Examining predictors of physical activity among inactive middle-aged women: an application of the health action process approach

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.

A study on acute expectation effects on affective state and intention after a brief full-body workout in a student sample

Brief exercise bouts can have positive effects on the affective state, which in turn could affect the intention for future exercise. Such benefits may be enhanced by manipulating expectations. The aim of this study was to examine whether the affective state after physical activity or the intention for future exercise can be influenced by manipulating expectations. Furthermore, the relationship between affect and intention was investigated. In an online experiment, 121 persons completed either a 10-minute workout (PA), a workout after manipulation of expectations (PA + EM), or a control intervention (CG) after randomized group allocation. Data on affective state, expectations, and intention were collected before and after the intervention using questionnaires. After intervention, PA groups showed significantly more positive values than CG in several affective parameters, in other affective parameters, only PA + EM differed from CG. Affect was positively associated with intention alongside outcome expectations. No difference was found in intention. Although no significant effects of expectation manipulation on affective state or intention were found, latent effects cannot be ruled out. Further exploration of the importance of word choice in describing physical activity in the context of interventions to increase physical activity is necessary. Here, affect should be considered.

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.

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.

Effectiveness of a tailored communication intervention to improve physical activity in hypertensive patients: a twelve-month randomized controlled trial

BACKGROUND

Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality globally. Arterial hypertension is one of the main cardiovascular risk factors. Despite this, individuals with hypertension often fail to follow medical advice to counteract cardiovascular risks. A physically active lifestyle is one of the most challenging behaviors to adopt. This study aimed to preliminarily investigate the effectiveness of a tailored print message intervention to increase physical activity in patients with arterial hypertension.

METHODS

A sample of 188 patients with hypertension (mean age = 63 years; SD = 10.9; 50% men) participated in a theory-based tailored health communication intervention. Participants were randomly assigned to three parallel groups: (1) the tailored group, which received tailored health brochures; (2) the non-tailored group, which received non-tailored health brochures; or (3) the usual care group, which received no informative print materials. The longitudinal physical activity trajectories (baseline, 6- and 12-month follow-ups) were examined using repeated measures ANOVA and growth curve models.

RESULTS

At the baseline, 38.8% of patients achieved the target physical activity. This percentage rose to 43.0% at 6-month follow-up and 46.0% at 12-month follow-up. The descriptive statistics divided in function of the experimental group suggested differences in the longitudinal trend of the mean physical activity depending on the experimental group. However, statistical significance using repeated measures ANOVA did not support this observation. The analysis of the growth curves suggested that the tailored group showed a progressive increase in physical activity over twelve months (the model that best described the longitudinal trajectory was a linear growth model). The non-tailored group showed an increase in physical activity six months after the beginning of the intervention, followed by a decrease (free time score model). The usual care group did not change over time (no-growth model).

CONCLUSIONS

Findings suggest the effectiveness of the tailored intervention proposed. However, further investigations and empirical confirmations are required.

TRIAL REGISTRATION

ISRCTN13415993 ( https://doi.org/10.1186/ISRCTN13415993 ). Registration date: 08/04/2019.

Examining acute environmental effects on affective state, expectancy, and intention in sport climbing

Introduction

Psychological research has shown that, among other variables, affective state, expectancy, and behavioral intention influence whether or not a (physically active) behavior is performed. Environmental effects during physical activity on affective state have been well studied; however, research regarding environmental effects on expectancy or intention is limited. Sport climbing is a form of physical activity that is performed both indoors and outdoors and is therefore considered as suitable to study environmental effects. Therefore, the aim of the present study was to investigate environmental effects during sport climbing on affective state, expectancy, and intention. The nature of the relationship between some of these parameters should also be explored.

Methods

Using a within-subjects design, 48 participants were to climb both once indoors in a climbing gym and once outdoors at a crag. The design included questionnaire-based surveys at multiple time points. Affective state, expectancy, and behavioral intention were measured at different test time points.

Results

Two-factor repeated-measures ANOVAs revealed significant main effects of the factors environment (indoor - outdoor) and time (T1 - T2 - T3) for affective state, indicating more positive affective state during outdoor climbing. No environment*time interactions were found. Furthermore, significantly higher intention (d = 0.32; p = 0.032) was measured after the outdoor condition (M = 32.5, SD = 4.1) compared to the indoor condition (M = 31.2, SD = 4.7). Multiple linear regressions revealed that expectancies (measured before and after the session) significantly predicted post-climbing intention only indoors.

Conclusion

The results at least partly suggest environmental effects on behaviorally relevant variables during climbing. Outdoor climbing might provide more favorable characteristics for physically active behavior compared to indoor climbing. Health psychologists or public health professionals who focus on increasing physical activity for their clients could recommend outdoor climbing over indoor climbing.

Efficacy of a novel patient-focused intervention aimed at increasing adherence to guideline-based preventive measures in asplenic patients: the PrePSS trial

PURPOSE

To determine whether a novel intervention improves the adherence to guideline-based preventive measures in asplenic patients at risk of post-splenectomy sepsis (PSS).

METHODS

We used a prospective controlled, two-armed historical control group design to compare a novel, health action process approach (HAPA)-based telephonic intervention involving both patients and their general practitioners to usual care. Eligible patients were identified in cooperation with the insurance provider AOK Baden-Wuerttemberg, Germany. Patients with anatomic asplenia (n = 106) were prospectively enrolled and compared to a historical control group (n = 113). Comparisons were done using a propensity-score-based overlap-weighting model. Adherence to preventive measures was quantified by the study-specific 'Preventing PSS score' (PrePSS score) which includes pneumococcal and meningococcal vaccination status, the availability of a stand-by antibiotic and a medical alert card.

RESULTS

At six months after the intervention, we estimated an effect of 3.96 (95% CI 3.68-4.24) points on the PrePSS score scale (range 0-10) with mean PrePSS scores of 3.73 and 7.70 in control and intervention group, respectively. Substantial improvement was seen in all subcategories of the PrePSS score with the highest absolute gains in the availability of stand-by antibiotics. We graded the degree of participation by the general practitioner (no contact, short contact, full intervention) and noted that the observed effect was only marginally influenced by the degree of physician participation.

CONCLUSIONS

Patients who had received the intervention exhibited a significantly higher adherence to guideline-based preventive measures compared to the control group. These data suggest that widespread adoption of this pragmatic intervention may improve management of asplenic patients. Health insurance provider-initiated identification of at-risk patients combined with a patient-focused intervention may serve as a blueprint for a wide range of other preventive efforts leading to patient empowerment and ultimately to better adherence to standards of care.

Predicting Physical Activity in Survivors of Breast Cancer: the Health Action Process Approach at the Intrapersonal Level

BACKGROUND

Benefits have been established for regular physical activity (PA) and exercise after breast cancer, but a decline of PA has also been a reported result of breast cancer diagnosis and treatments. The Health Action Process Approach (HAPA) model has been shown to predict various health behaviors, but few studies have tested it at the intrapersonal level. The aim of the present study was to test whether the HAPA constructs that are well confirmed at the interpersonal level also hold at the intrapersonal level in a group of women survivors of breast cancer.

METHOD

PA behaviors (N = 338) by nine survivors of breast cancer were observed for 6 weeks, and the associations between the HAPA constructs and PA over time were examined. Participants completed a questionnaire with the HAPA constructs related to PA behavior (direct step count and self-reported).

RESULTS

A multilevel model of behavior prediction found that optimistic beliefs about ability to initiate and maintain PA (self-efficacy) were positively related to intentions to be active, and these intentions predicted plans to be active. PA was directly and positively predicted by planning and by confidence in the ability to resume PA after a break.

CONCLUSION

Self-efficacy and planning are associated with PA behavior within women survivors of breast cancer over time, which was not the case for the outcome expectancies, social support, and action control at this intrapersonal level. A multilevel approach for psychological predictors of PA can be useful in grounding interventions for survivors of breast cancer.

Social cognitive predictors of regular dental visits and mouth self-examination behaviors among the elderly population: An application of the health action process approach model

OBJECTIVE

The present study aimed to identify the social cognitive predictors of regular dental visits and mouth self-examination behaviors among the elderly population, based on the Health Action Process Approach (HAPA) model.

