Integrating the Perceived Neighborhood Environment and the Theory of Planned Behavior When Predicting Walking in a Canadian Adult Sample

Purpose.

To integrate the characteristics of the perceived environment with the theory of planned behavior (TPB) to determine (1) whether the TPB mediates relations among environmental characteristics and walking, and (2) whether the environment moderates TPB-walking relations.

Design.

Cross-sectional.

Setting.

South Vancouver Island, British Columbia, Canada.

Subjects.

Random sample of 351 adults (36% response rate).

Measures.

Participants completed measures of the perceived neighborhood environment, the TPB, and walking behavior that was assessed using an adapted Godin leisure time questionnaire.

Results.

Results using structural equation modeling indicated that the TPB mediated the environment-walking relationship. Specifically, retail land-mix use and neighborhood aesthetics were associated with walking through affective and instrumental attitudes. Results using moderated regression analyses showed that recreation land-mix use moderated the intention-behavior relationship, with those individuals who perceived closer access to recreation facilities having a larger intention-behavior relationship. A significant moderating effect for crime on the instrumental attitude-intention relationship was also identified, but the effect size was small to trivial.

Conclusions.

These results suggest that the perceived neighborhood may influence walking through attitudes and may also influence the intention-behavior gap. Prospective studies using objective walking and environment data are required to improve the veracity of the findings and to identify possible causal relationships.

“Getting Around Town”: A Preliminary Investigation of the Theory of Planned Behavior and Intent to Change Driving Behaviors Among Older Adults

Research on why older adults change their driving behavior has typically neglected the psychological processes involved in this change. The purpose of this pilot study is to examine relations among difficulties with driving behaviors, motives toward driving, and intent to change driving behavior. A random sample of 224 drivers aged 60 and older reported on their driving-related motives and intentions within the framework of the theory of planned behavior and reported on their driving difficulties. Structural equation modeling was used to assess the relationship between motives toward driving and intention to change driving behavior. The model had a borderline acceptable fit. Instrumental attitude and subjective norm were predictive of 30% of the variance in intentions to change driving. Perceived social pressures and perceived benefits of driving appear to influence older drivers' intentions to change driving behaviors.

The confounded self-efficacy construct: conceptual analysis and recommendations for future research

Self-efficacy is central to health behaviour theories due to its robust predictive capabilities. In this paper, we present and review evidence for a self-efficacy-as-motivation argument in which standard self-efficacy questionnaires - i.e., ratings of whether participants 'can do' the target behaviour - reflect motivation rather than perceived capability. The potential implication is that associations between self-efficacy ratings (particularly those that employ a 'can do' operationalisation) and health-related behaviours simply indicate that people are likely to do what they are motivated to do. There is some empirical evidence for the self-efficacy-as-motivation argument, with three studies demonstrating causal effects of outcome expectancy on subsequent self-efficacy ratings. Three additional studies show that - consistent with the self-efficacy-as-motivation argument - controlling for motivation by adding the phrase 'if you wanted to' to the end of self-efficacy items decreases associations between self-efficacy ratings and motivation. Likewise, a qualitative study using a thought-listing procedure demonstrates that self-efficacy ratings have motivational antecedents. The available evidence suggests that the self-efficacy-as-motivation argument is viable, although more research is needed. Meanwhile, we recommend that researchers look beyond self-efficacy to identify the many and diverse sources of motivation for health-related behaviours.

Understanding the Reasons behind Anticipated Regret for Missing Regular Physical Activity

Anticipated affective reactions to missing physical activity (PA), often labeled anticipated regret, has reliable evidence as a predictor of PA intention and behavior independent of other standard social cognitive constructs. Despite this evidence, the sources of regret are understudied and may come from many different reasons. The purpose of this study was to theme the reasons for why people responded to anticipated regret over missing regular PA for 2 weeks. Participants were a random sample of 120 university students who were primed on the public health definition of PA, completed measures of regret, and were asked to list their reasons for regret. Ninety-five percent of participants expressed that they would regret not being active and gave a total of 357 reasons. The dominant theme (n = 247; 69%) was a missed opportunity to obtain the benefits of PA, followed by shame/guilt for not being able to follow-through with one's goals or self-categorized role (n = 99; 28%) with a final theme of perceived pressure from others (n = 11; 3%). From a practical perspective, the diversity of these reasons suggest that more clarity on the source of regret should be present in assessment, while building from both attitude and identity theories may help understand how regret motivates PA in future intervention.

