Understanding the predictors of medication adherence: applying temporal self-regulation theory

Comparison of approach/avoidance intentions for alcohol and vegetable consumption under a temporal self-regulation theory framework

OBJECTIVE

This study aimed to compare the differences between the framing of intention (approach vs. avoidance) and the type of self-regulatory capacity (planning vs. inhibition) to predict two behaviours (alcohol vs. vegetable consumption). Interaction effects between temporal self-regulation theory constructs were also explored.

METHODS

UK participants were recruited online (N = 254) and completed measures of intention (approach and avoidance), self-regulatory capacity (planning and inhibition), and behavioural prepotency (habit) related to alcohol and vegetable consumption. One week later, consumption was assessed.

RESULTS

Habit strength and approach-intentions consistently predicted consumption across each model for both behaviours. There was mixed support for avoidance-intentions and self-regulatory capacity variables in predicting consumption. Planning was more important in vegetable consumption than in alcohol consumption, and avoidance-intentions were only predictive in alcohol consumption. Inhibition was not significant for either behaviour. The interaction between approach-intention and planning was the only significant moderation detected and was only present in vegetable consumption.

CONCLUSION

The framing of intentions and the sub-facet of self-regulatory capacity are important to consider when attempting to explain health behaviours. Furthermore, theoretically defined moderation between temporal self-regulation theory variables might also depend on the type of behaviour and specific measured used to capture self-regulatory capacity.

Hydroxyurea Adherence for Personal Best in Sickle Cell Treatment (HABIT) efficacy trial: Community health worker support may increase hydroxyurea adherence of youth with sickle cell disease

Despite disease-modifying effects of hydroxyurea on sickle cell disease (SCD), poor adherence among affected youth commonly impedes treatment impact. Following our prior feasibility trial, the "Hydroxyurea Adherence for Personal Best in Sickle Cell Treatment (HABIT)" multi-site randomized controlled efficacy trial aimed to increase hydroxyurea adherence for youth with SCD ages 10-18 years. Impaired adherence was identified primarily through flagging hydroxyurea-induced fetal hemoglobin (HbF) levels compared to prior highest treatment-related HbF. Eligible youth were enrolled as dyads with their primary caregivers for the 1-year trial. This novel semi-structured supportive, multidimensional dyad intervention led by community health workers (CHW), was augmented by daily tailored text message reminders, compared to standard care during a 6-month intervention phase, followed by a 6-month sustainability phase. Primary outcomes from the intervention phase were improved Month 6 HbF levels compared to enrollment and proportion of days covered (PDC) for hydroxyurea versus pre-trial year. The secondary outcome was sustainability of changes up to Month 12. The 2020-2021 peak coronavirus disease 2019 (COVID-19) pandemic disrupted enrollment and clinic-based procedures; CHW in-person visits shifted to virtual scheduled interactions. We enrolled 50 dyads, missing target enrollment. Compared to enrollment levels, both HbF level and PDC significantly - but not sustainably - improved within the intervention group (p = .03 and .01, respectively) with parallel increased mean corpuscular volume (MCV) (p = .05), but not within controls. No significant between-group differences were found at Months 6 or 12. These findings suggest that our community-based, multimodal support for youth-caregiver dyads had temporarily improved hydroxyurea usage. Durability of impact should be tested in a trial with longer duration of CHW-led and mobile health support.

Effects of a temporal self-regulation theory-based intervention on self-management in hemodialysis patients: A randomized controlled trial

OBJECTIVE

To investigate the effects of a temporal self-regulation theory-based intervention on self-management in hemodialysis patients.

METHODS

A randomized controlled trial was carried out in Lanzhou, China. Participants were randomly allocated to either the intervention group (n = 42) or control group (n = 42). The outcomes of self-management level, interdialytic weight gain, serum potassium and serum phosphorus were collected at baseline (T0), 1 month after intervention (T1), and 2 months after follow-up (T2).

RESULTS

After intervention and follow-up, the self-management score of the intervention group was significantly higher than that of the control group, while the interdialytic weight gain, serum potassium, and serum phosphorus were significantly lower. The group and time interaction effects revealed that participants in the intervention group exhibited significantly greater improvement in self-management at T1 and T2. Interdialytic weight gain decreased significantly at T2. Serum potassium levels did not differ significantly at T1 or T2. The changes in serum phosphorus were both significant at T1 and T2.