BACKGROUND

Regular dental visits and mouth self-examination can prevent oral and dental problems among the elders. Little information is available regarding the social cognitive predictive factors of these two behaviors.

MATERIALS AND METHODS

A cross-sectional study was conducted in 24 municipality centers in Tehran, Iran in 2021. The centers were selected randomly using a multi-stage cluster sampling method and 301 elderly attendants aged 60≥years participated in the study. Data collection was done using a researcher-made questionnaire including demographic characteristics and the HAPA model constructs for two target behaviors. Data were analyzed using the Smart-PLS version 3.3.9 via correlation and PLS-SEM analysis.

RESULTS

The mean age of the participants was 65.3±5.33 years and 79.7% were female. The SEM analysis showed that Action Self-Efficacy [b (SD) = 0.595 (0.065), P< 0.001] and Risk Perception [b (SD) = 0.218 (0.070), P< 0.002] were predictors of Intention for mouth self-examination but only Action Self-Efficacy [b (SD) = 0.651 (0.043), P< 0.001] was predictor of Intention for regular dental visits. Recovery Self-Efficacy and Planning directly contributed to the prediction of Mouth Self-Examination. The relationship between Maintenance Self-Efficacy and both behaviors is mediated by Planning. Also, the mediating role of Planning between Intention and target behaviors was confirmed.

CONCLUSION

Action self-efficacy predicted the intention for regular dental visits and mouth self-examination behaviors. The relationship between intention and both behaviors was mediated by Planning. Emphasis on improving Action Self-Efficacy and Intention formation will enhance the effectiveness of interventions aiming at promoting the oral health of the elderly population.

Covariates of a healthy diet and physical activity self-management one year after Bariatric surgery: A cross-sectional study

BACKGROUND

Healthy diet and physical activity self-management is important in maintaining weight loss and preventing weight regain after bariatric surgery. We aimed at evaluating covariates of healthy diet and physical activity self-management among patients undergone bariatric surgery using Health Action Process Approach (HAPA) model.

METHOD

In this cross-sectional study, 272 patients with a history of bariatric surgery were selected from the data registry of Tehran Obesity Treatment Study (TOTS). Data were collected using bariatric surgery self-management standard questionnaire (BSSQ), and items based on HAPA model for healthy diet and physical activity self-management. Data were analyzed using Path analysis and AMOS version 24.

RESULTS

The mean score of self-management was (32 ± 10SD). Coping planning construct (β = 0.22; p<0.001) and risk perception (β = 0.02; p<0.01) in dietary self-management and action planning (β = 0.16; p = 0.001) and risk perception (β = 0.001; p = 0.17) in physical activity self-management had the highest and lowest effect powers, respectively. Coping planning (β = 0.22; p<0.001) and action planning (β = 0.17; p<0.03) in diet, and action planning (β = 0.16; p = 0.010) in physical activity were significantly related to self-management. Also, task-coping self-efficacy (β = 0.28; and p<0.001), outcome expectancies (β = 0.37; p<0.001), risk perception (β = 0.13; p = 0.015) in diet and coping self-efficacy (β = 0.50; p<0.001), outcome expectancies (β = 0.12; p = 0.021) in physical activity were significantly related to behavioral intention. The values of CFI = 0.939 and RMSEA = 0.052 for diet and CFI = 0.948 and RMSEA = 0.048 for physical activity indicated adequate fit.

CONCLUSION

HAPA was applicable as a framework for interventions promoting healthy diet and physical activity self-management in patients who have undergone bariatric surgery.

Assessing the Risk Perception and Knowledge Regarding Cardiovascular Diseases in Patients With Hypertension and Diabetes in Central India: A Mixed-Methods Study

Background Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality worldwide. The perceptions of patients can be important in health-related behaviors and disease prognosis. Thus, this study aimed to determine the risk perception and knowledge of hypertensive and diabetic patients. Methodology The study was conducted among 264 patients with diabetes and/or hypertension. A sequential exploratory mixed-methods design was used, which initially identified themes related to risk perception about CVDs among patients. Knowledge and risk perception about CVDs were quantified using a survey derived from predefined themes. CVD knowledge scores were categorized into low, intermediate, and high scores, and the trends of risk perception were studied across this spectrum of cardiovascular knowledge. Results The age of the participants ranged from 30 to 78 years. Overall, 57.19% of the participants were males, whereas 42.80% were females. The qualitative results revealed that the sources of knowledge about CVDs, physical activity, and maintaining a nutritious diet included family, friends, and media. On the other hand, doctors played a significant role in influencing perceptions related to medications. The observation of complications related to CVDs and the fear of mortality played a pivotal role in shaping the perception regarding the seriousness of the condition. Perceived susceptibility was low if there was unawareness of protection through medications and lifestyle changes, but it was high with stress or heredity. The analysis of CVD knowledge and risk perception survey data revealed the median CVD knowledge score to be 12 (interquartile range = 7.5-13), which showed a significant association with education and socioeconomic status (p < 0.05). The distribution of risk perception scores across the spectrum of CVD knowledge scores depicted that participants with higher scores agreed more with CVDs being serious and their susceptibility to them. Conclusions Despite having high knowledge scores regarding CVDs, the study population had average risk perception. Patient risk perceptions should be evaluated as it affects the health-seeking behavior and prognosis of the disease.

Promoting physical activity within breast cancer survivors using behavior change techniques: N-of-1 randomized controlled trials

Survivors of breast cancer are an important target for health promotion interventions, and physical activity (PA) is recommended with benefits being well established. More and more behavior theory guided interventions are planned and tailored to the individuals, targeting specifics needs and personal characteristics. We aimed to test the effectiveness of two behavior change techniques [coping planning (CP) and self-monitoring (SM)] for promoting PA in survivors of breast cancer, using a single-case design. In a powerful multiple sample N-of-1 RCT, 10 women post-breast cancer (M = 52.8 years) were randomly assigned to four experimental conditions (CP and/or SM, control) for 60 days and their daily step count was observed. The overall effects were analyzed using multilevel time-series with random intercepts. Time-series regression models and supplementary pairwise analyses were conducted for individuals. Multilevel analyses showed significant effects of CP and SM. Single-case analyses showed that six participants walked significantly more on the intervention days, that combined interventions were effective for five participants, but two participants had better results with the other two conditions. Combined self-regulatory techniques were more effective in promoting PA however, individual variability should be considered in future studies with survivors of breast cancer. Retrospectively registered: https://osf.io/eakjy/?view_only=81bf3dc084a0410a8ea28265e0f3c360, 31-01-2023.(raise query).

The AHAWOMEN project: study protocol of a multi-design research for exploring HAPA predictors of exercise in postmenopausal women

BACKGROUND

The postmenopausal period can represent an opportunity for women to improve their health and well-being. The Active and Healthy Ageing in Women during early postmenopause (AHAWOMEN) study aims to identify the key determinants of an active lifestyle among middle-aged women, with a focus on the stages and the social-cognitive variables outlined in the Health Action Process Approach (HAPA) model, a theoretical framework for understanding health behaviour change. We expected that HAPA factors and processes of intention creation (motivational phase) and action adoption (volitional phase) will be significant predictors of exercise initiation and maintenance, supporting both the HAPA tenets and the efficacy of HAPA-based interventions.

METHODS/DESIGN

This study was approved by the authors' Institutional Review Committee. Postmenopausal women aged between 45 and 65 years will voluntarily participate. The participants will be allocated to one of three groups: Intervention-Initiators (n = 100, random allocation), Control-Sedentary (n = 100, random allocation) or Control-Active (n = 100, non-random allocation). The intervention group will engage in a supervised exercise programme lasting at least 3 months, supplemented with a HAPA-based intervention for behaviour change. The sedentary control group will not receive any intervention to change their physical activity, while the active control group will consist of women who are already regularly adhering to an active lifestyle. Study variables will be measured at baseline and postintervention phases, as well as at 1, 3, 6 and 12-month follow-ups. The predictors of exercise behaviour in the different phases of the behavioural change process will be explored and compared within and between groups throughout the study. These analyses will help identify the factors that determine the adoption of a healthy active behaviour. Additionally, the effectiveness of the model and the intervention for changing active behaviour will be evaluated.

