Determinants of physical activity during cancer treatment: a longitudinal exploration of psycho-cognitive variables and physician counseling

Individuals with cancer are recommended to engage in regular physical activity (PA) even during cancer therapy. The aim of this study was to explore how patient-reported physician PA counseling influences their PA intention and behavior in addition to psycho-cognitive determinants derived from the theory of planned behavior (TPB). A longitudinal study during cancer treatment was conducted among N = 115 patients with breast, prostate, or colorectal cancer (Mage = 58.0, SD = 11.5; 55.7% female). The median time since diagnosis was 2 months, and 19.1% were diagnosed with metastases. Participants provided information on PA counseling by their physicians and on psycho-cognitive variables of the TPB at three measurement points. Additionally, they wore accelerometers for seven days at baseline and three months later. Nearly half of participants (48%) reported basic PA counseling and 30% reported in-depth PA counseling. Patients in poorer health and with lower education reported significantly less in-depth counseling. In addition to patient self-efficacy in performing PA, only in-depth physician PA counseling, but not basic physician counseling, predicted intention for PA four weeks later. Patients' PA three months after baseline was predicted by patients' PA at baseline and their intention for PA. Overall, the PA level at baseline was identified as the most important predictor of PA three months later. Nevertheless, physicians seem to have the ability to increase their cancer patients' intention for PA by in-depth counseling.

Postponing sleep after a stressful day: Patterns of stress, bedtime procrastination, and sleep outcomes in a daily diary approach

Sleep problems and stress are common among students and are associated with negative effects on academic performance as well as mental and physical health risks, but studies exploring mediating factors between stress and sleep on a daily basis are scarce. This study aimed to investigate the relationship of daily stress, Bedtime procrastination (BP) (i.e., postponing bedtime without external reasons), and sleep outcomes controlling for trait factors such as self-control. N = 96 students at a German university (M = 22.2 years, SD = 4.0) wore a sleep-tracking wearable (Fitbit Charge HR) for two weeks to assess sleep duration and to calculate the gap between the intended time to go to sleep and the objectively measured time of falling asleep. Stress, intended time to go to sleep, and sleep quality were assessed via daily diaries. Established questionnaires were used to measure trait self-control, trait BP, and smartphone addiction. Multilevel analyses indicated that more stress experienced during the day was associated with more BP (b = 2.32, p = 0.008), shorter sleep duration (b = -3.46, p = 0.003), and lower sleep quality (b = 1.03, p = 0.005) after controlling for several trait factors. The association of daily stress with sleep outcomes (quality and duration) was partly mediated by BP. Our findings indicate that BP might be one factor that contributes to stress-linked decreases in sleep duration and quality. Potential reasons for stress-related later time to fall asleep-like higher physiological arousal or stress-related worries-should be investigated in future studies.

Effects of mental contrasting on sleep and associations with stress: A randomized controlled trial

Mental contrasting with implementation intentions (MCII) has been successfully applied to improve health-related behaviors (e.g. exercise). We explored its effectiveness to improve sleep outcomes beyond effects of sleep hygiene (SH) information, and investigated associations with stress. Eighty university employees (mean age: 29.6, SD = 4.5) were randomized to either a MCII + SH or a SH-only condition. During a baseline-week and a post-intervention week, sleep duration (Fitbit Alta and self-report), sleep quality, and stress were assessed daily and saliva was collected to assess the cortisol awakening response (CAR). In total, self-reported sleep quality and duration increased, but there was no meaningful condition*week interaction for sleep parameters or CAR. Higher average stress was associated with shorter sleep duration and lower sleep quality. Within-person, days with higher stress were followed by nights with lower sleep quality. Despite overall improvements, effects of MCII were not confirmed. MCII might be less effective to improve behaviors which are less controllable.

Explaining the intention to get vaccinated against COVID-19: General attitudes towards vaccination and predictors from health behavior theories

The goal of our study was to examine the intention to get vaccinated using predictors from the 5C Model of vaccination attitudes, the Theory of Planned Behavior (TPB) and the Health Belief Model (HBM). Between August and November 2020, an online survey was delivered to 1428 participants in the UK and Germany (mean age = 40.6; 57% women), assessing socio-demographic and health factors, general vaccination attitudes, TBP and HBM variables, and COVID-19 vaccination intention. Vaccination intentions did not differ by country or survey period. Predictors of intention with the highest explanatory power in a relative weight analysis were confidence, collective responsibility (5C) perceived behavioral control, social norms, attitudes (especially negative affect & TPB cognitions), and perceived benefits (HBM). Women reported lower intention, although the effect size was small. Predictors from the TPB and HBM were effective to explain the intention to receive COVID-19 vaccines over and above socio-demographic variables, health-related factors and general vaccination attitudes. The results are interpreted in the context of current vaccination campaigns. Messages promoting sense of autonomy and control over the decision to get vaccinated, approval from significant others and reassurance that getting vaccinated will not be associated with fear or other negative feelings are important facilitators of vaccine uptake.

Improving Sleep Among Teachers: an Implementation-Intention Intervention

BACKGROUND

Insufficient sleep is common among teachers and is associated with diverse health risks. This study aimed to predict intention and sleep duration by applying the Theory of Planned Behavior (TPB) and to examine the effectiveness of an implementation-intention intervention to improve sleep duration and quality.

METHOD

Sixty-nine teachers (M = 36.8 years, SD = 10.4) were assigned to an active control group (CG) or intervention group (IG). At baseline, TPB variables were assessed and participants of the IG received instructions to develop implementation intentions to reach the goal of sleeping 8 h on average. During a 3-week intervention period, all participants wore an activity tracker (Fitbit Charge HR) to measure sleep duration and kept diaries to assess sleep quality, physical activity, and stress. After 1 month, a 1-week follow-up, including a booster for the IG, was conducted.

