Represent In-Group Foods With Eating Simulations

In two pre-registered experiments, we assessed how people cognitively represent meat and plant-based foods, to examine processes underlying dietary polarization in society. Food descriptions from U.K.-based omnivores (NExp. 1 = 109; NExp. 2 = 436) and vegans (NExp. 1 = 111; NExp. 2 = 407) were coded for features about consumption and reward (e.g., "rich," "indulgent," and "treat") or features independent of the consumption situation (e.g., "healthy," "protein," and "eco-friendly"). Participants used more consumption and reward features for diet-congruent dishes (meat dishes for omnivores and plant-based dishes for vegans) than for diet-incongruent dishes (vice versa). Omnivores focused on abstract, long-term consequences of plant-based foods, whereas vegans focused on the socio-political associations with meat foods. Consumption and reward features also positively predicted attractiveness ratings, the likelihood of ordering a dish, and eating intentions. These findings indicate the cognitive processes of polarized dietary groups that may hinder the mainstream transition to more sustainable food choices.

Longitudinal associations between self-regulation and physical activity behavior following metabolic bariatric surgery; an exploratory study

BACKGROUND

Low adherence to moderate-to-vigorous physical activity (MVPA) recommendations among patients undergoing metabolic bariatric surgery (MBS) is common. However, understanding of psychosocial factors that contribute to low adherence levels is limited. Self-regulation plays a key role in MVPA adherence. Still, the longitudinal and bidirectional associations between self-regulation and MVPA in the MBS patient population remains unexplored. This study aimed to investigate how self-regulatory processes of action- and coping planning, and action control, developed over a 1-5-year post-surgery period, and explore longitudinally the direct, indirect, and bidirectional associations between this development in self-regulation and MVPA assessed at 1- and 5-years after surgery.

METHODS

Participants from the Oslo Bariatric Surgery Study (OBSS) completed MVPA-specific self-regulation questionnaires at 1-, 3-, and 5-years post-surgery and wore ActiGraph monitors for seven days at 1- and 5-years to assess daily MVPA. Second-order latent growth curve modeling examined changes in the three self-regulation constructs, followed by path analysis to explore direct, indirect, and bidirectional associations between baseline levels and changes in self-regulation, and MVPA at 1- and 5-years post-surgery.

RESULTS

A total of 205 (82.8%), 195 (64.6%), and 79 (26.2%) male and females (77%) participated at 1-, 3-, and 5-years after surgery, respectively. Action- and coping- planning decreased with.52 and.30 sd, respectively, over 1-5 years post-surgery. This indicates a moderate effect size. Action control remained relatively stable. Indirect and bidirectional path analyses showed that only higher levels of action control at 1-year were indirectly associated with higher MVPA at 5-years through their impact on MVPA at 1-year, whereas there were no indications of bidirectional associations from MVPA levels at 1-year to changes in any of the self-regulation constructs over time.

CONCLUSIONS

After MBS, patients exhibited low self-regulation 1-year post-surgery, and many participants faced growing difficulties in self-regulating over time. Self-regulation at 1-year was positively linked to MVPA, with action control only, being associated with MVPA at 5-years. However, no bidirectional associations from MVPA to self-regulation were found. These findings suggest further research is needed to test interventions targeting action control to improve MVPA adherence and optimize surgical outcomes and overall health after MBS.

Perceived social support and treatment adherence in Chileans with Type 2 diabetes

This study aimed to determine if greater perceived social support was directly associated with better Type 2 diabetes (T2D) treatment adherence and if better T2D treatment adherence was related to lower HbA1c levels in Chilean adults with T2D. For this purpose, 200 adults were recruited from the Chilean Diabetic Association. Participants were asked to complete self-report instruments and provide a capillary blood sample to measure HbA1c. Structural equation model analyses were performed to determine direct associations. The study's results indicate that greater perceived social support was associated with healthier dietary habits, regular foot care, more frequent physical activity, and lower medication intake. Likewise, blood sugar testing and physical activity were related to HbA1c. These findings provide evidence of how perceived social support relates to T2D treatment adherence behaviors in Latino patients from South America and could be used for interventions to enhance social support from patients' families, partners, and friends.

Explicating college students' COVID-19 prevention behaviors: Integrating information seeking and response efficacy into the reasoned action approach

Objective: This study investigated correlations between college students' intentions to adopt COVID-19 prevention behaviors (i.e., handwashing, mask wearing, and social distancing) and their attitudes, perceived norms, perceived efficacy, and information seeking. Participants: Students (N = 326) from a large Midwestern university recruited via simple random sampling. Methods: Using a cross-sectional survey from mid-March to April 2021, structural equation modeling assessed intentions across behaviors. Results: Attitudes and perceived self-efficacy were variably associated with intentions. Perceived injunctive norms were linked to intention across all behaviors. Response efficacy was associated only with social distancing intentions. Information seeking was tied to attitudes, perceived injunctive norms, and perceived response efficacy, across all behaviors. Conclusions: Information seeking affected how college students evaluate prevention behaviors, emphasizing the importance of disseminating accessible and accurate health information in this context. The findings also highlight the need for future interventions to tailor to the unique barriers and motivators for different prevention behaviors.

The impact of action plans on habit and intention strength for physical activity in a web-based intervention: is it the thought that counts?

OBJECTIVE

Action planning is a common approach used in physical activity interventions. The aim of this study was to assess the association of frequency, consistency and content of action planning with physical activity behaviour, intention strength and habit strength.

METHODS AND MEASURES

Within a 3-month web-based, computer-tailored physical activity intervention, participants (N = 115; 68.7% female, M age =43.9; range = 22-73 years) could create 6 rounds of action plans for 4 activities each (24 total).

RESULTS

Consistency of action planning during the intervention was associated with change in physical activity at 9-months, and intention and habit strength at 3-months and 9-months. Frequency of action planning was negatively associated with intention at 3-months and 9-months. The effect of action planning consistency on physical activity behaviour was no longer significant when accounting for change in intention and habit strength.

CONCLUSION

Consistency of how, where, when and with whom people plan their physical activity may translate into stronger physical activity habits. Interventions should avoid encouraging making many distinct action plans, but rather encourage stable contexts through consistent action planning.

Disentangling the temporal relationship between alcohol-related attitudes and heavy episodic drinking in adolescents within a randomized controlled trial

BACKGROUND AND AIMS

Within many alcohol prevention interventions, changes in alcohol-related attitudes (ARA) are often proposed as precursors to changes in drinking behaviour. This study aimed to measure the longitudinal relationship between ARA and behaviour during the implementation of a large-scale prevention trial.

DESIGN AND SETTING

This study was a two-arm school-based clustered randomized controlled trial. A total of 105 schools in Northern Ireland and Scotland participated in the Steps Towards Alcohol Misuse Prevention Programme (STAMPP) Trial.

PARTICIPANTS

A sample of 12 738 pupils (50% female; mean age = 12.5 years at baseline) self-completed questionnaires on four occasions (T1-T4). The final data sweep (T4) was 33 months post baseline.

MEASUREMENTS

Individual assessments of ARA and heavy episodic drinking (HED) were made at each time-point. Additional covariates included location, school type, school socio-economic status and intervention arm. Estimated models examined the within-individual autoregressive and cross-lagged effects between ARA and HED across the four time-points (Bayes estimator).

FINDINGS

All autoregressive effects were statistically significant for both ARA and HED across all time-points. Past ARA predicted future ARA [e.g. ARAT1 → ARAT2 = 0.071, credibility interval (CI) = 0.043-0.099, P < 0.001, one-tailed]. Similarly, past HED predicated future HED (e.g. HEDT1 → HEDT2 = 0.303, CI = 0.222-0.382, P < 0.001, one-tailed). Autoregressive effects for HED were larger than those for ARA at all time-points. In the cross-lagged effects, past HED statistically significantly predicted more positive ARA in the future (e.g. HEDT2 → ARAT3 = 0.125, CI = 0.078-0.173, P < 0.001, one tailed) except for the initial T1-T2 path. In contrast, past ARA did not predict future HED across any time-points.

