Are diet-specific compensatory health beliefs predictive of dieting intentions and behaviour?

Development and psychometric assessment of Health Action Process Approach (HAPA) in terms of smoking cessation among Chinese smokers

The Health Action Process Approach (HAPA) is a two-stage (pre-intentional and post-intentional) behavioral change model that distinguishes between motivation and volition in behavior change process. This study aims to develop HAPA-based assessments for smoking cessation among current smokers. The HAPA-based measures were developed and the draft measures included nine constructs, namely, risk perception in smoking-induced cancer, risk perception in smoking-induced systemic disease, positive outcome expectancy, negative outcome expectancy, self-efficacy in quitting smoking, self-efficacy in maintaining, self-efficacy in re-initiating, quitting planning and coping planning in smoking cessation, with a total of 26 items. A cross-sectional survey was conducted in China in 2022. Principal Component Analysis was used for Exploratory Factor Analysis (EFA). Cronbach's α coefficient was calculated to evaluate the internal consistency. Variables such as severity of smoking addiction were selected to evaluate the correlation between the HAPA scale and these variables. Of the 928 participants, 76.4% (709/928) were male and the median age was 35 years. Five factors were extracted by EFA. The factor loadings of each item were all greater than 0.60, and the cumulative variance contribution rate was 90.15%. The Cronbach's α coefficient of each HAPA-based subscales was 0.929-0.986. The HAPA-based measurements are comprehensive, reliable and valid in the assessment of smokers' smoking cessation cognition, which can be used to guide the design and implementation of intervention and the development of theory.

Relationship between problematic smartphone use and sleep problems: The roles of sleep-related compensatory health beliefs and bedtime procrastination

Objective

Concerns regarding sleep problems in emerging adults and their antecedents, such as problematic smartphone use (PSU), have been growing. This study tested the association between PSU and sleep problems and further investigated the mechanisms of this relationship based on the theory of compensatory health beliefs (CHBs).

Methods

This study included 999 participants (74.87% female) in China, aged 17 to 25 years (M = 21.16; standard deviation = 1.60), who voluntarily filled in an anonymous survey.

Results

The findings showed positive correlations between sleep problems and PSU, sleep-related CHBs, and bedtime procrastination (rs = .25-.52, p < .001). Furthermore, the positive link between PSU and sleep problems was mediated by bedtime procrastination alone (β=.21, 95% confidence interval (CI) [.17, .26]) or a serial path of sleep-related CHBs and bedtime procrastination (β=.04, 95% CI [.02, .05]).

Conclusion

This study provides a new perspective to understand the internal mechanism underlying the PSU-sleep problem link. Interventions for sleep disorders ought to consider the theoretical guidelines of the CHBs model to reduce the risk of bedtime procrastination and sleep disorders in emerging adults.

Compensatory health motivations and behaviors scale: Development, evaluation, psychometric properties and a preliminary validation

The "Compensatory Health Beliefs" scale assesses the degree to which one believes that unhealthy behaviours can be compensated through healthier ones. However, no validated scale to assess compensatory weight-related behaviors exists. The study's objective was to develop (Study 1) and validate (Study 2) a questionnaire measuring compensatory health motivations and behaviors (CHMB) and to assess their associations with body mass index (BMI) and psychological weight-related measures. An initial 34-item measure was constructed based on a target sample's (Study 1, n = 158) suggestions and refined based on expert feedback. The measure was then tested in a representative Canadian adult sample (N = 1400, 48.7% male). The sample was stratified by sex and age and then randomly split into two (N = 701 for exploratory factor analysis; N = 699 for confirmatory factor analysis (CFA) cross-validation). Fit indices, standardized Cronbach's alphas and the associations between the CHMB model with cognitive restraint, weight concerns, and BMI were assessed in multiple linear regression models controlling for age and sex. The final CHMB model (n = 17 items) consisted of four subscales: (1) motivation, (2) use on special occasions, (3) general use, (4) compensatory health beliefs. Fit indices (Goodness of Fit Index = 0.922) and Cronbach's alphas were good (α = 0.88). In multiple linear regression models, all CHMB subscales were associated with greater cognitive restraint in eating. Compensatory behavior use on special occasions was associated with greater weight concern (B = 0.12, p < .0001), while general compensatory behavior use was associated with lower weight concern (B = -0.07, p < .05). None of the subscales were associated with BMI. The validated CHMB scale allows for the assessment of compensatory health motivations and behaviors in a Canadian population. Research on whether this scale can predict weight changes and general health is needed.

