Health Behavior Change in Older Adults: Testing the Health Action Process Approach at the Inter- and Intraindividual Level

Predicting Physical Activity in Survivors of Breast Cancer: the Health Action Process Approach at the Intrapersonal Level

BACKGROUND

Benefits have been established for regular physical activity (PA) and exercise after breast cancer, but a decline of PA has also been a reported result of breast cancer diagnosis and treatments. The Health Action Process Approach (HAPA) model has been shown to predict various health behaviors, but few studies have tested it at the intrapersonal level. The aim of the present study was to test whether the HAPA constructs that are well confirmed at the interpersonal level also hold at the intrapersonal level in a group of women survivors of breast cancer.

METHOD

PA behaviors (N = 338) by nine survivors of breast cancer were observed for 6 weeks, and the associations between the HAPA constructs and PA over time were examined. Participants completed a questionnaire with the HAPA constructs related to PA behavior (direct step count and self-reported).

RESULTS

A multilevel model of behavior prediction found that optimistic beliefs about ability to initiate and maintain PA (self-efficacy) were positively related to intentions to be active, and these intentions predicted plans to be active. PA was directly and positively predicted by planning and by confidence in the ability to resume PA after a break.

CONCLUSION

Self-efficacy and planning are associated with PA behavior within women survivors of breast cancer over time, which was not the case for the outcome expectancies, social support, and action control at this intrapersonal level. A multilevel approach for psychological predictors of PA can be useful in grounding interventions for survivors of breast cancer.

Using wearables to promote physical activity in old age : Feasibility, benefits, and user friendliness

Background

Wearables provide new opportunities to promote physical activity also among older adults but data on effectiveness and user friendliness are rare.

Objective

The effects of a comprehensive self-regulative intervention on moderate to vigorous physical activity (MVPA) and number of steps were examined using commercially available activity trackers. Acceptance regarding the devices was analysed in various domains.

Methods

In this study 80 older adults (mean = 67.03 years, standard deviation = 3.97 years; 59% women) wore a Fitbit Charge HR for 21 days including a baseline, a postintervention and a follow-up week. The intervention comprised feedback, goal setting and planning and 50% of the participants were additionally randomized to a role model component. Social cognitive predictors based on the health action process approach (HAPA) and user experience were assessed via questionnaires.

Results

The MVPA increased by an average of 19 min per week and steps by 1317 per day. An additional benefit of the role model component could be observed for MVPA. In the follow-up, the intervention effect was still significant for the number of steps, while MVPA dropped back to baseline. Multilevel models including HAPA variables explained small but significant amounts of variance in MVPA (8% within-person, 26% between-person) and steps (11% within-person, 12% between-person). User experience was rated as very high.

Conclusion

Providing an intervention based on established behavior change techniques and self-monitoring via wearables seems to be effective for increasing physical activity among older adults. The HAPA variables seem to play a limited role to explain activity levels. Acceptance of wearables can be expected to be high.

Supplementary Information

The online version of this article (10.1007/s00391-022-02083-x) contains supplementary material, which is available to authorized users.

Older adults' physical activity after lockdown: Testing the health action process approach and the moderating role of fear of Covid-19

The coronavirus pandemic has influenced many lives, particularly older adults'. Although isolation protects from infection, health behaviors like physical activity (PA) are important to reinstate after lockdown. However, fear of Covid-19 may act as a barrier, for example, by preventing people from going outside. Based on the health action process approach (HAPA), we investigated whether and why older adults' PA changed after lockdown, and whether fear of Covid-19 moderates the intention-behavior relationship. Participants of this longitudinal study aged 65+ from German-speaking Europe completed an online questionnaire about their PA, fear of Covid-19, and HAPA factors in April and May 2020. Data were analyzed using multiple linear regressions. Results showed that moderate to vigorous activity (MVPA) remained stable after lockdown and that self-efficacy most robustly influenced the intention to be active. PA was not explained by any volitional factor but was strongly related to past PA. Interestingly, the relationship of past and future MVPA was attenuated by fear of Covid-19, but this finding was not robust when outliers were removed. In conclusion, self-efficacy is the most important motivator for PA in older adults after an interruption like a lockdown. Strong physical activity habits may facilitate PA after a period of isolation.

