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

Predicting adherence to ankle-foot orthoses in people with stroke: An application of the Theory of Planned Behavior

BACKGROUND

Ankle-foot orthoses (AFOs) are often prescribed for people with stroke to address motor impairment. However, not all patients adhere to using their AFOs as prescribed. Predictors of AFO adherence are likely to constitute useful targets for interventions that aim to promote this behavior.

OBJECTIVE

To identify the predictors of AFO adherence in people with stroke using an established theoretical framework, namely the Theory of Planned Behavior (TPB; Ajzen, 1991).

STUDY DESIGN

Prospective survey design.

METHOD

N = 49 people who had been prescribed an AFO after a stroke completed a TPB questionnaire. One month later, they completed another questionnaire that measured adherence to AFOs as prescribed by an orthotic practitioner. Predictors of intention and AFO-adherence behavior were identified using regression analyses.

RESULTS

Adherence to AFOs was 63%. The TPB accounted for 61% of the variance in intentions and 43% of the variance in AFO-adherence behavior. Attitude and perceived behavioral control were predictors of intention, and intention was the sole predictor of behavior.

CONCLUSION

The TPB is a useful model for explaining adherence to AFOs in people with stroke. Interventions could be designed to increase intentions to use an AFO as prescribed by promoting positive attitudes towards, and perceived behavioral control of AFO adherence.

How future orientations predict healthy outcomes: Information avoidance as a potential mechanism

This study elucidates whether information avoidance may help explain demonstrated links between future orientation and health. In an online study, college students reported their self-reported prevention and detection health behaviors and responded to a prevention and detection health message. Path analyses indicated that information avoidance mediated the relationship with the future orientations (optimism and consideration of future consequences), such that, greater and more positive future orientations were associated with less information avoidance, and less information avoidance was associated with greater self-reported health behaviors and positive responses to health information. Correlational analyses revealed that information avoidance was particularly related to health outcomes, and to a greater extent than future orientations. Our findings join a growing literature showing the importance of information avoidance for a variety of health behaviors and suggest a potential intervention target for individuals whose characteristic ways of (not) thinking about their future might keep them unaware and unhealthy.

Development of an epilepsy self-management mobile health app framework: Content validity study results

BACKGROUND

Mobile health (mHealth) applications (apps) show promise in supporting epilepsy self-management (eSM). To delve deeper into this potential, we conducted a systematic review of epilepsy mHealth apps available on both iOS and Android platforms, examining articles related to eSM. This review allowed us to identify important domains related to eSM. Furthermore, based on the findings, we developed an epilepsy mHealth app framework that aims to improve self-management for the local population. This study aims to assess the practicality and usability of the proposed mHealth app framework designed to improve eSM. We will conduct an expert panel review to evaluate the effectiveness and feasibility of the framework.

MATERIAL AND METHODS

Content validity was assessed by an expert panel comprising epileptologists and pharmacists. The validation process involved scoring the items within each domain of the framework to evaluate their practicality and usability (quantitative component). In addition, a panel discussion was conducted to further explore and discuss the qualitative aspects of the items.

RESULTS

A total of 4 domains with 15 items were highly rated for their practicality and usefulness in eSM.

CONCLUSIONS

The locally validated framework will be useful for developing eSM mobile apps. Seizure Tracking, Medication Adherence, Treatment Management, and Healthcare Communication emerged as the most crucial domains for enhancing eSM.

Understanding the intention and behavior of psychological help-seeking among Chinese college students using theory of planned behavior: a three-month follow-up study

Underutilization of mental health services is common and associated with substantial suffering, mental disorders and death. The present study aimed to explore factors significantly affecting the professional psychological help-seeking behavior based on the Theory of Planned Behavior (TPB). A sample of 597 Chinese college students recruited online completed the questionnaires, which measured four constructs of TPB including help-seeking intention, attitude, subjective norm and perceived behavioral control in December 2020. Help-seeking behaviors were evaluated three months later in March 2021. A two-step structural equation modeling procedure was used to test the TPB model. Findings show that partially consistent with TPB, more positive attitudes about seeking professional help (Β = .258, p = .001) and higher perceived behavioral control (Β = .504, p < .001) directly predicted higher intention to seek mental health services, and perceived behavioral control (Β = .230, p = .006) directly predicted help-seeking behavior. However, behavioral intention (Β = -.017, p = .830) did not statistically significantly predict help-seeking behavior, while subjective norm (Β = .047, p = .356) did not predict help-seeking intention as well. The model accounted for 49.9% of the variance modeling help-seeking intention and 12.4% of the variance modeling help-seeking behavior. The results revealed the importance of attitude and perceived behavioral control in predicting help-seeking intention and behavior among Chinese college students and indicated that there existed a gap between intention and actual help-seeking behavior.

Impact of Perceived and Collective Norms on COVID-19 Preventive Behaviors in 23 Countries: A Multi-Level Approach

Social norms can be studied at both the individual and societal levels. While the influence of individual perceived norms on health behaviors has been well-documented, the role of societal-level factors in social normative influence remains unclear. We adopted a multilevel approach to investigate the impact of individual-level perceived norms, country-level collective norms, and individualistic culture on mask-wearing behavior during the COVID-19 pandemic. A secondary analysis of cross-sectional data collected from 23 countries (N = 450,223) was conducted. The findings reveal that perceived descriptive norms, perceived injunctive norms, and collective norms conjointly influenced mask-wearing behavior. Positive relationships between perceived descriptive and injunctive norms and mask wearing were stronger in countries with a higher collective norm. Furthermore, positive relationships between norms (i.e., perceived descriptive norms, perceived injunctive norms, and collective norms) and mask wearing were stronger in countries with a more individualistic culture. The study provides evidence for theorizing social normative influence beyond the individual level and underscores the importance of incorporating multilevel factors in social norm research.

First test of the theory of reasoned goal pursuit: predicting physical activity

OBJECTIVE

This study applied the theory of reasoned goal pursuit (TRGP) in predicting physical activity among Australian undergraduate students, providing the first empirical test of the model.Methods: The research comprised an elicitation study (N = 25; MAge= 25.76, SDAge= 11.33, 20 female, 5 male) to identify readily accessible procurement and approval goal beliefs and behavioural, normative, and control beliefs; and, a two-wave prospective online survey study (N = 109; MAge = 21.88, SDAge = 7.04, 63 female, 46 male) to test the tenets of the TRGP in relation to meeting World Health Organization physical activity guidelines during the COVID-19 pandemic among first year university students.Results: A linear PLS-SEM model displayed good fit-to-data, predicting 38%, 74%, and 48% of the variance in motivation, intention, and physical activity, respectively. The model supported the majority of hypothesised pattern of effects among theory constructs; in particular, the proposition that beliefs corresponding to procurement and approval goals would be more consequential to people's motivation and, thus, their intentions and behaviour, than other behavioural and normative beliefs, respectively.Conclusions: Results lend support for the TRGP and sets the agenda for future research to systematically test the proposed direct, indirect, and moderation effects for different health behaviours, populations, and contexts.

Supplemental data for this article is available online at https://doi.org/10.1080/08870446.2022.2026946 .

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.

Can temporal self-regulation theory and its constructs predict medication adherence? A systematic review and meta-analysis

The relationships between temporal self-regulation theory (TST) constructs (intention, behavioural prepotency and self-regulatory capacity) and medication adherence should be established before further applying the theory to adherence. Searches of PsychINFO, Medline, EMBASE, CINAHL and Web of Science were conducted in 2019 (updated November 2021). Studies had to be original quantitative research, assessed the relationship between one of the constructs and adherence in one illness, and used an adult population. The risk of bias was assessed using the NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Three meta-analyses were conducted using R. Moderation analyses were also conducted. A total of 57 articles (60 studies) with 13,995 participants were included, with 7 studies included in more than one analysis. Results identified significant correlations between intention (r = .369, [95% CI: .25, .48]), behavioural prepotency (r = .332, [95% CI: .18, .48]), self-regulatory capacity (r = .213, [95% CI: .10, .32]) and adherence. There was some evidence of publication bias and no significant moderators. No studies explored the interactions in the theory, so whilst the constructs adequately predict adherence, future research should apply the theory to adherence in a specific illness to assess these relationships. Pre-registered on Prospero: CRD42019141395.

