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Bogers S, Boyd A, Schim van der Loeff M, Geerlings S, Davidovich U. Opportunities for improved indicator-based HIV testing in the hospital setting: a structural equation model analysis. AIDS Care 2024; 36:840-848. [PMID: 37683267 DOI: 10.1080/09540121.2023.2254548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023]
Abstract
Indicator condition (IC)-guided HIV testing, i.e., testing when diagnosing a condition associated with HIV, is a feasible and cost-effective testing strategy to identify undiagnosed individuals. Assessing determinants for IC-guided testing may identify opportunities for improvement. A survey study based on the Theory of Planned Behaviour (TPB) was conducted among 163 hospital physicians from five specialties in Amsterdam, the Netherlands. Structural equation models were used to determine the association between the TPB domains (i.e., attitude, belief, norms, self-efficacy and behavioural control) and (1) the intention to test as a mediator for HIV testing behaviour (intentional model) and (2) actual HIV testing behaviour (direct model). Both models accounted for the effect of guideline recommendations. Behaviour scored lower than intention on a five-point scale (mean score of 2.8, SD = 1.6 versus 3.8, SD = 1.1; p<0.0001). The direct model had a better fit than the intentional model based on fit statistics. Discrepancies between the determinants most important for intention versus those for behaviour led to the following recommendations: interventions to improve IC-guided testing in hospitals should primarily focus on implementation of guideline recommendations, followed by improving physicians' attitude towards IC-guided HIV testing and self-efficacy, as these were the most important correlates of actual HIV testing behaviour.
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Affiliation(s)
- Saskia Bogers
- Internal Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Infectious diseases, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anders Boyd
- Infectious diseases, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Maarten Schim van der Loeff
- Internal Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Infectious diseases, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Suzanne Geerlings
- Internal Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Infectious diseases, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Social Psychology, University of Amsterdam, Amsterdam, The Netherlands
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Paul B, Kirubakaran R, Isaac R, Dozier M, Grant L, Weller D. A systematic review of the theory of planned behaviour interventions for chronic diseases in low health-literacy settings. J Glob Health 2023; 13:04079. [PMID: 37681679 PMCID: PMC10506128 DOI: 10.7189/jogh.13.04079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Background Due to their chronicity, prolonged morbidity, and high mortality, chronic respiratory diseases (CRDs) pose a huge burden of disease globally, primarily among low- and middle-income countries. Most of these diseases can be controlled by early diagnosis and treatment, correct practice of medications, regular follow-up, and avoidance of risk factors, which involves a change in health behaviour among patients. The theory of planned behaviour (TPB) has been proven to be effective and has been used increasingly as a behavioural framework for designing and evaluating behaviour change interventions, although most such studies were on affluent populations and from the global north. We aimed to collate evidence of TPB-based behavioural interventions in low health literacy settings for its effectiveness and feasibility by conducting a systematic review (SR). Methods We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines in conducting and reporting this study. We selected interventional studies using at least two constructs of TPB for behaviour change in chronic disease patients and conducted in LMICs, used the PICO framework, and exported the retrieved studies through the Endnote software. We evaluated the studies using the Risk of Bias (RoB) 2 and Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tools. Results We retrieved and reviewed the titles and abstracts 4281 titles and abstracts, identifying 186 articles for further detailed screening. Eleven studies met the criteria for a standardised independent full-text screening by two authors and four were selected for narrative synthesis. All studies were from urban settings, with established feasibility and fidelity; all interventions were effective in changing health behaviour and TPB constructs and provided structured education to participants in the intervention group (either face-to-face and through group education). Three studies had some concerns/moderate risk of bias and one had high risk of bias. Conclusions All studies demonstrated effectiveness, feasibility, and fidelity of TPB interventions in LMIC settings, although most were of moderate quality. Further studies should gather definitive evidence and prove their feasibility and utility in LMICs. Registration PROSPERO CRD42018104890.
