Autonomous and controlled motivational regulations for multiple health-related behaviors: between- and within-participants analyses

Relationship between motivations and dietary behaviours within parent-adolescent dyads: Application of actor-partner interdependence models

BACKGROUND

Parents play a substantial role in improving adolescent dietary behaviours.

OBJECTIVES

To examine the interdependent relationships between motivations (autonomous and emotional motivation) and dietary behaviours (fruit and vegetable [F/V] and junk food and sugar-sweetened beverage [JF/SSB] intake) within parent-adolescent dyads.

METHODS

This secondary data analysis was conducted on 1522 parent-adolescent dyads using a cross-sectional Family Life, Activity, Sun, Health, and Eating (FLASHE) study. The ratio of boys to girls among the adolescents was approximately equal, and 74% of the parents were mothers. The adolescents were between 12 and 17 years old, and 85.5% of the parents were between 35 and 59 years old. Parents and adolescents completed an online survey on dietary motivations and behaviours. Actor-partner interdependence models were performed within parent-adolescent dyads.

RESULTS

F/V and JF/SSB intake was influenced by parents' or adolescents' autonomous motivation (actor-only pattern), except among adolescents with obesity. A dyadic pattern was found in the relationship between autonomous motivation and F/V and JF/SSB intake, but only among adolescents with normal weight. No relationship was found between F/V and JF/SSB controlled motivation and F/V or JF/SSB intake among adolescents with overweight or obesity.

CONCLUSIONS

Autonomous motivation had a significant relationship with F/V and JF/SSB intake for both parents and adolescents, but the association varied depending on the adolescents' weight. Personalized programmes that foster autonomous motivation to change dietary behaviours should be provided based on the adolescents' weight status.

Relationships among age, motivation, and exercise among women Veterans

Physical activity (PA) and exercise are central to maintaining health, however research has shown steep declines in PA and exercise among women Veterans as they age. Though motivation may be an important contributor to initiating and sustaining exercise that may change across the lifespan, little is known about exercise motivation and its relation to age and exercise behavior among women Veterans. This cross-sectional study sought to describe exercise motivations, examine relationships among exercise motivations and age, and explore the degree to which age and motivation predict self-reported exercise behavior among women Veterans. We conducted a secondary data analysis from a regional mail survey of 197 women Veterans (mean age = 51; SD = 10.5) enrolled in Veterans Health Administration primary care in a northeastern region (N = 180 in analysis). Measures included demographics (age, body mass index), self-reported exercise motivation, and an estimate of average weekly exercise. Participants endorsed multiple motivators for exercise, most prominently fitness and health management. Age was significantly negatively related to amount of exercise and with socializing as an exercise motivation. After accounting for body mass index, age was a significant predictor of exercise behavior, and exercise motivations accounted for an additional 7.3% of variance in self-reported weekly exercise. Our results suggest that although motivation is a potentially important predictor of exercise, factors beyond motivation may better predict exercise in women Veterans. Further research is needed on personal and practical facilitators and barriers to exercise in this population.

What Effect Do Goal Setting Interventions Have on Physical Activity and Psychological Outcomes in Insufficiently Active Adults? A Systematic Review and Meta-Analysis

BACKGROUND

Goal setting is commonly used for promoting physical activity (PA) among insufficiently active individuals. Previous reviews have analyzed the effects of goal setting on PA, but the purpose of this systematic review was to examine the concurrent effects of goal setting on PA and psychological outcomes in insufficiently active individuals to support interventions aiming to produce sustained PA behavior change.

METHODS

In this review (PROSPERO: CRD42021243970), we identified 13 studies with 1208 insufficiently active adults that reported the effects of goal-setting interventions (range 3-24 wk) on both PA and psychological outcomes (eg, self-efficacy, motivation, and affect). We used meta-analysis and narrative synthesis to analyze these effects.

RESULTS

All goals used in the included studies were specific goals. Setting specific goals had a large, positive effect on PA (g [standard mean difference] = 1.11 [P < .001]; 95% confidence interval, 0.74-1.47), but only a small, positive effect on the combined psychological outcomes (g [standard mean difference] = 0.25 [P < .001]; 95% CI, 0.10-0.40). Moderator analyses revealed that interventions that did not reward participants had a significantly greater effect on PA than interventions that did provide rewards (g = 1.30 vs 0.60, respectively, P ≤ .003). No other significant moderators were found.

CONCLUSION

Our review offers initial insight into the long-term effects of specific goals on PA and psychological outcomes in insufficiently active adults. Further research that examines the PA and psychological effects of goal-setting interventions and investigates a wider range of goal types could develop a stronger evidence base to inform intervention for insufficiently active individuals.

Protecting children from COVID-19: examining U.S. parents motivation and behaviour using an integrated model of self-determination theory and the theory of planned behaviour

OBJECTIVES

This longitudinal study applied the integrated model of self-determination theory (SDT) and the theory of planned behaviour (TPB) to explain COVID-19 preventive behaviours among parents of young children in the United States.

DESIGN

The study adopted a two-wave longitudinal study design. Parents (N = 681) completed self-report questionnaires related to measures of SDT and the TPB constructs and behavioural adherence at baseline and after one month. We used standardised residual change scores to test the structural relationships of the integrated model.

RESULTS

The parameter estimates of the model (CFI > .96, TLI > .86, RMSEA = .05, SRMR = .03) fit acceptably well to the data. Psychological need support was positively and significantly linked to autonomous and controlled motivation and amotivation. Autonomous motivation was positively and significantly correlated with TPB factors, and intention. Intention was a significant and positive predictor of behavioural adherence.

CONCLUSION

The integrated model of SDT and the TPB appeared to be applicable to the explanation of COVID-19 prevention among the U.S. parents. Longitudinal data showed that a psychological need supportive social environment was related to favourable motivation, social cognition beliefs, intention and behavioural adherence to the preventive behaviours of parents protecting their young children from COVID-19.

Application of Self-Determination Theory to Substance Use and Its Treatment: A Scoping Review of the Literature

Background: Self-determination theory (SDT) may provide important insights for understanding substance misuse and treatment outcomes. However, to date, the literature applying SDT to substance use and its treatment is varied and difficult to integrate. Methods: The authors searched psycINFO and PubMed on October 26th, 2021 to identify articles applying SDT to substance use and its treatment. Eligible studies were published in peer-reviewed articles in English, on adult populations (18+), and explicitly applied SDT to the context of substance use or its treatment. Results were categorized as studies applying SDT in non-treatment or treatment settings and were synthesized within these categories by substance(s) of focus, primary outcome(s), component(s) of SDT utilized, and relevant findings. Results: The search revealed 38 articles applying SDT in non-treatment (k = 16) and treatment (k = 22) settings. Causality orientations and the basic psychological needs were the most frequently studied components of SDT. Studies that applied SDT in non-treatment settings placed a greater emphasis on causality orientations, whereas treatment studies more frequently targeted or measured basic psychological needs. Conclusions: SDT constructs consistently predicted both substance misuse and treatment outcomes in a theoretically consistent manner, however, several important gaps remain and opportunities for future research are discussed.

Comprehensive analysis of college students' autonomous fitness behavior-a narrative review

Although the physical health of college students is increasingly receiving attention, their autonomous fitness behavior has not been thoroughly investigated. This narrative review conducted a comprehensive literature search through databases such as PubMed, PsycINFO, Web of Science, and the China National Knowledge Infrastructure (CNKI), reviewing studies published up to December 2023. We explored the constructs of autonomy, fitness behavior, and agency, and discussed their integration within the autonomous fitness model. Our findings indicate a lack of comprehensive studies exploring the multifaceted factors influencing autonomous fitness behaviors. Future research should strive to deepen conceptual understanding and further explore the complex dynamics of the transition from autonomy to persistence, employing technological and interdisciplinary methodological perspectives to enhance understanding and promote sustainable fitness habits.