Addressing message fatigue for encouraging COVID-19 vaccination

During the prolonged COVID-19 pandemic, health communication researchers and practitioners should be aware of the unintended effects of message fatigue. Message fatigue is a motivational state caused by repeated and prolonged exposure to similar health-related messages that induces resistance to health behaviors. Messages encouraging COVID-19 vaccination tend to focus on scientific evidence and efficacy information. However, prolonged exposure to similarly framed repeated pro-COVID-19 vaccination messages may cause message fatigue, generate psychological reactance, and lead to ineffective persuasive outcomes. Scholars of message fatigue argue that health communication practitioners should select a less common frame to reduce fatigue responses and increase favorable attitudes toward message recommendations. Entering the second year since COVID-19 vaccination has begun, to reduce message fatigue, future pro-COVID-19 vaccination communication should increase the diversity of messages different than the frequently used types. This opinion piece proposes alternative dissemination of cognitive, affective, narrative, and non-narrative pro-COVID-19 vaccination messages.

A systematic review of the theory of planned behaviour interventions for chronic diseases in low health-literacy settings

Background

Due to their chronicity, prolonged morbidity, and high mortality, chronic respiratory diseases (CRDs) pose a huge burden of disease globally, primarily among low- and middle-income countries. Most of these diseases can be controlled by early diagnosis and treatment, correct practice of medications, regular follow-up, and avoidance of risk factors, which involves a change in health behaviour among patients. The theory of planned behaviour (TPB) has been proven to be effective and has been used increasingly as a behavioural framework for designing and evaluating behaviour change interventions, although most such studies were on affluent populations and from the global north. We aimed to collate evidence of TPB-based behavioural interventions in low health literacy settings for its effectiveness and feasibility by conducting a systematic review (SR).

Methods

We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines in conducting and reporting this study. We selected interventional studies using at least two constructs of TPB for behaviour change in chronic disease patients and conducted in LMICs, used the PICO framework, and exported the retrieved studies through the Endnote software. We evaluated the studies using the Risk of Bias (RoB) 2 and Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tools.

Results

We retrieved and reviewed the titles and abstracts 4281 titles and abstracts, identifying 186 articles for further detailed screening. Eleven studies met the criteria for a standardised independent full-text screening by two authors and four were selected for narrative synthesis. All studies were from urban settings, with established feasibility and fidelity; all interventions were effective in changing health behaviour and TPB constructs and provided structured education to participants in the intervention group (either face-to-face and through group education). Three studies had some concerns/moderate risk of bias and one had high risk of bias.

Conclusions

All studies demonstrated effectiveness, feasibility, and fidelity of TPB interventions in LMIC settings, although most were of moderate quality. Further studies should gather definitive evidence and prove their feasibility and utility in LMICs.

Registration

PROSPERO CRD42018104890.

Investigating the Psychological, Social, Cultural, and Religious Predictors of COVID-19 Vaccine Uptake Intention in Digital Age: A Media Dependency Theory Perspective

Media exposure to health communication contents related to the COVID-19 pandemic alone is inadequate to measure the influence of media on individuals in adopting precautionary behaviors against COVID-19, such as vaccine uptake. Certain individuals may pay attention to and be influenced by communication content. However, literature has suggested other instrumental determinants in developing and adopting health precautionary measures, such as culture or religion, especially regarding vaccination. In times of crisis, such as the COVID-19 pandemic, it is valuable to examine the interrelationships among psychological, sociocultural, and informational factors. This can provide valuable insights for policymakers in developing effective communication strategies. Drawing an analogy between the Media dependency theory (MDT) and the Theory of Planned Behavior (TPB) model, this study unravels the factors underpinning the COVID-19 vaccine uptake intention among Pakistanis. The study utilized a cross-sectional research design and employed a survey method to gather data from a sample of 993 participants. The findings obtained from the PLS-SEM analysis confirmed that individuals relied on both traditional and social media to cope with the COVID-19 pandemic. The findings show that individuals rely more on the informational content disseminated through conventional media channels. The findings also suggest that individuals from Asian countries, such as Pakistan, tend to be more inclined toward collectivism. The findings about the moderating role of religiosity suggest that religious beliefs significantly shape individuals' reliance on traditional media. Hence, this study has uniquely contributed to public health and media management by providing a strategy for managers to address disseminating misinformation related to religion and its impact on vaccination-related health issues. The study has theoretically confirmed the principles of media dependency theory. As a result, it is recommended that various information sources be utilized to cultivate resilience among individuals to manage health crises effectively.

The Intention of Inhaled Medication Adherence Scale (IMAS): The Development of a New Instrument for Assessing Inhaled Medication Adherence Among Patients with Chronic Obstructive Pulmonary Disease (COPD) Using Theory of Planned Behavior

Purpose

Inhaled medication adherence is an important issue for patients with chronic obstructive pulmonary disease (COPD) because adhering to inhaled medications could substantially improve their health. However, patients with COPD may not be always adhere to the prescribed inhaled medications. Therefore, understanding the underlying reasons for patients with COPD adhering to inhaled medications is important. The present study used Theory of Planned Behavior (TPB) as a theoretical framework to develop the Intention of Inhaled Medication Adherence Scale (IMAS) and assess its psychometric properties.

Patients and Methods

After reviewing papers using the TPB to design psychometric scales and the TPB scale development guidelines, 28 items were generated for expert evaluation. Eight experts reported that the 28 items all had good content validity (content validity index ranged from 0.88 to 1.00 at item-level; and from 0.981 to 0.987 at scale-level) comprising four factors. Following initial development, 235 patients with COPD (mean age 73.12 years; 93.6% males) completed the IMAS via interview with a respiratory therapist and a research assistant. The four-factor structure of the IMAS was evaluated using confirmatory factor analysis (CFA).

Results

Nine IMAS items were removed because of low factor loadings or offending estimates. The 19-item IMAS was confirmed as having a four-factor structure supported by the CFA results (comparative fit index=1.00; Tucker-Lewis index=1.00; root mean square error of approximation=0.00; standardized root mean square residual=0.06).

Conclusion

The 19-item IMAS had satisfactory psychometric properties in construct validity. The 19-item IMAS is an instrument that could help healthcare providers understand potential factors associated with adherence to inhaled medications among people with COPD.

Examining health sciences students' intention to uptake COVID-19 vaccination using the theory of planned behavior

To examine the association between the theory of planned behavior (TPB) constructs and Health Sciences students' intentions to receive COVID-19 vaccination. A cross-sectional study was conducted in Saudi Arabia by recruiting Health Sciences students as participants. Using Structural Equation Modeling (SEM), the proposed TPB model was evaluated. The sample of 505 individuals consisted of more males (n = 275; 54.5%) than females and was relatively young (88% were between the ages of 18 and 30). The suggested TPB model explained 78.2% of the variation in intention to get COVID-19 immunization. We found that greater levels of perceived behavioral control (β = 1.58, p < .001) and attitude (β = .44, p < .001) strongly predicted increased vaccination intentions. The subjective norm construct was not a significant predictor of vaccination intentions (β = 0.06, p = .34). The findings of this study indicate that the TPB can be utilized effectively to obtain insight into the factors associated with COVID-19 adherence and help in the development of effective COVID-19 intervention strategies.

