Implicit theories of health predict influenza vaccination intention among elder Chinese: The mediating role of anticipated regret

Receiving influenza vaccines is the most effective public health strategy to protect people against seasonal flu infection. However, influenza vaccination rates are extremely low in China. This study investigated the association between implicit theories of health and influenza vaccination intention among elder Chinese when the vaccine is free (vs not free), and examined the mediating effect of anticipated regret. The results suggested that implicit theories of health, especially incremental theory of health, significantly predicted Chinese elders' influenza vaccination intention and this relationship was mediated by anticipated regret. Implications of the current research for promoting influenza vaccination among elder Chinese and directions for future research are discussed.

Implicit theories of health predict HPV vaccination intention among young adult Chinese women: The mediating effect of consideration of future consequences and future self-continuity

This study investigated the predicting effect of implicit theories of health on HPV vaccination intention among young adult Chinese women and its underlying mechanisms. Four-hundred and eighty-three young Chinese women adults (18-26 years old) participated this study by completing measures on implicit theories of health, consideration of future consequences, future self-continuity, and reported their HPV vaccination intention. The results demonstrated that age, whether they knew someone being diagnosed with cancer, implicit (incremental) theories of health, consideration of future consequences (CFC-Future), and future self-continuity significantly predicted young adult Chinese women's HPV vaccination intention. The predicting effect of implicit theories of health was mediated by consideration of future consequences and future self-continuity. Implications of the current research for promoting HPV vaccination among young adult women and directions for future research are discussed.

Implicit Theories of Smoking and Intention to Quit: A Serial Mediation Model

INTRODUCTION

There is growing evidence that implicit theories of smoking (ITS)-whether smokers perceive smoking behavior as malleable or fixed-are significant predictors of quitting intentions.

AIMS AND METHODS

This cross-sectional study aims to investigate the underlying mechanisms of implicit theories on smoking in predicting smokers' intentions to quit. We conducted multiple linear regression with quitting intentions as the dependent variable, ITS as the independent variable, and sociodemographic variables, quitting attempts in the past year, and receiving quitting advice in the past 12 months as the covariates. The mediating role of consideration of future consequences (CFC) and self-efficacy in the relationship between implicit theories of smoking and quitting intentions was evaluated by mediation analyses.

RESULTS

A total of 510 smokers were included in the final analyses. Smokers holding a higher incremental theory of smoking reported a higher likelihood of considering future consequences (β = 0.289, p < .001) and a weaker possibility of considering immediate results (β = -0.317, p < .001), which, in turn, enhanced their quitting self-efficacy and then led to stronger intentions to quit smoking (β = 0.261, p < .001).

CONCLUSIONS

The current study enriched our understanding of the underlying mechanisms that connect smokers' ITS and their likelihood of smoking cessation such that higher incremental theories of smoking predict stronger intention to quit smoking, and the effect was serially mediated by smokers' likelihood of considering future consequences of their behavior and their perceived self-efficacy for smoking cessation.

IMPLICATIONS

This study indicated the mediating role of CFC and self-efficacy for smoking cessation on the relationship between the ITS and quitting intentions. These two psychological factors and the pathways may be important points for understanding the model of implicit theories for smoking and improving the effectiveness of implicit theories-based intervention on smoking cessation.

Effectiveness of a socioecological model-guided, smart device-based, self-management-oriented lifestyle intervention in community residents: protocol for a cluster-randomized controlled trial

BACKGROUND

Healthy lifestyles are crucial for preventing chronic diseases. Nonetheless, approximately 90% of Chinese community residents regularly engage in at least one unhealthy lifestyle. Mobile smart devices-based health interventions (mHealth) that incorporate theoretical frameworks regarding behavioral change in interaction with the environment may provide an appealing and cost-effective approach for promoting sustainable adaptations of healthier lifestyles. We designed a randomized controlled trial (RCT) to evaluate the effectiveness of a socioecological model-guided, smart device-based, and self-management-oriented lifestyles (3SLIFE) intervention, to promote healthy lifestyles among Chinese community residents.

