Reducing touching eyes, nose and mouth ('T-zone') to reduce the spread of infectious disease: A prospective study of motivational, volitional and non-reflective predictors

BACKGROUND

The route into the body for many pathogens is through the eyes, nose and mouth (i.e., the 'T-zone') via inhalation or fomite-based transfer during face touching. It is important to understand factors that are associated with touching the T-zone to inform preventive strategies.

PURPOSE

To identify theory-informed predictors of intention to reduce facial 'T-zone' touching and self-reported 'T-zone' touching.

METHODS

We conducted a nationally representative prospective questionnaire study of Canadians. Respondents were randomized to answer questions about touching their eyes, nose, or mouth with a questionnaire assessing 11 factors from an augmented Health Action Process Approach at baseline: intention, outcome expectancies, risk perception, individual severity, self-efficacy, action planning, coping planning, social support, automaticity, goal facilitation and stability of context. At 2-week follow-up, we assessed HAPA-based indicators of self-regulatory activities (awareness of standards, effort, self-monitoring) and self-reported behaviour (primary dependent variable).

RESULTS

Of 656 Canadian adults recruited, 569 responded to follow-up (87% response rate). Across all areas of the 'T-zone', outcome expectancy was the strongest predictor of intention to reduce facial 'T-zone' touching, while self-efficacy was a significant predictor for only the eyes and mouth. Automaticity was the strongest predictor of behaviour at the 2-week follow-up. No sociodemographic or psychological factors predicted behaviour, with the exception of self-efficacy, which negatively predicted eye touching.

CONCLUSION

Findings suggest that focusing on reflective processes may increase intention to reduce 'T-zone' touching, while reducing actual 'T-zone' touching may require strategies that address the automatic nature of this behaviour.

Study protocol for an adapted personal project analysis to measure vertical inter-goal relations on physical activity and diet

Background

The promotion of multiple healthy lifestyles has been implemented as part of public health efforts to prevent and reduce the burden of non-communicable diseases. However, these interventions have shown a heterogeneity in their effectiveness. The pursuit of multiple daily goals may influence overall progress in achieving health goals. Horizontal inter-goal relations can be conflicting (due to time constraints) or facilitating (due to goal compatibility) and impact progress towards goal achievement. Personal values also play an important role in health promotion. Personal values direct attention towards accomplishing a higher-level goal through goal setting. Identifying the conflicting or facilitating relationships between health goals and personal values would provide insights in how individuals value health and the personal values that may support the adoption of a healthy behavior. The health goals that this study will focus on are physical activity and a healthy diet.

Methods

Participants between 18 and 30 years old residing in Belgium and interested in a healthy diet and/or physical activity, will be recruited. The study will be a mixed-methods research study based on an adapted personal project analysis for goal elicitation, goal appraisal, and rating of inter-goal conflicting or facilitating relations on a cross-impact matrix. The main objectives include examining the conflicting and facilitating relations between health goals and personal values. Secondary objectives include: examining correlations between horizontal and vertical goal relations; and the goal self-concordance score as a method of data triangulation of facilitating relations between goals and personal values.

Discussion

This study will provide insights into how the emerging adult population relate healthy behaviors, specifically physical activity and a healthy diet, to their personal values. The degree to which individuals are able to pursue a health goal is also influenced by other life goals, and therefore the conflicting and facilitating relations between health goals and other life goals will also be examined. This study contributes to multiple health behavior change theories and has implications for the formulation of interventions for the promotion of healthy behaviors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00931-4.

Factors contributing to fidelity in a pilot trial of individualized resistant starches for pediatric inflammatory bowel disease: a fidelity study protocol

Background

The consumption of resistant starches is a promising adjuvant therapy for patients with inflammatory bowel disease. Rigorous evaluation of resistant starches in this setting depends on the intervention being delivered, received, and enacted as intended, that is, with fidelity. As part of a planned pilot trial, participants will be randomized to ingest resistant starches or a placebo. They will also be asked to collect stool samples and keep symptom and dose diaries to inform trial outcomes.

We aim to identify potential factors impacting fidelity to the receipt and enactment of trial intervention and data collection activities from the perspective of patients and caregivers in the trial. Identifying fidelity barriers and enablers at the pilot trial phase of a clinical intervention may help to determine optimization processes when expanding to multiple sites in future trials.

