Improving diabetes self-management by mental contrasting

Protocol for a cluster randomised waitlist-controlled trial of a goal-based behaviour change intervention for employees in workplaces enrolled in health and wellbeing initiatives

Many workplaces offer health and wellbeing initiatives to their staff as recommended by international and national health organisations. Despite their potential, the influence of these initiatives on health behaviour appears limited and evaluations of their effectiveness are rare. In this research, we propose evaluating the effectiveness of an established behaviour change intervention in a new workplace context. The intervention, 'mental contrasting plus implementation intentions', supports staff in achieving their health and wellbeing goals by encouraging them to compare the future with the present and to develop a plan for overcoming anticipated obstacles. We conducted a systematic review that identified only three trials of this intervention in workplaces and all of them were conducted within healthcare organisations. Our research will be the first to evaluate the effectiveness of mental contrasting outside a solely healthcare context. We propose including staff from 60 organisations, 30 in the intervention and 30 in a waitlisted control group. The findings will contribute to a better understanding of how to empower and support staff to improve their health and wellbeing. Trial registration: ISRCTN17828539.

Experiences of overweight and obese patients with diabetes and practice nurses during implementation of a brief weight management intervention in general practice settings serving Culturally and Linguistically Diverse disadvantaged populations

BACKGROUND

To explore the perspectives of overweight and obese patients with diabetes from culturally and linguistically diverse, and disadvantaged backgrounds, as well as practice nurses (PNs) during implementation of a brief PN-supported self-regulation nutrition strategy for weight management in general practice settings serving disadvantaged populations.

METHODS

During intervention implementation, semi-structured interviews were conducted with 12 patients and four nurses in two general practices located in metropolitan suburbs in Sydney, Australia.

RESULTS

Patients and PNs found challenges related to cultural expectations and the requirement of patients to set and adhere to dietary change goals and behaviours. Although patients expressed high levels of satisfaction with PNs, the suitability of the intervention to this group was questioned by PNs. Obstacles were also encountered in delivering the intervention in a busy general practice setting.

CONCLUSIONS

This pilot study provided initial evidence of the acceptability of a self-regulation nutrition intervention for weight management for overweight and obese patients with type 2 diabetes that was delivered by PNs. Cultural expectations of provider-patient roles, the type of intervention and flexibility in the workplace are important future considerations.

Mental contrasting with implementation intentions as a technique for media-mediated persuasive health communication

Mental Contrasting with Implementation Intentions (MCII) is a self-regulation strategy that combines the strategies mental contrasting (MC) in which individualscontrast a desired future with the current reality with the strategy of forming implementation intentions (II), which involves making concrete if-then plans (implementation intentions, II) to overcome the obstacles standing in the way of the desired future. Numerous studies across behavioral domains have demonstrated the effectiveness of this strategy in supporting people to adopt health-promoting behaviors or changing unhealthy behaviors. However, research on MCII has so far neglected the applicability of the concept in media-mediated persuasive health communication. This conceptual review aims to demonstrate and examine the potentials and effects of MCII as a technique to tailor media-mediated persuasive health messages and their dissemination through different media channels. In doing so, it draws on existing models of health behavior change, especially individuals' threat and coping appraisals. Potential effects of MCII on these cognitive factors are discussed, and practical implications for health message design are outlined.

Demand to Act and Use of Mental Contrasting

Abstract. Mentally contrasting a desired future with present reality fosters selective goal pursuit: People pursue feasible desired futures and let go from unfeasible ones. We investigated whether people spontaneously use mental contrasting when the demand to act toward their desired future is high. Study 1 provided correlational evidence: The participants who planned to act most immediately were also those who used mental contrasting. Studies 2 and 3 added experimental evidence: Imagining an immediate (vs. no immediate) action and being confronted with the opportunity to perform an instrumental (vs. noninstrumental) action, respectively, led participants to mentally contrast. The findings have theoretical implications by suggesting that people initiate mental contrasting as a problem-solving strategy; they have applied implications for interventions teaching mental contrasting.

