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Kalantzi V, Tsiampalis T, Kouvari M, Belitsi V, Zairis A, Migdanis A, Papadopoulou SK, Bonoti F, Panagiotakos DB, Kosti RI. Exploring the Role of Self-Efficacy in Maintaining Healthy Lifestyle Habits among Patients with Cardiometabolic Diseases; Findings from the Multi-Center IACT Cross-Sectional Study. Life (Basel) 2024; 14:736. [PMID: 38929719 PMCID: PMC11204498 DOI: 10.3390/life14060736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/01/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
(1) Background: Cardiometabolic disease progression can be delayed if patients engage in healthy lifestyle behaviors, adherence to which is highly influenced by psychosocial factors. The present study aimed at investigating the association of self-efficacy with the adherence level to healthy lifestyle behaviors among patients with cardiometabolic diseases in Greece. (2) Methods: 1988 patients (1180 females) with cardiometabolic diseases participated. Anthropometric, demographic, socioeconomic, clinical, and lifestyle characteristics were recorded. Patients were also asked to evaluate their efficacy to comply with healthy lifestyle behaviors. (3) Results: The majority exhibited unhealthy lifestyle behaviors. A subgroup demonstrated elevated self-efficacy in maintaining healthy habits despite facing diverse psychosocial challenges. Individuals with higher educational attainment, socioeconomic status, and rural/semi-urban residency had significantly elevated self-efficacy. Those with heightened self-efficacy exhibited significantly lower BMI and reduced prevalence of certain health conditions. Self-efficacy significantly influenced adherence to the Mediterranean diet, physical activity engagement, and smoking cessation, even in challenging circumstances. (4) Conclusions: This study represented an innovative approach in examining the role of self-efficacy in shaping health behaviors and outcomes within a Greek population. By integrating specific psychosocial circumstances into the analysis, valuable insights were provided into the contextual factors influencing self-efficacy and adherence to healthy lifestyle behaviors.
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Affiliation(s)
- Vasiliki Kalantzi
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece; (V.K.); (T.T.); (M.K.); (V.B.); (A.M.); (F.B.)
| | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece; (V.K.); (T.T.); (M.K.); (V.B.); (A.M.); (F.B.)
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece;
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece; (V.K.); (T.T.); (M.K.); (V.B.); (A.M.); (F.B.)
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece;
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
| | - Vasiliki Belitsi
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece; (V.K.); (T.T.); (M.K.); (V.B.); (A.M.); (F.B.)
| | - Antonios Zairis
- Department of Economics and Business, School of Economics, Business and Computer Sciences, Neapolis University, Paphos 8042, Cyprus;
| | - Athanasios Migdanis
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece; (V.K.); (T.T.); (M.K.); (V.B.); (A.M.); (F.B.)
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece;
| | - Fotini Bonoti
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece; (V.K.); (T.T.); (M.K.); (V.B.); (A.M.); (F.B.)
| | - Demosthenes B. Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece;
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
| | - Rena I. Kosti
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece; (V.K.); (T.T.); (M.K.); (V.B.); (A.M.); (F.B.)
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2
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Vilaro MJ, Bryan E, Palani T, Cooks EJ, Mertens G, Zalake M, Lok BC, Krieger JL. Rural adults' perceptions of nutrition recommendations for cancer prevention: Contradictory and conflicting messages. PREVENTIVE ONCOLOGY & EPIDEMIOLOGY 2023; 1:2237680. [PMID: 38390218 PMCID: PMC10883477 DOI: 10.1080/28322134.2023.2237680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Despite robust evidence linking alcohol, processed meat, and red meat to colorectal cancer (CRC), public awareness of nutrition recommendations for CRC prevention is low. Marginalized populations, including those in rural areas, experience high CRC burden and may benefit from culturally tailored health information technologies. This study explored perceptions of web-based health messages iteratively in focus groups and interviews with 48 adults as part of a CRC prevention intervention. We analyzed transcripts for message perceptions and identified three main themes with subthemes: (1) Contradictory recommendations, between the intervention's nutrition risk messages and recommendations for other health conditions, from other sources, or based on cultural or personal diets; (2) reactions to nutrition risk messages, ranging from aversion (e.g., "avoid alcohol" considered "preachy") to appreciation, with suggestions for improving messages; and (3) information gaps. We discuss these themes, translational impact, and considerations for future research and communication strategies for delivering web-based cancer prevention messages.
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Affiliation(s)
| | - Emma Bryan
- STEM Translational Communication Center, University of Florida
| | - Te Palani
- STEM Translational Communication Center, University of Florida
| | - Eric J Cooks
- STEM Translational Communication Center, University of Florida
| | - Gillian Mertens
- STEM Translational Communication Center, University of Florida
- Literacy Department, SUNY Cortland
| | - Mohan Zalake
- Computer and Information Sciences and Engineering, University of Florida
| | - Benjamin C Lok
- Computer and Information Sciences and Engineering, University of Florida
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Gray KE, Hoerster KD, Taylor L, Krieger J, Nelson KM. Improvements in physical activity and some dietary behaviors in a community health worker-led diabetes self-management intervention for adults with low incomes: results from a randomized controlled trial. Transl Behav Med 2021; 11:2144-2154. [PMID: 34424331 PMCID: PMC8670415 DOI: 10.1093/tbm/ibab113] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
People with low incomes have a disproportionate prevalence of diabetes and its complications and experience many barriers to self-management, which community health workers (CHWs) may help address. We sought to examine the effects of an in-home CHW-led intervention for adults with diabetes and incomes <250% of the federal poverty line on self-management behaviors and test mediators and moderators. From 2010 to 2013, we randomized participants from three Washington State health systems with type 2 diabetes and hemoglobin A1c (HbA1c) ≥ 8% to the CHW intervention (N = 145) or usual care control (N = 142) arms. We examined effects on 12-month self-management: physical activity, dietary behaviors, medication taking, blood glucose monitoring, foot care, and tobacco use. For behaviors with significant intervention-control group differences, we tested mediation by self-efficacy and social support. We also investigated whether intervention-associated changes in behaviors varied by race/ethnicity, gender, and baseline values of HbA1c, diabetes distress, depression, and food insecurity (moderators). Compared to controls, intervention participants engaged in more physical activity and reported better dietary behaviors for some measures (general diet, frequency of skipping meals, and frequency of eating out) at 12-months, but there was no evidence of mediation by self-efficacy or social support. Evidence of moderation was limited: improvements in the frequency of skipping meals were restricted to participants with baseline HbA1c < 10%. Study findings suggest CHWs could be integrated into diabetes care to effectively support lifestyle changes around physical activity and some eating behaviors among adults with low incomes. More research is needed to understand mechanisms of change.
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Affiliation(s)
- Kristen E Gray
- Department of Veterans Affairs, Health Services Research & Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Katherine D Hoerster
- Department of Veterans Affairs, Health Services Research & Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
- Mental Health Service, VA Puget Sound Healthcare System, Seattle Division, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Leslie Taylor
- Department of Veterans Affairs, Health Services Research & Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
| | - James Krieger
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Healthy Food America, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Karin M Nelson
- Department of Veterans Affairs, Health Services Research & Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- General Internal Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA
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4
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Pitpitan EV, MacKinnon DP, Eaton LA, Smith LR, Wagman J, Patterson TL. Using Novel Approaches to Evaluate Behavioral Interventions: Overlooked Significant HIV Prevention Effects in the HPTN 015 Project EXPLORE. J Acquir Immune Defic Syndr 2021; 87:1128-1135. [PMID: 33901103 PMCID: PMC8496973 DOI: 10.1097/qai.0000000000002711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 04/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mediated and moderated processes that lead to intervention efficacy may underlie results of trials ruled as nonefficacious. The overall purpose of this study was to examine such processes to explain the findings of one of the largest, rigorously conducted behavioral intervention randomized controlled trials, EXPLORE. METHODS Four thousand two hundred ninety-five HIV-negative men who have sex with men (MSM) in the United States were randomized in a 2-armed trial. Participants completed follow-up and an HIV test every 6 months up to 48 months. We used multiple and causal mediation analyses to test 5 mediators, including safer sex self-efficacy and condomless receptive anal sex with HIV-positive or status-unknown partners on our primary outcome (HIV seroconversion). We also examined whether intervention effects on the mediators would be moderated by robust correlates of HIV among MSM, including stimulant use. RESULTS There were significant effects of the intervention on all hypothesized mediators. Stimulant use moderated the effect on condomless receptive anal sex In stratified multiple mediation models, we found that among MSM with low stimulant use, the intervention significantly prevented HIV by reducing condomless receptive anal sex with HIV-positive or status-unknown partners. Among MSM with higher stimulant use, there were no indirect effects of the intervention on HIV through any of the hypothesized mediators. CONCLUSION The results suggest that the null effect found in the original EXPLORE trial might have occurred as a function of previously unexplored mediated and moderated processes. This study illustrates the value of testing mediated and moderated pathways in randomized trials, even in trials ruled out as nonefficacious.
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O'Connor EA, Evans CV, Rushkin MC, Redmond N, Lin JS. Behavioral Counseling to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2020; 324:2076-2094. [PMID: 33231669 DOI: 10.1001/jama.2020.17108] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Cardiovascular disease is the leading cause of death in the US, and poor diet and lack of physical activity are major factors contributing to cardiovascular morbidity and mortality. OBJECTIVE To review the benefits and harms of behavioral counseling interventions to improve diet and physical activity in adults with cardiovascular risk factors. DATA SOURCES MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through September 2019; literature surveillance through July 24, 2020. STUDY SELECTION English-language randomized clinical trials (RCTs) of behavioral counseling interventions to help people with elevated blood pressure or lipid levels improve their diet and increase physical activity. DATA EXTRACTION AND SYNTHESIS Data were extracted from studies by one reviewer and checked by a second. Random-effects meta-analysis and qualitative synthesis were used. MAIN OUTCOMES AND MEASURES Cardiovascular events, mortality, subjective well-being, cardiovascular risk factors, diet and physical activity measures (eg, minutes of physical activity, meeting physical activity recommendations), and harms. Interventions were categorized according to estimated contact time as low (≤30 minutes), medium (31-360 minutes), and high (>360 minutes). RESULTS Ninety-four RCTs were included (N = 52 174). Behavioral counseling interventions involved a median of 6 contact hours and 12 sessions over the course of 12 months and varied in format and dietary recommendations; only 5% addressed physical activity alone. Interventions were associated with a lower risk of cardiovascular events (pooled relative risk, 0.80 [95% CI, 0.73-0.87]; 9 RCTs [n = 12 551]; I2 = 0%). Event rates were variable; in the largest trial (Prevención con Dieta Mediterránea [PREDIMED]), 3.6% in the intervention groups experienced a cardiovascular event, compared with 4.4% in the control group. Behavioral counseling interventions were associated with small, statistically significant reductions in continuous measures of blood pressure, low-density lipoprotein cholesterol levels, fasting glucose levels, and adiposity at 12 to 24 months' follow-up. Measurement of diet and physical activity was heterogeneous, and evidence suggested small improvements in diet consistent with the intervention recommendation targets but mixed findings and a more limited evidence base for physical activity. Adverse events were rare, with generally no group differences in serious adverse events, any adverse events, hospitalizations, musculoskeletal injuries, or withdrawals due to adverse events. CONCLUSIONS AND RELEVANCE Medium- and high-contact multisession behavioral counseling interventions to improve diet and increase physical activity for people with elevated blood pressure and lipid levels were effective in reducing cardiovascular events, blood pressure, low-density lipoproteins, and adiposity-related outcomes, with little to no risk of serious harm.
