Assessment of healthy behaviors for metabolic syndrome among Korean adults: a modified information-motivation-behavioral skills with psychological distress

Understanding Health-Promoting Behaviors and Influential Factors in Schizophrenia Patients

(1) Background: People who are diagnosed with schizophrenia experience a reduced average lifespan compared to the general population. Also, approximately 85% of individuals with schizophrenia have chronic physical illnesses. Moreover, 60% of premature deaths in this population could be prevented through the adoption of health-promoting behaviors. (2) Methods: This study involved the recruitment of 220 participants from an outpatient clinic in Seoul, South Korea. Inclusion criteria comprised adults aged 19 years or older with a confirmed diagnosis of schizophrenia. Data collection occurred between 25 May 2021 and 2 August 2021, utilizing self-report questionnaires. A total of 202 responses were subjected to analysis using SPSS 23.0 and AMOS 23.0. (3) Results: The findings indicate that the final model is characterized by the following values: Normed x2 = 2.240, RMSEA = 0.079, TLI = 0.926, x2 = 562.2 (p < 0.001), AGFI = 0.830, GFI = 0.814, and CFI = 0.938. Notably, health knowledge did not exhibit a significant direct or overall impact on health-promoting behaviors. Conversely, social support and psychiatric symptoms demonstrated direct, indirect, and total effects on health promotion through an intervening variable. This study underscores the pivotal role of self-efficacy as the most influential factor affecting health-promoting behaviors in individuals with schizophrenia. (4) Conclusions: enhancing self-efficacy emerges as a crucial element in the design and implementation of intervention programs aimed at improving health-promoting behaviors in individuals with schizophrenia.

Development and effectiveness of a mobile-based autonomy support program for the prevention of metabolic syndrome in middle-aged women

Objective

Utilizing self-directed strategies for maintaining and managing healthy lifestyle habits is efficient, and it is essential to consider individual motivation, as it is a factor that directly influences the adoption and maintenance of healthy behaviors. The study aimed to assess the effects of a mobile-based autonomy support program on basic psychological needs, autonomous motivation, health behavior, and metabolic syndrome indicators in middle-aged women.

Methods

This study was a non-randomized controlled trial with a pre-test and post-test design, focused on validating a mobile-based autonomy-supportive program to prevent metabolic syndrome in middle-aged women. The experimental group participated in a 12-week mobile-based autonomy support program, which included components such as education, physical activity guidance, dietary management, and real-time data monitoring. In contrast, the control group was provided with comparable educational resources. Assessments of basic psychological needs, autonomous motivation, health behavior, and metabolic syndrome indicators were conducted at baseline and again at the 12-week mark.

Results

After a 12-week period, the experimental group demonstrated significant enhancements in autonomy (p = 0.004) and competence (p < 0.001), two key dimensions of basic psychological needs. Autonomous motivation (p < 0.001) and health behavior scores (p < 0.001) were also significantly higher in the experimental group, while waist circumference (p = 0.048) and systolic blood pressure (p = 0.011) were significantly reduced. Other variables such as relatedness, high-density cholesterol, fasting blood sugar, diastolic blood pressure, and neutral fat scores were also improved in the experimental group, but these changes were not statistically significant.

Conclusion

The autonomy support program offers a cost-effective and community-accessible health care strategy for middle-aged women and may be integrated into various nursing practices.

Factors Associated with Prevention of Metabolic Syndrome Among Middle-Aged Postmenopausal Korean Women: A Study Based on the Information, Motivation, Behavioral Skills (IMB) Model

Purpose

Metabolic syndrome (MetS) is a significant risk factor for cardiovascular disease. Middle-aged women, in particular, have been reported to have significantly increased cardiovascular disease rates after menopause; however, their adherence to health behaviors is lower than that of other populations. This study examined the factors associated with health behaviors for MetS prevention based on the Information-Motivation-Behavior skills model and described the relationships between the components of the model in middle-aged women.

Patients and Methods

This investigative study used an online self-report questionnaire survey that included 241 middle-aged postmenopausal women aged 45-64 years. The collected data were analyzed using descriptive statistics with SPSS 28.0, independent t-tests, one-way ANOVA, and Pearson's correlation coefficient. Multiple regression analysis was used to examine the relationships among the variables.

