Motivation for health behaviours: a systematic review of the nursing literature

Psychological determinants of the effectiveness of conjugated linoleic acid supplementation in overweight and obese women-a randomized controlled trial

Introduction

Previous studies investigating the effectiveness of conjugated linoleic acid (CLA) supplementation in body weight reduction provided unequivocal results. We hypothesized that psychological factors such as self-efficacy, locus of control or dispositional optimism can affect the success of the intervention. Therefore, this study aimed to determine the psychological factors that modulate the effectiveness of CLA supplementation in overweight or obese women and affect the ability to successfully complete the study.

Methods

In total, 74 subjects were recruited into this three-month randomized trial and divided into intervention and control groups receiving, respectively, capsules containing 3 g 80% CLA per day and capsules containing 3 g of sunflower oil. The following psychological tests were performed before the intervention: Multidimensional Health Locus of Control scale, Acceptance of Illness Scale, Satisfaction with Life Scale (SWLS), General Self Efficacy Scale (GSES), Health Behavior Inventory scale and Life Orientation Test (LOT-R).

Results

A total of 60 women completed the study and the subjects who dropped out obtained higher scores in the GSES (p = 0.0490) and the LOT-R (p = 0.0087) tests than subjects who completed the trial. Besides, multivariate linear regression demonstrated that the SWLS test (p = 0.0345) results were independent predictors of body weight changes.

Conclusion

In conclusion, psychological factors like self-efficacy and optimism may be associated with a higher risk of withdrawal from the study, while satisfaction with life may have an impact on the effectiveness of body weight reduction.Clinical trial registration: [https://drks.de/search/en], identifier [DRKS00010462].

Psychometric validity of the Thai version of the Motivation for Healthy Eating Scale in patients with acute coronary syndrome

Background

Motivation plays a crucial role in lifestyle modifications for disease control and preventing recurrent cardiac events. Higher motivation levels are associated with improved health outcomes, including adherence to a healthy diet and sustained behavior change. However, there is a lack of evaluation of instruments for assessing motivation to adhere to diet recommendations, specifically among patients in Thailand.

Objective

This study aimed to assess the psychometric validity of the Thai version of the Motivation for Healthy Eating Scale (MHES) in patients with acute coronary syndrome in Thailand.

Methods

The study was conducted between May and August 2022, involving 200 patients with acute coronary syndrome selected through multistage random sampling from tertiary care institutions in Bangkok, Thailand. The scale was translated from English to Thai using the back-translation method. Principal Component Analysis (PCA) and Cronbach's alpha were employed to evaluate the validity and reliability of the scale.

Results

The Thai version of the MHES demonstrated satisfactory reliability with a Cronbach's alpha coefficient of 0.73. The analysis revealed four factors consisting of 16 items: 1) 'integrated and integrated regulation' with seven items, 2) 'intrinsic and external regulation' with three items, 3) 'introjected regulation' with three items, and 4) 'amotivation' with three items. These factors collectively explained 66.78% of the total variance.

Conclusion

The findings indicate that the Thai version of the MHES is a reliable and valid instrument for assessing motivation related to dietary behavior among Thai patients with acute coronary syndrome. Nurses and healthcare professionals can use this scale to evaluate the motivation of dietary behavior among this population, thereby facilitating targeted interventions and promoting positive health outcomes.

Health motivations and perceived barriers are determinants of self-care behaviour for the prevention of hypertension in a Malaysian community

INTRODUCTION

Self-care behaviour is fundamental in preventing hypertension in the general population. According to the Health Belief Model, health beliefs and perceptions influence the success in adopting disease prevention strategies. While factors influencing hypertension self-care behaviour have been examined previously in patient populations, they have not been assessed in the general community.

METHODS

This was a cross-sectional study conducted between 12 June 2020 to 26 July 2021. An online survey was administered via email and social media to Malaysians in the Selangor and Kuala Lumpur communities. Respondents were over 18 years old, without a formal diagnosis of hypertension. The survey evaluated hypertension knowledge, Health Belief Model constructs, self-care behaviour frequency, and motivators and barriers to self-care behaviour. Multiple linear regression was performed to determine the main predictors of self-care behaviour, and descriptive statistics were used to characterise motivators and barriers of each self-care behaviour.

