‘The Ostrich Problem’: Motivated Avoidance or Rejection of Information About Goal Progress

Information Avoidance: Past Perspectives and Future Directions

In the present age of unprecedented access to information, it is important to understand how and why people avoid information. Multiple definitions of "information avoidance" exist, and key aspects of these definitions deserve attention, such as distinguishing information avoidance from (lack of) information seeking, considering the intentionality and temporal nature of information avoidance, and considering the personal relevance of the information. In this review, we provide a cross-disciplinary historical account of theories and empirical research on information avoidance and seeking, drawing from research in multiple fields. We provide a framework of antecedents of information avoidance, categorized into beliefs about the information (e.g., risk perceptions), beliefs about oneself (e.g., coping resources), and social and situational factors (e.g., social norms), noting that constructs across categories overlap and are intertwined. We suggest that research is needed on both positive and negative consequences of information avoidance and on interventions to reduce information avoidance (when appropriate). Research is also needed to better understand temporal dynamics of information avoidance and how it manifests in everyday life. Finally, comprehensive theoretical models are needed that differentiate avoidance from seeking. Research on information avoidance is quickly expanding, and the topic will only grow in importance.

Patterns and Predictors of Engagement With Digital Self-Monitoring During the Maintenance Phase of a Behavioral Weight Loss Program: Quantitative Study

BACKGROUND

Long-term self-monitoring (SM) of weight, diet, and exercise is commonly recommended by behavioral weight loss (BWL) treatments. However, sustained SM engagement is notoriously challenging; therefore, more must be learned about patterns of engagement with digital SM tools during weight loss maintenance (WLM). In addition, insight into characteristics that may influence SM engagement could inform tailored approaches for participants at risk for poor adherence.

OBJECTIVE

This study explored patterns of digital SM of weight, diet, and exercise during WLM (aim 1) and examined timing, patterns, and rates of disengagement and reengagement (aim 2). This study also assessed relationships between individual-level factors (weight-related information avoidance and weight bias internalization) and SM engagement (aim 3).

METHODS

Participants were 72 adults enrolled in a BWL program consisting of a 3-month period of weekly treatment designed to induce weight loss (phase I), followed by a 9-month period of less frequent contact to promote WLM (phase II). Participants were prescribed daily digital SM of weight, diet, and exercise. At baseline, self-report measures assessed weight-related information avoidance and weight bias internalization. SM adherence was objectively measured with the days per month that participants tracked weight, diet, and exercise. Repeated-measures ANOVA examined differences in adherence across SM targets. Multilevel modeling examined changes in adherence across phase II. Relationships between individual-level variables and SM adherence were assessed with Pearson correlations, 2-tailed independent samples t tests, and multilevel modeling.

RESULTS

During WLM, consistently high rates of SM (≥50% of the days in each month) were observed for 61% (44/72) of the participants for exercise, 40% (29/72) of the participants for weight, and 21% (15/72) of the participants for diet. Adherence for SM of exercise was higher than that for weight or diet (P<.001). Adherence decreased over time for all SM targets throughout phase II (P<.001), but SM of exercise dropped off later in WLM (mean 10.07, SD 2.83 months) than SM of weight (mean 7.92, SD 3.23 months) or diet (mean 7.58, SD 2.92 months; P<.001). Among participants with a period of low SM adherence (ie, <50% of the days in a month), only 33% (17/51 for weight, 19/57 for diet) to 46% (13/28 for exercise) subsequently had ≥1 months with high adherence. High weight-related information avoidance predicted a faster rate of decrease in dietary SM (P<.001). Participants with high weight bias internalization had the highest rates of weight SM (P=.03).

CONCLUSIONS

Participants in BWL programs have low adherence to the recommendation to sustain daily SM during WLM, particularly for SM of diet and weight. Weight-related information avoidance and weight bias internalization may be relevant indicators for SM engagement. Interventions may benefit from innovative strategies that target participants at key moments of risk for disengagement.

The effect of fear and situational motivation on online information avoidance: The case of COVID-19

During the COVID-19 pandemic, a plethora of online sources for information and news dissemination have emerged. Extant research suggests that very quickly, individuals become disinterested and begin avoiding the information. In this study, we investigate how an individual's fear and situational motivation impact Online Information Avoidance. Using the self-determination theory and information avoidance theories, we argue that fear and external regulation are associated with increased Online Information Avoidance. We also argue that intrinsic motivation and identified regulation are associated with a decrease in Online Information Avoidance. Our findings suggest that fear, intrinsic motivation, and external regulation drive Online Information Avoidance, where intrinsic motivation is the most significant driver. We also found that identified regulation is a crucial inhibitor of Online Information Avoidance. While focusing on COVID-19, our study contributes to the broader information systems research literature and specifically to the information avoidance literature during a pandemic or a prolonged crisis. Our study's findings will be useful for governments, health organizations, and communities that utilize online platforms, forums, and related outlets to reach larger audiences for disseminating pertinent information and recommendations during a crisis.