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Affiliation(s)
- Biswajit Paul
- Christian Medical College Vellore, India
- University of Edinburgh, UK
| | | | - Rita Isaac
- Christian Medical College Vellore, India
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Zhang W, Mei J, Evans R, Wu H. The effects of information framing on self-protective behavior: Evidence from the COVID-19 vaccine uptake. Digit Health 2023; 9:20552076231210655. [PMID: 37915790 PMCID: PMC10617298 DOI: 10.1177/20552076231210655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 10/12/2023] [Indexed: 11/03/2023] Open
Abstract
Objectives The Healthy China 2030 strategy outlines the government's plans for healthcare reform, emphasizing the need for increased awareness about infectious diseases to prevent and fight future infections. Information campaigns can be used as a medium to raise awareness and encourage citizens' willingness to protect themselves against diseases, such as COVID-19. Extant studies have found that individual health behavior decision-making can be changed under different information frames. However, limited evidence is available about emerging infectious diseases. Based on the Prospect Theory and Theory of Planned Behavior, the impact of information frames on self-protective behavior-vaccination against COVID-19 is investigated in this study. Methods A 2(gain/loss frame)*2(factual/emotional frame) intergroup experimental design was designed to explore the effects of different information frames. 228 valid participants in China were recruited and the experiment was performed online. Results First, the gain frame was more effective in promoting public self-protection behavior than the loss frame under information frame intervention. Compared with the factual frame, the emotional frame is more effective in reducing individual risk perception. Second, perceptual behavior control has masking effects on self-protection behavior under the influence of the gain/loss frame. Third, age, subjective norms, attitudes, and the gain frame, have predictive effects on self-protection behavior. Conclusions This study provides empirical evidence on the impact of information framing interventions on public self-protection behavior during the COVID-19 pandemic and provides important practical implications for public administrators and media practitioners.
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Affiliation(s)
- Wei Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Mei
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Richard Evans
- Faculty of Computer Science, Dalhousie University, Halifax, Canada
| | - Hong Wu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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The Moderating Power of Impulsivity: A Systematic Literature Review Examining the Theory of Planned Behavior. PHARMACY 2022; 10:pharmacy10040085. [PMID: 35893723 PMCID: PMC9326604 DOI: 10.3390/pharmacy10040085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/16/2022] [Accepted: 06/23/2022] [Indexed: 01/27/2023] Open
Abstract
The theory of planned behavior (TPB) states that behavioral intention is the best predictor of actual behavior change. However, intention explains only a portion of the variance in behavior. Of specific interest is the question of which moderating or mediating variables can be leveraged to aid health promotion interventions utilizing the tenets of behavioral economics (delay discounting and commitment contracts) in the intention–behavior pathway. Impulsivity has been postulated to fill this role and may be applied to multiple behaviors. We aim to determine if impulsivity moderates the association between intention and actual behavior in the TPB, to discover what other variables may moderate or mediate this association, and to apply the findings to future studies in the field of behavioral economics. To this end, a systematic review was conducted using the PubMed, PsychINFO, and Embase online databases. Eligible studies in peer-reviewed journals published prior to November 2021 were selected. Thirty-three studies were included in the final review, examining physical activity, diet, preventive health, mental health, addiction, and medication adherence behaviors. Three main concepts emerged: (1) impulsivity moderates the association between intention and behavior change; (2) self-efficacy moderates the association between intention and behavior change; and (3) planning and self-efficacy contribute to moderated mediation. This review demonstrates a gap in the literature regarding the application of the TPB to the intention–behavior pathway for health behaviors. Future studies in behavioral economics may leverage the variables of impulsivity, self-efficacy, and planning to predict follow-through in this area and to develop targeted change initiatives.