Methods

We will conduct 15-30 semi-structured interviews with pilot trial participants (aged 8-17) and their caregivers. Trial participants will be approached for interviews approximately 6 months after the start of their trial participation. Personal projects analysis, a tool for understanding how individuals manage competing demands in their daily lives, will guide an in-depth exploration of how trial participants engage in activities related to intervention and data collection fidelity (ingesting resistant starches or placebo, collecting stool samples, keeping a symptom and dose diary) amidst the complexities of daily living.

Discussion

The present study will seek to explore and demonstrate how theory-informed fidelity assessments can be conducted alongside pilot trials to inform future multisite trials. Study results will clarify what factors may affect fidelity to trial intervention and data collection activities. Results may suggest what to modify to optimize the design and conduct, and ensure the integrity, of future multisite trials. Conducting process evaluations alongside clinical trials has the potential to improve our understanding of trial participant experiences. Results will provide a better understanding of how trial participants manage to engage in necessary trial activities along with other priorities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-021-00815-1.

Inter-goal conflict and facilitation as predictors of adherence to dieting goals: an ecological momentary assessment study

Objectives: To examine dieting goals within a system of individual goals, and the patterns by personally-relevant goals might interfere or facilitate each other.Design: 94 dieters completed an assessment of goals using Little's personal project analysis. Participants identified 7 goals; one of which was pre-defined as adhering to diet. Over the beginning 14 days of their diet, participants completed an Ecological Momentary Assessment study recording their food intake in real-time. Every evening, participants reported their goal engagement and which goals conflicted or facilitated with each other.Main outcome measures/results: Over the study duration, 1452 days of food intake and goal conflict/facilitation were recorded. Participants completed an average of 1.54 (SD = 0.85) snacks, an average of 0.94 (SD = 1.81) goal conflicts, and 4.16 (SD = 4.70) goal facilitations per day. Inter-goal conflict was associated with a significant but small improvement on individuals' mood, but was not associated with daily dietary intake or long-term weight-loss. Similarly, inter-goal facilitation was not associated with daily dietary intake or long-term weight-loss. Daily food intake was a significant predictor of long-term weight-loss.Conclusions: The results of this study suggest the impact of inter-goal conflict and facilitation on dieting is not via overall snack or food consumption.

Making New Year's Resolutions that Stick: Exploring how Superordinate and Subordinate Goals Motivate Goal Pursuit

BACKGROUND

New Year's Eve is a time when people make resolutions, but, more often than not, fail to achieve them. Previous research highlighted the positive effect of subordinate goals in goal pursuit. We argue that combining superordinate and subordinate goals contributes to successful goal pursuit, especially in the long run. We test whether a simultaneous focus on both goal types helps people to keep their resolutions.

METHODS

Using a 2 × 2 between-subjects design, participants (N = 256) formulated a resolution from which they derived either a superordinate (yes/no) or a subordinate goal (yes/no). The control group focused exclusively on a self-set resolution. Main outcome measures were effort in goal pursuit and intentions to further pursue the goal after 3 months.

RESULTS

Focusing on superordinate and subordinate goals increased the amount of effort invested in goal pursuit. A group difference was found only between the group focusing on both goal types and the group focusing on a superordinate goal. No statement could be made about intentions for further goal pursuit and processes by which goal type affects goal pursuit.

CONCLUSION

The study provides preliminary insights into how combining superordinate and subordinate goals may be a helpful strategy to pursue long-term goals.

Development of a Parental Feeding Goal Measure: The Family Mealtime Goals Questionnaire

It is well established that parents' feeding practices predict children's eating behaviors. However, there has been little research into parents' mealtime goals-their desired outcomes for family mealtimes. These goals, and potential conflicts between them, may be important both in explaining parents' feeding practices and improving children's eating behaviors, as health behavior change is more likely to be achieved by programmes and interventions that are aligned with an individual's goals. The objectives of this study were to develop a reliable and valid measure that captures parental mealtime goals, and to describe parents' endorsement of these goals. Online questionnaire methods were used to design and test the Family Mealtime Goals Questionnaire with 1,140 parents and carers of at least one child aged from 1 to 16 years. Exploratory qualitative analysis, Principal Components Analysis, Confirmatory Factor Analysis, and test-retest analysis (using intraclass correlations) were conducted to establish the psychometric properties of the instrument. An 18-item questionnaire was produced with seven dimensions: stress/conflict avoidance, homemade food, shared family food, family involvement in mealtimes, price, occasional treats, and high/low fat regulation. Some differences were found in the goal structure of parents of children of different ages but stress/conflict avoidance was the most strongly endorsed mealtime goal for all age groups. The Family Mealtime Goals Questionnaire provides a useful measure of parents' feeding motivations. It will facilitate large-scale research into the relationships between parents' feeding goals and practices and could inform the design of more effective healthy eating interventions that target specific feeding goals.

