Mapping health behaviors: Constructing and validating a common-sense taxonomy of health behaviors

What Determines Healthcare Workers to Seek Professional Psychological Support? A Cross-Sectional Study

AIM

Although healthcare workers often experience significant mental health challenges, their willingness to seek professional psychological help remains relatively low. However, the factors associated with healthcare workers' psychological help-seeking remain unclear. This study aims to identify the determinants of professional psychological help-seeking intention among healthcare workers based on the theory of planned behaviour.

DESIGN

Cross-sectional study.

METHODS

A questionnaire, incorporating demographic information and latent variable items, was developed and employed on 403 healthcare workers through online and offline surveys from December 2022 to January 2023 using convenience sampling. Structural equation modelling was applied to test the research hypotheses.

RESULTS

The model explained 46.9% of the variance in help-seeking intention. Subjective norm had the strongest total association with help-seeking intention. Attitude towards help-seeking behaviour, subjective norm and perceived behavioural control were directly positively related to help-seeking intention. Moreover, self-stigma, public stigma, perceived barriers and perceived risk were indirectly associated with help-seeking intention mediated by attitude towards the behaviour and perceived behavioural control. Of the four constructs, public stigma showed the most significant indirect relation to behavioural intention.

CONCLUSION

Healthcare workers' intention to seek psychological support is associated with multiple interacting factors, particularly subjective norm and public stigma. Targeted interventions addressing individual and systemic barriers are essential to create a supportive environment for healthcare workers to access mental health services.

IMPACT

This study identified key barriers and facilitators to healthcare workers seeking psychological support, which can assist authorities in enhancing mental health services and implementing tailored intervention strategies, thereby promoting help-seeking behaviour among healthcare workers. Moreover, our research reinforces the applicability of the theory of planned behaviour in explaining healthcare workers' intention to seek professional psychological support.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Associations between vaccination and protective behaviors against COVID-19: transfer and redundancy effects as potential psychological mechanisms

This study aimed to investigate mechanisms explaining associations between vaccination and protective health behaviors during the COVID-19 pandemic. The study used a secondary analysis of data from a longitudinal online study at four time points between April 2020 and March 2021. Two hundred and forty participants responded to questionnaires assessing adherence to multiple COVID-19 protection behaviors, COVID-19 vaccination, behavioral specific outcome expectancies and general healthy lifestyle. Statistical analyses included z statistic for differences between correlations and moderation analysis by the SPSS PROCESS macro. The correlation between initial adherence to protective behaviors prior to availability of vaccination and actual vaccination was positive, but when vaccination was available, the concurrent correlation between these behaviors was null. Healthy lifestyle and outcome expectancies moderated the association between vaccination and adherence to protection behaviors. These results were explained by a 'redundancy effect', conceptualized as beliefs that engagement in specific health behaviors justifies evading other health behaviors. The 'redundancy effect' cancelled the initial positive correlation between vaccination and protective health behaviors, produced by a 'transfer effect', based on similarities between the perceived purposes of those behaviors. Theoretical and practical implications of the findings were discussed.

Nudging oral habits; application of behavioral economics in oral health promotion: a critical review

Background

Oral health disorders significantly contribute to the global incidence of chronic diseases. Nudge interventions have demonstrated effectiveness in enhancing people's decision-making and self-management capacities in a cost-efficient manner. As a result, these interventions could be valuable tools for fostering improved oral care habits. This critical review explores potential behavioral nudges applicable to promoting oral health.

Methods

A thorough electronic literature search was conducted on Scopus, Embase, and PubMed databases for papers published post-2008. The search focused on empirical evidence concerning the direct and indirect application of Nudge theory in oral health enhancement. In addition, the investigation included the nudge intervention's role in managing common non-communicable disease risk factors (tobacco, alcohol, and sugar) and their use in other health sectors.

Results and conclusion

There is a dearth of studies on behavioral economics, particularly those involving reward and reminder techniques. However, various successful nudge interventions have been identified in other sectors that aim to improve health decisions. These include strategies encouraging healthier nutritional choices, tobacco and alcohol cessation, medication compliance, routine physical activity, and regular health check-ups. Such interventions can also have direct or indirect positive impacts on oral health. Implementing these interventions within an oral care framework could promote oral health due to similar underlying cognitive mechanisms. However, different types of nudge interventions have varying degrees of effectiveness. Furthermore, factors such as the method of delivery and the characteristics of the targeted population significantly influence the outcome of the intervention. Hence, it is imperative to conduct extensive studies in diverse socioeconomic settings to fully understand the potentials, limitations, and impacts of nudge interventions in promoting oral health.