Covariates of a healthy diet and physical activity self-management one year after Bariatric surgery: A cross-sectional study

BACKGROUND

Healthy diet and physical activity self-management is important in maintaining weight loss and preventing weight regain after bariatric surgery. We aimed at evaluating covariates of healthy diet and physical activity self-management among patients undergone bariatric surgery using Health Action Process Approach (HAPA) model.

METHOD

In this cross-sectional study, 272 patients with a history of bariatric surgery were selected from the data registry of Tehran Obesity Treatment Study (TOTS). Data were collected using bariatric surgery self-management standard questionnaire (BSSQ), and items based on HAPA model for healthy diet and physical activity self-management. Data were analyzed using Path analysis and AMOS version 24.

RESULTS

The mean score of self-management was (32 ± 10SD). Coping planning construct (β = 0.22; p<0.001) and risk perception (β = 0.02; p<0.01) in dietary self-management and action planning (β = 0.16; p = 0.001) and risk perception (β = 0.001; p = 0.17) in physical activity self-management had the highest and lowest effect powers, respectively. Coping planning (β = 0.22; p<0.001) and action planning (β = 0.17; p<0.03) in diet, and action planning (β = 0.16; p = 0.010) in physical activity were significantly related to self-management. Also, task-coping self-efficacy (β = 0.28; and p<0.001), outcome expectancies (β = 0.37; p<0.001), risk perception (β = 0.13; p = 0.015) in diet and coping self-efficacy (β = 0.50; p<0.001), outcome expectancies (β = 0.12; p = 0.021) in physical activity were significantly related to behavioral intention. The values of CFI = 0.939 and RMSEA = 0.052 for diet and CFI = 0.948 and RMSEA = 0.048 for physical activity indicated adequate fit.

CONCLUSION

HAPA was applicable as a framework for interventions promoting healthy diet and physical activity self-management in patients who have undergone bariatric surgery.

Effects of Educational Interventions on Dietary Adherence among Type 2 Diabetics in Zahedan: Using the Health Action Process Approach

Background

Type 2 diabetes is the most common type of diabetes, and dietary adherence is a self-care practice. This research aims to improve dietary adherence among type 2 diabetics in Zahedan using the HAPA model.

Methods

In this cross-sectional study, a total of 210 type 2 diabetics admitted to hospital clinics in Zahedan during summer 2022 were selected. The intervention group (n = 105) and the control group (n = 105) were from hospitals in Zahedan. Samples were selected by the simple random sampling method among the diabetics. After data collection using the demographic characteristics questionnaire and the Dietary Adherence Questionnaire and the HAPA model constructs questionnaire, the pre-test analysis was performed. One and three months after the educational intervention, the questionnaires on HAPA model constructs and self-care behavior were filled out by the patients. Next, data were analyzed using independent t-test, chi-square test, and the Shapiro-Wilk test in SPSS 23.

Results

The results showed that all of the HAPA model constructs had significant differences, one and three months after the educational intervention (P = 0.001), indicating the effectiveness of education in the intervention group. However, there was no significant difference in the control group (P = 0.009).

Conclusion

After the intervention using the HAPA model, the model's constructs had a significant impact on the patients' self-care of dietary adherence following the training.

"Mummy, Can I Join a Sports Club?" A Qualitative Study on the Impact of Health-Promoting Schools on Health Behaviours in the Home Setting

Information regarding school-based health-promoting interventions' potential effects in the home environment is scarce. Gaining more insight into this is vital to optimise interventions' potential. The Healthy Primary School of the Future (HPSF) is a Dutch initiative aiming to improve children's health and well-being by providing daily physical activity sessions and healthy school lunches. This qualitative study examines if and how HPSF influenced children's and parents' physical activity and dietary behaviours at home. In 2018-2019, 27 semi-structured interviews were conducted with parents from two HPSFs. Interviews were recorded and transcribed, and data were coded and interpreted through thematic analysis. HPSF resulted in various behavioural changes at home, initiated by both children and parents. Parents reported improvements in healthy behaviours, as well as compensatory, unhealthy behaviours. Reasons for behavioural change included increased awareness, perceived support to adopt healthy behaviours, and children asking for the same healthy products at home. Barriers to change included no perceived necessity for change, lack of HPSF-related information provision, and time and financial constraints. Both child-to-adult intergenerational learning and parent-initiated changes play an important role in the transfer of health behaviours from school to home and are therefore key mechanisms to maximise school-based health-promoting interventions' impact.

