Should implementation intentions interventions be implemented in obesity prevention: the impact of if-then plans on daily physical activity in Dutch adults

The relationship of affective and bodily states with goals and plans to increase physical activity: An 8-day study in students

Planning is an important tool to translate intentions into physical activity (PA) behavior. Affective and bodily states are known to influence how much PA individuals perform, but their impact on to formulation of PA plans is not yet known. The aim of the current study is to explore the effect of within- and between-subject variations in affective and bodily states on the content of PA goals and plans. Over eight consecutive days, 362 students created action and coping plans to achieve their daily PA goals. They also reported their affective and bodily states. Generalized linear mixed effect models were used to analyze the associations between these states and the content of the goals and plans. The results showed that both between- and within-subject variations in affective and bodily states were associated with goals formulated in terms of minutes, the intensity and context of planned activities, and anticipated barriers, though more effects were found for within-subject differences. Affective and bodily states impact daily PA goals and plans, highlighting the dynamic nature of planning. Our findings can be a first step toward personalized suggestions for goals, action plans, and coping strategies that are based on individual affective and bodily states.

Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

IMPORTANCE

Unhealthful dietary patterns, low levels of physical activity, and high sedentary time increase the risk of cardiovascular disease.

OBJECTIVE

To synthesize the evidence on benefits and harms of behavioral counseling interventions to promote a healthy diet and physical activity in adults without known cardiovascular disease (CVD) risk factors to inform a US Preventive Services Task Force recommendation.

DATA SOURCES

MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials through February 2021, with ongoing surveillance through February 2022.

STUDY SELECTION

Randomized clinical trials (RCTs) of behavioral counseling interventions targeting improved diet, increased physical activity, or decreased sedentary time among adults without known elevated blood pressure, elevated lipid levels, or impaired fasting glucose.

DATA EXTRACTION AND SYNTHESIS

Independent data abstraction and study quality rating and random effects meta-analysis.

MAIN OUTCOMES AND MEASURES

CVD events, CVD risk factors, diet and physical activity measures, and harms.

RESULTS

One-hundred thirteen RCTs were included (N = 129 993). Three RCTs reported CVD-related outcomes: 1 study (n = 47 179) found no significant differences between groups on any CVD outcome at up to 13.4 years of follow-up; a combined analysis of the other 2 RCTs (n = 1203) found a statistically significant association of the intervention with nonfatal CVD events (hazard ratio, 0.27 [95% CI, 0.08 to 0.88]) and fatal CVD events (hazard ratio, 0.31 [95% CI, 0.11 to 0.93]) at 4 years. Diet and physical activity behavioral counseling interventions were associated with small, statistically significant reductions in continuous measures of blood pressure (systolic mean difference, -0.8 [95% CI, -1.3 to -0.3]; 23 RCTs [n = 57 079]; diastolic mean difference, -0.4 [95% CI, -0.8 to -0.0]; 24 RCTs [n = 57 148]), low-density lipoprotein cholesterol level (mean difference, 2.2 mg/dL [95% CI, -3.8 to -0.6]; 15 RCTs [n = 6350]), adiposity-related outcomes (body mass index mean difference, -0.3 [95% CI, -0.5 to -0.1]; 27 RCTs [n = 59 239]), dietary outcomes, and physical activity at 6 months to 1.5 years of follow-up vs control conditions. There was no evidence of greater harm among intervention vs control groups.

CONCLUSIONS AND RELEVANCE

Healthy diet and physical activity behavioral counseling interventions for persons without a known risk of CVD were associated with small but statistically significant benefits across a variety of important intermediate health outcomes and small to moderate effects on dietary and physical activity behaviors. There was limited evidence regarding the long-term health outcomes or harmful effects of these interventions.

The Effectiveness of Planning Interventions for Improving Physical Activity in the General Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Planning interventions such as action planning (AP) and coping planning (CP) have been recognized as influential strategies in promoting physical activity (PA), but mixed results of existing evidence have been observed. This study aims to perform a systematical meta-analysis to evaluate the efficacy of planning interventions for improving PA in the general population. Eight databases, including Medline, Embase, PsycINFO, Cochrane Library, Web of Science, ProQuest, CNKI, and Wanfang Data, were searched to locate relevant randomized controlled trials (RCTs) from their inception to 31 December 2021. In total, 41 trials with 5439 samples were included in this systematic review, and 35 trials were used in our meta-analysis. The results showed that PA was better promoted in the planned intervention group compared to the control group (SMD = 0.35, 95% CI = 0.25-0.44, I2 = 61.4%). Based on the subgroup analyses, we found that planning strategies were more effective among patients, males, when adopting AP intervention, when using the face-to-face sessions delivery mode, and when reinforcements were conducted during the follow-up. The findings of this study indicate that planning interventions significantly improved PA behavior, and, in some contexts, the effects performed better. Future research needs to be conducted to explore the underlying mechanisms of planning interventions and validate their effects more extensively.

Implementation intentions for weight loss in college students with overweight and obesity: a proof-of-concept randomized controlled trial

One in three college students have overweight or obesity and are in need of brief, simple weight loss interventions. Implementation intentions, a strategy that connects a goal-aligned behavior to a cue, facilitate goal attainment of health behaviors but have not been applied as a standalone treatment for weight loss. The purpose of this study was to examine the efficacy of an implementation intention weight loss intervention in college students. In this three-arm, proof-of-concept, randomized controlled trial, college students with overweight/obesity (N = 95) were randomized to one of three conditions: an implementation intention group (IMP), an enhanced implementation intention group (IMP+) that included text message reminders and fluency training (i.e., training for speed and accuracy), and a control goal intention group (GOL) for 4 weeks. Participants completed anthropometric and self-report assessments pretreatment and posttreatment and experience-sampling assessments during the study to assess how implementation intentions contribute to behavior change. Across the sample, IMP and IMP+ groups reported significantly more goal-congruent behaviors than the GOL group. However, no between-condition differences emerged for weight and diet outcomes. Across conditions, students lost a statistically significant amount of weight, improved diet quality, and reduced caloric intake (ps < .05). Setting implementation intentions was associated with increased behaviors consistent with weight loss goals. Moreover, participants in all groups lost a statistically significant amount of weight. Incorporating implementation intentions into weight loss interventions, and testing the efficacy of this approach on weight loss over a longer duration, may be beneficial for college students with overweight/obesity.