DISCUSSION

This paper describes the rationale, development and methods used in the AHAWOMEN project. Supporting women who intend to become active can help them to translate their goals into sustainable action. Verifying that the HAPA predictions are applicable to postmenopausal women's adoption of exercise would provide the basis for designing effective interventions for promoting healthy and active ageing that are also tailored to the experiences of middle-aged women.

TRIAL REGISTRATION

ISRCTN16251361. Registration date: 01/06/2023 (retrospectively registered).

Older adults' physical activity after lockdown: Testing the health action process approach and the moderating role of fear of Covid-19

The coronavirus pandemic has influenced many lives, particularly older adults'. Although isolation protects from infection, health behaviors like physical activity (PA) are important to reinstate after lockdown. However, fear of Covid-19 may act as a barrier, for example, by preventing people from going outside. Based on the health action process approach (HAPA), we investigated whether and why older adults' PA changed after lockdown, and whether fear of Covid-19 moderates the intention-behavior relationship. Participants of this longitudinal study aged 65+ from German-speaking Europe completed an online questionnaire about their PA, fear of Covid-19, and HAPA factors in April and May 2020. Data were analyzed using multiple linear regressions. Results showed that moderate to vigorous activity (MVPA) remained stable after lockdown and that self-efficacy most robustly influenced the intention to be active. PA was not explained by any volitional factor but was strongly related to past PA. Interestingly, the relationship of past and future MVPA was attenuated by fear of Covid-19, but this finding was not robust when outliers were removed. In conclusion, self-efficacy is the most important motivator for PA in older adults after an interruption like a lockdown. Strong physical activity habits may facilitate PA after a period of isolation.

Predicting physical activity change in cancer survivors: an application of the Health Action Process Approach

PURPOSE

Previous research has not examined the utility of the Health Action Process Approach (HAPA) to predict physical activity (PA) change in cancer survivors. The aim of the study was to investigate the efficacy of a HAPA-based model in predicting temporal change in moderate-to-vigorous physical activity (MVPA) in cancer survivors.

METHODS

Participants enrolled in the Wearable Activity Technology and Action Planning (WATAAP) trial completed validated questionnaires (n = 64) to assess HAPA constructs (action and maintenance self-efficacy, outcome expectancies, action planning, risk perceptions, and intention) and wore an ActiGraph to measure PA at baseline, 12 weeks, and 24 weeks later. Data were analyzed using variance-based structural equation modeling with residualized change scores for model variables.

RESULTS

Consistent with predictions, changes in action self-efficacy (β = 0.490, p < 0.001, ES = 0.258) and risk perceptions (β = 0.312, p = 0.003, ES = 0.099) were statistically significant predictors of intention change over time. Changes in intention (β = 0.217, p = 0.029, ES = 0.040) and action planning (β = 0.234, p = 0.068, ES = 0.068) predicted changes in MVPA. Overall, the model accounted for significant variance in intention (R2 = 0.380) and MVPA (R2 = 0.228) change.

CONCLUSIONS

Changes in intention and action planning were important correlates of MVPA change over 24 weeks. Further, changes in action self-efficacy and risk perceptions predicted changes in intention.

IMPLICATIONS FOR CANCER SURVIVORS

interventions that foster risk perceptions and self-efficacy, strengthen intentions, and promote action planning may be effective in promoting sustained PA change in cancer survivors.

Behaviour change techniques that constitute effective planning interventions to improve physical activity and diet behaviour for people with chronic conditions: a systematic review

OBJECTIVES

Action planning is a brief and effective behaviour change technique (BCT) to improve physical activity (PA) and diet behaviour (DB). This study aimed to identify critical BCTs and mechanisms of action (MoAs) to interpret the effectiveness of planning interventions based on the Health Action Process Approach (HAPA) model.

DESIGN

Systematic review.

DATA SOURCES

PubMed, Web of Science, CINAHL (EBSCO), PsycINFO (EBSCO), Psychology and Behavioural Sciences Collection (EBSCO), psyARTICLES and Medline were searched for studies from January 1990 to September 2021 published in English.

ELIGIBILITY CRITERIA

Experiment involving action planning intervention to improve PA or DB in community-dwelling adult patients with chronic conditions.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently coded the planning interventions into BCT combinations and MoA assemblies. Outcome was dichotomised according to the statistical power and Cohen's d. The Cochrane risk of bias assessment tool and the Risk of Bias in Nonrandomized Studies-of Interventions assessment tool were used to assess the quality of randomised controlled trials (RCTs) and non-RCTs, respectively.

RESULTS

From the 52 included studies, 46 BCTs were identified and linked to 21 MoAs. Long-term facilitators for planning intervention included 'self-monitoring of behaviour', 'problem solving', 'instruction on how to perform the behaviour' and 'adding objects to the environments'. The three most frequently occurring MoAs were 'intention', 'behavioural regulation', 'beliefs about capabilities'. The effective intervention groups had higher MoA scores that corresponded to the HAPA model constructs than the ineffective groups.

CONCLUSIONS

The findings from this review may inform scientific and effective planning intervention designs for community-dwelling people with chronic conditions in the future.

PROSPERO REGISTRATION NUMBER

CRD42021241227.

Linking Exercise Intention to Exercise Action: The Moderating Role of Self-Efficacy

As physical exercise benefits both physical and psychological health of college students, it is important to promote the habit of physical exercise among them. This study adopted the Health Action Process Approach (HAPA) model to understand the exercise intention–action link and determine the moderating role of self-efficacy. We recruited 242 students from a university in China and asked them to complete a six-wave survey. The survey results indicated that exercise intention was positively related to both coping planning and action planning, which pave the way to performing the action of exercise. However, such mediation effects varied under conditions of self-efficacy. Participants with high self-efficacy exhibited stronger relationships between intention and planning, and between planning and action. The study results suggest that planning has a time-lagged mediation effect in the relationship between intention and action. Additionally, the findings shed light on the moderating role of self-efficacy, which can be useful in developing health-promotion strategies for college students.

Within-person examination of the exercise intention-behavior gap among women in midlife with elevated cardiovascular disease risk

Engaging in moderate-to-vigorous intensity physical activity (MVPA) is important for protecting cardiovascular health among women in midlife (i.e., ages 40-60), particularly if they have already developed conditions that increase their risk for cardiovascular disease (e.g., hypertension). Although the gap between MVPA intentions and behavior is well documented in other populations, little is known about the intention-behavior gap in this at-risk group - particularly as it plays a role in daily life. The present study employed an ecological momentary assessment design to examine the relation between women's MVPA intentions and behavior in the subsequent 3 hours, as well as momentary moderators of this relation (i.e., affective states and body satisfaction). Surveys sent to women's smartphones 5 times per day for 10 days while they wore ActiGraph GT3X waistband accelerometers. Women achieved their exercise intentions at only 13% of occasions on which they set intentions. Although the most common intended exercise was walking, women engaged in more minutes of MVPA after setting intentions to do yoga or Pilates than any other type of exercise (sr = 0.25). Multilevel models showed a modest within-person relation between minutes of intended MVPA and observed MVPA in the next 3 hours (sr = 0.20). This relation was moderated within-person by the reported extent of positive affect (particularly contentment) and body satisfaction (srs = 0.35 and 0.28, respectively). Findings extend knowledge about the physical activity intention-behavior gap to an at-risk population of women and identify positive affect and body satisfaction as potential contextual influences for this group, which could inform improvements to existing interventions (e.g., delivering intervention content at times with lower-than-usual body satisfaction).

A randomized controlled trial comparing self-referred message to family-referred message promoting men's adherence to evidence-based guidelines on BRCA1/2 germline genetic testing: A registered study protocol

BACKGROUND

This is a registered study protocol on a randomized controlled trial (RCT) testing an intervention aimed to improve men's adherence to evidence-based guidelines on BRCA1/2 germline genetic testing. BRCA1- and BRCA2-associated Hereditary Breast and Ovarian Cancer Syndrome (HBOC) increases the relative and absolute risk of developing breast and ovarian cancer and, to a lesser extent, prostate and pancreatic cancer. Men face BRCA-related cancer risks as women do, although with a different magnitude, and they may also transmit the mutations to their children. Notwithstanding, men are under-tested compared to women and the communication is not tailored on their needs. The present RCT applies principles of the Health Action Process Approach (HAPA) in testing the psychological determinants of the men's adherence to evidence based guidelines on BRCA1/2 germline genetic and testing the efficacy of two messages.

