Knowledge and the Prediction of Behavior: The Role of Information Accuracy in the Theory of Planned Behavior

Impact of an Intervention Designed to Reduce Sexual Health Risk Behaviors of African American Adolescents: Results of a Randomized Controlled Trial

OBJECTIVES

To replicate an evidence-based HIV risk reduction program and assess its impact on 2 behavioral outcomes-inconsistency of condom use and frequency of sex-6 months after the program.

METHODS

The study was an individual-level randomized controlled trial in which we randomly assigned 850 youths (aged 14-18 years) to 1 of 2 conditions. The treatment (Becoming a Responsible Teen) is a group-level sociocognitive and skills training sexual education course; the control is a general health intervention that includes the same initial informational component as the treatment. Participants were recruited over 3 summers (2012-2014) from a summer employment program in New Orleans, Louisiana, that serves primarily African American adolescents.

RESULTS

Six months after program exposure, we found no statistically significant difference between treatment and control group members' self-reported inconsistency of condom use or frequency of sex (P > .05).

CONCLUSIONS

Although previous evidence has indicated that this particular program can be effective, this study's findings indicate that it was not effective in this setting with this specific population. Results should provide an incentive to learn why the intervention works in some cases and what conditions are necessary for causal impacts.

The Role of Perceived E-Collaborative Performance in an Extended Theory of Planned Behavior Model

Online web technologies are adopted to improve students' collaborative work. However, the factors that affect students' engagement in online collaboration (e-collaboration) have not been understood in previous studies. This research aimed to examine the extent to which students' intentions to e-collaborate can be explained by the theory of planned behavior. A sample of secondary and tertiary students was used (N = 175). The results from the partial least square approach to structural equation modeling (PLS-SEM) indicated that the path coefficients of the relationships partially reinforced the a priori construction of the hypothesized model. In brief, attitudes toward e-collaboration and subjective norms were positively and significantly related to e-collaborative intentions, while perceived behavioral control indirectly predicted e-collaborative intentions via perceived e-collaborative performance. Research and practical implications have been presented in the paper.

The role of STI-related attitudes on screening attendance in young adults

This study assessed whether attitudes towards STI screening, visiting a clinic and having an STI (STI stigma) predict STI screening attendance in young adults. Participants (N = 217) rated each of these attitudes and completed measures assessing their STI knowledge, past sexual behaviour and sexual health. STI stigma and having favourable attitudes towards STI screening positively predicted screening attendance. People were less likely to attend if they had a negative attitude towards visiting sexual health clinics. Researchers should assess attitudes towards the attitude object (screening), condition (STI stigma) and process (visiting a clinic) to understand the different ways that attitudes predict behaviour.

Theory of Planned Behavior in School-Based Adolescent Problem Gambling Prevention: A Conceptual Framework

Given its serious implications for psychological and socio-emotional health, the prevention of problem gambling among adolescents is increasingly acknowledged as an area requiring attention. The theory of planned behavior (TPB) is a well-established model of behavior change that has been studied in the development and evaluation of primary preventive interventions aimed at modifying cognitions and behavior. However, the utility of the TPB has yet to be explored as a framework for the development of adolescent problem gambling prevention initiatives. This paper first examines the existing empirical literature addressing the effectiveness of school-based primary prevention programs for adolescent gambling. Given the limitations of existing programs, we then present a conceptual framework for the integration of the TPB in the development of effective problem gambling preventive interventions. The paper describes the TPB, demonstrates how the framework has been applied to gambling behavior, and reviews the strengths and limitations of the model for the design of primary prevention initiatives targeting adolescent risk and addictive behaviors, including adolescent gambling.

The relationship between the theory of planned behavior and medication adherence in patients with epilepsy

PURPOSE

The aim of this study was to apply the theory of planned behavior (TPB) with two other factors (action planning and coping planning) to the medication adherence of adults with epilepsy.

METHODS

We measured the elements of the theory of planned behavior (attitude, subjective norm, perceived behavioral control, and behavioral intention), action planning, and coping planning at baseline among adults with epilepsy (n=567, mean±SD age=38.37±6.71years, male=48.5%). Medication adherence was measured using the Medication Adherence Report Scale (MARS) and antiepileptic serum level at the 24-month follow-up. Structural equation modeling (SEM) examined three models relating TPB elements to medication adherence.

RESULTS

Three SEM models all had satisfactory fit indices. Moreover, attitude, subjective norms, perceived behavioral control, and intention together explained more than 50% of the variance for medication adherence measured using MARS. The explained variance increased to 61.8% when coping planning and action planning were included in the model, with coping planning having greater association than action planning. In addition, MARS explained 3 to 5% of the objective serum level.

CONCLUSION

The theory of planned behavior is useful in understanding medication adherence in adults with epilepsy, and future interventions may benefit by improving such beliefs as well as beliefs about coping planning.

Awareness of HPV and Uptake of Vaccination in a High-Risk Population

BACKGROUND

Immunization against the human papillomavirus (HPV) is effective at preventing HPV-related cancers, but vaccination rates have remained low. Levels of awareness could conceivably influence vaccination rates, but currently the relationship is unknown. This is the first study to test how strongly levels of awareness among parents and adolescents are related to subsequent HPV vaccination among a high-risk population of adolescents.

METHODS

This longitudinal cohort study measured baseline levels of awareness (about HPV, cervical cancer, HPV vaccination, and news or advertisements about HPV vaccination) among parents of adolescents and also a separate sample of adolescents. Participants resided in predominantly low-income, African American neighborhoods of a large American city. During a 12-month follow-up period, the outcome measures were defined as adolescent receipt of any HPV vaccination, as measured by clinic records.

