Fostering active choice to empower behavioral change to reduce cardiovascular risk: A web-based randomized controlled trial

OBJECTIVE

To investigate the effect of an active choice (AC) intervention based on creating risk and choice awareness-versus a passive choice (PC) control group-on intentions and commitment to cardiovascular disease (CVD) risk-reducing behavior.

METHODS

Adults aged 50-70 (n = 743) without CVD history participated in this web-based randomized controlled trial. The AC intervention included presentation of a hypothetical CVD risk in a heart age format, information about CVD risk and choice options, and a values clarification exercise. The PC group received a hypothetical absolute numerical CVD risk and brief information and advice about lifestyle and medication. Key outcomes were reported degree of active choice, intention strength, and commitment to adopt risk-reducing behavior.

RESULTS

More AC compared to PC participants opted for lifestyle change (OR = 2.86, 95%CI:1.51;5.44), or lifestyle change and medication use (OR = 2.78, 95%CI:1.42;5.46), than 'no change'. No differences were found for intention strength. AC participants made a more active choice than PC participants (β = 0.09, 95%CI:0.01;0.16), which was sequentially mediated by cognitive risk perception and negative affect. AC participants also reported higher commitment to CVD risk-reducing behavior (β = 0.32, 95%CI:0.04;0.60), mediated by reported degree of active choice.

CONCLUSIONS

Fostering active choices increased intentions and commitment towards CVD risk-reducing behavior. Increased cognitive risk perception and negative affect were shown to mediate the effect of the intervention on degree of active choice, which in turn mediated the effect on commitment. Future research should determine whether fostering active choice also improves risk-reducing behaviors in individuals at increased CVD risk in real-life settings.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05142280. Prospectively registered.

Awareness of a disconnect between the value assigned to health and the effort devoted to health increases the intention to become more physically active

Background

Intrinsic values and priorities influence decision-making and are, therefore, important to consider explicitly in intervention development. Although health is generally considered an important value, individuals often make unhealthy choices, indicating a values disconnect.

Study aim

To investigate how becoming aware of a disconnect between the value assigned to health and the effort devoted to health is related to intentions and commitment for behavioural change and physical activity among inactive adults.

Methods

We performed a secondary exploratory analysis on previously collected data. The intervention included a values exercise based on the Disconnected Values Model (DVM) that made disconnected values explicit to participants in two study arms. We compared participants with a disconnect (n = 138) with participants without a disconnect (n = 101) regarding intentions and commitment for behavioural change and physical activity and sitting time 2-4 weeks follow-up. Logistic and linear regression analyses were performed to analyse the data.

Results

Between-group differences were found for the intention to devote more effort to health (OR = 3.75; 95%CI: 2.05; 6.86) and for the intention to become more physically active (OR = 2.21; 95%CI: 1.10; 4.46), indicating that significantly more participants with a disconnect were motivated to change, compared to participants without a disconnect. No between-group differences were found for commitment, intention strength, follow-up physical activity and sitting time.

Conclusion

Making explicit a disconnect regarding health in an active choice intervention was associated with intentions to become more physically active. Still, it did not translate in significant behaviour change at 2-4 weeks follow-up.

Trial registration

ClinicalTrials.gov: NCT04973813. Retrospectively registered.

Trial registration

ClinicalTrials.gov identifier: NCT04973813..

Behaviourally informed, patient-led interventions to reduce missed appointments in general practice: a 12-month implementation study

BACKGROUND

Scalable, positive, behaviourally informed interventions may help people remember to attend their primary care appointment or cancel in good time, but have not yet been implemented long term.

AIM

To examine effects of social norms and making active commitments on missed and cancelled appointments in primary care over 12 months and explore implementation factors.

DESIGN AND SETTING

A mixed-methods design evaluation and implementation study led by a Patient Participation Group (PPG) member in a large GP practice in the West Midlands.

METHODS

Following a 6-month baseline, waiting room notices were redesigned to emphasise positive social norms for desired behaviours. When booking appointments, receptionists were trained to invite patients to (i) verbally actively commit to cancelling if needed; (ii) write down their own appointment details. Monthly missed appointments (MAs) and cancellations were statistically compared with baseline averages and seasonally equivalent months. To explore implementation, reception staff completed a knowledge, attitude, and behaviour questionnaire at 9 months, analysed descriptively. Study team field notes were thematically analysed.

RESULTS

Across 12 intervention months there was a mean of 37.67 fewer MAs per month (20% reduction) and 102.66 more cancellations (21.07% increase) compared with 6-month baseline means [MAs t(11) = -6.15, P < 0.001; cancellations t(11) = 3.637, P = 0.004] with statistically significant differences in seasonally equivalent months [MAs t(5) = -4.65, P = 0.006; cancellations t(5) = 3.263, P = 0.022]. Receptionists (n = 12) reported implementing the strategies except when facing pressures; knowledge and attitudes varied.

