Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review

Objective

Adherence to lifestyle changes after bariatric surgery is associated with better health outcomes; however, research suggests that patients struggle to follow post-operative recommendations. This systematic review aimed to examine psychological factors associated with adherence after bariatric surgery.

Methods

PubMed, PsycInfo, and Embase were searched (from earliest searchable to August 2022) to identify studies that reported on clinically modifiable psychological factors related to adherence after bariatric surgery. Retrieved abstracts (n = 891) were screened and coded by two raters.

Results

A total of 32 studies met the inclusion criteria and were included in the narrative synthesis. Appointment attendance and dietary recommendations were the most frequently studied post-operative instructions. Higher self-efficacy was consistently predictive of better post-operative adherence to diet and physical activity, while pre-operative depressive symptoms were commonly associated with poorer adherence to appointments, diet, and physical activity. Findings were less inconsistent for anxiety and other psychiatric conditions.

Conclusions

This systematic review identified that psychological factors such as mood disorders and patients' beliefs/attitudes are associated with adherence to lifestyle changes after bariatric surgery. These factors can be addressed with psychological interventions; therefore, they are important to consider in patient care after bariatric surgery. Future research should further examine psychological predictors of adherence with the aim of informing interventions to support recommended lifestyle changes.

Factors related to human papillomavirus vaccine uptake and intentions among adults aged 18-26 and 27-45 years in the United States: A cross-sectional study

BACKGROUND

The current study examined self-reported human papillomavirus (HPV) vaccination uptake and intentions, and associations with psychosocial constructs among United States adults aged 18 to 26 and 27 to 45 years.

METHODS

Data were collected via an online survey from participants recruited from a research panel. Outcomes were HPV vaccination uptake and intentions. Multivariable binary and ordered logistic regression models were used to examine associations between HPV vaccination outcomes and psychosocial constructs, sociodemographics, and previous health behaviors.

RESULTS

HPV vaccination uptake in both age cohorts (N =  2722) was associated with multiple variables, including but not limited to: provider recommendation (adjusted odds ratio [aOR], 11.63 [95% CI, 7.70-17.56] and aOR, 14.26 [95% CI, 9.52-21.38], for those aged 18 to 26 and 27 to 45 years, respectively) and positive HPV vaccine attitudes (aOR, 2.40 [95% CI, 1.70-3.40] and aOR, 1.46 [95% CI,1.06-2.02]). Among those who did not report or were unsure of prior HPV vaccination (N =1894), only 4.6% and 8.1% (aged 18-26 and 27-45 years, respectively) reported being very likely to receive the HPV vaccine in the next year. Increased intentions were associated with more positive vaccine attitudes (aOR, 2.45 [95% CI, 1.91-3.15] and aOR, 2.19 [95% CI, 1.72-2.78]) and provider recommendation (yes vs no; aOR, 1.97 [95% CI, 1.38-2.83] and aOR, 1.82 [95% CI, 1.31-2.52]; don't know/can't remember vs no; aOR, 1.38 [95% CI, 1.03-1.84] and aOR, 1.60 [95% CI, 1.17-2.18]). Sociodemographics and health behaviors associated with increased intentions differed for each age cohort.

CONCLUSIONS

Individual and interpersonal factors were associated with HPV vaccination uptake and intentions. Findings reveal the need for targeted interventions to improve HPV vaccination rates among these age groups.

Safety Baby Shower Intervention Improves Safe Sleep Knowledge and Self-Efficacy among Expectant Teens

Introduction

Young, minority women are less likely to follow recommendations to prevent infant sleep-related deaths putting their children at risk. This study extended the past pre/post study designs to an RCT design and included both parent report and objective observation of the sleep environment.

Objective

This study focused on this population in a quantitative, randomized controlled trial using a low-cost, brief educational intervention, a Safety Baby Shower (SBS).

Methods

Pregnant teens aged 13–19 (N = 147) were recruited as a dyad with a senior female caregiver and randomized to intervention or control groups.

Results

Comparing self-report, safe sleep knowledge, attitudes, beliefs, and intent (KABI) to act scores across the two groups found intervention dyads to have more positive views on all four constructs than controls. Specifically, intervention dyad young mothers were significantly more likely to have positive beliefs about safe sleep and were more likely to report intent to practice infant safe sleep than control young mothers. Intervention dyad young mothers also had higher self-efficacy related to infant safety and more positive attitudes about safe sleep practices than control young mothers. Observations at a home visit conducted after delivery found no differences in the safe sleep practices by intervention status. Participant report of behaviors at the home visit also showed no differences in the use of safe position between the intervention and control groups.

