1
|
Nicholls N, Watson ED. Get active now or later? The association between physical activity and risk and time preferences. PSYCHOLOGY OF SPORT AND EXERCISE 2024; 73:102650. [PMID: 38648871 DOI: 10.1016/j.psychsport.2024.102650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024]
Abstract
Despite the well-established link between physical activity and positive health outcomes, much of the world's population remains inactive. Many people don't invest in health behaviours, such as physical activity, in the present, despite the long-term benefits of this. The aim of this study was to assess the relationship between physical activity levels and risk and time preferences in university students. A maximum likelihood model was used to jointly estimate risk and time preferences (elicited in an incentivised choice experiment), and to examine the relationship between these preferences and self-reported physical activity. Physically inactive people discounted the future significantly more than physically active people did. Physically active people made slightly more risky choices in our risk attitude task, although this directional relationship was not statistically significant. The link between time preferences and physical activity suggests that further research on behavioural strategies such as commitment devices, nudging or temptation bundling may be helpful in increasing physical activity for individuals who discount the future in favour of more immediate benefits.
Collapse
Affiliation(s)
- Nicky Nicholls
- Department of Economics, University of Pretoria, Lynnwood Road, Pretoria, South Africa.
| | - Estelle D Watson
- Department of Exercise Sciences, Faculty of Science, The University of Auckland, Auckland, New Zealand; Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
2
|
An YD, Ma GX, Cai XK, Yang Y, Wang F, Zhang ZL. Examining the association between delay discounting, delay aversion and physical activity in Chinese adults with type-2 diabetes mellitus. World J Diabetes 2024; 15:675-685. [PMID: 38680691 PMCID: PMC11045427 DOI: 10.4239/wjd.v15.i4.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/05/2024] [Accepted: 03/13/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND The role of physical activity in diabetes is critical, influencing this disease's development, man-agement, and overall outcomes. In China, 22.3% of adults do not meet the minimum level of physical activity recommended by the World Health Organization. Therefore, it is imperative to identify the factors that contributing to lack of physical activity must be identified. AIM To investigate the relationship among delay discounting, delay aversion, glycated hemoglobin (HbA1c), and various levels of physical activity in Chinese adults diagnosed with type 2 diabetes mellitus (T2DM). METHODS In 2023, 400 adults with T2DM were recruited from the People's Hospital of Linxia Hui Autonomous Prefecture of Gansu Province. A face-to-face questionnaire was used to gather demographic data and details on physical activity, delay discounting, and delay aversion. In addition, HbA1c levels were measured in all 400 participants. The primary independent variables considered were delay discounting and delay aversion. The outcome variables included HbA1c levels and different intensity levels of physical activity, including walking, moderate physical activity, and vigorous physical activity. Multiple linear regression models were utilized to assess the relationship between delay discounting, delay aversion, and HbA1c levels, along with the intensity of different physical activity measured in met-hours per week. RESULTS After controlling for the sample characteristics, delay discounting was negatively associated with moderate physical activity (β = -2.386, 95%CI: -4.370 to -0.401). Meanwhile, delay aversion was negatively associated with the level of moderate physical activity (β = -3.527, 95% CI: -5.578 to -1.476) in the multiple linear regression model, with statistically significant differences. CONCLUSION Elevated delay discounting and increased delay aversion correlated with reduced levels of moderate physical activity. Result suggests that delay discounting and aversion may influence engagement in moderate physical activity. This study recommends that health administration and government consider delay discounting and delay aversion when formulating behavioral intervention strategies and treatment guidelines involving physical activity for patients with T2DM, which may increase participation in physical activity. This study contributes a novel perspective to the research on physical activity in adults with T2DM by examining the significance of future health considerations and the role of emotional responses to delays.
Collapse
Affiliation(s)
- Yong-Dong An
- Department of Endocrinology, People's Hospital of Linxia Hui Autonomous Prefecture, Linxia Hui Autonomous Prefecture 731100, Gansu Province, China
| | - Guo-Xia Ma
- Department of Gynecology, People's Hospital of Linxia Hui Autonomous Prefecture, Linxia Hui Autonomous Prefecture 731100, Gansu Province, China
- The First Clinical Medical College, Lanzhou University, Lanzhou 730013, Gansu Province, China
| | - Xing-Kui Cai
- Department of Internal Medicine, People's Hospital of Hezheng, Linxia Hui Autonomous Prefecture 731200, Gansu Province, China
| | - Ying Yang
- Department of Endocrinology, People's Hospital of Linxia Hui Autonomous Prefecture, Linxia Hui Autonomous Prefecture 731100, Gansu Province, China
| | - Fang Wang
- Department of Geratology, People's Hospital of Linxia Hui Autonomous Prefecture, Linxia Hui Autonomous Prefecture 731100, Gansu Province, China
| | - Zhan-Lin Zhang
- Department of Medical, People's Hospital of Linxia Hui Autonomous Prefecture, Linxia Hui Autonomous Prefecture 731100, Gansu Province, China
| |
Collapse
|
3
|
Berardi V, Phillips CB, McEntee ML, Stecher C, Todd M, Adams MA. The Impact of Monetary Incentives on Delay Discounting Within a Year-Long Physical Activity Intervention. Ann Behav Med 2024; 58:341-352. [PMID: 38507617 PMCID: PMC11008587 DOI: 10.1093/abm/kaae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Delay discounting is the depreciation in a reward's perceived value as a function of the time until receipt. Monetary incentive programs that provide rewards contingent on meeting daily physical activity (PA) goals may change participants' delay discounting preferences. PURPOSE Determine if monetary incentives provided in close temporal proximity to meeting PA goals changed delay discounting, and if such changes mediated intervention effects. METHODS Inactive adults (n = 512) wore accelerometers during a 12-month intervention where they received proximal monetary incentives for meeting daily moderate-to-vigorous PA (MVPA) goals or delayed incentives for study participation. Delay discount rate and average MVPA were assessed at baseline, end of intervention, and a 24-month follow-up. Using structural equation modeling, we tested effects of proximal versus delayed rewards on delay discounting and whether any changes mediated intervention effects on MVPA. PA self-efficacy was also evaluated as a potential mediator, and both self-efficacy and delay discounting were assessed as potential moderators of intervention effects. RESULTS Proximal rewards significantly increased participants' delay discounting (β = 0.238, confidence interval [CI]: -0.078, 0.380), indicating greater sensitivity to reinforcement timing. This change did not mediate incentive-associated increases in MVPA at the end of the 12-month intervention (β = -0.016, CI: -0.053, 0.019) or at a 24-month follow-up (β = -0.020, CI: -0.059, 0.018). Moderation effects were not found. CONCLUSIONS Incentive-induced increases in delay discounting did not deleteriously impact MVPA. This finding may help assuage concerns about using monetary incentives for PA promotion, but further research regarding the consequences of changes in delay discounting is warranted.
