ArticleLiterature Review

Toward a theory-based analysis of behavioral maintenance

February 2000
Health Psychology 19(1 Suppl):64-9

February 2000
19(1 Suppl):64-9

DOI:10.1037//0278-6133.19.Suppl1.64

Source
PubMed

Authors:

Intervention strategies that can produce successful rates of long-term behavior change have proven elusive and indicate the need for new approaches to this vexing problem. However, the development of new intervention strategies is constrained by our current conceptualization of behavioral maintenance. This article reviews how the dominant models of health behavior change have operationalized the psychological processes that guide the initiation and maintenance of a new pattern of behavior. In light of this review, an alternative framework is proposed based on the premise that the decision criteria that lead people to initiate a change in their behavior are different from those that lead them to maintain that behavior. Decisions regarding behavioral initiation are predicted to depend on favorable expectations regarding future outcomes, whereas decisions regarding behavioral maintenance are predicted to depend on perceived satisfaction with received outcomes. The implications of this framework for behavioral interventions are addressed.

A Digital Lifestyle Coach (E-Supporter 1.0) to Support People With Type 2 Diabetes: Participatory Development Study

Article

Full-text available

Jan 2023

Background A healthy lifestyle, including regular physical activity and a healthy diet, is becoming increasingly important in the treatment of chronic diseases. eHealth interventions that incorporate behavior change techniques (BCTs) and dynamic tailoring strategies could effectively support a healthy lifestyle. E-Supporter 1.0 is an eCoach designed to support physical activity and a healthy diet in people with type 2 diabetes (T2D). Objective This paper aimed to describe the systematic development of E-Supporter 1.0. Methods Our systematic design process consisted of 3 phases. The definition phase included the selection of the target group and formulation of intervention objectives, and the identification of behavioral determinants based on which BCTs were selected to apply in the intervention. In the development phase, intervention content was developed by specifying tailoring variables, intervention options, and decision rules. In the last phase, E-Supporter 1.0 integrated in the Diameter app was evaluated using a usability test in 9 people with T2D to assess intervention usage and acceptability. Results The main intervention objectives were to stimulate light to moderate-vigorous physical activities or adherence to the Dutch dietary guidelines in people with T2D. The selection of behavioral determinants was informed by the health action process approach and theories explaining behavior maintenance. BCTs were included to address relevant behavioral determinants (eg, action control, self-efficacy, and coping planning). Development of the intervention resulted in 3 types of intervention options, consisting of motivational messages, behavioral feedback, and tailor-made supportive exercises. On the basis of IF-THEN rules, intervention options could be tailored to, among others, type of behavioral goal and (barriers to) goal achievement. Data on these variables could be collected using app data, activity tracker data, and daily ecological momentary assessments. Usability testing revealed that user experiences were predominantly positive, despite some problems in the fixed delivery of content. Conclusions The systematic development approach resulted in a theory-based and dynamically tailored eCoach. Future work should focus on expanding intervention content to other chronic diseases and lifestyle behaviors, enhancing the degree of tailoring and evaluating intervention effects on acceptability, use, and cost-effectiveness.

Which Intervention Strategies Promote the Adoption and Maintenance of Physical Activity? Evidence From Behavioral Trials With Cancer Survivors

Article

Full-text available

Dec 2022
ANN BEHAV MED

Background/purpose: We address four questions about interventions to promote physical activity in cancer survivors: (a) How often is both the adoption and maintenance of behavior change tested in trials? (b) How often do interventions generate adoption-plus-maintenance of behavior change? (c) Are intervention strategies specifically geared at promoting maintenance of behavior change deployed in trials? and (d) Which intervention strategies distinguish trials that promote both the adoption and maintenance of physical activity from trials that promote adoption-only or generate no behavioral changes? Methods: Computerized literature searches identified 206 reports of randomized trials that measured physical activity in the wake of the intervention. Results: Only 51 reports (24%) measured both behavioral adoption (postintervention) and behavioral maintenance (≥3 months follow-up). The 51 reports included 58 tests of interventions; 22% of tests observed both adoption and maintenance of physical activity, 26% reported adoption-only, and 52% found no change in behavior. Change techniques designed to promote behavioral maintenance were used much less frequently than adoption techniques or adoption and maintenance techniques. Interventions that aimed to improve quality of life, used supervised exercise sessions, were undertaken in community centers, and deployed fewer behavior change techniques were associated with adoption-plus-maintenance of physical activity in cancer survivors. Conclusions: The present findings offer new insights into the adoption and maintenance of physical activity and highlight the need to routinely assess these forms of behavior change in future trials. More extensive testing of intervention strategies specifically geared at maintenance of behavior change is warranted.

Treatment adherence : the contribution of different mechanisms

Thesis

Jan 2007

Imogen Tijou

p> The primary objective of the current programme of research was to determine the effects of cognitive variables (self-efficacy and outcome expectations) and other factors (affective state and aversive feedback) on adherence. First, a laboratory based simulation study was used, as this enabled isolation of the influence that aversive feedback (simulating the effect of pain) had on adherence. Self-efficacy, outcome expectations and affective state were assessed at baseline and after early experience of the simulation. Adherence behaviour was recorded by the computer programme throughout the simulation. In a follow-up study, a longitudinal field study measured self-efficacy, outcome expectations, affective state and pain at baseline and after early experience of physiotherapy. Adherence was assessed 8 weeks after starting treatment. In both studies, self-efficacy, outcome expectations, affective state and aversive feedback served as the independent variables, and various aspects of adherence behaviour formed the dependent variables. More positive cognitions predicted how long participants persisted with the simulated physiotherapy task and real world physiotherapy. Presence of aversive feedback in the laboratory study resulted in slower than instructed responding. Increased pain in the field study was also associated with poorer adherence during sessions. Simulated and perceived recovery, in the laboratory and field studies respectively, was related to both cognitions and aversive feedback. The conclusions were that both cognitions and aversive feedback were important to adherence behaviour. In addition, it was evident that different factors were important to different aspects of adherence behaviour. </p

Promoting physical activity during and after curative cancer treatment Assessment, experiences and effect of behaviour change support

Thesis

Full-text available

May 2021

Anne-Sophie Mazzoni

Aims:The overall aim of this thesis was to increase knowledge about the promotion of physical activity (PA) in patients during and after curative cancer treatment. Methods: Study I investigated agreement between a 7-day diary and the SenseWear Armband mini (SWA) when assessing PA and sedentary time in 65 participants with breast cancer. Agreement was examined with Bland-Altman plots. Studies II-IV used data from an RCT, where participants about to start curative treatment for breast, prostate or colorectal cancer, were randomised to six months of high or low-to-moderate intensity exercise (supervised group-based resistance- and home-based endurance training), with or without self-regulatory behaviour change techniques (BCTs; e.g. goal-setting and action planning). In study II, participants randomised to the groups with self-regulatory BCTs answered a questionnaire (n=229) and took part in semi-structured interviews (n=18) after exercise programme completion. The interviews were analysed with thematic analysis. In Study III, all participants (n=577) randomised were included. Exercise adherence during the intervention was assessed with attendance records, training logs and heart rate monitors. Regression analyses were performed to determine the effect of self-regulatory BCTs on exercise adherence. In Study IV, participants (n=301) who provided data about their PA level at 12-month follow-up were included. Regression analyses were performed to determine the effect of self-regulatory BCTs on PA maintenance and potential baseline predictors. Results: There were mean differences and wide limits of agreement between the 7-day diary and the SWA when assessing PA and sedentary time. Participants described different incentives to exercise, which fostered feelings of autonomy, competence and relatedness and helped them find motivation to exercise during cancer treatment. Social support from coaches, feedback, self-registration of exercise and scheduled sessions at a public gym were useful for exercising. There was no effect of the self-regulatory BCTs on exercise adherence during the intervention; however, a positive effect was found on PA maintenance at 12-month follow-up. Baseline predictors of PA maintenance at 12-month follow-up were health-related quality of life, exercise motivation, expectations of exercise and being a former or current smoker/snus user. Conclusions: A 7-day diary and the SWA have limited agreement and cannot be used interchangeably in patients with breast cancer. Individual incentives and a positive and supportive environment are crucial to increase exercise motivation in patients undergoing curative cancer treatment, and can be promoted using specific support (i.e. social support, feedback, self-registration of exercise and scheduled exercise sessions). The addition of self-regulatory BCTs is not likely to improve exercise adherence in patients undergoing curative treatment for breast, prostate or colorectal cancer and participating in structured, well-controlled exercise interventions, but may improve long-term PA maintenance in this population. Patients with low health-related quality of life, low exercise motivation, high expectations of exercise or with a history of tobacco use at the start of their cancer treatment may be those most in need of such support to maintain PA.

Prenatal breastfeeding knowledge, attitude and intention, and their associations with feeding practices during the first six months of life: a cohort study in Lebanon and Qatar

Article

Full-text available

Feb 2022

Background Prenatal knowledge, attitude, and intention related to breastfeeding are postulated as important modulators of feeding practices. Using data from the Mother and Infant Nutritional Assessment (MINA) study, a three year cohort conducted in Lebanon and Qatar, this study aimed to characterize breastfeeding practices during the first six months postnatally and examine their associations with prenatal breastfeeding knowledge, attitude, exposure, and intention. Methods Pregnant women during their first trimester were recruited from primary healthcare centers in Beirut and Doha. Data collection was conducted in 2015 − 2018. Participants were followed-up until the child was twoyears old. Exposure, knowledge, attitude, and intentions regarding breastfeeding were assessed during the third trimester of pregnancy ( n = 230), using validated questionnaires and scales. Breastfeeding practices were evaluated at four months ( n = 185) and six months ( n = 151) postpartum. Early initiation of breastfeeding was defined as putting the infant to the breast within one hour of birth, and exclusive breastfeeding (EBF) as feeding exclusively with breast milk. Results Breastfeeding practices were as follows: ever breastfeeding: 95.8%; early initiation of breastfeeding: 72.8%; breastfeeding at four and six months: 70.3% and 62.3%; EBF at four and six months: 35.7% and 18.5%. Over 95% of participants had high breastfeeding exposure, and 68.8% had strong / very strong intentions to breastfeed. Only 25% had very good knowledge, and 9.2% reported positive/strong positive attitude towards breastfeeding. After adjustment, high exposure was associated with greater odds of breastfeeding initiation (OR 10.1: 95% CI 1.25, 80.65). Both positive attitude towards breastfeeding and strong intention to breastfeed were associated with EBF at four months (OR 2.51; 95% CI 1.02, 6.16 and OR 4.0; 95% CI 1.67, 9.6), breastfeeding at four months (OR 2.92: 95% CI 1.29, 6.62 and OR 5.00: 95% CI 2.25, 11.1), and breastfeeding at six months (OR 3.74: 95% CI 1.24, 11.32 and OR 8.29: 95% CI 2.9, 23.68). Conclusions Findings of this study documented suboptimal knowledge and attitude towards breastfeeding and showed that prior exposure, a positive attitude, and a strong intention to breastfeed prenatally were significant predictors of breastfeeding practices postnatally. This highlights the need to develop specific interventions and policies aimed at improving breastfeeding attitudes and creating an enabling environment that supports women throughout their breastfeeding journey.

