Theory of planned behavior and adherence in chronic illness: a meta-analysis

Social Psychological Predictors of Sleep Hygiene Behaviors in Australian and Hong Kong University Students

BACKGROUND

Sleep hygiene behaviors in undergraduate students are associated with night-time sleep duration and quality, daytime sleepiness, and psychological distress. This study aimed to identify the social psychological factors that impact on university students' sleep hygiene behaviors in samples from two countries.

METHOD

Participants were undergraduate students from Australia (N = 201, M_Age = 22.82, SD_Age = 8.89; 165 female) and Hong Kong (N = 161, M_Age = 20.47, SD_Age = 7.80; 84 female). The study used a correlational-prospective design. Individuals self-reported their intention, attitude, subjective norms, perceived behavioral control, and past behavior with respect to sleep hygiene behaviors. Four weeks later, the students self-reported their action plans and participation in sleep hygiene behaviors.

RESULTS

Analysis indicated acceptable model fit to data for both the Australian and Hong Kong samples. Results showed significant direct effects of attitude, subjective norms, perceived behavioral control, and past behavior on intention, and significant direct effects of action planning and past behavior on prospectively measured sleep hygiene behavior. There were also significant indirect effects of attitude, subjective norms (Hong Kong sample only), and perceived behavioral control on behavior mediated by intention and action planning. Overall, the model predicted a large portion of the variance in sleep hygiene behavior for both the Australian (R² = .524) and Hong Kong (R² = .483) samples. Schenker and Gentleman t tests found no parameters significantly differed between samples.

CONCLUSION

Results indicate that university students' sleep hygiene behaviors are a function of both motivational and volitional processes. This formative data can inform future interventions to improve the sleep hygiene practices of university students.

Instrument to evaluate the behavioral intention of hypertensive people when taking anti-hypertensives

OBJECTIVES

to build and analyze the validity of an instrument to assess the behavioral intention of individuals with hypertension to take antihypertensive pills.

METHODS

methodological study based on the theory of planned behavior, developed in three stages: preparation of the instrument, validation of content and pre-test with the target audience. The content has been validated by six experts. The Content Validity Index was applied.

RESULTS

five nurses and one psychologist participated, with experiences in systemic arterial hypertension and/or planned behavior theory. The first version of the instrument contained 40 items. After analysis, the second version originated, with 36 items. 100% agreement was obtained for the scope of the constructions. The pre-test showed clarity and understanding of the items by the target audience.

CONCLUSIONS

the instrument is a reliable and innovative technological product for use in populations with systemic arterial hypertension and beliefs similar to those identified in the surveyed group.

Predicting school students' physical activity intentions in leisure-time and school recess contexts: Testing an integrated model based on self-determination theory and theory of planned behavior

Background

Identifying psychological correlates of children’s physical activity intentions may signpost potentially modifiable targets for interventions aimed at promoting physical activity participation. School recess and leisure-time outside of school are appropriate contexts in which such interventions may be delivered. However, few studies have identified correlates of physical activity intentions in these environments. Examining correlates in these contexts may provide formative evidence on which to base interventions to promote physical activity.

Purpose

The current study adopted an integrated theoretical model to test relations between motivational constructs from self-determination theory, social cognition constructs from the theory of planned behavior, and physical activity intentions in leisure-time and school recess contexts.

Methods

Finnish school children (N = 845, M age = 13.93, SD = 0.99) from three lower-secondary schools completed self-report measures of perceived autonomy support by peers, autonomous and controlled motivation, attitudes, subjective norms, perceived behavioral control, and physical activity intentions for both contexts.

Results

Well-fitting structural equation models controlling for past behavior indicated that autonomous motivation in the school recess context and attitude in both contexts were the most pervasive predictors of physical activity intentions, and mediated the relationship between perceived autonomy support and intentions. Multi-group analyses supported invariance of the models in both contexts across gender, grades, and school, with few variations.

Conclusions

The current study supports relations between motivational and social cognition correlates of children’s physical activity intentions in school recess and leisure-time contexts. Future research should extend these findings to the prediction of follow-up participation in physical activity.

Development of the Adherence to Healthy Behaviors Scale

Adherence to healthy behaviors is a protective factor in the disease progression of chronic kidney disease (CKD). Measuring adherence can lead to the recognition of unhealthy behaviors and the suggestion of programs to prevent poor health outcomes. An assessment measurement for patients with CKD not requiring dialysis was developed and psychometrically tested. A convenience sample (n = 330) of patients with CKD attending a nephrology clinic in southern Taiwan completed the 13-item Adherence to Healthy Behaviors Scale (AHBS). A principal axis factor analysis and a parallel analysis demonstrated a three-factor structure accounting for 47.16% of the total variance. Confirmatory factor analysis indicated a good model fit. The criterion-related validity was adequate (r = .51; p < .000), with a Cronbach's alpha of .70; the test-retest reliability demonstrated good stability (r = .70; p < .000). The AHBS is a valid, reliable instrument to assess adherence to healthy behaviors among patients with CKD.

Beliefs on COVID-19 Among Electronic Cigarette Users: Behavioral Responses and Implications for COVID Prevention and E-Cigarette Interventions

E-cigarette users’ beliefs about COVID-19 may shape their responses to the pandemic and their e-cigarette consumption. A U.S. national cross-sectional survey of 562 e-cigarette users was conducted in April 2020. Participants self-reported nicotine consumption, COVID-19 beliefs, beliefs about e-cigarettes, social distancing, COVID-19 disruptions, cessation considerations, and individual characteristics. Ordinary least squares (OLS) regression provided unstandardized, and standardized coefficients. Frequency of e-cigarette use is inversely associated with beliefs COVID-19 is relevant (β = −0.215). Beliefs e-cigarettes are addictive, harmful, or pose a risk to future health were positively associated with beliefs COVID-19 is relevant (β = 0.171; β = 0.164; β = 0.203), beliefs the media are truthful on COVID-19 (β = 0.133; β = 0.136; β = 0.137), and beliefs e-cigarette users are at greater risk (β = 0.279; β = 0.411; β = 0.447). All three COVID-19 beliefs (COVID relevant; media truthful; and greater risk) were positively associated with social distancing (β = 0.307; β = 0.259; β = 0.115), work disruptions (β = 0.134; β = 0.135; β = 0.130), family disruptions (β = 0.232; β = 0.131; β = 0.164), friendship disruptions (β = 0.214; β = 0.139; β = 0.133), and considerations of quitting (β = 0.250; β = 0.222; β = 0.620). Strong associations between e-cigarette beliefs and COVID-19 beliefs exist. COVID-19 beliefs are associated with behavioral responses, such as social distancing and considerations of e-cigarette cessation. Interventions may be able to leverage COVID-19 beliefs to reduce e-cigarette consumption or promote cessation during the pandemic.

