Predicting limiting 'free sugar' consumption using an integrated model of health behavior

Evaluation of an implementation intentions intervention for managing university student stress

University students consistently report high levels of stress, which has been associated with a range of adverse outcomes. Promoting adaptive coping behaviours, such as problem-focused coping for managing university stress, is therefore a timely area of investigation. Current coping intervention approaches target reasoned cognitive processes; however, recent research has suggested that automatic processes are more strongly associated with problem-focused coping behaviour. The current study examined the effect of an implementation intentions intervention, a technique that can support behaviour to be performed automatically by facilitating continued repetition of a plan, on problem-focused coping behaviour under stress and stress-related outcomes. Following a pilot study (N = 21), a preregistered randomized controlled trial was conducted with university students (N = 154) using an online survey. Participants completed baseline measures of problem-focused coping behaviour, behavioural automaticity, behavioural intentions, action planning, perceived stress, procrastination, and psychological wellbeing; before receiving the intervention or control condition stimuli, and then at a 2-week follow-up. Behavioural intention and action planning were also measured immediately post-intervention. The intervention had a significant medium-sized effect on action planning for problem-focused coping, but no other significant effects were detected. Exploratory assessment of plan quality revealed medium-sized correlations between plan quality and changes in problem-focused coping behaviour. Findings indicate that implementation intentions may be a promising approach for increasing planning for the use of problem-focused coping. Indicators of plan quality found to be associated with changes in problem-focused coping provide valuable avenues for intervention optimisation in future research.

Using an integrated social cognition model to identify the determinants of QR code check-in compliance behaviors in the COVID-19 pandemic

In Australia, checking in while entering venues was a legal requirement during the COVID-19 pandemic to track potential infection sites. This two-wave correlational study used an integrated theory of planned behavior model including moral norms, anticipated regret, and habit to predict check-in compliance in a sample of 181 Victorians (Mean Age = 41.88, 56.4% female) and 162 Queenslanders (Mean Age = 43.26, 47.5% female). Habit and intention predicted behavior, while perceived behavioral control did not. Intention was predicted by baseline habit, attitude, subjective norm, and moral norm in the Victorian sample, while only baseline habit and moral norm predicted intention in the Queensland sample. This study has potential implications for reviewing previous strategies and for future pandemic preparedness, both by identifying the drivers of infection control compliance, and through the discussion of how differences in effects between states may be linked to each state's experience of the pandemic (e.g. infection rates, lockdown length).

A Web-Based Physical Activity Promotion Intervention for Inactive Parent-Child Dyads: Protocol for a Randomized Controlled Trial

BACKGROUND

Low levels of physical activity are associated with numerous adverse health outcomes, yet sedentary lifestyles are common among both children and adults. Physical activity levels tend to decline steeply among children aged between 8 and 12 years, even though children's behavioral patterns are largely governed by familial structures. Similarly, parents' activity levels have been generally reported as lower than those of nonparents of comparable age. For this reason, family-based physical activity promotion interventions are a potentially valuable and relatively underresearched method for mitigating physical activity declines as children develop into adolescents and for increasing physical activity in parents.

OBJECTIVE

This study aims to assess the efficacy, feasibility, and acceptability of a novel theory-based web-based physical activity promotion intervention among parent-child dyads in Finland who do not meet physical activity recommendations at baseline.

METHODS

Participants (target N=254) will be recruited from the general population using a panel company and advertisements on social media and randomly assigned to either an immediate intervention group or a waitlist control group. The intervention consists of 4 web-based group workshops over the course of 10 weeks, web-based tasks and resources, and a social support chat group. Data on physical activity behavior and constructs from the integrated behavior change model will be collected through self-report surveys assessing physical activity, autonomy support, autonomous motivation, attitude, subjective norm, perceived behavioral control, intention, self-monitoring, habit, and accelerometer measurements at baseline, post intervention, and 3 months post intervention. Exit interviews with participants will assess the feasibility and acceptability of the intervention procedures.

RESULTS

This study will reveal whether the intervention changes leisure-time physical activity among intervention participants relative to the control group and will examine the intervention's effects on important theoretical predictors of physical activity. It will also yield data that can be used to refine intervention materials and inform further implementation. Trial recruitment commenced in September 2023, and data collection should be completed by December 2024.

