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Aulbach MB, van Alebeek H, Jones CM, Blechert J. Why we don't eat as intended: Moderators of the short-term intention-behaviour relation in food intake. Br J Health Psychol 2024; 29:576-588. [PMID: 38290795 DOI: 10.1111/bjhp.12714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVES A healthy diet is essential for preventing chronic disease and promoting overall health. Translating one's intention to eat healthy into actual behaviour has, however, proven difficult with a range of internal and contextual factors identified as driving eating behaviour. DESIGN We leverage Temporal Self-Regulation Theory to examine these momentary determinants' direct and moderating effects on the intention-behaviour relation with Ecological Momentary Assessment (EMA). METHODS Eighty-seven healthy participants (mage = 24.1 years; 59 women, 28 men) reported, 5 times daily for 10 weekdays, their intentions to stick to a self-set dietary restriction goal for the next 3 hr, the goal congruency of their eating behaviour in the past 3 hr, and a range of factors potentially influencing food intake, such as stress, emotions and environmental eating cues. RESULTS Two-part multilevel modelling revealed that craving, availability of goal-incongruent foods, social eating cues, giving in to other temptations and weaker momentary intentions directly increased the risk and severity of goal-incongruent intake within the next 3 hr. Social cues, stress and craving further influence behaviour through altering intention implementation. CONCLUSIONS Results imply that people regularly fail to implement intentions for 3-hr periods and that a range of factors influences this, both directly and by disrupting intentional processes. While for some barriers, fostering strong intentions throughout the day could be beneficial, others require different strategies for dietary adherence.
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Affiliation(s)
- Matthias Burkard Aulbach
- Fachbereich Psychologie, Paris-Lodron Universität Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience, Paris-Lodron Universität Salzburg, Salzburg, Austria
| | - Hannah van Alebeek
- Fachbereich Psychologie, Paris-Lodron Universität Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience, Paris-Lodron Universität Salzburg, Salzburg, Austria
| | - Christopher M Jones
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Division of Prevention, Center for Preventive Medicine and Digital Health (CPD), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Jens Blechert
- Fachbereich Psychologie, Paris-Lodron Universität Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience, Paris-Lodron Universität Salzburg, Salzburg, Austria
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Shi W, Mackert M, Kemp D, King AJ, Liu Y, Henson-García M, Yang J, Bouchacourt LM, Cahill AG. "Don't Touch Your Face"-Effectiveness of a Health Communication Intervention on Reducing Face-Touching Behaviors. Am J Infect Control 2024:S0196-6553(24)00688-6. [PMID: 39209030 DOI: 10.1016/j.ajic.2024.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Given the risk of infection through face-touching behaviors, investigators have called for more research into the development of interventions to reduce the frequency of face-touching. The current study aims to test the effectiveness of messages on reducing face-touching behaviors. METHODS Nine different messages that highlighted the risk of face-touching were developed. Study 1, an online survey-experiment with a national sample of U.S. adults (N = 998), examined message perceptions, risk perceptions, and face-touching related behavioral intentions. The most promising messages identified in Study 1 were then tested in Study 2, a follow-up behavioral observation study with a class of undergraduate students. Students' face-touching behaviors were observed during a four-week period when intervention versus control messages were displayed in the classroom. RESULTS Four messages performed better in Study 1, two of which were selected to test the actual message effectiveness in Study 2. Study 2 results showed that on average, students touched their faces less frequently when a "Don't touch your face" message was present, although such decrease was not statistically significant. CONCLUSIONS Having reminder messages of "Don't touch your face" in public spaces hold the potential to be a low-cost, effective strategy to reduce face-touching behaviors.
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Affiliation(s)
- Weijia Shi
- Center for Health Communication, Moody College of Communication & Dell Medical School, The University of Texas at Austin.
| | - Michael Mackert
- Center for Health Communication, Moody College of Communication & Dell Medical School, The University of Texas at Austin; Stan Richards School of Advertising and Public Relations, Moody College of Communication, The University of Texas at Austin; Department of Population Health, Dell Medical School, The University of Texas at Austin
| | - Deena Kemp
- Stan Richards School of Advertising and Public Relations, Moody College of Communication, The University of Texas at Austin
| | - Andy J King
- Department of Communication, The University of Utah
| | - Yan Liu
- School of Journalism and Communication, Shanghai University
| | - Mike Henson-García
- Health Promotion and Behavioral Sciences, UTHealth Science Center School of Public Health
| | | | - Lindsay M Bouchacourt
- Center for Health Communication, Moody College of Communication & Dell Medical School, The University of Texas at Austin
| | - Alison G Cahill
- Department of Women's Health, Dell Medical School, The University of Texas at Austin
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Zergani MJ, Taghdisi MH, Seirafi M, Malihialzackerin S, Kojidi HT. Mindfulness-based eating awareness training versus itself plus implementation intention model: a randomized clinical trial. Eat Weight Disord 2024; 29:53. [PMID: 39150627 PMCID: PMC11329387 DOI: 10.1007/s40519-024-01677-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/10/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Obesity causes many physical and mental illnesses. This study compares mindfulness-based eating awareness training (MB-EAT) versus MB-EAT plus implementation intention model for effectiveness on body mass index (BMI), weight self-efficacy, and physical activity in obese women with BMIs ≤ 25 (n = 52). METHODS In this randomized clinical trial, the participants were selected by the simple random sampling method and randomly divided into three groups. A 12-session MB-EAT of 150 min per session was performed for experimental group I. The experimental group II received MB-EAT alone for physical activity planning and MB-EAT plus implementation intention; also, both groups were compared to the control group. Data were measured by the scales, a questionnaire, and a checklist, and the P-values are based on the results of the generalized estimating equation (GEE) test. P < 0.001 were considered the significance level. RESULTS The MB-EAT and MB-EAT + implementation intention effectiveness on the two experimental groups' BMI, weight self-efficacy, and physical activity was significantly different from the control group. In the integrated group versus the MB-EAT group, BMI, physical activity, and physical discomfort, were more effective than the weight self-efficacy subscales. Both intervention groups were effective on BMI, weight self-efficacy, and physical activity, but the integrated group's effectiveness was more. CONCLUSIONS The MB-EAT effectiveness trial is theory-based, reducing weight and the psychological and behavioral consequences of overweight and obese adults. The MB-EAT + the Implementation intention model is to plan regular and daily exercise according to each individual's specific circumstances. TRIAL REGISTRATION The trial registration number: (IRCT20200919048767N1).
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Affiliation(s)
- Mona Jassemi Zergani
- Department of Clinical and Health Psychology, Faculty of Medical Sciences, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Mohammad Hossin Taghdisi
- Public Health Department, Faculty of Health and Medical Engineering, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mohammadreza Seirafi
- Department of Clinical and Health Psychology, Faculty of Medical Sciences, Karaj Branch, Islamic Azad University, Karaj, Iran.
| | - Saied Malihialzackerin
- Department of Clinical and Health Psychology, Faculty of Medical Sciences, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Habibeh Taghavi Kojidi
- Department of Clinical and Health Psychology, Faculty of Medical Sciences, Karaj Branch, Islamic Azad University, Karaj, Iran
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Muaddi MA, Makeen AM, Gosadi IM, Jareebi MA, Alharbi AA, Bahri AA, Ryani MA, Mahfouz MS, Albasheer O, Ali SA, Arishi AA, Alsam FA, Alqassim AY. Satisfaction Paradoxes in Health Behaviors: Contrasting Patterns across Weight, Physical Activity and Dietary Habits. Nutrients 2024; 16:2246. [PMID: 39064688 PMCID: PMC11279640 DOI: 10.3390/nu16142246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 06/29/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Obesity, a poor diet, and inactivity are major health issues among Saudi youth. However, satisfaction with unhealthy lifestyles could impede change. This study assessed lifestyle factors and related satisfaction among Saudi university students. (2) Methods: In this cross-sectional study, 1957 students at Jazan University completed surveys on demographics, physical activity, dietary habits, and 10-point satisfaction scales for weight, activity, and diet. Chi-squared tests and logistic regression were used to analyze the associations between behaviors and satisfaction. (3) Results: Overweight/obesity prevalence was 25.45%, and only 26.67% of the subjects met activity guidelines. Many of them exhibited poor dietary habits. Despite unhealthy behaviors, some expressed high satisfaction, especially regarding their diets. Subjects with a normal BMI had the highest weight satisfaction. Activity satisfaction increased with higher activity levels. Dietary satisfaction was minimally impacted by healthfulness. Males and higher incomes were correlated with greater satisfaction. (4) Conclusions: A concerning paradox exists between unhealthy lifestyles and satisfaction among Saudi university students, particularly regarding their diets. Multicomponent interventions informed by behavior change theories and employing motivational techniques are urgently needed to address this disconnect and facilitate positive behavior change.
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Affiliation(s)
- Mohammed A. Muaddi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (M.A.M.); (A.M.M.); (I.M.G.); (M.A.J.); (A.A.A.); (A.A.B.); (M.A.R.); (M.S.M.); (O.A.); (S.A.A.)
| | - Anwar M. Makeen
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (M.A.M.); (A.M.M.); (I.M.G.); (M.A.J.); (A.A.A.); (A.A.B.); (M.A.R.); (M.S.M.); (O.A.); (S.A.A.)
| | - Ibrahim M. Gosadi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (M.A.M.); (A.M.M.); (I.M.G.); (M.A.J.); (A.A.A.); (A.A.B.); (M.A.R.); (M.S.M.); (O.A.); (S.A.A.)
| | - Mohammad A. Jareebi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (M.A.M.); (A.M.M.); (I.M.G.); (M.A.J.); (A.A.A.); (A.A.B.); (M.A.R.); (M.S.M.); (O.A.); (S.A.A.)
| | - Abdullah A. Alharbi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (M.A.M.); (A.M.M.); (I.M.G.); (M.A.J.); (A.A.A.); (A.A.B.); (M.A.R.); (M.S.M.); (O.A.); (S.A.A.)
| | - Ahmed A. Bahri
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (M.A.M.); (A.M.M.); (I.M.G.); (M.A.J.); (A.A.A.); (A.A.B.); (M.A.R.); (M.S.M.); (O.A.); (S.A.A.)
| | - Majed A. Ryani
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (M.A.M.); (A.M.M.); (I.M.G.); (M.A.J.); (A.A.A.); (A.A.B.); (M.A.R.); (M.S.M.); (O.A.); (S.A.A.)
| | - Mohamed Salih Mahfouz
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (M.A.M.); (A.M.M.); (I.M.G.); (M.A.J.); (A.A.A.); (A.A.B.); (M.A.R.); (M.S.M.); (O.A.); (S.A.A.)
| | - Osama Albasheer
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (M.A.M.); (A.M.M.); (I.M.G.); (M.A.J.); (A.A.A.); (A.A.B.); (M.A.R.); (M.S.M.); (O.A.); (S.A.A.)
| | - Suhaila A. Ali
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (M.A.M.); (A.M.M.); (I.M.G.); (M.A.J.); (A.A.A.); (A.A.B.); (M.A.R.); (M.S.M.); (O.A.); (S.A.A.)
| | | | - Fatima A. Alsam
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Ahmad Y. Alqassim
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (M.A.M.); (A.M.M.); (I.M.G.); (M.A.J.); (A.A.A.); (A.A.B.); (M.A.R.); (M.S.M.); (O.A.); (S.A.A.)