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Affiliation(s)
- Elizabeth A O'Connor
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Corinne V Evans
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan C Rushkin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Mo J, Thomson CA, Sun V, Wendel CS, Hornbrook MC, Weinstein RS, Ercolano E, Grant M, Cidav Z, McCorkle RC, Krouse RS. Healthy behaviors are associated with positive outcomes for cancer survivors with ostomies: a cross-sectional study. J Cancer Surviv 2020; 15:461-469. [PMID: 32940890 PMCID: PMC7965775 DOI: 10.1007/s11764-020-00940-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/05/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cancer survivors (CS) with ostomies may face challenges in sustaining physical activity (PA) levels and maintaining healthy diets. This analysis describes lifestyle behaviors and their relationships with health-related quality of life (HRQOL) in CS with ostomies. METHODS This is a cross-sectional, secondary analysis of a multisite randomized self-management education trial for CS with ostomies. The baseline self-reported measures were queried on aerobic PA and diet using the City of Hope Quality of Life Ostomy measure, and the Self-Efficacy to Perform Self-Management Behaviors questionnaire (SE). PA was compared against the American Cancer Society PA guidelines for CS. Relationships between PA and HRQOL were evaluated using multiple linear regression, stratified by BMI. RESULTS Among 200 responders, fewer than 20% met or exceeded the PA guideline for cancer survivors; overall, confidence in the ability to perform gentle or aerobic PA was moderate (6/10 on the SE). Overall HRQOL (p = 0.038), psychological well-being (p = 0.017), and physical strength (p = 0.025) were associated with increased PA. Almost half (48.7%) of CS reported a special diet. CS with urostomies were less likely to report diet adjustments after their ostomy surgeries (OR: 0.16, 95% CI [0.08-0.38]) than CS with fecal ostomies. CONCLUSIONS Better HRQOL is associated with PA guideline achievement among CS with ostomies. Additionally, diet adjustments were reported more frequently in CS with fecal ostomies. Our findings bear clinical relevance for designing ostomy self-management and lifestyle recommendations for CS with ostomies. IMPLICATIONS FOR CANCER SURVIVORS The evaluation of lifestyle behaviors may be an especially important focus for CS with ostomies.
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Affiliation(s)
- Julia Mo
- Department of Surgery, University of Pennsylvania, 3400 Spruce St., 4 Silverstein, Philadelphia, PA, 19104, USA
| | - Cynthia A Thomson
- Mel & Enid Zuckerman College of Public Health and University of Arizona Cancer Center, Tucson, AZ, USA
| | - Virginia Sun
- Division of Nursing Research and Education, City of Hope, Duarte, CA, USA
| | | | - Mark C Hornbrook
- Center for Health Research, Kaiser Permanente, Portland, OR, USA
| | | | | | - Marcia Grant
- Division of Nursing Research and Education, City of Hope, Duarte, CA, USA
| | - Zuleyha Cidav
- Center for Mental Health, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Robert S Krouse
- Department of Surgery, University of Pennsylvania, 3400 Spruce St., 4 Silverstein, Philadelphia, PA, 19104, USA.
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7
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Castillo-Mayén R, Cano-Espejo C, Luque B, Cuadrado E, Gutiérrez-Domingo T, Arenas A, Rubio SJ, Delgado-Lista J, Pérez-Martínez P, Tabernero C. Influence of Self-Efficacy and Motivation to Follow a Healthy Diet on Life Satisfaction of Patients with Cardiovascular Disease: A Longitudinal Study. Nutrients 2020; 12:E1903. [PMID: 32605026 PMCID: PMC7400119 DOI: 10.3390/nu12071903] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 12/12/2022] Open
Abstract
Today, cardiovascular disease has a great impact on the global population due to its high prevalence. One challenge that cardiovascular patients face to achieve a better prognosis is to follow a healthy diet. This study focused on psychological factors linked to adaptation to a healthy diet in these patients. The main objective was to analyze the interrelationship between motivation to follow a healthy diet and self-efficacy to adhere to the Mediterranean diet with life satisfaction over time. The sample consisted of cardiovascular patients who were assessed at three measurement moments (NT1 = 755; NT2 = 593; NT3 = 323, average interval time: nine months). Correlation analyses showed that self-efficacy, motivation, and life satisfaction followed a pattern of positive relations across the three measurements. A time effect over the study variables was also observed. The results of path analyses showed that self-efficacy positively predicted autonomous motivation, which in turn was associated with patients' life satisfaction. This interrelation was stable over a period of 18 months. Moreover, life satisfaction predicted self-efficacy nine months later. Psychological interventions might be a positive resource for cardiovascular patients, since psychological variables influence their life satisfaction and their subsequent quality of life in their new health condition.
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Affiliation(s)
- Rosario Castillo-Mayén
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (E.C.); (T.G.-D.); (A.A.); (S.J.R.); (J.D.-L.); (P.P.-M.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain;
| | | | - Bárbara Luque
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (E.C.); (T.G.-D.); (A.A.); (S.J.R.); (J.D.-L.); (P.P.-M.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain;
| | - Esther Cuadrado
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (E.C.); (T.G.-D.); (A.A.); (S.J.R.); (J.D.-L.); (P.P.-M.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain;
| | - Tamara Gutiérrez-Domingo
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (E.C.); (T.G.-D.); (A.A.); (S.J.R.); (J.D.-L.); (P.P.-M.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain;
| | - Alicia Arenas
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (E.C.); (T.G.-D.); (A.A.); (S.J.R.); (J.D.-L.); (P.P.-M.)
- Department of Psychology, University of Seville, 41018 Seville, Spain
| | - Sebastián J. Rubio
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (E.C.); (T.G.-D.); (A.A.); (S.J.R.); (J.D.-L.); (P.P.-M.)
- Department of Didactics of Experimental Sciences, University of Cordoba, 14071 Cordoba, Spain
| | - Javier Delgado-Lista
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (E.C.); (T.G.-D.); (A.A.); (S.J.R.); (J.D.-L.); (P.P.-M.)
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Reina Sofia University Hospital, 14004 Córdoba, Spain
- Department of Medicine (Medicine, Dermatology and Otorhinolaryngology), University of Cordoba, 14004 Cordoba, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28007 Madrid, Spain
| | - Pablo Pérez-Martínez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (E.C.); (T.G.-D.); (A.A.); (S.J.R.); (J.D.-L.); (P.P.-M.)
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Reina Sofia University Hospital, 14004 Córdoba, Spain
- Department of Medicine (Medicine, Dermatology and Otorhinolaryngology), University of Cordoba, 14004 Cordoba, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28007 Madrid, Spain
| | - Carmen Tabernero
- Instituto de Neurociencias de Castilla y León (INCYL), University of Salamanca, 37007 Salamanca, Spain
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Röhr S, Löbner M, Gühne U, Heser K, Kleineidam L, Pentzek M, Fuchs A, Eisele M, Kaduszkiewicz H, König HH, Brettschneider C, Wiese B, Mamone S, Weyerer S, Werle J, Bickel H, Weeg D, Maier W, Scherer M, Wagner M, Riedel-Heller SG. Changes in Social Network Size Are Associated With Cognitive Changes in the Oldest-Old. Front Psychiatry 2020; 11:330. [PMID: 32431627 PMCID: PMC7212889 DOI: 10.3389/fpsyt.2020.00330] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/02/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Social isolation is increasing in aging societies and several studies have shown a relation with worse cognition in old age. However, less is known about the association in the oldest-old (85+); the group that is at highest risk for both social isolation and dementia. METHODS Analyses were based on follow-up 5 to 9 of the longitudinal German study on aging, cognition, and dementia in primary care patients (AgeCoDe) and the study on needs, health service use, costs, and health-related quality of life in a large sample of oldest-old primary care patients (AgeQualiDe), a multi-center population-based prospective cohort study. Measurements included the Lubben Social Network Scale (LSNS-6), with a score below 12 indicating social isolation, as well as the Mini-Mental Status Examination (MMSE) as an indicator of cognitive function. RESULTS Dementia-free study participants (n = 942) were M = 86.4 (SD = 3.0) years old at observation onset, 68.2% were women. One third (32.3%) of them were socially isolated. Adjusted linear hybrid mixed effects models revealed significantly lower cognitive function in individuals with smaller social networks (β = 0.5, 95% CI = 0.3-0.7, p < .001). Moreover, changes in an individual's social network size were significantly associated with cognitive changes over time (β = 0.2, 95% CI = 0.1-0.4, p = .003), indicating worse cognitive function with shrinking social networks. CONCLUSION Social isolation is highly prevalent among oldest-old individuals, being a risk factor for decreases in cognitive function. Consequently, it is important to maintain a socially active lifestyle into very old age. Likewise, this calls for effective ways to prevent social isolation.
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Affiliation(s)
- Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Uta Gühne
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Kathrin Heser
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Luca Kleineidam
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany.,DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Michael Pentzek
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Angela Fuchs
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Marion Eisele
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgitt Wiese
- Work Group Medical Statistics and IT-Infrastructure, Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Silke Mamone
- Work Group Medical Statistics and IT-Infrastructure, Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty, Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty, Mannheim/Heidelberg University, Mannheim, Germany
| | - Horst Bickel
- Department of Psychiatry, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dagmar Weeg
- Department of Psychiatry, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wolfgang Maier
- DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Psychiatry, University of Bonn, Bonn, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Wagner
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany.,DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
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Newby K, Teah G, Cooke R, Li X, Brown K, Salisbury-Finch B, Kwah K, Bartle N, Curtis K, Fulton E, Parsons J, Dusseldorp E, Williams SL. Do automated digital health behaviour change interventions have a positive effect on self-efficacy? A systematic review and meta-analysis. Health Psychol Rev 2019; 15:140-158. [PMID: 31847702 DOI: 10.1080/17437199.2019.1705873] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Self-efficacy is an important determinant of health behaviour. Digital interventions are a potentially acceptable and cost-effective way of delivering programmes of health behaviour change at scale. Whether behaviour change interventions work to increase self-efficacy in this context is unknown. This systematic review and meta-analysis sought to identify whether automated digital interventions are associated with positive changes in self-efficacy amongst non-clinical populations for five major health behaviours, and which BCTs are associated with that change. A systematic literature search identified 20 studies (n = 5624) that assessed changes in self-efficacy and were included in a random-effects meta-analysis. Interventions targeted: healthy eating (k = 4), physical activity (k = 9), sexual behaviour (k = 3) and smoking (k = 4). No interventions targeting alcohol use were identified. Overall, interventions had a small, positive effect on self-efficacy (g¯=0.190,CI[0.078;0.303]). The effect of interventions on self-efficacy did not differ as a function of health behaviour type (Q-between = 7.3704, p = .061, df = 3). Inclusion of the BCT 'information about social and environmental consequences' had a small, negative effect on self-efficacy (Δg¯=-0.297,Q=7.072,p=.008). Whilst this review indicates that digital interventions can be used to change self-efficacy, which techniques work best in this context is not clear.
