Development of an adolescent alcohol misuse intervention based on the Prototype Willingness Model: A Delphi study

Effectiveness of a Theory-Based Digital Animated Video Intervention to Reduce Intention and Willingness to Sext Among Diploma Students: Cluster Randomized Controlled Trial

BACKGROUND

Sexting refers to the exchange of sexually explicit digital content in the form of texts, photos, or videos. In recent years, sexting has become a public health concern. Surveys in Malaysia show a high prevalence of young adults engaged in sexting. Given that sexting is associated with sexual risk behavior, cyberbullying, and mental health issues, this behavior needs intervention to alleviate the resulting public health burden. However, there is a scarcity of theory-based intervention programs on the prevention of intention and willingness to sext among young adults.

OBJECTIVE

This study aimed to develop and implement a sexting intervention module guided by the prototype willingness model (PWM), delivered using web-based animated video, and evaluate its effectiveness among diploma students from a public higher educational institution. The primary outcomes were intention and willingness to sext, while the secondary outcomes were knowledge, attitude, perceived norms, and prototype perceptions of sexting.

METHODS

This 2-armed, parallel, single-blinded cluster randomized controlled trial was conducted in a public higher educational institution in the state of Melaka, Malaysia. Diploma students from 12 programs were randomly allocated into intervention and control groups. Both groups answered a self-administered web-based questionnaire assessing the outcomes at the baseline. The intervention group received a newly developed intervention module based on the PWM in the form of 5 animated videos posted on a private YouTube platform, while the control group was put on the waitlist. The intervention group was encouraged to discuss any issues raised with the researchers via WhatsApp private chat after viewing the videos. All participants were observed immediately and 3 months postintervention. Data analysis was performed with SPSS (version 26; IBM Corp). A generalized linear mixed model was used to determine the effectiveness of the intervention.

RESULTS

There were a total of 300 participants with an attrition rate of 8.3% (n=25). After adjusting for age, sex, relationship status, and the amount of time spent on the web, there were significant differences in the intention to sext (β=-.12; P=.002; Cohen d=0.23), willingness to sext (β=-.16; P<.001; Cohen d=0.40), knowledge (β=.12; P<.001; Cohen d=0.39), attitude (β=-.11; P=.001; Cohen d=0.31), perceived norms (β=-.06; P=.04; Cohen d=0.18), and prototype perceptions (β=-.11; P<.001; Cohen d=0.35) between the intervention and control groups over 3 months.

CONCLUSIONS

In this study, the sexting intervention module using the PWM that was delivered via web-based animated videos was effective in reducing intention and willingness to sext as well as in improving knowledge of sexting, attitudes, perceived norms, and prototype perceptions. Therefore, relevant agencies involved in the promotion of sexual and reproductive health among young adults in Malaysia can consider the implementation of this module.

TRIAL REGISTRATION

Thai Clinical Trial Registry TCTR20201010002; https://www.thaiclinicaltrials.org/show/TCTR20201002001.

Development of a Physical Activity and Sedentary Behaviour Policy for Canadian Childcare Settings: A Delphi Study