Collapse
Affiliation(s)
- Vincent Berardi
- Department of Psychology, Chapman University, Orange, CA, USA
| | | | - Mindy L McEntee
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Michael Todd
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Marc A Adams
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| |
Collapse
|
4
|
Molina M, Guindon GE, Anderson LN, Tarride JE. Association between children's caregivers time preferences and childhood overweight and obesity in Mexico. PLoS One 2024; 19:e0283455. [PMID: 38452044 PMCID: PMC10919595 DOI: 10.1371/journal.pone.0283455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 03/08/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Parents or children's primary caregivers are a key influence on child weight as both decision makers and role models for eating patterns, physical activity, and other social behaviors. It is unknown whether caregivers' time preferences are associated with overweight or obesity in children. The primary objective was to estimate the association between parents' or caregivers' time preferences and children having overweight or obesity in Mexico. METHODS A cross-sectional study was conducted using a representative survey of the Mexican population. A multinomial logistic model was used to examine the association between parents' or caregivers' time preferences (patience and time consistency) and child overweight or obesity, adjusting for potential confounders. RESULTS The study included 9,102 children (mean age 10, 43% female) and 5,842 caregivers (mean age 37; 95% female). Intertemporal preference was strongly associated with increased odds of overweight or obesity in children. A medium patient caregiver had higher odds of having overweight (adjusted OR: 1.73; 95% CI: 1.19, 2.52). Similarly, having a caregiver with a present (OR: 2.52; 95% CI: 1.72, 3.70) or future bias (OR: 1.48; 95% CI: 1.11, 1.98) was associated with higher odds of obesity. CONCLUSION Caregivers' time preferences were associated with having overweight and obesity in children and should be considered when developing policies to reduce children's obesity status.
Collapse
Affiliation(s)
- Mariana Molina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Godefroy Emmanuel Guindon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
- Department of Economics, McMaster University, Hamilton, Ontario, Canada
| | - Laura N. Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
- The Hospital for Sick Children Research Institute, Child Health Evaluative Sciences, Toronto, Ontario, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
- The Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- McMaster Chair in Health Technology Management Hamilton, Hamilton, ON, Canada
| |
Collapse
|
5
|
Dai Y, Shi H, Ji K, Han Y, De Ala M, Wang Q. Exercise preference in stroke survivors: a concept analysis. Front Neurol 2024; 15:1326649. [PMID: 38414548 PMCID: PMC10896848 DOI: 10.3389/fneur.2024.1326649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/23/2024] [Indexed: 02/29/2024] Open
Abstract
Background Exercise preference in stroke survivors is related to their adherence to long-term rehabilitation regimen and functional recovery. Although explored recently, the term exercise preference still lacks a clear definition. Objective The aim of this study is to conceptualize exercise preference in stroke survivors. Methods The Walker and Avant method was applied as a framework for the conceptual analysis of exercise preference. Data from 34 publications were collected using seven databases (PubMed, Web of Science, Embase, CINAHL, CNKI, Wanfang Data, and CBM) and applied in the analysis. The search period was from the inception of the database to April 30, 2023. Results Exercise preference in stroke survivors was defined according to four attributes: priority of choice, behavioral tendency, affective priming, and patience in adherence. The common antecedents of the concept of exercise preference in stroke survivors were classified into patient-related, therapy-related, and environmental-related categories and the consequences were classified into three categories: patient-related, rehabilitation provider-related, and rehabilitation service system-related. Conclusion Exercise preference in stroke survivors refers to the patient's choice, tendency, affective response, and attitude toward engagement in the recommended rehabilitation regimen. It is beneficial for understanding the essential attributes of exercise preference in stroke survivors by clarifying the concept. In addition, it will facilitate the development of instruments for assessing exercise preference in stroke survivors and the construction of theory-based intervention programs that can improve adherence to exercise rehabilitation.
Collapse
Affiliation(s)
- Yuting Dai
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Huiling Shi
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Kangling Ji
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yuxin Han
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Minerva De Ala
- School of Nursing, Philippine Women's University, Manila, Philippines
| | - Qing Wang
- Department of Nursing, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| |
Collapse
|
6
|
de Buisonjé DR, Reijnders T, Cohen Rodrigues TR, Santhanam P, Kowatsch T, Breeman LD, Janssen VR, Kraaijenhagen RA, Kemps HMC, Evers AWM. Less stick more carrot? Increasing the uptake of deposit contract financial incentives for physical activity: A randomized controlled trial. PSYCHOLOGY OF SPORT AND EXERCISE 2024; 70:102532. [PMID: 37678644 DOI: 10.1016/j.psychsport.2023.102532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 06/05/2023] [Accepted: 09/04/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Financial incentives are a promising tool to help people increase their physical activity, but they are expensive to provide. Deposit contracts are a type of financial incentive in which participants pledge their own money. However, low uptake is a crucial obstacle to the large-scale implementation of deposit contracts. Therefore, we investigated whether (1) matching the deposit 1:1 (doubling what is deposited) and (2) allowing for customizable deposit amounts increased the uptake and short term effectiveness of a deposit contract for physical activity. METHODS In this randomized controlled trial, 137 healthy students (age M = 21.6 years) downloaded a smartphone app that provided them with a tailored step goal and then randomized them to one of four experimental conditions. The deposit contract required either a €10 fixed deposit or a customizable deposit with any amount between €1 and €20 upfront. Furthermore, the deposit was either not matched or 1:1 matched (doubled) with a reward provided by the experiment. During 20 intervention days, daily feedback on goal progress and incentive earnings was provided by the app. We investigated effects on the uptake (measured as agreeing to participate and paying the deposit) and effectiveness of behavioral adoption (measured as participant days goal achieved). FINDINGS Overall, the uptake of deposit contracts was 83.2%, and participants (n = 113) achieved 14.9 out of 20 daily step goals. A binary logistic regression showed that uptake odds were 4.08 times higher when a deposit was matched (p = .010) compared to when it was not matched. Furthermore, uptake odds were 3.53 times higher when a deposit was customizable (p = .022) compared to when it was fixed. Two-way ANCOVA showed that matching (p = .752) and customization (p = .143) did not impact intervention effectiveness. However, we did find a marginally significant interaction effect of deposit matching X deposit customization (p = .063, ηp2 = 0.032). Customization decreased effectiveness when deposits were not matched (p = .033, ηp2 = 0.089), but had no effect when deposits were matched (p = .776, ηp2 = 0.001). CONCLUSIONS We provide the first experimental evidence that both matching and customization increase the uptake of a deposit contract for physical activity. We recommend considering both matching and customization to overcome lack of uptake, with a preference for customization since matching a deposit imposes significant additional costs. However, since we found indications that customizable deposits might reduce effectiveness (when the deposits are not matched), we urge for more research on the effectiveness of customizable deposit contracts. Finally, future research should investigate which participant characteristics are predictive of deposit contract uptake and effectiveness. PRE-REGISTRATION OSF Registries, https://osf.io/cgq48.