CONCLUSIONS

The planned intervention has potential implications for both theory and practice. Practically, the use of an entirely web-based intervention may have scalable future uses for improving physical activity in 2 key populations, while also potentially informing on the value of dyadic, family-based strategies for encouraging an active lifestyle as an alternative to strategies that target either parents or children independently. Further, by assessing change in psychological constructs alongside potential change in behavior, the intervention also allows for important tests of theory regarding which constructs are most linked to favorable behavior change outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06070038; https://clinicaltrials.gov/study/NCT06070038.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55960.

Testing the moderative role of automatic-reflective affect divergence in predicting physical activity

Dual process theories postulate that behaviour is the product of two distinct cognitive systems, the automatic and reflective, and that congruence/divergence between the two types of cognitions can influence the predictive strength of either system on behaviour. However, the congruence/divergence hypothesis has yet to experience strong empirical support. The aim of this study was to test a novel dual process model to determine the moderating effect of affect divergence on the relationship between automatic affective evaluations-affective judgements, and physical activity. A sample of 315 university students recruited from an undergraduate research pool completed the Affective Misattribution Procedure and Affective Exercise Experiences Questionnaire, followed by a measure of physical activity behaviour one week later. A path analysis revealed a significant moderation effect such that the predictive strength of affective judgements was stronger when participants' automatic affective evaluations and affective judgements were congruent. Findings support current dual process theory and contributes to calls for more interventions, such as evaluative conditioning that target automatic processes alongside consciously held beliefs.

Dual processing approach to sedentary behavior and physical activity in the workplace

Regular physical activity is an important health promoting behavior. Yet, many adults live sedentary lifestyles, especially during their workday. The current study applies an extended theory of planned behavior model, incorporating affective attitudes and instrumental attitudes, along with habit, to predict limiting sedentary behavior and physical activity within an office environment. Theory of planned behavior constructs and habit were assessed with an online survey on a sample of 180 full-time office workers, with self-reported behavior assessed 1 week later (Mage = 25.97, SDage = 10.24; 44 males, 134 females, and 2 nonbinary). Model fit was indicated by BRMSEA (M = 0.057, SD = 0.023), B γ^ (M = 0.984, SD = 0.010) and BCFI (M = 0.959, SD = 0.026), accounting for 46.1% of variance in intention, 21.6% of variance in sedentary behavior, and 17.4% of variance in physical activity behavior. A Bayesian structural equation model revealed direct effects of instrumental attitudes and perceived behavioral control on intention to limit sedentary behavior, direct effects of intention and perceived behavioral control on limiting sedentary behavior, and direct effects of perceived behavioral control and habit on engaging in physical activity. The current study indicates intentions to be active in the office are primarily driven by beliefs about the benefits of activity and individuals' perceived level of control, rather than normative or affective beliefs. As behavior was predicted by both intention and habit, findings also indicate office-based activity is likely not always a consciously driven decision. These findings may have implications for improving activity levels in this highly sedentary population.

Reciprocal relations between past behavior, implicit beliefs, and habits: A cross-lagged panel design

The current study assessed cross-lagged relationships between binge drinking, implicit beliefs, and habit in undergraduate university students (N = 105). Students completed self-report survey and implicit measures in lab visits 3 months apart. A structural equation model revealed cross-lagged relations between habit and behavior, and some evidence for a reciprocal relationship between implicit beliefs and habit. Implicit beliefs were related to alcohol behavior across time, but no cross-lagged relationship was observed. Findings provide preliminary support for recent advances in habit theory, suggesting that implicit beliefs and habit may develop in tandem or even share common knowledge structures and schemas.

Predicting sugar intake using an extended theory of planned behavior in a sample of adolescents: The role of habit and self-control

INTRODUCTION

High levels of sugar intake are associated with multiple maladaptive health outcomes in adult and younger populations. Identifying the psychological determinants of sugar intake in adolescents, and the processes involved, may help identify potentially modifiable targets and inform intervention development. We tested the predictions of an extended theoretical model based on the theory of planned behavior (TPB), which specified social cognition constructs, habit, and self-control as correlates of sugar intake in an adolescent sample.