This study aimed to obtain consensus on physical activity (PA) and sedentary behaviour (SB) policy items for use in Canadian childcare settings. Purposeful sampling of Canadian experts in PA/SB (n = 19) and Early Childhood Education (ECE; n = 20) was used to form two distinct (i.e., PA/SB and ECE) panels for a 3-round Delphi study. In round 1, the PA/SB experts suggested their top 10 items for a Canadian childcare PA/SB policy. Policy items were then pooled to generate a list of 24 unique items. In round 2, experts in both panels rated the importance of the 24 policy items using a 7-point Likert scale (i.e., 1 = Not at all important to 7 = Extremely important). The ECE panel was also asked to report on the feasibility of the policy items using a 4-point Likert scale (i.e., 1 = Not at all feasible to 4 = Very feasible). Policy items that received an interquartile deviation (IQD) score of ≤ 1 (indicating consensus) and a median score of ≥ 6 (indicating importance) in both panels were considered shared priorities. In round 3, members of both panels re-rated the importance of the policy items that did not achieve consensus among their respective panel in round 2 and were asked to order items based on importance. Descriptive statistics were used to assess feasibility of policy items, and differences in panel ratings were quantified using Mann Whitney U tests. Consensus was achieved for 23 policy items in the PA/SB panel and 17 items in the ECE panel. Overall, 15 shared priorities were identified (e.g., provide 120 min of outdoor time per day, sedentary behaviour should not be used as a punishment), and six policy items exhibited a statistical difference in ratings across panels. Members of the ECE panel indicated that the policy item, "children should be permitted to go outside whenever they want, for as long as they want" (M = 1.78; SD = 0.65) was lowest in terms of feasibility, and the policy item, "children should receive opportunities to engage in both unstructured and structured physical activity opportunities daily" (M = 3.89; SD = 0.32) was the most feasible for daily implementation. Findings from this study can inform the development of an expert-generated and feasibility-informed institutional PA/SB policy for use in Canadian childcare settings.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10643-023-01473-z.

Perceptions of active and inactive prototypes are associated with objective measures of physical activity in adolescents

The benefits of physical activity are known, but the proportion of adolescents meeting daily activity guidelines remains low. The Theory of Planned Behaviour (TPB), which assumes reasoned intentions explain actions, is a useful framework for predicting activity, but it leaves variance unexplained. The Prototype Willingness Model (PWM) which builds on the TPB, proposes a reasoned action pathway and a second social reactive pathway in which perceptions of social images, or prototypes, explain actions via behavioural willingness. We explored whether variables in the PWM's social reactive pathway explained variance in an objective measure of daily activity, over and above the reasoned action path. Participants aged 12-13 (n = 205) were invited to complete measures of constructs in the PWM and to wear an accelerometer for the next seven days. Overall, 126 students (65 males) participated. Reasoned intentions, attitudes and subjective norms explained 12.8% of variance in activity. Prototype perceptions and willingness explained an additional 13.1% of variance. Participants' perceived similarity to active prototypes, and unfavourable perceptions of inactive prototypes, significantly predicted activity. There were no significant differences between sexes on psychological variables. These findings highlight the importance of targeting prototype perceptions to encourage physical activity in this age group.

Exploring the application of the Prototype Willingness Model to weight loss dieting behaviour among UK adults

Frequent weight loss dieting leads to increased BMI and is associated with eating pathologies. Theoretical models can aid the development of interventions to reduce risk behaviours such as frequent dieting if they are able to adequately account for the target behaviour. The Prototype Willingness Model (PWM) may be able to account for weight loss dieting as this behaviour is often associated with social images. This study explored whether the PWM could predict weight loss dieting status over and above the Theory of Planned Behaviour (TPB). One hundred and ninety-two participants (69% female; mode age 35-44) completed PWM and TPB measures and recorded their height and weight. Males were more likely to be non-dieters than females. Frequent dieters had a higher BMI than non-dieters and rated themselves as more similar to the overweight prototype. Prototype perceptions predicted willingness to eat unhealthy foods alone. Similarity to the overweight prototype predicted weight loss dieting status over and above TPB measures and sex. Further research should explore prototype perceptions in an obese/overweight frequent dieting population as this may be a fruitful direction for developing interventions to reduce weight loss dieting.

Q sample construction: a novel approach incorporating a Delphi technique to explore opinions about codeine dependence

BACKGROUND

Q methodology is an evidenced approach to researching subjectivity, involving a combination of qualitative and quantitative techniques. The methodology has been used successfully in healthcare research to explore the opinions of patients and healthcare providers about topics such as the illness experience, healthcare services, clinical practice and professional training. Q methodology studies require the generation of a Q sample, a set of opinion statements representing the phenomenon of interest. This paper describes a novel and rigorous approach to develop a Q sample for a study exploring misusers' opinions about over-the-counter (OTC) codeine dependence and critically examines the associated methodological issues.