Counterfactual curiosity: motivated thinking about what might have been

Counterfactual information, information about what might have been, forms the content of counterfactual thoughts and emotions like regret and relief. Recent research suggests that human adults and children, as well as rhesus monkeys, demonstrate ‘counterfactual curiosity’: they are motivated to seek out counterfactual information after making decisions. Based on contemporary theories of curiosity and information seeking and a broad range of empirical literature, we suggest multiple heterogeneous psychological processes that contribute to people's motivation for counterfactual information. This includes processes that are identified in the curiosity literature more generally—the potential use of counterfactual information for adaptive decision making (its long-term instrumental value) and the drive to reduce uncertainty. Additionally, we suggest that counterfactual information may be particularly alluring because of its role in causal reasoning; its relationship with prediction and decision making; and its potential to fulfil emotion regulation and self-serving goals. Some future directions have been suggested, including investigating the role of individual differences in counterfactual curiosity on learning and wellbeing.

This article is part of the theme issue ‘Thinking about possibilities: mechanisms, ontogeny, functions and phylogeny’.

Hidden cues for approach and avoidance motivation: implicit cognitive associations among patients with Nonadherence to HIV treatment

Although patient motivation related to HIV treatment is widely acknowledged as a key factor related to consistent adherence and engagement with medical care, research has predominantly focused on explicit rather than implicit cognitive processes that underlie motivation. This study identified and examined implicit cognitive processes that influence approach and avoidance treatment motivation in a sample of 30 HIV patients with suboptimal adherence and poor engagement with medical care. Study participants were predominantly African American (87%) and gay/bisexual (63%). We examined 173 thought statements about treatment collected from patients during two previous studies. Thematic analysis described how implicit cognitive associations influenced patients to approach or avoid treatment and medical care. Findings revealed three major contextual categories of treatment-related thoughts: links with routines and habits, connections to physical changes and reactions, and interpersonal associations. Within each category, implicit cognitive associations about treatment in terms of these daily life events and experiences cued approach and avoidance motivational tendencies without the patient's awareness. Findings from this study support the need for interventions that use implicit, less effortful approaches aimed at promoting adherence and improving the retention of patients with poor engagement.

You Think Failure Is Hard? So Is Learning From It

Society celebrates failure as a teachable moment. But do people actually learn from failure? Although lay wisdom suggests people should, a review of the research suggests that this is hard. We present a unifying framework that points to emotional and cognitive barriers that make learning from failure difficult. Emotions undermine learning because people find failure ego-threatening. People tend to look away from failure and not pay attention to it to protect their egos. Cognitively, people also struggle because the information in failure is less direct than the information in success and thus harder to extract. Beyond identifying barriers, this framework suggests inroads by which barriers might be addressed. Finally, we explore implications. We outline what, exactly, people miss out on when they overlook the information in failure. We find that the information in failure is often high-quality information that can be used to predict success.

Motivating Personal Growth by Seeking Discomfort

Achieving personal growth often requires experiencing discomfort. What if instead of tolerating discomfort (e.g., feeling awkward or uncomfortable), people actively sought it out? Because discomfort is usually experienced immediately and is easy to detect, we suggest that seeking discomfort as a signal of growth can increase motivation. Five experiments (total N = 2,163 adults) tested this prediction across various areas of personal growth: taking improvisation classes to increase self-confidence, engaging in expressive writing to process difficult emotions, becoming informed about the COVID-19 health crisis, opening oneself to opposing political viewpoints, and learning about gun violence. Across these areas of personal development, seeking discomfort as a signal of self-growth motivated engagement and increased perceived goal achievement relative to standard instructions. Consistent with our theorizing, results showed that these effects occurred only in areas of personal growth that cause immediate discomfort.

Weight-Related Information Avoidance Prospectively Predicts Poorer Self-Monitoring and Engagement in a Behavioral Weight Loss Intervention

BACKGROUND

Self-monitoring is a key component of behavioral weight loss (BWL) interventions. Past research suggests that individuals may avoid self-monitoring in certain contexts (e.g., skipping self-weighing after higher-than-usual calorie intake). However, no studies have attempted to quantify individuals' inclination to avoid information about their weight control ("weight-related information avoidance"; WIA) or prospectively examined its implications for treatment engagement and outcomes in BWL programs.

PURPOSE

Characterize WIA using a validated questionnaire among adults enrolled in BWL treatment and examine whether WIA prospectively predicts self-monitoring adherence, session attendance, treatment discontinuation, or weight loss.