Cultural Adaptation, Validation, and Primary Application of a Questionnaire to Assess Intentions to Eat Low-Glycemic Index Foods among Rural Chinese Women

Different lines of evidence indicate that knowledge of low-glycemic index (GI) foods and the practice of eating them play important roles in blood glucose management and preventing T2DM in women with prior gestational diabetes mellitus (GDM). According to the theory of planned behavior (TPB), intention is a critical factor in complying with health-related behaviors. However, an instrument for assessing the intention to eat low-GI foods is lacking in China. We aimed to (1) adapt and validate a Chinese version of the intentions to eat low-GI foods questionnaire (CIELQ) and (2) apply the CIELQ among rural Chinese women to explore the associations between CIELQ scores and glycemic status. A cross-sectional study was conducted on 417 nondiabetic, nonpregnant participants with a history of GDM in Hunan, China. After cultural adaptation and validation, the CIELQ was applied in a target population. Glycemic status, anthropometric variables, dietary intake, and physical activity were measured; a self-developed, standard questionnaire was applied to collect relevant information. The CIELQ showed good internal consistency; model fitness was acceptable based on the confirmatory factor analysis results. Awareness of the glycemic index was low among the study population. TPB factors were found to be associated with each other; education level and parents’ diabetes history were associated with specific factors. The score for instrumental attitude showed a positive association with the risk for a high level of the 2-h 75-g oral glucose tolerance test (odds ratio, OR = 1.330), while the score for perceived behavior control (PBC) showed a negative association with the risk for a high level (OR = 0.793). The CIELQ was determined to be a valid instrument for assessing the intention to eat a low-GI diet among the study population. The awareness of the GI was poor among the study population. The score for instrumental attitude showed a positive association with the risk of a high level on the 2-h 75-g oral glucose tolerance test (OGTT), and the score for PBC showed a negative association with the risk for a high level on OGTT.

Impact of attitudes and beliefs on antiretroviral treatment adherence intention among HIV-positive pregnant and breastfeeding women in Zambia

OBJECTIVE

The aim of this study was to investigate if attitudes or behavioral beliefs about antiretroviral therapy (ART) influence ART adherence intention among pregnant and breastfeeding women in Zambia.

METHODS

We recruited 150 HIV-positive women receiving ART in urban (Lusaka) and rural (Sinazongwe) districts of Zambia. Generalized modified Poisson regression models were used to assess the extent to which adherence intention was influenced by attitude toward ART or behavioral beliefs about ART.

RESULTS

Intention to adhere to ART differed significantly by income, knowledge about HIV transmission, attitudes, and behavioral beliefs (all Ps < .05). In addition, strong intention to adhere to ART differed by urban (69%) and rural (31%) place of residence (P ≤ .01). In adjusted models, women in the weak adherence intention group were more likely to be older, have less knowledge about HIV transmission, and have a more negative attitude toward ART (PR 0.74; 95% CI 0.67-0.82). Behavioral belief about ART, however, was significant in unadjusted model (PR 0.85; 95% CI 0.76-0.94) but not significant after adjusting for covariates such as age, knowledge of transmission, and district locality.

CONCLUSION

Compared to behavioral beliefs, attitudes about ART were more influential for intention to adhere. This knowledge will help inform effective and appropriate ART counseling for pregnant and breastfeeding women at different points along their ART time course.

Using an integrated social cognition model to predict COVID-19 preventive behaviours

Objectives

Rates of novel coronavirus disease 2019 (COVID‐19) infections have rapidly increased worldwide and reached pandemic proportions. A suite of preventive behaviours have been recommended to minimize risk of COVID‐19 infection in the general population. The present study utilized an integrated social cognition model to explain COVID‐19 preventive behaviours in a sample from the Iranian general population.

Design

The study adopted a three‐wave prospective correlational design.

Methods

Members of the general public (N = 1,718, M_age = 33.34, SD = 15.77, male = 796, female = 922) agreed to participate in the study. Participants completed self‐report measures of demographic characteristics, intention, attitude, subjective norm, perceived behavioural control, and action self‐efficacy at an initial data collection occasion. One week later, participants completed self‐report measures of maintenance self‐efficacy, action planning and coping planning, and, a further week later, measures of COVID‐19 preventive behaviours. Hypothesized relationships among social cognition constructs and COVID‐19 preventive behaviours according to the proposed integrated model were estimated using structural equation modelling.

Results

The proposed model fitted the data well according to multiple goodness‐of‐fit criteria. All proposed relationships among model constructs were statistically significant. The social cognition constructs with the largest effects on COVID‐19 preventive behaviours were coping planning (β = .575, p < .001) and action planning (β = .267, p < .001).

Conclusions

Current findings may inform the development of behavioural interventions in health care contexts by identifying intervention targets. In particular, findings suggest targeting change in coping planning and action planning may be most effective in promoting participation in COVID‐19 preventive behaviours.

Social Distancing and Stigma: Association Between Compliance With Behavioral Recommendations, Risk Perception, and Stigmatizing Attitudes During the COVID-19 Outbreak

Introduction: Following behavioral recommendations is key to successful containment of the COVID-19 pandemic. Therefore, it is important to identify causes and patterns of non-compliance in the population to further optimize risk and health communication.