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Peixoto NMDSM, Peixoto TADSM, Pinto CAS, Santos CSVDB. Nursing intervention focusing on health promotion behaviors in adult cancer patients: a scoping review. Rev Esc Enferm USP 2021; 55:e03673. [PMID: 33886904 DOI: 10.1590/s1980-220x2019039403673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 05/29/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This review aims to map and provide an overview of literature concerning nursing strategies and intervention programs that promote healthy behaviors in cancer patients. METHOD A scoping review was conducted using the methodological framework developed by Joanna Briggs Institute and preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews. Twelve databases were searched (2012-2019). Retrieved data included descriptive analyses exploring studies' methodological characteristics and results. RESULTS From 1589 studies, 12 were included. Most studies included patients on survivorship period (n=10) and selected intervention strategies focusing patient's knowledge and awareness (n=8). Educational sessions were supported by behavioral change reinforcements and motivational incentives. Only two of the considered studies analysed intervention cost effectiveness, but none disclosed intervention-related costs. CONCLUSION Nursing interventions are effective in promoting health behaviors when include health education and encouragement towards change. Survivorship is the perfect time for health promotion. Nurses can be considered health promoters, by encouraging health education and enhance survivor's motivation.
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Kelly TA, Woko C, Jemmott LS, Icard L, Chittamuru D, Jemmott JB. Reasoned Action Approach Correlates of Physical Activity Among African American Men Living With HIV: A Cross-Sectional Study. J Assoc Nurses AIDS Care 2021; 32:47-56. [PMID: 32675644 DOI: 10.1097/jnc.0000000000000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Physical activity (PA) is associated with a reduced incidence of chronic diseases. However, little is known about the predictors of PA among African American men living with HIV. We report secondary analyses examining the strength of the relationships between the reasoned action approach constructs, attitude, subjective norm, descriptive norm, and self-efficacy and intention to exercise and self-reported adherence to Department of Health and Human Services PA guidelines using baseline data from a trial of a PA intervention with 302 African American men, between 40 and 88 years of age (M = 53.9; SD = 7.2) living with HIV. Multiple regression revealed that attitude, subjective norm, and self-efficacy were positively associated with intention. Logistic regression revealed higher odds of meeting PA guidelines as self-efficacy increased. Self-efficacy and descriptive norm predicted meeting the aerobic guideline. Self-efficacy predicted meeting the muscle-strengthening guideline. Interventions targeting reasoned action approach variables may contribute to efforts to improve PA among African American men living with HIV.
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Affiliation(s)
- Terri-Ann Kelly
- Terri-Ann Kelly, PhD, RN, is an Assistant Professor, School of Nursing, Rutgers University-Camden, Camden, New Jersey, USA. Chioma Woko, BS, is a Doctoral Student, Annenberg School of Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Loretta S. Jemmott, PhD, RN, FAAN, is Vice President, Health and Health Equity; and Professor, Drexel University College of Nursing and Health Professions, Philadelphia, Pennsylvania, USA. Larry Icard, PhD, DSW, is an Honorary Professor, Center for Community Technologies, Nelson Mandela University, Port Elizabeth, South Africa; and Professor Emeritus, College of Public Health, School of Social Work, Temple University, Philadelphia, Pennsylvania, USA. Deepti Chittamuru, PhD, is a Post-Doctoral Student, School of Social Sciences, Humanities and Arts, University of California, Merced, California, USA. John B. Jemmott III, PhD, is Director, Center for Health and Communication Research; and Professor, Annenberg School of Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Odunitan-Wayas FA, Hamann N, Sinyanya NA, King AC, Banchoff A, Winter SJ, Hendricks S, Okop KJ, Lambert EV. A citizen science approach to determine perceived barriers and promoters of physical activity in a low-income South African community. Glob Public Health 2020; 15:749-762. [PMID: 31992139 DOI: 10.1080/17441692.2020.1712449] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The study's objective was to assess the feasibility of using citizen science to identify and address physical activity (PA) barriers in a low-income South African community. We purposively selected as citizen scientists, eleven participants (21-45 years) from a cohort study who expressed interest in becoming physically active or were already active. They used the Stanford Neighborhood Discovery Tool mobile application to take photos and provide audio narratives of factors in their community that were barriers to or facilitated PA. Thereafter, in a facilitated workshop, citizen scientists thematically reviewed their findings, prioritised issues and proffered potential solutions. Researchers also thematically coded these data. PA levels were measured using standard questionnaires. None of the citizen scientists owned a car, and their PA was either work- or transport-related. Themes identified as priorities that hindered citizen scientists' PA were dirt, sidewalks appropriated by vendors or homeowners, parks and gym vandalisation, and personal safety fears. Access to stadiums and parks enabled PA. Citizen scientists identified their local councillors and street committee chairpersons as fundamental for advocacy for a PA-friendly environment. Low-income community members can be empowered to gather meaningful data using mobile technology and work together to identify potential solutions for promoting PA-friendly environments.