The Effects of the Healthy Primary School of the Future on Children's Fruit and Vegetable Preferences, Familiarity and Intake

Mere exposure is an often-described strategy to increase children’s food familiarity, preferences, and intake. Research investigating this method in less controlled settings is scarce. This study investigates the effects of repeated fruit and vegetable (FV) exposure through the Healthy Primary School of the Future (HPSF) on children’s FV familiarity, preferences, and intake. The study had a longitudinal quasi-experimental design comparing two full HPSFs (focus: nutrition and physical activity) with two partial HPSFs (focus: physical activity) in the Netherlands. Annual measurements (child-reported questionnaires) were conducted during 2015–2019 in 833 7–12-year-old children. The study was registered on ClinicalTrials.gov (NCT02800616). After correction for baseline, full HPSFs had, on average, a lower number of unfamiliar vegetable items after one (effect size (ES) = −0.28) and three years (ES = −0.35) and a higher number of disliked vegetable items after one year (ES = 0.24) than partial HPSFs. Unfavorable intervention effects were observed for fruit intake after one (odds ratio (OR) = 0.609) and four years (OR = 0.451). Repeated FV exposure had limited effects on children’s FV familiarity, preferences, and intake, likely due to insufficient taste exposure. Considering the widespread implementation of school-based mere exposure efforts, it is highly relevant to further investigate under which circumstances mere exposure effectively contributes to improvements in (determinants of) FV intake.

Compensatory Belief in Health Behavior Management: A Concept Analysis

Purpose

This study aimed to identify the exact definition of the concept of compensatory belief (CB) and to help clinicians and caregivers to distinguish patients who tend to form such beliefs.

Methods

This study is a conceptual analysis based on the strategy of Walker and Avant (2014). We retrieved studies from existing literature using databases such as PubMed, CINAHL, Wiley, and Web of Science, and extracted information from the results. No date limitations were applied.

Results

A total of 35 articles were sourced for data extraction. The identified attributes of CB were as follows: cognitive coping strategy, pleasure without guilt, compensatory behaviors, automatic motivated self-regulatory process, and implicit cognition. The observed antecedents were: failure to resist desire, reluctance, a conflicting motivational state, seeking appropriate balance, and self-image maintenance. The consequences of CB were lower health-related intentions, justification of unhealthy choices, relief from cognitive dissonance, continued existence of conflict feeling, and poor long-term health.

Conclusion

Compensatory belief stems from motivational dissonance or confliction. Despite causing feelings of pleasure and relief, it can negatively impact long-term health. Although CB is crucial to establish healthy behaviors, it is easily ignored in medical work.

Healthy Eating and Active Lifestyle After Bowel Cancer (HEAL ABC): feasibility randomised controlled trial protocol

Background

Targeting modifiable lifestyle factors including diet and physical activity represents a potentially cost-effective strategy that could support a growing population of colorectal cancer survivors and improve their health outcomes. Currently, effective, evidence-based interventions and resources helping people after bowel cancer to adopt new lifestyle habits are lacking. The aim of this trial is to test the Healthy Eating and Active Lifestyle After Bowel Cancer (HEAL-ABC) intervention to inform a future definitive randomised controlled trial.

Methods/design

This is a feasibility randomised controlled trial. A total of 72 survivors who have completed surgery and all anticancer treatments will be recruited. The intervention group will receive HEAL-ABC resources based on behaviour change theory combined with supportive telephone calls informed by motivational interviewing every 2 weeks during the 3-month intervention, and once a month for 6 months to follow-up. Participants in the control group will follow usual care and have access to resources available in the public domain. The study is testing feasibility of the intervention including adherence and ability to collect data on anthropometry, body composition, diet, physical activity, behaviour change, quality of life, blood markers, contact with healthcare services, morbidities and overall survival.

Discussion

The proposed study will add to the evidence base by addressing an area where there is a paucity of data. This study on lifestyle interventions for people after colorectal cancer follows the Medical Research Council guidance on evaluating complex interventions in clinical practice. It focuses on people living after treatment for colorectal cancer and targets an important research area identified by cancer survivors as a research priority reported by the National Cancer Institute and James Lind Alliance UK.

Trial registration

ClinicalTrials.gov NCT04227353 approved on the 13th of January 2020

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-020-00721-y.