METHODS

A total of 264 participants will be involved, among the men's relatives of women with verified germline mutations. The study entails a pre- post- evaluation with randomization of the participants in two conditions corresponding to the two messages.

DISCUSSION

The expected results provide answers related to the impact of action self-efficacy, outcome expectancy (personal or familiar), risk perception, health risk aversion, intolerance of uncertainty, perceived barriers, and coping self-efficacy on informed decision-making. Data gathered from this study may inform health care providers, policy makers, and public health managers about the communication strategy for men and about the psychological variables influencing decision-making.

TRAIL REGISTRATION

Name of the Registry: Clinical Trials. Trial registration number: NCT04683068. Date of registration: 16/12/2020. URL of trial registry record: https://www.clinicaltrials.gov/.

An Experimental Test of a Generic Messaging Approach for the Canadian 24-Hour Movement Guidelines for Adults

Many Canadian adults are failing to meet national recommendations for physical activity, sedentary behavior, and sleep (i.e., movement behaviors). Existing messaging strategies focus on thresholds, which may be unrealistic to the target audience. This article explores the utility of a novel messaging approach - generic messages - as a gateway to enhance adults' confidence to meet the Canadian 24-Hour Movement Guidelines for Adults ('Guidelines'). In an online study, adult Guideline end-users (N = 249) completed pre-, post- and two-week surveys following exposure to generic or threshold Guideline promotional materials. Hierarchal linear regressions predicting adults' confidence to meet the Guidelines revealed an activity status by experimental condition interaction. Post hoc analyses indicated low active adults exposed to generic messages had greater confidence to meet the Guidelines compared to low active adults exposed to threshold messages. Message processing was greater among adults exposed to the generic than threshold materials. This research highlights the importance of presenting achievable behavioral goals through generic messages. Specifically, this study demonstrated that generic messaging enhances self-efficacy beliefs among low active Canadian adults. Organizations promoting behavior change among adults with low levels of behavioral engagement should consider the use of generic motivational messages within a segmented health communication campaign.

Should Facebook advertisements promoting a physical activity smartphone app be image or video-based, and should they promote benefits of being active or the app attributes?

Social media provides a convenient platform for health campaigns. However, practitioners designing such campaigns are faced with a number of decisions regarding advertising formats and appeals. This study set out to compare the effectiveness of two advertising formats (image vs. video) and two advertising appeals (benefits of being active vs. app attributes and features) for promoting a physical-activity smartphone app. The advertising experiment was conducted on Facebook and employed a 2 × 2 full-factorial experimental design, examining two advertising formats: image versus video and two advertising appeals: benefit versus attribute. Outcome measures were advertisement cost (number of viewers reached according to the amount spent) and consumer engagement (rates of advertisement click-through and app downloads). Chi-Square analysis revealed that advertisement cost was found to differ according to the type of advertising format used, with image advertisements achieving a greater audience reach than video advertisements (χ 2(1) = 905.292, p < .001). Consumer engagement also differed according to advertising format and appeal: images achieved high rates of advertisement click-through (2.7% vs. 1.9%; χ 2(1) = 196.9, p < .001) and app downloads (0.6% vs. 0.5%; χ 2(1) = 4.0, p = .044) compared with videos. Furthermore, benefit appeal advertisements were more effective than attribute appeals, yielding a greater rate of advertisement click-through (2.8% vs. 1.8%; χ 2(1) = 282.2, p < .001) and app downloads (0.7% vs. 0.4%; χ 2(1) =106.0, p < .001). Overall, image advertisements were seen to be the most cost-effective and engaging. Advertisements employing a benefit appeal achieved greater consumer engagement than and attribute appeal advertisements.

Evaluating the effectiveness of a physical activity social media advertising campaign using Facebook, Facebook Messenger, and Instagram

Technology-based physical activity programs are a novel solution to the major public health issue of physical inactivity. However, to be successful, there must be a large and population-appropriate uptake, which depends heavily on promotion. This study evaluates the effectiveness of an advertising campaign to disseminate a physical activity smartphone app. The experiment used a 3 × 3 × 3 full-factorial design, examining platforms (Facebook; Facebook Messenger; Instagram), selling-techniques (hard-sell-sending viewers directly to (a) Apple Store or (b) Google Play, and soft-sell-sending viewers from an ad to a (c) landing-page, then to an app store) and themes (Health and Wellbeing; Body and Self-Confidence; Social Enjoyment). Outcomes were reach, click-through, and app downloads. Advertisements reached 1,373,273 people, achieving 2,989 clicks and 667 downloads. Instagram and Facebook Messenger had higher reach compared to Facebook (F[2,27] = 27.17, p < .001), whilst Facebook and Facebook Messenger both produced higher click-through (F[2,27] = 8.98, p < .001) and downloads (F[2,27] = 4.649, p = .018). Selling-technique differed, with soft-selling ads producing greater reach (F[2,27] = 4,616.077, p < .001); however, both hard-selling ads (Apple Store and Google Play) had greater click-through (F[2,27] = 10.77, p < .001) and downloads (F[2,27] = 3.791, p < .001). Advertising theme varied, with Social Enjoyment themes producing less click-through (F[2,27] = 5.709, p = .009) and downloads (F[2,27] = 5.480, p = .010). We recommend future studies to consider Facebook and Facebook Messenger, using hard-selling techniques, with themes relating to Health and Wellbeing and Body and Self-Confidence.

Application of the health action process approach model for reducing excessive internet use behaviors among rural adolescents in China: a school-based intervention pilot study

Objective

There are few studies regarding Internet use behaviors of Chinese rural adolescents based on behavioral theory. The aim of this study is to examine the applicability and effectiveness of the health action process approach model (HAPA) in the intervention of excessive Internet use behaviors among rural adolescents in China.

Methods

Three hundred twenty-seven participants who met the excessive Internet use criteria were involved in this study. Four interventions based on the HAPA model were conducted during 2015–2017. The structural equation model (SEM) was applied to fit the HAPA model.

Results

The rate of average daily time spent online on weekends more than 4 h dropped from 57.2 to 39.1% (P < 0.001). The rate of daily game time more than 2 h decreased from 51.1 to 35.2% (P < 0.001). The result of SEM showed that both the applicability and effectiveness of the HAPA model were well in the intervention of excessive Internet use behaviors with good fitted indicators (χ²/df = 2.066, GFI = 0.889, CFI = 0.938, TLI = 0.928, IFI = 0.938, RMSEA = 0.057). The direct and indirect effects of the main pathways in the HAPA model were statistically significant (P < 0.05). The comparison analysis of HAPA model variables identified that outcome expectancy, intention, maintenance self-efficacy had been improved significantly after interventions.

Conclusion

The intervention measures based on the HAPA model can effectively reduce excessive Internet use behaviors of Chinese rural adolescents, mainly through strengthen outcome expectancy, intention, and maintenance self-efficacy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10999-z.

Utilising a Behaviour Change Model to Improve Implementation of the Activate Injury Prevention Exercise Programme in Schoolboy Rugby Union

The Health Action Process Approach (HAPA) is a behaviour change model showing promise in positively changing youth sport coaches’ injury prevention behaviours. This study incorporated the HAPA model into coach training workshops for Activate, an efficacious rugby injury prevention programme. Primary aims were to investigate the effect of the workshop on schoolboy rugby union coaches’ (1) perceptions towards injury risk and prevention, (2) Activate adoption and adherence. Secondary aims were to (3) assess the differences in post-season HAPA constructs between workshop attendees and non-attendees, (4) explore associations between HAPA constructs and Activate adherence. In the pre-season, all participants (n = 76) completed a baseline survey, with 41 coaches electing to attend a workshop. Participants completed a post-season survey assessing HAPA constructs and Activate adoption and adherence throughout the season. The workshop did not affect coach perceptions of injury risk and prevention. Attendees had significantly greater rates of Activate adoption (95% vs. 54% χ² = 17.42, p < 0.01) and adherence (median = 2 sessions vs. ≤1 session per week; z = 3.45, p = 0.03) than non-attendees. At post-season, attendees had significantly greater task self-efficacy (z = −3.46, p < 0.05) and intention (z = −4.33, p < 0.05) to use Activate. These results support the delivery of coach workshops that utilise a behaviour change model to maximise programme implementation.