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Elliott PS, Devine LD, Gibney ER, O'Sullivan AM. What factors influence sustainable and healthy diet consumption? A review and synthesis of literature within the university setting and beyond. Nutr Res 2024; 126:23-45. [PMID: 38613922 DOI: 10.1016/j.nutres.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/15/2024]
Abstract
Globally, typical dietary patterns are neither healthy nor sustainable. Recognizing the key role of dietary change in reducing noncommunicable disease risk and addressing environmental degradation, it is crucial to understand how to shift individuals toward a sustainable and healthy diet (SHD). In this literature review, we introduced the concept of a SHD and outlined the dietary behaviors necessary to transition toward SHD consumption; we reviewed the literature on factors that may influence sustainable (and unsustainable) dietary behaviors in adults; and we developed a novel scoring system to rank factors by priority for targeting in future research. Given the significant potential to promote a sustainable and healthy dietary transition on the university campus-where factors that may impact dietary behaviors can be targeted at all levels of influence (i.e., individual, interpersonal, environmental, policy)-we narrowed our focus to this setting throughout. Aided by our novel scoring system, we identified conscious habitual eating, product price, food availability/accessibility, product convenience, self-regulation skills, knowledge of animal ethics/welfare, food promotion, and eating norms as important modifiable factors that may influence university students' dietary behaviors. When scored without consideration for the university population, these factors were also ranked as highest priority, as was modified portion sizes. Our findings offer insight into factors that may warrant attention in future research aimed at promoting SHDs. In particular, the high-priority factors identified from our synthesis of the literature could help guide the development of more personalized dietary behavioral interventions within the university setting and beyond.
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Affiliation(s)
- Patrick S Elliott
- Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Dublin 4, Ireland
| | - Lauren D Devine
- Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Dublin 4, Ireland
| | - Eileen R Gibney
- Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Dublin 4, Ireland
| | - Aifric M O'Sullivan
- Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Dublin 4, Ireland.
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Klinge I, de Vet E. Research priorities and considerations for nutrition research: methods of sex and gender analysis for biomedical and nutrition research. Proc Nutr Soc 2024; 83:66-75. [PMID: 38239085 DOI: 10.1017/s0029665124000065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
For some 20 years, science funding bodies have been asking for the integration of sex- and gender-related factors into the content of research and innovation. The rationale for those requirements has been the accumulated evidence that sex and gender are important determinants of health and disease. The European Commission (EC) has been the first, since 2002, to seriously ask for the integration of sex and gender into research and innovation in the context of their multi-annual framework programmes. When introduced, this condition was not immediately applauded by the research community, who perhaps lacked training in methods for the integration of sex- and gender-related factors. The EC Expert Group on Gendered Innovations sought to fill this gap. This review describes the work of this international collaborative project which has resulted in the development of general and field-specific methods for sex and gender analysis and 38 case studies for various research domains (science, health and medicine, environment, engineering) to illustrate how, by applying methods of sex and gender analysis, new knowledge could be created. Since 2010, science funding bodies in Canada, the USA and several EU member states have followed the example of the EC issuing similar conditions. Although the effects of nutritional patterns on a range of (physiological and health) outcomes may differ for men and women, sex and gender analyses are rarely conducted in nutrition research. In this review, we provide examples of how gender is connected to dietary intake, and how advancing gender analysis may inform gender-sensitive policies and dietary recommendations.
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Affiliation(s)
- Ineke Klinge
- Maastricht University, Maastricht, The Netherlands
- Charité Universitäts Medizin, Berlin, Germany
| | - Emely de Vet
- University College Tilburg, Tilburg University, Tilburg, The Netherlands
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Parke A, Eschle T, Keatley D. Risk factors for momentary loss of control and subsequent abandonment of self-devised dietary restraint plans in adults with weight-loss goals: a behaviour sequence analysis approach. Psychol Health 2024; 39:691-709. [PMID: 35791507 DOI: 10.1080/08870446.2022.2094929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 04/20/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The current study aims to improve understanding of events leading to lapses of dietary restraint, and to identify pathways to perseverance or abandonment of weight loss efforts in response to lapses. In addition, Behaviour Sequence Analysis (BSA) was also evaluated as an analytical tool in dietary behaviour. DESIGN A sample of 176 adults who were engaging in self-imposed dietary restraint for weight loss were recruited to participate. MAIN OUTCOME MEASURES Participants were instructed to provide a detailed written timeline of an episode where they lapsed in their dietary restraint plan. They were instructed to report their preceding behaviours and internal states, and social and environmental contexts, leading up to and after their lapse in dietary restraint. RESULTS Lapses in dietary restraint were precipitated by negative internal states in the presence of cues for highly palatable foods. In addition, abandonment of weight loss efforts after lapsing was preceded by dichotomous thinking, whereas perseverance was preceded by a more neutral, flexible interpretation of the lapse in self-control. CONCLUSION BSA has identified that neutral evaluation of inevitable lapses in dietary restraint are predictive of continuation with weight loss efforts, highlighting the importance of individual tolerance of lapses in self-regulation.
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Affiliation(s)
- Adrian Parke
- Psychology Division, Education and Social Sciences, University of West of Scotland, Paisley, Renfrewshire, UK
- Researchers in Behaviour Sequence Analysis (ReBSA)
| | - Timothy Eschle
- Psychology Division, Education and Social Sciences, University of West of Scotland, Paisley, Renfrewshire, UK
| | - David Keatley
- Researchers in Behaviour Sequence Analysis (ReBSA)
- Murdoch University, Perth, WesternAustralia
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Ho HC, Lai AY, Mui MWK, Wan A, Yew CWS, Lam TH. A cluster randomized controlled trial of a brief positive healthy eating intervention. J Health Psychol 2024:13591053231225934. [PMID: 38312008 DOI: 10.1177/13591053231225934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Excessive sugar intake poses a significant risk factor for non-communicable diseases. A positive healthy eating (PHE) intervention was developed to promote low-sugar dietary practices in families. The PHE intervention capitalized on positive psychological constructs to overcome barriers to health behavior change by helping families associate feelings of joy, gratitude, and savoring with healthy eating. In a cluster randomized controlled trial, 1983 participants from 1467 families were recruited in Hong Kong. PHE included a core and booster session. Data were collected at pre-intervention, post-intervention, and at 1-month and 3-month follow-up. Compared to the control, PHE showed greater increase in intention to change at post-intervention, engagement in low-sugar dietary practices individually and with family members at 3-month follow-up, and greater reduction in sugar-sweetened beverage intake at 1-month and 3-month follow-up. Intentions to change mediated PHE's effects on low-sugar dietary practices. Focus group interviews revealed the behavior-change process and family quality of life.
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Affiliation(s)
- Henry Cy Ho
- The Education University of Hong Kong, Hong Kong
- University of Hong Kong, Hong Kong
| | | | | | | | - Carol Wing-See Yew
- United Centre of Emotional Health and Positive Living, United Christian Nethersole Community Health Service, Hong Kong
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Lyon AR, Cook CR, Larson M, Hugh ML, Dopp A, Hamlin C, Reinke P, Bose M, Law A, Goosey R, Goerdt A, Morrell N, Wackerle-Hollman A, Pullmann MD. Protocol for a hybrid type 3 effectiveness-implementation trial of a pragmatic individual-level implementation strategy for supporting school-based prevention programming. Implement Sci 2024; 19:2. [PMID: 38167046 PMCID: PMC10763475 DOI: 10.1186/s13012-023-01330-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND For approximately one in five children who have social, emotional, and behavioral (SEB) challenges, accessible evidence-based prevention practices (EBPPs) are critical. In the USA, schools are the primary setting for children's SEB service delivery. Still, EBPPs are rarely adopted and implemented by front-line educators (e.g., teachers) with sufficient fidelity to see effects. Given that individual behavior change is ultimately required for successful implementation, focusing on individual-level processes holds promise as a parsimonious approach to enhance impact. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a pragmatic, multifaceted pre-implementation strategy targeting volitional and motivational mechanisms of educators' behavior change to enhance implementation and student SEB outcomes. This study protocol describes a hybrid type 3 effectiveness-implementation trial designed to evaluate the main effects, mediators, and moderators of the BASIS-T implementation strategy as applied to Positive Greetings at the Door, a universal school-based EBPP previously demonstrated to reduce student disruptive behavior and increase academic engagement. METHODS This project uses a blocked randomized cohort design with an active comparison control (ACC) condition. We will recruit and include approximately 276 teachers from 46 schools randomly assigned to BASIS-T or ACC conditions. Aim 1 will evaluate the main effects of BASIS-T on proximal implementation mechanisms (attitudes, subjective norms, self-efficacy, intentions to implement, and maintenance self-efficacy), implementation outcomes (adoption, reach, fidelity, and sustainment), and child outcomes (SEB, attendance, discipline, achievement). Aim 2 will examine how, for whom, under what conditions, and how efficiently BASIS-T works, specifically by testing whether the effects of BASIS-T on child outcomes are (a) mediated via its putative mechanisms of behavior change, (b) moderated by teacher factors or school contextual factors, and (c) cost-effective. DISCUSSION This study will provide a rigorous test of BASIS-T-a pragmatic, theory-driven, and generalizable implementation strategy designed to target theoretically-derived motivational mechanisms-to increase the yield of standard EBPP training and support strategies. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05989568. Registered on May 30, 2023.
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Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA.
| | - Clayton R Cook
- Character Strong, 4227 S Meridian, Puyallup, WA, 98373, USA
| | | | - Maria L Hugh
- University of Kansas, 1122 W Campus Rd, Lawrence, KS, 66045, USA
| | - Alex Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 91604, USA
| | - Corinne Hamlin
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Peter Reinke
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Mahasweta Bose
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Amy Law
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA
| | - Roger Goosey
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA
| | - Annie Goerdt
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Nicole Morrell
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | | | - Michael D Pullmann
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA
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Batcup C, Bonner C, Ayre J. What makes an action plan "100% me"? Think aloud interviews about CVD prevention tools for varying health literacy needs. Health Promot J Austr 2024; 35:68-78. [PMID: 36916638 DOI: 10.1002/hpja.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
ISSUE ADDRESSED Health behaviour change can be difficult to maintain. Action plans can address this issue, however, there has been little qualitative research to understand how to optimise action plan interventions. This study explored how people engage with a specific type of action plan intervention, the "volitional help sheet," in a cardiovascular disease (CVD) prevention context. METHODS Twenty adults in the target age for CVD risk assessment (45 to 74 years) with varying health literacy participated in interviews and created an action plan to change their behaviour. Transcripts were analysed using framework analysis. RESULTS Participants described how engagement with plans was related to how personally relevant the target behaviour and the options within the plan were. Also important was participants visualising themselves enacting the plan when deciding which option to choose. Amongst participants who already engaged in a target behaviour, some did not perceive the plan was useful; others perceived the plan as a helpful prompt or a formalisation of existing plans. For some, the barriers to behaviour change were out of the scope of an action plan, highlighting the need for alternative supports. CONCLUSION This study provides qualitative insights into unanticipated ways that people with varying health literacy use action plans, providing new guidance for future developers. SO WHAT?: Not all action plans are created equal. Careful selection of behavioural targets and plan options and encouraging users to imagine the plan may enhance user engagement. Alternative behaviour change strategies should be available if key barriers cannot be addressed by the plan.
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Affiliation(s)
- Carys Batcup
- Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, The University of Sydney, Sydney, NSW, Australia
| | - Carissa Bonner
- Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, The University of Sydney, Sydney, NSW, Australia
| | - Julie Ayre
- Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, The University of Sydney, Sydney, NSW, Australia
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Xu L, Pinxten W, Vandereyt F, Falter M, Scherrenberg M, Kizilkilic SE, Van Erum H, Dendale P, Kindermans H. Motivational communication skills to improve motivation and adherence in cardiovascular disease prevention: A narrative review. Clin Cardiol 2023; 46:1474-1480. [PMID: 37675783 PMCID: PMC10716351 DOI: 10.1002/clc.24128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023] Open
Abstract
Lifestyle optimization is one of the most essential components of cardiovascular disease prevention. Motivational counseling provided by health care professionals could promote lifestyle modification. The purpose of the review is to identify possible evidence-based psychological principles that may be applicable to motivational counseling in the prevention of cardiovascular disease. These motivational communication skills promote behavioral change, improved motivation and adherence to cardiovascular disease prevention. A personal collection of the relevant publications. The review identified and summarized the previous evidence of implementation intentions, mental contrasting, placebo effect and nocebo effects and identity-based regulations in behavior change interventions and proposed their potential application in cardiovascular disease prevention. However, it is challenging to provide real support in sustainable CVD-risk reduction and encourage patients to implement lifestyle changes, while avoiding being unnecessarily judgmental, disrespectful of autonomy, or engaging patients in burdensome efforts that have little or no effect on the long run. Motivational communication skills have a great potential for effectuating sustainable lifestyle changes that reduce CVD-related risks, but it is also surrounded by ethical issues that should be appropriately addressed in practice. It is key to realize that motivational communication is nothing like an algorithm that is likely to bring about sustainable lifestyle change, but a battery of interventions that requires specific expertise and long term joint efforts of patients and their team of caregivers.
