Examining the impact of perceived behavioral control and planning on closing the exercise intention-behavior gap: Insights from a meta-analytic structural equation modeling study

OBJECTIVE

This study aims to investigate the roles of perceived behavioral control (PBC), action planning, and coping planning in bridging the gap between exercise intention and behavior. By using a Meta-Analytic Structural Equation Model (MASEM), we quantify the specific effects of these variables and explore their mediating roles in the relationships between intention, PBC, and behavior. The study provides insights into how these constructs contribute to informing effective behavioral intervention strategies.

METHODS

A meta-analysis was conducted to calculate the correlation effect sizes between variables in the model, and MASEM was employed to examine the interrelationships among multiple variables. Data from 57 samples across 49 studies, with a total sample size of 19,883, were analyzed. We constructed an aggregated correlation matrix and performed path analysis using structural equation modeling. AMOS 26.0 software was used to estimate model parameters, including path coefficients, standard errors, and various model fit indices.

RESULTS

The results indicate that behavioral intention serves as a key predictor of behavior, showing a significant positive direct effect (β = 0.416, p < 0.001). Intention also significantly predicts both action planning (β = 0.439, p < 0.001) and coping planning (β = 0.360, p < 0.001), though its impact on behavior is mediated differently by these two forms of planning. Mediation analysis further revealed that intention indirectly predicts behavior through coping planning (β = 0.067, p < 0.001), while the mediation effect through action planning was not significant (β = -0.001, p > 0.05). PBC played multiple roles: it directly predicts behavior (β = 0.106, p < 0.001), indirectly predicts behavior through intention (β = 0.282, p < 0.001), and further mediates behavior through intention and coping planning (β = 0.046, p < 0.001), as well as through coping planning alone (β = 0.032, p < 0.001). Additionally, the mediation effect of PBC on behavior through action planning was statistically significant but negligible (β = 0.000, p = 0.003), reinforcing the stronger role of coping planning in driving behavior change.

CONCLUSION

This study highlights the important roles of behavioral intention and perceived behavioral control in promoting physical activity while challenging the effectiveness of focusing solely on action planning. The findings suggest that although action planning does not significantly impact behavior, coping planning plays a critical role in behavior implementation. By integrating action planning and coping planning, comprehensive behavioral intervention strategies can more effectively bridge the intention-behavior gap and promote sustained physical activity.

Stage-based analysis of an adaptive worksite intervention trial for diabetes prevention

OBJECTIVE

Stage-based models of change posit stage specific factors to promote motivation and intention formation for those not ready to change and volitional action strategies for others. The impact of two interventions on energy restriction and weight change among adults with prediabetes (n = 190) was examined by baseline stage.

METHODS

Stage classification included: Pre-intenders had no intention to change; Intenders set an intention but were not acting; and Actors reported eating a low-fat diet at baseline. Intervention impact on intention formation, planning, self-efficacy, energy intake, and weight change was evaluated. Structural equation modeling identified mechanisms of change.

RESULTS

At baseline, Pre-intenders (28.3 %) and Actors (41.7 %) significantly differed in action self-efficacy, planning, and energy intake. Post-intervention, 91.7 % of the sample remained Actors or progressed in stage placement; intention to consume a low-fat diet increased for Pre-intenders. An increase in action self-efficacy strengthened intention formation for Intenders/Actors. Model fit for post-intentional factors was unsatisfactory, but dietary planning may promote energy restriction.

CONCLUSIONS

The lifestyle interventions promoted stage progression. Whether post-intentional mechanisms of change differ for Pre-intenders compared to Intenders/Actors requires further research.

PRACTICE IMPLICATIONS

Classifying participants by intention and tailoring interventions to stage may promote greater intention formation and reduction in energy intake.

Effects of a nurse-led individualized mHealth nutrition intervention for post-discharged gastric cancer patients following gastrectomy: A randomized controlled trial

OBJECTIVE

To evaluate the effects of a nurse-led individualized mHealth nutrition intervention on nutritional status, nutritional intake, cognitive beliefs related to nutritional behavior, weight loss, blood parameters, gastrointestinal symptoms, and quality of life in post-discharged gastric cancer patients following gastrectomy.

DESIGN

This was an assessor-blinded parallel-arm randomized controlled trial with a repeated-measures design.

SETTING(S)

The participants were recruited from inpatient gastric surgery units of two tertiary hospitals in Guangzhou, China.

PARTICIPANTS

A total of 108 patients with gastric cancer who underwent gastrectomy and were scheduled to be discharged to their homes were included.

METHOD

Participants were randomly allocated to either the intervention or the control group (n = 54 per group). The intervention group received the nurse-led individualized mHealth nutrition intervention in addition to the usual care, whereas the control group received only usual care. The intervention included face-to-face education before discharge, the use of an applet and phone consultations. Baseline data were collected on the day of discharge from the hospital (T0). The patients' nutritional status, cognitive beliefs related to nutritional behavior, nutritional intake, weight loss, blood parameters, gastrointestinal symptoms and quality of life were repeatedly measured at 4-week (T1) and 12-week (T2) after discharge.

RESULTS

Compared with the control group, the intervention group showed significant improvement in nutritional status (ꞵ₄ weeks = -1.08, 95 % CI -2.12 to 0.04, p = 0.042; ꞵ₁₂ weeks = -1.52, 95 % CI -2.57 to -0.47, p = 0.005). Improvements were also observed in energy and protein intake, weight loss, and cognitive beliefs related to nutritional behavior, including risk perception, outcome expectancy, self-efficacy, intention, and action plan (p < 0.05). However, no statistically significant differences were observed in coping plan, gastrointestinal symptoms, blood parameters, and quality of life (p > 0.05).

CONCLUSIONS

The nurse-led individualized mHealth nutrition intervention was effective for improving the cognitive beliefs related to nutritional behavior, energy and protein intake, and nutritional status, as well as reducing weight loss among post-discharged gastric cancer patients following gastrectomy.

REGISTRATION NUMBER

ChiCTR2200064808.

Synthesizing comprehensive models for health behavior studies: connecting dots and revealing links on health enhancement through a meta-analysis approach

Objective

To systematically synthesize the impact of autonomy and key theoretical models, including Self-Determination Theory (SDT), Technology Acceptance Model (TAM), Value Adoption Model (VAM), Theory of Planned Behavior (TPB), and Health Action Process Approach (HAPA), on health behavior and behavior change determinants, focusing on self-determination and intrinsic motivation as central drivers of independent health decisions.

Methods

A meta-analysis was conducted on 135 studies published between 2005 and 2023, with a total sample size of 53,242 participants. We searched the Web of Science and PubMed databases for relevant literature. The theoretical frameworks explored include SDT, TAM, VAM, TPB, and HAPA. Data analysis was performed using Review Manager 5.4.1 software, with effect size calculated as the standardized mean difference with 95% confidence intervals. Heterogeneity was evaluated using I2 statistics.

Results

(1) SDT significantly impacted motivation, while TAM and VAM influenced perceived value [SMD = 0.96 > 0.8, 95% CI (0.68, 1.24), P < 0.001]. (2) Implementation intentions, action planning, and coping planning were key moderators of health behavior change (I2 = 65.4%). (3) HAPA's structured planning strategies positively impacted long-term health behavior changes.

Conclusion

Autonomy, self-determination, and intrinsic motivation play a crucial role in health behavior change. Integrating theoretical models such as SDT, TAM, VAM, and HAPA facilitates structured approaches to health interventions, emphasizing implementation intentions, action planning, and coping strategies.

Variances in Smoking Expectancies Predict Moment-to-Moment Smoking Behaviors in Everyday Life

BACKGROUND

Many policy decisions about tobacco control are predicated on rational choice models, which posit (1) that smokers are aware of the risks of cigarettes and (2) that perceived risks have a consistent influence on continued smoking behavior. However, research shows that beliefs about smoking may be vulnerable to changes in internal and external contexts.

METHODS

Using ecological momentary assessment, we tested this by measuring how smokers' (N = 52) beliefs about smoking varied over time. Four times per day over 1 week, participants responded to measures of smoking intentions, risk perceptions, mood and social outcome expectancies, and internal and external contextual factors.

RESULTS

We analyzed this data using multilevel modeling, finding that both smoking intentions, risk perceptions, and expectancies differed between participants as well as between moments.

CONCLUSION

Risk perceptions and mood expectancies were a significant predictor of intentions to smoke in the next 30 min, illustrating the importance of these beliefs in decisional processes. This study was preregistered at the Open Science Foundation: https://osf.io/wmv3s/?view_only=71ad66d3ce3845fcb3bf2b9860d820c9 . Our analytic plan was not preregistered.

Changes in shooting accuracy among basketball players under fatigue: a systematic review and meta-analysis

Objective

To investigate the influence of physical and mental fatigue of different intensities (mild, moderate or severe) on basketball shooting accuracy, with the aim of informing more effective training protocols and competition strategies.

Methods

Literature searches were conducted on Web of Science, PubMed, and EBSCO databases up to 25 June 2024. Inclusion and exclusion criteria were specified, and data extraction sheets were prepared. Study quality was assessed by using the Cochrane Risk of Bias Tool in Review Manager 5.4, and Stata18.0 software was used for heterogeneity analysis, subgroup analysis, forest plots, stratification analysis, and bias assessment.