METHODS

This two-arm, parallel, cluster-RCT with a 6-month intervention and 6-month follow-up period foresees to randomize a total of 20 communities/villages from 4 townships in a 1:1 ratio to either intervention or control. Within these communities, a total of at least 256 community residents will be enrolled. The experimental group will receive a multi-level intervention based on the socioecological model supplemented with a multi-dimensional empowerment approach. The control group will receive information only. The primary outcome is the reduction of modifiable unhealthy lifestyles at six months, including smoking, excess alcohol consumption, physical inactivity, unbalanced diet, and overweight/obesity. A reduction by one unhealthy behavior measured with the Healthy Lifestyle Index Score (HLIS) will be considered favorable. Secondary outcomes include reduction of specific unhealthy lifestyles at 3 months, 9 months, and 12 months, and mental health outcomes such as depression measured with PHQ-9, social outcomes such as social support measured with the modified Multidimensional Scale of Perceived Social Support, clinical outcomes such as obesity, and biomedical outcomes such as the development of gut microbiota. Data will be analyzed with mixed effects generalized linear models with family and link function determined by outcome distribution and accounting for clustering of participants in communities.

DISCUSSION

This study will provide evidence concerning the effect of a mHealth intervention that incorporates a behavioral change theoretical framework on cultivating and maintaining healthy lifestyles in community residents. The study will provide insights into research on and application of similar mHealth intervention strategies to promote healthy lifestyles in community populations and settings.

TRIAL REGISTRATION NUMBER

ChiCTR2300070575. Date of registration: April 17, 2023. https://www.chictr.org.cn/index.aspx .

Identifying potential action points for improving sleep and mental health among employees: A network analysis

BACKGROUND

Mental health issues are severe public health problems, inevitably affected by, also affecting, sleep. We used network analysis to estimate the relationship among various aspects of sleep and mental health simultaneously, and identify potential action points for improving sleep and mental health among employees.

METHODS

We used data from the baseline survey of the Chinese Cohort of Working Adults that recruited 31,105 employees between October 1st and December 31st, 2021. The mental health included anxiety (measured by the Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9]), loneliness (Short Loneliness Scale), well-being (Short Scales of Flourishing and Positive and Negative Feelings), and implicit health attitude (Lay Theory of Health Measures). Seven dimensions of sleep were assessed by the Pittsburgh Sleep Quality Index. An undirected network model and two directed network approaches, including Bayesian Directed Acyclic Graphs (DAGs) and Evidence Synthesis for Constructing-DAGs (ESC-DAGs), were applied to investigate associations between variables and identify key variables.

RESULTS

Depression, daytime dysfunction, and well-being were the "bridges" connecting the domains of sleep and mental health in the undirected network, and were in the main pathway connecting most variables in the Bayesian DAG. Anxiety constituted a gateway that activated other sleep and mental health variables, with sleep duration and implicit health attitude forming end points of the pathway. Similar directed pathways were confirmed in the ESC-DAG.

CONCLUSION

Our network study suggests anxiety, depression, well-being, and daytime dysfunction may be potential action points in preventing the development of poor sleep and mental health outcomes for employees.

COVID-19-Induced Inequalities and Mental Health: Testing the Moderating Roles of Self-rated Health and Race/Ethnicity

This study examines the relationship among COVID-19-induced social, economic, and educational inequalities on mental health (i.e., anxiety and depression). This study also examines if levels of self-rated health (SRH) moderate the relationship (i.e., COVID-induced inequalities [CII] and mental health), as well as examines the racial/ethnic group differences among 567 young adults in the mid-Atlantic region. Using a moderation model, results indicate that CII were significantly related to depression (b = .221, t(554) = 4.59, p = .000) and anxiety (b = .140, t(555) = 3.23, p = .001). SRH and race/ethnicity also moderated both relationships. At above-average SRH (i.e., moderator), higher CII were also significantly related to lower anxiety (Asian young adults only) and lower depression (Asian and White young adults only). Overall, SRH and race/ethnicity are important factors in the mental health impact of COVID-19 on young adults.