CONCLUSION

This study demonstrated that the temporal self-regulation theory-based intervention was effective in improving hemodialysis patients' self-management.

PRACTICE IMPLICATIONS

The findings suggest popularizing and applying this intervention in the clinic to maintain the long-term effectiveness of the intervention effect.

Validity, sensitivity and specificity of a measure of medication adherence instrument among patients taking oral anticoagulants

Although self-report instruments are currently considered a valuable tool for measuring adherence, due to their low cost and ease of implementation, there are still important factors that impact measurement accuracy, such as social desirability and memory bias. Thus, the Global Assessment of Medication Adherence Instrument (GEMA) was developed to provide an accurate measure of this construct. The aim of this study was to evaluate the properties of the measurement of the Global Evaluation of Medication Adherence Instrument (GEMA) among patients with chronic diseases. A methodological study was conducted in the public hospital of the state of São Paulo, Brazil. The adherence to anticoagulants as well as the international normalized ratio (INR) was assessed on 127 patients. Besides GEMA, two other instruments were used to assess adherence: the Morisky Medication Adherence Scale-8 (MMAS-8) and the Measurement of Adhesion to Treatments (MAT). The GEMA presented a satisfactory level of specificity (0.76) to identify adherents among those with a stable INR, low sensitivity (0.43) for the identification of non-adherents among those with an unstable INR, and a Positive Predictive Value of 0.70. Positive and weak to moderate correlations were observed between the proportion of doses assessed with GEMA and the scores on the MMAS-8 (r = .26 and r = .22, respectively) and the MAT (r = .22 and r = .30, respectively). The GEMA presented good practicality, acceptability, and evidence of specificity regarding the stability of the INR. The validity of the construct was partially supported by the relationship with self-reported measures of adherence.

Can temporal self-regulation theory and its constructs predict medication adherence? A systematic review and meta-analysis

The relationships between temporal self-regulation theory (TST) constructs (intention, behavioural prepotency and self-regulatory capacity) and medication adherence should be established before further applying the theory to adherence. Searches of PsychINFO, Medline, EMBASE, CINAHL and Web of Science were conducted in 2019 (updated November 2021). Studies had to be original quantitative research, assessed the relationship between one of the constructs and adherence in one illness, and used an adult population. The risk of bias was assessed using the NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Three meta-analyses were conducted using R. Moderation analyses were also conducted. A total of 57 articles (60 studies) with 13,995 participants were included, with 7 studies included in more than one analysis. Results identified significant correlations between intention (r = .369, [95% CI: .25, .48]), behavioural prepotency (r = .332, [95% CI: .18, .48]), self-regulatory capacity (r = .213, [95% CI: .10, .32]) and adherence. There was some evidence of publication bias and no significant moderators. No studies explored the interactions in the theory, so whilst the constructs adequately predict adherence, future research should apply the theory to adherence in a specific illness to assess these relationships. Pre-registered on Prospero: CRD42019141395.

Executive functioning as a moderator of flossing behaviour among young adults: a temporal self-regulation theory perspective

Background

Flossing among young adults is often infrequent and barriers not completely understood. One explanation concerns the capacity for executive functioning (EF) during the self-regulation of behaviour.

Methods

Using Temporal Self-Regulation Theory (TST) as a framework to explore EF, young adults from Norwegian universities completed a survey that measured monthly flossing frequency, flossing-related intentions and behavioural prepotency (BP), and EF using the Behaviour Rating Inventory of Executive Function - Adult Version (BRIEF-A).

Results

Data from 362 participants were analysed. The TST-model explained a substantial proportion of variance in monthly flossing (R2 = 0.74), and flossing was associated directly with intention and BP, and interactions between intention and both BP and global-EF. Sub-domains of EF were explored using the same model, revealing that behavioural regulation processes, specifically those related to emotional control and shifting between tasks, offered better fit. Simple slopes revealed that moderation effects were only present at lower levels of BP.