Implementation Intentions for Exercise and Physical Activity: Who Do They Work For? A Systematic Review

Background: As a behavior change technique, implementation intentions are a cost-effective strategy to promote physical activity and exercise. This technique helps individuals plan when and where they will do a behavior. However, previous research on implementation intentions and physical activity has shown heterogeneous outcomes. Methods: The primary aim of this review was to systematically review the literature on the social cognitive variables that moderate the mediating effects of implementation intentions on physical activity and exercise. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, 22 papers yielded 24 studies. Of the 24 reviewed studies, 1 was cross-sectional, 12 were randomized control trials, 10 were longitudinal, and 1 was secondary data from a randomized control trial. Results: Habit strength, self-concordance, self-efficacy, perceived behavioral control, and intention were identified as moderating variables. Conditions for effectiveness for implementation intentions were observed. Implementation intentions are an effective behavior change technique for individuals who have preexisting intentions and strong self-efficacy. Conclusions: Implementation intentions may be a valuable behavior change technique for certain individuals. For self-efficacious individuals who desire to be physically active, implementation intentions can help translate intentions into behavior.

A Couples-Based Approach for Increasing Physical Activity Among Adults With Type 2 Diabetes: A Pilot Feasibility Randomized Controlled Trial

Purpose

The purpose of the study was to examine feasibility outcomes and obtain initial efficacy data on an intervention testing collaborative implementation intentions (IIs) for physical activity (PA) among participants with type 2 diabetes.

Methods

The study used a pilot randomized design and enrolled people with diabetes (PWD) and their partners (N = 40 couples, 80 individuals). PWD reported psychosocial measures, including self-efficacy for PA, diabetes partner investment in diabetes self-management, and PA-related social support. Accelerometers (objective) and the International Physical Activity Questionnaire (self-report) were used to assess PA.

Results

Participants in both experimental conditions reported being satisfied with the intervention and highly committed to their PA plans. Participants were able to follow instructions and completed the intervention in less than 30 minutes. Participants in the collaborative IIs condition reported a greater increase in PA-related social support (partial2= .185, P < .05) and self-reported recreational PA (partial2= .210, P < .05) at 6 weeks compared to the other 2 conditions. In this pilot study, there were no significant group differences on other psychosocial outcomes or for objective PA; however, time in light PA trended higher for the collaborative IIs condition compared to the other 2 conditions (partial2= .237, P = .056).

Conclusions

This study provides initial support for collaborative IIs for PA with PWD and their partners. This brief intervention was feasible and highly acceptable, and it may improve relationship dynamics around PA as well as ultimately increase PA.

Time for change: using implementation intentions to promote physical activity in a randomised pilot trial

OBJECTIVE

A common barrier to exercise is a perceived lack of time. The current pilot study examined the effects of an implementation intention intervention to enhance exercise self-efficacy, increase confidence to exercise when facing time constraints, and increase physical activity in middle-aged adults (n = 63, aged 35-69).

DESIGN

Participants received a pedometer (Fitbit) to objectively measure activity and were randomly assigned to either a control or intervention condition. After a 1-week baseline, the intervention condition received instructions to plan how, where, and when they would add steps to their daily routine to meet their step goal, using personalised schedules and maps. Both groups were contacted nightly via email.

MAIN OUTCOME MEASURES

Physical activity (steps and time spent in moderate-to-vigorous activity), goal achievement, exercise self-efficacy, time-relevant exercise self-efficacy and affect.

RESULTS

Compared to the control, the intervention condition significantly increased in steps, time spent in moderate-to-vigorous activity, and time-relevant exercise self-efficacy. Goal achievement was related to greater time-relevant exercise self-efficacy and more positive affect at the daily level.

CONCLUSION

Findings suggest that the personalised planning intervention increased physical activity and confidence in achieving physical activity goals under time constraints. Avenues for future directions, especially for producing more sustained effects, are discussed.

Impact of implementation intentions on physical activity practice in adults: A systematic review and meta-analysis of randomized clinical trials

OBJECTIVE

The aim of this study was to verify the efficacy of using theory-based strategies on implementation intentions in promoting physical activity (PA) among adults.

METHODS

This review was conducted in accordance with the PRISMA recommendations. The search was carried out in seven electronic databases (LILACS, PubMed, SciELO, Cochrane, Web of Science) and two searches of the "grey literature" were performed (Openthesis and OpenGrey). Randomized clinical trials (RCT), published up to September 2016, were considered eligible for this study. Two reviewers independently and systematically evaluated the eligibility criteria, and performed data extraction. A meta-analysis was performed for the purpose of comparing the effect between the intervention and control groups. The effect sizes were grouped in two subgroups with the purpose of more accurately verifying the effect caused by reinforcing the implementation intentions strategy, and using the inverse variance statistical method with random effects models to estimate the main effect of the implementation intention strategy on the PA behavior. Heterogeneity among the studies was evaluated by using I-square statistics, and the Jadad scale to evaluate the quality of included papers.

RESULTS

The search resulted in 12,147 records, of which 13 RCTs were considered eligible for this review. Sample age ranged from 18 to 76 years, and participants had conditions such as medullary lesion, coronary disease, obesity, diabetes mellitus, sedentarism or occupational stress. When the summary of the effect was analyzed in the meta-analysis, the result found in the subgroup with reinforcement of the implementation intentions strategy was 0.25 (IC 95% = 0.05-0.45) in favor of the intervention group. This demonstrated that application of the implementation intentions strategy was capable of increasing PA practice in the participants of these studies, in comparison with others that did not use this reinforcement.