Collapse
Affiliation(s)
- David R de Buisonjé
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands.
| | - Thomas Reijnders
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands; Department of Human-Centered Design, Faculty of Industrial Design Engineering, TU Delft, Delft, the Netherlands
| | - Talia R Cohen Rodrigues
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Prabhakaran Santhanam
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland; Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland; School of Medicine, University of St.Gallen, St.Gallen, Switzerland
| | - Linda D Breeman
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Veronica R Janssen
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Center, Veldhoven, the Netherlands; Department of Industrial Design, Eindhoven University of Technology, the Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands; Leiden University, Technical University Delft, and Erasmus University, Rotterdam, the Netherlands
| |
Collapse
|
7
|
Firlik KS, Anupindi VR, Hayes V, DeKoven M, Shaikh A, Franchino-Elder J. Improved medication adherence in COPD patients using tiotropium or tiotropium olodaterol with the HealthPrize digital behavior change program. Expert Rev Pharmacoecon Outcomes Res 2023:1-15. [PMID: 38116664 DOI: 10.1080/14737167.2023.2296561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE To assess the impact of the HealthPrize RespiPoints™ program on treatment adherence and persistence in adults with chronic obstructive pulmonary disease (COPD). METHODS In this retrospective cohort study, program participants and nonparticipants receiving tiotropium bromide (TIO) or TIO and olodaterol between 1 January 2015-31 March 2020 were propensity score matched (PSM), from the linked database of the HealthPrize patient list and IQVIA PharMetrics® Plus. Treatment adherence, persistence, healthcare resource utilization, and costs were compared. Multivariable logistic regression models assessed the odds of adherence (≥80% proportion of days covered [PDC]), adjusted risk of discontinuation, and adjusted total healthcare costs. RESULTS Program participants (n = 262) demonstrated a 44% greater adherence during followup than nonparticipants (n = 262) (mean [standard deviation] PDC: 0.72 [0.27] vs 0.50 [0.36], p < 0.0001). Participants had higher odds of adherence vs nonparticipants (adjusted odds ratio: 2.51; 95% confidence interval: 1.72-3.66, p < 0.0001) and a lower percentage of participants discontinued their index medication (19.85% vs 33.59%, p = 0.0004). Fewer participants were hospitalized during follow-up (13.74% vs 17.56%, p = 0.23); adjusted total medical costs were 24% lower (p = 0.08). Higher pharmacy costs partially offset lower healthcare costs. CONCLUSIONS Program participants showed improved COPD medication adherence and persistence compared to nonparticipants.
Collapse
Affiliation(s)
| | | | | | - Mitchell DeKoven
- IQVIA, Health Economics and Outcomes Research, Falls Church, VA, USA
| | - Asif Shaikh
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA
| | | |
Collapse
|
8
|
Tang J, Yang Z, Kee F, Congdon N. Time and risk preferences and the perceived effectiveness of incentives to comply with diabetic retinopathy screening among older adults with type 2 diabetes. Front Psychol 2023; 14:1101909. [PMID: 37138986 PMCID: PMC10149913 DOI: 10.3389/fpsyg.2023.1101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Behavioral economics has the potential to inform the design of incentives to improve disease screening programs by accounting for various behavioral biases. We investigate the association between multiple behavioral economics concepts and the perceived effectiveness of incentive strategies for behavioral change among older patients with a chronic disease. This association is examined by focusing on diabetic retinopathy screening, which is recommended but very variably followed by persons living with diabetes. Five time and risk preference concepts (i.e., utility curvature, probability weighting, loss aversion, discount rate, and present-bias) are estimated simultaneously in a structural econometric framework, based on a series of deliberately-designed economic experiments offering real money. We find that higher discount rates and loss aversion and lower probability weighting are significantly associated with lower perceived effectiveness of intervention strategies whereas present-bias and utility curvature have an insignificant association with it. Finally, we also observe strong urban vs. rural heterogeneity in the association between our behavioral economic concepts and the perceived effectiveness of intervention strategies.
Collapse
Affiliation(s)
- Jianjun Tang
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| | - Ziwei Yang
- College of Economics and Management, Huazhong Agricultural University, Wuhan, China
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
- Orbis International, New York, NY, United States
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
9
|
Smyth LJ, Cruise SM, Tang J, Young I, McGuinness B, Kee F, McKnight AJ. Differential methylation in CD44 and SEC23A is associated with time preference in older individuals. ECONOMICS AND HUMAN BIOLOGY 2023; 49:101233. [PMID: 36812724 DOI: 10.1016/j.ehb.2023.101233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/25/2022] [Accepted: 02/06/2023] [Indexed: 05/08/2023]
Abstract
Time preference is a measure used to ascertain the level of which individuals prefer smaller, immediate rewards over larger, delayed rewards. We explored how an individual's time preference associates with their epigenetic profile. Time preferences were ascertained by asking participants of the Northern Ireland COhort for the Longitudinal study of Ageing to make a series of choices between two hypothetical income scenarios. From these, eight 'time preference' categories were derived, ranging from "patient" to "impatient" on an ordinal scale. The Infinium High Density Methylation Assay, MethylationEPIC (Illumina) was used to evaluate the status of 862,927 CpGs. Time preference and DNA methylation data were obtained for 1648 individuals. Four analyses were conducted, assessing the methylation patterns at single site resolution between patient and impatient individuals using two adjustment models. In this discovery cohort analysis, two CpG sites were identified with significantly different levels of methylation (p < 9 × 10-8) between the individuals allocated to the patient group and the remaining population following adjustment for covariates; cg08845621 within CD44 and cg18127619 within SEC23A. Neither of these genes have previously been linked to time preference. Epigenetic modifications have not previously been linked to time preference using a population cohort but they may represent important biomarkers of accumulated, complex determinants of this trait. Further analysis is warranted of both the top-ranked results and of DNA methylation as an important link between measurable biomarkers and health behaviours.