CONCLUSIONS

Changes in alcohol-related attitudes were not a precursor to changes in heavy episodic drinking within the Steps Towards Alcohol Misuse Prevention Programme (STAMPP) Trial in Scotland and Northern Ireland. Rather, alcohol-related attitudes were more likely to reflect prior drinking status than predict future status. Heavy episodic drinking status appears to have a greater impact on future alcohol attitudes than attitudes do on future heavy episodic drinking.

Implementing physical activity for individuals with cancer during treatment: protocol for the IMPACT implementation-effectiveness trial

INTRODUCTION

The prevalence of cancer in Canada is growing, leading to multiple lasting side effects in survivors. The physical and psychosocial benefits of regular physical activity (PA) during and after treatment for individuals with cancer are well established, however, not well implemented in a clinical setting. The overall aim of this project is to build on previous work and conduct a multicentred randomised controlled trial (RCT) and evaluate the effectiveness of a novel implementation strategy using PA and self-management versus usual care during cancer treatment.

METHODS AND ANALYSIS

Study design: a hybrid implementation-effectiveness RCT will occur at five cancer centres across Ontario, Canada. Participants: eligible participants include adults with a cancer diagnosis (any type or stage) who are receiving treatment and cleared for exercise by their oncology care team. Intervention: participants (n=129) will be randomised to one of three groups: (1) institution-based exercise and self-management (SM) (eight in-person sessions of aerobic exercise and eight SM modules), (2) SM alone (SM only: eight virtual modules) or (3) usual care (no intervention). Outcomes: the Reach, Effectiveness, Adoption, Implementation and Maintenance framework will assess implementation outcomes. The primary effectiveness outcome is self-report PA level postintervention. Data analysis: outcomes will be measured at four time points (baseline, postintervention, 6- and 12-month follow-up). Descriptive statistics will be used to present implementation outcomes. An analysis of covariance will assess change between groups over time.

ETHICS AND DISSEMINATION

Findings from this trial will build on previous work and inform the way PA services are provided within cancer institutions across Ontario, Canada, and inform decision-making on how to incorporate exercise evidence into real-world clinical practice in cancer care. The Hamilton Integrated Research Ethics Board (ID: 7673 & 17454) has approved this study. Results will be disseminated using a combination of peer-reviewed publications, conference presentations and community organisation presentations. Participants will contribute to dissemination by sharing 'participant perspectives', highlighting their experience in the project and thoughts on the implementation strategies used.

TRIAL REGISTRATION NUMBER

The study is registered on clinicaltrials.gov (ID: NCT06323707).

Development and validation of the Chinese version of the adult sedentary behavior reduction intention questionnaire based on the theory of planned behavior

PROM: The Chinese version of the Adult Sedentary Behavior Reduction Intention Questionnaire, a 16-item self-reported tool based on the Theory of Planned Behavior (TPB), was developed to assess adults' intentions to reduce sedentary behavior.

MEASUREMENT PROPERTY

Internal consistency is used to measure the reliability of the questionnaire, while content and structural validity are studied to assess its validity.

DESIGN

A mixed-methods exploratory sequential design with two phases.

SAMPLE

Adults aged over 18 years diagnosed with coronary heart disease, with a total daily sedentary time exceeding 6 h, normal cognitive function, and willingness to participate in the study were included.

METHODS

The study was conducted in two phases. In Phase 1, an initial item pool was developed through a literature review and refined using two rounds of Delphi expert consultation. Expert positivity, authority levels (Cr), coefficients of variation (CV), and Kendall's W coefficient were calculated to assess representativeness, credibility, and consensus. A pilot study evaluated face validity and finalized the scale. In Phase 2, a cross-sectional study involving 316 participants was conducted to assess psychometric properties. Reliability was evaluated using Cronbach's α and split-half reliability, while content validity was assessed using the content validity index (I-CVI). Construct validity was examined through confirmatory factor analysis (CFA).

RESULTS

Phase 1 resulted in a preliminary questionnaire with four dimensions and 16 items. Sixteen experts completed two rounds of Delphi consultation, with high response rates (85% and 94.1%) and authority levels (Cr = 0.88 and 0.91). Consensus was strong (CV = 0.05 ~ 0.23; Kendall's W = 0.338 and 0.382, p < 0.001). Phase 2 validation showed a Cronbach's α of 0.967, with individual dimensions ranging from 0.911 to 0.950. I-CVI ranged from 0.813 to 1. The adjusted model indices met the fitting criteria.

CONCLUSIONS

The developed questionnaire is a reliable and valid tool for assessing Chinese adults' intentions to reduce sedentary behavior. Grounded in TPB, it provides a theoretical foundation for future intervention studies aimed at addressing sedentary lifestyles.

Psychological and socio-structural determinants of intentions to use drug checking services

This study explored the determinants of intentions to use drug checking services among Australian undergraduate students (N = 324, M age = 22.32 years, SD = 7.21) using an integrated theoretical model that includes social cognition constructs (risk perception, subjective norms, attitudes), health and drug literacy, and socio-structural factors (education, race, employment). A cross-sectional correlational survey design and path analysis revealed that social cognition constructs directly influenced drug checking intentions, while drug literacy and socio-structural variables indirectly influenced intentions through these constructs. Notably, race had a negative indirect effect, while drug and health literacy had a positive indirect effect on intentions. The findings highlight the importance of utility beliefs, perceived risks, and social influences in shaping intentions to use drug checking services. These insights offer a foundation for future behavioral interventions targeting belief-based determinants to promote the use of drug checking services, potentially reducing health risks associated with drug use.

Predicting intentions towards long-term antidepressant use in the management of people with depression in primary care: A longitudinal survey study

BACKGROUND

Over the last two decades, antidepressant prescribing in the UK has increased considerably, due to an increased number of people staying on antidepressants for longer. Even when treatment is no longer clinically indicated, qualitative research suggests many people continue due to a fear of depressive relapse or antidepressant withdrawal symptoms. The quantitative effects of peoples' beliefs and attitudes towards long-term antidepressant use remain relatively unexplored.

OBJECTIVES

To determine the extent to which beliefs and attitudes towards antidepressant treatment are associated with intentions to stop or continue long-term use; and whether intentions translate into actual discontinuation.

METHODS

A questionnaire survey formed the main component of an embedded mixed-methods study. Twenty general practices posted questionnaires to adults aged over 18 receiving continuous antidepressant prescriptions for over two years. Outcomes and explanatory variables were determined using an extended model of the Theory of Planned Behaviour, conducting exploratory descriptive and regression analyses. The primary outcome was participants' intentions to discontinue antidepressants. The secondary outcome of behaviour change was determined by any change in antidepressant dosage at six months.

RESULTS

277 people were surveyed from 20 practices, with 10 years median antidepressant duration. Mean questionnaire scores for intention and subjective norms towards starting to come off antidepressants were low, and 85% of participants declared that continuing their antidepressant was necessary. Prescribing outcomes retrieved from 175 participants' medical records six months after they completed the survey found 86% had not changed their antidepressant, 9% reduced the dose, only 1% discontinued their antidepressant, and 4% increased the dose. All Theory of Planned Behaviour constructs and concerns were associated with intentions, with more favourable attitudes towards stopping and subjective norms having the strongest associations towards intentions to discontinue antidepressant use.

CONCLUSION

Given few intentions to stop taking antidepressants, patients should be made more aware of the importance of ongoing antidepressant monitoring and review from their primary care practitioners. This would promote discussion to support an attitudinal change and initiation of antidepressant tapering where appropriate.

Relationship between older coronary heart disease patients' phase II cardiac rehabilitation intentions, illness perceptions, and family caregivers' illness perceptions

BACKGROUND

Intention is an important factor in encouraging patients to receive cardiac rehabilitation. Illness perceptions of patients and individuals around them, such as family caregivers, may influence intention. However, no study has explored how family caregivers' illness perceptions enhance older coronary heart disease (CHD) patients' phase II cardiac rehabilitation intentions.

OBJECTIVES

To describe older CHD patients' phase II cardiac rehabilitation intentions and their relationship with family caregivers' illness perceptions and to examine the mediating role of patients' illness perceptions.