Conclusion

EF plays a role in moderating the translation of intentions into flossing behaviour. Specifically, emotional control and task-shifting appear to be influential, and this influence increases when habitual and environmental support (i.e. BP) is reduced. Overcoming EF-barriers may represent a key step in establishing flossing behaviours.

Combining Behavioral Economics-Based Incentives With the Anchoring Strategy: Protocol for a Randomized Controlled Trial

BACKGROUND

Chronic (ie, long-term) elevated stress is associated with a number of mental and physical health conditions. Mindfulness meditation mobile apps are a promising tool for stress self-management that can overcome several barriers associated with in-person interventions; however, to date, poor app-based intervention adherence has limited the efficacy of these mobile health tools. Anchoring, or pairing, a new behavior with an existing routine has been shown to effectively establish habits that are maintained over time, but this strategy typically only works for those with high initial motivation and has yet to be tested for maintaining meditation with a mobile app.

OBJECTIVE

This study will test novel combinations of behavioral economics-based incentives with the anchoring strategy for establishing and maintaining adherence to an effective dose of meditation with a mobile app.

METHODS

This 16-week study will use a 5-arm, parallel, partially blinded (participants only), randomized controlled design. We will implement a fractional factorial study design that varies the use of self-monitoring messages and financial incentives to support participants' use of their personalized anchoring strategy for maintaining adherence to a ≥10 minute-per-day meditation prescription during an 8-week intervention period, followed by an 8-week postintervention observation period. Specifically, we will vary the use of self-monitoring messages of either the target behavior (ie, meditation tracking) or the outcome associated with the target behavior (ie, mood symptom tracking). We will also vary the use of financial incentives conditional on either meditation at any time of day or meditation performed at approximately the same time of day as participants' personalized anchors.

RESULTS

Continuous meditation app use data will be used to measure weekly meditation adherence over the 16-week study period as a binary variable equal to 1 if participants complete ≥10 minutes of meditation for ≥4 days per week and 0 otherwise. We will measure weekly anchoring plan adherence as a binary variable equal to 1 if participants complete ≥10 minutes of meditation within +1 or -1 hour of the timing of their chosen anchor on ≥4 days per week and 0 otherwise. In addition to these primary measures of meditation and anchoring plan adherence, we will also assess the secondary measures of stress, anxiety, posttraumatic stress disorder, sleep disturbance, and meditation app habit strength at baseline, week 8, and week 16.

CONCLUSIONS

This study will fill an important gap in the mobile health literature by testing novel intervention approaches for establishing and maintaining adherence to app-based mindfulness meditation. If successful, this study will identify an accessible and scalable stress self-management intervention that can help combat stress in the United States.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05217602; https://clinicaltrials.gov/ct2/show/NCT05217602.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/39930.

A Study on the Localization of Urban Residents' Recreation: A Moderated Mediation Model Based on Temporal Self-Regulation Theory

The pandemic has resulted in a further reduction in travel distance, recreational radius of destinations and other levels of tourism activity, making "local people traveling locally" a new feature. From the perspective of localization of urban residents' recreation, this paper describes a moderated mediation model based on temporal self-regulation theory. Five representative urban parks in Beijing were selected as study areas, and data collected through a questionnaire were used to discuss the behavioral characteristics of localized recreation and the formation mechanism of sense of place among urban residents in Beijing. The results showed that: (1) connectedness beliefs and temporal valuations positively influenced sense of place, and had a positive indirect effect on sense of place through the mediating role of recreation involvement; (2) recreation benefits positively influenced sense of place; (3) recreation benefits reinforced the direct and mediating role of recreation involvement. Based on these findings, the paper concludes with a discussion of the theoretical value and practical implications, as well as future research directions for park and city management.

Applying the temporal self-regulation theory to understand sugar-sweetened beverage consumption among Chinese college students

Objective

Worldwide, there is a growing trend that college students are consuming more and more sugar-sweetened beverages (SSBs). In order to develop effective intervention strategies, it is important to explore what social-cognitive factors impact on college students' SSB consumption. Building on the temporal self-regulation theory (TST), the current study aimed to examine the effects of intention, behavioral prepotency, and self-regulatory capacity on SSB consumption among college students.

