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Wright CE, Sheeran P, Voils CI, Blalock DV. A review of implementation intentions as a tool to benefit high-need patients and healthcare systems: U.S. veterans affairs as an exemplar. PATIENT EDUCATION AND COUNSELING 2023; 116:107937. [PMID: 37595504 DOI: 10.1016/j.pec.2023.107937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023]
Abstract
Implementation intentions (if-then plans) are an evidence-based behavior change strategy designed to translate behavioral intentions into habits [1]. Despite extensive evidence of its potential utility, this behavior change strategy is underutilized and under-researched in high-need healthcare contexts within the United States (U.S.) which face high rates of chronic conditions and barriers to care such as rurality, lack of resources, and cognitive strain from mental health and neurological conditions [2,3]. Implementation intentions have demonstrated efficacy in promoting many health behaviors proven to mitigate chronic conditions, namely physical activity, healthy diet, and substance use reduction [4-6]. In addition, the accessible, adaptable, and self-driven nature of implementation intentions allow the technique to meet many of the individual and system-level priorities of these high-need care contexts. By being patient-driven, proactive, and personalized, implementation intentions can help these patients cultivate healthy habits as part of their everyday lives. At the systems-level, implementation intentions' inexpensiveness, scalability, and compatibility with telemedicine platforms allow them to be integrated easily into existing healthcare system infrastructure [7,8]. This review describes these concepts in detail, and uses the Veterans Affairs (VA) healthcare system as an exemplar to provide concrete examples of how and where implementation intentions could be integrated in a healthcare system, within some existing programs, to benefit both the system and individual patients.
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Affiliation(s)
- Charles E Wright
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
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Robb KA, Kotzur M, Young B, McCowan C, Hollands GJ, Irvine A, Macdonald S, McConnachie A, O'Carroll RE, O'Connor RC, Steele RJC. Increasing uptake of FIT colorectal screening: protocol for the TEMPO randomised controlled trial testing a suggested deadline and a planning tool. BMJ Open 2023; 13:e066136. [PMID: 37202130 PMCID: PMC10201271 DOI: 10.1136/bmjopen-2022-066136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 04/28/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Screening can reduce deaths from colorectal cancer (CRC). Despite high levels of public enthusiasm, participation rates in population CRC screening programmes internationally remain persistently below target levels. Simple behavioural interventions such as completion goals and planning tools may support participation among those inclined to be screened but who fail to act on their intentions. This study aims to evaluate the impact of: (a) a suggested deadline for return of the test; (b) a planning tool and (c) the combination of a deadline and planning tool on return of faecal immunochemical tests (FITs) for CRC screening. METHODS AND ANALYSIS A randomised controlled trial of 40 000 adults invited to participate in the Scottish Bowel Screening Programme will assess the individual and combined impact of the interventions. Trial delivery will be integrated into the existing CRC screening process. The Scottish Bowel Screening Programme mails FITs to people aged 50-74 with brief instructions for completion and return. Participants will be randomised to one of eight groups: (1) no intervention; (2) suggested deadline (1 week); (3) suggested deadline (2 weeks); (4) suggested deadline (4 weeks); (5) planning tool; (6) planning tool plus suggested deadline (1 week); (7) planning tool plus suggested deadline (2 weeks); (8) planning tool plus suggested deadline (4 weeks). The primary outcome is return of the correctly completed FIT at 3 months. To understand the cognitive and behavioural mechanisms and to explore the acceptability of both interventions, we will survey (n=2000) and interview (n=40) a subgroup of trial participants. ETHICS AND DISSEMINATION The study has been approved by the National Health Service South Central-Hampshire B Research Ethics Committee (ref. 19/SC/0369). The findings will be disseminated through conference presentations and publication in peer-reviewed journals. Participants can request a summary of the results. TRIAL REGISTRATION NUMBER clinicaltrials.govNCT05408169.
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Affiliation(s)
- Kathyrn A Robb
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Marie Kotzur
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ben Young
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- School of Medicine, University of St. Andrews, St Andrews, UK
| | - Gareth J Hollands
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - Audrey Irvine
- Scottish Bowel Screening Centre, NHS Tayside, Dundee, Dundee, UK
| | - Sara Macdonald
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Rory C O'Connor
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Rahimi T, Morowatisharifabad MA, Farajkhoda T, Fallahzadeh H. A comprehensive health-promoting neighborhood intervention to improve health care seeking behavior among reproductive age Iranian women. BMC Womens Health 2023; 23:171. [PMID: 37041521 PMCID: PMC10091519 DOI: 10.1186/s12905-023-02308-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 03/26/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Women's health care seeking delays remains an unresolved major public health problem in developing and underdeveloped countries. This study aimed to evaluate a health-promoting neighborhood intervention to improve health care seeking behavior (HCSB) among reproductive age Iranian women using Health Promotion Model (HPM). METHOD This randomized controlled trial was conducted on 160 women of reproductive age in two groups: experimental and control. Data were collected by self-administered questionnaire based on HPM constructs and a medical symptom checklist. A health-promoting neighborhood intervention was performed in seven sessions for the experimental group. HCSB and HPM constructs were measured before and 3 months after intervention in the two groups. p < 0.05 was considered significant level. RESULTS The average mean age of participants was 30.45 ± 7.80 years. After intervention, the mean score of self-efficacy, interpersonal influences, commitment to plan and HCSB was increased significantly in women in the experimental group, while negative constructs such as perceived barriers, negative activity-related affect, and immediate competing demands and preferences significantly decreased (p < 0.05). In addition, the mean score of referring for symptoms such as excessive sweating, persistent fatigue or weakness, headache, bleeding or spotting between periods, vaginal itching and irritation, unusual vaginal discharge, flashing, chest pain, rapid heartbeats, aching muscles or joints, urinary problems and some mental disorder was increased significantly in experimental group compared to control group (p < 0.05). CONCLUSIONS The results of study show that an intervention based on the HPM have a positive impact on HCSB and its associated factors and can help improve women's health behaviors and health outcomes.
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Affiliation(s)
- Tahereh Rahimi
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | - Tahmineh Farajkhoda
- Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Fallahzadeh
- Center for Healthcare Data Modeling, Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Young B, Robb KA. Understanding patient factors to increase uptake of cancer screening: a review. Future Oncol 2021; 17:3757-3775. [PMID: 34378403 DOI: 10.2217/fon-2020-1078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Early detection of cancer through organized screening is a central component of population-level strategies to reduce cancer mortality. For screening programs to be effective, it is important that those invited to screening participate. However, uptake rates are suboptimal in many populations and vary between screening programs, indicating a complex combination of patient factors that require elucidation to develop evidence-based strategies to increase participation. In this review, the authors summarize individual-level (sociodemographic and psychosocial) factors associated with cancer screening uptake and evidence for the effectiveness of behavioral interventions to increase uptake. The authors reflect on current trends and future directions for behavioral cancer screening research to overcome challenges and address unmet needs in reducing cancer mortality.
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Affiliation(s)
- Ben Young
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 0XH, UK
| | - Kathryn A Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 0XH, UK
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Cluster randomized controlled trial of volitional and motivational interventions to improve bowel cancer screening uptake: A population-level study. Soc Sci Med 2020; 265:113496. [PMID: 33189426 DOI: 10.1016/j.socscimed.2020.113496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/07/2020] [Accepted: 10/30/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Colorectal cancer (CRC) is a leading cause of cancer death worldwide, although effective uptake of bowel cancer screening is below 60% in England. This trial investigated the influence of volitional and motivational interventions and their combination on increasing guaiac fecal occult blood testing (gFOBT) screening uptake. METHOD In total, 34,633 participants were recruited (via North-East of England bowel cancer screening hub) into a 2×2 factorial cluster randomized controlled trial. Social norm-based motivational intervention (SNA); Implementation intention-based Volitional Help Sheet (VHS); Combined intervention (SNA+VHS); Treatment as usual control. Screening rate (gFOBT kit return rate within 8 weeks of invitation) was the primary outcome. RESULTS Screening kits were returned by 60% of participants (N=20,847/34,633). A substantial imbalance was observed in participant characteristics, participants in the combined intervention group were younger and more likely to be first time invitees. Adjusted analyses found insufficient evidence that any of the interventions were different to control (Combined: OR = 1.18, 95% CI 0.97-1.44; SNA alone: OR=0.93; 95% CI: 0.76-1.15; VHS alone OR= 0.88; 95% CI: 0.75-1.03). Subgroup analyses demonstrated a significant beneficial effect of the combined intervention in the youngest age group compared to control (OR = 1.27; 95% CI: 1.05-1.54). CONCLUSIONS The study did not support any benefit of either VHS or SNA interventions alone on bowel cancer screening uptake. The combined SNA+VHS intervention was significantly different from control only in the youngest age group in adjusted analyses. However, the magnitude of effect in the youngest age group suggests that further testing of VHS plus SNA interventions in carefully targeted populations may be warranted.