METHODS

A descriptive cross-sectional study was conducted among 202 older CHD patient‒family caregiver dyads. The Chinese versions of the Revised Illness Perception Questionnaire, Willingness to Participate in Cardiac Rehabilitation Questionnaire (WPCRQ), and Cardiac Rehabilitation Inventory (CRI) were adopted. Data analysis included descriptive statistics, Pearson correlations, and structural equation modeling. Reporting followed the STROBE checklist.

RESULTS

Patients were 69.81 years and mostly male (64.85 %); family caregivers were 52.58 years and mostly female (55.94 %). Family caregivers' personal control had a direct effect on patients' phase II cardiac rehabilitation intentions (βWPCRQ = -0.217, βCRI = -0.228; P = 0.001). Family caregivers' personal control, treatment control, and timeline acute/chronic had indirect effects on patients' cardiac rehabilitation intentions through patients' corresponding dimensions of illness perceptions (|β|WPCRQ = 0.086∼0.098, |β|CRI = 0.062∼0.097; P < 0.05).

CONCLUSION

Family caregivers' illness perceptions can affect patients' phase II cardiac rehabilitation intentions directly and indirectly through patients' illness perceptions. Interventions targeting illness perceptions in both older CHD patients and their family caregivers could be provided to improve patients' phase II cardiac rehabilitation intentions.

The impact of COVID-19 on physical activity and mental health: A mixed-methods approach

This mixed-methods study investigated how and why physical activity (PA), anxiety, depression and self-perceived loneliness are related, and the feasibility of social prescribing (SP). Whilst SP may involve PA with broader effects on health and wellbeing, there is little research exploring perceptions of this intervention. Data from the UCL-Penn Global COVID Study wave 1 (17 April-17 July 2020, N = 1037) were analysed. Twenty-one UK adults who self-identified as low (n = 15) and high (n = 6) on PA at wave 1 were interviewed at wave 4 (18 March-1 August 2022). At wave 1, depression was associated with higher odds of low-PA (OR = 1.05; 95% CI 1.01-1.10, p = 0.02). Both high/low-PA groups cited the threat of contracting COVID-19, general impacts of COVID-19 policies and heightened awareness of the mind-body connection. Five recommendations are made to address challenges in engaging with SP.

Sociodemographic drivers of waste management behaviors and public perceptions of environmental contaminants in coastal communities of Newfoundland, Canada

This study investigates waste management behaviors and public awareness of persistent organic pollutants (POPs) like PBDEs and PFAS in coastal communities of Newfoundland, Canada. Protecting these unique environments requires responsible waste disposal practices. Using an integrated theoretical framework combining the Theory of Planned Behavior (TPB), the Value-Belief-Norm (VBN) theory, and the Norm Activation Model (NAM), we conducted a mixed-methods study employing a pretested survey with open- and closed-ended questions. Although a larger sample was planned, 86 adult residents completed the survey. Our analysis revealed significant differences in waste management behaviors across community types (cities, big towns, and small towns). For example, cities showed higher engagement in e-waste recycling (82%) compared to smaller towns (68%), while smaller towns were more consistent in composting (78% vs. 50% in cities) and hazardous waste disposal (χ2 = 33.97, p = 0.0021). Higher education and income levels were positively correlated with increased recycling and proper waste disposal. However, despite a general awareness of environmental issues, knowledge of specific environmental contaminants was limited (45% for PBDEs, 33% for PFAS). These findings highlight the urgent need for targeted public education campaigns and improved waste management services tailored to the unique needs of diverse coastal communities. This study provides valuable insights for policymakers and environmental managers, emphasizing the importance of targeted interventions to promote sustainable practices and protect fragile coastal ecosystems.

Protection motivation theory and health behaviour: conceptual review, discussion of limitations, and recommendations for best practice and future research

Protection motivation theory is a pre-eminent health behaviour theory purposed to predict participation in health protection and risk behaviours. It has been widely applied across multiple behaviours, populations and contexts. In this conceptual review, we summarise research applying the theory and identify shortcomings and evidence gaps that limit reported inferences and impede theory and intervention development. Accordingly, we provide recommendations for best practices and suggestions for future research to resolve these limitations. Limitations identified include a dearth of comprehensive theory tests, sparse evidence of theory sufficiency, a lack of studies including additional constructs, overuse of correlational and cross-sectional research designs, a paucity of intervention studies and tests of theory-consistent mechanisms of action, few tests intrapersonal and environmental moderators of theory effects and measurement concerns. We provide recommendations to address these limitations including conducting comprehensive theory tests in support of nomological validity; incorporating past behaviour and other constructs to establish theory sufficiency and extend its scope; adopting cross-lagged panel and factorial experimental research designs to test directional effects, permit better causal inference and test mechanisms of action; testing effects of moderators to identify conditions that may affect theory applicability and developing measurement standards for study constructs and adopting non-self-report behaviour measures.

Physical activity during pregnancy: key beliefs to support intervention

Background

Physical activity (PA) provides maternal and fetal health benefits, but only 27.5% of Canadian pregnant women meet PA recommendations. Theory-based interventions like the theory of planned behavior (TPB) are useful in explaining what drives behavior. The first objective of this study was to validate the TPB model to predict prenatal moderate-to-vigorous physical activity (MVPA), including testing of the novel interaction between intention and perceived behavioral control (PBC). The second objective was to identify which specific beliefs predict intention toward prenatal MVPA to support intervention.

Method

We used a prospective correlational design. Healthy pregnant women completed two electronic questionnaires: at baseline, to assess TPB constructs, and one month later, to assess MVPA practice. Structural equation modeling was conducted with Latent Moderated Structural Equations. The interaction was interpreted with the pick-a-point method and the Johnson-Neyman graphical method.

Results

The sample consists of 193 women (M age = 31.2±3.6). Results indicate that prenatal MVPA at one month was marginally predicted by intention (β = 0.149; p < 0.10) and PBC (β = 0.322; p < 0.05, MVPA R 2 = 20%), but when their interaction was added to the model, MVPA R 2 increased to 44%. Specifically, the relationship between intention and MVPA is stronger when PBC is high (0.5 standard deviation over the mean). In the full model including the interaction, attitude (β = 0.59; p < 0.001), subjective norm (β = 0.20; p < 0.01) and PBC (β = 0.26; p < 0.05) all made a significant contribution to predicting MVPA intention (R 2  = 88%). Finally, the following beliefs displayed significant indirect paths toward the intention of being physically active: behavioral beliefs: unlikely to be more tired and likely feel better mentally; normative beliefs: approval from friends and from mother/father; and control beliefs: being tired and missing social support.

Conclusion

Interventions aiming to promote regular MVPA during pregnancy should prioritized the six significant beliefs identified to significantly predict intention toward prenatal MVPA.

Study on the key factors of public participation in low carbon city construction and willingness to pay

The popularity of urban distributed photovoltaics is crucial for building low-carbon cities. Retrofitting roofs with photovoltaic tiles is a new option. However, whether the public supports this initiative needs to be understood. Assessing willingness to pay is a critical way to measure public acceptance. Therefore, this paper assesses Chinese urban households' willingness to pay to support photovoltaic tiles retrofit roofs to promote the construction of low-carbon cities. To obtain factors that better explain the willingness to pay, variables such as personal of interest perception, moral perception and policy perception are added to the initial theory of planned behavior psychological interpretation framework for willingness to pay and the extended theory of planned behavior psychological explanatory framework for willingness to pay is constructed. It is encouraging to note that the expanded framework has increased the explanatory power of willingness to pay, where the personal of interest perception is the dominant variable in explaining willingness to pay. We believe that we should pay attention to the impact of the personal of interest perception on willingness to pay and increase the publicity of the importance of photovoltaic tiles retrofitting roofs to promote low-carbon city construction through Internet means and increase individual personal of interest perception, policy perception, and moral perception, which may help promote better public participation in low-carbon cities.