CONCLUSION

The findings of this review indicated that application of the theory of implementation intentions promoted PA behavior among the adults who received reinforcement of this strategy. The systematic review protocol was registered in the PROSPERO database under the number CRD42018090482.

What contributes to action plan enactment? Examining characteristics of physical activity plans

OBJECTIVES

Individuals with chronic conditions can benefit from formulating action plans to engage in regular physical activity. However, the content and the successful translation of plans into action, so-called plan enactment, are rarely adequately evaluated. The aim of this study was to describe the content of user-specified plans and to examine whether participants were more likely to enact their plans if these plans were highly specific, viable, and instrumental.

DESIGN AND METHODS

The study presents secondary analyses from a larger behavioural intervention in cardiac and orthopaedic rehabilitation. The content of 619 action plans from 229 participants was evaluated by two independent raters (i.e., qualitative analyses and ratings of specificity) and by participants themselves (i.e., instrumentality and viability). Plan enactment was also measured via self-reports. Multilevel analyses examined the relationship between these plan characteristics and subsequent plan enactment, and between plan enactment and aggregated physical activity.

RESULTS

Participants preferred to plan leisure-time physical activities anchored around time-based cues. Specificity of occasion cues (i.e., when to act) and highly instrumental plans were positively associated with plan enactment. Interestingly, individuals who planned less specific behavioural responses (i.e., what to do) were more likely to enact their plans. Plan enactment was positively associated with aggregated behaviour.

CONCLUSIONS

Interventions should not only emphasize the importance of planning, but also the benefits of formulating specific contextual cues. Planning of the behavioural response seems to require less precision. Allowing for some flexibility in executing the anticipated target behaviour seems to aid successful plan enactment. Statement of Contribution What is already known on this subject? Action planning interventions are efficacious in promoting health behaviour. Characteristics of plan content (i.e., specificity) matter for unconditional behaviour change. Plan enactment (i.e., degree to which plan is followed through) is positively linked to behaviour change. What does this study add? Specificity of occasion cues (i.e., when to act) and highly instrumental plans were positively associated with plan enactment. Individuals who planned less specific behavioural responses (i.e., what to do) were more likely to enact their plans. Planning interventions should focus on specificity of context cues but flexibility of behavioural action.

Implementation Intention for Initiating Intuitive Eating and Active Embodiment in Obese Patients Using a Smartphone Application

This article describes a study protocol, which aims to explore and describe the feasibility of a mobile-phone application for initiating intuitive eating and intuitive exercising in patients who are following an ambulatory treatment for obesity. Intuitive eating refers to one's ability to make food choices based on one's awareness of his/her body's response. Intuitive exercising encourages people in finding enjoyable ways of being physically active. These two components will be trained using an implementation intention procedure, that is, behavioral plans that aim at creating a strong link between a specified situation and a response. We aim to recruit up to 80 overweight and obese patients over a period of 2 years. The smartphone application will be assessed on the basis of (i) data obtained through a 4-week use period, (ii) self-report measures taken before and after the use of the mobile application, and (iii) feedbacks from participants after the use of the mobile application. This pilot study will allow us to better understand the applicability of the use of mobile application within ambulatory treatment settings, and to adapt the design of the app necessary for building cross-sectional studies investigating its efficacy.

Smoking cessation in cardiac patients: the influence of action plans, coping plans and self-efficacy on quitting smoking

Smoking cessation is the most effective action for cardiac patients who smoke to improve their prognosis, yet more than one-half of cardiac patients continue to smoke after hospital admission. This study examined the influence of action plans, coping plans and self-efficacy on intention to quit and smoking cessation in cardiac patients. Cardiac patients completed a baseline questionnaire (N = 245) assessing demographic characteristics, smoking behavior, intention, self-efficacy, relapse self-efficacy and action and coping plans. Six months later (N = 184) continued abstinence from smoking was assessed. Self-efficacy predicted intention to quit smoking and was an indirect predictor of continued abstinence, through intention. Intention to quit smoking and making action plans both directly influenced continued abstinence. Future interventions to facilitate smoking cessation in cardiac patients should put strong emphasis on enhancing self-efficacy and on making specific action plans to increase the likelihood of smoking cessation.

An intervention crossing two types of action planning with mental simulation for the promotion of physical activity among adolescents

BACKGROUND

Four of every five adolescents do not meet the current physical activity (PA) recommendations. Therefore, there is a need for effective interventions that promote PA behavior among adolescents.

OBJECTIVE

The present study aimed to evaluate the effectiveness of an integrated theory-based intervention to promote leisure-time PA (LTPA) among adolescents over a 1-month follow-up period.

METHODS

Following the completion of self-reported LTPA at baseline, 316 adolescents aged 14-16 years were randomized into one of six conditions based on a 2 (outcome mental simulation: present vs. absent)×3 (action planning: standard vs. reasoning vs. absent) factorial design. The LTPA was measured again 1 month later.

RESULTS

The intervention did not change adolescents' self-reported LTPA over a 1-month follow-up period. Participants receiving either of the intervention manipulation or combination of these intervention manipulations did not demonstrate significantly higher levels of LTPA compared with partcipants who did not receive intervention manipulations. This might be due to several reasons such as complexity of the target behavior, lack of booster sessions within the follow-up period, or seasonality issues.

CONCLUSION

The results of this study suggest that such an integrated intervention may not yet be ready for implementation in promoting LTPA behavior among adolescents.

Implementation intention and planning interventions in Health Psychology: Recommendations from the Synergy Expert Group for research and practice

The current article details a position statement and recommendations for future research and practice on planning and implementation intentions in health contexts endorsed by the Synergy Expert Group. The group comprised world-leading researchers in health and social psychology and behavioural medicine who convened to discuss priority issues in planning interventions in health contexts and develop a set of recommendations for future research and practice. The expert group adopted a nominal groups approach and voting system to elicit and structure priority issues in planning interventions and implementation intentions research. Forty-two priority issues identified in initial discussions were further condensed to 18 key issues, including definitions of planning and implementation intentions and 17 priority research areas. Each issue was subjected to voting for consensus among group members and formed the basis of the position statement and recommendations. Specifically, the expert group endorsed statements and recommendations in the following areas: generic definition of planning and specific definition of implementation intentions, recommendations for better testing of mechanisms, guidance on testing the effects of moderators of planning interventions, recommendations on the social aspects of planning interventions, identification of the preconditions that moderate effectiveness of planning interventions and recommendations for research on how people use plans.