Development of a novel instrument for assessing intentional non-adherence to official medical recommendations (iNAR-12): a sequential mixed-methods study in Serbia

OBJECTIVES

We aimed to (1) develop a novel instrument, suitable for the general population, capturing intentional non-adherence (iNAR), consisting of non-adherence to prescribed therapy, self-medication and avoidance of seeking medical treatment; (2) differentiate it from other forms of non-adherence, for example, smoking; and (3) relate iNAR to patient-related factors, such as sociodemographics, health status and endorsement of irrational beliefs (conspiratorial thinking and superstitions) and to healthcare-related beliefs and experiences ((mis)trust and negative experiences with the healthcare system, normalisation of patient passivity).

DESIGN

То generate iNAR items, we employed a focus group with medical doctors, supplemented it with a literature search and invited a public health expert to refine it further. We examined the internal structure and predictors of iNAR in an observational study.

SETTING

Data were collected online using snowball sampling and social networks.

PARTICIPANTS

After excluding those who failed one or more out of three attention checks, the final sample size was n=583 adult Serbian citizens, 74.4% female, mean age 39.01 years (SD=12.10).

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary, planned outcome is the iNAR Questionnaire, while smoking was used for comparison purposes.

RESULTS

Factor analysis yielded a one-factor solution, and the final 12-item iNAR Questionnaire had satisfactory internal reliability (alpha=0.72). Health condition and healthcare-related variables accounted for 14% of the variance of iNAR behaviours, whereas sociodemographics and irrational beliefs did not additionally contribute.

CONCLUSIONS

We constructed a brief yet comprehensive measure of iNAR behaviours and related them to health and sociodemographic variables and irrational beliefs. The findings suggest that public health interventions should attempt to improve patients' experiences with the system and build trust with their healthcare practitioners rather than aim at specific demographic groups or at correcting patients' unfounded beliefs.

STUDY REGISTRATION

The design and confirmatory analyses plan were preregistered (https://osf.io/pnugm).

The Latent Perception of Pregnancy

Background

The main purpose of this study was to describe the latent structure of pregnancy perception by investigating the role of risks and medical examinations in pregnancy perception across the sexes and pregnancy status.

Methods

Study 1 developed a questionnaire based on the responses of 29 young adults on their perception of pregnancy. Study 2 consisted of distributing the questionnaire among 290 participants (mean age 29.3; standard deviation = 7.5).

Results

The statistical clustering analysis revealed three major clusters of pregnancy perceptions: “evaluative,” “physio-medical,” and “future considerations,” each of them encompassing several meaningful sub-clusters. This structure of pregnancy perceptions supports Beck and Beck-Gernsheim’s modernization approach. Negative emotions toward pregnancy were related to social cognitions, whereas thoughts about risks were included in the medical sub-cluster. After reliability analyses, comparisons of scale scores revealed that women experienced more positive emotions, thought more about physical symptoms and about future issues compared to men (evolutionary explanation was offered).

Conclusion

Pregnant participants felt less ambivalence toward pregnancy, thought more about risks and medical examinations and less about parents’ duties than non-pregnant participants.

IC-Behavior: An interdisciplinary taxonomy of behaviors

Academic disciplines are often organized according to the behaviors they examine. While most research on a behavior tends to exist within one discipline, some behaviors are examined by multiple disciplines. Better understanding of behaviors and their relationships should enable knowledge transfer across disciplines and theories, thereby dramatically improving the behavioral knowledge base. We propose a taxonomy built on the World Health Organization's International Classification of Functioning, Disability, and Health (ICF), but design the taxonomy as a stand-alone extension rather than an improvement to ICF. Behaviors considered important enough to serve as the dependent variable in articles accepted for publication in top journals were extracted from nine different behavioral and social disciplines. A six-step development and validation process was employed, leading to the final taxonomy. A hierarchy of behaviors under the top banner of Engaging in activities/participating, reflective of ICF's D. hierarchy was constructed with eight immediate domains addressing behaviors ranging from learning, exercising, self-care, and substance use. The resulting International Classification of Behaviors (IC-Behavior), provides a behavior taxonomy targeted towards the interdisciplinary integration of nomological networks relevant to behavioral theories. While IC-Behavior has been labeled v.1.0 to communicate that it is by no means an endpoint, it has empirically shown to provide flexibility for the addition of new behaviors and is tested in the health domain.