Do compensatory health beliefs predict behavioural intention in a multiple health behaviour change context? Evidence in individuals with cardiovascular diseases?

Multiple health behaviour change (MHBC) represents one of the best ways to prevent reoccurrence of cardiovascular events. However, few individuals with cardiovascular diseases engage in this process. The present study examined the role of compensatory health beliefs (CHB; i.e., belief that a healthy behaviour compensates an unhealthy one) as a drag to engagement in this process. Some studies have shown that CHBs predict intention to engage in healthy behaviours, but no study has investigated CHBs in individuals who actually need to change multiple health behaviours. The goal was to better understand the role of CHBs in intentions formation process among individuals with cardiac diseases in an MHBC context. One hundred and four patients completed a questionnaire at the beginning of their cardiac rehabilitation program. Results showed that: (1) CHBs negatively predicted intentions (2) but only for participants with high self-efficacy or low risk perception; (3) CHBs predictions differed depending on the nature of the compensating behaviour, and were more predictive when medication intake was the compensating one. Findings only partially confirmed previous research conducted on healthy individuals who were not in an MHBC process, and emphasized the importance of considering CHBs for individuals in this process.

Use of nutritional information: analysing clusters of consumers who intend to eat healthily

Consumers intending to eat healthily should consult available information on the energy, salt, sugar and saturated fat content of foods. Some consumers, however, do this more than others do. The objective of this research was to identify distinct subgroups within the group of consumers who intend to eat healthily, segmented according to the timing and frequency of their use of information about energy, salt, sugar and saturated fat. Furthermore, we analysed whether consulting this information actually led to healthier food choices. Data on use of specific nutritional information in a computerised task in which participants made multiple dichotomous food choices (e.g. high-fat v. low-fat cheese) were recorded from 240 participants using process tracing software. Participants could view nutritional information by hovering the mouse over specific areas of the screen. We found three clusters of participants based on use of information about energy, salt, sugar and saturated fat: low, medium and high information users. There was a between-clusters difference in how often the healthy option was chosen (88·95 % with high information v. 67·17 % with low information usage). Presence in the medium and high information clusters was partially predicted by perceived self-efficacy in making healthy choices. It appears that some consumers are very confident of their ability to make healthy choices, which is a reason for making less use of nutritional information prior to making food choices and may result in unhealthy choices. Our findings improve understanding of the conditions needed to develop effective interventions targeted at health-conscious consumers.

Preliminary Validation of the Exercise-Snacking Licensing Scale: Rewarding Exercise with Unhealthy Snack Foods and Drinks

There is evidence that individuals’ compensatory health beliefs may be an important psychological driver of health behavior. Only recently, however, have researchers begun to develop and seek to validate instruments that are suited to measuring specific pairings of the diverse compensatory health beliefs that exist. The aim of this study was to provide support for key aspects of validity associated with the Exercise-Snacking Licensing Scale (ESLS), an instrument that was designed to assess individuals’ endorsement (or licensing) of unhealthy snacking behaviors around exercise. Participants (N = 1095) responded to a version of the ESLS that was designed to assess their licensing responses following either “light” or “tiring” physical activity, and completed additional instruments assessing dispositional, exercise-related, and diet-related constructs. Analyses indicated that scores derived from both versions of the ESLS (“light” and “tiring” physical activity) displayed a relatively consistent factor structure, favorable alpha coefficients, and meaningful correlations with variables that are theoretically aligned with licensing. Factor analytic procedures did, however, indicate that researchers may wish, in future, to consider the use (or not) of reverse-scored items within the ESLS. Together, these findings provide important insight into the structural, external, and generalizability aspects of validity for scores derived from the ESLS, and indicate that the ESLS may be a valuable instrument for the brief assessment of unhealthy licensing beliefs around exercise. Further use of the ESLS is encouraged to determine if and how these licensing beliefs actually influence subsequent snacking behaviors, and the potential downstream effects these beliefs may have in shaping health outcomes associated with exercise participation.

Predictors of Physical Activity among Adults with Type 2 Diabetes Mellitus, Isfahan, 2015: Structural Equation Modeling Approach

Background

The prevalence of Type 2 diabetes mellitus (T2DM) has been increasing globally in the recent decades. Physical activity (PA) helps preventing diabetes complications by keeping the blood sugar of T2DM patients within the normal range. The objective of this study was to explore underlying beliefs corresponding to PA in T2DM patients using health action process approach (HAPA).

