Modeling Health Behavior Change: How to Predict and Modify the Adoption and Maintenance of Health Behaviors

Weight loss methods and risk of depression: Evidence from the NHANES 2005-2018 cohort

BACKGROUND

Weight loss behaviors are increasingly common worldwide. While healthy weight loss methods, such as calorie control and exercise, can improve both physical and mental health, harmful practices-such as extreme dieting and the misuse of diet pills-may contribute to depressive symptoms. Understanding the psychological impact of different weight loss strategies is essential for promoting overall well-being.

METHODOLOGY

Data from 9334 non-pregnant participants aged 20-79 years from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed. The sample consisted of 60.72 % women and 39.28 % men, with a median age of 47 years and a median BMI of 28.84. Depressive symptoms were assessed using the PHQ-9 scale. Weight loss methods were categorized into healthy practices (e.g., calorie control, exercise) and harmful practices (e.g., extreme dieting, diet pills). Logistic regression models were applied, adjusting for demographic and health factors.

RESULTS

Protective methods, including switching to lower-calorie foods (OR = 0.80, 95 % CI = 0.68-0.94), exercising (OR = 0.61, 95 % CI = 0.53-0.72), and eating more fruits and vegetables (OR = 0.78, 95 % CI = 0.66-0.92), were associated with a reduction in depressive symptoms. In contrast, harmful methods such as skipping meals (OR = 1.71, 95 % CI = 1.45-2.02), using diet pills (OR = 1.90, 95 % CI = 1.34-2.69), and vomiting (OR = 2.61, 95 % CI = 1.62-4.21) increased the risk of depressive symptoms. The number of harmful methods was positively correlated with increased depressive symptom risk (OR = 2.72, 95 % CI = 2.09-3.54), while a higher number of protective methods was linked to a decreased risk (OR = 0.50, 95 % CI = 0.37-0.68).

CONCLUSION

The emotional impact of weight loss practices is significant. Healthy weight loss strategies, such as exercise and calorie control, reduce the risk of depressive symptoms, whereas harmful methods increase the risk. These findings underscore the importance of promoting safe and sustainable weight loss methods to protect both physical and mental health.

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.

Initiating and Continuing Long-Term Exercise in Heart Failure: A Qualitative Analysis From the GEtting iNTo Light Exercise-Heart Failure Study

BACKGROUND

Exercise is a class 1A recommendation to improve the lives of patients with heart failure, yet less than one-third adhere to physical activity guidelines, and less than 3% attend cardiac rehabilitation.

OBJECTIVE

The aim of this study was to determine the effect of gentle nonaerobic exercise on initial and long-term adherence in patients with heart failure.

METHODS

We used a qualitative descriptive approach with qualitative content analysis to analyze previously recorded interview data collected as part of the 6-month GEtting iNTo Light Exercise-Heart Failure study and looked for trends in responses among our sample. Thematic statements, representing salient aspects of the participants' experiences, were created and supported by illustrative excerpts from the data.

RESULTS

Twenty-two interviews were analyzed. Eight participants had ≥80% adherence, and the remaining 14 participants were super-adherers (>100% adherence). Super-adherers tended to be male and 65 years or older, and have no exercise for 3 months before the study, a body mass index ≥ 30, and poor to good Kansas City Cardiomyopathy Questionnaire scores. Participants initially enrolled because they saw the program as an opportunity to improve a health issue and to exercise. Long-term adherence was facilitated by convenience, individualization, experiencing psychological and physical improvements, and peer fellowship.

CONCLUSIONS

The GEtting iNTo Light Exercise-Heart Failure study that used home-based gentle nonaerobic exercise had 64% of participants come more than was asked. It is imperative that clinicians incorporate what participants with heart failure have directly stated is important for their initiation and long-term adherence to exercise so that we can work toward bridging sedentary patients to the full exercise guidelines to reduce morbidity and mortality.

Promoting Hand Hygiene During the COVID-19 Pandemic: Randomized Controlled Trial of the Optimized Soapp+ App

BACKGROUND

The adoption of protective behaviors represents a crucial measure to counter the spread of infectious diseases. The development of effective behavior change techniques therefore emerged as a public health priority during the COVID-19 pandemic, but randomized controlled trials (RCTs) testing such interventions during the pandemic were scarce. We conducted a Multiphase Optimization Strategy to develop, optimize, and evaluate a smartphone app, Soapp+, to promote hand hygiene during the COVID-19 pandemic.

OBJECTIVE

This RCT aims to evaluate the efficacy of the Soapp+ app (intervention group) targeting motivation and habit compared to a simplified version of the app mainly delivering hand hygiene information (active control group). We hypothesize that, compared to the control group, the intervention group will show greater improvements in hand hygiene behavior and behavioral determinants post intervention and at a 6-month follow-up.

METHODS

We conducted an RCT from March 2022 to April 2023, recruiting 193 adults living in Switzerland online. Following baseline assessment, the intervention lasted 32 days, followed by a postintervention assessment and a 6-month follow-up. The primary outcome was the change in hand hygiene behavior from pre- to postintervention and preintervention to follow-up. Hand hygiene was assessed with electronic diaries. The intervention group received content incorporating various behavior change techniques designed to address key motivational and volitional determinants of hand hygiene behavior (eg, skills, knowledge, intention, attitudes toward hand hygiene, risk perception, outcome expectancies, self-efficacy, action planning, coping planning, action control, habit). In contrast, the active control group was exposed to behavior change techniques targeting only a subset of these determinants (ie, skills, knowledge, and intention). The delivery of the intervention content was fully automated. Group differences were tested using an intention-to-treat approach with the nonparametric Wilcoxon rank sum test.

RESULTS

Of the 193 randomized participants, 146 completed the first hand hygiene diary preintervention and were included in the main analysis. The mean age was 41 (SD 17) years, and 69.2% (n=101) were women. The main analysis revealed significant superiority of the intervention compared to controls in the change in hand hygiene pre-post intervention (W=2034; P<.04; effect size r=0.17) and between preintervention and follow-up (W=2005; P<.03; effect size r=0.18). Regarding behavioral determinants, the change in coping planning pre-post intervention (W=3840; P=.03, effect size r=0.16) was significantly greater in the intervention group using Soapp+ compared to controls.

CONCLUSIONS

Soapp+ was developed through a rigorous experimental method during the ongoing COVID-19 pandemic. The RCT provided evidence for the efficacy of Soapp+ to promote hand hygiene in the context of a pandemic.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04830761; https://clinicaltrials.gov/study/NCT04830761.

A Mobile Health App Informed by the Multi-Process Action Control Framework to Promote Physical Activity Among Inactive Adults: Iterative Usability Study

BACKGROUND

Mobile health apps have high potential to address the widespread deficit in physical activity (PA); however, they have demonstrated greater impact on short-term PA compared to long-term PA. The multi-process action control (M-PAC) framework promotes sustained PA behavior by combining reflective (eg, attitudes) and regulatory (eg, planning and emotion regulation) constructs with reflexive (eg, habits and identity) constructs. Usability testing is important to determine the integrity of a mobile health app's intrinsic properties and suggestions for improvement before feasibility and efficacy testing.

OBJECTIVE

This study aimed to gather usability feedback from end users on a first and a second version of an M-PAC app prototype.

METHODS

First, 3 workshops and focus groups, with 5 adult participants per group, were conducted to obtain first impressions of the M-PAC app interface and the first 3 lessons. The findings informed several modifications to the app program (eg, added cards with reduced content) and its interface (eg, created a link placeholder image and added a forgot password feature). Subsequently, a single-group pilot usability study was conducted with 14 adults who were not meeting 150 minutes per week of moderate-to-vigorous PA. They used the updated M-PAC app for 2 weeks, participated in semistructured interviews, and completed the Mobile App Usability Questionnaire (MAUQ) to provide usability and acceptability feedback. The focus groups and interviews were recorded, transcribed, and analyzed with content analysis informed by usability heuristics. The MAUQ scores were analyzed descriptively.

RESULTS

Participants from the workshops and focus groups (mean age 30.40, SD9.49 years) expressed overall satisfaction with the app layout and content. The language was deemed appropriate; however, some terms (eg, self-efficacy) and acronyms (eg, frequency, intensity, time, and type) needed definitions. Participants provided several recommendations for the visual design (eg, more cards with less text). They experienced challenges in accessing and using the help module and viewing some images, and were unsure how to create or reset the password. Findings from the usability pilot study (mean age 41.38, SD12.92 years; mean moderate-to-vigorous PA 66.07, SD57.92 min/week) revealed overall satisfaction with the app layout (13/13, 100%), content (10/13, 77%), and language (7/11, 64%). Suggestions included more enticing titles and additional and variable forms of content (eg, visual aids and videos). The app was easy to navigate (9/13, 69%); however, some errors were identified, such as PA monitoring connection problems, broken links, and difficulties entering and modifying data. The mean MAUQ total and subscale scores were as follows: total=5.06 (SD1.20), usefulness=4.17 (SD1.31), ease of use=5.36 (SD1.27), and interface and satisfaction=5.52 (SD1.42).

CONCLUSIONS

Overall, the M-PAC app was deemed usable and acceptable. The findings will inform the development of the minimum viable product, which will undergo subsequent feasibility testing.

Effects of a nurse-led individualized mHealth nutrition intervention for post-discharged gastric cancer patients following gastrectomy: A randomized controlled trial

OBJECTIVE

To evaluate the effects of a nurse-led individualized mHealth nutrition intervention on nutritional status, nutritional intake, cognitive beliefs related to nutritional behavior, weight loss, blood parameters, gastrointestinal symptoms, and quality of life in post-discharged gastric cancer patients following gastrectomy.

DESIGN

This was an assessor-blinded parallel-arm randomized controlled trial with a repeated-measures design.

SETTING(S)

The participants were recruited from inpatient gastric surgery units of two tertiary hospitals in Guangzhou, China.