Questions to Measure Enjoyment of and Satisfaction With Physical Activity: Are They Appropriate for Use in an Older Population?

Article

Full-text available

Oct 2021

Background and Objectives Enjoyment of and satisfaction with physical activity have been proposed as two actionable mechanisms to promote sustained engagement in physical activity. An accurate understanding of how, why, and for whom these two mechanisms work (or not) in response to a particular intervention strategy is contingent on having suitable measures for the population of interest. This study aims to determine whether the Physical Activity Enjoyment Scale-8 and a novel approach to the measurement of satisfaction with physical activity are suitable for use among older adults (Mage = 66.25 years; range = 55 to 91 years). Research Design and Methods Participants answered an online questionnaire twice across four weeks. Measurement invariance was assessed within a structural equation modeling framework; convergent validity was assessed by correlating the latent variables enjoyment and satisfaction with each other and with physical activity behavior. Results Both measures were invariant between gender and across time. Enjoyment and satisfaction were related to each other (r = 0.72) and to physical activity (r = 0.48 and 0.64, respectively). Discussion and Implications Results support the suitability of these measures as tools to assess enjoyment of and satisfaction with physical activity among older adults.

The utility of the integrated behavior change model as an extension of the theory of planned behavior

Article

Full-text available

Aug 2022

Introduction There are several widely used theories of health behavior change, which mostly utilize the social cognitive approach. These theories tend to posit that intention is a direct predictor of behavior, do not include automatic influences on behavior, and propose a one-size-fits-all theory for both initiators and maintainers. However, the intention-behavior gap is a well-observed phenomenon, researchers have highlighted that both automatic and reflective factors promote behavioral engagement, and predictors of behavior have been shown to differ between initiators and maintainers—three issues that necessitate theory advancement. To that end, the present research compares the utility of the Integrated Behavior Change Model (IBCM) – a social cognitive model that includes automatic factors involved in behavioral engagement and a moderator of the intention-behavior gap – to its theoretical predecessor, the Theory of Planned Behavior (TPB). Further, the relevance of the IBCM factors for predicting exercise behavior is compared in initiators versus maintainers. Method Participants were 494 US undergraduates. Participants reported on variables from the IBCM (and TPB) at baseline and reported on their exercise behavior in two surveys at seven- and 14-days post-baseline. Results Findings supported the first hypothesis that the IBCM would be more relevant for initiators in comparison with maintainers, using structural equation modeling. Specifically, only the paths between intrinsic motivation and affective attitude, affective attitude and intention, and intention and behavior were reliably found for maintainers. For initiators, the aforementioned paths were also reliably supported and the additional following paths were also supported: intrinsic motivation and perceived behavioral control, perceived behavioral control and intention, and intention and action planning. However, results did not support the second hypothesis that the IBCM would predict significantly more variance in behavior than its theoretical predecessor, the TPB. Specifically, the addition of action planning, implicit attitude, implicit motivation, and the interaction between intention and action planning only predicted an additional 0.3% (p < 0:05) of the variance in exercise behavior above and beyond intention. Conclusion Results highlight the continued need for theoretical refinement in terms of delineating mechanisms of initiation and maintenance and the need for further development in terms of improving upon current predictions of behavior engagement and change.

Baseline and Process Factors of Anti-Retroviral Therapy That Predict Loss to Follow-up Among People Living with HIV/AIDS in China: A Retrospective Cohort Study

Article

Full-text available

Oct 2021
AIDS BEHAV

We explored the predictors and predictive models of loss to follow-up (LTFU) during the first year of anti-retroviral therapy (ART). LTFU was defined as the failure to visit the clinic for antiretroviral drugs for ≥ 90 days after the last missed scheduled visit. Based on the electronic medical records of 5953 patients who were HIV positive and began ART between 2016 and 2019 in China, the LTFU rate was 7.24 (95% confidence interval 6.49–7.97) per 100 person-years during the first year of ART. ART baseline factors were associated with LTFU, but were non-optimal predictors. A model including ART process-related factors such as follow-up behaviors and physical health status had an area under the receiver operating characteristic curve of 73.4% for predicting LTFU. Therefore, the medical records of follow-up visits can be used to identify patients with a high risk of LTFU and allow interventions to be implemented proactively.

Preditores da Morbidade Psicológica em Fumantes, motivados para deixar de fumar, e em Abstinentes

Article

Jul 2012

O presente estudo teve por objetivo estudar a morbidade psicológica, representações face ao tabaco, coping e suporte do parceiro em fumantes motivados para deixar de fumar e abstinentes. Participaram no estudo 106 fumantes e 68 abstinentes. Todos os fumantes encontravam-se em lista de espera para deixar de fumar e os abstinentes estavam sem fumar há pelo menos 3 meses. A amostra foi recolhida num hospital central e numa empresa privada no norte de Portugal. Os resultados mostram, nos fumantes, mais sintomas depressivos, mais coping de atenção e representações mais ameaçadoras, quando comparados com os abstinentes. Estes últimos revelam mais suporte positivo do parceiro para deixar de fumar quando comparados com os fumantes. Nos fumantes, ser mulher, a idade, o suporte negativo do parceiro, a coerência e a ansiedade-traço são preditores de depressão. Por sua vez, a depressão, a duração do consumo e a representação emocionaldo tabaco são preditores da ansiedade. Nos abstinentes, ser mulher, as consequências e a ansiedade foram preditores de depressão. De acordo com os resultados é importante que a intervenção na cessação tabágica tenha em conta a morbidade psicológica.

An online mind-body program improves mental health and quality of life in primary biliary cholangitis: A randomized controlled trial

Article

Full-text available

Nov 2023

Background and Aims: People with primary biliary cholangitis (PBC) experience high rates of mental distress and fatigue despite standard of care therapy. We aimed to assess the impact of an online mind-body intervention on these symptoms. Methods: This 12-week RCT used sequential mixed-methods evaluation. Alongside standard of care, participants with primary biliary cholangitis were randomized to receive weekly countdown emails, or the intervention consisting of (i) a weekly 20–30 minute-mind-body follow-along video, (ii) weekly 5–10-minute psychology-based “managing chronic disease skills videos,” and (iii) 10-minute telephone check-ins. The primary outcome was a change in the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes evaluated changes in fatigue, perceived stress, resilience, and health-related quality of life. ANCOVA determined between-group differences. Results: Of the 87 randomized patients (control group: n = 44, intervention group: n = 43), the between-group HADS total score improved by 20.0% (95% CI 4.7, 35.2, p = 0.011). Significant improvements were seen in depression (25.8%), perceived stress (15.2%), and 2 primary biliary cholangitis-40 domains [emotional symptoms (16.3%) and social symptoms (11.8%)] with a mean satisfaction of 82/100. This corresponded with end-of-study qualitative findings. Although no improvements were observed in fatigue in the main analysis, a significant benefit was observed in the subgroup of intervention participants (20/36;56%) who completed the mind-body video routine at least 3 times per week. Conclusion: This intervention improved measures of mental wellness and quality of life with high satisfaction and reasonable adherence. Future studies could explore strategies to optimize adherence and target fatigue.

Effect of health promotion interventions on small portion size consumption behavior among college students

Article

Full-text available

Jan 2023
Indian J Publ Health

Background: Large food portion size is contributing toward overweight and obesity rates and has been found directly proportional to increase in portion size. Objectives: The study was done to see the effect of health promotion intervention on small portion size consumption behavior using multitheory model (MTM). Materials and methods: A quasi-experimental study was conducted among students of age groups 18 - 21 years in two different colleges from North India between 2019 to 2020. About 150 participants in the intervention group as well as control group were selected and health promotion intervention in the form of motivational group counseling, one-to-one counseling, Power Point presentations, lectures, and messages were given to participants in intervention group. Difference in difference of proportions for meal consumption behavior and the difference in the difference of means for body mass index, waist-hip ratio and for constructs of MTM for portion size consumption behavior were calculated. Paired t-test was used to test the significance between the continuous variables. Results: There was a significant reduction (46% vs. 11%, P < 0.001) in proportion of participants consuming large portion-sized meals in the intervention group as compared to the control group. The mean change in constructs (participatory dialogues,behavioral confidence, change in physical environment, emotional transformation and practice for change) for portion size consumption behavior of participants in the intervention and control groups at base line and end line was found statistically significant. Conclusion: MTM is a useful tool for health promotion and health education to predict the initiation and sustenance of health behavior change.

Pretreatment changes in drinking: Theoretical and methodological implications for alcohol use disorder treatment outcome research

Article

Full-text available

Jul 2023

Background There is a growing recognition of the importance of changes in drinking prior to the first treatment session (i.e., pretreatment change). A major limitation of past studies of pretreatment change is the reliance on retrospective reporting on drinking rates between the baseline assessment and the first treatment session collected at the end of treatment. The present study sought to extend previous findings by examining 12‐month treatment outcomes and correlates of pretreatment changes in drinking measured weekly during treatment. Methods Data from a randomized behavioral clinical trial examining the effect of therapeutic alliance feedback on drinking outcomes were analyzed (n = 165). All participants received cognitive behavioral therapy for alcohol dependence, completed pre and posttreatment assessments, and provided weekly measures of drinking during treatment. Results Results indicated that approximately half of the sample reduced their heavy drinking days by 70% or more and number of drinking days by 50% or more prior to beginning treatment. Further, individuals who reported greater consideration of how their problematic drinking affected their social environment displayed greater changes in drinking days prior to treatment. Changes in heavy drinking days were also related to relationship status, such that individuals who were single/never married were less likely to change prior to treatment than those who were married/cohabitating or separated/divorced. Conclusion These confirm the importance of pretreatment change in the study of treatment outcomes, and suggest that interpersonal processes, including the appraisal of drinking behavior in a social context, may play an important role in pretreatment changes in drinking.

Editorial: Towards behavior maintenance processes

Article

Full-text available

May 2023

Social cognitive theory-based health promotion in primary care practice: A scoping review

Article

Full-text available

Mar 2023

Background: Using a theoretical perspective to guide research design and implementation can result in a coherent preventative intervention model. Among theoretical frameworks, Bandura's Social Cognitive Theory (SCT) is particularly useful for studies focused on behavior change in health promotion research. Objective: This scoping review explored and summarized the current evidence on health promotion interventions that integrated constructs of Social Cognitive Theory and the outcome of those interventions in primary care settings. Method: ology: We conducted this scoping review using the PRISMA scoping review guidelines; we reviewed articles from five electronic databases and additional sources that were peer-reviewed journal articles reporting interventions applying SCT constructs and synthesized the outcomes following the interventions. Results: Among 849 retrieved from multiple sources, 39 articles met our eligibility criteria. Most studies (n = 19) were conducted in the United States. Twenty-six studies followed a randomized control trial design. Most studies (n = 26) recruited participants utilizing the primary care network. All 39 studies mentioned "self-efficacy" as the most utilized construct of SCT to determine how behavior change operates, followed by "observational learning" through role models. Twenty-three studies integrated individual (face-to-face) or peered group-based counseling-training programs; eight interventions used telephonic health coaching by a specialist; eight studies used audio-visual mediums. All included studies reported positive health outcomes following the intervention, including increased self-reported moderate-to-vigorous physical activity, increased Knowledge of dietary intake, high-risk behaviors such as STIs transmission, adapting to a healthy lifestyle, and adherence to post-transplant medication. Conclusion: Current evidence suggests that SCT-based interventions positively impact health outcomes and intervention effectiveness. The results of this study indicate the importance of incorporating and assessing several conceptual structures of behavioral theories when planning any primary care health promotion practice.