RESULTS

Within 1 year, <16% of adolescents received vaccination. The relationship between awareness and subsequent vaccination was either not statistically significant or not meaningful in magnitude, with R(2) = 0.004 to 0.02. The predicted probability of getting vaccination was <0.50 for all awareness levels and prediction accuracy was poor (area under the curve = 0.56-0.64).

CONCLUSIONS

In this high-risk population, levels of awareness among parents and adolescents were not substantially related to subsequent adolescent HPV vaccination.

Physical activity-related social control and social support in older adults: Cognitive and emotional pathways to physical activity

A survey of 217 older adults assessed physical activity-related positive and negative social control and emotional and informational support, using structural equation modeling to investigate mediational effects of emotional responses and behavioral intentions on physical activity. There were significant indirect effects of social control and social support on intentions as mediated by positive, but not negative, emotional responses, and significant indirect effects of emotional responses on physical activity as mediated by intentions. These findings help to identify the cognitive and emotional pathways by which social control and social support may promote or detract from physical activity in later life.

Help-seeking intentions among Asian American and White American students in psychological distress: Application of the health belief model

OBJECTIVE

Underutilization of needed mental health services continues to be the major mental health disparity affecting Asian Americans (Sue, Cheng, Saad, & Chu, 2012). The goal of this study was to apply a social psychological theoretical framework-the health belief model (Rosenstock, 1966)-to understand potential reasons why Asian Americans underutilize mental health services relative to White Americans.

METHOD

Using a cross-sectional online questionnaire, this study examined how perceived severity of symptoms, perceived susceptibility to mental health problems, perceived benefits of treatment, and perceived barriers to treatment influenced intentions to seek help among a sample of 395 Asian American and 261 White American students experiencing elevated levels of psychological distress.

RESULTS

Analyses using structural equation modeling indicated that Asian Americans in distress had relatively lower intentions to seek help compared with White Americans. Perceived benefits partially accounted for differences in help-seeking intentions. Although Asian Americans perceived greater barriers to help seeking than did White Americans, this did not significantly explain racial/ethnic differences in help-seeking intentions. Perceived severity and barriers were related to help-seeking intentions in both groups.

CONCLUSIONS

Outreach efforts that particularly emphasize the benefits of seeking mental health services may be a particularly promising approach to address underutilization. The findings have implications in help-seeking promotion and outreach. (PsycINFO Database Record

Factors That Influence Women to Disclose Sexual Assault History to Health Care Providers

OBJECTIVE

To examine women's experiences with sexual assault screening by health care professionals and identify factors that influence women to disclose their sexual assault history to providers.

DESIGN

Cross-sectional descriptive survey with correlational analysis.

SETTING

On-line survey distributed nationally.

PARTICIPANTS

One hundred forty-three women.

METHODS

Participants were recruited through social media; the authors e-mailed organizations across the nation and asked them to share links to a Facebook page connected to the survey. Descriptive statistics, Spearman's rho, and contingency tables were calculated, and qualitative content analysis was performed by thematic analysis.

RESULTS

Most (n = 103, 72.5%) participants reported that they felt comfortable with being asked about sexual assault, but only 41 (28.7%) participants were screened for sexual assault by health care professionals. Positive attitude and increased comfort level with screening were associated with increased intention to disclose past assault (p < .05). A total of 113 (82.5%) women reported intentions to disclose sexual assault to a provider if asked, whereas only 35 (24.6%) women would voluntarily disclose. Women identified prevention of medical and physical consequences as main facilitators to disclosure, and provider attitude and demeanor as the main barriers. Sixty-nine (48.9%) participants were victims of sexual assault. Women with a history of sexual assault were no more likely than women not victimized to have been screened for sexual assault.

CONCLUSION

Study findings suggest that women are often not screened for sexual assault despite being receptive to inquiry. Health care professionals often do not identify those who have been sexually assaulted because they do not ask. Thus, many victims do not receive needed sexual assault resources and support.

Examining the psychosocial determinants of women's decisions to delay childbearing

STUDY QUESTION

What are the psychosocial determinants of women's intentions to delay childbearing until after 35 years?

SUMMARY ANSWER

Attitudes, pressure from important others, perceived self-confidence and anticipated regret all influence the decision-making process of women aged 18-30 years to defer their attempts to conceive their first child until 35+ years.

WHAT IS KNOWN ALREADY

Research has consistently demonstrated that, for many women, the decision to delay childbearing can lead to 'unintentional childlessness' due to a failure to consider the impact of age-related fertility decline. A large body of literature has also found strong links between age-related involuntary infertility and negative psychological impacts, including an increased prevalence of anxiety, depression, guilt, stigma and poor mental health.

STUDY DESIGN, SIZE, DURATION

The study initially conducted focus groups designed to ascertain important beliefs informing participants' intentions to delay childbearing. A subsequent larger-scale quantitative questionnaire followed.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants (n = 358) were female, aged between 18 and 30 years, lived in Australia, identified as being open to the idea of having children, were heterosexual, had not already had children, were not already pregnant, and had not received a diagnosis of medical infertility prior to participating.

MAIN RESULTS AND THE ROLE OF CHANCE

Hierarchical multiple regression analyses showed strong support for psychosocial predictors of attitude, pressure from others and perceived self-confidence as predictors of women's intentions to delay childbearing, accounting for 59% of total variance. The extended model that included anticipated regret, accounted for a significant additional 4.4% variance in intention to delay childbearing past the age of 35 years.