METHODS

Participants (N = 87; MBMI = 34.9 kg/m2, 83% female) completed a measure of WIA prior to starting a 12 week, group-based BWL intervention. Participants were given digital self-monitoring tools and instructed to self-monitor their food intake daily, physical activity daily, and body weight weekly (Weeks 1-10) and then daily (Weeks 11-12). Session attendance and treatment discontinuation were recorded. Weight was measured in-clinic pretreatment and posttreatment.

RESULTS

While mean WIA was low (M = 2.23, standard deviation [SD] = 0.95; potential scale range: 1-7), greater WIA predicted poorer attendance (r = -.23; p = .03) and poorer self-monitoring of physical activity (r = -.28; p = .009) and body weight (r = -.32; p = .003). WIA did not predict food monitoring (p = .08), treatment discontinuation (p = .09), or 12 week weight loss (p = .91).

CONCLUSIONS

Greater WIA, as assessed via a brief questionnaire, may place individuals at risk for poorer self-monitoring and treatment engagement during BWL. Further research on the implications of WIA in the context of weight management is warranted, including evaluation of correlates, moderators, and mechanisms of action of WIA.

CLINICAL TRIAL REGISTRATION

NCT03337139.

Are Machine Learning Methods the Future for Smoking Cessation Apps?

Smoking cessation apps provide efficient, low-cost and accessible support to smokers who are trying to quit smoking. This article focuses on how up-to-date machine learning algorithms, combined with the improvement of mobile phone technology, can enhance our understanding of smoking behaviour and support the development of advanced smoking cessation apps. In particular, we focus on the pros and cons of existing approaches that have been used in the design of smoking cessation apps to date, highlighting the need to improve the performance of these apps by minimizing reliance on self-reporting of environmental conditions (e.g., location), craving status and/or smoking events as a method of data collection. Lastly, we propose that making use of more advanced machine learning methods while enabling the processing of information about the user’s circumstances in real time is likely to result in dramatic improvement in our understanding of smoking behaviour, while also increasing the effectiveness and ease-of-use of smoking cessation apps, by enabling the provision of timely, targeted and personalised intervention.

Individualized Web-Based Attention Training With Evidence-Based Counseling to Address HIV Treatment Adherence and Psychological Distress: Exploratory Cohort Study

BACKGROUND

The prevalence of mood, trauma, and stressor-related disorders is disproportionately higher among people living with HIV than among individuals without the virus. Poor adherence to HIV treatment and heightened psychological distress have been linked to symptoms associated with these disorders.

OBJECTIVE

The objective of this exploratory pilot study was to develop and implement an intervention that combined individualized web-based attention training with evidence-based counseling to promote HIV treatment adherence and reduce psychological distress among people living with HIV. The study targeted African American and Latino young men who have sex with men, two population groups in the US that continue to experience disparities in HIV treatment outcomes.

METHODS

Study participants with elevated symptoms of depression and suboptimal adherence to antiretroviral therapy were recruited primarily through referrals from Los Angeles health and social service providers as well as postings on social media. Participants enrolled in the 4-week intervention received weekly counseling for adherence and daily access to web-based attention training via their personal mobile devices or computers.

RESULTS

Of the 14 participants who began the intervention, 12 (86%) completed all sessions and study procedures. Using a pretest-posttest design, findings indicate significant improvements in adherence, depressive symptoms, and attention processing. Overall, the proportion of participants reporting low adherence to antiretroviral therapy declined from 42% at baseline to 25% at intervention completion (P=.02, phi=0.68). Mean depressive symptoms measured by the 9 item Patient Health Questionnaire (PHQ-9) showed a substantial reduction of 36% (P=.002, Cohen d=1.2). In addition, participants' attentional processing speeds for all types of stimuli pairings presented during attention training improved significantly (P=.01 and P=.02) and were accompanied by large effect sizes ranging from 0.78 to 1.0.

CONCLUSIONS

Our findings support the feasibility of web-based attention training combined with counseling to improve antiretroviral therapy adherence among patients with psychological distress. Future research should include a larger sample, a control group, and longer-term follow-up.

Are politically diverse Thanksgiving dinners shorter than politically uniform ones?

Americans on the political left and right are engaged in a Culture War with one another, one that is often characterized by mutual fear, antipathy, and avoidance. Are there safe havens from the socially straining effects of this Culture War, times and places where Americans of different political stripes gather and put aside their political differences? Previous research (Chen & Rohla, 2018) implied that there might not be insofar as even intimate family gatherings seem to be subject to Culture War tensions. They found that politically diverse Thanksgiving Dinners were 35-70 minutes shorter than politically uniform ones, representing a 14-27% reduction in overall dinner duration. Noting analytical and methodological limitations in the prior analysis, we conducted two pre-registered studies to test whether diverse dinners are shorter than uniform ones and to attempt to conceptually replicate and extend this prior analysis. Individual analyses yielded mixed results, with null models generally supported but effect estimates generally overlapping with those of Chen and Rohla (2018). A mega-analysis found that, when controlling for various covariates, politically diverse dinners were 24 minutes shorter than politically uniform ones, 95% confidence interval = [9, 39], representing a 6% decrease in the total dinner time [2%-10%]. This final result successfully replicates Chen and Rohla (2018) both in terms of effect overlap and direct-and-significance criteria while nonetheless favoring the conclusion that politics is not straining family ties as much as previously thought.

