Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence

A prevention program for binge drinking among students based on mindfulness and implementation intention (ALCOMEDIIT): a randomized controlled trial

BACKGROUND

The emergence of new problematic alcohol consumption practices among young people requires new dynamics in prevention strategies. In this context, the ADUC project (Alcohol and Drugs at the University of Caen) aims to develop a better understanding of alcohol consumption, and in particular the practice of binge drinking (BD) in students, in order to develop relevant and adapted prevention tools. The ALCOMEDIIT study (Rin Normandie and IRESP funding; Agreement 20II31-00 - ADUC part 3) is a randomized controlled trial that focuses on the specific determinant of impulsivity. The main objective of this experiment is to assess a program for the prevention of BD practices based on motivational interviewing (MI) associated with implementation intention (II) and mindfulness meditation (MBM) in a student environment.

METHODS

This study will include 170 healthy subjects who will be students at the university, alcohol users, with a BD score > 1 in the month preceding the inclusion but not presenting any specific disorder. The trial will be proposed by e-mail and students who meet the inclusion criteria will join either a control group which will benefit from a MI or an experimental group which will additionally benefit from an initiation to MBM with II (initial visit T0). In order to measure the effectiveness of the prevention program in terms of BD decrease, a follow-up at 1 month (T1) as well as a follow-up at 6 months (T6; exploratory) will be proposed to all participants. The total duration of this research protocol is 21 months.

DISCUSSION

The purpose of this study is to evaluate the interest of associating mindfulness meditation practices and implementation of self-regulation strategies to optimize their use, with a motivational interview in an innovative prevention program aiming at reducing alcohol use and BD practice in the student population.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05565989, September 30, 2022. https://clinicaltrials.gov/study/NCT05565989 Protocol version 2.0 (September 2022) No.

ID-RCB

2022-A00983-40.

Social Cognitive Theory and Willingness to Perform Recommended Health Behavior: The Moderating Role of Misperceptions

More than 6 million people have died due to the COVID-19 pandemic. In order to slow down the spread of COVID-19, health authorities have created numerous guidelines. In the current study, we use survey data from the U.S. and social cognitive theory (SCT) to examine the associations among self-efficacy, outcome expectancies, and willingness to perform recommended COVID-19 related health behavior. Considering the misinformation-filled information ecology during the pandemic, we also examine the moderating role of misperceptions in these relationships. Our findings show that in general the SCT hypotheses hold for COVID-19 related behavior willingness. The interaction effects with COVID-19 misperceptions show that self-efficacy is not enough to understand people's health behavior. Higher outcome expectancies are important and may be able to overcome even if people held high misperceptions. Our findings have direct implications for communication theory and for health organizations in the contemporary information ecology.

Adherence Promotion With Tailored Motivational Messages: Proof of Concept and Message Preferences in Older Adults

This study examined the feasibility of using tailored text messages to promote adherence to longitudinal protocols and determined what facets of text message tone influence motivation. Forty-three older adults (Mage = 73.21, SD = 5.37) were recruited to engage in video-game-based cognitive training for 10 consecutive days. Participants received encouraging text messages each morning that matched their highest or lowest ranking reasons for participating in the study, after which they rated how effective each message was in motivating them to play the games that day. After 10 days, participants rated all possible messages and participated in semi-structured interviews to elicit their preferences for these messages. Results showed that messages matching participants' reasons for participating were more motivating than mismatched messages. Further, participants preferred messages that were personalized (i.e., use second person voice) and in formal tones. Messages consistent with these preferences were also rated as more motivating. These findings establish the feasibility of using message tailoring to promote adherence to longitudinal protocols and the relevance of tailoring messages to be personal and formal.

Gamification in Critical Care Education and Practice

OBJECTIVES

To explore gamification as an alternative approach to healthcare education and its potential applications to critical care.

DATA SOURCES

English language manuscripts addressing: 1) gamification theory and application in healthcare and critical care and 2) implementation science focused on the knowledge-to-practice gap were identified in Medline and PubMed databases (inception to 2023).

STUDY SELECTION

Studies delineating gamification underpinnings, application in education or procedural mentoring, utilization for healthcare or critical care education and practice, and analyses of benefits or pitfalls in comparison to other educational or behavioral modification approaches.

DATA EXTRACTION

Data indicated the key gamification tenets and the venues within which they were used to enhance knowledge, support continuing medical education, teach procedural skills, enhance decision-making, or modify behavior.

DATA SYNTHESIS

Gamification engages learners in a visual and cognitive fashion using competitive approaches to enhance acquiring new knowledge or skills. While gamification may be used in a variety of settings, specific design elements may relate to the learning environment or learner styles. Additionally, solo and group gamification approaches demonstrate success and leverage adult learning theory elements in a low-stress and low-risk setting. The potential for gamification-driven behavioral modification to close the knowledge-to-practice gap and enable guideline and protocol compliance remains underutilized.

CONCLUSIONS

Gamification offers the potential to substantially enhance how critical care professionals acquire and then implement new knowledge in a fashion that is more engaging and rewarding than traditional approaches. Accordingly, educational undertakings from courses to offerings at medical professional meetings may benefit from being gamified.

Gamification preferences in nutrition apps: Toward healthier diets and food choices

Background

Unhealthy eating habits are costly and can lead to serious diseases such as obesity. Nutrition apps offer a promising approach to improving dietary behavior. Gamification elements (GEs) can motivate users to continue using nutrition apps by making them more enjoyable, which can lead to more positive behavioral changes regarding dietary choices. However, the effects of users' preferences and individual characteristics on gamified systems are not yet understood. Current calls for research suggest that personalized gamified systems might lead to user satisfaction, continuous app use, and-ultimately-long-term improvements in diet.

Objective

The aim was to determine the most preferred GEs in nutrition apps and to define clusters of GEs preferences in terms of personality and socio-demographic characteristics.

Methods

We surveyed 308 people to measure their preferences regarding GEs in nutrition apps and applied best-worst scaling to determine the most preferred GEs. Furthermore, we used cluster analysis to identify different user clusters and described them in terms of personality and socio-demographic characteristics.

Results

We determine that GEs most favored are goals, progress bars, and coupons. We revealed three distinct user clusters in terms of personality and socio-demographic characteristics. Based on the individual factors of openness and self-perception, we find that significant differences exist between the preferences for leaderboards and coupons.

Conclusion

We contribute by shedding light on differences and similarities in GE preferences relating to specific contexts and individual factors, revealing the potential for individualized nutrition apps. Our findings will benefit individuals, app designers, and public health institutions.

Extending the theory of planned behavior to examine the role of meat-eater identity: The case of dry-aged beef

Dry-aged beef provides superior qualities and a unique taste experience due to its exceptional sensory attributes, including tenderness, juiciness, and flavor, compared to traditional beef. Our study focused on the factors that impact consumers' intention to consume and willingness to pay for dry-aged beef. We implemented an extended version of the Theory of Planned Behavior (TPB) model that contains a measure of meat-eater identity to analyze the intention to consume and the willingness to pay a premium for dry-aged beef steak that has undergone 21-30 days of aging. An online survey was conducted with a stratified sample of Italian respondents (n = 944). The data were analyzed using partial least squares structural equation modeling (PLS-SEM). The TPB's effectiveness was enhanced by adding the meat-eater identity construct to the model. Specifically, it was found that the participants' meat-eater identity significantly influenced their intention to consume. The results also revealed that the most critical impact of identity comes from the mediated influence of attitudes, subjective norms, and perceived behavioral control. Finally, the intention to consume strongly influenced the willingness to pay for a dry-aged beef steak.

The theory of planned behavior and alcohol protective behavioral strategies: a prospective study examining the role of habit and gender invariance

OBJECTIVES

Alcohol Protective Behavioral Strategies (PBS) have consistently shown to be effective in reducing alcohol use and its associated consequences. We aimed to examine the explanatory value of the Theory of Planned Behavior (TPB) for using five PBS, studying the role of habit, and its potential variation across genders.

METHODS

Targeted sampling was used to recruit 339 young adults in the community (women = 50.7%; mean age = 2.21[SD = 2.21]), who completed baseline and 2-month follow-up questionnaires.

RESULTS

The explained variance of the TPB ranged from 58-68% for intention to use PBS, and 18-50% for behavior. The inclusion of habit produced increases of 17-26% in explained variance in intention, while explained variance in behavior remained similar. Habit was the strongest predictor of intention to use PBS, followed by attitude. Except for one behavior (drinking slowly), habits did not moderate the intention-behavior relationship, and the explanatory value of the TPB did not differ across genders.