The use and evaluation of self-regulation techniques can predict health goal attainment in adults: an explorative study

Background. Self-regulation tools are not always used optimally, and implementation intention plans often lack quality. Therefore, this study explored participants' use and evaluation of self-regulation techniques and their impact on goal attainment. Methods. Data were obtained from 452 adults in a proof of concept (POC) intervention of 'MyPlan', an eHealth intervention using self-regulation techniques to promote three healthy behaviours (physical activity (PA), fruit intake, or vegetable intake). Participants applied self-regulation techniques to a self-selected health behaviour, and evaluated the self-regulation techniques. The quality of implementation intentions was rated by the authors as a function of instrumentality (instrumental and non-instrumental) and specificity (non-specific and medium to highly specific). Logistic regression analyses were conducted to predict goal attainment. Results. Goal attainment was significantly predicted by the motivational value of the personal advice (OR:1.86), by the specificity of the implementation intentions (OR:3.5), by the motivational value of the action plan (OR:1.86), and by making a new action plan at follow-up (OR:4.10). Interaction-effects with behaviour showed that the specificity score of the implementation intention plans (OR:4.59), the motivational value of the personal advice (OR:2.38), selecting hindering factors and solutions(OR:2.00) and making a new action plan at follow-up (OR:7.54) were predictive of goal attainment only for fruit or vegetable intake. Also, when participants in the fruit and vegetable group made more than three plans, they were more likely to attain their goal (OR:1.73), whereas the reverse was the case in the PA group (OR:0.34). Discussion. The chance that adults reach fruit and vegetable goals can be increased by including motivating personal advice, self-formulated action plans, and instructions/strategies to make specific implementation intentions into eHealth interventions. To increase the chance that adults reach short-term PA goals, it is suggested to keep eHealth PA interventions simple and focus only on developing a few implementation intentions. However, more research is needed to identify behaviour change techniques that can increase health goal attainment at long-term.

Acceptability, feasibility and effectiveness of an eHealth behaviour intervention using self-regulation: 'MyPlan'

OBJECTIVE

The study aims to evaluate the acceptability, feasibility and effectiveness of the eHealth intervention 'MyPlan', which targets health behaviour in adults.

METHODS

Flemish adults were randomly allocated to a control (n=155), or one of the three intervention groups: a physical activity (PA) (n=158), a fruit intake (n=161) or a vegetable intake group (n=48). PA, fruit or vegetable intake were measured at the start and after one month.

RESULTS

Adults with low education, and over 40 years evaluated the personal advice and action plans as more motivating, but also the personal advice as too long than adults with high education and younger adults. Overall, 48% completed the follow-up module after one week, and only 24% after one month. At one-month follow-up, the fruit intake intervention resulted in more fruit intake (F=9.5, p=0.003) and the PA intervention in a higher total physically activity level (F=5.6, p=0.020) than the control group. There was no effect for vegetable intake.

CONCLUSION

'MyPlan' was feasible and acceptable, and has the potential to increase PA levels, and fruit and vegetable intake.

PRACTICE IMPLICATIONS

Adaptations to the content of the intervention are further needed, and more attention is needed to motivate participants to complete the different follow-up parts.

Setting goal and implementation intentions in consultations between practice nurses and patients with overweight or obesity in general practice

Objective

Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight or obesity, in order to identify points for improvement.

Design

An observational checklist was developed to assess goal and implementation intentions and ‘missed opportunities for lifestyle counselling’. Comparisons were made with overall consultation goals set by practice nurses, as measured in a post-visit questionnaire.

Setting

Dutch general practice.

Subjects

One hundred video-taped consultations (2010/2011) between practice nurses and patients with overweight or obesity.

Results

Half of the consultations contained a goal intention, of which the majority aimed to change eating behaviour. Only part of these goal intentions could be considered implementation intentions. It appeared that actions (how elements) were not often included here. Lifestyle change was more often perceived as an overall consultation goal than weight change. Regarding patterns of overall consultation goals, the majority addressed only one lifestyle factor at a time. If practice nurses formulated weight change in their overall consultation goal, they also used goal or implementation intentions, especially for weight change. In a quarter of the consultations, practice nurses did not ask any further questions about weight, nutrition or physical activity to gain insight, which is an important ‘missed opportunity for lifestyle counselling’.

Conclusions

Matching implementation intentions to the broader overall consultation goals of practice nurses would be meaningful, leading to desired goal-directed behaviours and subsequent goal attainment.

Evidence that implementation intentions reduce drivers' speeding behavior: testing a new intervention to change driver behavior

Implementation intentions have the potential to break unwanted habits and help individuals behave in line with their goal intentions. We tested the effects of implementation intentions in the context of drivers' speeding behavior. A randomized controlled design was used. Speeding behavior, goal intentions and theoretically derived motivational pre-cursors of goal intentions were measured at both baseline and follow-up (one month later) using self-report questionnaires. Immediately following the baseline questionnaire, the experimental (intervention) group (N=117) specified implementation intentions using a volitional help sheet, which required the participants to link critical situations in which they were tempted to speed with goal-directed responses to resist the temptation. The control group (N=126) instead received general information about the risks of speeding. In support of the hypotheses, the experimental group reported exceeding the speed limit significantly less often at follow-up than did the control group. This effect was specific to 'inclined abstainers' (i.e., participants who reported speeding more than they intended to at baseline and were therefore motivated to reduce their speeding) and could not be attributed to any changes in goal intentions to speed or any other measured motivational construct. Also in line with the hypotheses, implementation intentions attenuated the past-subsequent speeding behavior relationship and augmented the goal intention - subsequent speeding behavior relationship. The findings imply that implementation intentions are effective at reducing speeding and that they do so by weakening the effect of habit, thereby helping drivers to behave in accordance with their existing goal intentions. The volitional help sheet used in this study is an effective tool for promoting implementation intentions to reduce speeding.