Exploring the relationship across autonomous motivation, affects, and anxiety among gym practitioners during the second COVID-19 lockdown

The present study explores the association of autonomous motivation and the relationship of positive and negative affect on anxiety levels among individuals engaged in gym practitioners during the second COVID-19 lockdown. A total of 196 exercisers (29.17 ± 10.77) were enrolled in the present study, of which 112 (57.1%) were women and 84 (42.9%) were men. The survey included sociodemographic data, as well as validated instruments measuring autonomous motivation, positive and negative affect, and anxiety states related to the COVID-19 pandemic. The results revealed a positive association between autonomous motivation and positive affect (β = 0.36, CI 0.12, 0.37; p < 0.001), and a negative association between autonomous motivation and negative affect (β = - 0.17, CI - 0.31, - 0.01; p = 0.03). Moreover positive, and negative affect are negatively (β = - 0.33, CI - 0.43, - 0.24; p < 0.001) and positively (β = 0.72, CI 0.57, 0.82; p < 0.001) associated to anxiety, respectively. Thus, this study appears to emphasize the association of autonomous motivation on affect as a potential buffer against anxiety levels, particularly in a context where practitioners found themselves restricted in their usual gym practices.

Dropout From Exercise Interventions in Adults With Knee or Hip Osteoarthritis: A Systematic Review and Meta-analysis

OBJECTIVE

To investigate the prevalence and moderators of dropout rates among adults with knee or hip osteoarthritis participating in exercise randomized controlled trials (RCTs).

DATA SOURCES

Two authors searched Embase, CINAHL, PsycARTICLES, and PubMed up to 01/09/2023.

STUDY SELECTION

We included RCTs of exercise interventions in people with knee or hip osteoarthritis that reported dropout rates.

DATA EXTRACTION

Dropout rates from exercise and control conditions and exerciser/participant, provider, and design/implementation related moderators.

DATA SYNTHESIS

In total, 209 RCTs involving 277 exercise arms in 13,102 participants were included (mean age at study level=64 years; median prevalence of men participants=26.8%). The trim-and-fill-adjusted prevalence of dropout across all RCTs was 17.5% (95% CI=16.7%-18.2%), which is comparable with dropout observed in control conditions (trim-and-fill-adjusted odds ratio=0.89; 95% CI=0.71-1.12, P=.37). Higher prevalence of antidepressant use at study-level predicted higher dropout (R2=0.75, P=.002, N RCTs=6, n exercisers=412). Supervision by an exercise professional was associated with lower dropout rates, with a trim-and-fill-adjusted rate of 13.2% (95% CI=11.7%-14.9%) compared with 20.8% without supervision (95% CI=18.3%-23.5%) (P<.001).

CONCLUSIONS

Dropout rates for exercise in RCTs are comparable with control conditions, suggesting that exercise is a generally well-accepted intervention. However, interventions should be supervised by an exercise professional, such as a physiotherapist or exercise physiologist, to further minimize the risk of dropout. Health professionals should consider participants' use of antidepressants as a risk factor for dropout from exercise.

A motivational approach to understanding problematic smartphone use and negative outcomes in university students

Considering the rising integration of smartphones into classrooms, the purpose of this research was to explore the relationship between problematic smartphone use (PSU) and negative outcomes through the lens of self-determination theory. This study examined 1,039 students' reported academic motivation, PSU, anxiety, insomnia, and perceived stress. The first objective of this study was to examine how motivational orientations could predict PSU. Then, we examined how motivational orientations and PSU, when used as a mediating variable, could be modeled to predict negative student mental health outcomes (anxiety, insomnia, and perceived stress). As predicted, statistically significant results suggested that autonomous academic motivation was associated with less PSU (β = -0.16), as well as less anxiety (β = -0.12), insomnia (β = -0.16), and stress (β = -0.10). In contrast, higher levels of controlled academic motivation were associated with more PSU (β = 0.37), as well as higher levels of anxiety (β = 0.49) and insomnia (β = 0.41). Amotivation was also positively related to PSU (β = 0.17), anxiety (β = 0.36), insomnia (β = 0.62), and stress (β = 0.22). All indirect effects (mediation effects) were statistically significant and in the predicted direction: the impact of autonomous motivation on negative outcomes was mediated by lower levels of PSU while controlled motivation and amotivation were mediated by higher levels of PSU. Overall, this study advanced the understanding of PSU in university classrooms by demonstrating a link with academic motivation and mental health outcomes.

How Modifiable Are Modifiable Dementia Risk Factors? A Framework for Considering the Modifiability of Dementia Risk Factors

Many risk factors for dementia, identified from observational studies, are potentially modifiable. This raises the possibility that targeting key modifiable dementia risk factors may reduce the prevalence of dementia, which has led to the development of dementia risk reduction and prevention strategies, such as intervention trials or dementia prevention guidelines. However, what has rarely been considered in the studies that inform these strategies is the extent to which modifiable dementia risk factors can (1) be identified by individuals, and (2) be readily modified by individuals. Characteristics of modifiable dementia risk factors such as readiness of identification and targeting, as well as when they should be targeted, can influence the design, or success of strategies for reducing dementia risk. This review aims to develop a framework for classifying the degree of modifiability of dementia risk factors for research studies. The extent to which these modifiable dementia risk factors could be modified by an individual seeking to reduce their dementia risk is determined, as well as the resources that might be needed for both risk factor identification and modification, and whether modification may be optimal in early-life (aged <45 years), midlife (aged 45-65 years) or late-life (aged >65 years). Finally, barriers that could influence the ability of an individual to engage in risk factor modification and, ultimately, dementia risk reduction are discussed.

The motivation behind better sleep: self-determination as a framework for examining sleep outcomes in college students

OBJECTIVE

To examine sleep health within a self-determination framework across a diverse college sample.

PARTICIPANTS

A nonclinical sample of undergraduate students (n = 399) from a large, urban, public university in the Mid-Atlantic United States in Spring 2020.

METHODS

Participants were recruited via an online research participation portal and received extra credit for participation. All measures were administered via an online survey.

RESULTS

Basic psychological need satisfaction was associated with sleep health. This association was partially mediated by sleep hygiene but not by regulatory style. There were no racial/ethnic differences in sleep health, sleep hygiene, basic need satisfaction, or regulatory style. Men reported more maladaptive motivational styles for sleep health, and non-binary/transgender students reported worse sleep hygiene.

CONCLUSION

Basic psychological need satisfaction and sleep hygiene are critical targets for intervention across diverse college student populations. Motivation may be less critical for nonclinical interventions.

Motivational Influences on Health, Well-Being, and Lifestyle: Validation of the Spanish Version of the Treatment Self-Regulation Questionnaire in Four Health Domains

BACKGROUND

Motivation is a central concept in self-determination theory (SDT). The Treatment Self-Regulation Questionnaire (TSRQ), which assesses motivation (autonomous, controlled, etc.), has been widely used. However, less is known about its applicability to samples such as college students, who may be at risk of having unhealthy behavior in many areas (including smoking, poor dietary habits, alcohol, or tobacco consumption). As this population is transitioning to adulthood, research is needed to understand motivation and changing health patterns. In addition, the lack of instruments for this population in Spain has made the measurement validation process a priority. The purpose of this psychometric study was to adapt the TSRQ to Spanish college students and to examine its structural and validity across four health domains.

METHODS

Two samples of Spanish college students (n = 347 and n = 244) agreed to participate in the study. Participants completed a booklet containing measures of motivation, well-being, general health, anxiety, depression, and lifestyle.

RESULTS

CFA supported a five-dimensional structure in each domain. Reliability values were also adequate for each questionnaire. Regarding other sources of validity, statistically significant relationships between self-determination, health, and well-being were clearly confirmed, and autonomy was a significant predictor of lifestyle.

CONCLUSIONS

The Spanish version of the TSRQ showed adequate psychometric properties (dimensionality and internal structure, reliability, and validity evidence regarding its relationships with other constructs) in college students. The Spanish TSRQ will provide future research aimed to understand the motivational role in college students' health behavior and well-being.

Exploring a peer-based physical activity program in the community for adults with moderate-to-severe traumatic brain injury

PRIMARY OBJECTIVE

To explore the experiences of program mentors, participants, and employees involved in a peer-based physical activity (PA) program for adults with moderate-to-severe TBI, being piloted by a community fitness center, to develop the program as a measurable intervention.

RESEARCH DESIGN

We adopted an exploratory case study approach through an interpretivist paradigm, which focused on discovering realities about the peer-based PA program across the study participants' views, backgrounds, and experiences.

METHODS AND PROCEDURES

Semi-structured focus groups and individual interviews were conducted with nine adult program participants (3 peer mentors, 6 participants), and three program employees. Inductive content analysis was used to develop themes about their perceived experiences.