LIMITATIONS, REASONS FOR CAUTION

Proportionally more participants were younger, Caucasian, and were university students, thus limiting the generalizability of results to the wider Australian community. Future research in this domain is recommended to adopt a prospective design and incorporate a measure of behaviour to investigate the link between intentions to delay childbearing and future fertility behaviour.

WIDER IMPLICATIONS OF THE FINDINGS

This research augments our understanding of the decision-making process and key beliefs underlying the decision to delay childbearing. Further efforts are needed to advise young women to investigate their fertility options during the peak of their reproductive years in order to prevent negative psychological consequences associated with unintentional childlessness.

STUDY FUNDING/COMPETING INTERESTS

None.

Modeling Psychologists’ Ethical Intention

At the core of all therapeutic and medical practice lies ethics. By applying an expanded Ajzen’s Theory of Planned Behavior formulation, the present investigation tested a model for explaining psychologists’ intention to behave ethically. In the pretest, dual relationships and money conflicts were seen as the most prevalent dilemmas. A total of 395 clinical psychologists filled out questionnaires containing either a dual relationship dilemma describing a scenario where a psychologist was asked to treat a son of a colleague or a money-focused dilemma where he or she was asked to treat a patient unable to pay for the service. Results obtained from applying the expanded Ajzen’s model to each dilemma, generally, supported the study hypotheses. In particular, attitudes were seen as the most important predictor in both dilemmas followed by a morality component, defined here as the commitment of the psychologist to the patient included here as an additional predictor in the model. The expanded model provided a better understanding of ethical intention. Practical implications were also discussed.

How Internal Political Efficacy Translates Political Knowledge Into Political Participation: Evidence From Germany

This study presents evidence for the mediation effect of political knowledge through political self-efficacy (i.e. internal political efficacy) in the prediction of political participation. It employs an action theoretic approach-by and large grounded on the Theory of Planned Behaviour-and uses data from the German Longitudinal Election Study to examine whether political knowledge has distinct direct effects on voting, conventional, and/or unconventional political participation. It argues that political knowledge raises internal political efficacy and thereby indirectly increases the chance that a citizen will participate in politics. The results of mediated multiple regression analyses yield evidence that political knowledge indeed translates into internal political efficacy, thus it affects political participation of various kinds indirectly. However, internal political efficacy and intentions to participate politically yield simultaneous direct effects only on conventional political participation. Sequentially mediated effects appear for voting and conventional political participation, with political knowledge being mediated by internal political efficacy and subsequently also by behavioural intentions. The mediation patterns for unconventional political participation are less clear though. The discussion accounts for restrictions of this study and points to questions for answer by future research.

A systematic review of behavioural interventions to increase maternal calcium intake

Pregnancy and lactation are a time when adequate calcium consumption is essential for the development of the fetus and to ensure the health of the mother. Over 50% of Canadian women of childbearing and rearing age fail to meet the recommended daily intake of calcium. Identification of effective behavioural intervention strategies for increasing calcium intake is needed within this specific population. This paper brings together all published behavioural interventions designed to increase calcium consumption in pregnant, lactating or post-partum mothers in a systematic review. Relevant studies were obtained through searches of MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Library with no date restrictions. Studies were evaluated using previously published criteria for evaluating calcium behaviour change interventions. This systematic literature review identified five behavioural calcium interventions conducted within this population. Three interventions aimed to improve overall dietary behaviours, the fourth aimed to promote breastfeeding (including increasing calcium consumption) and the fifth aimed to increase daily servings of yoghurt. Only one of the five interventions yielded large effect sizes, with a mean change of 954 mg of calcium per day post-intervention. The number of behavioural change techniques did not appear to be related to intervention efficacy. Only one study used a theoretical framework to guide the intervention. This review highlights the lack of research examining behaviour change interventions aimed at increasing calcium consumption in pregnant, lactating and post-partum women and provides practical suggestions for researchers wishing to intervene with this population in the future.

Perceptions of Human Papillomavirus (HPV) infection and acceptability of HPV vaccine among men attending a sexual health clinic differ according to sexual orientation

Our aim was to gain a better understanding of the knowledge about Human Papillomavirus (HPV) infection and attitudes toward the HPV vaccine among men at risk for sexually transmitted infections (STI). A self-administered questionnaire was completed by attendees of the largest STI Center in Rome, Italy, from April to June 2013. Determinants of vaccine acceptability were investigated using a Structured Equation Model. A total of 423 males participated in the survey: 296 (70.0%) men who have sex with men (MSM) and 127 (30.0%) men who have sex with women (MSW). Only one half of the participants knew that HPV is the cause of genital warts (56.9% of MSM vs. 49.5% of MSW, p=0.28). Even less were aware that HPV causes cancer in men (37.2% vs. 27.3%, p=0.08). MSW were more likely to indicate HPV as a cause of cervical cancer (80.8% vs. 69.3%, p=0.03) and to have heard about the vaccine (58.3 vs. 43.6%, p=0.01). Moreover, 72.1% of MSM and 70.3% of MSW were willing to be vaccinated. A rise of one-unit in the HPV awareness score increased the OR of vaccine acceptability among MSM by 25% (OR 1.25, 95%CI: 1.05-1.49; p=0.013). Differently, only attitudes had a relevant effect on willingness to be vaccinated among MSW (OR 3.32, 95%CI: 1.53-7.17; p=0.002). Efforts should be made to maximize awareness of HPV, especially as a causative agent of genital warts and male cancers, and to reinforce positive attitudes toward vaccination among men visiting STI centers.