Results

Moderate physical fatigue affected two-point shooting accuracy (P < 0.01),severe physical fatigue affected both two-point (P = 0.02) and three-point shooting accuracy (p < 0.01),with severe physical fatigue showing a greater detrimental impact on three-point shooting accuracy, while two-point shooting accuracy may vary under specific conditions. Additionally, adolescent athletes were less affected by severe physical fatigue compared to adult athletes or those with longer training experience. Moderate mental fatigue also significantly reduced free-throw accuracy (p < 0.01).

Conclusion

The shooting accuracy of basketball players was significantly affected by moderate and severe physical fatigue. Severe physical fatigue notably adversely affected the accuracy of three-point shooting relative to moderate fatigue; Additionally, moderate mental fatigue significantly reduced free-throw accuracy, which may be attributed to a decline in cognitive executive functions, highlighting the importance of fatigue management in sports training.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/#myprospero, identifier CRD42024539553.

How perceived risk of recurrence strengthens health management awareness in stroke patients: the chain mediating role of risk fear and health literacy

Background

Prior research has found that perceived risk in stroke patients motivates health behaviors in visitors. However, the role that perceived risk of recurrence in stroke patients plays in reinforcing health management awareness during the motivation phase is unclear.

Objective

This study explores this issue by examining the effects of risk fear and health literacy on health management awareness due to perceived risk of recurrence in stroke patients.

Methods

We validated the effect of perceived risk of recurrence on health management awareness and its internal mechanism by constructing a structural equation model and including 763 stroke patients, extending the relevant literature and application of the Healthy Behavior Procedural Approach (HAPA) model.

Result

The results suggest that perceived risk of recurrence in stroke patients can effectively reinforce and improve health management awareness, with risk fear and health literacy having a chain-mediated role in this group relationship.

Conclusion

This study reveals the differential effects of perceived risk of recurrence, risk fear, and health literacy in stroke patients on health management awareness at the individual level, providing valuable guidance for healthcare practitioners and families to improve patients' health outcomes and health well-being.

From mere 'stability' to 'durability'-Revisiting intention dynamics from a self-regulatory perspective with intensive longitudinal methods

Behavioral intentions predict behavior better if they are stable over time. A statistical argument suggests that this is due to less measurement error, but recent theoretical advances suggest self-regulatory effects: durable intentions remain temporally stable due to their persistence when faced with challenges. Here, we leverage intensive longitudinal data on adherence with non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic (N = 623; total assessments = 19,740; study duration: 6 months each). We operationalize intention durability as temporal order-dependent variability (reversed root mean square of successive differences [RMSSD] between each valid assessment). We then examine the within- and between-person moderating effects of intention durability on the intention-behavior association as well as the effects of past on current behavior. In line with the theoretical assumptions, we find that more durable intentions are not only associated with a stronger intention-behavior link on a within- and a between-person level but also a stronger effect of past on current adherence with NPIs. Our findings support the hypothesized moderating effects of intention durability and provide a more nuanced understanding of the self-regulatory processes underlying the temporal stability of intentions.

Maintaining habitual physical activity by overcoming disruptive competing actions: mechanisms and interventions

Habits are mental representations of associations between actions and contextual contingencies. Habit formation can be efficacious in promoting health behavior maintenance, including for highly complex behaviors such as physical activity. Changes in circumstances (e.g., job transitions, moving home) or the advent of disruptive events (e.g., work-related or personal responsibilities) can lead to habit discontinuity by eliminating the contextual contingencies associated with the behavior. Recently, habit theorists have distinguished between preparation or instigation and execution habits, with preparation or instigation habits proposed as central to the development and maintenance of complex habitual behaviors. Discontinuity for complex habitual behaviors may entail disruption of preparation, instigation, or execution habits making such behaviors highly vulnerable to disruption and discontinuity. We propose that the advent of events such as increased work demands or personal responsibilities (e.g., job demands or personal circumstances such as caregiving) and competing highly rewarding activities (e.g., technology-mediated screen activities such as using smartphone apps and games) have high potential to disrupt preparation and instigation habits for complex behaviors. We outline the mechanisms involved and propose several strategies that may be employed to minimize disruption and discontinuity of complex habitual behaviors using physical activity as an illustration. We identify reaffirming original goals, self-monitoring, and planning strategies as potentially efficacious means to minimize the potential for events and competing activities to disrupt physical activity preparation and instigation habits. We call for future research to investigate the efficacy of these strategies in managing disruptive events and promote maintenance of habitual physical activity habit maintenance.

Evidence inhibitory self-control moderates effects of habit on complex but not simple health behaviors

Theoretically, self-control can be considered as both a facilitator of habit development and a moderator of whether behavior occurs habitually. However, debate remains on the contexts in which such relationships are likely to occur. The current study tested whether self-control, conceptualized into inhibitory and initiatory facets, would predict healthy behavior via habits or moderate the habit-behavior relationship, and whether these effects differed across complex (bootcamp attendance N = 69, physical activity in pregnant women N = 115) and simple (flossing N = 254) behaviors. Three independent samples completed measures of self-control and habit, followed by a prospective measure of behavior. Data were fitted to PLS-SEM models. Inhibitory and initiatory self-control predicted habit in all three samples, and habit in turn predicted each health behavior. Inhibitory self-control only moderated the effect of habit in the bootcamp and physical activity samples. Initiatory self-control did not moderate effects in any sample. Findings indicate that both initiatory and inhibitory self-control are associated with habit. Further, as the moderating effect of inhibitory self-control was only present in the complex behavior samples, results suggest the moderating effects of self-control on the habit-behavior relationship may be best represented by the effect of inhibiting competing cues from disrupting automatically activated behavioral sequences.

A Medication Management App (Smart-Meds) for Patients After an Acute Coronary Syndrome: Pilot Pre-Post Mixed Methods Study

Background

Medication nonadherence remains a significant challenge in the management of chronic conditions, often leading to suboptimal treatment outcomes and increased health care costs. Innovative interventions that address the underlying factors contributing to nonadherence are needed. Gamified mobile apps have shown promise in promoting behavior change and engagement.

Objective

This pilot study aimed to evaluate the efficacy and usability of a gamified mobile app that used a narrative storytelling approach to enhance medication adherence among patients following acute coronary syndrome (ACS). The study aimed to assess changes in participants' beliefs about medication and self-reported adherence before and after the intervention. Additionally, user feedback regarding the narrative component of the app was gathered.

Methods

Overall, 18 patients who recently experienced ACS were recruited for a 1-month intervention using the gamified app. Participants' beliefs about medication and self-reported adherence were assessed using standardized scales pre- and postintervention. The app's usability was also evaluated through a postintervention questionnaire. Statistical analyses were performed to determine the significance of changes in belief and adherence scores.

Results

Although 33% (6/18) of the participants did not use the intervention more than once, the remaining 12 remained engaged during the 30 days of the study. The results did not indicate a significant improvement in participants' beliefs about medication following the intervention. However, self-reported adherence significantly improved (P<.05) after the intervention with a mean score going from 29.1 (SD 6.9) to 32.4 (SD 5.6), with participants demonstrating a greater self-efficacy to their prescribed medication regimen. However, the results did not indicate a significant improvement in participants' beliefs about medication. With a mean average score of 80.6, the usability evaluation indicates a good usability rating for the gamified app. However, the narrative storytelling component of the app was not favored by the participants, as indicated by their feedback.

Conclusions

This pilot study suggests that a gamified mobile app using narration may effectively enhance medication self-efficacy and positively influence patients' beliefs about medication following ACS. However, the narrative component of the app did not receive favorable feedback from participants. Future research should focus on exploring alternative methods to engage participants in the app's narrative elements while maintaining the positive impact on adherence and beliefs about medication observed in this study.

DepRescribing inapprOpriate Proton Pump InhibiTors (DROPIT): study protocol of a cluster-randomised controlled trial in Swiss primary care

OBJECTIVES

Proton pump inhibitors (PPIs) are widely prescribed medications and commonly used for the treatment of gastric acid-related disorders. Nevertheless, PPIs are often overused leading to potential adverse effects and unnecessary healthcare costs. Deprescribing strategies have emerged to safely reduce or substitute inappropriate PPIs and optimise patient care in an evidence-based manner. This protocol describes a study to evaluate the effectiveness of a PPI deprescribing intervention in comparison to usual care in the Swiss primary care setting.

DESIGN

An open-label, cluster randomised controlled trial.

SETTING

Swiss primary care settings.

PARTICIPANTS

Included participants will be adults with inappropriate PPI treatment and will be recruited by general practitioners (GPs). Participants treated by the same GP constitute a cluster. Clusters are randomised 1:1 to either the intervention group or the control group.

INTERVENTIONS

The intervention components consist of deprescribing tools including educational material, decision aids for both participants and GPs, and additional trainings for GPs only. Patients in the control group will receive usual care. Data will be collected at baseline, 3-, 6-, 9- and 12-month follow-up time through online surveys or a phone call for both GPs and participants.

PRIMARY AND SECONDARY OUTCOME MEASURES

The first co-primary endpoint is the effectiveness of the deprescribing intervention measured by the change of prescribed PPI dose. The second co-primary endpoint is safety, which is measured with the Reflux Disease Questionnaire assessing change in gastrointestinal symptoms. There are several secondary endpoints, such as the total number of prescribed medications, occurrences of changes in prescription patterns, PPI discontinuation and cost-effectiveness.