MAIN OUTCOMES AND RESULTS

44 open-codes were grouped into 10 subthemes and three final themes: 1) program impacts identified the importance of the program in daily life and resulting psychological, physical, and social outcomes; 2) program characteristics highlighted program leaders, accessibility, and social inclusion; 3) program sustainability included program adherence, benefits for the center, and the program's future.

CONCLUSIONS

Perceptions of program experiences and outcomes identified how peer-based PA for adults with moderate-to-severe TBI can lead to meaningful activities, functioning better, and buy-in from all parties. Implications for research and practice related to supporting health-related behaviors after TBI through group-based, autonomy-supporting approaches are discussed.

Latent Profile Analysis of Physical Activity Motivation during Behavioral Weight Loss Treatment

Participants in behavioral weight loss (BWL) treatment often struggle to meet and maintain physical activity (PA) prescriptions; improving participants' motivation for the behavior is a potential intervention strategy. Self-Determination Theory (SDT) outlines a continuum of qualitatively different dimensions of motivation, suggesting that more self-determined forms of motivation should predict more PA, whereas less self-determined forms of motivation should be unrelated or negatively related to PA. Although SDT has ample empirical support, most existing research in this area has used statistical analyses that oversimplify the complex, interdependent relationships between dimensions of motivation and behavior. This study's purpose was to explore commonly occurring motivational "profiles" for PA based on the SDT dimensions of motivation (amotivation, external, introjected, integrated/identified, and intrinsic motivation) and how these profiles relate to PA behavior among participants with overweight/obesity (N=281, 79.4% female) at baseline and six months into BWL treatment. Latent profile analysis determined that three motivational profiles fit the data best at both timepoints and the profile characterized by high self-determined (i.e., integrated/identified and intrinsic) motivation and moderate introjected motivation was by far the most common. There were no differences in physical activity behavior across motivational profiles, which contrasts previous literature. Findings suggest that participants who take the initiative to sign up for intensive BWL programs may have sufficiently high PA motivation, which may be a poor predictor of their actual behavior. Future research should examine these relationships later in treatment, when motivation may have more variability, as well as among participants who initiate lower-commitment weight loss programs (e.g., self-help).

Prediction of the adherence to sports practice of young Ecuadorians based on the perception of the coach's interpersonal style

Based on the framework of the self-determination theory, the present study aimed to test a predictive model in the Ecuadorian sports context by using autonomy support as a trigger, which was mediated by basic psychological needs and later by autonomous motivation. This procedure was used to predict the intention to be physically active and was carried out on 280 athletes from the province of Azuay (Ecuador) aged between 12 and 20 years (M = 15.28; SD = 1.71). Different scales were used to measure the perception of the interpersonal style of autonomy supported by the coach. The scales employed included the degree of satisfaction of basic psychological needs, motivation to practice sports, and intention to be physically active. A structural equation analysis revealed that perceived autonomy support positively predicted basic psychological needs, which in turn positively predicted autonomous motivation and, as a result, the athletes' intentions to be physically active. It was concluded that coaches' support for the interpersonal style of autonomy can benefit the development of basic psychological needs as well as autonomous motivation, which in turn can increase young athletes' intentions to be physically active. Future research is also recommended to verify this predictive model and to encourage further experimental studies in which coaches promote autonomy support for athletes intending to increase their adherence to practising sports.

Optimizing outcomes in psilocybin therapy: Considerations in participant evaluation and preparation

Recent studies have demonstrated the promise of psilocybin therapies in creating positive changes for those with poor mental health across multiple diagnostic categories, including major depressive disorder (MDD), end-of-life anxiety, and obsessive-compulsive disorder (OCD). While there may be a large population that is eligible to participate in psilocybin therapy based on psychiatric diagnosis and medical clearance, little attention has been given to intrapersonal and interpersonal factors that might influence patient's readiness (i.e., eligibility and capacity) for psychedelic interventions. This paper proposes that readiness assessment includes both intrapersonal and interpersonal factors in order to improve safety, patient care, and treatment outcomes. While at the present time a reliable and valid instrument has not been developed, we propose that three specific areas of focus - patient presentation, therapeutic alliance, and patient safety - may be used to establish a patient's readiness for psilocybin therapy, thus increasing therapy optimization and personalization.

The combined effect of motivational interviewing and wearable fitness trackers on motivation and physical activity in inactive adults: A randomized controlled trial

Despite overwhelming adoption of wearable fitness trackers (WFT), it is unclear if they affect physical activity (PA) engagement or PA motivation. We hypothesized that combining a WFT with an effective intervention, motivational interviewing (MI), would positively influence both motivation and PA. A 12-week randomized controlled trial was conducted in 40 adults who did not meet PA recommendations. The four conditions were: a PA education (Educational control, n = 10), a WFT (WFT, n = 10), bi-weekly MI sessions (MI, n = 10), or both interventions (WFT+, n = 10). Motivation and PA were measured through an online survey and actigraphy pre- and post-intervention. Both the WFT+ and MI groups improved autonomous forms and decreased controlled forms of motivation. They also had higher basic psychological needs scores when compared to the Education group post-intervention. We detected no changes in PA. High autonomous motivation at baseline predicted higher post-intervention PA in the WFT+ group but predicted lower post-intervention PA in the WFT group. Results suggests that MI alone or with a WFT can improve basic psychological needs and autonomous forms of motivation for PA, but not PA participation. Individual differences in motivation at baseline may moderate the effect of a WFT on PA. This study was registered at clinicaltrials.gov (NCT490014).

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.

Motivation, Physical Activity, and Affect in Community-Dwelling Stroke Survivors: An Ambulatory Assessment Approach

BACKGROUND

Motivation is a frequently reported but far less studied driver for post-stroke physical activity participation. Motivation and physical activity may be important contributors to the prevention management and alleviation of affective symptoms among stroke survivors.

PURPOSE

To investigate the real-time associations between motivation, physical activity, and affect in the daily lives of community-dwelling stroke survivors using ecological momentary assessment (EMA) and accelerometry.

METHODS

Forty community-dwelling stroke survivors wore an accelerometer on the thigh and completed EMA surveys assessing motivation (autonomous motivation, controlled motivation) and affect (negative affect, positive affect) eight times daily for 7 days. Multivariate regression analysis and multilevel modeling investigated the associations between motivation, physical activity, and affect.

RESULTS

Greater autonomous motivation for physical activity was associated with less sedentary behavior (β = -0.40, p = .049) and more moderate-to-vigorous physical activity (β = 0.45, p = .020) participation in daily life. Greater autonomous motivation was momentarily associated with less depressed affect (β = -0.05, p < .001) and greater positive affect (β = 0.13, p < .001). Moreover, greater controlled motivation was momentarily associated with greater depressed affect (β = 0.06, p < .001). More intense physical activity was momentarily associated with greater positive affect (β = 0.13, p = .016). No moderating effect of motivation on the association between physical activity and affect was found.

CONCLUSIONS

Motivation and physical activity are momentarily associated with affect among stroke survivors. Assessing and fostering autonomous motivation may be beneficial for promoting physical activity and managing positive and depressed affect as stroke survivors return to the community.

A peer support dietary change intervention for encouraging adoption and maintenance of the Mediterranean diet in a non-Mediterranean population (TEAM-MED): lessons learned and suggested improvements

Peer support interventions for dietary change may offer cost-effective alternatives to interventions led by health professionals. This process evaluation of a trial to encourage the adoption and maintenance of a Mediterranean diet in a Northern European population at high CVD risk (TEAM-MED) aimed to investigate the feasibility of implementing a group-based peer support intervention for dietary change, positive elements of the intervention and aspects that could be improved. Data on training and support for the peer supporters; intervention fidelity and acceptability; acceptability of data collection processes for the trial and reasons for withdrawal from the trial were considered. Data were collected from observations, questionnaires and interviews, with both peer supporters and trial participants. Peer supporters were recruited and trained to result in successful implementation of the intervention; all intended sessions were run, with the majority of elements included. Peer supporters were complimentary of the training, and positive comments from participants centred around the peer supporters, the intervention materials and the supportive nature of the group sessions. Attendance at the group sessions, however, waned over the intervention, with suggested effects on intervention engagement, enthusiasm and group cohesion. Reduced attendance was reportedly a result of meeting (in)frequency and organisational concerns, but increased social activities and group-based activities may also increase engagement, group cohesion and attendance. The peer support intervention was successfully implemented and tested, but improvements can be suggested and may enhance the successful nature of these types of interventions. Some consideration of personal preferences may also improve outcomes.

