Effects of an implementation intention-based intervention on fruit consumption

Systematic Review of Easy-to-Learn Behavioral Interventions for Dietary Changes Among Young Adults

INTRODUCTION

Improving the diet quality of young adults may support chronic disease prevention. The approaches used and efficacy of promoting small dietary behavior changes through easy-to-learn (ETL) interventions (requiring no more than 1 hour to teach the behavior) among young adults have not yet been systematically reviewed.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 2 independent electronic searches across 6 databases were conducted to identify any articles describing ETL interventions among young adults (aged 18-35 years) and reporting dietary intake outcomes.

RESULTS

Among 9,538 articles identified, 9 studies met eligibility criteria. Five studies reported significant improvement in the selected dietary outcome. Of these, 3 studies used an implementation intentions approach, in which participants were given or asked to write out a simple dietary behavior directive and carry it on their person. Less than half of included studies were rated as positive for overall quality.

DISCUSSION

The available evidence suggests that ETL interventions targeting the dietary behaviors of young adults may be effective in improving dietary intake. Limitations of included studies were lack of follow-up after the intervention period and low generalizability.

IMPLICATIONS FOR RESEARCH AND PRACTICE

Further dietary intervention studies targeting young adults should systematically evaluate the efficacy of ETL intervention approaches among diverse samples.

Situational Cues in Thoughts About the Future

Abstract: Based on stimulus–response learning accounts, we argue that including situational cues in thought about intended actions is an important aspect of self-regulation success in general and in successfully implementing delayed intentions. Accordingly, in Study 1 ( N = 328), we replicate a previous study and show a positive relationship between the self-reported inclusion of situational cues in thoughts about intended actions and beliefs of self-regulation success. In Study 2 ( N = 136), we find a similar tendency when measuring self-regulation success with an assigned task to be completed within one week. Our results fit with if-then planning perspectives on how to facilitate novel behavior and recent perspectives that attribute self-regulation success to beneficial habits.

Trends in the Number of Behavioural Theory-Based Healthy Eating Interventions Inclusive of Dietitians/Nutritionists in 2000-2020

Nutrition interventions developed using behaviour theory may be more effective than those without theoretical underpinnings. This study aimed to document the number of theory-based healthy eating interventions, the involvement of dietitians/nutritionists and the behaviour theories employed from 2000 to 2020. We conducted a review of publications related to healthy eating interventions that used behaviour change theories. Interventional studies published in English between 2000 and 2020 were retrieved from searching Medline, Cinahl, Embase, Psycinfo and Cochrane Central. Citation, country of origin, presence or absence of dietitian/nutritionist authors, participants, dietary behaviours, outcomes, theories and any behaviour change techniques (BCTs) stated were extracted. The publication trends on a yearly basis were recorded. A total of 266 articles were included. The number of theory-based interventions increased over the two decades. The number of studies conducted by dietitians/nutritionists increased, but since 2012, increases have been driven by other researchers. Social cognitive theory was the most used behaviour theory. Dietitians/nutritionists contributed to growth in publication of theory-based healthy eating interventions, but the proportion of researchers from other professions engaged in this field increased markedly. The reasons for this growth in publications from other professions is unknown but conjectured to result from greater prominence of dietary behaviours within the context of an obesity epidemic.

Implementation intentions for weight loss in college students with overweight and obesity: a proof-of-concept randomized controlled trial

One in three college students have overweight or obesity and are in need of brief, simple weight loss interventions. Implementation intentions, a strategy that connects a goal-aligned behavior to a cue, facilitate goal attainment of health behaviors but have not been applied as a standalone treatment for weight loss. The purpose of this study was to examine the efficacy of an implementation intention weight loss intervention in college students. In this three-arm, proof-of-concept, randomized controlled trial, college students with overweight/obesity (N = 95) were randomized to one of three conditions: an implementation intention group (IMP), an enhanced implementation intention group (IMP+) that included text message reminders and fluency training (i.e., training for speed and accuracy), and a control goal intention group (GOL) for 4 weeks. Participants completed anthropometric and self-report assessments pretreatment and posttreatment and experience-sampling assessments during the study to assess how implementation intentions contribute to behavior change. Across the sample, IMP and IMP+ groups reported significantly more goal-congruent behaviors than the GOL group. However, no between-condition differences emerged for weight and diet outcomes. Across conditions, students lost a statistically significant amount of weight, improved diet quality, and reduced caloric intake (ps < .05). Setting implementation intentions was associated with increased behaviors consistent with weight loss goals. Moreover, participants in all groups lost a statistically significant amount of weight. Incorporating implementation intentions into weight loss interventions, and testing the efficacy of this approach on weight loss over a longer duration, may be beneficial for college students with overweight/obesity.