Methods: A total of 157 participants [80% female; mean age = 27.82 years (SD = 11.01)] were surveyed regarding their intention to comply with behavioral recommendations issued by the German government. Latent class analysis examined patterns of compliance, and subsequent multinomial logistic regression models tested sociodemographic (age, gender, country of origin, level of education, region, and number of persons per household) and psychosocial (knowledge about preventive behaviors, risk perception, stigmatizing attitudes) predictors.

Results: Three latent classes were identified: high compliance (25%) with all recommendations; public compliance (51%), with high compliance regarding public but not personal behaviors; and low compliance (24%) with most recommendations. Compared to high compliance, low compliance was associated with male gender [relative risk ratio (RRR) = 0.08 (0.01; 0.85)], younger age [RRR = 0.72 (0.57; 0.93)], and lower public stigma [RRR = 0.21 (0.05; 0.88)]. Low compliers were also younger than public compliers [RRR = 0.76 (0.59; 0.98)].

Discussion: With 25% of the sample reporting full compliance, and 51% differing in terms of public and personal compliance, these findings challenge the sustainability of strict regulatory measures. Moreover, young males were most likely to express low compliance, stressing the need for selective health promotion efforts. Finally, the positive association between public stigma and compliance points to potential othering effects of stigma during a pandemic, but further longitudinal research is required to examine its impact on health and social processes throughout the pandemic.

Effects of socio-structural variables in the theory of planned behavior: a mediation model in multiple samples and behaviors

Objective: Observed variation in health behavior may be attributable to socio-structural variables that represent inequality. We tested the hypothesis that variability related to socio-structural variables may be linked to variation in social cognition determinants of health behavior. A proposed model in which effects of socio-structural variables (age, education level, gender, income) on health behavior participation was mediated by social cognition constructs was tested. Design: Model effects were tested in correlational datasets (k = 13) in different health behaviors, populations, and contexts. Samples included self-report measures of age, highest attained education level, gender, and net household income, and constructs from the theory of planned behavior (attitude, subjective norms, perceived behavioral control, intention). Ten samples provided follow-up self-reports of health behavior. Results: Path analyses supported sample-specific indirect effects of gender and age on health behavior with comparatively few income and education level effects. Meta-analytic structural equation modeling indicated consistent indirect and total effects of gender on intentions and health behavior through social cognition constructs, and a total effect of education level on behavior. Conclusion: Results provide support for the proposed mechanism by which socio-structural variables relate to health behavior. Replication in larger samples and meta-analytic synthesis across multiple health behavior studies is warranted.

Non-prescription medicines may contribute to non-adherence to prescription medicines in people living with chronic health conditions

BACKGROUND

Non-adherence to prescribed medicines is linked to adverse health outcomes in people living with chronic health conditions (CHCs). Multiple factors are known to contribute to non-adherence to medicines including polypharmacy, demographic features and disease and health systems. Both non-prescription and prescription medicines contribute to polypharmacy; however, there is limited data on the influence of non-prescription medicines to non-adherence.

AIM

Therefore, the aim of the study was to investigate the influence of non-prescription medicines to non-adherence in an Australian population.

METHODS

Data from the 2016 National Survey of a random sample of Australian adult residents were utilised in this study to investigate factors associated with non-adherence. Descriptive statistics, χ² , regression and generalised linear models were used to assess the relationships between variables of interest. Narrative response and comments were used to provide further insight.

RESULTS

This study recruited 1217 participants to explore factors associated with non-adherence to medicines. Weak but statistically significant correlations were identified showing the number of CHCs, patient's age, number of prescription medicines, number of non-prescription medicines and total number of medicines associated with non-adherence.

DISCUSSION

The findings suggest that people living with CHCs and taking multiple medicines, including non-prescription medicines, are likely to be non-adherent to prescription medicines. This study shows the possible involvement of non-prescription medicines in contributing to non-adherence in an Australian population and suggests that future studies with a broader demographic are warranted.

Investigating the potentially important role of psychological flexibility in adherence to antiretroviral therapy in people living with HIV

Antiretroviral therapy (ART) has significantly improved immune health and survival rates in HIV, but these outcomes rely on near perfect adherence. While many psychosocial factors are related to sub-optimal adherence, effectiveness of associated interventions are modest or inconsistent. The Psychological Flexibility (PF) model underlying Acceptance and Commitment Therapy (ACT) identifies a core set of broadly applicable transdiagnostic processes that may be useful to explain and improve non-adherence. However, PF has not previously been examined in relation to ART adherence. Therefore, this cross-sectional study (n = 275) explored relationships between PF and intentional/unintentional ART non-adherence in people with HIV. Adults with HIV prescribed ART were recruited online. Participants completed online questionnaires assessing self-reported PF, adherence and emotional and general functioning. Logistic regressions examined whether PF processes were associated with intentional/unintentional non-adherence. Fifty-eight percent of participants were classified as nonadherent according to the Medication Adherence Rating Scale, of which 41.0% reported intentional and 94.0% unintentional non-adherence. Correlations between PF and adherence were small. PF did not significantly explain intentional/unintentional non-adherence after controlling for demographic and disease factors. Further clarification of the utility of PF in understanding ART non-adherence is warranted using prospective or experimental designs in conjunction with more objective adherence measures.

Effectiveness of a pharmacist-led structured group-based intervention in improving medication adherence and glycaemic control among type 2 diabetes mellitus patients: A randomized controlled trial

BACKGROUND

A pharmacist-led structured group-based intervention (MEDIHEALTH) was formulated to improve medication adherence among Malay type 2 diabetes mellitus (T2DM) patients in the Malaysian state of Sarawak.

OBJECTIVES

The objective of this study was to examine the effectiveness of MEDIHEALTH and its mechanism of impact for improving medication adherence and the glycated haemoglobin (HbA1c) level.

METHODS

A two group and parallel randomised controlled trial with a twelve months follow-up period was conducted at two primary health clinics in Malaysia that were surrounded by Malay communities. Malay T2DM patients whose HbA1c was >7% and total score on the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) was <26 were recruited and parallelly randomised to the MEDIHEALTH or usual care (control) groups. The extended theory of planned behaviour was employed to test the mechanism of impact. Repeated measure analysis of variance was used to assess the difference in the estimated marginal mean of the SEAMS scores and HbA1c level between the intervention and control groups at different times.