RESULTS

Forty-two percent of variance in sleep duration were explained by control variables, past behavior, perceived behavioral control, and intention. Mixed ANOVAS with baseline covariates found a large main effect with longer sleep duration in the IG. A time x group interaction suggested that only the IG slept significantly longer in the follow-up period compared to the intervention period. For sleep quality, a medium-sized main effect for study group was found and a time x group interaction indicated higher sleep quality in the IG for week 3 and the follow-up.

CONCLUSION

The TPB was effective in predicting sleep intention and duration. Implementation intentions accompanied by daily monitoring and a booster appear to be promising for improving sleep.

FEELING YOUNG TODAY, FEELING GOOD TOMORROW? MICROLONGITUDINAL DYNAMICS IN SUBJECTIVE AGE

Insights into the short-term dynamics and micro-longitudinal consequences of subjective age can drive our understanding of its long-term mechanisms across adulthood. Using data from 80 newly retired individuals (aged 59 to 76 years; 59% women) collected on 21 days, we made use of a recent methodological advance—multilevel dynamic structural equation modeling. As possible same-day correlates and micro-longitudinal consequences of subjective age, we investigated physical activity, step number, sleep quality, affect, and stress, which were either assessed via wearables (FitBit Charge HR) or daily diaries. Analyses suggest a weak autoregression of subjective age, indicating that how old one feels is determined via daily rather than lasting experiences. Indeed, there were significant same-day relations to all suggested correlates. The one effect lasting across several days was from an older subjective age on subsequent negative affect—a potential short-term mechanism contributing to the detrimental long-term influence of an older subjective age.

The Relationship between Exercise Self-Efficacy, Intention, and Structural Barriers for Physical Activity after a Cancer Diagnosis

Simple Summary

Despite numerous benefits of physical activity for cancer patients, the majority is insufficiently active. Previous research has shown that structural barriers negatively affect patients’ physical activity behavior. Identifying underlying mechanisms could help to develop effective strategies that alleviate those barriers and increase physical activity levels. In the current survey study, we investigated whether cancer patients’ self-efficacy, i.e., their confidence in their ability, and their intention to exercise mediated the relationship between structural barriers and physical activity. The results revealed a negative relation between structural barriers and patients’ self-efficacy. Lower self-efficacy, in turn, decreased patients’ intention and their likelihood to engage in physical activity. This mediating effect especially applied to those individuals who were sufficiently active before the diagnosis. Thus, the findings suggest that interventions directly addressing the perception of structural barriers or patients’ self-efficacy in dealing with these barriers might be effective in improving the physical activity levels of cancer patients.

Abstract

Previous research has shown that structural barriers negatively influence the physical activity (PA) behavior of cancer patients, but underlying mechanisms are unclear. The aim of the current study was to explore the potential mediating role of social-cognitive factors, namely PA self-efficacy and PA intention in this context. A total of 856 cancer patients completed a questionnaire on sociodemographic and medical characteristics, pre- and post-diagnosis PA, PA self-efficacy, PA intention, and PA impediment by structural barriers. A serial mediation model was used to test whether the association between structural barriers and post-diagnosis PA was mediated by PA self-efficacy and/or PA intention, in the overall sample and in subsamples defined by individuals’ pre-diagnosis PA. The results confirmed that structural barriers were not directly (95%CI [−0.45; 0.10]) but indirectly associated with post-diagnosis PA. Higher impediment by structural barriers decreased the likelihood of sufficient post-diagnosis PA via lower PA self-efficacy (95%CI [−0.25; −0.06]) and via the serial pathway of lower PA self-efficacy and lower PA intention (95%CI [−0.19; −0.05]). Investigating differences in these mediations by pre-diagnosis PA yielded significance only among previously active cancer patients. Both structural barriers and PA self-efficacy might hence be relevant target points for interventions aiming to improve PA behavior, especially among pre-diagnosis active cancer patients.

Gender differences in the intention to get vaccinated against COVID-19: a systematic review and meta-analysis

AIM

We conducted a systematic review and meta-analysis to analyse gender differences in COVID-19 vaccination intentions.

SUBJECT AND METHODS

PubMed, Web of Science and PsycInfo were searched (November 2020 to January 2021) for studies reporting absolute frequencies of COVID-19 vaccination intentions by gender. Averaged odds ratios comparing vaccination intentions among men and women were computed. Descriptive analyses of the studies were reported.

RESULTS

Sixty studies were included in the review and data from 46 studies (n = 141,550) were available for meta-analysis. A majority (58%) of papers reported men to have higher intentions to get vaccinated against COVID-19. Meta-analytic calculations showed that significantly fewer women stated that they would get vaccinated than men, OR 1.41 (95% CI 1.28 to 1.55). This effect was evident in several countries, and the difference was bigger in samples of health care workers than in unspecified general population samples.

CONCLUSION

This systematic review and meta-analysis found lower vaccination intentions among women than men. This difference is discussed in the light of recent data on actual vaccination rates in different countries.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10389-021-01677-w.

Physical activity counseling to cancer patients: How are patients addressed and who benefits most?

OBJECTIVE

This study examined cancer patients' reporting on physicians' physical activity (PA) counseling, its associations with patients' PA, and comparisons of patients' and physicians' reports of the type(s) of PA counseling provided.

METHODS

Patients with breast, colorectal, or prostate cancer (n = 1206) participated in a nationwide cross-sectional study. Cancer patients' sociodemographic and treatment-related characteristics as well as self-reported PA levels (pre- and post-diagnosis) were assessed. PA counseling was queried according to the counseling steps of the 5As framework (Assess/Advise/Agree/Assist/Arrange). For a subsample (n = 135), matched patient-physician data were available.