METHODS

Adolescents aged 12 to 14 years (N = 88) recruited via a survey panel company and consenting to participate in the study completed online self-report measures of constructs from the TPB alongside measures of habit and self-control. One month later, participants completed a follow-up measure of free-sugar intake. Hypothesized effects of our proposed extended model were tested using partial least squares structural equation modeling.

RESULTS

We found statistically significant effects of attitude, subjective norm, and perceived behavioral control on sugar intake intentions. We also found significant effects of habit and self-control on sugar intake measured at follow-up, but no effect for intention. Perceived behavioral control moderated the intention-behavior relationship such that intention effects on behavior were larger when perceived behavioral control was high. However, self-control did not moderate the intention-behavior relationship.

CONCLUSION

Results indicate that sugar intake in this sample was a function of habits and self-control, and the effect of sugar intake intentions was conditional on perceived behavioral control. Results contribute to an evidence base of determinants and associated processes that relate to sugar intake in adolescents and may signal potentially modifiable targets for intervention.

Creating Implicit Measure Stimulus Sets Using a Multi-Step Piloting Method

The effect of arbitrary stimulus selection is a persistent concern when employing implicit measures. The current study tests a data-driven multi-step procedure to create stimulus items using a combination of free-recall and survey data. Six sets of stimulus items were created, representing healthy food and high sugar items in children, adolescents, and adults. Selected items were highly representative of the target concepts, in frequent use, and of near equal length. Tests of the piloted items in two samples showed slightly higher implicit measure-behavior relations compared to a previously used measure, providing preliminary support for the value in empirically based stimulus selection. Further, the items reported as being the most associated with their target concepts differed notably from what one may expect from the guidelines or population consumption patterns, highlighting the importance of informed stimulus selection.

Physical Movement Habit Formation in Sedentary Office Workers: Protocol Paper

Engaging in physical movement has a number of mental and physical health benefits, and yet 45% of Australia's population do not meet the recommended guidelines for physical activity. The current study aims to develop an online habit-based intervention designed to reduce sedentary behavior within the workplace, using environmental cues to instigate simple behavioral changes. Participants in this study will include full time office workers who self-report as having a highly sedentary job and work from either a commercial office, home office, or a mixture of both. Participants will complete a habit-based intervention over a four-week period designed to reduce sedentary behavior by increasing habitual responses to simple physical movement behaviors cued by their environment. Analysis will involve mixed methods ANOVAs to test the efficacy of the intervention. A successful intervention will show a reduction in sedentary behavior as a response to habitual simple physical movement behaviors.

Is Adolescents' Free Sugar Intake Associated with the Free Sugar Intake of Their Parents?

High free sugar intake can lead to increased dental caries, obesity, and other health risks among adolescents. Studies have shown that family factors, especially parents, are one of the primary factors influencing adolescents' sugar intake. This study aims to investigate the influence of adolescent parents' free sugar intake, knowledge, attitude, and practice (KAP) on adolescents' free sugar intake. A total of 1090 pairs of adolescents and their parents from 10 secondary schools in Changsha were enrolled in a cross-sectional study. Free sugar intakes of parents and adolescents were measured using the food frequency questionnaire (FFQ). The current status of parents' knowledge, attitude, and practice in consuming free sugar was investigated using online and offline questionnaires. Parental free sugar intake was 11.55 (5.08, 21.95) g/d, and that of adolescents was 41.13 (19.06, 80.58) g/d. Parental free sugar intake, free sugar knowledge level, intake behavior, and guidance behavior were associated with adolescent free sugar intake. A superior level of parental free sugar knowledge (adjusted OR = 0.726, 95% CI: 0.557~0.946) was a protective factor for adolescent free sugar intake. Moderate and high levels of parental free sugar intake (adjusted OR = 1.706, 95% CI: 1.212~2.401; adjusted OR = 2.372, 95% CI: 1.492~3.773, respectively) were risk factors for free sugar intake in adolescents. Given the importance of parental influence on the adolescent free sugar intake, further limiting parental intake and increasing awareness of free sugars could play an active role in future interventions for adolescents' free sugar intake.