CONCLUSIONS

Our findings support the utility of the TPB as an explanatory model of alcohol PBS, along with the need to include habits within the framework of dual-process models. Interventions aimed at promoting alcohol PBS could be optimized by targeting attitudes towards PBS and habits.

A survey of suicide literacy in Japanese school teachers

School teachers are in a unique position to recognize suicide-related problems in their students and to appropriately support them; teachers may need high levels of suicide literacy. However, few studies have examined current levels of suicide literacy in teachers. This study aimed to investigate suicide literacy in school teachers. Teachers (n = 857) from 48 Japanese schools (primary and junior-/senior-high) answered a self-administered questionnaire assessing (a) knowledge about suicide, (b) intention to ask about students' suicidal thoughts/plans, and (c) attitudes towards talking to students with mental health problems. The average proportion of correct answers to the knowledge questions (10 items) was 55.2%. Over half of the teachers knew that suicide is a leading cause of death in adolescents (55.0%), and that asking about suicidality is needed (56.2%). Half of the teachers intended to ask students about their suicidal thoughts (50.2%) and fewer intended to ask about experiences of planning suicide (38.8%). Most of the teachers (90.4%) agreed with the idea that talking to students with mental health problems was a teacher's responsibility. Intention to ask about students' suicidal thoughts/plans were higher in teachers in their 20s (vs. 40s-60s) and working at junior-/senior-high schools (vs. primary schools). Suicide literacy in Japanese school teachers was observed to be limited. However, teachers felt responsibility for helping students with mental health problems. The development and implementation of education programs may help improve teachers' suicide literacy, which, in turn, could encourage effective helping behaviors of teachers for students struggling with suicidality.

A Tale of Two Tweets: What Factors Predict Forgiveness of Past Transgressions on Social Media?

As more of our lives take place online, it is increasingly common for public figures to have their current image tarnished by their mistakes and transgressions in what is often the distant past. Three experiments (N = 2,296) found that judgments of a public figure who tweeted racist statements in the past were less harsh when more time had passed and when the public figure was younger at the time of the tweet. However, politics also played a powerful role. Independent of time and age, liberals allowed less possibility of redemption for anti-Black tweets, while conservatives were less forgiving for anti-White tweets. Such partisan differences extended not only to moral judgments of the individual, but also general moral principles and participants' subjective perceptions of the situation itself, including subjective temporal distance from the tweet, the subjective age of the public figure, and the current relevance of the past statements.

A Systematic Review of Validated Measures of U.S.-Based Bystander Intervention-Related Constructs

This review aimed to identify U.S.-based, construct-validated measures of bystander intervention. Following PRISMA-P guidelines, electronic databases were searched, and emails were solicited identifying 8,559 articles for title screening. Abstracts and full texts were double screened, resulting in 24 scales meeting inclusion criteria: (a) measured a bystander-related construct in a situation where there was a potential for actual or perceived imminent physical or emotional harm, (b) written in English, and (c) statistically validated on U.S. samples. Most scales addressed the domain of interpersonal violence (67%), with fewer relating to bias/bullying (8.2%), mental health crises (12.5%), and substance use (12.5%). Most scales (71%) assessed the "take action" step of the situational model. The modal construct represented was intent/willingness/likelihood to intervene (50%). The average number of items on a scale was 14, and most (79%) provided Likert-style response options. None of the validated scales assessing behavior first accounted for an opportunity. Sample sizes ranged from 163 to 3,397, with the modal setting from colleges. Overall, samples were young (21.8 years old), White (75%), women (64%), and heterosexual (89%). Results indicate the need to validate additional measures that capture the "interpreting the situation as problematic" step of the situational model. Scales also need to be validated using diverse samples, particularly within the mental health crisis domain. Across all domains, validated measures need to be developed that first account for an opportunity when measuring actual bystander behavior. The information gleaned can be used to assist researchers in selecting measures and guide future measure development.

Longitudinal Relationships Between Help-Seeking Intentions and Depressive Symptoms in Adolescents

PURPOSE

Cross-sectional studies have shown an association between lower help-seeking intentions and greater depressive symptoms among adolescents. However, no longitudinal study has examined the direction of this association. The current study investigated whether help-seeking intentions and depressive symptoms are reciprocally associated at the within-person (individual) level during early to mid-adolescence.

METHODS

Longitudinal data on help-seeking intentions and depressive symptoms in adolescents were obtained from a population-based birth cohort study (Tokyo Teen Cohort; N = 3,171) at four time points (10y, 12y, 14y, and 16y). A random intercept cross-lagged panel model was used to evaluate the within-person prospective associations between help-seeking intentions and depressive symptoms.

RESULTS

At the within-person level, significant associations were consistently observed between antecedent greater depressive symptoms and subsequent lower help-seeking intentions across all time points (10y-12y: standardized regression coefficient (β) = -0.12, p < .001; 12y-14y: β = -0.07, p < .05; and 14y-16y: β = -0.09, p < .01). Meanwhile, significant within-person associations were partly observed between antecedent lower help-seeking intentions and subsequent greater depressive symptoms from 10y to 12y (β = -0.07, p < .05) and from 14y to 16y (β = -0.12, p < .001). These prospective associations were almost the same when adjusted for the number of potential confidants as a time-varying confounder.

DISCUSSION

Adolescents with worsening depressive symptoms may become increasingly reluctant to seek help over time. Proactive early recognition and intervention with support from parents, teachers, and other individuals may facilitate the management of depression in adolescents.

Predicting Physical Activity in Survivors of Breast Cancer: the Health Action Process Approach at the Intrapersonal Level

BACKGROUND

Benefits have been established for regular physical activity (PA) and exercise after breast cancer, but a decline of PA has also been a reported result of breast cancer diagnosis and treatments. The Health Action Process Approach (HAPA) model has been shown to predict various health behaviors, but few studies have tested it at the intrapersonal level. The aim of the present study was to test whether the HAPA constructs that are well confirmed at the interpersonal level also hold at the intrapersonal level in a group of women survivors of breast cancer.

METHOD

PA behaviors (N = 338) by nine survivors of breast cancer were observed for 6 weeks, and the associations between the HAPA constructs and PA over time were examined. Participants completed a questionnaire with the HAPA constructs related to PA behavior (direct step count and self-reported).

RESULTS

A multilevel model of behavior prediction found that optimistic beliefs about ability to initiate and maintain PA (self-efficacy) were positively related to intentions to be active, and these intentions predicted plans to be active. PA was directly and positively predicted by planning and by confidence in the ability to resume PA after a break.

CONCLUSION

Self-efficacy and planning are associated with PA behavior within women survivors of breast cancer over time, which was not the case for the outcome expectancies, social support, and action control at this intrapersonal level. A multilevel approach for psychological predictors of PA can be useful in grounding interventions for survivors of breast cancer.

Perception of nudge interventions to mitigate medication errors risk in healthcare service delivery

BACKGROUND

Conventional cognitive interventions to reduce medication errors have been found to be less effective as behavioural change does not always follow intention change. Nudge interventions, which subtly steer one's choices, have recently been introduced.

METHODS

Conducted from February to May 2023, this study aimed to determine the relationships between perceived effectiveness and perceived ease of implementation of six nudge interventions to reduce medication errors, i.e., provider champion, provider's commitment, peer comparison, provider education, patient education and departmental feedback, and the moderating effects of seniority of job positions and clinical experience on nudge acceptability. Partial Least Square Structural Equation Modelling was used for data analysis.

RESULTS AND DISCUSSION

All six nudge strategies had significant positive relationships between perceived effectiveness and acceptability. In three out of six interventions, perceived ease of implementation was shown to have positive relationships with perceived acceptability. Only seniority of job position had a significant moderating effect on perceived ease of implementation in peer comparison intervention. Interventions that personally involve senior doctors appeared to have higher predictive accuracy than those that do not, indicating that high power-distance culture influence intervention acceptability.

CONCLUSION

For successful nudge implementations, both intrinsic properties of the interventions and the broader sociocultural context is necessary.

Causal effects of point-of-sale cigarette promotions and subjective social status on cigarette craving: a randomised within-person experiment

BACKGROUND

Cigarette smoking continues to be a leading cause of preventable deaths in the USA, in part because the USA has not adopted the WHO Framework Convention on Tobacco Control. One way the tobacco industry counteracts tobacco control policies is by heavily advertising cigarettes at the point of sale in retailers (eg, at the cash register) and by offering discounts on cigarettes.