A Smartphone-Based Implicit Theories Intervention for Health Behavior Change: Randomized Trial

BACKGROUND

Implicit theories of health describe individuals' beliefs about the malleability of health. Individuals with an incremental theory of health believe that health, in general, is malleable, whereas individuals with an entity theory of health endorse the idea that health is largely fixed and predetermined. Previous research has shown that an incremental theory of health is associated with beneficial health outcomes and behaviors. A mobile health implicit theories intervention could be an effective way to increase health-promoting behaviors in the general population.

OBJECTIVE

The aim of this study was to estimate the effect of a smartphone-based intervention designed to promote an incremental theory of health on the frequency of health-promoting behaviors in everyday life. The study used ecological momentary assessment to measure health behavior change.

METHODS

This 2-arm, single-blind, delayed intervention design included 149 German participants (mean age 30.58, SD 9.71 years; n=79 female). Participants were asked to report their engagement in 10 health-promoting behaviors throughout the day for 3 weeks. Participants were randomly assigned to either an early intervention group (n=72) or a delayed intervention group (n=77). The intervention materials, designed to promote an incremental theory of health, were provided to participants after 1 week (early intervention group) or 2 weeks (delayed intervention group) of baseline behavior measurement. Data for this study were collected between September 2019 and October 2019.

RESULTS

A paired-samples 2-tailed t test revealed that participants reported a stronger incremental theory after responding to the intervention materials (mean 5.58, SE 0.07) compared with incremental theory measured in an entry questionnaire (mean 5.29, SE 0.08; t148=4.07, SE 0.07; P<.001; 95% CI 0.15-0.43; d=0.33). Multilevel analyses showed that participants reported engaging in health-promoting behaviors more often after being presented with the intervention materials compared with baseline across conditions (b=0.14; t146.65=2.06, SE 0.07; P=.04; 95% CI 0.01-0.28). However, when the analysis was conducted separately for the early and delayed intervention groups, the intervention effect was only significant for the delayed intervention group (b=0.27; t1492.37=3.50, SE 0.08; P<.001; 95% CI 0.12-0.42). There was no significant increase in health-promoting behaviors for the early intervention group (b=0.02; t69.23=0.14, SE 0.11;P=.89; 95% CI -0.2 to 0.23).

CONCLUSIONS

This study suggests that a smartphone-based intervention designed to promote an incremental theory of health is a cost- and time-effective approach to increase the frequency of engaging in health-promoting behaviors. However, research is needed to understand the reasons for the difference in intervention effects between the early and delayed intervention groups. The results of this study can guide the development of future digital health interventions that focus on implicit theories to promote health behavior change.

TRIAL REGISTRATION

DRKS - German Clinical Trials Register DRKS00017379; https://drks.de/search/de/trial/DRKS00017379.

Parental Health Mindset Is Related to Preoperative Perceptions of Chest Wall Anomalies

INTRODUCTION

Mindsets of health have been linked to different outcomes for patients with both surgical and medical conditions. A "growth" mindset, in which health is defined as malleable and subject to improvement, is associated with improved attitudes and outcomes when compared to a "fixed" mindset, in which health is defined as unchangeable. In pediatric surgery, parental growth mindsets of health have been correlated with better postoperative outcomes, including lower scores of anxiety and pain perceptions, for children. This was particularly notable in a study of postoperative outcomes for patients with pectus excavatum. In our current study, we extend our investigations to explore how health mindsets are associated with perceptions of chest wall anomalies before correction is undertaken.

METHODS

Seventy-six patients (71 males, mean age 14 y, and 43 excavatum) and 18 parents were surveyed during a routine chest wall clinic visit. Demographic and clinical information as well as the Health Mindset Scale and Pectus Excavatum Evaluation Questionnaire were administered and collected pretreatment.