Methods

This cross-sectional study was conducted in Isfahan, 2015. A convenience sample of 203 participants with T2DM was collected. Participants completed HAPA inventory containing the following constructs: Risk perception, outcome expectation, task self-efficacy, intention, action and coping planning, coping self-efficacy, recovery self-efficacy, and PA questionnaire. Structural equation modeling was used for statistical analysis.

Results

The common fit indices revealed that the HAPA had an acceptable fit to the observations (CMIN/df = 2.36 [P < 0.001], root mean square error of approximation = 0.089, comparative fit index = 0.891, normal fit index = 0.902). Intention was associated with task self-efficacy (β = 0.92, P < 0.001), whereas risk perception (β = 0.16, P = 0.073) and outcome expectation (β = 0.32, P < 0.081) did not predict intention to participate in PA behavior. PA was well predicted by planning (β =0.84, P < 0.01) while it was not significantly associated to coping self-efficacy (β = 0.66, P = 0.73) and recovery self-efficacy (β = 0.6, P = 0.69).

Conclusions

HAPA could be used as a proper framework to identify the beliefs of the patients with T2DM and guide for effective theory-based interventions regarding PA.

Psychological factors of healthful diet promotion among diabetics: an application of health action process approach

Background and aim

Worldwide, type 2 diabetes mellitus (T2DM) prevalence has increased. Non-healthful diet is one of the main reasons to T2DM growth. This study aims to determine the efficacy of the health action process approach (HAPA) in explaining healthful diet (HD) in T2DM patients.

Methods

This cross-sectional study was conducted based on HAPA in Isfahan, Iran between July and December 2015. Participants were recruited by convenience sampling method. HAPA inventory was administered to 203 Isfahan diabetics. Intentions, outcome expectancies, risk perception, action self-efficacy, action and coping planning, maintenance and recovery self-efficacy, and dietary style were the constructs measured. Structural equation modeling (SEM) in AMOS 21 was used to test the hypothesis.

Results

The results based on the common fit indices revealed that the HAPA fitted the data acceptably well among the T2DM patients and within dietary behavior (p<0.001), RMSEA=0.082, CFI=0.903, NFI=0.899). Action self-efficacy was the best predictor of intention (β=2.49, p<0.001). Result revealed action and coping planning (β=5.36, p=0.027) and recovery self-efficacy (β=5.67, p=0.021) significantly predicted behavior.

Conclusions

Our findings provide preliminary support for the practical usage of the HAPA model for predicting HD intention and behavior among T2DM patients. Randomized controlled trials should be performed in the future in order to involve causality.

Back-of-pack information in substitutive food choices: A process-tracking study in participants intending to eat healthy

People are increasingly aware of the positive effects of a healthy diet. Concurrently, daily food consumption decisions - choices about both the quality and quantity of food that is ingested - are steered more by what consumers consider healthy. Despite the increased aim to eat healthier, however, consumers often do not read or incorrectly interpret on-pack nutrition information, resulting in suboptimal food choices in terms of health. This study aims to unravel the determinants of such inadvertent food choices from these consumers. In an online process-tracking study, we measured the actual usage of available back-of-pack nutrition information during substitutive food choices made by 240 participants who had the intention to eat healthy. Using mouse-tracking software in a computerized task in which participants had to make dichotomous food choices (e.g., coconut oil or olive oil for baking), we measured the frequency and time of nutritional information considered. Combined with demographic and psychosocial data, including information on the level of intention, action planning, self-efficacy, and nutrition literacy, we were able to model the determinants of inadvertent unhealthy substitutive food choices in a sequential multiple regression (R² = 0.40). In these consumers who intended to eat healthy, the quantity of obtained nutrition information significantly contributed as an associative factor of the percentage of healthy food choices made. Moreover, the level of correct answers in a nutrition literacy test, as well as taste preferences, significantly predicted the percentage of healthier choices. We discuss that common psychosocial determinants of healthy behavior, such as intention, action planning, and self-efficacy, need to be augmented with a person's actual reading and understanding of nutrition information to better explain the variance in healthy food choice behavior.

Who benefits from a dietary online intervention? Evidence from Italy, Spain and Greece

OBJECTIVE

The traditional Mediterranean diet includes high consumption of fruits, vegetables, olive oil, legumes, cereals and nuts, moderate to high intake of fish and dairy products, and low consumption of meat products. Intervention effects to improve adoption of this diet may vary in terms of individuals' motivational or volitional prerequisites. In the context of a three-country research collaboration, intervention effects on these psychological constructs for increasing adoption of the Mediterranean diet were examined.