CONCLUSIONS

Behaviourally informed interventions reduced primary care MAs longer term; PPGs and practice teams can work together on quality improvement projects with support from leaders to prioritise and embed new practices.

Testing Enhanced Active Choice to Optimize Acceptance and Participation in a Population-Based Colorectal Cancer Screening Program in Malta

Opt-out strategies have been shown to improve participation in cancer screening; however, there are ethical concerns regarding the presumed consent. In this study, we tested an alternative opt-in strategy, called: "enhanced active choice," in which the response options summarize the consequences of the decision. The study was conducted as part of the Maltese colorectal cancer screening program, which offers men and women, aged 60-64, a "one-off" fecal immunochemical test (FIT). A total of 8349 individuals were randomly assigned to receive either an invitation letter that featured a standard opt-in strategy (control condition), or an alternative letter with a modified opt-in strategy (enhanced active choice condition). Our primary outcome was participation three months after the invitation was delivered. Additionally, we also compared the proportion who said they wanted to take part in screening. We used multivariable logistic regression for the analysis. Overall, 48.4% (N = 4042) accepted the invitation and 42.4% (N = 3542) did the screening test. While there were no statistically significant differences between the two conditions in terms of acceptance and participation, enhanced active choice did increase acceptance among men by 4.6 percentage points, which translated to a significant increase in participation of 3.4 percentage points. We conclude that enhanced active choice can improve male screening participation. Given the higher risk of CRC in men, as well as their lower participation screening, we believe this to be an important finding.

Promoting an active choice among physically inactive adults: a randomised web-based four-arm experiment

BACKGROUND

Promoting active (i.e., conscious, autonomous, informed, and value-congruent) choices may improve the effectiveness of physical activity interventions. This web-based four-arm experimental study investigated the effect of promoting an active versus passive choice regarding physical activity on behavioural and psychological outcomes (e.g., physical activity intentions and behaviours, autonomy, commitment) among physically inactive adults.

METHODS

Dutch inactive adults were randomized into four groups: physical activity guideline only (control group G), guideline & information (GI), guideline & active choice (GA), or guideline & active choice & action planning (GA +). GA and GA + participants were stimulated to make an active choice by weighing advantages and disadvantages of physical activity, considering personal values, and identifying barriers. GA + participants additionally completed action/coping planning exercises. Passive choice groups G and GI did not receive exercises. Self-reported behavioural outcomes were assessed by a questionnaire pre-intervention (T0, n = 564) and at 2-4 weeks follow-up (T2, n = 493). Psychological outcomes were assessed post-intervention (T1, n = 564) and at follow-up. Regression analyses compared the outcomes of groups GI, GA and GA + with group G. We also conducted sensitivity analyses and a process evaluation.

RESULTS

Although promoting an active choice process (i.e., interventions GA and GA +) did not improve intention (T1) or physical activity (T2 versus T0), GA + participants reported higher commitment at T1 (β = 0.44;95%CI:0.04;0.84) and more frequently perceived an increase in physical activity between T0 and T2 (β = 2.61;95%CI:1.44;7.72). GA participants also made a more active choice at T1 (β = 0.16;95%CI:0.04;0.27). The GA and GA + intervention did not significantly increase the remaining outcomes. GI participants reported higher intention strength (β = 0.64;95%CI:0.15;1.12), autonomy (β = 0.50;95%CI:0.05;0.95), and commitment (β = 0.39;95%CI:0.04;0.74), and made a more active choice at T1 (β = 0.13;95%CI:0.02;0.24). Interestingly, gender and health condition modified the effect on several outcomes. The GA + intervention was somewhat more effective in women. The process evaluation showed that participants varied in how they perceived the intervention.

CONCLUSIONS

There is no convincing evidence of a beneficial effect of an active versus passive choice intervention on physical activity intentions and behaviours among inactive adults. Further research should determine whether and how active choice interventions that are gender-sensitized and consider health conditions can effectively increase physical activity.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT04973813 . Retrospectively registered.

Office workers' perspectives on physical activity and sedentary behaviour: a qualitative study

Background

Office workers spend a significant part of their workday sitting. Interventions that aim to reduce sedentary behaviour and increase physical activity might be more effective if greater attention is paid to individual perspectives that influence behavioural choices, including beliefs and values. This study aimed to gain insight into office workers' perspectives on physical activity and sedentary behaviour.

Methods

Sixteen Dutch office workers (50% female) from different professions participated in semi-structured face-to-face interviews in March 2019. To facilitate the interviews, participants received a sensitizing booklet one week before the interview. The booklet aimed to trigger them to reflect on their physical activity and sedentary behaviour and on their values in life. All interviews were audiotaped, transcribed verbatim and coded following codebook thematic analysis.

Results

Six themes were identified: 1) beliefs about health effects are specific regarding physical activity, but superficial regarding sedentary behaviour; 2) in addition to ‘health’ as a value, other values are also given priority; 3) motivations to engage in physical activity mainly stem from prioritizing the value ‘health’, reflected by a desire to both achieve positive short/mid-term outcomes and to prevent long-term negative outcomes; 4) attitudes towards physical inactivity and sedentary behaviour are diverse and depend on individual values and previous experiences; 5) perceived barriers depend on internal and external factors; 6) supporting factors are related to support and information in the social and physical environment.

