Activation Versus Change as a Principle Underlying Intervention Strategies to Promote Health Behaviors

Quality of patient-physician intercultural communication in healthcare tourism and medical interview experiences at an Indian hospital

PURPOSE

While many studies have addressed health communication and physician-patient interactions, knowledge about intercultural communication in medical tourism is limited. Our empirical study, therefore, investigates aspects related to patients' cultural beliefs regarding the quality of healthcare and the way this shapes their expectations and experiences in an intercultural medical interview setting at a Joint Commission International (JCI) accredited host country hospital in India. The theoretical foundation is the Communication Accommodation Theory.

DESIGN/METHODOLOGY/APPROACH

A quantitative design was used in this study using the convenience sampling method. Data were collected from 300 medical tourism (MT) patients immediately after their face-to-face medical interview at the hospital.

FINDINGS

The non-Western cultures displayed higher intercultural communication (ICC) expectations from the host country doctors than the Western patients, possibly on account of cultural similarity with and proximity to the host country. ICC beliefs of MT patients supported by convergent communication accommodation by the doctors led to the perception of better ICC experience in clinical consultations with the potential to improve word-of-mouth promotion, patient satisfaction and revisit intentions; patients' expectations mediated the relationship. Consultation time in minutes controlled the relationship between patient ICC beliefs, expectations and experience in the medical consultations. The proposed model was undifferentiated for age, gender and geography of the MT patient as well as wait time (in minutes).

ORIGINALITY/VALUE

While culture has been recognised as a significant factor in shaping the growth in medical tourism, research is scant on cultural and religious communication accommodation practices of host country doctors and medical staff and its effects on patient experience. Most studies on culture and MT have either evaluated the role of culture on the destination choice of international patients (cultural affinity or cultural familiarity) or have analysed the effect of distance between the host and the guest country as critical determinants of the choice of MT country. This study is probably the first to assess the quality of ICC beliefs, expectations and effects on MT patients' experiences. It is also the pioneering study to relate the context of MT with the well-regarded Communication Accommodation Theory, especially the manner in which convergent and divergent accommodation occurred between MT patients and MT service providers in the host country.

Psychological determinants and evidence-based behavior change interventions in adherence to therapy for familial hypercholesterolemia

PURPOSE OF REVIEW

Patients with familial hypercholesterolemia have an elevated risk of premature atherosclerotic cardiovascular disease. Risks can be minimized through pharmacological and 'lifestyle' behavioral (low fat diet, physical activity) therapies, although therapeutic adherence is sub-optimal. Behavioral interventions to promote familial hypercholesterolemia therapy adherence should be informed by theory-based psychological determinants for maximal efficacy. The current review summarizes research on determinants of familial hypercholesterolemia therapy adherence and behavior change interventions, identifies limitations of the extant research, and sets future research agenda.

RECENT FINDINGS

A recent meta-analysis identified attitudes, subjective norms, self-efficacy, and risk perceptions as key determinants of familial hypercholesterolemia therapy adherence intentions, with intentions identified as a key correlate of concurrent behavior. Studies have specified techniques targeting key theory-based determinants that may be efficacious in interventions. Research is limited by overuse of cross-sectional correlational study designs, use of self-report behavioral measures, few theory-based intervention tests, and limited consideration of nonconscious processes and effects of socio-structural variables.

SUMMARY

Researchers should adopt study designs permitting better directional and causal inferences in determinant effects, provide tests of interventions targeting determinants and their mechanisms of action, consider determinants representing nonconscious processes (habits, implicit attitudes), and test determinants as mediators of socio-structural variables on familial hypercholesterolemia therapy adherence.

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.

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.

Conscious Initiation to Promote Physical Activity: A Behavioral Experiment and A Randomized Controlled Trial Intervention

BACKGROUND

Previous studies have investigated the encouragement of healthy behaviors through both conscious manipulation and unconscious priming. However, direct comparisons between these two approaches are limited, resulting in interventions that may lack precision. This study aimed to evaluate the effects of conscious and unconscious priming on the intention to engage in physical activity, with the goal of identifying and applying the most effective method as a targeted intervention to bridge the gap between intention and actual physical activity.

METHOD

In study 1, 116 participants were screened in a 2 × 2 (conscious vs. unconscious) × (prime vs. control) online experiment to examine the influence of implementation intention manipulation and goal priming on physical activity. Building on these results, study 2 employed a randomized controlled trial with 127 participants to assess the effects of conscious mental simulation interventions on physical activity behavior.