DESIGN

A within-subject experimental design with adults who smoke cigarettes daily (n=281) investigated whether: (1) exposure to images of cigarette promotions in an online experiment is associated with greater cigarette craving relative to viewing images of non-smoking cues, and (2) if exposure to images of point-of-sale cigarette promotions with a discount (vs without) increases cigarette craving. The study also examined how participants' subjective social status (compared with others in the USA) relates to cigarette craving after exposure to images of cigarette promotions with and without a discount.

RESULTS

In an online experiment, exposure to images of smoking cues, including point-of-sale cigarette promotions, elicited greater craving relative to non-smoking cues (all p<0.001). In addition, images of promotions with a discount elicited higher levels of craving compared with those without a discount (b=0.09, p=0.001). Although participants with a higher (vs lower) subjective social status craved cigarettes less overall (b=-0.12, p=0.012), there was no difference in their craving between images of promotions with and without a discount, while craving was higher for images of promotions with a discount than without for participants with higher subjective social status (b=0.06, p=0.021).

CONCLUSION

Viewing images of point-of-sale cigarette promotions can causally increase cravings to smoke, which may also apply to real-world retail settings that display cigarette promotions. Restricting point-of-sale promotions generally, and discounts specifically, could help reduce cigarette smoking and address tobacco use disparities in the USA.

Adoption and Discontinuance of Innovation Packages: A Longitudinal Study of Transitions in COVID-19 Mitigation

The past decades have seen growing interest and application of interventions targeting the change of multiple behaviors at once. We advance this work by using the diffusion of innovations theory (DOI) to consider constellations of behaviors as innovation packages: multiple innovations that are logically related, interdependent in their use or effects, and often promoted as a set (Rogers, 2003). In addition, we embraced DOI's focus on behavioral decisions as a continual process that can include adoption and discontinuance over time, especially as new innovations (e.g., COVID-19 vaccine) appear. To that end, we conducted a latent transition analysis of COVID-19 mitigation behaviors (N = 697; 97% received a COVID-19 vaccine) across three time points in the pandemic: initial outbreak; a secondary, record-breaking rise in cases; and after the CDC recommended that fully vaccinated adults could discontinue wearing masks. This analysis allowed us to identify latent classes based on shared behavioral patterns and transitions between classes over time. The results showed evidence of three possible packages: (a) a package of traditional, symptom-management behaviors (covering coughs and sneezes, staying home if ill, and seeking medical care), (b) a package of just-novel COVID-19 behaviors (wearing masks, keeping six feet apart, and avoiding mass gatherings), and (c) a package of all COVID-19 mitigation behaviors. Movement between classes exemplified adoption and discontinuance of different packages, as well as widespread discontinuance with the replacement innovation: COVID-19 vaccines. Additional analyses showed that increases in hope were associated with sustained and delayed adoption; decreases in social approval were associated with discontinuance. Future directions in theorizing around innovation packages are discussed.

Challenging cultured meat naturalness perceptions: The role of consumers' mindset

Cultured meat, produced through in vitro cultivation of animal cells, has emerged as a promising solution to environmental, health, and ethical issues resulting from conventional meat production. However, acceptance remains a crucial challenge, significantly influenced by perceptions of unnaturalness. Previous research has demonstrated the limited success of messaging strategies aimed at countering these perceptions. Across two experimental studies, this research breaks new ground by examining these strategies through the lens of mindset theory-i.e., beliefs about the fixedness or malleability of human attributes. In Study 1, we present findings illustrating that a strategy challenging the importance of naturalness is effective at increasing cultured meat acceptance among consumers with a growth mindset. In Study 2, we demonstrate how complementing such messaging strategy with a specific form of creative narrative can make it effective among consumers with a fixed mindset too. Our findings are informative theoretically, extending mindset and narrative theories to the context of cultured meat and, practically, examining the effectiveness of different communication strategies in driving consumer acceptance of the product.

(Why) Is Misinformation a Problem?

In the last decade there has been a proliferation of research on misinformation. One important aspect of this work that receives less attention than it should is exactly why misinformation is a problem. To adequately address this question, we must first look to its speculated causes and effects. We examined different disciplines (computer science, economics, history, information science, journalism, law, media, politics, philosophy, psychology, sociology) that investigate misinformation. The consensus view points to advancements in information technology (e.g., the Internet, social media) as a main cause of the proliferation and increasing impact of misinformation, with a variety of illustrations of the effects. We critically analyzed both issues. As to the effects, misbehaviors are not yet reliably demonstrated empirically to be the outcome of misinformation; correlation as causation may have a hand in that perception. As to the cause, advancements in information technologies enable, as well as reveal, multitudes of interactions that represent significant deviations from ground truths through people's new way of knowing (intersubjectivity). This, we argue, is illusionary when understood in light of historical epistemology. Both doubts we raise are used to consider the cost to established norms of liberal democracy that come from efforts to target the problem of misinformation.

Natural Claims on Sugary Fruit Drinks: A Randomized Experiment With U.S. Parents

INTRODUCTION

Natural claims on food are largely unregulated in the U.S. This study examined the effects of natural claims on a fruit-flavored drink with added sugar (i.e., fruit drink).

METHODS

In 2019, U.S. parents of children aged 2-12 years (N=1,078) recruited from an online survey panel were randomized to one of three arms: natural claim on a fruit drink, 100% all-natural claim, or a no-claim control. Parents reported their intentions and perceptions regarding fruit drinks using 1-5 response scales. Analysis occurred in 2022-2023.

RESULTS

Both natural claims led parents to have higher intentions to purchase a fruit drink for their child than the control (average differential effect=0.20-0.24, both p<0.05). The natural claim (but not the 100% all-natural claim) also led parents to think that the fruit drink was healthier for their children (average differential effect=0.22, p=0.024). Claims made parents less likely to think that the drink contained added sugar (average differential effect= -0.08 to -0.12, both p<0.05) and led to lower estimated amounts of added sugar in teaspoons (average differential effect= -1.77 to -2.09, both p<0.05). Mediation analyses revealed that the claims led to higher intentions to purchase the fruit drink by increasing perceived healthfulness of the fruit drink and by leading parents to believe that there was no added sugar in the fruit drink.

CONCLUSIONS

Natural claims could increase interest in and perceived healthfulness of fruit drinks. Misperceptions about the nutritional content caused by claims appear to be driving greater purchase intentions. These findings suggest a need for stronger regulation around natural claims to prevent consumer misunderstanding.

Predicting Therapists' Intentions to Use Innovations: Comparing the Role of Individual, Organizational, and Innovation Characteristics

Theories emphasize the role of individual and organizational characteristics in implementation outcomes, yet research indicates that these characteristics account for only a small amount of variance in those outcomes. Innovation characteristics might be important proximal determinants of implementation outcomes but are infrequently examined in mental health services research. This study examined the relative variance explained by individual, organizational, and innovation characteristics on behavioral intentions, a central implementation outcome in implementation theories. Data were collected from 95 therapists and 28 supervisors who participated in a cluster randomized trial that tested the effectiveness of two clinical decision-making innovations. Multilevel models compared individual, organizational, and innovation characteristics as predictors of therapists' intentions to use the innovations. Subsequent mediational path analyses tested whether innovation characteristics mediated the effect of innovation type on intentions. Individual and organizational characteristics explained 29% of the variability in therapists' intentions. Approximately 75% of the variability in therapists' intentions was accounted for by innovation characteristics. Individual and organizational characteristics were not statistically significant predictors of intentions after controlling for innovation characteristics. The indirect effect of innovation type on intentions through therapists' beliefs was statistically significant (B = 0.410, 95% Bootstrapped CI = [0.071, 0.780]), but the direct effect of innovation type was not (B = 0.174, p = .365). Innovation characteristics are related to therapist intentions and might explain why some innovations are received more favorably than others. Future studies should explore the complex interrelationships between these beliefs alongside other individual or organizational characteristics.

Extended theory of planned behavior to explain the influence mechanism of low-speed driving behavior

Low-speed driving is an underestimated dangerous behavior that may cause safety issues, such as speed dispersion and traffic flow bottlenecks. To investigate the influence mechanism of low-speed driving behavior, this study constructed the low-speed specific model (LSSM) by extending theory of planned behavior (TPB). The LSSM incorporated two factors, namely, risk perception and behavior habit, into the standard TPB components (attitude, subjective norm, perceived behavioral control, and behavior intention). Web-based questionnaires were used to collect data from a valid sample of 374, of which males accounted for 50%. The participants were aged from 18 to 65 years (M = 35.40, SD = 0.88). The structural equation model was applied to calculate and validate the interrelationships among the components of LSSM. Results showed that the LSSM could explain the variance in low-speed driving behavior and behavior intention by 46% and 76%, respectively. Meanwhile, attitude (β = 0.52, p < 0.001) and behavior habit (β = 0.48, p < 0.001) had the strongest positive influence and prediction power over low-speed driving behavior, respectively, whereas subjective norm (β = 0.05, p > 0.01) and perceived behavioral control (β = -0.12, p > 0.01) showed few significant in influencing the intention. LSSM also showed that people who were sensitive to driving risk perception would avoid low-speed driving behaviors and attitudes. Our findings may provide theoretical support for interventions on low-speed driving behavior.

