Positive experience, self-efficacy, and action control predict physical activity changes: a moderated mediation analysis

The Big-Five personality factors, cognitive ability, health, and social-demographic indicators as independent predictors of self-efficacy: A longitudinal study

This study set out to examine to what extent a set of psychological, health and socio-demographic factors are associated with self-efficacy (SE) in a large sample of over 12,000 participants over a two-year period. We were interested in the correlates of self-efficacy (criterion variable) with gender, age, education and occupation, the Big-Five personality factors and cognitive ability, as well as mental and physical health (predictor variables). Regression analyses showed that four of the Big-Five personality factors (extraversion, neuroticism, conscientiousness, and openness), cognitive ability, mental and physical health, gender, education and occupation were all significant and independent predictors of self-efficacy, accounting for 23% of the variance of the outcome variable. Personality variables, particularly Neuroticism and Conscientiousness, were the most powerful predictors of SE two years later. The implications for encouraging SE in individuals are discussed.

Testing Behavior Change Techniques to Increase Physical Activity in Middle-Aged and Older Adults: Protocol for a Randomized Personalized Trial Series

BACKGROUND

Being physically active is critical to successful aging, but most middle-aged and older adults do not move enough. Research has shown that even small increases in activity can have a significant impact on risk reduction and improve quality of life. Some behavior change techniques (BCTs) can increase activity, but prior studies on their effectiveness have primarily tested them in between-subjects trials and in aggregate. These design approaches, while robust, fail to identify those BCTs most influential for a given individual. In contrast, a personalized, or N-of-1, trial design can assess a person's response to each specific intervention.

OBJECTIVE

This study is designed to test the feasibility, acceptability, and preliminary effectiveness of a remotely delivered personalized behavioral intervention to increase low-intensity physical activity (ie, walking) in adults aged 45 to 75 years.

METHODS

The intervention will be administered over 10 weeks, starting with a 2-week baseline period followed by 4 BCTs (goal-setting, self-monitoring, feedback, and action planning) delivered one at a time, each for 2 weeks. In total, 60 participants will be randomized post baseline to 1 of 24 intervention sequences. Physical activity will be continuously measured by a wearable activity tracker, and intervention components and outcome measures will be delivered and collected by email, SMS text messages, and surveys. The effect of the overall intervention on step counts relative to baseline will be examined using generalized linear mixed models with an autoregressive model that accounts for possible autocorrelation and linear trends for daily steps across time. Participant satisfaction with the study components and attitudes and opinions toward personalized trials will be measured at the intervention's conclusion.

RESULTS

Pooled change in daily step count will be reported between baseline and individual BCTs and baseline versus overall intervention. Self-efficacy scores will be compared between baseline and individual BCTs and between baseline and the overall intervention. Mean and SD will be reported for survey measures (participant satisfaction with study components and attitudes and opinions toward personalized trials).

CONCLUSIONS

Assessing the feasibility and acceptability of delivering a personalized, remote physical activity intervention for middle-aged and older adults will inform what steps will be needed to scale up to a fully powered and within-subjects experimental design remotely. Examining the effect of each BCT in isolation will allow for their unique impact to be assessed and support design of future behavioral interventions. In using a personalized trial design, the heterogeneity of individual responses for each BCT can be quantified and inform later National Institutes of Health stages of intervention development trials.

TRIAL REGISTRATION

clinicaltrials.gov NCT04967313; https://clinicaltrials.gov/ct2/show/NCT04967313.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/43418.

Examining Adolescent Tennis Participation in Contemporary China Using an Ecological Framework

Physical activity and sport participation behaviors in children and adolescents are consistently shaped by surrounding ecological systems. Accumulating evidence highlights individual, family, peer, school and teacher, and macroenvironment elements such as policies that affect unstructured physical activity choices in youth populations. However, the reason for participation has not been fully interpreted from the perspective of the youth themselves, especially those from an Asian cultural background. In our study, we aimed to better understand the self-identified reasons for adolescents’ participation in non-organized or spontaneous tennis practice in contemporary China. Twenty-six adolescents and informants were recruited in mainland China and participated in semi-structured interviews to provide thick descriptions of their continued tennis participation behaviors. Data were coded and analyzed via NVivo 12. Four themes emerged: (a) Individual characteristics and self-interpretations of tennis culture; (b) microsystems mediating adolescents’ tennis participation; (c) barriers and obstacles impacting tennis participation; and (d) policies and macroenvironments. Adolescent tennis participation is a result of the integration effect of the sociocultural and ecological factors dominated by multifaceted ecological systems. As a particular vision of their physical activity experiences, adolescents’ interpretation of tennis and their broader worldview has been continuously reshaped by concurrent sport and educational policies.

How Smart Technology Affects the Well-Being and Supportive Learning Performance of Logistics Employees?

The rapid improvement of technologies such as artificial intelligence in recent years has resulted in the development of smart technologies (ST) that can influence learning performance in different fields. The purpose of study is to explore the link between smart technology and learning performance. Using the S-O-R model as a framework, the researchers argue that smart technology (Stimuli) will increase corporate trust, self-efficacy, and well-being (Organism), resulting in improved learning performance (Response). The current model regards corporate trust and self-efficacy as relationship factors and investigates their direct influence on employee well-being and learning performance and the mediating role played by these variables. Additionally, the function of employee well-being in moderating the relationship between corporate trust, self-efficacy, and employee learning performance is also explored. The respondents (n = 516) in the present study are made up of employees from 10 logistics companies located in China. The data analysis is conducted using the AMOS software. The results show that that smart technologies can affect learning performance through corporate trust, self-efficacy, and employee well-being. The implementation of smart technology initiatives by corporations may provide positive workplace outcomes for employees (increased well-being), corporations (more engagement in workplace learning performance), and the relationship between employees and the companies that employ them (corporate trust and self-efficacy).

Explaining stress coping behaviors in patients with multiple sclerosis based on the PRECEDE model: a qualitative directed content analysis

BACKGROUND

Stress can be regarded as one of the consequences of Multiple Sclerosis (MS) and a factor in exacerbating or recurring the symptoms resulting from the disease. This study aimed to explain the stress coping behaviors in patients with MS based on the PRECEDE model.

