1
|
Garner NJ, Smith JR, Sampson MJ, Greaves CJ. Quantity and specificity of action-plans as predictors of weight loss: analysis of data from the Norfolk Diabetes Prevention Study (NDPS). Psychol Health 2024; 39:42-67. [PMID: 35333685 DOI: 10.1080/08870446.2022.2055026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Investigate associations between quantity, content and specificity of action-plans and weight loss in a diabetes prevention study. DESIGN Prospective cohort study nested within a randomised controlled trial. Participants completed action-planning worksheets during intervention sessions. MAIN OUTCOME MEASURES Action-plans were coded in terms of: number of plans set, their content, and specificity. Multivariate regression analyses assessed associations with weight loss at four-months. RESULTS 890 planning-worksheets from 106 participants were analysed. Participants wrote a mean of 2.12 (SD = 1.20) action-plans per worksheet, using a mean of 2.20 (SD = 0.68) specificity components per action-plan. Quantity of action-plans per worksheet decreased over time (r = -0.137, p < 0.001) and increased quantity was associated with reduced specificity [r = -.215, p < 0.001]. Walking (34.9% of action-plans) and reducing high fat/sugar snacks (26.1%) were the most commonly planned lifestyle actions. In multivariate modelling, increased quantity of action-plans was associated with greater weight loss (R2 = 0.135, Unstandardised Beta = 0.144, p = 0.002). Specificity was not significantly associated with weight-loss (p = 0.096). CONCLUSION Producing more action-plans was associated with greater weight loss. Further research should directly compare more versus less specific action-plans and explore ways to sustain engagement in action-planning. Our findings imply that participants should freely set numerous action-plans, rather than being encouraged to focus on specificity. Supplemental data for this article is available online at https://doi.org/10.1080/08870446.2022.2055026 .
Collapse
Affiliation(s)
- Nikki J Garner
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
- University of Exeter Medical School, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Jane R Smith
- University of Exeter Medical School, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Mike J Sampson
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Colin J Greaves
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
2
|
Jung SE, Shin YH, Kim S, Hermann J, Dougherty Henry R. Habit is the Bridge between Intention and Behavior: A Look at Fruit and Vegetable Consumption among Low-Income Older Adults. J Nutr Gerontol Geriatr 2021; 40:215-231. [PMID: 34170212 DOI: 10.1080/21551197.2021.1944423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the influence of habit and theory of planned behavior (TPB) variables in predicting low-income older adults' fruit and vegetable (F&V) consumption. DESIGN Cross-sectional study. SETTING A city in the southeast United States. PARTICIPANTS A total of 372 low-income older adults participated in this study. RESULTS Participants completed a validated survey measuring TPB variables (attitude, subjective norm, perceived behavioral control, and intention), F&V intake using the Block Dietary Fruit-Vegetable Screener, and self-reported habit index to measure F&V consumption. Perceived behavioral control was the largest factor influencing intention to consume F&V, followed by attitude and subjective norm. In addition, there was a significant interaction between habit strength and intention, such that intention influenced F&V consumption only among individuals with average or higher habit strength. CONCLUSIONS Findings from this study suggest health promotion programs aimed at increasing F&V intake among low-income older adults should focus on establishing F&V intake as a habit so that an individual's intentions to consume F&V can be transformed into actual F&V intake. Also, emphasizing how to overcome potential barriers would improve low-income older adults' actual F&V intake by increasing their sense of control over consuming F&V.
Collapse
Affiliation(s)
- Seung Eun Jung
- Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa, AL, USA
| | - Yeon Ho Shin
- Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa, AL, USA
| | - Seoyoun Kim
- Department of Sociology, Texas State University, San Marcos, TX, USA
| | - Janice Hermann
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Regan Dougherty Henry
- Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa, AL, USA
| |
Collapse
|
3
|
van Keulen HM, van Breukelen G, de Vries H, Brug J, Mesters I. A randomized controlled trial comparing community lifestyle interventions to improve adherence to diet and physical activity recommendations: the VitalUM study. Eur J Epidemiol 2021; 36:345-360. [PMID: 33377998 PMCID: PMC8032577 DOI: 10.1007/s10654-020-00708-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/08/2020] [Indexed: 11/27/2022]
Abstract
Worldwide, adherence to national guidelines for physical activity (PA), and fruit and vegetable consumption is recommended to promote health and reduce the risk for (chronic) disease. This study reports on the effectiveness of various social-cognitive interventions to improve adherence to guidelines and the revealed adherence predictors. Participants (n = 1,629), aged 45-70 years, randomly selected and recruited in 2005-2006 from 23 Dutch general practices, were randomized (centralized stratified allocation) to four groups to receive a 12-month lifestyle intervention targeting guideline adherence for PA and fruit and vegetable consumption. Study groups received either four computer-tailored print communication (TPC) letters (n = 405), four telephone motivational interviewing (TMI) sessions (n = 407), a combined intervention (two TPC letters and two TMI sessions, n = 408), or no intervention (control group, n = 409). After the baseline assessment, all parties were aware of the treatment groups. Outcomes were measured with self-report postal questionnaires at baseline, 25, 47 and 73 weeks. For PA, all three interventions were associated with better guideline adherence than no intervention. Odds ratios for TPC, TMI and the combined intervention were 1.82 (95% CI 1.31; 2.54), 1.57 (95% CI 1.13; 2.18), and 2.08 (95% CI 1.50; 2.88), respectively. No pedometer effects were found. For fruit and vegetable consumption, TPC seemed superior to those in the other groups. Odd ratio for fruit and vegetable consumption were 1.78 (95% CI 1.32; 2.41) and 1.73 (95% CI 1.28; 2.33), respectively. For each behaviour, adherence was predicted by self-efficacy expectations, habit strength and stages of change, whereas sex, awareness and the number of action plans predicted guideline adherence for fruit and vegetable intake. The season predicted the guideline adherence for PA and fruit consumption. The odds ratios revealed were equivalent to modest effects sizes, although they were larger than those reported in systematic reviews. This study indicated that less resource intensive interventions might have the potential for a large public health impact when widely implemented. The strengths of this study were the participation of lower educated adults and evaluation of maintenance effects. (Trial NL1035, 2007-09-06).
Collapse
Affiliation(s)
- Hilde Marijke van Keulen
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, PO Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Child Health, Now Employed by TNO, PO Box 3005, 2301 DA, Leiden, The Netherlands
| | - Gerard van Breukelen
- Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Johannes Brug
- Department of Epidemiology and Biostatistics, National Institute for Public Health and the Environment (RIVM), Utrecht RIVM and VU Medical Center, Amsterdam, The Netherlands
| | - Ilse Mesters
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
- CAPHRI Care and Public Health Research Institute, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| |
Collapse
|
4
|
Chamroonsawasdi K, Chottanapund S, Pamungkas RA, Tunyasitthisundhorn P, Sornpaisarn B, Numpaisan O. Protection motivation theory to predict intention of healthy eating and sufficient physical activity to prevent Diabetes Mellitus in Thai population: A path analysis. Diabetes Metab Syndr 2021; 15:121-127. [PMID: 33340872 DOI: 10.1016/j.dsx.2020.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Diabetes mellitus is a global health problem causing premature death and economic burden. The study aimed to investigate an application of the protection motivation theory (PMT) model to explain the intention of healthy eating behaviors and physical activity among healthy Thais. METHODS This study was a part of a large case control focused only on the control group without noncommunicable diseases. Nine hundred ninety-seven subjects were drawn from eleven provinces of Thailand. A self-administered questionnaire was constructed based on the PMT model to gather information on predictive factors on eating behaviors and physical activity. Path analysis was used to determine whether the empirical data fit the PMT structure as well as to assess the strength of association among PMT constructed factors predicting behavioral intention. RESULTS The findings demonstrated that empirical data of eating behaviors (CMIN χ2 p-value = 0.462; CMIN/df = 0.901; NFI = 0.997; CFI = 1; RMSEA <0.001) and physical activity (CMIN χ2 p-value = 0.053; CMIN/df = 2.187; NFI = 0.987; CFI = 0.993; RMSEA = 0.035) fit the PMT. The strongest predictive factor of behavioral intention on eating behaviors was response efficacy (β = 0.146), while self-efficacy was found to be the strongest factor for physical activity (β = 0.11). Knowledge had the only indirect effect on behavior intention through perceived susceptibility and perceived severity. CONCLUSION In conclusion, information on susceptibility and severity should be incorporated in intervention strategies to enhance response efficacy and self-efficacy to prevent diabetes.