How to Maintain Sustainable Consumer Behaviors: A Systematic Review and Future Research Agenda

Article

Full-text available

Feb 2023
Int J Consum Stud

Maintaining sustainable consumer behaviors is necessary for both mitigating environmental problems and the success of sustainable businesses. However, to date, the focus is mainly on the motivation‐adoption link (i.e., how to motivate sustainable consumer behaviors) rather than the adoption‐continuance link (i.e., how to maintain those behaviors). This study addresses the link between sustainability adoption and continuance, through a structured literature review. Specifically, this study synthesizes what is (and is not) known about the post‐adoption (continuance) stage of the sustainable consumer journey, by reviewing and integrating the results of 87 articles. This review has three key outcomes. First, it elaborates on the importance and distinction of the continuance stage, which is predicted by a set of different and ‘evolving’ factors, compared to motivation and initial adoption. Second, the key components of the continuance stage are identified and grouped under (I) post‐adoption cognitive perceptions, (II) emotional outcomes, and (III) subsequent behavioral patterns of (dis)continuance, spillover, advocacy, loyalty, and habit formation. Third, this study introduces the concept of sustainable consumer behavior continuity and discusses theoretical relationships in a conceptual framework. Finally, this review identifies knowledge gaps and provides research directions as well as implications for theory and practice.

The risk of acute and early HIV (AEH) infection among MSM with different behaviour trajectories: an open cohort study in Tianjin, China, 2011–2019

Article

Full-text available

Jan 2023
BMC INFECT DIS

Background Acute and early HIV (AEH) infection is characterized by a high viral load and infectivity. Approximately 50% of cases of HIV-1 transmission occur during AEH. Understanding sexual behaviour trajectories would be useful for predicting changes in the risk of HIV acquisition. However, few studies have investigated sexual behaviour trajectories and their association with AEH acquisition. This study identified behaviour trajectories among men who have sex with men (MSM), determined the risk of AEH infection, and compared risk factors between different behaviour trajectories. Methods The study was based on an ongoing prospective open cohort of voluntary HIV counselling and testing (VHCT) among MSM in Tianjin, China. From 2011 to 2019, 1974 MSM were recruited. Group-based trajectory modelling (GBTM) was used to identify behaviour trajectories by constructing a sexual risk behaviour score. Logistic regression and generalized estimating equation (GEE) were used to compare the risk of AEH infection and risk factors for different behaviour trajectories. All data analyses were performed using SAS 9.4. Results The incidence of AEH infection was 1.76/100 person-years, with 64 AEH infections documented in 3633 person-years of follow-up. Three sexual behaviour trajectories were identified: CL (consistently low risk, 35.46%), CH (consistently high risk, 42.71%) and HTL (high to low risk, 21.83%). MSM in the HTL and CH groups had higher AEH infection rates than MSM in the CL group (6.73%, 3.08% and 1.28%, respectively), with ORs of 5.54 (2.60, 11.82) and 2.44 (1.14, 5.25), respectively. MSM aged 30–50 years old and MSM who underwent HIV testing in the last year were more likely to be in the CH group and HTL group. In addition, the HTL group was characterized by a lower likelihood of local registration and a higher likelihood of working as a MSW. Conclusion MSM in the CH group and the HTL group had a higher risk of AEH infection. In the future, VHCT should be performed more often among younger MSM, and HIV counselling should be given the same priority as HIV testing. In addition, VHCT combined with PrEP may have a better preventive impact on MSM with a high risk of AEH infection.

Social Cognitive Theory-Based Health Promotion in Primary Care Practice: A Scoping Review

Article

Full-text available

Jan 2022

Middle-aged and older adults’ acceptance of mobile nutrition and fitness apps: A systematic mixed studies review

Article

Full-text available

Dec 2022
PLOS ONE

Background To promote healthy aging, the support of digital mobile health tools such as mobile applications (apps) addressing a healthy diet or physical activity appears promising, particularly when initiated before entering old age. For such tools to be effective, middle-aged and older adults’ acceptance need to be studied in depth. Objective The aim of this systematic review was to provide an integrative synthesis of the current state of research regarding the question in how far middle-aged and older adults (people aged 50 years and above) accept mobile nutrition and fitness apps to gain a deeper understanding of the influencing factors shaping this target group’s usage behaviour and needs. Methods The review process followed the PRISMA guidelines. The databases Medline, Embase, Web of Science as well as reference lists were systematically searched. Study quality was assessed using the MMAT and AXIS appraisal tools. Data of the included studies were extracted and thereupon narratively synthesized, involving thematic analysis. Results Of N = 8823 articles screened, n = 7 studies could be identified–five quantitative, cross-sectional ones and two qualitative studies. Overall, the synthesized findings showed a lower acceptance among middle-aged and older adults compared to younger populations, which was particularly reflected in lower usage rates and more negative attitudes towards such apps (e.g., Perceived usefulness , Ease of use ). The target group’s acceptance of fitness apps was greater compared to nutrition apps. Findings on contextual factors and social determinants were inconsistent (e.g., regarding gender differences). Conclusion While cross-study comparability was limited, the synthesized evidence underscores the importance to target mobile nutrition and fitness apps to the distinctive and heterogeneous needs of middle-aged and, particularly, of older adults. The scarcity of the existing body of knowledge highlights the need of further (longitudinal) research. PROSPERO protocol register number CRD42020159409.

The phenomenology of maintenance goals: lower threat and greater satisfaction with the current state

Article

Full-text available

Dec 2022
MOTIV EMOTION

This research tested the mental experience of maintenance goals as distinct from goals to approach better outcomes (approach goals) and goals to avoid worse outcomes (avoidance goals). In Studies 1 and 2, participants reported personal goals and categorized them as one of the three goal types. We theorized that maintenance centers on existing positive outcomes, while avoidance centers on future (expected) negative outcomes. We therefore predicted a lesser experience of threat and a greater experience of satisfaction in maintenance compared to avoidance. Additionally, we predicted greater satisfaction in maintenance compared to approach goals, wherein motivation comes from the value of future (desired) positive outcomes rather than current ones. Confirming our predictions, participants rated personal maintenance goals as lower on threat (Study 1) and higher on satisfaction (Studies 1 and 2) compared to avoidance goals. Additionally, revealing the centrality of maintenance, maintenance goals played a major role in reported central life goals (Study 1) and the largest role in goals pursued in the previous week (Study 2). Finally, in Study 3, participants judged another person engaged in maintenance as more satisfied and less threatened than a person engaged in avoidance or approach. Taken together, this work informs about the phenomenological nature of maintenance and advances a theory-driven ternary taxonomy of basic goal types.

Models to Explain and Change Health Behavior and Physical Activity

Chapter

Feb 2023

This chapter provides an overview on models that explain change processes in health behavior and change toward more physical activity. It is divided into four main parts. In the first section, models are introduced that focus on the motivational process of behavior change and how individuals' decision-making is influenced. The second section deals with theories of action execution-the part of health behavior change in which a person implements intentions into action. These models also focus on action and coping planning to overcome obstacles for intention implementation. In the third section, we address stage and process models of health behavior change that unify processes of motivation and action execution in holistic models. Finally, in the fourth section, dual-process theories are introduced that assume that human health behavior change is affected by at least two types of information processes that are automatic and reflective. Keywords (separated by "-") Exercise behavior-Behavior change-Social-cognitive theory-Theory of planned behavior-Transtheoretical model-Health action process approach-Planning-Dual-process theory-Affective-reflective theory-Physical activity adoption and maintenance model-Integrated models of health behavior AUTHOR QUERIES Q2 Please check if heading "Abstract" before paragraph starting "This chapter provides…" should be provided.

Sport Fan Motivation: A Comparison of Local, Nonlocal, and Distant National Basketball Association Fans in the United States and China

Article

Full-text available

Nov 2022

Sitong Guo

The aim of the current study was to examine the sport motivations of three types of National Basketball Association fans based on their geographic proximity to the team: local fans (i.e., U.S.-based fans of a local team), nonlocal fans (i.e., U.S.-based fans of a nonlocal team), and distant fans (i.e., China-based fans). The author used the psychological continuum model to measure level of psychological involvement with the team in order to determine whether fans were casual, moderate, or loyal. Using one-way analyses of variance and factorial analyses of variance, the author found that Chinese distant fans reported the highest motivation for seven of the nine types of motivation measured. Results also show that geographic locality predicted significant motivational differences among casual and moderate fans but not among loyal fans. The findings have both theoretical and applied implications and call for stronger focus on the influence of locality in the sport industry.

Evaluating behavior change factors over time for a simple vs. complex health behavior

Article

Full-text available

Sep 2022

Background Researchers are working to identify dynamic factors involved in the shift from behavioral initiation to maintenance—factors which may depend on behavioral complexity. We test hypotheses regarding changes in factors involved in behavioral initiation and maintenance and their relationships to behavioral frequency over time, for a simple (taking a supplement) vs. complex (exercise) behavior. Methods Data are secondary analyses from a larger RCT, in which young adult women, new to both behaviors, were randomly assigned to take daily calcium (N = 161) or to go for a daily, brisk walk (N = 171), for 4-weeks. Factors (intentions, self-efficacy, intrinsic motivation, self-identity, habit strength) were measured weekly. Multi-level modeling evaluated their change over time. Bivariate correlations and multiple regression determined the relationships between factors and the subsequent-week behavioral frequency (self-report and objective). Finding Results were partly in-line with expectations, in that individuals’ intentions and self-efficacy predicted initial behavioral engagement for both behaviors, and habit strength increased for both behaviors, becoming a significant predictor of behavioral frequency in later weeks of the study in some analyses. However, results depended on whether the outcome was self-reported or objectively measured and whether analyses were bivariate or multivariate (regression). Discussion The factors theorized to play a role in behavioral maintenance (intrinsic motivation, self-identity, and habit strength) started to develop, but only habit strength predicted behavioral frequency by study-end, for both behaviors. Differences in initiation and maintenance between behaviors of differing complexity may not be as stark as theorized, but longer follow-up times are required to evaluate maintenance factors.