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Affiliation(s)
- Katie Newby
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
| | - Grace Teah
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
| | - Richard Cooke
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Xinru Li
- Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Katherine Brown
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
| | | | - Kayleigh Kwah
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
| | - Naomi Bartle
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
| | - Kristina Curtis
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
| | - Emmie Fulton
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
| | - Joanne Parsons
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
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Leung AWY, Chan RSM, Sea MMM, Woo J. Identifying psychological predictors of adherence to a community-based lifestyle modification program for weight loss among Chinese overweight and obese adults. Nutr Res Pract 2019; 13:415-424. [PMID: 31583061 PMCID: PMC6760981 DOI: 10.4162/nrp.2019.13.5.415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/11/2019] [Accepted: 07/18/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/OBJECTIVES Existing evidence on lifestyle modification programs for weight loss is limited by the high attrition rate of such programs. Identifying predictors of adherence to a lifestyle modification program could result in program improvement. However, little is known about behavior-specific adherence and its psychological predictors. This study aimed to examine the psychological predictors of adherence after one-month participation in a community-based lifestyle modification program among Chinese overweight and obese adults in Hong Kong. SUBJECTS/METHODS A total of 205 Chinese overweight and obese adults aged 38.9 ± 10.5 years completed the study. Data were collected at baseline and after one month using self-reported questionnaires, which assessed knowledge (self-developed scale), motivation (Treatment Self-Regulation Questionnaire), stage of change (Stage of Exercise Scale) and self-efficacy (Self-Rated Abilities for Health Practices Scale). At one month, a 4-day dietary recall and the International Physical Activity Questionnaire-Short Form were used to assess dietary and physical activity (PA) adherence. Food and PA diaries were examined to indicate self-monitoring. Program attendance was tracked between baseline and one-month follow-up. RESULTS After one month, participants reported high dietary adherence, attendance, and adherence to self-monitoring but low PA adherence. Multiple regression analyses suggested that diet self-efficacy (baseline) and nutrition knowledge (one-month change) were independent predictors of dietary adherence score at one month, whereas autonomous PA motivation (baseline) and PA self-efficacy (both baseline and one-month change) were independent predictors of PA adherence score at one month. No significant psychological predictor was identified for attendance or self-monitoring. CONCLUSIONS The results suggest that the effect of psychological factors on adherence differs between diet and PA adherence outcomes. To promote adherence, practitioners should assess self-efficacy, knowledge, and motivation at the beginning of a weight-loss program and explore behavior-specific strategies to improve knowledge and self-efficacy. The results of this study have direct implications for program improvements.
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Affiliation(s)
- Alice Wai Yi Leung
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ruth Suk Mei Chan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Centre for Nutritional Studies, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Mandy Man Mei Sea
- Centre for Nutritional Studies, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Centre for Nutritional Studies, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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11
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Hunter RF, Gough A, Murray JM, Tang J, Brennan SF, Chrzanowski-Smith OJ, Carlin A, Patterson C, Longo A, Hutchinson G, Prior L, Tully MA, French DP, Adams J, McIntosh E, Xin Y, Kee F. A loyalty scheme to encourage physical activity in office workers: a cluster RCT. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background
Increasing physical activity in the workplace can provide physical and mental health benefits for employees and economic benefits for the employer through reduced absenteeism and increased productivity. However, there is limited evidence on effective behaviour change interventions in workplace settings that led to maintained physical activity. This study aimed to address this gap and contribute to the evidence base for effective and cost-effective workplace interventions.
Objectives
To determine the effectiveness and cost-effectiveness of the Physical Activity Loyalty scheme, a multicomponent intervention based on concepts similar to those that underpin a high-street loyalty card, which was aimed at encouraging habitual physical activity behaviour and maintaining increases in mean number of steps per day.
Design
A cluster randomised controlled trial with an embedded economic evaluation, behavioural economic experiments, mediation analyses and process evaluation.
Setting
Office-based employees from public sector organisations in Belfast and Lisburn city centres in Northern Ireland.
Participants
A total of 853 participants [mean age 43.6 years (standard deviation 9.6 years); 71% of participants were female] were randomly allocated by cluster to either the intervention group or the (waiting list) control group.
Intervention
The 6-month intervention consisted of financial incentives (retail vouchers), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of the workplaces allowed participants to monitor their accumulated minutes of physical activity.
Main outcome measures
The primary outcome was mean number of steps per day recorded using a sealed pedometer (Yamax Digiwalker CW-701; Yamax, Tasley, UK) worn on the waist for 7 consecutive days and at 6 and 12 months post intervention. Secondary outcomes included health, mental well-being, quality of life, work absenteeism and presenteeism, and the use of health-care resources.
Results
The mean number of steps per day were significantly lower for the intervention group than the control group [6990 mean number of steps per day (standard deviation 3078) vs. 7576 mean number of steps per day (standard deviation 3345), respectively], with an adjusted mean difference of –336 steps (95% confidence interval –612 to –60 steps; p = 0.02) at 6 months post baseline, but not significantly lower at 12 months post baseline. There was a small but significant enhancement of mental well-being in the intervention group (difference between groups for the Warwick–Edinburgh Mental Wellbeing Scale of 1.34 points, 95% confidence interval 0.48 to 2.20 points), but not for the other secondary outcomes. An economic evaluation suggested that, overall, the scheme was not cost-effective compared with no intervention. The intervention was £25.85 (95% confidence interval –£29.89 to £81.60) more costly per participant than no intervention and had no effect on quality-adjusted life-years (incremental quality-adjusted life-years –0.0000891, 95% confidence interval –0.008 to 0.008).
Limitations
Significant restructuring of participating organisations during the study resulted in lower than anticipated recruitment and retention rates. Technical issues affected intervention fidelity.
Conclusions
Overall, assignment to the intervention group resulted in a small but significant decline in the mean pedometer-measured steps per day at 6 months relative to baseline, compared with the waiting list control group. The Physical Activity Loyalty scheme was deemed not to be cost-effective compared with no intervention, primarily because no additional quality-adjusted life-years were gained through the intervention. Research to better understand the mechanisms of physical activity behaviour change maintenance will help the design of future interventions.
Trial registration
Current Controlled Trials ISRCTN17975376.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ruth F Hunter
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Aisling Gough
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Jennifer M Murray
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Jianjun Tang
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| | - Sarah F Brennan
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | | | | | - Chris Patterson
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Alberto Longo
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - George Hutchinson
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - Lindsay Prior
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Mark A Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, UK
| | - David P French
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Jean Adams
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Yiqiao Xin
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
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12
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Jo G, Rossow-Kimball B, Lee Y. Effects of 12-week combined exercise program on self-efficacy, physical activity level, and health related physical fitness of adults with intellectual disability. J Exerc Rehabil 2018; 14:175-182. [PMID: 29740549 PMCID: PMC5931151 DOI: 10.12965/jer.1835194.597] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/04/2018] [Indexed: 11/23/2022] Open
Abstract
The current study examined the effects of an exercise program on health related physical fitness, self-efficacy, and physical activity levels in adults with intellectual disability. The study used pre- and posttest experimental research design with a control group. Total of 23 adults with intellectual disability were recruited with 12 assigned for the exercise group and 11 for the control group, separately. The measures of health related physical fitness included cardio pulmonary endurance (step-test), body composition (bioelectrical impedance analysis), flexibility (sit and reach), muscle endurance (sit-up), and strength (hand grip strength). Self-efficacy was measured using the physical self-efficacy scale. Accelerometers were used to measure physical activity levels. All variables were measured and evaluated twice at baseline and at the end of the program. The exercise program consisted of band exercises and rhythmic activity for 90 min, twice per week for 12 weeks. After the intervention, significant improvements were found in the experimental group in muscle endurance, self-efficacy, and physical activity levels. An exercise program may be recommended as a nonpharmaceutical method to improve the health of adults with intellectual disabilities.
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Affiliation(s)
- Garam Jo
- Department of Physical Education, Seoul National University, Seoul, Korea
| | | | - Yongho Lee
- Department of Physical Education, Seoul National University, Seoul, Korea
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13
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Harris BS, Melton B, Bland H, Carpentier A, Gonzales J, Catenacci K. Enhancing Psychosocial Constructs Associated with Technology-Based Physical Activity: A Randomized Trial Among African American Women. AMERICAN JOURNAL OF HEALTH EDUCATION 2018. [DOI: 10.1080/19325037.2017.1414642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Sweeney AM, Wilson DK, Lee Van Horn M. Longitudinal relationships between self-concept for physical activity and neighborhood social life as predictors of physical activity among older African American adults. Int J Behav Nutr Phys Act 2017; 14:67. [PMID: 28532489 PMCID: PMC5440960 DOI: 10.1186/s12966-017-0523-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/11/2017] [Indexed: 12/25/2022] Open
Abstract
Background Engaging in regular physical activity (PA) as an older adult has been associated with numerous physical and mental health benefits. The aim of this study is to directly compare how individual-level cognitive factors (self-efficacy for PA, self-determined motivation for PA, self-concept for PA) and neighborhood perceptions of the social factors (neighborhood satisfaction, neighborhood social life) impact moderate-to-vigorous physical activity (MVPA) longitudinally among older African American adults. Methods Data were analyzed from a sub-set of older African American adults (N = 224, Mage = 63.23 years, SD = 8.74, 63.23% female, MBody Mass Index = 32.01, SD = 7.52) enrolled in the Positive Action for Today’s Health trial. MVPA was assessed using 7-day accelerometry-estimates and psychosocial data (self-efficacy for PA, self-determined motivation for PA, self-concept for PA, neighborhood satisfaction, neighborhood social life) were collected at baseline, 12-, 18-, and 24-months. Results Multilevel growth modeling was used to examine within- and between-person effects of individual-level cognitive and social environmental factors on MVPA. At the between-person level, self-concept (b = 0.872, SE = 0.239, p < 0.001), and neighborhood social life (b = 0.826, SE = 0.176, p < 0.001) predicted greater MVPA, whereas neighborhood satisfaction predicted lower MVPA (b = −0.422, SE = 0.172, p = 0.015). Among the between-person effects, only average social life was moderated by time (b = 0.361, SE = 0.147, p = 0.014), indicating that the impact of a relatively positive social life on MVPA increased across time. At the within-person level, positive increases in self-concept (b = 0.294, SE = 0.145, p = 0.043) and neighborhood social life (b = 0.270, SE = 0.113, p = 0.017) were associated with increased MVPA. Conclusions These results suggest that people with a higher average self-concept for PA and a more positive social life engaged in greater average MVPA. Additionally, changes in perceptions of one’s neighborhood social life and one’s self-concept for PA were associated with greater MVPA over 2 years. These factors may be particularly relevant for future interventions targeting long-term change and maintenance of MVPA in older African Americans. Trial registration ClinicalTrials.Gov #NCT01025726 registered 1 December 2009.