Hidden cues for approach and avoidance motivation: implicit cognitive associations among patients with Nonadherence to HIV treatment

Although patient motivation related to HIV treatment is widely acknowledged as a key factor related to consistent adherence and engagement with medical care, research has predominantly focused on explicit rather than implicit cognitive processes that underlie motivation. This study identified and examined implicit cognitive processes that influence approach and avoidance treatment motivation in a sample of 30 HIV patients with suboptimal adherence and poor engagement with medical care. Study participants were predominantly African American (87%) and gay/bisexual (63%). We examined 173 thought statements about treatment collected from patients during two previous studies. Thematic analysis described how implicit cognitive associations influenced patients to approach or avoid treatment and medical care. Findings revealed three major contextual categories of treatment-related thoughts: links with routines and habits, connections to physical changes and reactions, and interpersonal associations. Within each category, implicit cognitive associations about treatment in terms of these daily life events and experiences cued approach and avoidance motivational tendencies without the patient's awareness. Findings from this study support the need for interventions that use implicit, less effortful approaches aimed at promoting adherence and improving the retention of patients with poor engagement.

An integrated dual-process model for coping behaviour

Stress management interventions have traditionally aimed to change coping behaviour with little attention to mechanisms that drive behaviour change. We sought to test an integrated dual-process model, accounting for reasoned and automatic processes, for predicting problem-focussed coping behaviour. The study adopted a two-wave prospective correlational design with a 1-week follow-up. University students aged 17-25 (N = 272) completed survey measures online. At Time 1, participants completed self-report measures of attitude, subjective norm, perceived behavioural control, intention, behavioural automaticity, and past problem-focussed coping behaviour. At Time 2, participants completed follow-up measures of behavioural automaticity and problem-focussed coping behaviour. Structural equation modelling testing the hypothesised dual-process model exhibited a good fit to the data, accounting for 50.0% and 45.4% of the variance in intentions and problem-focussed coping behaviour, respectively. Attitude, subjective norm, perceived behavioural control, and past behaviour directly predicted intention. Intention, past behaviour, and behavioural automaticity directly predicted problem-focussed coping behaviour. Past behaviour also indirectly predicted problem-focussed coping behaviour via behavioural automaticity. Results suggest that problem-focussed coping behaviour tends to be regulated by reasoned psychological processes, and more strongly by automatic psychological processes. Future research aiming to increase problem-focussed coping should utilise behaviour change methods known to influence these processes.

Perceived determinants of physical activity among women with prior severe preeclampsia: a qualitative assessment

BACKGROUND

The objective of this study was to (1) qualitatively identify the perceived determinants of physical activity among women who have experienced severe preeclampsia, and (2) examine whether these determinants are consistent with the overarching processes outlined in the integrated behavior change (IBC) model, a novel model that describes physical activity as being a result of motivational, volitional, and automatic processes.

METHODS

Patients (n = 35) of the Follow-Up PreEClampsia (FUPEC) Outpatient Clinic, Erasmus MC, the Netherlands, participated in an anonymous online survey. The main outcomes under study were their perceived determinants of physical activity. Responses were analyzed using thematic analysis.

RESULTS

Thirteen themes emerged from the analysis. Six themes corresponded with motivational processes (future health, perceived ability, attitude, future reward or regret, physical appearance, and doing it for others), two with volitional processes (scheduling and planning), and two with automatic processes (affect and stress). Three themes were classified as environmental factors (time constraint, social support, and physical environment).

CONCLUSIONS

A range of facilitating and hindering factors were described by women with prior severe preeclampsia as the determinants of their physical activity. These factors corresponded well with the overarching motivational, volitional, and automatic processes described in the IBC model. In addition, motivational and environmental factors beyond the IBC model were described. Addressing these perceived determinants could enhance the efficacy of physical activity interventions in this population.

TWEETABLE ABSTRACT

Motivational, volitional, automatic, and environmental factors drive physical activity in women with prior severe preeclampsia.

Moving from intention to behaviour: a randomised controlled trial protocol for an app-based physical activity intervention (i2be)

INTRODUCTION

Efficacy tests of physical activity interventions indicate that many have limited or short-term efficacy, principally because they do not sufficiently build on theory-based processes that determine behaviour. The current study aims to address this limitation.