Personal Projects and Psychological Well-Being: Emerging Adults With and Without Diabetes

Objective

The goal of this study was to examine the nature of the personal projects that emerging adults with and without diabetes were pursuing and the implications of those projects for psychological well-being.

Methods

We asked emerging adults with and without type 1 diabetes to identify five personal projects, rate four dimensions of those projects (importance, typicality, stress, and progress), and complete several well-being measures (depressive symptoms, life purpose, life satisfaction, perceived stress, and resilience) when they were age 19. Those with diabetes also indicated the extent to which diabetes interfered with each of the projects. We followed participants for 1 year to determine the status of projects and reassess project dimensions and psychological well-being.

Results

The kinds of projects identified by the two groups were similar. However, those with diabetes reported lower levels of progress on projects and completed fewer projects 1 year later compared with controls. Project progress, importance, and completion were linked to higher psychological well-being, whereas project stress was linked to lower psychological well-being. However, the most robust cross-sectional and longitudinal predictor of psychological well-being was project typicality (i.e., the extent to which projects were typical of participants). The pursuit of more typical projects was linked to higher psychological well-being. These findings were largely similar for emerging adults with and without diabetes. Diabetes interference with projects revealed some links to psychological well-being.

Conclusions

These results suggest that personal project engagement and completion is linked to the overall mental health of emerging adults with and without diabetes.

Exploring the role of competing demands and routines during the implementation of a self-management tool for type 2 diabetes: a theory-based qualitative interview study

BACKGROUND

The implementation of new medical interventions into routine care involves healthcare professionals adopting new clinical behaviours and changing existing ones. Whilst theory-based approaches can help understand healthcare professionals' behaviours, such approaches often focus on a single behaviour and conceptualise its performance in terms of an underlying reflective process. Such approaches fail to consider the impact of non-reflective influences (e.g. habit and automaticity) and how the myriad of competing demands for their time may influence uptake. The current study aimed to apply a dual process theoretical approach to account for reflective and automatic determinants of healthcare professional behaviour while integrating a multiple behaviour approach to understanding the implementation and use of a new self-management tool by healthcare professionals in the context of diabetes care.

METHODS

Following Diabetes UK's national release of the 'Information Prescription' (DUK IP; a self-management tool targeting the management of cholesterol, blood pressure and HbA1c) in January 2015, we conducted semi-structured interviews with 13 healthcare professionals (general practitioners and nurses) who had started to use the DUK IP during consultations to provide self-management advice to people with type 2 diabetes. A theory-based topic guide included pre-specified constructs from a previously developed logic model. We elicited healthcare professionals' views on reflective processes (outcome expectations, self-efficacy, intention, action and coping planning), automatic processes (habit), and multiple behaviour processes (goal priority, goal conflict and goal facilitation). All interviews were audio recorded and transcribed verbatim and all transcripts were independently double coded and analysed using content analysis.

RESULTS

The majority of healthcare professionals interviewed reported strong intentions to use the DUK IP and having formed a habit of using them after a minimum of one month continuous use. Pop-up cues in the electronic patient records were perceived to facilitate the use of the tool. Factors that conflicted with the use of the DUK IP included existing pathways of providing self-management advice.

CONCLUSION

Data suggests that constructs from dual process and multiple behaviour approaches are useful to provide supplemental understanding of the implementation of new self-management tools such as the DUK IP and may help to advance behavioural approaches to implementation science.