Snacks and The City: Unexpected Low Sales of an Easy-Access, Tasty, and Healthy Snack at an Urban Snacking Hotspot

: While many people declare an intention to eat and snack more healthily, a large body of research has found that these intentions often do not translate into actual behavior. This failure to fulfil intentions is regularly attributed to the obesogenic environment, on which basis it is assumed that changing the food environment may lead to more healthy snacking behavior. To test this premise in real life practice, the present research project investigated whether making a healthy snack easy-to-access in an urban environment characterized by unhealthy snacking would support people in their intentions of purchasing more healthy snacks. The urban snack project consisted of three phases. In Phase 1, a hotspot location for unhealthy snacking was determined by using a Global Positioning System to track people's snacking locations anda survey to verify the location . In Phase 2, an attractive snack was developed that met consumers' criteria of what constituted a healthy and tasty snack, together with corresponding branding that also included a small food truck from which to sell the newly developed snacks. In Phase 3, the snack was sold from the food truck located at the previously determined unhealthy snacking hotspot. We counted the number of snacks sold and canvassed people's opinions about the snack and its branding, finding that in spite of people's appreciation for the snack, the food truck, and the branding, actual sales of the snack were very low. In the Discussion, we name predominant eating and purchasing habits as possible reasons for these low sales. Future research could focus on placing the healthy snack directly beside people's habitual snack purchase location to ensure that the new choice gets better recognized. Overall, the findings suggest that merely placing healthy snacks more prominently in people's food environment is not sufficient to lead people to snack more healthily.

Environmentally Sustainable Food Consumption: A Review and Research Agenda From a Goal-Directed Perspective

The challenge of convincing people to change their eating habits toward more environmentally sustainable food consumption (ESFC) patterns is becoming increasingly pressing. Food preferences, choices and eating habits are notoriously hard to change as they are a central aspect of people's lifestyles and their socio-cultural environment. Many people already hold positive attitudes toward sustainable food, but the notable gap between favorable attitudes and actual purchase and consumption of more sustainable food products remains to be bridged. The current work aims to (1) present a comprehensive theoretical framework for future research on ESFC, and (2) highlight behavioral solutions for environmental challenges in the food domain from an interdisciplinary perspective. First, starting from the premise that food consumption is deliberately or unintentionally directed at attaining goals, a goal-directed framework for understanding and influencing ESFC is built. To engage in goal-directed behavior, people typically go through a series of sequential steps. The proposed theoretical framework makes explicit the sequential steps or hurdles that need to be taken for consumers to engage in ESFC. Consumers need to positively value the environment, discern a discrepancy between the desired versus the actual state of the environment, opt for action to reduce the experienced discrepancy, intend to engage in behavior that is expected to bring them closer to the desired end state, and act in accordance with their intention. Second, a critical review of the literature on mechanisms that underlie and explain ESFC (or the lack thereof) in high-income countries is presented and integrated into the goal-directed framework. This contribution thus combines a top-down conceptualization with a bottom-up literature review; it identifies and discusses factors that might hold people back from ESFC and interventions that might promote ESFC; and it reveals knowledge gaps as well as insights on how to encourage both short- and long-term ESFC by confronting extant literature with the theoretical framework. Altogether, the analysis yields a set of 33 future research questions in the interdisciplinary food domain that deserve to be addressed with the aim of fostering ESFC in the short and long term.

Effectiveness of a self-regulation intervention for weight loss: A randomized controlled trial

OBJECTIVES

To evaluate effectiveness and acceptability of a novel intervention, based on self-regulation theory, for weight loss.

DESIGN

A two-arm parallel group design was employed.

METHODS

Adult participants with a BMI ≥ 30 kg/m² and the aim to lose weight were recruited and randomized to either a control or intervention group. Both groups were asked to weigh themselves daily for eight weeks. The intervention group was encouraged to use a weight tracking app, and complete daily and weekly questionnaires to prompt action planning, reflection, and evaluation of actions. Participants chose daily actions from a menu of 53 behaviours. The primary outcome was weight change after 8 weeks, assessed using linear mixed effects models. At follow-up, 20 intervention group participants were interviewed regarding their experiences in the trial.