Collapse
Affiliation(s)
- Laura J Smyth
- Epidemiology and Public Health Research Group, Centre for Public Health, Queen's University Belfast, BT12 6BJ Northern Ireland, United Kingdom
| | - Sharon M Cruise
- Epidemiology and Public Health Research Group, Centre for Public Health, Queen's University Belfast, BT12 6BJ Northern Ireland, United Kingdom
| | - Jianjun Tang
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China.
| | - Ian Young
- Epidemiology and Public Health Research Group, Centre for Public Health, Queen's University Belfast, BT12 6BJ Northern Ireland, United Kingdom
| | - Bernadette McGuinness
- Epidemiology and Public Health Research Group, Centre for Public Health, Queen's University Belfast, BT12 6BJ Northern Ireland, United Kingdom
| | - Frank Kee
- Epidemiology and Public Health Research Group, Centre for Public Health, Queen's University Belfast, BT12 6BJ Northern Ireland, United Kingdom
| | - Amy Jayne McKnight
- Epidemiology and Public Health Research Group, Centre for Public Health, Queen's University Belfast, BT12 6BJ Northern Ireland, United Kingdom
| |
Collapse
|
10
|
Zan H, Shin SH. The positive impact of informal spousal caregiving on the physical activity of older adults. Front Public Health 2022; 10:977846. [PMID: 36589971 PMCID: PMC9800888 DOI: 10.3389/fpubh.2022.977846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Although physical activity (PA) is crucial for health, the literature is mixed about how individuals' PA decisions are affected by their spouses. To fill this gap, we examined the extent to which providing care for one spouse affects the PA of the other spouse among those aged 50 or older in the United States. Methods We analyzed 9,173 older adults living with their spouses or partners from the 2004 to 2016 waves of the Health and Retirement Study. To identify the causal effect of spousal caregiving on the PA of older adults, we estimated individual-fixed effects models using a two-stage least squared instrumental variable approach with spousal falls as our instrument. We also estimated the models by splitting the sample by gender and race/ethnicity to identify heterogeneous impacts of spousal caregiving on PA decisions among subgroups. Results We found that a one percentage point increase in the probability of providing care to spouses led to an increase in the probability of initiating moderate or vigorous PA (MVPA) by 0.34-0.52 percentage points. This effect was salient, especially among female and non-Hispanic white older adults. Discussion Caregiving experience might provide opportunities to learn about caregiving burdens and trigger an emotional response about the salience of an event (i.e., they need care in the future). Older caregivers might start MVPA in an effort to improve or maintain their health and avoid burdening their families for caregiving in the future. This study demonstrated spousal influence on PA. Instead of delivering PA-promotion information (e.g., the harm of sedentary lifestyle and benefits of regular PA) to individuals, risk communication and education efforts on PA promotion might be more effective considering the family context. Family events such as health shocks or the emergence of caregiving needs from family members provide windows of opportunities for intervening. Subgroup differences should also be considered in targeted interventions.
Collapse
Affiliation(s)
- Hua Zan
- Center on the Family, University of Hawai'i at Mānoa, Honolulu, HI, United States,*Correspondence: Hua Zan, ✉
| | - Su Hyun Shin
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, United States
| |
Collapse
|
11
|
Qu X, Zhang C, Houser SH, Zhang J, Zou J, Zhang W, Zhang Q. Prediction model for early childhood caries risk based on behavioral determinants using a machine learning algorithm. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 227:107221. [PMID: 36384058 DOI: 10.1016/j.cmpb.2022.107221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/05/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND An easily accessible caries risk prediction model (CRPM) based on nonbiological predictors is lacking. Developing a CRPM for community screening is essential for children's dental health promotion by a public health approach. OBJECTIVE This study aimed to develop and validate a caries risk prediction model (CRPM) for children using a machine learning algorithm based on dental care behavioral factors and other nonbiological factors using a 3-month multicenter cohort. METHODS Children aged 12 months to 60 months were recruited at three primary care settings and three kindergartens in Chengdu, China. Dental examination was conducted for all enrolled children by calibrated pediatric dentists at baseline and three months later. All parents of the enrolled children were asked to complete a questionnaire with dental-related information. Machine learning algorithms, including random forest, logistic regression, and adaptive boosting, were used to develop a prediction model. Sensitivity, specificity, accuracy, precision, negative predictive value and F-score were reported to estimate the internal validation of the models. RESULTS A total of 481 out of 745 children without a history of caries experience at baseline remained for analysis. In the total sample population, 236 (49.1%) children were female, and the mean age was 31.2 months. During the follow-up exams, 66 (13.6%) children had new-onset caries. The child's age, height, weight, family caries status, brush teeth two minutes per time, fluoride toothpaste usage, brushing twice per day, parental monitoring brushing teeth, mother delivery method, brushing child's teeth every day, child number counts, and night feeding frequency in the last month were measured and included in a prediction model. Of the prediction models, the highest area under the curve of RF was 0.91 (95% CI: 0.87- 0.94), followed by 0.86 (95% CI: 0.81-0.91) of LR and 0.81 (95% CI: 0.76-0.86) of AdaBoost. CONCLUSION In this CRPM, new onset of dental caries in three months among children aged < 60 months could be predicted by answering twelve nonbiological questions. A good model performance was shown within the internal validation. Dental home care could be improved by referring the CRPM result before new caries onset.
Collapse
Affiliation(s)
- Xing Qu
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chao Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University; Med-X Center for Informatics, Sichuan University, Chengdu 610041, China
| | - Shannon H Houser
- Department of Health Services Administration, University of Alabama at Birmingham, Alabama 35294, USA
| | - Jian Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University; Med-X Center for Informatics, Sichuan University, Chengdu 610041, China
| | - Jing Zou
- Department of Pediatric Dentistry, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases & National Clinical Research, Sichuan Unversity, Chengdu 610041, China
| | - Wei Zhang
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, China; West China Biomedical Big Data Center, West China Hospital, Sichuan University; Med-X Center for Informatics, Sichuan University, Chengdu 610041, China.
| | - Qiong Zhang
- Department of Pediatric Dentistry, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases & National Clinical Research, Sichuan Unversity, Chengdu 610041, China.