Understanding the determinants of Australian hospital nurses' hand hygiene decisions following the implementation of a national hand hygiene initiative

Hand hygiene is the primary measure in hospitals to reduce the spread of infections, with nurses experiencing the greatest frequency of patient contact. The '5 critical moments' of hand hygiene initiative has been implemented in hospitals across Australia, accompanied by awareness-raising, staff training and auditing. The aim of this study was to understand the determinants of nurses' hand hygiene decisions, using an extension of a common health decision-making model, the theory of planned behaviour (TPB), to inform future health education strategies to increase compliance. Nurses from 50 Australian hospitals (n = 2378) completed standard TPB measures (attitude, subjective norm, perceived behavioural control [PBC], intention) and the extended variables of group norm, risk perceptions (susceptibility, severity) and knowledge (subjective, objective) at Time 1, while a sub-sample (n = 797) reported their hand hygiene behaviour 2 weeks later. Regression analyses identified subjective norm, PBC, group norm, subjective knowledge and risk susceptibility as the significant predictors of nurses' hand hygiene intentions, with intention and PBC predicting their compliance behaviour. Rather than targeting attitudes which are already very favourable among nurses, health education strategies should focus on normative influences and perceptions of control and risk in efforts to encourage hand hygiene adherence.

Raising Public Awareness: The Role of the Household Sector in Mitigating Climate Change

In addition to greenhouse gas emissions from the industrial, transportation and commercial sectors, emissions from the household sector also contribute to global warming. By examining residents of Taiwan (N = 236), this study aims to reveal the factors that influence households’ intention to purchase energy-efficient appliances. The assessment in this study is based on the theory of planned behavior (TPB), and perceived benefit or cost (BOC) is introduced as an independent variable in the proposed efficiency action toward climate change (ECC) model. According to structural equation modeling, most of the indicators presented a good fit to the corresponding ECC model constructs. The analysis indicated that BOC is a good complementary variable to the TPB, as the ECC model explained 61.9% of the variation in intention to purchase energy-efficient appliances, which was higher than that explained by the TPB (58.4%). This result indicates that the ECC model is superior to the TPB. Thus, the strategy of promoting energy-efficient appliances in the household sector should emphasize global warming and include the concept of BOC.

Concussion under-reporting and pressure from coaches, teammates, fans, and parents

Concussions from sport present a substantial public health burden given the number of youth, adolescent and emerging adult athletes that participate in contact or collision sports. Athletes who fail to report symptoms of a suspected concussion and continue play are at risk of worsened symptomatology and potentially catastrophic neurologic consequences if another impact is sustained during this vulnerable period. Understanding why athletes do or do not report their symptoms is critical for developing efficacious strategies for risk reduction. Psychosocial theories and frameworks that explicitly incorporate context, as a source of expectations about the outcomes of reporting and as a source of behavioral reinforcement, are useful in framing this problem. The present study quantifies the pressure that athletes experience to continue playing after a head impact--from coaches, teammates, parents, and fans--and assesses how this pressure, both independently and as a system, is related to future concussion reporting intention. Participants in the study were 328 male and female athletes from 19 teams competing in one of seven sports (soccer, lacrosse, basketball, softball, baseball, volleyball, field hockey) at four colleges in the northeast region of the United States. Results found that more than one-quarter of the sample had experienced pressure from at least one source to continue playing after a head impact during the previous year. Results of a latent profile mixture model indicated that athletes who experienced pressure from all four of the measured sources were significantly more likely to intend to continue playing in the future than were athletes who had not experienced pressure from all sources, or only pressure from coaches and teammates. These findings underscore the importance of designing interventions that address the system in which athletes make decisions about concussion reporting, including athletes' parents, rather than focusing solely on modifying the individual's reporting cognitions.

Concussion reporting intention: a valuable metric for predicting reporting behavior and evaluating concussion education

OBJECTIVE

This study aimed to evaluate whether preseason concussion knowledge and reporting intention predicted in-season concussion reporting behavior.

DESIGN

Prospective cohort study.

SETTING

Collegiate athletic facility of each participating team.

PARTICIPANTS

National Collegiate Athletic Association Division I men's ice hockey players in 1 conference of competition (n = 116).

INDEPENDENT VARIABLES

Intention to report symptoms of a "minor" concussion and concussion knowledge were assessed at preseason.

MAIN OUTCOME MEASURES

Postseason recall of non-report of postimpact symptoms.

RESULTS

Preseason concussion knowledge was not significantly associated with in-season reporting behavior. Intention to report concussion symptoms was significantly related to in-season reporting behavior. There was a significant interaction between the number of different symptoms experienced and both preseason reporting intention and in-season reporting behavior.

CONCLUSIONS

Evaluations of concussion education programs tend to measure concussion knowledge. The present findings suggest that reporting intention may be more strongly predictive of reporting behavior than concussion knowledge and should be included in evaluations of concussion effectiveness. New concussion education initiatives should consider targeting psychosocial constructs that increase reporting intention.

CLINICAL RELEVANCE

Sports medicine clinicians who are involved in evaluating concussion education programs should measure constructs other than just concussion knowledge. Intention, to report symptoms or to continue play while experiencing symptoms of a concussion, seems to be an important and feasible construct to include as part of proximal evaluations of education effectiveness.