Illness perception and treatment adherence in haemodialysis: a systematic review

Patients with kidney failure need lifelong renal replacement therapy to survive and, worldwide, in-centre haemodialysis is the most common modality. The efficacy of this treatment largely depends on the patients' adherence to several health behaviours. According to Leventhal's self-regulation model, patients' illness perceptions can be a key factor for treatment adherence. Therefore, it is of utmost importance to better understand this relationship to further fine-tune the effectiveness of renal rehabilitation programs. This study aimed to systematically review the literature on the association between illness perceptions and treatment adherence in adults undergoing in-centre haemodialysis. The search was performed on PubMed, Scopus, CINAHL, Web of Science (all databases included), and ProQuest (all databases included), from the 17th to the 21st of December 2020. The last update was performed on the 9th of June of 2022. Articles were critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists for Analytical Cross-Sectional Studies. Nine studies were included comprising a total of 1161 patients undergoing in-centre haemodialysis. Associations between illness perceptions and treatment adherence were found in six studies. Adherence to dietary restrictions was the type of adherence with more significant associations with illness perceptions, followed by fluid control and medication intake. Two studies combining several types of adherences into an overall score also showed significant associations with illness perceptions. No significant associations were found between illness perceptions and adherence to dialysis sessions. These findings suggest that illness perceptions in patients undergoing in-centre haemodialysis should continue to receive research attention. Future interventions should acknowledge the importance of modifying maladaptive illness perceptions to improve treatment adherence in kidney failure. The protocol for this systematic review was registered on PROSPERO (CRD42021231929).

Medication nonadherence: health impact, prevalence, correlates and interventions

Nonadherence to medicines is a global problem compromising health and economic outcomes for individuals and society. This article outlines how adherence is defined and measured, and examines the impact, prevalence and determinants of nonadherence. It also discusses how a psychosocial perspective can inform the development of interventions to optimise adherence and presents a series of recommendations for future research to overcome common limitations associated with the medication nonadherence literature. Nonadherence is best understood in terms of the interactions between an individual and a specific disease/treatment, within a social and environmental context. Adherence is a product of motivation and ability. Motivation comprises conscious decision-making processes but also from more 'instinctive', intuitive and habitual processes. Ability comprises the physical and psychological skills needed to adhere. Both motivation and ability are influenced by environmental and social factors which influence the opportunity to adhere as well as triggers or cues to actions which may be internal (e.g. experiencing symptoms) or external (e.g. receiving a reminder). Systematic reviews of adherence interventions show that effective solutions are elusive, partly because few have a strong theoretical basis. Adherence support targeted at the level of individuals will be more effective if it is tailored to address the specific perceptions (e.g. beliefs about illness and treatment) and practicalities (e.g. capability and resources) influencing individuals' motivation and ability to adhere.

Development and Validation of a Multivariable Exercise Adherence Prediction Model for Patients with COPD: A Prospective Cohort Study

Purpose

Pulmonary rehabilitation (PR) is considered a cost-effective method of improving health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). However, increasing demand and increasing costs of supply demands for sustainable and affordable care. One of the possible solutions to keep care affordable is self-management. A challenge here is non-adherence. Understanding who are adherent and who are non-adherent could be helpful to differentiate between patients who need more or less support. Therefore, the aim of this study was to develop and validate a model to predict adherence to PR in patients with COPD.

Patients and methods

A multivariable logistic regression model for exercise adherence was developed. Eight candidate predictors, that were prespecified, were obtained in a prospective cohort study from 196 patients with COPD following PR in 53 primary physiotherapy practices in the Netherlands and Belgium, between January 2021 and August 2022. To create a parsimonious model, variable selection using backward selection was performed with a p-value of >0.05 for elimination. Model performance was assessed by discrimination, calibration and clinical utility. Internal validation was assessed by bootstrapping (n = 500).

Results

The final model included four predictors: intention, depression, MRC-score and alliance. The optimism-corrected AUC after bootstrap internal validation was 0.79 (95% CI, 0.72-0.85). Calibration plots suggested good calibration and decision curve analysis showed great net benefit in a wide range of risk thresholds.

Conclusion

The exercise adherence prediction model has potential for clinical utility to predict adherence in patients with COPD. Information from such a model can be used to manage the patient instead of managing the disease, and thereby to determine the treatment frequency for each individual patient. As a result, healthcare capacity might be better distributed, potentially reducing pressure on healthcare without compromising the effectiveness of PR for the individual patient.

Applying the temporal self-regulation theory to understand sugar-sweetened beverage consumption among Chinese college students

Objective

Worldwide, there is a growing trend that college students are consuming more and more sugar-sweetened beverages (SSBs). In order to develop effective intervention strategies, it is important to explore what social-cognitive factors impact on college students' SSB consumption. Building on the temporal self-regulation theory (TST), the current study aimed to examine the effects of intention, behavioral prepotency, and self-regulatory capacity on SSB consumption among college students.

Design

Data were collected from five hundred Chinese college students online. Participants self-reported their intention, behavioral prepotency (environmental cues and habits), self-regulatory capacity, and behaviors of SSB consumption.

Results

Study findings showed that intention, behavioral prepotency, and self-regulatory capacity accounted for 32.9% of variance in SSB consumption. In terms of the direct effects, intention, behavioral prepotency, and self-regulatory capacity were significantly associated with the SSB consumption among college students. In addition, self-regulatory capacity and habits but not the environmental cues showed significant moderation effects on the intention-SSB consumption path, indicating that individual factors rather than environmental cues influenced the intention-behavior path of SSB consumption among college students.

Conclusion

Findings of the current study demonstrated that the TST can be used to explain and understand the impacts of social-cognitive factors on college students' SSB consumption. Future research can apply TST to develop effective intervention programs targeting the reduction of SSB consumption among college students.

Applying the theory of planned behavior to investigate type 2 diabetes patients' intention to receive injection therapy

Objectives

This study applied the theory of planned behavior (TPB) in shared decision making (SDM) to understand behavioral intention in patients with type 2 diabetes with regard to injection therapy for blood sugar control.

Methods

A cross sectional study was conducted. Two hundred and fifty-four patients with type 2 diabetes participated this study and were interviewed by pharmacists in different clinics. A patient decision aid (PDA) entitled "Should I receive injection therapy regarding my type 2 diabetes condition?" was developed for this study and served as interview agenda which comprised 18 items to inquire their willingness to use injection therapy and related considerations during the SDM process.

Results

The questionnaires were revised using item analysis, exploratory factor analysis, and a criteria of Cronbach's α > 0.7. This resulted in three constructs for all questionnaires that fit the TPB model. Attitude (β = 0.432; P < 0.001) and PBC (β = 0.258; P < 0.001) were directly correlated with intention. TPB explained 35.2% of the variance in intention toward the use of injection therapy.

Conclusions

Attitude and PBC toward injection therapy positively and significantly influence the patients' intention to use injection therapy.

Practical implications

These findings identify a key association for understanding behavioral intention in patients with type 2 diabetes with regard to blood sugar control during SDM.

How message appeals and prior product use influence information processing, risk perceptions, trust, attitudes, and genetic test purchase intentions

Within the direct-to-consumer (DTC) genetic test industry, attracting customers can be difficult especially due to the highly sensitive nature of these products. How these tests are communicated to consumers may be one avenue in which companies can impact customer purchase intentions. A 2 (message sidedness: one-way vs. two-way refutational) x 2 (hedging: present vs. absent) between-subjects experiment was conducted to understand how message features and prior product use influence information processing, risk and trust perceptions, and attitude toward the genetic test, which in turn, may influence direct-to-consumer (DTC) genetic test purchase intentions. Results demonstrated that having used a genetic test in the past predicted participants' trust in the company, information processing, and risk judgments; however, among those who used a genetic test, viewing a message that included hedging tended to increase their trust in the message. Trust in the message and company, information processing, and risk judgments significantly predicted participants' attitudes toward genetic testing, which in turn predicted their purchase intentions. The results suggest that in the context of DTC genetic test messaging, practitioners should strive to increase consumer trust in the message and the company and facilitate information processing, and they should work to diminish perceived risk. These results suggest opportunities for identifying other message features that may influence message and company trust, information processing, risk judgments, and attitudes related to DTC genetic testing.

Using Intervention Mapping to Develop an mHealth Intervention to Support Men Who Have Sex With Men Engaging in Chemsex (Budd): Development and Usability Study

BACKGROUND

Chemsex refers to the intentional use of drugs before or during sex among men who have sex with men (MSM). Engaging in chemsex has been linked to significant negative impacts on physical, psychological, and social well-being. However, no evidence-based support tools have addressed either these harms or the care needs of MSM who engage in chemsex.