RESULTS

Parental mindsets of health were significantly correlated with parent assessments of their children's chest pain, physical activity, and concerns about the life-time effect of the condition. A parental growth mindset was linked to lower scores of chest pain, higher ratings of activity, and lower overall level of concern. Furthermore, parental health mindsets also significantly correlated with children's own perceptions of their chest pain, physical activity, shortness of breath, and fatigue. Growth mindset also was linked to more positive ratings.

CONCLUSIONS

Parental growth mindset was associated with more positive assessments of children's symptoms and limitations due to pectus deformities than fixed mindsets. Health mindset has been linked to patient perceptions of, and outcomes for, diabetes, renal disease, allergies, scoliosis, and obesity. Further study into parental and patient mindset correlation may help elucidate factors for bracing compliance, and perhaps to better prepare children and parents for corrective surgical procedures.

The effects of labelling and health identity on subjective health

OBJECTIVES

Labels are used to describe people every day, and these labels can affect people's subjective health. However, little is known about how existing health identity (i.e., stable identification with being a healthy person) shapes these effects. This study examined the effect of health-related labelling on subjective health, and the potential role of existing health identity in moderating this association.

METHODS

Participants (N = 309) first answered questions related to their health identity, namely, the extent to which they identified with being a healthy person. Next, they were presented with a series of scenarios reflecting healthy (n = 154) or unhealthy (n = 155) labels. Participants' subjective health ratings were then measured using a self-report scale ranging from (0) "Worst health among age" to (100) "Best health among age."

RESULTS

Beyond chronological age effects, exposure to healthy labels was associated with higher ratings of subjective health. Participants with a greater health identity showed an amplified positive response to being labelled a healthy person.

CONCLUSIONS

Social-cognitive processes, both in terms of stable identity and situational labelling, inform subjective health. These perceptions may impact actual health downstream. Our results suggest that health identity and health-related labels may be used in future interventions to bolster objective health outcomes.

Designing mindfulness information for interaction in social media: The role of information framing, health risk perception and lay theories of health

In the post-pandemic era, our health is facing unprecedented challenges, and people are more willing to obtain health-related information or interact with each other than ever before. In this context, people’s interest in mindfulness information is also growing. However, not enough attention has been paid to the relationship between mindfulness information design and information interaction. The purpose of this study is to assess the impact of information design based on the gain and loss framework on people’s willingness to interact with mindfulness information, and to identify the framework for achieving better results. Through two experimental studies, we find that information design based on the framework of gains and losses can produce different effects. Specifically, the findings of the first experiment (N = 282) shows the individuals are more willing to interact mindfulness information when they are exposed to gain-framed information rather than loss-framed. In the second experiment (N = 308), we find that loss framing, compared with gain framing, led to greater health risk perception, which in turn make participants more likely to interact with mindfulness information with others. Additionally, our results show that the lay theories of health plays a moderating role in the direct effect of information framework on willingness to interact with mindfulness information in social media. When individuals hold incremental lay theories, they are more willing to interact with mindfulness information under the gain-framed information condition compared with the loss-framed information condition. However, when individuals are in entity condition, there is no significant difference in the willingness to interact with mindfulness information between the gain-framed and loss-framed information. Our studies of integrating information framework into designing mindfulness information suggest a promising strategy of health information interaction in social media.