METHODS

This study is a qualitative directed content analysis research based on the PRECEDE model. Data were obtained through in-depth semi-structured interviews with 26 patients with MS, who were selected using a purposive sampling and maximum diversity in terms of gender, age, education, marital status, and employment. Data collection continued until the saturation occurred. Simultaneously, collected data were analyzed using a qualitative directed content analysis method.

RESULTS

Data analysis led to the identification of 11 sub-categories. Of these, 10 sub-categories were assigned to three categories of predisposing factors (awareness, attitude, self-efficacy, and perceived severity), enabling factors (existence of resources, access to resources, skills of using resources, and educational preferences), and reinforcing factors (social support, important others and behavioral consequences). The social comparison category was a new category identified from the analysis of interviews.

CONCLUSIONS

Based on the results, individual, environmental and social factors play a role in the stress of these patients. Designing programs that lead to their empowerment and improvements in the environmental and social conditions can be effective in controlling stress in these patients. Based on the results, planners can adopt the most appropriate strategies to change these determinants, help reduce stress, and promote the psychological standard of living in these patients.

Chinese University Students' Perceptions of Facilitation Strategies, Learning Motivation, and Satisfaction in Cloud-Based Virtual Classrooms

This study investigated university students' perceptions of facilitation strategies, learning motivation, and satisfaction, and the relationships between them in a cloud-based virtual classroom in mainland China. The results of an online questionnaire survey from a sample of 7,210 university students showed that students perceived high levels of facilitation strategies, learning motivation, and satisfaction. Students' demographic characteristics, such as discipline, university type, gender, and grade, did not significantly affect their perceptions of facilitation strategies and learning outcomes. Instructor-student interaction and instructor innovation were positively related to student learning motivation and satisfaction whereas the relationships between student interaction and learning motivation and satisfaction were weak and had no practical meaning. The findings of this study have implications for creating more effective synchronous online learning environments and achieving desirable learning outcomes.

Comparing the Effectiveness of a Wearable Activity Tracker in Addition to Counseling and Counseling Only to Reinforce Leisure-Time Physical Activity among Breast Cancer Patients: A Randomized Controlled Trial

This randomized controlled trial aimed to compare the effectiveness of a wearable activity tracker (WAT) in addition to counseling (WAT+counseling) and counseling only for reinforcing leisure-time physical activity (LTPA) among breast cancer patients during radiotherapy (RT). A total of 152 breast cancer patients who were planning to undergo radiation therapy (RT) after surgery participated in the study. The WAT+counseling group (n = 76) underwent physical activity (PA) self-monitoring using a WAT and participated in counseling. The counseling-only group (n = 76) received telephone counseling once a week during RT and did not receive WAT. The WAT+counseling group had increased relative change in self-reported LTPA (102.8) compared with the counseling-only group (57.8) immediately after RT compared to baseline. Although the relative changes of self-reported LTPA of the WAT+counseling group were higher at three and six months after the end of RT compared to in the counseling-only group, the results were not significant. The mean average daily step count of the WAT+counseling group was 9351.7, which increased to 11,592.2 during RT and 12,240.1 after RT. In the subgroup analysis, patients who did not perform regular PA before cancer diagnosis had significantly increased step counts. This study shows the feasibility of WAT with counseling to reinforce PA among breast cancer patients.

Research on the Influence of Media Internalized Pressure on College Students' Sports Participation-Chained Intermediary Analysis of Social Physique Anxiety and Weight Control Self-Efficacy

Purpose: Discuss the relationship among college students’ media internalized pressure, social physique anxiety, weight control self-efficacy, and sports participation in providing a reference for promoting college students to develop healthy and confident living habits.

Methods: Take Southwest University in China as the object, select the subjects by stratified random sampling, and process the data with SPSS19.0 and AMOS21.0 statistical software.

Results: (1) Media internalized pressure is positively correlated with social physique anxiety, weight control self-efficacy, and sports participation; social physique anxiety is significantly positively correlated with weight control self-efficacy and sports participation, and weight control self-efficacy is significantly positively correlated with sports participation; (2) media internalized pressure has a direct effect on sports participation (ES = 0.456), and social physique anxiety (ES = 0.136) and weight control self-efficacy (ES = 0.102) play significant mediating roles in the relationship between media internalized pressure and sports participation, respectively; the chained mediating force of social physique anxiety and weight control self-efficacy also reaches a significant level (ES = 0.027).

Conclusion: Media internalized pressure can influence college students’ sports participation through the direct path as well as indirect paths such as social physique anxiety, the intermediary effect of weight control self-efficacy, and chained intermediary effect of social physique anxiety–weight control self-efficacy, and social physique anxiety is another key factor affecting college students’ sports participation except media internalized pressure.

Young Adults' Short-Term Trajectories of Moderate Physical Activity: Relations With Self-Evaluation Processes

Young adults face numerous barriers that can undermine their engagement in healthy behaviors. For example, young adults on average experience disproportionally large declines in physical activity (PA) participation compared to other demographic groups. Self-evaluation processes may help explain these declines. This study investigated young adults’ weekly trajectories of moderate physical activity, exploring self-evaluation processes, including self-efficacy and shame as time-varying covariates. A total of 71 young adults (Mage = 21.25, SD = 1.18; 55% male) reported moderate physical activity, exercise self-efficacy, and anticipated shame toward exercise once a week for 5 weeks. Latent growth curve models showed that a linear slope fit these data better than alternative models. Parameters of the linear model revealed that these young adults reported engaging in 40 min of moderate PA approximately 3 days per week. However, there were physical activity differences in initial levels and rates of change. Exercise self-efficacy consistently predicted physical activity in a positive direction and with a small-to-medium magnitude. Anticipated shame was an inconsistent predictor of physical activity, showing a negative direction and small magnitude at time one and on average across the 5 weeks. These findings highlight considerable variability in young adults’ short-term trajectories of physical activity and underscore both positive and negative processes of exercise related self-evaluations. Future physical activity interventions targeting young adults should incorporate strategies that enhance self-efficacy (e.g., mastery experiences) and reduce feelings of shame (e.g., attribution training).

