Do implementation intentions help to eat a healthy diet? A systematic review and meta-analysis of the empirical evidence

Translational Research in Cancer Screening: Long-Term Population-Action Bridges to Diffuse Adherence

The population-level implementation of innovative, evidence-based medical recommendations for adopting health-behaviors depends on the last link in the translation chain: the users. “User-friendly” medical interventions aimed at engaging users to adopt recommended health behaviors are best developed in a collaborative bio-medical and social sciences setting. In the 1990s, National Breast and Colorectal Cancer Early Detection Programs were launched at the Israeli Department of Community Medicine and Epidemiology. Operating under the largest HMO (Health Maintenance Organization) in Israel (“Clalit Health Services”), the department had direct access to HMO community primary-care clinics’ teams, insured members, and medical records. Academically affiliated, the department engaged in translational research. In a decades-long translational process, this multi-disciplinary unit led a series of interventions built upon basic and applied behavioral/social science phenomena such as framing, “Implementation Intentions,” and “Question-Behavior-Effect”. A heterogeneous team of disciplinary specialists created an integrated scientific environment. In order to enhance screening, the team focused on the establishment of a systematic mechanism actively inviting programs’ “users” (average-risk targeted individuals on the national level), and continuously applied social and health psychology concepts to study individuals’ perceptions, expectations, and needs related to cancer screening. The increase in adherence to screening recommendations was slow and incremental. A decrease in late-stage breast and colorectal cancer diagnoses was observed nationally, but participation was lower than expected. This paper positions screening adherence as a unique challenge and proposes new social and network avenues to enhance future participation.

The influence of 'deliberate' implementation intention on medical students' risk decision task outcomes

Implementation intention is a kind of behaviour choice strategy in which individuals adopt specific and definite behaviour patterns to achieve behavioural goals. The standard form is 'if something happens, then I will do something'. Previous studies have shown that implementation intention strategy is a fast and effective mental skill with notable advantages. However, adding the requirement of 'deliberate' to the implementation plan will increase the probability of decision adjustment to a certain extent. In this study, the classic Balloon Analogue Risk Task (BART) was selected as the evaluation index of risk decision-making, and the 'deliberate' implementation intention was adopted to explore the impact of this behavioural strategy on risk selection. The recruited medical students were divided into two groups: the implementation intention group (n = 37) and the control group (n = 34). The baseline assessment for the BART was performed by all participants, and the intensive training of 'deliberate' implementation intention to 'make as much money as possible' was conducted before the post-test decision-making after one week. The adjusted BART (adj BART) value and AvgIncome were significantly higher than those at baseline in the implementation intention group(adj BART value: baseline 12.63 ± 2.90, post-test: 14.78 ± 2.66, F = 15.978, p < 0.001, η ² = 0.307; AvgIncome: baseline 12.43 ± 2.56, post-test 15.00 ± 2.57, F = 20.953, p < 0.001, η ² = 0.368). The mixed-model ANOVAs showed that there was a significant interaction between test time and group (adj BART value: F = 4.859, p = 0.031, η ² = 0.066; AvgIncome: F = 4.261, p = 0.043, η ² = 0.058). Conclusion: The implementation of 'deliberate' intention can help medical students make more rational judgements in risk decision-making tasks, avoid over conservative behaviour and obtain more benefits.

A Meta-Analysis of the Effects of Mental Contrasting With Implementation Intentions on Goal Attainment

Mental contrasting with implementation intentions (MCII) is a self-regulation strategy that enhances goal attainment. This meta-analysis evaluated the efficacy of MCII for goal attainment and explored potential moderators. A total of 21 empirical studies with 24 independent effect sizes (15,907 participants) were included in the analysis. Results showed that MCII to be effective for goal attainment with a small to medium effect size (g = 0.336). The effect was mainly moderated by intervention style. Specifically, studies with interventions based on interactions between participants and experimenters (g = 0.465) had stronger effects than studies with interventions based on interactions between participants and documents (g = 0.277). The results revealed that MCII is a brief and effective strategy for goal attainment with a small to moderate effect; however, because of some publication bias, the actual effect sizes may be smaller. Due to small number of studies in this meta-analysis, additional studies are needed to determine the role of moderator variables.

Interventions to reduce meat consumption by appealing to animal welfare: Meta-analysis and evidence-based recommendations

Reducing meat consumption may improve human health, curb environmental damage, and limit the large-scale suffering of animals raised in factory farms. Most attention to reducing consumption has focused on restructuring environments where foods are chosen or on making health or environmental appeals. However, psychological theory suggests that interventions appealing to animal welfare concerns might operate on distinct, potent pathways. We conducted a systematic review and meta-analysis evaluating the effectiveness of these interventions. We searched eight academic databases and extensively searched grey literature. We meta-analyzed 100 studies assessing interventions designed to reduce meat consumption or purchase by mentioning or portraying farm animals, that measured behavioral or self-reported outcomes related to meat consumption, purchase, or related intentions, and that had a control condition. The interventions consistently reduced meat consumption, purchase, or related intentions at least in the short term with meaningfully large effects (meta-analytic mean risk ratio [RR] = 1.22; 95% CI: [1.13, 1.33]). We estimated that a large majority of population effect sizes (71%; 95% CI: [59%, 80%]) were stronger than RR = 1.1 and that few were in the unintended direction. Via meta-regression, we identified some specific characteristics of studies and interventions that were associated with effect size. Risk-of-bias assessments identified both methodological strengths and limitations of this literature; however, results did not differ meaningfully in sensitivity analyses retaining only studies at the lowest risk of bias. Evidence of publication bias was not apparent. In conclusion, animal welfare interventions preliminarily appear effective in these typically short-term studies of primarily self-reported outcomes. Future research should use direct behavioral outcomes that minimize the potential for social desirability bias and are measured over long-term follow-up.

Theory Integration for Lifestyle Behavior Change in the Digital Age: An Adaptive Decision-Making Framework

Despite the growing popularity of digital health interventions, limitations of traditional behavior change theories and a lack of theory integration hinder theory-driven behavior change applications. In this paper, we aim to review theories relevant to lifestyle behavior change from the broader psychology literature and then integrate these theories into a new theoretical framework called adaptive decision-making to address two specific problems. First, our framework represents lifestyle behaviors at two levels-one of individual daily decisions (action level) and one of larger behavioral episodes (reflection level)-to more closely match the temporal characteristics of lifestyle behaviors and their associated digital data. Second, the framework connects decision-making theories and learning theories to explain how behaviors and cognitive constructs dynamically influence each other, making it a suitable scaffold for building computational models. We map common digital intervention techniques onto the behavioral and cognitive processes in the framework and discuss possible contributions of the framework to both theory development and digital intervention design.

Characterising binge eating over the course of a feasibility trial among individuals with binge eating disorder and bulimia nervosa

Binge eating disorder and bulimia nervosa are eating disorders that are characterized by recurrent binge eating episodes. The highly contextualized nature of binge eating makes naturalistic research a particularly suitable means of understanding the context within which binge eating occurs. The present study aimed to characterise binge eating days with regards to the frequency and probability of negative affect, food craving, meal skipping, and dietary restriction. In addition, it aimed to examine whether a combined intervention that targets the experience of 'loss of control' over eating can decrease these potential maintenance factors that often precede binge eating episodes. Seventy-eight participants with bulimia nervosa (N = 40) or binge eating disorder (n = 38), who were randomly allocated to a food-specific or general intervention combining inhibitory control training and implementation intentions, completed mood and food diaries over four weeks. Results suggest that negative affect and food craving were elevated on binge eating days, but that dietary restraint and meal skipping did not characterise binge eating days. Moreover, meal skipping, binge eating, restriction, and compensation decreased throughout the intervention period, while negative affect and food craving did not. This suggests that some interventions may successfully reduce binge eating frequency without necessarily decreasing negative affect or food craving, thus pointing to the different routes to targeting binge eating and providing implications for future interventions.