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Affiliation(s)
- Allison M Sweeney
- Department of Psychology, University of South Carolina, 1233 Washington Street, 9th Floor, Columbia, SC, 29208, USA.
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, 1233 Washington Street, 9th Floor, Columbia, SC, 29208, USA
| | - M Lee Van Horn
- Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, NM, 87131, USA
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15
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Physical activity maintenance among Spanish-speaking Latinas in a randomized controlled trial of an Internet-based intervention. J Behav Med 2016; 40:392-402. [PMID: 27752866 DOI: 10.1007/s10865-016-9800-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022]
Abstract
Spanish-speaking Latinas have some of the lowest rates of meeting physical activity guidelines in the U.S. and are at high risk for many related chronic diseases. The purpose of the current study was to examine the maintenance of a culturally and individually-tailored Internet-based physical activity intervention for Spanish-speaking Latinas. Inactive Latinas (N = 205) were randomly assigned to a 6-month Tailored Physical Activity Internet Intervention or a Wellness Contact Control Internet Group, with a 6-month follow-up. Maintenance was measured by assessing group differences in minutes per week of self-reported and accelerometer measured moderate to vigorous physical activity (MVPA) at 12 months after baseline and changes in MVPA between the end of the active intervention (month 6) and the end of the study (month 12). Potential moderators of the intervention were also examined. Data were collected between 2011 and 2014, and were analyzed in 2015 at the University of California, San Diego. The Intervention Group engaged in significantly more minutes of MVPA per week than the Control Group at the end of the maintenance period for both self-reported (mean diff. = 30.68, SE = 11.27, p = .007) and accelerometer measured (mean diff. = 11.47, SE = 3.19, p = .01) MVPA. There were no significant between- or within-group changes in MVPA from month 6 to 12. Greater intervention effects were seen for those with lower BMI (BMI × intervention = -6.67, SE = 2.88, p = .02) and lower perceived places to walk to in their neighborhood (access × intervention = -43.25, SE = 19.07, p = .02), with a trend for less family support (social support × intervention = -3.49, SE = 2.05, p = .08). Acculturation, health literacy, and physical activity related psychosocial variables were not significant moderators of the intervention effect during the maintenance period. Findings from the current study support the efficacy of an Internet-delivered individually tailored intervention for maintenance of MVPA gains over time.
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16
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Hartman SJ, Dunsiger SI, Marinac CR, Marcus BH, Rosen RK, Gans KM. Internet-based physical activity intervention for women with a family history of breast cancer. Health Psychol 2016; 34S:1296-304. [PMID: 26651471 DOI: 10.1037/hea0000307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Physical inactivity is a modifiable risk factor for breast cancer. Physical activity interventions that can be delivered through the Internet have the potential to increase participant reach. The efficacy of an Internet-based physical activity intervention was tested in a sample of women at an elevated risk for breast cancer. METHOD A total of 55 women with at least 1 first-degree relative with breast cancer (but no personal history of breast cancer) were randomized to a 3-month theoretically grounded Internet-based physical activity intervention or an active control arm. Minutes of moderate to vigorous physical activity, psychosocial mediators of physical activity adoption and maintenance, as well as worry and perceived risk of developing breast cancer were assessed at baseline, 3-month, and 5-month follow up. RESULTS Participants were on average 46.2 (SD = 11.4) years old with a body mass index of 27.3 (SD = 4.8) kg/m2. The intervention arm significantly increased minutes of moderate to vigorous physical activity compared to the active control arm at 3 months (213 vs. 129 min/week) and 5 months (208 vs. 119 min/week; both ps < .001). Regression models indicated that participants in the intervention had significantly higher self-efficacy for physical activity at 3 months (p < .01) and borderline significantly higher self-efficacy at 5 months (p = .05). Baseline breast cancer worry and perceived risk were not associated with physical activity. CONCLUSION Findings from this study suggest that an Internet-based physical activity intervention may substantially increase physical activity in women with a family history of breast cancer.
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Affiliation(s)
- Sheri J Hartman
- Department of Family Medicine and Public Health and Moores Cancer Center, University of California, San Diego
| | - Shira I Dunsiger
- Centers for Behavioral and Preventive Medicine, Miriam Hospital, Brown University
| | | | - Bess H Marcus
- Department of Family Medicine and Public Health, University of California, San Diego
| | - Rochelle K Rosen
- Centers for Behavioral and Preventive Medicine, Miriam Hospital, Brown University
| | - Kim M Gans
- Department of Human Development and Family Studies, University of Connecticut
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17
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Nastaskin RS, Fiocco AJ. A survey of diet self-efficacy and food intake in students with high and low perceived stress. Nutr J 2015; 14:42. [PMID: 25902797 PMCID: PMC4416420 DOI: 10.1186/s12937-015-0026-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 04/08/2015] [Indexed: 11/24/2022] Open
Abstract
Objective Given the rise in obesity and obesity-related disorders, understanding the relationship between stress, self-efficacy and food choice in young adulthood may have implications for preventing negative health outcomes later in life that stem from poor eating habits. The current study examined whether stress levels and diet self-efficacy may be associated with unhealthy eating habits in young adults. Methods Male and female undergraduate students (N = 136) completed questionnaires that tap into diet self-efficacy (DSE), perceived stress (PS), sodium, and fat intake. Sex differences in choice of food were predicted, and low levels of perceived stress and high diet self-efficacy were expected to be associated with lower fat and sodium intake. Results Findings indicate an interaction between perceived stress and diet self-efficacy on fat intake and a main effect for diet self-efficacy on sodium intake in this population. As expected, low levels of perceived stress and high diet self-efficacy were associated with the lowest levels of fat and sodium intake in students. Findings were driven by females. Conclusions This study provides preliminary evidence that diet self-efficacy and perceived stress levels relate to nutrient intake in young adult females, and that increasing diet self-efficacy and reducing perceived stress in young adult females may lead to reductions in fat and sodium intake, leading to healthier eating habits.
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Affiliation(s)
- Robyn S Nastaskin
- Ryerson University, 350 Victoria Street, M5B 2K3, Toronto, Ontario, Canada.
| | - Alexandra J Fiocco
- Ryerson University, 350 Victoria Street, M5B 2K3, Toronto, Ontario, Canada.
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Teixeira PJ, Carraça EV, Marques MM, Rutter H, Oppert JM, De Bourdeaudhuij I, Lakerveld J, Brug J. Successful behavior change in obesity interventions in adults: a systematic review of self-regulation mediators. BMC Med 2015; 13:84. [PMID: 25907778 PMCID: PMC4408562 DOI: 10.1186/s12916-015-0323-6] [Citation(s) in RCA: 365] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/11/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Relapse is high in lifestyle obesity interventions involving behavior and weight change. Identifying mediators of successful outcomes in these interventions is critical to improve effectiveness and to guide approaches to obesity treatment, including resource allocation. This article reviews the most consistent self-regulation mediators of medium- and long-term weight control, physical activity, and dietary intake in clinical and community behavior change interventions targeting overweight/obese adults. METHODS A comprehensive search of peer-reviewed articles, published since 2000, was conducted on electronic databases (for example, MEDLINE) and journal reference lists. Experimental studies were eligible if they reported intervention effects on hypothesized mediators (self-regulatory and psychological mechanisms) and the association between these and the outcomes of interest (weight change, physical activity, and dietary intake). Quality and content of selected studies were analyzed and findings summarized. Studies with formal mediation analyses were reported separately. RESULTS Thirty-five studies were included testing 42 putative mediators. Ten studies used formal mediation analyses. Twenty-eight studies were randomized controlled trials, mainly aiming at weight loss or maintenance (n = 21). Targeted participants were obese (n = 26) or overweight individuals, aged between 25 to 44 years (n = 23), and 13 studies targeted women only. In terms of study quality, 13 trials were rated as "strong", 15 as "moderate", and 7 studies as "weak". In addition, methodological quality of formal mediation analyses was "medium". Identified mediators for medium-/long-term weight control were higher levels of autonomous motivation, self-efficacy/barriers, self-regulation skills (such as self-monitoring), flexible eating restraint, and positive body image. For physical activity, significant putative mediators were high autonomous motivation, self-efficacy, and use of self-regulation skills. For dietary intake, the evidence was much less clear, and no consistent mediators were identified. CONCLUSIONS This is the first systematic review of mediational psychological mechanisms of successful outcomes in obesity-related lifestyle change interventions. Despite limited evidence, higher autonomous motivation, self-efficacy, and self-regulation skills emerged as the best predictors of beneficial weight and physical activity outcomes; for weight control, positive body image and flexible eating restraint may additionally improve outcomes. These variables represent possible targets for future lifestyle interventions in overweight/obese populations.
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Affiliation(s)
- Pedro J Teixeira
- Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.
| | - Eliana V Carraça
- Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.
| | - Marta M Marques
- Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.
| | - Harry Rutter
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK.
| | - Jean-Michel Oppert
- Department of Nutrition Pitié-Salpetrière (AP-HP), Université Pierre et Marie Curie-Paris 6, Paris, France.
- UREN (Nutritional Epidemiology Research Unit), Université Paris 13, Sorbonne Paris Cité, Inserm (U557), Inra (U1125), Cnam, F-93017, Bobigny, France.
| | | | - Jeroen Lakerveld
- Department of General Practice and Elderly Care, The EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
| | - Johannes Brug
- Department of Epidemiology and Biostatistics, The EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
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McVay MA, King HA, Jeffreys AS, Coffman CJ, Voils CI. Mechanisms of patient health behavior change in a randomized controlled trial of a spouse-assisted intervention. PSYCHOL HEALTH MED 2015; 20:753-66. [PMID: 25774698 DOI: 10.1080/13548506.2015.1020817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Spouse-assisted interventions can improve health behaviors, but mechanisms of action are unknown. This study evaluated mediators of dietary and physical activity outcomes during a spouse-assisted intervention to improve low-density lipoprotein cholesterol. This is a secondary analysis of data from a randomized controlled trial comparing usual care (n = 128) to a spouse-assisted lifestyle change intervention (n = 127) comprising nine monthly goal setting telephone calls to participants and support planning calls to spouses over 11 months. Structural equation modeling was used to examine if the intervention influenced the putative mediators of participant self-efficacy and perceived spousal support at 6 months (i.e. action test); if changes in putative mediators at 6 months were associated with changes in diet and physical activity outcomes at 11 months (i.e. conceptual test); and if treatment condition effects on outcomes at 11 months were mediated by its effects on the 6-month putative mediators (i.e. indirect effects test). Participants were 94.9% male, 64.9% white and were 61.3 years old on average. The action test showed that the intervention increased dietary self-efficacy (p < .001) and perceived spousal support for diet (p < .001) and physical activity (p < .01) at 6 months. The conceptual test showed that increases in participant physical activity self-efficacy at 6 months were associated with increases in physical activity frequency (p = .01) and duration (p = .04) at 11 months; other putative mediators were not associated with changes in outcomes at 11 months. The indirect effects tests did not support a mediating role for self-efficacy or perceived spousal support. Intervention-induced changes in spousal support and dietary self-efficacy did not translate into behavior change. Other mechanisms may be driving behavior change.