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Lange D, Corbett J, Knoll N, Schwarzer R, Lippke S. Fruit and Vegetable Intake: the Interplay of Planning, Social Support, and Sex. Int J Behav Med 2019; 25:421-430. [PMID: 29572722 DOI: 10.1007/s12529-018-9718-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE Intention and planning are important predictors of dietary change. However, little attention has been given yet to the relationship between them as a function of other social-cognitive factors and their interplay with socio-demographics such as sex. METHODS In an observational study (1520 women, 430 men) with two measurement points in time, intention (predictor), planning (mediator), social support (first moderator), and sex (second moderator) were assessed to predict changes in diet separately for fruit and vegetable intake. RESULTS All predictors had a main effect on fruit intake but no interactions emerged. For vegetable intake, the mediation-chain was qualified by a three-way interaction: for women, the lower the perceived social support, the more the translation of planning into behavior; for men, the higher the perceived social support, the more the translation of planning into behavior. CONCLUSIONS Even though intention and planning are predictors of dietary change, they operate differently under specific conditions (level of social support), for specific subgroups (men vs. women), and for different target behaviors (fruit vs. vegetable intake). These results suggest to further examine the mechanisms by which intentions are translated into behavior via planning.
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Affiliation(s)
- Daniela Lange
- Health Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany
| | - Jana Corbett
- School of Psychological Science, Oregon State University, Corvallis, OR, 97331-5303, USA
| | - Nina Knoll
- Health Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany
| | - Ralf Schwarzer
- Health Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany.,SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Sonia Lippke
- Jacobs Center on Lifelong Learning and Institutional Development, Jacobs University Bremen, Campus Ring 1, 28759, Bremen, Germany.
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Abstract
Research on the Commonsense Self-Regulation Model has emphasised reflective/conscious perceptual processes regarding illness threat (beliefs about symptoms, consequences, timeline, and curability) in predicting and changing coping behaviours. Understanding of illness self-regulation and avenues for intervention might be enriched by consideration of automatic processes that influence the recognition and identification of illness, response to illness, and ongoing management. This article adopts an integrative approach to (1) outline the theoretical importance of implicit processes in patients' self-regulation of illness and methods to study them; (2) review research evidence for these processes, including interventions tested to modify them; and (3) outline avenues for future research. A substantial body of research on implicit processes (cognitive bias and interpretational bias) in illness maintenance in chronic illness has recently been extended to detection and interpretation of acute illness and new perspectives relating to the self-system. There is encouraging evidence that cognitive accessibility of coping and implicit attitudes may impact upon coping behaviours. Procedures that strategically automatise coping responses and create habits have considerable promise. We outline an agenda for future research in which health psychology accepts the challenge posed by the interplay of the reflective and associative systems in promoting effective self-regulation of illness.
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Affiliation(s)
- Sheina Orbell
- Department of Psychology, University of Essex, Colchester, UK
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Hamilton K, Kothe EJ, Mullan B, Spinks T. The mediating and moderating role of planning on mothers' decisions for early childhood dietary behaviours. Psychol Health 2017; 32:1518-1533. [PMID: 28728445 DOI: 10.1080/08870446.2017.1351970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Examine the roles of action and coping planning on the intention-behaviour relationship for mothers' decisions for their young children's dietary behaviours. DESIGN Prospective design with two waves of data collection, one week apart. MAIN OUTCOME MEASURES Mothers (N = 197, Mage = 34.39, SD = 5.65) of children aged 2-3 years completed a main questionnaire assessing planning constructs and intentions, and a one-week follow-up of the target behaviours - 'healthy eating' and 'discretionary choices'. RESULTS Intention was the strongest predictor of behaviour for both dietary behaviours. For healthy eating, intention moderated the indirect relationship between intention-behaviour via planning; coping planning was less important when intention was strong. Further, intention was not a direct predictor of behaviour when intention was relatively low. Action planning was not a direct predictor of either behaviour after accounting for intention and coping planning; action planning on behaviour was mediated by coping planning (only for healthy eating). Intention was not a direct predictor of coping planning; intention on coping planning was mediated by action planning. Neither type of planning predicted discretionary choices. CONCLUSION Current findings contribute novel information on the mechanisms underpinning the effect of action and coping planning on the intention-behaviour relationship.
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Affiliation(s)
- Kyra Hamilton
- a School of Applied Psychology, Menzies Health Institute Queensland, Griffith University , Brisbane , Australia.,b Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University , Perth , Australia
| | - Emily J Kothe
- c School of Psychology, Deakin University , Geelong , Australia
| | - Barbara Mullan
- b Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University , Perth , Australia.,d School of Psychology, University of Sydney , Sydney, Australia
| | - Teagan Spinks
- a School of Applied Psychology, Menzies Health Institute Queensland, Griffith University , Brisbane , Australia
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Shah SJ, Cronin P, Hong CS, Hwang AS, Ashburner JM, Bearnot BI, Richardson CA, Fosburgh BW, Kimball AB. Targeted Reminder Phone Calls to Patients at High Risk of No-Show for Primary Care Appointment: A Randomized Trial. J Gen Intern Med 2016; 31:1460-1466. [PMID: 27503436 PMCID: PMC5130951 DOI: 10.1007/s11606-016-3813-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/18/2016] [Accepted: 07/06/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND No-shows, or missed appointments, are a problem for many medical practices. They result in fragmented care and reduce access for all patients. OBJECTIVE To determine whether telephone reminder calls targeted to patients at high risk of no-show can reduce no-show rates. DESIGN Single-center randomized controlled trial. PARTICIPANTS A total of 2247 primary care patients in a hospital-based primary care clinic at high risk of no-show (>15 % risk) for their appointment in 7 days. INTERVENTION Seven days prior to their appointment, intervention arm patients were placed in a calling queue to receive a reminder phone call from a patient service coordinator. Coordinators were trained to engage patients in concrete planning. All patients received an automated phone call (usual care). MAIN MEASURES Primary outcome was no-show rate. Secondary outcomes included arrival rate, cancellation rate, reschedule rate, time to cancellation, and change in revenue. KEY RESULTS The no-show rate in the intervention arm (22.8 %) was significantly lower (absolute risk difference -6.4 %, p < 0.01, 95 % CI [-9.8 to -3.0 %]) than that in the control arm (29.2 %). Arrival, cancellation, and reschedule rates did not differ significantly. In the intervention arm, rescheduling and cancellations occurred further in advance of the appointment (mean difference, 0.35 days; 95 % CI [0.07-0.64]; p = 0.01). Reimbursement did not differ significantly. CONCLUSIONS A phone call 7 days prior to an appointment led to a significant reduction in no-shows and increased reimbursement among patients at high risk of no-show. The use of targeted interventions may be of interest to practices taking on increased accountability for population health.