Implementation intentions for weight loss in college students with overweight and obesity: a proof-of-concept randomized controlled trial

One in three college students have overweight or obesity and are in need of brief, simple weight loss interventions. Implementation intentions, a strategy that connects a goal-aligned behavior to a cue, facilitate goal attainment of health behaviors but have not been applied as a standalone treatment for weight loss. The purpose of this study was to examine the efficacy of an implementation intention weight loss intervention in college students. In this three-arm, proof-of-concept, randomized controlled trial, college students with overweight/obesity (N = 95) were randomized to one of three conditions: an implementation intention group (IMP), an enhanced implementation intention group (IMP+) that included text message reminders and fluency training (i.e., training for speed and accuracy), and a control goal intention group (GOL) for 4 weeks. Participants completed anthropometric and self-report assessments pretreatment and posttreatment and experience-sampling assessments during the study to assess how implementation intentions contribute to behavior change. Across the sample, IMP and IMP+ groups reported significantly more goal-congruent behaviors than the GOL group. However, no between-condition differences emerged for weight and diet outcomes. Across conditions, students lost a statistically significant amount of weight, improved diet quality, and reduced caloric intake (ps < .05). Setting implementation intentions was associated with increased behaviors consistent with weight loss goals. Moreover, participants in all groups lost a statistically significant amount of weight. Incorporating implementation intentions into weight loss interventions, and testing the efficacy of this approach on weight loss over a longer duration, may be beneficial for college students with overweight/obesity.

Greater Average Meal Planning Frequency Predicts Greater Weight Loss Outcomes in a Worksite-Based Behavioral Weight Loss Program

BACKGROUND

Planning in behavioral weight loss (BWL) programs helps participants enact changes in eating and exercise, although the direct impact on weight loss is unclear.

PURPOSE

To examine how meal and exercise planning frequencies change in a BWL program and their relations to weight loss outcomes.

METHODS

Participants (N = 139) in a 40 week worksite-based BWL program completed a questionnaire regarding meal and exercise planning frequency at Weeks 0, 10, 20, 30, and 40 and were weighed weekly. Growth curve models were used to determine trajectories in meal and exercise planning frequency and to assess the role of an individual's average meal and exercise planning (between-person effect) and individual variation in planning (within-person effect) on body mass index (BMI).

RESULTS

The best-fitting model, a linear random effect with a quadratic fixed-effect model, demonstrated that meal and exercise planning frequency increased over the course of the program with slowing growth rates. Between participants, higher average meal planning frequency (B = -0.029, t = -3.60), but not exercise planning frequency, was associated with greater weight loss. Within participants, exercise planning, but not meal planning, predicted a higher than expected BMI (B = 3.17, t = 4.21).

CONCLUSIONS

Frequent meal planning should be emphasized as a continued, as opposed to intermittent, goal in BWL programs to enhance weight loss. Average exercise planning frequency does not impact weight loss in BWL programs; however, acute increases in exercise planning frequency may be a popular coping strategy during a weight loss setback or, alternatively, may lead to increased calorie consumption and weight gain.

Immediate effects of a very brief planning intervention on fruit and vegetable consumption: A randomized controlled trial

Action planning interventions can effectively promote fruit and vegetable (FV) consumption, but not much is known about the day-to-day translation of intervention planning into action. In this randomized controlled trial, immediate intervention effects of a very brief planning intervention on FV consumption during the following 13 days were investigated. After a 13-day pre-intervention diary, N = 206 participants (aged 19-66 years) were randomly allocated to a waiting-list control condition or a planning condition, where they formed one FV plan. Participants from both conditions completed a 13-day post-intervention diary. Self-reported daily FV consumption, FV-specific self-efficacy, and action control were assessed. Segmented linear mixed models estimating a discrete change (i.e. "jump") between diary phases showed a positive "jump" of FV intake and self-efficacy in the planning condition when compared to the control condition. For action control, such effects were not observed. Changes in study variables throughout the post-intervention phase did not differ between both conditions. Present findings extend previous evidence on action planning interventions by showing that increases in self-regulatory (i.e. self-efficacy) and behavioral (i.e. FV intake) outcomes can occur very rapidly and already on the first day for which behavioral increases were planned.

An exploratory randomised controlled trial evaluating text prompts in Lebanon to encourage health-seeking behaviour for hypertension

AIMS OF THE STUDY

The current study evaluates the effectiveness of an opportunistic mobile screening on the percentage of people who are aware of whether they may be hypertensive (in an observational study) and the effectiveness of reminder prompts on the percentage of people who seek further medical attention (in a randomised controlled trial).

METHODS USED TO CONDUCT THE STUDY

The screening of 1227 participants (529 female) was conducted during the registration period of the 2018 Beirut International Marathon in Lebanon. Next, 266 participants whose screening indicated hypertension (64 Female) were randomly allocated to a treatment group or a control group in a 1:1 fashion. The treatment group received a reminder prompt to seek further medical attention for their potential hypertension and the control group did not. The overt nature of the text message meant that participants in the treatment group could not be blinded to their group allocation. The primary outcome is participants' self-reports of whether they sought further medical attention.

RESULTS OF THE STUDY

For the opportunistic screening, a 25% prevalence rate and a 24% awareness rate of hypertension was indicated. A McNemar analysis suggested that the screening increased participant awareness (X² (N = 1227) = 72.16, P < .001). For the randomised controlled trial, 219 participants provided follow-up data via a phone call (82% retention). A Chi-squared analysis suggested that the reminder prompt successfully encouraged more participants to seek further medical attention, 45.5% treatment group vs 28.0% control group (X² (1, N = 219) = 7.19, P = .007, φ = 0.18).

CONCLUSIONS DRAWN AND CLINICAL IMPLICATIONS

Extra support in the form of a brief reminder message can increase the percentage of people who seek further medical attention after attending an opportunistic screening at a marathon event. The discussion reviews how the results align with previous research, strengths and limitations of the current study, and implications for future research and practice.

Enhancing the translation of health behaviour change research into practice: a selective conceptual review of the synergy between implementation science and health psychology

Health psychology is at the forefront of developing and disseminating evidence, theories, and methods that have improved the understanding of health behaviour change. However, current dissemination approaches may be insufficient for promoting broader application and impact of this evidence to benefit the health of patients and the public. Nevertheless, behaviour change theory/methods typically directed towards health behaviours are now used in implementation science to understand and support behaviour change in individuals at different health system levels whose own behaviour impacts delivering evidence-based health behaviour change interventions. Despite contributing to implementation science, health psychology is perhaps doing less to draw from it. A redoubled focus on implementation science in health psychology could provide novel prospects for enhancing the impact of health behaviour change evidence. We report a Health Psychology Review-specific review-of-reviews of trials of health behaviour change interventions published from inception to April 2020. We identified 34 reviews and assessed whether implementation readiness of behaviour change interventions was discussed. We then narratively review how implementation science has integrated theory/methods from health psychology and related discipline. Finally, we demonstrate how greater synergy between implementation science and health psychology could promote greater follow-through on advances made in the science of health behaviour change.