Conclusion

It appears that even when young mothers gain knowledge and self-efficacy, they have difficulty implementing this knowledge. In practice, this suggests that exploring barriers prenatally with this population and offering suggestions to overcome them may be indicated.

Field Test of an m-Health Worksite Health Promotion Program to Increase Physical Activity in Taiwanese Employees: A Cluster-Randomized Controlled Trial

BACKGROUND

Occupational health nurses in workplaces aim to offer evidence-based interventions to increase physical activity among employees to promote health. Mobile health (m-health) interventions have demonstrated effectiveness in increasing physical activity, and the application of m-health solutions in workplaces warrants investigation. We examined the effectiveness of a cell phone/smart device and web-based (m-health) intervention in motivating the employees at financial enterprise firms to increase physical activity.

METHODS

This study included employees from 16 banks (n = 194) who were randomly assigned to either (a) an experimental group (6 banks, n = 89), which received an intervention that integrated the Theory of Planned Behavior (TPB)-based tailored Short Message Service (SMS) with web-based knowledge or (b) a comparison group (10 banks, n = 105), which received web-based messages alone. Outcomes included psychosocial variables (attitude toward physical activity, normative beliefs, and control beliefs) and the level of physical activity. Data were collected at baseline, immediately after the intervention, and 3 months after the intervention.

FINDINGS

The level of physical activity significantly increased in the experimental group (p < .05). TPB variables such as perceived social norms (p < .01) and behavioral control (p < .05) also significantly improved in the experimental group. However, all the effects had a small size (=.05) and diminished in 12 weeks.

CONCLUSIONS

In addition to internet-based information, the use of mobile phones/smart devices to encourage employees to exercise for 8 weeks effectively increased employees' physical activity level. More research, specifically addressing workplace culture, is warranted to establish methods for sustaining healthy behaviors to increase physical activity.

Virtual Reality as a Surgical Care Package for Patients Undergoing Weight Loss Surgery: A Narrative Review of the Impact of an Emerging Technology

While bariatric surgery is regarded as the most effective treatment for people with severe and morbid obesity, its pathway is regarded as a complex one due to the multidisciplinary approaches required from pre-surgery education until long-term management. This is essential to maintain weight loss and improve the quality of life after bariatric surgery. Although these approaches are broadened, patient education, pre-operative preparation, behavioural therapy, rehabilitation, and dietary changes are regarded as the main domains in such complex care. With the increase in technological adaptation in medical services, virtual reality (VR) has shown many benefits that can be utilized in the care of bariatric patients undergoing surgery. However, VR has not been innovated to be a multidomain care package in which bariatric patients could benefit throughout their journey from the pre-operative optimization, recovery, and long-term follow-up. This review aims to give a brief description of some of the applications of VR technology and question whether it has the potential to be considered as a virtual ecosystem to improve the bariatric patients’ experience and pathway throughout surgery and follow-up.

Perceived Behavioral Control and Barriers to Cleaning Skin Before Injecting Drugs

OBJECTIVES

Skin and soft-tissue infections (SSTI) among people who inject drugs (PWID) are common and represent a significant public health burden. In the current study, we examined the relationship between perceived behavioral control and perceived barriers to cleaning skin before injecting drugs.

METHODS

Participants (n = 248; 37.9 [±10.7] years of age, 58.5% male, 59.3% white, 16.1% Hispanic) were patients seeking medical care at a large urban hospital in the northeastern United States. We used ordinary least squares regression to estimate the associations between perceived barriers to skin cleaning with background characteristics and perceived behavioral control.

RESULTS

Controlling for background and other study variables, greater number of past-year skin abscesses was associated with greater level of perceived barriers to skin cleaning (P < 0.001), whereas higher level of education and higher perceived behavioral control were associated with lower levels of perceived barriers to skin cleaning (P < 0.001).

CONCLUSIONS

Interventions aiming to reduce the likelihood for SSTI among people who inject drugs may benefit from strengthening individual's behavioral control and providing skin cleaning skills training.