Seasonal Differences in the Cost and Engagement of Facebook Advertisements for a Physical Activity Smartphone App

PURPOSE

To evaluate the performance of Facebook advertisements for a physical activity smartphone app at different times of the year.

DESIGN

A repeated cross-sectional study examined the cost and engagement levels of advertisements during 3 time points: Post-Easter _{April-May 2019}, Pre-Summer _{October 2019}, and New Year _{January 2020 .}

SETTING

Advertisements were delivered on Facebook.

SUBJECTS

The target population was Australian females aged 25-60 years.

MEASURES

Cost was evaluated in terms of reach per dollar. Engagement was evaluated in terms of click-through and app downloads per reach.

ANALYSIS

ANOVA and Chi-square were used to assess differences in reach per dollar, click-through, and app downloads per reach between time points.

RESULTS

Reach per dollar was highest in Post-Easter, but declined in Pre-Summer and New Year (reach/$ 34.8 vs 31.5 vs 27.5; p = .004). Click-through was highest in New Year followed by Post-Easter, then Pre-Summer (click-through 3.2% vs 1.9% vs 1.2%; p < .001). New Year and Post-Easter advertisements achieved higher app downloads per reach than Pre-Summer (downloads 0.9% vs 0.7% vs 0.3%; p < .001).

CONCLUSION

Facebook advertisements were cheaper in the first time-point, and appear to be getting more expensive (i.e. declining reach/$). Advertisements in the New Year achieved the highest click-through and app downloads per reach, suggesting a useful time of year to promote physical activity products.

A single mindfulness session with informal caregivers of seniors living with dementia: a pilot qualitative descriptive study

BACKGROUND

Evidence suggests that informal caregivers who are providing care for seniors with dementia experience daily stressors due to their demanding caregiving roles. Current research recognizes the positive impact of mindfulness on caregivers' well-being. However, there is an existing gap in the current literature about informal caregivers' own perceptions and understanding of mindfulness intervention.

OBJECTIVE

To address this gap, this pilot study aims to explore informal caregivers' experience of a single mindfulness session and the feasibility of mindfulness to be integrated into their daily lives.

METHODS

Six informal caregivers who are providing care for seniors living with dementia participated in this qualitative descriptive study. Thematic analysis was used to derive themes to understand the participants' experience of a brief mindfulness session.

RESULTS

The findings of the study generated five major themes: (1) Comparison of mindfulness with other relaxation techniques; (2) Single mindfulness session as a social learning opportunity; (3) Positive impact of practicing mindfulness; (4) Perception about barriers to practicing mindfulness; and (5) Perception of self-efficacy to practice mindfulness in the future.

DISCUSSION

The study participants perceived mindfulness to be beneficial for their overall well-being. In addition, as participants were beginners of mindfulness, they considered mindfulness technique to be easy to learn through single practice session and feasible to be integrated into their daily lives.

CONCLUSION

This qualitative study highlights that as little as brief 15 min of mindfulness session is perceived positively by informal caregivers. There is a need for further research on the long-term outcomes of practicing mindfulness among informal caregivers of seniors.

Effectiveness of a nurse-led temporal self-regulation theory-based program on heart failure self-care: A randomized controlled trial

BACKGROUND

Heart failure self-care is crucial for sustainable heart failure management but its adherence remains poor worldwide. Despite having an intention to change, individuals often face difficulties in modifying existing lifestyle habits and sustaining change motivations.

OBJECTIVES

To examine the effectiveness of a novel theory-driven nurse-led self-regulation program on improving heart failure self-care behaviours, future-thinking and behavioural automaticity.

DESIGN

A two-arm randomized controlled trial.

SETTINGS & PARTICIPANTS

144 patients with heart failure were recruited from September 2018 to July 2019 at a tertiary hospital in Singapore.

METHODS

Participants were randomly assigned to a self-regulation intervention (n = 72) or usual care group (n = 72). The three-month intervention was developed based on the temporal self-regulation theory and consisted of one face-to-face session, a print booklet and three reinforcement telephone follow-ups at week 3, 6 and 9. Outcomes were measured at baseline (T0), immediate after a three-month intervention (T1) and a further three-month follow-up (T2). heart failure self-care was measured using the Self-Care of Heart Failure Index (SCHFI) maintenance subscale, future-thinking was measured using the Consideration of Future Consequences Scale (CFCS) and behaviour automaticity was measured using the Self-Reported Behavioural Automaticity Index (SRBAI). The outcomes were compared between groups by using generalized estimating equations (GEE) based on intention-to-treat principle.

RESULTS

No significant differences were found between the groups at baseline except for age. Participants were on average 61 years old, men (79.2%), had mild heart failure symptoms (50.7%) and had three comorbidities (66.0% dyslipidaemia; 65.3% hypertension; 61.8% history of myocardial infarction). Baseline scores indicated poor heart failure self-care (52.9±17.2, cut off ≥70). GEE results showed significantly higher heart failure self-care improvements in intervention group than control group at both T1 (regression coefficient, B = 13.9, 95% CI: 8.02 to 19.9, p < 0.001) and T2 (B = 8.34, 95% CI: 1.68 to 15.0, p = 0.014) after adjusting for gender, living alone, education level, comorbidity and age. Results also showed significantly higher increase in future-thinking (B[95% CI]=0.694[.123, 1.26], p = 0.017) and behaviour automaticity (B[95% CI]=0.656[.085, 1.23], p = 0.024) at T1 and only increase in behaviour automaticity (B[95% CI]=0.674[.099, 1.25], p = 0.022) at T2. However, only the differences in self-care scores at T1 remained significant after Bonferroni correction. No significant differences were found for intention, quality of life and clinical biomarkers.

CONCLUSIONS

The program was effective in improving heart failure self-care and has potential for clinical implementation and generalisation to other chronic illnesses. Longer follow-up study is needed to uncover its long-term benefits on clinical outcomes.

Predicting psychological factors affecting regular physical activity in hypertensive patients: Application of health action process approach model

Aim

The aim of this study was to determine the factors affecting the behaviour of regular physical activity in patients with hypertension using the health action process approach (HAPA) model.

Design

This cross-sectional study was conducted on 176 hypertension patients, in Astaneh-e-Ashrafiyeh, Guilan, Iran, 2018-2019.

Methods

Data collection tools included demographic characteristics, medical history, the short form of International Physical Activity Questionnaire (IPAQ) and scales related to the HAPA model. The data were analysed using chi-square, independent t test, one-way ANOVA, Pearson's correlation coefficient and path analysis on AMOS, version 23.0.

Results

Action self-efficacy (β = 0.59), outcome expectancy (β = 0.20) and risk perception (β = 0.18) had a statistically significant effect on intention. Moreover, the path coefficient between intention (β = 0.35) and coping self-efficacy (β = 0.29) with physical activity was statistically significant. The results revealed that HAPA constructs were able to describe 45% of the variance in intention and 31% of the variance in physical activity behaviour.

Conclusion

The HAPA model is a useful framework for describing the factors affecting physical activity in hypertension patients.

Which behaviour change techniques are effective to promote physical activity and reduce sedentary behaviour in adults: a factorial randomized trial of an e- and m-health intervention

BACKGROUND

E- and m-health interventions are promising to change health behaviour. Many of these interventions use a large variety of behaviour change techniques (BCTs), but it's not known which BCTs or which combination of BCTs contribute to their efficacy. Therefore, this experimental study investigated the efficacy of three BCTs (i.e. action planning, coping planning and self-monitoring) and their combinations on physical activity (PA) and sedentary behaviour (SB) against a background set of other BCTs.