Milieu matters: Evidence that ongoing lifestyle activities influence health behaviors

Health behaviors occur within a milieu of lifestyle activities that could conflict with health actions. We examined whether cognitions about, and performance of, other lifestyle activities augment the prediction of health behaviors, and whether these lifestyle factors are especially influential among individuals with low health behavior engagement. Participants (N = 211) completed measures of past behavior and cognitions relating to five health behaviors (e.g., smoking, getting drunk) and 23 lifestyle activities (e.g., reading, socializing), as well as personality variables. All behaviors were measured again at two weeks. Data were analyzed using neural network and cluster analyses. The neural network accurately predicted health behaviors at follow-up (R2 = .71). As hypothesized, lifestyle cognitions and activities independently predicted health behaviors over and above behavior-specific cognitions and previous behavior. Additionally, lifestyle activities and poor self-regulatory capability were more influential among people exhibiting unhealthy behaviors. Considering ongoing lifestyle activities can enhance prediction and understanding of health behaviors and offer new targets for health behavior interventions.

Do other goals influence physical activity? A systematic review examining the relationship between other goals and physical activity behavior

Promoting regular physical activity (PA) is essential to population health, yet intervention success has been modest. Most approaches have focused heavily on PA motivation but give limited attention to other facilitating and conflicting goals in daily life. The purpose of this review was to unite the literature examining other life goals and appraise their relationship with PA. Ten electronic databases were searched from February to December 2015 through EBSCO with the keywords: goal, facilitation, conflict, interference, intergoal, time displacement, behavioral resolve, cross-behavior, PA and exercise. Combined with manual bibliography and citation searches, 292 potentially relevant abstracts were screened, 40 of which full-text articles were retrieved. A total of 20 articles with 22 independent data-sets met the inclusion criteria and were included in the present review. Despite relatively heterogeneous measurement and a large proportion of cross sectional designs with student samples, the results indicated that PA is related to other life goals both in terms of facilitation (positive association) and conflict (negative association). Both facilitation and conflict goals had more consistent significant associations with PA when they were measured in terms of behavioral (e.g., study behavior, TV viewing) rather than higher-level objectives (e.g., getting healthy, being social). These goals explained additional variance in PA beyond PA intentions, plans, and perceived behavioral control and helped translate positive intentions into behavior. The results suggest that PA interventions should consider PA motivation with the integration of other facilitating and conflicting goals in one's daily life; however, better measurement of goals, with more diverse samples in experimental designs are needed.

"You Can't Always Get What You Want": A Novel Research Paradigm to Explore the Relationship between Multiple Intentions and Behaviours

Objective

Research investigating cognitive moderators of the intention–behaviour relationship and psychological consequences of failure to enact intentions is usually conducted in a single‐behaviour paradigm. A multiple‐behaviour paradigm is introduced which overcomes bias inherent to single‐behaviour designs and allows testing of novel hypotheses. Two exploratory studies illustrate the utility of this new paradigm by investigating the role of cognitive predictors and psychological correlates of intention–behaviour relationships.

Method

The proposed method involves measuring multiple intentions across common areas of life activity at baseline and corresponding behaviours at follow‐up. In two studies, 51 intentions and behaviours were assessed (49 by self‐report, 2 objectively). In Study 1, participants (n = 126) also completed self‐reported measures of everyday cognitive failures and dysexecutive behaviours, crystallised intelligence (Mill Hill Vocabulary Scale) at baseline and Quality of Life (QoL; follow‐up). In Study 2, objective executive function measures (Stroop, Go/NoGo task and Word Fluency test) were completed by N = 30 participants.

Results

The total number of intentions, cognitive, and QoL measures were unrelated to the percentage of intentions enacted. Crystallised intelligence was related to successful intention implementation and problems with emotion regulation were associated with forming fewer intentions and with fewer failed intentions. QoL was strongly related with more intentions, regardless of whether or not these were implemented. Study 2 showed that cognitive flexibility (word fluency) and task errors, rather than Stroop effect and Go/No‐Go performance were related, to intention–behaviour congruence.

Conclusion

Intention–behaviour relationships might be better understood when considering the multiple intentions and behaviours that people are engaged in at once at any one point in time. A multiple‐behaviour paradigm suggests novel hypotheses. Preliminary findings reported here require replication. Anticipated applications of the paradigm are outlined and discussed.