Designing mindfulness information for interaction in social media: The role of information framing, health risk perception and lay theories of health

In the post-pandemic era, our health is facing unprecedented challenges, and people are more willing to obtain health-related information or interact with each other than ever before. In this context, people's interest in mindfulness information is also growing. However, not enough attention has been paid to the relationship between mindfulness information design and information interaction. The purpose of this study is to assess the impact of information design based on the gain and loss framework on people's willingness to interact with mindfulness information, and to identify the framework for achieving better results. Through two experimental studies, we find that information design based on the framework of gains and losses can produce different effects. Specifically, the findings of the first experiment (N = 282) shows the individuals are more willing to interact mindfulness information when they are exposed to gain-framed information rather than loss-framed. In the second experiment (N = 308), we find that loss framing, compared with gain framing, led to greater health risk perception, which in turn make participants more likely to interact with mindfulness information with others. Additionally, our results show that the lay theories of health plays a moderating role in the direct effect of information framework on willingness to interact with mindfulness information in social media. When individuals hold incremental lay theories, they are more willing to interact with mindfulness information under the gain-framed information condition compared with the loss-framed information condition. However, when individuals are in entity condition, there is no significant difference in the willingness to interact with mindfulness information between the gain-framed and loss-framed information. Our studies of integrating information framework into designing mindfulness information suggest a promising strategy of health information interaction in social media.

Examining the Double-Edged Sword Effects of Lay Theories of Mental Health on Perceptions and Treatment of Others with Mental Health Problems

INTRODUCTION: We examined the implications of viewing mental health problems as changeable through personal effort (incremental lay theory), fixed due to genetics (entity lay theory), or manageable through perseverance on perceptions of others with mental health problems. METHOD: In two preregistered studies, samples of online American participants were randomly assigned to one of four experimental conditions: manageable, incremental (changeable), entity (fixed), or control, and completed self-report measures of onset responsibility, offset efficacy, blame, stigma, willingness to help, and perceived likelihood of success of interventions aimed at helping those with mental health problems. RESULTS: In both studies, the manipulation had a significant effect on each outcome except willingness to help. Compared to the entity (fixed) condition, individuals in the incremental (changeable) condition reported significantly higher offset efficacy and perceived likelihood of success, but also higher onset responsibility and blame. Results for the manageable condition were similar to the incremental (changeable) condition but individuals in the manageable condition also reported lower responsibility (Study 1) as well as lower blame and stigma (Study 2). DISCUSSION: This work informs the ‘double-edged sword’ effects of holding incremental (changeable) or entity (fixed) lay theories concerning mental health problems. Findings also provide evidence that viewing mental health problems as manageable may reduce some of the negative and boost the positive implications associated with incremental (changeable) and entity (fixed) lay theories.

The Hispanic Paradox: A Moderated Mediation Analysis of Health Conditions, Self-Rated Health, and Mental Health among Mexicans and Mexican Americans

This study investigates how mediating (e.g. history of health conditions) and moderating (e.g. self-rated health) factors are associated with nativity status on depression and anxiety in Mexican immigrants. Using data from the 2019 National Health Interview Survey (NHIS), results found a significant direct association between nativity status and anxiety and depression. Additionally, the association between nativity status and mental health was mediated by the history of health conditions, and self-rated health was a significant moderator in both mediation models. Study findings are discussed within the context of barriers to care, current literature, and strengths-based interventions. Future research can expand upon these findings by examining the specific types of physical and mental health conditions that may support the Hispanic Paradox, as well as how self-efficacy and internal locus of control are associated with the paradox within this population.

Risk Perception, Self-efficacy, Lay Theories of Health, and Engagement in Health-Protective Behaviors Among Hospital Pharmacists During the COVID-19 Pandemic

BACKGROUND

Risk perception is an important predictor of health-protective behaviors during pandemics. However, the underlying mechanism connecting risk perception and health-protective behaviors is not well understood. The current study investigates how risk perception predicts hospital pharmacists' engagement in health-protective behaviors during the peak period of COVID-19 pandemic in China and the mediating effects of lay theories of health and self-efficacy.

METHOD

A cross-sectional study on risk perception and engagement in health-protective behaviors was conducted among hospital pharmacists during the COVID-19 pandemic in China. A total of 4121 hospital pharmacists completed the study.