RESULTS

Only health motivations (β = 0.217, p < 0.001) and perceived barriers (β = 0.571, p < 0.001) significantly influenced self-care behaviour. Maintaining a healthy diet, regular physical activity and blood pressure checks need to be improved in the community, particularly in reducing salt and calorie intake. Lack of time, limited choices and laziness are the biggest challenges that need to be tackled in adopting a healthy diet and an active lifestyle in the community. Many are ignorant towards their health status, therefore, do not prioritize blood pressure screenings, suggesting a need to enhance community blood pressure checks for early diagnosis of hypertension.

CONCLUSION AND IMPLICATIONS

Motivations and barriers were the main determinants of self-care behaviour in the Selangor and Kuala Lumpur community. Targeting these aspects of self-care behaviour should be considered when developing interventions and education programmes tailored to local cultural, environmental and personal factors, to more effectively reduce the hypertension prevalence and burden.

Association of eHealth Literacy with Health Promotion Behaviors of Community-Dwelling Older People: The Chain Mediating Role of Self-Efficacy and Self-Care Ability

In the digital age, electronic health literacy (eHealth literacy) of community-dwelling older people plays a potentially important role in their health behaviors which are critical for health outcomes. Researchers have documented that self-efficacy and self-care ability are related to this relationship. This study aimed to assess the relationship between eHealth literacy and health promotion behaviors among older people living in communities and explore the chain mediating role of self-efficacy and self-care ability. For this cross-sectional study, we used data from 425 older adults at 3 communities in Qingdao, Shandong Province in Northeastern China, from June to September 2021. Path analysis using the structural equation model was performed. We found that eHealth literacy was significantly associated with health promotion behaviors in older people. Additionally, eHealth literacy indirectly affected health promotion behaviors through self-efficacy and self-care ability, respectively. In addition, the chain mediation effect was identified in the relationship of eHealth literacy and health promotion behaviors: eHealth literacy→ self-efficacy→ self-care ability→ health promotion behaviors. These findings offer promising directions for developing interventions to modify older adults' health behaviors through enhancing their eHealth literacy. These interventions should integrate components that target improving the self-efficacy and self-care ability of older people.

The Health Behaviour of German Outpatient Caregivers in Relation to Their Working Conditions: A Qualitative Study

Ongoing demographic change is leading to an increasingly older society and a rising proportion of people in need of care in the German population. Therefore, the professional group of outpatient caregivers is highly relevant. Their work is characterised not only by interacting with patients in a mobile setting but also by working in shifts. Health behaviour under these specific working conditions is crucial for ensuring long-term work ability and performance. Little is known about the health behaviour of German outpatient caregivers and its potential impact on their work. The aims of the study were (1) to examine health behavioural patterns (nutrition, exercise, smoking, regeneration) of outpatient caregivers, (2) to illuminate their personal health-promoting behaviours, and (3) to identify potential work-related factors influencing their health behaviour. Fifteen problem-centred interviews were conducted with outpatient caregivers working in Northern Germany in the period January-April 2020. Interviews were analysed by using qualitative content analysis. Outpatient caregivers reported improvable nutrition and hydration, with simultaneous high coffee consumption, low physical activity, poor regeneration (breaks and sleep quality), and good personal health-promoting behaviour (e.g., back-friendly habits), although the majority were smokers. Barriers to the implementation of health-promoting behaviours were a high perception of stress due to increased workload and time pressure, while aids to better health-promoting behaviour were described as being social support and personal resources. The respondents perceived their working conditions as potentially influencing their health behaviour. On the basis of their descriptions, various practice-relevant strategies were derived. The data explore a potential need for outpatient care services to develop interventions on behavioural and structural levels that can help create healthier working conditions for their employees so these caregivers can adopt better health behaviours.