Predictors of COVID-19 Vaccination Intention and Behavior Among Young People in a European Union Country With Low COVID-19 Vaccination Rates: Cross-Sectional Study

BACKGROUND

Vaccination against COVID-19 is a critical measure for managing the pandemic and achieving herd immunity. In 2021, Slovenia had a significantly lower COVID-19 vaccination rate compared to the average rate in the European Union, with individuals aged younger than 37 years showing the highest hesitancy. Previous studies primarily explored vaccination willingness before vaccines were available to young people, leaving a gap in understanding the factors influencing vaccination behavior and differences within the population of young people.

OBJECTIVE

This study aimed to investigate a wide set of predictors influencing COVID-19 vaccination intention and behavior among young people in Slovenia. Specifically, we aimed to compare vaccinated and unvaccinated young people, further categorizing the unvaccinated group into those who were hesitant, those who intended to vaccinate in the near future, and those who refused vaccination.

METHODS

An integrated model, based on the health belief model and theory of planned behavior, was developed, and it included additional contextual factors (such as trust in science, trust in vaccines, conspiracy theory tendencies, etc) and health-related and sociodemographic characteristics. Data were collected in August 2021 via the online access survey panel JazVem (Valicon), targeting individuals aged 15-30 years in Slovenia. Quotas ensured that the sample (n=507) was quasi-representative according to age, gender, education, and region. Bivariate analyses and multinomial logistic regression were performed to explore the determinants of vaccination intention and behavior.

RESULTS

Among respondents, 45.8% (232/507) were vaccinated, 30.0% (152/507) refused vaccination, 12.4% (63/507) were hesitant, and 11.8% (60/507) intended to undergo vaccination in the near future. Vaccinated individuals were predominantly aged 23-26 years, had higher education, and reported above-average material status. Refusers were more common among the youngest (15-18 years) and oldest (27-30 years) groups, had lower education, and showed higher conspiracy theory tendencies. Multinomial regression analysis revealed that unvaccinated respondents who perceived greater COVID-19-related health consequences were more likely to delay vaccination (adjusted odds ratio [aOR] 2.0, 95% CI 1.2-3.3) or exhibit hesitancy (aOR 1.9, 95% CI 1.1-3.2) compared with vaccinated respondents. Subjective norms were less influential among hesitant individuals (aOR 0.4, 95% CI 0.2-0.7) and refusers (aOR 0.3, 95% CI 0.2-0.7) than among vaccinated individuals. Self-efficacy in managing health problems was less evident among those who delayed vaccination to the near future (aOR 0.5, 95% CI 0.3-0.9) than among vaccinated individuals.

CONCLUSIONS

This study underscores the complexity of vaccination intentions and behaviors among young people, emphasizing the necessity for public health strategies promoting vaccination to be tailored to the specific reasons for nonvaccination within different subgroups. Interventions aimed at addressing vaccine hesitancy and delays should particularly focus on individuals with lower education and material disadvantages. By fostering trust and enhancing self-efficacy, these interventions could more effectively promote vaccine uptake.

Linking Autonomy-Supportive Parenting with Their Children's Autonomous Motivation Toward, and Participation in, Physical Activity

BACKGROUND

Health behaviors and motives within family units are likely to be associated with the motives and behaviors of other family members. A potential mechanism for these relations is that parents citing autonomous motives toward physical activity are more likely to support their child's autonomous motivation to be active. The current study tested a model specifying relations between parent autonomous motivation and parent, child, and parent-and-child joint physical activity behavior with parent autonomy-supportive parenting, child-perceived autonomy support, and child autonomous motivation specified as mediators of the autonomous motivation-child physical activity relationship.

METHOD

Data on autonomous motivation, autonomy-supportive parenting, perceived autonomy support, and physical activity, both alone and jointly between parents and children, were collected from a sample of 88 Finnish parent-child dyads and analyzed using a partial least squares structural equation modeling.

RESULTS

Findings indicated associations between parent autonomous motivation and parent and joint parent-child physical activity, and an indirect effect of autonomy-supportive parenting on child physical activity mediated by child-perceived autonomy support and autonomous motivation.

CONCLUSION

Results provide a potential explanation for relations between parental motives and child physical activity as a function of supportive parenting and signpost potential targets for family-based behavior change interventions.

Investigating factors influencing utilization of trauma-focused cognitive behavioral therapy among unaccompanied young refugees: an exploratory analysis

BACKGROUND

Unaccompanied young refugees (UYRs) exhibit elevated levels of mental distress, including posttraumatic stress symptoms (PTSS), depression and anxiety. Despite the considerable psychological burden, UYRs frequently lack access to mental health care (MHC). The factors that contribute to higher rates of treatment utilization among UYR remain poorly understood. Untreated PTSS can result in chronic impairment, underscoring the importance of identifying these factors. The aim of this study is to investigate factors associated with the intention and actual utilization of MHC of UYRs living in child and youth welfare facilities in Germany.

METHOD

This study is part of the multi-site project BETTER CARE which aims to implement a stepped and collaborative care approach. A sample of N = 139 UYRs who had received a treatment recommendation for trauma-focused cognitive behavioral therapy (TF-CBT) was analyzed. Binomial logistic regression was performed to identify factors predicting the likelihood of intention to seek MHC. In addition, the association between intention to seek MHC and actual utilization was determined using a chi square test.

RESULTS

The results demonstrated a significant correlation between age (η = 0.25, p <.01), length of stay in Germany (η = 0.28, p <.01), and severity of PTSD symptoms (η = 0.26, p <.01) with intention to use MHC. In the logistic regression analysis, PTSD emerged as a significant predictor of intended use (B = 2.66, p <.05). The utilization of MHC was found to be closely associated with the initial intention to use (χ²(1) = 88.846, p <.001).

CONCLUSIONS

The findings contribute to an expanding body of literature on the mental health requirements and service utilization patterns among UYRs, offering insights for policymakers, mental health professionals, and child welfare services striving to enhance care for this vulnerable population.

Predicting Physical Activity Intentions, Habits, and Action Plans in Finnish Parent-Child Dyads

Physical activity levels among early adolescents and their parents are insufficient for health benefits. Identifying modifiable determinants in parent-child dyads can inform future research and interventions. We tested a partial least squares path model based on the integrated behavior change model in insufficiently active Finnish parent-child dyads (n = 88), including measures of autonomous and controlled motivation, social cognition constructs (attitude, subjective norm, perceived behavioral control), intention, planning, and habits. Autonomous motivation predicted attitude in both samples, but only predicted subjective norms and perceived behavioral control in children. Attitude in turn predicted intention, planning, and habit, in the child sample, but only intention and planning in parents. Perceived behavioral control predicted intention and planning only in children, while subjective norm had minimal effects in either sample. Autonomous motivation and attitude consistently determined intention and planning for both parents and children, highlighting their importance in future research and interventions.

From mere 'stability' to 'durability'-Revisiting intention dynamics from a self-regulatory perspective with intensive longitudinal methods

Behavioral intentions predict behavior better if they are stable over time. A statistical argument suggests that this is due to less measurement error, but recent theoretical advances suggest self-regulatory effects: durable intentions remain temporally stable due to their persistence when faced with challenges. Here, we leverage intensive longitudinal data on adherence with non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic (N = 623; total assessments = 19,740; study duration: 6 months each). We operationalize intention durability as temporal order-dependent variability (reversed root mean square of successive differences [RMSSD] between each valid assessment). We then examine the within- and between-person moderating effects of intention durability on the intention-behavior association as well as the effects of past on current behavior. In line with the theoretical assumptions, we find that more durable intentions are not only associated with a stronger intention-behavior link on a within- and a between-person level but also a stronger effect of past on current adherence with NPIs. Our findings support the hypothesized moderating effects of intention durability and provide a more nuanced understanding of the self-regulatory processes underlying the temporal stability of intentions.

Health-Promoting Behaviors and Their Associations With Factors Related to Well-Being Among Former National Football League Players: An NFL-LONG Study

CONTEXT

Understanding former professional football players' engagement with health-promoting behaviors (physical exercise, high-quality diet, and good sleep hygiene) will be helpful for developing lifestyle interventions to improve their feelings of well-being, a relatively understudied facet of health among this population.

OBJECTIVE

Examine associations among health-promoting behaviors and subjective outcomes related to well-being among former National Football League (NFL) players.

