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Tomberge VMJ, Shrestha A, Meierhofer R, Inauen J. Interrelatedness of women's health-behaviour cognitions: A dyadic study of female family members on carrying heavy loads during pregnancy in Nepal. Br J Health Psychol 2024; 29:468-487. [PMID: 38092566 DOI: 10.1111/bjhp.12709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 07/19/2023] [Accepted: 11/22/2023] [Indexed: 04/09/2024]
Abstract
OBJECTIVES Decisions about reproductive health are often influenced by women's female family members, particularly in low-resource contexts. However, previous research has focused primarily on individual behavioural determinants. We investigated the interrelatedness of female family members' reproductive health behaviour with a dyadic version of an extended health action process approach. We investigated this for carrying heavy loads during pregnancy and postpartum, a risk factor for reproductive health in many low-income countries such as Nepal. DESIGN This cross-sectional study included dyads of daughters-in-law and mothers-in-law in rural Nepal (N = 476, nested in 238 dyads). METHODS Dyads of daughters- and mothers-in-law were surveyed about avoiding carrying heavy loads during pregnancy and postpartum. The effects of a woman's cognitions and her female dyadic partner's cognitions on their intention and behaviour about avoiding carrying loads were estimated using linear mixed models. RESULTS The results showed that a mother-in-law's cognitions were related to her daughter-in-law's intentions and vice versa. The mother-in-law's cognitions were also related to the daughter-in-law's behaviour. The mother-in-law's self-efficacy and injunctive norms related to the daughter-in-law's intention and behaviour over and above the daughter-in-law's own self-efficacy and injunctive norms. CONCLUSION Female Nepali family members' cognitions about carrying heavy loads during pregnancy and postpartum are interrelated. Including female family members in interventions to help women manage their reproductive health in low-resource populations seems promising. These novel findings add to the growing body of research indicating the importance of including a dyadic perspective when understanding and changing health behaviour.
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Affiliation(s)
- Vica Marie Jelena Tomberge
- Department of Health Psychology & Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Akina Shrestha
- Kathmandu University, School of Medical Sciences, Kathmandu, Nepal
| | - Regula Meierhofer
- Department of Sanitation, Water and Solid Waste for Development (Sandec), Eawag - Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Jennifer Inauen
- Department of Health Psychology & Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
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2
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Wyss C, Inauen J, Cignacco E, Raio L, Aubry EM. Mediating processes underlying the associations between maternal obesity and the likelihood of cesarean birth. Birth 2024; 51:52-62. [PMID: 37621158 DOI: 10.1111/birt.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/21/2022] [Accepted: 07/10/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Pregnant women with obesity are more likely to experience cesarean birth compared to women without obesity. Yet, little is known about the underlying mechanisms. The objective of this study was therefore to evaluate how mediators contribute to the association between obesity and prelabor/intrapartum cesarean birth. METHODS We retrospectively analyzed Swiss cohort data from 394,812 singleton, cephalic deliveries between 2005 and 2020. Obesity (BMI ≥ 30 kg/m2 ) was defined as the exposure and prelabor or intrapartum cesarean birth as the outcomes. Hypothesized mediators included gestational comorbidities, large-for-gestational-age infant, pregnancy duration >410/7 weeks, slower labor progress, labor induction, and history of cesarean birth. We performed path analyses using generalized structural equation modeling and assessed mediation by a counterfactual approach. RESULTS Women with obesity had a cesarean birth rate of 39.36% vs. 24.12% in women without obesity. The path models mainly showed positive direct and indirect associations between obesity and cesarean birth. In the total sample, the mediation models explained up to 39.47% (95% CI 36.92-42.02) of the association between obesity and cesarean birth, and up to 57.13% (95% CI 54.10-60.16) when including history of cesarean birth as mediator in multiparous women. Slower labor progress and history of cesarean birth were found to be the most clinically significant mediators. CONCLUSIONS This study provides empirical insights into how obesity may increase cesarean birth rates through mediating processes. Particularly allowing for a slower labor progress in women with obesity might reduce cesarean birth rates and prevent subsequent repeat cesarean births in multiparous women.
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Affiliation(s)
- Carmen Wyss
- Applied Research and Development, Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Jennifer Inauen
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Eva Cignacco
- Applied Research and Development, Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology, University Hospital of Bern, Bern, Switzerland
| | - Evelyne M Aubry
- Applied Research and Development, Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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3
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Baretta D, Inauen J. Implications of the COVID-19 trajectory for the evaluation of hand hygiene interventions: Secondary analysis of the Soapp trial. Transl Behav Med 2024; 14:66-71. [PMID: 38001051 PMCID: PMC10782897 DOI: 10.1093/tbm/ibad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023] Open
Abstract
Hand hygiene behavior is crucial to counter the spread of infectious diseases. However, its adoption during the early stages of the Coronavirus disease (COVID-19) pandemic showed temporal fluctuations associated with the trajectory of the pandemic (e.g. new COVID-19 infections). Such associations can confound conclusions about the effectiveness of interventions aimed at promoting hand hygiene during a pandemic. In this study, we performed a secondary analysis of a dataset from the optimization phase of Soapp, an app to promote hand hygiene during the COVID-19 pandemic. We used a longitudinal study design to test whether the associations between the pandemic trajectory and hand hygiene behavior were still present one year after the outbreak (primary outcome) and whether they impacted conclusions about the effectiveness of Soapp (secondary outcome). Participants (N = 216) were randomized to different versions of Soapp and used an electronic diary to self-report their hand hygiene behavior multiple times during the study. We considered the following indicators of the COVID-19 pandemic from the country of Switzerland in the period between March and August 2021: total cases/deaths, increases in recent new cases/deaths, new cases/deaths, and number of administered doses of vaccine. Data were analyzed using a multilevel approach. Results suggested that there were no significant associations between hand hygiene and the indicators of the pandemic trajectory. However, models including total cases/deaths impacted the conclusions about Soapp's effectiveness. Implications from this study are that the development and evaluation of hand hygiene interventions during a pandemic context should account for the trajectory indicators to maximize their effectiveness and control for confounding effects.
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Affiliation(s)
- Dario Baretta
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Jennifer Inauen
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
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4
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Herzog PJ, Herzog-Zibi RDL, Mattmann M, Möri C, Mooser B, Inauen J, Aubert CE. Perspectives of patients and clinicians on older patient mobility on acute medical wards: a qualitative study. BMC Geriatr 2023; 23:558. [PMID: 37704950 PMCID: PMC10500927 DOI: 10.1186/s12877-023-04226-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/08/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Low mobility during an acute care medical hospitalization is frequent and associated with adverse outcomes, particularly among older patients. Better understanding barriers and facilitators to improve mobility during hospitalization could help develop effective interventions. The goal of this study was to assess barriers and facilitators to older medical patients' hospital mobility, from the point of view of patients and clinicians, to develop a framework applicable in clinical practice. METHODS We conducted a qualitative study in one university and two non-university hospitals of two different language and cultural regions of Switzerland, including 13 focus groups (FGs; five with patients, eight with clinicians). We included 24 adults aged 60 years or older hospitalized on an acute general internal medicine ward of one of the three participating hospitals during the previous years, and 34 clinicians (15 physicians, nine nurses/nursing assistants, 10 physiotherapists) working on those wards. The FG guides included open-ended questions exploring mobility experiences, expectations, barriers and facilitators to mobility, consequences of low mobility and knowledge on mobility. We applied an inductive thematic analysis. RESULTS We identified four themes of barriers and facilitators to mobility: 1) patient-related factors; 2) clinician-related factors; 3) social interactions; and 4) non-human factors. Clinician-related factors were only mentioned in clinician FGs. Otherwise, subthemes identified from patient and clinician FGs were similar and codes broadly overlapped. Subthemes included motivation, knowledge, expectations, mental and physical state (theme 1); process, knowledge - skills, mental state - motivation (theme 2); interpersonal relationships, support (theme 3); hospital setting - organization (theme 4). CONCLUSIONS From patients' and clinicians' perspectives, a broad spectrum of human and structural factors influences mobility of older patients hospitalized on an acute general internal medicine ward. New factors included privacy issues and role perception. Many of those factors are potentially actionable without additional staff resources. This study is a first step in participatory research to improve mobility of older medical inpatients.
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Affiliation(s)
- Philippe J Herzog
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rose D L Herzog-Zibi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Charlotte Möri
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - Blandine Mooser
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Jennifer Inauen
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
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Gardner B, Arden MA, Brown D, Eves FF, Green J, Hamilton K, Hankonen N, Inauen J, Keller J, Kwasnicka D, Labudek S, Marien H, Masaryk R, McCleary N, Mullan BA, Neter E, Orbell S, Potthoff S, Lally P. Developing habit-based health behaviour change interventions: twenty-one questions to guide future research. Psychol Health 2023; 38:518-540. [PMID: 34779335 DOI: 10.1080/08870446.2021.2003362] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Habitual behaviours are triggered automatically, with little conscious forethought. Theory suggests that making healthy behaviours habitual, and breaking the habits that underpin many ingrained unhealthy behaviours, promotes long-term behaviour change. This has prompted interest in incorporating habit formation and disruption strategies into behaviour change interventions. Yet, notable research gaps limit understanding of how to harness habit to change real-world behaviours. METHODS Discussions among health psychology researchers and practitioners, at the 2019 European Health Psychology Society 'Synergy Expert Meeting', generated pertinent questions to guide further research into habit and health behaviour. RESULTS In line with the four topics discussed at the meeting, 21 questions were identified, concerning: how habit manifests in health behaviour (3 questions); how to form healthy habits (5 questions); how to break unhealthy habits (4 questions); and how to develop and evaluate habit-based behaviour change interventions (9 questions). CONCLUSIONS While our questions transcend research contexts, accumulating knowledge across studies of specific health behaviours, settings, and populations will build a broader understanding of habit change principles and how they may be embedded into interventions. We encourage researchers and practitioners to prioritise these questions, to further theory and evidence around how to create long-lasting health behaviour change.
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Affiliation(s)
- Benjamin Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Madelynne A Arden
- Centre for Behavioural Science and Applied Psychology, Department of Psychology, Sociology & Politics, Sheffield Hallam University, Sheffield, UK
| | - Daniel Brown
- Department of Applied Psychology, Griffith University, Brisbane, Australia
| | - Frank F Eves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - James Green
- School of Allied Health and Physical Activity for Health Research Cluster (Health Research Institute), University of Limerick, Limerick, Ireland
| | - Kyra Hamilton
- Griffith University and Menzies Health Institute Queensland, Mt Gravatt, Qld, Australia
| | - Nelli Hankonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Jennifer Inauen
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Jan Keller
- Division Health Psychology, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wrocław, Poland.,NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Sarah Labudek
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| | - Hans Marien
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Radomír Masaryk
- Institute of Applied Psychology, Faculty of Social and Economic Sciences, Comenius University Bratislava, Bratislava, Slovakia
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Barbara A Mullan
- Behavioural Science and Health Research Group, Curtin University, Perth, Australia
| | - Efrat Neter
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
| | - Sheina Orbell
- Department of Psychology, University of Essex, Essex, UK
| | - Sebastian Potthoff
- Department of Social Work, Education, and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Phillippa Lally
- Research Department of Behavioural Science and Health, University College London, London, UK
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Baretta D, Koch S, Cobo I, Castaño-Vinyals G, de Cid R, Carreras A, Buekers J, Garcia-Aymerich J, Inauen J, Chevance G. Resilience characterized and quantified from physical activity data: A tutorial in R. Psychol Sport Exerc 2023; 65:102361. [PMID: 37665834 DOI: 10.1016/j.psychsport.2022.102361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/25/2022] [Accepted: 12/05/2022] [Indexed: 09/06/2023]
Abstract
Consistent physical activity is key for health and well-being, but it is vulnerable to stressors. The process of recovering from such stressors and bouncing back to the previous state of physical activity can be referred to as resilience. Quantifying resilience is fundamental to assess and manage the impact of stressors on consistent physical activity. In this tutorial, we present a method to quantify the resilience process from physical activity data. We leverage the prior operationalization of resilience, as used in various psychological domains, as area under the curve and expand it to suit the characteristics of physical activity time series. As use case to illustrate the methodology, we quantified resilience in step count time series (length = 366 observations) for eight participants following the first COVID-19 lockdown as a stressor. Steps were assessed daily using wrist-worn devices. The methodology is implemented in R and all coding details are included. For each person's time series, we fitted multiple growth models and identified the best one using the Root Mean Squared Error (RMSE). Then, we used the predicted values from the selected model to identify the point in time when the participant recovered from the stressor and quantified the resulting area under the curve as a measure of resilience for step count. Further resilience features were extracted to capture the different aspects of the process. By developing a methodological guide with a step-by-step implementation, we aimed at fostering increased awareness about the concept of resilience for physical activity and facilitate the implementation of related research.