A Rasch analysis of emerging adults' health motivation questionnaire in higher education context

Objective

The College Students’ Health Motivation Questionnaire (CSHM-Q) is used to measure motivation for a healthy lifestyle among emerging adults. This study sought to validate the CSHM-Q using the Rasch measurement model.

Methods

322 participants were recruited based on a convenience sampling method. The Rasch analysis was carried out using the RUMM2030 software.

Results

Local item dependency was accommodated using the ‘super item’ approach. Disordered thresholds were resolved by collapsing some response options. After modification, each component of the CSHM-Q showed acceptable overall fit, item and person fit, internal consistency, and targeting. Unidimensionality was supported at the subscale level. Items did not exhibit disordered threshold, local item dependency, or differential item functioning. Transforming tables were also created to help convert the raw score into an interval scale.

Conclusions

Results of the Rasch analysis supported the interval scale measurement properties of the CSHM-Q and offered health education researchers an instrument to measure emerging adults’ health motivation in the higher education context.

Motivation to Care: A Qualitative Study on Iranian Nurses

Background:

The performance of nurses, which is rooted in personal motivation, determines the quality of care. Therefore, it is important that nurses are motivated to provide high-quality care.

Purpose:

The purpose of this study was to explore the factors that affect caring motivation from the perspectives of nurses in Iran.

Methods:

This was a qualitative study. Seventeen nurses were interviewed using a semistructured, in-depth interview method. The interviews were recorded, transcribed verbatim, and analyzed using content analysis.

Results:

Data analysis led to the identification of the two themes of (a) self-valuation and (b) providing beneficial care.

Conclusions/Implications for Practice:

The findings of this study increase scholarly understanding of the caring motivations of nurses. These motivations may be used in related programs by senior nursing managers to improve the quality of nursing care.

Assessing Patient Motivation for Treatment: A Systematic Review of Available Tools, Their Measurement Properties, and Conceptual Definition

BACKGROUND AND PURPOSE

Motivation is often reported by clinicians and researchers as a key factor related to treatment and health outcomes. This systematic review aims to (a) Identify and critically appraise tools that measure patient motivation for treatment and (b) determine how these tools define and evaluate motivation.

METHODS

Library databases and the search engine Google Scholar were examined. Identified tools measuring patient motivation for treatment and reported measurement properties were selected.

RESULTS

14 peer-reviewed articles covering 12 different tools made the final selection. Quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and a new measure checklist. Reliability evidence was predominantly estimated using internal consistency; validity evidence was limited, and responsiveness was seldom examined. Overall, quality ratings were poor or inadequately reported and serious methodological limitations were identified. A lack of conceptual foundation quality ratings as tools did not apply a theory related to motivation or have a clear definition of the construct of patient motivation.

CONCLUSIONS

A significant gap exists of available tools with adequate measurement properties that use relevant theoretical frameworks.

Identifying the Validity and Reliability of a Self-Report Motivation Instrument for Health-Promoting Lifestyles Among Emerging Adults

Objective: Studies on the effectiveness of health-promoting programs across educational contexts need a new tool for measuring health motivation. This study aims to develop a new health motivation questionnaire, namely the College Students' Health Motivation Questionnaire (CSHM-Q), for college students. Design: An original item pool of the CSHM-Q was developed based on a systematic synthesis and review of related instruments and the content analysis of focus group interviews (N = 93). The instrument was then validated using a sample of 205 college students. Setting: Interviews and survey were conducted at three universities in China. Methods: This study explores the content validity, construct validity, and reliability of a self-report motivation instrument based on the framework of Self-Determination Theory. Results: A pilot study showed satisfactory content validity of the motivation constructs and produced 40 items for the CSHM-Q. Results of exploratory factor analysis and parallel analysis further substantiated a three-factor structure of the CSHM-Q. The finalized three-component CSHM-Q has 16 items. Conclusion: Given adequate psychometric properties, the CSHM-Q is a promising measurement tool of health motivation for practical and research purposes.