Results

After controlling for age, time since menopause, and comorbidities, knowledge of MetS, social support, self-efficacy, and attitudes explained 42% of the variance in health behaviors for MetS prevention (F=18.38, p<0.001). Among these variables, self-efficacy (β=0.33, p<0.001), attitudes toward health behaviors (β=0.26, p<0.001), and knowledge of MetS (β=0.13, p=0.005) had a significant impact on health behaviors for MetS prevention.

Conclusion

Significant associations were found between knowledge, self-efficacy, and attitudes toward health behaviors for MetS prevention among middle-aged women. The results of this study suggest that it is essential for healthcare provider to consider the components of the Information-Motivation-Behavior skills model when developing interventions aimed at improving health behaviors for MetS prevention among middle-aged postmenopausal women.

Predictive Model of Self-management in Patients With Stroke Based on the Information-Motivation-Behavioral Skills Model

BACKGROUND

Patients who had a stroke are required to manage risk factors, and self-management for risk factor control in stroke is essential. Recent studies using the information-motivation-behavioral skills model reported that the model is effective for predicting and explaining self-management behavior in chronically ill patients.

OBJECTIVES

This study aimed to develop and verify the predictive model of self-management based on the information-motivation-behavioral skills model in patients with stroke.

METHODS

This was a descriptive, cross-sectional study; path analysis was conducted to develop and verify the hypothesized predictive model. We recruited 242 patients who had a stroke using convenience sampling from the neurological outpatient clinic.

RESULTS

The model's fit indices were adequate. Stroke self-management knowledge, social support, and self-efficacy had a direct effect on stroke self-management, and stroke self-management knowledge and attitude and social support had an indirect effect on stroke self-management, mediated by self-efficacy. Stroke self-management knowledge and attitude, social support, and self-efficacy explained 27.5% of the total variance in stroke self-management.

CONCLUSIONS

The information-motivation-behavioral skills model is potentially a predictive model for self-management for patients who had a stroke. Considering the level of stroke knowledge and attitude, social support, and self-efficacy together may help to understand the required level of self-management. In addition, using this model for the development of self-management interventions for patients who had a stroke could be a strategy for improving self-management in patients with stroke.

Yang AC, Zeng JL, Yang YY, Lo YT, Chang YH, Pai TH. Metabolic Syndrome-Related Knowledge, Attitudes, and Behavior among Indigenous Communities in Taiwan: A Cross-Sectional Study

BACKGROUND

Metabolic syndrome is characterized by cardiovascular and chronic disease risk factors that cause health problems. Inequalities in medical resources and information present a challenge in this context. Indigenous communities may be unaware of their risk for metabolic syndrome.

AIMS

This study explored factors associated with metabolic syndrome-related knowledge, attitudes, and behaviors among Taiwanese indigenous communities.

METHODS

For this descriptive cross-sectional survey, we collected anthropometric data and used a self-administered questionnaire between 1 July 2016, to 31 July 2017, from a convenience sample of an indigenous tribe in eastern Taiwan. The response rate was 92%.

RESULTS

The prevalence of metabolic syndrome was as high as 71%, and the average correct knowledge rate was 39.1%. The participants' self-management attitudes were mainly negative, and the self-management behaviors were low in this population. Stepwise regression analysis showed that knowledge, attitude, age, perception of physical condition, and body mass index, which accounted for 65% of the total variance, were the most predictive variables for self-management behaviors.

CONCLUSIONS

This is the first study to report the relationship between metabolic syndrome knowledge, attitudes, and behaviors in an indigenous population. There is an urgent need to develop safety-based MetS health education programs that can provide access to the right information and enhance self-management approaches to lessen the growing burden of MetS in indigenous communities.

Determinants of Non-Adherence to Exercise or Physical Activity in People with Metabolic Syndrome: A Mixed Methods Review

BACKGROUND

Long-term adherence to exercise or physical activity (EPA) is necessary for effective first-line management of metabolic syndrome (MetS). Little is known about the determinants of adherence in this population. This systematic review aims to identify the determinants of adherence to EPA in people with MetS.