Family planning to promote physical activity: a randomized controlled trial protocol

Background

Physical activity is associated with the reduction of several chronic conditions in adults. Additionally, physical activity is extremely important for children for their development and cognitive functioning and also to create a physically active lifestyle that continues into adulthood. Despite the known benefits of physical activity, only one in five adults are achieving the public health recommendations of 150 minutes of moderate-to-vigorous physical activity per week and only 13 % of boys and 6 % of girls between the ages of 5 and 17 years are meeting the guidelines of 60 minutes per day. This study aims to evaluate whether a planning condition improves adherence to regular physical activity compared to an education-only control condition among families. Families are eligible if there is at least one child between the ages of 6 and 12 years who is not meeting the Canadian Physical Activity Guidelines.

Methods/design

A six-month longitudinal randomized controlled trial will be used to compare the two conditions. Materials will be delivered at baseline with ‘booster’ sessions at six weeks and three months. Participants will be assessed at baseline and at six months with a fitness test, as well as questionnaires and accelerometery at baseline, six weeks, three months and six months. A total of 137 families have been recruited thus far from Greater Victoria. This study is ongoing and recruitment will continue until December 2015 with the target goal of reaching 160 families.

Discussion

This protocol describes the implementation of a randomized controlled trial that utilizes planning strategies to try and increase physical activity among families. Research findings could be useful in public health in providing effective strategies to families to help decrease sedentary lifestyles. Additionally, findings may help to inform future interventions aimed at increasing physical activity among families.

Trial registration

This trial was registered on June 5, 2012 with the Clinical Trials Registry maintained by the National Library of Medicine at the National Institutes of Health. The registration ID is NCT01882192.

Evaluating the ParticipACTION “Think Again” Campaign

Introduction. ParticipACTION’s 2011 “Think Again” campaign aimed to draw parents’, and specifically mothers’, attention to the amount of physical activity (PA) their children do relative to the national guidelines (physical activity guidelines [PAG]). Purpose. To evaluate ParticipACTION’s “Think Again” campaign in the context of the hierarchy of effects model. Methods. Data were drawn from “Think Again” campaign evaluations conducted among two cohorts of parents with children ages 5 to 11 years (3 months postcampaign launch [T1], n = 702; 15 months postlaunch [T2], n = 670). Results. At T2, campaign awareness was weakly associated with parents agreeing that their children were not active enough ( p = .01, d = .18). Parents who were aware of the campaign showed greater knowledge of PAG ( ps < .01, ϕs > .14), had higher outcome expectations about their children engaging in PA ( p < .01, d = .16), had stronger intentions to help their child meet the guidelines ( p < .01, d = .18), and engaged in more parental support behaviors ( p < .001, d = .31) as compared with parents who were not aware. At T1, parents aware of the campaign had greater perceived behavioral control (PBC) to influence their child’s PA participation ( p < .01, d = .22), whereas parents not aware of the campaign had greater PBC to find practical ways to help their child be active ( p < .01, d = .26). Parental awareness of the campaign was not associated with children meeting the PAG at either time point ( ps > .05). Conclusions. The campaign appeared marginally effective for increasing parental knowledge of PAG and for creating realistic awareness of children’s PA levels. Additional intervention strategies are needed to produce larger effects and to change parental behavior.