PARTICIPANTS

A total of 108 patients with gastric cancer who underwent gastrectomy and were scheduled to be discharged to their homes were included.

METHOD

Participants were randomly allocated to either the intervention or the control group (n = 54 per group). The intervention group received the nurse-led individualized mHealth nutrition intervention in addition to the usual care, whereas the control group received only usual care. The intervention included face-to-face education before discharge, the use of an applet and phone consultations. Baseline data were collected on the day of discharge from the hospital (T0). The patients' nutritional status, cognitive beliefs related to nutritional behavior, nutritional intake, weight loss, blood parameters, gastrointestinal symptoms and quality of life were repeatedly measured at 4-week (T1) and 12-week (T2) after discharge.

RESULTS

Compared with the control group, the intervention group showed significant improvement in nutritional status (ꞵ₄ weeks = -1.08, 95 % CI -2.12 to 0.04, p = 0.042; ꞵ₁₂ weeks = -1.52, 95 % CI -2.57 to -0.47, p = 0.005). Improvements were also observed in energy and protein intake, weight loss, and cognitive beliefs related to nutritional behavior, including risk perception, outcome expectancy, self-efficacy, intention, and action plan (p < 0.05). However, no statistically significant differences were observed in coping plan, gastrointestinal symptoms, blood parameters, and quality of life (p > 0.05).

CONCLUSIONS

The nurse-led individualized mHealth nutrition intervention was effective for improving the cognitive beliefs related to nutritional behavior, energy and protein intake, and nutritional status, as well as reducing weight loss among post-discharged gastric cancer patients following gastrectomy.

REGISTRATION NUMBER

ChiCTR2200064808.

Effectiveness of an intervention designed based on the Health Action Process Approach on obesity surgery outcomes in patients who have undergone bariatric surgery after one year: A randomized controlled trial

BACKGROUND

Bariatric surgery is effective in treating severe obesity. However, surgery alone, without additional behavior change management, may not lead to optimal long-term weight loss and maintenance. This study aimed to evaluate an intervention designed based on the Health Action Process Approach to improve outcomes of obesity surgery in patients who underwent bariatric surgery in Tehran, Iran.

METHODS

In this randomized controlled trial, a total of 100 patients who had undergone bariatric surgery after the past year were randomly assigned to two intervention (n = 50) and control (n = 50) groups. The intervention group received educational intervention for two months. Health action process approach (HAPA) constructs, the Bariatric Surgery Self-Management Behaviors Questionnaire (BSSQ), dietary recall, blood chemistry parameters, BMI, percentage of body weight loss, and the International Physical Activity Questionnaire (IPAC) were measured at baseline and four months after the intervention. To compare the changes between the two groups before and four months after the educational intervention, the interaction of group and time was analyzed using the generalized estimating equation (GEE). A p-value of less than 0.05 was considered statistically significant.

RESULTS

The educational intervention resulted in improvements in various aspects of self-efficacy, including task and coping self-efficacy constructs (P = 0.02), action planning (P < 0.01) and behavioral intention (P < 0.01) related to diet self-management. There were also statistically significant improvements in action planning (P = 0.02), risk perception (P = 0.01) and Recovery self- efficacy (P = 0.01) related to the self-management of physical activity. There were significant improvements in the iron blood test results (P =  0.01) among the patients.

CONCLUSION

Our intervention, designed based on the Health Action Process Approach, led to improvements in dietary and physical activity outcomes among patients who underwent bariatric surgery. Trial Registration: Iran Randomized Clinical Trials IRCT20230722058887N1.

Synthesizing comprehensive models for health behavior studies: connecting dots and revealing links on health enhancement through a meta-analysis approach

Objective

To systematically synthesize the impact of autonomy and key theoretical models, including Self-Determination Theory (SDT), Technology Acceptance Model (TAM), Value Adoption Model (VAM), Theory of Planned Behavior (TPB), and Health Action Process Approach (HAPA), on health behavior and behavior change determinants, focusing on self-determination and intrinsic motivation as central drivers of independent health decisions.

Methods

A meta-analysis was conducted on 135 studies published between 2005 and 2023, with a total sample size of 53,242 participants. We searched the Web of Science and PubMed databases for relevant literature. The theoretical frameworks explored include SDT, TAM, VAM, TPB, and HAPA. Data analysis was performed using Review Manager 5.4.1 software, with effect size calculated as the standardized mean difference with 95% confidence intervals. Heterogeneity was evaluated using I2 statistics.

Results

(1) SDT significantly impacted motivation, while TAM and VAM influenced perceived value [SMD = 0.96 > 0.8, 95% CI (0.68, 1.24), P < 0.001]. (2) Implementation intentions, action planning, and coping planning were key moderators of health behavior change (I2 = 65.4%). (3) HAPA's structured planning strategies positively impacted long-term health behavior changes.

Conclusion

Autonomy, self-determination, and intrinsic motivation play a crucial role in health behavior change. Integrating theoretical models such as SDT, TAM, VAM, and HAPA facilitates structured approaches to health interventions, emphasizing implementation intentions, action planning, and coping strategies.

Dynamic representations of theory testing in physical activity using ecological momentary assessment: an example guide utilizing multi-process action control

Behavioral theories are essential in understanding physical activity (PA) and developing effective intervention strategies, yet most theories have been developed alongside common research methods available at their inception. Contemporary data collection methods such as intensive longitudinal designs (e.g., Ecological Momentary Assessment; EMA) are beginning to facilitate more advanced approaches to theorizing. One of the primary challenges in applying traditional behavior change theories, however, relates to measurement, as traditional multi-item measures are not practical nor may they accurately capture the dynamic elements of the construct sought in intensive longitudinal sampling. The purpose of this paper was to provide a user's guide of measures of the Multi-Process Action Control (M-PAC) Framework for use in EMA, followed by preliminary working examples. EMA offers opportunities to sample and obtain real-time (or near real-time) information that include processes that are more automatically or immediately activated in response to environmental stimuli or informational cues. As a result, we propose a slight re-operationalization of M-PAC as it relates to the interacting psychological systems in determining PA. We outline some of the measurement challenges with M-PAC using EMA, and the opportunities to blend more traditional and contemporary real-time approaches to advance theory and our understanding of PA. Together, this paper is intended to be a starting point, acknowledging the need to adapt traditional behavioral theories to incorporate the dynamic factors in determining PA. By doing so, we can advance our understanding of PA and develop more effective, and theory-based, interventions tailored to individual needs and contexts.

Predicting dietary management intention of patients with chronic kidney disease using protection motivation theory

BACKGROUND

Psychological determinants underlying the dietary management intention (DMI) of Chinese patients with chronic kidney disease (CKD) are not well understood. This hinders the development of theory-informed dietary interventions targeting this population. The aim of this study was to identify factors influencing DMI of Chinese patients with CKD through the lens of Protection Motivation Theory (PMT).

METHODS

500 patients with CKD from a nephrology ward of a large teaching hospital in China completed a survey including measures of PMT constructs (i.e., perceived vulnerability, perceived severity, intrinsic and extrinsic rewards, self-efficacy, response efficacy, and response cost) using validated scales adapted from previous studies. Data were analyzed using confirmatory factor analysis and multiple linear regression.

RESULTS

Three PMT constructs, namely perceived severity [B = 0.198, P < 0.001], response efficacy [B = 0.331, P  < 0.001], and self-efficacy [B = 0.325, P  < 0.001], two demographic variables, namely single status [B = -0.180, P = 0.028] and education level [B = 0.080, P = 0.007], and a disease-related variable, namely CKD stage [B = .056, P = 0.001], predicted 39.3% of the variance of the CKD DMI. No significant effect on CKD DMI was observed for other predictor variables (P > 0.05).

CONCLUSIONS

Applying the PMT, significant predictors of DMI in Chinese patients with CKD were identified, which should be targeted in behavior change initiatives aimed at promoting dietary management.

Linking physical activity to workers' low back pain, back health, and theory-based psychological variables: study protocol of the workHealth intensive longitudinal observational study

BACKGROUND

The high prevalence of low back pain (LBP) in today's working population and its substantial impact on quality of life call for preventive and sustainable strategies. Physical activity (PA), especially during leisure-time (LTPA), has been proposed as one of the few promising, active preventive measures against the onset of LBP. This is the protocol for the prospective observational study workHealth that aims to describe the patterns of PA among workers (including back posture and movement), examine the link between PA, LBP and back health and identify theory-based psychological determinants of LTPA.

METHODS

The proposed study is a longitudinal observational study taking place over 2 months with an intensive-longitudinal ecological momentary assessment (EMA) phase. A sample of 252 adults will be recruited from two working populations, sedentary workers, and manually working physiotherapists. At baseline, participants complete a self-report questionnaire and undergo an objective measurement of their back posture and mobility. At 2, 4, and 8 weeks after baseline, participants fill in the follow-up questionnaires. Starting at baseline, participants will also wear an accelerometer and will complete three daily questionnaires for the following 14 days. In addition to the main study, a sub-sample of 8 observational N-of-1 studies will have an extended EMA phase of 68 days and a data-driven exit interview. The primary outcome is moderate-to-vigorous LTPA. Data will be analyzed using regression and multi-level models. For the N-of-1 studies, a mixed-methods approach will be used including dynamic regressions.

DISCUSSION

Rather than solely examining LBP from a pathological perspective, workHealth is one of the first studies to investigate psychological, behavioral and biomechanical risk factors and protective resources against LBP. The study will offer insight into theory-based, psychological determinants of LTPA and its relationship to both low back pain and back health. Between-person and within-person level analyses will provide insight on group comparisons of average effects and individual patterns of physical activity in daily life, respectively. Understanding these relationships can inform future behavioral interventions and ultimately contribute to prevention efforts against LBP and the promotion of back health.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00025296|| https://drks.de/ || Registration date 28/06/2021.