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Affiliation(s)
- Sachin J Shah
- Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. .,Massachusetts General Physicians Organization, Massachusetts General Hospital, 50 Staniford Street (940-J), Boston, MA, 02114, USA.
| | - Patrick Cronin
- Department of Medicine, Lab of Computer Science, Massachusetts General Hospital, Boston, MA, USA
| | - Clemens S Hong
- Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Andrew S Hwang
- Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jeffrey M Ashburner
- Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Benjamin I Bearnot
- Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Calvin A Richardson
- Massachusetts General Physicians Organization, Massachusetts General Hospital, 50 Staniford Street (940-J), Boston, MA, 02114, USA
| | - Blair W Fosburgh
- Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexandra B Kimball
- Massachusetts General Physicians Organization, Massachusetts General Hospital, 50 Staniford Street (940-J), Boston, MA, 02114, USA.,Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Farmer AJ, Oke J, Hardeman W, Tucker L, Sutton S, Kinmonth AL, Griffin S, Holman RR. The effect of a brief action planning intervention on adherence to double-blind study medication, compared to a standard trial protocol, in the Atorvastatin in Factorial with Omega EE90 Risk Reduction in Diabetes (AFORRD) clinical trial: A cluster randomised sub-study. Diabetes Res Clin Pract 2016; 120:56-64. [PMID: 27522034 PMCID: PMC6078174 DOI: 10.1016/j.diabres.2016.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/14/2016] [Accepted: 07/16/2016] [Indexed: 11/25/2022]
Abstract
AIMS Clinical trial patients are highly motivated but may encounter difficulty in taking study medication regularly when treatment burden is substantial. We assessed a brief behavioural intervention, given in addition to a standard trial protocol. METHODS We performed a two-arm adherence sub-study within a twelve-month randomised controlled drug trial evaluating the impact of statin and/or omega-3 EE90 treatment in 800 patients with type 2 diabetes. Fifty-nine United Kingdom general practices were cluster-randomised to action-planning or control groups. The former delivered an initial written exercise prompting participants to formulate action-plans to take study medication regularly, with brief nurse encouragement to use action-plans at later visits, whilst the latter followed the standard trial protocol. The primary outcome was proportion of days on which study medication were taken as intended measured by electronic medication containers. RESULTS Adjusted mean (95% CI) proportion of days with medication taken as intended was 79.3% (76.3-82.3%)for the 30 action-planning practices (321 participants), compared with 78.5% (75.8-81.1%) for 27 control group practices (426 participants, with a mean intervention effect of 0.9%, 95% CI -3.1% to +4.9%, p=0.67). Adjusted odds ratios for ⩾80% trial medication adherence for action-planning compared with control practices were 1.29 (0.90-1.84) and 1.38 (0.96-1.99) respectively. CONCLUSIONS Low-intensity action-planning interventions used alone are unlikely to have a clinically important impact on medication adherence, particularly in a clinical trial setting. These findings, do not exclude their contribution, as part of a multifactorial intervention, to improving treatment adherence. ISRCTN number 76737502.
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Affiliation(s)
- Andrew J Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Wendy Hardeman
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Lynne Tucker
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Stephen Sutton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ann-Louise Kinmonth
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Rury R Holman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
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Farhadifar F, Molina Y, Taymoori P, Akhavan S. Mediators of repeat mammography in two tailored interventions for Iranian women. BMC Public Health 2016; 16:149. [PMID: 26874508 PMCID: PMC4752754 DOI: 10.1186/s12889-016-2808-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 02/01/2016] [Indexed: 12/29/2022] Open
Abstract
Background Many theory-based interventions exist that incorporate theoretical constructs (e.g., self-efficacy, behavioral control) believed to increase the likelihood of mammography. Nonetheless, little work to date has examined if increased screening among women receiving such interventions occurs due to changes in these targeted constructs. The aim of this study is to address this gap in the literature in the context of two interventions for improving regular screening among Iranian women. Methods A sample of 176 women over 50 years old in Tehran, Iran were randomly allocated into one of these three conditions: 1) an intervention based on Health Belief Model (HBM); 2) an intervention based on an integration of the HBM and selected constructs from the TPB (TPB); and 3) a control group (CON). Questionnaires were administered before the intervention and after a 6-month follow-up. The Preacher and Hayes method of mediation was used in analytic models. Results Changes in susceptibility, self-efficacy, and perceived control appeared to mediate HBM-CON differences in screening. Barriers attenuated the mediating effect of self-efficacy. Changes in barriers and self-efficacy appeared to mediate TPB-CON differences in screening. Conclusion This study was successful in identifying which theory-based constructs appear to underlie the effectiveness of HBM- and TPB-based interventions. Specific constructs have been identified that should be targeted in clinical practice to increase mammography practices among Iranian women.
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Affiliation(s)
- Fariba Farhadifar
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Yamile Molina
- Community Health Sciences, School Of Public Health, University of Illinois-Chicago, Chicago, USA
| | - Parvaneh Taymoori
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Setareh Akhavan
- Tehran University of Medical Sciences, Imam Khomini Complex Hospital, Valiasr Hospital, Gynecology Oncology Ward, Tehran, Iran
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Compton J, Jackson B, Dimmock JA. Persuading Others to Avoid Persuasion: Inoculation Theory and Resistant Health Attitudes. Front Psychol 2016; 7:122. [PMID: 26903925 PMCID: PMC4746429 DOI: 10.3389/fpsyg.2016.00122] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/22/2016] [Indexed: 11/13/2022] Open
Abstract
Inoculation theory, a theory of conferring resistance to persuasive influence, has established efficacy as a messaging strategy in the health domain. In fact, the earliest research on the theory in the 1960s involved health issues to build empirical support for tenets in the inoculation framework. Over the ensuing decades, scholars have further examined the effectiveness of inoculation-based messages at creating robust positive health attitudes. We overview these efforts, highlight the structure of typical inoculation-based health messages, and describe the similarities and differences between this method of counter-persuasion and other preparatory techniques commonly employed by health researchers and practitioners. Finally, we consider contexts in which inoculation-oriented health messages could be most useful, and describe how the health domain could offer a useful scaffold to study conceptual issues of the theory.
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Affiliation(s)
- Josh Compton
- Institute for Writing and Rhetoric, Dartmouth College Hanover, NH, USA
| | - Ben Jackson
- School of Sport Science, Exercise and Health, The University of Western Australia Perth, WA, Australia
| | - James A Dimmock
- School of Sport Science, Exercise and Health, The University of Western Australia Perth, WA, Australia
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13
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Molina Y, Ornelas IJ, Doty SL, Bishop S, Beresford SAA, Coronado GD. Family/friend recommendations and mammography intentions: the roles of perceived mammography norms and support. HEALTH EDUCATION RESEARCH 2015; 30:797-809. [PMID: 26324395 PMCID: PMC4654755 DOI: 10.1093/her/cyv040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 08/06/2015] [Indexed: 05/07/2023]
Abstract
Identifying factors that increase mammography use among Latinas is an important public health priority. Latinas are more likely to report mammography intentions and use, if a family member or friend recommends that they get a mammogram. Little is known about the mechanisms underlying the relationship between social interactions and mammography intentions. Theory suggests that family/friend recommendations increase perceived mammography norms (others believe a woman should obtain a mammogram) and support (others will help her obtain a mammogram), which in turn increase mammography intentions and use. We tested these hypotheses with data from the ¡Fortaleza Latina! study, a randomized controlled trial including 539 Latinas in Washington State. Women whose family/friend recommended they get a mammogram within the last year were more likely to report mammography intentions, norms and support. Perceived mammography norms mediated the relationship between family/friend recommendations and intentions, Mediated Effect = 0.38, 95%CI [0.20, 0.61], but not support, Mediated Effect = 0.002, 95%CI [-0.07, 0.07]. Our findings suggest perceived mammography norms are a potential mechanism underlying the effect of family/friend recommendations on mammography use among Latinas. Our findings make an important contribution to theory about the associations of social interactions, perceptions and health behaviors.