Using short vignettes to disentangle perceived capability from motivation: a test using walking and resistance training behaviors

Self-efficacy is arguably the strongest correlate of physical activity, yet some researchers suggest this is because the construct confounds ability with motivation. We examine a more circumscribed construct, called perceived capability (PC), meant to measure ability but not motivation and propose that the construct will not be related to unskilled physical activities but may be linked to skilled behaviors. The purpose of this paper was to examine whether a PC construct can be stripped of motivation using a vignette approach in both walking and resistance training behaviors. Participants were a random sample of 248 university students, who were then randomly assigned to either answer resistance training or walking behavior questions. Both groups completed a PC measure and reasons for their answer before and after reading a vignette that clarified the phrasing of capability to a literal use of the term. PC was significantly (p < .01) higher post- compared to pre-vignette and the differences were greater (p < .01) for walking than for resistance training. PC had significantly (p < .01) smaller correlations with intention and self-reported behavior post-disambiguation, which resulted in a null relationship with walking but a small correlation with resistance training behavior. When PC was combined with intention to predict behavior, however, there was no significant (p > .05) difference in the amount of variance explained pre- to post-vignette. Thought listing showed that participants did not report capability barriers to walking and over half of the sample construed capability as motivation/other priorities pre-vignette. The findings support use of a vignette approach for researchers who wish to disentangle the assessment of PC from motivation while creating no overall loss in explained variance of physical activity.

Understanding action control of parental support behavior for child physical activity

OBJECTIVE

Parental support is the critical family-level variable linked to child physical activity (PA), yet the antecedents of support are poorly understood, and its relationship with intention is modest. The purpose of this study was to apply a framework designed to evaluate the intention-behavior gap, known as multiprocess action control (M-PAC), to understand parental support for regular child PA.

METHOD

Mothers (N = 1,253) with children 5-12 years of age completed measures of attitudes, perceived control over support, behavioral regulation tactics (e.g., planning, self-monitoring), and intention to support. Over half (58%) reported on subsequent support behaviors 6 months later.

RESULTS

Three intention-behavior profiles emerged: (a) nonintenders (26.4%; n = 331), (b) unsuccessful intenders (36.6%; n = 458), and (c) successful intenders (33%; n = 414). Congruent with M-PAC, a discriminant function analysis showed that affective attitude about support (r = .18), perceived behavioral control over support (r = .55), and behavioral regulation (r = .55) distinguished between all 3 intention-behavior profiles. A disaggregated analysis of specific behavioral regulation tactics showed that most distinguished all 3 profiles, yet planning, information seeking, and monitoring were the critical correlates of the discriminant function.

CONCLUSION

The majority of mothers had positive intentions to support regular child PA, yet over half failed to enact this support. Difficulty of intention translating into support behavior arises from compromised control over support, self-regulation skills, and perceptions that the support experience is unenjoyable. Interventions aimed at strengthening these factors are recommended to improve parental support action control.

Predictors of physical activity change among adults using observational designs

BACKGROUND

Regular physical activity (PA) is foundational to human health, yet most people are inactive. A sound understanding of the determinants of PA may be instructive for building interventions and/or identifying critical target groups to promote PA. Most research on PA correlates has been biased by cross-sectional or passive prospective designs that fail to examine within-person analysis of PA change.

OBJECTIVE

The purpose of this review was to collect and appraise the available literature on the predictors of PA change conceived broadly in terms of increases/decreases from baseline assessment as well as specifically in terms of adoption and maintenance.

METHODS

Eligible studies were from English, peer-reviewed published articles that examined predictors of natural change of PA over 3 months + using observational (non-experimental) data in adult samples. Searches were performed from June 2012 to January 2014 in eight databases.

RESULTS

Sixty-seven independent data-sets, from 12 countries, primarily of medium quality/risk of bias, were identified with 26 correlates spanning demographic, behavioral, intra-individual, inter-individual, and environmental categories. Only intention and the onset of motherhood could reliably predict overall PA change. Among datasets configured to predict PA adoption, affective judgments and behavioral processes of change were the only reliable predictors, although both only have a small number of available studies. There were no reliable predictors of maintenance when compared to PA relapse.