Positive and negative emotions predict weight loss intentions and behaviors beyond theory of planned behavior constructs

PURPOSE

The current study examined the predictive utility of emotional valence (i.e., positive and negative emotions) on weight loss intentions and behaviors, beyond theory of planned behavior constructs (i.e., attitude, subjective norm, and perceived control), among a community sample of people who were overweight (BMI > 25 kg/m²).

METHODS

Participants were recruited for a longitudinal study via an online panel. They completed a baseline survey (N = 732) and a follow-up survey 6 months later (N = 526), both administered online. The surveys included measures of attitude, subjective norms, perceived control, positive and negative emotions regarding one's current weight, intentions to engage in weight loss behaviors (time 1), and having engaged in weight loss behaviors in the past 6 months (time 2).

RESULTS

Emotion explained additional variance in weight loss intentions (range ΔR² = 0.03-0.10, all ps < 0.01) and behaviors (range ΔR² = 0.01-0.02, all ps < 0.05) beyond theory of planned behavior constructs. Negative emotions mainly predicted the intake of unhealthy food and seeking social support, whereas positive emotions predicted physical activity (intention and behavior). These results suggested that the differential relations might be based on whether the strategy is approach or avoidance oriented.

CONCLUSIONS

Based on these findings, comprehensive models of weight loss behaviors should consider emotion, and the valence of such emotion, regarding current weight.

LEVEL OF EVIDENCE

Level IV, multiple time series without intervention.

Psychosocial factors associated with physical activity in patients who have undergone bariatric surgery

BACKGROUND

Identifying psychosocial variables associated with physical activity may lead to the development of interventions that better address the challenges to participating in physical activity experienced by postbariatric surgery patients.

OBJECTIVE

To examine associations between select psychosocial variables and physical activity in patients who had undergone bariatric surgery within the past 2 years.

SETTINGS

Bariatric surgery candidates were recruited from the Greater Pittsburgh region.

METHODS

Eighty-three patients who had undergone bariatric surgery self-reported current physical activity and select psychosocial constructs. In addition, participants provided retrospective information on physical activity and psychosocial constructs before surgery.

RESULTS

Patients increased physical activity from baseline (median = 156.00 [25th, 75th percentiles: 53.00, 600.00] kcal/week) to post surgery (median = 976.00 [25th, 75th percentiles: 344.00, 1832.00] kcal/week) (P < .001). A number of pre- to postsurgery changes in psychosocial variables were associated with change in physical activity; however, only change in fitness orientation (P = .001), change in social support from friends (P = .005), and change in self-reported weight (P = .012) emerged as predictors of change in physical activity from pre- to postsurgery. Several postsurgery psychosocial factors were also significantly associated with postsurgery physical activity, but only postsurgery fitness orientation (P < .001), social support from co-workers (P = .002), and physical function (P = .023) emerged as predictive of the amount of postsurgical PA.

CONCLUSIONS

Pre- and postbariatric surgery interventions aimed at increasing physical activity participation may need to target important constructs that include the encouragement of social support and strategies to enhance the effort individuals put forward to engage in physical activity, as well as a focus on enhancing physical function and awareness of weight status.

Biopsychosocial correlates of physical activity and sedentary time in adults with severe obesity

Adults with severe obesity have poorer health, are less active and spend more time sedentary compared to people with a lower body mass index (BMI). There is a pressing need to understand the factors associated with low physical activity (PA) and excessive sedentary time to develop more effective behaviour change interventions for this population. The purpose of this study was to identify biopsychosocial correlates of PA and sedentary time in adults living with severe obesity. Forty-four adults living with severe obesity (age = 50.5 ± 13.3 years; BMI = 44.3 ± 7.8 kg/m² ) completed a survey including questions on sociodemographic characteristics, comorbidities, psychosocial factors (eg, social physique anxiety [SPA], social support for PA, PA level self-perception), quality of life, daily pain and self-reported moderate-to-vigorous intensity PA (MVPA). Participants also completed the 6-minute walk test (6MWT) to assess physical fitness and wore an accelerometer to assess objective PA and sedentary time. In stepwise linear multivariate analyses, higher objective MVPA was associated with higher 6MWT distance, being single and lower SPA (R² = 0.46, P < .001), whereas higher self-reported MVPA was associated with greater PA level self-perceptions (R² = 0.47, P < .001). Greater objective light intensity PA was associated with greater quality of life and self-efficacy for PA (R² = 0.26, P = .001). Greater sedentary time was associated with having more comorbidities (R² = 0.25, P < .001). This study shows that adults living with severe obesity who have more comorbidities, poorer quality of life and/or lower self-efficacy perception for PA are more likely to be sedentary and to practice less light intensity PA. Additionally, those who were in a relationship, had higher SPA and/or had lower physical fitness practiced less MVPA. Future research is needed to determine causal effects.