OBJECTIVE

The purpose of this paper was to describe the development of a mobile health intervention (named Budd) using the intervention mapping protocol (IMP). Budd aims to support and inform MSM who participate in chemsex, reduce the negative impacts associated with chemsex, and encourage more reasoned participation.

METHODS

The IMP consists of 6 steps to develop, implement, and evaluate evidence-based health interventions. A needs assessment was carried out between September 2, 2019, and March 31, 2020, by conducting a literature study and in-depth interviews. Change objectives were selected based on these findings, after which theory-based intervention methods were selected. The first version of the intervention was developed in December 2020 and pilot-tested between February 1, 2021, and April 30, 2021. Adjustments were made based on the findings from this study. A separate article will be dedicated to the effectiveness study, conducted between October 15, 2021, and February 24, 2022, and implementation of the intervention. The Budd app went live in April 2022.

RESULTS

Budd aims to address individual factors and support chemsex participants in applying harm reduction measures when taking drugs (drug information, drug combination tool, and notebook), preparing for participation in a chemsex session (articles on chemsex, preparation tool, and event-specific checklist), planning sufficient time after a chemsex session to recover (planning tool), seeking support for their chemsex participation (overview of existing local health care and peer support services, reflection, personal statistics, and user testimonials), taking HIV medication or pre-exposure prophylaxis in a timely manner during a chemsex session (preparation tool), and contacting emergency services in case of an emergency and giving first aid to others (emergency information and personal buddy).

CONCLUSIONS

The IMP proved to be a valuable tool in the planning and development of the Budd app. This study provides researchers and practitioners with valuable information that may help them to set up their own health interventions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/39678.

Psychosocial factors related to the behavioral intention of people with type 2 diabetes using insulin

OBJECTIVES

to analyze the psychosocial factors correlated with the behavioral intention of people with Type 2 Diabetes Mellitus (T2DM) towards insulin use.

METHODS

a cross-sectional study; a validated instrument based on the Theory of Planned Behavior was used to identify the direct measures (attitude, subjective norm and perceived control), indirect measures (behavioral, normative and control beliefs) and behavioral intention for the use of insulin. Descriptive analysis and Spearman's correlation were performed for data analysis.

RESULTS

a total of 211 individuals participated in the study, with a positive median of behavioral intention. Attitude, normative and behavioral beliefs were the psychosocial factors that presented a significant correlation (r=0.16, r=-0,15 and r=0.25, respectively; p<0.05) with the intention.

CONCLUSIONS

there is a positive behavioral intention in the use of insulin by people with T2DM. Attitude, normative beliefs and behavioral beliefs have a low magnitude correlation with the intention of people with T2DM to use insulin.

Adherence to Adjuvant Therapy in Patients with Resected Melanoma: An Application of the Theory of Planned Behavior

INTRODUCTION

Adherence to adjuvant therapy is crucial for effective disease management in patients with resected melanoma. This study assessed patient-reported adherence to adjuvant therapy and identified behavioral/belief constructs associated with adherence in patients with resected melanoma.

METHODS

Patients with resected stage III/IV melanoma were recruited through the Melanoma Research Foundation and a patient panel to complete an online survey. Patient characteristics, medical history, and adherence to therapy were captured. In accordance with the theory of planned behavior (TPB), the survey measured behavioral, normative, and control beliefs, and intention to adhere to therapy. Structural equation modeling (SEM) examined their relationships with adherence.

RESULTS

Among all patients who received adjuvant therapy and completed the survey (n = 184), 69% received intravenous and 31% received oral therapy; the majority (85.3%) were somewhat involved in deciding to start therapy. Mean age was 45 years, 44% of patients were female, and 83% had stage III/IV disease at diagnosis. Patients had a mean disease duration of 1.5 years, a time since complete resection of 10 months, and an adjuvant therapy duration of 8 months. Adherence to adjuvant therapy was high overall and higher with intravenous than with oral therapy (98.4% versus 91.2%, P = 0.002). All underlying TPB constructs were significant in the SEM model, which explained 60.3% of the variance in intention to adhere. Control beliefs had the strongest association with intention to adhere (standardized estimate = 0.47, P < 0.001) and intravenous therapy was associated with greater adherence than oral therapy (standardized estimate = 0.26, P < 0.001).

CONCLUSIONS

This study found that patients with resected melanoma are highly engaged in the decision to initiate systemic adjuvant therapy, with an overall high adherence rate to prescribed adjuvant treatment. Enhancing patients' view of their capability to adhere to treatments may further improve the adherence rate to melanoma adjuvant therapy.

An Application of the Risk Information Seeking and Processing Model in Understanding College Students' COVID-19 Vaccination Information Seeking and Behavior

This study tested the utility of risk information seeking and processing (RISP) model in understanding college students' information seeking about COVID-19 vaccines and their vaccination behavior. Participants (N = 158) completed a survey measuring the RISP constructs at Time 1 and their COVID-19 vaccination behavior at Time 2. The RISP model explained 71.1% of the variance in COVID-19 vaccine information seeking. Risk information seeking and attitude toward the COVID-19 vaccine positively influenced college students' intentions to get the vaccine, which positively predicted their vaccination behavior. Overall, these variables explained 33.4% of the variance in COVID-19 vaccine intention, and 37.2% of the variance in COVID-19 vaccination behavior.

The unappreciated relevance of auxiliary assumptions for evaluating theory-based interventions in health psychology

The use of theory in health behavior change interventions has been recently questioned with mixed results found for theory-based intervention effectiveness. But theory testing in intervention depends on not only theoretical assumptions, but on auxiliary assumptions too. Specifically, auxiliary assumptions are required to traverse the distance from nonobservational terms in theories and observational terms at the level of the empirical hypotheses in interventions. We believe intervention failures are often due to flaws in auxiliary assumptions rather than assumptions at the theoretical level. We use the theory of planned behavior to illustrate how the consideration of these auxiliary assumptions is important to appraise the effectiveness of interventions informed by theory. We hope that bringing attention to the importance of auxiliary assumptions provides a more nuanced and accurate appraisal of theory utility.

Predictors of Medication Adherence of Patients With Coronary Heart Disease After Percutaneous Coronary Intervention: A Structural Equation Modeling Based on the Extended Theory of Planned Behavior

BACKGROUND

The theory of planned behavior (TPB), combined with social support, forms the extended TPB, which has shown to predict adherence to health-related behavior effectively, but few studies have applied it to explain medication adherence in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI).

OBJECTIVES

The aim of this study was to explore the factors associated with medication adherence and the underlying mechanisms based on the extended TPB among patients with CHD after PCI.

METHODS

A cross-sectional descriptive study was conducted among patients with CHD after PCI in 2 major hospitals in Guangzhou, China. Medication adherence was measured with the Medication Adherence Report Scale. Constructs of the TPB contributing to medication adherence were assessed by the Theory of Planned Behavior Questionnaire for Medication Adherence. Social support was measured by the Multidimensional Scale of Perceived Social Support. Structural equation modeling was used to examine the hypotheses based on the extended TPB.

RESULTS

A total of 300 patients were surveyed and 26.0% of them were nonadherent. The structural equation modeling had good fit indices and estimated 62.6% of the variance in medication adherence. Regarding the relationships between the extended TPB constructs and medication adherence, "intention" was directly associated with medication adherence, and "perceived behavioral control" positively predicted medication adherence directly and indirectly. "Affective attitude" and "subjective norm" were indirectly associated with medication adherence through "intention." Social support exerted an indirect effect on medication adherence through "subjective norm."

CONCLUSIONS

The extended TPB is an appropriate model to predict medication adherence and provides an effective framework for adherence-enhancing interventions.