Design

Data were collected from five hundred Chinese college students online. Participants self-reported their intention, behavioral prepotency (environmental cues and habits), self-regulatory capacity, and behaviors of SSB consumption.

Results

Study findings showed that intention, behavioral prepotency, and self-regulatory capacity accounted for 32.9% of variance in SSB consumption. In terms of the direct effects, intention, behavioral prepotency, and self-regulatory capacity were significantly associated with the SSB consumption among college students. In addition, self-regulatory capacity and habits but not the environmental cues showed significant moderation effects on the intention-SSB consumption path, indicating that individual factors rather than environmental cues influenced the intention-behavior path of SSB consumption among college students.

Conclusion

Findings of the current study demonstrated that the TST can be used to explain and understand the impacts of social-cognitive factors on college students' SSB consumption. Future research can apply TST to develop effective intervention programs targeting the reduction of SSB consumption among college students.

Using an integrated model of the theory of planned behavior and the temporal self-regulation theory to explain physical activity in patients with coronary heart disease

Background

This study aimed to explore the psychosocial determinants of the physical activity (PA) levels in patients with coronary heart disease (CHD) using an integrated theoretical model based on the theory of planned behavior (TPB) and the temporal self-regulation theory (TST).

Method

This was a prospective study conducted at the Affiliated Hospital of Hangzhou Normal University, Zhejiang, China. A total of 279 patients with CHD [176 men aged 26-89 years, mean (M) = 64.69, standard deviation (SD) = 13.17] were selected under the study inclusion criteria by convenience sampling. The data on attitude, subjective norm (SN), perceived behavioral control (PBC), and intention variables for the TPB model and consideration of future consequences (CFC), habit, and self-control (SC) variables for the TST model were collected 1-2 days before the discharge (Time 1, T1) of the participants, and a telephone follow-up was made to assess the participants' self-reported PA levels 1 week after their discharge (Time 2, T2).

Results

The results revealed that only 39.8% of the patients with CHD met the guidelines' recommendations on PA. The data analyses using structural equation modeling (SEM) in the Mplus 8.3 modeling program showed that, in the simple mediation model, attitude, PBC, and CFC were positively related to the intention to practice guideline-recommended levels of PA but SN was not. In addition, intention was shown to mediate the relationships between attitude, PBC, CFC, and PA levels. Furthermore, based on the moderated mediating model, intention and habit were shown to be positively associated with PA levels but SC was not. Moreover, SC played a significant moderating role between intention and PA levels. However, habit strength did not moderate the relationship between intention and PA levels.

Conclusion

An integration of the TPB and TST models offers a good theoretical tool for understanding PA levels in patients with CHD.

Investigating the role of morningness/eveningness in physical activity engagement

Objective

Despite being aware of the positive health-related outcomes of physical activity, many people remain inactive. The aim of this study is to apply a combination of constructs from the health action process approach and self-determination theory, as well as habit and morningness/eveningness, to predict physical activity engagement.

Methods

A prospective design was used to collect data from 136 participants (16–64 years old), at two-time points, one week apart. The sample consisted of 99 women, 36 men and 1 individual who identified as non-binary. Participants preferred time-of-day was measured using the Morningness-Eveningness Stability Scale (MESSi), while physical activity engagement was measured using the International Physical Activity Questionnaire (short-version). Two hierarchical, multiple regressions were conducted, to predict motivation to engage and to directly predict physical activity engagement. Furthermore, a mediation analysis was conducted to determine the effect of planning on physical activity engagement.

Results

Results showed that younger individuals and those with greater self-efficacy were more motivated to engage while planning directly predicted physical activity engagement. However, morningness/eveningness did not significantly predict engagement. Additionally, planning was found to mediate the motivation-engagement relationship.

Conclusion

This study demonstrates how planning influences individuals’ physical activity engagement, as well as the role self-efficacy and age play in their motivation to engage. Even though morningness/eveningness was not an important predictor, behaviour change techniques related to action planning and the use of multi-component approaches to behaviour change, could be used in interventions focused on increasing individuals’ physical activity engagement.