| |
Collapse
|
12
|
de Buisonjé DR, Reijnders T, Cohen Rodrigues TR, Prabhakaran S, Kowatsch T, Lipman SA, Bijmolt THA, Breeman LD, Janssen VR, Kraaijenhagen RA, Kemps HMC, Evers AWM. Investigating Rewards and Deposit Contract Financial Incentives for Physical Activity Behavior Change Using a Smartphone App: Randomized Controlled Trial. J Med Internet Res 2022; 24:e38339. [PMID: 36201384 DOI: 10.2196/38339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Financial incentive interventions for improving physical activity have proven to be effective but costly. Deposit contracts (in which participants pledge their own money) could be an affordable alternative. In addition, deposit contracts may have superior effects by exploiting the power of loss aversion. Previous research has often operationalized deposit contracts through loss framing a financial reward (without requiring a deposit) to mimic the feelings of loss involved in a deposit contract. OBJECTIVE This study aimed to disentangle the effects of incurring actual losses (through self-funding a deposit contract) and loss framing. We investigated whether incentive conditions are more effective than a no-incentive control condition, whether deposit contracts have a lower uptake than financial rewards, whether deposit contracts are more effective than financial rewards, and whether loss frames are more effective than gain frames. METHODS Healthy participants (N=126) with an average age of 22.7 (SD 2.84) years participated in a 20-day physical activity intervention. They downloaded a smartphone app that provided them with a personalized physical activity goal and either required a €10 (at the time of writing: €1=US $0.98) deposit up front (which could be lost) or provided €10 as a reward, contingent on performance. Daily feedback on incentive earnings was provided and framed as either a loss or gain. We used a 2 (incentive type: deposit or reward) × 2 (feedback frame: gain or loss) between-subjects factorial design with a no-incentive control condition. Our primary outcome was the number of days participants achieved their goals. The uptake of the intervention was a secondary outcome. RESULTS Overall, financial incentive conditions (mean 13.10, SD 6.33 days goal achieved) had higher effectiveness than the control condition (mean 8.00, SD 5.65 days goal achieved; P=.002; ηp2=0.147). Deposit contracts had lower uptake (29/47, 62%) than rewards (50/50, 100%; P<.001; Cramer V=0.492). Furthermore, 2-way analysis of covariance showed that deposit contracts (mean 14.88, SD 6.40 days goal achieved) were not significantly more effective than rewards (mean 12.13, SD 6.17 days goal achieved; P=.17). Unexpectedly, loss frames (mean 10.50, SD 6.22 days goal achieved) were significantly less effective than gain frames (mean 14.67, SD 5.95 days goal achieved; P=.007; ηp2=0.155). CONCLUSIONS Financial incentives help increase physical activity, but deposit contracts were not more effective than rewards. Although self-funded deposit contracts can be offered at low cost, low uptake is an important obstacle to large-scale implementation. Unexpectedly, loss framing was less effective than gain framing. Therefore, we urge further research on their boundary conditions before using loss-framed incentives in practice. Because of limited statistical power regarding some research questions, the results of this study should be interpreted with caution, and future work should be done to confirm these findings. TRIAL REGISTRATION Open Science Framework Registries osf.io/34ygt; https://osf.io/34ygt.
Collapse
Affiliation(s)
- David R de Buisonjé
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Thomas Reijnders
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands
- Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Talia R Cohen Rodrigues
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Santhanam Prabhakaran
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Stefan A Lipman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Tammo H A Bijmolt
- Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Linda D Breeman
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Veronica R Janssen
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Center, Veldhoven, Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands
- Medical Delta, Leiden University, Technical University Delft, Erasmus University, Delft, Netherlands
| |
Collapse
|
13
|
Inghels M, Kim HY, Mathenjwa T, Shahmanesh M, Seeley J, Wyke S, McGrath N, Sartorius B, Yapa HM, Dobra A, Bärnighausen T, Tanser F. Can a conditional financial incentive (CFI) reduce socio-demographic inequalities in home-based HIV testing uptake? A secondary analysis of the HITS clinical trial intervention in rural South Africa. Soc Sci Med 2022; 311:115305. [PMID: 36084520 DOI: 10.1016/j.socscimed.2022.115305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 07/04/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
In sub-Saharan Africa, home-based HIV testing interventions are designed to reach sub-populations with low access to HIV testing such as men, younger or less educated people. Combining these interventions with conditional financial incentives (CFI) has been shown to be effective to increase testing uptake. CFI are effective for one-off health behaviour change but whether they operate differentially on different socio-demographic groups is less clear. Using data from the HITS trial in South Africa, we investigated whether a CFI was able to reduce existing home-based HIV testing uptake inequalities observed by socio-demographic groups. Residents aged ≥15 years in the study area were assigned to an intervention arm (16 clusters) or a control arm (29 clusters). In the intervention arm, individuals received a food voucher (∼3.5 US dollars) if they accepted to take a home-based HIV test. Testing uptake differences were considered for socio-demographic (sex, age, education, employment status, marital status, household asset index) and geographical (urban/rural living area, distance from clinic) characteristics. Among the 37,028 residents, 24,793 (9290 men, 15,503 women) were included in the analysis. CFI increased significantly testing uptake among men (39.2% vs 25.2%, p < 0.001) and women (45.9% vs 32.0%, p < 0.001) with similar absolute increase between men and women. Uptake was higher amongst the youngest or least educated individuals, and amongst single (vs in union) or unemployed men. Absolute uptake increase was also significantly higher amongst these groups resulting in increasing socio-demographic differentials for home-based HIV testing uptake. However, because these groups are known to have less access to other public HIV testing services, CFI could reduce inequalities for HIV testing access in our specific context. Although CFI significantly increased home-based HIV testing uptake, it did not do so differentially by socio-demographic group. Future interventions using CFI should make sure that the intervention alone does not increase existing health inequities.
Collapse
Affiliation(s)
- Maxime Inghels
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK; Centre Population et Développement (UMR 196 Paris Descartes - IRD), SageSud (ERL INSERM 1244), Institut de Recherche pour le Développement, Paris, France.
| | - Hae-Young Kim
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Department of Population Health, New York University School of Medicine, New York, NY, USA; KwaZulu-Natal Innovation and Sequencing Platform, KwaZulu-Natal, South Africa.
| | | | - Maryam Shahmanesh
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Institute for Global Health, University College London, London, United Kingdom.
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
| | - Nuala McGrath
- Africa Health Research Institute, KwaZulu-Natal, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, United Kingdom.
| | - Benn Sartorius
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
| | - H Manisha Yapa
- Africa Health Research Institute, KwaZulu-Natal, South Africa; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | | | - Till Bärnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Heidelberg Institute of Global Health (HIGH), Heidelberg University, 69120 Heidelberg, Germany.
| | - Frank Tanser
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK; Africa Health Research Institute, KwaZulu-Natal, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
| |
Collapse
|
14
|
Hashim J, Smith HE, Tai ES, Yi H. Lay perceptions of diabetes mellitus and prevention costs and benefits among adults undiagnosed with the condition in Singapore: a qualitative study. BMC Public Health 2022; 22:1582. [PMID: 35987615 PMCID: PMC9392359 DOI: 10.1186/s12889-022-14020-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Therapeutic lifestyle changes can reduce individual risk of type 2 diabetes (T2D) by up to 58%. In Singapore, rates of preventive practices were low, despite a high level of knowledge and awareness of T2D risk and prevention. The study explored the context of the discrepancy between knowledge and practices in T2D prevention among adults undiagnosed with the condition.