Targeting automatic processes to reduce unhealthy behaviours: a process framework

While previous frameworks to address health behaviours through targeting underlying automatic processes have stimulated an improved understanding of related interventions, deciding between intervention strategies often remains essentially arbitrary and atheoretical. Making considered decisions has likely been hampered by the lack of a framework that guides the selection of different intervention strategies targeting automatic processes to reduce unhealthy behaviours. We propose a process framework to fulfil this need, building upon the process model of emotion regulation. This framework differentiates types of intervention strategies along the timeline of the unfolding automatic response, distinguishing between three broad classes of intervention strategies - direct antecedent, indirect antecedent, and response-focused. Antecedent-focused strategies aim to prevent the exposure to or activation of automatic responses directly through the avoidance of unwanted stimulus-response associations (i.e., situation modification or situation-specific response selection), or indirectly through automatising self-control (i.e., attentional deployment or cognitive change). Response-focused strategies aim to directly downregulate automatic unwanted responses (i.e., response modulation). Three main working hypotheses derived from this process framework provide practical guidance for selecting interventions, but await direct testing in future studies.

Protocol for a hybrid type 2 cluster randomized trial of trauma-focused cognitive behavioral therapy and a pragmatic individual-level implementation strategy

BACKGROUND

More than two-thirds of youth experience trauma during childhood, and up to 1 in 5 of these youth develops posttraumatic stress symptoms that significantly impair their functioning. Although trauma-focused cognitive behavior therapy (TF-CBT) has a strong evidence base, it is rarely adopted, delivered with adequate fidelity, or evaluated in the most common setting where youth access mental health services-schools. Given that individual behavior change is ultimately required for successful implementation, even when organizational factors are firmly in place, focusing on individual-level processes represents a potentially parsimonious approach. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a pragmatic, motivationally focused multifaceted strategy that augments training and consultation and is designed to target precise mechanisms of behavior change to produce enhanced implementation and youth clinical outcomes. This study protocol describes a hybrid type 2 effectiveness-implementation trial designed to concurrently evaluate the main effects, mediators, and moderators of both the BASIS implementation strategy on implementation outcomes and TF-CBT on youth mental health outcomes.

METHODS

Using a cluster randomized controlled design, this trial will assign school-based mental health (SMH) clinicians and schools to one of three study arms: (a) enhanced treatment-as-usual (TAU), (b) attention control plus TF-CBT, or (c) BASIS+TF-CBT. With a proposed sample of 120 SMH clinicians who will each recruit 4-6 youth with a history of trauma (480 children), this project will gather data across 12 different time points to address two project aims. Aim 1 will evaluate, relative to an enhanced TAU condition, the effects of TF-CBT on identified mechanisms of change, youth mental health outcomes, and intervention costs and cost-effectiveness. Aim 2 will compare the effects of BASIS against an attention control plus TF-CBT condition on theoretical mechanisms of clinician behavior change and implementation outcomes, as well as examine costs and cost-effectiveness.

DISCUSSION

This study will generate critical knowledge about the effectiveness and cost-effectiveness of BASIS-a pragmatic, theory-driven, and generalizable implementation strategy designed to enhance motivation-to increase the yield of evidence-based practice training and consultation, as well as the effectiveness of TF-CBT in a novel service setting.

TRIAL REGISTRATION

ClinicalTrials.gov registration number NCT04451161 . Registered on June 30, 2020.

ImpulsePal: The systematic development of a smartphone app to manage food temptations using intervention mapping

BACKGROUND

Impulsive processes driving eating behaviour can often undermine peoples' attempts to change their behaviour, lose weight and maintain weight loss.

AIM

To develop an impulse management intervention to support weight loss in adults.

METHODS

Intervention Mapping (IM) was used to systematically develop the "ImpulsePal" intervention. The development involved: (1) a needs assessment including a qualitative study, Patient and Public advisory group and expert group consultations, and a systematic review of impulse management techniques; (2) specification of performance objectives, determinants, and change objectives; (3) selection of intervention strategies (mapping of change techniques to the determinants of change); (4) creation of programme materials; (5) specification of adoption and implementation plans; (6) devising an evaluation plan.

RESULTS

Application of the IM Protocol resulted in a smartphone app that could support reductions in unhealthy (energy dense) food consumption, overeating, and alcoholic and sugary drink consumption. ImpulsePal includes inhibition training, mindfulness techniques, implementation intentions (if-then planning), visuospatial loading, use of physical activity for craving management, and context-specific reminders. An "Emergency Button" was also included to provide access to in-the-moment support when temptation is strong.

CONCLUSIONS

ImpulsePal is a novel, theory- and evidence-informed, person-centred app that aims to support impulse management for healthier eating. Intervention Mapping facilitated the incorporation of app components that are practical operationalisations of change techniques targeting our specific change objectives and their associated theoretical determinants. Using IM enabled transparency and provided a clear framework for evaluation, and enhances replicability and the potential of the intervention to accomplish the desired outcome of facilitating weight loss through dietary change.

Resisting, Recognizing, and Returning: A Three-Component Model and Review of Persistence in Episodic Goals

According to prior work, persistent goal pursuit is a continuous process where persisting is a matter of resisting the urge to give up. In everyday goals, however, persistence is often episodic, and its causes are more complex. People pause and resume pursuit many times. Whether people persist reflects more than will power and motivation, it also reflects the other goals they pursue, their resources, and the attentional demands of daily life. People can fail to persist not just because they gave up, but also because they failed to act. We propose a general model of persistence that accommodates the complexity of episodic goals. We argue that persistent goal pursuit is a function of three processes: resisting the urge to give up, recognizing opportunities for pursuit, and returning to pursuit. The broad factors that help and hurt persistence can be organized within these components. These components can also explain the mechanisms of four effective strategies for persistence: removing distractions, using reminders, using implementation intentions, and forming habits. The recognizing-resisting-returning model integrates and improves on extant theories of persistence and goal pursuit and is consistent with empirical work from laboratory and naturalistic settings.

Lessons Learned from a Writing to Learn Program for Public Health Students at the University of Tokyo

We have taught writing for public health to students completing a Master of Public Health since 2016 in Japan. We adopted a writing-to-learn approach and assigned work to students to write health materials that encourage recipients to perform health behaviors (eg, drafting a poster to encourage lay audiences to adopt preventive behaviors during the COVID-19 pandemic). We collected students' work assignments and products from 2016 to 2020 and reviewed them to identify distinctive trends common to all years. We found that there was a curse of knowledge (ie, difficulties to imagine the state of mind of not knowing when knowing something) among students. Students strongly embraced the adage "knowledge is power" and underestimated the difficulties lay audiences face. Their writing was somewhat dogmatic, whereby experts imparted privileged knowledge to ignorant non-experts. However, it is well known that merely imparting knowledge often does not work to educate lay audiences about making better decisions. Debiasing this curse of knowledge among students will be the main target of our writing education.