Conclusions

The great value that office workers attach to health is reflected in their motivations and attitudes regarding physical activity. Increasing office workers' knowledge of the health risks of prolonged sitting may therefore increase their motivation to sit less. Although ‘health’ is considered important, other values, including social and work-related values, are sometimes prioritized. We conclude that interventions that aim to reduce sedentary behaviour and increase physical activity among office workers could be improved by informing about health effects of sedentary behaviour and short/mid-term benefits of physical activity, including mental health benefits. Moreover, interventions could frame physical activity as congruent with values and support value-congruent choices. Finally, the work environment could support physical activity and interruption of sedentary behaviour.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13024-z.

Effect of Personalized Messages Sent by a Health System's Patient Portal on Influenza Vaccination Rates: a Randomized Clinical Trial

BACKGROUND

Adult influenza vaccination rates are low. Tailored patient reminders might raise rates.

OBJECTIVE

Evaluate impact of a health system's patient portal reminders: (1) tailored to patient characteristics and (2) incorporating behavioral science strategies, on influenza vaccination rates among adults.

DESIGN

Pragmatic 6-arm randomized trial across a health system during the 2019-2020 influenza vaccination season. The setting was one large health system-53 adult primary care practices.

PARTICIPANTS

All adult patients who used the patient portal within 12 months, stratified by the following: young adults (18-64 years, without diabetes), older adults (≥65 years, without diabetes), and those with diabetes (≥18 years).

INTERVENTIONS

Patients were randomized within strata to either (1) pre-commitment reminder alone (1 message, mid-October), (2) pre-commitment + loss frame messages, (3) pre-commitment + gain frame messages, (4) loss frame messages alone, (5) gain frame messages alone, or (6) standard of care control. Patients in the pre-commitment group were sent a message in mid-October, asking if they planned on getting an influenza vaccination. Patients in loss or gain frame groups were sent up to 3 portal reminders (late October, November, and December, if no documented influenza vaccination in the EHR) about importance and safety of influenza vaccine.

MAIN MEASURES

Receipt of 1 influenza vaccine from 10/01/2019 to 03/31/2020.

KEY RESULTS

196,486 patients (145,166 young adults, 29,795 older adults, 21,525 adults with diabetes) were randomized. Influenza vaccination rates were as follows: for young adults 36.8%, for older adults 55.6%, and for diabetics 60.6%. On unadjusted and adjusted (for age, gender, insurance, race, ethnicity, and prior influenza vaccine history) analyses, influenza vaccination rates were not statistically different for any study group versus control.

CONCLUSIONS

Patient reminders sent by a health system's patient portal that were tailored to patient demographics (young adults, older adults, diabetes) and that incorporated two behavioral economic messaging strategies (pre-commitment and loss/gain framing) were not effective in raising influenza vaccination rates.

TRIAL REGISTRATION

This trial was registered with ClinicalTrials.gov (NCT04110314).

Social factors of procrastination: group work can reduce procrastination among students

Research on procrastination covers a variety of individual factors (e.g., conscientiousness) and this focus is reflected in interventions against procrastination. Less emphasis is put on situational and social factors that may help students reduce procrastination, such as social interdependence. Therefore, this study investigates the relationship between interdependence with academic procrastination and affective variables. Two vignette studies with student samples (N1 = 320, N2 = 193) were conducted and data was analyzed with regression analyses and analyses of covariance. Results of both studies show lower state procrastination in group work with interdependence compared to individual work, especially in participants with high trait procrastination. This difference is more pronounced when interdependence is accompanied by an active commitment to finish the task on time. Further, interdependent group work is related to increased positive affect and decreased negative affect. The results demonstrate the relevance of situational and social factors for academic procrastination, and point toward new approaches for intervention.

Monitoring a meat-free pledge with smartphones: An experimental study

Pledges are a popular strategy to encourage meat reduction, though experimental studies of their efficacy are lacking. Three-hundred and twenty-five participants from three different countries (UK, Germany, Australia) were randomly assigned to pledge 28 days meat-free or not, and their behavior was tracked via smartphones. Participants answered daily surveys regarding their eating behavior, meat cravings, and shared photos of their meals. Baseline data was collected prior to the pledge, after the 28 days, and one-month post-intervention. Participants assigned to the pledge condition ate less meat across the 28 days, compared to control participants. Meat reductions, observed at outtake, did not endure one-month post-intervention. Overall, German participants ate the least amount of meat, and showed the sharpest decrease in consumption when pledging. Meat cravings tended to increase among pledgers, relative to control participants. Pledgers who reported high starting intentions and conflict about meat tended to eat less meat and reported fewer cravings. All participants reported reduced meat-eating justifications one-month post-intervention. These findings provide experimental evidence that pledges can encourage meat consumers to reduce their intake, though additional mechanisms are needed to sustain commitments.