RESULTS

A total of 142 participants were recruited and randomised; three from the intervention group and eight from the control group withdrew before receiving any treatment. Hence, 68 participants in the intervention group and 63 in the control group were included for analyses. The MEDIHEALTH group had a significantly greater increase in the SEAMS score compared to the control group (p < 0.001) at one, three, six and twelve months post-intervention. There was also a significantly greater reduction in HbA1c in the MEDIHEALTH compared to the control group at one, three, six and twelve months post-intervention (p < 0.001). These improvements were mediated by enhancements in perceived behavioural control and knowledge about medications.

CONCLUSIONS

The MEDIHEALTH may improve medication adherence and glycaemic control among Malay T2DM patients.

Predicting physical activity among cancer survivors: Meta-analytic path modeling of longitudinal studies

OBJECTIVE

We conducted meta-analyses and meta-analytic structural equation modeling of longitudinal studies among cancer survivors to (a) quantify associations between psychosocial predictors and physical activity, (b) test how psychosocial predictors combine to influence physical activity, and (c) identify study, demographic, and clinical characteristics that moderate associations.

METHOD

Eligible studies used a longitudinal, observational design, included a sample of cancer survivors, and measured both a psychosocial predictor at baseline and physical activity at a later time-point. Of 2,431 records located through computerized searches, 25 independent tests (N = 5,897) met the inclusion criteria for the review. Random effects meta-analyses and meta-analytic structural equation modeling were conducted.

RESULTS

Eight psychosocial predictors of physical activity were identified. Self-efficacy (r+ = 0.26) and intentions (r+ = 0.33) were the strongest predictors in bivariate analyses. The structural equation models included attitudes, injunctive norms, self-efficacy, intentions, and physical activity (k = 22, N = 4,385). The model with the best fit, χ2(2) = 0.11, p = .95, root mean square error of approximation = .00, comparative fit index = 1.00, Tucker-Lewis index = 1.00, indicated that all specified paths were significant. Intentions were the strongest predictor of physical activity (β = 0.27, p < .001), and attitudes and self-efficacy were strong predictors of intentions (both βs = 0.29, ps < .001). Few significant moderators were observed.

CONCLUSION

This review indicates that self-efficacy and intentions are direct predictors of physical activity in cancer survivors. Further, attitudes and norms predict physical activity through intentions. Findings inform intervention development to increase physical activity engagement among cancer survivors. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Dealing With Artificially Dichotomized Variables in Meta-Analytic Structural Equation Modeling

Abstract. Meta-analytic structural equation modeling (MASEM) is a relatively new method in which effect sizes of different independent studies between multiple variables are typically first pooled into a matrix and next analyzed using structural equation modeling. While its popularity is increasing, there are issues still to be resolved, such as how to deal with primary studies in which variables have been artificially dichotomized. To be able to advise researchers who apply MASEM and need to deal with this issue, we performed two simulation studies using random-effects two stage structural equation modeling. We simulated data according to a full and partial mediation model and systematically varied the size of one (standardized) path coefficient (β MX = .16, β MX = .23, β MX = .33), the percentage of dichotomization (25%, 75%, 100%), and the cut-off point of dichotomization (.5, .1). We analyzed the simulated datasets in two different ways, namely, by using (1) the point-biserial and (2) the biserial correlation as effect size between the artificially dichotomized predictor and continuous variables. The results of these simulation studies indicate that the biserial correlation is the most appropriate effect size to use, as it provides unbiased estimates of the path coefficients in the population.

The use of discrete choice experiments in adherence research: A new solution to an old problem

Theory can play an important role in providing the framework, and underpinning the design and implementation of interventions to improve medication adherence. Interventions that are grounded in a theory are relatively more effective in improving medication adherence than interventions which do not have a theoretical support. However, a large body of adherence research does not appear to be linked to any theory or model, which therefore may have resulted in interventions that are either ineffective or not sustainable. Interventions that are based on theory have mainly employed socio-behavioural models to explain, and design interventions to address, the complex phenomenon of adherence. Yet, the effectiveness of these interventions is inconclusive, supporting the argument that socio-behavioural models alone have limited applicability in explaining behaviour associated with medication-taking. An important reason for this limitation may be the complex and dynamic nature of adherence. There is a need to include a wide variety of factors in a model and examine adherence in the context of its three phases (initiation, implementation, and discontinuation). One possible way forward is to also examine medication-taking behaviour from an economic perspective, for example, by using a discrete choice experiment (DCE), which provides a different approach to understanding human behaviour about medication-taking and the complexities of decision-making in adhering to medication. DCEs can help in understanding how patients decide to initiate, continue or discontinue taking medication, factors that influence their decision, and the relative importance of those factors, which can assist researchers to prioritise interventions to improve medication adherence. Integration of multiple theories is needed to examine adherence from multiple perspectives and design interventions that are effective and sustainable. This commentary focusses on the pros and cons of some of the commonly used socio-behavioural models in adherence research and suggests a way forward by incorporating DCEs in adherence research.

Modeling the Theory of Planned Behaviour to predict adherence to preventive dental visits in preschool children

Objectives

Dental caries is the most common chronic childhood disease that occurs in a continuum and can be prevented by children and their parents’ adherence to recommended oral health behaviors. Theory-driven tools help practitioners to identify the causes for poor adherence and develop effective interventions. This study examined the Expanded Theory of Planned Behaviour (TPB) Model by adding the concept of Sense of Coherence (SOC) to predict parental adherence to preschooler’s preventive dental visits.

Methods

Data regarding socio-economic demographics were collected from parents of children aged 2–6 years. Constructs of TPB including parental attitudes, subjective norms (SN), Perceived Behavioural Control (PBC), and intention to attend preventive dental visits for their preschoolers were collected by questionnaire, alongside parents’ sense of coherence (SOC). Dental attendance was measured by asking if the child had a regular dental visit during the last year. Structural Equation Modeling Analysis (SEMA) was carried out to identify significant direct and indirect (mediated) pathways in the extended TPB model.