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Affiliation(s)
- Linqi Xu
- UHasseltFaculty of Medicine and Life SciencesDiepenbeekBelgium
- Heart Centre HasseltJessa HospitalHasseltBelgium
- School of NursingJilin UniversityChangchunChina
| | - Wim Pinxten
- UHasseltFaculty of Medicine and Life SciencesDiepenbeekBelgium
| | | | - Maarten Falter
- UHasseltFaculty of Medicine and Life SciencesDiepenbeekBelgium
- Heart Centre HasseltJessa HospitalHasseltBelgium
- Department of Cardiology, KULeuvenFaculty of MedicineLeuvenBelgium
| | - Martijn Scherrenberg
- UHasseltFaculty of Medicine and Life SciencesDiepenbeekBelgium
- Heart Centre HasseltJessa HospitalHasseltBelgium
- Faculty of Medicine and Health SciencesAntwerp UniversityAntwerpBelgium
| | - Sevda Ece Kizilkilic
- UHasseltFaculty of Medicine and Life SciencesDiepenbeekBelgium
- Heart Centre HasseltJessa HospitalHasseltBelgium
| | - Hanne Van Erum
- UHasseltFaculty of Medicine and Life SciencesDiepenbeekBelgium
| | - Paul Dendale
- UHasseltFaculty of Medicine and Life SciencesDiepenbeekBelgium
- Heart Centre HasseltJessa HospitalHasseltBelgium
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Wilson M, van Allen ZM, Grimshaw JM, Brehaut JC, Durand A, Lalonde JF, Manuel DG, Michie S, West R, Presseau J. Reducing touching eyes, nose and mouth ('T-zone') to reduce the spread of infectious disease: A prospective study of motivational, volitional and non-reflective predictors. Br J Health Psychol 2023; 28:893-913. [PMID: 36997474 DOI: 10.1111/bjhp.12660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/31/2023] [Accepted: 03/14/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND The route into the body for many pathogens is through the eyes, nose and mouth (i.e., the 'T-zone') via inhalation or fomite-based transfer during face touching. It is important to understand factors that are associated with touching the T-zone to inform preventive strategies. PURPOSE To identify theory-informed predictors of intention to reduce facial 'T-zone' touching and self-reported 'T-zone' touching. METHODS We conducted a nationally representative prospective questionnaire study of Canadians. Respondents were randomized to answer questions about touching their eyes, nose, or mouth with a questionnaire assessing 11 factors from an augmented Health Action Process Approach at baseline: intention, outcome expectancies, risk perception, individual severity, self-efficacy, action planning, coping planning, social support, automaticity, goal facilitation and stability of context. At 2-week follow-up, we assessed HAPA-based indicators of self-regulatory activities (awareness of standards, effort, self-monitoring) and self-reported behaviour (primary dependent variable). RESULTS Of 656 Canadian adults recruited, 569 responded to follow-up (87% response rate). Across all areas of the 'T-zone', outcome expectancy was the strongest predictor of intention to reduce facial 'T-zone' touching, while self-efficacy was a significant predictor for only the eyes and mouth. Automaticity was the strongest predictor of behaviour at the 2-week follow-up. No sociodemographic or psychological factors predicted behaviour, with the exception of self-efficacy, which negatively predicted eye touching. CONCLUSION Findings suggest that focusing on reflective processes may increase intention to reduce 'T-zone' touching, while reducing actual 'T-zone' touching may require strategies that address the automatic nature of this behaviour.
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Affiliation(s)
- Mackenzie Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Zachary M van Allen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie C Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Audrey Durand
- Department of Computer Science and Software Engineering, Université Laval, Québec, Quebec, Canada
- Department of Electrical and Computer Engineering, Université Laval, Québec, Quebec, Canada
| | - Jean-François Lalonde
- Department of Electrical and Computer Engineering, Université Laval, Québec, Quebec, Canada
| | - Douglas G Manuel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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13
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Wright CE, Sheeran P, Voils CI, Blalock DV. A review of implementation intentions as a tool to benefit high-need patients and healthcare systems: U.S. veterans affairs as an exemplar. PATIENT EDUCATION AND COUNSELING 2023; 116:107937. [PMID: 37595504 DOI: 10.1016/j.pec.2023.107937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023]
Abstract
Implementation intentions (if-then plans) are an evidence-based behavior change strategy designed to translate behavioral intentions into habits [1]. Despite extensive evidence of its potential utility, this behavior change strategy is underutilized and under-researched in high-need healthcare contexts within the United States (U.S.) which face high rates of chronic conditions and barriers to care such as rurality, lack of resources, and cognitive strain from mental health and neurological conditions [2,3]. Implementation intentions have demonstrated efficacy in promoting many health behaviors proven to mitigate chronic conditions, namely physical activity, healthy diet, and substance use reduction [4-6]. In addition, the accessible, adaptable, and self-driven nature of implementation intentions allow the technique to meet many of the individual and system-level priorities of these high-need care contexts. By being patient-driven, proactive, and personalized, implementation intentions can help these patients cultivate healthy habits as part of their everyday lives. At the systems-level, implementation intentions' inexpensiveness, scalability, and compatibility with telemedicine platforms allow them to be integrated easily into existing healthcare system infrastructure [7,8]. This review describes these concepts in detail, and uses the Veterans Affairs (VA) healthcare system as an exemplar to provide concrete examples of how and where implementation intentions could be integrated in a healthcare system, within some existing programs, to benefit both the system and individual patients.
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Affiliation(s)
- Charles E Wright
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
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14
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Govindasamy S, Beek K, Yates K, Jayasuriya R, Reynolds R, de Wit JBF, Harris M. Experiences of overweight and obese patients with diabetes and practice nurses during implementation of a brief weight management intervention in general practice settings serving Culturally and Linguistically Diverse disadvantaged populations. Aust J Prim Health 2023; 29:358-364. [PMID: 36502858 DOI: 10.1071/py22013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 11/14/2022] [Indexed: 08/15/2023]
Abstract
BACKGROUND To explore the perspectives of overweight and obese patients with diabetes from culturally and linguistically diverse, and disadvantaged backgrounds, as well as practice nurses (PNs) during implementation of a brief PN-supported self-regulation nutrition strategy for weight management in general practice settings serving disadvantaged populations. METHODS During intervention implementation, semi-structured interviews were conducted with 12 patients and four nurses in two general practices located in metropolitan suburbs in Sydney, Australia. RESULTS Patients and PNs found challenges related to cultural expectations and the requirement of patients to set and adhere to dietary change goals and behaviours. Although patients expressed high levels of satisfaction with PNs, the suitability of the intervention to this group was questioned by PNs. Obstacles were also encountered in delivering the intervention in a busy general practice setting. CONCLUSIONS This pilot study provided initial evidence of the acceptability of a self-regulation nutrition intervention for weight management for overweight and obese patients with type 2 diabetes that was delivered by PNs. Cultural expectations of provider-patient roles, the type of intervention and flexibility in the workplace are important future considerations.
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Affiliation(s)
- Sumathi Govindasamy
- University of New South, School of Population Health, Samuels Building, F25, Samuel Terry Avenue, Kensington, NSW 2033, Australia
| | - Kristen Beek
- University of New South, School of Population Health, Samuels Building, F25, Samuel Terry Avenue, Kensington, NSW 2033, Australia
| | - Ken Yates
- Western Sydney University, School of Social Sciences, 100 Macquarie Street, Liverpool, NSW 2170, Australia
| | - Rohan Jayasuriya
- University of New South, School of Population Health, Samuels Building, F25, Samuel Terry Avenue, Kensington, NSW 2033, Australia
| | - Rebecca Reynolds
- University of New South, School of Population Health, Samuels Building, F25, Samuel Terry Avenue, Kensington, NSW 2033, Australia
| | - John B F de Wit
- UNSW Sydney, Centre for Social Research in Health, Level 2, Goodsell Building, Kensington, NSW 2052, Australia; and Utrecht University, Department of Interdisciplinary Social Science, PO Box 80140, 3508 TC Utrecht, the Netherlands
| | - Mark Harris
- University of New South, School of Population Health, Samuels Building, F25, Samuel Terry Avenue, Kensington, NSW 2033, Australia; and University of New South Wales, Centre for Primary Health Care and Equity, 3rd Floor AGSM Building, Sydney, NSW 2052, Australia
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15
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Moore DM, Madrid I, Lindsay KL. Systematic Review of Easy-to-Learn Behavioral Interventions for Dietary Changes Among Young Adults. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:509-522. [PMID: 37162435 DOI: 10.1016/j.jneb.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/24/2023] [Accepted: 04/02/2023] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Improving the diet quality of young adults may support chronic disease prevention. The approaches used and efficacy of promoting small dietary behavior changes through easy-to-learn (ETL) interventions (requiring no more than 1 hour to teach the behavior) among young adults have not yet been systematically reviewed. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 2 independent electronic searches across 6 databases were conducted to identify any articles describing ETL interventions among young adults (aged 18-35 years) and reporting dietary intake outcomes. RESULTS Among 9,538 articles identified, 9 studies met eligibility criteria. Five studies reported significant improvement in the selected dietary outcome. Of these, 3 studies used an implementation intentions approach, in which participants were given or asked to write out a simple dietary behavior directive and carry it on their person. Less than half of included studies were rated as positive for overall quality. DISCUSSION The available evidence suggests that ETL interventions targeting the dietary behaviors of young adults may be effective in improving dietary intake. Limitations of included studies were lack of follow-up after the intervention period and low generalizability. IMPLICATIONS FOR RESEARCH AND PRACTICE Further dietary intervention studies targeting young adults should systematically evaluate the efficacy of ETL intervention approaches among diverse samples.
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Affiliation(s)
- Dustin M Moore
- Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, Irvine, CA
| | - Isabella Madrid
- Department of Family and Consumer Sciences, College of Health and Human Services, California State University, Long Beach, Long Beach, CA
| | - Karen L Lindsay
- Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, Irvine, CA; Department of Pediatrics, School of Medicine, University of California, Irvine, Irvine, CA; Susan Samueli Integrative Health Institute, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA.
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Bonner C, Batcup C, Cvejic E, Ayre J, Pickles K, Copp T, Cornell S, Nickel B, Dhahir M, McCaffery K. Addressing Behavioral Barriers to COVID-19 Testing With Health Literacy-Sensitive eHealth Interventions: Results From 2 National Surveys and 2 Randomized Experiments. JMIR Public Health Surveill 2023; 9:e40441. [PMID: 37172319 PMCID: PMC10337324 DOI: 10.2196/40441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 03/31/2023] [Accepted: 05/12/2023] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Polymerase chain reaction (PCR) testing for COVID-19 was crucial in Australia's prevention strategy in the first 2 years of the pandemic, including required testing for symptoms, contact with cases, travel, and certain professions. However, several months into the pandemic, half of Australians were still not getting tested for respiratory symptoms, and little was known about the drivers of and barriers to COVID-19 PCR testing as a novel behavior at that time. OBJECTIVE We aimed to identify and address COVID-19 testing barriers, and test the effectiveness of multiple eHealth interventions on knowledge for people with varying health literacy levels. METHODS The intervention was developed in 4 phases. Phase 1 was a national survey conducted in June 2020 (n=1369), in which testing barriers were coded using the capability-opportunity-motivation-behavior framework. Phase 2 was a national survey conducted in November 2020 (n=2034) to estimate the prevalence of testing barriers and health literacy disparities. Phase 3 was a randomized experiment testing health literacy-sensitive written information for a wide range of barriers between February and March 2021 (n=1314), in which participants chose their top 3 barriers to testing to view a tailored intervention. Phase 4 was a randomized experiment testing 2 audio-visual interventions addressing common testing barriers for people with lower health literacy in November 2021, targeting young adults as a key group endorsing misinformation (n=1527). RESULTS In phase 1, barriers were identified in all 3 categories: capability (eg, understanding which symptoms to test for), opportunity (eg, not being able to access a PCR test), and motivation (eg, not believing the symptoms are those of COVID-19). Phase 2 identified knowledge gaps for people with lower versus higher health literacy. Phase 3 found no differences between the intervention (health literacy-sensitive text for top 3 barriers) and control groups. Phase 4 showed that a fact-based animation or a TikTok-style video presenting the same facts in a humorous style increased knowledge about COVID-19 testing compared with government information. However, no differences were found for COVID-19 testing intentions. CONCLUSIONS This study identified a wide range of barriers to a novel testing behavior, PCR testing for COVID-19. These barriers were prevalent even in a health system where COVID-19 testing was free and widely available. We showed that key capability barriers, such as knowledge gaps, can be improved with simple videos targeting people with lower health literacy. Additional behavior change strategies are required to address motivational issues to support testing uptake. Future research will explore health literacy strategies in the current context of self-administered rapid antigen tests. The findings may inform planning for future COVID-19 variant outbreaks and new public health emergencies where novel testing behaviors are required. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12621000876897, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382318 ; Australian New Zealand Clinical Trials Registry ACTRN12620001355965, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380916&isReview=true.