Utility of temporal self‐regulation theory in health and social behaviours: A meta‐analysis

PURPOSE

Temporal self-regulation theory was developed to address an observed intention-behaviour gap across behaviours. However, a synthesis of studies has not yet been conducted to investigate the theory's utility to explain behaviour and bridge the intention-behaviour gap. This review aimed to evaluate the predictive ability of temporal self-regulation theory to understanding behaviour and pre-registered at PROSPERO (ID: CRD42021253174).

METHOD

Forward citation searches on the original theory publication through Google Scholar until May 2021 identified 37 eligible articles, including, 12,555 participants assessing at least two of the three theory constructs. Random-effects meta-analyses assessed the strength of associations between theory constructs on behaviour and random effects meta-regressions assessed moderators of behaviour.

RESULTS

Findings provide support for temporal self-regulation theory to explain behaviour with very weak (self-regulatory capacity r = .039, CI = .00, -.07) to moderate (intention r = .331, CI = .26, .40; behavioural pre-potency r = .379, CI = .32, .44) effect sizes. Further, the strength of associations varied across behaviour types and contexts. However, there was high heterogeneity across studies and some moderating effects could not be assessed due to insufficient numbers of studies assessing interactions.

CONCLUSIONS

We urge researchers to assess and report interactions for better understanding of the drivers of behaviour to develop effective interventions for positive behaviour change.

A mobile self-control training app to improve self-control and physical activity in people with severe mental illness: Protocol for two single-case experiment designs (Preprint)

BACKGROUND

Lack of physical activity is a common issue with detrimental consequences for the health of people with severe mental illness (SMI). Existing physical activity interventions show suboptimal effects as they require substantial cognitive skills, including goal setting and writing, whereas cognitive deficits are common in this population. To bolster the effectiveness of physical activity interventions, self-control training (SCT), in which users practice the ability to override unwanted thoughts and behaviors, can be used in addition. Recent research has demonstrated the initial effectiveness of a mobile SCT app, but this has not been studied in psychiatric clinical practice.

OBJECTIVE

This study aims to evaluate to what extent adding a mobile SCT app designed for and with people with SMI to a mobile lifestyle intervention aimed at increasing physical activity increases physical activity and self-control levels.

METHODS

A mixed methods approach incorporating 2 single-case experimental designs (SCEDs) and qualitative interviews was used to evaluate and optimize SCT. Overall, 12 participants with SMI will be recruited from 2 organizations offering outpatient and inpatient care to people with SMI. Each experiment will include 6 patients. SCED I is a concurrent multiple-baseline design across participants that explores initial effectiveness and optimal intervention duration. Using accelerometry and experience sampling questionnaires, participants' physical activity and self-control will be monitored for ≥5 days from baseline, followed by the sequential introduction of Google Fit, the physical activity intervention, for 7 days and the addition of SCIPP: Self-Control Intervention App for 28 days. SCED II is an introduction/withdrawal design in which optimized SCT will be introduced and withdrawn to validate the findings from SCED I. In both experiments, the daily average of total activity counts per hour and the state level of self-control will serve as the primary and secondary outcome measures. Data will be analyzed using visual analysis and piecewise linear regression models.

RESULTS

The study was designated as not subject to the Dutch Medical Research Involving Human Subjects Act by the Medical Research Ethical Committee Oost-Nederland and approved by the Ethics Committee/domain Humanities and Social Sciences of the Faculty of Behavioural, Management, and Social Sciences at the University of Twente. Participant recruitment started in January 2022, and we expect to publish the results in early 2023.

CONCLUSIONS

The mobile SCT app is expected to be feasible and effective. It is self-paced and scalable and can increase patient motivation, making it a suitable intervention for people with SMI. SCED is a relatively novel yet promising method for gaining insights into whether and how mobile apps work that can handle heterogeneous samples and makes it possible to involve a diverse population with SMI without having to include a large number of participants.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/37727.