Development of a behaviour change intervention using a theory-based approach, Behaviour Centred Design, to increase nurses' hand hygiene compliance in the US hospitals

BACKGROUND

A behaviour change campaign is unlikely to be effective if its intervention is not carefully designed. While numerous frameworks are widely used to develop and evaluate interventions, the steps detailing how to create an intervention are not as clear because the process of linking behaviour analysis to the intervention design is seldom discussed. We document the application of the Behaviour Centred Design (BCD) approach to the development of an intervention to improve hand hygiene (HH) rates among nurses' hospital units in the USA.

METHODS

Intervention development is divided into the first three steps of the BCD approach: Assess, Build, and Create. The Assess step centres on understanding the target behaviour. The Build step expands the knowledge of the target behaviour and population through formative research which leads to a creative brief that explains the focus of the intervention. In the Create step, the creative brief guides the intervention design.

RESULTS

Drawing from the main findings of the Asses and Build steps, a focal insight was developed positing that nurses can rediscover the meaning and purpose of their role as a nurse and thus as a caregiver by practicing HH; in the process of cleaning their hands, nurses are living up to their ideal nurse-self. The focal insight was linked linguistically into a theory and change. The outcome was a simple intervention, called the Mainspring Intervention, which consisted of three major parts: a self-affirmation exercise to reduce defensiveness, a message that challenged nurses' perceptions about their HH practice, and an implementation intention activity to help nurses link HH behaviour to a cue.

CONCLUSIONS

We detailed the creation of an original HH intervention that used the BCD approach. The intervention is relatively simple compared to most HH initiatives in the literature, both in terms of having relatively few components to the intervention and relatively easy field implementation. This intervention will allow us to test how specific psychological processes contribute to the problem of low HH rates, how our proposed intervention changes these processes in the hospital setting, and how the expected change in nurses' cognition transforms over time because of the intervention.

Fruit and Vegetable Intake: the Interplay of Planning, Social Support, and Sex

PURPOSE

Intention and planning are important predictors of dietary change. However, little attention has been given yet to the relationship between them as a function of other social-cognitive factors and their interplay with socio-demographics such as sex.

METHODS

In an observational study (1520 women, 430 men) with two measurement points in time, intention (predictor), planning (mediator), social support (first moderator), and sex (second moderator) were assessed to predict changes in diet separately for fruit and vegetable intake.

RESULTS

All predictors had a main effect on fruit intake but no interactions emerged. For vegetable intake, the mediation-chain was qualified by a three-way interaction: for women, the lower the perceived social support, the more the translation of planning into behavior; for men, the higher the perceived social support, the more the translation of planning into behavior.

CONCLUSIONS

Even though intention and planning are predictors of dietary change, they operate differently under specific conditions (level of social support), for specific subgroups (men vs. women), and for different target behaviors (fruit vs. vegetable intake). These results suggest to further examine the mechanisms by which intentions are translated into behavior via planning.

Strength of Implementation Intentions to Use Condoms Among Men Who Have Sex with Men

Although pre-exposure prophylaxis (PrEP) use is increasing among men who have sex with men (MSM), condoms remain key to HIV prevention. Implementation intentions-which link a behavioral action plan with a situation or cue-may predict condom use. The Strength of Implementation Intentions Scale (SIIS), which assesses condom use implementation intentions, has not been evaluated among MSM. A structural model tested whether the SIIS mediated the relationship between condom use intentions and condomless sex acts among 266 sexually-active MSM (56% White, 26% Black, 15% Latino, M_age = 32.54). After controlling for PrEP use, HIV-status, and demographics (χ²(107) = 140.06, CFI = 0.98, TLI = 0.97, RMSEA = 0.03), the SIIS fully mediated the relationship between condom use intentions and condomless sex acts. The SIIS can serve as a fidelity check for interventions, a mediator in theoretical models, and future studies should incorporate implementation intentions into HIV prevention interventions for MSM.

Greater fruit selection following an appearance-based compared with a health-based health promotion poster

Background

This study investigated the impact of an appearance-based compared with a traditional health-based public health message for healthy eating.