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Affiliation(s)
- Carissa Bonner
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Carys Batcup
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Erin Cvejic
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Julie Ayre
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kristen Pickles
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Tessa Copp
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Samuel Cornell
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Brooke Nickel
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Mustafa Dhahir
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Stecher C, Cloonan S, Linnemayr S, Huberty J. Combining Behavioral Economics-Based Incentives With the Anchoring Strategy: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e39930. [PMID: 37115610 PMCID: PMC10182474 DOI: 10.2196/39930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 02/20/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Chronic (ie, long-term) elevated stress is associated with a number of mental and physical health conditions. Mindfulness meditation mobile apps are a promising tool for stress self-management that can overcome several barriers associated with in-person interventions; however, to date, poor app-based intervention adherence has limited the efficacy of these mobile health tools. Anchoring, or pairing, a new behavior with an existing routine has been shown to effectively establish habits that are maintained over time, but this strategy typically only works for those with high initial motivation and has yet to be tested for maintaining meditation with a mobile app. OBJECTIVE This study will test novel combinations of behavioral economics-based incentives with the anchoring strategy for establishing and maintaining adherence to an effective dose of meditation with a mobile app. METHODS This 16-week study will use a 5-arm, parallel, partially blinded (participants only), randomized controlled design. We will implement a fractional factorial study design that varies the use of self-monitoring messages and financial incentives to support participants' use of their personalized anchoring strategy for maintaining adherence to a ≥10 minute-per-day meditation prescription during an 8-week intervention period, followed by an 8-week postintervention observation period. Specifically, we will vary the use of self-monitoring messages of either the target behavior (ie, meditation tracking) or the outcome associated with the target behavior (ie, mood symptom tracking). We will also vary the use of financial incentives conditional on either meditation at any time of day or meditation performed at approximately the same time of day as participants' personalized anchors. RESULTS Continuous meditation app use data will be used to measure weekly meditation adherence over the 16-week study period as a binary variable equal to 1 if participants complete ≥10 minutes of meditation for ≥4 days per week and 0 otherwise. We will measure weekly anchoring plan adherence as a binary variable equal to 1 if participants complete ≥10 minutes of meditation within +1 or -1 hour of the timing of their chosen anchor on ≥4 days per week and 0 otherwise. In addition to these primary measures of meditation and anchoring plan adherence, we will also assess the secondary measures of stress, anxiety, posttraumatic stress disorder, sleep disturbance, and meditation app habit strength at baseline, week 8, and week 16. CONCLUSIONS This study will fill an important gap in the mobile health literature by testing novel intervention approaches for establishing and maintaining adherence to app-based mindfulness meditation. If successful, this study will identify an accessible and scalable stress self-management intervention that can help combat stress in the United States. TRIAL REGISTRATION ClinicalTrials.gov NCT05217602; https://clinicaltrials.gov/ct2/show/NCT05217602. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39930.
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Affiliation(s)
- Chad Stecher
- Arizona State University, Phoenix, AZ, United States
| | - Sara Cloonan
- Arizona State University, Phoenix, AZ, United States
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Rodger A, Vezevicius A, Papies EK. Can a simple plan change a complex behavior? Implementation intentions in the context of water drinking. Appetite 2023; 183:106459. [PMID: 36646386 DOI: 10.1016/j.appet.2023.106459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/02/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
Underhydration has significant adverse physical and mental health effects, yet many people drink too little water. Implementation intentions have been found to effectively promote many health behaviors, but little is known about the processes underlying their effects in naturalistic settings, and whether they could improve water drinking. This mixed-methods study assessed the impact and potential underlying processes of using implementation intentions to increase self-reported water intake over a five-day follow-up. Ninety-five participants (Mage = 39, SD = 12) received an educational quiz to increase their water drinking motivation before being randomly assigned to the control or intervention group. Participants also completed a qualitative survey that assessed the processes underlying their attempts to increase water intake. Quantitative results suggested that most participants increased their average daily water intake regardless of group. Qualitative results indicated that implementation intention participants struggled with remembering and the perceived effort of preparation and drinking behaviors, which reduced the effect of planning on behavior. This study provides essential theoretical and methodological considerations for researchers studying implementation intentions, as the effects and mechanisms of implementation intentions in real-life situations may be more complex than previously assumed. For example, the results suggest that implementation intentions did not automatize remembering and performing the behavior in ways the current literature theorizes. Other kinds of interventions may be needed to improve the complex daily-life behaviour of water drinking.
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Affiliation(s)
- Amy Rodger
- School of Psychology, Institute of Neuroscience and Psychology, University of Glasgow, UK.
| | - Ariel Vezevicius
- School of Psychology, Institute of Neuroscience and Psychology, University of Glasgow, UK
| | - Esther K Papies
- School of Psychology, Institute of Neuroscience and Psychology, University of Glasgow, UK
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19
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Could implementation intentions improve the efficacy of behavioral weight-loss treatment? Appetite 2023; 186:106508. [PMID: 36924801 DOI: 10.1016/j.appet.2023.106508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/10/2023] [Accepted: 02/22/2023] [Indexed: 03/17/2023]
Abstract
Although behavioral weight loss treatment can result in health benefits, the effects on weight loss are generally disappointing, with lost weight regained within a few years. Because these problems appear to be due to a failure to execute the strong weight control intentions formed during treatment, the use of implementation intentions has been suggested to bridge that intention-behavior gap. In contrast to behavioral intentions, implementation intentions specify the situation in which the behavior should be enacted. Although implementation intentions have generally been very effective in increasing the likelihood of goal attainment for a wide range of behaviors, results with regard to eating have been mixed. Especially disappointing have been the findings of a large study that added implementation intentions to a clinical weight loss treatment and found no effects either on weight loss or on weight loss maintenance (Knäuper et al., 2018). I argue that this failure is due to the use of implementation intentions that target specific eating behaviors. According to the goal conflict model of eating, implementation intentions are most effective if they prime the weight control goal; implementation intentions targeting specific behaviors do not reliably do that. I review evidence that the implementation intention to think of dieting when confronted with palatable food items primes weight control thoughts. It also reduces eating of primed foods and even result in weight loss.
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20
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Roordink EM, Steenhuis IHM, Kroeze W, Hoekstra T, Jacobs N, van Stralen MM. Social Environmental Predictors of Lapse in Dietary Behavior: An Ecological Momentary Assessment Study Amongst Dutch Adults Trying to Lose Weight. Ann Behav Med 2023:7000437. [PMID: 36694372 PMCID: PMC10354841 DOI: 10.1093/abm/kaac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND When losing weight, most individuals find it difficult to maintain a healthy diet. Social environmental conditions are of pivotal importance in determining dietary behavior. To prevent individuals from lapsing, insight in social environmental predictors of lapse in dietary behavior is needed. PURPOSE Identify social environmental predictors of lapse in dietary behavior, using ecological momentary assessment (EMA) amongst Dutch adults trying to lose weight. METHODS Adults (N = 81) participated in two 7-day EMA weeks. Six times a day semi-random prompts were sent. At each prompt, participants indicated whether a lapse had occurred and responded to questions assessing social support, descriptive norm, injunctive norm, social pressure, presence of others, and current location. Generalized estimating equations were used to examine associations with lapse. RESULTS Injunctive norm (OR = 1.07, 95% CI = 1.03-1.11), descriptive norm (OR = 1.04, 95% CI = 1.02-1.07), and social pressure (OR = 1.09, 95% CI = 1.05-1.14), all toward diverting from diet plans, predicted lapses. Social support toward sticking to diet plans and presence of others did not predict lapses. When controlling for a prior lapse, all other associations became nonsignificant. Lapses occurred most often at home and gradually occurred more often during the day. CONCLUSIONS Traditional public health perspectives have mainly focused on individual choice and responsibility for overweight related unhealthy lifestyles. This study shows that there may be opportunities to enhance intervention programs by also focusing on social norms and social pressure. The involvement of partners or housemates may create more awareness of the impact of (unintentional) social pressure on risk of lapsing, and reduce the level of exerted social pressure.
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Affiliation(s)
- Eline M Roordink
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Ingrid H M Steenhuis
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Willemieke Kroeze
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.,Care for Nutrition and Health Group, School of Nursing, Christian University of Applied Sciences, 6717 JS Ede, The Netherlands
| | - Trynke Hoekstra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Nele Jacobs
- Department of Lifespan Psychology, Faculty of Psychology, Open Universiteit, Heerlen, The Netherlands.,Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Maartje M van Stralen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
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Fowers R, Berardi V, Huberty J, Stecher C. Using mobile meditation app data to predict future app engagement: an observational study. J Am Med Inform Assoc 2022; 29:2057-2065. [PMID: 36164826 PMCID: PMC9667187 DOI: 10.1093/jamia/ocac169] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/19/2022] [Accepted: 09/20/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Meditation with mobile apps has been shown to improve mental and physical health. However, regular, long-term meditation app use is needed to maintain these health benefits, and many people have a difficult time maintaining engagement with meditation apps over time. Our goal was to determine the length of the timeframe over which usage data must be collected before future app abandonment can be predicted accurately in order to better target additional behavioral support to those who are most likely to stop using the app. METHODS Data were collected from a randomly drawn sample of 2600 new subscribers to a 1-year membership of the mobile app Calm, who started using the app between July and November of 2018. App usage data contained the duration and start time of all meditation sessions with the app over 365 days. We used these data to construct the following predictive model features: total daily sessions, total daily duration, and a measure of temporal similarity between consecutive days based on the dynamic time warping (DTW) distance measure. We then fit random forest models using increasingly longer periods of data after users subscribed to Calm to predict whether they performed any meditation sessions over 2-week intervals in the future. Model fit was assessed using the area under the receiver operator characteristic curve (AUC), and an exponential growth model was used to determine the minimal amount of data needed to reach an accurate prediction (95% of max AUC) of future engagement. RESULTS After first subscribing to Calm, 83.1% of the sample used the Calm app on at least 1 more day. However, by day 350 after subscribing, 58.0% of users abandoned their use of the app. For the persistent users, the average number of daily sessions was 0.33 (SD = 0.02), the average daily duration of meditating was 3.93 minutes (SD = 0.25), and the average DTW distance to the previous day was 1.50 (SD = 0.17). The exponential growth models revealed that an average of 64 days of observations after subscribing to Calm are needed to reach an accurate prediction of future app engagement. DISCUSSION Our results are consistent with existing estimates of the time required to develop a new habit. Additionally, this research demonstrates how to use app usage data to quickly and accurately predict the likelihood of users' future app abandonment. This research allows future researchers to better target just-in-time interventions towards users at risk of abandonment.