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Affiliation(s)
- Dario Baretta
- Institute of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
| | - Sarah Koch
- Barcelona Institute for Global Health (ISGlobal), C/ Doctor Aiguader, 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10-12, 08002, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), C/ Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Inés Cobo
- Barcelona Institute for Global Health (ISGlobal), C/ Doctor Aiguader, 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10-12, 08002, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), C/ Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Gemma Castaño-Vinyals
- Barcelona Institute for Global Health (ISGlobal), C/ Doctor Aiguader, 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10-12, 08002, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), C/ Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Rafael de Cid
- Genomes for Life-GCAT Lab, Germans Trias i Pujol Research Institute (IGTP), Camí de Les Escoles s/n, 08916, Badalona, Barcelona, Spain
| | - Anna Carreras
- Genomes for Life-GCAT Lab, Germans Trias i Pujol Research Institute (IGTP), Camí de Les Escoles s/n, 08916, Badalona, Barcelona, Spain
| | - Joren Buekers
- Barcelona Institute for Global Health (ISGlobal), C/ Doctor Aiguader, 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10-12, 08002, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), C/ Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Judith Garcia-Aymerich
- Barcelona Institute for Global Health (ISGlobal), C/ Doctor Aiguader, 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10-12, 08002, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), C/ Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Jennifer Inauen
- Institute of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland
| | - Guillaume Chevance
- Barcelona Institute for Global Health (ISGlobal), C/ Doctor Aiguader, 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10-12, 08002, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), C/ Monforte de Lemos 3-5, 28029, Madrid, Spain
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Buis L, Amrein MA, Bäder C, Ruschetti GG, Rüttimann C, Del Rio Carral M, Fabian C, Inauen J. Promoting Hand Hygiene During the COVID-19 Pandemic: Parallel Randomized Trial for the Optimization of the Soapp App. JMIR Mhealth Uhealth 2023; 11:e43241. [PMID: 36599056 PMCID: PMC9938438 DOI: 10.2196/43241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Hand hygiene is an effective behavior for preventing the spread of the respiratory disease COVID-19 and was included in public health guidelines worldwide. Behavior change interventions addressing hand hygiene have the potential to support the adherence to public health recommendations and, thereby, prevent the spread of COVID-19. However, randomized trials are largely absent during a pandemic; therefore, there is little knowledge about the most effective strategies to promote hand hygiene during an ongoing pandemic. This study addresses this gap by presenting the results of the optimization phase of a Multiphase Optimization Strategy of Soapp, a smartphone app for promoting hand hygiene in the context of the COVID-19 pandemic. OBJECTIVE This study aimed to identify the most effective combination and sequence of 3 theory- and evidence-based intervention modules (habit, motivation, and social norms) for promoting hand hygiene. To this end, 9 versions of Soapp were developed (conditions), and 2 optimization criteria were defined: the condition with the largest increase in hand hygiene at follow-up and condition with the highest engagement, usability, and satisfaction based on quantitative and qualitative analyses. METHODS This study was a parallel randomized trial with 9 intervention conditions defined by the combination of 2 intervention modules and their sequence. The trial was conducted from March to August 2021 with interested participants from the Swiss general population (N=232; randomized). Randomization was performed using Qualtrics (Qualtrics International Inc), and blinding was ensured. The duration of the intervention was 34 days. The primary outcome was self-reported hand hygiene at follow-up, which was assessed using an electronic diary. The secondary outcomes were user engagement, usability, and satisfaction assessed at follow-up. Nine participants were further invited to participate in semistructured exit interviews. A set of ANOVAs was performed to test the main hypotheses, whereas a thematic analysis was performed to analyze the qualitative data. RESULTS The results showed a significant increase in hand hygiene over time across all conditions. There was no interaction effect between time and intervention condition. Similarly, no between-group differences in engagement, usability, and satisfaction emerged. Seven themes (eg, "variety and timeliness of the task load" and "social interaction") were found in the thematic analysis. CONCLUSIONS The effectiveness of Soapp in promoting hand hygiene laid the foundation for the next evaluation phase of the app. More generally, the study supported the value of digital interventions in pandemic contexts. The findings showed no differential effect of intervention conditions involving different combinations and sequences of the habit, motivation, and social norms modules on hand hygiene, engagement, usability, and satisfaction. In the absence of quantitative differences, we relied on the results from the thematic analysis to select the best version of Soapp for the evaluation phase. TRIAL REGISTRATION ClinicalTrials.gov NCT04830761; https://clinicaltrials.gov/ct2/show/NCT04830761. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2021-055971.
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Affiliation(s)
| | | | - Carole Bäder
- Institute of Psychology, University of Bern, Bern, Switzerland
| | | | | | | | - Carlo Fabian
- Institute for Social Work and Health, FHNW School of Social Work, Olten, Switzerland
| | - Jennifer Inauen
- Institute of Psychology, University of Bern, Bern, Switzerland
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Bösch VD, Warner LM, Nyman SR, Haftenberger J, Clarke K, Inauen J. What do older adults think about when formulating implementation intentions for physical activity? Evidence from a qualitative study. Br J Health Psychol 2023; 28:221-236. [PMID: 36000441 PMCID: PMC10087560 DOI: 10.1111/bjhp.12621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 08/10/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Physical activity is an important health behaviour especially for older adults. Forming implementation intentions is an effective strategy to implement physical activity in daily life for young and middle-aged adults. However, evidence for older adults is inconclusive. This study explored the thoughts of older adults about implementation intentions and potential barriers and facilitators while formulating them. METHODS Three samples of older adults from the United Kingdom (n = 8), Germany (n = 9) and Switzerland (n = 17) were prompted to think aloud while formulating implementation intentions to be more physically active. After the task, semi-structured interviews were conducted. Data were analysed thematically. RESULTS Participants expressed pre-established thoughts about implementation intentions (e.g. they feel too restrictive). During the formulation of implementation intentions, several barriers to creating them were reported (e.g. problems with finding cues due to absence of recurring daily routines), but participants also mentioned that forming implementation intentions acted as a facilitator for physical activity (e.g. cues as useful reminders to be active, task itself triggering self-reflection about physical activity). After the task, participants reflected on circumstances that decrease the likelihood of enacting implementation intentions (e.g. spontaneous alternative activities, weather, health-related barriers, Covid-19-related barriers), which triggered spontaneous coping planning. CONCLUSIONS The results on barriers and facilitators of implementation intentions and physical activity from older adults' perspectives provide starting points for improving instructions for older adults on how to create implementation intentions for physical activity. Future studies are needed to investigate whether the findings extend to implementation intentions for other behaviours.
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Affiliation(s)
- Valérie Désirée Bösch
- Department of Health Psychology and Behavioral Medicine, University of Bern, Bern, Switzerland
| | - Lisa Marie Warner
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Samuel R Nyman
- Bournemouth University Clinical Research Unit, Department of Medical Science & Public Health, Bournemouth University, Bournemouth, UK
| | | | - Kye Clarke
- Department of Psychology, Bournemouth University, Poole, UK
| | - Jennifer Inauen
- Department of Health Psychology and Behavioral Medicine, University of Bern, Bern, Switzerland
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Ambuehl B, Inauen J. Contextualized Measurement Scale Adaptation: A 4-Step Tutorial for Health Psychology Research. Int J Environ Res Public Health 2022; 19:ijerph191912775. [PMID: 36232077 PMCID: PMC9566381 DOI: 10.3390/ijerph191912775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 05/31/2023]
Abstract
Health psychology research is inherently context specific: Different health behaviors are executed by different target groups (e.g., gender, age) in different social structures, cultures, and environments. This asks for the adaptation of research instruments to enhance specificity. For example, when using measurement scales in new contexts, translation and psychometric validation of the instruments are necessary but not sufficient if the validity of the psychological concept behind a measurement scale has not been researched. In this study, we build on existing guidelines of translation as well as psychometric validation and present four steps on how to adapt measurement scales to a new context: Step 1 asks whether the psychological concept is found in the new context. Step 2 asks whether the measurement scale and its items are understood in the new context. Step 3 asks whether a measurement scale is valid and reliable. Step 4 asks how the items of the measurement scale perform individually. Following these four steps, measurement scales are carefully translated, adapted, and validated and can therefore be transferred to very different contexts.
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Affiliation(s)
- Benjamin Ambuehl
- Eawag: Swiss Federal Institute of Aquatic Science and Technology, 8600 Duebendorf, Switzerland
- Institute of Psychology, University of Bern, 3012 Bern, Switzerland
| | - Jennifer Inauen
- Institute of Psychology, University of Bern, 3012 Bern, Switzerland
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10
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Koller JE, Villinger K, Lages NC, Absetz P, Bamert M, Branquinho C, Chaves-Avilés L, Dimitropoulou P, Fernández-Fernández AL, Gaspar de Matos M, Griskevica I, Gutiérrez-Doña B, Hankonen N, Inauen J, Jordanova Peshevska D, Kassianos AP, Kolesnikova J, Lavrič M, Mitanovska T, Neter E, Poštuvan V, Trups-Kalne I, Vargas-Carmiol J, Schupp HT, Renner B. Individual and collective protective responses during the early phase of the COVID-19 pandemic in 10 different countries: Results from the EUCLID online survey. Int J Infect Dis 2022; 122:356-364. [PMID: 35709963 PMCID: PMC9190179 DOI: 10.1016/j.ijid.2022.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/26/2022] [Accepted: 06/08/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In times of unprecedented infectious disease threats, it is essential to understand how to increase individual protective behaviors and support for collective measures. The present study therefore examines factors associated with individual and collective pathways. METHODS Data was collected through an online survey from 4483 participants (70.8% female, M = 41.2 years) across 10 countries from April 15, 2020 to June 2, 2020 as part of the "EUCLID" project (https://euclid.dbvis.de). Structural equation modeling was used to examine individual and collective pathways across and within countries. RESULTS Overall, the adoption of individual protective behaviors and support for collective measures were high. Risk perception on the individual level and perceived effectiveness at the collective level were positively associated with both individual protective behaviors and support for collective measures. Furthermore, the model explained considerable variance in individual (40.7%) and collective protective behaviors (40.8%) and was largely replicated across countries. CONCLUSIONS The study extends previous research by demonstrating that individual risk perception and perceived effectiveness of collective measures jointly affect individual protective health behaviors and support for collective measures. These findings highlight the need to jointly consider a variety of behavioral actions against infectious disease threats, acknowledging interactions between individual and collective pathways.
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Affiliation(s)
- Julia E. Koller
- Psychological Assessment and Health Psychology, Department of Psychology, University of Konstanz, Germany,Corresponding author: Julia E. Koller
| | - Karoline Villinger
- Psychological Assessment and Health Psychology, Department of Psychology, University of Konstanz, Germany,Applied Social and Health Psychology, Department of Psychology, University of Zurich, Switzerland,Corresponding author: Julia E. Koller
| | - Nadine C. Lages
- Psychological Assessment and Health Psychology, Department of Psychology, University of Konstanz, Germany
| | | | - Melanie Bamert
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Switzerland
| | - Cátia Branquinho
- Institute of Environmental Health, Faculty of Medicine, University of Lisbon, Portugal
| | - Lourdes Chaves-Avilés
- Universidad Estatal a Distancia (UNED), Central Pacific Office (Parrita-Quepos), Costa Rica
| | | | | | | | - Inguna Griskevica
- Department of Health Psychology and Pedagogy, Riga Stradins University, Riga, Latvia
| | - Benicio Gutiérrez-Doña
- Research Vice-Rectory, Research Program in Psychological/Behavioral Sciences, Universidad Estatal a Distancia (UNED), San José, Costa Rica
| | | | - Jennifer Inauen
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Switzerland
| | | | - Angelos P. Kassianos
- Department of Applied Health Research, UCL, London, UK,Department of Psychology, University of Cyprus, Cyprus
| | - Jelena Kolesnikova
- Department of Health Psychology and Pedagogy, Psychology laboratory, Riga Stradins University, Riga, Latvia
| | - Meta Lavrič
- Slovene Centre for Suicide Research, Andrej Marušič Institute, University of Primorska, Slovenia,Department of Psychology, Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Slovenia
| | - Tamara Mitanovska
- Neurovita - Center for Neuropsychology and Cognitive Psychology, Skopje, North Macedonia
| | - Efrat Neter
- Behavioral Sciences Department, Ruppin Academic Center, Israel
| | - Vita Poštuvan
- Slovene Centre for Suicide Research, Andrej Marušič Institute, University of Primorska, Slovenia,Department of Psychology, Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Slovenia
| | | | - Jorge Vargas-Carmiol
- Medicine School, Faculty of Medicine, Universidad de Costa Rica, San José, Costa Rica
| | - Harald T. Schupp
- General and Biological Psychology, Department of Psychology, University of Konstanz, Germany,Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Germany
| | - Britta Renner
- Psychological Assessment and Health Psychology, Department of Psychology, University of Konstanz, Germany,Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Germany
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11
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Bamert M, Inauen J. Physiological stress reactivity and recovery: Some laboratory results transfer to daily life. Front Psychol 2022; 13:943065. [PMID: 36046406 PMCID: PMC9421134 DOI: 10.3389/fpsyg.2022.943065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/22/2022] [Indexed: 11/24/2022] Open
Abstract
Stress is a prevalent theme in our daily lives and is related to numerous negative health outcomes. Laboratory research has studied the physiological stress response extensively with objective measures such as vagally-mediated heart rate variability (vmHRV). Recently, the vagal tank theory emerged as a promising approach to predicting adaptive vmHRV levels around stressful events. This study aimed to investigate whether the predictions of the vagal tank theory about vmHRV during stress reactivity and recovery translate into naturalistic stressful events in daily life. Sixty-seven students wore an EcgMove 4 sensor for 4 days to measure vmHRV. Through a combination of device-based and self-report assessment, vmHRV data were segmented into before, during, and after stressful events. VmHRV segments were analyzed with multilevel modeling, accounting for physiological and psychological covariates. VmHRV before stressful events predicted more adaptive vmHRV during the event but not vmHRV recovery afterwards. The results therefore partially support the vagal tank theory's predictions with data from daily life and allow recommendations for future studies of real-world stress reactivity and recovery. The value of intraindividual variations in vmHRV as predictors of adaptive stress response is underscored by these findings and could inform future interventions that seek to increase momentary vmHRV.