Predicting Hypnotic Use among Insomnia Patients with the Theory of Planned Behavior and Craving

While long-term hypnotic use is very common in clinical practice, the associated factors have been understudied. This study aims to explore the cognitive factors that might influence the long-term use of hypnotics based on the theory of planned behavior (TPB), and examines the moderating effect of craving between cognitive intention and actual hypnotic-use behavior at follow-up. A total of 139 insomnia patients completed a self-constructed TPB questionnaire to measure their attitude, subjective norm, perceived behavioral control, and behavioral intention of hypnotic use, as well as the Hypnotic-Use Urge Scale (HUS) to measure their craving for hypnotics. They were then contacted through phone approximately three months later to assess their hypnotic use. Hierarchical regression showed that perceived behavioral control was the most significant determinant for behavioral intention of hypnotic use. Behavioral intention, in turn, can predict the frequency of hypnotic use after three months. However, this association was moderated by hypnotic craving. The association was lower among the participants with higher cravings for hypnotic use. The findings suggest that the patients’ beliefs about their control over sleep and daily life situations, and their craving for hypnotics should be taken into consideration in the management of hypnotic use.

Theory of planned behaviour-based interventions in chronic diseases among low health-literacy population: protocol for a systematic review

BACKGROUND

Health behaviour can change outcomes in both healthy and unhealthy populations and are particularly useful in promoting compliance to treatment and maintaining fidelity to care seeking and follow-up options in chronic diseases. Interventions to change health behaviour based on psychological theory are more often successful than those without any underlying theory. The theory of planned behaviour (TPB) is one such psychological theory which had been found to predict human behaviour with respect to disease prevention and when applied to interventions can change the outcomes of diseases. Most of the research evidence of TPB-based interventions have been from developed world. Evidence is required whether TPB-based interventions can be applied and works in low-resource, low health-literacy settings of low- and middle-income countries (LMICs).

METHODS

The protocol has been developed as per PRISMA-P guidelines and incorporates PICO (population, intervention, comparison, outcomes) framework for describing the methodology. Population above 18 years of age and having any chronic disease (as defined for this systematic review) will be selected, while any health or educational intervention based on constructs of TPB will be included. Comparison will be with non-TPB-based interventions or treatment as usual without any intervention, and the primary outcome will be the behaviour change effected by the TPB-based intervention. Intervention studies will be considered, and relevant databases like MEDLINE, Embase, Cochrane Library and ProQuest will be explored. Data extraction will done in a standardised form, and risk-of-bias assessment will be done using the Cochrane Collaboration's tools for such assessment. Narrative synthesis of the selected studies will be done to draw the conclusions, and meta-analysis will be done to calculate the effect estimates with I-squared statistics to describe the heterogeneity.

DISCUSSION

This systematic review will provide new evidence on fidelity and effectiveness of the TPB-based interventions among chronic disease patients from low health literacy, resource-poor background. It will inform of how to plan and use such interventions to change health behaviour in chronic disease patients, particularly in LMIC settings.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018104890 .

Predicting college students' COVID-19 vaccination behavior: an application of the extended parallel process model

The two studies reported in the paper examined (1) the extended parallel process model’s (EPPM; Witte 1992) ability to predict and explain college students’ COVID-19 vaccination behavior, and (2) the EPPM-related reasons for college students’ COVID-19 vaccine hesitancy. Study 1 was a longitudinal study that measured the EPPM constructs at Time 1 and COVID-19 vaccine behavior two months later at Time 2. For danger control, results indicate that perceived threat and perceived efficacy positively predicted intentions and that intentions positively predicted behavior. For fear control, results indicate that perceived threat positively predicted fear, that perceived efficacy did not predict fear, and that fear negatively predicted defensive avoidance, reactance, and fatalism. Study 2 was a cross-sectional survey that assessed EPPM-related reasons for vaccine hesitancy. Results indicate that the main reasons for vaccine hesitancy were related to response efficacy (i.e., participants were concerned about the safety and effectiveness of the vaccine). The theoretical and practical implications of these results are discussed.

“I Think Deprescribing as a Whole Is a Gap!”: A Qualitative Study of Student Pharmacist Perceptions about Deprescribing

Introduction: Older adults often manage multiple medications simultaneously, contributing to significant pill burden. Pill burden is a major concern for both patients and providers alike, and student pharmacists may play a role in decreasing that burden. Few studies exist evaluating student pharmacists’ roles in and perceptions of deprescribing in the healthcare team. Thus, the aim of this study was to explore student pharmacist perceptions regarding deprescribing in their pharmacy curricula. Methods: This study used a focus group discussion (FGD) methodology to facilitate discussion on deprescribing among student pharmacists. The theory of planned behavior (TPB) informed the conceptualization of this study, data collection, and thematic analysis. Student pharmacists enrolled in three different colleges of pharmacy across various geographical regions of the U.S. were recruited to participate in the study. Data collection occurred in the Fall of 2021, and recruitment proceeded until thematic saturation was achieved. The audio recordings were transcribed verbatim, and the transcripts were uploaded into Dedoose®, a qualitative software that facilitated the data analysis. The inductive codes were grouped into categories based on similarities that resulted in the themes. Results: Three colleges, totaling 1366 student pharmacists across different geographic regions of the U.S., were invited to participate in this study (UTHSC, N = 682; UNE, N = 158, University of Arizona, N = 526). Twenty-six student pharmacists participated in four FGDs. Of 26 participants, fourteen self-identified as male and two declined to state their gender identity. The mean age was 24 years old, with participants ranging from 21 to 37 years old. Thematic analysis revealed two major themes: (1) student pharmacists indicated that they possessed limited information about the deprescribing process, which is best illustrated by the following quote: “I think deprescribing as a whole is a gap!”; and (2) student pharmacists recommended increasing emphasis on deprescribing in pharmacy curricula. Conclusions: Student pharmacists identified few educational experiences on deprescribing in their curriculum while demonstrating a strong desire for more emphasis on deprescribing in the pharmacy curricula. This study highlights an opportunity to improve the integration of deprescribing education into pharmacy curricula, and colleges of pharmacy should evaluate whether, where, and to what extent the incorporation of this topic into their curricula is appropriate.

Psychological Antecedents of the Intention to Open the Windows at Home and Exposure to a Ventilation Recommendation

Objective

The psychological antecedents of the intention to open the windows at home were explored through the Theory of Planned Behavior (TPB), supplemented with Habits regarding the behavior and contextual factors.

Design

A four-treatment design compared the effect of an exposure to a recommendation about home ventilation and the effect of one's own awareness odors (negative vs. positive) as a manipulated variable. Two quasi-experimental online surveys were conducted. A student sample (Study 1; N = 159) was replicated with a general population sample (Study 2; N = 338).

Results

Multiple hierarchical regression models were conducted (3 for Study 1; 3 for Study 2). The extended TPB model provided stable predictors explaining around sixty percent of variance. Attitude and Habits were the main predictors of window openings, Perceived Behavioral control as a secondary predictor. Perceived Behavioral Control contributed significatively with a negative interaction with Attitudes. Odor awareness decreased Intention to manually ventilate. No effect of recommendation was observed.

Discussion

The results filled a gap in the literature about the willingness to manually ventilate at home and efficacy of a recommendation. Practical implications argue that beyond a generic recommendation, effective messages need to be tailored regarding the determinants of willingness to open the windows.

