Commitment to health: a predictor of dietary change

Predictors of Self-Determined Module Choice in a Web-Based Computer-Tailored Diet and Physical Activity Intervention: Secondary Analysis of Data From a Randomized Controlled Trial

Background

Tailoring an online intervention to participant preferences (eg, by giving participants a choice which modules to follow) may increase engagement in the intervention, motivation for behavioral change, and possibly intervention effects. So far, little is known about what characteristics predict these module choices. Filling this knowledge gap is useful for optimizing program engagement.

Objective

We investigated participant choice for a dietary and/or physical activity (PA) promotion module in our web-based computer-tailored intervention based on self-determination theory (SDT) and motivational interviewing (MI). Furthermore, we investigated which demographic characteristics, current behavior, psychosocial constructs and constructs from SDT and MI, and program-related variables such as advice on which module to follow were associated with these choices.

Methods

Observational data were used from the randomized controlled trial MyLifestyleCoach of participants who were randomized into the intervention condition, completed the baseline questionnaire, and made a module choice in the opening session of the intervention. Here, they received advice on their own dietary and PA behavior. At the session’s end, they chose which lifestyle modules they would like to follow (both, diet, PA, or no module). Measurements included demographic information; self-reported diet and PA; and several psychosocial, SDT, and MI constructs. In total, data from 619 Dutch adults (59.6% women; mean age was 51.9 [SD 13.5] years) were analyzed. A stepwise multinomial logistic regression analysis was conducted to investigate which characteristics are related to module choice; the diet module served as reference category as almost everyone was advised to follow this module.

Results

Of this sample, 54.8% (339/619) chose to do both the diet and PA module, 25.4% (157/619) chose to follow the diet module, 17.8% (110/619) preferred to follow no module, and 2.1% (13/619) chose to do the PA module only. Furthermore, it was found that older people, those who consumed more fruit, and those who scored lower on importance to change their current diet were more likely to choose no module compared to the diet module. People who had more motivation to change their current PA and those who received strong advice compared with slight advice to follow the diet module were more likely to choose both modules compared with the diet module only.

Conclusions

The results show that more than half of the sample was interested in following both the diet and PA module in this online lifestyle intervention. Several characteristics were found to be related to module choice. A future challenge is to examine how this knowledge can be used to improve future interventions, such as tailoring (messages or content) on specific groups or examining where and how MI could be used to motivate people to make a certain module choice.

Trial Registration

Netherlands Trial Register NL7333; https://www.trialregister.nl/trial/7333

Reliability and Validity of the Commitment to Physical Activity Scale for Adolescents

PURPOSE

To examine psychometric properties of a Commitment to Physical Activity Scale for Adolescents (CPASA).

DESIGN

Two test-retest studies and a prospective study, approved by a university institutional review board, were conducted in midwestern U.S. urban areas.

SETTING

The first test-retest study occurred in four community centers, the second test-retest study took place in a community school, and the prospective study occurred in eight middle schools.

SUBJECTS

To measure commitment at baseline and 1 week later, 51 girls in the first test-retest study completed an original 26-item scale, and 91 in the second test-retest study completed a revised 11-item scale. In the prospective study, 503 girls completed the 11-item scale.

MEASURES

Commitment was measured via the CPASA. After completing the CPASA, girls in the prospective study wore ActiGraph GT3X-plus accelerometers that measured light, moderate, and vigorous physical activity (LMVPA) and moderate to vigorous physical activity (MVPA).

ANALYSIS

Internal consistency and test-retest reliability were estimated. Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to cross-validate the factor structure.

RESULTS

For the 11-item CPASA, Cronbach α ranged from .81 to .82, and test-retest reliability was .88. Both EFA and CFA indicated a single factor. The scale was significantly correlated with LMVPA (r = .10) and MVPA (r = .11).

CONCLUSION

The 11-item CPASA demonstrated acceptable reliability and validity with girls.