RESULTS

Patient-reported PA counseling was categorized into "no counseling" (indicated by 20.8% of participants), "basic counseling" (Assess and/or Advise; 58.8%), and "in-depth counseling" (Agree, Assist, and/or Arrange; 20.4%). "In-depth counseling" was associated with an increase in PA levels pre- to post-diagnosis. This relationship was enhanced for patients with metastases. There were low agreements between patients' and physicians' reporting of PA counseling steps.

CONCLUSION

In-depth PA counseling is rarely provided to cancer patients but seems to be required to affect PA levels. Patients often report receiving less intensive PA counseling than reported by their physician.

PRACTICE IMPLICATIONS

Physicians should be enabled to provide routine in-depth PA counseling to all patients with cancer.

What is the Image of the "Typical Cancer Patient"? The View of Physicians

Former research has identified stigmatizing attitudes toward cancer patients in the general population. Little is known about (implicit) attitudes of physicians toward cancer patients. By using the prototype approach, the study investigated German physicians’ prototypical perceptions of cancer patients. Five hundred nineteen physicians (mean age: 46 years, 47% female) who regularly treat cancer patients participated in the questionnaire study. Participants were asked to state three prototype attributes that describe the “typical cancer patient.” Open format answers were coded on the dimensions favorability (coded with unfavorable, favorable, or neutral) and gender-stereotypicality (coded with masculine stereotypical, feminine stereotypical, or gender-neutral). Of all prototype attributes (N = 1,589), 69.9% were coded as unfavorable and 14.3% as favorable, the remaining attributes were neutral (15.9%). Analysis of gender-stereotypicality revealed that nearly half of the attributes (49.5%) were compatible with the feminine, whereas only 6.5% were compatible with the masculine stereotype. The remaining attributes (44.0%) were gender-neutral. There were no significant associations between prototype favorability or gender-stereotypicality and demographic/professional characteristics of physicians. The prototype approach was successful to identify (implicit) attitudes toward cancer patients and might be more sensitive than social distance scales when investigating stigmatizing attitudes. Physicians described the “typical cancer patient” with predominantly unfavorable and feminine attributes, while favorable attributes were underrepresented and positive masculine attributes were barely mentioned. The finding that the “typical cancer patient” lacks (positive) masculine attributes should be followed up in further research.

Gender differences in self-reported family history of cancer: A review and secondary data analysis

Background

Assessment of family history of cancer (FHC) mostly relies on self‐report. Our goal was to find out whether there is a systematic gender difference in self‐reported FHC.

Methods

We identified nine population‐based studies which provided statistics of FHC in men and women (N₁ = 404 541). Furthermore, we analyzed data (N₂ = 167 154) from several iterations of the US‐based Health Information National Trends Survey (HINTS) and the National Health Interview Survey (NHIS). We calculated the proportion of positive FHC, odds ratios (OR M/F), 95% confidence intervals, and aggregated statistics. We additionally analyzed in‐depth questions about FHC from HINTS 5 Cycle 2.

Results

In the reviewed studies the odds of men reporting a FHC were lower compared with the odds of women with an average OR of 0.84 [0.71; 1.00] across all studies and an OR of 0.75 [0.70; 0.80] for the six studies from the US and Europe. The gender gap was replicated in our own analyses of HINTS and NHIS with an average OR of 0.75 [0.71; 0.79]. In HINTS 5 Cycle 2 men described themselves as less familiar with their FHC and less confident answering questions regarding FHC. They were also less likely to discuss FHC with family members.

Conclusions

Men— at least in the US and Europe—were consistently less likely to report FHC compared with women. Future research should investigate how the assessment of FHC can be improved to reduce these differences. Health care professionals should also consider the potential for biased reporting by gender when assessing FHC.

The Influence of Cancer Patient Characteristics on the Recommendation of Physical Activity by Healthcare Professionals

BACKGROUND

Although physical activity (PA) is beneficial for patients with cancer, healthcare professionals (HCP) still scarcely recommend it. This study aimed to determine how HCP' sociodemographic and professional characteristics and their subjective assessments of patient characteristics are associated with their PA recommendations to patients with cancer.

METHODS

A cross-sectional survey (paper-pencil or online) was completed by 929 HCP (159 general practitioners, 382 specialized physicians, and 388 oncology nurses). The survey collected information on HCP' sociodemographic and professional characteristics, PA recommendation frequency, and the likelihood of 13 patient characteristics influencing PA recommendations (on a 7-point Likert scale).

RESULTS

Descriptive results showed that 37.6% of HCP indicated often recommending PA and 41.7% indicated routinely recommending PA. More professional experience was associated with a higher reported PA recommendation frequency among specialized physicians and oncology nurses. Patient characteristics could be assigned to three higher-level categories. Characteristics from the categories "medical side effects" and "low affinity for PA" were more frequently judged by HCP as reasons for recommending PA and characteristics belonging to "indicators of poor general health" as reasons for not recommending PA. In all professional groups, the inclusion of patient characteristics resulted in additional variance explained in the prediction of a routine PA recommendation.

CONCLUSIONS

HCP in this study reported that they frequently recommend PA to patients with cancer. However, HCP consider cancer patient characteristics to influence their decision whether to recommend PA. Future research and interventions should aim to enable HCP to provide adequate PA recommendations to patients with cancer having different characteristics.