Collapse
Affiliation(s)
- Kanittha Chamroonsawasdi
- Department of Family Health, Faculty of Public Health, Mahidol University, Bangkok, 10400, Thailand.
| | - Suthat Chottanapund
- Bamrasnaradura Infectious Disease Institute, Ministry of Public Health, Nonthaburi, 11000, Thailand.
| | - Rian Adi Pamungkas
- Department of Nursing, Faculty of Health Sciences, Esa Unggul University, Jakarta, 11530, Indonesia.
| | | | | | | |
Collapse
|
5
|
de Vries H, Vluggen S. Persoonlijke gezondheidscounseling via e-health. ACTA ACUST UNITED AC 2020; 63:50-53. [PMID: 33191946 PMCID: PMC7652052 DOI: 10.1007/s12445-020-0930-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Zowel in de huisartsenpraktijk als in de klinische setting krijgt een gezonde leefstijl en trouw medicijngebruik meer aandacht bij chronische patiënten. Naast face-to-face-counseling kan leefstijl- en medicatieadvies ook via e-health plaatsvinden. E-health-interventies zijn effectief én kosten-effectief gebleken. Wanneer onderbouwd met een gedegen theoretisch gedragsmodel, kan e-health een zinvolle en waardevolle aanvulling zijn op face-to-facecounseling.
Collapse
Affiliation(s)
- Hein de Vries
- Hoogleraar Gezondheidscommunicatie, Universiteit Maastricht, Care and Public Health Research Institute (CAPHRI), Vakgroep Gezondheidsbevordering, Maastricht, Nederland
| | - Stan Vluggen
- Postdoc onderzoeker, Universiteit Maastricht, Care and Public Health Research Institute (CAPHRI), Vakgroep Gezondheidsbevordering, Maastricht, Nederland
| |
Collapse
|
6
|
Panahi H, Salehi L, Mahmoodi Z. A predictive model of the sunscreen use in the paddy workers based on the health action process approach model: a path analysis. J Egypt Public Health Assoc 2020; 95:23. [PMID: 32955668 PMCID: PMC7505911 DOI: 10.1186/s42506-020-00053-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 08/27/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Skin cancer is considered as one of the most common cancers in the world. There is little information about identifying factors affecting sunscreen use among paddy workers and their protective behavior. The present study aimed to determine a predictive model of the sunscreen use in the paddy workers based on the health action process approach model (HAPA). METHODS This cross-sectional study was conducted on 177 paddy workers who engaged in agricultural work in the north of Iran in 2018. Convenience sampling methods was used. Inclusion criteria were being a farmer for 5 years, working under the sunshine more than 2 h per day, and above the age of 30 years. A multi-sectional questionnaire (intention, risk perception (RP), outcome expectation (OE), action self-efficacy (ASE), action planning (AP), coping planning (CP), coping SE (CSE), self-monitoring (SM), and sunscreen use) was used for data collection. Data were analyzed with SPSS-21 and Lisrel-8.8 software. RESULTS The mean age of participants was 47.78 ± 12.66 years. The final path model fitted well (comparative fit index (CFI) = 0.98, RMSEA = 0.000), only coping self-efficacy (CSE) from both direct and indirect paths had an impact on sunscreen use (B = 0.73). Among the variables which are influenced only in one direction, coping planning (CP) had the most direct influence (B = 0.30) on behavior, and action planning had the lowest influence (B = 0.24). CONCLUSION Coping self-efficacy was the most important factor which had influence on the use of sunscreen, and it should be considered when designing interventional programs related to sunscreen use among paddy workers.
Collapse
Affiliation(s)
- Hadiseh Panahi
- Department of Health Education & Promotion, School of Health, Alborz University of Medical Sciences, Karaj, Iran
| | - Leili Salehi
- Research Center for Health, Safety and Environment, Alborz University of Medical Sciences, Karaj, Iran. .,Department of Health Education & Promotion, Alborz University of Medical Sciences, Karaj, Iran.
| | - Zohreh Mahmoodi
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Department of Midwifery, school of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| |
Collapse
|
7
|
Zhang CQ, Fang R, Zhang R, Hagger MS, Hamilton K. Predicting Hand Washing and Sleep Hygiene Behaviors among College Students: Test of an Integrated Social-Cognition Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041209. [PMID: 32069991 PMCID: PMC7068472 DOI: 10.3390/ijerph17041209] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 02/03/2020] [Accepted: 02/12/2020] [Indexed: 12/17/2022]
Abstract
Objective: Hand washing and sleep hygiene are two important health behaviors. The purpose of the current study was to identify the motivational and volitional antecedents of college students’ hand washing and sleep hygiene behaviors based on an integrated model of behavior that combined social-cognition constructs from the Theory of Planned Behavior (TPB) and Health Action Process Approach (HAPA). Methods: Using a prospective design, college students (N = 1106) completed a survey assessing the motivational constructs of action self-efficacy, attitudes, subjective norm, perceived behavioral control, intentions, and behaviors of hand washing and sleep hygiene at Time 1. Demographic variables were also collected. One month later, at Time 2, college students (N = 524) self-reported on their volitional factors of maintenance self-efficacy, action planning, coping planning, and behaviors of hand washing and sleep hygiene. A further 2 months later, at Time 3, college students (N = 297) were asked to self-report on their hand washing and sleep hygiene behaviors over the past month. Findings: Data were analyzed using variance-based structural equation modelling. Results showed significant direct effects of attitudes, subjective norm, and perceived behavioral control on intentions; significant direct effects of action self-efficacy on maintenance self-efficacy; and significant direct effects of maintenance self-efficacy on action planning and coping planning. Significant direct effects of intention on action planning (sleep hygiene only), and significant direct effects of intention, maintenance self-efficacy (hand washing only), action and coping planning on behavior were also observed. Action planning also moderated the intention–behavior relationship, but only for hand washing. There were also significant total indirect effects of action self-efficacy on behavior mediated by maintenance self-efficacy, action planning, and coping planning for both behaviors, and significant total indirect effects of subjective norm and perceived behavioral control on behavior mediated by intention for sleep hygiene. When past behavior was included in the integrated model predicting all the psychological variables and behavior, all of the structural relations were attenuated. Discussion: Current findings indicate that college students’ hand washing and sleep hygiene behaviors are a function of both motivational and volitional factors. Findings also indicate that the TPB and HAPA pathways might differ for the two health behaviors. Implications of the current findings for future health interventions aimed at improving college students’ hand washing and sleep hygiene are discussed.