What Is Slowing Us Down? Six Challenges to Accelerating Advances in Health Behavior Change

BACKGROUND

Accelerating advances in health behavior change requires releasing the brake, as well as applying the throttle. This paper discusses six challenges or "brakes" that have slowed progress.

PURPOSE/METHODS/RESULTS

We engage with six issues that limit investigators' ability to delineate and test the strategy-target and target-behavior relations that underlie effective interventions according to the experimental medicine approach. We discuss the need for guidance on how to identify the relevant mechanism of action (target) in an intervention and whether a periodic table of health behavior constructs might aid investigators. Experimental and correlational analyses (prospective surveys and behavior change techniques) have been used to test the validity of targets, and we present evidence that there is little agreement among the findings from different research designs. Whereas target engagement is typically analyzed in terms of increasing scores on constructs that impel behavior change, we discuss the role of impeding targets and the benefits of adopting a broader construal of potential targets and approaches to engagement. There is presently a paucity of competitive tests regarding which strategies best engage targets and we discuss empirical criteria and conceptual developments that could enhance the evidence base. Finally, we highlight the need to take "context" or conditional intervention effects more seriously by leveraging the interplay between questions about why interventions work and questions about when and for whom they work.

CONCLUSION

Candid appraisal of the challenges facing research on health behavior change can generate new opportunities for theoretical development and offer direction and cumulative impetus for empirical work.

A systematic review on consumer acceptance of alternative proteins: Pulses, algae, insects, plant-based meat alternatives, and cultured meat

Consumers' dietary patterns have a significant impact on planetary and personal health. To address health and environmental challenges one of the many possible solutions is to substitute meat consumption with alternative protein sources. This systematic review identifies 91 articles with a focus on the drivers of consumer acceptance of five alternative proteins: pulses, algae, insects, plant-based alternative proteins, and cultured meat. This review demonstrates that acceptance of the alternative proteins included here is relatively low (compared to that of meat); acceptance of insects is lowest, followed by acceptance of cultured meat. Pulses and plant-based alternative proteins have the highest acceptance level. In general, the following drivers of acceptance consistently show to be relevant for the acceptance of various alternative proteins: motives of taste and health, familiarity, attitudes, food neophobia, disgust, and social norms. However, there are also differences in relevance between individuals and between alternative proteins. For example, for insects and other novel alternative proteins the drivers of familiarity and affective processes of food neophobia and disgust seem more relevant. As part of gaining full insight in relevant drivers of acceptance, the review also shows an overview of the intervention studies that were included in the 91 articles of the review, providing implications on how consumer acceptance can be increased. The focal areas of the intervention studies included here do not fully correspond with the current knowledge of drivers. To date, intervention studies have mainly focussed on conscious deliberations, whereas familiarity and affective factors have also been shown to be key drivers. The comprehensive overview of the most relevant factors for consumer acceptance of various categories of alternative proteins thus shows large consistencies across bodies of research. Variations can be found in the nuances showing different priorities of drivers for different proteins and different segments, showing the relevance of being context and person specific for future research.

Strategic Self-Regulation in Groups: Collective Implementation Intentions Help Cooperate When Cooperation Is Called for

Groups need contributions that are personally costly to their members. Such cooperation is only adaptive when others cooperate as well, as unconditional cooperation may incur high costs to the individual. We argue that individuals can use We-if-then plans (collective implementation intentions, cIIs) to regulate their group-directed behavior strategically, helping them to cooperate selectively with group members in the situation planned for. In line with this prediction, a cII to consider group earnings increased cooperative decisions in a prisoners' dilemma game when playing against another group member but not when playing against a stranger (i.e., non-group member). Moreover, cIIs to cooperate in the prisoners' dilemma game did not increase cooperation in a structurally similar investment game that participants had not planned for. We discuss the role of collective planning in solving social dilemmas.

A Habit-Based Randomised Controlled Trial to Reduce Sugar-Sweetened Beverage Consumption: the Impact of the Substituted Beverage on Behaviour and Habit Strength

BACKGROUND

Excess sugar consumption has been linked to numerous negative health outcomes, such as obesity and type II diabetes. Reducing sugar-sweetened beverage (SSB) consumption may reduce sugar intake and thus improve health. The aim of the study was to test the impact of the potentially different rewarding nature of water or diet drinks as replacements for SSB, using a habit and implementation intention-based intervention.

METHOD

An online randomised, two-arm parallel design was used. One hundred and fifty-eight participants (mainly from the UK and USA) who regularly consumed SSBs (M_age = 31.5, 51% female) were advised to create implementation intentions to substitute their SSB with either water or a diet drink. Measures of SSB consumption, habit strength and hedonic liking were taken at baseline and at 2 months. Water or diet drink consumption was only measured at 2 months.

RESULTS

There was a large and significant reduction in SSB consumption and self-reported SSB habits for both the water and diet drink groups, but no difference between groups. There were no differences in hedonic liking for the alternative drink, alternative drink consumption and alternative drink habit between the two groups. Reduction in SSB hedonic liking was associated with reduced SSB consumption and habit.

CONCLUSION

This study demonstrates that an implementation intention-based intervention achieved substantial reductions in SSB consumption and habits. It also indicates that hedonic liking for SSBs and alternative drinks are associated with changes in consumption behaviour. Substituting SSBs with water or diet drinks was equally as effective in reducing SSB consumption.

Supporting patients to be involved in decisions about their health and care: Development of a best practice health literacy App for Australian adults living with Chronic Kidney Disease

ISSUE ADDRESSED

Inadequate health literacy is common in those with chronic kidney disease (CKD), especially among culturally and linguistically diverse groups. Patient information for people with CKD, including those with kidney failure requiring dialysis, is often written beyond their literacy level, and many CKD-related apps are not accurate or evidence based. These represent important barriers to health care decision-making and equity in access to health care.

METHODS

We developed a cross-platform application (the "SUCCESS app") to support Australian adults with kidney failure requiring dialysis to actively participate in self-management and decision-making. App content was informed by health literacy theory which recognises the importance of reducing the complexity of health information as well as equipping consumers with the skills necessary to access, understand and act on this information. The development team comprised members of diverse backgrounds and expertise, including nursing, allied health, psychology, epidemiology, nephrology and IT, as well as consumer representatives.

RESULTS

Content areas included diet, fluids, medicine, physical activity, emotional well-being and supportive care, chosen as they represent important decision points in the CKD trajectory. To support functional health literacy, a four-step process to simplify written content was used including calculating readability statistics, applying the Patient Education Materials Assessment Tool, supplementing written information with video and audio content, and incorporating micro-learning and interactive quizzes. To develop communicative and critical health literacy skills, question prompt lists and evidence-based volitional help sheets were included in each module to support question-asking and behaviour change. We also developed animated skills training related to communication, shared decision-making and critical appraisal of health information.

CONCLUSIONS

This is the first health literacy informed app developed to promote active patient participation in CKD management and decision-making. Ongoing evaluation of the SUCCESS app through analysis of quantitative and qualitative data will provide valuable insights into the feasibility of implementing the app with dialysis patients, and the impact of the intervention of psychosocial and clinical outcomes. SO WHAT?: Digital health solutions have been found to improve self-management for chronic conditions, and could optimise the use of health care services and patient outcomes.