METHODS

Development of the Q sample in this study involved three steps; (1) identification of opinion statements via a comprehensive literature search, (2) application of a theoretical framework, the Capability, Opportunity, Motivation - Behaviour (COM-B) model of behaviour, to group and then reduce the number of statements and (3) use of a Delphi technique to achieve expert consensus on the final selection of statements. The Delphi component involved a multidisciplinary panel of 15 addiction experts comprised of doctors, nurses, pharmacists, psychologists and researchers, who were recruited purposively. Experts rated each statement using a 5-point scale of perceived importance. Two Delphi rounds were undertaken and consensus for inclusion of a statement was set at a median score of ≥4 and an interquartile range of ≤1.

RESULTS

A total of 842 statements representing codeine misusers' opinions about OTC codeine dependence were identified from the literature. Statements were grouped thematically using the COM-B framework and representative statements were selected, reducing the number to 111. After two Delphi rounds, addiction experts achieved consensus on 46 statements which formed the final Q sample.

CONCLUSIONS

This paper describes a new and systematic approach to Q sample construction and explores associated methodological issues that could be useful for those considering Q methodology and for furthering the rigour of this research technique.

Similarity to prototypical heavy drinkers and non-drinkers predicts AUDIT-C and risky drinking in young adults: prospective study

OBJECTIVE

The aim of the present study was to explore whether constructs within the Prototype Willingness Model (PWM) predicted risky drinking as measured by AUDIT-C, drinking harms and unplanned drunkenness in a sample of UK young adults. Previous studies exploring the PWM often do not use validated measures of alcohol consumption, and the outcomes of risky drinking are underexplored.

DESIGN

An online prospective study design with 4 week follow-up was employed and 385 young adults completed the study (M age = 21.76, SD = 3.39, 69.6% female; 85.2% students).

MAIN OUTCOME MEASURES

Intentions to get drunk, AUDIT-C, drinking harms experienced in the last 4 weeks, and unplanned drunkenness in the last 4 weeks.

RESULTS

Heavy and non-drinker prototype similarity predicted AUDIT-C, drinking harms and unplanned drunkenness when controlling for past behaviour and reasoned action pathway constructs. Intentions and willingness both mediated the relationship between prototype perceptions and AUDIT-C.

CONCLUSION

This study supports the use of the PWM in the prediction of AUDIT-C, drinking harms and unplanned drinking in a UK sample. Prototype perceptions influenced behaviour via both reasoned and reactive cognitions. Targeting similarity to heavy and non-drinker prototypes should be the focus of future interventions in this population.

A prototype-targeting intervention for the promotion of healthy eating in adolescents

Purpose

Unhealthy eating among adolescents from families with lower social status is a major concern. The purpose of this paper is to describe the development and evaluation of a prototype-targeting intervention for the promotion of healthy eating in this target group.

Design/methodology/approach

The planning model intervention mapping (IM) was chosen to proceed systematically, to use theory and evidence herein and to make decisions transparent. A controlled study with three times of data assessment was conducted to evaluate process characteristics and effects (N=108).

Findings

“Provide opportunities for social comparison” (behavioural change technique 6.2) was chosen as change method and “perceived similarity” was identified as the condition for its effectiveness. An intervention unit was designed for application. The evaluation results show the feasibility of the unit; materials and activities successfully applied the change method and its condition for effectiveness; and intervention objectives were generally achieved.

Practical implications

A prototype-targeting intervention is provided that is based on theory and evidence, and is suitable for implementation. More generally, the paper can serve as a blueprint for the systematic planning of theory- and evidence-based interventions targeting specific personal determinants for behaviour change.

Originality/value

The paper makes an important contribution to the application of the prototype-related theory and a useful addition of IM to the growing field of intervention development and design.