Methods

A total of 166 British University students (41 males; aged 20.6 ± 1.9 years) were randomized to view either an appearance-based (n = 82) or a health-based (n = 84) fruit promotion poster. Intentions to consume fruit and immediate fruit selection (laboratory observation) were assessed immediately after poster viewing, and subsequent self-report fruit consumption was assessed 3 days later.

Results

Intentions to consume fruit were not predicted by poster type (largest β = 0.03, P = 0.68) but were associated with fruit-based liking, past consumption, attitudes and social norms (smallest β = 0.16, P = 0.04). Immediate fruit selection was greater following the appearance-based compared with the health-based poster (β = −0.24, P < 0.01), and this effect remained when controlling for participant characteristics (β = −0.21, P < 0.01). Subsequent fruit consumption was greater following the appearance-based compared with the health-based poster (β = −0.22, P = 0.03), but this effect became non-significant on consideration of participant characteristics (β = −0.15, P = 0.13), and was instead associated with fruit-based liking and past consumption (smallest β = 0.24, P = 0.03).

Conclusions

These findings demonstrate the clear value of an appearance-based compared with a health-based health promotion poster for increasing fruit selection. A distinction between outcome measures and the value of a behavioural measure is also demonstrated.

Predictive utility and measurement properties of the Strength of Implementation Intentions Scale (SIIS) for condom use

BACKGROUND

Implementation intentions are situation-linked action plans that increase health behaviors such as condom use. Few studies have measured the strength of implementation intentions, especially regarding condom use. Non-injection drug users are at high risk for HIV due to risky sexual practices. Substance use before sex may increase risky sexual behaviors, and implementation intentions are a promising, practical route for HIV prevention.

PURPOSE

This prospective study assessed the measurement properties of the newly developed Strength of Implementation Intentions Scale (SIIS) for condom use and investigated whether the SIIS predicted condom use one-year later. The study evaluated whether behavioral intentions and alcohol or methamphetamine use before sex modified the relationship between the SIIS and condom use.

METHODS

Participants were 590 non-injection drug users convicted of nonviolent drug offenses in court-mandated outpatient drug diversion programs. They completed self-directed computer assessments at baseline and at one-year follow-up. Measures included demographics, behavioral intentions to use condoms, the SIIS for condom use, alcohol and methamphetamine use before or during sex, and condom use. Psychometric properties, direct, and interaction effects of the SIIS were evaluated using structural equation modeling and general linear regressions.

RESULTS

The SIIS, behavioral intentions, and condom use were positively correlated and there was discriminant validity between all three constructs. In addition, the SIIS predicted condom use one-year later in this high-risk population. No significant interactions were detected.

CONCLUSIONS

The SIIS is predictive of condom use behavior, is psychometrically sound and distinct from behavioral intentions, and can be incorporated into HIV prevention interventions and used as a mediator variable. In addition, it can be used as an outcome measure where a follow-up is not feasible. The SIIS can also be tailored for additional HIV-related behaviors such as HIV-testing, adhering to antiretroviral medication, prescribing and adhering to pre-exposure prophylaxis, and other health behaviors.

Frightened by an Old Scarecrow: The Remarkable Resilience of Demand Characteristics

More than 50 years ago, the idea of demand characteristics was introduced by Martin Orne in a widely cited American Psychologist article. Through the 1960s and the mid-1970s, numerous studies were conducted investigating the role of demand characteristics in a variety of research areas. Demand characteristics faded from researchers’ attention in the late 1970s, relegated to brief descriptions in research methods textbooks. The present article traces the origins of and battles fought over demand characteristics during its heyday. Evidence is provided that suggests demand characteristics experienced a rebirth in the 1980s and it remains a widely referenced idea up to today. Demand characteristics reflect perennial concerns about the difficulties of and limitations to doing research with humans, concerns that often surface in the periodic crises that confront psychology. The types of problems that animated the crisis of confidence associated with demand characteristics in the 1970s form one dimension of the current replication crisis. Reinterpretation of this current replication crisis and a new direction for experimental research with human subjects are derived from this review of demand characteristics.

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.