The role of environmental cues in sugar-sweetened beverage consumption using a temporal self-regulation theory framework

Sugar-sweetened beverage consumption is related to adverse health outcomes such as obesity and Type 2 diabetes. The present research further examined the utility of the temporal self-regulation theory in predicting sugar-sweetened beverage consumption. In addition, the research aimed to identify salient cues that trigger intake. Two-hundred and eighty-seven participants were recruited using convenience sampling in US and Australian populations. Hierarchical multiple regression analyses were used, and the final model accounted for 27.1% of the variance in consumption, providing partial support for the temporal self-regulation theory (ƒ² = 0.37). Intention accounted for a significant 7.0% of variance (R² = 0.07, p < .001), behavioural prepotency variables (past behaviour, habit, and cues) together combined for an additional 15.1% of variance (R² = 0.15, p < .001), but neither measure of self-regulatory capacity (trait self-control, inhibition) was a significant predictor. No cues emerged as unique predictors, however the findings suggest that consumption may be influenced by a combination of cues across different situations. Behavioural prepotency moderated the intention-behaviour relationship such that as behavioural prepotency increased, the greater the influence intention had on behaviour. Further support for the role of both intention and automatic processes in sugar-sweetened beverage consumption was garnered, but more research is needed to identify when specific cues influence consumption most.

Mind the gap: Habit and self-determined motivation predict health behaviours in middle-aged and older adults

OBJECTIVES

Physical activity and fruit and vegetable consumption are two key health behaviours associated with the health and well-being of middle-aged and older adults. The present research investigated how habit and self-determined motivation interact with intention to prospectively predict physical activity and fruit and vegetable consumption in middle-aged and older adults.

DESIGN

A prospective correlational design (two data collection points) was used.

METHODS

A convenience sample of 195 adults completed online questionnaires measuring intention, habit, and self-determined motivation. One week later, 177 participants (67.2% female), aged 52-87 years (M = 61.50, SD = 5.90), completed self-report measures of physical activity and fruit and vegetable consumption over the previous week.

RESULTS

Separate hierarchical multiple regression analyses were conducted. For physical activity, the model explained 46% of the variance in behaviour, F(8, 168) = 17.88, p < .001 and a large effect size (ƒ2  = .85). Two-way interactions contributed an additional 3.70% of unique variance in physical activity, F(3, 165) = 4.07, p = .008, ƒ2  = .04. For fruit and vegetable consumption, the model explained 19.20% of the variance in behaviour, F(5, 171) = 8.13, p < .001 and a medium effect size (ƒ2  = .24). Two-way interactions did not significantly improve the model, F(3, 168) = 1.68, p = .174.

CONCLUSIONS

Habit and self-determined motivation were both important in narrowing the intention-behaviour gap for two key health behaviours, and combining these processes may better inform strategies to support people's intentions to improve these health behaviours.

Understanding the predictors of hand hygiene using aspects of the theory of planned behaviour and temporal self-regulation theory

OBJECTIVE

Adherence to proper hand hygiene practice is relatively low and is particularly salient in light of the current COVID-19 pandemic. Having a greater understanding of the psychosocial predictors of engaging in proper hand hygiene is warranted. One way to do this is through the application of a combined theory of planned behaviour and temporal self-regulation theory model.

DESIGN

A prospective two-part study was conducted between May - November 2020, with N = 232 Australians. At time one, variables from both the theory of planned behaviour (attitude, subjective norm, perceived behavioural control, and intention) and temporal self-regulation theory (habit, environmental cues, and planning) were completed.

MAIN OUTCOME MEASURES

One week later, engagement in proper hand hygiene behaviour over the previous week was assessed.

RESULTS

Two hierarchical multiple regressions were conducted, with 47% of variance accounted for in intention, with subjective norm being the strongest predictor, and 38% of variance accounted for in hand hygiene behaviour, with intention being the strongest predictor. Environmental cues also moderated the relationship between intention and behaviour.

CONCLUSIONS

To increase intention, incorporating subjective norm messages in advertisements may be helpful. Incorporating environmental cues in places where hand washing is recommended may assist in increasing hand hygiene.