Effectiveness of Mobile Applications Running on Smartphones to Promote Physical Activity: A Systematic Review with Meta-Analysis

Mobile applications reach a high number of individuals at low costs. This systematic review investigated the effectiveness of mobile application-based interventions to increase physical activity (PA) and self-efficacy and to decrease sedentarism. Randomized controlled trials (RCTs) and quasi-RCTs investigating the effect of PA interventions using an app compared to no intervention or traditional interventions were included. Pooled effects using the standardized mean difference (SMD) or the weighted mean difference (WMD) were calculated and the overall quality of the evidence was rated using the GRADE. Eleven studies were included. In the short term, pooled estimates showed a small and positive effect in the number of steps favoring interventions using a mobile app when compared with no interventions (WMD = 1579.04, 95%CI 454.04 to 2703.38) and with traditional interventions (WMD = 665.96, 95%CI 167.92 to 1164.00). For self-efficacy and at follow-up, results favoured traditional interventions (WMD = −8.20, 95%CI −14.25 to −2.15). Non-significant results were found for the remaining comparisons. The quality of the evidence ranged from very low to low. There is very low to low quality evidence that interventions using mobile apps running on smartphones, when combined with traditional interventions, are superior to traditional interventions in the short term. Further high-quality studies are required.

Leisure-Time Physical Activity and Depressive Symptoms Among Patients With Coronary Heart Disease: The Mediating Role of Physical Activity Self-Efficacy

BACKGROUND

Despite the positive effect of physical activity on reducing depressive symptoms among patients with coronary heart disease (CHD), the effect of physical activity on depressive symptoms is poorly understood.

AIMS

To examine the mediating role of physical activity self-efficacy in the relationship between leisure-time physical activity and depressive symptoms in CHD patients.

METHODS

This was a secondary data analysis study. A total of 593 CHD patients were included. Data on leisure-time physical activity, physical activity self-efficacy, and depressive symptoms were collected by validated questionnaires. Sociodemographic and clinical data were collected via patient interviews and medical records reviewing. The approach of Baron and Kenny was adopted to examine the mediating effect of physical activity self-efficacy on the association between leisure-time physical activity and depressive symptoms.

RESULTS

On average, participants aged 56.9 (± 12.5) years old, with 66% male. Statistical analyses showed that leisure-time physical activity was significantly associated with depressive symptoms (β = -0.041, p = .040) and physical activity self-efficacy (β = 0.197, p = .001), and physical activity self-efficacy was significantly associated with depressive symptoms (β = -0.223, p = .001) after adjusting for leisure-time physical activity. The indirect effect of leisure-time physical activity on depressive symptoms through physical activity self-efficacy was also significant (β = -0.044, 95% confidence interval: -0.064, -0.027), suggesting a mediating role of physical activity self-efficacy on the relationship between leisure-time physical activity and depressive symptoms.

LINKING EVIDENCE TO ACTION

Leisure-time physical activity is associated with reduced depressive symptoms among CHD patients, and this association is mediated by physical activity self-efficacy. This mediating model has important clinical implications, where integrating physical activity that is enjoyable and pleasant, and self-efficacy building elements in physical activity regimens should be considered, so as to improve psychological outcomes among CHD patients.

The Influence of Sports Participation on Body Image, Self-Efficacy, and Self-Esteem in College Students

Objectives

This study aimed to explore the relationship between body image, self-efficacy, self-esteem, and sports participation by gender, grade, and specialty and then to provide a reference for promoting participation in sports and physical activities in college students.

Methods

Using stratified random sampling, undergraduate students in western China were selected as participants. The data obtained in this study were processed by SPSS 19.0 and AMOS 21.0 statistical software.

Results

Body image was significantly positively correlated with self-efficacy, self-esteem, and sports participation. Self-efficacy was significantly positively correlated with self-esteem and sports participation. Self-esteem was significantly positively correlated with sports participation. Body image had a direct effect on sports participation, with an effect value of 0.124. Furthermore, the mediating effects of self-efficacy (0.079) and self-esteem (0.108) were significant in the relationship between body image and sports participation. Meanwhile, the chain mediating role of self-efficacy–self-esteem was also obvious (0.035).

Conclusion

Body image, self-efficacy, and self-esteem had significant influence on sports participation in college students. At the same time, the mediating effect of self-efficacy, self-esteem, and self-efficacy–self-esteem on body image and sports participation were established, and self-esteem was the key factor to sports participation.

Changes in Psychosocial Factors and Physical Activity Among Finnish Working-Age Men in the Adventures of Joe Finn Campaign

This study evaluated changes in psychosocial factors and self-reported physical activity (PA) among the sample of Finnish men who underwent the fitness tests during the national health campaign. Another aim was to examine whether the fitness test feedback was a meaningful experience for PA change. Baseline data were collected in 2011 by fitness test and questionnaire. Men who had low/moderate fitness along with overweight ( n = 361) were recruited to the postcampaign study in 2014. Data were analyzed with nonparametric tests, logistic regression analysis, and content analysis. The postcampaign survey was completed by 102 men. Positive PA change was associated with high goals, planning skills, and self-efficacy for PA. One fourth of men recalled that they had surprisingly poor fitness at baseline. This experience was not related to positive PA change. A fitness test may awake motivation, but promotion of self-efficacy and self-regulatory skills is needed to support concrete behavior change.

Predicting Engagement With Online Walking Promotion Among Metropolitan and Rural Cancer Survivors

BACKGROUND

Physical activity has numerous associated benefits for cancer survivors. Compared with their urban counterparts, rural Australians experience a health disadvantage, including poorer survival rate after diagnosis of cancer.

OBJECTIVE

The aims of this study were to test the effectiveness of an online 12-week walking intervention designed for cancer survivors and explore region-specific psychological predictors of behavior change.

METHODS

This was a quasi-randomized controlled trial of an online resource designed according to Social Cognitive Theory and Self-determination Theory, based on individualized goal setting. Measures of habitual walking, motivation, and self-efficacy were taken at baseline, postintervention, and 3-month follow-up in an intervention group (n = 46) and active control group (n = 45). The control group was provided a pedometer but did not have access to the online program.

RESULTS

An increase in steps/day at 12 weeks was observed in both groups, with a larger increase in the intervention group; these increases were not sustained at the 3-month follow-up. Psychological predictors of maintained change in steps per day (motivation, barrier self-efficacy, and relapse self-efficacy) did not differ between metropolitan and rural participants. Changes in steps per day among intervention participants were predicted by changes in relapse self-efficacy and barrier self-efficacy.