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12
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Bösch VD, Inauen J. Older adults' physical activity after lockdown: Testing the health action process approach and the moderating role of fear of Covid-19. Appl Psychol Health Well Being 2022; 15:369-389. [PMID: 35822243 PMCID: PMC9349855 DOI: 10.1111/aphw.12384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/26/2022] [Indexed: 02/07/2023]
Abstract
The coronavirus pandemic has influenced many lives, particularly older adults'. Although isolation protects from infection, health behaviors like physical activity (PA) are important to reinstate after lockdown. However, fear of Covid-19 may act as a barrier, for example, by preventing people from going outside. Based on the health action process approach (HAPA), we investigated whether and why older adults' PA changed after lockdown, and whether fear of Covid-19 moderates the intention-behavior relationship. Participants of this longitudinal study aged 65+ from German-speaking Europe completed an online questionnaire about their PA, fear of Covid-19, and HAPA factors in April and May 2020. Data were analyzed using multiple linear regressions. Results showed that moderate to vigorous activity (MVPA) remained stable after lockdown and that self-efficacy most robustly influenced the intention to be active. PA was not explained by any volitional factor but was strongly related to past PA. Interestingly, the relationship of past and future MVPA was attenuated by fear of Covid-19, but this finding was not robust when outliers were removed. In conclusion, self-efficacy is the most important motivator for PA in older adults after an interruption like a lockdown. Strong physical activity habits may facilitate PA after a period of isolation.
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Affiliation(s)
- Valérie D. Bösch
- Department of Health Psychology and Behavioral MedicineUniversity of BernBernSwitzerland
| | - Jennifer Inauen
- Department of Health Psychology and Behavioral MedicineUniversity of BernBernSwitzerland
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13
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Mani H, Möri C, Mattmann M, Liechti F, Inauen J, Aujesky D, Donzé J, Aubert CE. Barriers and facilitators to mobility of patients hospitalised on an acute medical ward: a systematic review. Age Ageing 2022; 51:6632477. [PMID: 35796134 DOI: 10.1093/ageing/afac159] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND low patient mobility is common during hospitalisation and is associated with adverse outcomes. To change practice, interventions should address barriers and facilitators to mobility. Our aim was to systematically review the literature to provide a synthesised overview of patient-, health care professional (HCP)- and environment-/system-related barriers and facilitators to mobility of patients hospitalised on an acute care medical ward. METHODS we searched Medline, Embase, PsycInfo, Web of Science Core Collection, Cochrane CENTRAL, CINHAHL and Google Scholar (inception to 18 October 2021) to identify studies reporting barriers and/or facilitators to mobility of adults hospitalised on an acute medical ward. We applied a deductive and inductive thematic analysis to classify barriers and facilitators into themes and subthemes relevant for clinical practice. RESULTS among 26 studies (16 qualitative, 7 quantitative and 3 mixed methods), barriers and facilitators were categorised into 10 themes: patient situation, knowledge, beliefs, experiences, intentions, emotions, social influences, role/identity, implementation/organisation and environment/resources. Barriers included patient characteristics (e.g. impaired cognitive/physical status) and symptoms, HCPs prioritising other tasks over mobility, HCPs labelling patients as 'too sick', fear of injury, lack of time, lack of clarity about responsibility, patient medical devices and non-encouraging environment. Facilitators included knowledge of mobility importance, HCP skills, interdisciplinarity, documentation and unit expectations, encouraging staff, goal individualisation, activity programme, family/visitor/volunteer support and availability of equipment. CONCLUSION this synthesised overview of patient-, HCP- and environment-/system-related barriers and facilitators to mobility of adults hospitalised on an acute medical ward can help researchers and clinicians focus on what can realistically be influenced to improve mobility. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021285954.
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Affiliation(s)
- Hugo Mani
- Department of Medicine, Neuchâtel Hospital Network, 2000 Neuchâtel, Switzerland
| | - Charlotte Möri
- Institute of Psychology, University of Bern, 3012 Bern, Switzerland
| | - Martina Mattmann
- Institute of Psychology, University of Bern, 3012 Bern, Switzerland
| | - Fabian Liechti
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Jennifer Inauen
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Drahomir Aujesky
- Division of General Internal Medicine, CHUV, University of Lausanne, 1011 Lausanne, Switzerland
| | - Jacques Donzé
- Department of Medicine, Neuchâtel Hospital Network, 2000 Neuchâtel, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.,Division of General Internal Medicine, CHUV, University of Lausanne, 1011 Lausanne, Switzerland
| | - Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
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14
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Meierhofer R, Tomberge VMJ, Inauen J, Shrestha A. Water carrying in hills of Nepal–associations with women’s musculoskeletal disorders, uterine prolapse, and spontaneous abortions. PLoS One 2022; 17:e0269926. [PMID: 35737697 PMCID: PMC9223305 DOI: 10.1371/journal.pone.0269926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/06/2022] [Indexed: 11/19/2022] Open
Abstract
More than a third of women in Nepal have to carry water from source to home to satisfy their families’ daily needs. A cross-sectional study was carried out in a hilly area in Nepal to assess water-carrying practices and their association with women’s health. Quantitative interviews were conducted with 1001 women of reproductive age and were complemented with health surveys carried out by health professionals and structured observations of water carrying. Multivariate mixed logistic regression models were used to assess the associations between water-carrying-related risk factors and health issues for women. Around 46% of women faced considerably increased to excessive physical stress due to water carrying during the dry season. Women suffered from a disproportionately high prevalence of back pain (61%), with about 18% of this pain being horrible to excruciating; pain in the knees (34%); uterine prolapse (11.3%); and at least one spontaneous abortion (9%). The risk category of water carrying was significantly associated with uterine prolapse (OR = 1.44, 95%CI = 1.12–1.85, p = 0.031) and pain in the hips (OR = 1.69, 95%CI = 1.27–2.26, p<0.001). Receiving help with water carrying during pregnancy and during the first three months after delivery was associated with reduced odds ratios for uterine prolapse (OR = 0.10, 95% CI = 0.01–0.87, p = 0.037), and strong back pain (OR = 0.32, 95% CI = 0.12–0.87, p = 0.026). Improvements to water supply infrastructure and the promotion of social support for carrying water during pregnancy and after delivery are recommended to reduce water-carrying-related health risks.
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Affiliation(s)
- Regula Meierhofer
- Department of Sanitation, Swiss Federal Institute of Aquatic Science and Technology (Eawag), Water and Solid Waste for Development (Sandec), Dübendorf, Switzerland
- * E-mail:
| | - Vica Marie Jelena Tomberge
- Department of Health Psychology & Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Jennifer Inauen
- Department of Health Psychology & Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Akina Shrestha
- Department of Sanitation, Swiss Federal Institute of Aquatic Science and Technology (Eawag), Water and Solid Waste for Development (Sandec), Dübendorf, Switzerland
- Kathmandu University, School of Medical Sciences, Kathmandu, Nepal
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15
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Amrein MA, Ruschetti GG, Baeder C, Bamert M, Inauen J. Mobile intervention to promote correct hand hygiene at key times to prevent COVID-19 in the Swiss adult general population: study protocol of a multiphase optimisation strategy. BMJ Open 2022; 12:e055971. [PMID: 35351716 PMCID: PMC8960462 DOI: 10.1136/bmjopen-2021-055971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Behaviour change is key to the public health measures that have been issued in many countries worldwide to contain COVID-19. Public health measures will only take preventive effect if people adhere to them. Interventions taking health psychology approaches may promote adherence to public health measures. However, evidence from randomised controlled behaviour change trials is scarce during an ongoing pandemic. We aim to use the example of hand washing with soap to optimise and test a digital, theory-based and evidence-based behaviour change intervention to prevent the spread of COVID-19. METHODS AND ANALYSIS This protocol describes the multiphase optimisation strategy for the preparation, optimisation and evaluation of a theory-based and evidence-based intervention delivered via app. The app aims to promote correct hand hygiene at key times in the adult general population. The study will be conducted in German-speaking Switzerland. The preparation phase has identified relevant behavioural determinants of hand hygiene during a pandemic from health behaviour theories and formative research with focus groups (n=8). The optimisation phase will identify the most effective and acceptable combination and sequence of three intervention modules in a parallel randomised trial (n=387) with analysis of variance (ANOVA) and regression analysis. Additionally, thematic analysis of qualitative interview data (n=15) will be used to gain insights on the feasibility, usability and satisfaction of the intervention. The evaluation phase will test the optimised intervention against an active control group in a randomised controlled trial (n=205), analysing pre-post differences and 6-month follow-up effects with ANOVA and regression analysis. ETHICS AND DISSEMINATION The trial was approved by the Cantonal Ethics Commission Bern of the Swiss Association of Research Ethics Committees (protocol ID: 2021-00164). Final results will be presented in peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER NCT04830761.
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Affiliation(s)
| | | | - Carole Baeder
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - Melanie Bamert
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - Jennifer Inauen
- Institute of Psychology, University of Bern, Bern, Switzerland
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16
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Tomberge VMJ, Shrestha A, Meierhofer R, Inauen J. Understanding safe water-carrying practices during pregnancy and postpartum: A mixed-methods study in Nepal. Appl Psychol Health Well Being 2021; 14:691-711. [PMID: 34862740 PMCID: PMC9300039 DOI: 10.1111/aphw.12325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 11/13/2021] [Indexed: 11/30/2022]
Abstract
Daily carrying of heavy loads of domestic water, especially during pregnancy and postpartum, bears a threat to maternal health in low‐income countries. Using an extended health action process approach (HAPA), we examined women's reasons for and psychosocial determinants of safe water‐carrying during pregnancy and postpartum. In a mixed‐methods study, trained local interviewers conducted 1001 quantitative interviews with women of reproductive age (n = 921 analyzed) and 21 qualitative interviews with women of reproductive age, in‐laws, and spouses in rural Nepal. We analyzed the quantitative data with generalized estimating equations to model the HAPA‐based psychosocial determinants of avoiding water‐carrying during pregnancy and postpartum. Subjective perspectives were investigated with thematic analysis. Outcome expectancies (B = 0.24), self‐efficacy (B = 0.20), and injunctive norms (B = 0.23) were significantly associated with the intention to avoid water‐carrying. Self‐efficacy (B = 0.36) and instrumental support (B = 0.05) are related to behavior (all p < 0.05). Women explained water‐carrying during pregnancy by a lack of family support, a shift of health decision‐making power to in‐laws, and low behavioral control. Overall, the necessity of water, family decision‐making structures, and low support make it difficult for women to discontinue water‐carrying. Additionally to infrastructural improvements, behavioral interventions may increase women's self‐efficacy for safe water‐carrying (e.g. reducing weight) and social support.
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Affiliation(s)
- Vica Marie Jelena Tomberge
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Akina Shrestha
- School of Medical Sciences, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Regula Meierhofer
- Department of Sanitation, Water and Solid Waste for Development (SANDEC), Eawag - Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Jennifer Inauen
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
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17
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Tomberge VMJ, Bischof JS, Meierhofer R, Shrestha A, Inauen J. The Physical Burden of Water Carrying and Women's Psychosocial Well-Being: Evidence from Rural Nepal. Int J Environ Res Public Health 2021; 18:7908. [PMID: 34360203 PMCID: PMC8345449 DOI: 10.3390/ijerph18157908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022]
Abstract
Many women in low-income countries carry heavy loads of drinking water for their families in difficult terrain. This can adversely affect their health and well-being. The present study is the first to investigate the physical burden of water carrying and women's psychosocial well-being, and how this relationship is moderated by environmental and health conditions. Trained local interviewers conducted interviews with 1001 women across five rural communities in Nepal. In addition, objective measurement was used to assess the weight carried and distance from the water source. The physical burden of water carrying was calculated from weight, distance, and frequency of trips. Its association with psychosocial well-being was modeled using generalized estimating equations. Two additional models included the terrain and uterine prolapse as moderators. The physical burden of water carrying is directly related to higher emotional distress and reduced daily functioning. This correlation was exacerbated for women carrying in hilly versus flat terrain, and for those who had uterine prolapse. Our results underline the importance of adequate water access for women's psychosocial well-being, especially for vulnerable populations such as women with impaired health (e.g., uterine prolapse) or those living in hilly terrain. The results further highlight the interconnectedness of the Sustainable Development Goal (SDG) 6: water access, SDG 3: health and well-being, and SDG 5: gender equality.