Dredged sediments as a resource for brick production: possibilities and barriers from a consumers' perspective

A possible solution for the oversupply of dredged sediments is their use as a raw material in brick production. Despite the fact that several examples (e.g., Agostini et al., 2007; Hamer and Karius, 2002; Xu et al., 2014) show that this application is feasible, some economic, technical and social limitations interfere with the development of a market of dredged materials in brick production in Flanders. While we describe the main characteristics of the supply side, we focus on the limitations and barriers from the demand side in the present study. Based on a consumers survey we analyze consumers' risk perceptions and attitudes towards bricks produced from dredged sediments. Consumers in Flanders are rather suspicious with respect to bricks produced from dredged sediments and their risk perception is mainly determined by the possibility of a bad bargain (brick of inferior quality) and the connotation with chemical contamination. The willingness to pay for bricks made from dredged sediments is mainly influenced by the age of the respondents, as well environmental awareness, and the respondents' belief in their ability to influence environmental problems. Sensitization and information of customers seems to be of primary importance to make dredged-sediment-derived bricks a successful product.

Predicting People's Intention to Donate Their Body to Medical Science and Research

Predictors of people's intention to register with a body bequest program for donating their deceased body to medical science and research were examined using standard theory of planned behavior (TPB) predictors (attitude, subjective norm, perceived behavioral control) and adding moral norm, altruism, and knowledge. Australian students (N = 221) at a university with a recently established body bequest program completed measures of the TPB's underlying beliefs (behavioral, normative, and control beliefs) and standard and extended TPB predictors, with a sub-sample reporting their registration-related behavior 2 months later. The standard TPB accounted for 43.6%, and the extended predictors an additional 15.1% of variance in intention. The significant predictors were attitude, subjective norm, and moral norm, partially supporting an extended TPB in understanding people's body donation intentions. Further, important underlying beliefs can inform strategies to target prospective donors.

The effectiveness of a web-based resource in improving postconcussion management in high schools

PURPOSE

Because many sports concussions happen during school-sponsored sports events, most state concussion laws specifically hold schools accountable for coach training and effective concussion management practices. Brain 101: The Concussion Playbook is a Web-based intervention that includes training in sports concussion for each member of the school community, presents guidelines on creating a concussion management team, and includes strategies for supporting students in the classroom.

METHODS

The group randomized controlled trial examined the efficacy of Brain 101 in managing sports concussion. Participating high schools (N = 25) were randomly assigned to the Brain 101 intervention or control. Fall athletes and their parents completed online training, and Brain 101 school administrators were directed to create concussion management policy and procedures.

RESULTS

Student athletes and parents at Brain 101 schools significantly outperformed those at control schools on sports concussion knowledge, knowledge application, and behavioral intention to implement effective concussion management practices. Students who had concussions in Brain 101 schools received more varied academic accommodations than students in control schools.

CONCLUSIONS

Brain 101 can help schools create a comprehensive schoolwide concussion management program. It requires minimal expenditures and offers engaging and effective education for teachers, coaches, parents, and students.

Parent and adolescent knowledge of HPV and subsequent vaccination

OBJECTIVE

Human papillomavirus (HPV) vaccination has been shown to have important health benefits, but vaccination rates are low. Parental and adolescent knowledge could possibly promote vaccination, but the relationship between knowledge and subsequent vaccination is unclear. This study examines how strongly HPV vaccination among high-risk adolescents is related to their or their parents' previous knowledge.

METHODS

A longitudinal cohort study enrolled participants from low-income, predominantly African American neighborhoods. Baseline questionnaires measuring knowledge of HPV and HPV vaccination, as well other variables, were completed by 211 adolescents and 149 parents of another adolescent sample. Adolescent vaccination was tracked prospectively for 12 months after baseline by using clinic reporting data. Analyses tested if parent or adolescent knowledge was associated with or predictive of adolescent HPV vaccination.

RESULTS

On average, parents and adolescents answered slightly less than 50% of knowledge items correctly at baseline, with 5% of parents and 10% of adolescents not answering any knowledge items correctly. Within 12 months, 20 of 149 (13.4%) of the parents' daughters received an HPV vaccination and 32 of 211 (15.2%) of the other adolescent sample did so. Neither parental nor adolescent knowledge was associated with or predictive of adolescent vaccination. For example, when testing the relationship between adolescent vaccination and parental knowledge scores, all R(2) values were <0.005. Results were independent of available potential confounders.

CONCLUSIONS

Those with higher levels of knowledge were not more likely to obtain vaccination for themselves or their daughters. Ideally, future interventions will target factors related to vaccination.

Do coaches perceive themselves as influential on physical activity for girls in organised youth sport?

Participation in organised youth sports (OYS) has been recommended as an opportunity to increase young peoples' physical activity (PA) levels. While coaches can potentially influence athletes' PA levels, what has not been explored is the question; do coaches perceive themselves as influential on PA for girls in OYS? Participants were 30 coaches of girls OYS teams aged 9–17 years in the Greater Sydney Metropolitan Area, Australia. Participants took part in a semi-structured interview that lasted approximately 30 minutes. They responded to questions regarding their perceived role as coaches, their perceptions of themselves as role models for PA, their views on their athletes' current PA levels, their opinions on improving their athletes' PA levels, and their perceived challenges as coaches in OYS. Many coaches considered themselves role models for PA due to their own involvement in organised sports. Coaches felt that they were conscious of girls' PA levels during training and could accurately gauge how active girls were. Coaches perceived their training sessions to provide sufficient PA and thus, did not feel the need to try to increase PA during training. Many coaches were cautious about conducting training sessions where the PA intensity was high for prolonged periods because they believed that it could potentially result in dropout from OYS. Coaches' perceived time commitment to OYS, variability of skill/experience amongst girls, and poor parental support as major challenges they experienced in OYS. This study provided a unique insight from the perspective of coaches in OYS. Most coaches felt that they had the potential to influence PA for girls in OYS; however, coaches may underestimate or not fully realise the impact they can have on the girls they coach. Future research should focus on educating coaches to capitalise on the opportunity they have to promote PA through OYS.