METHODS

Six databases (MEDLINE, CINAHL Complete, PubMed, PsycINFO, SPORTDiscus, and Cochrane Central Register of Controlled Trials (CENTRAL)) were searched for studies published before April 26, 2021. Primary research studies investigating factors affecting EPA adherence in adults with MetS in outpatient settings were included. Risk of bias was assessed using the QUIPS (Quality in Prognostic Factor Studies) and CASP (Critical Appraisal Skills Program) tools, for quantitative and qualitative methodologies, respectively.

RESULTS

Four quantitative studies (n = 766) and one qualitative (n = 21) study were included in the review, evaluating 34 determinants of adherence to EPA in MetS. Limited evidence was found for an association between ten determinants and non-adherence to EPA: lower self-rated health, lower baseline EPA, lower high-density lipoprotein cholesterol (HDL-C), fewer walk-friendly routes within 1 km, less consciousness raising, lower self-re-evaluation, lower self-liberation, reporting more arguments against EPA (cons), lower social support, and fewer positive psychological constructs. There was limited evidence of no association or conflicting evidence for the remaining 24 determinants.

CONCLUSION

A small number of included studies, most of low methodological quality, resulted in limited confidence in the findings for all determinants. The identified determinants associated with non-adherence are all potentially modifiable, thus further high-quality studies are required to increase confidence in the determinants of EPA in people with MetS, and test interventions.

Effect of informationmotivationbehavior skills on adherence of continuous positive airway pressure therapy in patients with obstructive sleep apnea hypopnea syndrome

OBJECTIVES

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common disease that seriously affects health. Continuous positive airway pressure (CPAP) therapy is the preferred treatment for moderate-to-severe OSAHS patients. However, poor adherence to CPAP is a major obstacle in the treatment of OSAHS. Information-motivation-behavioral (IMB) skills, as a kind of mature technology to change the behavior, has been used in various health areas to improve treatment adherence. This study aims to explore the effects of the IMB skills intervention on CPAP adherence in OSAHS patients.

METHODS

Patients who were primary diagnosed with moderate-to-severe OSAHS were randomly divided into the IMB group (n=62) and the control group (n=58). The patients in the IMB group received CPAP therapy and the IMB skills intervention for 4 weeks. The patients in the control group received CPAP therapy and a usual health care provided by a registered nurse. We collected the baseline data of the general information, including age, sex, body mass index (BMI), the Epworth Sleepiness Scale (ESS) score, the Hospital Anxiety and Depression Scale (HADS) score, and indicators about disease severity [apnea-hypopnea index (AHI), percentage of time with arterial oxygen saturation SaO2<90% (T90), average SaO2, lowest SaO2, arousal index]. After CPAP titration, we collected CPAP therapy-relevant parameters (optimal pressure, maximum leakage, average leakage, 95% leakage, and residual AHI), score of satisfaction and acceptance of CPAP therapy, and score of willingness to continue CPAP therapy. After 4 weeks treatment, we collected the ESS score, HADS score, CPAP therapy-relevant parameters, effective CPAP therapy time per night, CPAP therapy days within 4 weeks, CPAP adherence rate, score of satisfaction and acceptance of CPAP therapy, and score of willingness to continue CPAP therapy. Visual analog scale (VAS) of 0-5 was used to evaluate the satisfaction and acceptance of IMB intervention measures in the IMB group.

RESULTS

There were no significant differences in the baseline level of demographic parameters, ESS score, HADS score, disease severity, and CPAP therapy related parameters between the IMB group and the control group (all P>0.05). There were no significant differences in score of willingness to continue CPAP therapy, as well as score of satisfaction and acceptance of CPAP therapy after CPAP titration between the IMB group and the control group (both P>0.05). After 4 weeks treatment, the ESS score, HADS score, maximum leakage, average leakage, and 95% leakage of the IMB group were significantly decreased, while the score of satisfaction and acceptance of CPAP therapy and willingness to continue CPAP therapy of the IMB group were significantly increased (all P<0.05); while the above indexes in the control group were not different before and after 4 weeks treatment (all P<0.05). Compared with the control group, the ESS score, HADS score, maximum leakage, average leakage, and 95% leakage of the IMB group after 4 weeks treatment were significantly lower (all P<0.05); the effective CPAP therapy time, CPAP therapy days within 4 weeks, score of satisfaction and acceptance of CPAP therapy, score of willingness to continue CPAP therapy of the IMB group were significantly higher (all P<0.05). The rate of CPAP therapy adherence in 4 weeks of the IMB group was significantly higher than that of the control group (90.3% vs 62.1%, P<0.05). The VAS of overall satisfaction with IMB skills intervention measures was 4.46±0.35.