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Affiliation(s)
- Yamile Molina
- Community Health Sciences Division, University of Illinois-Chicago, Chicago, IL 60607, USA, Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA,
| | - India J Ornelas
- Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA, Department of Health Services, University of Washington, Seattle, WA 98122, USA
| | - Sarah L Doty
- Sea Mar community Health Centers, Seattle, WA 98108, USA
| | - Sonia Bishop
- Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Shirley A A Beresford
- Sea Mar community Health Centers, Seattle, WA 98108, USA, Department of Epidemiology, University of Washington, Seattle, WA 98122, USA and
| | - Gloria D Coronado
- Kaiser Permanente Research Center for Health Research, Portland, OR 97227, USA
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O'Brien N, Philpott-Morgan S, Dixon D. Using impairment and cognitions to predict walking in osteoarthritis: A series of n-of-1 studies with an individually tailored, data-driven intervention. Br J Health Psychol 2015; 21:52-70. [PMID: 26227024 DOI: 10.1111/bjhp.12153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 06/26/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVES First, this study compares the ability of an integrated model of activity and activity limitations, the International Classification of Functioning, Disability and Health (ICF), and the Theory of Planned Behaviour (TPB) to predict walking within individuals with osteoarthritis. Second, the effectiveness of a walking intervention in these individuals is determined. DESIGN A series of n-of-1 studies with an AB intervention design was used. METHODS Diary methods were used to study four community-dwelling individuals with lower-limb osteoarthritis. Data on impairment symptoms (pain, pain on movement, and joint stiffness), cognitions (intention, self-efficacy, and perceived controllability), and walking (step count) were collected twice daily for 12 weeks. At 6 weeks, an individually tailored, data-driven walking intervention using action planning or a control cognition manipulation was delivered. Simulation modelling analysis examined cross-correlations and differences in baseline and intervention phase means. Post-hoc mediation analyses examined theoretical relationships and multiple regression analyses compared theoretical models. RESULTS Cognitions, intention in particular, were better and more consistent within individual predictors of walking than impairment. The walking intervention did not increase walking in any of the three participants receiving it. The integrated model and the TPB, which recognize a predictive role for cognitions, were significant predictors of walking variance in all participants, whilst the biomedical ICF model was only predictive for one participant. CONCLUSION Despite the lack of evidence for an individually tailored walking intervention, predictive data suggest that interventions for people with osteoarthritis that address cognitions are likely to be more effective than those that address impairment only. Further within-individual investigation, including testing mediational relationships, is warranted. STATEMENT OF CONTRIBUTION What is already known on this subject? N-of-1 methods have been used to study within-individual predictors of walking in healthy and chronic pain populations An integrated biomedical and behavioural model of activity and activity limitations recognizes the roles of impairment and psychology (cognitions) Interventions modifying cognitions can increase physical activity in people with mobility limitations What does this study add? N-of-1 methods are suitable to study within-individual predictors of walking and interventions in osteoarthritis An integrated and a psychological model are better predictors of walking in osteoarthritis than a biomedical model There was no support for an individually tailored, data-driven walking intervention.
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Affiliation(s)
- Nicola O'Brien
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Siôn Philpott-Morgan
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Diane Dixon
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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15
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Adams SA, Choi SK, Eberth JM, Friedman DB, Yip MP, Tucker-Seeley RD, Wigfall LT, Hébert JR. Is Availability of Mammography Services at Federally Qualified Health Centers Associated with Breast Cancer Mortality-to-Incidence Ratios? An Ecological Analysis. J Womens Health (Larchmt) 2015. [PMID: 26208105 DOI: 10.1089/jwh.2014.5114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Mammography is the most effective method to detect breast cancer in its earliest stages, reducing the risk of breast cancer death. We investigated the relationship between accessibility of mammography services at Federally Qualified Health Centers (FQHCs) and mortality-to-incidence ratio (MIR) of breast cancer in each county in the United States. METHODS County-level breast cancer mortality and incidence rates in 2006-2010 were used to estimate MIRs. We compared breast cancer MIRs based on the density and availability of FQHC delivery sites with or without mammography services both in the county and in the neighboring counties. RESULTS The relationship between breast cancer MIRs and access to mammography services at FQHCs differed by race and county of residence. Breast cancer MIRs were lower in counties with mammography facilities or FQHC delivery sites than in counties without a mammography facility or FQHC delivery site. This trend was stronger in urban counties (p=0.01) and among whites (p=0.008). Counties with a high density of mammography facilities had lower breast cancer MIRs than other counties, specifically in urban counties (p=0.01) and among whites (p=0.01). Breast cancer MIR for blacks was the lowest in counties having mammography facilities; and was highest in counties without a mammography facility within the county or the neighboring counties (p=0.03). CONCLUSIONS Mammography services provided at FQHCs may have a positive impact on breast cancer MIRs. Expansion of services provided at the FQHCs and placement of FQHCs in additional underserved areas might help to reduce cancer disparities in the United States.
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Affiliation(s)
- Swann Arp Adams
- 1 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.,2 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.,3 College of Nursing, University of South Carolina , Columbia, South Carolina
| | - Seul Ki Choi
- 1 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.,4 Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
| | - Jan M Eberth
- 1 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.,2 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
| | - Daniela B Friedman
- 1 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.,4 Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
| | - Mei Po Yip
- 5 Division of General Internal Medicine, University of Washington , Seattle, Washington
| | - Reginald D Tucker-Seeley
- 6 Center for Community Based Research, Dana-Farber Cancer Institute , Boston, Massachusetts.,7 Department of Social and Behavioral Sciences, Harvard School of Public Health , Boston, Massachusetts
| | - Lisa T Wigfall
- 8 Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
| | - James R Hébert
- 1 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.,2 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
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Dehdari T, Hassani L, Hajizadeh E, Shojaeizadeh D, Nedjat S, Abedini M. Effects of an educational intervention based on the protection motivation theory and implementation intentions on first and second pap test practice in Iran. Asian Pac J Cancer Prev 2015; 15:7257-61. [PMID: 25227824 DOI: 10.7314/apjcp.2014.15.17.7257] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few Iranian women take the Papanicolaou test despite its important role in preventing cervical cancer. This study aimed to determine the effectiveness of an educational intervention based on the protection motivation theory (PMT) variables and implementation intentions in the first and second Pap test practice among Iranian women. MATERIALS AND METHODS In this quasi-randomized controlled trial, 200 women who were referred to 30 primary health care clinics in Tehran were randomly selected. PMT variables and Pap test practice were measured at baseline and again after 3 and 15 months. The 4-week educational intervention program was conducted for the intervention group. RESULTS Following the intervention, the mean scores of self-efficacy, perceived vulnerability, and behavior intention variables were significantly higher in the intervention group when compared to the control group (p<0.05). No significant differences were found in the perceived severity, response efficacy, response cost, and fear between the two groups following the intervention. Higher percent of women in the intervention group had obtained first and second Pap test compared to the controls. CONCLUSIONS The PMT and implementation intentions provide a suitable theory-based framework for developing educational interventions regarding Pap test practice in Iran.
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Affiliation(s)
- Tahereh Dehdari
- Department of Health Education and Health Promotion, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran E-mail :
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17
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Brewster SE, Elliott MA, Kelly SW. Evidence that implementation intentions reduce drivers' speeding behavior: testing a new intervention to change driver behavior. ACCIDENT; ANALYSIS AND PREVENTION 2015; 74:229-242. [PMID: 25463964 DOI: 10.1016/j.aap.2014.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 11/03/2014] [Accepted: 11/05/2014] [Indexed: 06/04/2023]
Abstract
Implementation intentions have the potential to break unwanted habits and help individuals behave in line with their goal intentions. We tested the effects of implementation intentions in the context of drivers' speeding behavior. A randomized controlled design was used. Speeding behavior, goal intentions and theoretically derived motivational pre-cursors of goal intentions were measured at both baseline and follow-up (one month later) using self-report questionnaires. Immediately following the baseline questionnaire, the experimental (intervention) group (N=117) specified implementation intentions using a volitional help sheet, which required the participants to link critical situations in which they were tempted to speed with goal-directed responses to resist the temptation. The control group (N=126) instead received general information about the risks of speeding. In support of the hypotheses, the experimental group reported exceeding the speed limit significantly less often at follow-up than did the control group. This effect was specific to 'inclined abstainers' (i.e., participants who reported speeding more than they intended to at baseline and were therefore motivated to reduce their speeding) and could not be attributed to any changes in goal intentions to speed or any other measured motivational construct. Also in line with the hypotheses, implementation intentions attenuated the past-subsequent speeding behavior relationship and augmented the goal intention - subsequent speeding behavior relationship. The findings imply that implementation intentions are effective at reducing speeding and that they do so by weakening the effect of habit, thereby helping drivers to behave in accordance with their existing goal intentions. The volitional help sheet used in this study is an effective tool for promoting implementation intentions to reduce speeding.