Motivation Measures in Sport: A Critical Review and Bibliometric Analysis

Motivation is widely-researched, in both sport psychology and other fields. As rigorous measurement is essential to understanding this latent construct, a critical appraisal of measurement instruments is needed. Thus, the purpose of this review was to evaluate the six most highly cited motivation measures in sport. Peer-reviewed articles published prior to August 2016 were searched to identify the six most highly cited motivation questionnaires in sport: Sport Motivation Scale (SMS), Intrinsic Motivation Inventory (IMI), Situational Motivational Scale (SIMS), Perceptions of Success Questionnaire (POSQ), Behavioural Regulation in Sport Questionnaire (BRSQ), and Task and Ego Orientation in Sport Questionnaire (TEOSQ). The questionnaires were then evaluated and discussed in four sections: Development, Reliability, Correlates, and Summary. Bibliometric data were also calculated (average weighted impact factor) and assessed (e.g., citations per year) to evaluate the impact of the use of each questionnaire. Despite some variance in their psychometric properties, conceptualization, structure, and utility, the six questionnaires are psychometrically strong instruments for quantifying motivation that are widely supported in the literature. Bibliometric analyses suggested that the IMI ranks first and the SMS ranks sixth according to the average weighted impact factors of their original publications. Consideration of each questionnaire's psychometric strengths/limitations, and conceptualization of motivation in the context of specific research questions should guide researchers in selecting the most appropriate instrument to measure motivation in sport. The average weighted impact factor of each questionnaire is a useful value to consider as well. With these points in mind, recommendations are provided.

How do older persons understand the purpose and relevance of preventive home visits? A study of experiences after a first visit

The aim of this study was to explore and describe older persons' experiences of their first Preventive Home Visit. Preventive Home Visits (PHV) are health services that aim to promote older persons' health, prevent functional decline, and reduce the need for comprehensive healthcare. The knowledge base to guide the design of effective PHV interventions is scarce. Studies that explore older persons' experiences of the first visit are essential, as compliance with the service is a prerequisite for positive outcomes. An explorative and descriptive design was applied. Qualitative research interviews with ten older persons who had received the first PHV the previous year were analysed with regard to manifest and latent content. The findings revealed that the understanding of the purpose of PHV varied. For some participants, the concepts and aims of health promotion and disease prevention were difficult to comprehend. The possibility to prepare for the visit was sought. All participants appreciated the service; the dialogue quality was good and a trusted municipal contact person provided security. To enhance compliance and ensure effective PHV, the invitation to the PHV service should include clearly stated aims and specific information about the first visit. An individualised, person-centred approach should be applied.

Contextual Design of a Motivated Medication Management Device

Many older adults find that they must manage one or more chronic illnesses entailing multiple medication regimens. These regimens can be daunting, with consequences for medication adherence and health outcomes. To promote adherence to medication regimens, we used contextual design to develop paper and digital prototypes of a medication management device. The design focused on enhancing users’ motivation to adhere to medication therapy. Our design process and outcome suggest that contextual design might serve as an effective data-driven method that can account for the less tangible aspects of work activities, such as motivation.

Self-Management of Wellness and Illness in an Aging Population

In this chapter, we review the last 10 years of literature on self-management of illnesses (acute/episodic and chronic) and wellness (e.g., health promotion). We focus on health self-management in the context of an aging population, wherein middle-aged adults are more likely to be managing wellness activities and older adults are often managing both maintenance of health and chronic illnesses. The critical issues related to self-management of health are discussed, including those imposed by health care demands and those stemming from individual differences in general abilities (e.g., motor, perception, cognition) and socioemotional characteristics. The dynamic relationship between theory and practice is highlighted. Health care demands reflect the nature of the illness or wellness activity and include managing comorbidities, symptoms, and medications; engaging in health promotion activities (e.g., exercise, diet); the required use of health technologies; the need for health-related information; and coordination of the care network. Individual differences in motor, perceptual, and cognitive abilities, as well as in the severity and complexity of the illness and the consequent demands, also impact how a person self-manages health. Cognitive abilities, such as decision making, knowledge, literacy (i.e., general, health, and e-health literacy), and numeracy are particularly implicated in the process of managing one’s own health and are especially important in the context of an aging population; therefore we give these cognitive abilities special attention in this chapter. Socioemotional characteristics, and attitudes and beliefs about one’s health, impact an individual’s self-management of health as well, impacting his or her motivation and goal-setting behaviors. Moreover, we discuss literature on interventions that have been used to improve self-management of health, and we examine the potential for technology. We conclude with guidelines for technology design and instruction, and discuss emerging themes.