Future-Oriented Happiness: Its Nature and Role in Consumer Decision-Making for New Products

Cognitive evaluations only partially explain the consumer purchasing patterns, especially when consumers approach a product for the first time. In such an encounter, consumers anticipate the emotions they might experience as a result of their decision, as they cannot realistically evaluate product performances. The work investigates the nature and the influence of these future-oriented emotions, namely anticipated and anticipatory happiness, in the first encounter with new products. Through a first laboratory study, adopting both physiological (micro-facial expressions analysis) and self-reported measures, we confirm the distinction between anticipated and anticipatory happiness. We further show the differential impact of these two emotional constructs on the consumer decision-making process by grounding on the Theory of Planned Behavior (TPB). Through a second study, based on a questionnaire, we further investigate the role of anticipated happiness within the TPB. We show that anticipated happiness is a pervasive emotional construct that influences all stages of the intention formation process. We discuss how these findings enrich existing knowledge on the interplay between cognitive and affective components of the decision-making process for new products. Moreover, we offer a methodological contribution to the use of physiological methods to assess emotions.

Go with the FLOW: Implementation of a psychological skills intervention in an exercise program for post-bariatric surgery patients

Bariatric surgery is an effective obesity treatment; however, most individuals regain weight following surgery. Following a Lifestyle of Wellness (FLOW) is a psychological skills intervention with strategies designed to increase self-efficacy and promote living a healthy lifestyle including regular physical activity. Eleven participants completed FLOW. Results indicated participants enjoyed the program and intended to continue this lifestyle upon program completion. Interviews indicated FLOW was effective for improving self-perceptions, and exercise motivation. The most effective sessions were goal setting, future planning, and stress management. Suggestions for program improvement were provided. This information can be used to improve the FLOW program and for implementation into other settings.

Evaluation of an exercise programme for post-bariatric surgery patients: views of participants

OBJECTIVE

Exercise programmes typically are evaluated with fitness assessments and psychological survey measures but seldom include participants' insights. The purpose of this study was to evaluate the benefits, facilitators and barriers of a 12-week exercise programme for post-bariatric surgery patients from the participants' perspective.

METHOD

Over a 2-year period, 20 patients recently having undergone bariatric surgery completed a 12-week programme that included participation in structured exercise and in focus groups designed to supplement standard evaluation data and provide insight into participants' views.

RESULTS

Participants were highly adherent to the programme, and focus group results reflected a clear positive evaluations. Benefits included helpful information, developing commitment, physical fitness and social support; notably, weight was seldom mentioned. Participants cited structure, accountability and group support as facilitators of exercise. Participants cited few barriers, although very few had set plans for continuing exercise after programme completion.

CONCLUSION

Participants saw many benefits to the exercise programme, and those benefits reflected lifestyle changes rather than a focus on weight. Programme structure, accountability and the support of the group were facilitators to exercise. Participants cited few barriers. However, the lack of plans for continued exercise suggested the need for a transition phase to help participants continue an active lifestyle after the 12-week structured programme.

Measurement of adherence in bariatric surgery: a systematic review

After bariatric surgery, rates of adherence to behavioral recommendations, including attending regular appointments and following specific dietary, physical activity, and vitamin use recommendations, tend to be highly variable across studies. Lack of consistency in measurement of adherence is a likely contributor to this variability, making it challenging to determine the prevalence and impact of nonadherence in this population. PubMed was searched for articles measuring behavioral adherence or compliance in patients after bariatric surgery, resulting in 85 articles. Articles were reviewed for the definition and measurement of adherence in each area (appointment attendance, as well as dietary, physical activity, and vitamin use adherence), and on the use and reporting of recommended adherence measurement strategies. Over half of the articles measured adherence to appointment attendance. Significant variability was found across adherence definitions and measurement methods, and use of recommended adherence measurement strategies was poor. Adherence was mostly commonly measured via self-report (either verbal or written) using cutoffs for adherent versus nonadherent behavior. Over half of studies assessed adherence up to ≥2 years postsurgery. Recommendations for ways to improve adherence measurement in patients who have had bariatric surgery are outlined.