Methods
In-depth interviews with 41 adults explored lay beliefs of T2D and the sources of these perceptions, subjective interpretation of how T2D may impact lives, and perceived costs and benefits of practising preventative behaviours. Purposive sampling was used to maximise the variability of participants in demographic characteristics. Thematic analysis was conducted to identify themes related to the domains of inquiry.
Results
Participants’ risk perceptions were influenced by familial, social, and cultural contexts of the representation and management of T2D conditions. The adverse effects of T2D were often narrated in food culture. The cost of adopting a healthy diet was perceived at a high cost of life pleasure derived from food consumption and social interactions. Inconveniences, loss of social functions, dependency and distress were the themes related to T2D management. Participants’ motivation to preventive practices, such as exercise and weight loss, were influenced by short-term observable benefits.
Conclusions
T2D risk communication needs to be addressed in emotionally impactful and interpersonally salient ways to increase the urgency to adopt preventative behaviours. Shifting perceived benefits from long-term disease prevention to short-term observable wellbeing could reduce the response cost of healthy eating.
Collapse
|
15
|
Mönninghoff A, Fuchs K, Wu J, Albert J, Mayer S. The Effect of a Future-Self Avatar Mobile Health Intervention (FutureMe) on Physical Activity and Food Purchases: Randomized Controlled Trial. J Med Internet Res 2022; 24:e32487. [PMID: 35797104 PMCID: PMC9305430 DOI: 10.2196/32487] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/03/2021] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Insufficient physical activity and unhealthy diets are contributing to the rise in noncommunicable diseases. Preventative mobile health (mHealth) interventions may help reverse this trend, but present bias might reduce their effectiveness. Future-self avatar interventions have resulted in behavior change in related fields, yet evidence of whether such interventions can change health behavior is lacking. OBJECTIVE We aimed to investigate the impact of a future-self avatar mHealth intervention on physical activity and food purchasing behavior and examine the feasibility of a novel automated nutrition tracking system. We also aimed to understand how this intervention impacts related attitudinal and motivational constructs. METHODS We conducted a 12-week parallel randomized controlled trial (RCT), followed by semistructured interviews. German-speaking smartphone users aged ≥18 years living in Switzerland and using at least one of the two leading Swiss grocery loyalty cards, were recruited for the trial. Data were collected from November 2020 to April 2021. The intervention group received the FutureMe intervention, a physical activity and food purchase tracking mobile phone app that uses a future-self avatar as the primary interface and provides participants with personalized food basket analysis and shopping tips. The control group received a conventional text- and graphic-based primary interface intervention. We pioneered a novel system to track nutrition by leveraging digital receipts from loyalty card data and analyzing food purchases in a fully automated way. Data were consolidated in 4-week intervals, and nonparametric tests were conducted to test for within- and between-group differences. RESULTS We recruited 167 participants, and 95 eligible participants were randomized into either the intervention (n=42) or control group (n=53). The median age was 44 years (IQR 19), and the gender ratio was balanced (female 52/95, 55%). Attrition was unexpectedly high with only 30 participants completing the intervention, negatively impacting the statistical power. The FutureMe intervention led to small statistically insignificant increases in physical activity (median +242 steps/day) and small insignificant improvements in the nutritional quality of food purchases (median -1.28 British Food Standards Agency Nutrient Profiling System Dietary Index points) at the end of the intervention. Intrinsic motivation significantly increased (P=.03) in the FutureMe group, but decreased in the control group. Outcome expectancy directionally increased in the FutureMe group, but decreased in the control group. Leveraging loyalty card data to track the nutritional quality of food purchases was found to be a feasible and accepted fully automated nutrition tracking system. CONCLUSIONS Preventative future-self avatar mHealth interventions promise to encourage improvements in physical activity and food purchasing behavior in healthy population groups. A full-powered RCT is needed to confirm this preliminary evidence and to investigate how future-self avatars might be modified to reduce attrition, overcome present bias, and promote sustainable behavior change. TRIAL REGISTRATION ClinicalTrials.gov NCT04505124; https://clinicaltrials.gov/ct2/show/NCT04505124.
Collapse
Affiliation(s)
- Annette Mönninghoff
- Institute for Mobility, University of St. Gallen, St Gallen, Switzerland.,Institute for Customer Insight, University of St. Gallen, St Gallen, Switzerland
| | - Klaus Fuchs
- ETH AI Center, ETH Zurich, Zurich, Switzerland
| | - Jing Wu
- Institute for Computer Science, University of St. Gallen, St Gallen, Switzerland
| | - Jan Albert
- Institute for Computer Science, University of St. Gallen, St Gallen, Switzerland
| | - Simon Mayer
- Institute for Computer Science, University of St. Gallen, St Gallen, Switzerland
| |
Collapse
|
16
|
Office workers' perspectives on physical activity and sedentary behaviour: a qualitative study. BMC Public Health 2022; 22:621. [PMID: 35354447 PMCID: PMC8966601 DOI: 10.1186/s12889-022-13024-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/15/2022] [Indexed: 01/02/2023] Open
Abstract
Background Office workers spend a significant part of their workday sitting. Interventions that aim to reduce sedentary behaviour and increase physical activity might be more effective if greater attention is paid to individual perspectives that influence behavioural choices, including beliefs and values. This study aimed to gain insight into office workers' perspectives on physical activity and sedentary behaviour. Methods Sixteen Dutch office workers (50% female) from different professions participated in semi-structured face-to-face interviews in March 2019. To facilitate the interviews, participants received a sensitizing booklet one week before the interview. The booklet aimed to trigger them to reflect on their physical activity and sedentary behaviour and on their values in life. All interviews were audiotaped, transcribed verbatim and coded following codebook thematic analysis. Results Six themes were identified: 1) beliefs about health effects are specific regarding physical activity, but superficial regarding sedentary behaviour; 2) in addition to ‘health’ as a value, other values are also given priority; 3) motivations to engage in physical activity mainly stem from prioritizing the value ‘health’, reflected by a desire to both achieve positive short/mid-term outcomes and to prevent long-term negative outcomes; 4) attitudes towards physical inactivity and sedentary behaviour are diverse and depend on individual values and previous experiences; 5) perceived barriers depend on internal and external factors; 6) supporting factors are related to support and information in the social and physical environment. Conclusions The great value that office workers attach to health is reflected in their motivations and attitudes regarding physical activity. Increasing office workers' knowledge of the health risks of prolonged sitting may therefore increase their motivation to sit less. Although ‘health’ is considered important, other values, including social and work-related values, are sometimes prioritized. We conclude that interventions that aim to reduce sedentary behaviour and increase physical activity among office workers could be improved by informing about health effects of sedentary behaviour and short/mid-term benefits of physical activity, including mental health benefits. Moreover, interventions could frame physical activity as congruent with values and support value-congruent choices. Finally, the work environment could support physical activity and interruption of sedentary behaviour. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13024-z.