Autonomous motivation, goal-facilitating behaviours, and dietary goal progress in individuals transitioning to a veg*n diet: A longitudinal study

Previous studies have consistently shown that autonomous motivation - pursuing goals because one wants to, rather than has to - is associated with greater behaviour maintenance in the context of healthy eating, exercise, and diet maintenance. The present study used a 7-wave longitudinal design to examine how autonomous motivation is related to dietary goal progress in individuals (N = 222) transitioning to a veg*n (i.e., vegetarian or vegan) diet. We hypothesized that when people reported more autonomous motivation (compared to their own average) they would be more successful in reaching their dietary goals. We also explored the role of goal-facilitating behaviours in this process. We found no directional effects of relative autonomous motivation on goal progress or goal-facilitating behaviours, although the concurrent relations were significant. There were also no within-person effects of behaviours on progress. These findings shed light onto the relationship between autonomous motivation, behaviours, and goal progress both at the same time and over time, and highlight the importance of examining within-person fluctuations over time.

Prospective associations between working alliance, basic psychological need satisfaction, and coaching outcome indicators: a two-wave survey study among 181 Dutch coaching clients

Background

The coach-coachee working alliance and coachee motivation seem important factors for achieving positive coaching results. Self-determination theory, specifically basic psychological need theory, has been proposed as a relevant framework for understanding these relationships. The current longitudinal survey study therefore investigates prospective associations between coachees’ appraisal of the working alliance, basic psychological need satisfaction, and the coaching outcome indicators goal attainment, wellbeing, absence of psychopathology, and personal growth initiative.

Methods

The sample (N = 181) consisted of Dutch coachees that were recruited across a range of coaching settings and contexts. Online self-report questionnaires were administered twice (T0 and T1), with an intervening time of 3 weeks, assessing working alliance, basic psychological need satisfaction, goal attainment, wellbeing, absence of psychopathology, and personal growth initiative. Parallel analysis with Monte Carlo simulations and confirmatory factor analyses were performed to assess the dimensionality of working alliance and basic psychological need satisfaction scores. Multiple regression analyses (stepwise) were used to examine prospective (T0 to T1) associations between working alliance and basic psychological need satisfaction, and their association with outcome indicators.

Results

The coachees’ perception of the working alliance was positively and reciprocally, although modestly, associated with basic psychological need satisfaction. In addition, both working alliance and basic psychological need satisfaction were prospectively associated with goal attainment, but not with other outcome indicators.

Conclusions

Results provide tentative support for a role of basic psychological need satisfaction in facilitating the establishment of a good working alliance. Additionally, the perception of a good quality, need supportive relationship with the coach appears to be associated with better goal achievement, but not with other outcome indicators. Associations were generally modest, and more research is needed to better measure and comprehend the unique contributions of specific relational and motivational factors to outcomes in coaching and assess the robustness of the current study findings.

Work stress, burnout, occupational commitment, and social support among Chinese pediatric nurses: A moderated mediation model

PURPOSE

Pediatric nurses are at high risk for burnout, resulting in unsatisfactory care quality. Although job resources like social support can prevent the development of burnout under work stress, the mediating role of personal resources like occupational commitment is not well studied. This study was to examine the mediating role of occupational commitment in the relationship between work stress and burnout, and test if the effect of work stress on occupational commitment varies at different levels of social support among pediatric nurses.

METHODS

A cross-sectional survey was conducted to collect data of pediatric nurses from 6 hospitals in Chengdu, China. Multiple linear regressions and bias-corrected bootstrap confidence intervals were used to test the proposed model.

RESULTS

In this sample of 488 pediatric nurses, work stress was significantly associated with emotional exhaustion (β = 0.278, p < 0.001), depersonalization (β = 0.112, p < 0.001), and personal accomplishment (β = -0.047, p < 0.05). Occupational commitment partly mediated the links of work stress and emotional exhaustion (β = 0.056, 95%CI: 0.034-0.082), and depersonalization (β = 0.026, 95%CI: 0.014-0.041), and fully mediated the relationship between work stress and personal accomplishment (β = -0.059, 95%CI: -0.080 ∼ -0.039). Social support significantly moderated the relationship between work stress and occupational commitment (β = 0.007, p < 0.01).

CONCLUSION

Among pediatric nurses, work stress has an indirect influence on burnout through occupational commitment, and such an effect is weakened when social support is high.

PRACTICE IMPLICATIONS

Nurse managers could consider developing interventions by promoting both occupational commitment and social support to prevent burnout of employees.

Influencing Factors of College Students’ Use of Sports Apps in Mandatory Situations: Based on UTAUT and SDT

Sports apps are third-party applications for smartphones or wearables that can help users record fitness data and guide their exercise behavior. Many Chinese college students are compelled to use sports apps for running exercises to improve their physical health and cultivate extracurricular exercise habits; however, the acceptance and use of sports apps by college students in mandatory situations requires elucidation. We explored the influencing factors of university students’ behavioral intention and usage behavior to use sports apps in mandatory situations by combining the unified theory of acceptance and use of technology and the Self-Determination Theory. A questionnaire survey was conducted among 249 students of Liaoning University of Technology by using non-probabilistic convenient sampling. Data analysis was performed by employing partial least squares structural equation modeling. The results showed that (1) the research model explained 66% (R2 = 0.66) of the variance in behavioral intention and 30% (R2 = 0.30) of the variance in usage behavior; (2) performance expectancy, effort expectancy, social influence, and autonomous motivation significantly positively affected behavioral intention, while controlled motivation negatively affected behavioral intention; and (3) behavioral intention, autonomous motivation, and controlled motivation significantly positively affected usage behavior. The influence of facilitating conditions on usage behavior was non-significant. The results will help technical developers and schools to better understand the influencing factors of college students’ use of sports apps in mandatory situations, and formulate corresponding improvement strategies and policies to further promote the role sports apps play in college students’ exercise behavior.

Motivating Social Influencers to Engage in Health Behavior Interventions

Social influencers are widely known as the promotors of purchase behavior as well as for their potential to change health behaviors among individuals in their social networks. For social influencers to be successful in changing behaviors, it is essential that they convey their message in an authentic, original, credible, and persistent manner. In the context of health behavior interventions, this requires a focus on the motivation of social influencers to engage in the intervention. This perspective article describes the importance of motivating social influencers to engage in the desired health behaviors themselves and to promote it within their social network. We briefly describe the current state of knowledge and our empirical experience in implementing health interventions with social influencers. Using insights from self-determination theory, we demonstrate how social influencers can be motivated optimally in health behavior interventions and, thereby, improving the success of the intervention. To illustrate these insights and guide intervention practice, we provide concrete examples of techniques that can be applied in health interventions involving social influencers. We conclude with directions for further research and intervention practice to improve the delivery of health behavior interventions.

Identifying Determinants of Neuro-Enchancement Substance Use in Students

Abstract. Background: Use of Neuro-Enhancement Substances (NES) such as prescription drugs, illicit drugs, or alcohol to improve cognition, prosocial behavior, and performance is increasing among students. Aims: The study applied a multi-theory, integrated theoretical model to identify motivational and social cognition determinants of NES use among students. Methods: A prospective longitudinal design was adopted with 306 high school (66.8% female; Mage = 17.31 years, SD = 0.93) and 692 university (70.5% female; Mage = 24.97 years, SD = 6.64) students. They completed measures of motivation, social cognition constructs, and planning with respect to studying behavior and NES use. Results: Well-fitting structural equation models indicated the pervasive influence of autonomous motivation, attitudes, subjective norms, and perceived behavioral control for studying, as well as of attitudes, subjective norms, and perceived behavioral control for NES use. Inclusion of past NES use increased explained variance in NES use and attenuated model effects, but the pattern of effects remained. Multi-group analyses indicated consistency in the pattern model effects across high school and university students. Limitations: The study findings might not be generalizable, as student samples were not randomly recruited. Furthermore, NES use only relied on self-report, and its assessment did not consider different NES substances. Finally, there was no assessment of implicit attitudes and habits toward studying and NES use. Conclusions: Findings extend prior literature by demonstrating the integrated guiding view that students’ motivation and beliefs about studying influence their beliefs about and use of NES. Furthermore, the findings provide starting points for interventions targeting the reduction in NES use.