See Me Smoke-Free: Protocol for a Research Study to Develop and Test the Feasibility of an mHealth App for Women to Address Smoking, Diet, and Physical Activity

BACKGROUND

This paper presents the protocol for an ongoing research study to develop and test the feasibility of a multi-behavioral mHealth app. Approximately 27 million women smoke in the US, and more than 180,000 women die of illnesses linked to smoking annually. Women report greater difficulties quitting smoking. Concerns about weight gain, negative body image, and low self-efficacy may be key factors affecting smoking cessation among women. Recent studies suggest that a multi-behavioral approach, including diet and physical activity, may be more effective at helping women quit. Guided imagery has been successfully used to address body image concerns and self-efficacy in our 3 target behaviors-exercise, diet and smoking cessation. However, it has not been used simultaneously for smoking, diet, and exercise behavior in a single intervention. While imagery is an effective therapeutic tool for behavior change, the mode of delivery has generally been in person, which limits reach. mHealth apps delivered via smart phones offer a unique channel through which to distribute imagery-based interventions.

OBJECTIVE

The objective of our study is to evaluate the feasibility of an mHealth app for women designed to simultaneously address smoking, diet, and physical activity behaviors. The objectives are supported by three specific aims: (1) develop guided imagery content, user interface, and resources to reduce weight concern, and increase body image and self-efficacy for behavior change among women smokers, (2) program a prototype of the app that contains all the necessary elements of text, graphics, multimedia and interactive features, and (3) evaluate the feasibility, acceptability, and preliminary efficacy of the app with women smokers.

METHODS

We created the program content and designed the prototype application for use on the Android platform in collaboration with 9 participants in multiple focus groups and in-depth interviews. We programmed and tested the application's usability with 6 participants in preparation for an open, pre- and posttest trial. Currently, we are testing the feasibility and acceptability of the application, evaluating the relationship of program use to tobacco cessation, dietary behaviors, and physical activity, and assessing consumer satisfaction with approximately 70 women smokers with Android-based smart phones.

RESULTS

The study was started January 1, 2014. The app was launched and feasibility testing began in April 1, 2015. Participants were enrolled from April 1-June 30, 2015. During that time, the app was downloaded over 350 times using no paid advertising. Participants were required to use the app "most days" for 30 days or they would be dropped from the study. We enrolled 151 participants. Of those, 78 were dropped or withdrew from the study, leaving 73 participants. We have completed the 30-day assessment, with a 92% response rate. The 90-day assessment is ongoing. During the final phase of the study, we will be conducting data analyses and disseminating study findings via presentations and publications. Feasibility will be demonstrated by successful participant retention and a high level of app use. We will examine individual metrics (eg, duration of use, number of screens viewed, change in usage patterns over time) and engagement with interactive activities (eg, activity tracking).

CONCLUSIONS

We will aggregate these data into composite exposure scores that combine number of visits and overall duration to calculate correlations between outcome and measures of program exposure and engagement. Finally, we will compare app use between participants and non-participants using Google Analytics.

Bridging the goal intention-action gap in rehabilitation: a study of if-then implementation intentions in neurorehabilitation

PURPOSE

To test the feasibility and acceptability of an implementation intention strategy (if-then plans) increasingly used in health psychology to bridge the goal intention-action gap in rehabilitation with people with neurological conditions who are experiencing difficulties with mobility.

METHODS

Twenty people with multiple sclerosis (MS) and stroke, randomised to an experimental and control group, set up to three mobility related goals with a physiotherapist. The experimental group also formulated if-then plans for every goal.

DATA COLLECTION

Focus groups and interviews with participants and therapists; Patient Activation Measure (PAM), 10-m walk test, Rivermead Mobility Index, self-efficacy, subjective health status, quality of life.

RESULTS

Qualitative data highlighted one main theme: Rehabilitation in context, encapsulating the usefulness of the if-then strategy in thinking about the patient in the context of complexity, the usefulness of home-based rehabilitation, and the perceived need for a few more sessions. Changes in walking speed were in the expected direction for both groups; PAM scores improved over 3 months in both groups.

CONCLUSION

If-then plans were feasible and acceptable in bridging the goal intention-action gap in rehabilitation with people with MS and stroke, who are experiencing difficulties with mobility. This approach can now be adapted and trialled further in a definitive study.

IMPLICATIONS FOR REHABILITATION

Goal planning in rehabilitation necessitates specific strategies that help people engage in goal-related tasks. If-then plans aim to support people to deal more effectively with self-regulatory problems that might undermine goal striving and have been found to be effective in health promotion and health behaviour change. This feasibility study with people with a stroke and multiple sclerosis has demonstrated that if-then plans are feasible and acceptable to patients and physiotherapists in supporting goal-directed behaviour.