Change patterns and determinants of physical activity differ between breast, prostate, and colorectal cancer patients

PURPOSE

The purpose of this study was to examine and compare pre- to post-diagnosis change patterns of physical activity (PA) among breast, prostate, and colorectal cancer patients. Moreover, the study aimed to investigate sociodemographic and medical determinants of post-diagnosis PA and to identify patient subgroups at increased risk of inactivity.

METHODS

A total of 912 cancer patients (457 breast, 241 prostate, 214 colorectal cancer) completed a questionnaire assessing their pre- and post-diagnosis PA behavior, and sociodemographic and medical variables. Age-adjusted regression and classification tree analyses were used to investigate PA determinants and detect subgroups that were most likely to meet or not meet PA guidelines.

RESULTS

Across cancer types, we found that PA yet decreased from pre- to post-diagnosis, but that 54.1% of participants still reported to be meeting PA guidelines after the diagnosis. While post-diagnosis PA was strongly affected by previous PA behavior among individuals of all patient groups, other sociodemographic and medical determinants played different roles depending on cancer type. The results yielded that previously active, longer diagnosed patients with higher education levels were most likely to be meeting PA guidelines post-diagnosis, whereas specifically previously inactive prostate cancer patients had an increased likelihood of insufficient activity.

CONCLUSIONS

An encouragingly high number of cancer patients indicated sufficient PA levels. For those having difficulties to maintain or adopt PA post-diagnosis, interventions should be tailored to the specific characteristics of each cancer type, as different factors are associated with PA for each patient group.

The impact of descriptive norms on motivation to participate in cancer screening - Evidence from online experiments

OBJECTIVE

The current study tested in two online experiments whether manipulating normative beliefs about cancer screening uptake increases intention to attend colorectal screening among previously disinclined individuals.

METHODS

2461 men and women from an Internet panel (Experiment 1 N = 1032; Experiment 2, N = 1423) who initially stated that they did not intend to take up screening were asked to guess how many men and women they believe to get screened for colorectal cancer. Across participants, we varied the presence/absence of feedback on the participant's estimate, as well as the stated proportion of men and women doing the screening test.

RESULTS

Across the two experiments, we found that receiving one of the experimental messages stating that uptake is higher than estimated significantly increased the proportion of disinclined men and women becoming intenders. While, we found a positive relationship between the communicated uptake and screening intentions, we did not find evidence that providing feedback on the estimate has an added benefit.

CONCLUSION

Screening intention can be effectively manipulated through a high uptake message.

PRACTICE IMPLICATIONS

Communication of high screening uptake is an easy and effective way to motivate disinclined individuals to engage in colorectal cancer screening.

Testing verbal quantifiers for social norms messages in cancer screening: evidence from an online experiment

BACKGROUND

Studies have shown that presenting correct information about group norms to correct misperceptions of norms can influence health behaviours. In two online studies we investigated how different ways of communicating the current uptake of 43% of the English Bowel Scope Screening (BSS) programme affects intention among disinclined men and women.

METHODS

In the first study, 202 participants were asked to interpret eight quantifiers for 43% uptake ('few', 'many', 'a considerable number', 'a large number', 'a great number', 'a lot', 'numerous' and 'nearly half') and to indicate how misleading they perceived each of them to be. In the second study, with 1245 participants, we compared the motivational impact of two quantifiers ('a large number' and 'nearly half' which were associated with the highest perceived uptake (48.9%) and considered least misleading in study 1 respectively) with a control message that did not contain any information on uptake, and a message which communicated actual uptake as a proportion (43%).

RESULTS

While we found that both verbal quantifiers increased screening intentions compared with the control group (from 7.8 to 12.5%, aOR 1.72; 95%CI 1.00-2.96 in the case of 'a large number' and 14.3%, aOR 2.02; 95%CI 1.20-3.38 for 'nearly half'), simply communicating that 43% do the test, however, had no impact on intentions (9.9% vs. 7.8% aOR 1.25; 95%CI 0.73-2.16).

CONCLUSION

Verbal quantifiers can be used to improve the perception of low uptake figures and avoid a demotivating effect.

Anforderungen, Entscheidungsfreiräume und Stress im Studium

Zusammenfassung. Mit dem Demand-Control-Modell und dem dazugehörigen Job Content Questionnaire (JCQ) existiert im Arbeitsumfeld ein bewährtes Modell zur Vorhersage physischer und psychischer Gesundheitsrisiken. Um diese auch unter Studierenden theoriegeleitet vorhersagen zu können, passten wir den JCQ auf den Hochschulkontext an und untersuchten mittels unseres Fragebogens zu strukturellen Belastungen und Ressourcen im Studium (StrukStud) den Erklärungsbeitrag hinsichtlich Stresserleben und Wohlbefinden. In 4 Studien mit insgesamt 732 Studierenden (Psychologie, Lehramt, Soziale Arbeit, Wirtschaftsrecht und Erziehung & Bildung) wurden die Demand-Control-Dimensionen (StrukStud), Stresserleben (Heidelberger Stress-Index HEI-STRESS & Perceived Stress Questionnaire) und weitere Referenzkonstrukte wie Studienzufriedenheit und körperliche Beschwerden erfasst. Befunde zur Reliabilität und Validität werden vorgestellt. Die Ergebnisse belegen die psychometrische Qualität des StrukStud sowie dessen Potenzial zur Erklärung von Stress im Studium. Mit dem StrukStud liegt für den deutschsprachigen Raum erstmals ein ökonomisches Selbsteinschätzungsinstrument zur Erfassung von psychologischen Anforderungen und Entscheidungsfreiräumen im Studium vor.