CONCLUSIONS

The intervention was successful in increasing physical activity postintervention; however, changes were not maintained at follow-up. There were no region-specific predictors of engagement in the intervention.

IMPLICATIONS FOR PRACTICE

Nurses are seamlessly positioned to promote health interventions like walking. Nurses should reframe physical activity with patients so that relapse is seen as common and possibly inevitable when adopting a regular physical activity habit.

Neurobiology of substance use in adolescents and potential therapeutic effects of exercise for prevention and treatment of substance use disorders

Substance use (e.g., alcohol, marijuana, opioids, cocaine., etc,) use often initiates during adolescence, a critical period of physiological and social development marked by an increase in risk-taking due, in part, to heightened motivation to obtain arousal from rewards. Substance use during adolescence has been associated with a greater risk of substance use disorders (SUD) in adulthood. Although use rates for most substances have remained relatively stable, the frequency of marijuana use and the perception that regular marijuana use is not harmful has increased in adolescents. Furthermore, the nonmedical use of opioids has increased, particularly in the South, Midwest, and rural low-income communities. Substance use in adolescence has been associated with adverse structural and functional brain changes and, may exacerbate the natural "imbalance" between frontal/regulatory and cortical-subcortical circuits, leading to further heightened impulsive and reward-driven behaviors. Exercise increases growth and brain-derived neurotrophic factors that stimulate endogenous dopaminergic systems that, in turn, enhance general plasticity, learning, and memory. Exercise may help to reinforce the "naïve" or underdeveloped connections between neurological reward and regulatory processes in adolescence from the "bottom up" and "offset" reward seeking from substances, while concomitantly improving cardiovascular health, as well as academic and social achievement. In this review, we provide an overview of the current state of substance use in adolescents and rationale for the utilization of exercise, particularly "assisted" exercise, which we have shown increases neural activity in cortical-subcortical regions and may modulate brain dopamine levels during adolescence, a unique window of heightened reward sensitivity and neural plasticity, for the prevention and adjunctive treatment of SUD.

Predictors of Physical Activity After Gastric Bypass-a Prospective Study

BACKGROUND

Most patients do not meet the recommended level of physical activity after bariatric surgery, and psychological factors underlying postoperative physical activity remain poorly understood. This study aimed at identifying self-regulatory predictors of physical activity after bariatric surgery.

METHODS

Questionnaire data including self-regulation variables and the short-version of the International Physical Activity Questionnaire were obtained in a prospective cohort of 230 patients 1 year after Roux-en-Y gastric bypass. The study sample consisted of participants consenting to wear an ActiGraph GT3X+ accelerometer for seven consecutive days, 18-24 months after surgery (n = 120).

RESULTS

A total of 112 participants with complete self-report data provided valid accelerometer data. Mean age was 46.8 years (SD = 9.3), and 81.3% was women. Preoperative and postoperative BMI was 44.8 ± 5.5 and 30.6 ± 5.0 kg/m², respectively. Total weight loss was 28.9% (SD = 7.5). By objective measures, 17.9% of the participants met the recommended level of moderate-to-vigorous-intensity of physical activity of ≥150 min/week, whereas 80.2% met the recommended level according to self-reported measures. Being single, higher education level, and greater self-regulation predicted objective physical activity in multivariate regression analysis. Greater self-regulation also predicted self-reported physical activity. Weight loss 1 year after surgery was not associated with self-reported or objectively measured physical activity.

CONCLUSIONS

Despite large differences between accelerometer-based and subjective estimates of physical activity, the associations of self-regulatory factors and weight loss with postoperative physical activity did not vary depending on mode of measurement. Self-regulation predicted both objective and self-reported physical activity. Targeting patients' self-regulatory ability may enhance physical activity after gastric bypass.

Health literacy in type 2 diabetes patients: a systematic review of systematic reviews

Aim To summarize, critically review, and interpret the evidence related to the systematic reviews on health literacy (HL) amongst type 2 diabetes mellitus (T2DM). Methods The methodology for this study consisted of a systematic review of systematic reviews, using the PRISMA statement and flowchart to select studies, and searching on PubMed, CINAHL, Scopus, and Cochrane. The search covered the period between January 2006 and June 2016. Results From the 115 identified record by the queries, only six systematic reviews were included, following a quality evaluation using AMSTAR. The included systematic reviews content was analyzed by the independent work of two authors, using a narrative synthesis approach. The findings of this study (i.e., main themes) are areas of consensus and gaps in knowledge. Areas of consensus are HL definition, HL measurement tools, and the relationship between T2DM patient knowledge (or literacy) and his/her HL. The gaps in knowledge were the assessment of the relations between HL and health outcomes and self-efficacy, the gender differences, the effectiveness of interventions to improve HL, the cost-effectiveness study of interventions to improve HL, and the understanding of the influence of organizational environment on HL. Conclusion This review provides a current state of knowledge to address clinical practice and research proposals. HL could be useful to personalize patients' follow-up and it should be routinely assessed in its three dimensions (i.e. functional, interactive and critical) to enhance patients' ability to cope with clinical recommendations. Future research should be mainly aimed to test the effectiveness of evidence-based interventions to improve HL amongst T2DM patients.

The Effects of Cognitive-Behavioral Model-Based Intervention on Depression, Anxiety, and Self-Efficacy in Alcohol Use Disorder

Exercise is constantly gaining attention as adjuvant treatment for alcohol use disorder (AUD), supplementing classical pharmacological and psychotherapeutic approaches. The aim of this study was to determine the effects of cognitive-behavioral model-based (CBM-based) intervention on the depression, anxiety, and self-efficacy levels in AUD. This quasi-experimental study was conducted using pre- and posttests and repeated measurements with a control group; it was completed between February 2015 and August 2015 in Turkey. Participants were 41 individuals with AUD, 20 in the experimental group and 21 in the control group. The individuals in the experimental group performed aerobic exercise 3 days a week as well as attended the psychoeducation provided 1 day a week. The difference between mean scores of the individuals in the experimental and control groups taken in posttest and 4-month follow-up test in the Beck Depression Inventory (BDI) as well as the difference between mean posttest scores in the Beck Anxiety Inventory (BAI) and Self-Efficacy Scale (SES) were found to be statistically significant ( p < .05). In the intragroup comparisons, a significant difference was found between the “BDI,” “BAI,” and “SES” measurement times ( p < .05). It was concluded that CBM-based intervention was effective in reducing depression and anxiety, increasing self-efficacy in individuals with AUD. Appropriate nurse-managed CBM-based intervention for individuals with AUD can promote their health.