Development and validation of the pandemic fatigue scale

The existence and nature of pandemic fatigue-defined as a gradually emerging subjective state of weariness and exhaustion from, and a general demotivation towards, following recommended health-protective behaviors, including keeping oneself informed during a pandemic-has been debated. Herein, we introduce the Pandemic Fatigue Scale and show how pandemic fatigue evolved during the COVID-19 pandemic, using data from one panel survey and two repeated cross-sectional surveys in Denmark and Germany (overall N = 34,582). We map the correlates of pandemic fatigue and show that pandemic fatigue is negatively related to people's self-reported adherence to recommended health-protective behaviors. Manipulating the (de)motivational aspect of pandemic fatigue in a preregistered online experiment (N = 1584), we further show that pandemic fatigue negatively affects people's intention to adhere to recommended health-protective behaviors. Combined, these findings provide evidence not only for the existence of pandemic fatigue, but also its psychological and behavioral associations.

Maximizing the Benefit of Respite for Dementia Caregivers: A Study Protocol Describing the Development & Evaluation of the Time for Living & Caring (TLC) Intervention

Dementia caregivers are susceptible to adverse physical and mental health outcomes, given the often prolonged and challenging care and support they provide to family members with Alzheimer's Disease and Related Dementias (ADRD). This report describes a community-engaged implementation of a novel behavioral intervention - an "app" (interactive website) called TLC (Time for Living and Caring) that coaches caregivers on how to maximize the benefits associated with respite time. The rationale and features of the TLC intervention and the full research protocol used to develop and then evaluate its feasibility, acceptability, and initial efficacy are described here.

Effects of media campaign videos on stigma and attitudes towards treatment seeking for alcohol use disorder: a randomized controlled study

BACKGROUND

Alcohol Use Disorder (AUD) is one of the most stigmatized diagnosis, and stigma imposes a major barrier to treatment seeking. There is a need to develop interventions that can reduce stigma and increase treatment seeking. Little is known about the effects of video materials. The aim of this study was to investigate effects of different videos. The primary outcome was public stigma, and secondary outcomes were: self-stigma, and motivation to change own alcohol use; talking to someone else about their alcohol use; seeking information about AUD treatment or seeking AUD treatment.

METHODS

This is a three-armed double blind randomized controlled study. The study included 655 Danish adults. Data was collected at a study webpage, and the survey could be completed anywhere with Internet access. After informed consent and completing baseline measures, participants were randomized, 1:1:1 ratio, to a video (video 1 n = 228; video 2 n = 198; video 3 n = 229). Video 1 and 2 have been used in a national mass media campaign and video 3 was recorded for use in the present study. Immediately after exposure, follow-up measures were completed. Outcomes were analyzed with mixed effects linear regression.

RESULTS

In total n = 616 completed follow-up (video 1 n = 215; video 2 n = 192; video 3 n = 209). Randomization to video 1 and 3 decreased public stigma measured with "Difference, Disdain & Blame Scales", while video 2 increased stigma. Video 2 compared to 1: 2.262 (95% CI 1.155; 3.369) p < 0.001. Video 3 compared to 1: -0.082 (95% CI -1.170; 1.006) p = 0.882. Video 3 compared to 2: -2.344 (95% CI -3.455; -1.233) p = 0.882. All videos reduced motivation to change own alcohol use. Participants with hazardous alcohol use, were more sensitive to the different videos, compared to low-risk alcohol use. Video 2 decreased motivation to seek information about treatment. No effects were seen on motivation to seek treatment, motivation to talk to someone else or self-stigma.

CONCLUSIONS

Videos can have an immediate effect on level of public stigma. Other types of interventions are needed to increase motivation and reduce self-stigma. To avoid adverse effects in future interventions, the use of theoretical frameworks and stakeholder involvement is emphasized.

Testing Assumptions of the Physical Activity Adoption and Maintenance Model: A Longitudinal Perspective of the Relationships Between Intentions and Habits on Exercise Adherence

In this study, we aimed to examine empirically the Physical Activity Adoption and Maintenance model (PAAM). We collected data on these variables at baseline (T0) and 6-months later (T1). We recruited 119 participants (42 male, 77 female) aged 18-81 years old (Mage = 44.89, SD = 12.95). who reported, at baseline, that they exercised an average of 3.76 days per week (SD = 1.33) in training periods lasting 15-60 minutes (M = 38.69; SD = 23.28). We conducted hierarchical multiple regression analysis to test the association between each determinant (intentions, habits, and frequency) and future exercise adherence. We tested four models by entering blocks of predictors according to PAAM assumptions. The variance change (R2) between the first and fourth models (ΔR2 = .391) was statistically significant, showing that the fourth model accounted for 51.2% of variance for future exercise adherence, F (6, 112) = 21.631, p < .001, R2 = .73, adjusted R2 = .512. Exercise intention at T1 maintained its significant association (p = .021) with exercise frequency at T1 in all tested models. Exercise frequency at T0 was the most significant predictor (p < .01) of future exercise adherence, with past experience the second most significant predictor (p = .013). Interestingly, exercise habits at T1 and T0 did not predict exercise frequency at T1 in the fourth model. Among the variables we studied, having constantly high exercise intentions and high regular exercise frequency are significantly associated with maintaining or increasing regular future exercise behavior.

The role of free will beliefs in social behavior: Priority areas for future research

Recent research has examined the consequences that holding views about free will has on social behavior. Specifically, through manipulating people's belief in free will, researchers have tested the psychological and behavioral consequences of free will belief change. However, findings of such manipulations have been shown to be relatively small and inconsistent. The purpose of this paper is to outline four key areas for researchers in this area to consider. We believe considering these areas will give a more nuanced understanding of the role of free will beliefs.

Openness to change among COVID misinformation endorsers: Associations with social demographic characteristics and information source usage

RATIONALE

Misinformation is a major concern for public health, with its presence and impact strongly felt in the COVID-19 pandemic. Misinformation correction has drawn strong research interest. In contrast, relatively little attention has been given to the likelihood of favorable behavioral change post correction (i.e., openness to change).

OBJECTIVE

This study seeks to identify the characteristics of COVID misinformation endorsers who are open to adopt more self-protective behaviors after misinformation correction.

METHODS

COVID misinformation endorsers (N = 1991) in a large, nationally representative survey (fielded in October and November 2021) were asked how likely they would adopt self-protective behaviors if a source they trusted debunked their prior misperceptions. Multiple linear regression estimated the relationships between openness to change and socio-demographics, health-related factors, and health information source usage patterns.

RESULTS

Less than half of the misinformation endorsers in the sample (41.3%) indicated any openness to change. Openness to change was positively associated with minority status and negatively associated with leaning Republican in political affiliation, higher income, being currently unvaccinated or unsure about vaccination status, better health, and a greater number of misinformation items endorsed. Past-month use of government, community, and personal sources for health information positively predicted openness. The use of online media was negatively associated with openness.

CONCLUSIONS

Openness to change is not guaranteed after misinformation correction. Targeted interventions based on openness to change are needed to enhance the public health impact of misinformation correction efforts.

Protocol for a cluster randomised waitlist-controlled trial of a goal-based behaviour change intervention for employees in workplaces enrolled in health and wellbeing initiatives

Many workplaces offer health and wellbeing initiatives to their staff as recommended by international and national health organisations. Despite their potential, the influence of these initiatives on health behaviour appears limited and evaluations of their effectiveness are rare. In this research, we propose evaluating the effectiveness of an established behaviour change intervention in a new workplace context. The intervention, 'mental contrasting plus implementation intentions', supports staff in achieving their health and wellbeing goals by encouraging them to compare the future with the present and to develop a plan for overcoming anticipated obstacles. We conducted a systematic review that identified only three trials of this intervention in workplaces and all of them were conducted within healthcare organisations. Our research will be the first to evaluate the effectiveness of mental contrasting outside a solely healthcare context. We propose including staff from 60 organisations, 30 in the intervention and 30 in a waitlisted control group. The findings will contribute to a better understanding of how to empower and support staff to improve their health and wellbeing. Trial registration: ISRCTN17828539.