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Affiliation(s)
- Rylan Fowers
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Vincent Berardi
- Department of Psychology, Chapman University, Orange, California, USA
| | - Jennifer Huberty
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
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22
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Renko E, Kostamo K, Hankonen N. Uptake of planning as a self-regulation strategy: Adolescents' reasons for (not) planning physical activity in an intervention trial. Br J Health Psychol 2022; 27:1209-1225. [PMID: 35451544 PMCID: PMC9790213 DOI: 10.1111/bjhp.12595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 03/21/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Planning is an effective self-regulation strategy. However, little is known why some people take up planning and some do not. Such understanding would help interventions to promote planning. We investigated how adolescents explain their (non) use of planning for physical activity after an intervention. METHODS Qualitative content analysis was employed to investigate follow-up interviews (a purposeful sampling; n = 19 low-to-moderately active, vocational school students) of Let's Move It trial participants twice post-intervention: 6-8 weeks and 14 months post-baseline. In the intervention, planning was one of the key techniques used to promote PA. RESULTS We identified seven categories linked to reasons for (not) using planning. Most were related to feelings anticipated to result from planning. Action- and identity-related concerns were also raised. The reasons for planning were that the plan (1) helps to clarify what to do and to get things done, (2) strengthens the feeling of autonomy, (3) promotes a sense of progress, ability and control over one's PA. The reasons for not planning were that (having) a plan may (1) feel forced and like an unpleasant duty, (2) take away life's spontaneity and freedom, (3) result in anticipated annoyance and bad mood if one fails to enact the plan, or (4) be an effective strategy for others but not for the interviewee. CONCLUSIONS Planning may not only link to behavioural control but also the sense of autonomy, and thus subsequent motivation. We suggest various strategies to promote planning, including challenging non-planner identity and harnessing social dimension of planning.
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Affiliation(s)
- Elina Renko
- Faculty of Social SciencesUniversity of HelsinkiHelsinkiFinland
| | - Katri Kostamo
- Faculty of Social SciencesUniversity of HelsinkiHelsinkiFinland
| | - Nelli Hankonen
- Faculty of Social SciencesUniversity of HelsinkiHelsinkiFinland,Faculty of Social SciencesTampere UniversityTampereFinland
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23
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Applying the Reasoned Action Approach and Planning to Understand Diabetes Self-Management Behaviors. Behav Sci (Basel) 2022; 12:bs12100375. [PMID: 36285944 PMCID: PMC9598101 DOI: 10.3390/bs12100375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/09/2022] Open
Abstract
Individuals managing diabetes are required to adhere to self-management behaviors to ensure the optimal regulation of their blood glucose levels. This study examined the psychological determinants underlying three important diabetes self-management behaviors (e.g., physical activity, diet, and blood glucose monitoring) using the reasoned action approach (RAA) and planning. A cross-sectional design was used, with participants (N = 273) completing measures of RAA constructs (e.g., experiential and instrumental attitude, descriptive and injunctive norm, and capacity and autonomy) and planning (e.g., action and control planning) at time 1 and participation in the behaviors one week later at time 2. Regressions showed that RAA constructs accounted for good variance in intention and behavior in all behaviors. Intention towards diet and blood glucose monitoring was significantly predicted by instrumental attitude, injunctive norm, and capacity. Intention towards physical activity was significantly predicted by instrumental attitude, experiential attitude, injunctive norm, capacity, and autonomy. All behaviors were significantly predicted by intention, action planning, and coping planning. Additionally, capacity significantly predicted physical activity and autonomy significantly predicted diet and blood glucose monitoring. Successfully intervening in the influential psychological constructs identified in the study could ensure optimal blood glucose regulation in those managing diabetes.
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24
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Lin H, Xu D, Yang M, Ma X, Yan N, Chen H, He S, Deng N. Behaviour change techniques that constitute effective planning interventions to improve physical activity and diet behaviour for people with chronic conditions: a systematic review. BMJ Open 2022; 12:e058229. [PMID: 35995541 PMCID: PMC9403139 DOI: 10.1136/bmjopen-2021-058229] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/22/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Action planning is a brief and effective behaviour change technique (BCT) to improve physical activity (PA) and diet behaviour (DB). This study aimed to identify critical BCTs and mechanisms of action (MoAs) to interpret the effectiveness of planning interventions based on the Health Action Process Approach (HAPA) model. DESIGN Systematic review. DATA SOURCES PubMed, Web of Science, CINAHL (EBSCO), PsycINFO (EBSCO), Psychology and Behavioural Sciences Collection (EBSCO), psyARTICLES and Medline were searched for studies from January 1990 to September 2021 published in English. ELIGIBILITY CRITERIA Experiment involving action planning intervention to improve PA or DB in community-dwelling adult patients with chronic conditions. DATA EXTRACTION AND SYNTHESIS Two reviewers independently coded the planning interventions into BCT combinations and MoA assemblies. Outcome was dichotomised according to the statistical power and Cohen's d. The Cochrane risk of bias assessment tool and the Risk of Bias in Nonrandomized Studies-of Interventions assessment tool were used to assess the quality of randomised controlled trials (RCTs) and non-RCTs, respectively. RESULTS From the 52 included studies, 46 BCTs were identified and linked to 21 MoAs. Long-term facilitators for planning intervention included 'self-monitoring of behaviour', 'problem solving', 'instruction on how to perform the behaviour' and 'adding objects to the environments'. The three most frequently occurring MoAs were 'intention', 'behavioural regulation', 'beliefs about capabilities'. The effective intervention groups had higher MoA scores that corresponded to the HAPA model constructs than the ineffective groups. CONCLUSIONS The findings from this review may inform scientific and effective planning intervention designs for community-dwelling people with chronic conditions in the future. PROSPERO REGISTRATION NUMBER CRD42021241227.
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Affiliation(s)
- Hui Lin
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Dongdong Xu
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Min Yang
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xueping Ma
- Cardiac Centre, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Ning Yan
- Cardiac Centre, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Han Chen
- Department of Information, Medical Security Center, Hainan Hospital, PLA General Hospital, Sanya, China
| | - Shilin He
- Department of Information, Medical Security Center, Hainan Hospital, PLA General Hospital, Sanya, China
| | - Ning Deng
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
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25
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Maillet MA, Grouzet FME. Healthy eating in daily life: the role of relative autonomous motivation when it is difficult. MOTIVATION AND EMOTION 2022; 46:640-657. [PMID: 35910091 PMCID: PMC9309594 DOI: 10.1007/s11031-022-09960-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2022] [Indexed: 11/26/2022]
Abstract
Most people try to eat healthy, but the temptation of unhealthy foods (among other factors) can make it difficult. Despite these difficulties, some people still achieve their healthy eating goals. Following self-determination theory (SDT; Ryan & Deci, 2000), we propose that relative autonomous motivation (RAM) can foster people’s effort in pursuing health goals. In two daily diary studies, we tested the hypothesis that RAM predicts attainment of healthy eating goals, especially when it is difficult. In Study 1, we focused on difficulties associated with trying to eat certain foods while avoiding others, whereas in Study 2, we focused on difficulties associated with the availability of unhealthy and healthy foods. Multilevel analyses provided some support our hypothesis, and highlighted the role of RAM for eating (vs. skipping) lunch and packing a lunch–two approach-based healthy eating strategies. We discuss these findings in relation to SDT and propose directions for future research on within-person changes in motivation and other sources of difficulty.
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Affiliation(s)
- Myles A. Maillet
- Department of Psychology and Centre for Youth and Society, University of Victoria, Victoria, BC Canada
| | - Frederick M. E. Grouzet
- Department of Psychology and Centre for Youth and Society, University of Victoria, Victoria, BC Canada
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26
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Guertin C, Pelletier L. The relationship between autonomous and controlled motivation and eating behaviors: examining the roles of self-regulating eating quality and quantity. MOTIVATION AND EMOTION 2022. [DOI: 10.1007/s11031-022-09964-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Zhang Q, O'Connor DB, Hugh-Jones S. Feasibility of a multiple-component mindfulness intervention for Chinese adolescents living with overweight: A pilot randomized trial. Appl Psychol Health Well Being 2022; 15:516-535. [PMID: 35860947 DOI: 10.1111/aphw.12393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/10/2022] [Indexed: 11/27/2022]
Abstract
The prevalence of obesity among Chinese adolescents is rising rapidly, and theoretically informed, scalable weight management interventions are needed. We developed and evaluated the feasibility and preliminary effects of an mHealth nutrition education and mindful snacking intervention for weight loss and improved dietary practices among Chinese adolescents with overweight. We examined whether including implementation intention formation (using if-then plans) improved outcomes. With user consultation, we created a 3-week mindful eating intervention delivered as 10 videos to user smartphones. Participants (n = 55) were randomly assigned to mindful eating or mindful eating + planning. Forty-six (83.6%) participants (age = 16.35 ± 0.48 years; body mass index [BMI] = 25.79 ± 2.05 kg/m2 ) completed the intervention. Both groups exhibited significant pre- to post-intervention weight loss (M = 1.42 and 1.79 kg, respectively); decreases in snacking frequencies, emotional eating, external eating, and trait craving; and significant increases in mindful eating and eating self-efficacy. No significant intervention group differences were observed. User experience data (n = 16) indicated acceptability and meaningful behavior change. Findings suggest that a smartphone-delivered mindfulness-based intervention for Chinese adolescents living with overweight is feasible and efficacious.
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Affiliation(s)
- Qian Zhang
- School of Psychology, University of Leeds, Leeds, UK
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28
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Tanis J, Vroling MS, Martijn C, van Heijningen LA, Maas J, Keijsers GPJ. Effects of implementation intentions on subthreshold binge eating. Eat Disord 2022; 30:370-384. [PMID: 33395366 DOI: 10.1080/10640266.2020.1868650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Binge eating disorder (BED) and bulimia nervosa (BN) are characterized by binge eating. Frequently related to negative affect, binge eating is considered unwanted eating behavior. It is often preceded by a shift away from the goal of a healthy eating pattern. Implementation intentions are 'if-then' plans that may prevent such shifts in goals. In a students' sample with subthreshold binge eating, two implementation intention conditions were compared to a control condition in which only goals were formed. In the behavior-focused condition, implementation intentions targeted binge eating; in the emotion-focused condition, implementation intentions targeted negative affect preceding binge eating. All participants received three sessions and kept food diaries for four weeks, followed by a post-test and a one-month, three-months, and six-months follow-up. Compared to the control condition, both implementation intention conditions showed significant and large reductions in binge eating lasting for six months. Effects did not differ between both implementation intention conditions. Three implementation intention sessions reduced subthreshold binge eating. This continued for six months after the final session. Contrary to expectations, behavior-focused and emotion-focused implementation intentions were equally effective, possibly due to other triggers than negative affect. Future research should address their usefulness in BED and BN.
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Affiliation(s)
- Jorg Tanis
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Maartje S Vroling
- GGNet Amarum, Expert Centre for Eating Disorders, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Carolien Martijn
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | | | - Joyce Maas
- Department of Work and Organizational Psychology, Radboud University, Nijmegen, The Netherlands
| | - Ger P J Keijsers
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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29
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Lin H, Yu P, Yang M, Wu D, Wang Z, An J, Duan H, Deng N. Making Specific Plan Improves Physical Activity and Healthy Eating for Community-Dwelling Patients With Chronic Conditions: A Systematic Review and Meta-Analysis. Front Public Health 2022; 10:721223. [PMID: 35664117 PMCID: PMC9160833 DOI: 10.3389/fpubh.2022.721223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Implementation intention formed by making a specific action plan has been proved effective in improving physical activity (PA) and dietary behavior (DB) for the general, healthy population, but there has been no meta-analysis of their effectiveness for patients with chronic conditions. This research aims to analyze several explanatory factors and overall effect of implementation intention on behavioral and health-related outcomes among community-dwelling patients. Methods We searched CIHNAL (EBSCO), PUBMED, Web of Science, Science Direct, SAGE Online, Springer Link, Taylor & Francis, Scopus, Wiley Online Library, CNKI, and five other databases for eligible studies. Random-effects meta-analysis was conducted to estimate effect sizes of implementation intention on outcomes, including PA, DB, weight, and body mass index. And the eligible studies were assessed by the Cochrane Collaboration's tool for risk of bias assessment. Sensitivity analysis adopted sequential algorithm and the p-curve analysis method. Results A total of 54 studies were identified. Significant small effect sizes of the intervention were found for PA [standard mean difference (SMD) 0.24, 95% confidence interval (CI) (0.10, 0.39)] and for the DB outcome [SMD -0.25, 95% CI (-0.34, -0.15)]. In moderation analysis, the intervention was more effective in improving PA for men (p < 0.001), older adults (p = 0.006), and obese/overweight patients with complications (p = 0.048) and when the intervention was delivered by a healthcare provider (p = 0.01). Conclusion Implementation intentions are effective in improving PA and DB for community dwelling patients with chronic conditions. The review provides evidence to support the future application of implementation intention intervention. Besides, the findings from this review offer different directions to enhance the effectiveness of this brief and potential intervention in improving patients' PA and DB. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=160491.