Worse or even better than expected? Outcome expectancies and behavioral experiences in the context of physical activity among cancer patients

Expectancies of cancer patients regarding their physical activity before they took part in a behavior change intervention were compared with their experiences during the intervention period. A total of 66 cancer patients completed either a randomly assigned 4-week physical activity or a stress-management counseling intervention. On average, participants had positive expectancies toward physical activity. Outcome expectancies predicted outcomes (e.g. physical activity) at a 10-week follow-up. Outcome realization (discrepancy between expectancies and experiences) further increased explained variance in self-efficacy and physical activity enjoyment. In conclusion, not only initial outcome expectancies but also their realizations seem to be important for subsequent behavior and cognitions.

"Don't Drink Too Much!" Reactance Among Young Men Following Health-Related Social Control

This study investigated conditions under which young men responded with reactance to the suggestion to reduce their alcohol consumption. In an experimental study, 84 young men (university students, mean age: 24 years) listened to a recorded telephone call and were asked to imagine that they themselves were the recipients of this call. In this call, either a girlfriend or a male friend suggested that the recipient of the call should reduce his alcohol intake that evening. In one condition, the suggestion was highly restrictive; in the other condition, the suggestion was framed in a nonrestrictive way. Perceived threat, negative thoughts, and feelings of anger after listening to the call were assessed. Further outcome variables were intention and perceived probability of complying with the suggestion. Participants felt more anger after hearing the highly restrictive suggestion and more threatened by the suggestion made by the girlfriend. Interaction effects emerged. Participants reported more negative thoughts and lower intention and perceived probability to comply when a highly restrictive suggestion was made by the girlfriend. The male friend’s highly restrictive suggestion resulted in a perceived probability of complying (54%) that was similar to the probability of the girlfriend’s nonrestrictive suggestion (55%). Women’s efforts to reduce their male partners’ alcohol consumption can result in boomerang effects. Male peers might be more effective in motivating other men to behave in a healthier way. These results support recent findings with regard to the potential of peer positive social control.

To rest or not to rest-Health care professionals' attitude toward recommending physical activity to their cancer patients

OBJECTIVE

While in the past cancer patients were advised to rest, recent research revealed various beneficial effects of physical activity, including increased treatment tolerability during cancer treatment and prolonged survival, which has led to a paradigm shift in relevant guidelines. This study examined if this paradigm shift from rest to activity has been consolidated in health care professionals' (HCP') attitude. It was investigated if the two dimensions of attitude (rest and activity) are endorsed empirically within the theory of planned behavior (TPB). Differences between physicians and nurses were examined.

METHODS

Five hundred forty seven physicians and 398 nurses treating breast, prostate, or colorectal cancer patients completed a cross-sectional questionnaire. To assess attitude toward physical activity during cancer treatment, we developed a 15-item scale, which included original statements of HCP. TPB variables were assessed.

RESULTS

A factor analysis revealed the proposed distinction of attitude into two dimensions. The activity-paradigm was stronger represented in HCP' attitude compared with rest-paradigm (M_{activity-paradigm}  = 4.1 versus M_{rest-paradigm}  = 2.7, p < 0.001). Additionally, the activity-paradigm had higher exploratory power in explaining intention to recommend physical activity in cancer patients. However, the rest-paradigm was able to explain intention to recommend physical activity over and above activity-paradigm (ΔR²  = 0.05). Nurses had higher scores on the rest-paradigm than physicians.

CONCLUSIONS

The activity-paradigm has already been consolidated in HCP' minds. However, the rest-paradigm is still present in the daily routine of oncology physicians and nurses. Addressing concerns and insecurities related to supporting cancer patients in maintaining or building up a physically active lifestyle is a very important educational task.

Which self-management strategies do health care professionals recommend to their cancer patients? An experimental investigation of patient age and treatment phase

This vignette based study aimed to examine recommendations of health care professionals (HCPs) in promoting self-management strategies to cancer patients. Nine-hundred-forty-two physicians and nurses were asked to (1) indicate if they would recommend self-management strategies to a vignette cancer patient, and (2) to specify those in an open format. Vignettes included a manipulation of patient age (60 vs. 75 years) and treatment phase (currently treated versus treatment completed). Six categories emerged through coding a total of 2303 recommendations: physical activity (71.8%), nutrition (64.3%), psychological support (36.7%), medical support (29.2%), conscious living (17.2%) and naturopathy (12.3%). While psychological support was particularly recommended during treatment, physical activity was more frequently recommended after completion of treatment. Results suggest that HCPs recommend a variety of self-management strategies besides standard medical treatment. Patient's treatment phase and age seem to partly influence recommendation behavior, potentially indicating insecurities regarding acute treatment situations and age-related stereotypes.

Can lifestyle preferences help explain the persistent gender gap in academia? The "mothers work less" hypothesis supported for German but not for U.S. early career researchers

Do lifestyle preferences contribute to the remaining gender gap in higher positions in academia with highly qualified women—especially those with children—deliberately working fewer hours than men do? We tested the “mothers work less” hypothesis in two samples of early career researchers employed at universities in Germany (N = 202) and in the US (N = 197). Early career researchers in the US worked on average 6.3 hours more per week than researchers in Germany. In Germany, female early career researchers with children had drastically reduced work hours (around 8 hours per week) compared to male researchers with children and compared to female researchers without children, whereas we found no such effect for U.S. researchers. In addition, we asked how long respondents would ideally want to work (ideal work hours), and results revealed similar effects for ideal work hours. Results support the “mothers work less” hypothesis for German but not for U.S. early career researchers.

Health Care Professionals' Perception of Contraindications for Physical Activity During Cancer Treatment

Introduction

Suggested medical contraindications for physical activity (PA) during cancer therapy might have an influence on PA recommendation behavior of Health Care Professionals (HCP). The purpose of the present study was to examine perceptions of physicians and oncology nurses (ON) toward specific medical conditions as contraindications for PA during cancer treatment.