METHODS

In a 2 (action planning: present vs absent) × 2 (coping planning: present vs absent) × 2 (self-monitoring: present vs absent) factorial trial, 473 adults from the general population used the self-regulation based e- and m-health intervention 'MyPlan2.0' for five weeks. All combinations of BCTs were considered, resulting in eight groups. Participants selected their preferred target behaviour, either PA (n = 335, age = 35.8, 28.1% men) or SB (n = 138, age = 37.8, 37.7% men), and were then randomly allocated to the experimental groups. Levels of PA (MVPA in minutes/week) or SB (total sedentary time in hours/day) were assessed at baseline and post-intervention using self-reported questionnaires. Linear mixed-effect models were fitted to assess the impact of the different combinations of the BCTs on PA and SB.

RESULTS

First, overall efficacy of each BCT was examined. The delivery of self-monitoring increased PA (t = 2.735, p = 0.007) and reduced SB (t = - 2.573, p = 0.012) compared with no delivery of self-monitoring. Also, the delivery of coping planning increased PA (t = 2.302, p = 0.022) compared with no delivery of coping planning. Second, we investigated to what extent adding BCTs increased efficacy. Using the combination of the three BCTs was most effective to increase PA (x² = 8849, p = 0.003) whereas the combination of action planning and self-monitoring was most effective to decrease SB (x² = 3.918, p = 0.048). To increase PA, action planning was always more effective in combination with coping planning (x² = 5.590, p = 0.014; x² = 17.722, p < 0.001; x² = 4.552, p = 0.033) compared with using action planning without coping planning. Of note, the use of action planning alone reduced PA compared with using coping planning alone (x² = 4.389, p = 0.031) and self-monitoring alone (x² = 8.858, p = 003), respectively.

CONCLUSIONS

This study provides indications that different (combinations of) BCTs may be effective to promote PA and reduce SB. More experimental research to investigate the effectiveness of BCTs is needed, which can contribute to improved design and more effective e- and m-health interventions in the future.

TRIAL REGISTRATION

This study was preregistered as a clinical trial (ID number: NCT03274271 ). Release date: 20 October 2017.

Predictors of physical activity following gestational diabetes: Application of health action process approach

Aim

Regular physical activity can reduce the chance of developing type 2 diabetes in women with a history of gestational diabetes. The present study investigated the relationship between the constructs of the health action process approach and regular physical activity in women with a history of gestational diabetes.

Design

This was a cross-sectional study.

Methods

A total of 150 women who had given birth 6-24 months prior to the study and had experienced gestational diabetes in their recent pregnancy were selected using multistage cluster sampling. Data were collected from December 2018 to May 2019 using a researcher-made questionnaire including constructs of health action process approach.

Results

The common fit indices revealed that health action process approach had an acceptable fit to the observations (root mean square error of approximation = 0.054, Tucker-Lewis index = 0.95, comparative fit index = 0.955). The model's constructs predicted 48% of intention variance and 35% of physical activity variance. Action self-efficacy and coping planning were the most important predictors of intention and behaviour, respectively.

Effects of a HAPA-based multicomponent intervention to improve self-management precursors of older adults with tuberculosis: A community-based randomised controlled trial

OBJECTIVE

To evaluate the effectiveness of a multicomponent intervention based on the Health Action Process Approach (HAPA) model to improve the self-management precursors of older adults with tuberculosis (TB).

METHODS

A cluster-randomised controlled trial was conducted. Older adults with TB in the intervention communities received HAPA-based multicomponent interventions at the beginning of treatment and in the first and sixth months after treatment initiation, and those in the control communities received health education alone. Self-management precursors were measured at baseline and 1 week after each intervention.

RESULTS

Among 262 randomized patients, 244 (93%) completed the trial. Compared with the control group, self-management precursor scores for the intervention group increased significantly over time (β_group*time = 2.92, p < 0.001) in the following 3 precursors: behaviour belief (β_group*time = 0.35, p < 0.001), behaviour plan (β_group*time = 0.72, p < 0.001), and self-efficacy (β_group*time = 1.85, p < 0.001). Education was significantly associated with behaviour belief (β = 0.18, p < 0.05). Chronic comorbidity was significantly associated with behaviour plan (β=-0.26, p < 0.05).

CONCLUSION

Compared with single health education, the HAPA-based multicomponent interventions significantly improved the self-management precursor of older adults with TB.

PRACTICE IMPLICATIONS

This HAPA-based multicomponent intervention strategy may be a promising self-management mode for the routine health care of TB patients.

Prevention of post-splenectomy sepsis in patients with asplenia - a study protocol of a controlled trial

Background

Patients with asplenia have a significantly increased lifelong risk of severe invasive infections, particular post-splenectomy sepsis (PSS). Clear preventive measures have been described in the literature, but previous studies found poor implementation of prevention recommendations. Aim of the study is to improve the adherence to guideline-based preventive measures and thereby reduce the incidence of PSS by a novel telephone-delivered intervention that involves both patients and their physicians.

Methods

A prospective controlled, two-armed historical control group design is used to evaluate the new intervention compared to usual care. The intervention for patients includes both educational aspects and, building on the Health Action Process Approach (HAPA), intervention components that promote motivation and planning of preventive measures. For physicians the intervention is primarily information-based. The primary outcome, the adherence to preventative measures, is indicated by a study-specific ‘Preventing PSS-score’ (PrePSS-score), which is assessed at baseline and at 6-months follow-up. Secondary outcomes include, amongst others, patient self-efficacy and action-planning, asplenia-specific health literacy, general self-management and asplenia-specific self-management. In a process-evaluating part of the study interview-data on patients’ and physicians’ evaluation of the intervention will be gathered.

Discussion

This trial will provide evidence about the effectiveness of the novel prevention intervention for asplenic patients. If demonstrated beneficial, the intervention manual will be made publicly available to enable implementation in practice. The experience gained within this trial may also be valuable for prevention strategies in patients with other diseases.

Trial registration

German Clinical Trials Register (DRKS): DRKS00015238; Trial registration date 07. December 2018.

Change in Physical Activity after Diagnosis of Diabetes or Hypertension: Results from an Observational Population-Based Cohort Study

Background: Chronic diseases like diabetes mellitus or hypertension are a major public health challenge. Irregular physical activity (PA) is one of the most important modifiable risk factors for chronic conditions and their complications. However, engaging in regular PA is a challenge for many individuals. The literature suggests that a diagnosis of a disease might serve as a promising point in time to change health behavior. This study investigates whether a diagnosis of diabetes or hypertension is associated with changes in PA. Methods: Analyses are based on 4261 participants of the population-based KORA S4 study (1999–2001) and its subsequent 7-and 14-year follow-ups. Information on PA and incident diagnoses of diabetes or hypertension was assessed via standardized interviews. Change in PA was regressed upon diagnosis with diabetes or hypertension, using logistic regression models. Models were stratified into active and inactive individuals at baseline to avoid ceiling and floor effects or regression to the mean. Results: Active participants at baseline showed higher odds (OR = 2.16 [1.20;3.89]) for becoming inactive after a diabetes diagnosis than those without a diabetes diagnosis. No other significant association was observed. Discussion: As PA is important for the management of diabetes or hypertension, ways to increase or maintain PA levels in newly-diagnosed patients are important. Communication strategies might be crucial, and practitioners and health insurance companies could play a key role in raising awareness.

The Process of Patient Engagement in Outpatient Cardiac Rehabilitation Programs

The primary aim of this study was to test the causal structure of the model of therapeutic engagement (MTE) for the first time, to examine whether the model assists in understanding the process of patient engagement in cardiac rehabilitation (CR) programs. This study used a prospective design, following up patients from the Gold Coast University Hospital Cardiology ward who attended Robina Cardiac Rehabilitation Clinic. A structural equation model of the interactions among the proposed variables within the three stages of the MTE (intention to engage in CR programs, CR initiation, and sustained engagement) revealed significant relationships among these variables in a dataset of 101 patients who attended a CR program. However, no relationship was discerned between outcome expectancies and patient intention to engage in CR. Patients’ willingness to consider the treatment also mediated the relationship between perceived self-efficacy and patient intention to engage in CR. These findings help clarify the process proposed by Lequerica and Kortte (2010) in the context of patient engagement in CR programs. The findings also reveal information on how patients engage in CR programs. Importantly, this provides new information for healthcare providers, enabling them to more effectively engage patients according to their stage of engagement.