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Affiliation(s)
- Hui Lin
- Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Hangzhou, China
| | - Ping Yu
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Min Yang
- Department of Nutrition and Food Hygiene, School of Public Health, Chronic Disease Research Institute, Zhejiang University School of Medicine, Hangzhou, China
| | - Dan Wu
- Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Hangzhou, China
| | - Zhen Wang
- Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Hangzhou, China
| | - Jiye An
- Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Hangzhou, China
| | - Huilong Duan
- Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Hangzhou, China
| | - Ning Deng
- Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Hangzhou, China
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30
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A high-fibre personalised dietary advice given via a web tool reduces constipation complaints in adults. J Nutr Sci 2022; 11:e31. [PMID: 35573462 PMCID: PMC9066321 DOI: 10.1017/jns.2022.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 11/07/2022] Open
Abstract
Constipation can greatly impact the quality of life (QoL), which can be relieved by dietary fibres; however, preserving a higher fibre intake remains a challenge. We investigated the effects of a personalised dietary advice (PDA) on fibre intake and mild constipation complaints. A total number of twenty-five adults with mild constipation complaints were included in a 4-week observation period followed by a 4-week personalised intervention. The PDA provided high-fibre alternatives via a web tool. In weeks 1, 4 and 8, dietary intake, constipation complaints and QoL were assessed. Furthermore, participants collected a faecal sample at weeks 1, 4 and 8 to determine microbiota diversity and composition, and short-chain fatty acids (SCFA). Participants completed questions daily for 8 weeks regarding abdominal complaints, stool frequency and stool consistency. Fibre intake in week 8 was significantly higher compared to week 1 (Δ = 5·7 ± 6·7 g, P < 0·001) and week 4 (Δ = 5·2 ± 6·4 g, P < 0·001). Constipation severity and QoL significantly improved at week 8 compared to the observation period (P < 0·001). A higher fibre intake significantly reduced constipation severity (β = -0·031 (-0·05; -0·01), P = 0·001) and the QoL (β = -0·022 (-0·04; -0·01), P = 0·009). Stool consistency (P = 0·040) and abdominal pain (P = 0·030) improved significantly during the intervention period (P = 0·040), but stool frequency did not. Average microbial alpha diversity and composition and SCFA concentrations did not change over time, but indicated individual-specific dynamics. Several SCFAs were associated with constipation complaints. To conclude, a PDA effectively increased fibre intake and subsequently reduced constipation complaints, indicating that guided dietary adjustments are important and feasible in the treatment of mild constipation complaints.
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Key Words
- BMI, body mass index
- Constipation
- Dietary fibre
- EMA, ecological momentary assessment
- FFQ, food frequency questionnaire
- Functional bowel disorders
- IBS-C, Irritable Bowel Syndrome constipation predominant
- MET, metabolic equivalent task
- PAC-QoL, Patient Assessment of Constipation Quality of Life
- PAC-SYM, Patient Assessment of Constipation Symptoms
- PDA, personalised dietary advice
- Personalised nutrition
- QoL, quality of life
- Quality of life
- SQUASH, short questionnaire to assess health-enhancing physical activity
- VAS, visual analogue scale
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Henn K, Bøye Olsen S, Goddyn H, Bredie WL. Willingness to replace animal-based products with pulses among consumers in different European countries. Food Res Int 2022; 157:111403. [DOI: 10.1016/j.foodres.2022.111403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/13/2022] [Accepted: 05/21/2022] [Indexed: 11/30/2022]
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32
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de Vries R, Boesveldt S, Sotomayor Sainz A, Copier J, de Vet E. Wired for harsh food environments: Human spatial memory favours the effortless location and consumption of high-calorie foods. Food Qual Prefer 2022. [DOI: 10.1016/j.foodqual.2021.104478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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33
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Chami R, Cardi V, Lawrence N, MacDonald P, Rowlands K, Hodsoll J, Treasure J. Targeting binge eating in bulimia nervosa and binge eating disorder using inhibitory control training and implementation intentions: a feasibility trial. Psychol Med 2022; 52:874-883. [PMID: 32713405 DOI: 10.1017/s0033291720002494] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND This trial examined the feasibility, acceptability, and effect sizes of clinical outcomes of an intervention that combines inhibitory control training (ICT) and implementation intentions (if-then planning) to target binge eating and eating disorder psychopathology. METHODS Seventy-eight adult participants with bulimia nervosa or binge eating disorder were randomly allocated to receive food-specific, or general, ICT and if-then planning for 4 weeks. RESULTS Recruitment and retention rates at 4 weeks (97.5% and 79.5%, respectively) met the pre-set cut-offs. The pre-set adherence to the intervention was met for the ICT sessions (84.6%), but not for if-then planning (53.4%). Binge eating frequency and eating disorder psychopathology decreased in both intervention groups at post-intervention (4 weeks) and follow-up (8 weeks), with moderate to large effect sizes. There was a tendency for greater reductions in binge eating frequency and eating disorders psychopathology (i.e. larger effect sizes) in the food-specific intervention group. Across both groups, ICT and if-then planning were associated with small-to-moderate reductions in high energy-dense food valuation (post-intervention), food approach (post-intervention and follow-up), anxiety (follow-up), and depression (follow-up). Participants indicated that both interventions were acceptable. CONCLUSIONS The study findings reveal that combined ICT and if-then planning is associated with reductions in binge eating frequency and eating disorder psychopathology and that the feasibility of ICT is promising, while improvements to if-then planning condition may be needed.
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Affiliation(s)
- Rayane Chami
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of General Psychology, University of Padova, Padova, Italy
| | | | - Pamela MacDonald
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katie Rowlands
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Hodsoll
- Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Mazar A, Wood W. Illusory Feelings, Elusive Habits: People Overlook Habits in Explanations of Behavior. Psychol Sci 2022; 33:563-578. [PMID: 35344455 DOI: 10.1177/09567976211045345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Habits underlie much of human behavior. However, people may prefer agentic accounts that overlook habits in favor of inner states, such as mood. We tested this misattribution hypothesis in an online experiment of helping behavior (N = 809 adults) as well as in an ecological momentary assessment (EMA) study of U.S. college students' everyday coffee drinking (N = 112). Both studies revealed a substantial gap between perceived and actual drivers of behavior: Habit strength outperformed or matched inner states in predicting behavior, but participants' explanations of their behavior emphasized inner states. Participants continued to misattribute habits to inner states when incentivized for accuracy and when explaining other people's behavior. We discuss how this misperception could adversely influence self-regulation.
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Affiliation(s)
- Asaf Mazar
- Department of Psychology, University of Southern California
| | - Wendy Wood
- Department of Psychology, University of Southern California
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35
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Domke A, Keller J, Knoll N, Sniehotta FF, Heuse S, Wiedemann AU. Plan pursuit in the context of daily fruit and vegetable consumption: The importance of cue detection and the execution of the planned behaviour for overall behaviour change. Br J Health Psychol 2022; 27:1172-1187. [PMID: 35318775 DOI: 10.1111/bjhp.12593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In action planning interventions, individuals specify and link cues with behavioural responses to implement behaviour change. To date, not much is known about how and how much the detection of the planned cue (entering and identifying the planned situation) and the execution of the planned behaviour (behavioural response exactly as planned) contribute to overall behavioural changes (changes in target behaviour) achieved by individuals. Using data from an intervention on daily fruit and vegetable (FV) action planning, this study aimed to test whether individuals' cue detection and execution of the planned behaviour are positively related to overall FV intake. DESIGN Secondary data analyses examined diary data of the intervention condition of a randomized controlled trial. Ninety participants (80% female, aged 19-63 years) formed one FV plan and completed a 13-days post-intervention self-report diary assessing daily FV consumption and situational characteristics of each consumed FV serving. Based on these self-reports and participants' FV plan, day-to-day cue detection and the execution of the planned behaviour were coded. METHODS With two-level models, cue detection and the execution of the planned behaviour were examined as between- and within-person predictors of daily FV intake. RESULTS Higher between-person execution of the planned behaviour (+1.68 daily servings), higher-than-usual within-person cue detection (+0.46 daily servings), and higher-than-usual within-person execution of the planned behaviour (+0.29 daily servings) were associated with more overall FV intake. CONCLUSIONS Detecting planned cues (within-person) and executing the planned behaviour (between- and within-person) are important for overall FV intake.
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Affiliation(s)
- Antonia Domke
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Germany
| | - Jan Keller
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Germany
| | - Nina Knoll
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Germany
| | - Falko F Sniehotta
- Department of Public Health, Preventive and Social Medicine, Mannheim Medical Faculty, Heidelberg University, Germany
| | - Silke Heuse
- University of Europe for Applied Sciences, Hamburg, Germany
| | - Amelie U Wiedemann
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Germany
- DearEmployee GmbH, Berlin, Germany
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Bugg JM, Streeper E, Yang NY. How to let go of the past: Lessons from research on aging and prospective memory. PSYCHOLOGY OF LEARNING AND MOTIVATION 2022. [DOI: 10.1016/bs.plm.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stecher C, Sullivan M, Huberty J. Using Personalized Anchors to Establish Routine Meditation Practice With a Mobile App: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e32794. [PMID: 34941558 PMCID: PMC8734923 DOI: 10.2196/32794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Physical and mental health benefits can be attained from persistent, long-term performance of mindfulness meditation with a mobile meditation app, but in general, few mobile health app users persistently engage at a level necessary to attain the corresponding health benefits. Anchoring or pairing meditation with a mobile app to an existing daily routine can establish an unconsciously initiated meditation routine that may improve meditation persistence. OBJECTIVE The purpose of this study was to test the use of either personalized anchors or fixed anchors for establishing a persistent meditation app routine with the mobile app, Calm. METHODS We conducted a randomized controlled trial and randomly assigned participants to one of 3 study groups: (1) a personalized anchor (PA) group, (2) fixed anchor (FA) group, or (3) control group that did not use the anchoring strategy. All participants received app-delivered reminder messages to meditate for at least 10 minutes a day using the Calm app for an 8-week intervention period, and app usage data continued to be collected for an additional 8-week follow-up period to measure meditation persistence. Baseline, week 8, and week 16 surveys were administered to assess demographics, socioeconomic status, and changes in self-reported habit strength. RESULTS A total of 101 participants across the 3 study groups were included in the final analysis: (1) PA (n=56), (2) FA (n=49), and (3) control group (n=62). Participants were predominantly White (83/101, 82.2%), female (77/101, 76.2%), and college educated (ie, bachelor's or graduate degree; 82/101, 81.2%). The FA group had a significantly higher average odds of daily meditation during the intervention (1.14 odds ratio [OR]; 95% CI 1.02-1.33; P=.04), and all participants experienced a linear decline in their odds of daily meditation during the 8-week intervention (0.96 OR; 95% CI 0.95-0.96; P<.001). Importantly, the FA group showed a significantly smaller decline in the linear trend of their odds of daily meditation during the 8-week follow-up (their daily trend increased by 1.04 OR from their trend during the intervention; 95% CI 1.01-1.06; P=.03). Additionally, those who more frequently adhered to their anchoring strategy during the intervention typically used anchors that occurred in the morning and showed a significantly smaller decline in their odds of daily meditation during the 8-week follow-up period (1.13 OR; 95% CI 1.02-1.35; P=.007). CONCLUSIONS The FA group had more persistent meditation with the app, but participants in the FA or PA groups who more frequently adhered to their anchoring strategy during the intervention had the most persistent meditation routines, and almost all of these high anchorers used morning anchors. These findings suggest that the anchoring strategy can create persistent meditation routines with a mobile app. However, future studies should combine anchoring with additional intervention tools (eg, incentives) to help more participants successfully establish an anchored meditation routine. TRIAL REGISTRATION ClinicalTrials.gov NCT04378530; https://clinicaltrials.gov/ct2/show/NCT04378530.