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Affiliation(s)
- Megan A McVay
- a Center for Health Services Research in Primary Care , Durham VA Medical Center , Durham , NC 27705 , USA
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Wilson K, Senay I, Durantini M, Sánchez F, Hennessy M, Spring B, Albarracín D. When it comes to lifestyle recommendations, more is sometimes less: a meta-analysis of theoretical assumptions underlying the effectiveness of interventions promoting multiple behavior domain change. Psychol Bull 2015; 141:474-509. [PMID: 25528345 PMCID: PMC4801324 DOI: 10.1037/a0038295] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A meta-analysis of 150 research reports summarizing the results of multiple behavior domain interventions examined theoretical predictions about the effects of the included number of recommendations on behavioral and clinical change in the domains of smoking, diet, and physical activity. The meta-analysis yielded 3 main conclusions. First, there is a curvilinear relation between the number of behavioral recommendations and improvements in behavioral and clinical measures, with a moderate number of recommendations producing the highest level of change. A moderate number of recommendations is likely to be associated with stronger effects because the intervention ensures the necessary level of motivation to implement the recommended changes, thereby increasing compliance with the goals set by the intervention, without making the intervention excessively demanding. Second, this curve was more pronounced when samples were likely to have low motivation to change, such as when interventions were delivered to nonpatient (vs. patient) populations, were implemented in nonclinic (vs. clinic) settings, used lay community (vs. expert) facilitators, and involved group (vs. individual) delivery formats. Finally, change in behavioral outcomes mediated the effects of number of recommended behaviors on clinical change. These findings provide important insights that can help guide the design of effective multiple behavior domain interventions.
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Jemmott JB, Stephens-Shields A, O'Leary A, Jemmott LS, Teitelman A, Ngwane Z, Mtose X. Mediation of effects of a theory-based behavioral intervention on self-reported physical activity in South African men. Prev Med 2015; 72:1-7. [PMID: 25565482 PMCID: PMC4351128 DOI: 10.1016/j.ypmed.2014.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 12/22/2014] [Accepted: 12/26/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Increasing physical activity is an important public-health goal worldwide, but there are few published mediation analyses of physical-activity interventions in low-to-middle-income countries like South Africa undergoing a health transition involving markedly increased mortality from non-communicable diseases. This article reports secondary analyses on the mediation of a theory-of-planned-behavior-based behavioral intervention that increased self-reported physical activity in a trial with 1181 men in Eastern Cape Province, South Africa. METHOD Twenty-two matched-pairs of neighborhoods were randomly selected. Within pairs, neighborhoods were randomized to a health-promotion intervention or an attention-matched control intervention with baseline, immediate-post, and 6- and 12-month post-intervention assessments. Theory-of-planned-behavior constructs measured immediately post-intervention were tested as potential mediators of the primary outcome, self-reported physical activity averaged over the 6- and 12-month post-intervention assessments, using a product-of-coefficients approach in a generalized-estimating-equations framework. Data were collected in 2007-2010. RESULTS Attitude, subjective norm, self-efficacy, and intention were significant mediators of intervention-induced increases in self-reported physical activity. The descriptive norm, not affected by the intervention, was not a mediator, but predicted increased self-reported physical activity. CONCLUSION The results suggest that interventions targeting theory-of-planned-behavior constructs may contribute to efforts to increase physical activity to reduce the burden of non-communicable diseases among South African men.
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Affiliation(s)
- John B Jemmott
- Department of Psychiatry, Perelman School of Medicine and Annenberg School for Communication, University of PA, USA.
| | - Alisa Stephens-Shields
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of PA, USA
| | - Ann O'Leary
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, USA
| | | | | | | | - Xoliswa Mtose
- Faculty of Education, University of Fort Hare, Alice, South Africa
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Derman EW, Patel DN, Nossel CJ, Schwellnus MP. Healthy lifestyle interventions in general practice. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2008.10873732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Belem da Silva CT, Schuch F, Costa M, Hirakata V, Manfro GG. Somatic, but not cognitive, symptoms of anxiety predict lower levels of physical activity in panic disorder patients. J Affect Disord 2014; 164:63-8. [PMID: 24856555 DOI: 10.1016/j.jad.2014.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 04/09/2014] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Anxiety disorders have gathered much attention as possible risk factors for the development of cardiovascular disease (CVD), possibly mediated by an unhealthy lifestyle (e.g. low physical activity). However, prospective studies on anxiety disorders and CVD show conflicting results. A possible explanation is that somatic symptoms of anxiety may have a more specific cardiovascular effect than cognitive symptoms across different anxiety disorders. The present study investigated the association between cognitive and somatic symptoms of anxiety and physical activity (PA) in a sample of panic disorder (PD) outpatients. METHODS One-hundred and two outpatients with a lifetime diagnosis of PD from a previously studied cohort were contacted. Patients were evaluated throughout the MINI, the Beck Anxiety Inventory (BAI) and the International Physical Activity Questionnaire (IPAQ). After performing a multivariate regression analysis, groups were divided into high and low somatic anxiety. RESULTS Patients with high somatic anxiety showed a significantly higher prevalence of low level of PA as compared to those with low somatic anxiety (62.5 versus 34.3%; χ²= 5.33; df=1; P=.021). Somatic symptoms of anxiety remained the only important predictors of low level of PA (odds ratio [OR] 2.81; 95% CI 1.00-7.90; p=.050) in the multivariate model. LIMITATIONS The main limitations of the present study are the cross-sectional design and the small sample size. CONCLUSIONS Results support specific effects of somatic symptoms of anxiety on risk for low level of PA, which might explain inconsistent results regarding CVD risk in the literature.
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Affiliation(s)
- Cristiano Tschiedel Belem da Silva
- Anxiety Disorders Outpatient Program, Hospital de Clínicas de Porto Alegre (HCPA), Department of Psychiatry, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Brazil; Post-graduation Program in Medical Sciences: Psychiatry, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Brazil.
| | - Felipe Schuch
- Anxiety Disorders Outpatient Program, Hospital de Clínicas de Porto Alegre (HCPA), Department of Psychiatry, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Brazil; Post-graduation Program in Medical Sciences: Psychiatry, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Brazil
| | - Marianna Costa
- Anxiety Disorders Outpatient Program, Hospital de Clínicas de Porto Alegre (HCPA), Department of Psychiatry, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Brazil
| | - Vania Hirakata
- Biostatistics Unit, Hospital de Clínicas de Porto Alegre (HCPA), Brazil
| | - Gisele Gus Manfro
- Anxiety Disorders Outpatient Program, Hospital de Clínicas de Porto Alegre (HCPA), Department of Psychiatry, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Brazil; Post-graduation Program in Medical Sciences: Psychiatry, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Brazil
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Janssen I, Dugan SA, Karavolos K, Lynch EB, Powell LH. Correlates of 15-year maintenance of physical activity in middle-aged women. Int J Behav Med 2014; 21:511-8. [PMID: 23813123 PMCID: PMC4267878 DOI: 10.1007/s12529-013-9324-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Interventions to increase sustained physical activity are needed and should be based on proven theories. PURPOSE To gain a better understanding of the correlates of sustained physical activity in midlife women, we used longitudinal epidemiologic data to investigate links between sustained physical activity and constructs advocated by three basic behavioral and social science theories: (1) self-determination, (2) social cognitive, and (3) social networks. A random sample of 90 midlife women, stratified by level of physical activity over 15 years, was selected from the Chicago cohort of the Longitudinal Study of Women's Health Across the Nation (SWAN). METHODS Using data on self-reported physical activity collected over 15 years, women were categorized into consistently active, sporadically active, and sedentary. New data were collected on theory-relevant constructs, i.e., autonomous motivation (assessed by the Treatment Self-Regulation Questionnaire) and self-efficacy (assessed by the Self-Efficacy and Exercise Habits Survey). Every SWAN woman identified a close female friend who also completed the physical activity questionnaire. RESULTS SWAN women with higher autonomous motivation (p = 0.002) and higher self-efficacy (p < 0.001) were more likely to be consistently physically active in analyses adjusted for age, race, and socioeconomic status. Sixty-one percent of SWAN women with a history of consistent physical activity had a friend who is currently highly active, versus 38 and 23 % for sporadically active and sedentary women, respectively (test for trend p = 0.008). CONCLUSION In midlife women, constructs advocated by basic behavioral and social science theories were consistent with long-term patterns of physical activity behavior. Special focus should be given to these basic theories in the design of interventions to promote sustained physical activity in mid-life women.
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Affiliation(s)
- Imke Janssen
- Department of Preventive Medcine, Rush University Medical Center, Chicago, IL 60612, Phone: 312-942-8122, FAX: 312 942 8119,
| | - Sheila A. Dugan
- Department of Preventive Medcine, Rush University Medical Center, Chicago, IL 60612, Phone: 312-942-8122, FAX: 312 942 8119,
| | - Kelly Karavolos
- Department of Preventive Medcine, Rush University Medical Center, Chicago, IL 60612, Phone: 312-942-8122, FAX: 312 942 8119,
| | - Elizabeth B. Lynch
- Department of Preventive Medcine, Rush University Medical Center, Chicago, IL 60612, Phone: 312-942-8122, FAX: 312 942 8119,
| | - Lynda H. Powell
- Department of Preventive Medcine, Rush University Medical Center, Chicago, IL 60612, Phone: 312-942-8122, FAX: 312 942 8119,
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Moderators of health behavior initiation and maintenance in a randomized telephone counseling trial. Prev Med 2014; 61:34-41. [PMID: 24412896 DOI: 10.1016/j.ypmed.2014.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/27/2013] [Accepted: 01/01/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study compares moderators of initiation and maintenance of health behavior changes. METHODS Data come from a cluster-randomized, 12-month telephone counseling intervention for physical activity and diet, targeting type 2 diabetes or hypertension patients (n=434, Australia,2005-2007). Demographic and health-related characteristics, theoretical constructs, and baseline behavioral outcomes were considered as moderators. Mixed models, adjusting for baseline values, assessed moderation of intervention effects for trial outcomes (physical activity, intakes of fat, saturated fat, fiber, fruit, vegetables) at end-of-intervention (12 months/initiation) and maintenance follow-up (18 months), and compared moderation between these periods. RESULTS Social support for physical activity and baseline physical activity were significant (p<0.05) moderators of physical activity at 12 months. Gender, marital status, social support for healthy eating, BMI, and number of chronic conditions were significant moderators of dietary changes at 12- and/or 18 months. Instances of moderation differing significantly between 12- and 18 months were: baseline physical activity for physical activity (initiation) and marital status for fat intake (maintenance). CONCLUSIONS This exploratory study showed that moderation of physical activity and diet effects sometimes differed between initiation and maintenance. To identify unique moderators for initiation and/or maintenance of behavior changes, future studies need to report on and statistically test for such differences.