'Just one more episode': Frequency and theoretical correlates of television binge watching

Binge watching is a relatively new behavioural phenomenon that may have health implications. The aim of this study was to estimate the frequency of, and identify modifiable factors associated with, TV binge watching. A total of 86 people completed an online questionnaire assessing self-efficacy, proximal goals, outcome expectations, anticipated regret, automaticity, goal conflict and goal facilitation, and self-reported binge watching over the last week. Participants reported binge watching a mean 1.42 days/week (standard deviation = 1.42). Intention and outcome expectations accounted for variance in binge watching, and automaticity, anticipated regret and goal conflict each separately accounted for additional variance in binge watching. Binge watching is commonplace and associated with both reflective and impulsive factors.

A community pain service solution-focused pain management programme: delivery and preliminary outcome data

1. This article introduces a rationale for a solution-focused approach to a community-based pain management programme (PMP), describing delivery and preliminary outcome data. 2. It suggests PMPs can be feasibly run in the community without necessity for hospital care setting. 3. A community setting is also advantageous in that it allows maintenance of social networks and close third-sector links to support long-term, sustained mental well-being. 4. Solution-focused psychological approaches help the clinician tap into patient expertise and develop rich descriptions of the patient's preferred future, enhancing self-efficacy and empowerment. 5. Evaluation found significant statistical and clinical improvements in pre-post pain self-efficacy, mental well-being and function (but findings were limited by internal and external validity and no significant effect was found on pain levels). 6. Statistically significant change was maintained at 10 weeks for self-efficacy and function (and for the latter, clinically significant change was also maintained); improvements in mental well-being showed maintenance at all measured time points (up to 12 months) in terms of both statistical and clinical significant changes.

The NULevel trial of a scalable, technology-assisted weight loss maintenance intervention for obese adults after clinically significant weight loss: study protocol for a randomised controlled trial

BACKGROUND

Effective weight loss interventions are widely available but, after weight loss, most individuals regain weight. This article describes the protocol for the NULevel trial evaluating the effectiveness and cost-effectiveness of a systematically developed, inexpensive, scalable, technology-assisted, behavioural intervention for weight loss maintenance (WLM) in obese adults after initial weight loss.

METHODS/DESIGN

A 12-month single-centre, two-armed parallel group, participant randomised controlled superiority trial is underway, recruiting a total of 288 previously obese adults after weight loss of ≥5 % within the previous 12 months. Participants are randomly assigned to intervention or control arms, with a 1:1 allocation, stratified by sex and percentage of body weight lost (<10 % vs ≥10 %). Change in weight (kg) from baseline to 12 months is the primary outcome. Weight, other anthropometric variables and 7-day physical activity (assessed via accelerometer) measures are taken at 0 and 12 months. Questionnaires at 0, 6 and 12 months assess psychological process variables, health service use and participant costs. Participants in the intervention arm initially attend an individual face-to-face WLM consultation with an intervention facilitator and then use a mobile internet platform to self-monitor and report their diet, daily activity (via pedometer) and weight through daily weighing on wirelessly connected scales. Automated feedback via mobile phone, tailored to participants' weight regain and goal progress is provided. Participants in the control arm receive quarterly newsletters (via links embedded in text messages) and wirelessly connected scales. Qualitative process evaluation interviews are conducted with a subsample of up to 40 randomly chosen participants. Acceptability and feasibility of procedures, cost-effectiveness, and relationships among socioeconomic variables and WLM will also be assessed.

DISCUSSION

It is hypothesised that participants allocated to the intervention arm will show significantly lower levels of weight regain from baseline than those in the control arm. To date, this is the first WLM trial using remote real-time weight monitoring and mobile internet platforms to deliver a flexible, efficient and scalable intervention, tailored to the individual. This trial addresses a key research need and has the potential to make a vital contribution to the evidence base to inform future WLM policy and provision.

TRIAL REGISTRATION

http://www.isrctn.com/ISRCTN14657176 (registration date 20 March 2014).

What matters to patients with heart failure? The influence of non-health-related goals on patient adherence to self-care management

OBJECTIVE

To describe the life goals of heart failure (HF) patients and to determine whether adherence is influenced by the extent to which these priorities are perceived as compatible with HF self-care regimens.

METHOD

Forty HF outpatients identified their top-five life goals and indicated the compatibility of HF self-care regimens (diet, exercise, weighing) with these priorities. HF knowledge, self-efficacy and reported adherence were also assessed.