Advancing behavioral interventions for African American/Black and Latino persons living with HIV using a new conceptual model that integrates critical race theory, harm reduction, and self-determination theory: a qualitative exploratory study

BACKGROUND

Rates of participation in HIV care, medication uptake, and viral suppression are improving among persons living with HIV (PLWH) in the United States. Yet, disparities among African American/Black and Latino PLWH are persistent, signaling the need for new conceptual approaches. To address gaps in services and research (e.g., insufficient attention to structural/systemic factors, inadequate harm reduction services and autonomy support) and improve behavioral interventions, we integrated critical race theory, harm reduction, and self-determination theory into a new conceptual model, then used the model to develop a set of six intervention components which were tested in a larger study. The present qualitative study explores participants' perspectives on the study's acceptability, feasibility, and impact, and the conceptual model's contribution to these experiences.

METHODS

Participants in the larger study were African American/Black and Latino PLWH poorly engaged in HIV care and with non-suppressed HIV viral load in New York City (N = 512). We randomly selected N = 46 for in-depth semi-structured interviews on their experiences with and perspectives on the study. Interviews were audio-recorded and professionally transcribed verbatim, and data were analyzed using directed qualitative content analysis.

RESULTS

On average, participants were 49 years old (SD = 9) and had lived with HIV for 19 years (SD = 7). Most were male (78%) and African American/Black (76%). All had taken HIV medication previously. Challenging life contexts were the norm, including poverty, poor quality/unstable housing, trauma histories exacerbated by current trauma, health comorbidities, and substance use. Participants found the study highly acceptable. We organized results into four themes focused on participants' experiences of: 1) being understood as a whole person and in their structural/systemic context; 2) trustworthiness and trust; 3) opportunities for self-reflection; and 4) support of personal autonomy. The salience of nonjudgment was prominent in each theme. Themes reflected grounding in the conceptual model. Participants reported these characteristics were lacking in HIV care settings.

CONCLUSIONS

The new conceptual model emphasizes the salience of systemic/structural and social factors that drive health behavior and the resultant interventions foster trust, self-reflection, engagement, and behavior change. The model has potential to enhance intervention acceptability, feasibility, and effectiveness with African American/Black and Latino PLWH.

Effects of an Explicit Value Clarification Method With Computer-Tailored Advice on the Effectiveness of a Web-Based Smoking Cessation Decision Aid: Findings From a Randomized Controlled Trial

Background

Smoking continues to be a driver of mortality. Various forms of evidence-based cessation assistance exist; however, their use is limited. The choice between them may also induce decisional conflict. Offering decision aids (DAs) may be beneficial; however, insights into their effective elements are lacking.

Objective

This study tested the added value of an effective element (ie, an “explicit value clarification method” paired with computer-tailored advice indicating the most fitting cessation assistance) of a web-based smoking cessation DA.

Methods

A web-based randomized controlled trial was conducted among smokers motivated to stop smoking within 6 months. The intervention group received a DA with the aforementioned elements, and the control group received the same DA without these elements. The primary outcome measure was 7-day point prevalence abstinence 6 months after baseline (time point 3 [t=3]). Secondary outcome measures were 7-day point prevalence of abstinence 1 month after baseline (time point 2 [t=2]), evidence-based cessation assistance use (t=2 and t=3), and decisional conflict (immediately after DA; time point 1). Logistic and linear regression analyses were performed to assess the outcomes. Analyses were conducted following 2 (decisional conflict) and 3 (smoking cessation) outcome scenarios: complete cases, worst-case scenario (assuming that dropouts still smoked), and multiple imputations. A priori sample size calculation indicated that 796 participants were needed. The participants were mainly recruited on the web (eg, social media). All the data were self-reported.

Results

Overall, 2375 participants were randomized (intervention n=1164, 49.01%), of whom 599 (25.22%; intervention n=275, 45.91%) completed the DAs, and 276 (11.62%; intervention n=143, 51.81%), 97 (4.08%; intervention n=54, 55.67%), and 103 (4.34%; intervention n=56, 54.37%) completed time point 1, t=2, and t=3, respectively. More participants stopped smoking in the intervention group (23/63, 37%) than in the control group (14/52, 27%) after 6 months; however, this was only statistically significant in the worst-case scenario (crude P=.02; adjusted P=.04). Effects on the secondary outcomes were only observed for smoking abstinence after 1 month (15/55, 27%, compared with 7/46, 15%, in the crude and adjusted models, respectively; P=.02) and for cessation assistance uptake after 1 month (26/56, 46% compared with 18/47, 38% only in the crude model; P=.04) and 6 months (38/61, 62% compared with 26/50, 52%; crude P=.01; adjusted P=.02) but only in the worst-case scenario. Nonuse attrition was 34.19% higher in the intervention group than in the control group (P<.001).

Conclusions

Currently, we cannot confidently recommend the inclusion of explicit value clarification methods and computer-tailored advice. However, they might result in higher nonuse attrition rates, thereby limiting their potential. As a lack of statistical power may have influenced the outcomes, we recommend replicating this study with some adaptations based on the lessons learned.

Trial Registration

Netherlands Trial Register NL8270; https://www.trialregister.nl/trial/8270

International Registered Report Identifier (IRRID)

RR2-10.2196/21772

Parental Autonomy Support in the Context of Parent-Child Negotiation for Children's Independent Mobility: 'I Always Feel Safer With My Parents' to 'Boom! Bust Down Those Walls!'

Autonomy - acting volitionally with a sense of choice - is a crucial right for children. Given parents' pivotal position in their child's autonomy development, we examined how parental autonomy support and children's need for autonomy were negotiated and manifested in the context of children's independent mobility - children's ability to play, walk or cycle unsupervised. We interviewed 105 Canadian children between 10 and 13-years-old and their parents (n = 135) to examine child-parents' negotiation patterns as to children's independent mobility. Four patterns emerged, varying on parental autonomy support and children's need/motivation for independent mobility: (1) child/parent dyad wants to increase independent mobility; (2) child only wants to increase independent mobility while parents do not; (3) child does not want to increase independent mobility while parents do; and (4) child/parent dyad does not want to increase independent mobility. Findings illuminate the importance of recognizing children as active and capable agents of change.

Physical Activity, Healthy Behavior and Its Motivational Correlates: Exploring the Spillover Effect through Stages of Change

On the basis of the spillover or transfer effect and the transtheoretical model of change, this study assessed the association between amount of physical activity, healthy and unhealthy weight control behaviors, and motivational types, as well as their variability across stages of change. A total of 1219 randomly selected Mexican adults from 18 to 65 years old, representative of the city of Monterrey (México), participated in the study. Correlation analyses, differences by gender, and multivariate analyses of variance, controlling for age, were performed. We found that in the maintenance stage, there is higher frequency of physical activity more healthy weight control behaviors, as well as higher autonomous motivation. In the contemplation stage, there is less physical activity, a higher frequency of unhealthy weight control behaviors, higher controlled motivation, and amotivation. Relationships were found between the healthy behaviors studied and the interaction dynamics observed across the stages of change, highlighting the key role of the contemplation and maintenance stages in weight control change. Physical activity as a targeted intervention objective could be a gateway to healthier weight control behavior, as well as higher autonomous motivation.

Effects of remotely-delivered physical activity education on exercise beliefs and intentions of active and nonactive cancer survivors and their partners

Physical activity (PA) is recommended for cancer survivors and their romantic partners yet cancer couples may be unaware of the benefits of PA specific to them. Exercise interventions targeting survivors and partners simultaneously may prove effective at increasing exercise knowledge, intentions, and outcomes. To examine the effects of a remotely-delivered cancer-specific exercise education video on cancer survivors’ and their partners’ exercise knowledge, beliefs, and intentions. Cancer survivors (N = 209) and their romantic partners (N = 155) completed an online survey with an embedded education video randomized to half the sample. Group differences (education vs. control) on study constructs among the whole sample and on a subset of the sample not meeting exercise guidelines [i.e., less than 150 min of moderate to vigorous physical activity (MVPA) per week; 50.5% survivors, 45.1% partners] were examined. Group differences on study constructs were also tested between survivors and partners meeting exercise guidelines or not. Survivors and partners in the education condition were more likely to correctly report the MVPA guidelines. The education increased survivors’ personal exercise importance, outcome expectations, and likelihood of joining an individual exercise program. Participants meeting guidelines were significantly different on multiple exercise beliefs compared to those who were not. Among those not meeting guidelines, the education increased survivors’ belief in the importance of exercising with their partner. A remotely-delivered exercise education video increased exercise knowledge and beliefs, which represents an important step in the development of couples’ exercise interventions for cancer survivors and their romantic partners.