Psychological predictors of protective behaviours during the Covid-19 pandemic: Theory of planned behaviour and risk perception

The Covid-19 outbreak was declared a public health emergency by the World Health Organization in January 2020. As a consequence, several protective measures were urged by national governments in order to limit the spread of the pandemic. Drawing on the literature on health behaviours, in the present study, we investigated the psychological factors (i.e., attitudes, social norms, perceived behavioural control, intentions, and risk perception) that were associated with two highly recommended behaviours: frequent hand washing and social distancing (i.e., staying at home except for essential reasons). The study employed a correlational design with a follow-up. A questionnaire including measures of psychological predictors was administered via social media to a sample of 403 adults residing in Italy during the lockdown. Self-reported behaviours were assessed one week later. Findings showed that attitudes, social norms, perceived behavioural control were significantly related to hand washing and social distancing through intentions. Risk perception was a significant predictor of social distancing but not of hand washing. These findings suggest that intervention and communication strategies aimed at encouraging preventive measures during the Covid-19 pandemic should be organized taking into account multiple factors which partially differ depending on the type of behaviour considered. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

College students' influenza vaccine hesitation: a reasoned action investigation with quantitative and qualitative data

This two-wave longitudinal study (performed pre-COVID), using both quantitative and qualitative data, investigated college students’ influenza vaccine hesitancy and confidence using the theory of planned behavior (TPB). At Time 1, college students (n = 277) completed TPB measures and reported past influenza vaccine behavior. At Time 2 (30 days later), participants indicated whether they received the influenza vaccine since Time 1. At Time 2, participants who indicated that they had not received the influenza vaccine since Time 1 also described their most important reasons for not doing so. The TPB model fit the quantitative data well; direct paths from attitude and norms to intention, and from intention to future behavior, were strong and significant. The TPB model explained 71% of the variance in intention and 28% of the variance in future behavior. Neither perceived behavioral control nor past behavior improved the model’s ability to predict intentions or future behavior. From the qualitative data, participants’ reasons for not getting vaccinated focused on perceived behavioral control (e.g., time cost) and attitudes (e.g., unimportance and low susceptibility). Theoretical implications for message development are discussed.

Effectiveness of a Pharmacist-Led Web-Based Medication Adherence Tool With Patient-Centered Communication: Results of a Clustered Randomized Controlled Trial

Background

Growing numbers of people use medication for chronic conditions; nonadherence is common, leading to poor disease control. A web-based tool to identify an increased risk for nonadherence with related potential individual barriers might facilitate tailored interventions and improve adherence.

Objective

This study aims to assess the effectiveness of a newly developed tool aimed at improving medication adherence.

Methods

We performed a cluster randomized controlled trial in patients initiating cardiovascular or oral blood glucose–lowering medication. Participants were recruited from community pharmacies. They completed an online questionnaire comprising assessments of their risk for medication nonadherence and subsequently of barriers to adherence. In pharmacies belonging to the intervention group, individual barriers displayed in a graphical profile on a tablet were discussed by pharmacists and patients with high nonadherence risk in face-to-face meetings and shared with their general practitioners and practice nurses. Tailored interventions were initiated by pharmacists. Barriers of control patients were not presented nor discussed and these patients received usual care. The primary outcome was the effectiveness of the intervention on medication adherence at 8 months’ follow-up between patients with an increased nonadherence risk from the intervention and control groups, calculated from dispensing data.

Results

Data from 492 participants in 15 community pharmacies were available for analyses (intervention 253, 7 pharmacies; control 239, 8 pharmacies). The intervention had no effect on medication adherence (B=–0.01; 95% CI –0.59 to 0.57; P=.96), nor in the post hoc per-protocol analysis (B=0.19; 95% CI –0.50 to 0.89; P=.58).

Conclusions

This study showed no effectiveness of a risk stratification and tailored intervention addressing personal barriers for medication adherence. Various potential explanations for lack of effectiveness were identified. These explanations relate, for instance, to high medication adherence in the control group, study power, and fidelity. Process evaluation should elicit possible improvements and inform the redesign of intervention and implementation.

Trial Registration

The Netherlands National Trial Register NTR5186; https://tinyurl.com/5d8w99hk

Why Do Hong Kong Parents Have Low Intention to Vaccinate Their Children against COVID-19? Testing Health Belief Model and Theory of Planned Behavior in a Large-Scale Survey

COVID-19 vaccines have been authorized for use in children in some societies. Parents’ intention to vaccinate their children is context-specific. Drawing upon health belief model (HBM) and theory of planned behavior (TPB), this study contributed to a timely topic by examining the extent to which parents intended to vaccinate their children and its associated factors in Hong Kong, where the government announced children as young as five could take COVID-19 vaccines starting from 21 January 2022. A large-scale, online survey was conducted among 11,141 Hong Kong parents (86% mothers) of children aged 5–12 (N = 14,468, 49.5% girls). They reported on measures that assessed HBM constructs (i.e., perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action), TPB constructs (i.e., attitudes, subjective norms, and perceived behavioral control), and their intention to vaccinate each of their children. Results of descriptive statistics showed that Hong Kong parents’ intention to vaccinate their children was very low (1.55 out of 5.00). Multilevel regression showed that after controlling for parents’ and children’s demographic variables (e.g., sex and age), parents’ intention to vaccinate their children was higher if parents had higher levels of perceived susceptibility, perceived benefits, positive attitudes, and subjective norms and if they had lower levels of perceived barriers. Positive attitudes were the strongest correlate of parents’ intention. These findings have important implications for public health by informing which factors authorities should address in order to boost Hong Kong parents’ intention to vaccinate their children.

Factors related to treatment adherence behaviors among old-age hemodialysis patients in Hamadan, Iran: the application of the extended theory of planned behavior during Covid-19 pandemic

Purpose

This study aimed to identify the factors related to treatment adherence behaviors among old-age hemodialysis patients in Hamadan based on the Extended Theory of Planned Behavior (ETPB) during the covid-19 pandemic.

Methods

This cross-sectional study was conducted from January to March 2021 in Hamadan, Iran. 191 hemodialysis patients were recruited who were referred to hemodialysis centers via the census method. Data were collected by a questionnaire containing items on socio-demographic information, End-Stage Renal Disease Adherence (ESRD-Adherence) Questionnaire, and ETPB constructs scale. Data analysis was performed using descriptive statistics and structural equation modeling.

Results

The mean (SD) age of participants was 62.49 (10.66). Also, the mean (SD) hemodialysis vintage/Month of them was 36.56 (43.34). Moreover, Treatment Adherence Behaviors are associated with education level, sex, and marital status (p < 0.001). Besides, Perceive Behavior Control (β = 0.414, t-value = 3.810) associated with intention. Also, intention (β = 0.158, t-value = 1.976) was associated to adherence behaviors. No significant associations were observed between positive attitudes, subjective norms, a perceived threat with intention, and adherence behaviors. The model explained about 54% of the variance of adherence behaviors. Finally, the goodness of fit index of 0.78, indicating the model good fit.

Conclusion

The present study demonstrates that some of the ETPB constructs such as perceived behavior control and intention are useful to improve adherence among the oldest hemodialysis patients. Also. This framework is revealed alongside the theory of planned behavior (TPB) applicable in the treatment adherence of old-age hemodialysis patients.

Integrating the Extended Theory of Planned Behavior With the Stages of Change to Predict Exercise Among Chinese People With Type 2 Diabetes

Background: There have been very limited prospective studies examining social-cognitive models within stages of behavior change in the exercise domain. Purpose: We examined the utility of the theory of planned behavior (TPB), incorporating self-identity and descriptive norm constructs, to predict exercise behavior across the stages of change, in individuals with type 2 diabetes. Methods: Data were obtained from a longitudinal study. Multi-group structural equation modeling was used to estimate the association between extended TPB constructs and exercise within different stages groups. Results: 647 individuals completed a self-report questionnaire at baseline and at 3 months follow-up. The extended TPB model explained 8-15% variance of exercise behavior and 42-81% variance of exercise intention within three stages groups in the cross-sectional design. The extended TPB model explained 4%-13% variance of exercise behavior and 42-66% variance of exercise intention in the longitudinal design. Intention was significantly related to exercise behavior in the pre-action and action stages. Self-identity, perceived behavioral control and descriptive norms were stronger predictors of intention in different stages. Conclusion: Discontinuity patterns in the extended theory of planned behavior for the different stages groups were found. Intention was a significant predictor of exercise in the pre-action and action stages at 3 months.

Patients' attitudes and intentions towards taking medical advice for type 2 diabetes mellitus: a theory of planned behaviour analysis

PURPOSE

A key component of effective diabetes care is understanding patients' perceptions about diabetes management. Patients' attitudes and intentions towards taking medical advice may predict the outcomes for effective diabetes care. This study aims to measure participants' attitudes, beliefs and intentions towards following medical advice to manage their diabetes using the Theory of Planned Behaviour (TPB). The domains of the TPB are correlated with clinical measures of diabetes to determine if these attitudes and intentions are predictive of better diabetes control.