Protocol for a hybrid type 2 cluster randomized trial of trauma-focused cognitive behavioral therapy and a pragmatic individual-level implementation strategy

BACKGROUND

More than two-thirds of youth experience trauma during childhood, and up to 1 in 5 of these youth develops posttraumatic stress symptoms that significantly impair their functioning. Although trauma-focused cognitive behavior therapy (TF-CBT) has a strong evidence base, it is rarely adopted, delivered with adequate fidelity, or evaluated in the most common setting where youth access mental health services-schools. Given that individual behavior change is ultimately required for successful implementation, even when organizational factors are firmly in place, focusing on individual-level processes represents a potentially parsimonious approach. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a pragmatic, motivationally focused multifaceted strategy that augments training and consultation and is designed to target precise mechanisms of behavior change to produce enhanced implementation and youth clinical outcomes. This study protocol describes a hybrid type 2 effectiveness-implementation trial designed to concurrently evaluate the main effects, mediators, and moderators of both the BASIS implementation strategy on implementation outcomes and TF-CBT on youth mental health outcomes.

METHODS

Using a cluster randomized controlled design, this trial will assign school-based mental health (SMH) clinicians and schools to one of three study arms: (a) enhanced treatment-as-usual (TAU), (b) attention control plus TF-CBT, or (c) BASIS+TF-CBT. With a proposed sample of 120 SMH clinicians who will each recruit 4-6 youth with a history of trauma (480 children), this project will gather data across 12 different time points to address two project aims. Aim 1 will evaluate, relative to an enhanced TAU condition, the effects of TF-CBT on identified mechanisms of change, youth mental health outcomes, and intervention costs and cost-effectiveness. Aim 2 will compare the effects of BASIS against an attention control plus TF-CBT condition on theoretical mechanisms of clinician behavior change and implementation outcomes, as well as examine costs and cost-effectiveness.

DISCUSSION

This study will generate critical knowledge about the effectiveness and cost-effectiveness of BASIS-a pragmatic, theory-driven, and generalizable implementation strategy designed to enhance motivation-to increase the yield of evidence-based practice training and consultation, as well as the effectiveness of TF-CBT in a novel service setting.

TRIAL REGISTRATION

ClinicalTrials.gov registration number NCT04451161 . Registered on June 30, 2020.

Prescriber Commitment Posters to Increase Prudent Antibiotic Prescribing in English General Practice: A Cluster Randomized Controlled Trial

Unnecessary antibiotic prescribing contributes to Antimicrobial Resistance posing a major public health risk. Estimates suggest as many as half of antibiotics prescribed for respiratory infections may be unnecessary. We conducted a three-armed unblinded cluster randomized controlled trial (ISRCTN trial registry 83322985). Interventions were a commitment poster (CP) advocating safe antibiotic prescribing or a CP plus an antimicrobial stewardship message (AM) on telephone appointment booking lines, tested against a usual care control group. The primary outcome measure was antibiotic item dispensing rates per 1000 population adjusted for practice demographics. The outcome measures for post-hoc analysis were dispensing rates of antibiotics usually prescribed for upper respiratory tract infections and broad spectrum antibiotics. In total, 196 practice units were randomized to usual care (n = 60), CP (n = 66), and CP&AM (n = 70). There was no effect on the overall dispensing rates for either interventions compared to usual care (CP 5.673, 95%CI -9.768 to 21.113, p = 0.458; CP&AM, -12.575, 95%CI -30.726 to 5.576, p = 0.167). Secondary analysis, which included pooling the data into one model, showed a significant effect of the AM (-18.444, 95%CI -32.596 to -4.292, p = 0.012). Fewer penicillins and macrolides were prescribed in the CP&AM intervention compared to usual care (-12.996, 95% CI -34.585 to -4.913, p = 0.018). Commitment posters did not reduce antibiotic prescribing. An automated patient antimicrobial stewardship message showed effects and requires further testing.

Commitments increase preparedness for floods

The current study investigated whether we could encourage Australian residents to become better prepared for floods by inviting them to make a specific commitment to do so. We sampled 374 residents of the state of Victoria (56% male, 81% metropolitan) and 400 residents of the state of New South Wales (45% male, 59% metropolitan) who lived in locations that were potentially at risk of floods. They residents were sampled so that their distributions of ages, genders and living locations were as representative as possible of the population of those two states. These residents completed two surveys that ascertained their preparedness for floods at two points in time, separate by a two-week period. At the end of the first survey all residents received information about how they could better prepare for floods. In addition, approximately half the residents were randomly selected to be invited to commit to becoming better prepared for floods. We found that 74% of residents who were invited to commit to becoming better prepared for floods, were willing to make this commitment. We found that the group that was invited to commit to become better prepared for floods increased their preparedness for floods over the two-week period that separated the two surveys more than the group that was not invited to make this commitment, F(1, 772) = 4.53, p = .034, η² = .006. We conclude that when emergency services inform residents of flood-prone areas how to better prepare for floods, they should also attempt to elicit from the residents a commitment to become better prepared for floods.