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Affiliation(s)
- Feyisayo A Odunitan-Wayas
- Research Centre for Health Through Physical Activity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nicola Hamann
- Research Centre for Health Through Physical Activity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nandipha A Sinyanya
- Research Centre for Health Through Physical Activity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Abby C King
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA.,Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ann Banchoff
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Sandra J Winter
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Sharief Hendricks
- Research Centre for Health Through Physical Activity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kufre J Okop
- Research Centre for Health Through Physical Activity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Estelle V Lambert
- Research Centre for Health Through Physical Activity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Draper CE, Tomaz SA, Zihindula G, Bunn C, Gray CM, Hunt K, Micklesfield LK, Wyke S. Development, feasibility, acceptability and potential effectiveness of a healthy lifestyle programme delivered in churches in urban and rural South Africa. PLoS One 2019; 14:e0219787. [PMID: 31365557 PMCID: PMC6668772 DOI: 10.1371/journal.pone.0219787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/01/2019] [Indexed: 11/19/2022] Open
Abstract
Rising levels of obesity in South Africa require innovation in community-level lifestyle change programmes. Our aim was to co-develop Impilo neZenkolo ('Health through Faith'), a healthy lifestyle programme for low-income, black South Africans delivered through churches, and evaluate its feasibility, acceptability and potential effectiveness. In the first phase we developed programme materials with church members. In the second phase we trained lay leaders to deliver the programme and assessed feasibility, acceptability (observation, focus groups and interviews) and potential effectiveness (pre and post measurement of weight, hip and waist circumferences, blood pressure, self-reported physical activity, dietary habits, health status, self-esteem, psychological distress). The study was conducted in four churches in urban and rural South Africa. The development workshops led to increased focus on positive benefits of participation, widening inclusion criteria to all adults and greater emphasis on Christian ethos. Challenges to feasibility included: recruitment of churches; scheduling of programme sessions (leading to one church not delivering the programme); attendance at the programme (63% attended more than half of the 12 weekly sessions); and poor programme fidelity (in particular in teaching behaviour change techniques). Aspects of the programme were acceptable, particularly the way in which the programme was aligned with a Christian ethos. There was some indication that amongst the 42/68 (62%) for whom we were obtained pre- and post-programme measurements the programme has potential to support weight loss. We conclude that a healthy lifestyle programme for low-income, black South Africans, delivered through churches, may be viable with extensive re-development of delivery strategies. These include finding external funding for the programme, endorsement from national level denominational organisations and the professionalization of programme leadership, including paid rather than volunteer leaders to ensure sufficient time can be spent in training.
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Affiliation(s)
- Catherine Elizabeth Draper
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Simone Annabella Tomaz
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Ganzamungu Zihindula
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, South Africa
| | - Christopher Bunn
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Cindy M. Gray
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Kate Hunt
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Institute for Social Marketing, Faculty of Health and Sports Sciences, University of Stirling, Stirling, United Kingdom
| | - Lisa Kim Micklesfield
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sally Wyke
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
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Hatefnia E, Alizadeh K, Ghorbani M. Applying the theory of planned behavior to determine factors associated with physical activity by women with hypertension in rural areas of Iran. ASIAN BIOMED 2019. [DOI: 10.1515/abm-2019-0005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Hypertension is the leading preventable cause of premature deaths worldwide. Physical activity reduces the levels of blood lipids and blood pressure in people suffering from hypertension.