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Affiliation(s)
- Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Mariah Sullivan
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Jennifer Huberty
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
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Mathur MB, Peacock JR, Robinson TN, Gardner CD. Effectiveness of a Theory-Informed Documentary to Reduce Consumption of Meat and Animal Products: Three Randomized Controlled Experiments. Nutrients 2021; 13:nu13124555. [PMID: 34960107 PMCID: PMC8708224 DOI: 10.3390/nu13124555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Several societal issues could be mitigated by reducing global consumption of meat and animal products (MAP). In three randomized, controlled experiments (n=217 to 574), we evaluated the effects of a documentary that presents health, environmental, and animal welfare motivations for reducing MAP consumption. Study 1 assessed the documentary's effectiveness at reducing reported MAP consumption after 12 days. This study used methodological innovations to minimize social desirability bias, a widespread limitation of past research. Study 2 investigated discrepancies between the results of Study 1 and those of previous studies by further examining the role of social desirability bias. Study 3 assessed the documentary's effectiveness in a new population anticipated to be more responsive and upon enhancing the intervention content. We found that the documentary did not decrease reported MAP consumption when potential social desirability bias was minimized (Studies 1 and 3). The documentary also did not affect consumption among participants whose demographics suggested they might be more receptive (Study 3). However, the documentary did substantially increase intentions to reduce consumption, consistent with past studies (Studies 2 and 3). Overall, we conclude that some past studies of similar interventions may have overestimated effects due to methodological biases. Novel intervention strategies to reduce MAP consumption may be needed.
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Affiliation(s)
- Maya B. Mathur
- Quantitative Sciences Unit and Department of Pediatrics, Stanford University, Stanford, CA 94305, USA
- Correspondence:
| | | | - Thomas N. Robinson
- Stanford Solutions Science Lab, Department of Pediatrics, Stanford University, Stanford, CA 94305, USA;
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Spring B, Champion K, Acabchuk R, Hennessy EA. Self-regulatory behaviour change techniques in interventions to promote healthy eating, physical activity, or weight loss: a meta-review. Health Psychol Rev 2021; 15:508-539. [PMID: 31973666 PMCID: PMC7429262 DOI: 10.1080/17437199.2020.1721310] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/22/2020] [Indexed: 12/28/2022]
Abstract
Poor quality diet, physical inactivity, and obesity are prevalent, covariant risk factors for chronic disease, suggesting that behaviour change techniques (BCTs) that effectively change one risk factor might also improve the others. To examine that question, registered meta-review CRD42019128444 synthesised evidence from 30 meta-analyses published between 2007 and 2017 aggregating data from 409,185 participants to evaluate whether inclusion of 14 self-regulatory BCTs in health promotion interventions was associated with greater improvements in outcomes. Study populations and review quality varied, with minimal overlap among summarised studies. AMSTAR-2 ratings averaged 37.31% (SD = 16.21%; range 8.33-75%). All BCTs were examined in at least one meta-analysis; goal setting and self-monitoring were evaluated in 18 and 20 reviews, respectively. No BCT was consistently related to improved outcomes. Although results might indicate that BCTs fail to benefit diet and activity self-regulation, we suggest that a Type 3 error occurred, whereby the meta-analytic research design implemented to analyse effects of multi-component intervention trials designed for a different purpose was mismatched to the question of how BCTs affect health outcomes. An understanding of independent and interactive effects of individual BCTs on different health outcomes and populations is needed urgently to ground a cumulative science of behaviour change.
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Affiliation(s)
- Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Katrina Champion
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney
| | - Rebecca Acabchuk
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut
| | - Emily A. Hennessy
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut
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Gültzow T, Hoving C, Smit ES, Bekker HL. Integrating behaviour change interventions and patient decision aids: How to accomplish synergistic effects? PATIENT EDUCATION AND COUNSELING 2021; 104:3104-3108. [PMID: 33952401 DOI: 10.1016/j.pec.2021.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/15/2021] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
People make numerous health-related choices each day: For example, deciding to brush one's teeth or to eat well and healthy - or not to do these activities. To support complex decisions and subsequent behaviour change, both Behaviour Change Interventions (BCIs) and Patient Decision Aids (PtDAs) have been developed and evolved independently to support people in health-related decision making. In this paper, we critically review BCIs and PtDAs, examine their similarities and differences, and identify potential for integration of expertise to increase the benefits for people engaging with healthcare and health behaviours. The two approaches appear to mainly differ in terms of their (1) goals and foci, (2) theoretical basis, (3) development frameworks, (4) active ingredients and (5) effect evaluation. To facilitate the integration of scientific insights from these two fields, we recommend to (1) bring both fields together and promote interprofessional discussions, (2) train (health) professionals to recognise strengths of both approaches, (3) investigate the synergy of the two fields, (4) be prepared for and try to mitigate a culture shock when the fields start to interact. Knowledge generated by researching PtDAs could be used to facilitate decisional processes that enable patients to choose goals that are in line with their values and preferences, while insights from researching BCIs could be used to facilitate engagement with, and implementation of those goals. This integration could allow researchers and intervention providers to increase the benefits for people engaging with healthcare and health behaviours.
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Affiliation(s)
- Thomas Gültzow
- Care and Public Health Research Institute (CAPHRI), Department of Health Promotion, Maastricht University, Maastricht, the Netherlands.
| | - Ciska Hoving
- Care and Public Health Research Institute (CAPHRI), Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Eline Suzanne Smit
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands
| | - Hilary L Bekker
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK; Research Centre for Patient Involvement (ResCenPI), Department of Public Health, Aarhus University, Denmark
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Hirsch A, Bieleke M, Bertschinger R, Schüler J, Wolff W. Struggles and strategies in anaerobic and aerobic cycling tests: A mixed-method approach with a focus on tailored self-regulation strategies. PLoS One 2021; 16:e0259088. [PMID: 34705866 PMCID: PMC8550367 DOI: 10.1371/journal.pone.0259088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022] Open
Abstract
Endurance sports pose a plethora of mental demands that exercisers have to deal with. Unfortunately, investigations of exercise-specific demands and strategies to deal with them are insufficiently researched, leading to a gap in knowledge about athletic requirements and strategies used to deal with them. Here, we investigated which obstacles exercisers experience during an anaerobic (Wingate test) and an aerobic cycling test (incremental exercise test), as well as the strategies they considered helpful for dealing with these obstacles (qualitative analysis). In addition, we examined whether thinking of these obstacles and strategies in terms of if-then plans (or implementation intentions; i.e., "If I encounter obstacle O, then I will apply strategy S!") improves performance over merely setting performance goals (i.e., goal intentions; quantitative analysis). N = 59 participants (age: M = 23.9 ± 6.5 years) performed both tests twice in a 2-within (Experimental session: 1 vs. 2) × 2-between (Condition: goal vs. implementation intention) design. Exercisers' obstacles and strategies were assessed using structured interviews in Session 1 and subjected to thematic analysis. In both tests, feelings of exertion were the most frequently stated obstacle. Motivation to do well, self-encouragement, and focus on the body and on cycling were frequently stated strategies in both tests. There were also test-specific obstacles, such as boredom reported in the aerobic test. For session 2, the obstacles and strategies elicited in Session 1 were used to specify if-then plans. Bayesian mixed-factor ANOVA suggests, however, that if-then plans did not help exercisers to improve their performance. These findings shed novel light into the mental processes accompanying endurance exercise and the limits they pose on performance.
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Affiliation(s)
- Anna Hirsch
- Department of Sport Science, Sport Psychology, University of Konstanz, Konstanz, Germany
| | - Maik Bieleke
- Department of Sport Science, Sport Psychology, University of Konstanz, Konstanz, Germany
| | - Raphael Bertschinger
- Department of Sport Science, Sport Psychology, University of Konstanz, Konstanz, Germany
| | - Julia Schüler
- Department of Sport Science, Sport Psychology, University of Konstanz, Konstanz, Germany
| | - Wanja Wolff
- Department of Sport Science, Sport Psychology, University of Konstanz, Konstanz, Germany
- Educational Psychology, Institute of Educational Science, University of Bern, Bern, Switzerland
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France JL, France CR, Rebosa M, Shaz BH, Kessler DA. Promoting awareness of donation-related iron depletion among high risk blood donors. Transfusion 2021; 61:3353-3360. [PMID: 34605554 DOI: 10.1111/trf.16694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The potential for iron deficiency is a known blood donor health concern and suggests the need to inform donors about the potential risks of low iron levels as well as strategies to address these risks. STUDY DESIGN AND METHODS Frequent (n = 904) and young (n = 629) donors were randomly assigned within risk group to either a control (n = 548) or an intervention (n = 985) group. The control group answered questions at baseline and 6-month follow-up regarding their awareness of the risk of donation-related iron depletion and whether they were taking actions to address their iron status. The intervention group answered the same questions at baseline and follow-up, but after completing the baseline survey, they received information regarding their risk of iron depletion and behaviors they could adopt to mitigate this risk. Intervention group participants were also offered the opportunity to develop an action plan to help them supplement their iron intake. RESULTS The intervention enhanced overall awareness of donation-related iron loss (OR = 1.5, 95% CI 1.171-1.864, p = .001), with no negative impact on retention. Reported iron health behaviors (iron supplementation, speaking with a doctor) showed significant increases when action planning was paired with the educational information. CONCLUSION These findings suggest that it is possible to increase awareness of donation-related risk for iron depletion without negatively influencing retention, and combining education with encouragement to develop an action plan may increase the likelihood of both retention and behavioral changes to promote healthy iron levels.
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Affiliation(s)
- Janis L France
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | | | - Mark Rebosa
- New York Blood Center, New York, New York, USA
| | - Beth H Shaz
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina, USA
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Cole SN, Smith DM, Ragan K, Suurmond R, Armitage CJ. Synthesizing the effects of mental simulation on behavior change: Systematic review and multilevel meta-analysis. Psychon Bull Rev 2021; 28:1514-1537. [PMID: 33948918 PMCID: PMC8500882 DOI: 10.3758/s13423-021-01880-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mental simulation of future scenarios is hypothesized to affect future behavior, but a large and inconsistent literature means it is unclear whether, and under what conditions, mental simulation can change people's behavior. A meta-analysis was conducted to synthesize the effects of mental simulation on behavior and examine under what conditions mental simulation works best. An inclusive systematic database search identified 123 (N = 5,685) effect sizes comparing mental simulation to a control group. After applying a multilevel random effects model, a statistically-reliable positive effect of Hedges' g = 0.49, 95% CI [0.37; 0.62] was found, which was significantly different than zero. Using a taxonomy to identify different subtypes of mental simulation (along two dimensions, class [process, performance, outcome] and purpose [whether an inferior, standard, superior version of that behavior is simulated]), it was found that superior simulations garnered more reliable beneficial effects than inferior simulations. These findings have implications for integrating theories of how mental simulations change behavior, how mental simulations are classified, and may help guide professionals seeking evidence-based and cost-effective methods of changing behavior.