Invited review: Determinants of farmers' adoption of management-based strategies for infectious disease prevention and control

The prevention and control of endemic pathogens within and between farms often depends on the adoption of best management practices. However, farmers regularly do not adopt recommended measures or do not enroll in voluntary disease control programs. This indicates that a more comprehensive understanding of the influences and extension tools that affect farmers' management decisions is necessary. Based on a review of relevant published literature, we developed recommendations to support policy-makers, industry representatives, researchers, veterinarians, and other stakeholders when motivating farmers to adopt best management practices, and to facilitate the development and implementation of voluntary prevention and control programs for livestock diseases. Farmers will make management decisions based on their unique circumstances, agricultural contexts, beliefs, and goals. Providing them with rational but universal arguments might not always be sufficient to motivate on-farm change. Implementation of recommended management practices is more likely if farmers acknowledge the existence of a problem and their responsibility to take action. The perceived feasibility and effectiveness of the recommended management strategy and sufficient technical knowledge further increase the likelihood of adequate adoption. Farmers will also weigh the expected advantages of a proposed change against the expected disadvantages, and these considerations often include internal drivers such as pride or the desire to conform with perceived standards. Extension tools and farmers' social referents (e.g., veterinarians, peers) not only provide technical information but also influence these standards. Whereas mass media have the potential to deliver information to a broad audience, more personal approaches such as participatory group learning or individual communication with farm advisors can enable the tailoring of recommendations to farmers' situations. Approaches that appeal to farmers' internal motivators or that unconsciously elicit the desired behavior will increase the success of the intervention. Collaboration among stakeholders, assisted by social scientists and communication specialists, is necessary to provide a context that facilitates on-farm change and transfers consistent messages across extension tools in the most effective way.

Why are adult women physically active? A systematic review of prospective cohort studies to identify intrapersonal, social environmental and physical environmental determinants

OBJECTIVE

This study aims to systematically review available evidence from prospective cohort studies to identify intrapersonal, social environmental and physical environmental determinants of moderate-to-vigorous intensity physical activity (MVPA) among working-age women.

METHODS

Six databases were searched to identify all prospective cohort studies that reported on intrapersonal (e.g. self-efficacy and socioeconomic status [SES]), social (e.g. crime, area SES and social support) and/or physical (e.g. weather, work and recreation) environmental determinants of MVPA in working-age (mean 18-65 years) women. A qualitative synthesis including harvest plots was completed.

PROSPERO

CRD42014009750 RESULTS: Searching identified 17,387 potential articles; 97 were used in the analysis. The majority (n = 87 studies) reported on ≥1 intrapersonal determinant. Very few (n = 34) examined factors in the social or physical environments, and none looked at social policy. Positive and consistent influencers included higher self-efficacy (n = 18/23), self-rated health (n = 8/13) and intentions (n = 10/11) and perceived behavioural control (n = 5/7) to be physically active. Having children in the household was negatively related to MVPA (n = 9/15).

CONCLUSIONS

Physical activity intervention studies should consider a woman's level of self-efficacy and perceived behavioural control to be physically active. Additional studies are needed on the impact of children in the household, having a spouse/partner and using group goal setting. More evidence is needed to evaluate the impact of environmental factors.

Examining the interplay between depression, motivation, and antiretroviral therapy adherence: a social cognitive approach

A large body of research identifies depressive symptoms as a barrier to optimal antiretroviral therapy (ART) adherence, whereas treatment motivation has been characterized as a facilitator. There is evidence, however, that these patterns may not hold for some ART patients despite the widespread use of motivational techniques aimed at promoting adherence. Little is known about how the interplay between different levels of depressive symptoms and variations in the types and levels of motivation may influence ART adherence. The purpose of this study was to examine the relationship between depressive symptoms, two types of motivation, and adherence, with self-efficacy as a mediator. The sample consisted of 121 ART patients who reported various levels of depressive symptoms (mean age = 41 years; 84% African-American; and 68% female). Path analysis revealed that self-efficacy fully mediated the relationship between the three predictor variables (depressive symptoms, intrinsic motivation, and extrinsic motivation) and adherence, χ²(3, N = 121) = .78, RMSEA = .00, SRMR = .02, CFI = 1.00, NNFI = 1.06. Findings suggest that interventions using motivational techniques to build adherence among patients with varying levels of depressive symptoms should address the role of treatment self-efficacy to improve their effectiveness.

The London Exercise And Pregnant smokers (LEAP) trial: a randomised controlled trial of physical activity for smoking cessation in pregnancy with an economic evaluation

BACKGROUND

Smoking during pregnancy is the main preventable cause of poor birth outcomes. Improved methods are needed to help women to stop smoking during pregnancy. Pregnancy provides a compelling rationale for physical activity (PA) interventions as cessation medication is contraindicated or ineffective, and an effective PA intervention could be highly cost-effective.

OBJECTIVE

To examine the effectiveness and cost-effectiveness of a PA intervention plus standard behavioural support for smoking cessation relative to behavioural support alone for achieving smoking cessation at the end of pregnancy.

DESIGN

Multicentre, two-group, pragmatic randomised controlled trial and economic evaluation with follow-up at the end of pregnancy and 6 months postnatally. Randomisation was stratified by centre and a computer-generated sequence was used to allocate participants using a 1 : 1 ratio.

SETTING

13 hospitals offering antenatal care in the UK.

PARTICIPANTS

Women between 10 and 24 weeks' gestation smoking five or more cigarettes a day before pregnancy and one or more during pregnancy.

INTERVENTIONS

Participants were randomised to behavioural support for smoking cessation (control) or behavioural support plus a PA intervention consisting of supervised treadmill exercise plus PA consultations. Neither participants nor researchers were blinded to treatment allocation.

MAIN OUTCOME MEASURES

The primary outcome was self-reported, continuous smoking abstinence between a quit date and end of pregnancy, validated by expired carbon monoxide and/or salivary cotinine. Secondary outcomes were maternal weight, depression, birth outcomes, withdrawal symptoms and urges to smoke. The economic evaluation investigated the costs of the PA intervention compared with the control intervention.