Factors influencing adults who participate in a physical activity coaching intervention: a theoretically informed qualitative study

Article

Full-text available

Aug 2022

Objective Behaviour change interventions targeting changes in physical activity (PA) can benefit by examining the underlying mechanisms that promote change. This study explored the use of the Capability, Opportunity, Motivation and Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) to code and contextualise the experiences of participants who completed a PA coaching intervention underpinned by motivational interviewing and cognitive–behavioural therapy. Design Semistructured interviews were conducted with a purposive sample of participants. Setting Interviews were conducted in a tertiary hospital in regional Victoria, Australia. Participants Eighteen participants who completed a PA coaching intervention were interviewed. The participants were recruited into the coaching intervention because they were insufficiently physically active at the time of recruitment. Results Thirteen (72%) participants were women and the average age of participants was 54 (±5) years. Four participant themes mapped directly onto five components of the COM-B model, and ten of the TDF domains. Increases in PA were influenced by changes in motivation and psychological capability. The autonomy-supportive PA coaching intervention helped to evoke participants’ own reasons (and motives) for change and influenced PA behaviours. Participants reflected on their own social and/or professional strengths, and used these skills to set appropriate PA goals and action plans. The structure of the PA coaching intervention provided clarity on session determinants and a framework from which to set an appropriate agenda. Relational components (eg, non-judgemental listening, collaboration) were continually highlighted as influential for change, and should be considered in future behaviour change intervention design. Conclusions We demonstrate the beneficial effect of using theory-informed behaviour change techniques, and delivering them in a style that promotes autonomy and relatedness. The views of participants should be a key consideration in the design and implementation of PA coaching interventions Trial registration number ACTRN12619000036112. Post-results analysis.

Theoretical Approach to Adherence to Safety Behaviours During COVID-19 Pandemic

Article

Full-text available

Jun 2022

Adherence to safety behaviours during the COVID-19 pandemic has become substantial in mitigating the viral spread. However, recently several countries entering into the deadly COVID-19 waves pointed out the issue of non-adherence to recommended COVID-19 guidelines and demand addressing the process of adherence from a different perspective. Approaching the pandemic only from an illness perspective and focusing mainly on symptom reduction is making the process of adherence even more challenging as a result of which COVID-19 cases are spiking daily and increasing the mortality rate globally. Therefore, this paper aims to address adherence behaviour during the Covid crisis, from the perspective of an individual’s perception of self, infection and treatment plan, which may provide a theoretical explanation for the process of adherence, using the Common-Sense Model of Self-Regulation (CSM). This health model highlights the constructs such as prototypes and representations, specific for self, illness and its treatment, in generating an action plan which may be continued or discontinued depending upon its efficacy and thereby explains the reason for varied responses of people towards the pandemic. CSM can be used to explain the prominence of concrete behavioural guidelines (action plan) during an infectious outbreak, the significance of providing concrete illness and treatment representation of the infection, the role of appraisal of treatment efficacy in long-term adherence and the essentiality of interventions focusing on self-prototypes. Therefore, understanding adherence during COVID-19 from all these aspects and appropriately adopting a holistic approach integrating the teamwork of medical practitioners, government policymakers, psychologists, social workers and other related experts may prove to be vital in improving adherence behaviour during this pandemic.

Investigating Microtemporal Processes Underlying Health Behavior Adoption and Maintenance: Protocol for an Intensive Longitudinal Observational Study (Preprint)

Article

Full-text available

Jan 2022

Background: Young adulthood (ages 18-29 years) is marked by substantial weight gain, leading to increased lifetime risks of chronic diseases. Engaging in sufficient levels of physical activity and sleep, and limiting sedentary time are important contributors to the prevention of weight gain. Dual-process models of decision-making and behavior that delineate reflective (ie, deliberative, slow) and reactive (ie, automatic, fast) processes shed light on different mechanisms underlying the adoption versus maintenance of these energy-balance behaviors. However, reflective and reactive processes may unfold at different time scales and vary across people. Objective: This paper describes the study design, recruitment, and data collection procedures for the Temporal Influences on Movement and Exercise (TIME) study, a 12-month intensive longitudinal data collection study to examine real-time microtemporal influences underlying the adoption and maintenance of physical activity, sedentary behavior, and sleep. Methods: Intermittent ecological momentary assessment (eg, intentions, self-control) and continuous, sensor-based passive monitoring (eg, location, phone/app use, activity levels) occur using smartwatches and smartphones. Data analyses will combine idiographic (person-specific, data-driven) and nomothetic (generalizable, theory-driven) approaches to build models that may predict within-subject variation in the likelihood of behavior "episodes" (eg, ≥10 minutes of physical activity, ≥120 minutes of sedentary time, ≥7 hours sleep) and "lapses" (ie, not attaining recommended levels for ≥7 days) as a function of reflective and reactive factors. Results: The study recruited young adults across the United States (N=246). Rolling recruitment began in March 2020 and ended August 2021. Data collection will continue until August 2022. Conclusions: Results from the TIME study will be used to build more predictive health behavior theories, and inform personalized behavior interventions to reduce obesity and improve public health. International registered report identifier (irrid): DERR1-10.2196/36666.

Leading the way together: a cluster randomised controlled trial of the 5R Shared Leadership Program in older adult walking groups

Article

Full-text available

Jun 2022
INT J BEHAV NUTR PHY

Background: With a rapidly ageing society, healthy ageing has become a key challenge. Engagement in physical activity, and particularly walking, is a key strategy that contributes to healthy ageing amongst older adults. The purpose of the present study was to evaluate the efficacy of a group walking program for older adults that incorporates the 5R Shared Leadership Program (5RS). By implementing a structure of shared leadership and strengthening peer leaders' identity leadership, 5RS aims to cultivate a shared social identity amongst participants, which has in other contexts been associated with greater performance and well-being. Methods: A cluster randomised controlled trial was conducted to test the efficacy of the 5RS group walking program on group identification, group cohesion, walking activity, and well-being, compared to a regular group walking program for older adults. Nineteen older adult walking groups (i.e., the clusters; N = 503; Mage = 69.23 years, SD = 6.68) all participated in a 12-week structured group walking program. Nine walking groups (n = 304) were randomly assigned to the intervention in which participants received the 5RS program in addition to regular group walking. Results: 5RS was successful in strengthening the identity leadership qualities of the appointed peer leaders. Multilevel regressions showed that 5RS succeeded in increasing group cohesion and walking activity to a greater extent than a regular group walking program, while participants' group identification and well-being increased to a similar extent in both conditions. Furthermore, structural equation modelling revealed that group identification mediated the impact of peer leaders' identity leadership on group cohesion and well-being (but not walking activity). Conclusion: By harnessing the capacity of the group and its peer leaders, the 5RS program offers a promising intervention to engage older adults in physical activity. Trial registration: The study was retrospectively registered as clinical trial on 9 September 2021 ( NCT05038423 ).

Effectiveness of a personal health coaching intervention (diabetescoach) in patients with type 2 diabetes: protocol for an open-label, pragmatic randomised controlled trial

Article

Full-text available

Jun 2022

Introduction The widespread prevalence of type 2 diabetes (T2D) not only influences patients’ daily lives but also has an economic impact on society. Increasing physical activity and a healthy diet can delay the progression of T2D. Although there are evidence-based recommendations on diet and physical activity, patients with T2D have difficulties implementing them. An appropriate lifestyle intervention can address this problem. Methods and analysis This study is based on the need to develop an intervention that helps patients to establish behavioural changes in order to achieve glycaemic control. The intervention will be evaluated in a monocentric, open-label, pragmatic, two-arm randomised controlled trial with a sample ratio of 1:1 and a parallel design. This superiority study will be conducted in Switzerland. All enrolled patients (n=90) will receive the standard medical treatment for T2D. The intervention group will receive personal health coaching by telephone and access to a smartphone and web application for 1 year. The control group will receive access to the application for 1 year and a one-time written diet and exercise recommendation. The primary outcomes are objectively measured physical activity and glycated haemoglobin. Secondary outcomes are self-reported physical activity, nutrition, cognitive mediators of changes in sport-related behaviour, blood values, medication and nutritional supplements, anthropometric data, quality of life, neuropathy and cost-effectiveness. All outcomes will be measured at baseline, at 27 weeks after inclusion and at 54 weeks after inclusion. The recruitment of participants and the measurements will be completed after 2 years. Linear mixed-effects models will be applied for each outcome variable to analyse the intervention effects. Ethics and dissemination This study was approved by the Ethics Committee North-western and Central Switzerland in February 2021 (ref: 2020-02755). All participants will be required to provide written informed consent. The results will be published in international peer-reviewed journals. Trial registration number ISRCTN79457541 .

Stories from the Living Lab, 2017–2018: A Look at Sustainability in Waste Management, Bike Commuting, and Investments

Article

Full-text available

Jan 2022

This report shares journeys from three WRI Sustainability Initiative projects focused on waste and plastics reduction, bike and active commutes, and sustainability of WRI's endowment. Each journey is authored by a different project lead and shares the implementation challenges, data, and outcomes, as well as relevant research and case studies that informed the project design and development.

Motivating Personal Growth by Seeking Discomfort

Article

Full-text available

Mar 2022
PSYCHOL SCI

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

Facilitators and barriers for lifestyle change in people with prediabetes: a meta-synthesis of qualitative studies

Article

Full-text available

Mar 2022
BMC PUBLIC HEALTH

Background The increasing prevalence of type 2 diabetes worldwide is a major global public health concern. Prediabetes is a reversible condition and is seen as the critical phase for the prevention of type 2 diabetes. The aim of this study is to identify and synthesize current evidence on the perceived barriers and facilitators of lifestyle change among people with prediabetes in terms of both initial change and lifestyle change maintenance. Methods A systematic literature search in six bibliographic databases was conducted in April 2021. Potential studies were assessed for eligibility based on pre-set criteria. Quality appraisal was done on the included studies, and the thematic synthesis approach was applied to synthesize and analyse the data from the included studies. Results Twenty primary studies were included, containing the experiences of 552 individuals. Thirteen studies reported participants perceived facilitators and barriers of lifestyle change when taking part in community-based lifestyle intervention programs, while seven studies reported on perceived facilitators and barriers of lifestyle change through consultations with health care professionals (no intervention involved). Three analytical themes illuminating perceived barriers and facilitators for lifestyle change were identified: 1) the individual’s evaluation of the importance of initiating lifestyle change, 2) the second theme was strategies and coping mechanisms for maintaining lifestyle changes and 3) the last theme was the significance of supportive relations and environments in initiating and maintaining lifestyle change. Conclusion Awareness of prediabetes and the perception of its related risks affects the motivation for lifestyle change in people at risk of type 2 diabetes; but this does not necessarily lead to lifestyle changes. Facilitators and barriers of lifestyle change are found to be in a complex interplay within multiple ecological levels, including the interpersonal, intrapersonal, environmental and policy level. An integrated understanding and analysis of the perceived barriers and facilitators of lifestyle change might inform people with prediabetes, healthcare professionals, and policy makers in terms of the need for psychological, social, and environmental support for this population.