Implementation Intentions on the Effect of Salt Intake among Hypertensive Women: A Pilot Study

This experimental study was aimed at assessing the potential effect of a theory-driven intervention-implementation intentions-on reducing salt intake among hypertensive Brazilian women. Ninety-eight participants were randomly assigned to participate in an implementation intentions intervention aimed at promoting lower salt intake through decreased addition of salt and salty spices to meals (intervention group, n = 49; group, n = 49). Endpoints were assessed at baseline and at the 2-month follow-up. Primary endpoints were a self-reporting measure of salt intake given by salt addition to meals (discretionary salt + salty spices = total added salt) and the 24 h urinary-sodium excretion. Secondary endpoints included intention, self-efficacy, and habit related to adding salt to meals. Patients in the intervention group showed a significant reduction in salt intake as assessed by 24 h urinary-sodium excretion. A significant reduction in the measure of habit was observed for both groups. No differences were observed for intention and self-efficacy. The results of this pilot study suggest the efficacy of planning strategies to help hypertensive women reduce their salt intake.

From the bench to public health: population-level implementation intentions in colorectal cancer screening

BACKGROUND

Early detection of colorectal cancer (CRC) using fecal occult blood test (FOBT) reduces mortality, yet screening adherence remains low.

PURPOSE

Enhancing FOBT adherence in a field experiment, using Implementation Intentions (II) technique.

DESIGN

Participants were randomly assigned to a standard care group or to II experimental group.

SETTING/PARTICIPANTS

A test kit was mailed to 29,833 HMO-insured members in two waves in 2011.

INCLUSION CRITERIA

eligible persons aged 50-74 who underwent the test the year before. A sample of 2200 participants was interviewed over the telephone for possible cognitive and background moderators.

INTERVENTION

Leaflet attached to the test kit containing an "if-then" condition and planning instructions of when, where, and how.

MAIN OUTCOME MEASURE

Test performance at 2 and 6 months following mailing of the test kit, retrieved from HMO's computerized database (2011-2012).

RESULTS

Adherence in the experimental group ranged 1.2%-6.6% higher than in the control group. Within 6 months of kits' mailing, test uptake for the two waves was 71.4% and 67.9% for experiment and control, respectively (χ(2)=40.58, p=0.0001). The difference remained significant after controlling for age, gender, marital status, and wave (OR=1.17, 95% CI=1.11, 1.23, p<0.0001). Test performance was related to cognitive and background variables. No interaction was found among cognitive or background variables and the intervention.

CONCLUSIONS

II technique is useful in increasing adherence to CRC screening, even in a mailed form rather than a face-to-face experimental situation. Mailed II is an inexpensive and effective method, applicable for public health.

Visualising future behaviour: Effects for snacking on biscuit bars, but no effects for snacking on fruit

In this study, participants ( N = 223) were randomised to visualise snacking on fruit, visualise snacking on biscuit bars or no visualisation, and intentions and attitudes towards fruit and biscuit bars, immediate selection of fruit or biscuit bars and subsequent consumption were measured. No effects of visualising snacking on fruit were found once background variables were taken into account. Visualising snacking on biscuit bars, however, resulted in greater intentions to consume biscuit bars (smallest β = 0.19, p < 0.01). These findings suggest that specifics of the visualised target behaviour may be important in visualisation. Further investigation is needed before recommending visualisation for increasing fruit consumption.

Implementation intention and action planning interventions in health contexts: state of the research and proposals for the way forward

The purpose of this paper is to provide an overview of the literature on two planning intervention techniques in health behaviour research, implementation intentions and action planning, and to develop evidence-based recommendations for effective future interventions and highlight priority areas for future research. We focused our review on four key areas: (1) definition and conceptualisation; (2) format and measurement; (3) mechanisms and processes; and (4) design issues. Overall, evidence supports the effectiveness of planning interventions in health behaviour with advantages including low cost and response burden. There is, however, considerable heterogeneity in the effects across studies and relatively few registered randomised trials that include objective behavioural measures. Optimally effective planning interventions should adopt "if-then" plans, account for salient and relevant cues, include examples of cues, be guided rather than user-defined, and include boosters. Future studies should adopt randomised controlled designs, report study protocols, include fidelity checks and relevant comparison groups, and adopt long-term behavioural follow-up measures. Priority areas for future research include the identification of the moderators and mediators of planning intervention effects. Future research also needs to adopt "best practice" components of planning interventions more consistently to elucidate the mechanisms and processes involved.