CONCLUSIONS

The findings from this study will provide evidence on the effectiveness and safety of a PPI deprescribing intervention for patients and GPs. Successful implementation of our PPI deprescribing strategy has the potential to improve patient outcomes and lower costs.

TRIAL REGISTRATION NUMBER

NCT06129474.

A staged integrated model informing the promotion of healthy dietary behaviors in adolescents: a prospective study

BACKGROUND

The promotion of healthy dietary behaviors in adolescence is critical, which have long-term implications for lifelong health. Integration is an important method for improving limited theories of dietary behavior change. The present study proposes an integrated model aimed at identifying the diverse determinants of healthy dietary behaviors in adolescents and assesses its stage-specific nature as the potential for effective interventions.

METHODS

A two-year prospective study was conducted in southwest China, involving a sample of 1990 adolescents (mean age: 15.06 years) from two randomly selected secondary schools. A total of 765 adolescents were exposed to the three-phase interventions while 1225 adolescents participated as the control group. The interventions aimed to promote healthy dietary behaviors in adolescents, which included health education sessions and health handbooks targeting specific constructs of the integrated model. The follow-up surveys after corresponding interventions were performed every six months. Self-reported frequency of healthy dietary behaviors, psychological constructs integrated from Health Action Process Approach, Health Belief Model, and Theory of Planned Behavior, as well as anxiety symptoms were measured.

RESULTS

Within structural equation modeling controlling for past behavior, the integrated model accounted for 61.7% variance of behavioral intentions and 19.1% variance of healthy dietary behaviors, and showed discontinuity patterns across behavior change phases. The pivotal constructs included outcome expectancies, perceived severity, subjective norms, action self-efficacy, behavioral intentions, action planning, and maintenance self-efficacy. Anxiety was an emotional barrier in the dietary behavior modification (β = -0.113, P < .001). Interventions within the staged integrated model, led to increased adoption of healthy dietary behaviors in intervention group compared to control group (33.40% vs. 25.70%, P < .05), indicating certain effectiveness, particularly in targeting action self-efficacy (stronger direct effects on behavioral intentions and maintenance self-efficacy, β = 0.489 to 0.704, P < .001).

CONCLUSIONS

The staged integrated model provides a detailed understanding of the determinants of healthy dietary behaviors in adolescence, highlighting anxiety as an emotional barrier that impedes positive cognition and healthy dietary behaviors. It provides valuable guidance for future interventions targeting specific constructs across behavior change phases, with particular emphasis on enhancing action self-efficacy.

Extending Our Understanding of the Social Determinants of Physical Activity and Sedentary Behaviors in Families: A Systems Mapping Approach

BACKGROUND

The social environment is important to consider for effective promotion of movement behaviors like increased physical activity (PA) and reduced sedentary behavior (SB); yet, it is less often considered than individual and built environments. One way to advance social environment research is to develop system maps, an innovative, participatory, action-oriented research process that actively engages stakeholders to visualize system structures and explore how systems "work." The purpose of this research was to develop PA and SB system maps of the social environment embedded within the core/nuclear family system.

METHODS

The development process began with a 2-day multicountry, 16-researcher, in-person participatory workshop in August 2023, followed by multiple online follow-up consultations. Attendees contributed to the creation of the maps through shared development of critical determinants and their causal pathways. The structure of the final maps was analyzed using network analysis methods to identify indicators of centrality, and key feedback loops and areas for potential intervention were explored.

RESULTS

Key central determinants that were likely critical targets for systems intervention to produce changes in PA and SB and featured prominently in most of the reinforcing and balancing feedback loops included shared family interests, values and priorities, family logistical support, family cohesion/organization, and shared experiences. The maps also highlighted key determinants of the broader social environment external to the family.

CONCLUSIONS

These system maps support current evidence on movement behaviors in family systems and socioecological theories and have the utility to galvanize future research and policy to promote PA and reduce SB.

Does stress compromise fruit and vegetable intake? A randomized controlled trial testing a model with planning as a mediator and stress as a moderator

OBJECTIVE

Individuals experiencing higher stress levels tend to consume fewer fruits and vegetables compared to their less stressed counterparts. Thus, to promote fruit and vegetable (FV) consumption, action planning has been proven effective in translating behavioral intentions into actual dietary behaviors. This study aims to evaluate a 7-day intervention designed to improve FV planning and intake, while also examining the role of stress.

METHODS

The trial employed a 3 (time: pretest, post-test, and follow-up) * 2 (group: intervention vs. control) between-participant factorial design. A total of 99 young Chinese adults (age = 23.84 years ± 4.63, 26 men) who had formed an explicit intention to consume more fruit and vegetables, participated in a 7-day online randomized controlled trial.

RESULTS

The intervention successfully enhanced FV planning as well as FV intake. Furthermore, a moderated mediation model revealed that FV planning mediated the relationship between experimental conditions and FV intake, with stress moderating this mediation. Specifically, planning facilitated FV intake for individuals with low stress levels, while this effect was not observed for those with high stress levels.

CONCLUSION

These findings confirm the positive impact of the planning intervention on improving FV intake, particularly for individuals with low stress levels, and highlight stress as a barrier to health behavior change that warrants further attention in future studies.

Psychological Determinants of Health Behavior

This review provides a critical overview of current evidence on psychological health behavior determinants and its value in informing intervention and future determinants research. The review begins with work labeling and classifying the myriad of determinants available in the extant research to arrive at core groups of determinants. Next, the conceptual bases of these determinant groups are identified, and the weight of the evidence for their purported effects on health behavior, including belief-based determinants (e.g., outcome expectancies, capacity beliefs), determinants representing self-regulatory capacity (e.g., planning, action control) and nonconscious processes (e.g., habit, implicit cognition), and dispositional determinants (e.g., personality, regulatory control), is critically evaluated. The review also focuses on the theory-based mechanisms underpinning determinant effects and moderating conditions that magnify or diminish them. Finally, the review recommends a shift away from research on determinants as correlates, outlines how determinants can inform intervention development and mechanisms of action tests, suggests alternatives to predominant individualist approaches, and proposes future research directions.

Modelling the compensatory and carry-over effects between physical activity and fruit-vegetable consumption in young adults

Physical activity (PA) and fruit and vegetable consumption (FVC) are crucial factors jointly affecting young adults' physical and mental health. However, the psychosocial interactive mechanisms of these behaviors remain understudied. Using a two-wave prospective design over two months, this study investigated the psychological mechanisms underlying multiple health behavior change (MHBC) through a novel two-layer social-cognitive framework, the Compensatory Carry-Over Action Model (CCAM), among 322 Chinese college students (19.47 ± 0.99 years; 55.6% female). Structural equation modeling with path analysis was conducted using Mplus 8.8 for data analysis. Results indicated an acceptable model fit for the hypothesized model, with χ2 = 120.845, df = 41, χ2/df = 2.947, CFI = 0.940, TLI = 0.901, RMSEA = 0.078 [90% CI = 0.062 to 0.094], and SRMR = 0.079. The model explained 54.9% and 50.0% of the variance in PA and FVC, respectively. In the first layer, focusing on the individual behavior change process, both volitional self-efficacy and planning were identified as significant mediators in the intention-behavior relationship for PA and FVC (indirect effects = 0.03 to 0.14, all p < .01). In the second layer, targeting the interaction between the two behaviors, the mediating role of compensatory cognition (e.g., PA/FVC can compensate for FVC/PA) in the relationship between intention and behavior was not supported (all p > .05). However, volitional self-efficacy and planning played a significant mediating role in the interaction between PA/FVC intention and FVC/PA behavior (indirect effects = 0.01 to 0.04, all p < .05). Future interventions aiming at promoting MHBC should address compensatory cognition and the carry-over effects between diverse behaviors.

Prevailing theories describing sports-related concussion symptom reporting intent and behavior among adolescent athletes: a scoping review

Diagnosis of sports-related concussion (SRC) primarily relies on an athlete's self-report of injury and associated symptoms. Social pressures and attitudes surrounding SRC influence athlete reporting behavior. Unfortunately, underreporting of SRC symptoms is an issue among adolescent athletes. Nondisclosure of SRC symptoms may lead to premature return-to-play and potential persistent symptoms. This scoping review summarizes prevailing theories that explain SRC symptom reporting intent and behavior among adolescent athletes. Literature was reviewed following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for Scoping Review guidelines. Inter-rater reliability was calculated at each stage. Thirty-four articles published between 2013-2024 were included. Inter-rater reliability was fair to perfect across all review stages. Of the 16 unique theories described, the Theory of Reasoned Action/Theory of Planned Behavior (TRA/TPB) was the most frequently cited theory explaining SRC symptom reporting behavior. Although the TRA/TPB framework was useful when predicting SRC symptom reporting intent, it did not adequately predict reporting behavior, consistent with the broader health behavior literature which has established that intention is not a good predictor of behavior. In light of these findings, new frameworks must be considered that consider neurodevelopmental, cognitive, and cultural factors, as these may be more useful for understanding SRC symptom reporting behavior in adolescence.

Health action process approach and spinal cord injury: a scoping review

PURPOSE

Spinal cord injury may result in chronic pain, difficulty walking and breathing, and/or paralysis. People with spinal cord injury (PwSCI) experience increased risk for chronic diseases and psychosocial distress (e.g. type 2 diabetes, substance use disorders) and premature mortality. The Health Action Process Approach (HAPA) is a social cognitive health behavior framework validated to explain modifiable preventative health behaviors (e.g. physical exercise, healthy eating, substance misuse) among people with chronic conditions. The present scoping review investigates what, how, and how much peer-reviewed research literature applies HAPA to preventative health behaviors among PwSCI.