Collapse
|
17
|
Eberth B, van der Pol M, Kemenev D. Is time preference and present bias associated with the decision to start, quit or maintain physical activity over time? J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01334-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Abstract
Aim
It is commonly observed that individuals transition into and out of physical activity behaviours over time. A better understanding of the determinants of these transitions is important in order to develop effective interventions. Our focus is on examining the role of time preference and present bias (how present or future oriented individuals are) in the decision to start, quit and maintain physical activity over time.
Subject and methods
We examine changes in different types of physical activity participation over time, allowing us to distinguish between physical activity initiation versus maintenance. We use data from the National Longitudinal Survey of Youth 1979 (NLSY79).
Results
We show that present bias impacts maintenance but not initiation of physical activity behaviour. The time preference rate impacts maintenance of strengthening exercise in men only.
Conclusion
The results of our study suggest that interventions aimed at overcoming present bias, such as commitment devices in the form of deposit contracts, may be effective in maintaining physical activity but not initiating physical activity.
Collapse
|
18
|
Fritz M, Fromell H. How to Dampen the Surge of Non-Communicable Diseases in Southeast Asia: Insights from a Systematic Review and Meta-Analysis. Health Policy Plan 2021; 37:152-167. [PMID: 34791261 PMCID: PMC8757494 DOI: 10.1093/heapol/czab138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 10/07/2021] [Accepted: 11/12/2021] [Indexed: 01/04/2023] Open
Abstract
Non-communicable diseases (NCDs), such as diabetes, cancer, cardiovascular diseases and chronic respiratory diseases, have overtaken infectious diseases as the number one cause of death worldwide. The rise of these diseases is especially grave in Southeast Asia, where existing research however falls short on offering guidance on how policy can best prevent and control NCDs in the region. Additionally, low- and middle-income countries in Southeast Asia cannot directly incorporate lessons drawn from interventions in richer countries, since health system capacities and human and financial resources are thoroughly different. Preventive interventions, thus, need to correspond to local capacities and require contextual solutions. In this article, we provide a systematic review of a wide scope of NCD interventions conducted in Southeast Asia to inform about existing intervention designs and to derive sound evidence of their effectiveness. Our literature search results in 51 studies from five Southeast Asian countries from which we can extract 204 estimates. We sort the studies into six intervention categories and analyse them with respect to 23 different health and behavioural outcomes. While we find positive and significant average effects across all six types of interventions, we also document evidence of substantial publication bias. Using a meta-regression approach in which we correct for the publication bias, we instead fail to confirm positive average effects for some interventions. Especially dietary and physical activity interventions fail to achieve improvements in analysed health outcomes, while programs focusing on smoking cessation, on the take-up of preventive screening activities or educating patients on how to cope with NCDs achieve sizeable effects. We also present evidence that the size of the effect differs with the participants’ characteristics as well as with design features of the intervention. For local policymakers, the results provide important knowledge on how to address the increasing NCD burden in the coming years.
Collapse
Affiliation(s)
- Manuela Fritz
- University of Passau, Faculty of Economics, Business and Information Systems, Chair of Development Economics, Innstraße 29, 94032 Passau, Germany.,University of Groningen, Department of Economics, Econometrics and Finance, Nettelbosje 2, 9747 AE Groningen, The Netherlands
| | - Hanna Fromell
- University of Groningen, Department of Economics, Econometrics and Finance, Nettelbosje 2, 9747 AE Groningen, The Netherlands.,Aarhus University, Department of Economics and Business Economics, Fuglesangs Allé 4, 8210 Aarhus V, Denmark
| |
Collapse
|
19
|
Abstract
Lack of exercise, which increases the risk of many serious physical and mental illness, has been a common health issue in Japan. Recent studies confirm that financial literacy discourages irrational behavior like gambling and smoking. We therefore investigate how financial literacy, as a rational decision-making instrument, relates to peoples’ exercise behavior in Japan. We hypothesize that financial literacy encourages people to exercise regularly. Using Osaka University’s Preference Parameters Study (PPS) for 2010, we categorized respondents into two groups: those who exercise regularly or at least once a week and those who do not. Our probit estimation results show that financial literacy is positively related with exercise behavior, meaning that financially literate people are more likely to exercise regularly. As the COVID-19 health pandemic seems to exacerbate peoples’ physical inactivity, the results of our study show an alternative approach to encourage exercise. We therefore recommend that governments implement a financial literacy improvement policy to alleviate the lack of exercise.
Collapse
|
20
|
Farías P. The Use of Fear versus Hope in Health Advertisements: The Moderating Role of Individual Characteristics on Subsequent Health Decisions in Chile. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9148. [PMID: 33297557 PMCID: PMC7730075 DOI: 10.3390/ijerph17239148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 02/06/2023]
Abstract
No studies have addressed the way the effectiveness of fear and hope advertisements differs across differently characterized individuals. The present study aims to find out in which situations related to different individual characteristics do fear and hope advertisements work as tools in generating healthy eating intention and physical activity intention. This study conducted an experiment using 283 adults from Chile. The results suggest that fear versus hope appeals in health advertisements have a more positive influence on healthy eating intention. The results suggest that the effect of fear advertisements on healthy eating intention is positively moderated by the frequency of fast food consumption and is negatively moderated by self-efficacy. The results suggest that fear versus hope appeals in health advertisements have no main effect on physical activity intention. However, the results suggest that the effect of fear advertisements on physical activity intention is positively moderated by perceived body weight and past healthy eating behavior and is negatively moderated by subjective norms. The results indicate that when making health advertising, homogenous messages are not persuasive for heterogeneous audiences. The present study results suggest that fear and hope advertisements should be delivered considering the individual characteristics identified in the present study.