RESULTS

Patients valued autonomy and social relationships as much as physical health. However, the rated importance of these domains did not predict adherence. Adherence positively correlated with the extent to which the regimen, specifically exercise, was considered compatible with life goals (r=.34, p<.05). Exercise adherence also correlated with illness severity and self-efficacy (rs=-.42 and .36, p<.05, respectively). The perceived compatibility of physical activity with personal goals predicted 11% of the variance in exercise adherence above and beyond that accounted for by illness severity and self-efficacy (FΔ (1, 36)=7.11, p<.05).

CONCLUSIONS

Patients' goals outside of the illness management context influence self-care practices.

PRACTICE IMPLICATIONS

Exploring patients' broad life goals may increase opportunities to resolve ambivalence and enhance motivation for self-care adherence.

Improving Diabetes care through Examining, Advising, and prescribing (IDEA): protocol for a theory-based cluster randomised controlled trial of a multiple behaviour change intervention aimed at primary healthcare professionals

Background

New clinical research findings may require clinicians to change their behaviour to provide high-quality care to people with type 2 diabetes, likely requiring them to change multiple different clinical behaviours. The present study builds on findings from a UK-wide study of theory-based behavioural and organisational factors associated with prescribing, advising, and examining consistent with high-quality diabetes care.

Aim

To develop and evaluate the effectiveness and cost of an intervention to improve multiple behaviours in clinicians involved in delivering high-quality care for type 2 diabetes.

Design/methods

We will conduct a two-armed cluster randomised controlled trial in 44 general practices in the North East of England to evaluate a theory-based behaviour change intervention. We will target improvement in six underperformed clinical behaviours highlighted in quality standards for type 2 diabetes: prescribing for hypertension; prescribing for glycaemic control; providing physical activity advice; providing nutrition advice; providing on-going education; and ensuring that feet have been examined. The primary outcome will be the proportion of patients appropriately prescribed and examined (using anonymised computer records), and advised (using anonymous patient surveys) at 12 months. We will use behaviour change techniques targeting motivational, volitional, and impulsive factors that we have previously demonstrated to be predictive of multiple health professional behaviours involved in high-quality type 2 diabetes care. We will also investigate whether the intervention was delivered as designed (fidelity) by coding audiotaped workshops and interventionist delivery reports, and operated as hypothesised (process evaluation) by analysing responses to theory-based postal questionnaires. In addition, we will conduct post-trial qualitative interviews with practice teams to further inform the process evaluation, and a post-trial economic analysis to estimate the costs of the intervention and cost of service use.

Discussion

Consistent with UK Medical Research Council guidance and building on previous development research, this pragmatic cluster randomised trial will evaluate the effectiveness of a theory-based complex intervention focusing on changing multiple clinical behaviours to improve quality of diabetes care.

Trial registration

ISRCTN66498413.

Action control of exercise behavior: evaluation of social cognition, cross-behavioral regulation, and automaticity

Intention is considered the proximal determinant of behavior in many popular theories applied to understanding physical activity, yet intention-behavior discordance is high. Thus, an understanding of constructs that facilitate or inhibit the successful translation of intentions into behavior is both timely and important. The action control approach of dividing the intention-behavior relationship into quadrants of successful/unsuccessful intenders has shown utility in the past by demonstrating the magnitude of intention-behavior discordance and allowing for an outcome variable to test predictors. The purpose of this article was to evaluate automaticity and cross-behavioral regulation as predictors of exercise action control, in conjunction with other more standard social cognitive predictors of perceived behavioral control and affective and instrumental attitudes. Participants were a random sample of 263 college students who completed predictor measures at time one, followed by exercise behavior two weeks later. Participants were classified into three intention-behavior profiles: (1) nonintenders (14.1%; n = 31), (2) unsuccessful intenders (35.5%; n = 78), and (3) successful intenders (48.6%; n = 107). Affective attitude, perceived behavioral control, automaticity, and cross-behavioral regulation were predictors of action control. The results demonstrate that automaticity and cross-behavioral regulation, constructs not typically used in intention-based theories, predict intention-behavior discordance.