Examining the Role of Memorable Messages in the Process of Communication about Aging

Given that individuals have (some) agency to influence their own experiences of aging via communication, it is important to better understand factors that may play a role in these processes. Specifically, this study examined whether and how themes of aging-related memorable messages (e.g. aging involves physical or mental health struggles; age is merely a subjective state) and the extent to which a message offered a sense of positivity and efficacy predicted individuals' efficacy assessments (coping, target, communication) and intention to seek additional information about aging processes. Analyses of responses from a sample of 232 older adults from the United States revealed that memorable message: (a) themes about aging predicted participants' reports of memorable message positivity and efficacy, (b) valence predicted memorable message positivity and efficacy, and (c) characteristics (positivity and efficacy) predicted individuals' efficacy assessments and, ultimately, intention to seek information about aging processes (both directly and indirectly). Results offer theoretical and practical implications.

Message framing effects on attitude and intention toward social participation in old age

BACKGROUND

Message framing is frequently used to advocate health perceptions and behaviors. The effects of message framing on various health behaviors have been examined; however, its effects on social participation, a key determinant of healthy aging, are unclear. This study investigated the effects of message framing on older adults' attitudes and intentions toward social participation.

METHODS

A questionnaire survey conducted in 2020 targeted community-dwelling people aged ≥ 65 years in two rural areas in Japan. Participants were randomly allocated to four groups according to the types of framed messages to promote social participation activities: "private gain-framed message," "private loss-framed message," "public gain-framed message," or "no message." Outcomes included attitudes and intentions toward social participation (impression, interest, and readiness for social participation activities).

RESULTS

A total of 1,524 participants were analyzed (men: 46.3%; average age: 75.7 ± 7.9 years). Ordinal logistic regression analyses of individuals who engaged in any social participation activity showed no significant intergroup difference in the outcomes after adjusting for potential covariates. Among people who did not engage in any activity, the private loss-framed message was associated with a more favorable impression and higher interest and readiness than no message. The private gain-framed message was related to a higher interest in social participation.

CONCLUSIONS

Private loss-framed messages are possibly most effective in reinforcing attitudes and intentions toward social participation, particularly among individuals without social participation experience. These findings highlight the possibility of using a message-framing approach to promote social participation in older adults.

Evaluating the impact of continuing professional development courses on physician behavioral intention: a pre-post study with follow-up at six months

BACKGROUND

Continuing professional development (CPD) for health professionals includes educational activities to maintain or improve skills. We evaluated the impact of a series of CPD courses by identifying factors influencing physicians' intention to adopt targeted behaviors and assessing self-reported behavior adoption six months later.

METHODS

In this pre-post study, eligible participants attended at least one in-person course at the Fédération des Médecins Spécialistes du Québec annual meeting in November 2019. Before and afterwards, participants completed CPD-REACTION, a validated questionnaire based on Godin's integrated model for health professional behavior change that measures intention and psychosocial factors influencing intention. We used Wilcoxon signed-rank test to compare pre- and post-course intention scores and linear regression analyses to identify factors influencing intention. We also compared the post-course intention scores of participants reporting a behavior change six months later with the scores of those reporting no behavior change six months later. Qualitative data was collected only six months after courses and responses to open-ended questions were analyzed using the Theoretical Domains Framework.

RESULTS

A total of 205/329 course attendees completed CPD-REACTION (response rate 62.3%). Among these participants, 158/329 (48%) completed the questionnaire before CPD courses, 129/329 (39.2%) only after courses and 47/329 (14.3%) at 6 months. Study population included 192 physicians of whom 78/192(40.6%) were female; 59/192(30.7%) were between 50 and 59 years old; and 72/192 (37.5%) were surgical specialist physicians. Mean intention scores before (n = 158) and after (n = 129) courses were 5.74(SD = 1.52) and 6.35(SD = 0.93) respectively. Differences in mean (DM) intention before and afterwards ranged from - 0.31(p = 0.17) to 2.25(p = 0.50). Multivariate analysis showed that beliefs about capabilities (β = 0.15, p = 0.001), moral norm (β = 0.75, p < 0.0001), and beliefs about consequences (β = 0.11, p = 0.04) influenced post-course intention. Post-course intention was correlated with behavior six months later (DM = 0.63; p = 0.02). Qualitative analysis showed that facilitators to behavior adoption after six months were most often related to the TDF domains of beliefs about capabilities. Most frequent barriers to adoption related to lack of resources.

CONCLUSIONS

Overall, scores for intention to adopt targeted behaviors increased after the courses. CPD providers could increase participants' intention by including interventions that emphasize beliefs about capabilities, moral norm and beliefs about consequences.

How to entice restaurant patrons to order low-emissions meals? A meta-analysis and research agenda

Climate change mitigation is now a matter of urgency. Substantial mitigation effects can be achieved by changing consumer behavior, including food choice. Food systems generate 34% of global greenhouse emissions. Researchers can contribute to climate change mitigation by developing theory-informed interventions that entice consumers to choose low-emissions foods. This meta-analysis synthesizes past research, which developed interventions to influence food choices in restaurants and tested them experimentally. We meta-analyzed 83 interventions that aimed to entice people to choose low emissions meals. Results indicate that the primary focus of interventions developed to date is to change beliefs to alter food choices. Our meta-analysis reveals that such belief-based interventions have only a small effect particularly on food choice behavior (compared to intentions). Some alternative behavior change approaches prove to be more effective, including increasing the enjoyment associated with choosing the target meal, increasing its availability, and making it more convenient to choose. Our meta-analysis highlights that more field studies are needed. Only 25 out of 83 interventions took place in the field, with the remainder taking place in simulated restaurants (i.e., survey studies). Future research should focus on intervention mechanisms that have proven successful in the simulated restaurant context as well as on novel theoretical approaches that remain entirely unexplored, including targeting habits by either activating or deliberately disrupting them.

A Two-Pronged Educational Intervention for Caregivers to Prevent Residential Pesticide Exposure Among Thai Young Children Living in Agricultural Area

Background

Residential pesticide exposure can be harmful to the health of young children, particularly in agricultural areas. It is critical to educate their caregivers on pesticide exposure prevention. The purpose of this study was to determine the effectiveness of a two-pronged education intervention for caregivers in preventing pesticide exposure among Thai young children living in agricultural areas.

Methods

This was an experimental study with 90 primary caregivers of young children aged 6 months to 5 years. Thirty caregivers each were assigned to one of three groups: booklet plus lecture intervention, only booklet intervention, and control. Caregivers in both interventions received a booklet that educated them on residential pesticide exposure and prevention. The caregivers in the booklet plus lecture group also attended a 2-hour lecture with the same content as the booklet. A questionnaire was developed to assess caregivers' knowledge, attitudes, intention, and behaviors regarding residential pesticide exposure and prevention in children. Face-to-face interviews were conducted at their homes three times: baseline, post-intervention, and follow-up (three weeks after the end of the intervention).

Results

Linear mixed models showed that, from baseline to post-intervention, the intervention effect on knowledge and attitude in both intervention groups, as well as intention in the booklet plus lecture group, was significant (p<0.05). From baseline to follow-up, the knowledge, attitude, intention, and behavior scores in both intervention groups increased significantly more than the control group (p<0.01). Only the attitude score increased more in the booklet plus lecture group than in the booklet group at post-intervention (p=0.009) and follow-up (p=0.003).

Conclusion

Both the booklet plus lecture method and the booklet method alone have a positive effect on improving the caregiver's knowledge and behaviors regarding pesticide exposure prevention at home. Thus, providing a booklet to caregivers to reduce children's risk of pesticide exposure is recommended.

Effects of Prosocial and Hope-Promoting Communication Strategies on COVID-19 Worry and Intentions for Risk-Reducing Behaviors and Vaccination: Experimental Study

BACKGROUND

The COVID-19 pandemic has engendered widespread fear and skepticism about recommended risk-reducing behaviors including vaccination. Health agencies are faced with the need to communicate to the public in ways that both provide reassurance and promote risk-reducing behaviors. Communication strategies that promote prosocial (PS) values and hope are being widely used; however, the existing research on the persuasiveness of these strategies has offered mixed evidence. There is also very little research examining the comparative effectiveness of PS and hope-promoting (HP) strategies.

OBJECTIVE

The aim of this study is to evaluate the comparative effectiveness of PS and HP messages in reassuring the public and motivating COVID-19 risk-reducing behaviors.