CONCLUSION

The results underscore the importance of individual-level motivation and behavioral regulation in PA change, but also denote critical social variables. These findings, however, are constrained by PA measurement bias and limited studies that employed time-varying covariation between predictor variables and PA.

An Evaluation of the My ParticipACTION Campaign to Increase Self-Efficacy for Being More Physically Active

The objective of the My ParticipACTION campaign was to inspire Canadian adults to increase their physical activity through messaging that was relevant, engaging, and designed to build self-efficacy to be more active. This research examined the communication effects of the campaign according to the a priori Hierarchy of Effects Model (saliency → cognitive engagement → self-efficacy to become more active → trial behavior) and investigated how these effects related to overall self-efficacy for physical activity, intention to be active, and current activity level. Participants (N = 1,110) were recruited from an existing panel of Canadian adults 18 years and older and completed a short online questionnaire about the potential communication effects. Logistic regression models were constructed to test the communication effects adjusting for age, gender, and education. The relations were consistent with those hypothesized in the model. In addition, some earlier outcomes in the sequence of effects were associated with other outcomes further down the progression. When intention to be active was included, the initial relation between ad-specific self-efficacy and current physical activity disappeared. This analysis suggested that the campaign was successful in increasing self-efficacy to be more active and that using the Hierarchy of Effects Model was useful in guiding the design of campaign messages and assessing communication effects. Given the limited amount of theoretical testing of the Hierarchy of Effects Model, future research employing longitudinal designs is required to further confirm the communication effects of such an intervention and further test the model.

Knowledge and awareness of Canadian Physical Activity and Sedentary Behaviour Guidelines: a synthesis of existing evidence

The aim of this review was to consolidate and synthesize existing evidence regarding current knowledge and awareness of the Canadian Physical Activity (PA) and Sedentary Behaviour (SB) Guidelines. MEDLINE, Embase, and PsycINFO were searched for peer-reviewed publications pertaining to the guidelines. Content experts, key organizations (i.e., ParticipACTION and the Canadian Fitness and Lifestyle Research Institute), journal Web sites, and service organizations (i.e., the Canadian Society for Exercise Physiology (CSEP) and the Public Health Agency of Canada) were consulted for additional evidence. Scientific publications (n = 6) and research from ParticipACTION and the Canadian Fitness and Lifestyle Research Institute reported that awareness of the guidelines is low, especially with respect to the SB guidelines. Less than 10% of survey respondents from the Canadian population were aware of the PA guidelines, and less than 5% were aware of the SB guidelines. Information on the guidelines was available on 51% of public health unit and CSEP partner Web sites. Online metrics (e.g., downloads, site accessions) from CSEP, the Public Health Agency of Canada, and journal Web sites showed that online accession of the guidelines was high (e.g., all “highly accessed” on journal Web sites). This review showed that awareness of the Canadian PA and SB Guidelines is low among the general population but higher among the scientific and stakeholder communities. Governmental, nongovernmental, and stakeholder organizations should collaborate in creating sustained, long-term, and well-resourced communication plans to reach the Canadian population to raise awareness of PA and SB guidelines and should implement programs to facilitate their uptake.

GrOup based physical Activity for oLder adults (GOAL) randomized controlled trial: study protocol

BACKGROUND

Physical activity has health benefits across the lifespan, yet only 13 % of Canadian older adults are sufficiently active. Results from a number of observational studies indicate that adults display positive preferences for exercising with others of a similar age and same gender, and that intra-group age- and gender-similarity are associated with elevated exercise adherence. However, research has yet to experimentally examine the extent to which intra-group age- and gender-related similarity affect exercise adherence behaviors.

METHODS/DESIGN

The GrOup-based physical Activity for oLder adults (GOAL) trial is a three-arm randomized control trial that will examine the efficacy of two different group-based exercise programs for older adults (informed by the tenets of self-categorization theory) in relation to a standard group-based exercise program. Within this manuscript we outline the design and proposed evaluation of the GOAL trial. The first arm is comprised of exercise groups made up of participants of a similar-age and of the same gender; the second arm consists of groups with similar-aged mixed gender participants; the control arm is comprised of mixed-aged mixed gender participants. We aim to compare the adherence rates of participants across conditions, as well as potential moderation effects and mediating mechanisms.