Tell Me a Story About Healthy Snacking and I Will Follow: Comparing the Effectiveness of Self-Generated Versus Message-Aided Implementation Intentions on Promoting Healthy Snacking Habits Among College Students

In the context of healthy snacking, this study examines whether the quality of mental imagery determines the effectiveness of combining the implementation intention (II) intervention with mental imagery. This study further explores whether providing narrative healthy snacking scenarios prior to forming an II enhances people's mental imagery experience when they are not motivated to snack healthfully. A 2 × 2 factorial design was employed to test the main effect of providing healthy snacking scenarios prior to II formation, and whether such effect depends on people's motivation level. The results from the experiment (N =148) showed significant main as well as interaction effects of the manipulation (with vs. without reading healthy snacking scenarios prior to II formation) and motivation level on ease and vividness of mental imagery. The regression model with the experiment and follow-up survey data (n = 128) showed a significant relationship between ease of mental imagery and actual snacking behavior after controlling for habit strength. The findings suggest that adding a narrative message to the II intervention can be useful, especially when the intervention involves mental imagery and invites less motivated people.

The "Moving Heart Program": an intervention to improve physical activity among patients with coronary heart disease

AIM

this paper reports the results of a nursing-administered theory-based intervention, the "Moving Heart Program", based on the implementation intention theory and pointed at improving physical activity adherence among coronary heart disease outpatients in Brazil.

METHODS

this experimental study applied assessments at baseline, 1 and 2 months after baseline. The Consolidated Standards of Reporting Trials statement was followed. Participants were randomly assigned to intervention, comprising action and coping plans on how to deal with anticipated barriers (n=69), or a standard-care control group (n=67).

RESULTS

participants submitted to the intervention showed significant higher levels of physical activity 2 months after baseline and were significantly more active than the control group.

CONCLUSIONS

the results indicate that the intervention is feasible for patients with coronary heart disease and can be a useful tool to facilitate intended lifestyle changes. This study brings relevant contributions to the Nursing field and other health-related areas, once the intervention presents low cost to health services and can be applied in cardiac rehabilitation programs, showing significant benefits to participants.

Implementation intention and action planning interventions in health contexts: state of the research and proposals for the way forward

The purpose of this paper is to provide an overview of the literature on two planning intervention techniques in health behaviour research, implementation intentions and action planning, and to develop evidence-based recommendations for effective future interventions and highlight priority areas for future research. We focused our review on four key areas: (1) definition and conceptualisation; (2) format and measurement; (3) mechanisms and processes; and (4) design issues. Overall, evidence supports the effectiveness of planning interventions in health behaviour with advantages including low cost and response burden. There is, however, considerable heterogeneity in the effects across studies and relatively few registered randomised trials that include objective behavioural measures. Optimally effective planning interventions should adopt "if-then" plans, account for salient and relevant cues, include examples of cues, be guided rather than user-defined, and include boosters. Future studies should adopt randomised controlled designs, report study protocols, include fidelity checks and relevant comparison groups, and adopt long-term behavioural follow-up measures. Priority areas for future research include the identification of the moderators and mediators of planning intervention effects. Future research also needs to adopt "best practice" components of planning interventions more consistently to elucidate the mechanisms and processes involved.

Determining who responds better to a computer- vs. human-delivered physical activity intervention: results from the community health advice by telephone (CHAT) trial

BACKGROUND

Little research has explored who responds better to an automated vs. human advisor for health behaviors in general, and for physical activity (PA) promotion in particular. The purpose of this study was to explore baseline factors (i.e., demographics, motivation, interpersonal style, and external resources) that moderate intervention efficacy delivered by either a human or automated advisor.

METHODS

Data were from the CHAT Trial, a 12-month randomized controlled trial to increase PA among underactive older adults (full trial N = 218) via a human advisor or automated interactive voice response advisor. Trial results indicated significant increases in PA in both interventions by 12 months that were maintained at 18-months. Regression was used to explore moderation of the two interventions.

RESULTS

Results indicated amotivation (i.e., lack of intent in PA) moderated 12-month PA (d = 0.55, p < 0.01) and private self-consciousness (i.e., tendency to attune to one's own inner thoughts and emotions) moderated 18-month PA (d = 0.34, p < 0.05) but a variety of other factors (e.g., demographics) did not (p > 0.12).

CONCLUSIONS

Results provide preliminary evidence for generating hypotheses about pathways for supporting later clinical decision-making with regard to the use of either human- vs. computer-delivered interventions for PA promotion.

Selbstkontrollstrategien bei hohem wahrgenommenem Stress und hohen Bewegungsbarrieren

Die Ressourcen der exekutiven Funktionen von Menschen sind begrenzt, weshalb nicht unbeschränkt Energie in die Selbstkontrollfunktion investiert werden kann. Aus sport- und gesundheitspsychologischer Perspektive bedeutet dies, dass chronischer Stress möglicherweise die Kapazität von Personen herabsetzt, die kognitive Kontrolle über ihr Sportverhalten aufrechtzuerhalten. Aufbauend auf den Postulaten des Strength Model of Self-Control wird in der vorliegenden Studie geprüft, ob der häufige Gebrauch spontaner Selbstkontrollstrategien bei 300 Polizeiangestellten (30 % Frauen, M = 41.8 Jahre) mit mehr Sportaktivität einhergeht, wenn sich diese hohem Stress ausgesetzt fühlen oder ein hohes Mass an sportbezogenen Barrieren wahrnehmen. Die Befunde zeigen, dass der spontane Gebrauch von Implementierungsintentionen und Strategien der Intentionsabschirmung mit erhöhter Sportaktivität assoziiert ist. Dieser Zusammenhang scheint jedoch unabhängig vom Stressniveau und den wahrgenommenen Bewegungsbarrieren zu sein. Die Studie unterstützt die Annahme, dass volitionale Selbstkontrollstrategien wie das Formulieren von Handlungsplänen und das Antizipieren von Bewegungsbarrieren und Bewältigungsstrategien bei Polizeiangestellten zur verbesserten Umsetzung gesundheitsbezogener Verhaltensziele beiträgt.