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Bryan AD, Magnan RE, Hooper AEC, Ciccolo JT, Marcus B, Hutchison KE. Colorado stride (COSTRIDE): testing genetic and physiological moderators of response to an intervention to increase physical activity. Int J Behav Nutr Phys Act 2013; 10:139. [PMID: 24359456 PMCID: PMC3880176 DOI: 10.1186/1479-5868-10-139] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 12/05/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The purpose of this research was to replicate a successful intervention to increase physical activity in a different region of the country, and explore genetic and physiological moderators of intervention efficacy drawn from a transdisciplinary theoretical framework. METHOD A randomized controlled trial comparing a print-based physical activity intervention (COSTRIDE) to a print-based health and wellness contact control (HW) intervention was conducted. Sedentary participants (n = 219) completed assessments at baseline and follow-up assessments at 3, 6, 9, and 12 months following the initiation of the intervention. RESULTS Participants in both conditions significantly increased exercise behavior in the first six months, and then leveled off or decreased physical activity in the second six months of the study. Those in the COSTRIDE intervention increased significantly more than those in the HW intervention, and were better able to maintain their exercise behavior. Genetic factors (BDNF, rs6265; FTO, rs8044769), but not selected physiological (body temperature, blood lactate, systolic blood pressure, plasma norepinephrine, and heart rate) or subjective (perceived pain, affect) responses to physical activity, moderated response to the intervention. CONCLUSIONS There are underlying genetic factors that influence response to behavioral intervention, and a better understanding of these factors has the potential to influence the development, targeting and tailoring of behavioral interventions to increase physical activity. TRIAL REGISTRATION Clinicaltrials.gov registration: NCT01091857.
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Affiliation(s)
| | - Renee E Magnan
- Washington State University Vancouver, Vancouver, WA 98686, USA
| | | | | | - Bess Marcus
- University of California San Diego, La Jolla, CA 92093, USA
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Wang KY, Chu NF, Lin SH, Chiang IC, Perng WC, Lai HR. Examining the causal model linking health literacy to health outcomes of asthma patients. J Clin Nurs 2013; 23:2031-42. [PMID: 24329740 DOI: 10.1111/jocn.12434] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore health literacy status in asthma patients and to examine the causal model linking health literacy to health outcome-related factors via mediator and moderator variables. BACKGROUND Understanding how low health literacy may influence health outcomes is important. DESIGN This is a cross-sectional survey study. METHODS A total of 326 asthma patients aged 20 years and older (average: 51 ± 18·3 years) were recruited by purposive sampling from pulmonary medicine outpatient departments at three medical centres and a regional teaching hospital in northern Taiwan. Data were collected via structured questionnaires, including measures of socio-demographic and disease characteristics; medical decision-making; asthma knowledge, attitudes and self-efficacy; healthcare experience and health outcome-related factors (metered-dose inhaler/dry-powder inhaler usage proficiency, medical use, self-management behaviour). Three hundred patients who met the inclusion criteria and completed the questionnaire survey were analysed. RESULTS Overall, 217 subjects (72·3%) had adequate functional health literacy, 42 (14%) had inadequate functional health literacy, and 41 (13·7%) had marginal functional health literacy. Subjects' average asthma knowledge, attitudes and self-efficacy scores were 7·23 ± 2·69, 51·46 ± 6·18 and 58·31 ± 8·10, respectively. Health literacy correlated positively with asthma knowledge (r = 0·605), attitudes (r = 0·192) and medical decision-making (r = 0·413). CONCLUSIONS Health literacy is positively associated with proficiency in metered-dose inhaler usage, asthma knowledge, attitudes and medical decision-making, but is not significantly associated with medical care use and self-management behaviour. Health literacy had an indirect effect on self-management behaviour through the mediation effect of asthma attitudes. No moderator was found for the effect of health literacy on health outcome-related factors. RELEVANCE TO CLINICAL PRACTICE Results of this study may help to develop adequate intervention strategies to improve the health outcomes of asthma patients.
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Affiliation(s)
- Kwua-Yun Wang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan; School of Nursing, National Defense Medical Center, Taipei, Taiwan
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Higgins TJ, Middleton KR, Winner L, Janelle CM. Physical activity interventions differentially affect exercise task and barrier self-efficacy: a meta-analysis. Health Psychol 2013; 33:891-903. [PMID: 23957904 DOI: 10.1037/a0033864] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Researchers have yet to establish how interventions to increase physical activity influence specific self-efficacy beliefs. The current study sought to quantify the effect of interventions to increase physical activity among healthy adults on exercise task (EXSE) and barrier self-efficacy (BSE) via meta-analysis. Intervention characteristics associated with self-efficacy and physical activity changes were also identified. METHODS A systematic database search and manual searches through reference lists of related publications were conducted for articles on randomized, controlled physical activity interventions. Published intervention studies reporting changes in physical activity behavior and either EXSE or BSE in healthy adults were eligible for inclusion. RESULTS Of the 1,080 studies identified, 20 were included in the meta-analyses. Interventions had a significant effect of g = 0.208, 95% confidence interval (CI) [0.027, 0.388], p < .05, on EXSE; g = 0.128, 95% CI [0.05, 0.20], p < .05 on BSE; and g = 0.335 95% CI [0.196, 0.475], p < .001, on physical activity. Moderator analyses indicated shorter interventions that did not include structured exercise sessions effectively increased EXSE and physical activity, whereas long interventions improved BSE. Interventions that did not provide support increased BSE and physical activity levels. Further, interventions that did not require the use of daily exercise logs improved EXSE and physical activity behavior. CONCLUSION Interventions designed to increase physical activity differentially influenced EXSE and BSE. EXSE appeared to play a more significant role during exercise adoption, whereas BSE was involved in the maintenance of exercise behavior. Recommendations are offered for the design of future interventions.
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Kim CJ, Park JW, Park HR. Effects of a community-based intervention on cardio-metabolic risk and self-care behaviour in older adults with metabolic syndrome. Int J Nurs Pract 2013; 20:212-220. [PMID: 24713018 DOI: 10.1111/ijn.12139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This pilot study was performed to investigate the effects of a community-based intervention (CBI) on cardio-metabolic risk and self-care behaviour in 92 older adults with metabolic syndrome at public health centres in Suwon, Korea. A prospective, pretest and posttest, controlled, quasi-experimental design was used. The older adults in the intervention group participated in an 8-week intensive lifestyle counselling, whereas those in the control group received usual care. The mean (standard deviation) age of the participants was 71.4 (4.43) years ranging from 60 to 84, and 75.0% of the participants were female. The intervention group at 8 weeks showed significant reduction in waist circumference by -1.35 cm (P<0.001) and improved self-care behaviour (+5.17 score, P<0.05) and self-efficacy (+4.84 score, P<0.001) when compared with the control group. The percentages of those who successfully completed the targeted behavioural modification were 71.7% for exercise and 52.2% for dietary control in the intervention group at 8 weeks. This pilot study provided evidence of the beneficial impact of the CBI for Korean older adults with metabolic syndrome.
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Affiliation(s)
- Chun-Ja Kim
- Ajou University College of Nursing, Suwon, South Korea
| | - Jee-Won Park
- Ajou University College of Nursing, Suwon, South Korea
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Prestwich A, Kellar I, Parker R, MacRae S, Learmonth M, Sykes B, Taylor N, Castle H. How can self-efficacy be increased? Meta-analysis of dietary interventions. Health Psychol Rev 2013; 8:270-85. [PMID: 25053214 DOI: 10.1080/17437199.2013.813729] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Targeting individuals' beliefs that they are able to eat healthily can improve dietary-related behaviours. However, the most effective behaviour change techniques (BCTs) to promote dietary self-efficacy have not been systematically reviewed. This research addressed this gap. Studies testing the effect of interventions on healthy eating and underlying dietary-related self-efficacy, within randomised controlled trials, were systematically reviewed in MEDLINE, EMBASE and PSYCINFO. Two reviewers independently coded intervention content in both intervention and comparison groups. Data pertaining to study quality were also extracted. Random effects meta-analysis was used to calculate an overall effect size on dietary self-efficacy for each study. The associations between 26 BCTs and self-efficacy effects were calculated using meta-regression. In some of the analyses, interventions that incorporated self-monitoring (tracking one's own food-related behaviour), provided feedback on performance, prompted review of behavioural goals, provided contingent rewards (rewarding diet success), or planned for social support/social change increased dietary self-efficacy significantly more than interventions that did not. Stress management was consistently associated with self-efficacy effects across all analyses. There was strong evidence for stress management and weaker evidence for a number of other BCTs. The findings can be used to develop more effective, theory- and evidence-based behavioural interventions.
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Affiliation(s)
- Andrew Prestwich
- a Institute of Psychological Sciences , University of Leeds , Leeds , UK
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Kelly NR, Mazzeo SE, Bean MK. Systematic review of dietary interventions with college students: directions for future research and practice. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2013; 45:304-313. [PMID: 23433967 DOI: 10.1016/j.jneb.2012.10.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 10/02/2012] [Accepted: 10/06/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To clarify directions for research and practice, research literature evaluating nutrition and dietary interventions in college and university settings was reviewed. DESIGN Systematic search of database literature. SETTING Postsecondary education. PARTICIPANTS Fourteen research articles evaluating randomized controlled trials or quasi-experimental interventions targeting dietary outcomes. MAIN OUTCOME MEASURES Diet/nutrition intake, knowledge, motivation, self-efficacy, barriers, intentions, social support, self-regulation, outcome expectations, and sales. ANALYSIS Systematic search of 936 articles and review of 14 articles meeting search criteria. RESULTS Some in-person interventions (n = 6) show promise in improving students' dietary behaviors, although changes were minimal. The inclusion of self-regulation components, including self-monitoring and goal setting, may maximize outcomes. Dietary outcomes from online interventions (n = 5) were less promising overall, although they may be more effective with a subset of college students early in their readiness to change their eating habits. Environmental approaches (n = 3) may increase the sale of healthy food by serving as visual cues-to-action. CONCLUSIONS AND IMPLICATIONS A number of intervention approaches show promise for improving college students' dietary habits. However, much of this research has methodological limitations, rendering it difficult to draw conclusions across studies and hindering dissemination efforts.
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Affiliation(s)
- Nichole R Kelly
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA.