RESULTS

Risk perception, self-efficacy, and lay theories of health were significant predictors of health-protective behaviors among pharmacists. Lay (entity) theories of health and self-efficacy mediated the relationship between risk perception and engagement in health-protective behaviors among hospital pharmacists.

CONCLUSION

Risk perception, self-efficacy, and lay theories (entity versus incremental) of health significantly predicted hospital pharmacists' engagement in health-protective behaviors during the COVID-19 pandemic in China.

Implicit theories of body weight and engagement in healthy lifestyles among young adults: The mediating effect of self-control

Engaging in a healthy lifestyle could be helpful to decrease lifestyle-related health risks and bring long-term health benefits. This research investigated how implicit theories of body weight influence people's engagement in healthy lifestyle among young adults in China. The results suggested that implicit theories of body weight significantly influence people's engagement in heathy eating behaviors and physical activity. Self-control mediated the effect of implicit (incremental) theories of body weight on people's engagement in healthy eating. Implications of the current research for understanding how to promote engagement in healthy lifestyle and directions for future research are discussed.

The Influence of Health Mindset on Perceptions of Illness and Behaviors Among Adolescents

BACKGROUND

Health mindsets can be viewed on a continuum of malleability from fixed (health cannot be altered) to growth (health can be affected by behavior). We propose that mindsets may influence the health perceptions of healthy adolescents as well as the health behaviors of adolescents with a chronic illness.

METHODS

In Study 1, we surveyed healthy adolescents about their health mindsets and their judgments of illness in response to vignettes of fictional others. In Study 2, we measured the health mindsets and health behaviors of adolescents with type 1 diabetes RESULTS: In Study 1, healthy adolescents with a fixed health mindset were more likely to rate fictional others as being less healthy, less likely to recover, and more vulnerable to additional diseases. In Study 2, a growth mindset was associated with a greater frequency of glucose monitoring among younger, but not older, adolescents with type 1 diabetes. Further, growth mindset was associated with lower HbA1c levels for younger adolescents.

CONCLUSIONS

Health mindsets may shape views of the implications of illness or injury for overall health and, in adolescents with a chronic condition, may interact with age to influence health behaviors and outcomes.

Implicit theories of health, consideration of future consequences, and engagement in health protective behaviors during the COVID-19 pandemic in China

This research investigated how implicit theories of health and consideration of future consequences influence people's engagement in health-protective behaviors during the COVID-19 pandemic in China. Three hundred and ninety Chinese completed the study during the peak period of COVID-19 pandemic in China. Gender, education level, implicit theories of health, and consideration of future consequences were significant predictors of people's engagement in health-protective behaviors. Consideration of future consequences mediated the effect of implicit (incremental) theories of health on people's engagement in health-protective behaviors. Implications of the current research for promoting engagement in health-protective behaviors during pandemics of infectious diseases and directions for future research are discussed.

Patterns of older Australians’ engagement in health-promoting activities: a latent profile analysis

Being active in later life is key to remaining physically and mentally healthy, and health in turn influences individuals’ ability to remain active. Activity prevalence figures can disguise the existence of clusters of older people who are very active due to regular participation in multiple categories of activity versus those who are sedentary. The aim of this study was to conduct segmentation analyses based on retired seniors’ engagement in various activities (walking, active sport/exercise, gardening and volunteering) to identify groups characterised by varying patterns of participation. The sample comprised 746 Western Australians aged 60+ years (range 60–95 years, average age 71.66 years, standard deviation = 6.57), 61 per cent of whom were female. Using latent profile analysis, four distinct segments emerged. Those respondents classified as belonging to the most active group exhibited moderate to high levels of participation across all four forms of activity, and tended to be older and more educated than other respondents. Those allocated to the least active group had very low levels of participation across most of the assessed activities and the least favourable physical and mental health scores. Overall, the results indicate the existence of highly divergent segments within the older population in terms of participation across various combinations of health-promoting activities. Segment membership appears to be more closely associated with physical and psychological factors than socio-demographic characteristics.