METHODS AND ANALYSIS

The efficacy of the 8-week intervention will be tested using a three-condition randomised controlled trial delivered through an app, in women with a prior hypertensive pregnancy disorder. The intervention is based on the integrated behaviour change model, which outlines the motivational, volitional and automatic processes that lead to physical activity. The mechanisms by which the behaviour change techniques lead to physical activity will be tested.Following stratification on baseline factors, participants will be randomly allocated in-app to one of three conditions (1:1:1). The information condition will receive information, replicating usual care. Additionally to what the information condition receives, the motivation condition will receive content targeting motivational processes. Additionally to what the motivation condition receives, the action condition will receive content targeting volitional and automatic processes.The primary outcome is weekly minutes of moderate-to-vigorous physical activity, as measured by an activity tracker (Fitbit Inspire 2). Secondary outcomes include weekly average of Fitbit-measured daily resting heart rate, and self-reported body mass index, waist-hip ratio, cardiorespiratory fitness and subjective well-being. Tertiary outcomes include self-reported variables representing motivational, volitional, and automatic processes. Outcome measures will be assessed at baseline, immediately post-intervention, and at 3 and 12 months post-intervention. Physical activity will also be investigated at intervention midpoint. Efficacy will be determined by available case analysis. A process evaluation will be performed based on programme fidelity and acceptability measures.

ETHICS AND DISSEMINATION

The Medical Ethics Committee of the Erasmus MC has approved this study (MEC-2020-0981). Results will be published in peer reviewed scientific journals and presented at scientific conferences.

TRIAL REGISTRATION NUMBER

Netherlands trial register, NL9329.

A Dual-Process Model Applied to Two Health-Promoting Nutrition Behaviours

We tested a dual process model incorporating constructs that reflect both performing the target behaviour (behaviour directed habit) and habits that run counter to the target behaviour (opposing behaviour habit) in accounting for variance in two health behaviours: eating the recommended serves of fruits and vegetables a day and restricting sugar-sweetened beverage consumption. A prospective correlational design with two waves of data collection separated by one week was adopted. Participants (N = 606) comprising middle school students (n = 266) and university students (n = 340) completed an initial survey comprising self-report measures of past behaviour, intention, and habit to perform the target behaviour and habits that run counter to the target behaviour. One week later, participants (N = 414) completed a self-reported measure of behaviour. Results revealed that behaviour directed habits predicted fruit and vegetable consumption in both samples, while opposing behaviour habits predicted restriction of sugar-sweetened beverages in the middle-school sample only, with a moderating effect also observed. Current findings indicate that habits specifying avoidance of the target behaviour did not predict future behaviour. However, the moderating effect observed provides preliminary evidence that strong habits to perform a behaviour may override habit to avoid the behaviour.

Using an Integrated Social Cognition Model to Explain Green Purchasing Behavior among Adolescents

Strengthening pro-environmental behaviors such as green purchasing behavior is important for environmental sustainability. An integrated social cognition model which incorporates constructs from habit theory, health action process approach (HAPA), and theory of planned behavior (TPB) is adopted to understand Iranian adolescents’ green purchasing behavior. Using a correlational-prospective design, the study recruited Iranian adolescents aged between 14 and 19 years (N = 2374, n = 1362 (57.4%) females, n = 1012 (42.6%) males; Mean (SD) age = 15.56 (1.22)). At baseline (T1), participants self-reported on the following constructs: past behavior; habit strength (from habit theory); action planning and coping planning (from HAPA); and intention, perceived behavioral control, subjective norm, and attitude (from TPB) with respect to green purchasing behavior. Six months later (T2), participants self-reported on their actions in terms of purchasing green goods. Our findings reported direct effects of perceived behavioral control, subjective norms, attitude, and past behavior on intention; intention and perceived behavioral control on green purchase behavior; intention on two types of planning (i.e., action and coping planning); both types of planning on green purchase behavior; and past green purchase behavior and habits on prospectively measured green purchase behavior. These results indicate that adolescent green purchasing behavior is underpinned by constructs representing motivational, volitional, and automatic processes. This knowledge can help inform the development of theory-based behavior change interventions to improve green purchasing in adolescents, a key developmental period where climate change issues are salient and increased independence and demands in making self-guided decisions are needed.