Literature review: perceptions and management of body size among normal weight and moderately overweight people

Improved understanding of how normal weight and moderately overweight people manage their body weight and shape could be used to inform initiatives to prevent and treat obesity. This literature review offers a thorough appraisal of existing research into perceptions and management of own body size among normal weight and moderately overweight people. The studies reported in the 47 publications reviewed here address various themes based on different conceptualizations. The studies point out that normal weight and moderately overweight people are much concerned about their body size, but huge discrepancies are found between their own perceptions and study categorizations. The studies also indicate that normal weight and moderately overweight people are actively engaged in managing their body size through numerous managing strategies, and dieting is widespread. Together the studies do not form a unified and coherent research field, and there is a bias towards North American study populations. Methodological problems were identified in some publications, raising questions about generalizability of the findings. Moreover, only few studies give deeper insight into the specific perceptions and actions. Repeated studies are needed in broader and more differentiated geographical, social and cultural contexts, and longitudinal studies and more in-depth explorations are especially needed.

Health capabilities and diabetes self-management: the impact of economic, social, and cultural resources

While the "social determinants of health" view compels us to explore how social structures shape health outcomes, it often ignores the role individual agency plays. In contrast, approaches that focus on individual choice and personal responsibility for health often overlook the influence of social structures. Amartya Sen's "capabilities" framework and its derivative the "health capabilities" (HC) approach attempts to accommodate both points of view, acknowledging that individuals function under social conditions over which they have little control, while also acting as agents in their own health and well-being. This paper explores how economic, social, and cultural resources shape the health capability of people with diabetes, focusing specifically on dietary practices. Health capability and agency are central to dietary practices, while also being shaped by immediate and broader social conditions that can generate habits and a lifestyle that constrain dietary behaviors. From January 2011 to December 2012, we interviewed 45 people with diabetes from a primary care clinic in Ontario (Canada) to examine how their economic, social, and cultural resources combine to influence dietary practices relative to their condition. We classified respondents into low, medium, and high resource groups based on economic circumstances, and compared how economic resources, social relationships, health-related knowledge and values combine to enhance or weaken health capability and dietary management. Economic, social, and cultural resources conspired to undermine dietary management among most in the low resource group, whereas social influences significantly influenced diet among many in the medium group. High resource respondents appeared most motivated to maintain a healthy diet, and also had the social and cultural resources to enable them to do so. Understanding the influence of all three types of resources is critical for constructing ways to enhance health capability, chronic disease self-management, and health.

Hand hygiene behavior: translating behavioral research into infection control practice

BACKGROUND

In 2009, the World Health Organization (WHO) recommended "My Five Moments for Hand Hygiene" (5MHH) to optimize hand hygiene (HH). Uptake of these recommendations by healthcare workers (HCWs) remains uncertain.

METHODS

We prospectively observed HCW compliance to 5 MHH. After observations, eligible HCWs who consented to interviews completed surveys on factors associated with HH compliance based on constructs from the transtheoretical model of behavioral change (TTM) and the theory of planned behavior (TPB). Survey results were compared with observed HCW behaviors.

RESULTS

There were 968 observations among 123 HCWs, of whom 110 (89.4%) were female and 63 (51.3%) were nurses. The mean HH compliance for all 5 MHH was 23.2% (95% confidence interval [CI], 18.1%-28.3%) by direct observation versus 82.4% (95% CI, 79.9%-84.9%) by self report. The HCW 5 MHH compliance was associated with critical care unit encounters (P < .05), medicine unit encounters (P - 0.08, P < .001]), immunocompromised patient encounters (P < .05), and HCW prioritized patient advocacy (P < .001). Self-reported TTM stages of action or maintenance (P < .08) and the total TPB behavior score correlated with observed 5 MHH (r = 0.21, P < .02) and with self-reported 5 MHH compliance (r = 0.53, P < .001).

CONCLUSION

Observed HCW compliance to 5 MHH was associated with the type of hospital unit, type of provider-patient encounter, and theory-based behavioral measures of 5 MHH commitment.