Digital tools to support the maintenance of physical activity in people with long-term conditions: A scoping review

Article

Full-text available

Apr 2022

Objective This scoping review aimed to bring together and identify digital tools that support people with one or more long-term conditions to maintain physical activity and describe their components and theoretical underpinnings. Methods Searches were conducted in Cumulative Index to Nursing and Allied Health Literature, Medline, EMBASE, IEEE Xplore, PsycINFO, Scopus, Google Scholar and clinical trial databases, for studies published between 2009 and 2019, across a range of long-term conditions. Screening and data extraction was undertaken by two independent reviewers and the Preferred Reporting Items for Scoping Reviews guidelines informed the review's conduct and reporting. Results A total of 38 results were identified from 34 studies, with the majority randomised controlled trials or protocols, with cardiovascular disease, type 2 diabetes mellitus and obesity the most common long-term conditions. Comorbidities were reported in >50% of studies but did not clearly inform intervention development. Most digital tools were web-browser-based ± wearables/trackers, telerehabilitation tools or gaming devices/components. Mobile device applications and combination short message service/activity trackers/wearables were also identified. Most interventions were supported by a facilitator, often for goal setting/feedback and/or monitoring. Physical activity maintenance outcomes were mostly reported at 9 months or 3 months post-intervention, while theoretical underpinnings were commonly social cognitive theory, the transtheoretical model and the theory of planned behaviour. Conclusions This review mapped the literature on a wide range of digital tools and long-term conditions. It identified the increasing use of digital tools, in combination with human support, to help people with long-term conditions, to maintain physical activity, commonly for under a year post-intervention. Clear gaps were the lack of digital tools for multimorbid long-term conditions, longer-term follow-ups, understanding participant's experiences and informs future questions around effectiveness.

Work-to-Unlock Rewards: Leveraging Goals in Reward Systems to Increase Consumer Persistence

Article

Full-text available

Jan 2022

Eight studies (N = 5,025) demonstrate that consumers persist more when they must complete a target number of goal-related actions before receiving continuous rewards (i.e., what we term work-to-unlock rewards) than when they receive continuous rewards for their effort right away (i.e., what we term work-to-receive rewards). The authors suggest that the motivating power of work-to-unlock rewards arises because these rewards (1) naturally encourage consumers to set an attainable goal to start earning rewards, motivating consumers initially through goal setting and (2) keep consumers engaged after reaching this goal due to low perceived progress in earning rewards. A work-to-unlock reward structure increases persistence relative to standard continuous rewards across a variety of consumer-relevant domains (e.g., exercising, flossing, evaluating products), and even when work-to-unlock rewards offer rewards of a lower magnitude. Further, a work-to-unlock reward structure outperforms other reward structures that encourage goal setting. Lastly, the authors identify a theoretically consistent boundary condition of this effect: the length of the unlocking period.

The 10th�European Conference on Information Systems Management

Conference Paper

Full-text available

Feb 2022

Гульфарида Тулемисова

Abstract: The article "Sharing of teaching staff information via QR-code usage" presented at the conference, which has the common name "Information Systems Management and Evaluation ». One of the most famous information systems in user practice is an information system - "Human Resources Information System" (HRIS), which is essentially a database of the HR organization, which in itself does not provide any management decisions and need a special person who to this database is constantly filled and made changes. In this article, based on the analysis of empirical data is offered a specific solution for database management of HRIS remotely by members of the company. The process of personnel management becomes more effective and operational with the help of one of the technologies IoT- QR code. University Information about the instructors are constantly changing and the human resources department is necessary each time to make changes to the database. There are cases when you need urgent information on the teacher, and it is impossible to obtain an instant on a number of subjective reasons. QR code technology offers amazing features such as: 1. Easy access 2. Deeper relationship with customers 3. Bridge online and offline media 4. Real-time information 5. Invoke user's curiosity These technologies can provide information about the teachers for students, undergraduates, doctoral students, researchers and administration. Files using this technology consist of not only text but also videos in 3D animation. This article describes a practical example of the use of IoT technologies - QR code to improve the efficiency of the automated human resource management system (for example, Almaty Management University).The purpose of this work: to show the ways to improve the information system "Human Resources Information System” (HRIS) through the use of user-friendly, intuitive and fast QR code technology. The object of study: the work of the personnel department, IC ‘Human Resources Information System’ (HRIS) 6. Research model: observation, cross sectional model 7. Variables: behavioral variables 8. Methodology: analysis of the usage and importance of QR code for users. 9. The results of studies: the formation of stable opinion of the importance of the QR code. 10. Criteria for evaluation of thinking: creativity, innovation and technological advancement 11. Findings: not fully disclosed the potential of QR code technology has a significant impact on society. Practical implications: all the legal information about the instructors optically encoded from paper, which definitely contributes to the idea of open systems. It provides simplicity and high reading speed and user interaction with the information. Keywords: QR code, human resource information system, new content, IoT and IoE, physical web, file formats 1

Differences in Older Adults Walking Football Initiation and Maintenance Influences Across Respondent Characteristics: A Cross-Sectional Survey

Article

Full-text available

Feb 2022
J AGING PHYS ACTIV

Despite health benefits gained from physical activity and sport participation, older adults are less likely to be active. This study investigates what influences 50–75-year-olds (N=439) to initiate and maintain walking football, across gender, socioeconomic status, number of health conditions and physical activity level. It also considers relationships between participant characteristics and influences, and intentions to play after a forced break (COVID-19). Results of a UK online cross-sectional survey found those with two or more health conditions rated social influences significantly higher in initiation and maintenance, than participants with no health conditions. Multiple regression analysis found a positive walking football culture and perceived use of maintenance resources contributed significantly to intentions to return to play after COVID-19 restrictions eased. Practitioners should consider providing opportunities for social connection, foster a positive walking football culture, and encourage players to utilise maintenance resources (e.g., scheduling sessions) in older adult walking football sessions. Keywords: behaviour change, soccer, physical activity, survey research, older adults

A diagnosis of diabetes and health behavior maintenance in middle-aged and older adults in the United States: The role of self-efficacy and social support

Article

Jan 2022
PREV MED

Weidi Qin

The present study aims to investigate the relationship between a diagnosis of diabetes and the maintenance of health behaviors, and whether self-efficacy and social support moderate the relationship. The study sample came from the 2006 to 2016 waves of the Health and Retirement Study in the United States (N = 13,143). A diagnosis of diabetes was ascertained by self-reported physician-diagnosed condition. Self-efficacy was measured using a 5-item scale. Social support from family and friends were measured separately by a 3-item scale. Three health behaviors were examined, namely alcohol consumption, smoking, and physical activity. Cox proportional hazards regression models were performed to test the study aims. Respondents who reported a diagnosis of diabetes were 1.50 times more likely to fail to maintain physical activity (95% CI = 1.26, 1.77). This relationship was moderated by social support from family, which was related to lower hazards of failure to maintain physical activity among individuals who had a diagnosis of diabetes compared to those without a diagnosis. The study suggests that a diagnosis of diabetes may be a stressful health event that negatively affects physical activity maintenance. In addition, the findings highlight the importance of incorporating strategies to mobilize social support from family, which may help individuals sustain their efforts to maintaining health-promoting behaviors after a diabetes diagnosis.

Activité physique et maladies chroniques. Principes motivationnels pour contribuer à un comportement physiquement actif

Article

Full-text available

Jan 2022
Rev Med Liege

FR: Bien que l’activité physique soit perçue comme un agent thérapeutique efficace dans la prise en charge des maladies chroniques, la littérature rapporte un faible taux de participation aux programmes d’activité physique adaptée ainsi qu’un taux élevé d’abandon lors de leur participation. Le soutien à l’engagement des malades chroniques vers un style de vie actif semble perfectible, notamment en optimisant le processus allant de la prise en charge médicale vers l’intégration au sein d’une structure sportive locale adaptée. En regard des principes motivationnels liés à la théorie de l’auto-détermination, nous proposons des pistes d’action permettant d’optimiser l’accompagnement du malade chronique lors de son processus de changement de comportement. Cet article met l’accent sur l’intérêt de placer l’individu au centre de sa prise en charge physique ainsi que sur l’importance de prendre en compte les caractéristiques individuelles afin d’agir sur sa motivation intrinsèque. EN: Although physical activity is perceived as an effective therapeutic agent in the management of chronic diseases, the literature reports a low participation rate in adapted physical activity programmes and a high drop-out rate during participation. There is room for improvement in supporting the engagement of chronically ill patients in an active lifestyle, especially in optimising the process from medical management to integration into a local adapted sports structure. Based on the motivational principles of the self-determination theory, we propose courses of action to optimise the support of the chronically ill patient in the process of behavioural change. This article emphasises the importance of placing the individual at the centre of his or her physical care and the importance of taking into account individual characteristics in order to act on intrinsic motivation.

The Predictive Utility of Valuing the Future for Smoking Cessation: Findings from the ITC 4 Country Surveys

Article

Full-text available

Jan 2022
Int J Environ Res Publ Health

Background: Delay discounting (DD) and time perspective (TP) are conceptually related constructs that are theorized as important determinants of the pursuit of future outcomes over present inclinations. This study explores their predictive relationships for smoking cessation. Methods: 5006 daily smokers at a baseline wave provided 6710 paired observations of quitting activity between two waves. Data are from the International Tobacco Control (ITC) smoking and vaping surveys with samples from the USA, Canada, England, and Australia, across three waves conducted in 2016, 2018 and 2020. Smokers were assessed for TP and DD, plus smoking-specific predictors at one wave of cessation outcomes defined as either making a quit attempt and/or success among those who tried to quit which was ascertained at the subsequent survey wave. Results: TP and DD were essentially uncorrelated. TP predicted making quit attempts, both on its own and controlling for other potential predictors but was negatively associated with quit success. By contrast, DD was not related to making quit attempts, but high DD predicted relapse. The presence of financial stress at baseline resulted in some moderation of effects. Conclusions: Understanding the mechanisms of action of TP and DD can advance our understanding of, and ability to enhance, goal-directed behavioural change. TP appears to contribute to future intention formation, but not necessarily practical thought of how to achieve goals. DD is more likely an index of capacity to effectively generate competing future possibilities in response to immediate gratification.

Exercise and Cognitive Aging

Book

Nov 2021

Mindfulness-Informed Guided Imagery to Target Physical Activity: A Mixed Method Feasibility and Acceptability Pilot Study

Article

Full-text available

Dec 2021

Physical activity offers substantial mind-body health benefits and reduced mortality, yet many individuals are chronically underactive. Physical activity interventions may benefit from integrative approaches that join components of mindfulness and neurobiological models of behavior. Mindfulness increases one’s awareness of cognitions and physical sensations to potentially facilitate self-regulation, while neurobiological models such as the dual system model of health behavior offer guidance on improving physical activity intervention targets. This 2-phase study includes an initial development process to create brief (∼4 min) mindfulness informed guided imagery audio files that target distinct cognitive and affective processes to promote physical activity. In the second phase, participants completed a 2-week pilot intervention study to gather qualitative and quantitative data on intervention feasibility and acceptability. Participants endorsed the mindfulness informed guided imagery as easy to use, enjoyable and helpful. Over a 2-week intervention period participants reported positive shifts in behavior change, physical activity enjoyment, increased mindfulness during physical activity, and increased physical exercise self-efficacy and satisfaction. Interview data revealed that participants increased their frequency of physical activity and tended to experience positive affect during physical activity, engaged in future oriented thinking and were able to view physical activity in a more positive light. Findings support the feasibility and acceptability of an integrative online mindfulness informed guided imagery intervention to promote physical activity enjoyment and engagement. This study extends health behavior change intervention research and provides supporting evidence for a flexible and tailorable online mindfulness-based intervention.