MATERIALS AND METHODS

A search was conducted in seven community health databases including PubMed, CINAHL, PsycINFO, SocIndex, Scopus, Web of Science, Sociological Abstracts, and Library and Information Science Source. Seven peer-reviewed articles were identified. Conventional content analysis was used in the full-text review to identify themes and calculate theme frequency.

RESULTS

All studies were quantitative and applied HAPA to physical exercise. HAPA explained differences in sports participation, leisure time physical activity, and strength training.

CONCLUSIONS

A strong predictor of physical exercise was belief in the capability to overcome psychosocial barriers. More attention is needed on HAPA-identified barriers, and customized HAPA-based interventions to promote physical exercise among PwSCI.

Designing Social Media Messages to Promote Action by Suicide Gatekeepers

OBJECTIVE

Suicide prevention professionals and programs have focused on reaching not only individuals with suicide ideation, but also family, friends, and other acquaintances, referred to as suicide gatekeepers. Social media provide platforms that allow health communicators to reach a large population. This research focuses on examining and testing the most effective message framing (how the message provides a reward or consequence for the receiver) and message construct (precise focus and wording of a message) for social media posts intended to positively influence suicide gatekeeper intervention behavior on behalf of a friend or peer.

METHOD

An experiment tested the influence of message construct (between subjects) and message frame (within subjects). The experiment randomized the 1285 participants between the ages of 18 and 34 into the three message construct conditions (significance, preventability, and beneficence).

RESULTS

The results suggest gain-framed messages have a more positive influence than loss-framed messages on all social media message outcome variables (likelihood of social media message engagement, perceived message effectiveness, self-efficacy, response efficacy, empathy, and behavioral expectation), and state empathy mediates the relationship between message frame and these variables. Message construct condition and other mediation results were less substantial, although some evidence suggests that the significance message construct may increase social media message sharing and perceived message effectiveness.

CONCLUSION

Results show strong evidence of the effectiveness of using gain frames in social media messages aimed at suicide gatekeepers. Other considerations include highlighting the significance of suicide and utilizing empathy appeals to strengthen social media message engagement and behavioral intention.

Explain the behavior change and maintenance in diabetic patients using MTM-HAPA framework

Objectives

The aim of the study was to to uncover the factors influencing the initiation and maintenance of health behaviors indiabetes mellitus (DM) patients, utilizing baseline data from a randomized controlled trial to construct a structural equation model based on the Multi-Theory Model (MTM) and Health Action Process Approach (HAPA) scales.

Methods

The study recruited participants with type 2 diabetes, aged between 18 and 75 years, from 45 distinct locations in Beijing, China.Patients [N = 406, n = 232 (57.1%) females, n = 232 (42.9%) males; Mean (SD) age = 56.7(10.9)] completed self-reported questionnaire about constructs from integrated theories concerning health behavior. To test the associations between the variables, structural equation modeling with latent variables was employed. Based on the path coefficients of Structural Equation Modeling(SEM), we verified all the hypotheses.

Results

Disadvantages, Advantages, Self-efficacy for Initiating Behavior, and Changes in Physical Environment are all prove to have an effect on intention, with the effect of Disadvantages being negative. Intention positively influenced Action Planning and Coping Planning, both of which in turn significantly predicted Initiation of Behavior Change. Practice for change, Emotional Transformation, Changes in Social Environment, and Self-efficacy for Sustaining Behavior were all affected by Outcome Expectancies and Risk Perception positively. Meanwhile, Practice for change, Emotional Transformation, Changes in Social Environment and Self-efficacy for Sustaining Behavior- would have a significant predictive effect on Maintenance of Behavioral Change.

Conclusion

The empirical evidence from this study robustly validates the majority of its theoretical constructs, affirming that MTM-HAPA possess significant explanatory capability in delineating the factors that underpin both the Maintenance of health-related behaviors and the Initiation of Behavior Changes in individuals suffering from DM.

Men and women choose moderate-to-vigorous physical activity and sedentary behaviors with a "hot" mind rather than a "cold" one

BACKGROUND

The primary aim of our study is to explore how moderate-intensity physical activity (MPA), vigorous-intensity physical activity (VPA), moderate-to-vigorous physical activity (MVPA), and sedentary behavior (SB) in men and women (ages 18-74; 4545 females and 1824 males) are associated with age, education, psychological factors (cognitive reflection/"cold" mind, emotional intelligence (E), impulsivity, perceived stress), health behaviors (overeating, breakfast consumption, smoking, alcohol use), body mass index (BMI), and sleep duration.

METHODS

The information was collected by means of an online survey ( https://docs.google.com/forms/ ) to ensure the anonymity of participation and confidentiality of data.

RESULTS

MVPA and SB in men and women are significantly influenced by education, age, BMI, lifestyle, and psychological factors, with some gender differences. Higher education reduces MVPA and increases SB, while age lowers SB and raises MVPA in women. BMI inversely affects MVPA and VPA, and breakfast supports higher activity levels, while overeating and alcohol (in men) are linked to lower MVPA and higher SB. Sleep duration weakly affects activity structure but inversely relates to SB. While Cognitive Reflection Test (CRT) scores-an indicator of logical reasoning-do not show a significant positive impact on physical activity levels (MPA, VPA, or MVPA) in either gender, they are associated with increased sedentary behavior in women. Emotional Intelligence (EI), however, plays a clear and positive role: higher EI is strongly associated with increased VPA and MVPA in both men and women, especially in women, and inversely related to SB in both genders.

CONCLUSIONS

The results of our study suggest that enhancing EI ("hot" mind) may be more effective than reasoning skills ("cold" mind) in promoting physical activity and reducing sedentary behavior, particularly in women. These findings highlight EI's potential as a key driver of active lifestyles, while logical reasoning appears to have a lesser impact.

Development of the social dimensions of health behaviour framework

Despite rapid theoretical expansion in conceptualising individual and environmental processes, the examination of social processes associated with health behaviours has a less cohesive theoretical landscape. The purpose of this mapping review and content analysis was to develop a taxonomy of social dimensions applicable to health behaviours. Michie et al. (2014) 'ABC of Theories of Behaviour Change' text, which includes 83 behaviour change theories, was used as the data-set, whereby an iterative concurrent content analysis was undertaken with respect to all relational/interpersonal psychological dimensions. The analysis resulted in a social dimensions of health behaviour (SDHB) framework of 10 dimensions, including seven sub-types of social appraisal dimensions and three-sub-types of social identification dimensions. The SDHB revealed that specific dimensions, such as descriptive norm, are prevalent in behavioural theories, while other dimensions have seen less attention. Further, while most social constructs in behavioural theories are represented by only one social dimension in the SDHB, other constructs have complex representation. This version 1.0 of the SDHB framework should assist in specifying the core social dimensions in health behaviour, provide a common lexicon to discuss relational constructs in psychological theories, amalgamate the disparate social constructs literature and identify opportunities for further research to advance theory development and interventions.

Trait self-control as a determinant of health behavior: Recent advances on mechanisms and future directions for research

We summarize theory and research testing a mechanistic explanation for the trait self-control-health behavior relationship. Specifically, social cognition constructs summarizing individuals' utility, normative, risk, and capacity beliefs with respect to future health behavior performance are proposed to mediate the self-control-health behavior relationship. The effect represents the informational function of self-control in decision making. We also specify a mechanism wherein trait self-control moderates the intention-behavior relationship such that 'good' self-control affords effective intention-to-action translation. Both effects have pervasive support in the extent literature. We propose ongoing meta-analyses expected to provide further robust support for these mechanistic effects and the need for research employing designs enabling better directional and causal inferences in the effects, including experimental or types of cross-lagged panel design.

Physical Activity Interventions Framed by the Health Action Process Approach for Adults with Long-Term Conditions: A Scoping Review

BACKGROUND

Interventions that use the Health Action Process Approach (HAPA) model show promise for increasing PA frequency, duration, and intensity. However, there is limited understanding of how HAPA model variables have been operationalized for PA interventions in chronic disease to promote behavior change and sustained PA or whether the phase or continuous form of the HAPA model was used. The aim of this scoping review is to describe how the HAPA model variables for PA interventions were operationalized and provide details of implementation.

METHOD

We searched five databases to identify studies published between January 1992 and March 2024. We aimed to describe (1) the characteristics of interventions including setting, delivery mode, duration, and content; (2) which HAPA variables were operationalized and the strategies used; and (3) the physical activity measures and outcome effects.

RESULTS

The search identified 23 interventions in 30 papers (12 protocols, 3 quasi-experimental studies, and 15 randomized controlled trials (RCTs)). Seven of the 15 RCTs reported significant positive effects of the HAPA model on PA behavior outcomes. Interventions operationalized between three and nine HAPA constructs showed significant variability in how the HAPA model is used in intervention research. PA measures varied from self-report to validated objective instruments.

CONCLUSION

We found a lack of clarity in decisions about which HAPA constructs were included in interventions. The wide variability in operationalized HAPA constructs made it challenging to compare interventions. Researchers should provide more detail about intervention design and implementation procedures to enhance transparency.