Maternal Attitudes, Normative Beliefs, and Subjective Norms of Mothers of 2- and 3-Year-Old Children

INTRODUCTION

This exploratory study examined maternal attitudes, normative beliefs, subjective norms, and meal selection behaviors of mothers of 2- and 3-year-old children.

METHODS

Guided by the Theory of Reasoned Action, we had mothers complete three surveys, two interviews, and a feeding simulation exercise. Data were analyzed using descriptive and bivariate statistics and multivariate linear regression.

RESULTS

A total of 31 mothers (50% Latino, 34% Black, 46.9% ≤ high school education, 31.3% poor health literacy) of 32 children (37.5% overweight/obese) participated in this study. Maternal normative beliefs (knowledge of U.S. Department of Agriculture recommendations) did not reflect actual U.S. Department of Agriculture recommendations. Collectively, regression models explained 13% (dairy) to 51% (vegetables) of the variance in behavioral intent, with normative belief an independent predictor in all models except grain and dairy.

DISCUSSION

Meal selection behaviors, on average, were predicted by poor knowledge of U.S. Department of Agriculture recommendations. Dietary guidance appropriate to health literacy level should be incorporated into well-child visits.

Determinants of Prostate Cancer Screening Intentions of Young Black Men Aged 18 to 40 Years

INTRODUCTION

Black men are more likely to be diagnosed with prostate cancer, with higher stage and higher grade at presentation. Evidence suggests that for education in health promotion behaviors (such as screenings) in early adult years, young Black men can be better equipped to make informed decisions in later years.

OBJECTIVE

Using the theory of reasoned action (TRA), we assessed the intention of young Black men to screen for prostate cancer when it is recommended and determined its correlates.

METHODS

This was a cross-sectional study of 267 Black men aged 18 to 40 years. A 47-item questionnaire collected information on demographics/personal factors, attitudes toward prostate cancer screening, social influence, comfortability with prostate examinations, cues to action, health screening experiences, knowledge of prostate cancer and screening, and intention. Descriptive statistics were calculated for all variables and hierarchical logistic regression was employed to determine significant predictors of prostate cancer screening intentions.

RESULTS

The regression model accounted for 46% of the variance in intention (p < 0.01), with excellent perception of health, having private or public health insurance, longer regular source of care, positive attitude, positive social influence, positive cues to action, and higher knowledge levels being significant predictors of intentions.

CONCLUSION

This study provides support for the use of TRA in predicting prostate cancer screening intentions among young Black men when it is recommended by a physician. Findings may inform the development of empirical-based interventions to educate and inform at-risk young Black men about the pros and cons of prostate cancer screening so that they can make informed decision on screening when recommended later in life.

Impact of the clinical Pilates exercises and verbal education on exercise beliefs and psychosocial factors in healthy women

[Purpose] Exercise is one of the most important components of a healthy life. The purpose of this study was to analyze exercise beliefs and psychosocial factors in sedentary and active healthy women and observe the changes in these parameters resulting from clinical Pilates exercises and verbal education in healthy women. [Subjects and Methods] Sixty-six healthy women were included in the study. Participants were divided into clinical Pilates (n=21), verbal education (n=25), and control groups (n=20). Prior to and at the end of the study, demographic information, body mass index, waist-hip circumference, exercise beliefs, physical activity index, and psychosocial factors (Rosenberg self-esteem scale, Body Cathexis Index, SF-36 quality of life, Beck Depression Scale, visual analog scale for tiredness) of the subjects were recorded. [Results] Meaningful changes for all the parameters took place in the clinical Pilates and verbal education groups. Our analyses indicated that the changes in the clinical Pilates group were more meaningful than those in the verbal education group. When the data of the study groups were compared with those of the control group, the clinical Pilates group showed meaningful differences. [Conclusion] The result of this study indicate that both clinical Pilates and verbal education are effective in changing exercise beliefs and physical and psychosocial parameters.