Community violence exposure and positive youth development in urban youth

Youth in urban environments are exposed to community violence, yet some do well and continue on a positive developmental trajectory. This study investigated the relationships between lifetime community violence exposure (including total, hearing about, witnessing, and victimization), family functioning, and positive youth development (PYD) among 110 urban youth ages 10-16 years (54% female) using a paper and pen self-report survey. This cross-sectional study was part of an interdisciplinary community-based participatory research effort in West/Southwest Philadelphia. Almost 97% of the sample reported some type of community violence exposure. Controlling for presence of mother in the home and presence of father in the home, separate linear regression models for PYD by each type of community violence exposure indicated that gender and family functioning were significantly associated with PYD. None of the types of community violence exposure were significant in the models. Significant interactions between gender and presence of mother in the home and gender and family functioning helped better explain these relationships for some of the types of community violence exposure. Presence of mother was associated with higher PYD for girls, but not for boys. Boys with poor family functioning had lower PYD than girls with poor family functioning. This study helps to better delineate relationships between CVE and PYD by adding new knowledge to the literature on the role of family functioning. Points of intervention should focus on families, with attention to parental figures in the home and overall family functioning.

Motivation of fitness center participants toward resistance training

There is a need to better understand the behavior and sense of motivation of fitness center participants. The purpose of this study was to assess whether or not demographic characteristics and health self-determinism (intrinsic or extrinsic motivation) of fitness center participants were predictive of their levels of resistance training. A cross-sectional design was used; participants were recruited via the Internet to complete an online survey. There were 185 participants (age = 39.1 +/- 11.3 years) in the study. The majority of respondents reported having carried out levels of resistance training that met national health organization recommendations. Regression analysis of the data revealed that health self-determinism predicted quantity of resistance training reported (p = 0.014), whereas demographics did not. Being intrinsically motivated to health self-determinism predicted meeting national resistance training recommendations compared to participants extrinsically motivated (p = 0.007). For those who work with fitness center participants, our findings are useful by identifying participants as a predominantly intrinsically motivated group of people that performs adequate quantities of resistance training; the methodology employed in this study can be used to identify participants in need of increased levels of resistance training and heightened sense of motivation to do so.

Timing of impairment and health-promoting lifestyles in women with disabilities

The purpose of this study was to develop a substantive theory to explain how the timing of impairment in women's lives influenced health-promoting lifestyles among 45 women age 43 to 79 years with impairments of varying onset across the life course. From this grounded theory exploration, we suggest that women created health-related lifestyles that were comprised of changing abilities, roles, and rituals in support of perceived self. The ultimate goal of a healthy lifestyle was healthy aging, which was self-determination in the support of positive relationships. Environment and resources had direct influence on the perceived self. Our proposed substantive theory provides an understanding of how women develop a healthy lifestyle after the onset of permanent sensory or physical impairment. It also takes steps toward an understanding of how timing of impairment influences the perceptions women have of themselves and their health behaviors.

What factors affect influenza vaccine uptake among community-dwelling older Chinese people in Hong Kong general outpatient clinics?

AIM

This study aimed to identify the influenza vaccination rate among community-dwelling older Chinese people in Hong Kong general outpatient clinics and to identify the factors affecting their vaccine uptake.

BACKGROUND

Community-dwelling older Chinese people in Hong Kong underuse influenza vaccination. The first step to increase their vaccination rates is to understand the factors affecting their influenza vaccine uptake.

DESIGN

This was a retrospective and descriptive study.