Materials and methods

A total of 539 physicians and 386 ON were enrolled in this cross-sectional survey. HCP judged 13 medical conditions as to whether they are contraindications for PA during cancer treatment. Answering format was "no contraindication"/"potentially a contraindication"/"yes, a contraindication."

Results

χ² analyses revealed significant differences between general practitioners, specialized physicians, and ON in their perception of 10 medical conditions. Approximately half of the medical conditions were answered cautiously, showing high numbers on the response option potentially (36-72%). Moreover, physicians' ratings differed significantly depending on their practical experience with particular medical conditions. Those being familiar with a specific medical condition was more permissive to PA during treatment, with effect sizes (Cramer's V) ranging from 0.13 to 0.27.

Conclusion

Results indicate high cautiousness among HCP in judging medical conditions and their impact on PA during cancer treatment. However, group comparisons show that familiarity and clinical experience with potential contraindications facilitate a confident handling of safety issues, which at best leads to higher levels of PA recommendations during cancer treatment.

Social support and social control in the context of cancer patients' exercise: A pilot study

Social support is an important factor for exercise among cancer patients, but too much control might elicit reactance and lead to detrimental effects. In this pilot study, 56 dyads (cancer patient + relative) filled out a questionnaire assessing social support, social control, and reactance. After 4 weeks (T2), patients' exercise was assessed with a 7-day recall. About half of the patients did not engage in any self-reported exercise behavior. Relative-reported support was the only variable associated with exercise behavior at T2. Perceived control (r = .4) but not perceived support was significantly correlated with reactance. Male patients reported more support, but were also more prone to reactance.

Physical Activity Enjoyment and Self-Efficacy As Predictors of Cancer Patients' Physical Activity Level

BACKGROUND

Physical activity (PA) can support cancer patients during medical treatment by reducing side-effects and increasing quality of life. However, PA levels mostly decline after diagnosis. Which factors can explain if patients are able to remain or even increase their PA level? Self-efficacy is an important cognitive factor that has been linked to cancer patients' PA across many studies. In contrast, affective factors such as PA enjoyment have rarely been examined. We compare the influence of self-efficacy and PA enjoyment on cancer patients' PA levels after completion of an exercise or stress-management intervention.

METHODS

Outpatient cancer patients [N = 72; 54% female; M = 56 years, SD = 12.34; most with breast or colon cancer (34%, 15%)] were enrolled in the MOTIVACTION study, a 4-week intervention (1 h counseling followed by weekly phone calls), with pre-test (T1), post-test (T2), and a 10-week follow-up (T3). Participants were randomized to either an exercise intervention (emphasizing self-regulatory strategies for behavior change) or to a stress management intervention (coping and relaxation techniques). Sixty-seven patients remained in the study and completed the SQUASH assessment of PA, a measure of maintenance self-efficacy (7 items, Cronbach's α = 0.88) and PA enjoyment (2 items, Cronbach's α = 0.89). Regression analyses were calculated with PA level (at T2 and T3) as dependent variable and relative weight analyses were conducted. The study was registered at clinicalTrials.gov (unique identifier:NCT01576107; URL: https://clinicaltrials.gov/ct2/show/NCT01576107?term=motivaction&rank=1).

RESULTS

Baseline self-efficacy and change in PA enjoyment significantly predicted cancer patients' PA level at T2 adjusting for baseline PA and type of intervention. Relative weight (RW) analysis revealed that PA enjoyment (baseline and change together) explained 34.3% of the dependent variable, self-efficacy (baseline and change) explained 38.4%. At follow-up, self-efficacy was still a significant predictor of PA (RW = 74.6%), whereas PA enjoyment was no longer a relevant factor (RW = 5.2%).

CONCLUSION

The affective factor PA enjoyment was equally important as self-efficacy for predicting cancer patient' PA level directly after completion of the intervention. Reasons for the reduced relevance at follow-up and a broader range of affective factors should be analyzed in future studies on cancer patients' PA level.

Improved water and child health in Egypt: impact of interrupted water supply and storage of household water on the prevalence of diarrhoea

Egypt is approaching universal access to improved water supply, but the variable quality of improved water may have a measureable health impact. We investigated the impact of different measures of improved water access on the prevalence of diarrhoea among children aged under 5 years. Using data from the 2008 Egypt Demographic and Health Survey and propensity score matching techniques we compared children in households with improved water supplies, with/without interruptions to supplies and with/without in-home storage of water. Access to improved water that was not subject to cuts resulted in a significant 2.6 percentage point reduction in the prevalence of diarrhoea (4.7% reduction in rural areas), and access to improved water that was not stored prior to use resulted in a 3.5% reduction. Further research is needed to better understand the nature and causes of piped water interruptions in Egypt, in order to address potential infrastructure challenges that are leading to poorer health outcomes.

Intervention-Elicited Reactance and Its Implications

Abstract. The present research investigated whether an intervention designed to increase the consumption of fruits and vegetables (FVs) would elicit reactance and explored the consequences of reactance. Eighty-four students were randomized to one of two intervention groups or a control group. During the 1-week intervention, which was accompanied by a food diary, the 5aday-group had to eat 5 portions of FVs per day, the just1more group had to eat 1 more portion of FVs than usual, and the control group had to eat as usual. Both intervention groups reported higher reactance than the control group immediately after the intervention (T2) and still 1 week later (T3) with high effect sizes. Trait-reactance had no effect on any of the study variables. Intervention-elicited reactance was associated with a lower FV intake at follow-up (T4), and this association was mediated by a more negative attitude toward eating 5aday assessed 1 week after the intervention (T3).