The influence of a blended, theoretically-informed pre-implementation strategy on school-based clinician implementation of an evidence-based trauma intervention

BACKGROUND

Individual-level implementation determinants, such as clinician attitudes, commonly influence the successful adoption of evidence-based practices, but few explicit strategies have been tested with regard to their ability to impact these key mechanisms of change. This paper reports on an initial test of a blended, theoretically informed pre-implementation strategy designed to target malleable individual-level determinants of behavior change. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a brief and pragmatic pre-implementation strategy that uses strategic education, social influence techniques, and group-based motivational interviewing to target implementation attitudes, perceived social norms, perceived behavioral control, and behavioral intentions to implement among mental health clinicians working in the education sector.

METHODS

As part of a pilot trial, 25 school mental health clinicians were randomized to BASIS (n = 12) or an attention control placebo (n = 13), with both conditions receiving training and consultation in an evidence-based intervention for youth experiencing trauma (the Cognitive Behavioral Intervention for Trauma in Schools). Theorized mechanisms of change (attitudes, perceived social norms, perceived behavioral control, and behavioral intentions) were assessed at baseline, post-training, and 4-month follow-up. Clinician participation in post-training consultation and intervention adoption were also tracked.

RESULTS

A series of regression models and independent sample t tests indicated that BASIS had significant, medium to large effects on the majority of its proximal mechanisms from baseline to post-training. BASIS was also associated with a greater latency between initial training in the intervention and discontinuation of participation in post-training consultation, with clinicians in the BASIS condition persisting in consultation for an average of 134 days versus 32 days for controls, but this difference was not statistically significant. At 4-month follow-up, most differences in the theorized mechanisms had attenuated, and approximately the same small number of BASIS clinicians adopted the trauma intervention as controls.

CONCLUSION

Findings suggest that the brief BASIS pre-implementation strategy had a significant influence on its proximal mechanisms of change, but that these changes did not persist over time or translate into adoption of the trauma intervention. Implications for theory refinement, revisions to the BASIS protocol, and next steps for research surrounding individual-level implementation strategies are discussed.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03791281 . Registered 31 December 2018-Retrospectively registered.

Using Behavioral Economics to Encourage Parent Behavior Change: Opportunities to Improve Clinical Effectiveness

Pediatric clinical practice often involves improving child health by changing parents' behavior. Strategies from behavioral economics-a field that leverages predictable patterns in human decision making to overcome barriers to behavior change-can improve health outcomes in adults. Although more research is needed, the application of these approaches to parent behavior change in pediatric settings has the potential to improve the clinical effectiveness of child health care. We review the foundational concepts of behavioral economics and identify the unique role of pediatricians in motivating parent behavior change. We then discuss how to apply 4 key strategies in practice-message framing, use of defaults, enhanced active choice, and harnessing social forces-to support parent decision making to improve child health. Leveraging behavioral economic principles around parental decision making has the potential to supercharge program effectiveness and improve patient and family health.

Beyond Willpower: Strategies for Reducing Failures of Self-Control

Almost everyone struggles to act in their individual and collective best interests, particularly when doing so requires forgoing a more immediately enjoyable alternative. Other than exhorting decision makers to "do the right thing," what can policymakers do to reduce overeating, undersaving, procrastination, and other self-defeating behaviors that feel good now but generate larger delayed costs? In this review, we synthesize contemporary research on approaches to reducing failures of self-control. We distinguish between self-deployed and other-deployed strategies and, in addition, between situational and cognitive intervention targets. Collectively, the evidence from both psychological science and economics recommends psychologically informed policies for reducing failures of self-control.

From paper to practice: Strategies for improving antibiotic stewardship in the pediatric ambulatory setting

Antibiotic stewardship aims to better patient outcomes, reduce antibiotic resistance, and decrease unnecessary health care costs by improving appropriate antibiotic use. More than half of annual antibiotic expenditures for antibiotics in the United States are prescribed in the ambulatory setting. This review provides a summary of evidence based strategies shown to improve antibiotic prescribing in ambulatory care settings including: providing education to patients and their families, providing education to clinicians regarding best practices for specific conditions, providing communications training to clinicians, implementing disease-specific treatment algorithms, implementing delayed prescribing for acute otitis media, supplying prescribing feedback to providers with peer comparisons, using commitment letters, and prompting providers to justify antibiotic prescribing for diagnoses for which antibiotics are not typically recommended. These various mechanisms to improve stewardship can be tailored to a specific practice's work flow and culture. Interventions should be used in combination to maximize impact. The intent with this review is to provide an overview of strategies that pediatric providers can take from paper to practice.

Examining situational continuous mobile game play behavior from the perspectives of diversion and flow experience

Purpose

The purpose of this paper is to investigate users’ continuous adoption behaviors on mobile game playing from the perspective of situational habit formation.