Effectiveness of a motivational interviewing intervention on weight loss, physical activity and cardiovascular disease risk factors: a randomised controlled trial with a 12-month post-intervention follow-up

BACKGROUND

Intensive diet and physical activity interventions have been found to reduce cardiovascular disease (CVD) risk, but are resource intensive. The American Heart Association recently recommended motivational interviewing (MI) as an effective approach for low-intensity interventions to promote health-related outcomes such as weight loss. However, there is limited research evaluating the long-term effectiveness of MI-based interventions on health-related outcomes associated with CVD risk. The current research evaluated the effectiveness of a six-month low-intensity MI intervention in a UK primary-care setting in maintaining reductions in CVD risk factors at12 months post-intervention.

METHODS

Primary-care patients were randomised to an intervention group that received standard exercise and nutrition information plus up to five face-to-face MI sessions, delivered by a physical activity specialist and registered dietician over a 6-month period, or to a minimal intervention comparison group that received the standard information only. Follow-up measures of behavioural (vigorous and moderate physical activity, walking, physical activity stage-of-change, fruit and vegetable intake, and dietary fat intake) and biomedical (weight, body mass index [BMI], blood pressure, cholesterol) outcomes were taken immediately post-intervention and at a 12-month follow-up occasion.

RESULTS

Intent-to-treat analyses revealed significant differences between groups for walking and cholesterol. Obese and hypercholesterolemic patients at baseline exhibited significant improvements in BMI and cholesterol respectively among those allocated to the intervention group compared to the comparison group. Post-intervention improvements in other health-related outcomes including blood pressure, weight, and BMI were not maintained.

CONCLUSIONS

The present study suggests that a low-intensity MI counselling intervention is effective in bringing about long-term changes in some, but not all, health-related outcomes (walking, cholesterol levels) associated with CVD risk. The intervention was particularly effective for patients with elevated levels of CVD risk factors at baseline. Based on these findings future interventions should be conducted in a primary care setting and target patients with high risk of CVD. Future research should investigate how the long-term gains in health-related outcomes brought about by the MI-counselling intervention in the current study could be extended to a wider range of health outcomes.

Assessing and Comparing the Short-Term Effects of TPB Only and TPB plus Implementation Intentions Interventions on Snacking Behavior in Iranian Adolescent Girls: A Cluster Randomized Trial

Purpose.

The evidence for the effectiveness of theory of planned behavior (TPB)–based interventions is mixed. There is also mixed evidence on the effectiveness of adding implementation intentions to TPB-based interventions. In this study we assessed and compared the short-term effects of TPB-only intervention and TPB plus implementation intentions intervention on snacking behavior and intention to consume unhealthy snacks in Iranian adolescent girls.

Design.

Three-arm cluster randomized controlled trial.

Setting.

Ten middle schools in Tehran (Iran).

Subjects.

A total of 29 classes included 739 female adolescents (age range: 12–15 years).

Intervention.

Two brief interventions including TPB-only intervention and TPB plus implementation intentions intervention.

Measures.

Food frequency questionnaire and intentions at baseline, 10 days, and 3 months measuring snacking behavior and cognitions about unhealthy snack consumption, respectively.

Analysis.

Hierarchical linear modeling to assess the interventions' effects.

Results.

Both interventions successfully decreased intention to consume and consumption of unhealthy snacks at postintervention. Calculation of the effect sizes revealed that the TPB plus implementation intentions intervention was more effective than the TPB-only intervention. The effects remained significant at 3-month follow-up in the TPB plus implementation intentions intervention group only, although the effect size decreased.

Conclusion.

Overall, the study suggests that adding implementation intentions on top of TPB-based persuasive messages improves effectiveness and sustainability of desirable changes.

The use of implementation intentions to promote vitamin D supplementation in young children

Only 50% of Dutch children aged 0-4 years receive sufficient daily vitamin D supplementation. This study aims to investigate the effectiveness of implementation intentions in promoting vitamin D supplementation among young children. An electronic survey was conducted among parents of children aged 0-4 (n = 171). These parents were randomly assigned to two groups: one that received implementation intention instructions and one that did not. At follow-up, there were no significant between group differences in any outcome measures. These results suggest that merely asking parents to formulate an implementation intention with respect to giving their child daily vitamin D supplementation is insufficient to improve vitamin D intake among young children. However, testing the intervention via the Internet may not have allowed us to exploit the full potential of the strategy. Investigation of the use of implementation intentions in the setting of toddler consultation clinics is therefore recommended.

Action and coping plans related to the behavior of adherence to drug therapy among coronary heart disease outpatients

OBJECTIVE: to analyze the action and coping plans related to the behavior of adhering to drug therapy, developed by coronary heart disease (CHD) outpatients, and to identify the barriers perceived to adopting this behavior. METHODS: the participants (n=59) were invited to formulate action plans and coping plans for the behavior of adhering to the cardio-protective medications and the symptom-relief medications. RESULTS: specific action plans for taking the medications associated with temporal markers and the sleep-wake cycle were shown. The most frequently reported obstacles were forgetfulness and absence of routine in daily living activities. The coping plans for overcoming forgetfulness were the most specific. CONCLUSION: this study's findings support the application of implementation intentions aimed at optimizing adherence to drug therapy among patients with CHD.