METHODS

A web-based factorial experiment was conducted in which a diverse sample of the US public was randomized to read messages which adapted existing COVID-19 information from a public website produced by a state government public health department to include alternative framing language: PS, HP, or no additional framing (control). Participants then completed surveys measuring COVID-19 worry and intentions for COVID-19 risk-reducing behaviors and vaccination.

RESULTS

COVID-19 worry was unexpectedly higher in the HP than in the control and PS conditions. Intentions for COVID-19 risk-reducing behaviors did not differ between groups; however, intentions for COVID-19 vaccination were higher in the HP than in the control condition, and this effect was mediated by COVID-19 worry.

CONCLUSIONS

It appears that HP communication strategies may be more effective than PS strategies in motivating risk-reducing behaviors in some contexts but with the paradoxical cost of promoting worry.

Relational climate and openness to plant-forward diets among cohabitating couples

Plant-forward diets offer a potential solution to many of the health and ecological crises that we find ourselves facing today. A key barrier to the adoption and maintenance of plant-forward diets is an anticipated lack of support from family members, friends and romantic partners. The present study examined how relational climate (i.e., the cohesion and flexibility of a partnership) contributes to the tension individuals anticipate in their relationship when a member reduces their animal-product consumption, and their own openness to reducing. Four hundred and ninety-six coupled individuals took part in an online survey. Analyses revealed that couples with more flexible leadership styles anticipated less tension should they or their partner adopt a plant-forward diet. However, dimensions of relational climate were largely unrelated to openness to plant-forward diets. Romantic couples who perceived themselves to be matched in terms of dietary habits were less open to reducing their animal-product consumption than unmatched couples. Politically left-leaning couples and females were more open to plant-forward diets. The meat attachments of male partners were reported as a particular barrier to dietary goals, as were practical concerns about meal coordination, finance, and health. Implications for promoting plant-forward dietary transitions are discussed.

The Effects of an Educational Intervention on Exercise Advice Behaviors of Thai Oncology Nurses

OBJECTIVE

To evaluate an educational intervention based on the Theory of Planned Behavior to increase oncology nurses' exercise advice behaviors.

METHODS

A single-group, quasi-experimental repeated measures design study was used with 124 oncology nurses in a Thai cancer institute. The educational intervention included preeducation self-directed activities for 1 hour, a 2-hour group education session, and posteducation outreach contact 1 week later. The outcome measures, including the Theory of Planned Behavior constructs, exercise knowledge, and self-reported exercise prescription behaviors, were collected at three time points: Time 1 (2 weeks preintervention), Time 2 (immediately preintervention), and Time 3 (2 weeks after the intervention).

CONCLUSION

Results indicated a statistically significant increase in scores after the intervention for all outcomes, including the Theory of Planned Behavior constructs (overall P value <.001), exercise knowledge (β = 2.99, P < .001), and exercise prescription behaviors: asking (odds ratio [OR] = 12.98, P < .001), assessing (OR = 6.20, P < .001), referring (OR = 4.10, P < .001), and writing exercise advice (OR = 11.52, P < .001). Additionally, verbal counseling behavior was performed by all participants, and therefore, the odds for verbal counseling were not reported. Structural equation modeling analysis demonstrated that attitudes and perceived behavioral control explained 41% of the variance in exercise advice intention. Perceived behavioral control and intention also explained 20% of the variance in self-reported exercise advice behaviors.

IMPLICATIONS FOR NURSING PRACTICE

Attitudinal and perceived behavioral control constructs should be a focus of attention to improve health care professionals' exercise advice behaviors. More focused research is required to examine whether patients engage in and follow the exercise advice provided by oncology nurses.

Application of Protection Motivation Theory to COVID-19 vaccination among a predominantly Hispanic sample of adolescents

Despite the efficacy and widespread availability of COVID-19 vaccines, vaccine uptake has been relatively low in U.S. Hispanic communities, especially among adolescents. This study examined vaccination status among 444 high school students in predominantly Hispanic neighborhoods of Los Angeles County, California in May-June 2022 (mean age = 15.74 years, 55% female, 93% Hispanic). Guided by Protection Motivation Theory, we hypothesized that the odds of being fully vaccinated (at least 2 vaccine doses) would be significantly associated with higher levels of perceived severity, perceived vulnerability, response efficacy, and self-efficacy. 79% of the respondents were fully vaccinated. Binary logistic regression analyses found that response efficacy (belief in the effectiveness of the COVID-19 vaccine) and self-efficacy to get vaccinated were significantly associated with the likelihood of being fully vaccinated. Perceived severity of COVID-19 and perceived vulnerability to COVID-19 were not associated with the likelihood of being fully vaccinated. Results indicate that health communications are needed to convince Hispanic adolescents and their parents that the COVID-19 vaccine is effective, and outreach efforts are needed to remove barriers to vaccination among this population.

The AHAWOMEN project: study protocol of a multi-design research for exploring HAPA predictors of exercise in postmenopausal women

BACKGROUND

The postmenopausal period can represent an opportunity for women to improve their health and well-being. The Active and Healthy Ageing in Women during early postmenopause (AHAWOMEN) study aims to identify the key determinants of an active lifestyle among middle-aged women, with a focus on the stages and the social-cognitive variables outlined in the Health Action Process Approach (HAPA) model, a theoretical framework for understanding health behaviour change. We expected that HAPA factors and processes of intention creation (motivational phase) and action adoption (volitional phase) will be significant predictors of exercise initiation and maintenance, supporting both the HAPA tenets and the efficacy of HAPA-based interventions.

METHODS/DESIGN

This study was approved by the authors' Institutional Review Committee. Postmenopausal women aged between 45 and 65 years will voluntarily participate. The participants will be allocated to one of three groups: Intervention-Initiators (n = 100, random allocation), Control-Sedentary (n = 100, random allocation) or Control-Active (n = 100, non-random allocation). The intervention group will engage in a supervised exercise programme lasting at least 3 months, supplemented with a HAPA-based intervention for behaviour change. The sedentary control group will not receive any intervention to change their physical activity, while the active control group will consist of women who are already regularly adhering to an active lifestyle. Study variables will be measured at baseline and postintervention phases, as well as at 1, 3, 6 and 12-month follow-ups. The predictors of exercise behaviour in the different phases of the behavioural change process will be explored and compared within and between groups throughout the study. These analyses will help identify the factors that determine the adoption of a healthy active behaviour. Additionally, the effectiveness of the model and the intervention for changing active behaviour will be evaluated.

DISCUSSION

This paper describes the rationale, development and methods used in the AHAWOMEN project. Supporting women who intend to become active can help them to translate their goals into sustainable action. Verifying that the HAPA predictions are applicable to postmenopausal women's adoption of exercise would provide the basis for designing effective interventions for promoting healthy and active ageing that are also tailored to the experiences of middle-aged women.

TRIAL REGISTRATION

ISRCTN16251361. Registration date: 01/06/2023 (retrospectively registered).

Do Vaping Prevention Messages Impact Adolescents and Young Adults? A Meta-Analysis of Experimental Studies

Vaping prevention messages are widely used to communicate the health harms and addiction risks of vaping and discourage vaping among adolescents and young adults. We conducted a meta-analysis of experimental studies to examine the effects of these messages and to understand their theoretical mechanisms. Systematic, comprehensive searches generated 4,451 references, among which 12 studies (cumulative N = 6,622) met inclusion criteria for the meta-analysis. Across these studies, a total of 35 different vaping-related outcomes were measured, and 14 outcomes assessed in two or more independent samples were meta-analyzed. Results showed that compared to control, exposure to vaping prevention messages led to higher vaping risk perceptions, including harm perceptions (d = 0.30, p < .001), perceived likelihood of harm (d = 0.23, p < .001), perceived relative harm (d = 0.14, p = .036), addiction perceptions (d = 0.39, p < .001), perceived likelihood of addiction (d = 0.22, p < .001), and perceived relative addiction (d = 0.33, p = .015). Also, compared to control, exposure to vaping prevention messages led to more vaping knowledge (d = 0.37, p < .001), lower intentions to vape (d = -0.09, p = .022), and higher perceived message effectiveness (message perceptions; d = 0.57, p < .001; effects perceptions; d = 0.55, p < .001). Findings suggest vaping prevention messages have an impact, yet may operate through different theoretical mechanisms than cigarette pack warnings.