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Affiliation(s)
- Vica Marie Jelena Tomberge
- Department of Health Psychology & Behavioral Medicine, Institute of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland; (J.S.B.); (J.I.)
| | - Janine Stefanie Bischof
- Department of Health Psychology & Behavioral Medicine, Institute of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland; (J.S.B.); (J.I.)
| | - Regula Meierhofer
- Department of Sanitation, Water and Solid Waste for Development (Sandec), Eawag, Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstrasse 133, 8600 Duebendorf, Switzerland;
| | - Akina Shrestha
- School of Medical Sciences, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel 1008, Nepal;
| | - Jennifer Inauen
- Department of Health Psychology & Behavioral Medicine, Institute of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland; (J.S.B.); (J.I.)
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Abstract
Abstract. Increasing demands on ecosystems, decreasing biodiversity, and climate change are among the most pressing environmental issues of our time. As changing weather conditions are leading to increased vector-borne diseases and heat- and flood-related deaths, it is entering collective consciousness: environmental issues are human health issues. In public health, the field addressing these issues is known as environmental health. This field addresses both the effects people have on their environment as well as the effects of the environment on people. Psychology, as a discipline concerned with explaining, predicting, and changing behavior has much to contribute to these issues because human behavior is key in promoting environmental health. To date, however, an integrative view of environmental health in psychology is lacking, hampering urgently needed progress. In this paper, we review how the environment and human health are intertwined, and that much can be gained through a systemic view of environmental health in psychology. Based on a review of the literature, we suggest that psychologists unite efforts to promote an integrative science and practice of environmental health psychology, and jointly address environmental-health related behavior. The research agenda for this field will include integrating behavior change theory and intervention approaches. Thereby, psychology can potentially make an important contribution to sustained environmental health for generations to come.
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Affiliation(s)
- Jennifer Inauen
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Switzerland
| | - Nadja Contzen
- Eawag: Swiss Federal Institute of Aquatic Science & Technology, Duebendorf, Switzerland
- Faculty of Behavioural and Social Sciences, University of Groningen, The Netherlands
| | - Vivan Frick
- Institute for Ecological Economy Research (IÖW), Center for Technology and Society, TU Berlin, Germany
| | - Philipp Kadel
- School of Social Sciences, Chair of Health Psychology, University of Mannheim, Germany
| | - Jan Keller
- Department of Education and Psychology, Freie Universität Berlin, Germany
| | | | - Jutta Mata
- School of Social Sciences, Chair of Health Psychology, University of Mannheim, Germany
- Mannheim Center for Data Science, University of Mannheim, Germany
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19
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Tomberge VMJ, Harter M, Inauen J. The importance of collective and individual psychological ownership for safe sanitation: A multilevel analysis in rural Ghana. Glob Public Health 2021; 17:1314-1329. [PMID: 34016017 DOI: 10.1080/17441692.2021.1928260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Unsafe sanitation practices can severely affect public health. Strengthening psychological ownership, the feeling of owning an object (e.g. the latrine) individually or collectively, may promote safe sanitation practices, e.g. decreased open defecation. This study investigated psychological ownership in communities that participated in a sanitation intervention. We used follow-up survey data of a cluster-randomised controlled trial in rural Ghana (N = 2012 households), which assessed psychological ownership, and safe sanitation outcomes. The data were analysed using multilevel modelling and generalised estimating equations. In line with our assumptions, greater psychological ownership for the latrine related to decreased open defecation. Higher individual psychological ownership for the open defecation space related to safe sanitation outcomes, whereas collective ownership related to lesser safe sanitation. The present study shows that the concept of psychological ownership may play an important role in safe sanitation. Collective and individual psychological ownership seem to distinctly relate to safe sanitation outcomes, which has high relevance for promoting communities' health behaviour.
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Affiliation(s)
- Vica Marie Jelena Tomberge
- Department of Health Psychology & Behavioral Medicine, Institute of Psychology, University of Bern, Switzerland
| | - Miriam Harter
- Department of Environmental Social Sciences, Eawag - Swiss Federal Institute of Aquatic Science and Technology, Duebendorf, Switzerland
| | - Jennifer Inauen
- Department of Health Psychology & Behavioral Medicine, Institute of Psychology, University of Bern, Switzerland
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20
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Berli C, Inauen J, Stadler G, Scholz U, Shrout PE. Understanding Between-Person Interventions With Time-Intensive Longitudinal Outcome Data: Longitudinal Mediation Analyses. Ann Behav Med 2021; 55:476-488. [PMID: 32890399 PMCID: PMC8122473 DOI: 10.1093/abm/kaaa066] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mediation analysis is an important tool for understanding the processes through which interventions affect health outcomes over time. Typically the temporal intervals between X, M, and Y are fixed by design, and little focus is given to the temporal dynamics of the processes. PURPOSE In this article, we aim to highlight the importance of considering the timing of the causal effects of a between-person intervention X, on M and Y, resulting in a deeper understanding of mediation. METHODS We provide a framework for examining the impact of a between-person intervention X on M and Y over time when M and Y are measured repeatedly. Five conceptual and analytic steps involve visualizing the effects of the intervention on Y, M, the relationship of M and Y, and the mediating process over time and selecting an appropriate analytic model. RESULTS We demonstrate how these steps can be applied to two empirical examples of health behavior change interventions. We show that the patterns of longitudinal mediation can be fit with versions of longitudinal multilevel structural equation models that represent how the magnitude of direct and indirect effects vary over time. CONCLUSIONS We urge researchers and methodologists to pay more attention to temporal dynamics in the causal analysis of interventions.
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Affiliation(s)
- Corina Berli
- Department of Psychology, Applied Social and Health Psychology, University of Zurich, Binzmuehlestrasse, Zurich, Switzerland
| | - Jennifer Inauen
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - Gertraud Stadler
- Gender in Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Urte Scholz
- Department of Psychology, Applied Social and Health Psychology, University of Zurich, Binzmuehlestrasse, Zurich, Switzerland
- University Research Priority Program “Dynamics of Healthy Aging,” University of Zurich, Zurich, Switzerland
| | - Patrick E Shrout
- Department of Psychology, New York University, New York, NY, USA
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21
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Nigg C, Amrein M, Rackow P, Scholz U, Inauen J. Compensation and transfer effects of eating behavior change in daily life: Evidence from a randomized controlled trial. Appetite 2021; 162:105170. [PMID: 33621613 DOI: 10.1016/j.appet.2021.105170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/10/2020] [Accepted: 02/12/2021] [Indexed: 02/07/2023]
Abstract
Pursuing specific eating goals may lead to the adoption of other healthy behaviors (transfer) or compensation with unhealthy behaviors. Previous research has mostly investigated such processes using non-experimental studies focusing on interindividual differences. To investigate transfer or compensation of eating behavior in daily life, we analyzed data from a 2 (eating goal: more fruit and vegetables [FV] vs. fewer unhealthy snacks) x 2 (intervention vs. control group) factorial randomized trial. Adopting a within-person perspective, we studied potential transfer and compensation 1) between different eating behaviors and physical activity (PA), and 2) in response to an eating behavior change intervention. Participants (N = 203) received either goals to increase FV intake or decrease unhealthy snack intake and completed a daily e-diary. Eating more unhealthy snacks predicted 0.16 less FV portions (β = -0.07; p < 0.001) and 18% less unhealthy snack intake the next day (p < 0.001). Eating more FV predicted 0.42 less FV portions the next day (β = -0.07; p < 0.001). Participants with the FV eating goal intervention decreased unhealthy snacks (p = 0.012) and PA (p = 0.019) by 8% compared to controls, respectively. Similar but non-significant patterns were observed for participants with the decreasing unhealthy snack goal intervention (p > 0.05). Results indicated both compensation and transfer processes in daily life. Relationships mostly occur within the same behavior and rather support compensatory effects. In turn, a behavior change intervention to promote FV intake potentially enhances non-assigned eating behaviors, indicating transfer, but may lower PA.
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Affiliation(s)
- Carina Nigg
- Karlsruhe Institute of Technology, Institute of Sports and Sports Science, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany.
| | - Melanie Amrein
- University of Zurich, Department of Psychology, Binzmühlestrasse 14 / Box 14, CH-8050, Zurich, Switzerland
| | - Pamela Rackow
- University of Stirling, Division of Psychology, Faculty of Natural Sciences, Stirling FK9 4LA, Scotland, UK
| | - Urte Scholz
- University of Zurich, Department of Psychology, Binzmühlestrasse 14 / Box 14, CH-8050, Zurich, Switzerland
| | - Jennifer Inauen
- University of Bern, Institute of Psychology, Bern, Fabrikstrasse 8, 3012, Bern, Switzerland
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Inauen J, Zhou G. Health and Well-Being in the Early Stages of the Covid-19 Pandemic: Insights from Applied Psychology. Appl Psychol Health Well Being 2020; 12:937-945. [PMID: 33135315 DOI: 10.1111/aphw.12245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/22/2022]
Affiliation(s)
| | - Guangyu Zhou
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, China
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Hoffmann S, Feldmann U, Bach PM, Binz C, Farrelly M, Frantzeskaki N, Hiessl H, Inauen J, Larsen TA, Lienert J, Londong J, Lüthi C, Maurer M, Mitchell C, Morgenroth E, Nelson KL, Scholten L, Truffer B, Udert KM. A Research Agenda for the Future of Urban Water Management: Exploring the Potential of Nongrid, Small-Grid, and Hybrid Solutions. Environ Sci Technol 2020; 54:5312-5322. [PMID: 32233462 DOI: 10.1021/acs.est.9b05222] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Recent developments in high- and middle-income countries have exhibited a shift from conventional urban water systems to alternative solutions that are more diverse in source separation, decentralization, and modularization. These solutions include nongrid, small-grid, and hybrid systems to address such pressing global challenges as climate change, eutrophication, and rapid urbanization. They close loops, recover valuable resources, and adapt quickly to changing boundary conditions such as population size. Moving to such alternative solutions requires both technical and social innovations to coevolve over time into integrated socio-technical urban water systems. Current implementations of alternative systems in high- and middle-income countries are promising, but they also underline the need for research questions to be addressed from technical, social, and transformative perspectives. Future research should pursue a transdisciplinary research approach to generating evidence through socio-technical "lighthouse" projects that apply alternative urban water systems at scale. Such research should leverage experiences from these projects in diverse socio-economic contexts, identify their potentials and limitations from an integrated perspective, and share their successes and failures across the urban water sector.