METHODS

A pilot study was conducted. A 34-item survey was designed using the Theory of Planned Behaviour (TPB) framework and administered via mail by four general practice clinics. Included participants (N = 104; response rate 29.5%) had a diagnosis of type 2 diabetes and were taking medication for glycaemic control. Scores for each domain of the TPB survey were correlated with participants' clinical indicators for diabetes: HbA1c, blood pressure, lipid profile, cholesterol, and kidney health (eGFR and albumin: creatinine ratio) and BMI.

RESULTS

Participants surveyed generally reported positive attitudes and intention to follow medical advice. Medical advice was perceived to be beneficial and useful by the majority. However, in general, there was no correlation between positive intentions and improved clinical indicators of disease. Clinical indicators did not improve with duration of illness. The burden of illness is likely a mitigating factor for positive intention as participants perceive medical advice as difficult and inconvenient to follow.

CONCLUSIONS

Patients' individual capacity to implement medical advice should be addressed in shared-decision making models to potentially improve patient outcomes towards therapeutic targets.

Adolescents at a Distance

Abstract. Background: In many countries, physical distancing is seen as one of the crucial preventive measures for limiting the COVID-19 pandemic. However, it is likely to be very difficult to ensure that adolescents keep apart from one another since peer interactions are extremely significant for them. Aims: We examined the utility of the Theory of Planned Behavior enhanced with a construct of the Protection Motivation Theory for predicting physical distancing behavior among adolescents during the period following the national lockdown imposed in Italy to tackle the pandemic. Method: Measures of attitude, subjective norm, perceptions of behavioral control, perceptions of threat regarding personal health and the health of loved ones, and intention were administered to the participants ( N = 363) at baseline. Measures of physical distancing behavior were then administered 3 weeks later ( N = 350). Results: The tested structural equation model accounted for 77% of variance in intention and 25% of variance in behavior. Perceived behavioral control and attitude were important predictors of intention and behavior, while the data did not support the hypothesized impact of perceptions of threat. Limitation: Due to the observational nature of the data caution should be taken in drawing causal inferences. Conclusion: The results suggest that programs for increasing physical distancing behavior in adolescents by concentrating exclusively on risks to their health or that of their loved ones might prove to be ineffective. Instead, it seems likely that prevention campaigns targeting adolescents will be more successful if they focus on perceived behavioral control and attitude.

Patient values and preferences on polypharmacy and deprescribing: a scoping review

Background Understanding how patient values and preferences towards polypharmacy and deprescribing have been studied is important to gain insight on current knowledge in this area and to identify knowledge gaps. Aim To describe methods and outcomes for studying patient values and preferences towards polypharmacy and deprescribing, and to identify gaps in the existing literature. Method A scoping review was conducted on English-language studies that examined patient preferences and values related to polypharmacy and/or deprescribing among community-dwelling adults. MEDLINE, Embase, PubMed, PsycINFO, EconLit, Social Science Citation Index, Science Citation Index Expanded, International Pharmaceutical Abstracts, and CINAHL/AgeLine were searched. Results Thirty articles were included. Surveys (n = 17, 56.7%), interviews/focus groups (n = 9, 30.0%), and mixed methods (n = 3, 10.0%), were commonly used methods. Patients Attitudes Towards Deprescribing (PATD) was the most common tool used (n = 9, 30.0%). Twelve themes related to attitudes, social pressure, and control of polypharmacy/deprescribing were identified. The most frequently-encountered themes included desire or willingness to reduce medication load and influence of healthcare provider on medication use. Conclusion PATD was commonly used to assess preferences and values towards polypharmacy and limited knowledge on patient-important outcomes were addressed. Future research should focus on shared decision-making and communicating risk versus benefit of medications.

A tool to assess the quality perception of healthcare employees

PURPOSE

The purpose of this project was to determine the validity and reliability of the Healthcare Quality Perception (HQP) questionnaire tool designed to capture employees' perceptions of healthcare quality in Indian hospitals.

DESIGN/METHODOLOGY/APPROACH

Two hundred employees in private and public sector hospitals in India were randomly selected and given the HQP tool. It consisted of 38 Likert-scale items and six different subscales: (1) Planning and Documentation (n = 7); (2) Employee Participation in Quality Management Activities (n = 5); (3) Existence of Policies/Procedures/Guidelines (n = 5); (4) Quality and Patient Safety Management (n = 9); (5) Perceived Effect of Quality Improvement (n = 7) and (6) Training and Development Opportunities (n = 5). 156 completed questionnaires were received, demonstrating a 78% response rate. HQP tool subjected to statistical analysis to measure its reliability and validity. A p-value of less than 0.05 was considered as "significant."

FINDINGS

Factor analysis pulled out six factors that conjointly demonstrated 66.4 % of the variance in healthcare professionals' (HCPs') perception of healthcare service quality in selected Indian hospitals. The overall Cronbach's alpha coefficient was measured at 0.959 for internal consistency reliability. This study demonstrates that the identified six critical factors are important determinants influencing HCPs' perception of the quality of healthcare services in private and public sector hospitals in India.

ORIGINALITY/VALUE

This study provides evidence for the reliability and validity of the newly developed HCP Scale for the assessment of employee perception of the quality of services offered in selected hospitals in India, with potential applications in other contexts.

Fear of COVID-19 and Perceived COVID-19 Infectability Supplement Theory of Planned Behavior to Explain Iranians' Intention to Get COVID-19 Vaccinated

One of the most efficient methods to control the high infection rate of the coronavirus disease 2019 (COVID-19) is to have a high coverage of COVID-19 vaccination worldwide. Therefore, it is important to understand individuals’ intention to get COVID-19 vaccinated. The present study applied the Theory of Planned Behavior (TPB) to explain the intention to get COVID-19 vaccinated among a representative sample in Qazvin, Iran. The TPB uses psychological constructs of attitude, subjective norm, and perceived behavioral control to explain an individual’s intention to perform a behavior. Fear and perceived infectability were additionally incorporated into the TPB to explain the intention to get COVID-19 vaccinated. Utilizing multistage stratified cluster sampling, 10,843 participants (4092 males; 37.7%) with a mean age of 35.54 years (SD = 12.00) completed a survey. The survey assessed TPB constructs (including attitude, subjective norm, perceived behavioral control, and intention related to COVID-19 vaccination) together with fear of COVID-19 and perceived COVID-19 infectability. Structural equation modeling (SEM) was performed to examine whether fear of COVID-19, perceived infectability, and the TPB constructs explained individuals’ intention to get COVID-19 vaccinated. The SEM demonstrated satisfactory fit (comparative fit index = 0.970; Tucker-Lewis index = 0.962; root mean square error of approximation = 0.040; standardized root mean square residual = 0.050). Moreover, perceived behavioral control, subjective norm, attitude, and perceived COVID-19 infectability significantly explained individuals’ intention to get COVID-19 vaccinated. Perceived COVID-19 infectability and TPB constructs were all significant mediators in the relationship between fear of COVID-19 and intention to get COVID-19 vaccinated. Incorporating fear of COVID-19 and perceived COVID-19 infectability effectively into the TPB explained Iranians’ intention to get COVID-19 vaccinated. Therefore, Iranians who have a strong belief in Muslim religion may improve their intention to get COVID-19 vaccinated via these constructs.

COVID-19 Experiences and Social Distancing: Insights From the Theory of Planned Behavior

Purpose:

The objective of this study is to identify the relationship between COVID-19 experiences, perceived COVID-19 behavioral control, social norms and attitudes, and future intention to follow social distancing guidelines.

Design:

This is a cross-sectional study.

Setting:

Participants responded to an on-line survey in June 2020.

Subjects:

The study included 3,183 residents within Quebec, Canada aged 18 and over.

Measures:

Measures include perceived COVID-19 related discrimination, fear of COVID-19 infection, prior exposure to COVID-19, and prior social distancing behavior. Participants self-reported attitudes, perceived behavioral control, and perceived norms related to social distancing. Finally, we measured social distancing behavioral intention.