Results

Three hundred and seventy-eight mothers (mean age = 34.41 years, range 22–48) participated in the study. The mean age of children was 3.92 years, range: 2–6), and 75.9% had dental insurance. Results of the final model showed that predisposing factors (child’s birthplace and mother’s birthplace) significantly predicted enabling resources (family monthly income and child’s dental insurance status); both predicted the TPB components (PBC, SN, and attitude). TPB components, in turn, predicted behavioural intention. However, contrary to expectation, intention did not significantly predict dental attendance in the past 12 months. Parent’s SOC significantly predicted TPB components and dental attendance. Overall, 56% of the variance in dental attendance was explained by the expanded TPB model.

Conclusions

The expanded TPB model explained a great deal of variance in preschooler’s dental attendance. These findings suggest that the expanded model could be used as the framework for designing interventions or strategies to enhance dental attendance among preschoolers; in particular, such strategies should focus specifically on enhancing parental SOC including empowerment.

Psychosocial determinants of adherence to oral antidiabetic medication among people with type 2 diabetes

AIMS AND OBJECTIVES

The aim of this study was to identify the psychosocial determinants of adherence to oral antidiabetic medication, according to the Theory of Planned Behaviour (TPB).

BACKGROUND

Appropriate adherence to oral antidiabetic medication contributes to long-term glycaemic control. However, glycaemic control is often poor in people with type 2 diabetes, mainly due to the poor adherence to oral antidiabetic agents.

DESIGN

Prospective study with 2 waves of data collection, based on STROBE checklist was conducted. One hundred and fifty-seven adults with type 2 diabetes, in chronic use of oral antidiabetic agents, composed the sample. At baseline, self-reported measures of medication adherence (proportion and global evaluation of adherence) and of metabolic control (glycated haemoglobin) of diabetes were obtained.

METHODS

The TPB main constructs (attitude, subjective norm and perceived control) and related beliefs were measured. Adherence and metabolic control measurements were obtained in a two-month follow-up (n = 157).

RESULTS

Attitude and subjective norm, together, explained 30% of the variability in intention; their underlying belief-based measures (behavioural and normative beliefs) explained 28% of the variability in intention. In addition, intention predicted behaviour at follow-up. However, when added to the prediction model, past behaviour was the only explanatory factor of adherence behaviour.

CONCLUSION

Adherence behaviour to oral antidiabetic medication was predicted by intention, which, in turn, was determined by attitude and subjective norm. In order to promote adherence to oral antidiabetic agents, health professionals should include motivational strategies as well as strategies targeted to attitude and subjective norm when designing interventions.

RELEVANCE TO CLINICAL PRACTICE

The nonadherence to antidiabetic medication contributes to lack of control of diabetes and ensuing complications. The comprehension of the factors explaining the variability in medication adherence can inform the design of theory-based interventions aimed at promoting this behaviour.

The lived experience of young Australian adults with type 1 diabetes

The purpose of the research was to explore the challenges, frustrations and experiences faced by young Australian adults with type 1 diabetes. We focused on the navigation of health behaviours (e.g. eating out, consuming alcohol, physical activity), which impact blood glucose levels, posing particular challenges for people with type 1 diabetes. Semi-structured interviews were conducted with 25 young adults with type 1 diabetes, between May and August 2016. Interviews were transcribed verbatim, and coded using thematic analysis. Participants reported that the experience of type 1 diabetes made simple things complicated and involved constant vigilance and control. Difficult experiences in social situations were also mentioned; participants felt that their privacy was often threatened, that people voiced misunderstandings about type 1 diabetes, and that members of the public often judge and critique their health behaviours or lifestyle choices. Simple behaviours like eating out with friends, responsible alcohol consumption, and engaging in physical activity pose particular challenges for young people with type 1 diabetes. Public education may reduce stigma and improve health behaviour.

Proposing a Value Field Model for Predicting Homebuyers’ Purchasing Behavior of Green Residential Buildings: A Case Study in China

Understanding the motivations that stimulate homebuyers’ green purchasing behavior can increase market demand for green products, especially considering the comparably low market share of green products worldwide. In this context, various studies have been conducted examining consumers’ intentions to pay for green products. Nevertheless, there is still limited research on evaluating homebuyers’ purchasing behavior toward green residential buildings. This study argues that the value of green residential buildings (GRBs) affects their adoption, and thus exerts an invisible force on homebuyers’ purchasing behavior. It also finds that field theory provides a scientific perspective on this phenomenon. Thus, this paper proposes a value field model for evaluating homebuyers’ GRB purchasing behavior based on physical field theory and psychology field theory. In particular, physical field theory provides the measurement formula, while psychological field theory explains the effect of the force stimulating homebuyers’ purchasing intention, and ultimately influencing their purchasing behavior. The initial model consisted of a field source (green perceived value), target charge (GRB demand), distance (psychological distance), and value field factor. As the value field factor was calculated to be approximately equal to 1, the final model is a composite of a field source (green perceived value), target charge (GRB demand), and distance (psychological distance). The results validate the construction of the value field model on the basis of field theory. This research contributes to the body of knowledge by analyzing GRB value and provides a clearer understanding of how GRBs and the environment combine to fulfill homebuyers’ requirements and influence their GRB purchasing behavior.

Factors influencing self-management in Parkinson's disease: A cross-sectional study

This study aimed to identify factors influencing self-management in patients with Parkinson's disease (PD) based on social cognitive theory. A cross-sectional design was used; data were collected at three tertiary medical centers in Korea from a convenience sample of 356 PD patients. Higher self-management scores were associated with higher education level, having a religion, and higher family income. Self-management score was positively correlated with activities of daily living, self-efficacy, and social support, and negatively correlated with non-motor symptoms. Hierarchical regression analysis revealed that demographic factors and non-motor symptoms explained 26.2% of the variance in self-management in PD. The explanatory power increased by 7.5% when self-efficacy was added, and by 6.7% when social support was added. Assessment of self-management in patients with PD should consider self-efficacy and social support, along with demographic factors and non-motor symptoms. Self-management programs that reflect these factors may be useful for improving self-management in PD patients.