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Affiliation(s)
- Sabine Hoffmann
- Eawag, Swiss Federal Institute for Aquatic Science and Technology, 8600 Dübendorf, Switzerland
| | - Ulrike Feldmann
- Eawag, Swiss Federal Institute for Aquatic Science and Technology, 8600 Dübendorf, Switzerland
| | - Peter M Bach
- Eawag, Swiss Federal Institute for Aquatic Science and Technology, 8600 Dübendorf, Switzerland
- ETH Zürich, Institute of Environmental Engineering, 8093 Zürich, Switzerland
- Monash Water for Liveability, Department of Civil Engineering, Monash University, Clayton, Victoria 3800, Australia
| | - Christian Binz
- Eawag, Swiss Federal Institute for Aquatic Science and Technology, 8600 Dübendorf, Switzerland
- Circle, Centre for Innovation, Research and Competence in the Learning Economy, Lund University, 221 00 Lund, Sweden
| | - Megan Farrelly
- School of Social Sciences, Monash University, Clayton, Victoria 3800, Australia
| | - Niki Frantzeskaki
- Centre for Urban Transitions, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
- Drift, Dutch Research Institute For Transitions, Erasmus University PA Rotterdam, 3062, The Netherlands
| | - Harald Hiessl
- Fraunhofer Institute for Systems and Innovation Research ISI, 76139 Karlsruhe, Germany
| | - Jennifer Inauen
- Eawag, Swiss Federal Institute for Aquatic Science and Technology, 8600 Dübendorf, Switzerland
- Institute for Psychology, University of Berne, 3012 Berne, Switzerland
| | - Tove A Larsen
- Eawag, Swiss Federal Institute for Aquatic Science and Technology, 8600 Dübendorf, Switzerland
| | - Judit Lienert
- Eawag, Swiss Federal Institute for Aquatic Science and Technology, 8600 Dübendorf, Switzerland
| | - Jörg Londong
- Faculty of Civil Engineering, Bauhaus University, 99421 Weimar, Germany
| | - Christoph Lüthi
- Eawag, Swiss Federal Institute for Aquatic Science and Technology, 8600 Dübendorf, Switzerland
| | - Max Maurer
- Eawag, Swiss Federal Institute for Aquatic Science and Technology, 8600 Dübendorf, Switzerland
- ETH Zürich, Institute of Environmental Engineering, 8093 Zürich, Switzerland
| | - Cynthia Mitchell
- Eawag, Swiss Federal Institute for Aquatic Science and Technology, 8600 Dübendorf, Switzerland
- Institute for Sustainable Futures, University of Technology Sydney, Ultimo New South Wales 2007, Australia
| | - Eberhard Morgenroth
- Eawag, Swiss Federal Institute for Aquatic Science and Technology, 8600 Dübendorf, Switzerland
- ETH Zürich, Institute of Environmental Engineering, 8093 Zürich, Switzerland
| | - Kara L Nelson
- Department of Civil & Environmental Engineering, University of California at Berkeley, Berkeley, California 94720, United States
| | - Lisa Scholten
- Delft University of Technology, 2628 CN Delft, The Netherlands
| | - Bernhard Truffer
- Eawag, Swiss Federal Institute for Aquatic Science and Technology, 8600 Dübendorf, Switzerland
- Faculty of Geosciences, University of Utrecht, 3584 CS Utrecht, The Netherlands
| | - Kai M Udert
- Eawag, Swiss Federal Institute for Aquatic Science and Technology, 8600 Dübendorf, Switzerland
- ETH Zürich, Institute of Environmental Engineering, 8093 Zürich, Switzerland
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Inauen J, Lilje J, Mosler HJ. Refining hand washing interventions by identifying active ingredients: A cluster-randomized controlled trial in rural Zimbabwe. Soc Sci Med 2019; 245:112712. [PMID: 31846857 DOI: 10.1016/j.socscimed.2019.112712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/17/2019] [Accepted: 11/30/2019] [Indexed: 11/17/2022]
Abstract
RATIONALE Consistent hand washing with soap can reduce the risk of diarrhea, but changing hand-washing behavior is difficult. Systematic behavior change approaches promise to enhance hand washing with soap effectively, and allow the identification of active intervention ingredients using mediation analysis. This knowledge can then be used to derive hypotheses for systematically refining the intervention. OBJECTIVE We demonstrate this at the example of a behavior change intervention to promote hand washing with soap based on the RANAS approach (risk, attitudes, norms, ability, and self-regulation). METHODS Sixteen wards of Masvingo province in Zimbabwe were randomly allocated to the RANAS-based intervention or a wait-list control group. Hand washing at baseline and follow-up was observed for 224 randomly selected caregivers of young children. They additionally participated in quantitative face-to-face interviews assessing psychosocial factors. RESULTS At baseline, hand washing with soap was <3% on average, and did not differ between groups (p = .526). At follow-up, intervention participants washed hands with soap more frequently than controls (in 29.4% vs. 8.2% of all stool- and food-related situations, B = 1.88, SE = 0.32, OR = 6.6, p < .001). Mediation analyses revealed that the intervention enhanced several of the targeted psychosocial factors; return, descriptive and injunctive norms, action knowledge, action self-efficacy, maintenance self-efficacy, action planning, and remembering. The intervention effect was mediated through increased remembering. CONCLUSION This study supports the efficacy of a systematic approach to behavior change to promote hand washing with soap. The analyses of the mechanisms revealed important insights into the active ingredients of the intervention, which will facilitate its future refinement.
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Affiliation(s)
- Jennifer Inauen
- Institute of Psychology, University of Bern, Bern, Switzerland; Department of Environmental Social Sciences, Eawag: Swiss Federal Institute of Aquatic Science & Technology, Duebendorf, Switzerland.
| | - Jonathan Lilje
- Department of Environmental Social Sciences, Eawag: Swiss Federal Institute of Aquatic Science & Technology, Duebendorf, Switzerland
| | - Hans-Joachim Mosler
- Department of Environmental Social Sciences, Eawag: Swiss Federal Institute of Aquatic Science & Technology, Duebendorf, Switzerland
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Harter M, Inauen J, Mosler HJ. How does Community-Led Total Sanitation (CLTS) promote latrine construction, and can it be improved? A cluster-randomized controlled trial in Ghana. Soc Sci Med 2019; 245:112705. [PMID: 31838334 PMCID: PMC6983942 DOI: 10.1016/j.socscimed.2019.112705] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/11/2019] [Accepted: 11/26/2019] [Indexed: 11/08/2022]
Abstract
Rationale Open defecation is connected to poor health and child mortality, but billions of people still do not have access to safe sanitation facilities. Community-Led Total Sanitation (CLTS) promotes latrine construction to eradicate open defecation. However, the mechanisms by which CLTS works and how they can be improved remain unknown. The present study is the first to investigate the psychosocial determinants of CLTS in a longitudinal design. Furthermore, we tested whether CLTS can be made more effective by theory- and evidence-based interventions using the risks, attitudes, norms, abilities, and selfregulation (RANAS) model. Methods A cluster-randomized controlled trial of 3216 households was implemented in rural Ghana. Communities were randomly assigned to classic CLTS, one of three RANAS-based interventions, or to the control arm. Prepost surveys at 6-month follow-up included standardized interviews assessing psychosocial determinants from the RANAS model. Regression analyses and multilevel mediation models were computed to test intervention effects and mechanisms of CLTS. Results Latrine coverage increased pre-post by 67.6% in all intervention arms and by 7.9% in the control arm (p < .001). The combination with RANAS-based interventions showed non-significantly greater effects than CLTS alone. The effects of CLTS on latrine construction were significantly mediated by changes in four determinants: others' behaviour and approval, self-efficacy, action planning and commitment. Changes in vulnerability, severity, and barrier planning were positively connected to latrine construction but not affected by CLTS. Conclusion This study corroborates the effectiveness of CLTS in increasing latrine coverage, and additional activities can be improved further. Behaviour change techniques within CLTS that strengthened the relevant factors should be maintained. The study also recommends interventions based on the RANAS approach to improve CLTS. Further research is needed to understand the effects of RANAS-based interventions combined with CLTS at longer follow-up Randomized-controlled trial examined Community-Led Total Sanitation (CLTS) in Ghana. CLTS increased latrine coverage by 67.6%. CLTS achieved changes in psychosocial determinants based on a psychosocial model. Changes in psychosocial determinants explain success of CLTS. Changes in factors such as social norms explain why participants construct latrines.
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Affiliation(s)
- Miriam Harter
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstrasse 133, 8600, Dübendorf, Switzerland.
| | - Jennifer Inauen
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstrasse 133, 8600, Dübendorf, Switzerland; Department of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
| | - Hans-Joachim Mosler
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstrasse 133, 8600, Dübendorf, Switzerland.
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Harter M, Contzen N, Inauen J. The role of social identification for achieving an open-defecation free environment: A cluster-randomized, controlled trial of Community-Led Total Sanitation in Ghana. J Environ Psychol 2019; 66:101360. [PMID: 31885413 PMCID: PMC6919339 DOI: 10.1016/j.jenvp.2019.101360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 06/10/2023]
Abstract
Unsafe sanitation practices are a major source of environmental pollution and are a leading cause of death in countries of the Global South. One of the most successful campaigns to eradicate open defecation is "Community-Led Total Sanitation" (CLTS). It aims at shifting social norms towards safe sanitation practices. However, the effectiveness of CLTS is heterogeneous. Based on social identity theory, we expect CLTS to be most effective in communities with stronger social identification, because in these communities individuals should rather follow social norms. We conducted a cluster-randomized controlled trial with 3,216 households in 132 communities in Ghana, comparing CLTS to a control arm. Self-reported open defecation rates and social identification were assessed pre-post. Generalized Estimating Equations showed that CLTS achieved lower open defecation rates compared to controls. This effect was significantly stronger for communities with stronger average social identification. The results confirm the assumptions of social identity theory. They imply that pre-existing social identification needs to be considered for planning CLTS, and strengthened beforehand if needed.
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Affiliation(s)
- Miriam Harter
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Nadja Contzen
- University of Groningen, Department of Psychology, the Netherlands
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27
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Landes FC, Inauen J, Ponce‐Canchihuamán J, Markowski K, Ellis TK, van Geen A. Does Involving Parents in Soil Sampling Identify Causes of Child Exposure to Lead? A Case Study of Community Engagement in Mining-Impacted Towns in Peru. Geohealth 2019; 3:218-236. [PMID: 32159043 PMCID: PMC7007120 DOI: 10.1029/2019gh000200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 05/05/2023]
Abstract
Over a million people in Peru may be exposed to lead (Pb) due to past or present mining-related activities; however, neither soil Pb nor blood Pb are routinely monitored throughout the country. Because little is known about Pb contamination in smaller mining-impacted towns, soil Pb was mapped in four such towns with a portable X-ray fluorescence analyzer in 2015. The roadside mapping delineated hotspots of highly contaminated soil (1,000-6,000 mg/kg Pb) in two of the towns. The local health department, provided with a LeadCare II analyzer, then measured blood-Pb levels >5 in 65% and >10 μg/dL in 15% of children (n = 200) up to 6 years of age in these same four communities. There were no clear relations between child blood-Pb levels and Pb levels in soil samples collected inside (n = 50) or outside the home (n = 50). Increased child blood Pb was associated with decreased level of cleanliness of parent clothing (n = 136) and shoes (n = 138), linking a possible behavioral factor for transferring contaminated soil and dust to children. In order to explore individual exposure and variations in soil Pb, 10 parents of children with blood Pb >10 μg/dL and 10 parents of children with blood Pb <5 μg/dL were invited to collect soil samples in areas where their children play and screen it for Pb using a color-based field procedure. Importantly, parents identified a new hotspot of Pb contamination that had been missed by the previous portable X-ray fluorescence soil mapping. The findings highlight the feasibility and value of involving families impacted by environmental contamination to identify and reduce environmental health risk.
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Affiliation(s)
- Franziska C. Landes
- Lamont‐Doherty Earth ObservatoryColumbia UniversityPalisadesNYUSA
- Department of Earth and Environmental SciencesColumbia UniversityNew YorkNYUSA
| | | | - Johny Ponce‐Canchihuamán
- Center for Research in Environmental HealthLimaPeru
- Facultad de Salud Publica y AdministracionUniversidad Peruana Cayetano HerediaLimaPeru
| | - Kathie Markowski
- Lamont‐Doherty Earth ObservatoryColumbia UniversityPalisadesNYUSA
| | - Tyler K. Ellis
- Lamont‐Doherty Earth ObservatoryColumbia UniversityPalisadesNYUSA
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Kwasnicka D, Inauen J, Nieuwenboom W, Nurmi J, Schneider A, Short CE, Dekkers T, Williams AJ, Bierbauer W, Haukkala A, Picariello F, Naughton F. Challenges and solutions for N-of-1 design studies in health psychology. Health Psychol Rev 2019; 13:163-178. [PMID: 30626274 DOI: 10.1080/17437199.2018.1564627] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Theories of behaviour change and health behaviour change interventions are most often evaluated in between-person designs. However, behaviour change theories apply to individuals not groups and behavioural interventions ultimately aim to achieve within-person rather than between-group change. Within-person methodology, such as N-of-1 (also known as single case design), can circumvent this issue, though has multiple design-specific challenges. This paper provides a conceptual review of the challenges and potential solutions for undertaking N-of-1 studies in health psychology. Key challenges identified include participant adherence to within-person protocols, carry-over and slow onset effects, suitability of behaviour change techniques for evaluation in N-of-1 experimental studies, optimal allocation sequencing and blinding, calculating power/sample size, and choosing the most suitable analysis approach. Key solutions include involving users in study design, employing recent technologies for unobtrusive data collection and problem solving by design. Within-person designs share common methodological requirements with conventional between-person designs but require specific methodological considerations. N-of-1 evaluation designs are appropriate for many though not all types of interventions. A greater understanding of patterns of behaviours and factors influencing behaviour change at the within-person level is required to progress health psychology into a precision science. Video abstract: Supplementary Material 1.
