Predicting and explaining transtheoretical model stage transitions in relation to condom-carrying behaviour

Reproductive Life Planning and Contraceptive Action Planning for Privately Insured Women: The MyNewOptions Study

CONTEXT

Although reproductive life planning (RLP) is recommended in federal and clinical guidelines and may help insured women make personalized contraceptive choices, it has not been systematically evaluated for effectiveness.

METHODS

In 2014, some 984 privately insured women aged 18-40 who were not intending to become pregnant in the next year were randomly assigned to receive RLP, RLP with contraceptive action planning (RLP+) or information only (the control group). Women's contraceptive use, prescription contraceptive use, method adherence, switching to a more effective method, method satisfaction and contraceptive self-efficacy were assessed at six-month intervals during the two-year follow-up period. Differences between groups were identified using binomial logistic regression, linear regression and generalized estimating equation models.

RESULTS

During the follow-up period, the proportion of women using any contraceptive method increased from 89% to 96%, and the proportion using a long-acting reversible contraceptive or sterilization increased from 8% to 19%. Contraceptive adherence was high (72-76%) in all three groups. In regression models, the sole significant finding was that women in the RLP+ group were more likely than those in the RLP group to use a prescription method (odds ratio, 1.3). No differences were evident between the intervention groups and the control group in overall contraceptive use, contraceptive adherence, switching to a more effective method, method satisfaction or contraceptive self-efficacy.

CONCLUSIONS

The study does not provide evidence that web-based RLP influences contraceptive behaviors in insured women outside of the clinical setting. Further research is needed to identify strategies to help women of reproductive age identify contraceptive methods that meet their needs and preferences.

Views on Public Transport and How Personal Experiences Can Contribute to a More Positive Attitude and Behavioural Change

To reduce car usage, several strategies are needed, one of which focuses on social psychological factors. The aim of this study was to predict and explain bus usage using the theory of planned behaviour and the transtheoretical model of change in a sample of 983 residents. The study also evaluated the effect of providing a group of regular car users (n = 34) with a free travel pass, to be used on busses and trains in the region. A regression analysis showed that the theory of planned behaviour (TPB) explained 26% of the variance in intention to use the bus, increasing to 59% when past behaviour was added. The use of the free travel pass resulted in a more positive attitude towards bus usage, with a large number having either changed or having started to change their behaviour. When the same people were contacted three months later, 50% still used public transport. The conclusion is that negative attitudes and travel habits can be altered by experience. Although, a reduction of car use can only be achieved if several measures are implemented that make car driving less attractive and sustainable modes of transport more attractive.

Strength of Implementation Intentions to Use Condoms Among Men Who Have Sex with Men

Although pre-exposure prophylaxis (PrEP) use is increasing among men who have sex with men (MSM), condoms remain key to HIV prevention. Implementation intentions-which link a behavioral action plan with a situation or cue-may predict condom use. The Strength of Implementation Intentions Scale (SIIS), which assesses condom use implementation intentions, has not been evaluated among MSM. A structural model tested whether the SIIS mediated the relationship between condom use intentions and condomless sex acts among 266 sexually-active MSM (56% White, 26% Black, 15% Latino, M_age = 32.54). After controlling for PrEP use, HIV-status, and demographics (χ²(107) = 140.06, CFI = 0.98, TLI = 0.97, RMSEA = 0.03), the SIIS fully mediated the relationship between condom use intentions and condomless sex acts. The SIIS can serve as a fidelity check for interventions, a mediator in theoretical models, and future studies should incorporate implementation intentions into HIV prevention interventions for MSM.

Application of multiple behaviour change models to identify determinants of farmers' biosecurity attitudes and behaviours

It has been recognised that few cattle farmers undertake biosecurity practices on their farms. Approaches that take into consideration individuals' preparedness for change, alongside beliefs thought to motivate the enactment of certain behaviours, may provide a framework for actuating tangible change. The aim of this study was to use a combination of behaviour change models to link beliefs with behaviour and identify possible key interventions to improve the uptake of biosecurity measures by dairy cattle farmers in Great Britain (GB). This is the first study to explore farmers' practices and attitudes in relation to the prevention of direct (animal to animal contact); indirect (via fomites); and other biosecurity measures using a multitheory approach. A cross-sectional study was carried out, with postal questionnaires sent to 2505 dairy cattle farmers. Questions were asked about the extent to which a host of biosecurity measures were used, the influence of various stakeholders (e.g. veterinarians, industry bodies) in informing biosecurity choices, and the perceived control farmers felt they had over biosecurity on their farms. Farmer attitudes towards biosecurity were also explored. Two behaviour change models, the Transtheoretical Model, and the Theory of Planned Behaviour, were utilised. A variety of analysis methods were used to interrogate the data, including multivariable logistic regression. A total of 908/2505 (36.2%) farmers responded, with 757 responses (30.2%) deemed eligible for inclusion. Farmers generally fell into one of two categories: those that reported not applying biosecurity measures with no intention of doing so in the future, and those that reported undertaking biosecurity measures for some time. Farmers felt that biosecurity improved cattle health and welfare, but also felt that disease was inevitable. More farmers agreed with statements relating to their ability to control, rather than prevent disease. Analysis suggested a difference between influencing beliefs and whether specific types of measure were more likely to be undertaken. For example, farmers' beliefs about other stakeholders appeared to play a role in influencing the utilisation of measures preventing direct contact (e.g. nose to nose contact), rather than indirect contact (e.g. fomite transmission). The use of a combination of behaviour change models has identified key variables to use for interventional approaches targeted towards the different type of biosecurity measure (preventing direct or indirect transmission) to improve the uptake of biosecurity on dairy cattle farms in GB. Other industry stakeholders should be aware of these variables when working with farmers to achieve optimal cattle herd health.