Objectives
To apply the theory of planned behavior (TPB) to determine factors associated with physical activity by women with hypertension who were referred to health care centers in Kiashahr in 2016.
Methods
The present observational study was conducted in a cross-section of 215 women diagnosed with hypertension who had records in health care centers in Kiashahr and who were recruited through census from August to September 2016. The data collection tool was a custom-designed questionnaire based on the TPB, and the collected data were analyzed using descriptive and analytical statistical methods.
Results
The mean scores of knowledge, attitudes, subjective norms, perceived behavioral control, and intention to undertake physical activity were significantly (P < 0.01) higher among women who performed regular physical activity than in those without regular physical activity. Constructs including behavioral intention (P < 0.001, odds ratio (OR) 1.36, 95% confidence interval (CI) 1.15, 1.61) and attitude (P = 0.004, OR 1.27, 95% CI 1.08, 1.50) were significant predictors for undertaking physical activities.
Conclusions
Attitude and behavioral intention were predictors for undertaking physical activities. We recommended the design of interventional programs based on these 2 factors for women with hypertension living in rural areas of Iran.
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Affiliation(s)
- Effat Hatefnia
- Social Determinants of Health Research Center, Alborz University of Medical Sciences , Karaj 3146883811, Iran
| | - Kobra Alizadeh
- Department of Health Education and Promotion, School of Public Health, Alborz University of Medical Sciences , Karaj 3146883811, Iran
| | - Mostafa Ghorbani
- Non-communicable Disease Research Center, Alborz University of Medical Sciences , Karaj 3146883811, Iran
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute , Tehran University of Medical Sciences , Tehran 1417614418, Iran
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Heeren GA, Jemmott JB, Marange CS, Rumosa Gwaze A, Batidzirai JM, Ngwane Z, Mandeya A, Tyler JC. Health-Promotion Intervention Increases Self-Reported Physical Activity in Sub-Saharan African University Students: A Randomized Controlled Pilot Study. Behav Med 2018; 44:297-305. [PMID: 28682186 PMCID: PMC6292207 DOI: 10.1080/08964289.2017.1350134] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To evaluate the efficacy of a health-promotion intervention in increasing self-reported physical activity among university students in Sub-Saharan Africa. Randomly selected second-year students at a university in South Africa were randomized to an intervention based on social cognitive theory: health-promotion, targeting physical activity and fruit, vegetable, and fat consumption; or HIV risk-reduction, targeting sexual-risk behaviors. Participants completed assessments via audio computer-assisted self-interviewing pre-intervention and 6 and 12 months post-intervention. A total of 176 were randomized with 171 (97.2%) retained 12 months post-intervention. Generalized-estimating-equations analyses indicated that the health-promotion-intervention participants were more likely to meet physical-activity guidelines than were control participants, post-intervention, adjusting for pre-intervention physical activity (odds ratio [OR] = 3.35; 95% CI: 1.33-8.41). Health-promotion participants reported a greater number of days they did vigorous-intensity (risk ratio [RR] = 2.01; 95% CI: 1.43-2.83) and moderate-intensity (RR = 1.40; 95% CI: 1.01-1.95) aerobic activity, but not strength-building activity (RR = 1.37; 95% CI: 0.091-2.07). The intervention reduced self-reported servings of fried foods (mean difference = -0.31; 95% CI: -0.60, -0.02). The findings suggest that theory-based, contextually appropriate interventions may increase physical activity among university students in Sub-Saharan Africa.