Collapse
Affiliation(s)
- Pablo Farías
- Departamento de Administración, Facultad de Economía y Negocios, Universidad de Chile, Santiago 8330015, Chile
| |
Collapse
|
21
|
Finkelstein EA, Lim RSM, Ward DS, Evenson KR. Leveraging family dynamics to increase the effectiveness of incentives for physical activity: the FIT-FAM randomized controlled trial. Int J Behav Nutr Phys Act 2020; 17:113. [PMID: 32912260 PMCID: PMC7488241 DOI: 10.1186/s12966-020-01018-2] [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: 04/07/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background Insufficient physical activity is a global public health concern. Research indicates incentives can increase physical activity levels of children but has not tested whether incentives targeted at children can be leveraged to increase physical activity levels of their parents. This study evaluates whether a novel incentive design linking children’s incentives to both their and their parent’s physical activity levels can increase parent’s physical activity. Methods We conducted a two-arm, parallel, open-labelled randomized controlled trial in Singapore where parent-child dyads were randomly assigned to either (1) rewards to child contingent on child’s physical activity (child-based) or (2) rewards to child contingent on both child’s and parent’s physical activity (family-based). Parents had to be English-speaking, computer-literate, non-pregnant, full-time employees, aged 25–65 years, and with a participating child aged 7–11 years. Parent-child dyads were randomized within strata (self-reported low vs high weekly physical activity) into study arms in a 1:1 ratio. Participants were given activity trackers to assess daily steps. The outcome of interest was the between-arm difference in the change from baseline in parent’s mean steps/day measured by accelerometry at months 6 and 12 (primary endpoint). Results Overall, 159 and 157 parent-child dyads were randomized to the child-based or family-based arms, respectively. Outcomes were evaluated on an intent-to-treat basis. At month 6, there was a 613 steps/day (95% CI: 54–1171) differential in favour of family-based parents. At month 12, our primary endpoint, the differential was reduced to 369 steps/day (95% CI: − 88–1114) and was no longer statistically significant. Conclusions Our findings suggest that novel incentive designs that take advantage of group dynamics may be effective. However, in this design, the effectiveness of the family-based incentive to increase parent’s physical activity was not sustained through one year. Trial registration NCT02516345 (ClinicalTrials.gov) registered on August 5, 2015.
Collapse
Affiliation(s)
- Eric Andrew Finkelstein
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Robyn Su May Lim
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Dianne Stanton Ward
- Center for Health Promotion and Disease Prevention, University of North Carolina Chapel Hill, 1700 Martin Luther King Jr. Boulevard #7426, Chapel Hill, NC, 27514, USA.,Department of Nutrition, Gillings School of Global Public Health, University of North Carolina Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Kelly R Evenson
- Center for Health Promotion and Disease Prevention, University of North Carolina Chapel Hill, 1700 Martin Luther King Jr. Boulevard #7426, Chapel Hill, NC, 27514, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, 27599-8050, USA
| |
Collapse
|
22
|
Riegel B, Stephens-Shields A, Jaskowiak-Barr A, Daus M, Kimmel SE. A behavioral economics-based telehealth intervention to improve aspirin adherence following hospitalization for acute coronary syndrome. Pharmacoepidemiol Drug Saf 2020; 29:513-517. [PMID: 32237005 PMCID: PMC7217735 DOI: 10.1002/pds.4988] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 02/08/2020] [Accepted: 02/11/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE A significant number of patients with acute coronary syndrome (ACS) are nonadherent to aspirin after hospital discharge, with an associated increased risk of subsequent cardiovascular events. The purpose of this pilot study was to test the efficacy of a telehealth intervention based on behavioral economics to improve aspirin adherence following hospitalization for ACS. METHODS We enrolled 130 participants (c¯X = 58 ± 10.7 years of age, 38% female, 45% black) from two hospitals. Patients were eligible if they owned a smartphone and were admitted to the hospital for ACS, prescribed aspirin at discharge, and responsible for administering their own medications. Consenting participants were randomized to the intervention or usual care group. The intervention group was eligible to receive up to $50 per month if they took their medicine daily, with $2 per day deducted if a dose was missed. All participants received an electronic monitoring (EM) pill bottle containing a 90-day supply of aspirin, which was used to measure adherence calculated as the proportion of prescribed drug taken using the EM device. Based on the skewness in the adherence distribution, quantile regression was used to evaluate the effect of the intervention on median adherence over time. RESULTS After 90 days, adherence fell in the control group but remained high in the intervention group (median adherence 81% vs 90%, P = .18). Rehospitalization was higher in the control group (24% vs 13%, P = .17). CONCLUSION A loss aversion behavioral economics-based telehealth intervention is a promising approach to improving aspirin adherence following hospitalization for ACS.
Collapse
Affiliation(s)
- Barbara Riegel
- School of Nursing at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alisa Stephens-Shields
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anne Jaskowiak-Barr
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marguerite Daus
- School of Nursing at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen E Kimmel
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
23
|
Madsen KP, Kjaer T, Skinner T, Willaing I. Time preferences, diabetes self-management behaviours and outcomes: a systematic review. Diabet Med 2019; 36:1336-1348. [PMID: 31392757 DOI: 10.1111/dme.14102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 11/30/2022]
Abstract
AIM Time preferences, i.e. individuals' degree of patience/impatience in intertemporal choice, have been found to be associated with suboptimal health behaviours and health outcomes such as smoking, physical inactivity, unhealthy food intake and obesity. In this systematic review, we aimed to synthesise reported associations between time preferences, diabetes self-management behaviours, including use of diabetes technology, and outcomes. METHODS We searched MEDLINE, EMBASE, PsycINFO, CINAHL, EconLit and all databases in the Web of Science Core Collection. Peer-reviewed studies of people with diabetes that included at least one diabetes-related behaviour or outcome and a measure of time preferences were included. Non-English language studies were excluded. RESULTS A total of 961 records were identified, of which 12 articles were included. Three studies analysed both time-consistent and time-inconsistent preferences, three studies solely analysed time-inconsistent preferences and six studies did not explicitly define a time preference model. Measured outcomes across studies included self-care activities, such as medication-taking, exercising and eating a healthy diet, and biomedical outcomes, such as HbA1c and diabetes-related complications. There were 10 cross-sectional studies and two panel-data studies. No studies explicitly analysed the relationship between time preferences and diabetes technology use. CONCLUSIONS Associations between measures of time preferences, diabetes self-management behaviours and clinical outcomes exist. Higher discount rates determined by both time-consistent and time-inconsistent models predict less diabetes-related self-care and worse outcomes. These findings may add to explanations of the observed variation in diabetes-related health and provide new insights for tailoring interventions and policies aimed at improving diabetes self-management.
Collapse
Affiliation(s)
- K P Madsen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - T Kjaer
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - T Skinner
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - I Willaing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| |
Collapse
|