Predictive utility and measurement properties of the Strength of Implementation Intentions Scale (SIIS) for condom use

BACKGROUND

Implementation intentions are situation-linked action plans that increase health behaviors such as condom use. Few studies have measured the strength of implementation intentions, especially regarding condom use. Non-injection drug users are at high risk for HIV due to risky sexual practices. Substance use before sex may increase risky sexual behaviors, and implementation intentions are a promising, practical route for HIV prevention.

PURPOSE

This prospective study assessed the measurement properties of the newly developed Strength of Implementation Intentions Scale (SIIS) for condom use and investigated whether the SIIS predicted condom use one-year later. The study evaluated whether behavioral intentions and alcohol or methamphetamine use before sex modified the relationship between the SIIS and condom use.

METHODS

Participants were 590 non-injection drug users convicted of nonviolent drug offenses in court-mandated outpatient drug diversion programs. They completed self-directed computer assessments at baseline and at one-year follow-up. Measures included demographics, behavioral intentions to use condoms, the SIIS for condom use, alcohol and methamphetamine use before or during sex, and condom use. Psychometric properties, direct, and interaction effects of the SIIS were evaluated using structural equation modeling and general linear regressions.

RESULTS

The SIIS, behavioral intentions, and condom use were positively correlated and there was discriminant validity between all three constructs. In addition, the SIIS predicted condom use one-year later in this high-risk population. No significant interactions were detected.

CONCLUSIONS

The SIIS is predictive of condom use behavior, is psychometrically sound and distinct from behavioral intentions, and can be incorporated into HIV prevention interventions and used as a mediator variable. In addition, it can be used as an outcome measure where a follow-up is not feasible. The SIIS can also be tailored for additional HIV-related behaviors such as HIV-testing, adhering to antiretroviral medication, prescribing and adhering to pre-exposure prophylaxis, and other health behaviors.

Correlates of Young Men's Intention to Discuss Birth Control with Female Partners

CONTEXT

Heterosexually active men who wish to prevent conception, but are not willing to use condoms consistently, need to discuss birth control with female partners. Improving the understanding of correlates of men's intention to have such discussions is one step toward supporting this health-facilitating behavior.

METHODS

A sample of 372 heterosexually active men aged 18-25 were recruited and surveyed online between December 2010 and June 2011. Men answered questions on attitudes toward, norms regarding and self-efficacy about discussing birth control, and about endorsement of two sexual scripts. Multiple regression analyses tested these measures' associations with intention to discuss birth control, controlling for age and relationship status.

RESULTS

Attitudes, norms and self-efficacy were each positively associated with men's intention to discuss birth control, accounting for 34% of variance. The more strongly men endorsed a traditional masculinity sexual script, the less likely they were to intend to discuss birth control (coefficient, -0.2). Endorsement of an alternative, gender-equitable "sex-positive woman" script, which emphasizes sexual pleasure and emotional connection as goals for both partners, had no association with intention.

CONCLUSION

Strategies that merit further exploration as potential supports for men's intention to discuss birth control include improving men's self-efficacy and positive attitudes and norms pertaining to such discussions, and reducing belief in traditionally masculine sexual scripts or transforming them to include discussing birth control. Future research should work both experimentally and longitudinally to document each element of the process that ends with men's full participation in effective contraceptive use.

Self-Efficacy and Planning as Predictors of Physical Activity in the Context of Workplace Health Promotion

BACKGROUND

Fostering self-efficacy and planning in individuals can support the uptake and maintenance of regular physical activity. This study examined self-efficacy and planning as mechanisms of an online-delivered workplace health promotion intervention to enhance employees' physical activity. A special focus lay on reciprocal interrelations among self-efficacy and planning over time, as previous work predominantly accounted for only one predictive direction at a time.