DISCUSSION

Results from this trial will inform intervention designs to improve the exercise adherence behaviors of older adult. At a systems-level, should support be derived for the efficacy of the interventions tested in this trial, changing group composition (i.e., age, gender) represents a feasible program adaptation for physical activity centers.

TRIAL REGISTRATION

ClinicalTrials.gov # NCT02023632 . Registered December 13, 2013.

Social-ecological correlates of physical activity in kidney cancer survivors

PURPOSE

Previous studies in cancer survivors have examined behavioral correlates of physical activity (PA), but no study to date has adopted a broader social-ecological framework in understanding PA. This study examined the associations among demographic, medical, social-cognitive, and environmental correlates of meeting PA guidelines among kidney cancer survivors (KCS).

METHODS

All 1985 KCS diagnosed between 1996 and 2010 identified through a Canadian provincial registry were mailed a survey that consisted of medical, demographic, and social-cognitive measures, as well as PA as measured by the Godin Leisure Time Exercise Questionnaire. Environmental constructs were also assessed for both self-report and objective measures using geographic information systems (GIS). A series of binary logistic regression analyses were conducted in this cross-sectional study.

RESULTS

Completed surveys with geographical information were received from 432 KCS with M age = 64.4 ± 11.1 years, 63.2 % male, and 82.2 % having localized kidney cancer. In the final multivariate model, meeting PA guidelines was associated with disease stage (OR = 0.25, p = .005), having drug therapy (OR = 3.98, p = .009), higher levels of instrumental attitudes (OR = 1.66, p = .053), higher levels of intention (OR = 1.72, p = .002), and the perceived presence of many retail shops in the neighborhood (OR = 1.37, p = .032).

CONCLUSIONS

Meeting PA guidelines in KCS were associated with various aspects of the social-ecological model.

IMPLICATIONS FOR CANCER SURVIVORS

Understanding the social-ecological correlates for PA can provide insight into future interventions designed to increase PA in KCS. Prime targets for PA promotion should consider treatment-related factors, promote the benefits of PA, and enhance positive perceptions of the built environment.

Factors associated with higher sitting time in general, chronic disease, and psychologically-distressed, adult populations: findings from the 45 & up study

This study examined factors associated with higher sitting time in general, chronic disease, and psychologically-distressed, adult populations (aged ≥45 years). A series of logistic regression models examined potential socio-demographic and health factors associated with higher sitting (≥6hrs/day) in adults from the 45 and Up Study (n = 227,187), including four separate subsamples for analysis comprising those who had ever had heart disease (n = 26,599), cancer (n = 36,381), diabetes (n = 19,550) or psychological distress (n = 48,334). Odds of higher sitting were significantly (p<.01) associated with a number of factors across these groups, with an effect size of ORs≥1.5 observed for the high-income ≥$70,000AUD, employed full-time and severe physical limitations demographics. Identification of key factors associated with higher sitting time in this population-based sample will assist development of broad-based, public health and targeted strategies to reduce sitting-time. In particular, those categorized as being high-income earners, full-time workers, as well as those with severe physical limitations need to be of priority, as higher sitting appears to be substantial across these groups.

A comparison of Theory of Planned Behavior beliefs and healthy eating between couples without children and first-time parents

OBJECTIVE

To examine the relationship between Theory of Planned Behavior (TPB) beliefs and eating behavior, explore which beliefs have the greatest association with eating behavior, and explore differences between adults without children and first-time parents.

DESIGN

Longitudinal evaluation via questionnaires and food records at baseline and 6 and 12 months.

PARTICIPANTS

Couples without children (n = 72) and first-time parents (n = 100).

DEPENDENT VARIABLES

fruit and vegetable consumption and fat consumption.

INDEPENDENT VARIABLES

TPB beliefs.