Behavioural determinants of physiologically-relevant light exposure

Light exposure triggers a range of physiological and behavioural responses that can improve and challenge health and well-being. Insights from laboratory studies have recently culminated in standards and guidelines for measuring and assessing healthy light exposure, and recommendations for healthy light levels. Implicit to laboratory paradigms is a simplistic input-output relationship between light and its effects on physiology. This simplified approach ignores that humans actively shape their light exposure through behaviour. This article presents a novel framework that conceptualises light exposure as an individual behaviour to meet specific, person-based needs. Key to healthy light exposure is shaping behaviour, beyond shaping technology.

CO-CREATION-HF protocol: clinical trial to evaluate the impact of a comprehensive and hybrid cardiac rehabilitation model on patients with heart failure

Introduction

Comprehensive, hybrid cardiac rehabilitation (CR) models have been scantly investigated in heart failure (HF) populations, particularly in low-resource settings. CO-CREATION-HF aims to evaluate the effectiveness of such a model compared to supervised exercise alone.

Methods and analysis

A 2 parallel-arm, multi-center randomized clinical superiority trial will be conducted with blinded outcome assessment. 152 HF patients (NYHA class II or III) will be recruited consecutively, and randomly assigned using permuted blocks; allocation will be concealed. The 12-week intervention will include evaluation, medical and nurse management, aerobic interval training, resistance exercise training, psychosocial support, and education. These will initially be delivered in a center, transitioning to home in 4 stages. Controls will receive similar management, but face-to-face continuous aerobic exercise sessions and resistance exercises. The main outcomes are cardiorespiratory fitness (VO2 max), functional capacity (m from 6 MWT), and quality of life (Minnesota Living with Heart Failure Questionnaire). Program adherence and completion, NT-proBNP, functioning, all-cause and HF-specific mortality and hospitalization, muscle strength, adverse events and cost will be secondary outcomes. These will be measured at baseline, end of intervention, and 12-month follow-up. The sample size was calculated considering 90% power, a significance level of 5%, a between-group difference equivalent to 1/2 MET, and a 10% potential loss to follow-up. Intention-to-treat analysis will be considered. Between-group differences will be assessed using Student's t-tests or Z-tests along with 95% confidence intervals, and the rate ratio will be computed to compare mortality.

Ethics and dissemination

The study protocol and the Informed Consent form were approved by Ethical Committees at the Universidad de La Frontera (No. 081-23) and each center participating. Research findings will be disseminated to the scientific community and will be shared with relevant stakeholder groups and policy-makers. Finally, investigators shall reach HF patients via various dissemination channels such as social media.

Clinical Trial Registration

clinicaltrials.gov, identifier (NCT06313684).

Effects of physical activity planning interventions on reducing sedentary behavior in parent-child dyads: A randomized controlled trial

Effects of parent-child dyad interventions on behavior remain unclear. This randomized controlled trial investigated if, compared with a control condition, three types of physical activity (PA) planning interventions (individual "I-for-me," dyadic "we-for-me," and collaborative "we-for-us") would reduce sedentary behavior (SB) time in parents and their children. The study involved 247 dyads comprising parents (aged 29-66) and their children (aged 9-15), randomized into one of the three types of PA planning-intervention arms or the control condition. Mixed models were applied to analyze data from a preregistered trial (NCT02713438) with the outcome of accelerometer-measured SB time, assessed at 1-week and 36-week follow-ups. Although children's SB remained unaffected by the planning interventions, a small reduction of SB time was found among parents in the collaborative (p = .048) and individual (p = .042) planning conditions. The effects were observed at the 1-week follow-up only. While short-term reductions in parents' SB were achieved, these were not sustained long-term. PA planning interventions delivered to parent-child dyads did not substantially reduce children's SB, which may be due to young people's needs of increased independence from their parents.

Analyzing early childhood allergy prevention motivation of mothers of infants and its predictors using latent class analysis and structural equation modelling

BACKGROUND

Allergic diseases are among the most common chronic diseases in childhood. Early childhood allergy prevention (ECAP) behaviors of those caring for the infant during pregnancy and the first months of life may influence the risk of allergy development over the life course. Motivation and intention to use appropriate primary ECAP measures are thus of critical importance.

AIMS

To characterize parental ECAP motivation, (a) valid indicators will be developed and (b) typical parental characteristics will be identified. (c) According to socio-cognitive models, the predictive value of parental risk perception, control belief and self-efficacy for parental ECAP motivation shall be determined.

METHOD

A sample of N = 343 (expectant) mothers of infants completed a questionnaire on self-reported ECAP motivation, risk perception, control belief, and self-efficacy. The cross-sectional data were analyzed using latent class analysis and structural equation modelling including nominal regression models.

RESULTS

Four typical maternal response profiles (motivated to a customary degree, 70%; motivated to use primary preventive measures, 17.8%; reluctant towards new prevention measures, 6.4%; highly motivated to apply preventive measures in case of an existing allergy, 5.8%) could be identified for the items on ECAP motivation. After splitting the model variables "risk perception" (allergy vs. allergy-associated general health problems) and "self-efficacy" (trust vs. insecurity) a satisfactory model-fit was achieved (CFI = .939; RMSEA = .064). Particularly, increased "risk perception-allergy" (OR = 1.655) and "self-efficacy-insecurity" (OR = 2.013) as well as lower "risk perception-general health" (OR = 0.555) and "control belief" (OR = 0.217), respectively, are associated with higher ECAP motivation.

CONCLUSION

The use of ECAP-measures by parents to protect their newborns from allergies is important, but there are deficiencies in their implementation. Based on a social cognitive model approach, predictive characteristics could be identified, which are associated with increased motivation to implement ECAP-measures. For public health our findings provide a promising basis for conception of behavioral and environmental ECAP prevention measures and their motivated implementation by parents.

Development and psychometric assessment of a health action process approach (HAPA) inventory for home nutritional behavior among postoperative gastric cancer patients

Objective

The aim of this study was to develop and validate a health action process approach (HAPA) inventory for measuring cognitive belief factors influencing home nutritional behavior among postoperative gastric cancer patients.

Methods

Item pool of the inventory was constructed based on the HAPA, literature review, and qualitative interview. Expert consultations were used for item improvement. Then postoperative gastric cancer patients (n = 404) were surveyed to conduct item analysis, reliability and validity test of the inventory. Reliability was evaluated through internal, split-half, and test-retest reliability. Validity was assessed through content and construct validity.

Results

Starting with 44 items in the item pool, the final inventory comprised 23 items. The exploratory factor analysis identified six dimensions-namely, risk perception, outcome expectancy, self-efficacy, intention, action planning, coping planning. And the cumulative variance contribution rate was 70.676%. Confirmatory factor analysis showed the model fits well (χ2 = 370.794, df = 214, and χ2/df = 1.733, root mean square of approximation error = 0.054, comparative fit index = 0.943, Tucker-Lewis index = 0.933, and incremental fitting index = 0.944). The item and scale level content validity were 0.83-1.00, and 0.98, which was considered good. The reliability was acceptable (Cronbach's α = 0.922, split-half reliability = 0.781, test-retest reliability = 0.716).

Conclusions

The developed inventory was valid and reliable to assess HAPA-based cognitive belief factors of home nutritional behavior of postoperative gastric cancer patients. Future research is needed to examine the applicability of the inventory in patients across diverse cultural backgrounds and healthcare systems.

A Longitudinal Theory-Based Investigation of How Environmental Aesthetics Predicts Home-Based Exercise

INTRODUCTION

Environmental aesthetics is a recognized macro environmental correlate of physical activity participation. Extrapolating this effect, we hypothesize this variable to also function as a determinant of exercise participation in the microenvironment , such as the home. Specifically, we predict that the environmental aesthetics of the location of cardio and resistance training equipment will predict determinants of exercise participation within the integrated behavior change model.

METHODS

Adult owners of exercise equipment ( N = 231) completed measures on the environmental aesthetics of their cardio and resistance training equipment, exercise time, and constructs from the integrated behavior change model across three consecutive monthly surveys. Study hypotheses were tested using multilevel structural equation modeling with participants (level 2) nested within time (level 1).

RESULTS

The model revealed predictive effects of intention, habit, and planning on exercise participation over time. The findings indicated a total effect of autonomous motivation on intention and habit. In addition, environmental aesthetics of cardio and strength training equipment predicted autonomous motivation, along with habit and intention when accounting for indirect effects. Finally, planning moderated the intention-behavior relationship, indicating that participants who scored higher on planning were more likely to translate their intentions to behavior.

CONCLUSIONS

These findings provide informative notes for designing effective home-based exercise programs, which have increased in popularity over the past recent years. Specifically, experimental studies that provide exercise equipment should ensure that the location of the equipment is appealing to the participant to increase the likelihood equipment use and exercise engagement.

Older Veterans' perspectives on participation in a clinical exercise program: A qualitative study of the VA Gerofit exercise program

Objectives

We explored the perspectives of older veterans in Gerofit, a Department of Veteran Affairs (VA) supervised clinical exercise program, to understand the factors associated with participation and how the program supported personal health goals.

Methods

Twenty semistructured interviews were conducted with active and inactive Gerofit participants. We used a hybrid inductive and deductive approach to thematic analysis of transcripts, with the latter informed by the Health Action Process Approach model of behavior change.

Results

Active and inactive participants differed in their perspectives about how Gerofit impacted their progress toward meeting personal health goals. Active participants noted program features (e.g., schedule, staffing) as facilitators and suggested greater self-efficacy about program participation compared to inactive participants. Both groups perceived the camaraderie with other veterans as a facilitator.