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Affiliation(s)
- Dominika Kwasnicka
- a School of Psychology , Curtin University , Perth , Western Australia.,b SWPS University of Social Sciences and Humanities , Wroclaw , Poland
| | - Jennifer Inauen
- c Department of Environmental Social Sciences, Environmental and Health Psychology , Eawag - Swiss Federal Institute of Aquatic Science & Technology , Duebendorf , Switzerland
| | - Wim Nieuwenboom
- d University of Applied Sciences Northwestern Switzeland, School of Social Work , Institute for Social Work and Health , Olten , Switzerland
| | - Johanna Nurmi
- e Faculty of Social Sciences , University of Helsinki , Helsinki , Finland.,f Behavioural Science Group, Institute of Public Health , University of Cambridge , Cambridge , UK
| | - Annegret Schneider
- g Department of Clinical, Educational and Health Psychology , University College London , London , UK
| | - Camille E Short
- h The Freemasons Foundation Centre for Men's Health, School of Medicine , University of Adelaide , Adelaide , South Australia , Australia
| | - Tessa Dekkers
- i Faculty of Industrial Design Engineering , Delft University of Technology , Delft , The Netherlands
| | - A Jess Williams
- j Institute for Mental Health, School of Psychology , University of Birmingham , Birmingham , UK
| | - Walter Bierbauer
- k Department of Psychology, Applied Social and Health Psychology , University of Zurich , Zurich , Switzerland
| | - Ari Haukkala
- e Faculty of Social Sciences , University of Helsinki , Helsinki , Finland
| | - Federica Picariello
- l Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology, and Neuroscience , King's College London , London , UK
| | - Felix Naughton
- m School of Health Sciences , University of East Anglia , Norwich , UK
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Inauen J, Stocker A, Scholz U. Why and for Whom May Coping Planning Have Adverse Effects? A Moderated Mediation Analysis. Appl Psychol Health Well Being 2018; 10:272-289. [PMID: 29740980 DOI: 10.1111/aphw.12130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Coping planning, the formation of plans to overcome behavioral barriers is assumed to promote health behavior maintenance, but the literature on this is inconsistent. In this study, we aimed to investigate the mechanisms of a coping planning intervention that adversely affected maintained safe water consumption. We also explored perceived behavioral difficulty as a potential moderator of coping planning interventions. METHODS In the second phase of a cluster-randomised trial, households (N = 177 analyzed) were randomly allocated to a coping planning intervention or a comparison group (repetition of interventions from first intervention phase). Safe water consumption, the mechanisms of coping planning, and perceived difficulty were measured pre-post. The data were analyzed using mediation and moderated mediation analysis. RESULTS Changes in behavioral intention mediated the intervention effects on behavioral maintenance (b = -0.36, 95% CI [-0.91, -0.03]). Changes in perceived coping planning (b = 0.08, 95% CI [-0.12, 0.34]), and maintenance self-efficacy (b = -0.13, 95% CI [-0.45, 0.01]) did not mediate the effects. Prior perceived difficulty moderated the coping planning intervention effects on maintenance via intention. CONCLUSIONS Coping planning may decrease motivation for health behavior maintenance for persons who experienced few barriers prior to the planning intervention.
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Affiliation(s)
- Jennifer Inauen
- Eawag: Swiss Federal Institute of Aquatic Science & Technology, Switzerland
| | - Andrea Stocker
- Eawag: Swiss Federal Institute of Aquatic Science & Technology, Switzerland
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Abstract
Abstract. This study tested the effects of exercise on eating behavior. The transfer hypothesis proposes that exercise leads to a generalization of healthy behavior and therefore an improved diet. The compensation hypothesis assumes that exercise leads to increased caloric intake in order to “compensate” for the energy expenditure. We tested these hypotheses for actual as well as imagined exercise. Female university employees or students (N = 227) were randomly assigned to three experimental groups: actual exercise vs. imagined exercise vs. control. After baseline data had been obtained, the participants engaged in a 5-minute experimental task and were then left alone with unhealthy snacks. Participants who had imagined themselves exercising (M = 101 kcal, SD = 128 kcal) consumed significantly fewer calories than did controls (M = 129 kcal, SD = 142 kcal), consistent with a transfer effect. Participants who had engaged in actual exercise, but had been distracted from thinking about exercise, consumed quantities (M = 127 kcal, SD = 111 kcal) similar to those consumed by controls. This study suggests that transfer effects are underpinned by psychological processes, such as goal activation, which should be investigated in the future.
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Affiliation(s)
- Jennifer Inauen
- Department of Environmental Social Sciences, Eawag – Swiss Federal Institute of Aquatic Science & Technology, Dübendorf, Switzerland
| | - Theda Radtke
- Department of Psychology, University of Zurich, Switzerland
| | - Laura Rennie
- B-Research, Université Paris Ouest Nanterre La Défense, Nanterre, France
| | - Urte Scholz
- Department of Psychology & University Research Priority Program “Dynamics of Healthy Aging,” University of Zurich, Switzerland
| | - Sheina Orbell
- Department of Psychology, University of Essex, Colchester, UK
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Bierbauer W, Inauen J, Schaefer S, Kleemeyer MM, Lüscher J, König C, Tobias R, Kliegel M, Ihle A, Zimmerli L, Holzer BM, Siebenhuener K, Battegay E, Schmied C, Scholz U. Health Behavior Change in Older Adults: Testing the Health Action Process Approach at the Inter- and Intraindividual Level. Appl Psychol Health Well Being 2017; 9:324-348. [PMID: 29024515 DOI: 10.1111/aphw.12094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Health behavior change theories usually claim to be universally and individually applicable. Most research has tested behavior change theories at the interindividual level and within young-to-middle-aged populations. However, associations at the interindividual level can differ substantially from associations at the intraindividual level. This study examines the applicability of the Health Action Process Approach (HAPA) at the inter- and the intraindividual level among older adults. METHODS Two intensive longitudinal studies examined the HAPA model covering two different health behaviors and two different time spans: Study 1 (physical activity, N = 52 × 6 monthly observations) and Study 2 (medication adherence, N = 64 × 30 daily observations). The HAPA constructs (risk awareness, outcome expectancy, self-efficacy, intention, action planning, action control), and self-reported behaviors were assessed. RESULTS Overall, at the interindividual level, results of both studies largely confirmed the associations specified by the HAPA. At the intraindividual level, results were less in line with the HAPA. Only action control emerged as consistent predictor of behavior. CONCLUSIONS This study emphasises the importance of examining health behavior change theories at both, the inter- and the intraindividual level.
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Affiliation(s)
- Walter Bierbauer
- University of Zurich, Switzerland University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Switzerland
| | - Jennifer Inauen
- Eawag: Swiss Federal Institute of Aquatic Science & Technology, Switzerland Columbia University, USA
| | - Sabine Schaefer
- Max Planck Institute for Human Development, Germany Saarland University, Germany
| | | | | | | | | | - Matthias Kliegel
- Department of Psychology, University of Geneva, Switzerland Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland
| | - Andreas Ihle
- Department of Psychology, University of Geneva, Switzerland Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland
| | - Lukas Zimmerli
- Cantonal Hospital Olten, Switzerland University Hospital Zurich, Switzerland
| | - Barbara M Holzer
- University Hospital Zurich, Switzerland Center of Competence Multimorbidity, University of Zurich, Switzerland
| | - Klarissa Siebenhuener
- University Hospital Zurich, Switzerland Center of Competence Multimorbidity, University of Zurich, Switzerland
| | - Edouard Battegay
- University Hospital Zurich, Switzerland Center of Competence Multimorbidity, University of Zurich, Switzerland
| | | | - Urte Scholz
- University of Zurich, Switzerland University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Switzerland Center of Competence Multimorbidity University of Zurich, Switzerland
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Inauen J, Bolger N, Shrout PE, Stadler G, Amrein M, Rackow P, Scholz U. Using Smartphone-Based Support Groups to Promote Healthy Eating in Daily Life: A Randomised Trial. Appl Psychol Health Well Being 2017; 9:303-323. [PMID: 28948690 DOI: 10.1111/aphw.12093] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although many people intend to eat healthily, they often fail to do so. We report the first randomised trial testing whether smartphone-based support groups can enhance healthy eating. METHODS Adults (N = 203) were randomised to the support or control condition (information), and to one of two eating goals (increasing fruit and vegetable/decreasing unhealthy snack consumption). After baseline, participants received information on their assigned eating goal, and completed a 13-day electronic diary. During Days 4-10, support participants were asked to support each other in achieving their eating goal in smartphone-based groups. The primary outcome was daily servings of fruit/vegetables or unhealthy snacks. Maintenance of intervention effects was assessed on Days 11-13, and at 1-month and 2-month follow-ups. RESULTS Support participants showed a gradual increase in healthy eating over time, and ate 1.4 fruits and vegetables more, 95% CI [0.3, 2.6], or 0.8 unhealthy snacks less, 95% CI [-1.4, -0.2] than controls on Day 10. Most effects were not maintained at follow-ups. CONCLUSIONS Smartphone-based groups can promote fruit and vegetable consumption and decrease unhealthy snack intake. This study extends previous findings of the benefits of support groups, and sheds light on the temporal dynamics of behavior change.
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Affiliation(s)
- Jennifer Inauen
- Eawag: Swiss Federal Institute of Aquatic Science & Technology, Switzerland.,Columbia University, USA
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Amrein MA, Rackow P, Inauen J, Radtke T, Scholz U. The role of Compensatory Health Beliefs in eating behavior change: A mixed method study. Appetite 2017; 116:1-10. [DOI: 10.1016/j.appet.2017.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 04/15/2017] [Accepted: 04/15/2017] [Indexed: 01/04/2023]
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Inauen J, Bierbauer W, Lüscher J, König C, Tobias R, Ihle A, Zimmerli L, Holzer BM, Battegay E, Siebenhüner K, Kliegel M, Scholz U. Assessing adherence to multiple medications and in daily life among patients with multimorbidity. Psychol Health 2017; 32:1233-1248. [PMID: 28043163 DOI: 10.1080/08870446.2016.1275632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Chronic conditions often require multiple medication intake. However, past research has focused on assessing overall adherence or adherence to a single index medication only. This study explored adherence measures for multiple medication intake, and in daily life, among patients with multiple chronic conditions (i.e. multimorbidity). DESIGN Eighty-four patients with multimorbidity and multiple-medication regimens completed three monthly panel questionnaires. A randomly assigned subsample additionally completed a 30-day daily diary. MAIN OUTCOME MEASURE The Non-Adherence Report; a brief self-report measure of adherence to each prescribed medication (NAR-M), and in daily life. We further assessed the Medication Adherence Report Scale (MARS), and a subsample of participants were randomised to electronic adherence monitoring. RESULTS The NAR-M indicated M = 94.7% adherence at Time 1 (SD = 9.3%). The NAR-M was significantly correlated with the MARS (rt1 = .52, rt2 = .57, and rt3 = .65; p < .001), and in tendency with electronically assessed adherence (rt2 = .45, rt3 = .46, p < .10). Variance components analysis indicated that between-person differences accounted for 10.2% of the variance in NAR-M adherence rates, whereas 22.9% were attributable to medication by person interactions. CONCLUSION This study highlights the importance and feasibility of studying adherence to multiple medications differentially, and in daily life. Future studies may use these measures to investigate within-person and between-medication differences in adherence.
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Affiliation(s)
- Jennifer Inauen
- a Department of Psychology , Columbia University , New York , NY , USA.,b Department of Psychology , University of Zurich , Zurich , Switzerland.,c Center of Competence Multimorbidity, University of Zurich , Zurich , Switzerland
| | - Walter Bierbauer
- b Department of Psychology , University of Zurich , Zurich , Switzerland.,g University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich , Zurich , Switzerland
| | - Janina Lüscher
- b Department of Psychology , University of Zurich , Zurich , Switzerland
| | - Claudia König
- b Department of Psychology , University of Zurich , Zurich , Switzerland.,g University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich , Zurich , Switzerland
| | - Robert Tobias
- b Department of Psychology , University of Zurich , Zurich , Switzerland
| | - Andreas Ihle
- d Department of Psychology , University of Geneva , Geneva , Switzerland.,h Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva , Geneva , Switzerland.,i Swiss National Center of Competences in Research LIVES-Overcoming Vulnerability: Life Course Perspectives , Lausanne , Switzerland
| | - Lukas Zimmerli
- c Center of Competence Multimorbidity, University of Zurich , Zurich , Switzerland.,e Cantonal Hospital Olten , Olten , Switzerland
| | - Barbara M Holzer
- c Center of Competence Multimorbidity, University of Zurich , Zurich , Switzerland.,f Department of Internal Medicine , University Hospital Zurich , Zurich , Switzerland.,g University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich , Zurich , Switzerland
| | - Edouard Battegay
- c Center of Competence Multimorbidity, University of Zurich , Zurich , Switzerland.,f Department of Internal Medicine , University Hospital Zurich , Zurich , Switzerland.,g University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich , Zurich , Switzerland
| | - Klarissa Siebenhüner
- c Center of Competence Multimorbidity, University of Zurich , Zurich , Switzerland.,f Department of Internal Medicine , University Hospital Zurich , Zurich , Switzerland.,g University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich , Zurich , Switzerland
| | - Matthias Kliegel
- d Department of Psychology , University of Geneva , Geneva , Switzerland.,h Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva , Geneva , Switzerland.,i Swiss National Center of Competences in Research LIVES-Overcoming Vulnerability: Life Course Perspectives , Lausanne , Switzerland
| | - Urte Scholz
- b Department of Psychology , University of Zurich , Zurich , Switzerland.,c Center of Competence Multimorbidity, University of Zurich , Zurich , Switzerland.,g University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich , Zurich , Switzerland
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Ihle A, Inauen J, Scholz U, König C, Holzer B, Zimmerli L, Battegay E, Tobias R, Kliegel M. Prospective and retrospective memory are differentially related to self-rated omission and commission errors in medication adherence in multimorbidity. Appl Neuropsychol Adult 2016; 24:505-511. [PMID: 27450575 DOI: 10.1080/23279095.2016.1209675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We investigated the relations of self-rated omission errors (i.e., forgetting to take one's medication) and commission errors (i.e., unnecessary repetitions of medication intake because of forgetting that it has already been taken) in medication adherence in multimorbidity to prospective and retrospective memory performance. Moreover, we examined whether these relations were moderated by the number of medications that had to be taken. Eighty-four patients with multimorbidity (aged 28-84 years, M = 62.4) reported medication adherence regarding the last seven days and the number of medications they had to take. In addition, we administered psychometric tests on prospective memory (PM) and retrospective memory performance. We found that reported omission errors in medication adherence were related significantly to lower PM performance. This relationship was increased in individuals with a lower number of medications. In comparison, reported commission errors in medication adherence were related significantly to lower retrospective memory performance. This relationship was increased in individuals with a larger number of medications. Present data suggest that omission errors in medication adherence in multimorbidity may reflect primarily PM errors, particularly if few medications have to be taken, while commission errors may reflect mainly retrospective memory failures, especially with a large number of medications that need to be taken as prescribed. From an applied neuropsychological perspective, these results underline the importance of trying to enhance PM and retrospective memory performance in patients with multimorbidity.