Planning and self-monitoring the quality and quantity of eating: How different styles of self-regulation strategies relate to healthy and unhealthy eating behaviors, bulimic symptoms, and BMI

This research examined if planning and self-monitoring could be distinguished in terms of quality and quantity, and if differences in the uses of these strategies were associated with distinct eating outcomes. In Study 1 (n = 355), the structure of a new scale designed to measure planning and self-monitoring in terms of quality (i.e., nutrient intake) and quantity (i.e., calories and portion sizes) was examined through Confirmatory Factor Analysis. Structural equation models were also tested in which the relationships between the proposed strategies, healthy and unhealthy eating behaviors and bulimic symptoms, as well as BMI, were examined. The purpose of Study 2 (n = 318) was to replicate the results found in Study 1, using a different sample. Overall, a 6-factor structure was found for the scale and results revealed that strategies related to the quality of eating were more strongly and positively associated with healthy eating and more strongly and negatively associated with unhealthy eating behaviors, whereas strategies related to the quantity of eating were more strongly and positively associated with bulimic symptoms and BMI. Results are discussed in terms of implications for health professionals who wish to improve individuals' eating behaviors and/or weight.

Effectiveness of the use of implementation intentions on reduction of substance use: A meta-analysis

OBJECTIVE

Background: Substance use, such as alcohol drinking, tobacco smoking and illicit drug use, have been associated with severe health conditions and an annual estimated 12 % of all deaths worldwide. Implementation intentions are self-regulatory processes which help achieve health-related behaviour change.

OBJECTIVES

To investigate the effectiveness of forming implementation intentions to reduce substance use.

DESIGN

Data sources: PsycINFO, MEDLINE, Psychology and Behavioural Science Collection, clinicaltrials.gov, UK Clinical Trials Gateway, Reference lists.

INCLUSION CRITERIA

RCT of substance users forming implementation intentions to reduce consumption (active or passive control condition present).

STUDY APPRAISAL AND SYNTHESIS METHODS

the SIGN checklist for RCT quality was used for quality appraisal, data was extracted by two reviewers.

RESULTS

Twenty-one studies were included in the meta-analysis. The overall effect size for alcohol use was g = 0.31 (95 % CI: 0.21, 0.42), p < .001; for tobacco smoking g = 0.31 (CI: 0.12, 0.5), p = .002; no studies were retrieved for the use of implementation intentions on illicit drug use.

CONCLUSION

This review suggests that implementation intention interventions are effective in reducing some forms of substance use (alcohol use and tobacco smoking), albeit revealing small effect sizes, among the general population and students in secondary and higher education. Review registration number: CRD42018116170.

Demonstrating and disrupting well-learned habits

Researchers have exerted tremendous efforts to empirically study how habits form and dominate at the expense of deliberation, yet we know very little about breaking these rigid habits to restore goal-directed control. In a three-experiment study, we first illustrate a novel approach of studying well-learned habits, in order to effectively demonstrate habit disruption. In Experiment 1, we use a Go/NoGo task with familiar color-response associations to demonstrate outcome-insensitivity when compared to novel, more flexible associations. Specifically, subjects perform more accurately when the required mapping is the familiar association of green-Go/red-NoGo than when it is red-Go/green-NoGo, confirming outcome-insensitive, habitual control. As a control condition, subjects show equivalent performance with unfamiliar color-response mappings (using the colors blue and purple mapped to Go and NoGo responses). Next, in Experiments 2 and 3, we test a motivation-based feedback manipulation in varying magnitudes (i.e., performance feedback with and without monetary incentives) to break the well-established habits elicited by our familiar stimuli. We find that although performance feedback prior to the contingency reversal test is insufficient to disrupt outcome-insensitivity in Experiment 2, a combination of performance feedback and monetary incentive is able to restore goal-directed control in Experiment 3, effectively breaking the habits. As the first successful demonstration of well-learned habit disruption in the laboratory, these findings provide new insights into how we execute and modify habits, while fostering new and translational research avenues that may be applicable to treating habit-based pathologies.

Fight, Flight, - Or Grab a Bite! Trait Emotional and Restrained Eating Style Predicts Food Cue Responding Under Negative Emotions

In today's society, obesity rates are rising as food intake is no longer only a response to physiological hunger signals that ensure survival. Eating can represent a reward, a response to boredom, or stress reduction and emotion regulation. While most people decrease food intake in response to stress or negative emotions, some do the opposite. Yet, it is unclear who shows emotional overeating under which circumstances. Emotion regulation theories describe emotional overeating as a learned strategy to down-regulate negative emotions. Cognitive theories, by contrast, attribute emotional overeating to perceived diet breaches in individuals who chronically attempt to diet. After consuming "forbidden foods", they eat more than individuals who do not restrict their food intake. This laboratory study investigated emotional overeating by exposing individuals to a personalized emotion induction while showing images of palatable foods. Outcome variables indexed cue reactivity to food images through picture ratings (valence, desire to eat), facial expressions (electromyography of the corrugator supercilii muscle), and brain reactivity by detecting event-related potentials (ERPs) by means of electroencephalography (EEG). The influence of emotion condition (negative, neutral) and individual differences (self-reported trait emotional and restrained eating) on outcome variables was assessed. Valence ratings and appetitive reactions of the corrugator muscle to food pictures showed a relative increase in the negative condition for individuals with higher emotional eating scores, with the opposite pattern in lower scores. Desire to eat ratings showed a similar pattern in individuals who showed a strong response to the emotion induction manipulation, indicative of a dose-response relationship. Although no differences between conditions were found for ratings or corrugator activity with restrained eating as a predictor, an ERP at P300 showed increased activation when viewing food compared to objects in the negative condition. Findings support emotion regulation theories: Emotional eaters showed an appetitive reaction in rating patterns and corrugator activity. EEG findings (increased P300) suggest a motivated attention toward food in restrained eaters, which supports cognitive theories. However, this did not translate to other variables, which might demonstrate successful restraint. Future studies may follow up on these findings by investigating eating disorders with emotion regulation difficulties.

Examining mediators of intervention efficacy in a randomised controlled m-health trial to improve physical activity and sleep health in adults

Objectives: Examining mediators of intervention efficacy in an m-health intervention targeting physical activity and sleep in 160 Australian adults.Design: Nationwide randomised controlled trial.Main outcome measures: Moderate- and vigorous-intensity physical activity (MVPA), assessed using the Active Australia Questionnaire; sleep quality (Pittsburgh Sleep Quality Index); and sleep hygiene practices (Sleep Hygiene Index). Hypothesised psychosocial (e.g. self-efficacy) and behavioural (i.e. MVPA, sleep quality, sleep hygiene) mediators were tested on primary endpoint data at 3 months using bias-corrected bootstrapping (PROCESS 2 for SPSS). All outcomes and mediators were assessed using self-report.Results: At three months, the intervention had significantly improved sleep quality (d = 0.48, 95% CI: -2.26, -0.33, p = 0.009) and sleep hygiene (d = 0.40, 95% CI: -3.10, -0.19, p = 0.027). Differences in MVPA were not significant (d = 0.24, 95% CI: -35.53, 254.67, p = 0.139). Changes in MVPA were mediated by self-efficacy, perceived capability, environment, social support, intentions and planning, some of which showed inconsistent mediation (suppression). None of the hypothesised psychosocial factors mediated sleep outcomes. Changes in sleep hygiene mediated changes in sleep quality.Conclusions: Several psychosocial factors mediated changes in physical activity but not in sleep outcomes. Mediation effects of sleep hygiene on sleep quality highlight the importance of providing evidence-based strategies to improve sleep quality.