ANALYSIS

Pearson correlations between TPB beliefs and eating behavior; exploratory data reduction via linear regression.

RESULTS

Control beliefs were associated with eating behavior (r = .26-.46; P < .05). After controlling for past behavior, control beliefs were associated with eating behavior for first-time parents only. Control beliefs regarding preparation and time had the strongest associations with fruit and vegetable consumption for mothers (β = .26; P < .05) and fathers (β = .38; P < .01). The absence of a ceiling effect for control beliefs suggests room for improvement via intervention.

CONCLUSIONS AND IMPLICATIONS

Interventions guided by TPB should target control beliefs to enhance healthy eating among new parents. Strategies (eg, individual, environmental, policy) to enhance control beliefs regarding healthy eating despite limited time and opportunity for preparation may be particularly valuable.

Parental correlates in child and adolescent physical activity: a meta-analysis

OBJECTIVE

Physical activity (PA) has a profound impact on health and development in children. Parental behaviors (i.e., modeling and support) represent an obvious important factor in child PA. The purpose of this paper was to provide a comprehensive meta-analysis that overcomes the limitations of prior narrative reviews and quantitative reviews with small samples.

METHODS

Ten major databases were used in the literature search. One-hundred and fifteen studies passed the eligibility criteria. Both fixed and random effects models with correction for sampling and measurement error were examined in the analysis. Moderator analyses investigating the effects of child's developmental age, study design, parental gender, measurement of child PA, and quality rating were performed.

RESULTS

Based on the random effects model, the results showed that parental modeling was weakly associated with child PA (summary r = .16, 95% CI .09-.24) and none of the proposed moderators were significant. Separate analyses examining the moderating effects of parental gender and boys' PA found that that father-son PA modeling (r = .29, 95% CI .21-.36) was significantly higher compared to mother-son PA (r = .19, 95% CI .14-.23; p < .05). However, parental gender did not moderate the relationship between parental modeling and girls' PA (p > .05). The random effects model indicated an overall moderate effect size for the parental support and child PA relationship (summary r = .38, 95% CI .30-.46). Here, the only significant moderating variable was the measurement of child PA (objective: r = .20, 95% CI .13-.26; reported: r = .46, 95% CI .37-.55; p < .01).

CONCLUSIONS

Parental support and modeling relate to child PA, yet our results revealed a significant degree of heterogeneity among the studies that could not be explained well by our proposed moderators.

Text2Plan: Exploring changes in the quantity and quality of action plans and physical activity in a text messaging intervention

BACKGROUND

The primary purpose of our study was to determine if the content and tailoring of text messages affected action planning and physical activity. Second, we determined if the quantity and the quality of action plans changed between a month of receiving text messages (T1-T2) and a month without text messages (T2-T3). We further explored if the quantity and quality of action plans predicted changes in physical activity at T2 and T3.

METHODS

Adults (n = 337, M(age) = 30.72 ± 4.80) with intentions to be active were recruited on the internet. Participants were assigned to receive tailored text messages about action planning for physical activity, generic text messages about action planning for physical activity or generic text messages about physical activity. All participants received weekly planning tools. At T2 and T3, number of action plans created each month was tallied to generate a plan quantity score. For each plan created, three components (what, where and when) were assessed by independent coders to determine plan quality. Physical activity was assessed at each time point using the Godin Leisure Time Exercise Questionnaire. Mixed model ANOVA, paired sample t-tests and multiple regression were applied to test our hypotheses.

RESULTS

There were no differences in action planning or physical activity based on the content or tailoring of text messages. The absence of text messages corresponded with declines in the quantity, but not the quality, of action plans between T2 and T3. The quantity of action plans predicted changes in physical activity.

CONCLUSIONS

Although there were no differences in action planning or physical activity based on the content or tailoring of messages, the absence of text messages corresponded with declines in the quantity, but not the quality, of action plans. Furthermore, the quantity of action plans predicted changes in physical activity. Future research is needed to determine ways to facilitate sustained formation of multiple, specific action plans over the duration of action planning interventions.