Förderung berufsbezogener Ziele in der psychosomatischen Rehabilitation durch Mentales Kontrastieren und Wenn-Dann-Pläne

Zusammenfassung. Theoretischer Hintergrund: In der medizinischen Rehabilitation besteht ein Bedarf an Interventionen zur Förderung von Arbeitsmotivation. Mental Contrasting with Implementation Intentions (MCII) hat sich als Methode zur Unterstützung von Zielverfolgung, -bindung und -erreichung etabliert. Die vorliegende Studie untersuchte die Frage: Kann MCII berufsbezogene Ziele fördern? Methode: Patient_innen der psychosomatischen Rehabilitation nahmen an einer berufsbezogenen MCII-Intervention teil (IG; n = 100). Die Kontrollgruppe (KG; n = 100) erhielt eine MBOR-Behandlung ohne MCII-Intervention. Verwendet wurden Fragebogen zu Symptomen, Behandlungszufriedenheit sowie Therapiezielen. Ergebnisse: Patient_innen der IG nannten im Vergleich zur KG etwa zweimal häufiger Ziele mit Berufsbezug (OR = 2.292, 95 % KI [1.049, 5.004]). Nach der Intervention schätzten Patient_innen die Wahrscheinlichkeit der Zielerreichung positiver ein und hatten häufiger einen Zielerreichungsplan. Sie waren zufriedener mit ihrem Behandlungsergebnis. Schlussfolgerungen: Durch MCII priorisierten Patient_innen berufsbezogene Ziele. Die Intervention stellt eine zeit- und kostenökonomische Methode dar, um die Motivation zur Rückkehr ins Erwerbsleben in den Fokus der Reha-Maßnahme zu rücken.

Self-regulation resources and physical activity participation among adults with type 2 diabetes

Physical activity plays a crucial role in the prevention and treatment of type 2 diabetes. Therefore, it is important to understand why so few adults with type 2 diabetes regularly engage in physical activity. The role of self-regulation in the context of health-related behavior adherence, especially in terms of physical activity engagement and adherence, has largely been reviewed based on the strength energy model. Building on this line of research, the aim of this theoretical work was to highlight how self-regulation and ego depletion can influence the lower rate of physical activity participation among adults with type 2 diabetes, compared to adults from the general population.

The Vivid Present: Visualization Abilities Are Associated with Steep Discounting of Future Rewards

Humans and other animals discount the value of future rewards, a phenomenon known as delay discounting. Individuals vary widely in the extent to which they discount future rewards, and these tendencies have been associated with important life outcomes. Recent studies have demonstrated that imagining the future reduces subsequent discounting behavior, but no research to date has examined whether a similar principle applies at the trait level, and whether training visualization changes discounting. The current study examined if individual differences in visualization abilities are linked to individual differences in discounting and whether practicing visualization can change discounting behaviors in a lasting way. Participants (n = 48) completed the Vividness of Visual Imagery Questionnaire (VVIQ) and delay discounting task and then underwent a 4-week intervention consisting of visualization training (intervention) or relaxation training (control). Contrary to our hypotheses, participants who reported greater visualization abilities (lower scores) on the VVIQ were higher discounters. To further examine this relationship, an additional 106 participants completed the VVIQ and delay discounting task. In the total sample (n = 154), there was a significant negative correlation between VVIQ scores and discount rates, showing that individuals who are better visualizers are also higher discounters. Consistent with this relationship but again to our surprise, visualization training tended, albeit weakly, to increase discount rates, and those whose VVIQ decreased the most were those whose discount rates increased the most. These results suggest a novel association between visualization abilities and delay discounting.