METHODS

Data from N = 1,063 employees of a pharmaceutical company who reported an intention to increase their physical activity levels were assessed at three measurement points up to 12 weeks following the intervention. Cross-lagged panel analyses were performed to examine effects of self-efficacy and planning on physical activity as well as reciprocal interrelations between self-efficacy and planning.

RESULTS

Findings indicated an increase in self-efficacy, planning, and physical activity following the intervention. Planning was consistently linked to subsequent physical activity, whereas self-efficacy was not associated. Also, reciprocal interrelations among self-efficacy and planning were found across both measurement lags.

CONCLUSIONS

Planning was confirmed as a predictor of physical activity, whereas self-efficacy was not. However, cross-lagged interrelations indicated reciprocal reactivation among self-efficacy and planning over time, suggesting beneficial effects of including strategies that foster both volitional constructs in interventions.

Resilience, tipping, and hydra effects in public health: emergent collective behavior in two agent-based models

Background

Collective health behavior often demonstrates counter-intuitive dynamics, sometimes resisting interventions designed to produce change, or even producing effects that are in the opposite direction than intended by the intervention, e.g. lowering infectivity resulting in increased infections. At other times collective health behavior exhibits sudden large-scale change in response to small interventions or change in the environment, a phenomenon often called “tipping.” I hypothesize that these seemingly very different phenomena can all be explained by the same dynamic, a type of collective resilience.

Methods

I compared two simple agent-based models of interactions in networks: a public health behavior game, in which individuals decide whether or not to adopt protective behavior, and a microbial-level game, in which three different strains of bacteria attack each other. I examined the type of networks and other conditions that support a dynamic balance, and determined what changes of conditions will tip the balance.

Results

Both models show lasting dynamic equilibrium and resilience, resulting from negative feedback that supports oscillating coexistence of diversity under a range of conditions. In the public health game, health protection is followed by free-riding defectors, followed by a rise in infection, in long-lasting cycles. In the microbial game, each of three strains takes turns dominating. In both games, the dynamic balance is tipped by lowering the level of local clustering, changing the level of benefit, or lowering infectivity or attack rate. Lowering infectivity has the surprising effect of increasing the numbers of infected individuals. We see parallel results in the microbial game of three bacterial strains, where lowering one strain’s attack rate (analogous to lowering infectivity) increases the numbers of the restrained attacker, a phenomenon captured by the phrase, “the enemy of my enemy is my friend.”

Conclusions

Collective behavior often shows a dynamic balance, resulting from negative feedback, supporting diversity and resisting change. Above certain threshold conditions, the dynamic balance is tipped towards uniformity of behavior. Under a certain range of conditions we see “hydra effects” in which interventions to lower attack rate or infectivity are self-defeating. Simple models of collective behavior can explain these seemingly disparate dynamics.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2938-8) contains supplementary material, which is available to authorized users.

Effects of a one-hour intervention on condom implementation intentions among drug users in Southern California

Approximately 36% of HIV cases are related to substance abuse. Substance abusers, including non-injection drug users, are at a high-risk for contracting HIV due to risky behaviors, including unprotected sex. Due to these behavioral and infection risks, feasible interventions that focus on condom use within this population are imperative. The current study involved the development of brief intervention designed to increase implementation intentions (situation-linked action plans) to use condoms in convicted non-violent drug offenders participating in drug diversion programs in Southern California. Participants (n = 143) were randomized at the individual level to either waitlist control or experimental conditions. The randomized waitlist control group received the HIV survey for the pre-test before the intervention, while the experimental group received a neutral, non-HIV-related, survey at pre-test. The experimental group received the HIV survey as the post-test after the intervention (waitlist control group received the neutral, non-HIV-related, survey). One-tailed Mann Whitney U tests were used to compare the waitlist control and experimental groups. The experimental group was more likely to report stronger implementation intentions to use condoms (p <0.001). These results indicate in the short term that a brief, easily disseminated HIV intervention can be effective for increasing implementation intentions to use condoms in an extremely high HIV-risk population.

Predicting having condoms available among adolescents: the role of personal norm and enjoyment

OBJECTIVES

Having condoms available has been shown to be an important predictor of condom use. We examined whether or not personal norm and goal enjoyment contribute to predicting having condoms available in the context of cognition specified by the theory of planned behaviour (TPB).

DESIGN

Prospective survey study, with a baseline and follow-up measurement (at 3 months).

METHODS

Data were gathered using an online survey. In total 282 adolescents (mean age = 15.6, 74% female adolescents) completed both questionnaires. At baseline, demographics, sexual experience, condom use, TPB variables, descriptive norm, personal norm, and enjoyment towards having condoms available were measured. At T2 (3 months later) having condoms available was measured. Direct and moderating effects of personal norm and goal enjoyment were examined by means of hierarchical linear regression analyses.