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Affiliation(s)
- G Anita Heeren
- a St. Joseph's University , Philadelphia , Pennsylvania , USA
| | - John B Jemmott
- a St. Joseph's University , Philadelphia , Pennsylvania , USA
| | | | | | - Jesca Mercy Batidzirai
- b University of Fort Hare , Alice , South Africa
- c University of KwaZulu-Natal , Durban , South Africa
| | - Zolani Ngwane
- d Haverford College , Philadelphia , Pennsylvania , USA
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12
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Efficacy and Mediation of a Theory-Based Physical Activity Intervention for African American Men Who Have Sex with Men: A Randomized Controlled Trial. Ann Behav Med 2018; 51:106-116. [PMID: 27658914 DOI: 10.1007/s12160-016-9832-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Few trials have tested physical-activity interventions among sexual minorities, including African American men who have sex with men (MSM). PURPOSE We examined the efficacy and mediation of the Being Responsible for Ourselves (BRO) physical-activity intervention among African American MSM. METHOD African American MSM were randomized to the physical-activity intervention consisting of three 90-min one-on-one sessions or an attention-matched control intervention and completed pre-intervention, immediately post-intervention, and 6- and 12-month post-intervention audio computer-based surveys. RESULTS Of the 595 participants, 503 completed the 12-month follow-up. Generalized estimating equation models revealed that the intervention increased self-reported physical activity compared with the control intervention, adjusted for pre-intervention physical activity. Mediation analyses suggested that the intervention increased reasoned action approach variables, subjective norm and self-efficacy, increasing intention immediately post-intervention, which increased physical activity during the follow-up period. CONCLUSIONS Interventions targeting reasoned action approach variables may contribute to efforts to increase African American MSM's physical activity. CLINICAL TRIAL REGISTRATION The trial was registered with the ClinicalTrials.gov Identifier NCT02561286 .
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Morales A, Espada JP, Orgilés M. Mediation of an efficacious HIV risk reduction intervention for adolescents: A cluster-randomised controlled trial. J Health Psychol 2017; 24:1884-1896. [PMID: 28810466 DOI: 10.1177/1359105317707256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The 'Cuidate' programme for adolescents in Spain has proven to be effective for promoting healthy sexuality (N = 626), but the mechanisms underlying its effects are unknown. This study aimed to identify mediators of the intervention's effects compared to a control group. Participants were students from five areas of Spain, who completed baseline, immediate-posttest, 12-month and 24-month follow-up assessments. Mediation analyses revealed that 'Cuidate' positively affected consistent condom use indirectly through knowledge in serial with the intention to use condoms. The findings underscore the importance of targeting knowledge on HIV and sexually transmitted infections to promote condom use intention and consistent condom use.
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Escribano S, Espada JP, Morales A, Orgilés M. Mediation analysis of an effective sexual health promotion intervention for Spanish adolescents. AIDS Behav 2015; 19:1850-9. [PMID: 26267253 DOI: 10.1007/s10461-015-1163-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objective of this study is to determinate the factors that mediate in the self-reported consistent condom use over the 24-months post-intervention period in adolescents who received COMPAS, a sexual health promotion intervention targeted to Spanish adolescents. Twelve high schools located in Spain were randomized to an intervention or a control group with baseline, immediate-post, 12 and 24-month post-intervention assessments. Self-reported consistent condom use by 24 months post-intervention was the primary outcome. Based on the theory of planned behavior, we identified which theory-based variables mediated the intervention's effect on consistent condom use. Serial multiple mediation analysis indicated that attitudes toward condom use, when there are obstacles to use it, and self-efficacy mediated the COMPAS's effect in increasing consistent condom use. This is the first study that identifies the theoretical constructs that mediate the efficacy of a school-based intervention to promote sexual health in adolescents from Spain.
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Affiliation(s)
- S Escribano
- Department of Health Psychology, Miguel Hernández University, 03202, Elche, Spain.
| | - J P Espada
- Department of Health Psychology, Miguel Hernández University, 03202, Elche, Spain
| | - A Morales
- Department of Health Psychology, Miguel Hernández University, 03202, Elche, Spain
| | - M Orgilés
- Department of Health Psychology, Miguel Hernández University, 03202, Elche, Spain
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