Implicit Theories about Athletic Ability Modulate the Effects of If-Then Planning on Performance in a Standardized Endurance Task

Muscular strength has a strong positive impact on cardiometabolic health and fitness. However, building up strength endurance requires effortful exercises. From a health perspective, it is important to understand which psychological strategies help people deal with straining exercise. Self-regulation strategies like if-then planning (also known as implementation intentions) appear particularly promising because they might directly alter how people deal with exercise-induced sensations. However, research on the effects of if-then planning on exercise performance has yielded mixed results so far. One possible reason for these inconsistent results is the lack of tailored interventions and the neglect of potential moderators. To address this, we investigated the efficacy of if-then plans that were tailored to perceived limits of endurance performance (i.e., perceptions of exertion versus pain). In addition, we investigated the effects of these tailored if-then plans while taking into account the potentially moderating effects of individual differences in implicit theories. Specifically, we were interested in the role of implicit theories about athletic performance (i.e., entity versus incremental beliefs) and about the limitation of athletic performance by mental versus physical factors (i.e., mind-over-body beliefs). N = 66 male students (age: M = 25.8 years, SD = 3.2) performed a static muscular endurance task twice (measurement: baseline task vs. main task) and were randomly assigned to a goal or an implementation intention condition. They were instructed to hold two intertwined rings for as long as possible while avoiding contacts between them (measure of performance: time-to-failure and errors). After the baseline task, participants were either given an implementation intention or were simply asked to rehearse the task instructions. The content of the instruction depended on whether they ascribed ultimate baseline task termination to perceptions of exertion or pain. After the main task, implicit theories on athletic ability were assessed. No differences in performance emerged between conditions. In the implementation intention condition, however, stronger entity beliefs were associated with increasing time-to-failure when participants planned to ignore exertion but with decreasing time-to-failure when they planned to ignore pain. This pattern of results was reversed with regard to mind-over-body beliefs. These findings indicate that the efficacy of psychological strategies hinges on recreational athletes' beliefs regarding athletic performance.

Exploring the Effect of Health App Use on Fruit and Vegetable Consumption

People may use multiple health apps at the same time or in close sequence, and the effect of health apps may vary across different socioeconomic groups. However, in the context of healthy eating, studies have focused on the effect of using a single health app. This study aims to test the relationship of using multiple health apps with fruit and vegetable consumption, assessing moderation by education level. Employing longitudinal survey data from South Korean adults, we conducted regression analyses to test the lagged association between use of health apps and intake of fruits and vegetables, and whether education moderates the relationship. The results supported the positive lagged relationship of health app use with fruit and vegetable consumption, significant after controlling for confounders and baseline fruit and vegetable consumption. The association was smaller among respondents with higher education. Our findings suggest the positive effect of using multiple health apps on fruit and vegetable consumption, implying the importance of finding the best combination of health apps to maximize their effectiveness in promoting healthy eating. Also, the negative interaction of health app use and education support using mobile communication technology to improve the public health of low socioeconomic status individuals.

Gaining a deeper understanding of nutrition using social networks and user-generated content

Using user-generated content (UGC) on Twitter, the present study identifies the main themes that revolve around the concept of healthy diet and determine user feelings about various foods. Using a dataset of tweets with the hashtag "#Diet" or "#FoodDiet" (n = 10.591), we first use a Latent Dirichlet Allocation (LDA) model to identify the food categories most discussed on Twitter. Then, based on the results of the LDA model, we apply sentiment analysis to divide the identified tweets into three groups (negative, positive and neutral) based on the feelings expressed in corresponding tweets. Finally, the text mining approach is performed to identify foods according to the feelings expressed about those in corresponding tweets, as well as to derive key indicators that collectively present the UGC-based knowledge of healthy eating. The results of the present study show that among the foods most negatively perceived in the UGC are bacon, sugar, processed foods, red meat, and snacks. By contrast, water, apples, salads, broccoli and spinach are evaluated more positively. Furthermore, our findings suggest that the collective UGC knowledge is lacking on such healthy foods as fish, poultry, dry beans, nuts, as well as yogurt and cheese. The results of the present study can help the World Health Organization (WHO), as well as other institutions concerned with the study of healthy eating, to improve their communication policies on healthy products and preparation of balanced diets.

Peer-Education as a Tool to Educate on Antibiotics, Resistance and Use in 16-18-Year-Olds: A Feasibility Study

Peer education (PE) interventions may help improve knowledge and appropriate use of antibiotics in young adults. In this feasibility study, health-care students were trained to educate 16-18 years old biology students, who then educated their non-biology peers, using e-Bug antibiotic lessons. Knowledge was assessed by questionnaires, and antibiotic use by questionnaire, SMS messaging and GP record searches. Five of 17 schools approached participated (3 PE and 2 control (usual lessons)). 59% (10/17) of university students and 28% (15/54) of biology students volunteered as peer-educators. PE was well-received; 30% (38/127) intervention students and 55% (66/120) control students completed all questionnaires. Antibiotic use from GP medical records (54/136, 40% of students' data available), student SMS (69/136, 51% replied) and questionnaire (109/136, 80% completed) data showed good agreement between GP and SMS (kappa = 0.72), but poor agreement between GP and questionnaires (kappa = 0.06). Median knowledge scores were higher post-intervention, with greater improvement for non-biology students. Delivering and evaluating e-Bug PE is feasible with supportive school staff. Single tiered PE by university students may be easier to regulate and manage due to time constraints on school students. SMS collection of antibiotic data is easier and has similar accuracy to GP data.

Self-nudging and the citizen choice architect

This article argues that nudges can often be turned into self-nudges: empowering interventions that enable people to design and structure their own decision environments – that is, to act as citizen choice architects. Self-nudging applies insights from behavioral science in a way that is practicable and cost-effective, but that sidesteps concerns about paternalism or manipulation. It has the potential to expand the scope of application of behavioral insights from the public to the personal sphere (e.g., homes, offices, families). It is a tool for reducing failures of self-control and enhancing personal autonomy; specifically, self-nudging can mean designing one's proximate choice architecture to alleviate the effects of self-control problems, engaging in education to understand the nature and causes of self-control problems and employing simple educational nudges to improve goal attainment in various domains. It can even mean self-paternalistic interventions such as winnowing down one's choice set by, for instance, removing options. Policy-makers could promote self-nudging by sharing knowledge about nudges and how they work. The ultimate goal of the self-nudging approach is to enable citizen choice architects’ efficient self-governance, where reasonable, and the self-determined arbitration of conflicts between their mutually exclusive goals and preferences.