DESIGN

Cross-sectional.

SETTING

Online or hard-copy survey.

PATIENTS OR OTHER PARTICIPANTS

Former NFL players.

MAIN OUTCOME MEASURE(S)

Self-reported health-promoting behaviors (exercise frequency, diet quality, and sleep duration and disturbance) and factors related to well-being (Patient-Reported Outcomes Measurement Information System - Meaning and Purpose [MP], Self-Efficacy, and Ability to Participate in Social Roles and Activities [SRA]). Multivariable linear regression models were fit for each well-being-related factor with health-promoting behaviors as explanatory variables alongside select demographic, behavioral, and functional covariates. Models were fit for the full sample and separately for individual age groups: <30 years, 30 to 39 years, 40 to 49 years, 50 to 59 years, 60 to 69 years, and 70+ years.

RESULTS

A total of 1784 former NFL players (aged 52.3 ± 16.3 years) completed the survey. Lower sleep disturbance was associated with better MP (β [standard error] = -0.196 [0.024]), Self-Efficacy (β [standard error] = -0.185 [0.024]), and SRA (β [standard error]= -0.137 [0.017]) in the full sample and almost all the individual age groups. More frequent moderate-to-vigorous exercise was associated with higher MP (β [standard error] = 0.068 [0.025]) and SRA (β [standard error] = 0.151 [0.065]) in the full sample and with better MP, Self-Efficacy, and SRA among select middle-aged groups (between 40 and 69 years old). Diet quality, resistance training exercise frequency, other wellness activity frequency, and sleep duration were not associated with well-being-related factors in the full group, and sparse significant associations were observed in individual age group models.

CONCLUSION

Lower sleep disturbance and more frequent moderate-to-vigorous exercise frequency may be important targets for improving overall health and well-being among former NFL players.

An extension of the theory of planned behaviour to predict exclusive breastfeeding among Australian mother-father dyads using structural equation modelling

OBJECTIVES

The objective of this paper was to examine the predictors of breastfeeding exclusivity at two time-points (6 and 26 weeks postpartum) using a dyadic mother-father extended model of the theory of planned behaviour.

DESIGN/METHOD

A sample of 1139 first-time Australian mother-father dyads completed measures of each of the Theory of Planned Behaviour variables (intention, attitudes, subjective norms, and perceived behavioural control) and additional psychosocial and behavioural predictors of breastfeeding, including problems with breastfeeding, psychological distress, childcare stress, partner support, and the frequency and time of first public breastfeed. Confirmatory factor analyses were used to determine the factor structures of the latent constructs to be included in the structural model. Structural equation modelling was used to model pathways between variables.

RESULTS

Breastfeeding exclusivity at 6 weeks was significantly predicted by breastfeeding self-efficacy at 6 weeks, intention to exclusively breastfeed, and frequency of public breastfeeding over the month prior, whereas childcare stress, partner support, time of first public breastfeed, and fathers' variables (attitudes and subjective norms) had little influence. Self-efficacy mediated the relationship between mothers' attitudes, psychological distress, and breastfeeding problems with breastfeeding exclusivity at 6 weeks. Breastfeeding exclusivity at 26 weeks was significantly predicted by mothers' attitudes, self-efficacy, breastfeeding exclusivity at 6 weeks, and frequency of public breastfeeding in the month prior.

CONCLUSIONS

The results highlight the importance of breastfeeding self-efficacy and confidence to breastfeed in public as crucial constructs in promoting long-term exclusive breastfeeding and provides support for an extended theory of planned behaviour model in predicting breastfeeding outcomes.

Predicting adherence to ankle-foot orthoses in people with stroke: An application of the Theory of Planned Behavior

BACKGROUND

Ankle-foot orthoses (AFOs) are often prescribed for people with stroke to address motor impairment. However, not all patients adhere to using their AFOs as prescribed. Predictors of AFO adherence are likely to constitute useful targets for interventions that aim to promote this behavior.

OBJECTIVE

To identify the predictors of AFO adherence in people with stroke using an established theoretical framework, namely the Theory of Planned Behavior (TPB; Ajzen, 1991).

STUDY DESIGN

Prospective survey design.

METHOD

N = 49 people who had been prescribed an AFO after a stroke completed a TPB questionnaire. One month later, they completed another questionnaire that measured adherence to AFOs as prescribed by an orthotic practitioner. Predictors of intention and AFO-adherence behavior were identified using regression analyses.

RESULTS

Adherence to AFOs was 63%. The TPB accounted for 61% of the variance in intentions and 43% of the variance in AFO-adherence behavior. Attitude and perceived behavioral control were predictors of intention, and intention was the sole predictor of behavior.

CONCLUSION

The TPB is a useful model for explaining adherence to AFOs in people with stroke. Interventions could be designed to increase intentions to use an AFO as prescribed by promoting positive attitudes towards, and perceived behavioral control of AFO adherence.

Progress on theory of planned behavior research: advances in research synthesis and agenda for future research

The theory of planned behavior is a social cognition theory that has been widely applied to identify the psychological determinants of intentions and behavior in health contexts. Our 2015 meta-analysis of theory applications in chronic illness contributed to a burgeoning evidence base comprising syntheses supporting theory predictions in health behavior. In this review, we identify limitations of prior meta-analyses of theory applications in health behavior and highlight salient evidence gaps, summarize how recent meta-analyses of the theory have addressed some of the limitations, outline outstanding research questions, and suggest future research syntheses, including those currently in progress, to resolve them. We point to recent and ongoing meta-analyses addressing theory hypotheses and assumptions not tested in previous syntheses, such as perceived behavioral control moderating effects and indirect effects of environmental (e.g., sociostructural variables) and intrapersonal (e.g., personality traits) determinants on health behavior mediated by theory constructs. We also highlight meta-analyses examining behavioral effects of constructs representing extended processes (e.g., habit, implicit cognition) in the context of the theory. Further, we summarize recent meta-analyses addressing directional and causal inferences in theory effects, including meta-analyses of longitudinal studies and experimental and intervention research. We also highlight attempts to test the mechanisms of action of interventions based on the theory including the change meta-analysis method and mediation analyses. We conclude by summarizing the advances that recent meta-analyses of the theory have made to the evidence base of health behavior determinants and interventions and highlighting suggestions for meta-analyses that will further progress the evidence base.

Evidence inhibitory self-control moderates effects of habit on complex but not simple health behaviors

Theoretically, self-control can be considered as both a facilitator of habit development and a moderator of whether behavior occurs habitually. However, debate remains on the contexts in which such relationships are likely to occur. The current study tested whether self-control, conceptualized into inhibitory and initiatory facets, would predict healthy behavior via habits or moderate the habit-behavior relationship, and whether these effects differed across complex (bootcamp attendance N = 69, physical activity in pregnant women N = 115) and simple (flossing N = 254) behaviors. Three independent samples completed measures of self-control and habit, followed by a prospective measure of behavior. Data were fitted to PLS-SEM models. Inhibitory and initiatory self-control predicted habit in all three samples, and habit in turn predicted each health behavior. Inhibitory self-control only moderated the effect of habit in the bootcamp and physical activity samples. Initiatory self-control did not moderate effects in any sample. Findings indicate that both initiatory and inhibitory self-control are associated with habit. Further, as the moderating effect of inhibitory self-control was only present in the complex behavior samples, results suggest the moderating effects of self-control on the habit-behavior relationship may be best represented by the effect of inhibiting competing cues from disrupting automatically activated behavioral sequences.