Progress in conducting and reporting behaviour change intervention studies: a prospective retrospection

BACKGROUND

ehaviour change is a key to addressing many health and healthcare problems and interventions have been designed to improve health outcomes. These behaviour change interventions have been evaluated in many ways, including randomised controlled trials, and over recent decades there has been considerable progress in the conduct and reporting these studies. This paper is a personal retrospection on the changes occurring that have resulted in our current improved methods and their potential for future advancement.

ADVANCES

There has been steady development of methods for conducting trials, including advances in statistical methods enabled by increase computing power and programmes, greater attention to the recruitment of participants and in the specification of outcomes. Trial reporting has improved, largely due to publication of guidelines for reporting interventions and trials, but until recently the reporting of behaviour change interventions has been quite limited. Developments in the specification of active ingredients of these interventions, the behaviour change techniques, has transformed our ability to report interventions in a manner that facilitates evidence synthesis and enables replication and implementation. However, further work using ontological approaches is needed to adequately represent the evidence contained in the mass of accumulated studies. Meanwhile, attention is gradually being paid to the comparator groups in trials leading to better reporting but with continuing challenges about how control groups are selected.

CONCLUSIONS

These developments are important for the advancements of behavioural science - but also in consolidating the expertise needed to address global social, environmental and health challenges.

The Association Between Healthy Lifestyle Behaviours and Coronavirus Protective Behaviours

BACKGROUND

Based on models of cross-behavioural associations and the role of past behaviour in predicting behaviour, an association was hypothesized between healthy lifestyle behaviours prior to the COVID-19 pandemic and adherence to coronavirus protective behaviours. Self-assessed health was also examined as a potential moderator.

METHODS

A cross-sectional sample (N = 463) completed online questionnaires during a COVID-19-related lockdown that measured engagement in healthy lifestyle behaviours (e.g., exercising and eating fruits and vegetables), adherence to coronavirus protective behaviours (e.g., wearing a face mask and practicing social distancing), and self-assessed health (subjective evaluation of overall health).

RESULTS

As predicted, higher engagement in healthy lifestyle behaviours prior to the pandemic was significantly correlated with higher adherence to coronavirus protective behaviours (Pearson r(459) = .308, p < .001). Adherence levels were higher than engagement in healthy lifestyle behaviours, and self-assessed health was related to the latter but not to the former. Moderation was examined using model 1 in PROCESS for SPSS; as expected, the association was stronger among individuals with higher levels of self-assessed health (coefficient 95% CI [.04, .20]).

CONCLUSIONS

The findings highlight cross-behavioural facilitating processes, specifically between lifestyle behaviours and adherence to recommended protective behaviours during the pandemic. They also draw attention to the need to address individuals whose poorer evaluations of their general health might prevent them from implementing their behavioural intentions.

Ready, Willing and Able? An Investigation of the Theory of Planned Behaviour in Help-Seeking for a Community Sample with Current Untreated Depressive Symptoms

Applying health behaviour change models, such as the theory of planned behaviour (TPB), to help-seeking for mental health problems can address the deficit in health care utilisation. However, previous studies largely focused on help-seeking intentions and not behaviour, which might be problematic due to the intention-behaviour gap. Hence, TPB and help-seeking were examined in a German community sample with current untreated depressive symptoms: 188 adults (Mage = 50.34; SD = 16.19; 70.7% female) participated in a baseline interview and survey measuring components of the TPB (attitudes, subjective norms and perceived behavioural control) and help-seeking intentions. They reported actual help-seeking from mental health professionals via telephone surveys 3 and 6 months later. To better understand the potential gap between help-seeking intentions and behaviour and to investigate the contributions of readiness, willingness and ability to seek help, two path models were constructed in accordance with the TPB controlling for covariates. Attitudes (β = .24), subjective norms (β = .25) and self-efficacy (β = .15) were significantly associated with intentions (R2 = 26%), which predicted help-seeking (Cox and Snell's pseudo-R2 = 23%); controllability did not predict help-seeking. In sum, the TPB provides a reliable framework to explore help-seeking behaviour for mental health problems. Based on these findings, prevention efforts should focus on readiness and willingness to seek help (e.g. foster positive attitudes and social support of treatment). However, the role of ability, operationalised as perceived behavioural control and (perceived) barriers to help-seeking, warrants further research, as self-efficacy but not controllability was associated with help-seeking.