Does action planning moderate the intention-habit interaction in the exercise domain? A three-way interaction analysis investigation

Both habit strength and action planning have been found to moderate the intention-exercise behaviour relationship, but no research exists that has investigated how habit strength and action planning simultaneously influence this relationship. The present study was designed to explore this issue in a prospective sample of undergraduate students (N = 415): action planning, habit strength, intention, attitudes, subjective norms and perceived behavioural control were assessed at baseline and exercise behaviour was assessed 2 weeks later. Both habit strength and action planning moderated the intention-exercise relationship, with stronger relationship at higher levels of planning or habit strength. Decomposing a significant action planning × habit strength × intention interaction showed that the strength of the intention-exercise relationship progressed linearly through levels of action planning and habit strength. These novel results show that action planning strengthens the intention-habit strength interaction in the exercise domain: exercise interventions should therefore focus on simultaneously bolstering action planning and habit strength.

Effectiveness of a brief intervention using mental simulations in reducing alcohol consumption in corporate employees

A theory-based intervention aimed at reducing corporate employees' alcohol consumption in excess of guideline limits is presented. The intervention adopted an outcome mental simulation technique and was administered to a sample of corporate employees from three companies. A single-arm randomized-controlled design was adopted. All participants completed baseline psychological measures and self-reported number of alcohol units consumed and binge-drinking occasions. Participants allocated to the intervention condition were presented with a mental simulation exercise. One month later, participants completed follow-up measures of the psychological variables and alcohol consumption. Results revealed a significant effect of the mental simulation intervention on number of units of alcohol consumed at follow-up. There was no effect of the intervention on frequency of binge-drinking occasions. There was no evidence for the mediation of the effect of mental simulations on alcohol consumption by the perceived behavioural control and motivation variables. Results support the efficacy of the mental simulation intervention in reducing alcohol consumption but not in reducing binge drinking or alcohol consumption in excess of guideline limits, among corporate employees. Results are discussed with respect to the importance of the mental simulation intervention to inform practice and the proposed processes by which mental simulations affect alcohol consumption.

An intervention to reduce alcohol consumption in undergraduate students using implementation intentions and mental simulations: a cross-national study

BACKGROUND

Excessive alcohol consumption has been linked to deleterious health consequences among undergraduate students. There is a need to develop theory-based and cost-effective brief interventions to attenuate alcohol consumption in this population.

PURPOSE

The present study tested the effectiveness of an integrated theory-based intervention in reducing undergraduates' alcohol consumption in excess of guideline limits in national samples from Estonia, Finland, and the UK.

METHOD

A 2 (volitional: implementation intention vs. no implementation intention) × 2 (motivation: mental simulation vs. no mental simulation) × 3 (nationality: Estonia vs. Finland vs. UK) randomized-controlled design was adopted. Participants completed baseline psychological measures and self-reported number of alcohol units consumed and binge-drinking frequency followed by the intervention manipulation. One month later, participants completed follow-up measures of the psychological variables and alcohol consumption.

RESULTS

Results revealed main effects for implementation intention and nationality on units of alcohol consumed at follow-up and an implementation intention × nationality interaction. Alcohol consumption was significantly reduced in the implementation intention condition for the Estonian and UK samples. There was a significant main effect for nationality and an implementation intention × nationality interaction on binge-drinking frequency. Follow-up tests revealed significant reductions in binge-drinking occasions in the implementation intention group for the UK sample only.

CONCLUSION

Results support the implementation intention component of the intervention in reducing alcohol drinking in excess of guideline limits among Estonian and UK undergraduates. There was no support for the motivational intervention or the interaction between the strategies. Results are discussed with respect to intervention design based on motivational and volitional approaches.

Testing an integrated model of the theory of planned behaviour and self-determination theory for different energy balance-related behaviours and intervention intensities

OBJECTIVES

The aim of the study was to test the relations between constructs from the self-determination theory (autonomous and controlled motivation), the theory of planned behaviour (attitudes, self-efficacy, and intentions), and behaviour change within a theoretically integrated model. Additionally, the aim was to test if these relations vary by behaviour (physical activity or dietary behaviour) or intervention intensity (frequency).

DESIGN

It was a randomized controlled trial with a 'usual care' condition (medical screening only) and an intervention condition (medical screening+access to a website and coaching). Participants in the latter condition could freely determine their own intervention intensity.

METHODS

Participants (N= 287) completed measures of the theoretical constructs and behaviour at baseline and after the first intervention year (N= 236). Partial least squares path modelling was used.

RESULTS

Changes in autonomous motivation positively predicted changes in self-efficacy and intentions towards a healthy diet. Changes in controlled motivation positively predicted changes in attitudes towards physical activity, changes in self-efficacy, and changes in behavioural intentions. The intervention intensity moderated the effect of self-efficacy on intentions towards physical activity and the relationship between attitude and physical activity. Changes in physical activity were positively predicted by changes in intentions whereas desired changes in fat intake were negatively predicted by the intervention intensity.

CONCLUSIONS

Important relations within the theoretically integrated model were confirmed but others were not. Moderation effects were found for behaviour and intervention intensity.

A theory-based intervention to reduce alcohol drinking in excess of guideline limits among undergraduate students

OBJECTIVES

Undergraduate students frequently exceed guideline limits for alcohol intake in a single session and are highly susceptible to associated health, social, and economic problems. Psychological theory suggests that interventions aimed at reducing alcohol consumption should target both motivational and volitional phases of action to be effective. This study reports an integrated theory-based intervention aimed at reducing undergraduates' alcohol consumption in excess of guideline limits.

DESIGN

The study adopted a 2 (motivation: mental simulation vs. no mental simulation) × 2 (volitional: implementation intention vs. no implementation intention) randomized controlled design presented in an online format.

METHODS

Undergraduate students (N= 238; females, n= 133, M age = 20.11, SD= 2.09; males, n= 105, M age = 20.38, SD= 1.35) completed baseline psychological measures and self-reported alcohol consumption as units consumed and heavy episodic drinking occasions followed by the intervention manipulation (if any). One month later participants completed follow-up measures of the psychological variables and alcohol consumption.