METHODS

The sample comprised 197 subjects from five general outpatient clinics in the Kowloon East cluster of Hong Kong. A self-report questionnaire was used for data collection via individual face-to-face interviews.

RESULTS

Out of 197 subjects, 64.47% reported having received the vaccine within the previous 12 months. The regression model revealed that perceived benefits including 'vaccination prevents me from catching influenza (OR = 12.18, CI = 3.61-41.07, p < 0.001)', 'If I get vaccinated, I will decrease the frequency of medical consultation (OR = 8.12, CI = 2.70-24.38, p = 0.001)' and 'If I am vaccinated and still get flu, I will not be as sick with it (OR = 0.43, CI = 0.24-0.76, p = 0.004)', perceived barriers, which are 'the side-effects of influenza vaccination interfere with my usual activities (OR = 0.04, CI = 0.01-0.13, p < 0.001)', 'influenza vaccination is painful (OR = 2.73, CI = 1.55-4.81, p = 0.001)' and 'I am scared of needles (OR = 0.43, CI = 0.23-0.79, p = 0.007)' and recommendations from doctors (OR = 14.18, CR = 4.09-49.16, p < 0.001) and families (OR = 3.67, CR = 1.24-10.83, p = 0.019) interactively influenced the subjects' vaccine uptake.

CONCLUSION

Specific benefits and barriers affecting the influenza uptake of community-dwelling older Chinese people in general outpatient clinics have been identified. Specifically, recommendation from families plays a significant role in motivating the uptake of this Chinese ageing group.

RELEVANCE TO CLINICAL PRACTICE

We adopt strategies including personal invitation and reminders of influenza vaccination by doctors and educating doctors, older people and their families on influenza vaccination to increase the uptake of community-dwelling Chinese older people in general outpatient clinics.

What is effective intervention? – using theories of health promotion

The NHS must be smoke free by the end of 2006 (Department of Health, 2004). The necessary elements to introducing a smoke-free policy, which is workable and equitable, are the management of the policy and offering support to smokers. Smoking and second-hand smoking are responsible for many illnesses, premature deaths and reduced productivity. Employers have a responsibility to ensure the health of their employees by protecting them from exposure to cigarette smoke in the workplace. Although smoking restrictions in the workplace are popular, it is important to ensure good communication with everyone who will be affected, since there are many fears associated with the introduction of the policy. Help must be offered to people who wish to quit through behavioural and pharmacological interventions and support must also be given to the smoker who must abstain from smoking on the premises during work or hospital stay.

The motivation to care

PURPOSE

The purpose of this research is to describe a model of nurses' work motivation relevant to the human caring stance of professional nursing work.

DESIGN/METHODOLOGY/APPROACH

The model was derived from selected theories of behavioral motivation and work motivation. Evidence-based theory addressing nurses' work motivation and nurses' motivational states and traits in relation to characteristics of organizational culture and patient health outcomes is suggested in an effort to make a distinct contribution to health services research. An integrated review of selected theories of motivation is presented, including conceptual analyses, theory-building techniques, and the evidence supporting the theoretical propositions and linkages among variables intrinsic to nurses' work motivation.

FINDINGS

The model of the Motivation to Care for Professional Nursing Work is a framework intended for empirical testing and theory building. The model proposes specific leadership and management strategies to support a culture of motivational caring and competence in health care organizations.

ORIGINALITY/VALUE

Attention to motivation theory and research provides insights and suggests relationships among nurses' motivation to care, motivational states and traits, individual differences that influence nurses' work motivation, and the special effects of nurses' work motivation on patient care outcomes. Suggestions for nursing administrative direction and research are proposed.

Adolescent survivors: a secondary analysis of a clinical trial targeting behavior change

BACKGROUND

The late effects of radiation and chemotherapy increase childhood cancer survivors' risk of chronic health problems. Survivors' behavior is important in modifying this risk, yet adolescent and young adult survivors fail to engage in important health-promoting behaviors and frequently practice high-risk behaviors. This secondary analysis re-evaluated a multi-component behavior-change intervention that had previously demonstrated no impact in adolescent survivors of childhood cancer.