Optimising planned medical education strategies to develop learners' person-centredness: A realist review

CONTEXT

Person-centeredness is a stated aim for medical education; however, studies suggest this is not being achieved. There is a gap in our understanding of how, why and in what circumstances medical education interventions that aim to develop person-centredness are successful.

METHODS

A realist review was conducted with a search of Medline, Embase, HMIC and ERIC databases and the grey literature using the terms 'medical education' and 'person-centred' and related synonyms. Studies that involved a planned educational intervention in medical education with data on outcomes related to person-centredness were included. The analysis focused on how and why different educational strategies interact with biomedical learner perspectives to trigger mechanisms that may or may not lead to a change in perspective towards person-centredness.

RESULTS

Sixty-one papers representing fifty-three interventions were included in the final synthesis. Nine context-intervention-mechanism-outcome configuration (CIMOc) statements generated from the data synthesis make up our refined programme theory. Where educational interventions focused on communication skills learning or experiences without person-centred theory, learners experienced dissonance with their biomedical perspective which they resolved by minimising the importance of the learning, resulting in perspective endurance. Where educational interventions applied person-centred theory to meaningful experiences and included support for sense making, learners understood the relevance of person-centeredness and felt able to process their responses to learning, resulting in perspective transformation towards person-centredness.

CONCLUSION

Our findings offer explanations as to why communication skills-based interventions may be insufficient to develop learners' person-centredness. Integrating experiential person-centred learning with theory on why person-centredness matters to clinical practice and enabling learners to make sense of their responses to learning, may support perspective transformation towards person-centredness. Our findings offer programme and policymakers testable theory to inform the development of medical education strategies that aim to support person-centredness.

Using machine learning to identify important predictors of COVID-19 infection prevention behaviors during the early phase of the pandemic

Before vaccines for coronavirus disease 2019 (COVID-19) became available, a set of infection-prevention behaviors constituted the primary means to mitigate the virus spread. Our study aimed to identify important predictors of this set of behaviors. Whereas social and health psychological theories suggest a limited set of predictors, machine-learning analyses can identify correlates from a larger pool of candidate predictors. We used random forests to rank 115 candidate correlates of infection-prevention behavior in 56,072 participants across 28 countries, administered in March to May 2020. The machine-learning model predicted 52% of the variance in infection-prevention behavior in a separate test sample—exceeding the performance of psychological models of health behavior. Results indicated the two most important predictors related to individual-level injunctive norms. Illustrating how data-driven methods can complement theory, some of the most important predictors were not derived from theories of health behavior—and some theoretically derived predictors were relatively unimportant.

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We studied predictors of COVID-19 prevention behaviors in a cross-national study

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The strongest predictors related to injunctive norms

In the absence of a vaccine or cure, virus containment depended on individual-level compliance with behaviors recommended by the World Health Organization. We used machine learning to identify the most important indicators of compliance, based on a large international psychological survey and on country-level secondary data. The most important indicators were not the “usual suspects,” such as personal threat of virus infection, but rather injunctive norms—namely, the belief that one’s community should engage in such behavior and that society should take restrictive virus-containment measures. People who tend to engage in infection-prevention behaviors also tend to believe that general compliance is necessary to defeat the pandemic, which extends to endorsement of “ought” norms and support for behavioral mandates. These results highlight the potential to intervene by shaping social norms and expectations.

Adherence and satisfaction in Argus II prosthesis users: a self determination theory model

BACKGROUND

Self-determination theory (SDT) of human motivation was used to examine associations between different forms of motivation in Argus II retinal prosthesis users and their engagement and satisfaction with the Argus device.

MATERIALS AND METHODS

Nine subjects were administered: 1) a Situational Motivation Scale (SIMS) questionnaire to measure intrinsic motivation, identified regulation, external regulation, and amotivation, and 2) the Argus questionnaire (AQ) which was organized into 5 categories to measure 'Decision to get an Argus implant,' 'Self-perception as an Argus user', 'Utility of Argus,' 'Perceived competence,' and 'Family support.' Spearman correlations (r_s) were used to find associations between measures from SIMS and AQ.

RESULTS

Nine subjects completed both questionnaires. Statistically significant associations were observed between identified regulation and AQ items from categories: Decision to get Argus, Self-perception, Utility of Argus, and Perceived competence; and between intrinsic motivation and AQ items from Self-perception and Utility. External regulation was negatively associated with Family support, and amotivation was associated with one item from Self-perception. Engagement with the device and satisfaction were associated to both identified regulation and intrinsic motivation. There was no significant relationship between external regulation and adherence to the device.

CONCLUSIONS

The SDT model can be used to investigate the types of motivation that influence uptake and engagement of the Argus device. Clinicians can use this knowledge to improve outcomes by supporting confidence in users and by encouraging them to maintain internalization and continued commitment to adherence.

How supervisors can support employees' needs and motivation? an experimental study based on SDT

Supervisors and managers have an increasingly significant role in employees' motivation. The applied framework in this field research was the Self-Determination Theory (SDT). In this way, it was assessed that whether supervisors can be trained in order to support employees' basic psychological needs including autonomy, relatedness, and competence. As a result, their need satisfaction and autonomous motivation were promoted, at the same time, the controlled motivation and amotivation were reduced. The training was provided to 15 supervisors then employees' need satisfaction, amotivation, controlled motivation, and autonomous motivation were investigated, pre- and post-intrvention. Performing a multilevel regression analysis revealed that employees in the intervention group showed an increment in autonomous motivation and need satisfaction, as well as a significant reduction in amotivation than those of the control group. Furthermore, increasing autonomous motivation and decreasing amotivation were moderated via increasing need satisfaction. An added value has been provided for the mentioned theory on need satisfaction by the current study. It was also indicated that a relatively brief intervention for supervisors may affect creating employees need support, and autonomous motivation increment, and amotivation reduction.

The Psychometric Properties of the Behavioural Regulation in Exercise Questionnaire (BREQ-3): Factorial Structure, Invariance and Validity in the Italian Context

Background: Motivation to engage in physical activity plays a central role in ensuring the health of the population. The present study investigated the psychometric properties and validity in Italy of the Behavioral Regulation in Exercise Questionnaire (BREQ-3), a widely used instrument for assessing individuals’ motivation to exercise based on self-determination theory (SDT). Methods: A large sample (N = 2222; females = 55.4%; M_age = 36.4 years, SD_age = 13.9, min = 20, max = 69) of young people, and middle aged and older adults completed the Italian translation of the BREQ-3, also indicating their intentions to exercise in the following weeks. Results: Confirmatory factor analyses showed that the posited six-factor structure of the BREQ-3 fitted the data well (CFI = 0.96; RMSEA = 0.05; SRMR = 0.04) and provided evidence for full measurement invariance across gender and different age groups. The construct validity of the BREQ-3 was supported by the latent correlations among the subscales, which were consistent with the quasi-simplex pattern theorized by SDT. The overall level of self-determination and the intention to exercise were positively correlated, providing evidence for the criterion validity of the scale. Conclusions: The Italian version of the BREQ-3 has proved to be a reliable and valid instrument for measuring the behavioral regulation of exercise in individuals with different demographic characteristics.

Validity and Reliability of the Portuguese Version of the Healthy Lifestyle Questionnaire—EVS III

The main objective of this study was to validate the Healthy Lifestyle Questionnaire—EVS III, using confirmatory factor analysis of the measurement model. A total of 822 Portuguese individuals of both genders, aged between 18 and 66 years old (M = 28.43 SD = 12.07), participated in this study, of which 382 were male (46.5%) and 440 were female (53.5%). The main results obtained revealed that the psychometric qualities prove the adequacy of the factor structure of the Healthy Lifestyles Questionnaire—EVS III (7 factors/32 items) and that it has acceptable validity indices: χ² = 644.6828, p = 0.000, df = 168, χ²/df = 3.84, NFI = 0.901, TLI = 0.902, CFI = 0.921, IFI = 0.922, MFI = 0.900, GFI = 0.909, AGFI = 0.901, RMR = 0.073, SRMR = 0.059 and RMSEA = 0.059, enabling the assessment of factors related to a balanced diet, respect for mealtimes, tobacco consumption, alcohol consumption, consumption of other drugs, resting habits and physical activity habits. The Portuguese version of the Healthy Lifestyles Questionnaire—EVS III can be used with reasonable confidence for the assessment of healthy lifestyles.