Conclusions

Exercise program features, including camaraderie, are important factors that affect the ability of older veterans to participate in exercise and achieve personal health goals.

Application of an Adapted Health Action Process Approach Model to Predict Engagement With a Digital Mental Health Website: Cross-Sectional Study

BACKGROUND

Digital Mental Health (DMH) tools are an effective, readily accessible, and affordable form of mental health support. However, sustained engagement with DMH is suboptimal, with limited research on DMH engagement. The Health Action Process Approach (HAPA) is an empirically supported theory of health behavior adoption and maintenance. Whether this model also explains DMH tool engagement remains unknown.

OBJECTIVE

This study examined whether an adapted HAPA model predicted engagement with DMH via a self-guided website.

METHODS

Visitors to the Mental Health America (MHA) website were invited to complete a brief survey measuring HAPA constructs. This cross-sectional study tested the adapted HAPA model with data collected using voluntary response sampling from 16,078 sessions (15,619 unique IP addresses from United States residents) on the MHA website from October 2021 through February 2022. Model fit was examined via structural equation modeling in predicting two engagement outcomes: (1) choice to engage with DMH (ie, spending 3 or more seconds on an MHA page, excluding screening pages) and (2) level of engagement (ie, time spent on MHA pages and number of pages visited, both excluding screening pages).

RESULTS

Participants chose to engage with the MHA website in 94.3% (15,161/16,078) of the sessions. Perceived need (β=.66; P<.001), outcome expectancies (β=.49; P<.001), self-efficacy (β=.44; P<.001), and perceived risk (β=.17-.18; P<.001) significantly predicted intention, and intention (β=.77; P<.001) significantly predicted planning. Planning was not significantly associated with choice to engage (β=.03; P=.18). Within participants who chose to engage, the association between planning with level of engagement was statistically significant (β=.12; P<.001). Model fit indices for both engagement outcomes were poor, with the adapted HAPA model accounting for only 0.1% and 1.4% of the variance in choice to engage and level of engagement, respectively.

CONCLUSIONS

Our data suggest that the HAPA model did not predict engagement with DMH via a self-guided website. More research is needed to identify appropriate theoretical frameworks and practical strategies (eg, digital design) to optimize DMH tool engagement.

Psychometric Properties of Scales Assessing Psychosocial Determinants of Staff Compliance with Surgical Site Infection Prevention: The WACH-Study

Purpose

Psychosocial determinants influence healthcare workers' compliance with surgical site infection (SSI) preventive interventions. In order to design needs-based interventions promoting compliance, such determinants must first be assessed using valid and reliable questionnaire scales. To compare professional groups without bias, the scales must also be measurement-equivalent. We examine the validity/reliability and measurement equivalence of four scales using data from physicians and nurses from outside the university sector. Additionally, we explore associations with self-reported SSI preventive compliance.

Participants and Methods

N = 90 physicians and N = 193 nurses (response rate: 31.5%) from nine general/visceral or orthopedic/trauma surgery departments in six non-university hospitals in Germany participated. A written questionnaire was used to assess the compliance with SSI preventive interventions and the determinants of compliance based on the Capability-Opportunity-Motivation-Behavior-Model. Psychometric testing involved single- and multiple-group confirmatory factor analyses, and explorative analyses used t-tests and multiple linear regression.

Results

The scales assessing individual determinants of compliance (capability, motivation, and planning) were found to be reliable (each Cronbach's α ≥ 0.85) and valid (each Root-Mean-Square-Error of Approximation ≤ 0.065, each Comparative-Fit-Index = 0.95) and revealed measurement equivalence for physicians and nurses. The scale assessing external determinants (opportunity) did not demonstrate validity, reliability, or measurement equivalence. Group differences were found neither in compliance (p = 0.627) nor determinants (p = 0.192; p = 0.866; p = 0.964). Capability (β = 0.301) and planning (β = 0.201) showed associations with compliance for nurses only.

Conclusion

The scales assessing motivation, capability, and planning regarding SSI preventive compliance provided reliable and valid scores for physicians and nurses in surgery. Measurement equivalence allows group comparisons of scale means to be interpreted without bias.

'We may need some help; we are just parents who have chosen to engage in football': a qualitative study on amateur coaches' experiences of use of and support for injury prevention training in Sweden

INTRODUCTION

Achieving sufficient adherence with injury prevention exercise programmes is a challenge. The aim was to explore how amateur football coaches experience the use of and support for injury prevention training using the Knee Control programmes as examples.

METHODS

Semistructured interviews with 20 amateur football coaches around experiences of injury prevention training, facilitators and barriers, and perceived support, analysed with qualitative content analysis. Participants coached male and female, junior and senior teams. Experience of having used the Knee Control programmes was an inclusion criteria.

RESULTS

Four main categories were developed: Why are we really doing this?, How do we make it work?, What are our drivers and challenges? and What could be improved? Coaches were motivated for injury prevention training but faced challenges such as limited access to football grounds and low player motivation. To make the prevention programme work for them, they integrated it and used exercises in the pauses during football-specific drills, or used as a warm-up. Many conducted prevention routines from an early player age. Coaches believed preventive training use could be further enhanced by education and practical support, and by football associations and clubs working together to reduce injuries.

CONCLUSION

Coaches were motivated and creatively worked with the prevention programme to make it fit their team. Even coaches with long-term experience of using prevention programmes wanted support, indicating that present implementation strategies targeting those about to start using prevention programmes should be complemented by continuous support for maintained use. These strategies should preferably target both coaches and players.

Factors influencing physical activity levels in elderly community-dwelling convalescent stroke survivors: A cross-sectional study

AIM

This study aimed to investigate factors affecting physical activity (PA) among elderly stroke survivors living in the community and assess the mediating role of exercise planning in the relationship between exercise self-efficacy and PA.

METHODS

300 participants were surveyed using questionnaires and scales, with data analyzed using SPSS 26.0.

RESULTS

Univariate analysis identified sociological, disease-related factors, exercise self-efficacy, and exercise planning as influencing PA. Ordered logistic regression showed significant associations between PA, exercise self-efficacy (OR 1.093, 95 % CI 1.055-1.133, P < 0.001), and exercise planning (OR 1.296, 95 % CI 1.202-1.398, P < 0.001). Exercise planning partially mediated the relationship between exercise self-efficacy and PA, accounting for 64.86 % of the total effect.

CONCLUSIONS

Multiple factors, including sociological and disease-related ones, as well as exercise self-efficacy and planning, influence PA in elderly stroke survivors. Exercise planning partially mediates the relationship between exercise self-efficacy and PA.

Players are positive regarding injury prevention exercise programmes, but coaches need ongoing support: a survey-based evaluation using the Health Action Process Approach model across one season in amateur and youth football

Objectives

Implementation of injury prevention exercise programmes (IPEPs) in sports is challenging, and behaviour change among players and coaches is essential for success. The aim was to describe players' and coaches' motivation and coaches' goal pursuit when using IPEPs in amateur and youth football across a season. A secondary aim was to describe players' motivation to engage in IPEP use in relation to presence or absence of injury.

Methods

The study was based on questionnaires to amateur and youth, male and female football players and coaches at baseline, mid-season and post-season in a three-armed randomised trial in 2020 in Sweden. Questionnaires were based on the Health Action Process Approach (HAPA) model with questions about the motivational phase when intention for change is created (players and coaches) and a goal-pursuit phase when intention is translated into action (coaches).

Results

In total, 455 players (126 male), mean age 20.1 years (SD±5.8, range 14-46) and 59 (52 male) coaches took part. Players generally gave positive answers in the HAPA motivational phase (Likert 6-7 on a 1-7 Likert scale). Differences in ratings between injured and uninjured players were minor. Coaches had positive or neutral ratings (Likert 4-6) in the motivational and goal-pursuit phases. Ratings deteriorated across the season, with less positive responses from 40% of players and 38-46% of coaches post-season.

Conclusion

Positive ratings in the HAPA motivational phase indicated fertile ground for IPEP use. Neutral ratings by coaches and deterioration across the season in players and coaches suggest a need for ongoing support for IPEP use.

Trial registration number

NCT04272047.

Validation of an improved questionnaire assessing the social cognitive constructs of the Health Action Process Approach among parents regarding brushing their children's teeth

OBJECTIVE

The Health Action Process Approach (HAPA) describes social cognitive constructs related to behaviour change. A validated questionnaire is needed to measure these constructs in paediatric dentistry. The aim of this study was to improve an existing HAPA-based questionnaire for parents regarding brushing their children's teeth and to assess its validity and reliability in a population of parents of high caries risk children.

METHODS

Parents of high caries risk children of 3-10 years filled out the adjusted HAPA-based questionnaire. Mokken scale analysis, graded response model analyses, factor analyses and reliability analyses were performed according to the protocol of Dima. Discriminant validity was assessed by comparing the mean scores of the HAPA constructs between two groups of participants, based on different levels of caries experience, brushing frequency and education level of the mother.

RESULTS

The Mokken scale analysis and factor analyses indicated a multidimensional eight factor scale. The graded response model did not fit our data. The subscale action control could be identified as a two-factor subscale. Reliability indices from the Dima protocol varied, for instance Cronbach alpha ranged from 0.73 to 0.96. The constructs coping self-efficacy, action planning and action control discriminated between brushing frequencies.