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Hendrick P, Milosavljevic S, Hale L, Hurley DA, McDonough SM, Herbison P, Baxter GD. Does a patient's physical activity predict recovery from an episode of acute low back pain? A prospective cohort study. BMC Musculoskelet Disord 2013; 14:126. [PMID: 23560880 PMCID: PMC3626659 DOI: 10.1186/1471-2474-14-126] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 04/02/2013] [Indexed: 11/14/2022] Open
Abstract
Background Advice to remain active and normalisation of activity are commonly prescribed in the management of low back pain (LBP). However, no research has assessed whether objective measurements of physical activity predict outcome and recovery in acute low back pain. Method The aims of this study were to assess the predictive relationship between activity and disability at 3 months in a sub-acute LBP population. This prospective cohort study recruited 101 consenting patients with sub-acute LBP (< 6 weeks) who completed the Roland Morris Disability Questionnaire (RMDQ), the Visual Analogue Scale, and resumption of full ‘normal’ activity question (Y/N), at baseline and 3 months. Physical activity was measured for 7 days at both baseline and at 3 months with an RT3 accelerometer and a recall questionnaire. Results Observed and self-reported measures of physical activity at baseline and change in activity from baseline to 3 months were not independent predictors of RMDQ (p > 0.05) or RMDQ change (p > 0.05) over 3 months. A self-report of a return to full ‘normal’ activities was significantly associated with greater RMDQ change score at 3 months (p < 0.001). Paired t-tests found no significant change in activity levels measured with the RT3 (p = 0.57) or the recall questionnaire (p = 0.38) from baseline to 3 months. Conclusions These results question the predictive role of physical activity in LBP recovery, and the assumption that activity levels change as LBP symptoms resolve. The importance of a patient’s perception of activity limitation in recovery from acute LBP was also highlighted. Trial registration Clinical Trial Registration Number, ACTRN12609000282280
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Affiliation(s)
- Paul Hendrick
- Division of Physiotherapy Education, University of Nottingham, Hucknall Road, Nottingham NG5 1PB, UK.
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What are the most effective techniques in changing obese individuals' physical activity self-efficacy and behaviour: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2013; 10:29. [PMID: 23452345 PMCID: PMC3639155 DOI: 10.1186/1479-5868-10-29] [Citation(s) in RCA: 308] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 02/26/2013] [Indexed: 01/22/2023] Open
Abstract
Increasing self-efficacy is generally considered to be an important mediator of the effects of physical activity interventions. A previous review identified which behaviour change techniques (BCTs) were associated with increases in self-efficacy and physical activity for healthy non-obese adults. The aim of the current review was to identify which BCTs increase the self-efficacy and physical activity behaviour of obese adults. A systematic search identified 61 comparisons with obese adults reporting changes in self-efficacy towards engaging in physical activity following interventions. Of those comparisons, 42 also reported changes in physical activity behaviour. All intervention descriptions were coded using Michie et al's (2011) 40 item CALO-RE taxonomy of BCTs. Meta-analysis was conducted with moderator analyses to examine the association between whether or not each BCT was included in interventions, and size of changes in both self-efficacy and physical activity behaviour. Overall, a small effect of the interventions was found on self-efficacy (d = 0.23, 95% confidence interval (CI): 0.16-0.29, p < 0.001) and a medium sized effect on physical activity behaviour (d = 0.50, 95% CI 0.38-0.63, p < 0.001). Four BCTs were significantly associated with positive changes in self-efficacy; 'action planning', 'time management', 'prompt self-monitoring of behavioural outcome' and 'plan social support/social change'. These latter two BCTs were also associated with positive changes in physical activity. An additional 19 BCTs were associated with positive changes in physical activity. The largest effects for physical activity were found where interventions contained 'teach to use prompts/cues', 'prompt practice' or 'prompt rewards contingent on effort or progress towards behaviour'. Overall, a non-significant relationship was found between change in self-efficacy and change in physical activity (Spearman's Rho = -0.18 p = 0.72). In summary, the majority of techniques increased physical activity behaviour, without having discernible effects on self-efficacy. Only two BCTs were associated with positive changes in both physical activity self-efficacy and behaviour. This is in contrast to the earlier review which found a strong relationship between changes in physical activity self-efficacy and behaviour. Mechanisms other than self-efficacy may be more important for increasing the physical activity of obese individuals compared with non-obese individuals.
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Schwerdtfeger AR, Schmitz C, Warken M. Using text messages to bridge the intention-behavior gap? A pilot study on the use of text message reminders to increase objectively assessed physical activity in daily life. Front Psychol 2012; 3:270. [PMID: 22876237 PMCID: PMC3410409 DOI: 10.3389/fpsyg.2012.00270] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 07/16/2012] [Indexed: 11/13/2022] Open
Abstract
Sedentarism is a serious health concern in industrialized countries throughout the world. We examined whether a text message-based intervention, targeted at increasing daily levels of physical activity, would be more effective than a standard psychoeducational intervention and a control condition. Sixty-three individuals (43 women) with a mean age of 23.7 years participated in the study. They were randomly assigned to a psychoeducational standard intervention; an augmented intervention with additional short text messages sent to the mobile phones to remind participants of their action plans, and a control condition. Objectively assessed physical activity and self-efficacy were assessed pre- and post-intervention. Participants in the control condition showed a significant decline in physical activity from pre-assessment to post-assessment, whereas participants in both intervention arms exhibited a slight increase. Moreover, the augmented intervention resulted in a marginally significant increase in self-efficacy, whereas the standard intervention resulted in a significant decrease. The findings suggest that short text messages reminding individuals of their action plans are not more effective than an intervention without text messages, although there seems to be a beneficial effect on self-efficacy, which might facilitate behavior change in the long-term. Challenging aspects of the research design (e.g., reactivity of the assessment protocol) are discussed and suggestions for future research are highlighted.
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The effectiveness of a motivational interviewing primary-care based intervention on physical activity and predictors of change in a disadvantaged community. J Behav Med 2012; 35:318-33. [PMID: 22476812 DOI: 10.1007/s10865-012-9417-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 03/19/2012] [Indexed: 10/28/2022]
Abstract
Little research exists on the impact of behavior change interventions in disadvantaged communities. We conducted a prospective study to explore the effectiveness of motivational interviewing on physical activity change within a deprived community and the social- psychological and motivational predictors of change in physical activity including stage of change, self-efficacy, social support, and variables from self-determination theory and the theory of planned behavior. Five motivational interviewing counsellors recruited 207 patients and offered motivational interviewing sessions to support physical activity behavior change. At 6-months there were significant improvements in physical activity, stage of change, and social support. A dose-response relationship was evident; those who attended 2 or more consultations increased their total physical activity, stage of change and family social support more than those who attended just one. Hierarchical regression analyses indicated that number of sessions and change in stage of change predicted 28.4% of the variance in change in total physical activity and, with social support from friends, 21.0% of the variance in change walking time. Change in perceived behavioral control and attitudes, friend social support, and number of sessions predicted 16.8% of the variance in change in vigorous physical activity. Motivational interviewing is an effective approach for promoting physical activity amongst lower socio-economic status groups in the short term. The study demonstrates good translational efficacy, and contributes to a limited number of physical activity interventions targeting low income groups in the UK.
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Jerant A, Franks P, Kravitz RL. Associations between pain control self-efficacy, self-efficacy for communicating with physicians, and subsequent pain severity among cancer patients. PATIENT EDUCATION AND COUNSELING 2011; 85:275-280. [PMID: 21159483 DOI: 10.1016/j.pec.2010.11.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 10/21/2010] [Accepted: 11/21/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Coaching patients to be more active in health encounters may improve communication with physicians but does not necessarily improve health outcomes. We explored this discrepancy by examining relationships between self-efficacy for communicating with physicians and pain control self-efficacy and subsequent pain severity among cancer patients participating in a coaching trial. METHODS We analyzed data from 244 English-speaking adults with various cancer types reporting significant pain, recruited from 49 oncology physicians' offices. Mixed model linear regression examined relationships between post-intervention communication self-efficacy and pain control self-efficacy and subsequent pain severity over 12 weeks. RESULTS Post-intervention pain control self-efficacy (but not communication self-efficacy) was significantly related to subsequent pain severity: a one standard deviation increase was associated with a 0.19 point decrease (95% confidence interval=-0.33, -0.04; p=0.01) in pain severity over time, approximately 25% of the effect size of the influence of post-intervention pain on subsequent pain. CONCLUSION Among cancer patients enrolled in a coaching trial, post-intervention pain control self-efficacy, but not communication self-efficacy, was significantly related to subsequent pain severity. PRACTICE IMPLICATIONS Identifying behavioral mediators of cancer pain severity may lead to coaching interventions that are more effective in improving cancer pain control.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine, University of California, Davis, Sacramento, CA 95817, USA.
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Van Dyck D, De Greef K, Deforche B, Ruige J, Tudor-Locke CE, Kaufman JM, Owen N, De Bourdeaudhuij I. Mediators of physical activity change in a behavioral modification program for type 2 diabetes patients. Int J Behav Nutr Phys Act 2011; 8:105. [PMID: 21958233 PMCID: PMC3191467 DOI: 10.1186/1479-5868-8-105] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 09/29/2011] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Many studies have reported significant behavioral impact of physical activity interventions. However, few have examined changes in potential mediators of change preceding behavioral changes, resulting in a lack of information concerning how the intervention worked. Our purpose was to examine mediation effects of changes in psychosocial variables on changes in physical activity in type 2 diabetes patients. METHODS Ninety-two patients (62 ± 9 years, 30, 0 ± 2.5 kg/m(2), 69% males) participated in a randomized controlled trial. The 24-week intervention was based on social-cognitive constructs and consisted of a face-to-face session, telephone follow-ups, and the use of a pedometer. Social-cognitive variables and physical activity (device-based and self-reported) were collected at baseline, after the 24-week intervention and at one year post-baseline. PA was measured by pedometer, accelerometer and questionnaire. RESULTS Post-intervention physical activity changes were mediated by coping with relapse, changes in social norm, and social modeling from family members (p ≤ 0.05). One-year physical activity changes were mediated by coping with relapse, changes in social support from family and self-efficacy towards physical activity barriers (p ≤ 0.05) CONCLUSIONS For patients with type 2 diabetes, initiatives to increase their physical activity could usefully focus on strategies for resuming regular patterns of activity, on engaging family social support and on building confidence about dealing with actual and perceived barriers to activity. TRIAL REGISTRATION NCT00903500, ClinicalTrials.gov.