Self-Leadership Practices of Nurse Educators at South African Nursing Education Institutions

Background:

Self-leadership has emerged as a leadership style that could be used to achieve successful performance for individuals and organisations, including higher education institutions. It is, however, not known how nurse educators perceive their self-leadership practices.

Objective:

To describe the self-leadership practices of nurse educators at nursing education institutions.

Methods:

This article reports the quantitative phase of a broader exploratory, descriptive, sequential mixed-method design study conducted with conveniently selected nurse educators (n=265) in two provinces in South Africa. Data were collected using a self-administered questionnaire.

Results:

Constructs found to be valid for self-leadership practices were autonomy-supportive environment, continuing professional development, role modelling, and shared leadership. Respondents perceived themselves to be engaged in self-leadership practices. The Cronbach alpha coefficient indicated the internal consistency of the constructs.

Conclusion:

Educational institutions should create environments that support autonomy and role modelling to facilitate the engagement of nurse educators in self-leadership practices.

The Role of Controlled Motivation in the Self-Esteem of Adolescent Students in Physical Education Classes

The aim of this cross-sectional study was to analyse the relationships between the satisfaction of psychological basic needs, physical education, academic controlling motivation, and self-esteem, and to propose a prediction model in line with the postulates from the hierarchical model found in the self-determination theory. The participants were 618 physical education students from primary and secondary school (317 girls and 301 boys) aged between 10 and 14 years old (M = 11.62; SD = 0.94). The questionnaires basic psychological needs in exercise measurement scale (BPNES), perceived locus of causality scale (PLOC), the academic motivation scale (EME), and physical self-perception profile (PSPP) were used to measure the studied variables. The results showed that autonomy and relatedness significantly and negatively predicted physical education controlling motivation, which predicted a positive and significant academic controlling motivation. This, in turn, negatively and significantly predicted self-esteem. It is concluded that it is essential to avoid controlling motivation to promote the development of a positive self-perception in students.

Advancing understanding of influences on cervical screening (non)-participation among younger and older women: A qualitative study using the theoretical domains framework and the COM-B model

BACKGROUND

Effective screening can prevent cervical cancer, but many women choose not to attend their screening tests.

OBJECTIVE

This study aimed to investigate behavioural influences on cervical screening participation using the Theoretical Domains Framework (TDF) and COM-B models of behaviour change.

DESIGN

A qualitative study and semistructured phone interviews were conducted with women invited for routine screening tests within the national cervical screening programme in Ireland.

SETTING AND PARTICIPANTS

Forty-eight women aged 25-65 years were recruited from the national screening register.

RESULTS

Seven core themes were identified that mapped to three COM-B components and 11 TDF domains: (1) knowledge of cervical cancer and screening, (2) coping with smear tests, (3) competing motivational processes-automatic and reflective, (4) cognitive resources, (5) role of social support, (6) environmental influences and (7) perceputal and practical influences. A range of knowledge about screening, perceived risk of cervical cancer and human papillomavirus infection was evident. Factors that influenced screening behaviours may be hierarchical-some were assigned greater importance than others. Positive screening behaviours were linked to autonomous motivation. Deficits in physical and psychological capability (inadequate coping skills) were barriers to screening, while physical and social opportunity (e.g. healthcare professional 'champions') could facilitate participation. Older women raised age-related issues (e.g. screening no longer necessary) and had more negative attitudes to screening, while younger women identified practical barriers.

CONCLUSIONS

This study provides insight into screening participation and will aid development of theoretically informed interventions to increase uptake.

PATIENT OR PUBLIC CONTRIBUTION

Women invited for screening tests through the national screening programme were interviewed. A Public & Patient Involvement (PPI) Panel, established to provide input into all CERVIVA research projects, advised the research team on recruitment materials and were given the opportunity to review and comment on the interview topic guide. This panel is made up of six women with various cervical screening histories and experiences.

Effects of a School-Based Intervention on Motivation for Out-of-School Physical Activity Participation

Purpose: We tested the effects of an autonomy-supportive intervention in physical education (PE) on high-school students' autonomous motivation in PE, and their autonomous motivation, intentions, and physical activity (PA) behavior in a leisure time guided by the trans-contextual model. Method: PE classes in two schools were assigned to receive either an autonomy-supportive intervention and/or a control intervention via random allocation by the school. The PE teacher of the school assigned to the autonomy-supportive intervention was trained to provide autonomy support while the PE teacher of the school assigned to the control intervention received no training. Students (N = 256) in all classes completed measures of perceived teacher autonomy support, autonomous motivation in PE and leisure time, and beliefs, intentions, and PA in leisure time before and immediately after the intervention. Results: Results revealed direct effects of the autonomy-supportive intervention on changes in perceived autonomy support. However, there were no direct intervention effects on change in intentions and PA behavior. The intervention also had indirect effects on changes in autonomous motivation in PE and leisure time. Additionally, change in perceived autonomy support had direct effects on change in autonomous motivation in PE and indirect effects on change in leisure-time autonomous motivation. Changes in autonomous motivation in leisure time had direct effects on changes in beliefs and indirect effects on changes in intentions and PA behavior through changes in beliefs. Conclusion: The study provides valuable information on the effect of autonomous supportive climate on students' beliefs toward PA in PE lessons and in their leisure time outside of school.

Improving the Safety-Performance Nexus: A Study on the Moderating and Mediating Influence of Work Motivation in the Causal Link between Occupational Health and Safety Management (OHSM) Practices and Work Performance in the Oil and Gas Sector

The preventive systems required to ensure workers are protected from occupational accidents and injuries dwell heavily on effective occupational health and safety management (OHSM) systems and practices. In this study, the concepts of the job demand-resource model (JD-R), self-determination theory (SDT), and perceived organizational support for safety (POSS) theory were adopted to develop a holistic conceptual model that seeks to unravel moderating and mediating effects of work motivation on the causal link between OHSM practices and work performance in the oil and gas sector. The study measured OHSM practices from six distinct safety dimensional perspectives and work performance using a two-dimensional distinct construct that assesses different aspects of positive work behaviours. A quantitative research approach through the structural equation modelling analysis technique was applied. A total of 1310 participants were selected across three major organizations that represent downstream, upstream, and middle stream of the Ghanaian oil and gas sector. Respondents were recruited through stratified, purposive, and convenient sampling techniques. The findings from the path estimate through the SEM analysis suggested that OHSM practices positively and significantly influenced both safety performance and task performance of employees. However, OHSM practices indicated a higher positive significant influence on task performance than safety performance. The significant influence of OHSM practices on both task and safety performance was significantly moderated and partially mediated by work motivation, while both task performance and safety performance were significantly determined by work motivation. In this study, the dimensions for assessing work performance extend the performance theories established in previous literature, whereas the integrated multifaceted OHSM practices employed diverge from the traditional individualistic approach by providing insights into more flexible managerial practices that are employee-centred and outcome-oriented. The findings from this study address the need for organizations to appreciate the importance of managing workers’ perception of OHSM practices as a motivational drive that induces work performance.

Mechanisms of Action in a Behavioral Weight-Management Program: Latent Growth Curve Analysis

Background

A greater understanding of the mechanisms of action of weight-management interventions is needed to inform the design of effective interventions.

Purpose

To investigate whether dietary restraint, habit strength, or diet self-regulation mediated the impact of a behavioral weight-management intervention on weight loss and weight loss maintenance.

Methods

Latent growth curve analysis (LGCA) was conducted on trial data in which adults (N = 1,267) with a body mass index (BMI) ≥28 kg/m² were randomized to either a brief intervention (booklet on losing weight), a 12 week weight-management program or the same program for 52 weeks. LGCA estimated the trajectory of the variables over four time points (baseline and 3, 12 and 24 months) to assess whether potential mechanisms of action mediated the impact of the weight-management program on BMI.