Collapse
Affiliation(s)
- Chun-Qing Zhang
- Department of Sport and Physical Education, Hong Kong Baptist University, Hong Kong
- School of Psychology, Curtin University, Perth, WA 6102, Australia
- Correspondence: (C.-Q.Z.); (R.F.); Tel.: +852-3411-6404 (C.-Q.Z.); Fax: +852-3411-5757 (C.-Q.Z.)
| | - Rongyu Fang
- Department of Hygiene and Health Management, Qujing Medical College, Qujing 655011, China
- Correspondence: (C.-Q.Z.); (R.F.); Tel.: +852-3411-6404 (C.-Q.Z.); Fax: +852-3411-5757 (C.-Q.Z.)
| | - Ru Zhang
- Department of Sports Science & Physical Education, The Chinese University of Hong Kong, Hong Kong;
| | - Martin S. Hagger
- Psychological Sciences, University of California, Merced, CA 95343, USA;
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylä, Finland
- School of Applied Psychology, Griffith University, Brisbane, QLD 4122, Australia;
| | - Kyra Hamilton
- School of Applied Psychology, Griffith University, Brisbane, QLD 4122, Australia;
| |
Collapse
|
8
|
Luten KA, Dijkstra A, de Winter AF, Reijneveld SA. Developing a community-based intervention for Dutch older adults in a socioeconomically disadvantaged community. Health Promot Int 2020; 34:567-580. [PMID: 29590352 DOI: 10.1093/heapro/day011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Unhealthy eating and low levels of physical activity are major health risks, especially for older adults and people with a low socioeconomic status. The aim of this article is to describe the development of a community-based intervention aimed at promoting physical activity and healthy eating among people aged 55 years and over, in a socioeconomically disadvantaged community. The Intervention Mapping protocol was used to develop the intervention. We conducted a literature search, consultation with community partners and inhabitants, and a quantitative study, in order to obtain insight into the determinants of the target population and to identify appropriate theory-based methods and practical strategies for behavioural change. An assessment was performed of the problem with respect to health behaviour and the underlying determinants. Findings were translated into program, performance and change objectives which specify determinants related to behavioural change. Theory-based methods and practical applications were selected, resulting in a plan for adoption and implementation. The intervention included a local media campaign, social environmental approaches and physical environmental activities in the community, with an intermediating role for inhabitants and health professionals in the promotion of the campaign. An evaluation plan was produced to evaluate the effectiveness of the intervention. The Intervention Mapping protocol was a helpful instrument in developing a feasible, theory and evidence-based intervention tailored to a specific target population in the area of health promotion. The systematic and structured approach provided insight into the relationship between the objectives, methods and strategies used to develop the comprehensive intervention.
Collapse
Affiliation(s)
- Karla A Luten
- Division of Community & Occupational Medicine, Department of Health Sciences, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD Groningen, The Netherlands
| | - Arie Dijkstra
- Department of Social Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - Andrea F de Winter
- Division of Community & Occupational Medicine, Department of Health Sciences, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Division of Community & Occupational Medicine, Department of Health Sciences, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD Groningen, The Netherlands
| |
Collapse
|
9
|
Pereira B, Rosário P, Silva C, Figueiredo G, Núñez JC, Magalhães P. The Mediator and/or Moderator Role of Complexity of Knowledge about Healthy Eating and Self-Regulated Behavior on the Relation between Family's Income and Children's Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4207. [PMID: 31671595 PMCID: PMC6862626 DOI: 10.3390/ijerph16214207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 12/26/2022]
Abstract
Childhood obesity rates have been increasing over the years and is considered one of the most serious public health problems of the century. Low socioeconomic status has been associated with a higher body mass index. However, the pathways underlying this complex relationship are poorly understood. This study aimed to evaluate the possible mediation and/or moderation effects of complexity of knowledge about healthy eating, and self-regulation processes towards healthy eating, in the association between family's income and weight of elementary school age children. The results showed that complexity of knowledge does not mediate the relationship between socioeconomic status and weight. Still, whenever the levels of complexity of knowledge and self-regulation are high, there is a moderation effect of complexity of knowledge on the relationship between family's income and weight, conditioned by self-regulation scores. These promising findings support the idea that knowledge about healthy eating in isolation could be insufficient for practicing a healthy diet and underline the relevance of combining transmission of knowledge with training in specific competences (e.g., self-regulation strategies). Considering that complexity of knowledge about healthy eating and self-regulation strategies are interrelated and can be both improved, future preventive interventions could consider incorporating both in their design to mitigate childhood obesity.
Collapse
Affiliation(s)
- Beatriz Pereira
- Department of Applied Psychology, Escola de Psicologia, Universidade do Minho, Campus Gualtar, 4710-052 Braga, Portugal.
| | - Pedro Rosário
- Department of Applied Psychology, Escola de Psicologia, Universidade do Minho, Campus Gualtar, 4710-052 Braga, Portugal.
| | - Cátia Silva
- Department of Applied Psychology, Escola de Psicologia, Universidade do Minho, Campus Gualtar, 4710-052 Braga, Portugal.
| | - Gabriela Figueiredo
- Department of Applied Psychology, Escola de Psicologia, Universidade do Minho, Campus Gualtar, 4710-052 Braga, Portugal.
| | - José Carlos Núñez
- Department of Psychology, Universidad de Oviedo, Plaza Feijoo s/n. 33003 Oviedo, Spain.
- Facultad de Ciencias Sociales y Humanidades, Universidad Politécnica y Artística de Paraguay, Mayor Sebastián Bullo s/n, Asunción 1628, Paraguay.
| | - Paula Magalhães
- Department of Applied Psychology, Escola de Psicologia, Universidade do Minho, Campus Gualtar, 4710-052 Braga, Portugal.
| |
Collapse
|
10
|
Predicting fruit and vegetable consumption in long-haul heavy goods vehicle drivers: Application of a multi-theory, dual-phase model and the contribution of past behaviour. Appetite 2018; 121:326-336. [DOI: 10.1016/j.appet.2017.11.106] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/24/2017] [Accepted: 11/25/2017] [Indexed: 11/22/2022]
|
11
|
Kasten S, van Osch L, Eggers SM, de Vries H. From action planning and plan enactment to fruit consumption: moderated mediation effects. BMC Public Health 2017; 17:832. [PMID: 29058594 PMCID: PMC5651584 DOI: 10.1186/s12889-017-4838-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 10/06/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Sufficient fruit consumption is beneficial for a healthy live. While many Dutch adults intent to eat the recommended amount of fruit, only 5-10% of the population actually adheres to the recommendation. One mechanism that can help to narrow this gap between intention and actual fruit consumption is action planning. However, action planning is only assumed to be effective if plans are enacted. This study assessed which action plans are made and enacted, and further aimed to investigate two main hypotheses: 1. the effect of action planning (at T1) on fruit consumption (at T2) is mediated by plan enactment (at T3); 2. positive intentions (2a), high self-efficacy (2b) and a strong habit to eat fruit (2c) enhance the mediation of plan enactment, whereas a strong habit to eat snacks (2d) hinders the mediation of plan enactment. METHODS This study was a self-reported longitudinal online survey study. A total of 428 participants filled in a survey, measuring demographic factors (e.g. gender, age, education level), several socio-cognitive constructs (i.e. attitudes, self-efficacy, habit, action planning, plan enactment), and fruit consumption, at three points in time (baseline, after 1 month, and after 3 months). Mediation and moderated mediation analyses were used to investigate the planning-plan enactment- fruit consumption relationship. RESULTS Up to 70% of the participants reported to have enacted their T1 action plans at T2. Action planning on fruit consumption was fully mediated by plan enactment (Hypothesis 1). All four proposed moderators (i.e. intention, self-efficacy, habit to consume fruit, and habit to consume snacks) significantly influenced the mediation (Hypotheses 2a-2d). Mediation of plan enactment was only present with high levels of intention, high levels of self-efficacy, strong habits to eat fruit, and weak habits to eat snacks. CONCLUSION The study suggests the importance of plan enactment for fruit consumption. Furthermore, it emphasizes the necessity of facilitating factors. High levels of intention, self-efficacy and a strong habit to consume fruit clearly aid the enactment of action plans. This suggests that when these factors are moderately low, plan enactment may fail and thus an intervention may require first steps to foster these moderating factors.