RESULTS

In total, 789 women were randomised (n = 394 PA, n = 395 control). Four were excluded post randomisation (two had been enrolled twice in sequential pregnancies and two were ineligible and randomised erroneously). The intention-to-treat analysis comprised 785 participants (n = 392 PA, n = 393 control). There was no significant difference in the rate of abstinence at the end of pregnancy between the PA group (7.7%) and the control group (6.4%) [odds ratio for PA group abstinence 1.21, 95% confidence interval (CI) 0.70 to 2.10]. For the PA group compared with the control group, there was a 33% (95% CI 14% to 56%), 28% (95% CI 7% to 52%) and 36% (95% CI 12% to 65%) significantly greater increase in self-reported minutes of moderate- and vigorous-intensity PA from baseline to 1 week, 4 weeks and 6 weeks respectively. Accelerometer data showed that there was no significant difference in PA levels between the groups. There were no significant differences between the groups for change in maternal weight, depression, withdrawal symptoms or urges to smoke. Adverse events and birth outcomes were similar between the groups except for there being significantly more caesarean births in the control group than in the PA group (28.7% vs. 21.3%; p < 0.023). The PA intervention was less costly than the control intervention by £35 per participant. This was mainly attributable to increased health-care usage in the control group. However, there was considerable statistical uncertainty around this estimate.

CONCLUSIONS

During pregnancy, offering an intervention combining supervised exercise and PA counselling does not add to the effectiveness of behavioural support for smoking cessation. Only 10% of participants had PA levels accessed by accelerometer and it is, therefore, unclear whether or not the lack of an effect on the primary outcome is the result of insufficient increases in PA. Research is needed to identify the smoking populations most suitable for PA interventions and methods for increasing PA adherence.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN48600346.

FUNDING

This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 84. See the NIHR Journals Library website for further project information.

Exercise Experiences and Changes in Affective Attitude: Direct and Indirect Effects of In Situ Measurements of Experiences

OBJECTIVES

The purpose of this study was to examine the relationship between exercise experiences (perceptions of competence, perceived exertion, acute affective responses to exercise) and affective attitudes toward exercise. This relationship was analyzed in a non-laboratory setting during a 13-weeks exercise program.

MATERIALS AND METHODS

56 women and 49 men (aged 35-65 years; M age = 50.0 years; SD = 8.2 years) took part in the longitudinal study. Affective responses to exercise (affective valence, positive activation, calmness) as well as perceptions of competence and perceived exertion were measured at the beginning, during, and end of three exercise sessions within the 13-weeks exercise program. Affective attitude toward exercise were measured before and at the end of the exercise program. A two-level path analysis was conducted. The direct and indirect effects of exercise experiences on changes in affective attitude were analyzed on the between-person level: firstly, it was tested whether perceptions of competence and perceived exertion directly relate to changes in affective attitude. Secondly, it was assessed whether perceptions of competence and perceived exertion indirectly relate to changes in affective attitudes-imparted via the affective response during exercise.

RESULTS AND CONCLUSION

At the between-person level, a direct effect on changes in affective attitude was found for perceptions of competence (β = 0.24, p < 0.05). The model revealed one significant indirect pathway between perceived exertion and changes in affective attitude via positive activation: on average, the less strenuous people perceive physical exercise to be, the more awake they will feel during exercise (β = -0.57, p < 0.05). Those people with higher average levels of positive activation during exercise exhibit more improvements in affective attitudes toward exercise from the beginning to the end of the 13-weeks exercise program (β = 0.24, p < 0.05). Main study results have revealed that in situ experiences predicted changes in affective attitude during multi-week exercise programs. These relevant in situ experiences encompass cognitive factors, the sensation of interoceptive cues, and affective responses to exercise. Considering the predictive role of affective attitudes for exercise behavior, these findings suggest that exercise interventions should put greater emphasis on specific exercise experiences.

Mechanisms of Change in Diet and Activity in the Make Better Choices 1 Trial

OBJECTIVE

The Make Better Choices 1 trial demonstrated that participants with unhealthy diet and activity behaviors who were randomized to increase fruits/vegetables and decrease sedentary leisure achieved greater diet and activity improvement than those randomized to change other pairs of eating and activity behaviors. Participants randomized to decrease saturated fat and increase physical activity achieved the least diet-activity improvement. This study examined which psychological mechanisms mediated the effects of the study treatments on healthy behavior change.

METHODS

Participants (n = 204) were randomized to 1 of 4 treatments: increase fruits/vegetables and physical activity; decrease saturated fat and sedentary leisure; decrease saturated fat and increase physical activity; increase fruits/vegetables and decrease sedentary leisure. Treatments provided 3 weeks of remote coaching supported by mobile decision support technology and financial incentives. Mediational analyses were performed to examine whether changes in positive and negative affect, and self-efficacy, stages of readiness to change, liking, craving and attentional bias for fruit/vegetable intake, saturated fat intake, physical activity, and sedentary leisure explained the impact of the treatments on diet-activity improvement.

RESULTS

Greater diet-activity improvement in those randomized to increase fruits/vegetables and decrease sedentary leisure was mediated by increased self-efficacy (indirect effect estimate = 0.04; 95% bias corrected CI, 0.003-0.11). All treatments improved craving, stage of change and positive affect.

CONCLUSION

Accomplishing healthy lifestyle changes for 3 weeks improves positive affect, increases cravings for healthy foods and activities, and enhances readiness to make healthy behavior changes. Maximal diet and activity improvement occurs when interventions enhance self-efficacy to make multiple healthy behavior changes. (PsycINFO Database Record

Body, Person and Environment: Why Promoting Physical Activity (PA) with Stroke Survivors Requires Holistic Thinking

The role of physical activity (PA) after stroke is increasingly recognised as important for function, fitness and wellbeing. Current evidence shows that targeted PA after stroke improves cardiovascular fitness, walking ability and muscle strength and may ameliorate depression and improve quality of life. Secondary stroke prevention and management of cardiovascular risk factors are further health benefits. Despite increasing emphasis on organised exercise classes for stroke, PA levels remain low and effects of organised exercise interventions are not maintained once programmes have finished. Barriers to PA after stroke are complex and innovative approaches to maintaining and promoting long-term engagement in activity are required. This commentary proposes that using the International Classification of Disability and Functioning (ICF) to guide thinking about PA after stroke may help us develop and apply comprehensive solutions that increase PA levels. This approach considers stroke survivors’ PA engagement in terms of Body – the physical impairments imposed by stroke; Person – the role of identity, and psychological factors on PA; and Environment – the physical and social environments that influence PA engagement. The commentary discusses how innovative solutions addressing these issues may enable stroke survivors to be better supported to lead active lifestyles.