RESULTS

Study 1 showed that both conscious manipulation (p = .046) and unconscious priming (p = .004) significantly increased the choice of sports activities, with conscious manipulation being more effective. Study 2 found significant impacts of mixed simulation on activity levels immediately and one-week post-intervention (p = .001), with day-after intervention effects notable in the simulation group.

CONCLUSIONS

This study explored the causal relationship between priming process physical activity, and found out the promotion effect of conscious mental simulation intervention on physical activity.

The Health4Life e-health intervention for modifying lifestyle risk behaviours of adolescents: secondary outcomes of a cluster randomised controlled trial

OBJECTIVES

To investigate the effectiveness of a school-based multiple health behaviour change e-health intervention for modifying risk factors for chronic disease (secondary outcomes).

STUDY DESIGN

Cluster randomised controlled trial.

SETTING, PARTICIPANTS

Students (at baseline [2019]: year 7, 11-14 years old) at 71 Australian public, independent, and Catholic schools.

INTERVENTION

Health4Life: an e-health school-based multiple health behaviour change intervention for reducing increases in the six major behavioural risk factors for chronic disease: physical inactivity, poor diet, excessive recreational screen time, poor sleep, and use of alcohol and tobacco. It comprises six online video modules during health education class and a smartphone app.

MAIN OUTCOME MEASURES

Comparison of Health4Life and usual health education with respect to their impact on changes in twelve secondary outcomes related to the six behavioural risk factors, assessed in surveys at baseline, immediately after the intervention, and 12 and 24 months after the intervention: binge drinking, discretionary food consumption risk, inadequate fruit and vegetable intake, difficulty falling asleep, and light physical activity frequency (categorical); tobacco smoking frequency, alcohol drinking frequency, alcohol-related harm, daytime sleepiness, and time spent watching television and using electronic devices (continuous).

RESULTS

A total of 6640 year 7 students completed the baseline survey (Health4Life: 3610; control: 3030); 6454 (97.2%) completed at least one follow-up survey, 5698 (85.8%) two or more follow-up surveys. Health4Life was not statistically more effective than usual school health education for influencing changes in any of the twelve outcomes over 24 months; for example: fruit intake inadequate: odds ratio [OR], 1.08 (95% confidence interval [CI], 0.57-2.05); vegetable intake inadequate: OR, 0.97 (95% CI, 0.64-1.47); increased light physical activity: OR, 1.00 (95% CI, 0.72-1.38); tobacco use frequency: relative difference, 0.03 (95% CI, -0.58 to 0.64) days per 30 days; alcohol use frequency: relative difference, -0.34 (95% CI, -1.16 to 0.49) days per 30 days; device use time: relative difference, -0.07 (95% CI, -0.29 to 0.16) hours per day.

CONCLUSIONS

Health4Life was not more effective than usual school year 7 health education for modifying adolescent risk factors for chronic disease. Future e-health multiple health behaviour change intervention research should examine the timing and length of the intervention, as well as increasing the number of engagement strategies (eg, goal setting) during the intervention.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12619000431123 (prospective).

Promoting fluid intake to increase urine volume for kidney stone prevention: Protocol for a randomized controlled efficacy trial of the sipIT intervention

BACKGROUND

Risk of kidney stone recurrence can be reduced by increasing fluid intake and urine production but most patients fail to adhere to recommended clinical guidelines. Patients have indicated that common barriers to fluid intake include a lack of thirst, forgetting to drink, and not having access to water. We developed the sipIT intervention to support patients' fluid intake with semi-automated tracking (via a mobile app, connected water bottle and a smartwatch clockface that detects drinking gestures) and provision of just-in-time text message reminders to drink when they do not meet the hourly fluid intake goal needed to achieve the recommended volume. This trial evaluates the efficacy of sipIT for increasing urine output in patients at risk for recurrence of kidney stones.

METHOD/DESIGN

Adults with a history of kidney stones and lab-verified low urine production (<2 L/day) will be randomly assigned to receive either usual care (education and encouragement to meet fluid intake guidelines) or usual care plus the sipIT intervention. The primary outcome is 24-h urine volume; secondary outcomes include urinary supersaturations, past week fluid intake, and experienced automaticity of fluid intake. Outcomes will be assessed at baseline, 1 month, 3 months, and 12 months.

CONCLUSIONS

The sipIT intervention is the first to prompt periodic fluid intake through integration of just-in-time notifications and semi-automated tracking. If sipIT is more efficacious than usual care, this intervention provides an innovative treatment option for patients needing support in meeting fluid intake guidelines for kidney stone prevention.