Association of health empowerment and handgrip strength with intention to participate in physical activity among community-dwelling older adults

INTRODUCTION

Health empowerment is an individual's perceived control and competence related to health and health care. The projected increased growth of the older adult population calls for a health-related empowerment movement in health education that targets older adults. Using the theory of planned behavior, the purpose of this study was to investigate the association of health empowerment and handgrip strength with intention to participate in physical activity among older adults.

METHODS

The Korean Health Empowerment Scale (K-HES) was used as a measure of health empowerment. Handgrip strength was used as a measure of muscle strength. Intention to participate in physical activity was measured using five items. Participants of this study included 103 community-dwelling older adults (Mage = 76.45 ± 9.395; Male = 42, Female = 61).

RESULTS

Statistical analyses revealed all participants were knowledgeable about the health benefits of exercise and most participated in regular physical activity (n = 84.5%). The majority had normal handgrip strength (n = 60.7%) and most indicated strong intentions to participate in regular physical activity (n = 85%). A stepwise multiple regression revealed health empowerment significantly and positively (F(1,101) = 30.511, p < .001, R² = 0.232, R²_Adjusted = 0.224) associated intention to participate in physical activity. Health empowerment explained 23.2% of the variance in intentions. There was no significant contribution of muscle strength on intention.

DISCUSSION

Findings suggest overall health empowerment may be affected by a variety of subscales such as problem-solving, obtaining support, motivation, psychosocial coping, and decision making.

CONCLUSION

Future research should explore potential associations between health empowerment and intention to participate in physical activity.

Examining Constructs of Parental Reflective Motivation towards Reducing Unhealthy Food Provision to Young Children

Parents are an ideal target to reduce children's unhealthy food intake. Motivation is one component of behavior change; however, there is a paucity of research exploring parental motivation in unhealthy food provision. This study aimed to understand the relationships between, and relative importance of, constructs of parents' reflective motivation and children's intake of unhealthy foods. An online survey captured parent-rated reflective motivation constructs based on the health action process approach (HAPA) model, and children's intake of unhealthy food using the short food survey. The HAPA model includes constructs of self-efficacy, risk perception, outcome expectancies, intention, and planning. Structural equation modelling was used to examine relationships between constructs and the HAPA model in its structural form. Four-hundred and ninety-five parents of three to seven-year olds completed the study. Model fit statistics (X2 = 210.03, df = 83, p < 0.001; Comparative fit index (CFI) = 0.96; Tucker Lewis index (TLI) = 0.94) supported suitability of the HAPA model. The HAPA model explained 9.2% of the variance in children's unhealthy food intake. Constructs of self-efficacy (action to maintenance β = 0.69; maintenance to recovery β = 0.70; maintenance to planning β = 0.82) were found to be the most important constructs for reducing children's unhealthy food intake, followed by planning (to unhealthy food intake β = -0.32) and intention (to planning β = 0.21). This study provides an initial insight into parental motivation and identifies primary intervention targets to enhance parental motivation to reduce unhealthy food provision, and subsequently children's unhealthy food intake.

Mediators of Lifestyle Behaviour Changes in Obese Pregnant Women. Secondary Analyses from the DALI Lifestyle Randomised Controlled Trial

A better understanding of what drives behaviour change in obese pregnant overweight women is needed to improve the effectiveness of lifestyle interventions in this group at risk for gestational diabetes (GDM). Therefore, we assessed which factors mediated behaviour change in the Vitamin D and Lifestyle Intervention for GDM Prevention (DALI) Lifestyle Study. A total of 436 women, with pre-pregnancy body mass index ≥29 kg/m², ≤19 + 6 weeks of gestation and without GDM, were randomised for counselling based on motivational interviewing (MI) on healthy eating and physical activity, healthy eating alone, physical activity alone, or to a usual care group. Lifestyle was measured at baseline, and at 24⁻28 and 35⁻37 weeks of gestation. Outcome expectancy, risk perception, task self-efficacy and social support were measured at those same time points and considered as possible mediators of intervention effects on lifestyle. All three interventions resulted in increased positive outcome expectancy for GDM reduction, perceived risk to the baby and increased task self-efficacy. The latter mediated intervention effects on physical activity and reduced sugared drink consumption. In conclusion, our MI intervention was successful in increasing task self-efficacy, which was related to improved health behaviours.

Implementing behaviour change theory and techniques to increase physical activity and prevent functional decline among adults aged 61-70: The PreventIT project

The health and wellbeing benefits of engaging in physical activity (PA), and of improving strength and balance, are well documented. The World Health Organization's recommendations of 150 min per week of moderate intensity physical activity have been adopted across the world in policy and practice recommendations. However, the number of older adults engaging in this level of PA remains low. The European Project, PreventIT, has adapted the Lifestyle-integrated Functional Exercise (LiFE) programme, which reduced falls in people 75 years and over, for a younger cohort (aLiFE). aLiFE incorporates challenging strength and balance/agility tasks, as well as specific recommendations for increasing physical activity and reducing sedentary behaviour in young-older adults, aged 60-70 years. Personalised advice is given on how to integrate strength, balance and physical activities into daily life. aLiFE has been further developed to be delivered using smartphones and smartwatches (eLiFE), providing the opportunity to send timely motivational messages and real-time feedback to the user. Both aLiFE and eLiFE are behaviour change interventions, supporting older adults to form long-term physical activity habits. PreventIT has taken the original LiFE concept and further developed the behaviour change elements, explicitly mapping them to Social Cognitive Theory, Habit Formation Theory and 30 Behaviour Change Techniques (BCTs). Goal setting, planning, prompts and real-time feedback are used to deliver a person-centred experience. Over 1300 motivational messages have been written, mapped to psychological theory, BCTs and evidence regarding the importance of strength, balance and PA. A motivational assessment tool has been developed to enable us to investigate stated motivational drivers with actual performed behaviour within the feasibility Randomised Controlled Trial. The PreventIT mHealth intervention focusses on behaviour change from initiation to long-term maintenance, addressing the different phases of adopting a healthier lifestyle. As such, it makes a strong contribution to the developing field of evidence-based mobile health (mHealth).

Intención de implementar un plan de acción para el uso del condón en adolescentes: Action plan for condom use implementation intentions in adolescents

Introducción:

La intención de implementar un plan para el uso del condón ha sido efectiva para alcanzar diversas conductas de salud, desarrollarla permitirá a los adolescentes contemplar conductas anticipadas para su uso, de esta manera podrán disminuir riesgo de adquirir una Infección de Transmisión Sexual (ITS). El objetivo del estudio fue determinar si los adolescentes cuentan con la intención de implementar un plan de acción para el uso del condón.

Método:

El diseño del estudio fue descriptivo transversal. La muestra se conformó por 130 adolescentes inscritos en una preparatoria pública del área metropolitana de Monterrey, Nuevo León, México. Se incluyeron adolescentes que declararon haber iniciado vida sexual y aceptaron participar en el estudio.

Resultados:

Los participantes cuentan con la intención de implementar un plan para el uso del condón de forma incompleta, principalmente para negociar y usar el condón. Los hombres mostraron ligeramente mayor intención de implementar un plan de forma general, para adquirir y llevar un condón.

Conclusión:

Es necesario que los adolescentes adquieran habilidades que le permitan fortalecer la intención de implementar un plan para el uso del condón. Se requiere incorporar en los programas de prevención de ITS diferentes estrategias que puedan brindar o reforzar habilidades para planear el uso del condón.

An integrated model of condom use in Sub-Saharan African youth: A meta-analysis

OBJECTIVE

We tested an integrated social-cognitive model derived from multiple theories of the determinants of young people's condom use in Sub-Saharan Africa. The model comprised seven social-cognitive antecedents of condom use: Attitudes, norms, control, risk perceptions, barriers, intentions, and previous condom use.

METHOD

We conducted a systematic search of studies including effects between at least one model construct and intended or actual condom use in young people from sub-Saharan African countries. Fifty-five studies comprising 72 independent data sets were included and subjected to random-effects meta-analysis. Demographic and methodological variables were coded as moderators. Hypotheses of the integrated model were tested using meta-analytic structural equation modeling.