CONCLUSIONS

The adjusted HAPA-based questionnaire is an improved, valid and reliable instrument that could be used to evaluate HAPA-based interventions to improve children's oral health.

Social cognition correlates of self-management behaviors in patients with familial hypercholesterolemia (FH): A meta-analytic review

OBJECTIVE

Familial Hypercholesterolemia (FH) is an inherited disorder leading to increased risk of premature atherosclerotic cardiovascular disease. This risk can be ameliorated through adherence to pharmacological treatment and salient lifestyle behaviors (e.g., physical activity participation, healthy eating). Identifying theory-based, modifiable determinants of these behaviors may inform behavioral interventions promoting participation in FH self-management behaviors. We aimed to identify the belief-based social cognition constructs uniquely associated with intentions to perform, and actual participation in, FH self-management behaviors in the extant research.

METHOD

A systematic database search identified studies (k = 9, N = 1394) reporting relations between social cognition theory constructs and intention toward, or actual participation in, self-management behaviors in FH patients. As no studies examining prospectively-measured behaviors were identified, we tested relations among social cognition constructs, intentions, and past FH-self-management behavior using random effects multi-level meta-analysis and meta-analytic structural equation modelling.

RESULTS

We found non-zero averaged correlations among the key social cognition constructs (attitudes, norms, risk perceptions, self-efficacy), intentions, and past behavior. A meta-analytic structural equation model indicated non-zero averaged direct effects of attitudes, norms, self-efficacy, and past behavior on FH self-management behavioral intentions. There were also non-zero averaged indirect effects of past behavior on intentions mediated by the social cognition constructs.

CONCLUSION

Findings provide evidence to support the proposed model and highlight the importance of personal, normative, and capacity related beliefs and past experience as unique correlates of intentions to perform FH self-management behaviors. The model may signal potential constructs that could be targeted in behavioral interventions to promote participation in FH self-management behaviors.

Testing the Effect of Cue Consistency on the Past Behavior-Habit-Physical Activity Relationship

Behavior performed in the presence of consistent cues is a core element for successful habit development, with the repeated presence of consistent cues facilitating the activation of automatic responses in future. Yet, little is known about the effects of different cue types on habit. Using a two-wave prospective PLS-SEM model with a sample of 68 undergraduate students, we assessed the mediating effects of habit on the past-behavior-to-physical-activity relationship, and how the mediating effects of habit were moderated by the consistent presence of different forms of cues. Habit mediated the effects of past behavior on physical activity, with a significantly stronger mediating effect of habit in those reporting undertaking physical activity at the same time of day, doing the same activity, and in the same mood. Consistent place, people, and part of routine did not moderate the effects of habit. The results provide formative evidence for a key assertion of the habit theory that consistent contextual and internal cues are a cornerstone of habitual development and action, but they also indicate the importance of examining different forms of cues and their impact on the formation and enaction of habits as some cues may be more relevant than others.

A Behavioral Perspective for Improving Exercise Adherence

Adherence to exercise is a crucial aspect of behavioral changes related to exercise. However, current models fail to predict behavioral change, and exercise programs struggle to foster adherence. In this Current Opinion article, we defined adherence as a process linking behavior and attitude. More specifically, exercise adherence is the process by which people's behaviors conform to their attitudes and vice versa. Behavioral change theories should be able to predict changes, transformations, and modifications of behaviors; however, this is not currently the case. Prediction models of behavior are mainly focused on how to predict behavioral changes by affecting attitudes; however, these models have not considered the target behavior as a facilitator of adherence. Herein, a behavioral perspective is considered in three directions: first, exercise is a therapeutic modality that has the potential to improve motivation; second, chronic exercise helps sustain effort over time and increase executive functions and willpower; and third, exercise is an active behavior that has the potential to facilitate attitude change.

A blended face-to-face and eHealth lifestyle intervention on physical activity, diet, and health outcomes in Hong Kong community-dwelling older adults: a study protocol for a randomized controlled trial

Background

Aging individuals are vulnerable to various Noncommunicable Diseases (NCDs). Different behaviors are closely related to a decreased risk of suffering from NCDs: sufficient Physical Activity (PA) (e.g., at least 150 mins Moderate-to-vigorous Physical Activity (MVPA) per week) and a healthy daily diet (e.g., at least five portions of Fruit and Vegetable Intake (FVI), 5-6 taels (189.0-226.8 g) Meat, Fish, Egg and Alternatives (MFEA)). Traditional face-to-face interventions were effective in behavior change. However, it was revealed to be resource-intensive and limited transfer due to poor self-regulation skills outside of face-to-face sessions. Thus, eHealth could be a supplement for older adults outside traditional face-to-face settings. The blended approach combining these two interventions might optimize the intervention effects on lifestyle behavior initiation and maintenance, but little research can be found among Hong Kong older adults. Therefore, the study aims to test a blended intervention to promote PA, diet, and health outcomes among Hong Kong community-dwelling older adults.

Methods

This study will adopt a 10-week three-arm randomized controlled trial. The blended group will receive weekly (1) two 60-min face-to-face sessions with one for PA and one for diet, and (2) two web-based sessions with one for PA and one for diet. The face-to-face group will receive the same intervention content as the face-to-face sessions in the blended group. The control condition will receive a biweekly telephone call. The outcomes will include MVPA (minutes/week), FVI (portions/day), MFEA consumption (taels/day), social-cognitive factors (self-efficacy, planning, social support, action control), physical health outcomes (clinical indicators, senior physical fitness), mental health outcomes (depression, loneliness) and health-related quality of life. Data collection will be implemented at the pre-test, post-test, and 3-month follow-up test.

Discussion

This is the first study evaluating a blended intervention promoting multiple health behaviors among Hong Kong community-dwelling older adults. If the effect of the blended intervention is superior to the traditional face-to-face group and the control group, it will enrich lifestyle intervention approaches and can be applied to older adults, helping them obtain health benefits. Furthermore, a better understanding of mechanisms will also have implications for theory-building.

Clinical trial registration

https://www.isrctn.com/ISRCTN32329348, ISRCTN32329348.

Personality and change in physical activity across 3-10 years

OBJECTIVE

To examine the association between personality traits, defined by the Five-Factor Model, and the initiation and termination of physical activity across adulthood.

DESIGN

Longitudinal analysis of participants from nine samples (N > 28,000).

MAIN OUTCOME MEASURES

Physical activity status at follow-up.

RESULTS

A random-effect meta-analysis revealed that higher conscientiousness, extraversion, and openness were related to a higher likelihood of initiation of physical activity over time among individuals who were physically inactive at baseline and to a lower risk of termination of physical activity among those who were physically active at baseline. In contrast, higher neuroticism was associated with a lower probability of initiation of physical activity and a higher likelihood of termination over time. Although not hypothesised, agreeableness was also associated with better physical activity outcomes over time.

CONCLUSION

This study provides the largest and the longest evidence of a replicable association between personality and change in physical activity status. Personality may motivate both the initiation and termination of physical activity.

The Impact of Video-Based Microinterventions on Attitudes Toward Mental Health and Help Seeking in Youth: Web-Based Randomized Controlled Trial

BACKGROUND

Mental health (MH) problems in youth are prevalent, burdening, and frequently persistent. Despite the existence of effective treatment, the uptake of professional help is low, particularly due to attitudinal barriers.

OBJECTIVE

This study evaluated the effectiveness and acceptability of 2 video-based microinterventions aimed at reducing barriers to MH treatment and increasing the likelihood of seeking professional help in young people.

METHODS

This study was entirely web based and open access. The interventions addressed 5 MH problems: generalized anxiety disorder, depression, bulimia, nonsuicidal self-injury, and problematic alcohol use. Intervention 1 aimed to destigmatize and improve MH literacy, whereas intervention 2 aimed to induce positive outcome expectancies regarding professional help seeking. Of the 2435 participants who commenced the study, a final sample of 1394 (57.25%) participants aged 14 to 29 years with complete data and sufficient durations of stay on the video pages were randomized in a fully automated manner to 1 of the 5 MH problems and 1 of 3 conditions (control, intervention 1, and intervention 2) in a permuted block design. After the presentation of a video vignette, no further videos were shown to the control group, whereas a second, short intervention video was presented to the intervention 1 and 2 groups. Intervention effects on self-reported potential professional help seeking (primary outcome), stigma, and attitudes toward help seeking were examined using analyses of covariance across and within the 5 MH problems. Furthermore, we assessed video acceptability.

RESULTS

No significant group effects on potential professional help seeking were found in the total sample (F2,1385=0.99; P=.37). However, the groups differed significantly with regard to stigma outcomes and the likelihood of seeking informal help (F2,1385=3.75; P=.02). Furthermore, separate analyses indicated substantial differences in intervention effects among the 5 MH problems.

CONCLUSIONS

Interventions to promote help seeking for MH problems may require disorder-specific approaches. The study results can inform future research and public health campaigns addressing adolescents and young adults.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00023110; https://drks.de/search/de/trial/DRKS00023110.