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Affiliation(s)
- Sarah E Brewster
- School of Psychological Sciences and Health, University of Strathclyde, UK.
| | - Mark A Elliott
- School of Psychological Sciences and Health, University of Strathclyde, UK
| | - Steve W Kelly
- School of Psychological Sciences and Health, University of Strathclyde, UK
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18
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Greiner KA, Daley CM, Epp A, James A, Yeh HW, Geana M, Born W, Engelman KK, Shellhorn J, Hester CM, LeMaster J, Buckles DC, Ellerbeck EF. Implementation intentions and colorectal screening: a randomized trial in safety-net clinics. Am J Prev Med 2014; 47:703-14. [PMID: 25455115 PMCID: PMC4311575 DOI: 10.1016/j.amepre.2014.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 07/08/2014] [Accepted: 08/05/2014] [Indexed: 02/06/2023]
Abstract
CONTEXT Low-income and racial/ethnic minority populations experience disproportionate colorectal cancer (CRC) burden and poorer survival. Novel behavioral strategies are needed to improve screening rates in these groups. BACKGROUND The study aimed to test a theoretically based "implementation intentions" intervention for improving CRC screening among unscreened adults in urban safety-net clinics. DESIGN Randomized controlled trial. SETTING/PARTICIPANTS Adults (N=470) aged ≥50 years, due for CRC screening, from urban safety-net clinics were recruited. INTERVENTION The intervention (conducted in 2009-2011) was delivered via touchscreen computers that tailored informational messages to decisional stage and screening barriers. The computer then randomized participants to generic health information on diet and exercise (Comparison group) or "implementation intentions" questions and planning (Experimental group) specific to the CRC screening test chosen (fecal immunochemical test or colonoscopy). MAIN OUTCOME MEASURES The primary study outcome was completion of CRC screening at 26 weeks based on test reports (analysis conducted in 2012-2013). RESULTS The study population had a mean age of 57 years and was 42% non-Hispanic African American, 28% non-Hispanic white, and 27% Hispanic. Those receiving the implementation intentions-based intervention had higher odds (AOR=1.83, 95% CI=1.23, 2.73) of completing CRC screening than the Comparison group. Those with higher self-efficacy for screening (AOR=1.57, 95% CI=1.03, 2.39), history of asthma (AOR=2.20, 95% CI=1.26, 3.84), no history of diabetes (AOR=1.86, 95% CI=1.21, 2.86), and reporting they had never heard that "cutting on cancer" makes it spread (AOR=1.78, 95% CI=1.16, 2.72) were more likely to complete CRC screening. CONCLUSIONS The results of this study suggest that programs incorporating an implementation intentions approach can contribute to successful completion of CRC screening even among very low-income and diverse primary care populations. Future initiatives to reduce CRC incidence and mortality disparities may be able to employ implementation intentions in large-scale efforts to encourage screening and prevention behaviors.
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Affiliation(s)
- K Allen Greiner
- Department of Family Medicine; University of Kansas Cancer Center.
| | - Christine M Daley
- Department of Family Medicine; Center for American Indian Community Health; Department of Preventive Medicine; University of Kansas Cancer Center
| | | | - Aimee James
- Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Hung-Wen Yeh
- Department of Biostatistics; University of Kansas Cancer Center
| | - Mugur Geana
- Department of Family Medicine; University of Kansas Cancer Center; Center of Excellence for Health Communications to Underserved Populations, William Allen White School of Journalism and Mass Communications
| | | | | | - Jeremy Shellhorn
- School of Architecture Design and Planning, University of Kansas, Kansas City, Kansas
| | | | | | - Daniel C Buckles
- Department of Internal Medicine, University of Kansas Medical Center
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Tapper K, Jiga-Boy G, Maio GR, Haddock G, Lewis M. Development and preliminary evaluation of an internet-based healthy eating program: randomized controlled trial. J Med Internet Res 2014; 16:e231. [PMID: 25305376 PMCID: PMC4210956 DOI: 10.2196/jmir.3534] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/11/2014] [Accepted: 08/16/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The HealthValues Healthy Eating Programme is a standalone Internet-based intervention that employs a novel strategy for promoting behavior change (analyzing one's reasons for endorsing health values) alongside other psychological principles that have been shown to influence behavior. The program consists of phases targeting motivation (dietary feedback and advice, analyzing reasons for health values, thinking about health-related desires, and concerns), volition (implementation intentions with mental contrasting), and maintenance (reviewing tasks, weekly tips). OBJECTIVE The aim was to examine the effects of the program on consumption of fruit and vegetables, saturated fat, and added sugar over a 6-month period. METHODS A total of 82 females and 18 males were recruited using both online and print advertisements in the local community. They were allocated to an intervention or control group using a stratified block randomization protocol. The program was designed such that participants logged onto a website every week for 24 weeks and completed health-related measures. Those allocated to the intervention group also completed the intervention tasks at these sessions. Additionally, all participants attended laboratory sessions at baseline, 3 months, and 6 months. During these sessions, participants completed a food frequency questionnaire (FFQ, the Block Fat/Sugar/Fruit/Vegetable Screener, adapted for the UK), and researchers (blind to group allocation) measured their body mass index (BMI), waist-to-hip ratio (WHR), and heart rate variability (HRV). RESULTS Data were analyzed using a series of ANOVA models. Per protocol analysis (n=92) showed a significant interaction for fruit and vegetable consumption (P=.048); the intervention group increased their intake between baseline and 6 months (3.7 to 4.1 cups) relative to the control group (3.6 to 3.4 cups). Results also showed overall reductions in saturated fat intake (20.2 to 15.6 g, P<.001) and added sugar intake (44.6 to 33.9 g, P<.001) during this period, but there were no interactions with group. Similarly, there were overall reductions in BMI (27.7 to 27.3 kg/m(2), P=.001) and WHR (0.82 to 0.81, P=.009), but no interactions with group. The intervention did not affect alcohol consumption, physical activity, smoking, or HRV. Data collected during the online sessions suggested that the changes in fruit and vegetable consumption were driven by the motivational and maintenance phases of the program. CONCLUSIONS Results suggest that the program helped individuals to increase their consumption of fruit and vegetables and to sustain this over a 6-month period. The observed reduction in fat and sugar intake suggests that monitoring behaviors over time is effective, although further research is needed to confirm this conclusion. The Web-based nature of the program makes it a potentially cost-effective way of promoting healthy eating.
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Affiliation(s)
- Katy Tapper
- Department of Psychology, City University London, London, United Kingdom.
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20
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Abstract
The premise of this article is that an understanding of psychology and other social science disciplines can inform the effectiveness of the economic tools traditionally deployed in carrying out the functions of government, which include remedying market failures, redistributing income, and collecting tax revenue. An understanding of psychology can also lead to the development of different policy tools that better motivate desired behavior change or that are more cost-effective than traditional policy tools. The article outlines a framework for thinking about the psychology of behavior change in the context of market failures. It then describes the research on the effects of a variety of interventions rooted in an understanding of psychology that have policy-relevant applications. The article concludes by discussing how an understanding of psychology can also inform the use and design of traditional policy tools for behavior change, such as financial incentives.
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22
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From the bench to public health: population-level implementation intentions in colorectal cancer screening. Am J Prev Med 2014; 46:273-80. [PMID: 24512866 DOI: 10.1016/j.amepre.2013.11.008] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 10/28/2013] [Accepted: 11/18/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Early detection of colorectal cancer (CRC) using fecal occult blood test (FOBT) reduces mortality, yet screening adherence remains low. PURPOSE Enhancing FOBT adherence in a field experiment, using Implementation Intentions (II) technique. DESIGN Participants were randomly assigned to a standard care group or to II experimental group. SETTING/PARTICIPANTS A test kit was mailed to 29,833 HMO-insured members in two waves in 2011. INCLUSION CRITERIA eligible persons aged 50-74 who underwent the test the year before. A sample of 2200 participants was interviewed over the telephone for possible cognitive and background moderators. INTERVENTION Leaflet attached to the test kit containing an "if-then" condition and planning instructions of when, where, and how. MAIN OUTCOME MEASURE Test performance at 2 and 6 months following mailing of the test kit, retrieved from HMO's computerized database (2011-2012). RESULTS Adherence in the experimental group ranged 1.2%-6.6% higher than in the control group. Within 6 months of kits' mailing, test uptake for the two waves was 71.4% and 67.9% for experiment and control, respectively (χ(2)=40.58, p=0.0001). The difference remained significant after controlling for age, gender, marital status, and wave (OR=1.17, 95% CI=1.11, 1.23, p<0.0001). Test performance was related to cognitive and background variables. No interaction was found among cognitive or background variables and the intervention. CONCLUSIONS II technique is useful in increasing adherence to CRC screening, even in a mailed form rather than a face-to-face experimental situation. Mailed II is an inexpensive and effective method, applicable for public health.