'I am not a depressed person': how identity conflict affects help-seeking rates for major depressive disorder

BACKGROUND

There is a significant treatment gap for patients with depression. A third of sufferers never seek help, and the vast majority of those who do only do so after considerable delay. Little is understood regarding poor help-seeking rates amongst people with depression, with existing research mainly focussed on the impact of barriers to treatment. The current study explored psychological factors affecting help-seeking behaviour in clinically depressed individuals.

METHODS

Semi-structured interviews were conducted with 20 current or previously clinically depressed participants who either had or had not sought professional help. Thematic analysis was used to analyse results.

RESULTS

The onset of depressive symptoms created conflict with participants' identity and personal goals. Delays in seeking help were primarily attributed to the desire to protect identity and goals from the threat of depressive symptoms. Participants used avoidance strategies to reduce the perceived threat of depressive symptoms on identity. These strategies interfered with help-seeking. Help-seeking was only undertaken once participants reached a point of acceptance and began to make concessions in their identity and goals, at which time they reduced their use of avoidance.

CONCLUSIONS

Difficulties resolving conflict between identity and depressive symptoms may account for significant delays in seeking help for depression. The results have implications for predicting health behaviour and improving treatment uptake for depression, and may inform existing help-seeking models.

Optimizing acceptability and feasibility of an evidence-based behavioral intervention for obese adults with obesity-related co-morbidities or additional risk factors for co-morbidities: an open-pilot intervention study in secondary care

OBJECTIVE

To test and optimize the feasibility and acceptability of a physical activity (PA) and healthy eating behavior change intervention for obese adults with obesity-related co-morbidities or additional risk factors for co-morbidities.

METHODS

Open-pilot intervention study using an uncontrolled pre and post design with ongoing measures on intervention acceptability and feasibility. Participants received 5 weekly nurse-led one-hour long group sessions. Acceptability and feasibility were assessed throughout. PA, dietary behavior and weight were measured before and after the intervention.

RESULTS

Of 74 consenting participants, 61 (82%) received and 47 (64%) completed the intervention. Average ratings of intervention materials and components by participants ranged between 4.1 and 4.9 out of 5. Average facilitator satisfaction rating was 90% (range 75-100%). The intervention delivery was feasible as indicated by ratings and comments from participants and the facilitator. Participants lost -0.86 kg of weight t(45)=3.84, p=0.0001, and increased PA by an additional 1.6 (SD=2.7) sessions/week, t(31)=-3.3, p=0.002. No significant dietary differences emerged.

CONCLUSION

The intervention was acceptable to the facilitator and participants and feasible for delivery. Several intervention aspects were further optimized.

PRACTICE IMPLICATIONS

The current study outlines a PA and dietary behavior change pilot intervention coupled with a systematic and transparent process of intervention optimization.

Goal conflict, goal facilitation, and health professionals' provision of physical activity advice in primary care: an exploratory prospective study

Background

The theory of planned behaviour has well-evidenced utility in predicting health professional behaviour, but focuses on a single behaviour isolated from the numerous potentially conflicting and facilitating goal-directed behaviours performed alongside. Goal conflict and goal facilitation may influence whether health professionals engage in guideline-recommended behaviours, and may supplement the predictive power of the theory of planned behaviour. We hypothesised that goal facilitation and goal conflict contribute to predicting primary care health professionals' provision of physical activity advice to patients with hypertension, over and above predictors of behaviour from the theory of planned behaviour.

Methods

Using a prospective predictive design, at baseline we invited a random sample of 606 primary care health professionals from all primary care practices in NHS Grampian and NHS Tayside (Scotland) to complete postal questionnaires. Goal facilitation and goal conflict were measured alongside theory of planned behaviour constructs at baseline. At follow-up six months later, participants self-reported the number of patients, out of those seen in the preceding two weeks, to whom they provided physical activity advice.

Results

Forty-four primary care physicians and nurses completed measures at both time points (7.3% response rate). Goal facilitation and goal conflict improved the prediction of behaviour, accounting for substantial additional variance (5.8% and 8.4%, respectively) in behaviour over and above intention and perceived behavioural control.

Conclusions

Health professionals' provision of physical activity advice in primary care can be predicted by perceptions about how their conflicting and facilitating goal-directed behaviours help and hinder giving advice, over and above theory of planned behaviour constructs. Incorporating features of multiple goal pursuit into the theory of planned behaviour may help to better understand health professional behaviour.