Collapse
Affiliation(s)
- Stefanie Kasten
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200, Maastricht, MD, Netherlands. .,CAPHRI-School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.
| | - Liesbeth van Osch
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200, Maastricht, MD, Netherlands.,CAPHRI-School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Sander Matthijs Eggers
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200, Maastricht, MD, Netherlands.,CAPHRI-School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Hein de Vries
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200, Maastricht, MD, Netherlands.,CAPHRI-School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
12
|
de Ridder D, Kroese F, Evers C, Adriaanse M, Gillebaart M. Healthy diet: Health impact, prevalence, correlates, and interventions. Psychol Health 2017; 32:907-941. [DOI: 10.1080/08870446.2017.1316849] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Denise de Ridder
- Department of Social Health and Organizational Psychology, Utrecht University, Utrecht, The Netherlands
| | - Floor Kroese
- Department of Social Health and Organizational Psychology, Utrecht University, Utrecht, The Netherlands
| | - Catharine Evers
- Department of Social Health and Organizational Psychology, Utrecht University, Utrecht, The Netherlands
| | - Marieke Adriaanse
- Department of Social Health and Organizational Psychology, Utrecht University, Utrecht, The Netherlands
| | - Marleen Gillebaart
- Department of Social Health and Organizational Psychology, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
13
|
de Bruijn GJ, Nguyen MH, Rhodes RE, van Osch L. Effects of preparatory and action planning instructions on situation-specific and general fruit and snack intake. Appetite 2017; 108:161-170. [DOI: 10.1016/j.appet.2016.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 09/12/2016] [Accepted: 09/14/2016] [Indexed: 10/21/2022]
|
14
|
Naidoo S, Satorius BK, de Vries H, Taylor M. Verbal Bullying Changes Among Students Following an Educational Intervention Using the Integrated Model for Behavior Change. THE JOURNAL OF SCHOOL HEALTH 2016; 86:813-822. [PMID: 27714870 DOI: 10.1111/josh.12439] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/07/2016] [Accepted: 06/05/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Bullying behavior in schools can lead to psychosocial problems. School-based interventions are important in raising student awareness, developing their skills and in planning to reduce bullying behavior. METHODS A randomized controlled trial, using a school-based educational intervention to reduce verbal bullying, was conducted among grade 10 students in 16 urban and rural schools in KwaZulu-Natal, South Africa in 2013. Baseline and postintervention questionnaires, developed using the Integrated Model for Behavior Change theoretical model, were used to assess changes in verbal bullying. RESULTS Postintervention there were reduced verbal bullying experiences. Improved social norms and awareness of verbal bullying were associated with reduced verbal bullying experiences and behavior. Although less likely to bully others verbally, girls were more likely to experience verbal bullying. Students with no living father were more likely to bully others verbally. CONCLUSIONS The study findings indicate that a school-based intervention can positively impact on verbal bullying experiences and behavior.
Collapse
Affiliation(s)
- Saloshni Naidoo
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 2nd Floor, Room 236, George Campbell Building, Howard College, Durban 4041, South Africa.
| | - Benn K Satorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 2nd Floor, Room 236, George Campbell Building, Howard College, Durban 4041, South Africa.
| | - Hein de Vries
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University, POB 616, 6200 MD, Maastricht, the Netherlands.
| | - Myra Taylor
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 2nd Floor, Room 236, George Campbell Building, Howard College, Durban 4041, South Africa.
| |
Collapse
|
15
|
Romeike K, Abidi L, Lechner L, de Vries H, Oenema A. Similarities and differences in underlying beliefs of socio-cognitive factors related to diet and physical activity in lower-educated Dutch, Turkish, and Moroccan adults in the Netherlands: a focus group study. BMC Public Health 2016; 16:813. [PMID: 27534933 PMCID: PMC4989297 DOI: 10.1186/s12889-016-3480-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/11/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Unhealthy eating patterns and a lack of physical activity (PA) are highly prevalent in most Western countries, especially among lower-educated people, including people of non-Western origin. The aim of this study was to investigate and compare the beliefs and barriers that underlie socio-cognitive and planning constructs related to healthy eating and PA among lower-educated Dutch, Turkish, and Moroccan adults. METHODS Focus group interviews were conducted with 90 Dutch, Turkish, and Moroccan lower-educated adults between March and August 2012. Five semi-structured group interviews were conducted with Dutch participants, five with Turkish participants, and four with Moroccan participants. Men and women were interviewed separately. The question route was based on the Theory of Planned Behavior and self-regulation theories. The theoretical method used for the qualitative data analysis was content analysis. The interviews were recorded, transcribed, and analyzed by applying the framework approach. RESULTS Some participants seemed to lack knowledge of healthy eating and PA, especially regarding the health consequences of an unhealthy lifestyle. Important attitude beliefs concerning healthy eating and PA were taste and health benefits. Participants suggested that social support can encourage the actual performance of healthy behavior. For instance, exercising with other people was perceived as being supportive. Perceived barriers to PA and cooking healthily were a lack of time and tiredness. These previously mentioned beliefs arose in all the ethnic groups. Differences were also found in beliefs between the ethnic groups, which were mainly related to religious and cultural issues. Turkish and Moroccan participants discussed, for example, that the Koran contains the recommendation to eat in moderation and to take care of one's body. Furthermore, they reported that refusing food when offered is difficult, as it can be perceived as an insult. Finally, men and women usually cannot exercise in the same location, which was perceived as a barrier. These factors did not emerge in the Dutch groups. CONCLUSIONS The same cognitive beliefs were discussed in all three ethnic groups. The importance of cultural and religious factors appeared to be the most significant difference between the Turkish/Moroccan groups and the Dutch groups. Accordingly, interventions for all three ethnic groups should focus on socio-cognitive beliefs, whereas interventions for Turkish and Moroccan populations can additionally take religious and cultural rules into account.