Design/methodology/approach

Based on the literature research, a continuous adoption model for situational mobile game is proposed. And the research model is assessed based on data gathered from a sample of 226 mobile game players by employing the structural equation model methodology.

Findings

The results show that situational cues represented by availability, perceived ease of use and diversion lead to repeated performance that can be represented by flow experience and satisfaction in the situational mobile game playing context. But only flow experience and diversion influence continuous usage directly. Additionally diversion, as a critical situational variable, not only indirectly affects continuous usage intention through flow experience, but also directly affects continuous usage intention for situational mobile game playing.

Originality/value

Mobile game adoption has been studied from different perspectives, but most research is based on the technology acceptance model. They could not explain the common fact that young people tend to be highly motivated by mobile games and can be regarded as pro-active mobile game players, but many people play mobile games only when they are bored and need a diversion. So this study attempts to illustrate the phenomena to fill the gaps.

Action Dominance: The Performance Effects of Multiple Action Demands and the Benefits of an Inaction Focus

Four experiments uncovered an action dominance error by which people's natural focus on actions hinders appropriate responses to social and nonsocial stimuli. This surprising error comprises higher rates of both omission (misses) and commission (false alarms) when, in responding to action and inaction demands, people have higher numbers of action targets. The action dominance error was verified over four experiments using an analog that required responses to words and to target individuals. Experiments 1 and 2 tested our hypotheses and distinguished the action error effect from the effects of practicing action or inaction responses. Experiment 3 linked the error to the greater cognitive load imposed by the higher proportion of action over inaction targets. Furthermore, Experiment 4 demonstrated that (a) there is a default tendency to pay more attention to action (vs. inaction) targets and (b) shifting focus to inaction targets reduces the action dominance error.

The offline spill-over of signing online petitions against companies

Purpose

The purpose of this paper is to examine cognitive, emotional, and behavioral reactions caused by online petition campaigns against cases of perceived corporate malpractice, while also contributing to the ongoing debate over the spill-over effects of online activism to offline contexts. A dual pathway model is advanced based on the individual’s motivation to help the people affected by irresponsible corporate behavior and punish the deviant corporation.

Design/methodology/approach

Two studies (USA and UK) are used to gather cross-sectional and longitudinal data, which are analyzed using structural equation modeling.

Findings

Online petition campaigns relying on the display of victims affected by irresponsible behavior trigger feelings of compassion and anger. While the former leads to campaign support motivated by a desire to help, the latter causes intentions to punish. Intentions to support the petition resulting from this dual pathway influence the actual signing of the petition online and self-reported offline negative word of mouth against the company.

Social implications

Both identified pathways should be activated by online petition campaigns to increase online support and spreading offline negative word of mouth. To do so, such campaigns need to increase perceptions of unfairness and victim’s similarity, and likeability.

Originality/value

Scant research has examined the psychological processes that explain the effectiveness of online petition campaigns against businesses and the motivations to sign an online petition and engage in subsequent offline behavior. Implications for businesses are also discussed.

The Effect of Response Options on Decisions and Subsequent Behavior: Sometimes Inaction is Better

An active decision can result in more extreme self-inference than a passive decision. In the present study, however, induced inaction had the greatest effect on later behavior Students were asked to indicate their intentions about donating blood the following week. The rate of nonresponding to this request was highest when the only provided response option was to actively convey an intention not to donate, and the actual blood donation rate among these nonresponders was high. Recipients of this response option may have suspended a decision about donation, a suspension which in turn could have increased the probability of eventual donation through one or more social and self perceptual pathways. The behavioral effect of response option frames can be significantly modified by specific features of the request situation.

Opportunity Cost Neglect Attenuates the Effect of Choices on Preferences

The idea that choices alter preferences has been widely studied in psychology, yet prior research has focused primarily on choices for which all alternatives were salient at the time of choice. Opportunity costs capture the value of the best forgone alternative and should be considered as part of any decision process, yet people often neglect them. How does the salience of opportunity costs at the time of choice influence subsequent evaluations of chosen and forgone options? In three experiments, we found that there was a larger postchoice spread between evaluations of focal options and opportunity costs when opportunity costs were explicit at the time of choice than when they remained implicit.

Commitment questions targeting patients promotes uptake of under-used health services: Findings from a national quality improvement program in Australia

RATIONALE

Interventions asking patients to commit to speaking with their doctor about a health-related issue could be used to improve quality of care.

OBJECTIVE

To evaluate the impact of commitment questions targeting patients on the uptake of recommended health services within a national quality improvement program (Veterans' MATES).

METHODS

Patients targeted in the home medicines reviews (HMRs), dose administration aids (DAAs), renal function testing and diabetes interventions were posted educational information and response forms which asked whether they intended to talk to their general practitioner (GP) about the targeted service. Uptake of the service after each intervention was determined using health claims data. Log binomial regression models compared the monthly rate of service use in the nine months post-intervention among patients answering 'yes' to a commitment question with non-responders and patients answering 'no' or 'unsure'.