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Prestwich A, Kellar I. How can the impact of implementation intentions as a behaviour change intervention be improved? EUROPEAN REVIEW OF APPLIED PSYCHOLOGY-REVUE EUROPEENNE DE PSYCHOLOGIE APPLIQUEE 2014. [DOI: 10.1016/j.erap.2010.03.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Allan JL, Sniehotta FF, Johnston M. The best laid plans: planning skill determines the effectiveness of action plans and implementation intentions. Ann Behav Med 2013; 46:114-20. [PMID: 23456214 DOI: 10.1007/s12160-013-9483-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Theories of action control emphasise the importance of planning, but plans are not universally beneficial. PURPOSE The present study investigates whether the effectiveness of plans depends upon the skill of the planner. METHODS Study 1 prospectively predicted changes in unhealthy snacking behaviour over 1 week from intentions, action planning and performance on a standardised cognitive test of planning skill (n = 72). Study 2 experimentally randomised skilled and poor planners to receive (or not) a planning intervention before completing an online food diary (n = 144) RESULTS: Spontaneously generated action plans about snacking explained significantly more variance in subsequent snacking if produced by a skilled rather than a poor planner. The planning intervention (implementation intention) significantly improved goal attainment but only in poor planners. CONCLUSIONS Plans are only as good as the people who make them. Poor planners' plans do not help achieve goals. Planning interventions can compensate for a lack of planning skill.
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Affiliation(s)
- Julia L Allan
- Health Psychology, Institute of Applied Health Sciences, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
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Hagger MS, Luszczynska A. Implementation intention and action planning interventions in health contexts: state of the research and proposals for the way forward. Appl Psychol Health Well Being 2013; 6:1-47. [PMID: 24591064 DOI: 10.1111/aphw.12017] [Citation(s) in RCA: 256] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The purpose of this paper is to provide an overview of the literature on two planning intervention techniques in health behaviour research, implementation intentions and action planning, and to develop evidence-based recommendations for effective future interventions and highlight priority areas for future research. We focused our review on four key areas: (1) definition and conceptualisation; (2) format and measurement; (3) mechanisms and processes; and (4) design issues. Overall, evidence supports the effectiveness of planning interventions in health behaviour with advantages including low cost and response burden. There is, however, considerable heterogeneity in the effects across studies and relatively few registered randomised trials that include objective behavioural measures. Optimally effective planning interventions should adopt "if-then" plans, account for salient and relevant cues, include examples of cues, be guided rather than user-defined, and include boosters. Future studies should adopt randomised controlled designs, report study protocols, include fidelity checks and relevant comparison groups, and adopt long-term behavioural follow-up measures. Priority areas for future research include the identification of the moderators and mediators of planning intervention effects. Future research also needs to adopt "best practice" components of planning interventions more consistently to elucidate the mechanisms and processes involved.
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Scholz U, Ochsner S, Luszczynska A. Comparing different boosters of planning interventions on changes in fat consumption in overweight and obese individuals: A randomized controlled trial. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2013; 48:604-15. [DOI: 10.1080/00207594.2012.661061] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ahmadian M, Samah AA. Application of Health Behavior Theories to Breast Cancer Screening among Asian Women. Asian Pac J Cancer Prev 2013; 14:4005-13. [DOI: 10.7314/apjcp.2013.14.7.4005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Offman J, Wilson M, Lamont M, Birke H, Kutt E, Marriage S, Loughrey Y, Hudson S, Hartley A, Smith J, Eckersley B, Dungey F, Parmar D, Patnick J, Duffy SW. A randomised trial of weekend and evening breast screening appointments. Br J Cancer 2013; 109:597-602. [PMID: 23867998 PMCID: PMC3738129 DOI: 10.1038/bjc.2013.377] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/19/2013] [Accepted: 06/22/2013] [Indexed: 12/04/2022] Open
Abstract
Background: There is a need to research interventions that improve access to and convenience of breast cancer screening services. Methods: We conducted a randomised trial comparing invitations to out-of-hours appointments with standard office hour appointments. Women who were to be invited for routine breast screening were randomised (3 : 1 : 1 : 1) to one of these screening invitations: standard office hour appointment, office hour appointment with the option to change to an out-of-hours appointment, weekday evening appointment, or weekend appointment. Results: A total of 9410 women were invited to an office hour, 3519 to an office hour with the option to change, 3271 to a weekday evening, and 3162 to a weekend appointment. The offer of an initial out-of-hours appointment was associated with a non-significant decrease in attendance rates (73.7% vs 74.1%). The highest attendance was observed in the group offered an initial office hour appointment with the option to change to out-of-hours (76.1% vs 73.3% for standard office hour, P=0.001), with 7% of invitees exercising the option to change. Conclusion: The optimum strategy for improving attendance at breast screening is to offer a traditional office hour appointment and including in the letter of invitation an option to change to an evening or weekend appointment if wished.
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Affiliation(s)
- J Offman
- Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London EC1M 6BQ, UK
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Hirai K, Harada K, Seki A, Nagatsuka M, Arai H, Hazama A, Ishikawa Y, Hamashima C, Saito H, Shibuya D. Structural equation modeling for implementation intentions, cancer worry, and stages of mammography adoption. Psychooncology 2013; 22:2339-46. [PMID: 23661593 DOI: 10.1002/pon.3293] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 03/13/2013] [Accepted: 03/24/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study aimed to develop a structural model for mammography adoption in Japanese middle-aged women by using constructs from the transtheoretical model (TTM), the theory of planned behavior (TPB), implementation intentions, and cancer worry. METHODS Questionnaires based on items including TTM, TPB, implementation intentions, cancer worry-related variables, and demographic variables were distributed to 1000 adult women aged 40 to 59 years, with 641 subjects being used in the final analysis (response rate = 64.1%). RESULTS Regarding the stage of adoption, 79 participants (12.3%) were at the precontemplation stage, 30 (4.7%) were at the relapse stage, 142 (22.2%) were at the contemplation stage, 88 (13.7%) were at the action stage, and 302 (47.1%) were at the maintenance stage. Our model, derived from structural equation modeling, revealed that the stage of mammography adoption was significantly affected by goal intentions, implementation intentions, perceived barriers, history of breast cancer screening, and relative risk. A logistic regression analysis revealed that goal intentions and implementation intentions significantly predicted mammography uptake within 1 year. CONCLUSION This study developed an integrated model constructed from TTM, TPB, implementation intentions, and cancer worry to account for mammography adoption in Japan, and also confirmed the predictive validity of the model.