L’intention environnementale des dirigeants de PME

Les recherches sur les processus comportementaux environnementaux représentent des thèmes privilégiés dans le champ de la PME. Toutefois, ils sont difficilement saisissables, car ils entrainent des changements de visions, de valeurs, d’attitudes et d’intentions. Par ailleurs, nous en savons peu sur l’intention des dirigeants de PME à l’égard de l’environnement. L’objectif de cet article est d’explorer la nature et la pertinence des relations entre l’intention environnementale des dirigeants et ses déterminants. Cette recherche s’ancre dans le champ de l’entrepreneuriat durable et mobilise la théorie du comportement planifié d’Ajzen (1991). Elle retient une perspective exploratoire à partir d’une enquête auprès de vingt dirigeants de PME du secteur du textile-habillement en Tunisie et d’une analyse lexicale. Les résultats conduisent à la formulation de huit propositions relatives aux déterminants de l’intention environnementale. Ceux-ci concernent plus précisément les conséquences attendues du comportement recherché, les actions entreprises en vue de le réaliser, les pressions des pouvoirs publics et des donneurs d’ordres étrangers, les perceptions des aptitudes environnementales et de la disponibilité des ressources, la nature de l’activité et le souhait d’imiter des modèles d’entrepreneurs.

How to reduce the latent social risk of disease: the determinants of vaccination against rabies in Taiwan

To control the latent social risk of disease, the government usually spreads accurate information and attempts to improve the public’s attitude toward adopting prevention. However, these methods with the Knowledge, Attitudes, and Practices (KAP) model do not always work. Therefore, we used the theory of planned behavior (TPB) to understand dog owners’ behavior and distinguished the knowledge effect as objective knowledge (OK) and subjective knowledge (SK). A total of 310 dog owners completed a questionnaire based on our model. We employed structural equation modeling to verify the structural relationships and found three main results. First, our model was fit, and each path was significant. People with better attitudes, stronger subjective norms, and more perceptive behavioral control have stronger behavioral intention. Second, perceived behavioral control, not attitude, was the best predictive index in this model. Finally, on perceived behavioral control, subjective knowledge showed more influence than objective knowledge. We successfully extended TPB to explain the behavioral intention of dog owners and presented more workable recommendations. To reduce the latent social risk of disease, the government should not only address dog owners’ attitudes, but also their subjective norms and perceptive behavioral control. Indeed, perceptive behavioral control and SK showed the most influence in this model. It is implied that the self-efficacy of dog owners is the most important factor in such a behavior. Therefore, the government should focus on enhancing dog owners’ self-efficacy first while devoted to prevention activities.

Effectiveness of a preventive campaign for noise-induced hearing damage in adolescents

OBJECTIVES

Many studies have documented a high incidence of hearing loss and tinnitus in adolescents after recreational noise exposure. The prevalence of noise-induced symptoms is in contradiction to the low preventive use of hearing protection. The effects of preventive campaigns on the attitudes toward noise in young people are under debate. The aim of the present study is to investigate whether a preventive campaign can alter attitudes toward noise in adolescents and whether this results in an increase of hearing protection use in this population.

METHODS

A cohort of 547 Flemish high school students, aged 14 to 18 years old, completed a questionnaire prior to and after a governmental campaign focusing on the harmful effects of recreational noise and the preventive use of hearing protection. At both occasions the attitudes toward noise and toward hearing protection were assessed by use of the youth attitudes toward noise scale (YANS) and the beliefs about hearing protection and hearing loss (BAHPHL), respectively. These questionnaires fit into the model of the theory of planned behavior which provides a more clear insight into the prediction of a certain behavior and the factors influencing that behavior.

RESULTS

The score on the YANS and the BAHPHL decreased significantly (p < 0.001) implying a more negative attitude toward noise and a more positive attitude toward hearing protection. The use of hearing protection increased significantly from 3.6% prior to the campaign to 14.3% (p = 0.001) post campaign in students familiar with the campaign.

CONCLUSIONS

Measurable alteration of all the variables in the theory of planned behavior caused an increase of the intentions to use hearing protection as well as the actual use of hearing protection. The present study shows the usefulness of the theory of planned behavior to change and guide adolescents' preventive actions toward noise damage. In addition, preventive campaigns can establish attitude and behavioral adjustments. However, the long term effects of preventive campaigns should be investigated in future research.

Understanding concussion reporting using a model based on the theory of planned behavior

PURPOSE

Athlete's report of concussion symptoms to coaching or medical personnel is an important component of concussion risk reduction. This study applies a model based on the Theory of Planned Behavior (TPB) to the prediction of concussive symptom underreporting among late adolescent and young adult male ice hockey players.

METHODS

Participants were members of an American Tier III Junior A ice hockey league (ages 18-21 years; male; n = 256). Twelve of 14 league teams and 97% of players within these teams agreed to participate. Written survey items assessed symptom reporting behavior, intention, perceived norms, self-efficacy, perceived outcomes of reporting, and concussion knowledge. Structural equation modeling was used to assess the significance of relationships hypothesized by the TPB-based model and the overall model fit. Data were collected in January 2013.

RESULTS

Results supported the fit of the TPB-based model in explaining reporting behavior; all model pathways were significant in the hypothesized direction. Of the perceived reporting outcomes assessed, those related to athletic performance were identified as most strongly associated with reporting intention.