Collapse
Affiliation(s)
- Kristina Romeike
- Department of Health Promotion, School of Public Health and Primary Care CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Latifa Abidi
- Department of Health Promotion, School of Public Health and Primary Care CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Lilian Lechner
- Faculty of Psychology and Educational Science, Open University of the Netherlands, Heerlen, the Netherlands
| | - Hein de Vries
- Department of Health Promotion, School of Public Health and Primary Care CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Anke Oenema
- Department of Health Promotion, School of Public Health and Primary Care CAPHRI, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
16
|
Individual and Environmental Factors Influencing Adolescents' Dietary Behavior in Low- and Middle-Income Settings. PLoS One 2016; 11:e0157744. [PMID: 27447169 PMCID: PMC4957796 DOI: 10.1371/journal.pone.0157744] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 06/04/2016] [Indexed: 12/29/2022] Open
Abstract
Objective Given the public health importance of improving dietary behavior in chronic disease prevention in low- and middle-income countries it is crucial to understand the factors influencing dietary behavior in these settings. This study tested the validity of a conceptual framework linking individual and environmental factors to dietary behavior among Ecuadorian adolescents aged 10–16 years. Methods A cross-sectional survey was conducted in 784 school-going Ecuadorian adolescents in urban and rural Southern Ecuador. Participants provided data on socio-economic status, anthropometry, dietary behavior and its determining factors. The relationships between individual (perceived benefits and barriers, self-efficacy, habit strength, and a better understanding of healthy food) and environmental factors (physical environment: accessibility to healthy food; social environment: parental permissiveness and school support), and their association with key components of dietary behavior (fruit and vegetables, sugary drinks, breakfast, and unhealthy snack intake) were assessed using structural equation modeling. Results The conceptual model performed well for each component of eating behavior, indicating acceptable goodness-of-fit for both the measurement and structural models. Models for vegetable intake and unhealthy snacking showed significant and direct effects of individual factors (perceived benefits). For breakfast and sugary drink consumption, there was a direct and positive association with socio-environmental factors (school support and parental permissiveness). Access to healthy food was associated indirectly with all eating behaviors (except for sugary drink intake) and this effect operated through socio-environmental (parental permissiveness and school support) and individual factors (perceived benefits). Conclusion Our study demonstrated that key components of adolescents’ dietary behaviors are influenced by a complex interplay of individual and environmental factors. The findings indicate that the influence of these factors varied by type of dietary behavior.
Collapse
|
17
|
Generating and predicting high quality action plans to facilitate physical activity and fruit and vegetable consumption: results from an experimental arm of a randomised controlled trial. BMC Public Health 2016; 16:317. [PMID: 27066779 PMCID: PMC4828759 DOI: 10.1186/s12889-016-2975-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 03/23/2016] [Indexed: 11/16/2022] Open
Abstract
Background In order to improve the transition from an intention to a change in health behaviour, action planning is a frequently used behavioural change method. The quality of action plans in terms of instrumentality and specificity is important in terms of supporting a successful change in health behaviour. Until now, little has been known about the predictors of action plan generation and the predictors of high quality action plans and, therefore, the current study investigates these predictors. Method A randomised controlled trial was conducted to improve physical activity (PA) and fruit and vegetable (FV) consumption using a web-based computer tailored intervention. During the 8-week intervention period, participants in the intervention arm (n = 346) were guided (step-by-step) to generate their own action plans to improve their health behaviours. Demographic characteristics, social cognitions, and health behaviour were assessed at baseline by means of self-reporting. Whether participants generated action plans was tracked by means of server registrations within two modules of the intervention. Results The action planning component of the intervention regarding physical activity and fruit and vegetable consumption was used by 40.9 and 20.7 % of the participants, respectively. We found that participants who were physically active at baseline were less likely to generate action plans concerning physical activity. With regards to generating fruit and vegetable action plans, participants with a high risk perception and a strong intention to eat fruit and vegetables on a daily basis made more use of the action planning component for this behaviour. Finally, the large majority of the action plans for physical activity (96.6 %) and fruit and vegetable consumption (100 %) were instrumental and about half of the action plans were found to be highly specific (PA = 69.6 %/FV = 59.7 %). The specificity of the action plans is associated with having a relationship and low levels of negative outcome expectancies. Conclusion Risk perception and intention are predictors of using the application of action planning. Increasing the motivation to change behaviour should be prioritised in interventions concerning changes in health behaviour before participants are asked to generate action plans. This would also make the intervention suitable for unmotivated people. For those participants who already perform the desired health behaviour prior to the intervention, action plans might be less relevant. Nevertheless, using a guided step-by-step approach to generate action plans resulted in highly instrumental and specific action plans and might be integrated into other interventions concerning changes in health behaviour. Trial Registration Netherlands Trial Register: NTR 3706, ClinicalTrials.gov: NCT01909349.
Collapse
|
18
|
Reed JR, Yates BC, Houfek J, Pullen CH, Briner W, Schmid KK. Eating Self-Regulation in Overweight and Obese Adults: A Concept Analysis. Nurs Forum 2016; 51:105-116. [PMID: 25611400 DOI: 10.1111/nuf.12125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Poor eating behaviors greatly influence the development of becoming overweight or obese. Learning to better self-regulate eating is one area in which individuals can positively influence their own health. PURPOSE The purpose of this concept analysis is to provide an in-depth analysis of the concept eating self-regulation as it pertains to overweight and obese adults using Walker and Avant's method. RESULTS The definition for eating self-regulation formulated as a result of this concept analysis and based on the critical attributes is the ability to initiate goal-related behaviors, to consistently self-monitor dietary intake, to regularly apply willpower to resist temptations, to self-evaluate where one stands in relationship to goal attainment, and finally to maintain motivation to positively change eating behaviors. Cognitive restraint, moderation, mindfulness, disinhibition, delayed gratification, emotions and moods, self-efficacy, social support, the environment, and physical activity are the antecedents that may influence eating self-regulation. CONCLUSION Examining an individual's weight, body mass index, lipid levels, or blood pressure are some ways to determine if self-regulation of eating behavior is achieved. With a consistent definition of self-regulation and a better understanding of the critical factors that influence eating behaviors, research can better explore how to help individuals change their eating behaviors more effectively.
Collapse
Affiliation(s)
- Jill R Reed
- College of Nursing, University of Nebraska Medical Center, Kearney, NE
| | - Bernice C Yates
- College of Nursing, University of Nebraska Medical Center, Omaha, NE
| | - Julia Houfek
- College of Nursing, University of Nebraska Medical Center, Omaha, NE
| | - Carol H Pullen
- College of Nursing, University of Nebraska Medical Center, Omaha, NE
| | - Wayne Briner
- Department of Psychology, Ashford University, San Diego, CA
| | - Kendra K Schmid
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
19
|
Turton R, Bruidegom K, Cardi V, Hirsch CR, Treasure J. Novel methods to help develop healthier eating habits for eating and weight disorders: A systematic review and meta-analysis. Neurosci Biobehav Rev 2016; 61:132-55. [DOI: 10.1016/j.neubiorev.2015.12.008] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 11/12/2015] [Accepted: 12/10/2015] [Indexed: 12/21/2022]
|
20
|
Jayasuriya R, Pinidiyapathirage MJ, Jayawardena R, Kasturiratne A, de Zoysa P, Godamunne P, Gamage S, Wickremasinghe AR. Translational research for Diabetes Self-Management in Sri Lanka: A randomized controlled trial. Prim Care Diabetes 2015; 9:338-345. [PMID: 25733343 DOI: 10.1016/j.pcd.2015.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 05/17/2014] [Accepted: 01/29/2015] [Indexed: 11/25/2022]
Abstract
AIMS The study tested the hypothesis that a theory driven Diabetes Self-Management (DSM) intervention delivered by trained nurses would result in a clinically significant improvement in glycaemic control. METHODS Patients with an HbA1c >7.5% (58mmol/mol) and free of diabetes complications were enrolled into a randomized controlled trial (n=85). Intervention consisted of four sessions and monthly follow up for 6 months. Biochemical tests, and diet and physical activity assessments were done in both groups. Analysis of covariance was used to test the effectiveness of the intervention. RESULTS At 6 months, there was a significant difference (P=0.001) in HbA1c between the groups controlling for baseline values and other variables. Based on the primary outcome, 28% in the intervention group achieved the target value of 6.5% HbA1c, compared to 8% in the "usual care" group (P<0.001; η(2)=0.65). The reduction in total energy intake and increase in physical activity was significant in the intervention group between baseline and follow up. CONCLUSIONS The DSM intervention has resulted in a clinically significant impact on glycaemia, change in diet and physical activity, and has demonstrated the feasibility of using it within existing care arrangements in a developing country setting.