Does the Message Frame Promote People's Willingness to Vaccinate when they Worry about Side Effects from the COVID-19 Vaccine? Evidence from an Online Survey Experiment in China

Vaccination is an effective strategy for controlling the coronavirus disease 2019 (COVID-19) pandemic. However, worrying about side effects (WSE) from the COVID-19 vaccine is the leading concern making people hesitant to get vaccinated. Regrettably, there are few studies on alleviating the negative impacts of WSE on COVID-19 vaccination. This study aimed to assess whether message framing (gain- and loss-framed) can moderate the impacts of WSE on the willingness to vaccinate. We conducted an online self-administered survey experiment with three groups: control group (non-framed group), gain-framed groups, and loss-framed groups. In total, 981 participants were randomly assigned to one of the three groups, and their willingness to vaccinate themselves, their children, and elderly members was recorded. People with a higher level of WSE exhibited a lower willingness to vaccinate against COVID-19. However, the gain- and loss-framed messages increased people's willingness to vaccinate themselves, their children, and the elderly. Compared to the gain-framed messages, the loss-framed messages had a greater impact on enhancing people's willingness to self-vaccinate, but not on vaccinating their children and the elderly. Although the gain- and loss-framed messages weakened the negative impacts of WSE on the willingness to be vaccinated, their buffer effect was non-significantly different. The findings in this study suggest that a loss-framed messaging strategy could be a valuable tool in disseminating information on vaccination against COVID-19.

Adolescent peer support for mental health problems: evaluation of the validity and reliability of the Mental Health Support Scale for Adolescents

BACKGROUND

The Mental Health Support Scale for Adolescents (MHSSA) is a criterion-referenced measure of adolescents' supportive intentions towards peers with mental health problems, which was developed for use in evaluations of adolescent mental health interventions, such as the teen Mental Health First Aid (tMHFA) program. The present study aimed to examine the validity and reliability of the MHSSA.

METHODS

A sample of 3092 school students (Mean ± SD: 15.9 ± 0.4 years old) and 65 tMHFA Instructors (the adult group with known expertise in tMHFA) completed the 12 items of the MHSSA. A sub-sample of 1201 students repeated the scale after a 3-4-week interval. Item concordance rates with the tMHFA Action Plan across helpful and harmful intentions scales were calculated. Scale reliabilities were assessed using agreement coefficients from a single test administration and test-retest reliability measured by intraclass correlation coefficients. The mean differences of MHSSA scores of students and Instructors were compared using independent samples t-tests, while convergent validity was tested via correlations of the scale with validated measures of confidence in providing help, social distance and personal stigma.

RESULTS

The average score of Instructors was significantly higher than that of students. The scale was positively associated with confidence in providing help, whilst negatively associated with social distance and dimensions of personal stigma. All scales of MHSSA had high agreement coefficients (all > 0.80) and fair to good test-retest reliability over 3-4 weeks.

CONCLUSIONS

The MHSSA shows evidence of validity and reliability for use among adolescents for evaluating the quality of intentions to help peers with mental health problems.

The effect of numeric information about the likelihood of receiving a false negative or false positive result on people's attitudes towards colorectal cancer screening using faecal immunochemical testing (FIT)

OBJECTIVE

To examine the impact of numeric risk information about false negative (FN) and false positive (FP) rates in fecal immunochemical testing (FIT) on attitudes towards screening.

METHODS

102 people aged 45-55, living in the UK, read 6 hypothetical vignettes presented online about the use of FIT kits to detect colorectal cancer, in which information about FN and FP rates was systematically varied.

RESULTS

Numeric FN risk information reduced people's interest in screening, perception of screening effectiveness and lowered trust in screening compared to verbal FN information. Verbal FN information reduced perceptions of screening effectiveness and trust compared to no FN information. People with high subjective numeracy reported lower trust in screening following the provision of numeric FN information but numeracy did not moderate any other associations. FP information did not affect attitudes towards FIT testing.

CONCLUSION

Numeric FN risk information decreased people's perceptions of screening effectiveness and trust in the results of screening. While it influenced people's interest in screening, the effect was small.

PRACTICE IMPLICATIONS

Numeric FN information has a small effect on interest in screening and could promote informed decision making without affecting screening uptake.

Combatting negative bias: a mental contrasting and implementation intentions online intervention to increase help-seeking among individuals with elevated depressive symptomatology

Background

There are many reasons why individuals with depression may not seek help. Among those with elevated depressive symptomatology, some previous interventions aimed at increasing help-seeking have unintentionally decreased help-seeking intentions. Beck's cognitive theory of depression posits that individuals with elevated depressive symptomatology process information differently from those without depression (i.e., increased cognitive errors, negative bias); potentially explaining the iatrogenic results of previous interventions. Mental contrasting and implementation intentions (MCII; a self-regulatory strategy) interventions have successfully influenced physical and mental health behaviors. However, MCII has not been used specifically for initiating help-seeking for depression. The goal of this research was to ascertain whether an online MCII intervention could increase actual help-seeking or the intention to seek help for depression.

Method

Two online randomized pre-post experiments were conducted to measure the primary outcome measures 2 weeks post-intervention (Study 1 collected Summer 2019: information-only control ["C"], help-seeking MCII intervention ["HS"], and comparison MCII intervention ["E"]; Study 2 collected Winter 2020: "C" and "HS"). At Time 1, adults recruited from MTurk had a minimum Beck Depression Inventory (BDI-II) score of 14 (mild depressive symptoms) and were not seeking professional help.

Results

Study 1 (N = 74) indicated that the intervention was feasible, provided preliminary support, and clarified intervention components for Study 2. Study 2 (N = 224) indicated that the HS group reported greater intentions to seek help and actual help-seeking than the C group. Proportionally, actual help-seeking was more likely among individuals who received the HS intervention and either did not perceive themselves as depressed at Time 2 or had BDI-II scores indicating that their depressive symptomatology decreased from Time 1.

Limitations

Participation was limited to US residents who self-reported data.

Discussion

These studies indicate that a brief online MCII intervention to encourage help-seeking is feasible and preliminarily successful. Future studies should consider using ecological momentary assessment measurements to establish the temporal precedence of intervention effects and whether MCII is effective for encouraging help-seeking among individuals prone to experiencing cognitive errors who may not be experiencing negative bias (e.g., bipolar disorder or anxiety). Clinicians may find this method successful in encouraging ongoing treatment engagement.

Why Do Employers (Fail to) Hire People with Disabilities? A Systematic Review of Capabilities, Opportunities and Motivations

PURPOSE

To increase the number of people with disabilities in employment, we need to understand what influences employers' hiring decisions. In this systematic review, we map out factors affecting employers' hiring decisions about people with disabilities.

METHODS

This study is a systematic review that applies the COM-B model to identify factors that contribute to employers (not) hiring people with disabilities. The COM-B model proposes that employers will perform hiring behavior (B) if they have the capability (C), opportunity (O) and motivation (M) to do so. We also investigate if factors have a negative, positive or no effect. We report in accordance with the PRISMA guidelines.

RESULTS

In a review of 47 studies, we find 32 factors. Most of these factors are barriers. The most frequently mentioned barriers are employers' (1) expectations that people with disabilities are unproductive, (2) expectations that people with disabilities cost a lot of money, and employers' (3) lack of knowledge about disabilities. The most researched facilitators for employers to hire people with disabilities include (1) the motivation to help others, (2) working in a large organization, and (3) expecting a competitive advantage. The effect of factors can differ depending on contextual circumstances, including the type of organization, the type of disability and different policies.

CONCLUSIONS

We conclude that hiring decisions are influenced by an array of different barriers and facilitators. The effect of these factors can differ across organizations and disability types. Our study of factors affecting hiring can be used by scholars, policy makers, and organizations to create interventions to increase the hiring of people with disabilities.

Political repression motivates anti-government violence

We examined whether political repression deters citizens from engaging in anti-government behaviour (its intended goal) or in fact motivates it. Analyses of 101 nationally representative samples from three continents (N = 139 266) revealed a positive association between perceived levels of repression and intentions to engage in anti-government violence. Additional analyses of fine-grained data from three countries characterized by widespread repression and anti-government violence (N = 2960) identified a positive association between personal experience with repression and intentions to engage in anti-government violence. Randomized experiments revealed that thoughts about repression also motivate participation in anti-government violence. These results suggest that political repression, aside from being normatively abhorrent, motivates anti-repressor violence.

