A Systematic Review and Meta-analysis of the Outcome Expectancy Construct in Physical Activity Research

Making it transparent: A worked example of articulating programme theory for a digital health application using Intervention Mapping

Objective

Digital health interventions for behaviour change are usually complex interventions, and intervention developers should 'articulate programme theory', that is, they should offer detailed descriptions of individual intervention components and their proposed mechanisms of action. However, such detailed descriptions often remain lacking. The objective of this work was to provide a conceptual case study with an applied example of 'articulating programme theory' for a newly developed digital health intervention.

Methods

Intervention Mapping methodology was applied to arrive at a detailed description of programme theory for a newly developed digital health intervention that aims to support cardiac rehabilitation patients in establishing heart-healthy physical activity habits. Based on a Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) logic model of the problem, a logic model of change was developed. The proposed mechanisms of action were visualised in an acyclic behaviour change diagram.

Results

Programme theory for this digital health intervention includes 4 sub-behaviours of the main target behaviour (i.e. habitual heart-healthy physical activity), 8 personal determinants and 12 change objectives (i.e. changes needed at the determinant level to achieve the sub-behaviours). These are linked to 12 distinct features of the digital health intervention and 12 underlying behaviour change methods.

Conclusions

This case study offers a worked example of articulating programme theory for a digital health intervention using Intervention Mapping. Intervention developers and researchers may draw on this example to replicate the method, or to reflect on most suitable approaches for their own behaviour change interventions.

A meta-theoretical framework for organizing and integrating theory and research on motivation for health-related behavior

The concept of motivation is broad and multi-faceted. In health psychology, motivation has been conceptualized as cravings, urges, or desires for unhealthy behaviors, such as consumption of alcohol, cigarettes, or calorie-dense foods; or as behavioral intentions or proximal goals for healthy behaviors, such as smoking cessation, physical activity, or condom use. Because of the differences in terminology and associated theoretical underpinnings, it is difficult to characterize the state of the science or integrate research findings on motivation for health-related behavior. The present paper introduces a meta-theoretical Automatic-Reflective Motivation Framework (ARM-F) with the goals of organizing and integrating theory and research on motivation for health-related behaviors. At the first and broadest level, the ARM-F defines general motivation as a wanting or desire to do something. At the second level, it distinguishes between automatic and reflective motivation types, consistent with emerging perspectives in health psychology, historical and contemporary philosophical views on desire, and dual-processing perspectives in psychology. At the third level, the ARM-F preserves the nuanced terminologies and conceptualizations within the automatic (e.g., craving, urge, desire) and reflective (e.g., behavioral intention) motivation categories. The ARM-F has potential utility for organizing and integrating theory and research on motivation for health-related behavior, with implications for future research.

Multi-Process Action Control in Physical Activity: A Primer

The gap between the decision to engage in physical activity and subsequent behavioral enactment is considerable for many. Action control theories focus on this discordance in an attempt to improve the translation of intention into behavior. The purpose of this mini-review was to overview one of these approaches, the multi-process action control (M-PAC) framework, which has evolved from a collection of previous works. The main concepts and operational structure of M-PAC was overviewed followed by applications of the framework in physical activity, and concluded with unanswered questions, limitations, and possibilities for future research. In M-PAC, it is suggested that three layered processes (reflective, regulatory, reflexive) build upon each other from the formation of an intention to a sustained profile of physical activity action control. Intention-behavior discordance is because of strategic challenges in goal pursuit (differences in outcome vs. behavioral goals; balancing multiple behavioral goals) and automatic tendencies (approach-avoidance, conservation of energy expenditure). Regulatory processes (prospective and reactive tactics) are employed to hold the relationship between reflective processes and behavior concordant by countering these strategic challenges and automatic tendencies until the development of reflexive processes (habit, identity) begin to co-determine action control. Results from 29 observational and preliminary experimental studies generally support the proposed M-PAC framework. Future research is needed to explore the temporal dynamic between reflexive and regulatory constructs, and implement M-PAC interventions in different forms (e.g., mobile health), and at different levels of scale (clinical, group, population).