RESULTS

100 participants were recruited, and 98% were followed up at 8 weeks. Mean weight loss was -4.18 kg (SD = 3.84) in the intervention compared to -1.01 kg (SD = 2.67) in the control group; the adjusted difference was -3.20 kg (95% CI -4.49, -1.92). Participants rated the intervention's usefulness as 8.25 (SD = 2.04) on a scale from 1 to 10. Adherence was a significant independent predictor of weight loss success (-1.54 kg per one SD, 95% CI -2.16, -0.93), but not a mediator of the intervention effect. Participants reported that the intervention enabled them to experiment with and identify effective weight loss actions.

CONCLUSIONS

Guiding participants through the self-regulation process was feasible, acceptable to participants, and led to significantly greater short-term weight loss than unguided self-weighing.

Patterns in Weight and Physical Activity Tracking Data Preceding a Stop in Weight Monitoring: Observational Analysis

Background

Self-regulation for weight loss requires regular self-monitoring of weight, but the frequency of weight tracking commonly declines over time.

Objective

This study aimed to investigate whether it is a decline in weight loss or a drop in motivation to lose weight (using physical activity tracking as a proxy) that may be prompting a stop in weight monitoring.

Methods

We analyzed weight and physical activity data from 1605 Withings Health Mate app users, who had set a weight loss goal and stopped tracking their weight for at least six weeks after a minimum of 16 weeks of continuous tracking. Mixed effects models compared weight change, average daily steps, and physical activity tracking frequency between a 4-week period of continuous tracking and a 4-week period preceding the stop in weight tracking. Additional mixed effects models investigated subsequent changes in physical activity data during 4 weeks of the 6-week long stop in weight tracking.

Results

People lost weight during continuous tracking (mean −0.47 kg, SD 1.73) but gained weight preceding the stop in weight tracking (mean 0.25 kg, SD 1.62; difference 0.71 kg; 95% CI 0.60 to 0.81). Average daily steps (beta=−220 daily steps per time period; 95% CI −320 to −120) and physical activity tracking frequency (beta=−3.4 days per time period; 95% CI −3.8 to −3.1) significantly declined from the continuous tracking to the pre-stop period. From pre-stop to post-stop, physical activity tracking frequency further decreased (beta=−6.6 days per time period; 95% CI −7.12 to −6.16), whereas daily step count on the day’s activity was measured increased (beta=110 daily steps per time period; 95% CI 50 to 170).

Conclusions

In the weeks before people stop tracking their weight, their physical activity and physical activity monitoring frequency decline. At the same time, weight increases, suggesting that declining motivation for weight control and difficulties with making use of negative weight feedback might explain why people stop tracking their weight. The increase in daily steps but decrease in physical activity tracking frequency post-stop might result from selective measurement of more active days.

Towards a Smart Smoking Cessation App: A 1D-CNN Model Predicting Smoking Events

Nicotine consumption is considered a major health problem, where many of those who wish to quit smoking relapse. The problem is that overtime smoking as behaviour is changing into a habit, in which it is connected to internal (e.g., nicotine level, craving) and external (action, time, location) triggers. Smoking cessation apps have proved their efficiency to support smoking who wish to quit smoking. However, still, these applications suffer from several drawbacks, where they are highly relying on the user to initiate the intervention by submitting the factor the causes the urge to smoke. This research describes the creation of a combined Control Theory and deep learning model that can learn the smoker’s daily routine and predict smoking events. The model’s structure combines a Control Theory model of smoking with a 1D-CNN classifier to adapt to individual differences between smokers and predict smoking events based on motion and geolocation values collected using a mobile device. Data were collected from 5 participants in the UK, and analysed and tested on 3 different machine learning model (SVM, Decision tree, and 1D-CNN), 1D-CNN has proved it’s efficiency over the three methods with average overall accuracy 86.6%. The average MSE of forecasting the nicotine level was (0.04) in the weekdays, and (0.03) in the weekends. The model has proved its ability to predict the smoking event accurately when the participant is well engaged with the app.

Exploring Predictors of Moral Disengagement in Collegiate Athletic Trainers

CONTEXT

Considering recent high-profile reports of malpractice and negligence by National Collegiate Athletic Association (NCAA) athletic trainers (ATs), it is prudent to investigate the psychological mechanisms that may influence ATs' ability to justify unethical behaviors. When treating injured student-athletes, ATs may undergo a cognitive process known as moral disengagement, which involves convincing oneself that ethical standards do not apply in a particular context.

OBJECTIVE

To explore the psychological factors and traits among ATs that may predict moral disengagement pertaining to allowing athletes to play through injuries.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

A total of 187 Division I, II, and III ATs from 100 NCAA universities.

MAIN OUTCOME MEASURE(S)

In addition to the primary outcome variable of moral disengagement, the survey captured the AT's demographic background, sport and athletic training histories, and measures of sport ethic, contesting orientations, commitment, and social identity.