Self-regulation mechanisms in health behavior change: a systematic meta-review of meta-analyses, 2006-2017

Self-regulation is one primary mechanism in interventions for health behavior change and has been examined in numerous recent meta-analyses. This pre-registered meta-review (PROSPERO CRD42017074018) examined Mmeta-analyses of any intervention and health behavior/outcome were eligible if they quantitatively assessed self-regulation and appeared between January 2006 and August 2017. In total, 66 meta-analyses were ultimately eligible; 27% reported a protocol, 11% used GRADE; 58% focused on RCTs. Reviews satisfied only a moderate number of items on the AMSTAR 2 (M = 45.45%, SD = 29.57%). Only 6% of meta-analyses directly examined whether changes in self-regulation predicted the behavior change (i.e., self-efficacy and physical activity, l = 2; frequency of self-monitoring and goal attainment, l = 1; cognitive bias modification and addiction, l = 1). Meta-analyses more routinely assessed self-regulation by comparing the efficacy of intervention components (97%), such as those from behavior change taxonomies. Meta-analyses that focused on intervention components identified several as successful, including personalized feedback, goal setting, and self-monitoring; however, none were consistently successful in that each worked only for some health behaviors and with particular populations. Some components had inconclusive evidence, given that they were only examined in low- quality reviews. Future reviewers should utilize advanced methods to assess mechanisms, and study authors should report hypothesized mechanisms to facilitate synthesis.

What makes a good action plan? Characteristics and enactment of fruit and vegetable plans

BACKGROUND

One promising intervention strategy to increase fruit and vegetable (FV) consumption is action planning. However, conditions of successful plan enactment, i.e., the translation of plans into action, have rarely been studied. Therefore, the relationship between plan characteristics and plan enactment is being examined.

METHODS

Secondary analyses of an existing data set were conducted, based on a larger behavioral intervention study with a baseline assessment as well as a 2-weeks and a 4-weeks follow-up. After baseline assessment, participants completed action plan calendars for the following seven days and subsequently reported on each plan's enactment. Two independent raters coded 1732 morning, noon/afternoon, and evening plans by n = 92 individuals regarding the level of specificity (unspecific vs. specific) and type of planned behavior (fruit vs. vegetable intake). To predict plan enactment, multilevel logistic regression analyses were conducted.

FINDINGS

Overall specificity of plans was unrelated to plan enactment, but interacted with time of day in predicting plan enactment. Only in the morning, specific plans were more likely being enacted than unspecific plans. Overall, plan enactment decreased during the day and throughout the seven days of the plan calendar. Furthermore, fruit plans were more likely being enacted than vegetable plans.

DISCUSSION

Specific morning plans were found most beneficial for the enactment of FV plans. Here, possible underlying mechanisms such as stable morning routines should be further investigated. Moreover, the nutritional choice appeared to make a difference for plan enactment: Increasing one's fruit consumption may be easier than integrating more vegetables into one's daily diet.

Effects of interventions based on the theory of planned behavior on sugar-sweetened beverage consumption intentions and behavior

There is increasing concern about the health risks of added dietary sugar, perhaps particularly when consumed in beverages that contain no essential nutrients (e.g., sodas). The purpose of this experiment was to examine the relative and combined efficacy of three interventions based on the theory of planned behavior (TPB) for motivating reductions in sugar sweetened beverage (SSB) consumption. Four-hundred-thirty undergraduates were randomised in a 2*2*2 factorial design. Participants received either information designed to increase awareness of the risks of SSB consumption or control information, and received either information about SSB consumption norms or no norms information, and either made plans to reduce their SSB consumption or engaged in a control planning task. Results demonstrated that the interventions, separately and in conjunction, resulted in greater intentions to reduce SSB consumption in the future, and there was evidence that these effects were mediated by the effects the interventions had on the TPB constructs. Further, the risks information resulted in more behaviors indicative of preparations to alter SSB consumption and those who engaged in the SSB planning task reported significantly lower SSB consumption at follow-up compared to controls. The three interventions utilized showed promise for altering SSB consumption intentions and behavior and, given their brevity and low cost, have potential to be developed into large scale community-based interventions that may lead to meaningful public health benefits.

Analysing self-regulatory behaviours in response to daily weighing: a think-aloud study with follow-up interviews

Objective: To examine the extent to which people who are trying to lose weight naturally self-regulate in response to self-weighing and to identify barriers to self-regulation. Design/Main Outcome Measures: Twenty-four participants, who were overweight and trying to lose weight, recorded their thoughts during daily weighing for eight weeks. Semi-structured follow-up interviews assessed participant experiences. Qualitative analysis identified steps of the self-regulation process and barriers to self-regulation. Exploratory regression analysis assessed the relationship between the self-regulation steps and weight loss. Results: On 90% of 498 occasions, participants compared their weight measurement to an expectation or goal, and on 58% they reflected on previous behaviour. Action planning only occurred on 20% of occasions, and specific action planning was rare (6%). Only specific action planning significantly predicted weight loss (−2.1 kg per 1 SD increase in the predictor, 95% CI = −3.9, −0.3). Thematic analysis revealed that barriers to the interpretation of daily weight changes were difficulties in understanding day-to-day fluctuations, losing the overview of trends, forgetting to weigh, and forgetting previous measurements. Conclusion: Specific action planning can lead to weight loss, but is rare in a naturalistic setting. Barriers to self-regulation relate to the interpretation of weight changes.

What makes implementation intention interventions effective for promoting healthy eating behaviours? A meta-regression

This study examines the efficacy of implementation intentions (II), a widely used self-regulatory strategy to help people achieve their goals. Although previous research has shown that the effect of II interventions is significantly higher in promoting healthy eating behaviours than in diminishing unhealthy eating behaviours, the factors that can moderate the effectiveness of these interventions remain unclear. In a meta-analysis of 70 interventions (N = 9689), we confirmed that II interventions for healthy eating behaviours yielded a medium significant effect size (d = 0.33) and a low significant effect size for unhealthy eating behaviors (d = 0.18). We show that the moderator variables of II interventions for healthy and unhealthy eating goals are very different. Regarding healthy eating, since moderator variables explain 53% of the variance in the heterogeneity of the effect sizes, the present study helps in gaining an understanding of the previous inconsistent results and offers suggestions for designing more efficient interventions. Effect size was negatively predicted by age, indicating that for younger people the effect size is higher, and II check, showing that if the instructor checks the plan it decreases its efficacy. Moreover, the effect of II interventions on students is significantly smaller than in non-student samples. In contrast, the effect size was positively predicted by initial training, off-line delivered interventions and, specific if-then and action plans versus complex plans. For unhealthy eating behaviours, our results show that there is less room to improve the intervention; there is only one moderator variable (plan formulation), and the heterogeneity found in the studies is lower for unhealthy eating behaviours (I² = 46.70%) than for healthy eating behaviours (I² = 73.25%), indicating that the intervention has low efficacy regardless of the design of the intervention.

Experimental test of a planning intervention for forming a 'higher order' health-habit

Objective: Habit-formation interventions may help individuals initiate and maintain behaviour change. This paper proposes and empirically tests the idea that it is possible for individuals to form 'higher-order habits', or behaviours that can be executed in more than one way, and still be habitual. Design: Participants (N = 82) were healthy adults randomly assigned to an action-and-coping-planning intervention for forming a 'higher-order habit' of filling half of their dinner plates with fruits and vegetables or a control condition. Key measures were collected at baseline and 1, 2 and 3 weeks post-baseline. Participants submitted 3 pictures per week of their dinner plates via snapchat/email. Main Outcome Measures: Intrinsic motivation, habit strength and behavioural frequency for filling half their dinner plates with fruits and vegetables. Results: Intervention participants reported significantly greater habit strength at each follow-up time point. Controls did show some degree of habit formation, despite not fully forming a habit. Behavioural automaticity increased despite consuming a variety of fruits/vegetables; results did not depend on participants' intrinsic motivation to consume fruits/vegetables. Conclusion: It may be possible for individuals to form 'higher-order' habits, which may be particularly important in health contexts, in which many target behaviours are complex and can be seen as higher-order.