Behavior Change Techniques Included in Reports of Social Media Interventions for Promoting Health Behaviors in Adults: Content Analysis Within a Systematic Review

BACKGROUND

Social media are an increasingly commonly used platform for delivering health promotion interventions. Although recent research has focused on the effectiveness of social media interventions for health promotion, very little is known about the optimal content within such interventions, and the active ingredients to promote health behavior change using social media are not clear. Identifying which behavior change techniques (BCTs) are reported may help to clarify the content of interventions using a generalizable terminology that may facilitate future intervention development.

OBJECTIVE

This study aimed to identify which BCTs are reported in social media interventions for promoting health behavior change in adults.

METHODS

We included 71 studies conducted with adult participants (aged ≥18 years) and for which social media intervention was considered interactive in a Cochrane review of the effectiveness of such interventions. We developed a coding manual informed by the Behavior Change Technique Taxonomy version 1 (BCTTv1) to identify BCTs in the included studies. We identified BCTs in all study arms (including control) and described BCTs in the group and self-directed components of studies. We characterized the dose of delivery for each BCT by low and high intensity. We used descriptive analyses to characterize the reported BCTs.

RESULTS

Our data consisted of 71 studies published from 2001 to 2017, mainly conducted in high-income countries (n=65). Most studies (n=31) used tailored, interactive websites to deliver the intervention; Facebook was the most used mainstream platform. In developing our coding manual, we adapted some BCTTv1 instructions to better capture unique nuances of how BCTs were operationalized in social media with respect to likes, retweets, smiles, congratulations, and badges. Social support (unspecified), instruction on how to perform the behavior, and credible source were most frequently identified BCTs in intervention arms of studies and group-delivery settings, whereas instruction on how to perform the behavior was most commonly applied in self-directed components of studies, control arms, and individual participant settings. Instruction on how to perform the behavior was also the most frequently reported BCT in both intervention and control arms simultaneously. Instruction on how to perform the behavior, social support (unspecified), self-monitoring of behavior, information about health consequences, and credible source were identified in the top 5 BCTs delivered with the highest intensity.

CONCLUSIONS

This study within a review provides a detailed description of the BCTs and their dose to promote behavior change in web-based, interactive social media interventions. Clarifying active ingredients in social media interventions and the intensity of their delivery may help to develop future interventions that can more clearly build upon the existing evidence.

Exploring dimensions of health behaviors' representations

Objectives: To discover underlying dimensions of health behavior representations and to suggest a new framework for their investigation.Methods: A total of 1709 participants rated 45 health behaviors on 14 theoretical constructs denoting features by which individuals can cognitively represent health behaviors. Correlations among constructs were aggregated across behaviors using a meta-analytic approach, and subjected to factor analysis.Results: The analysis resulted in three interpretable dimensions: 'Importance', 'Negative Experience' and 'Ease', and one tentative factor, 'Other'.Conclusion: 'Importance', 'Negative Experience' and 'Ease' may be considered key dimensions for studying perceptions of health behaviors within a self-regulatory framework. These dimensions suggest new integrative and parsimonious ways for investigating health behaviors. The findings also highlight the importance of expanding the category of health behaviors to include psycho-social behaviors (e.g. stress management, social relationships), and the need for theoretical refinement of affective constructs anticipated during and after performance of health behaviors. This may improve the understanding and potential modification of health behaviors.

Parental Depression Predicts Child Body Mass via Parental Support Provision, Child Support Receipt, and Child Physical Activity: Findings From Parent/Caregiver-Child Dyads

Objective

Although there is substantial evidence corroborating the within-individual associations between depression, social support, moderate-to-vigorous physical activity (MVPA), and body mass, much less is known about across-individual associations. This study investigated the indirect associations between parental depression and objectively measured body mass in children. In particular, it was hypothesized that higher levels of parental depression (measured at Time 1, T1) would explain higher levels of child body mass in children (assessed at Time 2, T2), via three mediators, namely parental reports of provision of MVPA support (T1), child reports of receipt of MVPA support (T1), and child MVPA (T2).