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Affiliation(s)
- Scott N Cole
- Department of Psychology, York Saint John University, York, YO31 7EX, UK
| | - Debbie M Smith
- Psychology, Leeds Trinity University, Leeds, LS18 5HD, UK
| | - Kathryn Ragan
- Psychology, Newcastile University, Newcastle upon Tyne, NE1 7RU, UK
| | - Robert Suurmond
- School of Business and Economics, Maastricht University, 6229 GT, Maastricht, Netherlands
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, University of Manchester, Manchester, M13 9PL, UK.
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, M13 9PL, UK.
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, M13 9PL, UK.
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Hielkema MH, Lund TB. Reducing meat consumption in meat-loving Denmark: Exploring willingness, behavior, barriers and drivers. Food Qual Prefer 2021. [DOI: 10.1016/j.foodqual.2021.104257] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
Efforts to guide peoples' behavior toward environmental sustainability, good health, or new products have emphasized informational and attitude change strategies. There is evidence that changing attitudes leads to changes in behavior, yet this approach takes insufficient account of the nature and operation of habits, which form boundary conditions for attitude-directed interventions. Integration of research on attitudes and habits might enable investigators to identify when and how behavior change strategies will be most effective. How might attitudinally driven behavior change be consolidated into lasting habits? How do habits protect the individual against the vicissitudes of attitudes and temptations and promote goal achievement? How might attitudinal approaches aiming to change habits be improved by capitalizing on habit discontinuities and strategic planning? When and how might changing or creating habit architecture shape habits directly? A systematic approach to these questions might help move behavior change efforts from attitude change strategies to habit change strategies. Expected final online publication date for the Annual Review of Psychology, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Bas Verplanken
- Department of Psychology, University of Bath, Bath BA2 7AY, United Kingdom;
| | - Sheina Orbell
- Department of Psychology, University of Essex, Colchester CO4 3SQ, United Kingdom;
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Can individual, dyadic, or collaborative planning reduce sedentary behavior? A randomized controlled trial. Soc Sci Med 2021; 287:114336. [PMID: 34482277 DOI: 10.1016/j.socscimed.2021.114336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/27/2021] [Accepted: 08/19/2021] [Indexed: 11/21/2022]
Abstract
RATIONALE Although effects of individual planning interventions on physical activity (PA) are well established, less is known about the relationships between planning and sedentary behavior (SB). OBJECTIVE This study evaluated the efficacy of individual planning, dyadic planning (i.e., joint planning, targeting the behavior of one person only: the target person), and collaborative planning (i.e., joint planning and joint behavioral performance) on sedentary behavior among dyads. METHODS Dyads (N = 320 target persons and their partners, aged 18-90 years) were randomized into three PA planning conditions (individual, dyadic, or collaborative) or an active (education) control condition. Main outcomes, i.e., sedentary time, proportion of time spent in SB and light-intensity PA, proportion of time spent in SB and total PA were measured with GT3X-BT accelerometers at baseline, 1-week follow-up, and 36-week follow-up. Two-level models with measurement points nested in participants were fit, separately for target persons and partners. RESULTS Findings for target persons obtained at 1-week follow-up indicated that in the collaborative planning condition SB time significantly decreased, compared to the control condition (p = .013). There was an improvement in the proportion of time spent in SB and light-intensity PA (p = .019), and the proportion of time spent in SB and total PA (p = .018), indicating that SB time was displaced by PA. Effects of individual and dyadic planning were not significant, compared to the control condition. None of interventions had a significant effect on SB indices at 36-week follow-up. Regarding dyadic partners, there were no effects of planning interventions at 1-week follow-up or 36-week follow-up, compared to the control condition. CONCLUSIONS Collaborative planning may prompt a short-term reduction of SB time and result in a shift towards a healthier balance between SB time and PA time among target persons, who did not adhere to PA guidelines at baseline.
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Assessment of Food Quality in School Canteens: A Comparative Quantitative Study between Primary and Secondary Schools in Malaysia. Nutrients 2021; 13:nu13093009. [PMID: 34578887 PMCID: PMC8471405 DOI: 10.3390/nu13093009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/11/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022] Open
Abstract
Schools are an important food environment to cultivate and promote healthy food choices and practices among children and adolescents. The aim of the present study was to assess the type and quality of food and beverages sold in school canteens in public primary and secondary schools in Kelantan, Malaysia. Eligible schools were randomly selected from the list of all schools and detailed information of all food and beverage items sold in the school canteens were collected during school days. Food and beverages were classified based on food groups derived from the Malaysian Food Dietary Guideline and the Recommended Foods for Healthy Cafeteria Guideline. An assessment of the traffic-light nutrition food-labelling system of the total sugar content in all pre-packaged foods was also undertaken. A total of 568 food items were identified, with secondary school canteens selling a greater proportion of food items than the primary schools (55.5% vs. 44.5%). In terms of the main food groups, grains and cereal products represented the largest food group served (33–36%), followed by beverages (21–25%) and confectionary and sweet foods (12–13%). In contrast, the vegetable and fruit group represented the smallest proportion of food items sold (1–3%). Comparisons between primary and secondary schools showed a similar trend and pattern of food types and quality of foods sold, except for animal-based foods. A greater percentage of food items in this category was found among secondary schools (12.1%) versus primary schools (6.7%). When total sugar content of all pre-packaged foods was quantified based on the traffic-light nutrition-labelling system, almost one-third of foods and beverages were classified as high (29.1%). Confectionary (19.1%) and flavoured milk and fruit drinks (10.0%) both exceeded the recommended sugar levels of >22.5 g per 100 g and >11.25 mL per 100 m L, respectively. Only one of these packaged foods and beverages (0.9%) was classified as a healthy food choice. About a quarter of the food items available in school canteens were classified as prohibited based on a new revised list of prohibited food and beverage items. These findings indicate that, despite the Guidelines, a large number of unhealthy food items are being sold in school canteens. Hence, interventions such as sustainable healthy school canteen menus should be implemented to promote healthy food choices amongst school-aged children.
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Huh J, Cerrada CJ, Dzubur E, Dunton GF, Spruijt-Metz D, Leventhal AM. Effect of a mobile just-in-time implementation intention intervention on momentary smoking lapses in smoking cessation attempts among Asian American young adults. Transl Behav Med 2021; 11:216-225. [PMID: 31901165 DOI: 10.1093/tbm/ibz183] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Identifying vulnerable windows for a given problematic behavior and providing timely and appropriate support are critical for building an effective just-in-time (JIT) intervention for behavioral change. We developed and evaluated an implementation intention (II) based, JIT cessation intervention prototype to support Asian American young adult smokers to prevent lapses in their cessation attempts in real-time. We examined how a JIT II reminder may prevent lapses during self-identified high-risk smoking situation (HRSS) as a microtemporal process. We also tested whether the effect of JIT reminder changes over the course of study and differed between those who used their own versus project loan phones. Asian American young adult smokers (N = 57) who were interested in quitting or reducing smoking participated in a 4 week, mobile-based, cessation study (MyQuit USC, MQU). MQU is a JIT mobile app that deploys a user-specified II reminder at user-specified HRSS and assesses momentary lapse status. Generalized mixed linear models were conducted to assess the effect of the JIT intervention on lapse prevention. We found a significant interaction effect (p = .03) such that receiving JIT reminder reduced the likelihood of lapses for participants using their own phones but not for the loaners. The results also showed that when participants enacted the suggested II, they were less likely to lapse (p < .001). The JIT effect did not change over time in study (p = .21). This study provides evidence that receiving a reminder of a smoker's own plan just before a self-identified risky situation on a familiar device and successfully executing specified plans can be helpful in preventing lapses. Our results highlighted factors to consider when designing and refining a JIT intervention.
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Affiliation(s)
- Jimi Huh
- Department of Preventive Medicine, Institute for Prevention Research, University of Southern California, Los Angeles, CA, USA
| | - Christian J Cerrada
- Department of Preventive Medicine, Institute for Prevention Research, University of Southern California, Los Angeles, CA, USA
| | - Eldin Dzubur
- Department of Preventive Medicine, Institute for Prevention Research, University of Southern California, Los Angeles, CA, USA
| | - Genevieve F Dunton
- Department of Preventive Medicine, Institute for Prevention Research, University of Southern California, Los Angeles, CA, USA
| | - Donna Spruijt-Metz
- Department of Preventive Medicine, Institute for Prevention Research, University of Southern California, Los Angeles, CA, USA.,Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Adam M Leventhal
- Department of Preventive Medicine, Institute for Prevention Research, University of Southern California, Los Angeles, CA, USA.,Department of Psychology, University of Southern California, Los Angeles, CA, USA
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Bieleke M, Martarelli CS, Wolff W. If-then planning, self-control, and boredom as predictors of adherence to social distancing guidelines: Evidence from a two-wave longitudinal study with a behavioral intervention. CURRENT PSYCHOLOGY 2021; 42:9095-9108. [PMID: 34413619 PMCID: PMC8363486 DOI: 10.1007/s12144-021-02106-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2021] [Indexed: 11/24/2022]
Abstract
In the wake of the Coronavirus Disease 2019 (COVID-19), social distancing is instrumental for containing the pandemic. To maximize its effectiveness, it is paramount to investigate psychological factors that predict adherence to social distancing guidelines and examine corresponding interventions. We focused on individual differences in if-then planning, self-control, and boredom, and tested an intervention based on if-then planning. We conducted a two-wave longitudinal study combining observational and experimental methods. Participants (N = 574, 35.7% female, age: M = 37.5 years, SD = 10.8) reported their adherence to social distancing guidelines and the perceived difficulty of adherence at T1, along with trait measures of if-then planning, self-control, and boredom. Afterwards, they were randomly assigned to an if-then planning intervention to increase adherence, or to a control intervention. One week later at T2, participants again reported their adherence and the perceived difficulty of adhering. Multiple regression and structural equation modeling were used to establish whether trait if-then planning, self-control, and boredom predicted adherence, and to examine the effects of the if-then planning intervention. Trait if-then planning, self-control, and boredom were associated with T1 adherence, while only if-then planning and boredom predicted T2 adherence. No overall treatment effect of the if-then planning intervention emerged; however, participants who complied with the intervention (75.6%) maintained higher levels of adherence over time than control participants. In sum, individual differences in if-then planning, self-control, and boredom predicted adherence to social distancing guidelines. If-then planning interventions are promising but require further steps to ascertain compliance.
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Affiliation(s)
- Maik Bieleke
- Department of Sport Science, University of Konstanz, Konstanz, Germany
| | | | - Wanja Wolff
- Department of Sport Science, University of Konstanz, Konstanz, Germany.,Department of Educational Psychology, University of Bern, Bern, Switzerland
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Translational Research in Cancer Screening: Long-Term Population-Action Bridges to Diffuse Adherence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157883. [PMID: 34360176 PMCID: PMC8345519 DOI: 10.3390/ijerph18157883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022]
Abstract
The population-level implementation of innovative, evidence-based medical recommendations for adopting health-behaviors depends on the last link in the translation chain: the users. “User-friendly” medical interventions aimed at engaging users to adopt recommended health behaviors are best developed in a collaborative bio-medical and social sciences setting. In the 1990s, National Breast and Colorectal Cancer Early Detection Programs were launched at the Israeli Department of Community Medicine and Epidemiology. Operating under the largest HMO (Health Maintenance Organization) in Israel (“Clalit Health Services”), the department had direct access to HMO community primary-care clinics’ teams, insured members, and medical records. Academically affiliated, the department engaged in translational research. In a decades-long translational process, this multi-disciplinary unit led a series of interventions built upon basic and applied behavioral/social science phenomena such as framing, “Implementation Intentions,” and “Question-Behavior-Effect”. A heterogeneous team of disciplinary specialists created an integrated scientific environment. In order to enhance screening, the team focused on the establishment of a systematic mechanism actively inviting programs’ “users” (average-risk targeted individuals on the national level), and continuously applied social and health psychology concepts to study individuals’ perceptions, expectations, and needs related to cancer screening. The increase in adherence to screening recommendations was slow and incremental. A decrease in late-stage breast and colorectal cancer diagnoses was observed nationally, but participation was lower than expected. This paper positions screening adherence as a unique challenge and proposes new social and network avenues to enhance future participation.
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