Telephone Counseling and Messaging Guided by Mobile Profiling of Tobacco Users for Smoking Cessation: A Randomized Clinical Trial

Importance

Evidence-based pharmacotherapy and behavioral therapy could increase tobacco abstinence but are underused and require further investigation.

Objective

To evaluate the effectiveness of a novel mobile health (mHealth) profiling via ecological momentary assessment (EMA) in personalizing smoking cessation intervention for individuals who use tobacco with no intention to use smoking cessation services and medications.

Design, Setting, and Participants

A 2-arm, assessor-blind, individual-randomized clinical trial was conducted. With online recruitment through social media or email advertisement, 459 adults with daily tobacco use in Hong Kong were recruited from March 23, 2022, to January 4, 2023, with follow-up completed by July 4, 2023. Individuals who had not used smoking cessation services or medications in the preceding 7 days and had no intention to use these aids in the next month were included. Participants were randomized 1:1 to intervention (n = 231) or control (n = 228) groups.

Interventions

Both groups completed 5 EMAs daily for 7 days to report smoking behaviors and triggers. The intervention group additionally received nurse-led telephone counseling and 10-week instant messaging support guided by mHealth profiling from EMA.

Main Outcomes and Measures

Primary outcomes were biochemically validated tobacco abstinence and Incremental Behavior Change Toward Smoking Cessation (IBC-S) score at 3 months after EMA initiation. Secondary outcomes were biochemically validated tobacco abstinence and IBC-S status at 6 months, self-reported 7-day point prevalence, abstinence, and use of smoking cessation medications and services at 3 and 6 months after EMA initiation. Intention-to-treat analysis was used.

Results

The study included 459 participants (304 males [66.2%]) with a mean (SD) age of 36.7 (10.7) years. Biochemically validated tobacco abstinence rates were 8.2% in the intervention group and 3.5% in the control group (odds ratio [OR], 2.46; 95% CI, 1.06 to 5.75; P = .04) at 3-month follow-up. The corresponding rates at 6-month follow-up were 9.5% and 4.0% (OR, 2.56; 95% CI, 1.15-5.70; P = .02). The intervention group showed a greater increase in IBC-S scores from baseline to both 3-month (β = 1.03; 95% CI, 0.46-1.59; P < .001) and 6-month (β = 0.95; 95% CI, 0.37-1.53; P = .001) follow-ups.

Conclusions and Relevance

The findings of this randomized clinical trial suggest that telephone counseling and instant messaging support, guided by mHealth profiling, increased tobacco abstinence vs EMA alone. This intervention may be used to supplement conventional smoking cessation for individuals who use tobacco and are unwilling to use smoking cessation aids.

Trial Registration

ClinicalTrials.gov Identifier: NCT05212220.

Acceptance of disability in stroke: A qualitative metasynthesis

Disability acceptance has been conceptualized as an internalization of oneself as a person experiencing disability and associated with better coping and motivation for rehabilitation. This is particularly pertinent to individuals experiencing stroke because many are initially not fully aware of their stroke-related impairments, which affects the acceptance process. This qualitative metasynthesis aimed to synthesize qualitative findings regarding disability acceptance in stroke and identify barriers and facilitators associated with it. Eighteen studies published from 2003 to 2022, conducted in Asia, Europe, and Australasia, were included in our review. A thematic synthesis was carried out through line-by-line coding and identification of descriptive and analytical themes. Three analytical themes emerged from the analysis: "understanding impairments," "flexibility and active engagement," and "disability acceptance as a non-linear process." Healthcare professionals may facilitate this process by guiding individuals experiencing stroke to recognize that they can manage their limitations and still lead meaningful lives.

Contextual and affective precursors of physical activity intention and enactment examined through ecological momentary assessment

BACKGROUND

Regular physical activity (PA) provides numerous health benefits, which is why many people intend to lead an active lifestyle. Yet, internal and external states and barriers can hinder the translation of such intentions into actual behavior. This study prospectively studied such barriers, namely, the temporal relationship between the independent variables momentary affect (stress, emotions), and the dependent variables PA intentions and subsequent PA behavior. The variables were measured using Ecological Momentary Assessment (EMA) at the within-person level.

METHODS

A total of 41 healthy participants (aged 19-67) completed 4 daily EMA prompts over three weeks on their smartphones, capturing data on momentary affective states (happy, active, irritated, tired, concerned, nervous, relaxed, energetic), anticipated contextual barriers (i.e., PA-incompatible external circumstances), prospective PA intentions, and PA behavior (retrospective, since the last prompt). We applied generalized linear mixed effect models to examine the influence of momentary affect and contextual barriers onto a) PA intentions, b) their consecutive enactment, and c) directly onto PA behavior.

RESULTS

Individuals were more likely to form PA intentions when feeling happy, active, or energetic, but less likely when external/contextual barriers were high or when they felt tired. Furthermore, only PA intentions were significant precursors of subsequent PA behavior, while neither contextual barriers, nor momentary affect directly affected PA behavior.

CONCLUSIONS

Interventions for fostering PA, such as Just-in-Time Adaptive Interventions, should address and 'stabilize' intentions through addressing external barriers and positive affects (happy, active, energetic). The present results call for more temporally sensitive and dynamic health behavior theories of PA.

Intervention effects on physical activity identity: a systematic review and meta-analysis

Physical activity (PA) identity (i.e., categorisation of oneself in a particular role) has been linked to PA behaviour in observational research, yet experimental research has seen less attention. The purpose of this meta-analysis was to examine the effectiveness of interventions to change identity and subsequent PA. Eligible studies were published in a peer-reviewed journal in English, included an experimental or quasi-experimental design in the PA domain with a measure of identity as the dependent variable, among an adult (>18 yrs.) sample. A literature search was completed in March 2024 using five common databases. The search yielded 40 independent effect sizes, representing 4939 participants. Random-effects meta-analysis showed positive changes in identity favouring the intervention over the control group g = 0.18 (95% CI = 0.11-0.24) and positive changes in a sub-sample (k = 30) of these studies that also measured PA g = 0.61 (95% CI = 0.41-0.81). Changes in identity did not have significant (Q = 43.08, p = 0.30) heterogeneity, yet changes in PA showed heterogeneity (Q = 204.62, p < .001) and follow-up moderator analyses found potential publication bias, and differences by methods (comparison group, length of intervention) and theoretical approach. Overall, PA identity can change as a result of interventions, but the effect may be smaller than changes in behaviour in these interventions.

Sound mind, sound body, or vice versa? Mind-body beliefs shape health behaviors

The present research examines whether and how lay intuitive theory regarding the interconnectedness of the mind and body, which we term mind-body correspondence (MBC), predicts engagement in health behaviors. Specifically, we hypothesised that MBC would strengthen mind influences the body (MIB) and body influences the mind (BIM) beliefs, which would in turn increase mental and physical health behaviors, respectively. We tested associations among MBC (independent variable), MIB and BIM beliefs (proposed mediators), and mental and physical health behaviors (dependent variables) using correlational designs in Studies 1a to 1c. Results revealed positive associations between MBC and (1) MIB and BIM and (2) mental and physical health behaviors, as well as between MIB and mental health behaviors and between BIM and physical health behaviors. We then tested the full model in Study 2 with an experimental manipulation of MBC and in Study 3 with a two-wave longitudinal design. Both studies revealed significant indirect effects of MBC on mental health behaviors via MIB and on physical health behaviors via BIM. Together, our findings suggest that one can encourage mental health behaviors by emphasizing the mind-to-body connection and physical health behaviors by highlighting the body-to-mind connection.

Contextual and psychosocial factors predicting sanitation behaviours in rural Indonesia

BACKGROUND

Rural areas in the Southern hemisphere bear the brunt of inadequate sanitation services and high prevalence of open defecation. Our study in an Indonesian remote village underscores the critical role of psychosocial factors influencing sanitation behavior in such marginalised communities. This study explores contextual and RANAS (Risk, Attitudes, Norms, Abilities, and Self-regulation) psychosocial factors determining sanitation behaviour in rural Indonesia.

METHODS

In a cross-sectional survey of 371 rural households, we gathered data on personal characteristics, sanitation behaviours, and RANAS factors and performed regression analysis.

RESULTS

We found that most respondents do not use the toilet regularly, and no household has safely managed sanitation facilities. Among all contextual factors, households with equal power in determining household expenses between husbands and wives and households with access to hygiene information tend to practice better sanitation behaviours and latrine use. Meanwhile, RANAS factors that primarily affect sanitation behaviour in this study are remembering (part of self-regulation, OR = 0.35), followed by feeling (attitude, OR = 0.31) and commitment (self-regulation, OR = 0.18).

CONCLUSIONS

One in every four people interviewed in rural Luwu practices open defecation and no household has access to safely managed sanitation. In reducing open defecation rate in rural areas of Indonesia, the government should strengthen their efforts and concentrate on programmes that address the three identified psychosocial variables, along with improving access. While many studies on the determinants of sanitation behaviours in LMICs analyse contextual factors only, we argue that Indonesian sanitation behavioural interventions should use the RANAS model to identify psychosocial factors.

Effect of healthy dietary intention-behavior (in)consistency on depression and anxiety in the process of behavior change

Although an increasing number of people are now committed to pursuing a healthy diet, it remains unclear how mental health changes during this process. The present study aimed to examine the combined effect of healthy dietary intention and behavior on depression and anxiety across two sub-studies. This study consisted of two parts: a cross-sectional survey (Study 1) involving 1,433 college students and an 11-day daily diary study (Study 2) with 117 college students. Polynomial regression and response surface analysis indicated that in cases of congruence, individuals' intention and behavior align at a high level and were associated with lower levels of depression and anxiety in the motivational phase but were not found similar association in the volitional phase. In cases of incongruence, individuals with high intention-low behavior tend to experience lower levels of depression and anxiety in the motivational phase. However, individuals with high intention-low behavior tend to experience higher levels of depression and anxiety in the volitional phase. These findings not only enrich the current understanding of diet and health but also contribute to the development of holistic strategies for promoting a healthy diet.