Design:

Parent–child dyads provided self-reports twice, at baseline (T1) and 7- to 8-month follow-up (T2). A total of 879 dyads were enrolled (1,758 individuals; 5- to 11-year-old children, 52.4% girls, 83.2% mothers). Body weight and height were measured objectively. Manifest path analyses were performed to test the indirect effects.

Results

Analyses corroborated the assumed indirect effects: high levels of depression in parents (T1) were indirectly associated with high levels of body mass in children (T2), via three mediators: low levels of parental support provision (T1), low levels of child support receipt (T1), and low levels of child MVPA (T2). The alternative models assuming that either parental support provision or child support receipt can be excluded as the mediators yelded a poor model-data fit. The hypothesized mediation effects were corroborated when controlling for the baseline levels of parental and child MVPA and body mass.

Conclusion

The findings confirm complex across-individual effects of parental depression on high levels of body mass in children. Parental mental health may contribute to the childhood obesity epidemic.

Self-compassion, physical health, and health behaviour: a meta-analysis

This meta-analysis investigated relationships between self-compassion and (1) physical health and (2) health-promoting behaviour in a large pooled sample (N = 29,588) sourced from 94 peer-reviewed articles. As hypothesised, omnibus analyses revealed positive associations between self-compassion and both physical health (r = .18) and health behaviour (r = .26). Moderation analyses using 290 effects found that both associations varied according to health domain, participant age, intervention duration, and self-compassion measure. Self-compassion predicted outcomes in most health domains, with the strongest effects observed on global physical health, functional immunity, composite health behaviour, sleep, and danger avoidance. It did not predict frailty, maladaptive bodily routines, and substance abuse. Multi-session interventions designed to boost self-compassion predicted increased physical health and health behaviour, thereby supporting causal links between self-compassion and health outcomes. The effects of single-session inductions were non-significant. The mean effect of self-compassion on physical health was non-significant for young participants (12.00-19.99) and its effect on health behaviour was weakest among older participants (40.00+). Results support the proposition that self-compassion can promote better physical health. Practical implications of these findings are discussed.

Social, biological, behavioural and psychological factors related to physical activity during early pregnancy in the Screening for Pregnancy Endpoints (Cork, Ireland) cohort study

OBJECTIVE

The aim of this study was to identify the social, biological, behavioural and psychological factors related to physical activity (PA) in early pregnancy.

DESIGN

This is a secondary analysis of data from a prospective cohort study.

SETTING

The study was conducted in Cork, Ireland.

PARTICIPANTS

Nulliparous women with singleton pregnancies were recruited and then interviewed at 15±1 weeks' gestation.

PRIMARY AND SECONDARY OUTCOMES

The biopsychosocial model identified factors including social (age), biological (body mass index), behavioural (diet) and psychological (anxiety) at 15±1 weeks' gestation. PA subgroups were identified based on a latent class analysis of their responses to a set of questions about the amount and intensity of activity they were engaging in during the pregnancy. Associations were estimated with multivariable multinomial logistic regression models.

RESULTS

From a total of 2579, 1774 (69%) women were recruited; ages ranged from 17 to 45 years. Based on a combination of model fit, theoretical interpretability and classification quality, the latent class analyses identified three PA subgroups: low PA (n=393), moderate PA (n=960) and high PA (n=413). The fully adjusted model suggests non-smokers, and consumers of fruit and vegetables were more likely to be in the high PA subgroup (vs low). Women with more than 12 years of schooling and a higher socioeconomic status were more likely to be in the moderate PA subgroup (vs low).

CONCLUSION

The findings highlight potential links between PA, a low education level and a low socioeconomic background. These factors should be considered for future interventions to improve low PA levels during pregnancy.

TRIAL REGISTRATION NUMBER

ACTRN 12607000551493.