RESULTS

Cluster analysis was used to identify homogeneous subgroups of participants based on these variables. A 2-cluster solution emerged, with cluster 1 (n = 94) scoring higher in the sport-ethic and sport-contesting orientations but lower in commitment and social identity compared with cluster 2 (n = 93). An independent-samples t test revealed that moral disengagement was highest (t185 = 19.59, P < .001, d = 0.69) among ATs in cluster 1.

CONCLUSIONS

These findings advance our understanding of the psychological processes that may predict moral disengagement of ATs in allowing student-athletes to play through injury. Although additional research is needed to test whether moral disengagement influences return-to-play decisions, we provide initial evidence that ATs who conform to sport norms (eg, "no pain, no gain") and who tend to view sport competition with a "war-like" orientation are more likely to morally disengage.

Powerful audiences are linked to health information avoidance: Results from two surveys

OBJECTIVE

We examined the extent to which community members avoid medical information that they may very much want, yet fear that others may use to harm them.

METHODS

In two online studies, we surveyed participants (N = 659) about their experiences with insurer and employer harm, past avoidance of medical information, intentions to avoid medical information, and reasons for avoiding medical information. Study 2 was a conceptual replication of Study 1 with some minor variations.

RESULTS

Several key findings emerged. 1) Although reports of past audience harm were relatively rare, reports of past avoidance were common, both for audience reasons and resource reasons. 2) Participants who were younger and who reported avoiding medical tests in the past (for audience or resource reasons) generally reported greater intentions to avoid health information in the future. 3) Participants reported that receiving unfavorable medical test results would elicit more harm from financially powerful audiences (health insurers and employers) than from interpersonally powerful audiences (close friends/family and others). 4) Participants indicated that the prospect of harm from an audience (i.e., negative effects on insurance coverage) rather than the prospect of bad news would dissuade them from seeking a medical test. Finally, 5) Participants reported that they were most inclined to avoid testing for medical conditions that were untreatable, unimportant, embarrassing/stigmatizing, or expensive.

CONCLUSIONS

Findings demonstrate that people are concerned with audience perceptions of their health and these concerns may adversely affect decision making and behavior.

Professional Fulfillment: Concept and Instrument Proposition

Abstract This paper aims to propose a concept and an instrument of professional fulfillment (PF), which is theoretically defined as the perception of having attained or being on the right track for attaining one’s most important career goals. The Professional Fulfillment Scale (PFS) was developed in order to operationalize PF, being tested across two studies. Regarding Study 1, in which 406 workers took part, results from exploratory factor analysis evidenced construct validity for PFS. In Study 2, in which 270 workers took part, results from confirmatory factor analysis and structural equation modeling presented satisfactory model fit indices for PFS. We conclude that both the professional fulfillment concept and the scale are useful for mapping people’s importance and achievement of career goals and evaluation of progress, working as a diagnostic tool for career management.

Why Effective Interventions Do Not Work for All Patients: Exploring Variation in Response to a Chronic Disease Management Intervention

BACKGROUND

Half of all Americans have a chronic disease. Promoting healthy behaviors to decrease this burden is a national priority. A number of behavioral interventions have proven efficacy; yet even the most effective of these has high levels of nonresponse.

OBJECTIVES

In this study, we explore variation in response to an evidence-based community health worker (CHW) intervention for chronic disease management.

RESEARCH DESIGN

We used a convergent parallel design that combined a randomized controlled trial with a qualitative process evaluation that triangulated chart abstraction, in-depth interviews and participant observation.

SUBJECTS

Eligible patients lived in a high-poverty region and were diagnosed with 2 or more of the following chronic diseases: diabetes, obesity, hypertension or tobacco dependence. There were 302 patients in the trial, 150 of whom were randomly assigned to the CHW intervention. Twenty patients and their CHWs were included in the qualitative evaluation.

RESULTS

We found minimal differences between responders and nonresponders by sociodemographic or clinical characteristics. A qualitative process evaluation revealed that health behavior change was challenging for all patients and most experienced failure (ie, gaining weight or relapsing with cigarettes) along the way. Responders seemed to increase their resolve after failed attempts at health behavior change, while nonresponders became discouraged and "shut down."

CONCLUSIONS

Failure is a common and consequential aspect of health behavior change; a deeper understanding of failure should inform chronic disease interventions.

Goal-setting to Promote a Healthier Lifestyle in Later Life: Qualitative Evaluation of the AgeWell Trial

OBJECTIVE

We report a mixed method evaluation of the feasibility and implementation of the AgeWell goal-setting intervention to promote healthy ageing later life.

METHOD

Researcher field notes, goal-setting interview content, and semi-structured interviews with participants were content analysed to review trial implementation and participants' perspective on the goal-setting and mentoring intervention.