Exercise training - A beneficial intervention in the treatment of alcohol use disorders?

BACKGROUND

A growing body of evidence suggests that exercise training may have multiple beneficial effects in individuals with mental health or substance use disorders. Yet, relatively little knowledge exists regarding the benefits of exercise training to augment treatment for alcohol use disorders (AUDs).

PURPOSE

The purpose of this narrative review is to present a summary of the growing body of published literature supporting exercise training as a treatment strategy for individuals with AUDs. We will provide evidence on the myriad of ways in which exercise may exert a positive effect on AUD outcomes including stress, anxiety, impulsivity, and depression. Further, we will explore how these mechanisms share common neurobiological pathways. The role of exercise in enhancing the social environment and increasing individual self-efficacy to reduce excess and/or inappropriate alcohol consumption will also be discussed.

DISCUSSION

We will conclude with a description of completed investigations involving exercise training and provide suggestions for next steps in this innovative field of study.

Fulfilled Emotional Outcome Expectancies Enable Successful Adoption and Maintenance of Physical Activity

Although outcome expectancies are regarded as key determinants of health behavior change, studies on the role of their degree of fulfillment in long-term activity changes are lacking. This study investigated the impact of (un-)fulfilled outcome expectancies (OE) on (un-)successful attempts to increase physical activity, assuming that disengagement is the logical consequence of perceived futility. Participants (n = 138) of a longitudinal cohort study with three measurement waves were assigned to eight different groups according to a staging algorithm of their self-reported, 1-year-long physical activity behavior track. Stages were validated by objective changes in objective fitness, e.g., Physical Working Capacity (PWC). Social cognitive variables, self-efficacy, proximal and distal OE, and fulfillment of OE, were assessed via self-report. Discriminant analyses revealed that OE fulfillment was the predominant predictor for differentiating between successful and unsuccessful behavior change. Amongst OE, proximal OE concerning emotional rewards, in conjunction with action self-efficacy, further improved discriminatory power. OE adjustment warranting hedonic rewards appears to be a crucial mechanism as it facilitates long-term changes through interventions aimed at increasing physical activity rates. Theoretical models might benefit by including the concept of fulfilled expectations acting in terms of feedback loops between volitional and motivational processes.

Psychometric Properties of a Short Measure for Psychosocial Factors and Associations With Phase of Physical Activity Change Among Finnish Working-Aged Men

Insufficient physical activity (PA) and poor physical fitness are risks for several noncommunicable diseases among working-aged men. PA programs have been launched to increase activity levels in the population but working-aged men have been underrepresented in these programs. The aim of the present cross-sectional study was to evaluate validity of a short scale for psychosocial factors among Finnish working-aged men who participated in a PA campaign. The study examined also the associations between psychosocial factors and phase of PA change across fitness groups. Physical fitness was assessed with a body fitness index constructed on the basis of a handgrip test, the Polar OwnIndex Test, and body composition analysis (InBody 720). The men were classified into low ( n = 162), moderate ( n = 358), and high ( n = 320) body fitness index groups. Psychosocial factors and self-reported phase of PA change were assessed with a questionnaire. Psychometric properties of the scale were assessed with confirmatory factor analysis and differences between phases of PA change were examined with one-way analysis of variance. The evaluated scale included factors for self-efficacy, goal setting, skills, and social support. Good physical fitness was related to better perceived self-efficacy and ability to manage one's PA environment. Goal setting was critical for PA change at all fitness levels. Better understanding of the interactions between psychosocial factors and PA change could help in targeting PA programs to low-fit men. Further study should examine the validity of the improved psychosocial measure.

The influence of motivation and attentional style on affective, cognitive, and behavioral outcomes of an exercise class

Exercise classes are a popular form of physical activity. A greater understanding of the individual difference factors that might influence the outcomes of such classes could help to minimize the high dropout rates associated with exercise. The study explored the effects of dominant attentional style and degree of self-determination on affective, cognitive, and behavioral outcomes following structured exercise classes. Data from 417 female participants revealed that those with a dominant attentional style for association (Associators) reported significantly (P < 0.05) more positive affective, cognitive, and behavioral outcomes than did Dissociators, and were more self-determined. Highly self-determined individuals reported the most positive outcomes. Almost 29% of the variance in participants' affective valence could be explained by Dissociators' behavioral regulations. Results lend support to the notion that attentional style is associated with motivation. The combination of attentional style and degree of self-determination appear to be noteworthy individual difference factors that influence responses to exercise classes and could thus have a bearing on long-term exercise adherence.

Qualitative study on adolescents' reasons to non-adherence to dental treatment

The study aimed to reflect on adolescents' speeches regarding their justifications for non-adherence to dental treatment. This is a qualitative research derived from a quantitative research aimed at adolescents from 15 to 19 years of public schools belonging to the area of 34 Primary Health Units - Family Health, in Piracicaba, SP, in 2012. The adolescents were evaluated, diagnosed and referred for dental treatment. One year after this intervention and with non-adherence to treatment, we used a qualitative method to deeply understand this phenomenon. We conducted 25 interviews with a semi-structured script, divided into three blocks: adopted or did not adopt actions recommended; arguments justifying the non-adherence of recommended actions; dimensions related to oral health importance. We adopted the thematic analysis and non-adherence was related to some aspects and grouped in: no priority; priority and change of priority. We concluded that the main reasons for non-adherence are related to different priorities, and orthodontic brace was a potent stimulator of interest and establishment of priorities in oral health care among adolescents.

Gender differences in social support and leisure-time physical activity

OBJECTIVE

To identify gender differences in social support dimensions’ effect on adults’ leisure-time physical activity maintenance, type, and time.