Child Sexual Abuse: Toward a Conceptual Model and Definition

The problem of defining "child sexual abuse" (CSA), and the need to define this concept, has been recognized by major policy bodies and leading researchers since the 1970s. Recent demands for a more theoretically robust, explicit definition of CSA show this challenge remains urgent. In this article, we identify problems caused by variance in definitions of CSA for five domains: research and knowledge formation, legal frameworks and principles, prevention efforts, policy responses, and the establishment of social norms. We review and analyze definitions used in leading international epidemiological studies, national and international policy documents, social science literature, and legal systems in the United States, Canada, and Australia to demonstrate the continuing use of different concepts of CSA and identify key areas of conceptual disagreement. Informed by our literature review, we use a methodology of conceptual analysis to develop a conceptual model of CSA. The purpose of this model is to propose a more robust, theoretically sound concept of CSA, which clarifies its defining characteristics and distinguishes it from other concepts. Finally, we provide operational examples of the conceptual model to indicate how it would translate to a classificatory framework of typologies of acts and experiences. A sound conceptual model and classificatory system offers the prospect of more appropriate and effective methods of research, response, regulation, and prevention. While total consensus is unattainable, this analysis may assist in developing understanding and advancing more coherent approaches to the conceptual foundation of CSA and its operationalization.

The centrality of health behaviours: A network analytic approach

OBJECTIVES

Since behavioural risk factors are the foremost causes of disability and premature mortality, developing new perspectives for understanding them is of utmost importance. This paper describes an innovative approach that conceptualizes health-related behaviours as nodes in a weighted network.

DESIGN & METHODS

Using self-reported data from a representative sample (n = 374), a network of 37 health behaviours was analysed, with the aim of identifying 'central' nodes, that is, behaviours that are likely to co-occur with others and potentially influence them.

RESULTS

In line with conservation of resources theory, the analysis indicated that behaviours related to basic physiological needs (nutrition and sleep) were most central. Behaviour centrality also varied across subpopulations: Periodic medical examinations, eating meals regularly, and sleep hygiene were more central among high- compared to low-socio-economic status participants; behaviours related to supportive social relationships and sun protection were more central among women compared to men.

CONCLUSION

By emphasizing behavioural connectivity, the approach applied herein has identified core health behaviours with potentially high impact on healthy lifestyle behaviours. Statement of Contribution What is already known on this subject? Many health behaviours are related to each other. Engagement in one health behaviour can affect engagement in other behaviours. What does this study add? Health behaviour can be viewed and analysed as a network. Sleep and nutrition behaviours are the most central behaviours in the network. Centrality varies as a function of socio-economic status and gender.

The relationship between frequency of performance and perceived importance of health behaviours

The relationship between performance of health behaviours and their perceived importance was examined among 250 adults. Frequency of performance and perceived importance of 21 health behaviours, self-assessed health and the Big Five personality traits were measured. As expected, importance and performance were positively correlated. Self-assessed health was more strongly associated with performance than importance, and a model wherein importance affects performance, which in turn affects self-assessed health, was superior to a model wherein performance affects importance. The Big Five significantly explained performance, particularly conscientiousness, and importance explained performance beyond this effect. Consequently, importance perceptions should be considered when developing behavioural interventions.

Determinants of health knowledge and health perceptions from the perspective of health-related education of patients with spinal cord injury: a systematic review

Appropriate health knowledge (HK) and health perceptions (HP) of patients with spinal cord injury (SCI) are linked to health-related behaviors, compliance, the involvement of caregivers and efficacy of prophylaxis, and management of secondary conditions. The significance of factors determining the efficacy of educational interventions in patients with SCI is underestimated. This systematic literature review aims at identification of determinants of HK and HP among patients with SCI. We identified 16 papers with quantitative HK and HP measurements conclusive in the identification of HK and HP determinants in individuals with SCI. Better HK and HP correlated with health condition-related variables (traumatic SCI, history of secondary conditions, except depression), body functions and structures (tetraplegia, incomplete deficit), activities (independence in daily living activities, ability of locomotion on a wheelchair, inability to walk), social and vocational participation, environmental factors (access to a computer with Internet connection, living in a big city, being married, healthcare recently received), and personal factors (younger age among adults, living with SCI for a longer time, younger age at SCI onset, higher educational level, internal locus of control). Limitations encountered included high nonresponse rates among the patients enrolled, and use of heterogeneous and nonvalidated tools. The results of these studies do not cover the entire scope of possible interactions and exclusively apply univariate correlations. The paucity and methodological limitations of studies conclusive in the identification of HK and HP determinants in SCI patients and the development of new approaches to information and education warrant more high-quality research on the basis of multivariate analyses.