Article

Nov 2021
NICOTINE TOB RES

Background: This paper explores whether plans to quit, wanting to quit and quit efficacy add predictive value over measures of habit strength and dependence in making quit attempts and/or attaining smoking abstinence. Aims and methods: We used three waves of the International Tobacco Control (ITC) Four Country Smoking and Vaping Survey conducted in 2016, 2018, and 2020. Baseline daily smokers (N=6710) who provided data for at least one wave-to-wave transition (W1 to W2, N=3511 or W2 to W3, N=3199) and providing outcome data at the next wave (follow-up) formed the analytic sample. Generalized estimating equations (GEE) logistic regression analyses examined predictors of quit attempts and abstinence at follow-up (1 and 6 months sustained abstinence). Results: Wanting and planning to quit were significantly positively associated with making quit attempts, but negatively associated with smoking abstinence. A significant interaction between the Heaviness of Smoking Index and age warranted an age-stratified analysis for both abstinence outcomes. Lower HSI predicted abstinence in only the younger smokers Motivation and plans to quit were positively associated with abstinence in younger smokers, but surprisingly were negatively associated with abstinence in older smokers. Quit efficacy was associated with abstinence in the older, but not the younger smokers. Conclusions: Models of smoking abstinence are significantly improved by including motivational predictors of smoking. Age was an important moderator of the association between abstinence for both dependence and motivational variables. Implications: The findings from this large cohort study indicate there are age-related differences in predictors of smoking abstinence but not quit attempts. These associations may reflect differential experiences of older and younger cohorts of smokers, which may have implications for interventions to motivate and assist smokers in quitting.

The acceptability, usability, engagement and optimisation of a mHealth service promoting healthy lifestyle behaviours: A mixed method feasibility study

Article

Full-text available

Apr 2024

Objective Mobile health (mHealth) services suffer from high attrition rates yet represent a viable strategy for adults to improve their health. There is a need to develop evidence-based mHealth services and to constantly evaluate their feasibility. This study explored the acceptability, usability, engagement and optimisation of a co-developed mHealth service, aiming to promote healthy lifestyle behaviours. Methods The service LongLife Active® (LLA) is a mobile app with coaching. Adults were recruited from the general population. Quantitative results and qualitative findings guided the reasoning for the acceptability, usability, engagement and optimisation of LLA. Data from: questionnaires, log data, eight semi-structured interviews with users, feedback comments from users and two focus groups with product developers and coaches were collected. Inductive content analysis was used to analyse the qualitative data. A mixed method approach was used to interpret the findings. Results The final sample was 55 users (82% female), who signed up to use the service for 12 weeks. Engagement data was available for 43 (78%). The action plan was the most popular function engaged with by users. The mean scores for acceptability and usability were 3.3/5.0 and 50/100, respectively, rated by 15 users. Users expressed that the service’s health focus was unique, and the service gave them a ‘kickstart’ in their behaviour change. Many ways to optimise the service were identified, including to increase personalisation, promote motivation and improve usability. Conclusion By incorporating suggestions for optimisation, this service has the potential to support peoples’ healthy lifestyle behaviours.

Primary care-led weight-management intervention: qualitative insights into patient experiences at two-year follow-up

Article

Full-text available

Nov 2023

Purpose The prevalence of overweight and obesity is continuously increasing globally and long-term weight loss intervention outcomes remain disappointing. To determine which behavioural intervention approaches improve the probability of achieving long-term weight loss, this two-year follow-up study aimed to identify distinct factors and strategies for successful long-term weight loss maintenance. Methods A cohort of 20 participants with overweight and obesity from a primary-care led weight management programme with diverse backgrounds was interviewed at baseline, after 1 and 2 years, and asked to do quantitative self-description. This study focused on the 2-year follow-up interviews from this study series. Results We found that agile, continuous self-monitoring with personalized, sustainable lifestyle habits correlated with positive outcomes. Participants reported health benefits, maintained weight loss, and found motivation in supportive peer networks. Challenges like anxiety, disappointment, and disruptions derailed progress. Long-term success relied on a strong support system of healthcare professionals, friends, and family. Conclusions The findings of this study series highlight the intricate nature of long-term weight loss maintenance. This study corroborates the persistence of overarching themes while highlighting the individual variability in their relative importance. Findings emphasize the importance of long-term support to effectively address the diverse needs of patients trying to achieve long-term weight loss maintenance.

Anticipated barriers and enablers to signing up for a weight management program after receiving an opportunistic referral from a general practitioner

Article

Full-text available

Sep 2023

Introduction General Practitioners (GP) are advised to opportunistically refer patients with overweight or obesity to a tier 2 weight management program, but few patients sign up after receiving the referral. Signing up to a weight management program is a behaviour, as such, behaviour change interventions are needed to increase sign ups. However, no research has explored the influences on signing up after an opportunistic referral specifically. Aim To investigate the influences (i.e., barriers and enablers) on signing up to a tier 2 weight management service after receiving an opportunistic referral from a GP, using a theoretical framework to inform intervention development. Method Semi-structured interviews were conducted with 18 residents from the London borough of Hounslow who were eligible for the service. Interview guides were informed by the Theoretical Domains Framework (TDF). Data were analyzed inductively using Reflexive Thematic Analysis and Coding Reliability to identify influences on signing up, before being deductively coded to the TDF and grouped into themes. Results Eight theoretical domains were identified as influences on signing up. Fifteen sub-themes were developed and categorized as either a barrier (5), enabler (3), or mixed (7) influence. Beliefs about Consequences was the most frequently reported influence on signing up. Beliefs that were expressed the most often include how effective the program would be, whether the program is needed to lose weight and whether the program would be compatible with their lifestyle. Leveraging Social Influences and changing patient’s Knowledge could address these beliefs and provide a potential route for Behaviour change. Discussion The present study provides the first insight into behavioural influences on signing up for a weight management service opportunistically using a validated theoretical framework. This study has implications for intervention development in that public health researchers can identify intervention, content and implementation options based on the findings. Interventions targeting the key domains of Knowledge, Social influences and Beliefs about consequences would likely be the most effective because of their prominence and influence on other domains.

الوجدان الإيجابي والسلبي والحاجة الشخصية للتنظيم كمنبئات بالتوجه الصحي لدى عينة من طلاب الجامعة والدراسات العليا Positive and Negative Affect, And Personal Need of Structure As Predictors of Health Orientation among a sample of university and Post graduate students

Article

Full-text available

Sep 2020

The current study aimed to uncover the correlation between Positive and Negative Affect and the personal need for Structure and health orientation among university students and Post Graduate, the differences between university students in the health orientation according to some demographic variables, the differences between high and low positive and negative Affect in the health orientation, and determine the predictive value of positive and negative Affects and the need The personal Structure to health, and the study participants were divided into: Participants in the exploratory study, which consisted of 141 male and female students at the university and graduate studies; To calculate the psychometric characteristics, and the basic study participants, who numbered 250 students in both the university and postgraduate levels, ranged between 21-35 years, with an average age of 24.69 years, a standard deviation of 4.11, an average monthly income of 2775 pounds, and a standard deviation of 2,191. applying the study tools, These are: The health orientation Scale; Snell ,Johnson, Lloyd & Hoover (1991) Translation & Validation via Ahmed Khairy Hafez, Fouad Muhammad AlDawash, Mustafa Abdel-Mohsen Al-Hudaibi (2020), and a Schedule of positive and negative Affects prepared by Watson, Clark, & Tellegen (1988)., And a measure of personal need for Structure by Thompson, Naccarato, Parker & Moskowitz (2001) Translation & Validation via Fouad Muhammad Al-Dawash, Mustafa Abdel-Mohsen Al-Hudaibi (2020). The results of the study Showed that: in a positive correlation and health orientation as a whole with positive Affect, and was not Correlate to self-control and external health, and health Status, while negative Affect and health anxiety, health personal awareness , Evaluation, health confidence, attention to health perception, negative expectations of health, the general need for Structure and the dimensions of the health orientation and its overall degree, The dimension response of the lack of Structure correlated with the overall degree of health orientation and its sub-dimensions except for the self-control of health, and the overall degree of personal need for Structure was correlated with the dimensions of the health orientation and was not related to health motivation, external health control, health expectations, health Statues, and the absence of significant differences Statistically among the five taxonomic variables of the participants in the basic study on the scale of health orientation, the presence of statistically significant differences between high and low positive and negative Affect in the health orientation in favor of high positive and low positive Affect, and the presence of statistically significant differences between high and low personal need for Structure and two dimensions in the health orientation in favor of high The personal need for Structure, and the existence of a predictive ability statistically significant for the health orientation of positive and negative Affect and the personal need for Structure, and the results were interpreted in the light of the theoretical literature of study variables and related studies, and based on these results and their interpretation a number of recommendations have been formulated.

New Developments in the Intention-Behavior Gap for Physical Activity – Recent Trends, Controversies, and a Critical Outlook

Book

Full-text available

Jan 2023

Adherence to Antiretroviral Therapy and Its Predictive Factors Among People Living with HIV in China: A Behavioral Theory-Based Prospective Cohort Study

Article

Sep 2022

Background Free antiretroviral therapy (ART) has been expanded to all people living with HIV (PLWH) in China since 2016, and adherence to ART has been shown to be the primary determinant of viral suppression. This study aimed to investigate the ART adherence and its associated factors among PLWH in China in the context of a scaling-up of treatment policy.MethodA prospective cohort study was conducted from June 2016 to May 2018 in Guangzhou, China. A total of 400 eligible participants were recruited from the Guangzhou Eighth People’s hospital in Guangzhou, China. The Theory of Planned Behavior and the Behavioral Maintenance Theory were applied to guide the questionnaire design. Participants were invited to completed self-administered questionnaire at baseline and months 3 and 6 post-baseline. Logistic regression models were fitted to explore factors associated with ART adherence.ResultsOf the 400 participants, the prevalence of optimal ART adherence was 83.6% at month 3 and 83.3% at month 6. The baseline attitude (ORa = 1.11, P < 0.05), behavioral intention (ORa = 1.90, P < 0.05), and outcome expectations (ORa = 1.09, P < 0.001) predicted ART adherence at month 3 in adjusted analyses, but only outcome expectations (ORa = 1.09, P < 0.01) remained significant in the final multivariate model. At month 3, negative experiences (ORa = 0.62, P < 0.05) were the only predictor of adherence at month 6.Conclusion Approximately 15% of participants reported suboptimal ART adherence. The developments of tailored interventions that target factors such as outcome expectations at baseline and negative experiences during treatment are warranted.