RESULTS

Regression analyses yielded a direct effect of self-efficacy and personal norm on condom availability. In addition, moderation of the intention-behaviour relation by goal enjoyment added to the variance explained. The final model explained approximately 35% of the variance in condom availability.

CONCLUSIONS

Personal norm and goal enjoyment add to the predictive utility of a TPB model of having condoms available and may be useful intervention targets.

STATEMENT OF CONTRIBUTION

What is already known about this subject? Having condoms available is an important prerequisite for actual condom use. The theory of planned behaviour has successfully been applied to explain condom availability behaviour. The theory of planned behaviour has been criticized for not adequately taking into account affective motivation. What does this study add? Personal norm and goal enjoyment add to the predictive utility of the model. Personal norm explains condom availability directly, enjoyment increases intention enactment. Personal norm and goal enjoyment therefore are useful intervention targets.

Changes in social-cognitive variables are associated with stage transitions in physical activity

When it comes to the adoption or maintenance of physical activity, individuals can be placed along a continuum or into stages of change. The Health Action Process Approach proposes three such stages: non-intentional, intentional and actional. Intraindividual differences are reflected by stage transitions: either progression or regression. The present study examines social-cognitive factors of stage transitions: outcome expectancies, self-efficacy and planning. In an online study on physical activity, 660 adults completed questionnaires at baseline and approximately 3 weeks later. Social-cognitive factors were converted into standardized residual change scores to account for changes in outcome expectancies, self-efficacy and planning within the observation period. Discriminant function analyses revealed stage-specific patterns: progression out of non-intentional stage was associated with self-efficacy increases. Out of intentional stage, regression was correlated with decreases in planning, whereas progression was linked to increases in self-efficacy and planning. Regression from action stage was associated with decreases in self-efficacy. Physical activity promotion should focus on improving self-efficacy for non-intending, intending and acting individuals, whereas planning interventions are recommended for intending individuals. Interventions may be more effective by considering specific mechanisms instead of providing generic interventions for all individuals at different stages.

Test of a brief theory of planned behaviour-based intervention to promote adolescent safe sex intentions

The present study tested a brief (303 word) intervention designed to change attitude, subjective norm, and perceived behavioural control regarding a safe sex behaviour in a sample of 16- to 18-year-olds. Participants (N=288) were randomized to receive either an experimental intervention or a control (knowledge only) intervention and completed measures of their reactions to the stimuli as well as pre- and post-test measures of theory of planned behaviour variables. The experimental intervention significantly increased message processing (mean between-group difference=0.73, 95% CI=0.40, 1.06; Cohen's d=.52), message acceptance (mean between-group difference=0.82, 95% CI=0.57, 1.07; Cohen's d=.77), subjective norm (adjusted Mean between-group difference=0.54, 95% CI = 0.26, 0.81; Cohen's d=.37; mean within-group difference for intervention condition=0.59, 95% CI = 0.36, 0.81; Cohen's d=.38) and intention (adjusted Mean between-group difference=0.27, 95% CI = 0.02, 0.53; Cohen's d=.20; mean within-group difference for intervention condition=0.54, 95% CI = 0.33, 0.75; Cohen's d=.31), but not attitude or perceived behavioural control. The effects of the experimental intervention on intention were mediated solely through subjective norm. The present findings: (a) compare favourably in terms of the effect sizes reported in previous research in this area (mean Cohen's d for within-group difference for intervention conditions=.009 and .09, for norms and intention, respectively, see Albarracín et al. (2003)), (b) imply that subjective norms are causally related to intentions, and (c) suggest that interventions designed to change subjective norms (as opposed to communication of risks and fear appeals) might ultimately be effective in changing behaviour.

Is there utility in the transtheoretical model?

OBJECTIVES

The transtheoretical model is arguably the dominant model of health behaviour change, having received unprecedented research attention, yet it has simultaneously attracted exceptional criticism. However, the criticisms have been directed almost exclusively at the stages of change, just one of fourteen components of the transtheoretical model, which may have diverted attention away from more fruitful avenues of research based on the model.

DESIGN AND METHODS

Narrative review.

RESULTS

The evidence would suggest some flaws in the concept of stages of change as currently articulated in the transtheoretical model. On a conceptual level, even studies incorporating the five stages of change point to a model that better fits Gollwitzer (1993) and Heckhausen's (1991) idea of a motivational phase followed by a volitional phase. Potentially the processes of change components of the transtheoretical model may actually prove the most useful, yet have been under-researched, at least experimentally. Three studies that successfully utilise the processes of change to reduce alcohol consumption, encourage smoking cessation and increase physical activity are described.

CONCLUSIONS

Elements of the transtheoretical model offer promise in developing effective health behaviour change interventions, but the question arises as to whether extracting these elements undermines completely the idea of a transtheoretical model.