From Values to Behavior: Proposition of an Integrating Model

Human values are at the heart of our lives. We all hold a set of values that influence our actions. The protection of the natural environment is no exception to this rule. That is why the study of human values is key to reaching the imperative of sustainability. In this conceptual paper, we aim to (1) integrate the key theories and models explaining the influence of human values on behavior and to (2) identify factors that might have previously been overlooked. Drawing from a range of disciplines, this article proposes an integrated model mapping the influence of human values on behavior. It also puts forward the concept of consequences as an emerging factor that could play an important role in this relationship. Recommendations are to extend the research to an empirical investigation of the model and to develop the definition of the concept of consequences and the role they play in the influence of values on consumer behavior.

Disclosure of maternal HIV infection to children among Chinese women with HIV: The application of the Theory of Planned Behaviour and the role of various norms

Maternal HIV disclosure to children has numerous benefits for both mothers and children. However, the prevalence of maternal HIV disclosure to children remains low in many countries. The present study examined factors associated with intention to disclose maternal HIV status to children among Chinese HIV+ women who have not disclosed their HIV status to their child. Factors from the Theory of Planned Behavior and various norms (injunctive, descriptive and moral norm) were examined. Findings from 179 HIV+ women revealed that only 16.8% intended to disclose their HIV status to their child in the future. Adjusted for significant background variables, all factors from the TPB and various norms (i.e. attitude, injunctive norm, descriptive norm, moral norm, perceived behavioural control) were associated with intention to disclose HIV status (adjusted odds ratios ranged from 3.22, 15.85). Stepwise logistic regression showed that attitude (ORm = 6.96) and injunctive norm (ORm = 6.81) were associated with intention to disclose HIV status. Interventions to promote maternal HIV disclosure were warranted to promote attitude, perceived behavioural control, and various norms associated with HIV disclosure.

Are Walking Treatment Beliefs and Illness Perceptions Associated With Walking Intention and 6-Min Walk Distance in People With Intermittent Claudication? A Cross-Sectional Study

Intermittent claudication is debilitating leg pain affecting older people with peripheral arterial disease, which is improved by regular walking. This study evaluated associations between psychosocial variables and 6-min walk distance (6MWD) to identify factors that motivate walking. A total of 142 individuals with intermittent claudication (116 males; M_age = 66.9 years [SD = 10.2]) completed cross-sectional assessments of sociodemographics, walking treatment beliefs and intention (Theory of Planned Behaviour), illness perceptions (Revised Illness Perceptions Questionnaire), and 6MWD. Multiple linear regression was used to evaluate relationships among psychosocial variables (treatment beliefs and illness perceptions) and outcomes (walking intention and 6MWD). Theory of planned behavior constructs were associated with intention (R = .72, p < .001) and 6MWD (R = .08, p < .001). Illness perceptions were associated with 6MWD only (R = .27, p < .001). Intention (β = 0.26), treatment control (β = -0.27), personal control (β = 0.32), coherence (β = 0.18), and risk factor attributions (β = 0.22; all ps < .05) were independently associated with 6MWD. Treatment beliefs and illness perceptions associated with intention and 6MWD in people with intermittent claudication are potential intervention targets.

Concept analysis of adherence

Objective

To explore the concept of adherence in the context of rehabilitation of patients with chronic illnesses. This concept analysis is helpful in predicting health behaviors and intentions including physical activity and dietary behaviors in patients with chronic illnesses.

Methods

The framework of Walker and Avant was used to analyze the concept of adherence.

Results

Adherence is defined as the extent to which a person’s behavior, such as taking medication, following a diet, and/or executing lifestyle changes, corresponds to agreed recommendations from a health-care provider. The antecedents of adherence are the biomedical status of the individual, social support, self-efficacy, and education. Self-report questionnaires and patient self-reporting are the most common measurement tools of adherence. Thus, the reliable and valid instrument of monitoring adherence in the clinical settings is challenging.

Conclusions

Analyzing the concept of adherence is necessary to help understand how best to promote adherence to improve health-related outcomes.

Trait Self-Control, Social Cognition Constructs, and Intentions: Correlational Evidence for Mediation and Moderation Effects in Diverse Health Behaviours

BACKGROUND

We examined effects of trait self-control, constructs from social cognition theories, and intentions on health behaviours. Trait self-control was expected to predict health behaviour indirectly through theory constructs and intentions. Trait self-control was also predicted to moderate the intention-behaviour relationship.

METHODS

Proposed effects were tested in six datasets for ten health-related behaviours from studies adopting prospective designs. Participants (N = 3,249) completed measures of constructs from social cognition theories and self-control at an initial time point and self-reported their behaviour at follow-up.

RESULTS

Results revealed indirect effects of self-control on behaviour through social cognition constructs and intentions for eight behaviours: eating fruit and vegetables, avoiding fast food, dietary restrictions, binge drinking, physical activity, walking, out-of-school physical activity, and pre-drinking. Self-control moderated the intention-behaviour relationship in four behaviours: dietary restriction, and alcohol-related behaviours.

CONCLUSIONS

Mediation effects suggest that individuals with high self-control are more likely to hold beliefs and intentions to participate in future health behaviour, and more likely to act. Moderation effects indicate that individuals with high self-control are more likely to enact healthy intentions and inhibit unhealthy intentions, but findings were restricted to few behaviours. Training self-control and managing contingencies that derail goal-directed action may be effective intervention strategies.

The effect of psychological distress on self-care intention and behaviour in young adults with type 1 diabetes

An extended theory of planned behaviour including psychological distress was used to predict blood glucose monitoring in young adults with type 1 diabetes. Participants completed two surveys, a week apart (n = 167). Attitudes and perceived behavioural control were significantly associated with intention but subjective norm was not. Intention predicted blood glucose monitoring at T2. Higher scores in psychological distress significantly predicted poorer blood glucose monitoring at T2 but did not moderate the intention-behaviour relationship. Findings demonstrate some concerns with the theory of planned behaviour to predict self-care behaviour, yet highlight the importance of addressing psychological distress in diabetes self-management.