RESULTS

75 people were recruited: 21 in the goal-setting and 22 in the goal-setting with mentoring arms of the intervention. Goal-setting was feasible in the main domains of interest. Adherence to the protocol was good and the mentoring schedule was adhered to. Participants reported satisfaction with their goal attainment, but barriers for non-achievement were also identified. Recommendations for small changes to the intervention included reducing the number of goals.

CONCLUSIONS

Participants understood the goal-setting process, and were able to set realistic and achievable lifestyle goals. The intervention and the procedures were acceptable but changes in how goal-setting is both introduced and monitored are needed for wider implementation.

CLINICAL IMPLICATIONS

Goal-setting can be a useful process to help people alter their lifestyle to allow them to age more successfully and reduce risk factors associated with dementia.

The relationship between time perspective and self-regulatory processes, abilities and outcomes: a protocol for a meta-analytical review

INTRODUCTION

Both theoretical and empirical evidence suggests that time perspective is likely to influence self-regulatory processes and outcomes. Despite the theoretical and practical significance of such relations, the relationship between time perspective and self-regulatory processes and outcomes across different measures, samples and life domains, including health, has yet to be explored.

METHODS AND ANALYSIS

The proposed review will develop a taxonomy for classifying measures according to the self-regulatory process, ability or outcome that they are likely to reflect. Electronic scientific databases will be searched, along with relevant conference abstract booklets and citation lists. Additionally, a call for unpublished data will be submitted to relevant bodies. To be eligible for inclusion, studies must include a measure of time perspective and a measure of at least one self-regulatory process, ability and/ or outcome. Eligibility will not be restricted by publication date, language, type of sample or setting. The bivariate correlations will be extracted (or calculated) and submitted to a random-effects meta-analysis. The sample-weighted average effect size, heterogeneity, risk of bias and publication bias will be calculated, and the effects of categorical and continuous moderator variables on the effect sizes will be determined.

ETHICS AND DISSEMINATION

The proposed meta-analysis will synthesise previously conducted research; thus, ethical approval is not required. The findings will be submitted for publication in an international peer-reviewed journal and reported as part of the first author’s PhD thesis. The findings will also be disseminated to the research community and, where appropriate, to other interested parties through presentations at relevant academic and non-academic conferences.

Which Factors Are Associated with Monitoring Goal Progress?

Three studies examined how people assess their progress on personal goals (e.g., whether they compare their progress to the past and/or to a desired target state), along with factors that might influence the nature of progress monitoring (e.g., whether the goal involves attaining a positive outcome or avoiding a negative outcome). Study 1 involved semi-structured interviews with 40 participants, in which we examined how participants monitored their progress and whether this was related to: (a) their level of self-efficacy, (b) whether the goal was prevention focused, and (c) whether goal progress was represented in quantifiable terms. Studies 2 (N = 492) and 3 (N = 481) were conducted online and additionally examined whether how participants monitored their progress differed as a function of the domain of the goal (i.e., whether it was related to physical development/health, finances, work/study, or social relationships). The findings suggest that participants: (i) were less likely to monitor their progress toward goals that were related to avoiding negative outcomes, (ii) were less likely to monitor their progress toward goals related to finances, work, or study with reference to the past, than progress toward other goals (e.g., those relating to physical development and health), (iii) found it easier to monitor their progress toward goals that they felt confident of attaining, but harder to monitor their progress toward goals related to work or study. Finally, the more participants thought about their goal in quantifiable terms, the more likely they were to monitor their progress, and the easier they found monitoring their progress to be. Taken together, these studies begin to describe the nature of progress monitoring and the factors that influence this important self-regulatory process.

Improving Financial Management via Contemplation: Novel Interventions and Findings in Laboratory and Applied Settings

The present research tackles two main areas of financial mismanagement, namely avoiding debt-related information and underestimating expenditure. We draw upon research which has shown that inviting people to think about reasons for avoiding something actually serves to reduce the likelihood that they will then avoid it, and potentially improves what they know about it. Therefore, in three studies we investigated if prompting participants to contemplate their debt (Studies 1 and 2) and expenditure (Study 3) would decrease avoidance of debt-related information and improve estimates of expenditure, respectively. Conform to our expectations prompting contemplation via questionnaire (Study 1) and video (Study 2) reduced avoidance of debt-related information. In other words, contemplation reduced the likelihood that people would avoid viewing their risk of debt. The success of prompting contemplation via video offers a new and important addition to the literature on contemplation, which has previously focused on using the traditional questionnaire format. In Study 3 we observed that contemplation improved the estimates of expenditure that loan applicants at a credit union provided. Specifically, contemplation resulted in participants providing larger and more detailed accounts of their expenditure, and increased the agreement between staff and clients for the number of expenditure items provided by the clients. In sum, these findings suggest that contemplation in the context of the above financial decision-making is a robust intervention, as it was effective for different types of interventions (questionnaire and video), behaviors (avoidance of debt-related information and improving estimates of expenditure), and samples (students and university staff; Studies 1 and 2 and loan applicants at a credit union; Study 3). We discuss the theoretical, policy and applied impact of these findings, and highlight limitations and considerations for future research.