Factors and associations for physical activity in severely obese adults during a two-year lifestyle intervention

Objective. This study of severely obese adults participating in a two-year lifestyle intervention investigates associations between the independent variables: change in self-efficacy for physical activity (PA) in the face of psychological barriers, perceived behavioural control over PA, and PA self-identity and the dependent variable of change in objectively assessed PA. The intervention comprised four residential periods in a rehabilitation centre and combined diet, physical activity, and cognitive behavioural therapy.

Materials and Methods. Forty-nine severely obese adults (37 women, mean body mass index 42.1 kg/m²) were included in the study. Assessment was done four times using questionnaires and an accelerometer. A linear mixed model based on restricted maximum likelihood was used in analyses for change over time. Associations were studied using linear regression analyses. Age, gender, and change in body mass index were used as control variables.

Results. In the adjusted analyses, change in perceived behavioural control over PA was associated with change in PA (Stand. coeff. = 0.32, p = .005). Change in PA was not associated with either change in self-efficacy over PA in the face of psychological barriers (Stand. coeff. = 0.13, p = .259) or PA self-identity (Stand. coeff. = −0.07, p = .538).

Conclusion. Perceived behavioural control may be a valid target to increase and maintain PA in severely obese adults participating in lifestyle interventions. More research is needed to investigate the process of behaviour change in this population.

Ecological momentary assessment of the relationship between intention and physical activity behavior in bariatric surgery patients

BACKGROUND

Performing habitual physical activity (PA) is challenging for many bariatric surgery patients.

PURPOSE

We used electronic ecological momentary assessment to naturalistically examine whether insufficient PA among bariatric surgery patients was due to infrequent PA intentions or inadequate follow through on PA intentions.

METHOD

Twenty-one patients 6-months post-bariatric surgery were recruited from multiple clinics in Providence, Rhode Island, USA. Participants used a palmtop computer upon waking for 6 days to indicate whether they intended to be active, and if so, the amount of PA they intended to perform in bouts ≥10 min. Each evening, participants reported PA minutes and barriers encountered that day.

RESULTS

All 21 participants reported intending to be active on at least 1 day but only 9 (42%) intended to be active on ≥70% of days. Twelve (57%) participants performed PA on each of the days they intended, but none achieved the amount of PA they intended on all of these days. Overall, participants had PA intentions on 81 of 123 days (66%); these were partially implemented (≥10 PA minutes) on 49 days, but fully implemented on only 15 days. Participants spent 34 min in PA, or 20 fewer minutes than intended. "Lack of time" was the only frequently cited barrier, particularly on days that PA was neither intended nor performed.

CONCLUSION

Few patients intended to be active on a near daily basis and all patients had difficulty in implementing their intentions. Interventions that target planning strategies may help facilitate PA intentions and limit discrepancy between intended and actual PA.

Feasibility of implementing a meditative movement intervention with bariatric patients

Successful interventions are needed to help improve obesity rates in the United States. Roughly two-thirds of adults in the United States are overweight, and almost one-third are obese. In 1991, the National Institutes of Health released a consensus statement endorsing bariatric surgery as the only means for sustainable weight loss for severely obese patients. However, approximately one-third of bariatric patients will experience significant post surgical weight gain.

PURPOSE OF STUDY

This study is designed to determine if meditative movement (MM) would be a feasible physical activity (PA) modality to initiate weight loss in bariatric surgery patients who have re-gained weight.

METHODS USED

A feasibility study was recently completed in 39 bariatric patients at Scottsdale Bariatric Center (SBC) during regularly scheduled bariatric support groups at SBC. A short demonstration of MM was presented after which a short focus group was conducted to gauge interest level, acceptability and the potential demand for MM programs in this population. Attitudes and intentions surrounding MM were also collected.

FINDINGS

Approximately 75% of participants indicated they would consider practicing MM as part of their post surgical PA routine.

CONCLUSIONS

MM may be a feasible PA modality in bariatric patients to improve bariatric surgery weight outcomes.

Applying Psychological Theories to Promote Healthy Lifestyles

Over the past few decades, researchers have been developing and refining psychological theories and models to provide solid behavioral frameworks for evidence-based research. Each year new theories and models are created; however, a select few appear to have withstood the test of time and continue to be frequently utilized in present-day research. The objectives of this review are to highlight these psychological theories and models and describe their application to various public health issues and behaviors. Descriptions and example applications of the following theories and models are described in this review: health belief model, theory of reasoned action/planned behavior, social cognitive theory, transtheoretical model, and socioecological model.