Evaluating mobile apps for sun protection: content analysis and user preferences in a two-part study

Background

Sunburn and intermittent sun exposure elevate melanoma skin cancer risk. Sun protection behaviours, including limiting sun exposure, seeking shade, wearing protective gear, and using sunscreen, help mitigate excessive sun exposure. Smartphone apps present a promising platform to enhance these behaviours.

Objective

Part 1 aimed to analyse and evaluate the content of mobile apps that encourage sun protection behaviours, focusing on features, and behaviour change techniques (BCTs). Part 2 explored user preferences and usability post-initial use and two weeks later.

Results

Part 1 identified 1294 apps; after applying exclusion criteria, 87 apps were downloaded, with 48 included for analysis. The apps presented opportunities for enhancement in their theoretical and evidence basis, and visualisations use (e.g. UV-index). The apps mapped across a total of 12 BCTs (M = 1.71, SD = 1.07; range = 0-5). The most frequently identified BCTs were 'instruction on how to perform behaviour' (65%), 'information about health consequences' (29%), and 'prompts/cues' (27%). In Part 2, participants favoured features supporting knowledge and ease of use. Participants expressed a preference for apps that are free of paid features, advertisements, and external purchases. Tailored advice (e.g. location, skin type) was deemed crucial, particularly for initial exposure. Proactive features integrating behavioural, personal, and contextual information for adaptive and just-in-time sun protection advice were seen as essential for sustaining engagement.

Conclusions

Sun protection apps emphasizing knowledge, ease of use, tailored advice, and proactive features are likely to encourage sustained engagement. Suggestions for optimising current and future sun protection apps are provided.

Feature Selection for Physical Activity Prediction Using Ecological Momentary Assessments to Personalize Intervention Timing: Longitudinal Observational Study

Background

There has been a surge in the development of apps that aim to improve health, physical activity (PA), and well-being through behavior change. These apps often focus on creating a long-term and sustainable impact on the user. Just-in-time adaptive interventions (JITAIs) that are based on passive sensing of the user's current context (eg, via smartphones and wearables) have been devised to enhance the effectiveness of these apps and foster PA. JITAIs aim to provide personalized support and interventions such as encouraging messages in a context-aware manner. However, the limited range of passive sensing capabilities often make it challenging to determine the timing and context for delivering well-accepted and effective interventions. Ecological momentary assessment (EMA) can provide personal context by directly capturing user assessments (eg, moods and emotions). Thus, EMA might be a useful complement to passive sensing in determining when JITAIs are triggered. However, extensive EMA schedules need to be scrutinized, as they can increase user burden.

Objective

The aim of the study was to use machine learning to balance the feature set size of EMA questions with the prediction accuracy regarding of enacting PA.

Methods

A total of 43 healthy participants (aged 19-67 years) completed 4 EMA surveys daily over 3 weeks. These surveys prospectively assessed various states, including both motivational and volitional variables related to PA preparation (eg, intrinsic motivation, self-efficacy, and perceived barriers) alongside stress and mood or emotions. PA enactment was assessed retrospectively via EMA and served as the outcome variable.

Results

The best-performing machine learning models predicted PA engagement with a mean area under the curve score of 0.87 (SD 0.02) in 5-fold cross-validation and 0.87 on the test set. Particularly strong predictors included self-efficacy, stress, planning, and perceived barriers, indicating that a small set of EMA predictors can yield accurate PA prediction for these participants.

Conclusions

A small set of EMA-based features like self-efficacy, stress, planning, and perceived barriers can be enough to predict PA reasonably well and can thus be used to meaningfully tailor JITAIs such as sending well-timed and context-aware support messages.

Gender differences in awareness and practices of cancer prevention recommendations in Korea: a cross-sectional survey

OBJECTIVES

Gender is a major determinant of health behaviors that influences cancer prevention awareness and practices. This study investigated the relationship of the awareness and practice rates of cancer prevention recommendations with gender and socioeconomic status.

METHODS

We used data from the Korean National Cancer Prevention Awareness and Practice Survey (2023). The sample included 4,000 men and women aged 20-74 years. We conducted multiple logistic regression analyses to evaluate associations with the awareness and practices of cancer prevention, and a joinpoint regression analysis using age-standardized rates to analyze trends in awareness and practice rates from 2007 to 2023.

RESULTS

The awareness rates were 79.4% and 81.2% for men and women, respectively. The overall practice rates were substantially lower (43.1% for men and 48.9% for women). For men, awareness rates did not differ significantly by socio-demographic characteristics, but practice rates increased with age (20-29: 15.9%; 60-74: 53.8%). For women, both awareness (20-29: 73.0%; 60-74: 85.7%) and practice (20-29: 16.8%; 60-74: 67.5%) rates increased with age. The easiest recommendations to follow were "reducing salt intake and avoiding burnt or charred foods" (men: 29.9%; women: 28.4%), whereas the most difficult recommendation was "engaging in regular physical activity" (men: 32.5%; women: 34.4%).

CONCLUSIONS

While awareness of cancer prevention recommendations was high, the practice of these recommendations was low. Gender influenced changes in awareness and practice rates over time, reflecting a large gap in practice. Future research should explore appropriate intervention points for cancer prevention practices and the development of more effective cancer prevention policies.

Analysis of an intergenerational service-learning experience based on physical exercise in a community setting: a mixed-method study

Introduction

Physical activity offers numerous benefits that improve psychological well-being, reduce dependency, and foster intergenerational relationships. Universities play a key role in promoting the health of students by proposing actions that contribute to a sustainable future, fostering a mature society and reducing ageism. This service-learning project aimed to assess the impact of an intergenerational cane-walking program on older adults and physiotherapy students in a community setting. The project focused on promoting health and fostering intergenerational relationships.

Methods

A concurrent, nested mixed-methods design was used for the intervention, involving intergenerational group walks during the 2022-2023 academic year. The program was designed and supervised by faculty members and three fourth-year fellows. Data collection was based on adherence to the intervention, the Behavioral Regulation in Exercise Questionnaire (BREQ-3), interviews with older adults and feedback questionnaires completed by them and participating students.

Results

Satisfactory adherence was evidenced among older adults, with 65.79% of participants who completed the project and 72% who adhered to the intervention, although there were no statistically significant differences in terms of motivation to exercise taking that adherence into account. The project's ability to foster intergenerational relationships was rated by the seniors at 9.50 ± 0.6, and 100% answered affirmatively about its capacity of contribute to improving their health and well-being. Student feedback also reflected high scores for fostering intergenerational relationships, with scores of 10 (fellows), 8.7 ± 1.2 (third-year students), and 8.27 ± 1.2 (second-year students). The project's contribution to skills development was rated positively by 100% of the fellows, 88.6% of the second-year students, and 74.1% of the third-year students. In the nested study, three key themes related to exercise emerged by older adults: (1) perceptions of exercise, (2) barriers to exercise and (3) motivations for exercise. Regarding satisfaction with the program, three main themes emerged: (1) intergenerational relationships, (2) strengths of the program and (3) suggestions for improvement.

Conclusion

The program appears to improve the well-being of older adults and provide valuable experiential learning for students. Thus, service-learning projects could effectively promote sustainable health practices, highlighting the important role of universities in community health initiatives.

Evaluation and adaptation of a two-way text messaging intervention in the WIC breastfeeding peer counseling program: A qualitative analysis

Breastfeeding (BF) is vital for maternal and infant health, yet post-hospital discharge support remains a challenge. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides BF peer counseling prenatally and up to 1-year postpartum among low-income women in the United States. The Lactation Advice Through Texting Can Help (LATCH) intervention is an evidence-based two-way text messaging intervention that provides BF education and support in the WIC peer counseling program. The intervention is implemented by peer counselors (PCs) in the WIC program, with the supervision and support of a lactation consultant. The aim of this qualitative study was to assess the barriers and facilitators to the implementation of LATCH during the feasibility trial and to investigate strategies for adapting and scaling up the intervention. In-depth interviews with LATCH and PC program key informants aimed to evaluate the intervention and explore its adaptation and scale-up. Interviews were analyzed using line by line inductive thematic analysis. Findings were mapped to the Model for Adaptation Design and Impact (MADI) framework to describe the proposed adaptations, and to the Program Impact Pathways (PIP) framework to identify causal pathways and critical quality control points. Results demonstrate that LATCH facilitates continued engagement between PCs and WIC mothers; however, implementation feasibility issues remain. Suggested adaptations to LATCH include the use of an integrated comprehensive platform, ensuring continuity of care through an expanded spectrum of communication options, the need to develop a PC support model for "off hours" (non-business hours), and the need to obtain local WIC office management's buy-in for the communications platform and the off-hours PC model. Critical quality control points were identified when results were mapped to the MADI and PIP frameworks. Implementing these changes has the potential to expand access to BF peer counseling support and improve BF equity among low-income women.

A staged integrated model informing the promotion of healthy dietary behaviors in adolescents: a prospective study

BACKGROUND

The promotion of healthy dietary behaviors in adolescence is critical, which have long-term implications for lifelong health. Integration is an important method for improving limited theories of dietary behavior change. The present study proposes an integrated model aimed at identifying the diverse determinants of healthy dietary behaviors in adolescents and assesses its stage-specific nature as the potential for effective interventions.

METHODS

A two-year prospective study was conducted in southwest China, involving a sample of 1990 adolescents (mean age: 15.06 years) from two randomly selected secondary schools. A total of 765 adolescents were exposed to the three-phase interventions while 1225 adolescents participated as the control group. The interventions aimed to promote healthy dietary behaviors in adolescents, which included health education sessions and health handbooks targeting specific constructs of the integrated model. The follow-up surveys after corresponding interventions were performed every six months. Self-reported frequency of healthy dietary behaviors, psychological constructs integrated from Health Action Process Approach, Health Belief Model, and Theory of Planned Behavior, as well as anxiety symptoms were measured.