PROCEDURE

The parent trial compared 132 adolescent survivors in the intervention arm with 135 in the standard-care arm at baseline and at 1 year for disease and treatment knowledge, perception of late effects risk, and the frequency of health-risk and health-protective behaviors (combined as a single summative measure). In contrast, the secondary analysis examined each of the 14 behaviors separately. Additionally, an analysis of covariance (ANCOVA) was conducted to examine the change in health behaviors while statistically controlling for age, gender, and the wide variation in baseline behaviors.

RESULTS

Knowledge (P = 0.038), breast self-examination (BSE) (P < or = 0.0001) and testicular self-examination (P = 0.004) increased, as did perceptions about the need to change behavior (P = 0.004) and the effort needed to stay healthy (P < or = 0.0001). In the treatment group, junk food consumption decreased (P = 0.052) and smoking abstinence was maintained (P = 0.088). Significant interactions between gender and treatment group were demonstrated.

CONCLUSIONS

Health-risk and health-protective behaviors cannot be effectively combined in a one-dimensional measure. Gender and age influence the impact of interventions targeting health behavior in survivors. Future trials should include observation of the patient-clinician encounter, more complex sampling methods, and pre-trial knowledge of the distribution of the study behaviors.

Gender differences in health habits and in motivation for a healthy lifestyle among Swedish university students

The aim of the present study was to investigate gender differences in students' health habits and motivation for a healthy lifestyle. The sample of students comprised a probability systematic stratified sample from each department at a small university in the south-west of Sweden (n = 479). A questionnaire created for this study was used for data collection. Self-rated health was measured by number of health complaints, where good health was defined as having less than three health complaints during the last month. A healthy lifestyle index was computed on habits related to smoking, alcohol consumption, food habits, physical activity and stress. Female students had healthier habits related to alcohol consumption and nutrition but were more stressed. Male students showed a high level of overweight and obesity and were less interested in nutrition advice and health enhancing activities. The gender differences are discussed in relation to the impact of stress on female students' health, and the risk for male students in having unhealthy nutritional habits in combination with being physically inactive and drinking too much alcohol.

Online exclusive: a model of health behavior to guide studies of childhood cancer survivors

PURPOSE/OBJECTIVES

To describe the Interaction Model of Client Health Behavior (IMCHB) and its application to health promotion in childhood cancer survivors.

DATA SOURCES

Periodical literature about cancer survivors, health behavior models, and the IMCHB.

DATA SYNTHESIS

Childhood cancer survivors are at risk for various late complications of treatment. The primary goal of intervention is the modification of health-related behavior. Conceptual models that extend beyond health beliefs are needed to guide explanatory and intervention studies in this group.

CONCLUSIONS

The IMCHB identifies background, cognitive, affective, motivational, and contextual variables that explain health-related behaviors. The model defines the interactive and collective contributions of a survivor, family, and provider to adherence to protocols, reduction of risk behavior, and promotion of health-protective behavior.

IMPLICATIONS FOR NURSING

This model may identify new determinants of health-related behavior that can be targeted by specific inter- or intrapersonal interventions to protect the health of childhood cancer survivors and reduce their risk of late sequelae.

Determinants of physical activity and adherence to a 24-week home-based walking program in African American and Caucasian women

The purposes of this study were to: (a) identify which determinants of physical activity among African American and Caucasian women predict adherence to a 24-week home-based walking program; and (b) explore differences between African American and Caucasian women. Participants were 153 working women who were sedentary at leisure. The program included an exercise prescription, instructions, and support. Background determinants included demographics, previous exercise experience, and social role influences. Intrapersonal determinants (self-efficacy, self-determinism) were measured at baseline and 24 weeks. Adherence was measured with heart rate monitors and logs. Adherence was significantly higher in Caucasians, those with less previous exercise experience, and those with higher self-efficacy. Findings suggest that adherence to a walking program is influenced by multiple factors including background and intrapersonal determinants of physical activity.