Treating Excessive Consumers With Brief Intervention to Reduce Their Alcohol Consumption

Abstract. Background: General Practitioners’ (GP) readiness to implement screening and brief intervention to reduce alcohol consumption of excessive consumers is low. Although several barriers were identified by past research, improving these conditions has not led to improved implementation. Based on Expectancy Value Theory of Achievement Motivation we assume that low seriousness of the health problem in association with the treatment of excessive alcohol consumers may be considered as a crucial barrier too. Aims: By our study, we tested for the influence of the seriousness of the health problem on the GP’s readiness to implement brief intervention (BI) in comparison to crucial barriers such as insufficient financial reimbursement and low patient adherence. Method: In order to manipulate the seriousness of the health problem GPs were confronted with three different situations each introducing a fictitious patient with either excessive alcohol consumption, or binge drinking, or harmful alcohol consumption. Results: Questionnaires of 185 GPs were analyzed. As hypothesized GPs were less ready to treat patients with excessive consumption in comparison to patients with harmful consumption, t(184) = 5.51, p < .001, d = .40, and binge drinking, t(184) = 6.14, p < .001, d = .43. Their readiness was higher in case of high adherence, F(1, 181) = 17.35, p < .001, η2 = .09. Limitations: Recruitment of GPs was based on voluntary participation. GPs had to assess their readiness in the artificial context of case vignettes. Conclusion: GPs’ readiness to implement a BI was influenced by the seriousness of the health problem and expected patient adherence. No such effect was found for financial reimbursement.

A single mindfulness session with informal caregivers of seniors living with dementia: a pilot qualitative descriptive study

BACKGROUND

Evidence suggests that informal caregivers who are providing care for seniors with dementia experience daily stressors due to their demanding caregiving roles. Current research recognizes the positive impact of mindfulness on caregivers' well-being. However, there is an existing gap in the current literature about informal caregivers' own perceptions and understanding of mindfulness intervention.

OBJECTIVE

To address this gap, this pilot study aims to explore informal caregivers' experience of a single mindfulness session and the feasibility of mindfulness to be integrated into their daily lives.

METHODS

Six informal caregivers who are providing care for seniors living with dementia participated in this qualitative descriptive study. Thematic analysis was used to derive themes to understand the participants' experience of a brief mindfulness session.

RESULTS

The findings of the study generated five major themes: (1) Comparison of mindfulness with other relaxation techniques; (2) Single mindfulness session as a social learning opportunity; (3) Positive impact of practicing mindfulness; (4) Perception about barriers to practicing mindfulness; and (5) Perception of self-efficacy to practice mindfulness in the future.

DISCUSSION

The study participants perceived mindfulness to be beneficial for their overall well-being. In addition, as participants were beginners of mindfulness, they considered mindfulness technique to be easy to learn through single practice session and feasible to be integrated into their daily lives.

CONCLUSION

This qualitative study highlights that as little as brief 15 min of mindfulness session is perceived positively by informal caregivers. There is a need for further research on the long-term outcomes of practicing mindfulness among informal caregivers of seniors.

Couples' daily self-regulation: The Health Action Process Approach at the dyadic level

Objective

Regulating health behavior change often occurs in a dyadic context of romantic relationships. Dyadic approaches to standard health behavior change models are, however, barely considered. We investigated volitional processes of the Health Action Process Approach model for two health behaviors within a dyadic context of romantic couples. Specifically, we tested whether day-to-day volitional self-regulation predicted one’s own and one’s partner’s cigarettes smoked (Study 1) and physical activity (Study 2).

Methods

In two dyadic intensive longitudinal studies (Study 1: 83 dual-smoker couples intending to jointly quit smoking; Study 2: 61 overweight couples intending to become physically active), heterosexual partners independently reported on intention, self-efficacy, action planning, and action control in end-of-day diaries. In Study 1, daily number of cigarettes smoked was assessed via self-report. In Study 2, daily moderate-to-vigorous physical activity (MVPA) was assessed objectively via accelerometers. In both studies, dyadic cross-lagged intensive longitudinal analyses based on the Actor-Partner Interdependence Model were applied.

Results

Across both studies, individual’s own volitional self-regulation positively predicted one’s own health behavior (less cigarettes smoked and more MVPA). One’s partner’s action control and intention also positively predicted one’s own health behavior. A marginal partner effect for self-efficacy was found in the context of smoking only.

Conclusions

Behavioral self-regulation is not only relevant for individuals themselves, but some volitional processes may spill over to their partners. This highlights the need to specify couple-level processes involved in health behavior change, and to consider a social context of self-regulation.