Collapse
Affiliation(s)
- R Jayasuriya
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - M J Pinidiyapathirage
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - R Jayawardena
- Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - A Kasturiratne
- Department of Public Health, University of Kelaniya, Faculty of Medicine, Ragama, Sri Lanka
| | - P de Zoysa
- Faculty of Medicine, University of Colombo, Colombo 9, Sri Lanka
| | - P Godamunne
- Medical Education Centre, University of Kelaniya, Faculty of Medicine, Ragama, Sri Lanka
| | - S Gamage
- Department of Psychiatry, University of Peradeniya, Peradeniya, Sri Lanka
| | - A R Wickremasinghe
- Department of Public Health, University of Kelaniya, Faculty of Medicine, Ragama, Sri Lanka
| |
Collapse
|
21
|
Girelli L, Hagger M, Mallia L, Lucidi F. From perceived autonomy support to intentional behaviour: Testing an integrated model in three healthy-eating behaviours. Appetite 2015; 96:280-292. [PMID: 26423363 DOI: 10.1016/j.appet.2015.09.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/22/2015] [Accepted: 09/24/2015] [Indexed: 11/30/2022]
Abstract
A motivational model integrating self-determination theory, the theory of planned behaviour, and the health action process approach was tested in three samples in three behavioural contexts: fruit and vegetable, breakfast, and snack consumption. Perceived support for autonomous (self-determined) forms of motivation from parents and autonomous motivation from self-determination theory were hypothesised to predict intention and behaviour indirectly via the mediation of attitude and perceived behavioural control from the theory of planned behaviour. It was also expected that planning strategies would mediate the effect of intention on behaviour. Relations in the proposed models were expected to be similar across the behaviours. A two-wave prospective design was adopted. Three samples of high-school students (total N = 1041; 59.60% female; M age = 17.13 years ± 1.57) completed measures of perceived autonomy support, autonomous motivation, theory of planned behaviour constructs, planning strategies and behaviour for each of the three behavioural contexts. Three months later, 816 participants (62,24% female; M age: 17.13 years, SD = 1.58) of the initial sample self-reported their behaviour referred to the previous three months. Structural equation models provided support for the key hypothesised effects of the proposed model for the three health-related behaviours. Two direct effects were significantly different across the three behaviours: the effect of perceived autonomy support on perceived behavioural control and the effect of attitude on intention. In addition, planning strategies mediated the effect of intention on behaviour in fruit and vegetable sample only. Findings extend knowledge of the processes by which psychological antecedents from the theories affect energy-balance related behaviours.
Collapse
Affiliation(s)
- Laura Girelli
- Department of Psychology of Development and Socialization Processes - Sapienza, University of Rome, Italy.
| | - Martin Hagger
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Australia
| | - Luca Mallia
- Department of Psychology of Development and Socialization Processes - Sapienza, University of Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome, "Foro Italico", Italy
| | - Fabio Lucidi
- Department of Psychology of Development and Socialization Processes - Sapienza, University of Rome, Italy
| |
Collapse
|
22
|
Barz M, Lange D, Parschau L, Lonsdale C, Knoll N, Schwarzer R. Self-efficacy, planning, and preparatory behaviours as joint predictors of physical activity: A conditional process analysis. Psychol Health 2015; 31:65-78. [PMID: 26155825 DOI: 10.1080/08870446.2015.1070157] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Planning can bridge the gap between intentions and action, but what bridges the gap between planning and action? This study helps to answer the question by disentangling the interrelationships between self-efficacy, planning and preparatory behaviours in predicting physical activity. Preparatory behaviours are tested as a working mechanism of planning. Moreover, it is tested whether the utility of preparatory behaviours depends on an individual's level of self-efficacy. METHODS A survey assessed planning, self-efficacy and preparatory behaviours for physical activity. Adults (N = 166) provided data at two measurement points. In a longitudinal model, preparatory behaviours were specified as a mediator between planning and physical activity. Self-efficacy was specified as a possible moderator at two points in the model. RESULTS Preparatory behaviours mediated the relationship between planning and physical activity. An interaction between self-efficacy and preparatory behaviours on physical activity was found, indicating that individuals with low self-efficacy beliefs were more active if they engaged more frequently in preparatory behaviours. CONCLUSION Planning seems to stimulate preparatory behaviours, which in turn make future physical activity more likely. Furthermore, as performing preparatory behaviours represent a step forward towards the enactment of behavioural goals, preparatory behaviours may be particular beneficial for individuals afflicted by self-doubts regarding physical activity.
Collapse
Affiliation(s)
- Milena Barz
- a Department of Health Psychology , Freie Universität Berlin , Berlin , Germany
| | - Daniela Lange
- a Department of Health Psychology , Freie Universität Berlin , Berlin , Germany
| | - Linda Parschau
- a Department of Health Psychology , Freie Universität Berlin , Berlin , Germany
| | - Chris Lonsdale
- b Institute for Positive Psychology and Education , Australian Catholic University , Strathfield , Australia
| | - Nina Knoll
- a Department of Health Psychology , Freie Universität Berlin , Berlin , Germany
| | - Ralf Schwarzer
- b Institute for Positive Psychology and Education , Australian Catholic University , Strathfield , Australia.,c Warsaw School of Social Sciences and Humanities , Wroclaw , Poland
| |
Collapse
|
23
|
Setting goal and implementation intentions in consultations between practice nurses and patients with overweight or obesity in general practice. Public Health Nutr 2015; 18:3051-9. [DOI: 10.1017/s1368980015000075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AbstractObjectivePatients 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.DesignAn 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.SettingDutch general practice.SubjectsOne hundred video-taped consultations (2010/2011) between practice nurses and patients with overweight or obesity.ResultsHalf 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’.ConclusionsMatching implementation intentions to the broader overall consultation goals of practice nurses would be meaningful, leading to desired goal-directed behaviours and subsequent goal attainment.