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Affiliation(s)
- Kei Hirai
- Department of Complementary and Alternative Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuhiro Harada
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan.,Japan Society for the Promotion of Sciences, Chiyoda-ku, Tokyo, Japan
| | - Aiko Seki
- Graduate School of Human Sciences, Osaka University, Japan, Suita, Osaka, Japan
| | - Miwa Nagatsuka
- National Hospital Organization Osaka Medical Center, Tyuo-ku, Osaka, Japan
| | - Hirokazu Arai
- Department of Psychology, Faculty of Letters, Hosei University, Chiyoda-ku, Tokyo, Japan
| | - Ayako Hazama
- Public Health Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yoshiki Ishikawa
- Department of Public Health, Jichi Medical School, Shimono City, Tochigi, Japan
| | - Chisato Hamashima
- Screening Assessment and Management Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Hiroshi Saito
- Screening Assessment and Management Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Daisuke Shibuya
- Cancer Detection Center, Miyagi Cancer Society, Sendai, Miyagi, Japan
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The role of action planning and plan enactment for smoking cessation. BMC Public Health 2013; 13:393. [PMID: 23622256 PMCID: PMC3644281 DOI: 10.1186/1471-2458-13-393] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 04/12/2013] [Indexed: 11/13/2022] Open
Abstract
Background Several studies have reemphasized the role of action planning. Yet, little attention has been paid to the role of plan enactment. This study assesses the determinants and the effects of action planning and plan enactment on smoking cessation. Methods One thousand and five participants completed questionnaires at baseline and at follow-ups after one and six months. Factors queried were part of the I-Change model. Descriptive analyses were used to assess which plans were enacted the most. Multivariate linear regression analyses were used to assess whether the intention to quit smoking predicted action planning and plan enactment, and to assess which factors would predict quitting behavior. Subsequently, both multivariate and univariate regression analyses were used to assess which particular action plans would be most effective in predicting quitting behavior. Similar analyses were performed among a subsample of smokers prepared to quit within one month. Results Smokers who intended to quit smoking within the next month had higher levels of action planning than those intending to quit within a year. Additional predictors of action planning were being older, being female, having relatively low levels of cigarette dependence, perceiving more positive and negative consequences of quitting, and having high self-efficacy toward quitting. Plan enactment was predicted by baseline intention to quit and levels of action planning. Regression analysis revealed that smoking cessation after six months was predicted by low levels of depression, having a non-smoking partner, the intention to quit within the next month, and plan enactment. Only 29% of the smokers who executed relatively few plans had quit smoking versus 59% of the smokers who executed many plans. The most effective preparatory plans for smoking cessation were removing all tobacco products from the house and choosing a specific date to quit. Conclusion Making preparatory plans to quit smoking is important because it also predicts plan enactment, which is predictive of smoking cessation. Not all action plans were found to be predictive of smoking cessation. The effects of planning were not very much different between the total sample and smokers prepared to quit within one month.
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Kwasnicka D, Presseau J, White M, Sniehotta FF. Does planning how to cope with anticipated barriers facilitate health-related behaviour change? A systematic review. Health Psychol Rev 2013. [DOI: 10.1080/17437199.2013.766832] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Dominika Kwasnicka
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK and Fuse, UKCRC Centre for Translational Research in Public Health, UK
| | - Justin Presseau
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK and Fuse, UKCRC Centre for Translational Research in Public Health, UK
| | - Martin White
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK and Fuse, UKCRC Centre for Translational Research in Public Health, UK
| | - Falko F. Sniehotta
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK and Fuse, UKCRC Centre for Translational Research in Public Health, UK
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Edmonds JK, Paul M, Sibley L. Determinants of place of birth decisions in uncomplicated childbirth in Bangladesh: an empirical study. Midwifery 2012; 28:554-60. [PMID: 22884893 PMCID: PMC3472154 DOI: 10.1016/j.midw.2011.12.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 11/03/2011] [Accepted: 12/15/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE to test the predictive value of women's self-identified criteria in place of birth decisions in the event of uncomplicated childbirth in a setting where facility based skilled birth attendants are available. DESIGN a retrospective, cross-sectional study was conducted in two phases. The first phase used data from in-depth interviews. The second phase used data from semi-structured questionnaires. SETTING the service area of Matlab, Bangladesh. PARTICIPANTS women 18-49 years who had an uncomplicated pregnancy and delivery resulting in a live birth. FINDINGS a women's intention about where to deliver during pregnancy, her perception of labour progress, the availability of transportation at the time of labour, and the close proximity of a dai to the household were independent predictors of facility-based SBA use. Marital age was also significant predictor of use. KEY CONCLUSIONS the availability of delivery services does not guarantee use and instead specific considerations and conditions during pregnancy and in and around the time of birth influence the preventive health seeking behaviour of women during childbirth. Our findings have implications for birth preparedness and complication readiness initiatives that aim to strengthen timely use of SBAs for all births. Demand side strategies to reduce barriers to health seeking, as part of an overall health system strengthening approach, are needed to meet the Millennium Development 5 goal.
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Affiliation(s)
- Joyce K. Edmonds
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA. 100 Morrissey Blvd (Science 301-13) Boston, MA 02125, Office: 617-287-7510 Cell: 678-429-7641
| | - Moni Paul
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (ICDDR,B). Public Health Sciences Division, ICDDR,B, GPO Box 128, Dhaka 1000, Bangladesh,
| | - Lynn Sibley
- Nell Hodgson Woodruff School of Nursing, Department of Family and Community Nursing Rollins School of Public Health, Hubert Department of Global Health Emory University. 1520 Clifton Road NE, Room 436 Atlanta, Georgia 30322 USA, Office: 404-712-8428
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Browne† J, Chan A. Using the Theory of Planned Behaviour and implementation intentions to predict and facilitate upward family communication about mammography. Psychol Health 2011; 27:655-73. [DOI: 10.1080/08870446.2011.615396] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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The contribution of behavioural science to primary care research: development and evaluation of behaviour change interventions. Prim Health Care Res Dev 2011; 12:284-92. [DOI: 10.1017/s1463423611000168] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Using implementation intentions prompts to enhance influenza vaccination rates. Proc Natl Acad Sci U S A 2011; 108:10415-20. [PMID: 21670283 DOI: 10.1073/pnas.1103170108] [Citation(s) in RCA: 172] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We evaluate the results of a field experiment designed to measure the effect of prompts to form implementation intentions on realized behavioral outcomes. The outcome of interest is influenza vaccination receipt at free on-site clinics offered by a large firm to its employees. All employees eligible for study participation received reminder mailings that listed the times and locations of the relevant vaccination clinics. Mailings to employees randomly assigned to the treatment conditions additionally included a prompt to write down either (i) the date the employee planned to be vaccinated or (ii) the date and time the employee planned to be vaccinated. Vaccination rates increased when these implementation intentions prompts were included in the mailing. The vaccination rate among control condition employees was 33.1%. Employees who received the prompt to write down just a date had a vaccination rate 1.5 percentage points higher than the control group, a difference that is not statistically significant. Employees who received the more specific prompt to write down both a date and a time had a 4.2 percentage point higher vaccination rate, a difference that is both statistically significant and of meaningful magnitude.
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Heverin M, Byrne M. The effect of implementation intentions on testicular self-examination using a demonstration video. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/03033910.2011.611614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Wiedemann AU, Lippke S, Reuter T, Ziegelmann JP, Schwarzer R. How planning facilitates behaviour change: Additive and interactive effects of a randomized controlled trial. EUROPEAN JOURNAL OF SOCIAL PSYCHOLOGY 2011. [DOI: 10.1002/ejsp.724] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Webb TL, Sheeran P. Mechanisms of implementation intention effects: The role of goal intentions, self-efficacy, and accessibility of plan components. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2010; 47:373-95. [DOI: 10.1348/014466607x267010] [Citation(s) in RCA: 238] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Wiedemann AU, Lippke S, Reuter T, Ziegelmann JP, Schüz B. The More the Better? The Number of Plans Predicts Health Behaviour Change. Appl Psychol Health Well Being 2010. [DOI: 10.1111/j.1758-0854.2010.01042.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Petersen S, Hydeman J, Flowers K. The Decisional Processing Model: How Cognitive Processing Affects Adherence to Mammography Among African American Women. JOURNAL OF BLACK PSYCHOLOGY 2010. [DOI: 10.1177/0095798410385680] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
While mammography rates are increasing, timely repetition of mammography remains underutilized, particularly for low-income African American women. This study examined the decision-making process used by women during a culturally sensitive attitude change intervention designed to increase adherence to mammography guidelines. The sample included 318 low-income, urban African American women. A Solomon Four design was used to test the intervention in three public health clinics. Participants were followed for 12 months. Women used four different decisional styles (information seeking, 22%; information processing, 22%; advice following, 47%; and ruminating, 8%). Those engaging in information-seeking and information-processing decisional styles demonstrated more pro-attitudes toward mammography, greater intention to obtain a mammogram, and actual increase in mammography utilization. Furthermore, the link between intention and action was significant for those in the information-seeking decisional style but not in the other decisional styles.