DESIGN

An intervention was conducted to improve Mediterranean diet consumption with a two-month follow-up. Linear multiple-level models examined which psychological constructs (outcome expectancies, planning, action control and stage of change) were associated with changes in diet scores.

SETTING

Web-based intervention in Italy, Spain and Greece.

SUBJECTS

Adults (n 454; mean age 42·2 (sd 10·4) years, range 18-65 years; n 112 at follow-up).

RESULTS

Analyses yielded an overall increase in the Mediterranean diet scores. Moreover, there were interactions between time and all four psychological constructs on these changes. Participants with lower levels of baseline outcome expectancies, planning, action control and stage of change were found to show steeper slopes, thus greater behavioural adoption, than those who started out with higher levels.

CONCLUSIONS

The intervention produced overall improvements in Mediterranean diet consumption, with outcome expectancies, planning, action control and stage of change operating as moderators, indicating that those with lower motivational or volitional prerequisites gained more from the online intervention. Individual differences in participants' readiness for change need to be taken into account to gauge who would benefit most from the given treatment.

Beliefs Are Not Behavior

Abstract. Compensatory health beliefs (CHBs), defined as belief that an unhealthy behavior can be compensated by engaging in another healthy behavior, are negatively predictive of health-behavior change intentions and behavior. However, CHBs have to be distinguished from compensatory health behavior (CBs), which is defined as compensatory behavior that an individual engages in. As it has not been investigated to date, the aim of this study was to systematically examine the distinction between CHBs and CBs in the context of alcohol consumption. The baseline sample consisted of 898 participants (mainly students, mean age = 23.57 years). For running exploratory and confirmatory factor analyses on CHBs and CBs, the split-half sample method was used. Moreover, the relationships of CHBs and CBs with health-related variables were assessed by regression analyses. The cross-sectional analyses supported the distinction between CHBs and CBs. In contrast to the CHBs, CBs were positively predictive of the intention to drink less alcohol and alcohol consumption. The consideration of CBs when investigating health behavior is highly relevant.

Development and Psychometric Evaluation of a Health Action Process Approach Inventory for Healthful Diet Among Type 2 Diabetes Patients

BACKGROUND

Long-term effects of diabetes could be prevented or delayed by adopting a proper diet. The aim of this study was to adapt and provide a pilot test using health action process approach (HAPA)-based inventory to capable of capturing significant determinants of healthful diet for diabetics.

METHODS

The inventory was reviewed by eight diabetes patients and verbal feedbacks with regard the comprehension, item relevance, and potential new content were obtained. Then, the inventory items were evaluated by an expert panel. Next exploratory factor analysis (EFA) was conducted to assess the scale constructs. Criterion validity was measured by Pearson correlation. Finally, reliability measures of internal consistency and test-retest analysis were determined.

RESULTS

A total of 121 diabetic patients participated in this study. EFA extracted seven factors (risk-perception, action self-efficacy, outcome expectancies, maintenance self-efficacy, action and coping planning, behavioral intention, and recovery self-efficacy) explaining 81.14% of the total variance. There were significant correlations between behavioral intentions and both outcome expectancies (r = 0.55, P < 0.05) and action self-efficacy (r = 0.31, P < 0.004) and small to moderate correlations (rs = 23-40) between behavior and the volitional constructs of the HAPA model. Cronbach's alpha ranging from 0.65 to 0.95 and intraclass correlation coefficients ranging from 0.71 to 0.92 indicated an acceptable internal consistency.

CONCLUSIONS

Developed scales were valid and reliable for measuring HAPA variables to be used with type 2 diabetes mellitus patients. Further examination with minority persons is warranted.

Structural Factors Affecting Health Examination Behavioral Intention

Disease screening instruments used for secondary prevention can facilitate early determination and treatment of pathogenic factors, effectively reducing disease incidence, mortality rates, and health complications. Therefore, people should be encouraged to receive health examinations for discovering potential pathogenic factors before symptoms occur. Here, we used the health belief model as a foundation and integrated social psychological factors and investigated the factors influencing health examination behavioral intention among the public in Taiwan. In total, 388 effective questionnaires were analyzed through structural model analysis. Consequently, this study yielded four crucial findings: (1) The established extended health belief model could effectively predict health examination behavioral intention; (2) Self-efficacy was the factor that most strongly influenced health examination behavioral intention, followed by health knowledge; (3) Self-efficacy substantially influenced perceived benefits and perceived barriers; (4) Health knowledge and social support indirectly influenced health examination behavioral intention. The preceding results can effectively increase the acceptance and use of health examination services among the public, thereby facilitating early diagnosis and treatment and ultimately reducing disease and mortality rates.