Predictors of school students' leisure-time physical activity: An extended trans-contextual model using Bayesian path analysis

The present study aimed to examine effects of motivational and social cognition constructs on children’s leisure-time physical activity participation alongside constructs representing implicit processes using an extended trans-contextual model. The study adopted a correlational prospective design. Secondary-school students (N = 502) completed self-report measures of perceived autonomy support from physical education (PE) teachers, autonomous motivation in PE and leisure-time contexts, and social cognition constructs (attitudes, subjective norms, perceived behavioral control), intentions, trait self-control, habits, and past behavior in a leisure-time physical activity context. Five weeks later, students (N = 298) self-reported their leisure-time physical activity participation. Bayesian path analyses supported two key premises of the model: perceived autonomy support was related to autonomous motivation in PE, and autonomous motivation in PE was related to autonomous motivation in leisure time. Indirect effects indicated that both forms of autonomous motivation were related to social cognition constructs and intentions. However, intention was not related to leisure-time physical activity participation, so model variables reflecting motivational processes did not account for substantive variance in physical activity participation. Self-control, attitudes, and past behavior were direct predictors of intentions and leisure-time physical activity participation. There were indirect effects of autonomous motivation in leisure time on intentions and physical activity participation mediated by self-control. Specifying informative priors for key model relations using Bayesian analysis yielded greater precision for some model effects. Findings raise some questions on the predictive validity of constructs from the original trans-contextual model in the current sample, but highlight the value of extending the model to incorporate additional constructs representing non-conscious processes.

Distancing Adherence and Negative Emotions among the Israeli Elderly Population during the COVID-19 Pandemic

Social distancing was found to prevent COVID-19 contagion. Therefore, understanding the factors associated with the public’s adherence is important. Acknowledging the importance of emotional wellbeing regarding older people’s health, and understanding their emotional state during the pandemic, are crucial. This study assessed factors associated with older people’s adherence to social distancing and their emotional status. A cross-sectional online survey was conducted among 1822 respondents above the age of 60. Distancing adherence, negative emotion, trust, social support, threat perception, attitudes, and subjective norms were assessed, and a path analysis was performed. Adherence was positively associated with attitudes (β = 0.10; p < 0.001), and with subjective norms (β = 0.19; p < 0.001). Negative emotions were positively associated with threat perception (β = 0.33; p < 0.001), and negatively associated with social support (β = −0.13; p < 0.001) and subjective norms (β = −0.10; p < 0.001). Attitudes mediated the relationship of threat perception (95% CI = 0.009, 0.034), trust (95% CI = 0.008, 0.029), and social support (95% CI = 0.006, 0.023) with distancing adherence. Subjective norms mediated the relationship between threat perception (95% CI = 0.014, 0.034), trust (95% CI = 0.026, 0.055), and social support (95% CI = 0.002, 0.048) with distancing adherence. Subjective norms mediated the relationship between threat perception (95% CI = −0.022, −0.006), trust (95% CI = −0.034, −0.010), and social support (95% CI = −0.029, −0.009) with negative emotions. When promoting social distancing adherence, subjective norms and attitudes must be considered, as they play a role in promoting adherence and negative-emotion regulation.

Evidence That Habit Moderates the Implicit Belief-Behavior Relationship in Health Behaviors

BACKGROUND

Theory suggests that implicit beliefs are more likely to be associated with spontaneous, impulsive health behaviors (e.g., smoking, snacking), while controlled, consciously accessible beliefs are more likely to be associated with behaviors that require deliberation and reasoned decision-making (e.g., physical activity, healthy food selection). Consistent with these predictions, we proposed that as behaviors become habitual, they require less deliberation to enact and are thus more likely to be controlled by non-conscious processes, as indicated by stronger associations with implicit beliefs. The present study tested the moderating effect of habit on the effects of implicit beliefs on two health behaviors.

METHOD

Two samples of university students completed measures of attitude, habit, and implicit beliefs for free-sugar intake (sample 1) and heavy episodic drinking (sample 2) at an initial time point, with follow-up behavioral measures taken at 2 and 4 weeks later, respectively.

RESULTS

Path analyses indicated that attitude and habit predicted behavior in both samples, and habit moderated the implicit belief-behavior relationship in both samples. The effect of implicit beliefs on behavior was larger among participants reporting strong habits. Implicit beliefs did not moderate the effect of explicit attitudes on behavior.

CONCLUSION

Findings provide preliminary evidence that experiencing health behaviors as habitual is associated with a stronger implicit beliefs-health behavior relationship.