Collapse
|
24
|
Smith KL, Straker LM, Kerr DA, Smith AJ. Overweight adolescents eat what? And when? Analysis of consumption patterns to guide dietary message development for intervention. J Hum Nutr Diet 2014; 28 Suppl 2:80-93. [PMID: 25157498 DOI: 10.1111/jhn.12263] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about overweight adolescent dietary consumption patterns, with challenges to collecting meaningful data making it difficult to develop targeted obesity interventions. The present study aimed to examine the timing and consumption of fruit, vegetables and junk food by time of the day and day of the week. METHODS Overweight adolescents (n = 61), aged 12-16 years, completed 3-day food records. Negative binomial and binary logistic regression using generalised estimating equations were used to compare the amount and likelihood of the consumption of each food group between time periods. RESULTS Overweight adolescent girls were more likely to eat fruit on weekdays than weekends [odds ratio (OR) = 5.0. P < 0.001], as were boys (OR = 2.5, P = 0.034). Adolescents consumed more fruit at school than other meals [girls: incident rate ratio (IRR) = 7.5, P < 0.001; boys: IRR = 4.0, P = 0.050]. Weekday dinner was the meal where girls were most likely to consume vegetables (OR = 3.0, P = 0.009) and when boys consumed the most vegetables (IRR = 30.9, P = 0.006). Fast food consumption was most likely for girls at dinner on the weekend (OR = 9.6, P = 0.042), whereas fast food intake for boys increased overall on the weekend (IRR = 3.6, P = 0.001). Intake of 'other junk' (e.g. crisps) peaked during school hours for girls (IRR = 7.2, P < 0.001) and sugar-sweetened beverage consumption increased for boys on the weekend (IRR = 3.3, P = 0.001). Overall, trends in fruit intake showed opposing times for high and low consumption compared to vegetable intake. CONCLUSIONS These results represent the next step in using time of day and day of week consumption patterns to develop targeted, evidence-based dietary messages for interventions in overweight adolescents.
Collapse
Affiliation(s)
- K L Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | | | | | | |
Collapse
|
25
|
de Vries H, Eggers SM, Lechner L, van Osch L, van Stralen MM. Predicting fruit consumption: the role of habits, previous behavior and mediation effects. BMC Public Health 2014; 14:730. [PMID: 25037859 PMCID: PMC4223379 DOI: 10.1186/1471-2458-14-730] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 06/30/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND This study assessed the role of habits and previous behavior in predicting fruit consumption as well as their additional predictive contribution besides socio-demographic and motivational factors. In the literature, habits are proposed as a stable construct that needs to be controlled for in longitudinal analyses that predict behavior. The aim of this study is to provide empirical evidence for the inclusion of either previous behavior or habits. METHODS A random sample of 806 Dutch adults (>18 years) was invited by an online survey panel of a private research company to participate in an online study on fruit consumption. A longitudinal design (N = 574) was used with assessments at baseline and after one (T2) and two months (T3). Multivariate linear regression analysis was used to assess the differential value of habit and previous behavior in the prediction of fruit consumption. RESULTS Eighty percent of habit strength could be explained by habit strength one month earlier, and 64% of fruit consumption could be explained by fruit consumption one month earlier. Regression analyses revealed that the model with motivational constructs explained 41% of the behavioral variance at T2 and 38% at T3. The addition of previous behavior and habit increased the explained variance up to 66% at T2 and to 59% at T3. Inclusion of these factors resulted in non-significant contributions of the motivational constructs. Furthermore, our findings showed that the effect of habit strength on future behavior was to a large extent mediated by previous behavior. CONCLUSIONS Both habit and previous behavior are important as predictors of future behavior, and as educational objectives for behavior change programs. Our results revealed less stability for the constructs over time than expected. Habit strength was to a large extent mediated by previous behavior and our results do not strongly suggest a need for the inclusion of both constructs. Future research needs to assess the conditions that determine direct influences of both previous behavior and habit, since these influences may differ per type of health behavior, per context stability in which the behavior is performed, and per time frame used for predicting future behavior.
Collapse
Affiliation(s)
- Hein de Vries
- Department of Health Education and Health Promotion, Research School Caphri, Maastricht University, 6200MD Maastricht, The Netherlands
| | - Sander M Eggers
- Department of Health Education and Health Promotion, Research School Caphri, Maastricht University, 6200MD Maastricht, The Netherlands
| | - Lilian Lechner
- Department of Psychology, Open University of the Netherlands, 6419AT Heerlen, The Netherlands
| | - Liesbeth van Osch
- Department of Health Education and Health Promotion, Research School Caphri, Maastricht University, 6200MD Maastricht, The Netherlands
| | - Maartje M van Stralen
- EMGO Institute for Health and Care Research and Department of Public and Occupational Health, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| |
Collapse
|
26
|
de Bruijn GJ, Wiedemann A, Rhodes RE. An investigation into the relevance of action planning, theory of planned behaviour concepts, and automaticity for fruit intake action control. Br J Health Psychol 2013; 19:652-69. [DOI: 10.1111/bjhp.12067] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 07/16/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Gert-Jan de Bruijn
- Faculty of Social and Behavioural Sciences; University of Amsterdam; The Netherlands
| | - Amelie Wiedemann
- Department of Education and Psychology; Freie Universitaet Berlin; Germany
| | - Ryan E. Rhodes
- Behavioral Medicine Laboratory; University of Victoria; British Columbia Canada
| |
Collapse
|
27
|
de Bruijn GJ, Rhodes RE, van Osch L. Does action planning moderate the intention-habit interaction in the exercise domain? A three-way interaction analysis investigation. J Behav Med 2012; 35:509-19. [PMID: 21979328 PMCID: PMC3439603 DOI: 10.1007/s10865-011-9380-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 09/08/2011] [Indexed: 01/19/2023]
Abstract
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.
Collapse
Affiliation(s)
- Gert-Jan de Bruijn
- Amsterdam School of Communication Research ASCoR, University of Amsterdam, Kloveniersburgwal 48, 1012 CX, Amsterdam, The Netherlands.
| | | | | |
Collapse
|
28
|
de Vries H, Logister M, Krekels G, Klaasse F, Servranckx V, van Osch L. Internet based computer tailored feedback on sunscreen use. J Med Internet Res 2012; 14:e48. [PMID: 22547528 PMCID: PMC3376524 DOI: 10.2196/jmir.1902] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 01/20/2012] [Accepted: 01/20/2012] [Indexed: 11/13/2022] Open
Abstract
Background Skin cancer incidence rates signify the need for effective programs for the prevention of skin cancer and for helping skin cancer patients. Internet and computer tailored (CT) technology fosters the development of highly individualized health communication messages. Yet, reactions to Internet CT programs may differ per level of involvement and education level and remain understudied. Objective First, we identified perceptions concerning sunscreen use in Dutch adults and assessed differences in differences between the general public and skin cancer patients, and between low and high educated respondents. Second, we assessed program evaluations of these groups about a new Dutch CT Internet-based program promoting sunscreen use, and potential differences between groups Methods A cross-sectional research design was used. In total, 387 respondents participated and filled out an online questionnaire based on the I-Change Model assessing socio-demographics, history of skin cancer, sunscreen use, and beliefs about sunscreen use. The responses were fed into a computer program that generated personal tailored feedback on screen; next we assessed their program evaluations Results Of the 132 patients, 92 were female (69.7%) and 40 were male (30.3%). In the general population (N = 225), 139 (54.5%) respondents were female and 116 (45.5%) were male. Men (50.9 years) were 8 years older than women (43.1 years). Most patients were diagnosed with basal cell carcinoma (N = 65; 49.2%), followed by melanoma (N = 28; 21.2%) and squamous cell carcinoma (N = 10; 7.6%); 22% (N = 29) did not remember their skin cancer type. Patients had higher knowledge levels, felt significantly more at risk, were more convinced of the pros of sunscreen, experienced more social support to use sunscreen, had higher self-efficacy, and made more plans to use sunscreen than respondents without skin cancer (N=255; all P’s< .01). Low (N=196) educated respondents scored lower on knowledge (P<.003) but made more action plans (P<.03) than higher educated respondents (N=191). The CT feedback was evaluated positively by all respondents, and scored a 7.8 on a 10 point scale. Yet, patients evaluated the CT program slightly more (P<.05) positive (8.1) than non-patients. (7.6). Lower educated respondents were significantly (P<.05) more positive about the advantages of the program. Conclusions First, involvement with skin cancer was reflected in more positive beliefs toward sunscreen use in patients in comparison with non-patients. Second, the CT Internet program was well accepted by both patients and non-patients, and low and high educated respondents, perhaps because higher educated respondents were more knowledgeable about sunscreen use and skin cancer. Third, a pro-active approach as conducted in our study is very well suited to reach various groups of people and is more likely to be successful than a reactive approach
Collapse
Affiliation(s)
- Hein de Vries
- Department of Health Promotion, School for Public Health and Primary Care, CAPHRI, Maastricht University, Maastricht, Netherlands.