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Affiliation(s)
- Andreas Ihle
- a Department of Psychology , University of Geneva , Geneva , Switzerland.,e Center for the Interdisciplinary Study of Gerontology and Vulnerability , University of Geneva , Geneva , Switzerland.,f Swiss National Center of Competences in Research LIVES-Overcoming Vulnerability: Life Course Perspectives
| | - Jennifer Inauen
- b Department of Psychology , University of Zurich , Zurich , Switzerland.,g Center of Competence Multimorbidity , University of Zurich , Zurich , Switzerland.,h University Research Priority Program "Dynamics of Healthy Aging" , University of Zurich , Zurich , Switzerland.,i Department of Psychology , Columbia University , New York , USA
| | - Urte Scholz
- b Department of Psychology , University of Zurich , Zurich , Switzerland.,g Center of Competence Multimorbidity , University of Zurich , Zurich , Switzerland.,h University Research Priority Program "Dynamics of Healthy Aging" , University of Zurich , Zurich , Switzerland
| | - Claudia König
- b Department of Psychology , University of Zurich , Zurich , Switzerland.,h University Research Priority Program "Dynamics of Healthy Aging" , University of Zurich , Zurich , Switzerland
| | - Barbara Holzer
- c Department of Internal Medicine , University Hospital Zurich , Zurich , Switzerland.,g Center of Competence Multimorbidity , University of Zurich , Zurich , Switzerland.,h University Research Priority Program "Dynamics of Healthy Aging" , University of Zurich , Zurich , Switzerland
| | - Lukas Zimmerli
- d Department of Internal Medicine , Hospital Olten , Olten , Switzerland.,g Center of Competence Multimorbidity , University of Zurich , Zurich , Switzerland
| | - Edouard Battegay
- c Department of Internal Medicine , University Hospital Zurich , Zurich , Switzerland.,g Center of Competence Multimorbidity , University of Zurich , Zurich , Switzerland.,h University Research Priority Program "Dynamics of Healthy Aging" , University of Zurich , Zurich , Switzerland
| | - Robert Tobias
- b Department of Psychology , University of Zurich , Zurich , Switzerland
| | - Matthias Kliegel
- a Department of Psychology , University of Geneva , Geneva , Switzerland.,e Center for the Interdisciplinary Study of Gerontology and Vulnerability , University of Geneva , Geneva , Switzerland.,f Swiss National Center of Competences in Research LIVES-Overcoming Vulnerability: Life Course Perspectives
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Abstract
More than 100 million people globally are estimated to be exposed to arsenic in drinking water that exceeds the World Health Organization guideline of 10 µg/L. In an effort to develop and test a low-cost sustainable approach for water arsenic testing in Bangladesh, we conducted a randomized controlled trial which found arsenic educational interventions when combined with fee-based water arsenic testing programs led to nearly all households buying an arsenic test for their drinking water sources (93%) compared with only 53% when fee-based arsenic testing alone was offered. The aim of the present study was to build on the findings of this trial by investigating prospectively the psychological factors that were most strongly associated with switching to arsenic-safe wells in response to these interventions. Our theoretical framework was the RANAS (risk, attitude, norm, ability, and self-regulation) model of behavior change. In the multivariate logistic regression model of 285 baseline unsafe well users, switching to an arsenic-safe water source was significantly associated with increased instrumental attitude (odds ratio [OR] = 9.12; 95% confidence interval [CI] = [1.85, 45.00]), descriptive norm (OR = 34.02; 95% CI = [6.11, 189.45]), coping planning (OR = 11.59; 95% CI = [3.82, 35.19]), and commitment (OR = 10.78; 95% CI = [2.33, 49.99]). In addition, each additional minute from the nearest arsenic-safe drinking water source reduced the odds of switching to an arsenic-safe well by more than 10% (OR = 0.89; 95% CI = [0.87, 0.92]). Future arsenic mitigation programs should target these behavioral determinants of switching to arsenic-safe water sources.
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Affiliation(s)
| | - Jennifer Inauen
- 2 Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Jamie Perin
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer Tighe
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Khaled Hasan
- 3 International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Yan Zheng
- 4 United Nations Children's Fund Bangladesh, Dhaka, Bangladesh
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Berli C, Stadler G, Inauen J, Scholz U. Action control in dyads: A randomized controlled trial to promote physical activity in everyday life. Soc Sci Med 2016; 163:89-97. [PMID: 27421075 DOI: 10.1016/j.socscimed.2016.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 06/30/2016] [Accepted: 07/02/2016] [Indexed: 11/27/2022]
Abstract
RATIONALE Engaging in regular physical activity requires substantial self-regulatory effort such as action control (e.g., continuously monitoring and evaluating an ongoing behavior with regard to one's standards). OBJECTIVE The present study examined the effectiveness of an ecological momentary action control intervention for promoting daily physical activity. Also, we tested whether a dyadic compared to an individual intervention displayed an additional benefit. METHODS 121 overweight and obese individuals and their partners were randomly allocated to an intervention (n = 60; information + action control text messages) or a control group (n = 61; information only). The intervention was delivered in a dyadic vs. individual version of action control. Allocation ratio was 1:1:2 for the dyadic, individual, and control groups, respectively. Daily physical activity was assessed with triaxial accelerometers during a 14-day intervention phase and a 14-day follow-up phase. RESULTS Participants in the intervention group showed a higher probability (36.5%) to achieve the recommended daily activity levels (≥30 min of moderate-to-vigorous physical activity per day performed in bouts of at least 10 min) during the intervention and follow-up phase compared to those in the control group (23.0%). The intervention and control group did not differ in terms of daily moderate-to-vigorous physical activity (40.7 vs. 38.6 min per day, p = 0.623). CONCLUSION Interventions facilitating action control via text messages seem to be an effective tool for increasing adherence to physical activity guidelines in everyday life. The comparable effects for the dyadic and individual intervention suggest that automated text messages may be just as effective as personalized messages from the romantic partner. Further investigation is needed to examine the usefulness of a dyadic conceptualizing of action control. (controlled-trials.com ISRCTN15705531).
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Affiliation(s)
- Corina Berli
- Columbia University, Department of Psychology, 219 Schermerhorn Ext, 1190 Amsterdam Avenue MC: 5501, New York, NY 10027, USA.
| | - Gertraud Stadler
- Columbia University, Department of Psychology, 219 Schermerhorn Ext, 1190 Amsterdam Avenue MC: 5501, New York, NY 10027, USA; University of Aberdeen, Department of Applied Health Sciences, Aberdeen Health Psychology Group, 2nd Floor, Health Sciences Building, Aberdeen AB25 2ZD, Scotland, UK
| | - Jennifer Inauen
- Columbia University, Department of Psychology, 219 Schermerhorn Ext, 1190 Amsterdam Avenue MC: 5501, New York, NY 10027, USA
| | - Urte Scholz
- University of Zurich, Department of Psychology, Applied Social and Health Psychology, Binzmühlestrasse 14/Box 14, 8050 Zurich, Switzerland
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Inauen J, Shrout PE, Bolger N, Stadler G, Scholz U. Mind the Gap? An Intensive Longitudinal Study of Between-Person and Within-Person Intention-Behavior Relations. Ann Behav Med 2016; 50:516-22. [DOI: 10.1007/s12160-016-9776-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
Theory-based interventions can enhance people's safe water consumption, but the sustainability of these interventions and the mechanisms of maintenance remain unclear. We investigated these questions based on an extended theory of planned behaviour. Seven hundred and ten (445 analysed) randomly selected households participated in two cluster-randomised controlled trials in Bangladesh. Study 1 promoted switching to neighbours' arsenic-safe wells, and Study 2 promoted switching to arsenic-safe deep wells. Both studies included two intervention phases. Structured interviews were conducted at baseline (T1), and at 1-month (T2), 2-month (T3) and 9-month (T4) follow-ups. In intervention phase 1 (between T1 and T2), commitment-based behaviour change techniques--reminders, implementation intentions and public commitment--were combined with information and compared to an information-only control group. In phase 2 (between T2 and T3), half of each phase 1 intervention group was randomly assigned to receive either commitment-based techniques once more or coping planning with reminders and information. Initial well-switching rates of up to 60% significantly declined by T4: 38.3% of T2 safe water users stopped consuming arsenic-safe water. The decline depended on the intervention. Perceived behavioural control, intentions, commitment strength and coping planning were associated with maintenance. In line with previous studies, the results indicate that commitment and reminders engender long-term behavioural change.
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Affiliation(s)
- Jennifer Inauen
- a Department of Psychology , University of Zurich , Zurich , Switzerland
| | - Hans-Joachim Mosler
- b Department of Environmental Social Sciences , Eawag: Swiss Federal Institute of Aquatic Science & Technology , Duebendorf , Switzerland
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Contzen N, Inauen J. Social-cognitive factors mediating intervention effects on handwashing: a longitudinal study. J Behav Med 2015; 38:956-69. [PMID: 26243641 DOI: 10.1007/s10865-015-9661-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 07/11/2015] [Indexed: 01/15/2023]
Abstract
Handwashing with soap effectively prevents diarrhoea, a leading cause of death in infants. Theory-based interventions are expected to promote handwashing more successfully than standard approaches. The present article investigates the underlying change processes of theory-based handwashing interventions. A nonrandomised field study compared a standard approach to two theory-based interventions that were tailored to the target population, the inhabitants of four villages in southern Ethiopia (N = 408). Data were collected before and after interventions by structured interviews and analysed by mediation analysis. In comparison to the standard approach (i.e., education only), education with public commitment and reminder was slightly more effective in changing social-cognitive factors and handwashing. Education with an infrastructure promotion and reminder was most effective in promoting handwashing through enhancing social-cognitive factors. The results confirm the relevance of testing interventions' underlying change processes.
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Affiliation(s)
- Nadja Contzen
- Environmental and Health Psychology Group, Department of Environmental Social Sciences, Eawag: Swiss Federal Institute of Aquatic Science and Technology, Überlandstrasse 133, 8600, Dübendorf, Switzerland.
| | - Jennifer Inauen
- Chair of Applied Social Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
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Johnston R, Hug SJ, Inauen J, Khan NI, Mosler HJ, Yang H. Enhancing arsenic mitigation in Bangladesh: findings from institutional, psychological, and technical investigations. Sci Total Environ 2014; 488-489:477-83. [PMID: 24377677 DOI: 10.1016/j.scitotenv.2013.11.143] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 11/26/2013] [Accepted: 11/27/2013] [Indexed: 05/22/2023]
Abstract
As part of a trans-disciplinary research project, a series of surveys and interventions were conducted in different arsenic-affected regions of rural Bangladesh. Surveys of institutional stakeholders identified deep tubewells and piped water systems as the most preferred options, and the same preferences were found in household surveys of populations at risk. Psychological surveys revealed that these two technologies were well-supported by potential users, with self-efficacy and social norms being the principal factors driving behavior change. The principal drawbacks of deep tubewells are that installation costs are too high for most families to own private wells, and that for various socio-cultural-religious reasons, people are not willing to walk long distances to access communal tubewells. In addition, water sector planners have reservations about greater exploitation of the deep aquifer, out of concern for current or future geogenic contamination. Groundwater models and field studies have shown that in the great majority of the affected areas, the risk of arsenic contamination of deep groundwater is small; salinity, iron, and manganese are more likely to pose problems. These constituents can in some cases be avoided by exploiting an intermediate depth aquifer of good chemical quality, which is hydraulically and geochemically separate from the arsenic-contaminated shallow aquifer. Deep tubewells represent a technically sound option throughout much of the arsenic-affected regions, and future mitigation programs should build on and accelerate construction of deep tubewells. Utilization of deep tubewells, however, could be improved by increasing the tubewell density (which requires stronger financial support) to reduce travel times, by considering water quality in a holistic way, and by accompanying tubewell installation with motivational interventions based on psychological factors. By combining findings from technical and social sciences, the efficiency and success of arsenic mitigation in general - and installation of deep tubewells in particular - can be significantly enhanced.