RESULTS

Each intervention targeted up to 58,000 patients. The average response rate was 28%. Positive responses were associated with increased uptake of HMRs (rate ratio (RR) 2.64, 95% CI 2.39-2.92; p < 0.0001), dose administration aids (RR 2.53, 95% CI 2.29-2.79; p < 0.0001), renal function tests (RR 1.18, 95% CI 1.13-1.24; p < 0.0001), GP management plans (RR 1.30, 95% CI 1.14-1.48; p < 0.0001) and diabetes care plans (RR 1.47, 95% CI 1.24-1.75; p < 0.0001) compared to non-responders. Similar increases in uptake were also observed among positive responders when compared to patients responding 'no' or 'unsure' to the commitment question.

CONCLUSION

Positive responses to commitment questions distributed as part of national, multifaceted interventions were consistently associated with increased uptake of targeted services.

Maintaining Employees’ Commitment to Organizational Change

Via a longitudinal study of organizational change, we found that employees’ later commitment to change, in both affective and normative forms, was generally greater when they initially felt more rather than less commitment to change and that more commitment to change was sustained over time when employees perceived their leaders to have provided more transformational and informational justice behaviors within their work units. We also found that employees’ later commitment to change was a strong predictor of employees’ later behavioral support for change and turnover intention. The implications of our findings for how to maintain employee commitment to organizational change will be discussed.

Invitation choice structure has no impact on attendance in a female business training program in Kenya

Business training programs are a common form of support to small businesses, but organizations providing this training often struggle to get business owners to attend. We evaluate the role of invitation choice structure in determining agreement to participate and actual attendance. A field experiment randomly assigned female small business owners in Kenya (N = 1172) to one of three invitation types: a standard opt-in invitation; an active choice invitation where business owners had to explicitly say yes or no to the invitation; and an enhanced active choice invitation which highlighted the costs of saying no. We find no statistically significant effect of these alternative choice structures on willingness to participate in training, attending at least one day, and completing the course. The 95 percent confidence interval for the active treatment effect on attendance is [−1.9%, +9.5%], while for the enhanced active choice treatment it is [−4.1%, +7.7%]. The effect sizes consistent with our data are smaller than impacts measured in health and retirement savings studies in the United States. We examine several potential explanations for the lack of effect in a developing country setting. We find evidence consistent with two potential reasons being limited decision-making power amongst some women, and lower levels of cognition making the enhanced active choice wording less effective.

Staying the course: the option of doing nothing and its impact on postchoice persistence

Individuals regularly face adversity in the pursuit of goals that require ongoing commitment. Whether or not individuals persist in the face of adversity greatly affects the likelihood that they will achieve their goals. We argue that a seemingly minor change in the individual's original choice set-specifically, the addition of a no-choice option-will increase persistence along the chosen path. Drawing on self-perception theory, we propose that choosing from a set that includes a no-choice (do nothing) option informs individuals that they both prefer the chosen path to other paths and that they consider this path alone to be worth pursuing, an inference that cannot be made in the absence of a no-choice option. This unique information strengthens individuals' commitment to, and increases their persistence on, their chosen path. Three studies employing incentive-compatible designs supported our predictions and ruled out several rival accounts.

Naïve Definitions of Action and Inaction: The Continuum, Spread, and Valence of Behaviors

The cohesiveness of a society depends, in part, on how its individual members manage their daily activities with respect to the goals of that society. Hence, there should be a degree of social agreement on what constitutes action and what constitutes inaction. The present research investigated the structure of action and inaction definitions, the evaluation of action versus inaction, and individual differences in these evaluations. Action-inaction ratings of behaviors and states showed more social agreement at the ends of the inaction-action continuum than at the middle, suggesting a socially shared construal of this definition. Action-inaction ratings were also shown to correlate with the valence of the rated behaviors, such that the more active the behavior the more positive its valence. Lastly, individual differences in locomotion, need for closure, and Christian religious beliefs correlated positively with a preference for action.

How addiction happens, how change happens, and what social workers need to know to be effective facilitators of change

During the last two decades, neuroscience research has proliferated examining brain mechanisms that explain why some people are compelled to pursue drugs and alcohol. The findings suggest that addiction is independent of pleasure, and that drug seeking can be triggered outside of conscious awareness (Berridge, Robinson, & Aldridge, 2009; Goldstein et al., 2009; Kalivas, Volkow, & Seamans, 2005). The observations and conclusions from this research can be used to advantage in treating addiction. The use of social psychological principles, in the context of motivational interviewing, offers a platform for taking advantage of these new insights. After a brief sketch of the latest understanding of the physiological forces operating in addiction, the author examines those ways to interact with substance dependent clients that promote change without provoking resistance in this article. Action plans are later described that can supplant automatic, addiction-induced behaviors (Gollwitzer, Fujita, & Oettingen, 2004). Mechanisms such as building coping skills are discussed, that help in maintaining new behaviors. Some of these mechanisms are efficacious because they bolster the brain's self-regulatory capacity (Baumeister, Vohs, & Tice, 2007; Littrell, 2010). Thus, for every step in the change process, from resistance to change maintenance, validated guidelines for altering the outcome from addiction will be provided.