What explains the intention to be physically active in cancer patients? Different determinants for active and insufficiently active patients

In a qualitative elicitation study with 61 cancer patients, a broad range of attitudes toward physical activity could be obtained, especially negative attitudes among insufficiently active patients. Based on these results, a second quantitative study was conducted; 64 patients [40 men; 42% insufficiently active (<150 minutes/week)] completed a Theory of Planned Behavior (TPB) questionnaire. Regression analyses revealed that different variables of the TPB are relevant for explaining the intention to exercise for physically active (subjective norm) and insufficiently active (attitudes) cancer patients. Health professionals should adapt their support to the special needs of insufficiently active and active cancer patients.

Who makes use of Internet-delivered health information? The role of gender role self-concept in young men and women

This study examined the contribution of gender role self-concept (expressiveness and instrumentality) on active interest in and use of Internet-delivered health information among young men and women. Four hundred and twenty university students reported health behaviours and perceived personal vulnerability regarding five diseases. We analysed active interest in receiving health-related information concerning these diseases (providing email address to receive a link to health-related websites) and actual use of provided websites two weeks afterwards. Usage of health-related information via the Internet was objectively assessed by recording log-ins on the website and obtaining individual click counts. In both sexes, higher expressiveness was independently associated with being more likely to show active interest in health-related information. Additionally, expressiveness was positively associated with website use in men independent of age, personal vulnerability and reported health behaviours. Thus, an expressive self-concept facilitates the use of health-related information, especially among men.

Why do Highly Qualified Women (Still) Earn Less? Gender Differences in Long-Term Predictors of Career Success

Our study investigated gender differences in the long-term effects of education, work experience, agentic personality traits, and number of children on career success (i.e., salary) in medicine. German male and female students ( N = 99) were surveyed at a German medical school (T1) and 15 years later (T2). Women interrupted their careers for longer than men ( d = .92). Men had a substantially higher income at T2 ( d = 1.07). Career interruptions, agentic personality traits, and high school grades were significant predictors of salary for both sexes. High final grades at medical school were significantly and positively related to salary but only for men. Low final grades at medical school and number of children predicted the length of career interruptions. For women, number of children was significantly and positively related to career interruptions. For men, number of children was significantly but negatively related to career interruptions. The findings corroborate research from other occupational fields, showing that a discontinuous work history has a negative influence on career success and that human capital variables are better rewarded for men than for women.

Stress und Studienzufriedenheit bei Bachelor- und Diplom-Psychologiestudierenden im Vergleich

In unserer Studie wandten wir das Demand-Control-Modell auf die Studiensituation von Psychologiestudierenden im Bachelor-/Diplomstudium an. An der 2009 bis 2010 durchgeführten Erhebung nahmen insgesamt 405 Studierende verschiedener Psychologischer Institute teil. Es zeigte sich, dass nach Kontrolle von Alter und Fachsemester der in vielen Studierendensurveys erfasste Studienaufwand (in Stunden pro Woche) nur einen geringen Beitrag zur Erklärung von Stress und Studienzufriedenheit leistete, während die Dimensionen des Demand-Control-Modells die Unterschiede in Stress und Studienzufriedenheit zwischen Bachelor- und Diplomstudierenden mediierten. Regressionsanalysen identifizierten hohe Anforderungen als Hauptprädiktor für Stress im Studium und hohe Anforderungen und geringe Entscheidungsfreiräume als relevante Prädiktoren für eine geringe Studienzufriedenheit. Die Ergebnisse verweisen auf konkrete Ansatzpunkte für mögliche Verbesserungen des Bachelorstudiums.

Aktueller und erwünschter Obst- und Gemüsekonsum bei Studierenden

Das Anliegen der Studie war es, die persönlichen Ziele bezüglich des Obst- und Gemüsekonsums bei männlichen und weiblichen Studierenden zu erfassen und zu überprüfen, ob die explizite Vorgabe der „5 am Tag”-Empfehlung einen Effekt auf diese persönlichen Ziele hat. Die Hälfte der teilnehmenden 482 Studierenden erhielt einen Fragebogen mit der „5 am Tag”-Empfehlung der Deutschen Gesellschaft für Ernährung (DGE), die andere Hälfte erhielt einen Fragebogen ohne die Empfehlung. Abhängige Variablen waren die Angaben, wie viele Portionen Obst und Gemüse die Befragten zurzeit am Tag essen (aktueller Konsum) und wie viele Portionen sie gern essen würden (Wunsch-Konsum). Es zeigte sich ein signifikanter Geschlechterunterschied im aktuellen Konsum und im Wunsch-Konsum, während die Vorgabe der „5 am Tag”-Empfehlung nur einen minimalen Effekt hatte. In beiden Untersuchungsbedingungen lagen die persönlichen Ziele hinsichtlich des täglichen Obst- und Gemüsekonsums bei Männern (mit durchschnittlich 2 Portionen) wie bei Frauen (mit durchschnittlich 3 Portionen) deutlich unter 5 Portionen. Auch wenn Studierende nicht repräsentativ für die Gesamtbevölkerung sind, können die Ergebnisse dieser Studie einen Hinweis darauf geben, warum die „5 am Tag”-Kampagne bisher nicht erfolgreicher war. Es könnte sein, dass das „5 am Tag”-Ziel für viele Personen zu hoch ist und deshalb die persönlichen Ziele nicht beeinflussen kann.