RPC Teacher-Based Program for Improving Coping Strategies to Deal with Cyberbullying

BACKGROUND

Cyberbullying is a serious threat to public health and teachers can play a key role in its detection, prevention and intervention. The present study evaluated the effectiveness of the RPC ("Relazioni per crescere"-Relationships to Grow) program, a short intervention, implemented at classroom level by trained teachers, aimed at improving awareness on cyberbullying and increasing proactive coping strategies to deal with cyberbullying behaviors.

METHOD

The effectiveness of the RPC project was analyzed through an observational study (pre/post-intervention comparison), involving 898 Italian students of Lower Secondary schools (6th⁻8th grades).

RESULTS

Hierarchical logistic regression showed that after the intervention students were more likely to consider the different roles in cyberbullying (cyberbully, cybervictim, reinforce/assistant, defender and bystander/observer). In addition, hierarchical linear regressions highlighted an improvement of social coping and cognitive coping strategies after the intervention.

CONCLUSIONS

RPC is a short, teacher-based program that can increase the awareness of cyberbullying among students and improves their effective coping strategies to address cyberbullying. Further research on the efficacy of short teacher-based programs would be worthwhile, given the limited financial and time resources of the schools, emphasizing the active and crucial role of teachers in tackling cyberbullying.

Update and future perspective of behavioral medicine in the treatment for chronic pain

Chronic pain is a biopsychosocial condition, and behavioral medicine has made significant contributions to the understanding of the phenomenon and optimization of therapeutic outcomes. The objective of this article is to provide future perspectives of behavioral medicine in pain management based upon recent development in the field. We will briefly review the mainstream approach of cognitive-behavioral therapy, its variations and new and innovative approaches that are on the horizon. We also review strategies that address potential barriers to pain management. Behavioral medicine is a promising field in pain medicine. The future growth is likely to come from addressing how we incorporate the patient heterogeneity into our treatment approaches and a better understanding of its role in a multimodal treatment.

Trialing an online intervention to improve retirement planning goal setting and goal specificity

Purpose

Time perspective (TP) is the term used to describe people’s preferences to focus on the past, present, and the future. Previous research demonstrates a link between TP and retirement planning. The objective of this study was to evaluate a TP-based online training intervention to improve retirement planning emphasizing the accumulation of resources.

Patients and methods

Twenty-two (M=59.41 years) working and fully retired participants were compared to a control group of 18 (M=56.67 years) participants. The intervention included three separate modules delivered online at the rate of one per week over a 3-week testing session. Outcomes focused on retirement goals and goal specificity.

Results

When compared to the control group, subjects in the intervention improved the number of goals relating to the accumulation of health (F(1,35)=10.15, P<0.01, 95% CI [0.28, 2.77]) and emotional resources (F(1,35)=5.16, P<0.05, 95% CI [−0.22, 2.37]). Goals relating to the accumulation of health resources also became more specific within the experimental group when compared to the control group and a significant interaction was recorded (F(1,38)=15.78, P<0.01, 95% CI [0.33, 1.74]). Similar interactions between the control and experimental groups were reported for the accumulation of cognitive resources (F(1,38)=13.15, P<0.01, 95% CI [0.28, 1.96]) and for emotional resources (F(1,38)=7.39, P<0.01, 95% CI [0.00, 1.50]). Qualitative feedback included recommendations to improve engagement by using more activities, providing clearer navigation instructions and avoiding the use of animation.

Conclusion

Applying a TP-based framework to the design of an online training intervention helped improve the accumulation and specificity of emotional and health resources for retirement. The study contains a number of theoretical and practical recommendations informing the design of future retirement planning interventions.

Fruit and Vegetable Intake: the Interplay of Planning, Social Support, and Sex

PURPOSE

Intention and planning are important predictors of dietary change. However, little attention has been given yet to the relationship between them as a function of other social-cognitive factors and their interplay with socio-demographics such as sex.

METHODS

In an observational study (1520 women, 430 men) with two measurement points in time, intention (predictor), planning (mediator), social support (first moderator), and sex (second moderator) were assessed to predict changes in diet separately for fruit and vegetable intake.

RESULTS

All predictors had a main effect on fruit intake but no interactions emerged. For vegetable intake, the mediation-chain was qualified by a three-way interaction: for women, the lower the perceived social support, the more the translation of planning into behavior; for men, the higher the perceived social support, the more the translation of planning into behavior.

CONCLUSIONS

Even though intention and planning are predictors of dietary change, they operate differently under specific conditions (level of social support), for specific subgroups (men vs. women), and for different target behaviors (fruit vs. vegetable intake). These results suggest to further examine the mechanisms by which intentions are translated into behavior via planning.

Implicit process interventions in eating behaviour: a meta-analysis examining mediators and moderators

Dual-process models integrate deliberative and impulsive mental systems and predict dietary behaviours better than deliberative processes alone. Computerised tasks such as the Go/No-Go, Stop-Signal, Approach-Avoidance, and Evaluative Conditioning have been used as interventions to directly alter implicit biases. This meta-analysis examines the effects of these tasks on dietary behaviours, explores potential moderators of effectiveness, and examines implicit bias change as a proposed mechanism. Thirty randomised controlled trials testing implicit bias interventions (47 comparisons) were included in a random-effects meta-analysis, which indicated small cumulative effects on eating-related behavioural outcomes (g = -0.17, CI₉₅ = [-0.29; -0.05], p = .01) and implicit biases (g = -0.18, CI₉₅= [-0.34; -0.02], p = .02). Task type moderated these effects, with Go/No-Go tasks producing larger effects than other tasks. Effects of interventions on implicit biases were positively related to effects on eating behaviour (B = 0.42, CI₉₅= [0.02; 0.81], p = .03). Go/No-Go tasks seem to have most potential for altering dietary behaviours through implicit processes. While changes in implicit biases seem related to the effects of these interventions on dietary outcomes, more research should explore whether repeated exposure to implicit bias interventions may have any practical intervention value in real world settings.

Time for change: using implementation intentions to promote physical activity in a randomised pilot trial

OBJECTIVE

A common barrier to exercise is a perceived lack of time. The current pilot study examined the effects of an implementation intention intervention to enhance exercise self-efficacy, increase confidence to exercise when facing time constraints, and increase physical activity in middle-aged adults (n = 63, aged 35-69).

DESIGN

Participants received a pedometer (Fitbit) to objectively measure activity and were randomly assigned to either a control or intervention condition. After a 1-week baseline, the intervention condition received instructions to plan how, where, and when they would add steps to their daily routine to meet their step goal, using personalised schedules and maps. Both groups were contacted nightly via email.

MAIN OUTCOME MEASURES

Physical activity (steps and time spent in moderate-to-vigorous activity), goal achievement, exercise self-efficacy, time-relevant exercise self-efficacy and affect.

RESULTS

Compared to the control, the intervention condition significantly increased in steps, time spent in moderate-to-vigorous activity, and time-relevant exercise self-efficacy. Goal achievement was related to greater time-relevant exercise self-efficacy and more positive affect at the daily level.

CONCLUSION

Findings suggest that the personalised planning intervention increased physical activity and confidence in achieving physical activity goals under time constraints. Avenues for future directions, especially for producing more sustained effects, are discussed.