Information seeking from media and family/friends increases the likelihood of engaging in healthy lifestyle behaviors

The amount of cancer-related information available to the general population continues to grow; yet, its effects are unclear. This study extends previous cross-sectional research establishing that cancer information seeking across a variety of sources is extensive and positively associated with engaging in health-related behaviors. The authors studied how active information seeking about cancer prevention influenced three healthy lifestyle behaviors using a 2-round nationally representative sample of adults ages 40-70 years (n = 1,795), using propensity scoring to control for potential confounders including baseline behavior. The adjusted odds of dieting at follow-up were 1.51 (95% CI: 1.05, 2.19) times higher for those who reported baseline seeking from media and interpersonal sources relative to nonseekers. Baseline seekers ate 0.59 (95% CI: 0.28, 0.91) more fruits and vegetable servings per day and exercised 0.36 (95% CI: 0.12, 0.60) more days per week at 1-year follow-up compared with nonseekers. The effects of seeking from media and friends/family on eating fruits and vegetables and exercising were independent of seeking from physicians. The authors offer several explanations for why information seeking predicts healthy lifestyle behaviors: information obtained motivates these behaviors; information sought teaches specific techniques; and the act of information seeking may reinforce a psychological commitment to dieting, eating fruits and vegetables, and exercising.

Self-regulation prompts can increase fruit consumption: a one-hour randomised controlled online trial

OBJECTIVE

The purpose was to examine whether a 1-h intervention would help increase fruit consumption in motivated individuals and to study the role of self-regulatory mechanisms in the behaviour change process, with a particular focus on dietary planning and action control.

METHODS

A randomised controlled trial compared a 1-h online intervention with controls in 791 participants. Dependent variables were fruit intake, planning to consume and dietary action control.

RESULTS

Experimental condition by time interactions documented superior treatment effects for the self-regulation group, although all participants benefited from the study. To identify the contribution of the intervention ingredients, multiple mediation analyses were conducted that yielded mediator effects for dietary action control and planning.

CONCLUSIONS

A very brief self-regulatory nutrition intervention was superior to a control condition. Dietary planning and action control seem to play a major role in the mechanisms that facilitate fruit intake.

Enhancing planning strategies for sunscreen use at different stages of change

To promote sun safety by implementing different plans for sunscreen use, different psychological interventions are compared. Self-regulatory strategies such as action planning and coping planning are seen as proximal predictors of actual behavior. The study compares a pure planning intervention with a broader resource communication and examines differential effects at different stages of change. A sun safety online study was designed with two intervention groups (resource communication versus planning) and one control group at two assessment points, 2 weeks apart. Participants (N = 292) were grouped post hoc according to their stage of change, resulting in 51 pre-intenders (no intention to use sunscreen), 102 intenders (high intention but no regular use of sunscreen) and 139 actors (sunscreen use on a regular basis). No overall treatment effects on planning, but an interaction between time, stage and intervention emerged. The resource communication was more effective for pre-intenders, whereas the planning intervention proved more effective for intenders. A planning treatment was more beneficial in motivated individuals, whereas a broader approach was better for unmotivated ones. Findings highlight the potential that stage-matched interventions might have in the context of sun safety promotion.

Using a combined motivational and volitional intervention to promote exercise and healthy dietary behaviour among undergraduates

AIMS

This study tested the impact of combining a motivational intervention based on protection motivation theory (PMT, Rogers, 1983 [18]) plus a volitional intervention based on action planning and coping planning, as a way to promote the prevention of type 2 diabetes among UK undergraduates.

METHODS

Eighty-four participants were randomly assigned to either a control group or one of three experimental conditions: motivational intervention (PMT), volitional intervention (APCP), or combined motivational and volitional intervention (PMT&APCP). PMT variables, dietary and exercise behaviours were measured at three time-points over a four-week period.

RESULTS

The motivational intervention significantly changed PMT variables. The combined motivational and volitional intervention significantly decreased fat intake and increased the frequency of exercise relative to all other groups, and significantly increased the amount of fruit and vegetables consumed relative to control and volitional intervention groups.