RESULTS

Within structural equation modeling controlling for past behavior, the integrated model accounted for 61.7% variance of behavioral intentions and 19.1% variance of healthy dietary behaviors, and showed discontinuity patterns across behavior change phases. The pivotal constructs included outcome expectancies, perceived severity, subjective norms, action self-efficacy, behavioral intentions, action planning, and maintenance self-efficacy. Anxiety was an emotional barrier in the dietary behavior modification (β = -0.113, P < .001). Interventions within the staged integrated model, led to increased adoption of healthy dietary behaviors in intervention group compared to control group (33.40% vs. 25.70%, P < .05), indicating certain effectiveness, particularly in targeting action self-efficacy (stronger direct effects on behavioral intentions and maintenance self-efficacy, β = 0.489 to 0.704, P < .001).

CONCLUSIONS

The staged integrated model provides a detailed understanding of the determinants of healthy dietary behaviors in adolescence, highlighting anxiety as an emotional barrier that impedes positive cognition and healthy dietary behaviors. It provides valuable guidance for future interventions targeting specific constructs across behavior change phases, with particular emphasis on enhancing action self-efficacy.

Does stress compromise fruit and vegetable intake? A randomized controlled trial testing a model with planning as a mediator and stress as a moderator

OBJECTIVE

Individuals experiencing higher stress levels tend to consume fewer fruits and vegetables compared to their less stressed counterparts. Thus, to promote fruit and vegetable (FV) consumption, action planning has been proven effective in translating behavioral intentions into actual dietary behaviors. This study aims to evaluate a 7-day intervention designed to improve FV planning and intake, while also examining the role of stress.

METHODS

The trial employed a 3 (time: pretest, post-test, and follow-up) * 2 (group: intervention vs. control) between-participant factorial design. A total of 99 young Chinese adults (age = 23.84 years ± 4.63, 26 men) who had formed an explicit intention to consume more fruit and vegetables, participated in a 7-day online randomized controlled trial.

RESULTS

The intervention successfully enhanced FV planning as well as FV intake. Furthermore, a moderated mediation model revealed that FV planning mediated the relationship between experimental conditions and FV intake, with stress moderating this mediation. Specifically, planning facilitated FV intake for individuals with low stress levels, while this effect was not observed for those with high stress levels.

CONCLUSION

These findings confirm the positive impact of the planning intervention on improving FV intake, particularly for individuals with low stress levels, and highlight stress as a barrier to health behavior change that warrants further attention in future studies.

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.

Modelling the compensatory and carry-over effects between physical activity and fruit-vegetable consumption in young adults

Physical activity (PA) and fruit and vegetable consumption (FVC) are crucial factors jointly affecting young adults' physical and mental health. However, the psychosocial interactive mechanisms of these behaviors remain understudied. Using a two-wave prospective design over two months, this study investigated the psychological mechanisms underlying multiple health behavior change (MHBC) through a novel two-layer social-cognitive framework, the Compensatory Carry-Over Action Model (CCAM), among 322 Chinese college students (19.47 ± 0.99 years; 55.6% female). Structural equation modeling with path analysis was conducted using Mplus 8.8 for data analysis. Results indicated an acceptable model fit for the hypothesized model, with χ2 = 120.845, df = 41, χ2/df = 2.947, CFI = 0.940, TLI = 0.901, RMSEA = 0.078 [90% CI = 0.062 to 0.094], and SRMR = 0.079. The model explained 54.9% and 50.0% of the variance in PA and FVC, respectively. In the first layer, focusing on the individual behavior change process, both volitional self-efficacy and planning were identified as significant mediators in the intention-behavior relationship for PA and FVC (indirect effects = 0.03 to 0.14, all p < .01). In the second layer, targeting the interaction between the two behaviors, the mediating role of compensatory cognition (e.g., PA/FVC can compensate for FVC/PA) in the relationship between intention and behavior was not supported (all p > .05). However, volitional self-efficacy and planning played a significant mediating role in the interaction between PA/FVC intention and FVC/PA behavior (indirect effects = 0.01 to 0.04, all p < .05). Future interventions aiming at promoting MHBC should address compensatory cognition and the carry-over effects between diverse behaviors.

Construction of a Risk Factor Intervention Program for Perimenopausal Patients with Coronary Heart Disease Based on Health Action Process Orientation Theory

Background

To construct a risk factor intervention program for perimenopausal patients with coronary heart disease based on the health action process orientation theory, to provide a reference for perimenopausal women to reduce the controllable risk factors of coronary heart disease.

Methods

By reviewing relevant literature, guidelines, and expert consensus, we performed a retrospective analysis of the factors influencing perimenopausal patients with coronary heart disease to engage in risk factor reduction behaviors in the preliminary stage, conducted qualitative interviews on patients' cognition of and motivation for adherence to cardiac rehabilitation, and initially formulated an intervention program for perimenopausal patients with coronary heart disease regarding their risk factors based on the theoretical model of the process of action orientation to health and formed Expert Correspondence Form.

Results

The positive response rate of experts in the 2 rounds of correspondence was 100%, the basis of expert judgment (Ca) was 0.955, the familiarity (Cs) was 0.964, the authority coefficient (Cr) was 0.960, and the Kendall's W coefficients were 0.294 and 0.343, respectively (P<0.05). The final result was a risk factor intervention program for perimenopausal patients consisting of coronary heart disease based on the health action process orientation theory with 3 level 1, 10 level 2, and 42 level 3 entries.

Conclusion

Based on the health action process orientation theory of perimenopausal patients with coronary heart disease risk factor intervention program scientific construction process, the construction of the content around the perimenopausal patients with coronary heart disease characteristics, the development of targeted interventions.

Health action process approach and spinal cord injury: a scoping review

PURPOSE

Spinal cord injury may result in chronic pain, difficulty walking and breathing, and/or paralysis. People with spinal cord injury (PwSCI) experience increased risk for chronic diseases and psychosocial distress (e.g. type 2 diabetes, substance use disorders) and premature mortality. The Health Action Process Approach (HAPA) is a social cognitive health behavior framework validated to explain modifiable preventative health behaviors (e.g. physical exercise, healthy eating, substance misuse) among people with chronic conditions. The present scoping review investigates what, how, and how much peer-reviewed research literature applies HAPA to preventative health behaviors among PwSCI.

MATERIALS AND METHODS

A search was conducted in seven community health databases including PubMed, CINAHL, PsycINFO, SocIndex, Scopus, Web of Science, Sociological Abstracts, and Library and Information Science Source. Seven peer-reviewed articles were identified. Conventional content analysis was used in the full-text review to identify themes and calculate theme frequency.

RESULTS

All studies were quantitative and applied HAPA to physical exercise. HAPA explained differences in sports participation, leisure time physical activity, and strength training.

CONCLUSIONS

A strong predictor of physical exercise was belief in the capability to overcome psychosocial barriers. More attention is needed on HAPA-identified barriers, and customized HAPA-based interventions to promote physical exercise among PwSCI.

Understanding the mechanisms underlying the socioeconomic disparities in cancer screening among Australian women

BACKGROUND

Little is known about individual, as opposed to area-level, variance in socioeconomic status (SES) and how this impacts screening participation. This study explores potential mechanisms underlying the relationship between SES and cancer screening amongst women eligible for breast, cervical, and bowel cancer screening.

METHODS

Australian women aged 50-74 years (N = 874) took part in an online survey examining participants' health and cancer screening behaviours. Relationships between individual and area-level SES, cancer screening participation, stress, general self-efficacy, and screening literacy were examined using structural equation modelling. Frequency of cancer screening barriers were calculated for each cancer type and compared for SES categories.

RESULTS

The structural equation model including stress and screening literacy as mediators yielded excellent fit, χ2 (26) = 33.322, p = .153, TLI = 0.992. Lower individual level SES was associated with higher stress and lower screening literacy. Higher stress was related to lower screening participation in all three programs, and lower screening literacy was associated with low cervical and breast cancer screening. The only significant relationship between area-level SES and screening participation was with participation in cervical screening. All indirect effects between area level SES and screening were non-significant. The types of barriers reported for each cancer screening type were similar between high and low socioeconomic individuals. In all three screening programs, intending to participate in cancer screening but not getting around to it, and not liking the screening method were commonly reported reasons for non-participation.

CONCLUSIONS

This study is the first to investigate the effects of individual level SES on cancer screening in Australia and one of the few studies to examine underlying mechanisms simultaneously across various screening programs. Reducing stress and improving screening literacy may help to improve cancer screening participation among low SES individuals. Our results also suggest that tailoring interventions to the SES background of women may not enhance their effectiveness. Interventions aiming to reduce the SES screening disparities may achieve more success through addressing underlying mechanisms as opposed to the behavioural barriers themselves.

Determinants of physical activity habit formation: a theory-based qualitative study among young adults

PURPOSE

Engagement in physical activity significantly contributes to reducing the onset and severity of chronic diseases. Nonetheless, establishing habits around this behaviour remains a persistent challenge. This research endeavours to discern the determinants influencing the formation of physical activity habit among young adults in Israel, drawing upon a socio-ecological model.

METHODS

A qualitative approach with phenomenological-hermeneutical method was used. In-depth interviews were carried to cover four levels of the socio-ecological model.

RESULTS

Interviewees were categorized into three subgroups according to their physical activity habit strength: Habitually physically active (n = 8), Variably physically active (n = 11), and physically inactive (n = 6). The content analysis yielded four overarching themes associated with physical activity habit formation. Intrapersonal determinants encompassed personal traits, perceptions and attitudes, perceived benefits, and emotional responses related to physical activity. Interpersonal determinants encompassed social support, modelling support, and peer pressure. Community determinants pertained to social norms, resource availability, and accessibility. Finally, public policy considerations encompassed educational policies as well as workplace policies and cultural influences.