CONCLUSIONS

Results of this study suggest the importance of considering factors such as perceived outcomes of reporting, perceived norms, and self-efficacy, in addition to knowledge, when analyzing concussion underreporting among adolescent athletes. As concussion education for athletes becomes increasingly mandated, testing and applying psychosocial theories such as TPB may help increase program efficacy.

Knowledge, attitudes, and practices towards prevention and early detection of chronic kidney disease

OBJECTIVE

To describe the knowledge, attitudes and practices of Jordanian patients with chronic illnesses towards prevention and early detection of chronic kidney disease.

BACKGROUND

Patients with chronic illnesses such as hypertension and diabetes need to adopt healthy attitudes and practices and gain knowledge regarding prevention and early detection of kidney disease to decrease the prevalence of dialysis-related complications and costs.

METHODS

A total of 740 patients were recruited from out-patients clinics in Jordan. Knowledge, attitudes and practices about kidney disease prevention and early detection were measured using the Chronic Kidney Disease Screening Index which was developed by the researcher and tested for validity and reliability.

RESULTS

The results revealed that most of the participants have knowledge about kidney disease; however, half of them had wrong information related to signs and symptoms of chronic kidney disease. The majority of the participants were not aware about the importance of discovering health problems at early stages.

CONCLUSION AND IMPLICATIONS

Improvement in population understanding about chronic kidney disease is needed to advance their awareness and practices to make appropriate decisions towards health promotion and better quality of life.

IMPLICATION FOR POLICY DEVELOPMENT

Nurses need to be involved in development of protocols for screening and intervention programmes, taking into consideration the cultural issues and the financial status of individuals at risk for kidney disease. Governments should adopt a public health policy for chronic kidney disease that supports programmes for screening and programmes for improving public awareness for kidney disease prevention.

The role of communication inequality in mediating the impacts of socioecological and socioeconomic disparities on HIV/AIDS knowledge and risk perception

INTRODUCTION

Although the link between social factors and health-related outcomes has long been widely acknowledged, the mechanisms characterizing this link are relatively less known and remain a subject of continued investigation across disciplines. In this study, drawing on the structural influence model of health communication, the hypothesis that differences in concern about and information needs on HIV/AIDS, HIV/AIDS-related media use, and perceived salience of HIV/AIDS-related information, characterized as communication inequality, can at least partially mediate the impacts of socioecological (urban vs. rural) and socioeconomic (education) disparities on inequalities in HIV/AIDS knowledge and risk perception was tested.

METHODS

Data were collected from a random sample of 986 urban and rural respondents in northwest Ethiopia. Structural equation modeling, using the maximum likelihood method, was used to test the mediation models.

RESULTS

The models showed an adequate fit of the data and hence supported the hypothesis that communication inequality can at least partially explain the causal mechanism linking socioeconomic and socioecological factors with HIV/AIDS knowledge and risk perception. Both urbanity versus rurality and education were found to have significant mediated effects on HIV/AIDS knowledge (urbanity vs. rurality: β = 0.28, p = .001; education: β = 0.08, p = .001) and HIV/AIDS risk perception (urbanity vs. rurality: β = 0.30, p = .001; education: β = 0.09, p = .001).

CONCLUSIONS

It was concluded that communication inequality might form part of the socioecologically and socioeconomically embedded processes that affect HIV/AIDS-related outcomes. The findings suggest that the media and message effects that are related to HIV/AIDS behavior change communication can be viewed from a structural perspective that moves beyond the more reductionist behavioral approaches upon which most present-day HIV/AIDS communication campaigns seem to be based.

Towards improved uptake of malaria chemoprophylaxis among West African travellers: identification of behavioural determinants

BACKGROUND

Malaria is a potentially lethal illness for which preventive measures are not optimally used among all travellers. Travellers visiting friends and relatives in their country of origin (VFRs) are known to use chemoprophylaxis less consistently compared to tourist travellers. In this study, factors explaining the low use of chemoprophylaxis were pursued to contribute to improving uptake of preventive measures among VFRs.

METHODS

Following in-depth interviews with Ghanaians living in Amsterdam, a questionnaire was developed to assess which behavioural determinants were related to taking preventive measures. The questionnaire was administered at gates of departing flights from Schiphol International Airport, Amsterdam (the Netherlands) to Kotoka International Airport, Accra (Ghana).

RESULTS

In total, 154 questionnaires were eligible for analysis. Chemoprophylaxis had been started by 83 (53.9%) and bought by 93 (60.4%) travellers. Pre-travel advice had been obtained by 104 (67.5%) travellers. Those who attended the pre-travel clinic and those who incorrectly thought they had been vaccinated against malaria were more likely to use preventive measures. Young-, business- and long-term travellers, those who had experienced malaria, and those who thought curing malaria was easier than taking preventive tablets were less likely to use preventive measures.

CONCLUSION

Almost half of the VFRs travelling to West Africa had not started chemoprophylaxis; therefore, there is room for improvement. Risk reduction strategies could aim at improving attendance to travel clinics and focus on young-, business and long term travellers and VFRs who have experienced malaria during consultation. Risk reduction strategies should focus on improving self-efficacy and conceptions of response efficacy, including social environment to aim at creating the positive social context needed.