Dishonest Deed, Clear Conscience: When Cheating Leads to Moral Disengagement and Motivated Forgetting

People routinely engage in dishonest acts without feeling guilty about their behavior. When and why does this occur? Across four studies, people justified their dishonest deeds through moral disengagement and exhibited motivated forgetting of information that might otherwise limit their dishonesty. Using hypothetical scenarios (Studies 1 and 2) and real tasks involving the opportunity to cheat (Studies 3 and 4), the authors find that one’s own dishonest behavior increased moral disengagement and motivated forgetting of moral rules. Such changes did not occur in the case of honest behavior or consideration of the dishonest behavior of others. In addition, increasing moral saliency by having participants read or sign an honor code significantly reduced unethical behavior and prevented subsequent moral disengagement. Although dishonest behavior motivated moral leniency and led to forgetting of moral rules, honest behavior motivated moral stringency and diligent recollection of moral rules.

Impact of an informed choice invitation on uptake of screening for diabetes in primary care (DICISION): trial protocol

Background

Screening invitations have traditionally been brief, providing information only about population benefits. Presenting information about the limited individual benefits and potential harms of screening to inform choice may reduce attendance, particularly in the more socially deprived. At the same time, amongst those who attend, it might increase motivation to change behavior to reduce risks. This trial assesses the impact on attendance and motivation to change behavior of an invitation that facilitates informed choices about participating in diabetes screening in general practice. Three hypotheses are tested:

1. Attendance at screening for diabetes is lower following an informed choice compared with a standard invitation.

2. There is an interaction between the type of invitation and social deprivation: attendance following an informed choice compared with a standard invitation is lower in those who are more rather than less socially deprived.

3. Amongst those who attend for screening, intentions to change behavior to reduce risks of complications in those subsequently diagnosed with diabetes are stronger following an informed choice invitation compared with a standard invitation.

Method/Design

1500 people aged 40–69 years without known diabetes but at high risk are identified from four general practice registers in the east of England. 1200 participants are randomized by households to receive one of two invitations to attend for diabetes screening at their general practices. The intervention invitation is designed to facilitate informed choices, and comprises detailed information and a decision aid. A comparison invitation is based on those currently in use. Screening involves a finger-prick blood glucose test. The primary outcome is attendance for diabetes screening. The secondary outcome is intention to change health related behaviors in those attenders diagnosed with diabetes. A sample size of 1200 ensures 90% power to detect a 10% difference in attendance between arms, and in an estimated 780 attenders, 80% power to detect a 0.2 sd difference in intention between arms.

Discussion

The DICISION trial is a rigorous pragmatic denominator based clinical trial of an informed choice invitation to diabetes screening, which addresses some key limitations of previous trials.

Trial registration

Current Controlled Trials ISRCTN73125647

Reactions to Social Dilemmas as a Function of Group Identity, Rational Calculations, and Social Context

A group identification approach to social dilemmas is proposed, and the results of three studies are presented. Study 1 found that members of real groups were more cooperative than members of contrived groups and that this effect was mediated by group identification. Study 2 showed that participants were more cooperative when their in-group was in the majority and that this effect was moderated by strength of group identity. Study 3 replicated the mediation pattern found in Study 1 using different groups and a more rigorous method. In all three studies, measures of group concern, group trust, normative expectations, concern for personal benefit, estimated futility, and estimated redundancy were also administered. Both group identification and ego incentive motives need to be considered to fully understand people's responses to social dilemmas under varying social circumstances.

Retirees' Social Identity and Satisfaction with Retirement

The purpose of this study was to examine the structure of retirees' social identity and its impact on satisfaction with retirement. From social identity theory formulations, we assumed that (1) retiree-identity was comprised of three distinct components (cognitive, evaluative, and affective), and (2) only the affective component would play a role in satisfaction with retirement. Results of the present study conducted with 154 retired people in France revealed only two components of social identity: a cognitive identity which refers to self-categorization as “retired people,” and an affective identity which refers to evaluation of the group and affective involvement. As expected, regression analyses results indicated that only affective identity was a predictor of satisfaction with retirement. These results will be discussed in the framework of social identity theory literature.

Social influence: compliance and conformity

This review covers recent developments in the social influence literature, focusing primarily on compliance and conformity research published between 1997 and 2002. The principles and processes underlying a target's susceptibility to outside influences are considered in light of three goals fundamental to rewarding human functioning. Specifically, targets are motivated to form accurate perceptions of reality and react accordingly, to develop and preserve meaningful social relationships, and to maintain a favorable self-concept. Consistent with the current movement in compliance and conformity research, this review emphasizes the ways in which these goals interact with external forces to engender social influence processes that are subtle, indirect, and outside of awareness.