9th Annual Symposium on Self-Monitoring of Blood Glucose, April 28-30, 2016, Madrid, Spain

International experts in the field of diabetes and diabetes technology met in Madrid, Spain, for the 9th Annual Symposium on Self-Monitoring of Blood Glucose. The goal of these meetings is to establish a global network of experts, thus facilitating new collaborations and research projects to improve the lives of people with diabetes. The 2016 meeting comprised a comprehensive scientific program, parallel interactive workshops, and two keynote lectures.

Supporting Sustainable Food Consumption: Mental Contrasting with Implementation Intentions (MCII) Aligns Intentions and Behavior

With growing awareness that sustainable consumption is important for quality of life on earth, many individuals intend to act more sustainably. In this regard, interest in reducing meat consumption is on the rise. However, people often do not translate intentions into actual behavior change. To address this intention-behavior gap, we tested the self-regulation strategy of mental contrasting with implementation intentions (MCII). Here, people identify and imagine a desired future and current obstacles standing in its way. They address the obstacles with if-then plans specifying when, where, and how to act differently. In a 5-week randomized controlled experimental study, we compared an information + MCII intervention with an information-only control intervention. As hypothesized, only MCII participants’ intention of reducing their meat consumption was predictive of their actual reduction, while no correspondence between intention and behavior change was found for control participants. Participants with a moderate to strong intention to reduce their meat consumption reduced it more in the MCII than in the control condition. Thus, MCII helped to narrow the intention-behavior gap and supported behavior change for those holding moderate and strong respective intentions.

The effects of self-management intervention among middle-age adults with knee osteoarthritis

AIM

The aim of this study was to explore the effects of a self-management intervention for middle-aged adults with knee osteoarthritis.

BACKGROUND

Knee osteoarthritis is a common cause of lower limb disability in middle-aged and older adults. Use of self-management interventions that apply the self-regulation theory have not been reported for patients with knee osteoarthritis.

DESIGN

A quasi-experimental design was applied.

METHODS

Knee osteoarthritis patients were recruited from two medical centres in northern Taiwan by convenience sampling between July 2013-May 2014. We developed a self-management intervention programme for knee osteoarthritis; participants began an individualized programme 4 weeks after recruitment. Effectiveness of the intervention was evaluated using the Knee Injury and Osteoarthritis Outcome Score, Health Care Questionnaire and the Short-Form Health Survey. A generalized estimating equation compared assessment scores for 105 participants after the intervention (10 and 18 weeks) with scores at 4 weeks.

RESULTS

Knee symptoms and physical function scores significantly improved and quality-of-life scores significantly increased while body mass index, unplanned medical consultations and doses of pain medication significantly decreased at 10 and 18 weeks compared with 4 weeks. After adjusting for the effect of time- and significant-related factors, knee symptoms and physical function, body mass index and quality of life significantly improved at 10 and 18 weeks compared with 4 weeks.

CONCLUSIONS

The self-management intervention based on self-regulation theory, improved participants' symptoms and functions of knee osteoarthritis, overall health and quality of life. Offering self-management interventions in clinical practice can be beneficial for patients with knee osteoarthritis.

Mind wandering via mental contrasting as a tool for behavior change

When people engage in mind wandering they drift away from a task toward their inner thoughts and feelings. These thoughts often circle around people's personal futures. One assumed function of mind wandering is that it aids problem solving and planning for the future. We will discuss different forms of mind wandering and their effects on problem solving and behavior change. While solely fantasizing about a desired future leads to poor problem solving and little behavior change, mind wandering in the form of mental contrasting leads to skilled problem solving and substantial behavior change. In mental contrasting, people first envision the desired future and then imagine the obstacles that need to be surmounted to reach said future. Mental contrasting instigates behavior change by modulating the strength of associations between future and reality and between reality and instrumental action. Intervention research shows that mental contrasting can be taught as a cost- and time-effective self-regulation strategy of behavior change. The findings have implications for research on mind wandering, problem solving, and on creating effective interventions of behavior change.