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Affiliation(s)
- Richard Johnston
- Eawag-Swiss Federal Institute of Aquatic Science and Technology, Sandec, Department of Water and Sanitation in Developing Countries, Switzerland.
| | - Stephan J Hug
- Eawag-Swiss Federal Institute of Aquatic Science and Technology, Department of Water Resources and Drinking Water, Switzerland.
| | - Jennifer Inauen
- University of Zurich, Department of Psychology, Switzerland.
| | - Nasreen I Khan
- Fenner School of Environment and Society, The Australian National University, Canberra, ACT 0200, Australia.
| | - Hans-Joachim Mosler
- Eawag-Swiss Federal Institute of Aquatic Science and Technology, Department of Environmental Social Sciences, Switzerland.
| | - Hong Yang
- Eawag-Swiss Federal Institute of Aquatic Science and Technology, Department of System Analysis, Integrated Assessment and Modelling, Switzerland.
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Hossain MM, Inauen J. Differences in stakeholders’ and end users’ preferences of arsenic mitigation options in Bangladesh. J Public Health (Oxf) 2014. [DOI: 10.1007/s10389-014-0625-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Abstract
Compensatory health beliefs (CHBs)–beliefs that an unhealthy behavior can be compensated for by a healthy behavior–can be distinguished into trait and state beliefs. Trait CHBs are stable individual differences, whereas state CHBs are activated in a tempting situation–for example, when faced with an attractive snack. The aim of this study was to test whether diet-specific trait or state CHBs are predictive for an unhealthy behavior–namely, high-calorie snack consumption. A scenario was created in which 66 women aged 16 to 50 were faced with a high-calorie snack. Diet-specific trait and state CHBs correlated moderately with each other. Regression analyses revealed that diet-specific trait CHBs with exercise as the compensatory behavior were significantly predictive for high-calorie snack consumption, over and above control variables such as age, whereas state CHBs were only marginally significant. Diet-specific trait and state CHBs with reduced intake (eat less later) as the compensatory behavior were not related to high-calorie snack consumption. Results showed that trait CHBs are relevant for the prediction of high-calorie snack consumption. Future studies might want to further refine the measurement of CHBs, especially state CHBs.
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Affiliation(s)
- Theda Radtke
- Department of Psychology, Developmental and Health Psychology, University of Konstanz, Germany
| | - Jennifer Inauen
- Department of Psychology, Applied Social Psychology, University of Zurich, Switzerland
| | - Laura Rennie
- B-Research/Université Paris-Ouest Nanterre La Défense, Paris, France
| | - Sheina Orbell
- Department of Psychology, University of Essex, Colchester, UK
| | - Urte Scholz
- Department of Psychology, Applied Social Psychology, University of Zurich, Switzerland
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Inauen J, Tobias R, Mosler HJ. The role of commitment strength in enhancing safe water consumption: Mediation analysis of a cluster-randomized trial. Br J Health Psychol 2013; 19:701-19. [DOI: 10.1111/bjhp.12068] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 07/12/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Jennifer Inauen
- Department of Environmental Social Sciences; Eawag: Swiss Federal Institute of Aquatic Science & Technology; Duebendorf Switzerland
- Department of Psychology; University of Konstanz; Germany
| | - Robert Tobias
- Department of Environmental Social Sciences; Eawag: Swiss Federal Institute of Aquatic Science & Technology; Duebendorf Switzerland
| | - Hans-Joachim Mosler
- Department of Environmental Social Sciences; Eawag: Swiss Federal Institute of Aquatic Science & Technology; Duebendorf Switzerland
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Inauen J, Mosler HJ. Developing and testing theory-based and evidence-based interventions to promote switching to arsenic-safe wells in Bangladesh. J Health Psychol 2013; 19:1483-98. [PMID: 23864069 DOI: 10.1177/1359105313493811] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Millions of people in Bangladesh drink arsenic-contaminated water despite increased awareness of consequences to health. Theory-based and evidence-based interventions are likely to have greater impact on people switching to existing arsenic-safe wells than providing information alone. To test this assumption, we first developed interventions based on an empirical test of the Risk, Attitudes, Norms, Abilities and Self-regulation (RANAS) model of behaviour change. In the second part of this study, a cluster-randomised controlled trial revealed that in accordance with our hypotheses, information alone showed smaller increases in switching to arsenic-safe wells than information with reminders or information with reminders and implementation intentions.
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Affiliation(s)
- Jennifer Inauen
- Eawag: Swiss Federal Institute of Aquatic Science & Technology, Switzerland University of Konstanz, Germany
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George CM, Inauen J, Rahman SM, Zheng Y. The effectiveness of educational interventions to enhance the adoption of fee-based arsenic testing in Bangladesh: a cluster randomized controlled trial. Am J Trop Med Hyg 2013; 89:138-44. [PMID: 23716409 DOI: 10.4269/ajtmh.12-0664] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Arsenic (As) testing could help 22 million people, using drinking water sources that exceed the Bangladesh As standard, to identify safe sources. A cluster randomized controlled trial was conducted to evaluate the effectiveness of household education and local media in the increasing demand for fee-based As testing. Randomly selected households (N = 452) were divided into three interventions implemented by community workers: 1) fee-based As testing with household education (HE); 2) fee-based As testing with household education and a local media campaign (HELM); and 3) fee-based As testing alone (Control). The fee for the As test was US$ 0.28, higher than the cost of the test (US$ 0.16). Of households with untested wells, 93% in both intervention groups HE and HELM purchased an As test, whereas only 53% in the control group. In conclusion, fee-based As testing with household education is effective in the increasing demand for As testing in rural Bangladesh.
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Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Inauen J, Tobias R, Mosler HJ. Predicting water consumption habits for seven arsenic-safe water options in Bangladesh. BMC Public Health 2013; 13:417. [PMID: 23634950 PMCID: PMC3649919 DOI: 10.1186/1471-2458-13-417] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 04/19/2013] [Indexed: 11/13/2022] Open
Abstract
Background In Bangladesh, 20 million people are at the risk of developing arsenicosis because of excessive arsenic intake. Despite increased awareness, many of the implemented arsenic-safe water options are not being sufficiently used by the population. This study investigated the role of social-cognitive factors in explaining the habitual use of arsenic-safe water options. Methods Eight hundred seventy-two randomly selected households in six arsenic-affected districts of rural Bangladesh, which had access to an arsenic-safe water option, were interviewed using structured face-to-face interviews in November 2009. Habitual use of arsenic-safe water options, severity, vulnerability, affective and instrumental attitudes, injunctive and descriptive norms, self-efficacy, and coping planning were measured. The data were analyzed using multiple linear regressions. Results Linear regression revealed that self-efficacy (B = 0.42, SE = .03, p < .001), the instrumental attitude towards the safe water option (B = 0.24, SE = .04, p < .001), the affective attitude towards contaminated tube wells (B = −0.04, SE = .02, p = .024), vulnerability (B = −0.20, SE = .02, p < .001), as well as injunctive (B = 0.08, SE = 0.04, p = .049) and descriptive norms (B = 0.34, SE = .03, p < .001) primarily explained the habitual use of arsenic-safe water options (R2 = 0.688). This model proved highly generalizable to all seven arsenic-safe water options investigated, even though habitual use of single options were predicted on the basis of parameters estimated without these options. Conclusions This general model for the habitual use of arsenic-safe water options may prove useful to predict other water consumption habits. Behavior-change interventions are derived from the model to promote the habitual use of arsenic-safe water options.
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Affiliation(s)
- Jennifer Inauen
- Environmental and Health Psychology, Department of Environmental Social Sciences, Eawag: Swiss Federal Institute of Aquatic Science & Technology, Überlandstrasse 133, Dübendorf, 8600, Switzerland.
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Inauen J, Hossain MM, Johnston RB, Mosler HJ. Acceptance and use of eight arsenic-safe drinking water options in Bangladesh. PLoS One 2013; 8:e53640. [PMID: 23326477 PMCID: PMC3542352 DOI: 10.1371/journal.pone.0053640] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 12/03/2012] [Indexed: 11/18/2022] Open
Abstract
Arsenic contamination of drinking water is a serious public health threat. In Bangladesh, eight major safe water options provide an alternative to contaminated shallow tubewells: piped water supply, deep tubewells, pond sand filters, community arsenic-removal, household arsenic removal, dug wells, well-sharing, and rainwater harvesting. However, it is uncertain how well these options are accepted and used by the at-risk population. Based on the RANAS model (risk, attitudes, norms, ability, and self-regulation) this study aimed to identify the acceptance and use of available safe water options. Cross-sectional face-to-face interviews were used to survey 1,268 households in Bangladesh in November 2009 (n = 872), and December 2010 (n = 396). The questionnaire assessed water consumption, acceptance factors from the RANAS model, and socioeconomic factors. Although all respondents had access to at least one arsenic-safe drinking water option, only 62.1% of participants were currently using these alternatives. The most regularly used options were household arsenic removal filters (92.9%) and piped water supply (85.6%). However, the former result may be positively biased due to high refusal rates of household filter owners. The least used option was household rainwater harvesting (36.6%). Those who reported not using an arsenic-safe source differed in terms of numerous acceptance factors from those who reported using arsenic-safe sources: non-users were characterized by greater vulnerability; showed less preference for the taste and temperature of alternative sources; found collecting safe water quite time-consuming; had lower levels of social norms, self-efficacy, and coping planning; and demonstrated lower levels of commitment to collecting safe water. Acceptance was particularly high for piped water supplies and deep tubewells, whereas dug wells and well-sharing were the least accepted sources. Intervention strategies were derived from the results in order to increase the acceptance and use of each arsenic-safe water option.
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Affiliation(s)
- Jennifer Inauen
- Eawag: Swiss Federal Institute of Aquatic Science & Technology, Department of System Analysis, Integrated Assessment and Modelling, Dübendorf, Switzerland.
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Tobias R, Inauen J. Gathering time-series data for evaluating behavior-change campaigns in developing countries: reactivity of diaries and interviews. Eval Rev 2010; 34:367-390. [PMID: 21071433 DOI: 10.1177/0193841x10383940] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Gathering time-series data of behaviors and psychological variables is important to understand, guide, and evaluate behavior-change campaigns and other change processes. However, repeated measurement can affect the phenomena investigated, particularly frequent face-to-face interviews, which are often the only option in developing countries. This article presents three intervention control studies to investigate this issue. Daily diaries in Cuba did not affect behavior or attitudes for persons with intervention but reduced attitudes for persons without intervention. Reactivity of face-to-face interviews in Bolivia was negligible if applied weekly, but strong if applied twice per week. The article concludes with recommendations for gathering time-series data in developing countries.
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Affiliation(s)
- Robert Tobias
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland.
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Mosler HJ, Blöchliger OR, Inauen J. Personal, social, and situational factors influencing the consumption of drinking water from arsenic-safe deep tubewells in Bangladesh. J Environ Manage 2010; 91:1316-23. [PMID: 20207069 DOI: 10.1016/j.jenvman.2010.02.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 01/18/2010] [Accepted: 02/09/2010] [Indexed: 05/02/2023]
Abstract
Naturally occurring arsenic in groundwater in Bangladesh poses a well-known public health threat. The aim of the present study is to investigate fostering and hindering factors of people's use of deep tubewells that provide arsenic-safe drinking water, derived from the Protection Motivation Theory and the Theory of Planned Behavior. Structured personal interviews were conducted with 222 households in rural Sreenagar, Bangladesh. Multiple linear regressions were carried out to identify the most influential personal, social, and situational behavior determinants. Data revealed that social factors explained greater variance in the consumption of drinking water from deep tubewells than did situational and personal factors. In an overall regression, social factors played the biggest role. In particular, social norms seem to strongly influence deep tubewell use. But also self-efficacy and the perceived taste of shallow tubewell water proved influential. Concurrently considering other important factors, such as the most mentioned response cost (i.e., time needed to collect deep tubewell water), we propose a socially viable procedure for installing deep tubewells for the extended consumption of arsenic-safe drinking water by the Bangladeshi population.
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Affiliation(s)
- Hans-Joachim Mosler
- Eawag: Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstrasse 133, P.O. Box 611, 8600 Duebendorf, Switzerland
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