Considerations when conducting moderation analysis with a binary outcome: Applications to clinical and social pharmacy research

Clinical and social pharmacy researchers often have questions regarding contingencies of effects (i.e., moderation) that are tested by including interactions in statistical models. Much of the available literature for estimating and testing effects that emanate from moderation models is based on extensions of the linear model with continuous outcomes. Binary (or dichotomous) outcome variables, such as prescription-medication misuse versus no misuse, are commonly encountered by clinical and social pharmacy researchers. In moderation analysis, binary outcomes have led to an increased focus on the fact that measures of interaction are scale-dependent; thus, researchers may need to consider both additive interaction and multiplicative interaction. Further complicating interpretation is that the statistical model chosen for an interaction can provide different answers to questions of moderation. This manuscript will: 1) identify research questions in clinical and social pharmacy that necessitate the use of these statistical methods, 2) review statistical models that can be used to estimate effects when the outcome of interest is binary, 3) review basic concepts of moderation, 4) describe the challenges inherent in conducting moderation analysis when modeling binary outcomes, and 5) demonstrate how to conduct such analyses and interpret relevant statistical output (including interpretations of interactions on additive and multiplicative scales with a focus on identifying which statistical models for binary outcomes lead to which measure of interaction). Although much of the basis for this paper comes from research in epidemiology, recognition of these issues has occurred in other disciplines.

Investigating mechanisms for recruiting and retaining volunteers: The role of habit strength and planning in volunteering engagement

Volunteering rates in high-income countries are declining. Most research into understanding volunteering engagement has focused on conscious processes (e.g., motives), with little exploration of non-conscious antecedents of volunteering engagement. Adopting a new line of investigation, this research used temporal self-regulation theory to investigate the influence of both rational and automatic processes on volunteering engagement. Two related studies using different methodologies were conducted to investigate the influence of intention, planning, and habit strength on volunteering engagement. In both studies, intention and habit strength were significant predictors of volunteering engagement, with planning only significantly predicting volunteering engagement in Study 1. It was also found, in Study 2, that habit strength moderated the intention-behavior relationship. These findings highlight that both rational and automatic processes play a part in volunteering engagement and have implications for recruiting and retaining volunteers.

Adherence to the oral contraceptive pill: the roles of health literacy and knowledge

OBJECTIVE

The oral contraceptive pill is the most widely used method of contraception and when adhered to perfectly is 99% effective at preventing pregnancy. However, adherence to the pill is relatively low. Knowledge has shown to be important in continuation of the pill, and previous research shows the importance of health literacy in adhering to medication in chronic illnesses, but its role has yet to be explored in this behavior.

METHODS

This cross-sectional study examined the associations between health literacy, knowledge of the pill and adherence, as well as the predictive ability of these two variables and their interaction, in predicting adherence. Recruited through CloudResearch, 193 women (M age = 32.63 years, SD = 5.98) residing in the United States completed the Health Literacy Skills Instrument - Short Form, a previously validated measure of oral contraceptive pill knowledge and the Medication Adherence Report Scale.

RESULTS

Results showed a strong positive correlation between health literacy and adherence (r = .76) and moderate associations between health literacy and knowledge (r = .42), and knowledge and adherence (r = .42). The final model of the hierarchical multiple regression accounted for 59.8% of variance in adherence, with health literacy (β = .69) and length of time taking the pill (β = .13) the only significant predictors of adherence.

CONCLUSION

Family planning clinics should consider assessing the patient's health literacy skills before prescribing the pill to ensure patients fully understand the requirements.

A Qualitative Application of Temporal Self-Regulation Theory to Understand Adherence to Simple and Complex Medication Regimens

Medication adherence is a global health concern, and variables of temporal self-regulation theory (TST) have been shown to be important in improving adherence. This qualitative study aims to explore how TST can help explain medication adherence in people’s daily lives, and whether there are differences in the adherence to simple and complex medication regimens. Twenty-nine participants from Australia engaged in semi-structured interviews based on TST (intention, behavioural prepotency, self-regulation), and other variables important to adherence. Interviews were analysed using thematic analysis. Six themes were identified (Routines, External Supports, Cost, Sense of Agency, Adverse Outcomes, and Weighing Up Pros and Cons), with partial support for TST (specifically intention, past behaviour, cues and planning). Four themes not related to TST were also identified. Individuals with more complex medication regimens spoke of the importance of routines, planning, and knowledge-seeking, whereas those with simpler regimens spoke of the importance of visual cues. TST may be useful for identifying some variables important in medication adherence, however, additional factors were also identified. For simple regimens, future research should focus on the manipulation of visual cues. For complex regimens, health professionals should consider supporting the use of medication management apps to assist in planning and ensuring a consistent routine.