CONCLUSIONS

This study highlights the unique determinants contributing to the formation of physical activity habit. As intrapersonal and interpersonal factors are significant determinants, interventions should focus on these elements in order to promote this behaviour among young adults.

Requirements and Key Features of a Mobile Application for Adolescent Self-Care From a Stakeholders Perspective: A Qualitative Study

Adolescence is characterized by many changes and these changes differentiate adolescents' self-care needs. The use of smartphones and tablets to provide healthcare services has expanded, and the user-centered design could help to create mobile applications based on users' needs. Therefore, the present study aimed to identify the data requirements and key features of mobile application for adolescent self-care from a stakeholder perspective. This study was conducted with a qualitative approach to identify the key features of mobile application for adolescent's self-care as well as educational content axes for five component of self-care using conventional and directed content analysis respectively. From 3 sub-groups 30 participants were selected based on purposive sampling with maximum variety and sampling was performed until data saturation. Data were collected through in-depth semi-structured interviews. Participants' informed consent was obtained before the interview. The interview lasted 20-40 min and MAXQDA software version 10 was used for data analysis. In this study, four criteria of acceptability, reliability, transferability, and validity proposed by Guba and Lincoln were used to evaluate and validate the data. After conducting the interviews, 789 initial codes, 12 sub-categories, and 3 categories (app view, app content architecture, app self-care content) were emerged, which reflects the key features of a mobile application and the necessary educational content. The research findings could provide a guide for future mobile application development considering the viewpoints of health professionals, content, and software experts. Addressing the features and requirements in practice could lead to designing efficient and effective mobile applications.

Assessing motivational interviewing integrity in the Toddler Oral Health Intervention study

OBJECTIVES

The Toddler Oral Health Intervention (TOHI) was launched in 2017 to promote oral health prevention at well-baby clinics, with a focus on parents with children aged 6-48 months. This study aims to evaluate the integrity of motivational interviewing (MI) as one of the core intervention pillars in the TOHI study.

METHODS

The TOHI study was conducted at nine well-baby clinics in the central and southern regions of the Netherlands, with 11 trained oral health coaches (OHCs) delivering a tailored individual counselling programme. Audio recordings of counselling sessions were uploaded by the OHCs into an online portal for feedback and integrity evaluation purposes. A trained independent assessor evaluated MI integrity using the MITI 4.2.1 coding scale. IBM SPSS Statistics was used to analyse the data, with ratings on technical and relational components and behavior counts computed by adding up the scores and categorizing them into six key MI skills. Descriptive statistics, including frequencies, percentages and median scores with interquartile ranges, were calculated.

RESULTS

The median ratings on the technical and relational components were 2.5 (IQR 2.0-3.5) and 3.5 (IQR 3.0-4.0) out of a maximum of 5, with 45% and 58% of recordings showing fair or good MI integrity, respectively. A median of 38% (IQR 25-55%) of complex reflections and a reflection-to-question ratio of 0.7 (IQR 0.4-1.0), with 47% and 24% of recordings showing fair or good MI integrity, respectively. Median counts of MI-adherent and non-adherent statements were 3.0 (IQR 2.0-5.0) and 0.0 (IQR 0.0-1.0), respectively. The duration of recordings and MI integrity varied among oral health coaches.

CONCLUSION

Overall, this study revealed that, while intensive training was provided, not all OHCs in the TOHI study met fair thresholds for MI integrity. These findings emphasize the necessity of ongoing training, reflection and support to achieve and maintain a fair or good level of MI integrity in clinical practice.

An analysis of physical activity coping plans: mapping barriers and coping strategies based on user ratings

Introduction

Personalising recommendations for physical activity coping plans can help bridging the physical activity intention-behaviour gap. Data-driven 'black-box' approaches result in recommendations that prove difficult to explain, and may have undesired consequences. This study aimed to explicitly link barriers and coping strategies using end-user input.

Method

152 participants (85 female) took part in an online task. Participants were asked to judge the relevance of coping strategies for barriers to physical activity, and under which circumstances coping strategies were relevant for a given barrier. Data was aggregated and heat maps were produced. Necessary conditions for the relevance of each combination were coded and their frequencies were reported.

Results

Relevance of 1570 combinations of barriers and coping strategies were assessed, with 2 combinations rated 'always relevant' by all participants, and 37 combinations rated as 'always relevant' by no participants. Barriers differ strongly in how many coping strategies are relevant for them, and coping strategies differ strongly in how many barriers they are relevant for. Resulting aggregates concerning the average rating as 'never relevant', 'always relevant' and 'relevant under certain conditions' are shared for each barrier coping strategy combination, as are the conditions associated with different barriers and coping strategies.

Discussion

This study introduces a novel method to create rules for recommendations using input from stakeholders. The datasets created throughout this research are available for re-use in future research, as well as for clinical practice and (digital) intervention development. This data can be used as a base for explainable personalised recommendations for physical activity coping plans.

Effect of the oral examinations in the national health screening program on preventive oral health care and treatments: a 19-year follow-up study

OBJECTIVES

The national health screening (NHS) program in Korea serves as primary prevention by detecting oral diseases early for easier management. Dental scaling helps prevent oral disease and treat early periodontal disease. This study evaluated the effects of national oral examinations (NOE) in NHS on preventive oral hygiene care and dental treatments for a 19-year follow-up study.

METHODS

We conducted a longitudinal observation of Korean adults ≥ 19 years between 2002 and 2003 from the Korean National Health Insurance Service (n = 4,669,107; men = 2,518,704; women = 2,150,403). The independent variable involved tracking the number of people who underwent the NOE recruited between 2002 and 2003 from 2002 to 2013. The dependent variables pertained to the number of dental scaling and the presence or absence of periodontal and dental caries treatments from 2014 to 2020.

RESULTS

Individuals receiving 6 to 7 dental scaling during the follow-up exhibited an adjusted odds ratio (AOR) of 2.91 in the NOE-middle (3-4 times) and 3.30 in the NOE-high (5-6 times) (p < 0.001). The adjusted rate ratios were 1.69 in the NOE-middle and 1.77 in the NOE-high (p < 0.001). The AOR for periodontal treatment was 1.23 in the NOE-middle and NOE-high (p < 0.001).

CONCLUSION

Frequent NOEs lead to undergoing dental scaling and dental treatment, highlighting the importance of encouraging NOE attendance to improve population oral health. Expanding the scope of dental coverage for preventive intervention combined with NOE could help encourage greater participation and promote preventive oral healthcare.

Conspiracy Thinking, Conspiracy Beliefs, Denialism, Motivation, and COVID-19 Vaccination Intentions in Costa Rica

An observational cross-sectional study was conducted among inhabitants of Costa Rica to examine motivational determinants of COVID-19 vaccination intentions (CVI), as well as to better understand the role of a set of conspiracy-related variables within the framework of the Theory of Planned Behavior (TPB). Data were collected online, and a subsample of those not yet vaccinated (N = 406, age = 44.35, S. D. = 13.23, 74.9% women) was selected. They reported TPB-variables, risk perception, conspiracy-related variables, and sociodemographic information. Structural equation was used to model the assumption that conspiracy beliefs presented direct and indirect effects on intentions. Conspiracy thinking, denialism, and sociodemographic information were also specified as determinants of conspiracy beliefs and vaccination intentions. Most determinants presented direct effects on intentions. Only perceived behavioral control, denialism, and conspiracy thinking presented no direct effects on intentions. Conspiracy beliefs had indirect effects on intentions via most TPB-variables and risk perception. Conspiracy beliefs were predicted only by conspiracy thinking, gender (male), and education. Sociodemographic variables had no effects on intentions. Evidence suggested that a mechanism integrating conspiracy-related variables, risk perception, and TPB-variables predicted CVI. Education and gender played a role in the onset of conspiracy beliefs and thereafter vaccination intentions.

Long-Term Effects of Individual-Focused and Team-Based Training on Health Professionals' Intention to Have Serious Illness Conversations: A Cluster Randomised Trial

We aimed to measure the sustainability of health professionals' intention to have serious illness conversations with patients using the Serious Illness Conversation Guide (SICG) after individual-focused training versus team-based training. In a cluster randomised trial, we trained healthcare professionals in 40 primary care clinics and measured their intention to hold serious illness conversations immediately (T1), after 1 year (T2) and after 2 years (T3). Primary care clinics (n = 40) were randomly assigned to individual-focused training (comparator) or team-based training (intervention). Average age of the 373 participants was 35-44 years, 79% were women. On a scale of 1 to 7, at T1, the mean intention was 5.33 (SD 0.20) in the individual-focused group and 5.36 (SD 0.18) in the team-based group; at T2, these scores were 4.94 (SD 0.23) and 4.87 (SD 0.21) and at T3, 5.14 (SD 0.24) and 4.59 (SD 0.21), respectively. At T3, the difference in mean intention between study groups had a significant p-value of 0.01. Intention to have serious illness conversations was lower at T2 and T3 after team-based training than after individual-focused training, with a significant difference at 2 years in favour of individual-focused training. Health professionals reported not enough time during consultations for serious illness conversations as a major barrier.

Registration number

ClinicalTrials.gov (ID NCT03577002) for the parent clinical trial.

Psychometric Properties of the Cardiac Rehabilitation Self-Efficacy Questionnaire in Heart Failure Patients: A Cross Sectional Study Using Health Action Process Approach Perspective

Background and Aim

The present study aimed to develop and psychometrically evaluate the exercise self-efficacy tool within the Health Action Process Approach (HAPA) framework among heart failure patients undergoing cardiac rehabilitation.

Methods

This study assessed 205 patients who had suffered heart attacks at the Shahid Chamran Cardiac Rehabilitation Center of Isfahan. Exploratory factor analysis (EFA) was employed to evaluate the construct. Internal reliability was determined using Cronbach's alpha. Additionally, external reliability was measured through a test-retest approach.