METHODS

Longitudinal study of 1,278 non-faculty public employees at a university in Rio de Janeiro, RJ, Southeastern Brazil. Physical activity was evaluated using a dichotomous question with a two-week reference period, and further questions concerning leisure-time physical activity type (individual or group) and time spent on the activity. Social support was measured with the Medical Outcomes Study Social Support Scale. For the analysis, logistic regression models were adjusted separately by gender.

RESULTS

A multinomial logistic regression showed an association between material support and individual activities among women (OR = 2.76; 95%CI 1.2;6.5). Affective support was associated with time spent on leisure-time physical activity only among men (OR = 1.80; 95%CI 1.1;3.2).

CONCLUSIONS

All dimensions of social support that were examined influenced either the type of, or the time spent on, leisure-time physical activity. In some social support dimensions, the associations detected varied by gender. Future studies should attempt to elucidate the mechanisms involved in these gender differences.

Action control bridges the planning-behaviour gap: a longitudinal study on physical exercise in young adults

OBJECTIVES

Maintaining physical exercise levels may not only require motivation and planning but also action control which is supposed to mediate between planning and exercise.

DESIGN

Behavioural intention, action planning, coping planning and past behaviour were assessed at baseline, and action control and concurrent exercise were measured one month later in 497 young adults.

METHOD

Three nested structural models were specified to examine different mediation mechanisms. One model reflected the intention-planning-behaviour chain, the other one focused on the intention-action control-behaviour chain and the third model comprised the full sequence.

RESULTS

Indirect effects from intentions on exercise involved either planning or action control as mediating variables. In Model 3, all three constructs (action planning, coping planning and action control) were sequential mediators between intentions and later physical exercise levels. Action and coping planning were not directly but indirectly related to exercise via action control.

CONCLUSIONS

Findings support the sequential mediation for planning and action control as antecedents of physical exercise. Action control is needed for exercise, because planning in itself is not always sufficient. Maintaining exercise levels may be attributed to effective self-regulatory strategies such as action control in combination with planning.

Psychosocial factors associated with increased physical activity in insufficiently active adults with arthritis

OBJECTIVES

Although physical activity can potentially reduce symptoms of arthritis, 50% of people with arthritis are insufficiently active. The aim was to identify psychosocial factors associated with increased physical activity in mid-age adults with arthritis who did not meet recommended physical activity levels.

DESIGN

Longitudinal cohort study.

METHODS

Data were from 692 insufficiently active men and women (mean age 55 ± 6.6 years) with arthritis, who answered mailed surveys in 2007 and 2009 in the HABITAT study. Increased physical activity was defined as a change of ≥ 200 MET min/week in walking, moderate and vigorous activities from 2007 to 2009. Scale scores were used to measure psychosocial factors including intention, experiences, attitudes, efficacy, barriers, motivation, social support, and health professional advice. Associations between (1) 2007 psychosocial factors and (2) 2007-2009 improvement (≥ +1 standard deviation) in psychosocial factors and increased physical activity were examined with logistic regression models. Results were adjusted for education, body mass index, and self-rated health.

RESULTS

Between 2007 and 2009, 296 participants (42.8%) increased their physical activity. Engagement, mastery and physical activity intention in 2007 were associated with this increase in physical activity (engagement OR = 1.11, 99% confidence interval (CI) = 1.05-1.17; mastery OR = 1.12, 99%CI = 1.02-1.22; physical activity intention OR = 1.29, 99%CI = 1.06-1.56). Improved scores for encouragement (OR = 2.07, CI = 1.07-4.01) and self-efficacy (OR =2 .27, CI = 1.30-3.97) were also significantly associated with increased physical activity.

CONCLUSIONS

Positive physical activity experiences and intentions were predictors of increased physical activity among people with arthritis. Improved physical activity confidence and social support were associated with increased physical activity. It is important to consider these psychosocial factors when planning physical activity interventions for people with arthritis.

Environmental determinants of cardiovascular diseases risk factors: a qualitative directed content analysis

Background:

Cardiovascular diseases (CVDs) are the number one cause of death in the world. In most analyses of health problems, environment plays a significant and modifiable role in causing the problem either directly or indirectly through behavior.

Objectives:

This study aims to understand the patients and healthcare providers’ experiences about the environmental determinants of CVD risk factors based on the Precede Model.

Patients and Methods:

This qualitative study conducted over six months in 2012 at Diabetes Units of Health Centers associated with Alborz University of Medical Sciences and Health Services which is located in Karaj, Iran. The data were collected based on individual semi-structured interviews with 50 patients and 12 healthcare providers. Data analysis was performed simultaneous with data collection using the content analysis directed method.

Results:

Lack of behaviors like stress control, healthy eating and physical activity were the roots of the risk factors for CVD. The environmental factor is one of the barriers for conducting these behaviors. The environmental barriers included of structural environment including “availability and accessibility of health resources”, “new skills”, and “law and policies” which are located in enabling category and social environment including “social support”, “motivation to comply” and “consequences of behavior” which are located in reinforcing category. The most barriers to performing health behaviors were often structural.

Conclusions:

The environmental factors were barriers for doing healthy behaviors. These factors need to be considered to design health promotion interventions. Policymakers should not only focus on patients’ education but also should provide specific facilities to enhance economic, social and cultural status.

Positive Exercise Experience Facilitates Behavior Change via Self-Efficacy

PURPOSE

Motivational processes can be set in motion when positive consequences of physical exercise are experienced. However, relationships between positive exercise experience and determinants of the motivational and the volitional phases of exercise change have attracted only sparse attention in research.

METHOD

This research examines direct and indirect associations between positive experience and motivational as well as volitional self-efficacy, intention, action planning, and exercise in two distinct longitudinal samples. The first one originates from an online observational study in the general population with three measurement points in time (N = 350) and the second one from a clinical intervention study in a rehabilitation context with four measurement points (N = 275).

RESULTS

Structural equation modeling revealed the following: Positive experience is directly related with motivational self-efficacy as well as intentions in both samples. In the online sample only, positive experience is associated with volitional self-efficacy. In each sample, experience is indirectly associated with action planning via motivational self-efficacy and intentions. Moreover, action planning, in turn, predicts changes in physical exercise levels.

CONCLUSIONS

Findings suggest a more prominent role of positive experience in the motivational than in the volitional phase of physical exercise change. Thus, this research contributes to the understanding of how positive experience is involved in the behavior change process.