Ekonomik ve Sosyal Araştırmalar Dergisi

Article

Full-text available

Oct 2020

Bu çalışmanın amacı, çalışanların algıladığı örgütsel desteğin yapıcı sapkın işyeri davranışları üzerinde etkili olup olmadığını araştırmaktır. Ayrıca, örgütsel destek algısı ile yapıcı sapkın işyeri davranışları arasındaki ilişkide öz yeterliğin düzenleyici rolü de çalışma kapsamında değerlendirilmiştir. Araştırma verileri toplam 301 özel banka çalışanından elde edilmiştir. Sonuçlar, algılanan örgütsel desteğin yapıcı sapkın işyeri davranışlarının her bir boyutu üzerinde olumlu etkisi olduğunu göstermiştir. Ayrıca, algılanan örgütsel desteğin sadece kişiler arası yapıcı sapkın iş yeri davranışları üzerindeki etkisinde öz yeterliliğin düzenleyici bir rolünün olduğu belirlenmiştir. Anahtar Sözcükler: Yapıcı sapkın işyeri davranışı, algılanan örgütsel destek, öz yeterlik

A randomized controlled trial comparing prevention and promotion cognitive strategies in a behavioral weight‐loss intervention

Article

Dec 2021

Objective Two approaches may shift attention from short-term rewards to longer-term weight-loss goals: focusing on long-term consequences of unhealthy choices (prevention) or benefits of healthy choices (promotion). This randomized controlled trial tested the impact of prevention- versus promotion-focused strategies in an internet-delivered behavioral weight-loss intervention (iBWL). Methods A total of 95 participants with overweight/obesity were randomized to one of three 12-week iBWLs: (1) STANDARD (n = 31), (2) PREVENT (standard iBWL+prevention-focused training; n = 32), or (3) PROMOTE (standard iBWL+promotion-focused training; n = 32). Participants in the two enhanced arms were trained in their assigned strategy, and lessons and weekly feedback featured arm-specific content and reminders. Results Intent-to-treat analysis revealed significant differences in weight loss and self-control use at 12 weeks (weight loss p = 0.002, self-control p = 0.0006). PREVENT was associated with 6.6% (±4.5%) weight loss and a 20.3% (±26.5%) increase in self-control, STANDARD and PROMOTE were associated with 4.4% (±4.2%) and 3.1% (±3.1%) weight losses, respectively, and neither STANDARD nor PROMOTE participants exhibited significant changes in self-control. Across arms, increased self-control was associated with greater weight loss (p = 0.0005). Conclusions Cognitive strategies to focus on preventing negative consequences of unhealthy choices led to greater weight loss and self-control compared with both standard iBWL and promotion-focused iBWL. Prevention strategies should be given further attention for overweight/obesity treatment.

Individual-level barriers to bariatric surgery from patient and provider perspectives: A qualitative study

Article

Dec 2021
AM J SURG

Background Less than 1% adults in the United States who meet body mass index criteria undergo bariatric surgery. Our objective was to identify patient and provider perceptions of individual-level barriers to undergoing bariatric surgery. Methods Adults with severe obesity and obesity care providers described their experiences with the bariatric surgery care process in semi-structured interviews. Using conventional content analysis, individual-level barriers were identified within Andersen's Behavioral Model of Health Services Use. Results Of the 73 individuals interviewed, 36 (49%) were female, and 15 (21%) were non-white. Six individual-level barriers were identified: fear of surgery, fear of lifestyle change, perception that weight had not reached its “tipping point,” concerns about dietary changes, lack of social support, and patient characteristics influencing referral. Conclusions Patient and provider education should address patient fears of surgery and the belief that surgery is a “last resort.” Bariatric surgery programs should strengthen social support networks for patients.

Do post‐quitting experiences predict smoking relapse among former smokers in Australia and the United Kingdom? Findings from the International Tobacco Control Surveys

Article

Dec 2021

Introduction Many smokers attempt to stop smoking every year, but the vast majority of quit attempts fail. This study examined prospectively the association between post-quitting experiences and smoking relapse among ex-smokers in Australia and the United Kingdom. Methods Data came from 584 adult ex-smokers from Australia and the United Kingdom who participated in Wave 9 of the International Tobacco Control Four Country Survey and successfully followed up a year later (Wave 10). Binary logistic regression was used to examine whether baseline post-quitting experiences predicted relapse back to smoking at follow-up. Results Ex-smokers who perceived their stress coping ability had gotten worse since quitting were more likely to relapse back to smoking compared to their counterparts who reported no change (odds ratio = 5.77, 95% confidence interval = 1.64, 20.31, P < 0.01). Ex-smokers who reported their homes had become fresher and cleaner post quitting were less likely to relapse compared to those who did not notice any change (odds ratio = 0.34, 95% confidence interval = 0.13, 0.93, P < 0.05). Perceived changes in life enjoyment, negative affect control, social confidence, work performance, leisure time and financial situation did not independently predict relapse. No country differences were found. Discussion and Conclusions The study showed that ex-smokers' relapse risk was elevated if they perceived any negative impact of quitting on their stress coping whereas relapse risk was reduced if they perceived any positive impact of quitting on the home (e.g. fresher and cleaner). Helping ex-smokers to develop alternative stress coping strategies and highlighting the positive impacts of quitting smoking on the homes may help protect against smoking relapse.

The Theory of Planned Behavior

Article

Full-text available

Dec 1991

Icek Ajzen

Research dealing with various aspects of* the theory of planned behavior (Ajzen, 1985, 1987) is reviewed, and some unresolved issues are discussed. In broad terms, the theory is found to be well supported by empirical evidence. Intentions to perform behaviors of different kinds can be predicted with high accuracy from attitudes toward the behavior, subjective norms, and perceived behavioral control; and these intentions, together with perceptions of behavioral control, account for considerable variance in actual behavior. Attitudes, subjective norms, and perceived behavioral control are shown to be related to appropriate sets of salient behavioral, normative, and control beliefs about the behavior, but the exact nature of these relations is still uncertain. Expectancy value formulations are found to be only partly successful in dealing with these relations. Optimal rescaling of expectancy and value measures is offered as a means of dealing with measurement limitations. Finally, inclusion of past behavior in the prediction equation is shown to provide a means of testing the theory*s sufficiency, another issue that remains unresolved. The limited available evidence concerning this question shows that the theory is predicting behavior quite well in comparison to the ceiling imposed by behavioral reliability.

Expectation, fantasy, and weight loss: Is the impact of positive thinking always positive?

Article

Full-text available

Apr 1991

We investigated the impact of expectation and fantasy on the weight losses of 25 obese women participating in a behavioral weight reduction program. Both expectations of reaching one's goal weight and spontaneous weight-related fantasies were measured at pretreatment before subjects began 1 year of weekly group-treatment. Consistent with our hypothesis that expectation and fantasy are different in quality, these variables predicted weight change in opposite directions. Optimistic expectations but negative fantasies favored weight loss. Subjects who displayed pessimistic expectations combined with positive fantasies had the poorest treatment outcome. Finally, expectation but not fantasy predicted program attendance. The effects of fantasy are discussed with regard to their potential impact on weight reduction therapy and the need for further studies of dieters' spontaneous thoughts and images.

Behavioral theories and the problem of compliance

Article

Full-text available

Oct 1987
PATIENT EDUC COUNS

Capsule presentations are given of the 5 major theoretical approaches to compliance research (Biomedical; Behavioral — Operant and Social Learning; Communication; Rational Decision — Health Belief and Reasoned Action; Self-Regulative Systems) and brief summaries made of their respective contributions and deficits. Suggestions are made for integrating the Biomedical, Behavioral and Rational Decision models into the Self-Regulative Systems Model. The advantages for doing so include completeness of understanding and improved interventions; better integration of the natural history of illness with the individual's perception, understanding, and strategies for coping with illness; recognition of the separate contributions of automatic (habitual) and deliberative (reasoned) determinants of compliance; and the possibility of taking into account the uniqueness of individual understanding of illness and individual patterns of coping with illness. It is also suggested that the self-regulative approach helps to organize insights into the differences between compliance to behavioral measures for prevention and compliance to behavioral measures for cure.

Protection Motivation and Self-Efficacy: A Revised Theory of Fear Appeals and Attitude Change

Article

Full-text available

Sep 1983

The effects of fear appeals on persuasion were investigated in a factorial experiment that was designed to test a combined model of protection motivation theory and self-efficacy theory. As predicted, the probability of a threat's occurrence and the effectiveness of a coping response both had positive main effects on intentions to adopt a recommended preventive health behavior. More importantly, the findings provided support for self-efficacy expectancy as a fourth component of protection motivation theory: Self-efficacy had a direct influence on intentions and interacted with two other variables of protection motivation theory. The interaction effect was interpreted in terms of two new decision-making strategies that people use when confronted with a fear appeal: a precaution strategy and a hyperdefensiveness strategy. In addition, the results replicated previous findings on the relationship between self-efficacy expectancy and outcome expectancy. A model incorporating protection motivation theory and self-efficacy theory is presented as a possible general model of attitude change.

In Search of How People Change

Article

Full-text available

Sep 1992

How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key transtheoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages—pre-contemplation, contemplation, preparation, action, and maintenance—and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a transtheoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.

The Problem of Creating Habits: Establishing Health-Protective Dental Behaviors

Article

Full-text available

Jan 1992

We describe three experiments testing treatments to promote the performance of health-protective dental behaviors. Subjects included 55 women from an introductory psychology course (Experiment 1), 45 men and women (Experiment 2), and 81 older-than-average students identified as at risk for gum disease (Experiment 3). The interventions, derived from social cognitive theory, included health education, skills training, and self-monitoring. In each study, we examined the contribution of additional treatment components, including social support (Experiment 1), intensive contact (Experiment 2), and flexible goal setting (Experiment 3). Across experiments, the behavioral results were remarkably similar: Subjects exhibited excellent adherence while in the study but, at follow-up, reported behavior that differed little from baseline. We discuss parallels between attempts to promote health-protective dental behaviors and other health-promotion programs, and we describe different perspectives from which to address the problem of creating healthy habits. Key words: regimen adherence, health-protective behavior, behavioral dentistry

Optimism, coping, and health: Assessment and implications of generalized outcome expectancies

Article

Full-text available

Feb 1985

This article describes a scale measuring dispositional optimism, defined in terms of generalized outcome expectancies. Two preliminary studies assessed the scale's psychometric properties and its relationships with several other instruments. The scale was then used in a longitudinal study of symptom reporting among a group of undergraduates. Specifically, respondents were asked to complete three questionnaires 4 weeks before the end of a semester. Included in the questionnaire battery was the measure of optimism, a measure of private self-consciousness, and a 39-item physical symptom checklist. Subjects completed the same set of questionnaires again on the last day of class. Consistent with predictions, subjects who initially reported being highly optimistic were subsequently less likely to report being bothered by symptoms (even after correcting for initial symptom-report levels) than were subjects who initially reported being less optimistic. This effect tended to be stronger among persons high in private self-consciousness than among those lower in private self-consciousness. Discussion centers on other health related applications of the optimism scale, and the relationships between our theoretical orientation and several related theories.