CONCLUSIONS

IMB skills intervention measures can effectively improve the adherence of CPAP therapy in OSAHS patients, and is suitable for clinical promotion.

Effect of information, motivation, and behavioral skills model on adherence to medication, diet, and physical activity in HIV/ADIS patients: A health promotion strategy

BACKGROUND

Adherence to treatment is one of the major challenges in patients with HIV/ADIS. If the patients do not adhere, they will face recurrent consequences, such as disease progression. The aim of this study was to investigate the effect of information, motivation, and behavioral Skills (IMB) model on medication adherence, diet adherence, and physical activity in HIV/ADIS patients.

MATERIALS AND METHODS

This interventional study was conducted on 122 patients with 20 years of age and over with HIV/AIDS in Kerman City, Iran, in 2018. A total of patients were selected by census method and categorized into the intervention and control groups. Later, a researcher-made questionnaire on IMB was used before and 3 months after the intervention to assess medication adherence, diet adherence, and physical activity .The intervention study consisted of at least 8 training sessions (90 min) over a 12-week period.

RESULTS

In adherence to medication, information (P = 0.034) and personal motivation (P = 0.003) constructs and in adherence to diet, information (P = 0.025), personal motivation (P = 0.001), self-efficacy (P = 0.010), and skills (P = 0.011) were significantly different between the two groups after the intervention (P = 0.011). However, regarding the adherence to physical activity, no significant difference was found between the two groups after the intervention.

CONCLUSIONS

The IMB model can be effective in promoting the diet adherence in HIV/AIDS patients. In this regard, more qualitative and quantitative studies are recommended on the adherence to medication and physical activity.

Factors Associated with Dietary Control and Physical Activity in the Management of Metabolic Syndrome in Korean Menopausal Women

The increased prevalence of metabolic syndrome (MetS) among menopausal women necessitates successful management strategies such as applying dietary restrictions and engaging in physical activity to improve their health and quality of life. We investigate factors associated with dietary control and physical activity in 564 menopausal Korean women classified as having MetS who partook in the 2016 and 2017 Korean National Health and Nutrition Examination Survey (KNHANES). To determine socio-demographic characteristics, lifestyle features, and MetS-related characteristics associated with dietary control and physical activity, multiple logistic regression analysis was performed. Of the women with MetS 36.1% applied diet control and 39.5% engaged in physical activity. Women who applied dietary control strategies to improve their health were more likely to be in the 40–49 age group (odds ratio (OR): 3.38; 95% confidence interval (CI): 1.25–9.18), to engage in physical activity (OR: 2.24; CI: 1.43–3.52), and to take hypertension medication (OR: 1.66; CI: 1.04–2.67) or diabetes mellitus medication (OR: 2.99; CI: 1.80–4.97). Physically active menopausal women with MetS were more likely to also engage in dieting (OR: 2.32; CI: 1.42–3.51). Accordingly, suggestions can be provided to healthcare workers in designing, not only individual approaches to lifestyle modification but also comprehensive interventions including dietary control and physical activity for menopausal MetS women. Health-care interventions like dietary control, which provide additional support to vulnerable MetS women, should target women aged 60 or above or those who do not take medicines for hypertension and diabetes mellitus.

Applying the information-motivation-behavioral model to explore the influencing factors of self-management behavior among osteoporosis patients

BACKGROUND

The prevalence of osteoporosis (OP) is rapidly increasing. Healthy behaviors are crucial for the management of OP. Application of the information-motivation-behavioral skills (IMB) model has been verified in various chronic diseases, but this model has not been investigated for behavioral interventions among people with OP. This study aimed to examine factors influencing OP self-management behavior and their interaction paths based on the IMB model.