Why Do People Act Like the Proverbial Ostrich? Investigating the Reasons That People Provide for Not Monitoring Their Goal Progress

Two studies examined peoples' reasons for not monitoring their progress toward their personal goals—a phenomenon that has been termed “the ostrich problem” (Webb et al., 2013). Study 1 used factor analysis to organize the reasons that people gave for not monitoring their goal progress, resulting in 10 factors. The most strongly endorsed reasons were: (a) that information on goal progress would demand a change in beliefs, or (b) undesired action; (c) that progress was poor, and (d) that thinking about and/or working on the goal was associated with negative emotions. Study 2 adopted a prospective design and investigated whether the reasons identified in Study 1 predicted: (a) the likelihood that participants would decline an opportunity to monitor their goal progress, and (b) the frequency with which participants monitored their goal progress. We found evidence that some of the most strongly endorsed reasons from Study 1 also predicted the avoidance of monitoring in Study 2; however, the belief that information about goal progress was likely to be inaccurate and not useful, and perceived control over goal attainment also reliably predicted the avoidance of monitoring in Study 2. Taken together, the findings explain why people do not monitor their goal progress and point to potential avenues for intervention.

What is the psychological impact of self-weighing? A meta-analysis

Many people self-weigh and many interventions addressing weight-related problems such as obesity promote self-weighing. However, while self-weighing has been associated with weight loss, there is mixed evidence regarding the psychological impact of this behaviour. The present review aimed to quantify the relationship between self-weighing and: (i) affect (e.g., anxiety, depression); (ii) psychological functioning (e.g., self-esteem); (iii) body-related attitudes and (iv) disordered eating. A computerized search of scientific databases in September 2014 and subsequent ancestry and citation searches identified 29 independent tests of the relationship between self-weighing on psychological outcomes. Meta-analysis was used to quantify the size of the association across the tests. Results indicated that there was no association between self-weighing and affect, body-related attitudes or disordered eating. There was, however, a small-sized negative association between self-weighing and psychological functioning. The age of participants, obesity status, the extent of weight loss, duration of self-weighing and study design (RCT versus correlational) were found to influence at least some of the psychological outcomes of self-weighing. The findings suggest that, for the most part, self-weighing is not associated with adverse psychological outcomes. However, in some cases the association between self-weighing and psychological outcomes may be more negative than in others.

The effect of spatial barriers on realised accessibility to heath services after a natural disaster

The closure of the Manawatu Gorge in New Zealand in August 2011 caused a change in the travel time for patients living in the east of the MidCentral Health District to their health services located in Palmerston North. This presented an opportunity to study the effect a change in spatial access had on a population before and after such an event. We used a retrospective cohort design with routinely collected data from general practice and hospital services. Realised accessibility was calculated for 101,456 patients over 3.5 years. General practice utilization appeared to be the only service affected negatively during the gorge closure (rate ratio 1.106). Outpatient attendances had an increase in use by those with increased travel time (rate ratio 0.922). There was evidence of other unidentified factors that impacted the use of services across both intervention and control groups between the gorge open and closed periods. These results were more conservative than those produced by a traditional uncontrolled travel time category analysis which suggested a correlation in non-urgent ED attendance and general practice and boundary effects in all ED attendances and hospital admissions.

The neural basis of monitoring goal progress

The neural basis of progress monitoring has received relatively little attention compared to other sub-processes that are involved in goal directed behavior such as motor control and response inhibition. Studies of error-monitoring have identified the dorsal anterior cingulate cortex (dACC) as a structure that is sensitive to conflict detection, and triggers corrective action. However, monitoring goal progress involves monitoring correct as well as erroneous events over a period of time. In the present research, 20 healthy participants underwent functional magnetic resonance imagining (fMRI) while playing a game that involved monitoring progress toward either a numerical or a visuo-spatial target. The findings confirmed the role of the dACC in detecting situations in which the current state may conflict with the desired state, but also revealed activations in the frontal and parietal regions, pointing to the involvement of processes such as attention and working memory (WM) in monitoring progress over time. In addition, activation of the cuneus was associated with monitoring progress toward a specific target presented in the visual modality. This is the first time that activation in this region has been linked to higher-order processing of goal-relevant information, rather than low-level anticipation of visual stimuli. Taken together, these findings identify the neural substrates involved in monitoring progress over time, and how these extend beyond activations observed in conflict and error monitoring.