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Affiliation(s)
- Delfien Van Dyck
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000 Ghent, Belgium
- Research Foundation Flanders (FWO), Belgium
| | - Karlijn De Greef
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000 Ghent, Belgium
| | - Benedicte Deforche
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000 Ghent, Belgium
- Department of Human Biometry and Biomechanics, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Johannes Ruige
- Department of Endocrinology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Catrine E Tudor-Locke
- Walking Behavior Laboratory, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Neville Owen
- Baker IDI Heart and Diabetes Institute, Melbourne; The University of Queensland, Brisbane, Australia
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000 Ghent, Belgium
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Bélanger-Gravel A, Godin G, Vézina-Im LA, Amireault S, Poirier P. The effect of theory-based interventions on physical activity participation among overweight/obese individuals: a systematic review. Obes Rev 2011; 12:430-9. [PMID: 20331511 DOI: 10.1111/j.1467-789x.2010.00729.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Little attention has been paid to the evaluation of the long-term impact of theory-based interventions on physical activity participation among overweight/obese individuals after the interventions have ended. The primary aim of this systematic review was to investigate the long-term effectiveness of theory-based interventions increasing physical activity and identify the most effective techniques for behaviour change among overweight/obese individuals. The secondary aim was to investigate the effect of these interventions on theoretical variables. Eighteen studies were reviewed. Among these studies, three reported significant short-term and two long-term effects of interventions on physical activity participation. Most of the studies observed a significant short- or long-term effect of time on this behaviour. Theoretical frameworks most often applied included the Behavioural Model and the Social Learning/Cognitive Theory. However, few of the studies reported any impact on theoretical variables. The most prevalent techniques consisted of providing opportunities for social comparison and instruction as well as self-monitoring. Leading techniques differentiating the experimental group from the control group included prompting practice and intentions formation and barriers identification. Although the combination of these three techniques appears successful, the long-term impact of theory-based interventions remains ambiguous.
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Affiliation(s)
- A Bélanger-Gravel
- Department of Social and Preventive Medicine, Division of Kinesiology, Laval University, Quebec City, QC, Canada.
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Williams SL, French DP. What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour--and are they the same? HEALTH EDUCATION RESEARCH 2011; 26:308-322. [PMID: 21321008 DOI: 10.1093/her/cyr005] [Citation(s) in RCA: 370] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
There is convincing evidence that targeting self-efficacy is an effective means of increasing physical activity. However, evidence concerning which are the most effective techniques for changing self-efficacy and thereby physical activity is lacking. The present review aims to estimate the association between specific intervention techniques used in physical activity interventions and change obtained in both self-efficacy and physical activity behaviour. A systematic search yielded 27 physical activity intervention studies for 'healthy' adults that reported self-efficacy and physical activity data. A small, yet significant (P < 0.01) effect of the interventions was found on change in self-efficacy and physical activity (d = 0.16 and 0.21, respectively). When a technique was associated with a change in effect sizes for self-efficacy, it also tended to be associated with a change (r(s) = 0.690, P < 0.001) in effect size for physical activity. Moderator analyses found that 'action planning', 'provide instruction' and 'reinforcing effort towards behaviour' were associated with significantly higher levels of both self-efficacy and physical activity. 'Relapse prevention' and 'setting graded tasks' were associated with significantly lower self-efficacy and physical activity levels. This meta-analysis provides evidence for which psychological techniques are most effective for changing self-efficacy and physical activity.
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Affiliation(s)
- S L Williams
- Applied Research Centre in Health and Lifestyle Interventions and Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK.
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Dishman RK, Vandenberg RJ, Motl RW, Wilson MG, DeJoy DM. Dose relations between goal setting, theory-based correlates of goal setting and increases in physical activity during a workplace trial. HEALTH EDUCATION RESEARCH 2010; 25:620-631. [PMID: 19654220 DOI: 10.1093/her/cyp042] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The effectiveness of an intervention depends on its dose and on moderators of dose, which usually are not studied. The purpose of the study is to determine whether goal setting and theory-based moderators of goal setting had dose relations with increases in goal-related physical activity during a successful workplace intervention. A group-randomized 12-week intervention that included personal goal setting was implemented in fall 2005, with a multiracial/ethnic sample of employees at 16 geographically diverse worksites. Here, we examined dose-related variables in the cohort of participants (N = 664) from the 8 worksites randomized to the intervention. Participants in the intervention exceeded 9000 daily pedometer steps and 300 weekly minutes of moderate-to-vigorous physical activity (MVPA) during the last 6 weeks of the study, which approximated or exceeded current public health guidelines. Linear growth modeling indicated that participants who set higher goals and sustained higher levels of self-efficacy, commitment and intention about attaining their goals had greater increases in pedometer steps and MVPA. The relation between change in participants' satisfaction with current physical activity and increases in physical activity was mediated by increases in self-set goals. The results show a dose relation of increased physical activity with changes in goal setting, satisfaction, self-efficacy, commitment and intention, consistent with goal-setting theory.
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Affiliation(s)
- Rod K Dishman
- Department of Kinesiology, Ramsey Student Center, The University of Georgia, Athens, GA 30602-6554, USA.
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Lockwood CM, DeFrancesco CA, Elliot DL, Beresford SAA, Toobert DJ. Mediation analyses: applications in nutrition research and reading the literature. ACTA ACUST UNITED AC 2010; 110:753-62. [PMID: 20430137 DOI: 10.1016/j.jada.2010.02.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Accepted: 09/01/2009] [Indexed: 12/01/2022]
Abstract
Mediation analysis is a newer statistical tool that is becoming more prominent in nutrition research. Its use provides insight into the relationship among variables in a potential causal chain. For intervention studies, it can define the influence of different programmatic components and, in doing so, allows investigators to identify and refine a program's critical aspects. We present an overview of mediation analysis, compare mediators with other variables (confounders, moderators, and covariates), and illustrate how mediation analysis permits interpretation of the change process. A framework is outlined for the critical appraisal of articles purporting to use mediation analysis. The framework's utility is demonstrated by searching the nutrition literature and identifying articles citing mediation cross referenced with the terms "nutrition," "diet," "food," and "obesity." Seventy-two articles were identified that involved human subjects and behavior outcomes, and almost half mentioned mediation without tests to define its presence. Tabulation of the 40 articles appropriately assessing mediation demonstrates an increase in these techniques' appearance and the breadth of nutrition topics addressed. Mediation analysis is an important new statistical tool. Familiarity with its methodology and a framework for assessing articles will allow readers to critically appraise the literature and make informed independent evaluations of works using these techniques.
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Affiliation(s)
- Chondra M Lockwood
- Division of Health Promotion and Sports Medicine, Department of Medicine, Oregon Health and Science University, Portland, OR, USA
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van Stralen MM, Lechner L, Mudde AN, de Vries H, Bolman C. Determinants of awareness, initiation and maintenance of physical activity among the over-fifties: a Delphi study. HEALTH EDUCATION RESEARCH 2010; 25:233-247. [PMID: 18927443 DOI: 10.1093/her/cyn045] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
To develop effective interventions to stimulate physical activity (PA), insight into its underlying variables is needed. The aim of this study was to obtain an overview of the most relevant determinants of awareness, initiation and maintenance of PA among the over-fifties by means of a three-round Delphi study. In the first round, 17 key-experts outlined possible relevant determinants into an open-ended electronic questionnaire. In the second round, 118 experts completed a structured electronic questionnaire that was based on the first round results, in which they scored each determinant on its relevance. In the third round, experts were asked to re-rate the relevance of each determinant, after feedback was given about the group median relevance score. After three rounds, the experts agreed on 30 relevant determinants of the three phases of PA. When compared with longitudinal studies, the Delphi study pointed out new concepts, such as several post-motivational and social and environmental determinants as possible relevant determinants, suggesting that this method has the potential to trace new and promising determinants. The results further showed that next to similarities, much dissimilarity in relevant determinants of awareness, initiation and maintenance of PA was found, suggesting that most determinants could be phase specific.
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Affiliation(s)
- M M van Stralen
- Department of Psychology, Open University of the Netherlands, PO Box 2960, 6401 DL, Heerlen, the Netherlands.
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van Stralen MM, De Vries H, Mudde AN, Bolman C, Lechner L. Determinants of initiation and maintenance of physical activity among older adults: a literature review. Health Psychol Rev 2009. [DOI: 10.1080/17437190903229462] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Asakawa Y, Usuda S, Mizukami M, Imura S. Moderator and Mediator Effects of Personal Factors in Patients with Stroke. J Phys Ther Sci 2009. [DOI: 10.1589/jpts.21.55] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yasutsugu Asakawa
- Gunma University Graduate School of Health Sciences
- Department of Physical Therapy, Nippon Engineering College
| | | | - Masafumi Mizukami
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences
| | - Shigeyuki Imura
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences
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Pettman TL, Misan GM, Owen K, Warren K, Coates AM, Buckley JD, Howe PR. Self-management for obesity and cardio-metabolic fitness: description and evaluation of the lifestyle modification program of a randomised controlled trial. Int J Behav Nutr Phys Act 2008; 5:53. [PMID: 18954466 PMCID: PMC2582031 DOI: 10.1186/1479-5868-5-53] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 10/27/2008] [Indexed: 11/22/2022] Open
Abstract
Background Sustainable lifestyle modification strategies are needed to address obesity and cardiovascular risk factors. Intensive, individualised programs have been successful, but are limited by time and resources. We have formulated a group-based lifestyle education program based upon national diet and physical activity (PA) recommendations to manage obesity and cardio-metabolic risk factors. This article describes the content and delivery of this program, with information on compliance and acceptability. Methods Overweight/obese adults (n = 153) with metabolic syndrome were recruited from the community and randomly allocated to intervention (INT) or control (CON). Written copies of Australian national dietary and PA guidelines were provided to all participants. INT took part in a 16-week lifestyle program which provided a curriculum and practical strategies on 1) dietary and PA information based on national guidelines, 2) behavioural self-management tools, 3) food-label reading, supermarkets tour and cooking, 4) exercise sessions, and 5) peer-group support. Compliance was assessed using attendance records and weekly food/PA logs. Participants' motivations, perceived benefits and goals were assessed through facilitated discussion. Program acceptability feedback was collected through structured focus groups. Results Although completion of weekly food/PA records was poor, attendance at information/education sessions (77% overall) and exercise participation (66% overall) was high, and compared with CON, multiple markers of body composition and cardio-metabolic health improved in INT. Participants reported that the most useful program components included food-label reading, cooking sessions, and learning new and different physical exercises, including home-based options. Participants also reported finding self-management techniques helpful, namely problem solving and short-term goal setting. The use of a group setting and supportive 'peer' leaders were found to be supportive. More frequent clinical assessment was suggested for future programs. Conclusion This group-based lifestyle program achieved improvements in body composition and cardio-metabolic and physical fitness similar to individualised interventions which are more resource intensive to deliver. It confirmed that active training in lifestyle modification is more effective than passive provision of guidelines. Such programs should include social support and self-management techniques. Continued clinical follow up may be required for long-term maintenance in individuals attempting lifestyle behaviour change. Program facilitation by peers may help and should be further investigated in a community-based model.
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Affiliation(s)
- Tahna L Pettman
- Australian Technology Network (ATN) Centre for Metabolic Fitness and Nutritional Physiology Research Centre, School of Health Sciences, University of South Australia, Adelaide 5000, South Australia, Australia.
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