Intention to Engage in Alcohol Use during Pregnancy: The Role of Attitudes and Prototypes

Background: There is no known risk-free level of alcohol use in pregnancy. Despite this, many still believe that occasional drinking is safe. To-date, there is limited evidence of the influences on women's decisions about low to moderate alcohol use in pregnancy. The aim of this study was to explore alcohol use intentions during pregnancy, using variables from the theory of planned behavior, the prototype/willingness model and personality variables. The study also investigated whether priming participants with exposure to prototypes describing different alcohol use behaviors had an impact on intentions.Methods: Participants, 746 women aged 20 to 45 years, were randomized to be prompted to think of one of two different "types" of behaviors, i.e., small level of alcohol use in pregnancy and ambiguous level of alcohol use in pregnancy. They then completed measures of theoretical variables, impulsivity, venturesomeness, and self-efficacy. Participants then answered whether they intended to use alcohol during a future pregnancy.Results: Over half of the variance in intentions to consume alcohol while pregnant were predicted by the final model (R2= .527, F (1, 438) = 13.201, p < .001). Positive attitudes toward alcohol use in pregnancy, from the theory of planned behavior, were the most significant predictor of intentions and intentions did not differ between groups according to prototype exposure.Conclusions: Future research should aim to explore the efficacy of interventions to reduce low to moderate alcohol use in pregnancy that utilize both the theory of planned behavior and prototype/willingness model to target determinants of intentions.

Increasing uptake of FIT colorectal screening: protocol for the TEMPO randomised controlled trial testing a suggested deadline and a planning tool

INTRODUCTION

Screening can reduce deaths from colorectal cancer (CRC). Despite high levels of public enthusiasm, participation rates in population CRC screening programmes internationally remain persistently below target levels. Simple behavioural interventions such as completion goals and planning tools may support participation among those inclined to be screened but who fail to act on their intentions. This study aims to evaluate the impact of: (a) a suggested deadline for return of the test; (b) a planning tool and (c) the combination of a deadline and planning tool on return of faecal immunochemical tests (FITs) for CRC screening.

METHODS AND ANALYSIS

A randomised controlled trial of 40 000 adults invited to participate in the Scottish Bowel Screening Programme will assess the individual and combined impact of the interventions. Trial delivery will be integrated into the existing CRC screening process. The Scottish Bowel Screening Programme mails FITs to people aged 50-74 with brief instructions for completion and return. Participants will be randomised to one of eight groups: (1) no intervention; (2) suggested deadline (1 week); (3) suggested deadline (2 weeks); (4) suggested deadline (4 weeks); (5) planning tool; (6) planning tool plus suggested deadline (1 week); (7) planning tool plus suggested deadline (2 weeks); (8) planning tool plus suggested deadline (4 weeks). The primary outcome is return of the correctly completed FIT at 3 months. To understand the cognitive and behavioural mechanisms and to explore the acceptability of both interventions, we will survey (n=2000) and interview (n=40) a subgroup of trial participants.

ETHICS AND DISSEMINATION

The study has been approved by the National Health Service South Central-Hampshire B Research Ethics Committee (ref. 19/SC/0369). The findings will be disseminated through conference presentations and publication in peer-reviewed journals. Participants can request a summary of the results.

TRIAL REGISTRATION NUMBER

clinicaltrials.govNCT05408169.

Fukushima study for Engaging people with type 2 Diabetes in Behaviour Associated Change (FEEDBACK): study protocol for a cluster randomised controlled trial

BACKGROUND

The growing burden of type 2 diabetes mellitus (T2DM) and the rising cost of healthcare worldwide make it imperative to identify interventions that can promote sustained self-management behaviour in T2DM populations while minimising costs for healthcare systems. The present FEEDBACK study (Fukushima study for Engaging people with type 2 Diabetes in Behaviour Associated Change) aims to evaluate the effects of a novel behaviour change intervention designed to be easily implemented and scaled across a wide range of primary care settings.

METHODS

A cluster randomised controlled trial (RCT) with a 6-month follow-up will be conducted to evaluate the effects of the FEEDBACK intervention. FEEDBACK is a personalised, multi-component intervention intended to be delivered by general practitioners during a routine diabetes consultation. It consists of five steps aimed at enhancing doctor-patient partnership to motivate self-management behaviour: (1) communication of cardiovascular risks using a 'heart age' tool, (2) goal setting, (3) action planning, (4) behavioural contracting, and (5) feedback on behaviour. We aim to recruit 264 adults with T2DM and suboptimal glycaemic control from 20 primary care practices in Japan (cluster units) that will be randomly assigned to either the intervention or control group. The primary outcome measure will be the change in HbA1c levels at 6-month follow-up. Secondary outcome measures include the change in cardiovascular risk score, the probability to achieve the recommended glycaemic target (HbA1c <7.0% [53mmol/mol]) at 6-month follow-up, and a range of behavioural and psychosocial variables. The planned primary analyses will be carried out at the individual level, according to the intention-to-treat principle. Between-group comparisons for the primary outcome will be analysed using mixed-effects models. This study protocol received ethical approval from the research ethics committee of Kashima Hospital, Fukushima, Japan (reference number: 2022002).

DISCUSSION

This article describes the design of a cluster RCT that will evaluate the effects of FEEDBACK, a personalised, multicomponent intervention aimed at enhancing doctor-patient partnership to engage adults with T2DM more effectively in self-management behaviour.

TRIAL REGISTRATION

The study protocol was prospectively registered in the UMIN Clinical Trials Registry (UMIN-CTR ID UMIN000049643 assigned on 29/11/2022). On submission of this manuscript, recruitment of participants is ongoing.

How to motivate employees towards organizational energy conservation: Insights based on employees perceptions and an IoT-enabled gamified IS intervention

Employees can help organizations attain Corporate Environmental Performance (CEP) goals and save on energy bills, by conserving electricity. However, they lack the motivation. Information Systems (IS)-enabled energy-related feedback interventions featuring gamification (utilizing game-design elements), have been suggested to increase organizational energy conservation. To identify the behavioral factors that should be considered when designing such interventions towards optimizing their results, this paper focuses on unravelling the intricacies of employee energy consumption behavior and providing answers to the research question: "What drives employees to save energy at work?". Our research is conducted in three workplaces across Europe. First, we analyze employees' energy-saving motivation and behavior at an individual level of analysis to identify defining behavioral factors behind it. Then, considering these drivers of employees' energy consumption behavior, we focus on answering the question: "How a gamified IS that provides real-time energy usage feedback affects employees' motivation to conserve energy at work, and in turn the actual energy savings in organizations". Our findings suggest that employees' level of self-determination to conserve energy, energy-saving personal norms, and personal and organizational profile, significantly explain both their energy-saving behavior and the energy behavior change attained through a gamified IS intervention. Moreover, the provision of feedback to employees, via an Internet-Of-Things (IoT)-enabled gamified IS, is proven an effective strategy for accomplishing actual energy conservation at work. The acquired insight on what drives employees' energy usage behavior supports the design of gamified IS interventions that have higher motivational capacity and, thus, can change employees' energy behavior. When designing behavioral interventions aimed at energy conservation at work, we should primarily focus on monitoring (to decide whether a behavioral intervention would be worth organizing) and ultimately positively affecting employees' energy-saving habits and intention. Our findings can be transformed to specific practical suggestions for firms to encourage employees' energy saving behavior when aspiring to attain CEP goals. They include satisfying their basic psychological needs for autonomy, competence, and relatedness, activating their personal norms in the context of energy-saving at work, and educating and encouraging them towards specific energy-saving behaviors by utilizing gamified IoT-enabled IS that keep their energy-saving "in shape".

Activation Versus Change as a Principle Underlying Intervention Strategies to Promote Health Behaviors

BACKGROUND AND PURPOSE

Interventions are effective in promoting health behavior change to the extent that (a) intervention strategies modify targets (i.e., mechanisms of action), and (b) modifying targets leads to changes in behavior. To complement taxonomies that characterize the variety of strategies used in behavioral interventions, we outline a new principle that specifies how strategies modify targets and thereby promote behavior change. We distinguish two dimensions of targets-value (positive vs. negative) and accessibility (activation level)-and show that intervention strategies operate either by altering the value of what people think, feel, or want (target change) or by heightening the accessibility of behavior-related thoughts, feelings, and goals (target activation).

METHODS AND RESULTS

We review strategies designed to promote target activation and find that nudges, cue-reminders, goal priming, the question-behavior effect, and if-then planning are each effective in generating health behavior change, and that their effectiveness accrues from heightened accessibility of relevant targets. We also identify several other strategies that may operate, at least in part, via target activation (e.g., self-monitoring, message framing, anticipated regret inductions, and habits).

CONCLUSIONS

The Activation Vs. Change Principle (AVCP) offers a theoretically grounded and parsimonious means of distinguishing among intervention strategies. By focusing on how strategies modify targets, the AVCP can aid interventionists in deciding which intervention strategies to deploy and how to combine different strategies in behavioral trials. We outline a research agenda that could serve to further enhance the design and delivery of interventions to promote target activation.