METHODS

We conducted a cross-sectional study using a convenience sampling method in 20 community health service centers in Shanghai, China. Predictive relationships between IMB model variables and self-management behaviors were evaluated using an anonymous questionnaire. Structural equation modeling was used to test the IMB model.

RESULTS

In total, 571 participants completed the questionnaire, of which 461 (80.7%) were female. Participants' mean age was 68.8 ± 10.1 years. Only 101 (17.7%) participants were classified as having better OP self-management behaviors. The model demonstrated the data had an acceptable fit. Paths from information to self-efficacy (β = 0.156, P < 0.001) and self-management behaviors (β = 0.236, P < 0.001), from health beliefs to self-efficacy (β = 0.266, P < 0.001), from medical system support to self-efficacy (β = 0.326, P < 0.001) and self-management behaviors (β = 0.230, P < 0.001), and from self-efficacy to self-management behaviors (β = 0.376, P < 0.001) were all significant and in the predicted direction.

CONCLUSION

This study validated the utility of the IMB model for OP self-management behaviors in this population. Middle-aged and older adult patients with OP have poor self-management behaviors. Enhanced knowledge about OP and is important for improving self-management behaviors.

Understanding and Measuring Adaptation Level Among Community-Dwelling Patients with Metabolic Syndrome: A Cross-Sectional Survey

PURPOSE

This study aimed to translate the Roy adaptation model concept of adaptation level into measurable concepts when considering the health-related quality of life, social support, and self-efficacy of community-dwelling Chinese adults with metabolic syndrome.

PATIENTS AND METHODS

This was a descriptive cross-sectional study. Data were collected from 144 adults with metabolic syndrome in the suburban area of Hangzhou, China. Correlation analysis was performed to examine the relationships between environmental stimuli (sociodemographic characteristics), adaptation level (health-related quality of life and social support), and prerequisite of behavior (self-efficacy). Regression analysis was applied to test the effect of stimuli on adaptation level and their associations with behavior.

RESULTS

Adaptation level was potentially influenced by environmental stimuli and evaluated by the quality of life. Age and education level were related to physiological and psychological function. Besides, family income was related to physiological function. Thus, adaptation level may predict individuals' behavior towards illness management, with a percentage classification accuracy of 76.40%. The vitality and social functioning of the quality of life were identified as significant correlates of self-efficacy.

CONCLUSION

Our findings demonstrate that individuals' internal and external resources should be considered when developing nursing interventions to improve patients' adaptation level. Future research should explore whether facilitating self-efficacy among community-dwelling adults with metabolic syndrome may positively influence an individual's adaptation process in health management.

Antiretroviral therapy adherence based on information, motivation, and behavioral skills model and its association with depression among HIV-positive patients: Health promotion strategy towards the 909090 target

BACKGROUND

HIV-infected patients with poor antiretroviral therapy (ART) adherence are prone to depression, and depression can exacerbate the disease condition. This study was conducted to determine ART Adherence based on Information, Motivation, and Behavioral Skills (IMB) Model and its association with depression among HIV-positive patients.

MATERIALS AND METHODS

This descriptive-correlational study was carried out on people over the age of 18 years with HIV/AIDS, who referred to the Behavioral Diseases Counseling Center in Kerman City, Iran, in 2017. In this regard, 119 patients were selected using the table of random numbers. To collect the data, we used the Beck's depressioninventory-II and the IMB researcher made questionnaire to evaluate the ART adherence.

RESULTS

The results of the study reveal that a significant association was observed between the total adherence and all constructs of the IMB model (P < 0.001). Risk perception and self-efficacy had the highest mean scores regarding the ART adherence. The prevalence of depression was 71.5% among patients. Information, personal motivation, and total adherence had a significant association with depression.

CONCLUSIONS

IMB model was an appropriate and practical strategy with regard to the ART adherence among people living with HIV who are prone to depression and drug consumption is crucial for them to achieve the 90-90-90 target. This article created a questionnaire to assist policy-makers and health professionals designing interventions to improve adherence and health outcomes of ART.