Analysis:

We evaluated a theory of planned behavior (TPB) measurement model of social distancing using confirmatory factor analysis (CFA). The association between COVID-19 perceived discrimination, fear of infection, previous social distancing behavior, exposure to COVID-19, TPB constructs and behavioral intentions to social distance were estimated using SEM path analysis.

Results:

TPB constructs were positively associated with intention to follow social distancing guidelines. Fear of COVID-19 infection and prior social distancing behavior were positively associated with behavioral intentions. In contrast, perceived discrimination was negatively associated with the outcome. Associations between fear of COVID-19, perceived COVID-19 discrimination and behavioral intentions were partially mediated by constructs of TPB.

Conclusions:

COVID-19 prevention efforts designed to emphasize positive attitudes, perceived control, and social norms around social distancing should carefully balance campaigns that heighten fear of infection along with anti- discrimination messaging.

Development and Pilot Testing of MyGoutCare: A Novel Web-Based Platform to Educate Patients With Gout

BACKGROUND

Management guidelines have identified unmet educational needs in gout patients. Our objective was to develop and pilot test MyGoutCare (MGC©)-a web-based, interactive educational resource for gout patients, tailored to improve knowledge.

METHODS

The website was developed with input from patients and experts. A health informatics expert tailored content areas so the patient could walk through a journey to learn various aspects of gout. During the pilot study, patients completed baseline demographics and a 10-item validated gout knowledge questionnaire. After reviewing the website, patients completed a post-survey within 2 weeks of their physician visit. Data were analyzed using paired t-tests and effect size (ES) was calculated for the changed scores.

RESULTS

Gout patients and experts agreed on these content areas-triggers of flares, comorbidities, pharmacologic and non-pharmacologic treatment, healthy gout diet, and lifestyle choices. In the pilot study, 50 patients (mean age of 54 years, mean disease duration of 9.5 years, and mean 3-5 flares/year) were recruited. Their post-survey scores (0-10) on knowledge questions improved significantly when compared to pre-survey scores with mean (SD) of 1.95 (1.76) p < 0.0001, ES = 0.95. Patients identified actionable changes moving forward after reviewing the website-decision to continue lifelong urate-lowering therapy, complying with periodic monitoring of serum urate, and making dietary changes.

CONCLUSIONS

Web-based platforms that offer patient-focused materials can serve as a practical tool to address ongoing educational needs of gout patients. Additional studies are needed to evaluate if the website can improve patient-physician communication and lead to better long-term outcomes.

Self-Management Apps for People With Epilepsy: Systematic Analysis

BACKGROUND

Patients with epilepsy (PWEs) are motivated to manage and cope with their disorder themselves (ie, self-management [SM] is encouraged). Mobile health (mHealth) apps have multiple features that have a huge potential to improve SM of individuals with chronic disorders such as epilepsy.

OBJECTIVE

This study aimed to review all freely available apps related to the SM of PWEs and to determine the SM domains covered in these apps.

METHODS

We performed a search of apps on Google Play and App Store using the keywords "epilepsy" or "seizures" from May to August 2018. Apps were included if they were free and in English language. We excluded apps with installation-related issues and not related to epilepsy self-management (eSM).

RESULTS

A total of 22 eSM apps were identified in our search: 6 of these run only on iOS, 7 only on Android, and 9 run on both operating systems. Of the 11 domains of SM, seizure tracking and seizure response features were covered by most apps (n=22 and n=19, respectively), followed by treatment management (n=17) and medication adherence (n=15). Three apps (Epilepsy Journal, Epilepsy Tool Kit, and EpiDiary) were installed more than 10,000 times, with features focused specifically on a few domains (treatment management, medication adherence, health care communication, and seizure tracking). Two apps (Young Epilepsy and E-Epilepsy Inclusion) covered more than 6 SM domains but both had lower installation rates (5000+ and 100+, respectively).

CONCLUSIONS

Both Android and iOS mHealth apps are available to improve SM in epilepsy, but the installation rate of most apps remains low. The SM features of these apps were different from one another, making it difficult to recommend a single app that completely fulfills the needs of PWEs. The common features of the apps evaluated included seizure tracking and seizure response. To improve the efficacy and availability of these apps, we propose the following: (1) involve the stakeholders, such as physicians, pharmacists, and PWEs, during the development of mHealth apps; (2) assess the efficacy and acceptance of the apps objectively by performing a usability analysis; and (3) promote the apps so that they benefit more PWEs.

Whistleblowing Against Doping Misconduct in Sport: A Reasoned Action Perspective With a Focus on Affective and Normative Processes

Whistleblowing against doping misconduct represents an effective deterrent of doping use in elite competitive sport. The present study assessed the effects of social cognitive variables on competitive athletes' intentions to report doping misconduct. A second objective was to assess whether the effects of social norms on whistleblowing intentions were mediated by actor prototype evaluations and group identification and orientation. In total, 1,163 competitive athletes from Greece, Russia, and the United Kingdom completed a questionnaire on demographics, past behavior, social cognitive variables, and intentions toward whistleblowing. Regression analyses showed that whistleblowing intentions were associated with different social cognitive variables in each country. Multiple mediation modeling showed that attitudes and subjective norms were associated with whistleblowing intentions indirectly, via the effects of anticipated negative affect and group identification and orientation, respectively. The findings of this study are novel and have important implications about the social, cognitive, and normative processes underlying decision making toward reporting doping misconduct.

Preventive Behaviors During the COVID-19 Pandemic: Associations With Perceived Behavioral Control, Attitudes, and Subjective Norm

Background: The coronavirus disease 2019 (COVID-19) is a highly contagious and potentially fatal infectious disease that has swept the globe. To reduce the spread, it is important to engage in preventive behaviors recommended by health authorities, such as washing your hands, wearing a face mask, and social distancing. Aim: In the present study, we draw from the Theory of Planned Behavior (TPB) to examine the associations between perceived behavioral control, attitudes, and subjective norm and whether people engage in eight different preventive behaviors. Methods: For each of the preventive behaviors (washing hands; using hand sanitizer; not touching your face; social distancing; wearing a face mask; disinfecting surfaces; coughing in your elbow; staying home if sick), we conducted separate logistic regressions predicting whether the participants (N = 2,256; age range = 1898 years) reported engaging in the behavior from their perceived behavioral control, attitudes, and subjective norm. Results: We found that perceived behavioral control, attitudes, and subjective norm had independent significant associations with each preventive behavior. Moderation analyses revealed that for most behaviors the associations with perceived behavioral control were stronger for older adults than for younger adults. Limitation: The present study was cross-sectional; future longitudinal studies and interventions are needed to disentangle directionality. Conclusion: Our findings suggest several ways to increase adherence to health behaviors that reduce the spread of coronavirus and other infectious diseases.

Investigating the role of self-control beliefs in predicting exercise behaviour: A longitudinal study

BACKGROUND

Engaging in exercise behaviour regularly requires a repeated investment of resources to reap the health benefits. An individual's self-control resources, when performing a behaviour can be perceived as being recharged or depleted. The investigation on how self-control beliefs resources predict exercise behaviour is very limited in the literature. The purpose of this study was to understand how self-control beliefs predict exercise behaviour across time in a physical activity model.

METHODS

Participants (N = 161) were a sample of adults recruited across twelve gyms and recreation centres in a large city. Participants completed surveys across five months. Data were analysed using a multilevel structural equation model with participants (level 2) nested within time (level 1).

RESULTS

Behaviour was found to be a function of intention, habit, and planning. Specifically, planning moderated the intention-behaviour relationship, where those who scored higher on planning engaged in more exercise. Self-control beliefs functioned as a proximal predictor of autonomous motivation and predicted habit, and intention when accounting for total effects.

CONCLUSIONS

Self-control beliefs played a pivotal role in supporting recognized exercise determinants. Exercise-focussed interventions that help participants strengthen their beliefs as recharging and reduce depletion beliefs could be beneficial for promoting regular exercise.