Results

EFA identified four factors within the self-efficacy questions (task self-efficacy 1, task self-efficacy 2, coping self-efficacy, and recovery self-efficacy), which accounted for 70.1% of the total variance explained. The Cronbach's alpha coefficients were as follows: 0.836 for the first factor, 0.896 for the second factor, 0.921 for the third factor, 0.914 for the fourth factor, and 0.9 for the overall instrument. The intra-class correlation coefficient was 0.901 for the first factor, 0.887 for the second factor, 0.826 for the third factor, and 0.885 for the fourth factor.

Conclusion

The cardiac rehabilitation self-efficacy questionnaire exhibited high validity, reliability, and desirable item commonalities. Therefore, it can be effectively employed in pertinent HAPA-based studies involving heart failure patients.

Multiple recommended health behaviors among medical students in Western Canada: a descriptive study of self-reported knowledge, adherence, barriers, and time use

Background

General medical practitioners are responsible for promoting and prescribing lifestyle modification and serve as role models for healthy behaviors. We aimed to assess self-reported knowledge, adherence, barriers and time spent on all recommended health behaviors among medical students.

Methods

A cross-sectional online survey of eight behavioral domains among undergraduate medical students in The University of British Columbia, Canada, was analysed using descriptive statistics and visual display.

Results

Between March and April 2023, 137 medical students participated in the survey (74% female). Over 80% had knowledge of five health behavior recommendations, but lacked knowledge of specific dietary recommendations in particular. Over 60% reported meeting guideline-recommended levels for tobacco, weekly alcohol, daily alcohol (females only), and physical activity (males only). Large gaps existed between knowledge and adherence for physical activity, sleep, sedentariness, screen time, and dietary recommendations. Sex differences in knowledge and adherence to recommended health behaviors were identified. Time spent on wellness focused on sleep (47-49 h/week), diet (9.6 h/week), exercise (5.8 h/week), and hobbies (6.1 h/week). Forgetting recommendations (69% of females, 71% of males), and lack of time (72% of females, 52% of males) were principal barriers to knowledge and adherence.

Conclusion

Most medical students in Western Canada reported not meeting multiple recommended health behaviors. Time was the largest barrier to adherence and free time was spent on sleep. Medical education may require protected time and dedicated content for health behaviors to ensure future physicians can be role models of health promotion for patients.

A study on acute expectation effects on affective state and intention after a brief full-body workout in a student sample

Brief exercise bouts can have positive effects on the affective state, which in turn could affect the intention for future exercise. Such benefits may be enhanced by manipulating expectations. The aim of this study was to examine whether the affective state after physical activity or the intention for future exercise can be influenced by manipulating expectations. Furthermore, the relationship between affect and intention was investigated. In an online experiment, 121 persons completed either a 10-minute workout (PA), a workout after manipulation of expectations (PA + EM), or a control intervention (CG) after randomized group allocation. Data on affective state, expectations, and intention were collected before and after the intervention using questionnaires. After intervention, PA groups showed significantly more positive values than CG in several affective parameters, in other affective parameters, only PA + EM differed from CG. Affect was positively associated with intention alongside outcome expectations. No difference was found in intention. Although no significant effects of expectation manipulation on affective state or intention were found, latent effects cannot be ruled out. Further exploration of the importance of word choice in describing physical activity in the context of interventions to increase physical activity is necessary. Here, affect should be considered.

The Association Between the Perception of Exercise Benefits and Barriers and Exercise Self-Efficacy During the Induction Phase of Dialysis in Patients with End-Stage Kidney Disease: A Cross-Sectional Study

Background/Objectives: The physical function of patients with chronic kidney disease gradually declines as kidney function deteriorates, and this decline becomes more pronounced after the initiation of dialysis. Encouraging the development of exercise habits from the initiation phase of dialysis is crucial. Increased exercise self-efficacy is essential for establishing these habits. However, the related factors at this stage are unclear. This study hypothesized that perceptions of exercise benefits and barriers are related to exercise self-efficacy and aimed to investigate this association. Methods: This single-center, cross-sectional study included 72 patients and assessed the stages of exercise behavior change, perceptions of exercise benefits and barriers, and exercise self-efficacy. Multiple regression analysis was used to examine the association between exercise self-efficacy and perceptions of the benefits and barriers of exercise. Results: Perceptions of exercise benefits were still significantly associated with self-efficacy for exercise after adjustment for age, gender, history of cardiovascular disease, diabetic kidney disease, living alone, employment, and physical function (β = 0.474, p < 0.001). Similarly, perceptions of exercise barriers were also significantly associated with self-efficacy for exercise (β = -0.410, p = 0.001). A subgroup analysis that only examined participants without exercise habits revealed a similar association. Conclusions: Perceptions of exercise benefits and barriers may be associated with exercise self-efficacy in patients with end-stage kidney disease during the initiation phase of dialysis. As patients are temporarily hospitalized during this phase, it provides an opportunity for intervention. Exercise education and supportive environments during hospitalization may enhance perceptions of exercise benefits, reduce perceptions of exercise barriers, and improve exercise self-efficacy.

A Behavioral Change-Based Mobile Intervention for Promoting Regular Physical Activity in Medical Rehabilitation Maintenance of Patients With Coronary Artery Disease: Controlled Trial

BACKGROUND

Cardiac rehabilitation is known to reduce coronary artery disease (CAD) severity and symptoms, but adoption of a healthy postrehabilitation lifestyle remains challenging. Innovative eHealth solutions could help, but behavioral change-based eHealth maintenance programs for patients with CAD are scarce. RehaPlus+ aims to improve postrehabilitation outcomes with a personalized eHealth intervention built on behavioral change concepts emphasizing healthy lifestyle changes, especially regular physical activity (PA).

OBJECTIVE

This study aims to evaluate the effectiveness of the personalized eHealth program RehaPlus+ for promoting regular PA against usual care.

METHODS

A total of 169 patients with CAD who had undergone stent implantation or bypass surgery were recruited after completing center-based phase II rehabilitation. They were then divided, without blinding, into 2 groups using a quasi-experimental approach: a case manager-assisted 24-week eHealth program (RehaPlus+; n=84) and a conventional physician-assisted outpatient program (usual care; n=85). The study was designed as a noninferiority trial. RehaPlus+ participants received motivational messages twice weekly for 6 months, and the usual care group engaged in a 6-month outpatient program (twenty-four 90-minute strength and endurance training sessions). The primary outcomes, evaluated using the self-assessed Bewegungs- und Sportaktivität questionnaire, were regular PA (≥150 min/wk) and weekly activities of daily living (ADLs) 6 months after rehabilitation. Secondary outcomes involved PA during work and floors climbed weekly (measured by Bewegungs- und Sportaktivität questionnaire), psychological well-being (assessed by the 5-item World Health Organization Well-Being Index), cardiac self-efficacy, health-related quality of life (measured by the 36-Item Short Form Survey), and work ability (using the Work Ability Index).

RESULTS

Data of 105 patients (RehaPlus+: n=44, 41.9%; usual care: n=61, 58.1%; male patients: n=80, 76.2%; female patients: n=25, 23.8%; mean age 56.0, SD 7.3 years) were available at the 6-month follow-up. At 6 months after discharge from phase II cardiac rehabilitation, the RehaPlus+ group exhibited 182 (SD 208) minutes per week of PA and the usual care group exhibited 119 (SD 175) minutes per week of PA (P=.15), with no interaction effect (P=.12). The RehaPlus+ group showed an ADL level of 443 (SD 538) minutes per week compared to the usual care group with 308 (SD 412) minutes per week at the 6-month follow-up, with no interaction effect (P=.84). The differences observed in PA and ADL levels between the RehaPlus+ and usual care groups were within the predefined 1-sided noninferiority margin, indicating that the RehaPlus+ intervention is not inferior to usual care based on these outcomes. There were no differences between the groups for all secondary outcomes (P>.05).

CONCLUSIONS

RehaPlus+ is not inferior to the usual care program, as both groups improved PA and ADLs to a similar extent. These findings emphasize the potential of eHealth interventions to assist in maintaining healthy lifestyles after rehabilitation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06162793; https://clinicaltrials.gov/study/NCT06162793.

Oral-hygiene-related self-efficacy in periodontal therapy: A 4-year longitudinal study

AIM

Oral hygiene-related self-efficacy (OHSE) describes one's confidence to successfully execute oral hygiene behaviour. The aim of this study was to investigate the long-term course of OHSE in patients during initial periodontal therapy (IPT) and supportive periodontal therapy (SPT) and its association with clinical parameters.

MATERIALS AND METHODS

Patients diagnosed with periodontitis, undergoing either IPT or SPT, were evaluated at two timepoints. Clinical examination included pocket probing depths (PPDs), clinical attachment loss (CAL), bleeding on probing (BOP), plaque index (PI) and gingival index (GI). Patients' OHSE was assessed with a questionnaire. Statistical analyses included t-tests and linear regression models.

RESULTS

Ninety-eight patients from an initial group of 201 patients were evaluated after 4 years. The overall OHSE score increased significantly in the IPT group (mean 11.65 ± 15.6, p = .001). The increase in the OHSE category 'interdental cleaning' was significantly correlated with a decrease in the number of pockets requiring treatment (Spearman correlation rs = -.2349, p = .022) and periodontal inflamed surface area (PISA) (rs = -.2099, p = .042).

CONCLUSIONS

Patients under IPT showed a significant increase of OHSE compared to those under SPT. Improved OHSE, particularly in interdental cleaning, appears to be associated with sustained success of periodontal therapy.