Antiretroviral Therapy Adherence Among People Living With HIV: Directed Content Analysis Based on Information-Motivation-Behavioral Skills Model

Antiretroviral therapy (ART) is one of the complexities of treatment and care for people living with HIV (PLHIV). It is essential to understand the challenges of admitting ART in PLHIV based on the Information Motivation Behavioral skills (IMB) model. This study was conducted using qualitative and directed content analysis on 15 participants. The participants included 10 patients and five health-care providers selected from the behavioral diseases counseling center affiliated with a medical university in southeast of Iran using purposive sampling method. Data were collected through semistructured interviews. Data analysis has led to three main categories—information, motivation, and behavioral skills—and eight subcategories. ART adherence in an Iranian context is like an iceberg that the IMB model can deeply identify underwater and unanticipated motivations and factors that lead to nonadherence. Therefore, it can be useful in designing and developing context-based nonadherence to ART interventions.

An Exploratory Mixed Method Study for Developing and Psychometric Properties of the Sexual Information, Motivation and Behavioral Skills Scale (SIMBS) in Iranian Couples

BACKGROUND

This study was designed to construct and assay the psychometric properties of a scale in order to recognize sexual information, motivation and behavioral skills of Iranian couples.

STUDY DESIGN

a mixed method study.

METHODS

This was an exploratory mixed method investigation conducted in two stages from Sep 2017 to Jun 2018 in Isfahan, Iran. First, qualitative methods (individual interviews with 22 couples) were applied to generate items and develop the questionnaire. Second, psychometric properties of the questionnaire were assessed. Reliability was evaluated by composite reliability, Interclass Correlation Coefficient (ICC) and internal consistency. Moreover, Exploratory Factor Analyses (EFA) and Confirmatory Factor Analyses (CFA) were carried out to examine construct validity. To evaluate content validity were performed CVI and CVR.

RESULTS

An item pool comprising 107 statements related to couple 'sexual information, motivation and behavioral skills were generated in the first stage. In the second stage, item reduction was exerted and the final issue of the questionnaire including 51 items was expanded. The evaluation of the psychometric properties of the final version displayed that the scale had good reliability and structure. The results from exploratory factory analysis demonstrated a 9-factor solution for the scale that jointly reported for the 39.5% of the observed variance. The mean scores of the CVI and CVR were 0.92 and 0.90, respectively. Additional analyses indicated acceptable results for composite reliability for the subscale of instrument ranging from 0.78 to 0.95.

CONCLUSION

The sexual information, motivation and behavioral skills scale is a reliable and valid instrument that can be used in future studies on Iranian couples.

A study on the information-motivation-behavioural skills model among Chinese adults with peritoneal dialysis

AIM AND OBJECTIVE

To examine whether the information-motivation-behavioural skills model could predict self-care behaviour among Chinese peritoneal dialysis patients.

BACKGROUND

Peritoneal dialysis is a treatment performed by patients or their caregivers in their own home. It is important to implement theory-based projects to increase the self-care of patients with peritoneal dialysis. The information-motivation-behavioural model has been verified in diverse populations as a comprehensive, effective model to guide the design, implementation and evaluation of self-care programmes.

DESIGN

A cross-sectional, observational study.

METHODS

A total of 201 adults with peritoneal dialysis were recruited at a 3A grade hospital in China. Participant data were collected on demographics, self-care information (knowledge), social support (social motivation), self-care attitude (personal motivation), self-efficacy (behaviour skills) and self-care behaviour. We also collected data on whether the recruited patients had peritoneal dialysis-associated peritonitis from electronic medical records. Measured variable path analysis was performed using mplus 7.4 to identify the information-motivation-behavioural model.

RESULTS

Self-efficacy, information and social motivation predict peritoneal dialysis self-care behaviour directly. Information and personal support affect self-care behaviour through self-efficacy, whereas peritoneal dialysis self-care behaviour has a direct effect on the prevention of peritoneal dialysis-associated peritonitis.

CONCLUSIONS

The information-motivation-behavioural model is an appropriate and applicable model to explain and predict the self-care behaviour of Chinese peritoneal dialysis patients. Poor self-care behaviour among peritoneal dialysis patients results in peritoneal dialysis-associated peritonitis.

RELEVANCE TO CLINICAL PRACTICE

The findings suggest that self-care education programmes for peritoneal dialysis patients should include strategies based on the information-motivation-behavioural model to enhance knowledge, motivation and behaviour skills to change or maintain self-care behaviour.