| | | | | | | | | | | |
Collapse
|
29
|
An extended theory of planned behavior intervention for older adults with type 2 diabetes and cardiovascular disease. J Aging Phys Act 2011; 20:281-99. [PMID: 22190336 DOI: 10.1123/japa.20.3.281] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A randomized controlled trial evaluated the effectiveness of a 4-wk extended theory of planned behavior (TPB) intervention to promote regular physical activity and healthy eating among older adults diagnosed with Type 2 diabetes or cardiovascular disease (N = 183). Participants completed TPB measures of attitude, subjective norm, perceived behavioral control, and intention, as well as planning and behavior, at preintervention and 1 wk and 6 wk postintervention for each behavior. No significant time-by-condition effects emerged for healthy eating. For physical activity, significant time-by-condition effects were found for behavior, intention, planning, perceived behavioral control, and subjective norm. In particular, compared with control participants, the intervention group showed short-term improvements in physical activity and planning, with further analyses indicating that the effect of the intervention on behavior was mediated by planning. The results indicate that TPB-based interventions including planning strategies may encourage physical activity among older people with diabetes and cardiovascular disease.
Collapse
|
30
|
Johannessen KB, Oettingen G, Mayer D. Mental contrasting of a dieting wish improves self-reported health behaviour. Psychol Health 2011; 27 Suppl 2:43-58. [PMID: 22149291 DOI: 10.1080/08870446.2011.626038] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Mentally contrasting a desired future with present reality standing in its way promotes commitment to feasible goals, whereas mentally indulging in a desired future does not. Dieting students (N = 134) reported their most important dieting wish that they deemed attainable within a 2-week period. Then, they were directed to mentally contrast or indulge in thoughts and images about the named dieting wish. A control condition was given no directions. Two weeks after the experiment, dieters retrospectively rated their behaviour change: in the mental contrasting condition they reported having eaten relatively fewer calories overall, fewer high-calorie food and more low-calorie food compared to those in the indulging and control conditions, and they also reported having been more physically active. This transfer effect from one health domain to another suggests a more generalised effect of mental contrasting versus indulging and control than previously assumed.
Collapse
Affiliation(s)
- K B Johannessen
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.
| | | | | |
Collapse
|
31
|
The importance of habits in eating behaviour. An overview and recommendations for future research. Appetite 2011; 57:585-96. [DOI: 10.1016/j.appet.2011.07.010] [Citation(s) in RCA: 223] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 07/11/2011] [Accepted: 07/15/2011] [Indexed: 02/06/2023]
|
32
|
Vitória PD, Salgueiro MF, Silva SA, de Vries H. Social influence, intention to smoke, and adolescent smoking behaviour longitudinal relations. Br J Health Psychol 2011; 16:779-98. [PMID: 21988064 DOI: 10.1111/j.2044-8287.2010.02014.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There is a debate on the determinants of smoking behaviour, their relative impact, and how impacts are exerted. This longitudinal study is on the relations among social influence, intention to smoke, and smoking behaviour, controlling for attitude and self-efficacy. DESIGN AND METHODS A model combining parents and peers with subjective and descriptive norms, resulting in four factors, was used to assess social influence. Data were collected at the beginning of the 7th(-T1), 8th(-T2), and 9th(-T3) school years, concerning 578 students (M(age) = 13.04 at T1). Structural Equation Modelling was used to test longitudinal effects. RESULTS Variances explained by the model were high: R(2) (intention-T2) = .65, R(2) (behaviour-T2) = .67, and R(2) (behaviour-T3) = .76. Longitudinal analyses confirmed the effects of social influence on intention and behaviour. These effects on behaviour were direct and indirect (peers' and parents' descriptive norms in both cases). Descriptive norms had a stronger effect on behaviour than subjective norms. Peers' effect on behaviour was stronger than parents', but peers' effect was exerted only through descriptive norms while parents' effect was exerted through both norms. The intention effect on behaviour was not as detached as expected and its role of full mediator between other variables' effects on behaviour was not confirmed, since descriptive norms and self-efficacy had also a mediation role. CONCLUSIONS Results show direct and indirect effects of social influence on behaviour. Descriptive norms are an important variable to operationalize social influence. Peers and parents exert influence on adolescents' intention and behaviour through different processes. The impact of intention on behaviour is not as important as expected.
Collapse
Affiliation(s)
- Paulo D Vitória
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.
| | | | | | | |
Collapse
|
33
|
White KM, Terry DJ, Troup C, Rempel LA, Norman P. Predicting the consumption of foods low in saturated fats among people diagnosed with Type 2 diabetes and cardiovascular disease. The role of planning in the theory of planned behaviour. Appetite 2010; 55:348-54. [DOI: 10.1016/j.appet.2010.07.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 06/24/2010] [Accepted: 07/24/2010] [Indexed: 11/30/2022]
|
34
|
Helmink JH, Meis JJ, de Weerdt I, Visser FN, de Vries NK, Kremers SP. Development and implementation of a lifestyle intervention to promote physical activity and healthy diet in the Dutch general practice setting: the BeweegKuur programme. Int J Behav Nutr Phys Act 2010; 7:49. [PMID: 20504352 PMCID: PMC3224934 DOI: 10.1186/1479-5868-7-49] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 05/26/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of patients with diabetes is increasing. BeweegKuur (Dutch for 'Exercise Therapy') is a Dutch lifestyle intervention which aims to effectively and feasibly promote physical activity and better dietary behaviour in primary health care to prevent diabetes. METHODS The goal of this paper is to present the development process and the contents of the intervention, using a model of systematic health promotion planning. The intervention consists of a 1-year programme for diabetic and prediabetic patients. Patients are referred by their general practitioner (GP) to a lifestyle advisor (LSA), usually the practice nurse or a physiotherapist. Based on specific inclusion criteria and in close collaboration with the patient, an individual exercise programme is designed and supervised by the LSA. This programme can be attended at existing local exercise facilities or (temporarily) under the supervision of a specialized exercise coach or physiotherapist. All participants are also referred to a dietician and receive diet-related group education. In the first pilot year (2008), the BeweegKuur programme was implemented in 7 regions in the Netherlands (19 GP practices and health centres), while 14 regions (41 GP practices and health centres) participated during the second year. The aim is to implement BeweegKuur in all regions of the Netherlands by 2012. DISCUSSION The BeweegKuur programme was systematically developed in an evidence- and practice-based process. Formative monitoring studies and (controlled) effectiveness studies are needed to examine the diffusion process and the effectiveness and cost-effectiveness of the intervention.
Collapse
Affiliation(s)
- Judith Hm Helmink
- School for Public Health and Primary Care (CAPHRI) and School for Nutrition, Toxicology and Metabolism (NUTRIM), Department of Health Promotion, Maastricht University, the Netherlands.
| | | | | | | | | | | |
Collapse
|