Development and validation of the Patient's Health Belief Questionnaire on Psychiatric Treatment

BACKGROUND

Our previous studies with regard to adherence to psychiatric medications measured pharmacophobia, psychological reactance, and locus of control using a 42-item questionnaire requiring ~1.5 hours for completion. This study aims to develop the Patient's Health Belief Questionnaire on Psychiatric Treatment, a 17-item inventory which requires only 15 minutes to complete.

METHODS

Our new questionnaire with five subscales was based on 17 items from three previously validated scales (on pharmacophobia, psychological reactance, and locus of control). In 588 consecutive Spanish psychiatric outpatients taking 1,114 psychiatric medications, we studied the responses to the questionnaire; to validate it, medication adherence was assessed by the Sidorkiewicz tool.

RESULTS

Validation of the construct was addressed by performing two exploratory factor analyses independent of each other (one for the eight-item section measuring the attitudes of patients toward psychotropic drugs and one for the nine-item section measuring perceived health locus of control [HLOC]), which led to five subscales that were called Positive and Negative Aspects of Medications, Doctor-HLOC, Internal-HLOC, and Psychological Reactance. The five subscales showed better internal consistency when corrected by number of items than the original 17-item scale. Logistic regression models of the continuous scores, dichotomized subscales, and Chi-squared Automatic Interaction Detector (CHAID) analysis indicated that all five subscales help in predicting adequate adherence, although the various subscales behave differently in different analyses.

CONCLUSION

Future studies need to verify and further extend the preliminary findings of this study that the questionnaire may have construct and predictive validity.

Confronting Co-workers: Role Models, Attitudes, Expectations, and Perceived Behavioral Control as Predictors of Employee Voice in the Military

Speaking up and confronting co-workers when they behave undesirably is important for the well-being of the personnel and organizational performance. In some organizations, a culture of silence prevails, however. Although a number of organizational environments are particularly receptive to employee voice, others are less open to voice behavior, which gives rise to a risk of undesirable behavior. Direct communication (voice) can reduce this enhanced risk. In this study, we used the Theory of Planned Behavior to examine the extent to which attitude, social norm and perceived behavioral control determine voice in hierarchical contexts, which, in general, tend to inhibit voice behavior. For this purpose, a survey study was conducted among military and civilian personnel of the Netherlands Ministry of Defense (n = 374). Results showed that employee voice is rather high, regardless of rank, position or gender. Structural equation modeling showed that voice was significantly predicted by perceived behavioral control and injunctive norms (i.e., what is considered to be normal in a certain working-environment). Contrary to expectations, voice was not predicted by attitude and descriptive social norms (i.e., what people see that others are doing in this respect). Stimulating confronting skills and creating a climate in which speaking up is perceived as normal may be beneficial for organizations in general and hierarchical organizations in particular.

Applying the theory of planned behavior to examine adjuvant endocrine therapy adherence intentions

OBJECTIVE

Adherence to adjuvant endocrine therapy (AET) in breast cancer survivors is suboptimal. Using the theory of planned behavior (TPB), this study aimed to identify the strongest predictors from the TPB of AET intentions and past behavior and assessed whether ambivalence and anticipatory emotions increased the predictive capacity of TPB.

METHODS

Two hundred eighty women diagnosed with hormone positive (HR+) breast cancer who filled at least one prescription of AET responded to a survey measuring TPB constructs, attitudinal ambivalence, and anticipatory emotions. The outcomes were intentions to adhere to AET and past medication adherence (previous 2 weeks).

RESULTS

The TPB explained 66% of intentions to adhere to AET (P < 0.001). Ambivalence did not improve the TPB model's predictive value. When emotions were included with TPB, the model explained 70% of adherence intentions F_11,226  = 52.84, P < 0.001 (R² _c  = .70). This increase of 4% in predictability was statistically significant (ΔR²  = 0.04), F_{6, 226}  = 7.90, P < 0.001. Women who self-reported nonadherence in the past 2 weeks differed significantly in the TPB variables, ambivalence, and anticipatory emotions from adherent women. Nonadherent participants reported lower-future intentions to adhere F_{1, 236}  = 5.63, P = 0.018.

CONCLUSIONS

Results suggest key concepts, such as anticipatory positive emotions that should be addressed in future interventions to enhance AET adherence and survivorship.

Being active in pregnancy: Theory-based factors associated with physical activity among pregnant women

Although regular physical activity is recommended for pregnant women, compared to pre-pregnancy, antenatal physical activity often reduces or ceases completely. Drawing from the theory of planned behavior, self-determination theory, and theory on self-control, we aimed to test an integrative model of physical activity in a sample of pregnant women. The current study was conducted in Brisbane, Australia, in 2014-2015 using a prospective-correlational design with a one-week follow-up. Participants (N = 207, Time 1; Meanage = 30.03 years, SDage = 4.49 years) completed an initial survey measuring: intrinsic motivation from the self-determination theory, social cognitive constructs from the theory of planned behavior, and self-control from the self-control theory, followed by a self-report measure of physical activity one-week later (n = 117, Time 2). A well-fitting structural equation model accounted for 73 and 42 percent of the variance in intention and physical activity behavior, respectively. Perceived behavioral control and attitude, but not subjective norm, mediated the effect of intrinsic motivation on intention. Intention, perceived behavioral control, and self-control were positively associated with physical activity behavior. Future behavioral interventions aiming to promote physical activity during pregnancy, a period when the physical activity levels typically decline, should consider the multiple processes advocated in the integrative model as necessary for motivated action.