CONCLUSIONS

These results suggest that motivational intervention is effective at changing cognitions but changing behaviour requires an intervention based on both motivation and volition.

Effectiveness of a brief intervention using mental simulations in reducing alcohol consumption in corporate employees

A theory-based intervention aimed at reducing corporate employees' alcohol consumption in excess of guideline limits is presented. The intervention adopted an outcome mental simulation technique and was administered to a sample of corporate employees from three companies. A single-arm randomized-controlled design was adopted. All participants completed baseline psychological measures and self-reported number of alcohol units consumed and binge-drinking occasions. Participants allocated to the intervention condition were presented with a mental simulation exercise. One month later, participants completed follow-up measures of the psychological variables and alcohol consumption. Results revealed a significant effect of the mental simulation intervention on number of units of alcohol consumed at follow-up. There was no effect of the intervention on frequency of binge-drinking occasions. There was no evidence for the mediation of the effect of mental simulations on alcohol consumption by the perceived behavioural control and motivation variables. Results support the efficacy of the mental simulation intervention in reducing alcohol consumption but not in reducing binge drinking or alcohol consumption in excess of guideline limits, among corporate employees. Results are discussed with respect to the importance of the mental simulation intervention to inform practice and the proposed processes by which mental simulations affect alcohol consumption.

A volitional help sheet to increase physical activity in people with low socioeconomic status: A randomised exploratory trial

Volitional help sheets use Gollwitzer's (1993) concept of implementation intentions as a vehicle to change behaviour using Prochaska and DiClemente's (1983) processes of change. The present study designed and tested a volitional help sheet to increase physical activity in a group with low socioeconomic status (low-SES). Sixty-eight people (33 women, 35 men; mean age 27) with low-SES were randomly allocated to either an experimental group or a control group. Both groups received a questionnaire and a volitional help sheet; the only difference between the experimental and control groups was that the former were given explicit instructions to link occasions on which they were tempted not to be physically active with appropriate behavioural responses (processes of change). Physical activity (Metabolic Equivalent minutes per week) was the main outcome measure; behavioural intention and self-efficacy were the secondary outcome measures. The findings revealed significant increase in physical activity in the experimental condition, relative to the control condition, F (1, 66) = 7.28, p < 0.01, η2(10) = 0.10, but no differences for social cognitive variables. Furthermore, the participants who were most responsive to the intervention engaged in more than three times the physical activity at baseline than those who received the intervention but did not subsequently change. The findings provide further support for volitional help sheets to change health behaviour and extend them to a group with low-SES. Further work is required to refine this intervention tool.

Fruitful plans: adding targeted mental imagery to implementation intentions increases fruit consumption

Forming implementation intentions ('If I encounter situation X, then I will perform behaviour Y!') increases the probability of carrying out goals. This study tested the hypothesis that mental imagery targeting key elements of implementation intentions further increases goal achievement. The residents of a student residence were assigned the goal of consuming extra portions of fruit every day for 7 days and randomly assigned to one of four conditions: control (active rehearsal), implementation intentions, goal intention mental imagery or mental imagery targeted to the implementation intentions. Among low fruit consumers, but not high fruit consumers, fruit consumption at follow-up was higher in the targeted mental imagery group than in the other group, with the lowest fruit consumption in the control group. The findings suggest that it may be beneficial to use targeted mental imagery when forming implementation intentions.

Breaking Habits With Implementation Intentions: A Test of Underlying Processes

Implementation intentions specifying the replacement of a habitual response with an alternative response in a critical situation can overrule habits. In three experiments the cognitive effects of such counterhabitual implementation intentions were investigated. Results showed that implementation intentions eliminated the cognitive advantage of the habitual means in the “horse race” with the alternative response. That is, in the control condition, the habitual means was more accessible than the alternative means on encountering the critical situation, but this was no longer the case when implementation intentions were formulated. However, the cognitive advantage of the habitual means was not immediately replaced by an automatic activation of the alternative means. This suggests that formulating counterhabitual implementation intentions increases individuals’ flexibility to choose which behavior to perform in the critical situation but that actual behavior will depart from their habits only to the extent that individuals have strong alternative goal intentions.