[Gender (role) aspects in doctor-patient communication]

Aspects of gender and gender roles are important factors influencing the interactions between physicians and their patients. On the one hand, gender roles have an impact on the behavior of the patients, such as in health care utilization or use of preventive examinations. On the other hand, gender issues influence doctors' actions with respect to communication, diagnosis, and treatment. Here, a gender bias may lead to misdiagnosis and inadequate treatment. In this paper certain pertinent aspects of gender roles in the doctor-patient relationship are discussed and illustrated by empirical findings.

Eine deutsche Adaptation des ENRICHD Social Support Inventory (ESSI)

Zusammenfassung. Zur Erfassung der wahrgenommenen emotionalen sozialen Unterstützung bei kardialen Patienten wird das ESSI-D (ENRICHD Social Support Inventory – Deutsch), eine deutsche Adaptation des englischen ESSI, vorgestellt. Mit einer Stichprobe von N = 1597 Patienten (22.7% Frauen), die sich einer Bypass-Operation unterzogen, wurden die psychometrischen Eigenschaften des ESSI-D überprüft. Cronbachs Alpha der Gesamtskala lag bei α = .89. Eine konfirmatorische Faktorenanalyse bestätigte die einfaktorielle Struktur der Skala. Korrelationen mit unterschiedlichen Kriteriumsvariablen wie Partnerstatus, soziale Funktionsfähigkeit, körperliche Funktion und Depressivität lieferten Hinweise für eine zufriedenstellende Konstruktvalidität. Das ESSI-D erweist sich für diese Patientengruppe als ein ökonomisches Instrument zur Erfassung der emotionalen sozialen Unterstützung mit guten psychometrischen Eigenschaften.

Do psychological variables mediate sex differences in young adults' alcohol use?

This study applied an extended theory of planned behavior to test whether psychological variables mediate sex differences in alcohol consumption in social contexts. Questionnaires of 300 young adults (urban, mean age 25 years, 49% female) were collected in 2007 prior to a sociable drinking occasion; consumption data were obtained through telephone interviews thereafter. The multiple-path mediation model was analyzed using structural equation modeling. Sex differences in alcohol consumption, which were considerable, were partly mediated by the significant specific indirect effects of subjective norms through intention and of self-efficacy through both intention and willingness. Body weight was not a significant mediator. Limitations are noted and implications for future research are discussed.

Colonoscopy use in a country with a long-standing colorectal cancer screening programme: evidence from a large German survey

BACKGROUND

Given the potential colonoscopy has in prevention and early detection of colorectal cancer (CRC), its overall use within a population is a meaningful parameter to estimate the future CRC burden. We aimed to examine overall prevalence and correlates of colonoscopy use in Germany, a country with a long-standing, opportunistic CRC screening programme.

METHODS

The data were collected in 2004 through the Health Care Access Panel, a nationally generalisable survey of German households. The sample comprised 15,810 men and women aged 50 to 70 years without a personal history of cancer.

RESULTS

Overall, 36 % of respondents reported to have had at least one colonoscopy in the past (25 % once and 11 % more than once). Prevalence of colonoscopy use strongly increased by age (from 25 % to 43 % in age groups 50 - 54 and 65 - 70, respectively), but hardly differed by sex. Previous faecal occult blood testing (FOBT) was the most important correlate of colonoscopy use in either sex.

CONCLUSIONS

Our survey from 2004, when FOBT was still the most important screening tool in Germany, suggests that more than one third of the German population underwent colonoscopy at least once up to age 70. While introduction of screening colonoscopy is expected to impact on overall colonoscopy use in the long run, these data can serve as point of reference to assess the extent and the patterns of such changes.

Young adults’ images of abstaining and drinking: Prototype dimensions, correlates and assessment methods

This research investigated contents of actor and abstainer prototypes with regard to young adults’ social drinking combining quantitative and qualitative approaches (adjective ratings, N = 300; open answers, N = 90). Exploratory and confirmatory factor analyses yielded two factors (sociability/hedonism, responsibility) in both prototypes, confirmed by qualitative data. Given the importance for intention and willingness to drink alcohol, interventions should focus on the factor ‘sociability/hedonism’ of the actor and the abstainer prototype to reduce heavy drinking; addressing ‘responsibility’ may be ineffective. Participants’ evaluations appeared to be less prone to mean tendencies subsequent to open answers compared with adjective scales.

What role do social norms play in the context of men's cancer screening intention and behavior? Application of an extended theory of planned behavior

OBJECTIVE

Our research investigated the role of social norms in an extended theory of planned behavior (TPB) in the explanation of prostate/colorectal cancer screening (CS) intention and the prediction of CS uptake among men.

DESIGN

A cross-sectional study (Study 1) assessed sociodemographic and TPB variables (extended by descriptive norm) in 2,426 German men (mean age 56.3 years) who differed in their past CS behavior. A subsample of Study 1 (former nonattenders and irregular attenders, n = 1,032) were followed up 12 months later (Study 2).

MAIN OUTCOME MEASURES

The authors measured cross-sectionally the intention to undergo a CS examination within the next 12 months (Study 1), and longitudinally self-reported uptake of prostate and/or colorectal CS within the last 12 months (Study 2).

RESULTS

When sociodemographic variables were controlled, TPB variables predicted a substantial amount of CS-intention (Delta R2 = .49). Descriptive norm explained variance beyond the classic TPB variables and interacted significantly with subjective norm. Significant predictors of CS uptake were intention and subjective norm with the latter having a different effect in the two subgroups: a high subjective norm (assessed at T1) was associated with higher CS attendance in (former) nonattenders but lower CS attendance in irregular attenders in the following 12 months.

CONCLUSION

Social norms play an important role in men's CS intention and behavior. For intention formation, descriptive norm is influential in addition to subjective norm. The fact that a high subjective norm resulted in a lower likelihood of screening among irregular attenders suggests possible reactance effects.