Women's Beliefs on Early Adherence to Adjuvant Endocrine Therapy for Breast Cancer: A Theory-Based Qualitative Study to Guide the Development of Community Pharmacist Interventions

Adjuvant endocrine therapy (AET) taken for a minimum of five years reduces the recurrence and mortality risks among women with hormone-sensitive breast cancer. However, adherence to AET is suboptimal. To guide the development of theory-based interventions to enhance AET adherence, we conducted a study to explore beliefs regarding early adherence to AET. This qualitative study was guided by the Theory of Planned Behavior (TPB). We conducted focus groups and individual interviews among women prescribed AET in the last two years (n = 43). The topic guide explored attitudinal (perceived advantages and disadvantages), normative (perception of approval or disapproval), and control beliefs (barriers and facilitating factors) towards adhering to AET. Thematic analysis was conducted. Most women had a positive attitude towards AET regardless of their medication-taking behavior. The principal perceived advantage was protection against a recurrence while the principal inconvenience was side effects. Almost everyone approved of the woman taking her medication. The women mentioned facilitating factors to encourage medication-taking behaviors and cope with side effects. For adherent women, having trouble establishing a routine was their main barrier to taking medication. For non-adherent women, it was side effects affecting their quality of life. These findings could inform the development of community pharmacy-based adherence interventions.

Effectiveness and sustainability of a structured group-based educational program (MEDIHEALTH) in improving medication adherence among Malay patients with underlying type 2 diabetes mellitus in Sarawak State of Malaysia: study protocol of a randomized controlled trial

BACKGROUND

Amidst the high disease burden, non-adherence to medications among patients with type 2 diabetes mellitus (T2DM) has been reported to be common and devastating. Sarawak Pharmaceutical Services Division has formulated a pharmacist-led, multiple-theoretical-grounding, culturally sensitive and structured group-based program, namely "Know Your Medicine - Take if for Health" (MEDIHEALTH), to improve medication adherence among Malay patients with T2DM. However, to date, little is known about the effectiveness and sustainability of the Program.

METHODS/DESIGN

This is a prospective, parallel-design, two-treatment-group randomized controlled trial to evaluate the effectiveness and sustainability of MEDIHEALTH in improving medication adherence. Malay patients who have underlying T2DM, who obtain medication therapy at Petra Jaya Health Clinic and Kota Samarahan Health Clinic, and who have a moderate to low adherence level (8-item Morisky Medication Adherence Scale, Malaysian specific, score <6) were randomly assigned to the treatment group (MEDIHEALTH) or the control group. The primary outcome of this study is medication adherence level at baseline and 1, 3, 6 and 12 months post-intervention. The secondary outcomes are attitude, subjective norms, perceived behavioural control, intention and knowledge related to medication adherence measured at baseline and 1, 6 and 12 months post-intervention. The effectiveness and sustainability of the Program will be triangulated by findings from semi-structured interviews with five selected participants conducted 1 month after the intervention and in-depth interviews with two main facilitators and two managerial officers in charge of the Program 12 months after the intervention. Statistical analyses of quantitative data were conducted using SPSS version 22 and Stata version 14. Thematic analysis for qualitative data were conducted with the assistance of ATLAS.ti 8.

DISCUSSION

This study provides evidence on the effectiveness and sustainability of a structured group-based educational program that employs multiple theoretical grounding and a culturally sensitive approach in promoting medication adherence among Malays with underlying T2DM. Both the quantitative and qualitative findings of this study could assist in the future development of the Program.

TRIAL REGISTRATION

National Medical Research Register, NMRR-17-925-35875 (IIR). Registered on 19 May 2017. ClinicalTrials.gov, NCT03228706 . Registered on 25 July 2017.

Accounting for Missing Correlation Coefficients in Fixed-Effects MASEM

Meta-analytic structural equation modeling (MASEM) is increasingly applied to advance theories by synthesizing existing findings. MASEM essentially consists of two stages. In Stage 1, a pooled correlation matrix is estimated based on the reported correlation coefficients in the individual studies. In Stage 2, a structural model (such as a path model) is fitted to explain the pooled correlations. Frequently, the individual studies do not provide all the correlation coefficients between the research variables. In this study, we modify the currently optimal MASEM-method to deal with missing correlation coefficients, and compare its performance with existing methods. This study is the first to evaluate the performance of fixed-effects MASEM methods under different levels of missing correlation coefficients. We found that the often used univariate methods performed very poorly, while the multivariate methods performed well overall.

Incorporating the 'Theory of Planned Behavior' into personalized healthcare behavior change research: a call to action

The 'Theory of Planned Behavior' (TPB) has been tested and validated in the scientific literature across multiple disciplines and is arguably the most widely accepted theory among behavior change academics. Despite this widespread acceptability, the TPB has yet to be incorporated into personalized healthcare behavior change research. Several prominent personalized healthcare researchers suggest that personalizing healthcare recommendations have a positive impact on changes in lifestyle habits. However, research in this area has demonstrated conflicting findings. We provide a scientific and theoretical basis to support a proposed expansion of the TPB to include personalization, and call to action-personalized healthcare behavior change researchers to test this expansion. Specific recommendations for study design are included.

On Nomological Validity and Auxiliary Assumptions: The Importance of Simultaneously Testing Effects in Social Cognitive Theories Applied to Health Behavior and Some Guidelines

Tests of social cognitive theories provide informative data on the factors that relate to health behavior, and the processes and mechanisms involved. In the present article, we contend that tests of social cognitive theories should adhere to the principles of nomological validity, defined as the degree to which predictions in a formal theoretical network are confirmed. We highlight the importance of nomological validity tests to ensure theory predictions can be disconfirmed through observation. We argue that researchers should be explicit on the conditions that lead to theory disconfirmation, and identify any auxiliary assumptions on which theory effects may be conditional. We contend that few researchers formally test the nomological validity of theories, or outline conditions that lead to model rejection and the auxiliary assumptions that may explain findings that run counter to hypotheses, raising potential for ‘falsification evasion.’ We present a brief analysis of studies (k = 122) testing four key social cognitive theories in health behavior to illustrate deficiencies in reporting theory tests and evaluations of nomological validity. Our analysis revealed that few articles report explicit statements suggesting that their findings support or reject the hypotheses of the theories tested, even when findings point to rejection. We illustrate the importance of explicit a priori specification of fundamental theory hypotheses and associated auxiliary assumptions, and identification of the conditions which would lead to rejection of theory predictions. We also demonstrate the value of confirmatory analytic techniques, meta-analytic structural equation modeling, and Bayesian analyses in providing robust converging evidence for nomological validity. We provide a set of guidelines for researchers on how to adopt and apply the nomological validity approach to testing health behavior models.