The analysis on forest farmers' intention to participate in construction of the National Reserve Forest Project and its driving factors

The construction of the National Reserve Forest Project is the fundamental measure to alleviate the contradiction between national wood supply and demand and maintain national ecological security and wood security. This study analyzed the forest farmers' intention to participate in the project and its driving factors. It provides a scientific basis for mobilizing forest farmers' enthusiasm for continuous participation, improving their sense of gain, and realizing the established goals of constructing the National Reserve Forest Project. Based on the planned behavior theory, this study built a driving factor model regarding participation intention. From February to April 2022, forest farmers in the National Reserve Forest Project implementation area in Guizhou Province were selected as research objects for the questionnaire survey. A binary logistic regression model was used to verify and investigate the forest farmers' participation intention and driving factors. Among the behavioral attitudes, income from participation in forest land transfer had a significant and positive correlation with concerns about forest use change. In the subjective norms, the study found a significant positive correlation between the degree of self-determination of forest farmers in participating in the project and the level of support from local government, village collectives, previously participating villagers, and family members. In perceived behavior control, qualification for project participation and acceptance of participation risk have a significant and positive correlation. The model based on planned behavior theory can well explain and predict the forest farmers' intention to participate and driving factors. Currently, most forest farmers have a strong sense of intention to participate in the National Reserve Forest Project. Economic benefits, partners' support in participation, guidance from superiors, and participation risk are important driving factors.

Psychological Determinants of Health Behavior

This review provides a critical overview of current evidence on psychological health behavior determinants and its value in informing intervention and future determinants research. The review begins with work labeling and classifying the myriad of determinants available in the extant research to arrive at core groups of determinants. Next, the conceptual bases of these determinant groups are identified, and the weight of the evidence for their purported effects on health behavior, including belief-based determinants (e.g., outcome expectancies, capacity beliefs), determinants representing self-regulatory capacity (e.g., planning, action control) and nonconscious processes (e.g., habit, implicit cognition), and dispositional determinants (e.g., personality, regulatory control), is critically evaluated. The review also focuses on the theory-based mechanisms underpinning determinant effects and moderating conditions that magnify or diminish them. Finally, the review recommends a shift away from research on determinants as correlates, outlines how determinants can inform intervention development and mechanisms of action tests, suggests alternatives to predominant individualist approaches, and proposes future research directions.

Evaluating the social acceptability of the Re-Connect concept: A smartphone-based, nonfinancial, contingency management intervention

Contingency management is a well-validated behavior change intervention; however, the financial incentives can prevent it from being widely adopted. Most Americans have a smartphone with applications (apps) that they find enjoyable and engage with for a considerable amount of time. A potential avenue for contingency management dissemination is a mobile smartphone application that leverages the existing reward value of smartphone apps as a tool for behavior change. The present study examined the acceptability of the Re-Connect concept, which proposes to block nonessential but highly preferred apps and unlock them contingent on meeting the user's health goals. Out of the sample surveyed (N = 146), 63.02% reported that they would be likely to use Re-Connect and 67.81% would recommend it to someone. Acceptability of Re-Connect increased with greater user control. These results suggest that access to preferred smartphone apps could be a socially acceptable incentive in a contingency management intervention.

An environmental scan of messages promoting compliance behaviour for a medical directive in COVID-19

Compliance with COVID-19 preventive behaviours together with the urgency to contain the virus underscored the need for rapid yet effective public health massaging. While messages aimed to inform and protect the public, the evolving situation often precluded the use of theoretically-based and empirically-informed approaches. This study aimed to analyse the presence and prevalence of belief-based constructs and strategies known to foster behaviour change embedded within Australian Government communications regarding compliance with QR code check-in behaviour during the COVID-19 pandemic using the Theory of Planned Behaviour as a guiding framework. Six belief codes and five behaviour change techniques were identified in 17 communication messages. Findings highlight the use of potentially effective strategies in the messages to change behaviour; for example, drawing on attitudinal and self-efficacy beliefs. Yet, results identified gaps, such as a lack of strategies to highlight normative influences and build habits that can inform future messaging and pandemic preparedness.

Predicting adherence to COVID-19 behavioural guidelines: a comparison of Protection Motivation Theory and the Theory of Planned Behaviour

OBJECTIVE

To compare the utility of Protection Motivation Theory (PMT) and the Theory of Planned Behaviour (TPB) for understanding diversity in adherence to COVID-19 behavioural guidelines.

METHODS AND MEASURES

A representative sample (N = 600) completed two online questionnaires: One that included measurements of PMT and TPB components that predict behaviour, and another (after one week) consisting of adherence to COVID-19 behavioural guidelines. TPB was represented by a single model, while PMT was represented by three models: Model 1, which did not include a measure of protection motivation; Model 2, which included protection motivation - represented by behavioural intentions; and Model 3, which was similar to Model 2 and included a direct link from self-efficacy to behaviour.

RESULTS

The TPB model displayed the best fit-to-complexity ratio (i.e. information criterion), and its capacity to explain adherence was similar to PMT Models 1 and 2, but lower than Model 3.

CONCLUSION

The findings highlight the need to reach a consensus regarding the definition and measurement of protection motivation. While the TPB model exhibited superior fit-to-complexity ratio, variance was better explained when self-efficacy was included, and interventions may benefit from targeting different constructs depending on the context.

Development of the social dimensions of health behaviour framework

Despite rapid theoretical expansion in conceptualising individual and environmental processes, the examination of social processes associated with health behaviours has a less cohesive theoretical landscape. The purpose of this mapping review and content analysis was to develop a taxonomy of social dimensions applicable to health behaviours. Michie et al. (2014) 'ABC of Theories of Behaviour Change' text, which includes 83 behaviour change theories, was used as the data-set, whereby an iterative concurrent content analysis was undertaken with respect to all relational/interpersonal psychological dimensions. The analysis resulted in a social dimensions of health behaviour (SDHB) framework of 10 dimensions, including seven sub-types of social appraisal dimensions and three-sub-types of social identification dimensions. The SDHB revealed that specific dimensions, such as descriptive norm, are prevalent in behavioural theories, while other dimensions have seen less attention. Further, while most social constructs in behavioural theories are represented by only one social dimension in the SDHB, other constructs have complex representation. This version 1.0 of the SDHB framework should assist in specifying the core social dimensions in health behaviour, provide a common lexicon to discuss relational constructs in psychological theories, amalgamate the disparate social constructs literature and identify opportunities for further research to advance theory development and interventions.

Adults' beliefs related to reducing red meat consumption: An exploratory study in the province of Quebec, Canada

A significant consumption of red meat is associated with various issues (e.g. public health, sustainability, animal welfare). This exploratory study aims to identify the perceived advantages and disadvantages, perceived approval and disapproval by important others, and perceived barriers and facilitators pertaining to reducing red meat consumption among adults. An online questionnaire based on the Theory of Planned Behaviour was used to elicit the salient beliefs of 55 red meat eaters living in the province of Quebec (Canada). A content analysis performed by two independent coders revealed that the predominant themes (modal beliefs) included health, environment, saving money, food preferences, social influence, perceptions of the alternatives of meat, and efforts related to change. This study can inform the development of interventions aimed at promoting the reduction of red meat consumption.

Streamlining COM-B model: Insights from the Healthy Eating Context

The global rise in diet-related diseases highlights the urgent need for effective behavioural interventions. While theoretical frameworks like the Capability, Opportunity, Motivation-Behaviour (COM-B) model are valuable for understanding and influencing healthy eating behaviours, their practical application is often hindered by complexity and extensive measurement demands. This study addresses these challenges by testing a simplified version of the COM-B model, focusing on a select set of items representing seven core constructs. We conducted a cross-sectional survey with 347 Australian young adults to validate this streamlined model, making it more accessible for researchers and practitioners. Our findings underscore the importance of automatic motivation, the physical environment, and physical capability as critical factors in promoting healthy eating behaviours. By simplifying the COM-B model, this research contributes to developing more practical and effective strategies for healthier eating, addressing a critical public health issue.