Theory-driven assessment of intentions and behaviours related to mobility of older inpatients: a survey of patients and healthcare professionals

BACKGROUND

Low mobility of patients during hospitalisation is associated with adverse outcomes. To successfully change behaviours related to mobility of older hospitalised patients, we need to better understand the mechanisms underlying patient and healthcare professional behaviours. In this study, we thus assessed patient- and healthcare professional-reported intentions and behaviours related to mobility of older patients hospitalised on an acute medical ward, based on a theoretical framework - the Health Action Process Approach (HAPA) model - and on additional barriers and facilitators to mobility.

METHODS

We conducted a cross-sectional survey in April 2022 among patients aged ≥60 years recently hospitalised on an an acute medical ward of one of three hospitals of different language/cultural regions of Switzerland, and healthcare professionals (physicians, nurses/nursing assistants, physiotherapists) working on those wards. The survey assessed the HAPA model and additional barriers and facilitators to patient mobility at hospital, as previously identified in the literature. The target behaviour studied was "to move as much as possible during hospitalisation" for patients and "to ensure my patients move as much as possible during hospitalisation" for healthcare professionals. We conducted hierarchical linear regressions to determine factors associated with the self-reported intention to perform the behaviour and with the self-reported behaviour itself.

RESULTS

A total of 142 healthcare professionals (61 physicians, 59 nurses, 22 physiotherapists) and 200 patients (mean age 74 years) completed the survey. Patients with higher intention to move as much as possible during hospitalisation scored significantly higher on factual knowledge, outcome expectancies and risk perception. Healthcare professionals with higher intention to ensure that their patients move as much as possible during hospitalisation scored higher on action knowledge, outcome expectancies and risk perception. The more the patients reported that they moved as much as possible during hospitalisation, the higher their action knowledge and action control. The more healthcare professionals reported that they ensure that patients move as much as possible during hospitalisation, the higher they scored on factual knowledge, role perception, planning and action control.

CONCLUSIONS

factual and action knowledge, self-efficacy, outcome expectancies, risk perception, planning and action control were identified as important drivers of patient- and healthcare professional-reported intentions and behaviours related to inpatient mobility. These parameters can be addressed through behaviour-change interventions and should be considered in future interventions to successfully implement practice changes, with the goal of improving mobility of older patients during hospitalisation, and thus the outcomes of this particularly vulnerable population.

Increasing physical activity among adults affected by COVID-19 social distancing restrictions: A feasibility trial of an online intervention

In response to COVID-19 social distancing restrictions, digitally delivered health interventions present as a potential solution for maintaining or improving individuals' physical activity. This study explored the feasibility of a web-based intervention, informed by the multi-process action control (M-PAC) framework to promote PA among individuals affected by social distancing. Fifty adults self-reporting as insufficiently active were randomized to a 6-week web-intervention (n = 27) or wait-list control (n = 23). Primary feasibility outcomes included recruitment and retention rates and usability and satisfaction scores; secondary outcomes of MVPA and M-PAC constructs and tertiary outcomes of mental health and wellbeing were also assessed. Overall, feasibility of the intervention was high, with a 96% recruitment rate, 84% retention rate, high satisfaction and usability scores, and comparable website usage to similar eHealth interventions. Intervention participants trended towards improved MVPA and M-PAC constructs and outcomes of mental health and wellbeing. Findings suggest study extension to a full-scale RCT.

Study protocol: process and outcome evaluation of the Walk with Ease program for fall prevention

BACKGROUND

Falls are the leading cause of injury related morbidity and mortality in older adults. Primary and secondary prevention strategies that address modifiable risk factors are critically important to reduce the number of falls and fall related injuries. A number of evidence-based fall prevention programs are available, but few offer potential for broad dissemination and public health impact due to implementation barriers, such as a need for trained program leaders and clinicians.

METHODS

The study will use a randomized controlled trial design to evaluate incorporating physical therapy exercises (primary prevention strategy) within an existing intervention called Walk with Ease. While Walk with Ease has an established evidence-base related to the management of arthritis pain and symptoms, the present study will determine the potential to also reduce falls and fall risk in community-dwelling older adults. The integrated process and outcome evaluation will determine the relative effectiveness of individually-prescribed exercises (compared to standardized exercises) as well as the potential of 'habit training' resources (relative to generic behavior prompts) to improve compliance with exercises in this population.

DISCUSSION

The study, conducted through a local clinical-community partnership will advance both the science and practice of community-based fall prevention programming, while also informing implementation strategies needed to promote broader dissemination.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05693025, Registered January 20, 2023, Updated March 1, 2023.

Co-designing planning interventions to facilitate participation in mail-out bowel cancer screening

BACKGROUND

Population mail-out bowel cancer screening programs save lives through prevention and early detection; however, their effectiveness is constrained by low participation rates. Many non-participants are "intenders"; that is, they intend to screen but fail to do so, often forgetting or procrastinating. This study aimed to co-design interventions to increase screening participation among intenders in the Australian National Bowel Cancer Screening Program.

METHODS

Three semi-structured interviews, and one online cross-sectional survey, were conducted between August 2021 and December 2022. Interviews with people who had completed and returned their latest screening kit ("completers") were first conducted to identify the planning strategies they had used. Using survey data, logistic regressions were conducted to analyse strategies predictive of participants having returned their latest bowel cancer screening kit. Then, intenders were interviewed to explore their opinions of these strategies and worked with researchers to adapt these strategies into prototype interventions to facilitate screening participation. All interviews were analysed using the framework approach of codebook thematic analysis.

RESULTS

Interview participants who returned their kit shared their effective planning strategies, such as putting the kit in a visible place or by the toilet, planning a time at home to complete the kit, and using reminders. Survey participants who reported using such strategies were more likely to have completed their screening kit compared to those who did not. Prototype interventions developed and endorsed by intenders included providing a prompt to place the kit or a sticker near the toilet as a reminder, a deadline for kit return, the option to sign up for reminders, and a bag to store the sample in the fridge.

CONCLUSIONS

These novel, consumer-led interventions that are built upon the needs and experience of screening invitees provide potential solutions to improve participation in population bowel cancer screening.

A Longitudinal Theory-Based Investigation of How Environmental Aesthetics Predicts Home-Based Exercise

INTRODUCTION

Environmental aesthetics is a recognized macro environmental correlate of physical activity participation. Extrapolating this effect, we hypothesize this variable to also function as a determinant of exercise participation in the microenvironment , such as the home. Specifically, we predict that the environmental aesthetics of the location of cardio and resistance training equipment will predict determinants of exercise participation within the integrated behavior change model.

METHODS

Adult owners of exercise equipment ( N = 231) completed measures on the environmental aesthetics of their cardio and resistance training equipment, exercise time, and constructs from the integrated behavior change model across three consecutive monthly surveys. Study hypotheses were tested using multilevel structural equation modeling with participants (level 2) nested within time (level 1).

RESULTS

The model revealed predictive effects of intention, habit, and planning on exercise participation over time. The findings indicated a total effect of autonomous motivation on intention and habit. In addition, environmental aesthetics of cardio and strength training equipment predicted autonomous motivation, along with habit and intention when accounting for indirect effects. Finally, planning moderated the intention-behavior relationship, indicating that participants who scored higher on planning were more likely to translate their intentions to behavior.

CONCLUSIONS

These findings provide informative notes for designing effective home-based exercise programs, which have increased in popularity over the past recent years. Specifically, experimental studies that provide exercise equipment should ensure that the location of the equipment is appealing to the participant to increase the likelihood equipment use and exercise engagement.

A cluster randomized controlled trial of a brief positive healthy eating intervention

Excessive sugar intake poses a significant risk factor for non-communicable diseases. A positive healthy eating (PHE) intervention was developed to promote low-sugar dietary practices in families. The PHE intervention capitalized on positive psychological constructs to overcome barriers to health behavior change by helping families associate feelings of joy, gratitude, and savoring with healthy eating. In a cluster randomized controlled trial, 1983 participants from 1467 families were recruited in Hong Kong. PHE included a core and booster session. Data were collected at pre-intervention, post-intervention, and at 1-month and 3-month follow-up. Compared to the control, PHE showed greater increase in intention to change at post-intervention, engagement in low-sugar dietary practices individually and with family members at 3-month follow-up, and greater reduction in sugar-sweetened beverage intake at 1-month and 3-month follow-up. Intentions to change mediated PHE's effects on low-sugar dietary practices. Focus group interviews revealed the behavior-change process and family quality of life.

Understanding aberrant driving intentions based on the Theory of Planned Behavior: Literature review and Meta-Analysis

INTRODUCTION

Despite deployed efforts to establish strict road safety standards, human factors is still the leading cause of road crashes. To identify determinants of driver's behavior, TPB (Theory of Planned Behavior) is widely used as a prominent theory of behavior change. However, the existence of different aberrant driving behaviors (decision errors, recognition errors, violations, and physical condition related errors) and several studies using TPB to understand driving behavior, makes it important to conduct a literature review and a meta-analysis of existing studies to use their results in effective driving behavior change interventions.

METHOD

The selection process provided 125 relevant studies that were published between 1991 and 2022, and that used TPB for the understanding of aberrant driving behavior. Five fundamental research questions were defined to identify information to be discovered from the literature review and from the meta-analysis.

RESULTS

In addition to the standard TPB constructs (attitudes, subjective norms, and perceived behavioral control), past behavior, moral norms, and descriptive norms were used in studies for a more comprehensive understanding of aberrant driving intention. This analysis demonstrated a significant correlation between aberrant driving intentions and past behavior. Also, moral norms construct was correlated with violations and recognition errors, whereas descriptive norms construct was correlated just with recognition errors.

CONCLUSIONS

The results of this study highlight the strength of TPB in the prediction of aberrant driving intention and its potential effectiveness to guide interventions aimed at changing aberrant driving behaviors. The study contributes to the comprehension of the relevant psychological factors influencing the engagement of drivers in each category of aberrant driving behaviors.

PRACTICAL APPLICATIONS

Researchers can use the results of this study to select the relevant psychological factors adapted to their interventions of driving behavior change. The results of the meta-analysis can also be used in the prediction of driver's intentions.