Media use and HIV/AIDS knowledge: a knowledge gap perspective

Despite the widespread utilization of the mass media in HIV/AIDS prevention, little is known about the knowledge gap that results from disparities in mass media use. This study examined the relationship between HIV/AIDS-related mass media use and HIV/AIDS-related knowledge among urban and rural residents of northwestern Ethiopia. A hierarchical regression analysis indicated that HIV/AIDS-related mass media use has both sequestering and mainstreaming effects in certain segments of the study population, although it was not a significant predictor of HIV/AIDS-related knowledge in the total population. The knowledge gaps between individuals with high and low education and between individuals who experience high and low levels of interpersonal communication about HIV/AIDS narrowed as HIV/AIDS-related media use increased, but the gap between urban and rural residents widened. The widening gap could be explained by differences in perceptions of information salience and several theoretical assumptions. Current mass media information campaigns, which are often prepared and broadcast from urban centers, may not only fail to improve the HIV/AIDS knowledge of the rural populace but also put rural populations at a disadvantage relative to their urban counterparts. Communication interventions informed by socioecological models might be helpful to redress and/or narrow the widening knowledge gap between urban and rural residents.

Determinants of HIV/AIDS-related information needs and media use: beyond individual-level factors

Despite the centrality of information and communication in the fight against HIV/AIDS, little research has investigated the factors associated with HIV/AIDS-related information needs and media use in hard-hit Sub-Saharan Africa. This study explored individual-level and socioecological determinants among urban and rural residents in northwest Ethiopia. Urbanity versus rurality, education, direct experience with HIV/AIDS, perceived salience of HIV/AIDS-related information, and personal health concern were tested as predictors. Regression analyses showed that urbanity versus rurality and education are the major determinants of HIV/AIDS-related information needs and media use. Being urbanite and educated were associated with high concern about and information needs on HIV/AIDS and HIV/AIDS-related mass media use. Moreover, urbanity versus rurality and education significantly predicted preferences for specific types of HIV/AIDS-related information. While rurality and low education were associated with a preference for basic HIV transmission and prevention information, urbanity was associated with a preference for information on HIV/AIDS-related care and support. In most cases, urbanity versus rurality emerged as a substantial predictor and also significantly moderated the effects of other variables. Given the evolving nature of the pandemic and its expansion to rural areas, ruralites' low information needs and media use deserve due attention. Equally, communication interventions targeting urban contexts need to move beyond providing only the ABCs of HIV transmission and prevention and should attend to urbanites' progressive information needs, which seem to have now become more on care and support so as to live and deal with the pandemic.

Attitudes and beliefs regarding depression, HIV/AIDS, and HIV risk-related sexual behaviors among clinically depressed African American adolescent females

Individuals' attitudes and beliefs toward behaviors are key indicators of behavioral performance. The purposes of this study were to elucidate attitudes and beliefs about depression, HIV/AIDS, and HIV risk-related sexual behaviors among clinically depressed African American adolescent females and to develop an understanding of their context for HIV risk. For this descriptive qualitative inquiry, semistructured interviews and surveys were employed (N = 24). The narratives reveal that behavioral sequelae of depression (i.e., loneliness) can produce risk for HIV. These findings may guide psychiatric nurse educators, scientists, and practitioners to modify HIV risk among clinically depressed African American adolescent females.

Involvement of citizens in hazardous waste management and use of recycling centres in the city of Madrid (Spain)

In Spain, hazardous household waste management by citizens occurs via fixed recycling centres (FRC) and mobile recycling centres (MRC) which usually depend on local governments. This paper addresses a request by the Madrid City Council, in an attempt to improve the service it provides to the city of Madrid. The aim of the study involved analysing the information people possess in relation to hazardous waste and to the use of available equipment, and conducting a post-evaluation of the effectiveness of an environmental communication campaign conducted by the Madrid City Council and aimed at providing awareness of the existence of new FRCs and MRCs. To this end, a questionnaire was conducted with 5644 inhabitants of the city of Madrid. Qualitative data was categorized using content analysis followed by chi-squared tests, considering some socio-demographic characteristics of the sample, such as age or place of residence (district). Communication campaigns influenced citizen awareness of what constituted hazardous waste, of how to properly separate waste and of the existence of FRCs and MRCs. However, few citizens actually used FRCs or MRC (18% across four districts), a fact that might be related to a lack of knowledge of downstream waste treatment issues, or to self-limiting hindrances to householders, such as distance to recycling centres. It is recommended that future communication campaigns investigate householder needs and pre-conceptions in relation to recycling, as well as tailored education aimed at addressing the barriers, perceived or otherwise, facing citizens.

Training programmes can change behaviour and encourage the cultivation of over-harvested plant species

Cultivation of wild-harvested plant species has been proposed as a way of reducing over-exploitation of wild populations but lack of technical knowledge is thought to be a barrier preventing people from cultivating a new species. Training programmes are therefore used to increase technical knowledge to encourage people to adopt cultivation. We assessed the impact of a training programme aiming to encourage cultivation of xaté (Chamaedorea ernesti-augusti), an over-harvested palm from Central America. Five years after the training programme ended, we surveyed untrained and trained individuals focusing on four potential predictors of behaviour: technical knowledge, attitudes (what individuals think about a behaviour), subjective norms (what individuals perceive others to think of a behaviour) and perceived behavioural control (self assessment of whether individuals can enact the behaviour successfully). Whilst accounting for socioeconomic variables, we investigate the influence of training upon these behavioural predictors and examine the factors that determine whether people adopt cultivation of a novel species. Those who had been trained had higher levels of technical knowledge about xaté cultivation and higher belief in their ability to cultivate it while training was not associated with differences in attitudes or subjective norms. Technical knowledge and perceived behavioural control (along with socio-economic variables such as forest ownership and age) were predictors of whether individuals cultivate xaté. We suggest that training programmes can have a long lasting effect on individuals and can change behaviour. However, in many situations other barriers to cultivation, such as access to seeds or appropriate markets, will need to be addressed.