Results

Participants randomized to the 12 and 52 week programs had a significantly greater decrease in BMI than the brief intervention. This direct effect became nonsignificant when dietary restraint, habit strength, and autonomous diet self-regulation were controlled for. The total indirect effect was significant for both the 12 (estimate = −1.33, standard error [SE] = 0.41, p = .001) and 52 week (estimate = −2.13, SE = 0.52, p < .001) program. Only the individual indirect effect for dietary restraint was significant for the 12 week intervention, whereas all three indirect effects were significant for the 52 week intervention.

Conclusions

Behavior change techniques that target dietary restraint, habit strength, and autonomous diet self-regulation should be considered when designing weight loss and weight loss maintenance interventions. Longer interventions may need to target both deliberative and automatic control processes to support successful weight management.

Development and Validation of the Diet-Related Beliefs of Exercisers Scale

Many exercise-based weight-loss interventions result in considerably less weight loss than predicted. One possible explanation could be that people have certain beliefs about the interplay of exercise and food that also influence their eating behavior, such as the belief that food is a reward for exercise. The current research outlines a systematic multiphase process to develop a psychometrically sound scale to assess these beliefs. In Study 1, regular exercisers (N = 520) completed an exploratory questionnaire on their beliefs related to diet and exercise. In Study 2 (N = 380), the factor structure of the newly developed scale was corroborated by confirmatory factor analysis. In addition, a test-retest (N = 166) was used to confirm reliability and stability. In sum, the Diet-Related Beliefs of Exercisers Scale with its four subscales ("Refrain from Eating," "Food as Reward," "Healthy Eating," and "Nutritional Replenishment") represents a valid and reliable measure of exercisers' diet-related beliefs.

Healthy and binge eating behaviours: the motivational processes underlying peer pressure

The WHOunderlined the importance of a healthy diet for the psychophysical well-being of the person. Self Determination Theory highlighted how the interaction between contextual, such as peer pressure, and motivational factors play a fundamental role in promoting healthy eating habits. The present study aims to assess if peer pressure affects eating habits and binge eating through the mediation of motivation. Questionnaires were administered to 588 young-adults aged between 18 and 24 years (M = 20.56, DS = 1.78) in the Italian context. Results suggest that Peer Pressure predicted Controlled Motivation and Autonomous Motivation, and that motivation predicted Eating Behaviors and Binge Eating. In addition, Peer Pressure also has a direct effect on Binge Eating. The results confirm the importance of investigating contextual and motivational factors in the area of prevention and intervention in eating habits.

Patient Perspectives on Hospital Falls Prevention Education

Hospital falls remain an intractable problem worldwide and patient education is one approach to falls mitigation. Although educating patients can help their understanding of risks and empower them with prevention strategies, patient experiences of hospital falls education are poorly understood. This study aimed to understand the perspectives and preferences of hospitalized patients about falls prevention education. Three focus groups were conducted in Australian hospitals. A phenomenological approach was used to explore patient perspectives and data were analyzed thematically. The focus groups revealed that most people did not realize their own risk of falling whilst an inpatient. Experiences of falls prevention education were inconsistent and sometimes linked to beliefs that falls were not relevant to them because they were being cared for in hospital. Other barriers to falls mitigation included poor patient knowledge about hospital falls risk and inconsistencies in the delivery of falls prevention education. A strong theme was that individualized, consistent education, and small interactive groups were helpful.

Does stress attenuate motivation for healthful eating in pregnancy and postpartum?

Despite high motivation for healthful eating during pregnancy, maternal diet quality is inadequate. During pregnancy, women may relax effortful control over eating to reduce stress; thus, stress may override motivation to eat healthfully. This secondary analysis of data from the Pregnancy Eating Attributes Study longitudinal cohort investigated associations of motivation for healthful eating and perceived stress with diet quality during pregnancy (n = 365) and postpartum (n = 266), and investigated whether stress modifies associations of motivation with diet quality. Women (M_age = 31.3; gestational age ≤ 12 weeks) were recruited from the Chapel Hill, North Carolina area and completed multiple 24-h diet recalls (once each trimester of pregnancy, and at 4-6 weeks, 6 months, and 1 year postpartum) and validated measures of perceived stress and motivation for healthful eating (autonomous and controlled). Hierarchical multiple regressions tested associations of diet quality (Healthy Eating Index-2015) with stress, motivation, and their interactions. Additionally, themes extracted from previously-analyzed focus groups conducted with a subsample of participants were re-examined for content relevant to stress, motivation, and diet. Pregnancy and postpartum diet quality was positively associated with autonomous motivation, but was unassociated with controlled motivation and stress. Interaction terms did not appreciably improve model fit. Focus group participants described both internal and external forces contributing to their motivation for healthy eating during pregnancy and described the impact of stress on eating behaviors through amplification of food cravings. Future research is needed to identify influences on maternal motivation for healthful eating.

The impact of cognitive impairment on self-regulatory styles in breast cancer survivors

OBJECTIVE

Cognitive impairment (CI) is highly prevalent in breast cancer survivors (BCS), and can be a barrier to health-promoting behaviours. However, the ways in which CI may affect self-regulation or motivation to perform such behaviours have not been explored. We assessed if BCS with CI report greater extrinsic self-regulation compared to those without CI and if this relationship persists after controlling for depression.

METHODS

We recruited BCS with diabetes and assessed cognition and motivation to perform healthy diabetes management behaviours (e.g., diet and exercise). Participants completed a cognitive battery evaluating attention, working memory, executive functioning (EF), processing speed (PS), language and memory. The Treatment Self-Regulation Questionnaire (TSRQ) assessed intrinsic versus extrinsic motivation. Depression was determined by a score ≥16 on the Center for Epidemiological Studies Depression Scale. Wilcoxon rank-sum test compared associations between CI and TSRQ scores.

RESULTS

Participants were 118 older adults (mean age 65 years). Participants with CI in the following domains had higher extrinsic self-regulation scores compared to those without CI: attention (p < 0.01), PS (p = 0.01), EF (p < 0.01), language (p = 0.02; p = 0.04) and memory (p = 0.04; p = 0.03). After adjusting for depression, the relationship between CI and higher extrinsic self-regulation scores remained significant.

CONCLUSIONS

BCS with CI appear to rely more on external sources of motivation to perform health behaviours, regardless of depression. Future studies and interventions to improve health behaviours should consider screening for CI and involving caregivers for those with CI to improve outcomes.

Promoting water consumption among Dutch children: an evaluation of the social network intervention Share H2O

Background

There is a need to develop and improve interventions promoting healthy drinking behaviors among children. A promising method could be to stimulate peer influence within children’s social networks. In the Share H₂O social network intervention (SNI), peer influence was utilized by selecting a subset of influential children and training them as ‘influence agents’ to promote water consumption—as an alternative to SSBs. Previous research has mainly focused on the process of selecting influence agents. However, the process of motivating influence agents to promote the behavior has hardly received any research attention. Therefore, in the SNI Share H₂O SNI, this motivation process was emphasized and grounded in the self-determination theory (SDT). This study evaluated the implementation of the Share H₂O SNI, focusing on whether and how applying SDT-based techniques can motivate the influence agents and, indirectly, their peers.

Methods

This study included data collected in the Netherlands from both the influence agents (n = 37) and the peers (n = 112) in the classroom networks of the influence agents.

Self-reported measurements assessed the influence agents’ enjoyment of the training, duration and perceived autonomy support during the training, and changes in their intrinsic motivation and water consumption before and after the start of the intervention. Changes in the peers’ intrinsic motivation, perceived social support, and social norms were measured before and after the start of the intervention.

Results

The influence agents enjoyed the training, the duration was adequate, and perceived it as autonomy supportive. There was an increase in the influence agents’ intrinsic motivation to drink water and their actual water consumption. Providing personal meaningful rationales seemed to have motivated the influence agents. The intrinsic motivation and perceived descriptive norm of the peers remained stable. The peers reported an increase in their perceived social support and injunctive norm concerning water drinking after the intervention. Influence agents appeared to mainly use face-to-face strategies, such as modeling, talking to peers, and providing social support to promote the behavior.

Conclusions

The current findings provided preliminary evidence of the promising effects of using SDT-based techniques in an SNI to motivate the influence agents and, indirectly, their peers.

Trial registration

NTR, NL6905, Registered 9 January 2018, https://www.trialregister.nl/trial/6905