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Affiliation(s)
- Suni Petersen
- California School of Professional Psychology, Sacramento, CA, USA,
| | | | - Kristin Flowers
- Borough of Morrisville School District, Morrisville, PA, USA
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Skår S, Sniehotta FF, Molloy GJ, Prestwich A, Araújo-Soares V. Do brief online planning interventions increase physical activity amongst university students? A randomised controlled trial. Psychol Health 2010; 26:399-417. [PMID: 20830646 DOI: 10.1080/08870440903456877] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Brief planning interventions, usually delivered within paper and pencil questionnaires, have been found to be effective in changing health behaviours. Using a double-blind randomised controlled trial, this study examined the efficacy of two types of planning interventions (action plans and coping plans) in increasing physical activity levels when they are delivered via the internet. Following the completion of self-reported physical activity (primary outcome) and theory of planned behaviour (TPB) measures at baseline, students (N = 1273) were randomised into one of four conditions on the basis of a 2 (received instructions to form action plans or not) × 2 (received instructions to form coping plans or not) factorial design. Physical activity (primary outcome) and TPB measures were completed again at two-month follow-up. An objective measure (attendance at the university's sports facilities) was employed 6 weeks after a follow-up for a duration of 13 weeks (secondary outcome). The interventions did not change self-reported physical activity, attendance at campus sports facilities or TPB measures. This might be due to low adherence to the intervention protocol (ranging from 58.8 to 76.7%). The results of this study suggest that the planning interventions under investigation are ineffective in changing behaviour when delivered online to a sample of participants unaware of the allocation to different conditions. Possible moderators of the effectiveness of planning interventions in changing health behaviours are discussed.
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Affiliation(s)
- Silje Skår
- School of Psychology, University of Aberdeen, Scotland, UK
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van Osch L, Lechner L, Reubsaet A, De Vries H. From theory to practice: An explorative study into the instrumentality and specificity of implementation intentions. Psychol Health 2010; 25:351-64. [PMID: 20204939 DOI: 10.1080/08870440802642155] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The present study explores the behavioural impact of instrumentality and specificity of implementation intentions. METHOD At baseline, 764 participants in a smoking cessation contest were asked to formulate three implementation intentions on how they planned to cope with difficult situations. Two independent researchers evaluated all formulated plans and rated them according to their instrumentality (instrumental and non-instrumental) and specificity (non-specific, medium and highly specific). Point prevalence and continuous smoking abstinence rates were measured 7 months after baseline. RESULTS One in four participants (23%) made at least one non-instrumental implementation intention. On average, participants made medium to highly specific plans. The mere instrumentality of plans did not significantly affect smoking abstinence. Plan specificity positively predicted point prevalence abstinence; medium to highly specific planning resulted in higher abstinence rates than less specific planning. Smoking abstinence rates did not differ between respondents with medium and highly specific planning. Women, higher educated participants, and experienced quitters were more likely to formulate instrumental implementation intentions. Women and highly motivated participants were more specific in their planning. CONCLUSION By encouraging participants to furnish goal-directed actions with sufficient detail the efficacy of implementation intention formation can be increased. Implications for future studies and interventions are discussed.
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Affiliation(s)
- Liesbeth van Osch
- Care and Public Health Research Institute (CAPHRI), Heerlen, Netherlands.
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Bennett P. How can We Reduce the Distress Associated with Health Screening? From Psychological Theory to Clinical Practice. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2009. [DOI: 10.1111/j.1751-9004.2009.00212.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Naito M, O'Callaghan FV, Morrissey S. Understanding women's mammography intentions: a theory-based investigation. Women Health 2009; 49:101-18. [PMID: 19533505 DOI: 10.1080/03630240902915119] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The present study compared the utility of two models (the Theory of Planned Behavior and Protection Motivation Theory) in identifying factors associated with intentions to undertake screening mammography, before and after an intervention. The comparison was made between the unique components of the two models. The effect of including implementation intentions was also investigated. Two hundred and fifty-one women aged 37 to 69 years completed questionnaires at baseline and following the delivery of a standard (control) or a protection motivation theory-based informational intervention. Hierarchical multiple regressions indicated that theory of planned behavior variables were associated with mammography intentions. Results also showed that inclusion of implementation intention in the model significantly increased the association with mammography intentions. The findings suggest that future interventions aiming to increase screening mammography participation should focus on the theory of planned behavior variables and that implementation intention should also be targeted.
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Affiliation(s)
- Mikako Naito
- School of Psychology, Griffith University, Gold Coast, Queensland, Australia
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Adriaanse MA, de Ridder DTD, de Wit JBF. Finding the critical cue: implementation intentions to change one's diet work best when tailored to personally relevant reasons for unhealthy eating. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2009; 35:60-71. [PMID: 19106078 DOI: 10.1177/0146167208325612] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Implementation intentions promote acting on one's good intentions. But does specifying where and when to act also suffice when goals involve complex change that requires not merely initiating a behavior but rather substituting a habit with a new response? In a pilot study and two experiments, the authors investigated the efficacy of implementation intentions to replace unhealthy snacks with healthy snacks by linking different types of cues for unhealthy snacking (if-part) to healthy snacking (then-part). The pilot study identified cues for unhealthy snacking, differentiating between situational (where/when) and motivational (why) cues. Studies 1 and 2 tested the efficacy of implementation intentions that specified either situational or motivational cues in altering snacking habits. Results showed that implementation intentions specifying motivational cues decreased unhealthy snack consumption whereas the classic specification of where and when did not. Extending previous research, for complex behavior change "why" seems more important than "where and when."
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Affiliation(s)
- Marieke A Adriaanse
- Department of Clinical & Health Psychology, Utrecht University, Utrecht, the Netherlands.
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O'Neill SC, Bowling JM, Brewer NT, Lipkus IM, Skinner CS, Strigo TS, Rimer BK. Intentions to maintain adherence to mammography. J Womens Health (Larchmt) 2009; 17:1133-41. [PMID: 18657041 DOI: 10.1089/jwh.2007.0600] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Recent attention has focused on moving women from having initial mammograms to maintaining adherence to regular mammography schedules. We examined behavioral intentions to maintain mammography adherence, which include the likelihood of performing a behavior, and implementation intentions, specific action plans to obtain mammograms. Potential predictors were Theory of Planned Behavior constructs, previous barriers, previous mammography maintenance, and age. METHODS Respondents were 2062 currently adherent women due for their next mammograms in 3-4 months according to American Cancer Society recommendations for annual screening. Statistical models were used to examine predictors of behavioral and two implementation intentions, including having thought about where women would get their next mammograms and having thought about making appointments. RESULTS With the exception of pros, cons, and subjective norms, all variables predicted behavioral intentions (p <or= 0.05). Stronger perceived control, previous mammography maintenance, and one barrier (vs. none) predicted being more likely to have thought about where to get their next mammograms. Previous maintenance and no barriers (vs. two) predicted being more likely to have thought about making appointments. CONCLUSIONS Our findings suggest that among women currently adherent to mammography, volitional factors, such as barriers, may be better predictors of implementation intentions than motivational factors, such as attitudes. Implementation variables may be useful in understanding how women move from intentions to action. Future research should examine how such factors relate to mammography maintenance behaviors and can be integrated into behavior change interventions.
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Affiliation(s)
- Suzanne C O'Neill
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA.
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Schweiger-Gallo I, de Miguel J, Rodríguez-Monter M, Álvaro JL, Gollwitzer PM. Efectos de las intenciones de implementación en las intervenciones sobre la salud. INTERNATIONAL JOURNAL OF SOCIAL PSYCHOLOGY 2009. [DOI: 10.1174/021347409789050579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sniehotta FF. Towards a theory of intentional behaviour change: plans, planning, and self-regulation. Br J Health Psychol 2008; 14:261-73. [PMID: 19102817 DOI: 10.1348/135910708x389042] [Citation(s) in RCA: 222] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE Briefly review the current state of theorizing about volitional behaviour change and identification of challenges and possible solutions for future theory development. METHOD Review of the literature and theoretical analysis. RESULTS Reasoned action theories have made limited contributions to the science of behaviour change as they do not propose means of changing cognitions or account for existing effective behaviour change techniques. Changing beliefs does not guarantee behaviour change. The implementation intentions (IMPs) approach to planning has advanced theorizing but the applications to health behaviours often divert substantially from the IMPs paradigm with regard to interventions, effects, mediators and moderators. Better construct definitions and differentiations are needed to make further progress in integrating theory and understanding behaviour change. CONCLUSIONS Further progress in theorizing can be achieved by (a) disentangling planning constructs to study their independent and joint effects on behaviour, (b) progressing research on moderators and mediators of planning effects outside the laboratory and (c) integrating planning processes within learning theory and self-regulation theory.
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