Adding sugar to children's beverages: a theory of planned behavior study of Lebanese mothers

This study, guided by the theory of planned behavior (TPB), aimed to investigate whether attitude, subjective norms, and perceived behavioral control can predict parents' intentions to reduce or stop adding sugar to their child's beverages, such as tea or milk. The research also seeks to determine the predictive power of the TPB on the actual behavior of parents in reducing or halting sugar intake in their children's drinks. A questionnaire was developed to assess sweetening beverage behavior variables by mothers of children aged 3-7 years attending Lebanese public schools, with 184 responses retained with no missing values for analysis. Regression analysis was utilized to examine determinants of self-reported practice and intentions regarding sweetening beverages. Results showed that attitude and perceived behavioral control were significant predictors of intention to reduce or stop adding sugar to a child's beverages. The perception of behavioral control was found to predict the behavior of adding sugar to a child's beverages, even though the intention to reduce or stop did not. The study findings suggest that individuals with low perceived behavioral control and strong habits would be more likely to be actual performers of the adding sugar behavior regardless of their intention level. When adding sugar to a child's beverages is a common parental habit in low-income Lebanese families, our findings offer valuable insights for developing culturally and socially tailored health promotion strategies to reduce or stop adding sugar to children's beverages and raise parental awareness about the health risks associated with excessive sugar consumption in children.

Identifying the psychological correlates of parents' intentions to enroll their children in learn-to-swim lessons for the first time

INTRODUCTION

While enrollment in swimming lessons is associated with lower drowning risk in children, many parents do not enroll their children in formal lessons. To understand these decisions, the current research investigated the social cognition factors that drive parents' intentions to enroll their children for the first time.

METHODS

Using a mixed methods design, beliefs about enrolling one's child in swimming lessons were elicited in a sample of 22 Australian parents. A second sample of 323 then rated the extent to which they agree with each of these beliefs and completed measures of an extended theory of planned behavior (TPB) model including autonomous motivation, risk perception, and role construction.

RESULTS

Results showed a range of behavioral, normative, and control beliefs to significantly predict intention to enroll. In the model, subjective norm, perceived behavioral control, risk perception, and role construction all predicted intention to enroll. Autonomous motivation had an indirect effect on intention via the TPB constructs.

CONCLUSIONS

Targeting beliefs that non-enrollment places a child at risk, that enrollment is under a parent's control, that others would want parents to enroll their child, and that it is the responsibility as a parent to enroll their child may be viable messages for intervention.

PRACTICAL IMPLICATIONS

Current results signpost several potential belief-based targets for interventions encouraging enrollment in swimming lessons. However, as qualitative data also indicated structural barriers to enrolment, such strategies should be paired with attempts to ensure swimming lessons are affordable and accessible to the wider population.

Improving processing fluency to encourage family health information seeking: The mediating role of communication efficacy

Drawing from the metacognitive literature, this experimental study examines how the relative ease of retrieving information (i.e. processing fluency) impacts individuals' efficacy about engaging in family health discussions and interpersonal information seeking intention across two health topics: family organ donation status and family health history. Participants (N = 609) were randomly assigned to one of three conditions. Those in the easy retrieval task condition (versus a difficult or no task control), who were asked to recall information regarding two (versus six or zero) family members, reported greater processing fluency. Moreover, those who reported greater fluency also reported higher communication efficacy, and a greater intention to seek out family health information. Practically, this study highlights how metacognitive strategies may be used in healthcare settings to motivate patient information seeking. For example, it may be advantageous to start by collecting information for relatively few diseases/family members and slowly build a family history over time.

Theory-Based Message Design for Recruitment of Underrepresented Racial/Ethnic Groups Into Alzheimer's-Focused Research Registries

Alzheimer's disease (AD)-focused recruitment research registries can help identify eligible participants for AD studies, but registry participation is limited among racial and ethnic groups most at risk for AD. Using the Reasoned Action Approach (RAA), this study is part of a larger project to design theory-based persuasive recruitment messages that would encourage registry enrollment among underrepresented racial and ethnic groups. National survey data were collected in May/June 2021 from adults aged 50-80 years old living in the United States (n = 1,501) with oversamples of non-Hispanic Black (n = 334) and Hispanic (n = 309) adults for group comparisons. Regression analysis was used to estimate the relationship of the attitudes, norms, and perceived behavioral control on intention to sign up for an AD-focused research registry for each racial/ethnic and sex group (i.e., Black women, Black men, Hispanic female, Hispanic men, non-Hispanic White women, and non-Hispanic White men), followed by an audience segmentation analysis based on intender status. Across almost all target groups, attitudes were an important determinant of intention, and norms and capacity were secondary determinants for Black and Hispanic adults, respectively. There was considerable overlap in attitudinal beliefs most salient to the behavior which focused on benefits to society in some way, either generally (i.e., "helping others in the future"; "advancing science") or more specifically (i.e., "helping others like you"). Differences between groups were more apparent regarding norms and capacity. Targeted recruitment messages based on beliefs that were common across the groups could be an efficient way of recruiting people of color into AD research registries.

Predictors of consistent condom use among male construction workers who have engaged in concurrent sex with regular sex partners, casual sex partners, and sex workers over a 3-month period

This study investigates the predictors of consistent condom use among male construction workers in South Africa who reported concurrent sexual relationships with regular partners, casual partners, and sex workers over a 3-month period. A cross-sectional survey was used to collect data from a convenience sample of 450 male workers across 18 construction work sites in the Western Cape province. Of these, 245 (54%) indicated that they had engaged in sex with all three partner types during the 3-month study period. Hierarchical multiple linear regression was then used to assess consistent condom use as a function of demographic, experiential, behavioural and cognitive characteristics. Three statistically significant predictors of consistent condom use were identified: perceived control over condom use (β = 0.252, p < 0.001), positive attitude toward condom use (β = 0.154, p < 0.05) and fear of HIV infection (β = 0.121, p < 0.05). These findings highlight the high prevalence of sexual concurrency among study participants. It also suggests that amid declining condom use, interventions which focus on enhancing an individuals' condom application skills and efficacy, that foster positive attitudes toward condom use and that strategically incorporate fear-based messaging within a multilevel framework may potentially increase condom use among individuals in concurrent sexual relationships.

Predictors of Concussion Symptom-Reporting Intention Among Collegiate Athletes

CONTEXT

Underreporting of concussion symptoms in college athletics presents a challenge for sports medicine clinicians in evaluating and diagnosing such injuries. Some athletes do not report concussion symptoms because they do not recognize that they have a brain injury; however, many athletes intentionally withhold symptoms to avoid removal from sport participation.

OBJECTIVE

To examine individual factors that influence college athletes' intentions to report concussion symptoms.

DESIGN

Cross-sectional study.

SETTING

Collegiate athletics.

PATIENTS OR OTHER PARTICIPANTS

Participants were 2649 student-athletes from 23 sports, across 22 colleges and universities.

MAIN OUTCOME MEASURE(S)

The primary outcome was intention to report concussion symptoms. Predictor variables included demographics (age, race/ethnicity, sex, sport type, number of years in sport, number of previous concussions, and perceived concussion symptom knowledge), athletic identity, attitudes toward symptom reporting, perceived social pressure (injunctive and descriptive norms), and perceived behavioral control (capacity and autonomy).

RESULTS

Hierarchical ordinary least-squares regression revealed positive effects of attitude (b = 0.063, P = .005), descriptive norms (b = 0.131, P < .001), injunctive norms (b = 0.107, P < .001), and capacity (b = 0.196, P < .001) on intention to report symptoms. Athletic identity and participation in collision sports had small negative indirect effects on intention, and perceived concussion knowledge had a small positive indirect effect. The full regression model explained 14.24% of the variance in concussion-reporting intention.

CONCLUSIONS

These findings may help clinicians develop more focused interventions that address key social and individual determinants of underreporting, including attitude, injunctive and descriptive norms, and capacity to report. Athletic identity, sport type, and perceived understanding of concussion symptoms also influence reporting intention to a lesser extent. Previous research in this area has often failed to address a diverse population of college-age athletes from different sports and National Collegiate Athletic Association divisions.

Predicting alcohol consumption: Application of an integrated social cognition model of intentions, habits, and cue consistency

Drinking alcohol in excess is associated with deleterious health outcomes, highlighting the need for research to identify potentially modifiable correlates of excessive alcohol consumption to target in behavioral interventions. The present two-wave prospective correlational study applied an integrated theoretical model that included theory of planned behavior constructs alongside habit, cue consistency, affective attitudes, and past behavior as predictors of two alcohol-related behaviors, drinking within safe limits and regular alcohol drinking, in separate samples of Australian undergraduate students (total N = 474). Structural equation models identified direct effects of habit, affective attitude, and subjective norms on intention for both behaviors. Habit at follow-up, cue consistency, and past behavior directly predicted behavior in both samples, whereas intention predicted behavior only for drinking within safe limits, and affective attitude only predicted behavior for regular drinking. Cue consistency moderated the effects of habit on behavior for both behaviors and moderated the effect of past behavior on regular drinking. Results corroborate past behavior and habit as key correlates of behavior and provide preliminary evidence of the importance of integrating cue consistency, a defining characteristic of habit, as a moderator of habit and past behavior effects an integrated theory test.