Developing a scale to assess health regulatory focus

RATIONALE

Regulatory focus (i.e., focus on motivation to achieve gains or avoid losses and non-gains) is used to tailor health behavior change interventions, improving efficacy, but is currently assessed by scales that are not health-specific and may capture a version of the construct that is not ideally matched to the rationale for tailoring.

OBJECTIVE

We developed and validated a Health Regulatory Focus Scale (HRFS), which assesses tendencies to avoid negative health consequences (prevention focus) or achieve positive health outcomes (promotion focus).

METHODS

Across four studies (and a scale development study in supplementary online materials), we established convergent, discriminant, and predictive validity for the HRFS. In studies examining predictive validity, main outcome measures were health behavior intentions, including intentions to reduce alcohol use, quit smoking, eat a healthy diet, exercise, be screened for cancer, and engage in general cancer preventive behaviors.

RESULTS

The promotion and prevention sub-scales performed well in confirmatory factor analyses. Single-factor models had significantly poorer fit than models delineating promotion and prevention. The sub-scales were differentially (and only modestly) correlated with related constructs (anxiety, optimism, information avoidance, ambiguity/fatalism). Higher HRFS-Promotion focus generally corresponded with greater health behavior intentions. Conversely, higher HRFS-Prevention focus corresponded with lower health behavior intentions. Associations were largely maintained even when controlling for established regulatory focus measures, supporting the assertion that the HRFS would predict unique variance in health behavior intentions.

CONCLUSION

The HRFS has the potential to improve the precision with which framed health messages change behavior, as it may assess a version of regulatory focus that is more ideally matched to rationale for tailoring interventions.

The Health Behavior Checklist: Factor structure in community samples and validity of a revised good health practices scale

This study examined the factor structure and predictive validity of the commonly used multidimensional Health Behavior Checklist. A three-factor structure was found in two community samples that included men and women. The new 16-item Good Health Practices scale and the original Wellness Maintenance scale were the only Health Behavior Checklist scales to be related to cardiovascular and metabolic risk factors. While the other Health Behavior Checklist scales require further validation, the Good Health Practices scale could be used where more objective or longer measures are not feasible.

"You Can't Always Get What You Want": A Novel Research Paradigm to Explore the Relationship between Multiple Intentions and Behaviours

Objective

Research investigating cognitive moderators of the intention–behaviour relationship and psychological consequences of failure to enact intentions is usually conducted in a single‐behaviour paradigm. A multiple‐behaviour paradigm is introduced which overcomes bias inherent to single‐behaviour designs and allows testing of novel hypotheses. Two exploratory studies illustrate the utility of this new paradigm by investigating the role of cognitive predictors and psychological correlates of intention–behaviour relationships.

Method

The proposed method involves measuring multiple intentions across common areas of life activity at baseline and corresponding behaviours at follow‐up. In two studies, 51 intentions and behaviours were assessed (49 by self‐report, 2 objectively). In Study 1, participants (n = 126) also completed self‐reported measures of everyday cognitive failures and dysexecutive behaviours, crystallised intelligence (Mill Hill Vocabulary Scale) at baseline and Quality of Life (QoL; follow‐up). In Study 2, objective executive function measures (Stroop, Go/NoGo task and Word Fluency test) were completed by N = 30 participants.

Results

The total number of intentions, cognitive, and QoL measures were unrelated to the percentage of intentions enacted. Crystallised intelligence was related to successful intention implementation and problems with emotion regulation were associated with forming fewer intentions and with fewer failed intentions. QoL was strongly related with more intentions, regardless of whether or not these were implemented. Study 2 showed that cognitive flexibility (word fluency) and task errors, rather than Stroop effect and Go/No‐Go performance were related, to intention–behaviour congruence.

Conclusion

Intention–behaviour relationships might be better understood when considering the multiple intentions and behaviours that people are engaged in at once at any one point in time. A multiple‐behaviour paradigm suggests novel hypotheses. Preliminary findings reported here require replication. Anticipated applications of the paradigm are outlined and discussed.