RESULTS

 Significant reductions in alcohol consumption were observed at follow-up. Participants receiving a mental simulation intervention reported significantly fewer units of alcohol consumed and heavy episodic drinking occasions. Among participants with high baseline alcohol consumption, participants in the combined mental simulation and implementation intention intervention group consumed significantly fewer units than other groups.

CONCLUSION

Results support the use of these theory-based strategies to reduce alcohol drinking in excess of guideline limits among undergraduates. There was preliminary support for the interaction between the two strategies among heavier drinkers. Targeting both motivational and implemental phases of action poses a high probability for success in changing alcohol-related behaviour in this population.

Psychometric properties of the KPAS in diverse ethnic groups of midlife women

The Kaiser Physical Activity Survey (KPAS), designed specifically for diverse activity domains (housework, caregiving, occupational activity), is used to assess physical activity among multiethnic midlife women. This study evaluates KPAS reliability and validity (not widely documented) in measuring physical activity among 341 groups in this classification. Internal consistency coefficients are adequate for all ethnic groups except non-Hispanic (N-H) African Americans. To evaluate construct validity, the researchers use multiple analytic approaches, including correlation between behavioral intention and KPAS scores and factor analysis. KPAS scores correlate positively with behavioral intention scores among all ethnic groups. Eight factors are extracted among all groups except N-H Asian Americans. In the convergent validity test, N-H African Americans and N-H Asian Americans show unique patterns. Overall, the KPAS proves reliable as a reasonably accurate instrument to assess physical activities among multiethnic groups of midlife women. However, cultural sensitivity among N-H African Americans and N-H Asian Americans needs further examination.

Effect of Implementation Intentions to Change Behaviour: Moderation by Intention Stability

The aim of this study was to assess the effects of implementation intentions on leisure-time physical activity, taking into account the stability of intention. At baseline (T0), 349 participants completed a psychosocial questionnaire and were randomly assigned to implementation intention or control condition. Three months after baseline assessment (T1), participants in the experimental group were asked to plan where, when, and how they would exercise. Leisure-time physical activity was assessed 3 mo. later (i.e., at 6-mo. follow-up; T2). The intervention had no significant effect on physical activity at 6-mo. follow-up. However, a significant interaction of group and intention stability was observed, with the effect of the intervention on behaviour statistically significant only among those with unstable intention. Intention stability thus moderated the effect of the intervention, i.e., the intervention was more successful among individuals who needed support to change (unstable intenders).

Design of the Balance@Work project: systematic development, evaluation and implementation of an occupational health guideline aimed at the prevention of weight gain among employees

Background

Occupational health professionals may play an important role in preventive health promotion activities for employees. However, due to a lack of knowledge and evidence- and practice based methods and strategies, interventions are hardly being implemented by occupational physicians to date. The aim of the Balance@Work project is to develop, evaluate, and implement an occupational health guideline aimed at the prevention of weight gain among employees.

Methods

Following the guideline development protocol of the Netherlands Society of Occupational Medicine and the Intervention Mapping protocol, the guideline was developed based on literature, interviews with relevant stakeholders, and consensus among an expert group. The guideline consists of an individual and an environmental component. The individual component includes recommendations for occupational physicians on how to promote physical activity and healthy dietary behavior based on principles of motivational interviewing. The environmental component contains an obesogenic environment assessment tool. The guideline is evaluated in a randomised controlled trial among 20 occupational physicians. Occupational physicians in the intervention group apply the guideline to eligible workers during 6 months. Occupational physicians in the control group provide care as usual. Measurements take place at baseline and 6, 12, and 18 months thereafter. Primary outcome measures include waist circumference, daily physical activity and dietary behavior. Secondary outcome measures include sedentary behavior, determinants of behavior change, body weight and body mass index, cardiovascular disease risk profile, and quality of life. Additionally, productivity, absenteeism, and cost-effectiveness are assessed.

Discussion

Improving workers' daily physical activity and dietary behavior may prevent weight gain and subsequently improve workers' health, increase productivity, and reduce absenteeism. After an effect- and process evaluation the guideline will be adjusted and, after authorisation, published. Together with several implementation aids, the published guideline will be disseminated broadly by the Netherlands Society of Occupational Medicine.

Trial Registration

ISRCTN73545254/NTR1190

Action planning as predictor of health protective and health risk behavior: an investigation of fruit and snack consumption

BACKGROUND

Large discrepancies between people's intention to eat a healthy diet and actual dietary behavior indicate that motivation is not a sufficient instigator for healthy behavior. Research efforts to decrease this 'intention - behavior gap' have centered on aspects of self-regulation, most importantly self-regulatory planning. Most studies on the impact of self-regulatory planning in health and dietary behavior focus on the promotion of health protective behaviors. This study investigates and compares the predictive value of action planning in health protective behavior and the restriction of health risk behavior.

METHODS

Two longitudinal observational studies were performed simultaneously, one focusing on fruit consumption (N = 572) and one on high-caloric snack consumption (N = 585) in Dutch adults. Structural equation modeling was used to investigate and compare the predictive value of action planning in both behaviors, correcting for demographics and the influence of motivational factors and past behavior. The nature of the influence of action planning was investigated by testing mediating and moderating effects.

RESULTS

Action planning was a significant predictor of fruit consumption and restricted snack consumption beyond the influence of motivational factors and past behavior. The strength of the predictive value of action planning did not differ between the two behaviors. Evidence for mediation of the intention - behavior relationship was found for both behaviors. Positive moderating effects of action planning were demonstrated for fruit consumption, indicating that individuals who report high levels of action planning are significantly more likely to translate their intentions into actual behavior.

CONCLUSION

The results indicate that the planning of specific preparatory actions predicts the performance of healthy dietary behavior and support the application of self-regulatory planning in both health protective and health risk behaviors. Future interventions in dietary modification may turn these findings to advantage by incorporating one common planning protocol to increase the likelihood that good intentions are translated into healthy dietary behavior.