Comparing closure compliance and ease of use for consumer product packs designed to reduce access to children

Child impeding packs are difficult for children to open so protect them from unintended access to hazardous contents inside the pack. However, if packs are difficult for adults to open, in normal usage scenarios, this may result in a higher occurrence of packs being left open. This research explores differences in ease of usage and closure compliance between two types of child impeding packs of liquid laundry detergent capsules. The two packs, "Pinch & Lift" and "Press & Lift", had different opening and closing mechanisms. "Press & Lift" also included an audible "click" signal to confirm complete closure to the user. The research was performed across two studies. In both studies, the packs were used in participants' homes according to their usual storage and usage practices as replacements to their current liquid laundry detergent capsule pack. All participants had small children living with them in their household. In Study 1, self-reported closure and ease of use data was collected from 99 adult participants in Germany. They used each package in their home for 10 days. Study 2 extended Study 1 by measuring closure rates with an objective assessment using in pack sensors for a 10-day period for each pack. Self-reported closure and ease of use data were also collected. Study 2 was conducted with 87 participants in the United Kingdom. Results across both studies showed "Press & Lift" with the audible "Click" close signal to be rated by participants to be significantly easier to open and close and have a higher self-reported closure rate than "Pinch & Lift". In addition, Study 2 results demonstrated higher closure rates using "Press & Lift" based on the sensor-measured closure compliance. Together, the results suggest transition to a pack with a mechanism that is child impeding and easier for an adult to use with an audible closure signal, like the "Press & Lift" system, has potential to reduce child access to a capsule from a pack by reducing the likelihood of the pack being left open by the adult user. Ultimately, such packs could protect children from potential poisoning injury across a range of consumer products.

Understanding physical exercise among individuals with substance use disorders using an integrated theoretical perspective of the health action process approach and theory of planned behavior

Introduction

Physical exercise is considered a useful non-pharmacological adjunctive treatment for promoting recovery from substance use disorders (SUD). However, adherence to physical exercise treatments is low, and little is known about what factors are associated with the initiation and maintenance of physical exercise behaviors. The aim of this study was to explore the psychosocial factors underlying these behaviors in individuals with SUD using an integrated theoretical model based on the health action process approach (HAPA) and the theory of planned behavior (TPB).

Methods

A total of 1,197 individuals with SUDs (aged 37.20 ± 8.62 years) were recruited from 10 compulsory isolation drug rehabilitation centers in Zhejiang Province via convenience sampling according to a set of inclusion criteria. Self-reported data were collected to assess task self-efficacy (TSE), maintenance self-efficacy (MSE), recovery self-efficacy (RSE), outcome expectations (OE), action planning (AP), coping planning (CP), social support (SS), subjective norms (SN), attitude behavior (AB), behavioral intention (BI), perceived behavioral control (PBC), risk perception (RP), exercise stage, and exercise behavior in this integrated model. ANOVA and structural equation modeling (SEM) were used to evaluate this model.

Results

One-way ANOVA revealed that the majority of the moderating variables were significantly different in the exercise phase. Further SEM showed that the model fit the data and revealed several important relationships. TSE, RP, SS, AB, and SN were indirectly associated with physical exercise behavior in individuals with SUD through the BI in the SUD initiation stage. In addition, PBC was directly related to physical exercise behavior in individuals with SUD. In the maintenance stage, MSE, AP, CP and exercise behavior were significantly related. Moreover, AP and CP were mediators of BI and MSE.

Conclusion

This study is the first attempt to integrate patterns of physical exercise behavior in individuals with SUD. The HAPA-TPB integration model provides a useful framework for identifying determinants of physical exercise behavioral intentions and behaviors in individuals with SUD and for explaining and predicting the initiation and maintenance of physical exercise behaviors in these individuals. Moreover, the model provides scientific guidance for the enhancement of physical exercise adherence in individuals with SUD.

Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease

BACKGROUND AND OBJECTIVE

Coeliac disease is a chronic, immune-mediated disorder for which the only treatment consists of lifelong strict adherence to gluten-free diet (GFD). However, there is a lack of evidence-based guidelines on the GFD dietary management of coeliac disease. This position paper, led by the Special Interest Group in coeliac disease of the European Society of Pediatric, Gastroenterology Hepatology, and Nutrition, supported by the Nutrition Committee and the Allied Health Professionals Committee, aims to present evidence-based recommendations on the GFD as well as how to support dietary adherence.

METHODS

A wide literature search was performed using the MeSH Terms: "diet, gluten free," "gluten-free diet," "diets, gluten-free," "gluten free diet," and "coeliac disease" in Pubmed until November 8th, 2022.

RESULTS

The manuscript provides an overview of the definition of the GFD, regulations as basis to define the term "gluten-free," which foods are naturally gluten-free and gluten-containing. Moreover, it provides recommendations and educational tips and infographics on suitable food substitutes, the importance of reading food labels, risk of gluten cross-contact at home and in public settings, nutritional considerations as well as factors associated to dietary adherence based on available evidence, or otherwise clinical expertise.

CONCLUSIONS

This position paper provides guidance and recommendations to support children with coeliac disease to safely adhere to a GFD.

Step away from depression-results from a multicenter randomized clinical trial with a pedometer intervention during and after inpatient treatment of depression

Evidence for the effectiveness of physical activity (PA) in the treatment of depression prevails for outpatients with mild and moderate symptom levels. For inpatient treatment of severe depression, evidence-based effectiveness exists only for structured and supervised group PA interventions. The Step Away from Depression (SAD) study investigated the effectiveness of an individual pedometer intervention (PI) combined with an activity diary added to inpatient treatment as usual (TAU). In this multicenter randomized controlled trial, 192 patients were randomized to TAU or TAU plus PI. The two primary outcomes at discharge were depression-blindly rated with the Montgomery-Åsberg Depression Rating Scale (MADRS)-and average number of daily steps measured by accelerometers. Secondary outcomes were self-rated depression and PA, anxiety, remission and response rates. Multivariate analysis of variance (MANOVA) revealed no significant difference between both groups for depression and daily steps. Mean MADRS scores at baseline were 29.5 (SD = 8.3) for PI + TAU and 28.8 (SD = 8.1) for TAU and 16.4 (SD = 10.3) and 17.2 (SD = 9.9) at discharge, respectively. Daily steps rose from 6285 (SD = 2321) for PI + TAU and 6182 (SD = 2290) for TAU to 7248 (SD = 2939) and 7325 (SD = 3357). No differences emerged between groups in secondary outcomes. For severely depressed inpatients, a PI without supervision or further psychological interventions is not effective. Monitoring, social reinforcement and motivational strategies should be incorporated in PA interventions for this population to reach effectiveness.

Psychosocial correlates of physical activity in cancer survivors: a systematic review and meta-analysis

BACKGROUND

Physical activity (PA) is a non-pharmacological approach to optimize health benefits in cancer survivors and is recommended as part of care. However, most cancer survivors fail to meet PA recommendations. The current systematic review and meta-analysis aimed to identify psychosocial correlates of free-living PA in cancer survivors.

METHODS

Three electronic databases were searched (PubMed, PsycINFO, and SportDiscus). Meta-analyses were conducted for psychosocial correlates tested ≥ 3 times.

RESULTS

Sixty-four articles were included. Eighty-eight different free-living PA correlates were identified. Meta-analyses (n = 32 studies) tested 23 PA correlates, of which 16 were significant (p < 0.05). Larger effect sizes (0.30 < ES > 0.45) were found for exercise self-efficacy, perceived behavioral control, intention, lower perceived barriers for exercise, enjoyment, perceived PA benefits, and attitudes. Small-to-moderate effects (0.18 < ES < 0.22) were found for subjective norms, physical functioning, quality of life, depression, and mental health. These findings were generally in line with narrative results.

CONCLUSIONS

This systematic review highlights important psychosocial correlates of free-living PA that can be targeted in future PA promotion interventions for cancer survivors. Constructs mainly from SCT and TPB were the most studied and appear to be associated with free-living PA in this population. However, we cannot currently assert which frameworks might be more effective. Further studies of better methodological quality, per correlate and theory, exploring longer-term associations and across different types of cancer, are needed.

IMPLICATIONS FOR CANCER SURVIVORS

Having higher exercise self-efficacy, perceived behavioral control, intention, enjoyment and perceived PA benefits, more positive attitudes towards PA, and lower perceived barriers for exercise, can help increase PA in cancer survivors.

Community-embedded follow-up management intervention for geriatric primary care: a mixed-methods study of an integrated health services model

BACKGROUND

To propose a community-embedded follow-up management model to provide health services for elderly patients with osteoporosis who live alone.

METHODS

Researchers randomly selected 396 people with osteoporosis living alone from five communities in Nantong, China, for the study. These participants were randomly assigned to control and intervention groups. Twenty-four community physicians in five communities provided professional support based on a community-embedded follow-up management model. Participants completed quantitative questionnaires at baseline and after the 6-month follow-up intervention, and some participants underwent semi-structured face-to-face interviews. The primary outcome is the effectiveness of the community-embedded follow-up management model in improving the quality of life of elderly patients with osteoporosis living alone. Based on an objective quantitative assessment, the qualitative study explains and adds essential components of this community-based follow-up management model.

RESULTS

The quantitative study showed that scores in physical functioning, ability to perform daily activities, self-efficacy, and mental status were significantly improved in the intervention group compared to the control group (p < 0.05). The most significant improvements were found in "mental status" (p = 0.012) and "self-care skills" (p = 0.003). The qualitative study reported the essential elements of a community healthcare model for older people living alone with osteoporosis, including professional support, personalized services, social support, and empowerment.

CONCLUSIONS

Community-embedded follow-up management meets the need for elderly patients with osteoporosis living alone. It helps to improve health perception, promote physical and mental health, and optimize the quality of life in this population. Personalized services and professional support are two major contributing factors to effective embedded follow-up management in the community.