Exploring a mother's engagement in team sport: An application of an extended theory of planned behaviour

OBJECTIVES

Mothers of young children are at-risk for low physical activity. Organised team sport provides additional social and mental health benefits above that of physical activity. To better understand engagement in team sport, this study aimed to apply the theory of planned behaviour, with the addition of maternal identity and social support.

DESIGN

A prospective two-part online study was conducted two weeks apart to collect data from 122 mothers in Australia (M = 32.22, SD = 4.42).

METHODS

Two hierarchical multiple regression analyses were conducted to predict intention and engagement in team sports. A moderation was conducted to determine the effect of social support on the intention-behaviour relationship.

RESULTS

Results indicated that 65.1 % of the variance in intention was explained, with years since previously played (β = -0.17), attitudes (β = 0.20), subjective norms (β = 0.41), and perceived behavioural control (β = 0.16) being significant, and level of team sport social support, and maternal identity being non-significant. Additionally, 65.7 % of the variance in behaviour was explained, with perceived behavioural control (β = 0.28) and intention (β = 0.50) being significant, and years since previously played and social supportbeing non-significant. Social support moderated the relationship between intention and engagement, such that social support facilitated engagement.

CONCLUSIONS

The findings show support for the predictive ability of the theory and mothers within a sporting context. Behaviour change techniques related to strengthening intention and personal agency could be used to inform interventions intending to increase team sports participation.

Descriptive Norms and eHealth Use Among Older Adults: A Cross-Country Comparative Study

eHealth use enables older adults to access and manage healthcare resources, and benefits their health; however, older adults' uptake of eHealth remains low across societies. Social influences such as descriptive norms may be of critical importance in promoting the elderly's usage of eHealth. Based on the Integrative Model of Behavioral Prediction, this study investigates how descriptive norms relate to eHealth use among the elderly in China and the United States. Analysis of the combined sample (N = 1,070) showed that descriptive norms were positively related to eHealth use. Also, descriptive norms were indirectly associated with eHealth use via injunctive norms, attitudes and self-efficacy. Moderated mediation analysis indicated that these direct and indirect relationships differed across the two countries. This study highlights the important role of descriptive norms in promoting older adults' eHealth use behavior and addresses potential country differences in how the elderly respond to descriptive norms. Several important theoretical and practical implications are also discussed.

Predicting physical activity behavior among university students using the multi-process action control framework

Most university students do not engage in enough physical activity (PA) despite the known physical and mental health benefits. Action control theories such as the Multi-Process Action Control (M-PAC) framework have been proposed to better understand the translation of intentions into action by incorporating post-intentional processes. However, the explanatory power of the M-PAC framework beyond traditional social cognitive constructs has received limited attention. This study examined the predictive utility of the M-PAC framework for explaining variance in self-reported and device-measured PA behavior among university students. A total of 2418 undergraduate students (Mean age = 19.1 ± 1.73 [SD] years) completed an online survey that included a self-reported measure of moderate-to-vigorous PA (MVPA) as well as constructs outlined in the M-PAC framework: instrumental and affective attitudes, perceived capability and opportunity, behavioral regulation, habit and identity. A subsample (n = 376) also wore an ActiGraph wGT3x-BT accelerometer on their non-dominant wrist for seven full days to assess MVPA. Robust linear regression models were computed to investigate associations between M-PAC framework constructs and PA behavior. Findings showed the M-PAC framework explained as high as 14.3 % and 37.9 % of the variance in device-measured and self-reported MVPA, respectively. Regulatory (behavioral regulation), and reflexive (habit and identity) processes were significant predictors of self-reported MVPA when examining the full M-PAC framework, whereas the role identity dimension of PA identity was the only significant predictor of device-assessed MVPA. Taken together, these results reinforce the importance of post-intentional processes, specifically role identity, in understanding PA behavior among university students.

Physical Activity Behaviors of Female Adolescents in Saudi Arabia

BACKGROUND

Saudi Arabia has one of the highest childhood obesity rates worldwide. The primary factor associated with the high prevalence of obesity among adolescents is a lack of physical activity (PA). Compared to male adolescents, very few Saudi female adolescents meet the World Health Organization recommendation of achieving 60 minutes of moderate-to-vigorous PA per day, putting them at a higher risk of overweight and obesity.

OBJECTIVE

This cross-sectional study aimed to examine the relationship between the theory of planned behavior and psychosocial factors, including attitude toward PA, subjective norms, perceived behavioral control (PBC), PA intention, and self-reported PA among Saudi female adolescents.

METHODS

A convenience sample of 329 Saudi female adolescents was recruited from all-female public intermediate and high schools in the Eastern Region of Saudi Arabia. Data were collected using online self-administered questionnaires. The theoretical model was examined using structural equation modeling.

RESULTS

The findings revealed a higher prevalence of overweight compared to obesity among participants. About half the participants were from families with a medium monthly income. The mean PA score indicated a low level of PA. The model demonstrated significant explanatory power for both PA intention and PA behavior, respectively. The strongest predictor of adolescents' intention was attitude, followed by PBC.Moreover, the female adolescents' attitudes and PBC had significant indirect effects on self-reported PA through intention, whereas intention had a direct effect on PA. The model did not support a direct or indirect relationship between subjective norms and PA.

DISCUSSION

The findings provide essential support for targeting attitude and perceived behavior control of female adolescents in order to enhance their PA intention. This theoretical understanding can help design effective theory-based interventions that promote PA among Saudi female adolescents.

An integrated dual process model in predicting e-cigarette use in undergraduate students

The use of e-cigarette or vape devices is a growing concern on an international scale, given the devices' addictive nature and questions regarding their short- and long-term health impacts. Their use is especially an issue in young people, many of whom have little or no previous nicotine use experience. This study tested an integrated dual process model in 363 young Australian undergraduates where prospectively measured e-cigarette use was predicted by the psychological constructs of the theory of planned behavior, supplemented with risk perception, e-cigarette dependence, habit, and implicit attitude. Intention to use an e-cigarette was predicted by affective attitude, subjective norm, and e-cigarette dependance, but not instrumental attitude, perceived behavioral control, or risk perception. E-cigarette use was predicted by e-cigarette dependance, intention, habit, implicit attitude, and previous nicotine use, although perceived behavioral control did not directly predict behavior nor moderate the intention-behavior relationship. Current findings provide evidence for important psychological predictors of e-cigarette use, signposting potential intervention targets. Specifically, interventions may benefit from using strategies that tap affective or normative beliefs alongside automatic constructs and dependence, while focusing less on beliefs about the health impacts of e-cigarettes or control over using.

Effects of experimental, network-based social circle norm feedback on studying behavior and alcohol consumption

Misrepresentation of peer behavior has often been observed in college students and may lead to over-expression of alcohol consumption and under-expression of studying. While social norm feedback approaches have had mixed success in addressing these misrepresentations and altering behavior, they may have been too unspecific to be effective and did not directly assess individual perception accuracy. We thus investigated how specific, one-time feedback on the behavioral distribution of alcohol consumption or study time of a clearly defined, individually-adjusted social circle would affect the respective norm estimations and behavior of a class of Psychology students (n = 89 in January) across their first year of study. Students overestimated alcohol consumption and partially underestimated studying norms. While social circle feedback on alcohol consumption did not clearly affect both individual estimation accuracy and alcohol consumption, feedback on peers' studying time increased studying with no clear effect on estimation accuracy. This indicates that social circle norm feedback may be suitable to evoke behavioral effects. The correction of the detected inaccuracies did not appear to be a precondition for the feedback to be effective.