Brief report: Compensatory health beliefs are negatively associated with intentions for regular fruit and vegetable consumption when self-efficacy is low

Compensatory health beliefs (the beliefs that an unhealthy behaviour can be compensated by a healthy behaviour) can interfere with adherence to fruit and vegetable consumption recommendations. Fruit and vegetable consumption, social cognitive variables and compensatory health beliefs were investigated via self-report at baseline (T0) and 8-week follow-up (T1) in N = 790 participants. Self-efficacy predicted fruit and vegetable consumption intentions. Planning mediated between intentions and T1 fruit and vegetable consumption. Compensatory health beliefs negatively predicted intentions at low self-efficacy levels only. The results propose the use of self-efficacy interventions to diminish the negative effects of compensatory health beliefs when forming fruit and vegetable consumption intentions and foster planning to translate intentions into behaviour.

Weight status and body image perceptions in adolescents: current perspectives

Adolescence represents a pivotal stage in the development of positive or negative body image. Many influences exist during the teen years including transitions (eg, puberty) that affect one’s body shape, weight status, and appearance. Weight status exists along a spectrum between being obese (ie, where one’s body weight is in the 95th percentile for age and gender) to being underweight. Salient influences on body image include the media, which can target adolescents, and peers who help shape beliefs about the perceived body ideal. Internalization of and pressures to conform to these socially prescribed body ideals help to explain associations between weight status and body image. The concepts of fat talk and weight-related bullying during adolescence greatly contribute to an overemphasis on body weight and appearance as well as the development of negative body perceptions and dissatisfaction surrounding specific body parts. This article provides an overview of the significance of adolescent development in shaping body image, the relationship between body image and adolescent weight status, and the consequences of having a negative body image during adolescence (ie, disordered eating, eating disorders, and dysfunctional exercise). Practical implications for promoting a healthy weight status and positive body image among adolescents will be discussed.

Autonomous motivation is not enough: the role of compensatory health beliefs for the readiness to change stair and elevator use

Compensatory health beliefs (CHBs) are beliefs that an unhealthy behavior can be compensated with a healthy behavior. In line with the CHBs model, the aim of this study was twofold. First, the study investigated the relationship between autonomous motivation and CHBs that physical inactivity can be compensated by taking the stairs instead of the elevator. Second, the study focused on the associations between CHBs and readiness to use the stairs more often and stair and elevator use. Thus, a cross-sectional online questionnaire was designed that was filled out by 135 participants. Path analysis showed that individuals with stronger autonomous motivation to use the stairs strongly agreed that sedentary behavior could be compensated by taking the stairs instead of the elevator. Moreover, CHBs were positively related to readiness to change behavior, but not to self-reported stair and elevator use. Even though future research is necessary to replicate these findings, autonomous motivation seems to have a positive impact on CHBs which, in turn, might boost an intended behavior change. Thus, promoting possible compensation of physical inactivity might foster the readiness to change the unhealthy behavior.

Trait Versus State

Compensatory health beliefs (CHBs)–beliefs that an unhealthy behavior can be compensated for by a healthy behavior–can be distinguished into trait and state beliefs. Trait CHBs are stable individual differences, whereas state CHBs are activated in a tempting situation–for example, when faced with an attractive snack. The aim of this study was to test whether diet-specific trait or state CHBs are predictive for an unhealthy behavior–namely, high-calorie snack consumption. A scenario was created in which 66 women aged 16 to 50 were faced with a high-calorie snack. Diet-specific trait and state CHBs correlated moderately with each other. Regression analyses revealed that diet-specific trait CHBs with exercise as the compensatory behavior were significantly predictive for high-calorie snack consumption, over and above control variables such as age, whereas state CHBs were only marginally significant. Diet-specific trait and state CHBs with reduced intake (eat less later) as the compensatory behavior were not related to high-calorie snack consumption. Results showed that trait CHBs are relevant for the prediction of high-calorie snack consumption. Future studies might want to further refine the measurement of CHBs, especially state CHBs.