RESULTS

The meta-analysis revealed significant nontrivial sample-weighted correlations among most model constructs. Moderator analyses revealed differences in six correlations for studies that included a formative research component relative to studies that did not. There was little evidence of systematic moderation of relations among model constructs by other candidate moderators. Meta-analytic structural equation models revealed significant direct effects of attitudes, norms, and control on condom use intentions, and of intention, control, and barriers on condom use. Including past condom use increased explained variance in condom use intentions and behavior but did not attenuate model effects. There were also significant indirect effects of attitudes, norms, and control on condom use through intentions.

CONCLUSIONS

Findings provide preliminary evidence to support the integrated condom use model in sub-Saharan African youth. The model provides guidance on potential targets for improving the effectiveness of condom promotion interventions. (PsycINFO Database Record

The Use of Theory-Based Formative Research to Design Suicide Prevention Messaging for U.S. Veterans in Midlife

BACKGROUND

Communication campaigns offer a viable mechanism to promote suicide prevention and reinforce mental health for U.S. veterans in midlife, a group with a high suicide burden. However, little empirical investigation of this type of messaging has been conducted, with formative campaign research conspicuously missing from the limited literature.

AIMS

Using the theory of planned behavior as a guide, formative research was conducted to inform the design of suicide prevention messaging by (a) describing and measuring several theoretical constructs among our audience and (b) modeling associations between constructs and intentions to seek help for suicidal behaviors and mental health more broadly.

METHODS

Telephone-based cross-sectional surveys were collected between 2014 and 2016 from a nationally representative sample of veterans with analyses restricted to those aged between 44 and 65 years ( n = 809). Multiple logistic regression was used to identify significant factors associated with intentions to seek help for either suicidal behaviors or mental health.

RESULTS

Perceived behavioral control was one of the largest predictors of intentions to seek help for both suicidal behaviors and mental health concerns. Descriptive norms were also significantly associated with suicide-related intentions. Data further suggest several types of attitudes (i.e., discordant beliefs, stereotypes) to consider when designing messages for this group.

DISCUSSION

This study represents one of the first efforts to document and describe theoretical constructs and their influence on intentions among veterans in midlife to contribute to the development of evidence-based messaging for veterans informed by a conceptual framework.

CONCLUSION

Findings have important implications as the use of communication strategies for suicide prevention grows increasingly popular.

Self-efficacy and planning strategies can improve physical activity levels in women with a recent history of gestational diabetes mellitus

INTRODUCTION

Regular physical activity can reduce the risk of developing diabetes in high risk populations including in women with gestational diabetes mellitus (GDM). This study applied the Health Action Process Approach (HAPA) to determine the motivational and volitional factors important in increasing physical activity among women with previous GDM.

METHODS

Women with GDM receiving obstetric care at a teaching hospital in Sri Lanka were invited to participate in a survey 6-36 months post-delivery. At baseline and 8 weeks later, 152 women completed postal and telephone surveys that collected socio-cognitive and physical activity data. The study hypotheses were tested using structural equation modelling.

RESULTS

The modified model fit the data well (CFI = .95, TLI = .94, RMSEA = .057) and explained 11% of the variance in behaviour. Action self-efficacy was the only important predictor of intention to be physically active. Intention as well as maintenance self-efficacy predicted planning, which, in turn, predicted physical activity. Planning mediated the effect of intention and self-efficacy (maintenance and recovery) on physical activity.

CONCLUSION

This study has identified predictors of physical activity among women with previous GDM that can inform intervention studies. Interventions targeting this population need to include planning strategies and enhance self-efficacy.

Expectation for Physical Activity to Minimize Dementia Risk and Physical Activity Level Among Older Adults

This study aimed to examine whether the expectation for physical activity to minimize dementia risk was associated with physical activity level and whether this association was moderated by perceived high value of dementia prevention among older adults. Participants (n = 2,824) completed questionnaires and wore accelerometers to measure their average daily steps and levels of physical activity. The expectation for physical activity to minimize dementia risk, perceived value of dementia prevention, and potential covariates (expectation of other desirable outcomes, demographics, and health-related factors) were also measured. The main effects of the expectation and perceived value and their interaction were not significant for physical activity variables in generalized linear models. These findings indicate that expecting physical activity in minimizing dementia risk might not be sufficient to influence physical activity behavior regardless of perceived high value of dementia prevention among older adults.

Health Behavior Change in Older Adults: Testing the Health Action Process Approach at the Inter- and Intraindividual Level

BACKGROUND

Health behavior change theories usually claim to be universally and individually applicable. Most research has tested behavior change theories at the interindividual level and within young-to-middle-aged populations. However, associations at the interindividual level can differ substantially from associations at the intraindividual level. This study examines the applicability of the Health Action Process Approach (HAPA) at the inter- and the intraindividual level among older adults.

METHODS

Two intensive longitudinal studies examined the HAPA model covering two different health behaviors and two different time spans: Study 1 (physical activity, N = 52 × 6 monthly observations) and Study 2 (medication adherence, N = 64 × 30 daily observations). The HAPA constructs (risk awareness, outcome expectancy, self-efficacy, intention, action planning, action control), and self-reported behaviors were assessed.

RESULTS

Overall, at the interindividual level, results of both studies largely confirmed the associations specified by the HAPA. At the intraindividual level, results were less in line with the HAPA. Only action control emerged as consistent predictor of behavior.

CONCLUSIONS

This study emphasises the importance of examining health behavior change theories at both, the inter- and the intraindividual level.

Changes in physical activity among coronary and hypertensive patients: A longitudinal study using the Health Action Process Approach

OBJECTIVES

Physical activity (PA) is a key factor in cardiovascular disease prevention. Through the Health Action Process Approach (HAPA), the present study investigated the process of change in PA in coronary patients (CPs) and hypertensive patients (HPs).

DESIGN

Longitudinal survey study with two follow-up assessments at 6 and 12 months on 188 CPs and 169 HPs.

MAIN OUTCOME MEASURES

Intensity and frequency of PA.

RESULTS

A multi-sample analysis indicated the equivalence of almost all the HAPA social cognitive patterns for both patient populations. A latent growth curve model showed strong interrelations among intercepts and slopes of PA, planning and maintenance self-efficacy, but change in planning was not associated with change in PA. Moreover, increase in PA was associated with the value of planning and maintenance self-efficacy reached at the last follow-up Conclusions: These findings shed light on mechanisms often neglected by the HAPA literature, suggesting reciprocal relationships between PA and its predictors that could define a plausible virtuous circle within the HAPA volitional phase. Moreover, the HAPA social cognitive patterns are essentially identical for patients who had a coronary event (i.e. CPs) and individuals who are at high risk for a coronary event (i.e. HPs).

Predicting Physical Activity-Related Outcomes in Overweight and Obese Adults: A Health Action Process Approach

BACKGROUND

We tested the adequacy of a model based on the Health Action Process Approach (HAPA) in predicting changes in psychological, body composition, and cardiovascular risk outcomes with respect to physical activity participation in overweight and obese adults.

METHODS

Measures of HAPA constructs (action and maintenance self-efficacy, outcome expectancies, action planning, risk perceptions, intentions, behaviour), psychological outcomes (quality of life, depression, anxiety, stress symptoms), body composition variables (body weight, body fat mass), cardiovascular risk measures (total cholesterol, low density lipoprotein), and self-reported physical activity behaviour were administered to participants (N = 74) at baseline, and 6 and 12 weeks later.

RESULTS

Data were analysed using variance-based structural equation modelling with residualised change scores for HAPA variables. The model revealed effects of action self-efficacy and outcome expectancies on physical activity intentions, action self-efficacy on maintenance self-efficacy, and maintenance self-efficacy and intentions on action planning. Intention predicted psychological and body composition outcomes indirectly through physical activity behaviour. Action planning was a direct predictor of psychological, cardiovascular, and body composition outcomes.

CONCLUSIONS

Data supported HAPA hypotheses in relation to intentions and behaviour, but not the role of action planning as a mediator of the intention-behaviour relationship. Action planning predicted outcomes independent of intentions and behaviour.