A theory-based intervention to reduce alcohol drinking in excess of guideline limits among undergraduate students

OBJECTIVES

Undergraduate students frequently exceed guideline limits for alcohol intake in a single session and are highly susceptible to associated health, social, and economic problems. Psychological theory suggests that interventions aimed at reducing alcohol consumption should target both motivational and volitional phases of action to be effective. This study reports an integrated theory-based intervention aimed at reducing undergraduates' alcohol consumption in excess of guideline limits.

DESIGN

The study adopted a 2 (motivation: mental simulation vs. no mental simulation) × 2 (volitional: implementation intention vs. no implementation intention) randomized controlled design presented in an online format.

METHODS

Undergraduate students (N= 238; females, n= 133, M age = 20.11, SD= 2.09; males, n= 105, M age = 20.38, SD= 1.35) completed baseline psychological measures and self-reported alcohol consumption as units consumed and heavy episodic drinking occasions followed by the intervention manipulation (if any). One month later participants completed follow-up measures of the psychological variables and alcohol consumption.

RESULTS

 Significant reductions in alcohol consumption were observed at follow-up. Participants receiving a mental simulation intervention reported significantly fewer units of alcohol consumed and heavy episodic drinking occasions. Among participants with high baseline alcohol consumption, participants in the combined mental simulation and implementation intention intervention group consumed significantly fewer units than other groups.

CONCLUSION

Results support the use of these theory-based strategies to reduce alcohol drinking in excess of guideline limits among undergraduates. There was preliminary support for the interaction between the two strategies among heavier drinkers. Targeting both motivational and implemental phases of action poses a high probability for success in changing alcohol-related behaviour in this population.

Planning What Not to Eat: Ironic Effects of Implementation Intentions Negating Unhealthy Habits

The present studies tested the effectiveness of implementation intentions with an “if [situation], then not [habitual response]” structure. Based on ironic process theory and the literature on the processing of negations, it was expected that these “negation implementation intentions” would, ironically, strengthen the habit (situation—response association) one aims to break. In line with the hypotheses, forming negation implementation intentions resulted in cognitive ironic rebound effects as well as behavioral ironic rebound effects compared to an intention only condition or a replacement implementation intention. Additionally, it was found that negation implementation intentions are most likely to result in ironic rebound effects when the habit to be negated is strong. Although implementation intentions are generally highly effective in facilitating behavior change even when this involves breaking unwanted habits, the present research suggests that they are ineffective when they have a negating structure.

Evidence that boosters augment the long-term impact of implementation intentions on fruit and vegetable intake

The present study tests the efficacy of a single implementation intention to increase intake over a 6-month period, and investigates whether deploying a second implementation intention at 3 months can sustain the long-term impact, compared with passive and active control groups. Participants (N = 650) completed single-item and FFQ measures of behaviour and motivation at baseline before being randomised to one of six conditions in a between-persons design. Intention to treat analysis revealed that for the single-item measure: (1) a single implementation intention is an effective means of initiating fruit and vegetable increase over a 3-month period, but this effect is not sustained over 6 months; (2) administering a second implementation intention at 3 months was successful in increasing intake over 6 months, and acted as a booster on the initial impact; and (3) neither the passive nor active control condition had any impact on behaviour. However, no effects of the manipulations on fruit and vegetable intake were found when behaviour was assessed by the FFQ measure. Secondary analyses showed that reported increases in intake were not related to demand characteristics. The findings are discussed in relation to their conceptual and practical value.

A simple and promising tool to improve self-monitoring of blood glucose in patients with diabetes

AIM

To examine patient formation of implementation plans, a volitional strategy, and its influence on self-monitoring of blood glucose (SMBG).

METHODS

A randomized experimental-control design over a 2-week time period was used. The study population was diabetes patients with HbA1c >7% and requiring insulin therapy. Patients were recruited from a southeastern Michigan healthcare system. A self-administered intervention was designed to assist patients to formulate plans to perform SMBG. The primary outcome measure was SMBG rates. Three control groups were used to control for testing effects. Hypotheses were tested using ANOVA at a significance level of 0.05. SMBG was measured using a 2-week diary and two recall measures.

RESULTS

There were 402 patients with diabetes recruited for the study. Analyses indicated that making implementation plans increased SMBG rates as assessed by a diary and two recall measures. The patients in the experimental group checked their blood sugar up to 7.77 times more than the control groups (sig<0.05) over a 2-week time period as measured by the diary.

CONCLUSIONS

Patient behavior can be impacted by using an implementation planning tool. This technique can help improve patient self-monitoring behavior.