Behavioral Choice Treatment Promotes Continuing Weight Loss: Preliminary Results of a Cognitive–Behavioral Decision-Based Treatment for Obesity

Article

Full-text available

Apr 1999

Twenty-four obese women were randomly assigned to 1 of 2 group treatments: behavioral choice treatment (BCT) or traditional behavioral treatment (TBT). BCT uses decision theory to promote moderate behavior change that can be comfortably, and therefore permanently, maintained. Groups completed a moderate-intensity walking program and obtained feedback from computerized eating dairies. The TBT group evidenced greater weight loss at posttreatment. However, the TBT group also evidenced a trend to regain weight, whereas the BCT group continued a slow weight loss during follow-up. Exercise followed a similar pattern. Both groups decreased in restraint and increased in self-esteem.

Social support and smoking cessation and maintenance.

Article

Aug 1986

Robin Mermelstein

Examined the role of social support in smoking cessation and maintenance in 2 longitudinal, prospective studies with 64 Ss each (mean ages 38.4 yrs and 38.8 yrs). Three kinds of support factors were assessed: support from a partner directly related to quitting, perceptions of the availability of general (i.e., nonsmoking) support resources, and the presence of smokers in Ss' social networks. Ss were smokers in cessation programs. Corroborated smoking status was obtained through 12 mo posttreatment. There was evidence for all 3 support factors, but they operated at different points in the process of cessation and maintenance. High levels of partner support and of the perceived availability of general support were associated with cessation and with short-term (to 3 mo posttreatment) maintenance of abstinence. The presence of smokers in Ss' social networks was a hindrance to maintenance and significantly differentiated between relapsers and long-term (12-mo) abstainers. (33 ref)

Initiation and Maintenance of Tobacco Smoking: Changing Personality Correlates in Adolescence and Young Adulthood1

Article

Jan 1996
J APPL SOC PSYCHOL

Youthful smokers have been described as extroverted and peer-involved, whereas older smokers are often characterized as depressed and withdrawn. Recognizing this contradiction, we examined cross-sectional and prospective associations between smoking and personality and social constructs assessed every 4 years in a sample (N= 461) originally recruited in junior high school. At Time 1, smoking was positively related to good social relations, extroversion, friends' cigarette use, and cheerfulness. At Times 2–4, smoking was positively related to depression and friends' cigarette use, negatively correlated with good Social Relations, and unrelated to extroversion. Cigarette use was stable over time, but least stable between Times 1 and 2. Findings suggest the instability of early social smoking with peers; those who persist may smoke for tension reduction and self-medication.

Correlates of maintenance of a low-fat diet among women in the Women's Health Trial

Article

Jun 1992

Background: The Women's Health Trial (WHT) was a feasibility study for a randomized controlled trial designed to test the hypothesis that a reduction in dietary fat reduces breast cancer incidence among women age 45 to 69. Between 1984 and 1988, 2,064 women participated in its two phases. Methods: A follow-up study of 525 women who were randomized to receive the WHT dietary intervention program was conducted to assess maintenance of the diet 1 year on average after the trial ended. Among 448 participants, the mean percentage of energy from fat as measured by a food frequency questionnaire was 40.0% at baseline, 26.3% at the end of the trial, and 27.7% at follow-up. Based on 408 women with complete data, a recursive model was estimated, describing the influence of baseline characteristics of the women on attendance at intervention program sessions, adherence to the diet during the trial, and long-term maintenance of the diet after the trial ended. The effects of women's experiences during the trial on adherence and long-term maintenance were investigated as well. Results: Attendance at the educational sessions was strongly related to adherence to the diet during the trial (P less than 0.001), and adherence was the most important predictor of long-term maintenance (P less than 0.001). The percentage of energy from dietary fat at baseline was an important correlate of both adherence (P less than 0.001) and long-term maintenance (P less than 0.001). College-educated women were more likely to adhere to the diet during the trial (P less than 0.001). Feelings of deprivation adversely affected long-term maintenance (P less than 0.01), primarily through their effect on adherence during the trial (P = 0.01). Costliness of the diet in time and money negatively influenced long-term maintenance (P less than 0.05). Development of a distaste for fat encouraged adherence (P = 0.06). Conclusions: The low-fat dietary pattern established during the WHT was maintained for as long as 20 months after the trial ended. A recursive model was useful in analyzing the process and correlates of long-term maintenance of dietary behavior change. Both predisposing variables and women's experiences while on a low-fat diet were associated with long-term maintenance. The results suggest that feelings of deprivation should be avoided, perhaps by use of low-fat substitutes, by those attempting to lower their dietary fat and that more research is needed on the development of a distaste for fat among individuals who adopt low-fat diets.

A Theory of Social Comparison Processes

Article

May 1954

Leon A. Festinger

The abstract for this document is available on CSA Illumina.To view the Abstract, click the Abstract button above the document title.

Smoking cessation: What Have We Learned Over the Past Decade?

Article

Sep 1992

This article discusses developments in understanding smoking and smoking cessation, methodological issues, and intervention approaches over the past 10 years. Although effective multisession clinic interventions have been developed, such programs reach relatively few smokers. This has led to self-help, work site, health care setting, and community interventions aimed at delivering less intensive programs to larger populations. Conceptual and empirical developments and trends within these above delivery contexts are reviewed, and avenues of research are identified. Nicotine replacement strategies have benefited from technological advances (e.g., transdermal patches) and present continuing challenges with respect to integration with behavioral strategies and incorporation into primary care medical settings. Research over the next decade should focus on the development of cost-effective interventions that can reach representative and high-risk smokers.

Direct Mail recruitment to home-based smoking and weight control programs: A comparison of strategies

Article

Aug 1989

Obesity and smoking remain major public health problems. Because of their widespread prevalence, large scale community-wide programs are needed to have an impact on public health. The purpose of this study was to determine the magnitude of response to four variations in recruitment and demographic characteristics of people enrolling in self-help programs for weight control and smoking cessation. A total of 76,900 households from three communities were offered correspondence-based programs in weight control and smoking cessation. Rates of enrollment ranged from 0.1 to 5% for smoking and from 0.3 to 12% for weight after adjusting for estimated prevalence of smoking and obesity. Recruitment rates were positively related to amount of money spent on recruitment per household. Sending sign-up packages only to those returning interest cards was less costly than sending sign-up packages to everyone. Those who received announcements of the program prior to receiving sign-up packages enrolled at a higher rate than those not receiving announcements. Mass media campaigns did not clearly increase enrollment. A flat fee/materials only option was about 10 times more popular than an incentive option which required a deposit and was refunded proportional to success. Enrollees were somewhat older, better educated and less overweight than those enrolling in traditional programs. Average recruitment costs per enrollee ranged from +14 to +27 in the three communities. Total enrollment was 1990 for weight and 298 for smoking across the three communities in what may be the largest direct mail recruitment effort and intervention program of its kind yet attempted.

Social Learning Theory and the Health Belief Model

Article

Feb 1988
Health Educ Q

The Health Belief Model, social learning theory (recently relabelled social cognitive theory), self-efficacy, and locus of control have all been applied with varying success to problems of explaining, predicting, and influencing behavior. Yet, there is conceptual confusion among researchers and practitioners about the interrelationships of these theories and variables. This article attempts to show how these explanatory factors may be related, and in so doing, posits a revised explanatory model which incorporates self-efficacy into the Health Belief Model. Specifically, self-efficacy is proposed as a separate independent variable along with the traditional health belief variables of perceived susceptibility, severity, benefits, and barriers. Incentive to behave (health motivation) is also a component of the model. Locus of control is not included explicitly because it is believed to be incorporated within other elements of the model. It is predicted that the new formulation will more fully account for health-related behavior than did earlier formulations, and will suggest more effective behavioral interventions than have hitherto been available to health educators.

Relapse Rates in Addiction Programs

Article

Nov 1971

The Healthy Worker Project: A work-site intervention for weight control and smoking cessation

Article

Apr 1993

A randomized trial was conducted to evaluate the effectiveness of a work-site health promotion program in reducing obesity and the prevalence of cigarette smoking. Thirty-two work sites were randomized to treatment or no treatment for 2 years. Treatment consisted of health education classes combined with a payroll-based incentive system. Evaluation was based on cohort and cross-sectional surveys. Of 10,000 total employees in treatment work sites, 2041 and 270 participated in weight control and smoking cessation programs, respectively. Weight losses averaged 4.8 lbs, and 43% of smoking participants quit. Net 2-year reductions in smoking prevalence in treatment vs control work sites were 4.0% and 2.1% in cross-sectional and cohort surveys, respectively. No treatment effect was found for weight. Treatment effects for smoking prevalence and weight were both positively correlated with participation rates in the intervention programs (r = .45 for smoking and r = .55 for weight). This work-site health promotion program was effective in reducing smoking prevalence at a cost that is believed to make the investment worthwhile.

Smoker Networks and the "Typical Smoker": A Prospective Analysis of Smoking Cessation

Article

Nov 1996

Perceptions of the typical smoker (i.e., prototype) were assessed in a sample of 174 adult smokers when they first joined a cessation clinic and were used to predict smoking status at 6-month follow-up. As predicted, consistent with a prototype-based model of health risk behavior (F. X. Gibbons & M. Gerrard, 1995, in press), smokers with more favorable perceptions were more likely to have relapsed at follow-up. Also as predicted, this prospective effect was moderated by smokers' social networks: Prototypes did not predict status among those who had a lot of friends and family members who smoked, suggesting that these other smokers were inhibiting smokers' attempts to distance themselves psychologically from the prototype. Implications of the results for interventions that use prototypes to discourage smoking are discussed.

Application of random-effects regression models in relapse research

Article

Jan 1997

This article describes and illustrates use of random-effects regression models (RRM) in relapse research. RRM are useful in longitudinal analysis of relapse data since they allow for the presence of missing data, time-varying or invariant covariates, and subjects measured at different timepoints. Thus, RRM can deal with "unbalanced" longitudinal relapse data, where a sample of subjects are not all measured at each and every timepoint. Also, recent work has extended RRM to handle dichotomous and ordinal outcomes, which are common in relapse research. Two examples are presented from a smoking cessation study to illustrate analysis using RRM. The first illustrates use of a random-effects ordinal logistic regression model, examining longitudinal changes in smoking status, treating status as an ordinal outcome. The second example focuses on changes in motivation scores prior to and following a first relapse to smoking. This latter example illustrates how RRM can be used to examine predictors and consequences of relapse, where relapse can occur at any study timepoint.

Stage theories of health behavior: Conceptual and methodological issues

Article

Jun 1998

Despite growing interest in stage theories of health behavior, there is considerable confusion in the literature concerning the essential characteristics of stage theories and the manner in which such theories should be tested. In this article, the 4 key characteristics of a stage theory-a category system, an ordering of categories, similar barriers to change within categories, and different barriers to change between categories--are discussed in detail. Examples of stage models of health behavior also are described. Four major types of research designs that might be used for testing stage theories are examined, including examples from the empirical literature. The most commonly used design, which involves cross-sectional comparisons of people believed to be in different stages, is shown to have only limited value for testing whether behavior change follows a stage process.

Toward a theory-based analysis of behavioral maintenance

Abstract

No full-text available

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