Understanding the intention-behavior gap: The role of intention strength

Living together-does it help or hinder the pursuit of a healthful diet, physical activity, and weight loss among cancer survivors and their chosen partners?

PURPOSE

Parental or spousal cohabitating relationships are often targeted in behavioral interventions, but the contribution of cohabitation is poorly understood. This study explored whether cohabitation status moderated the impact of social cognitive theory constructs on adiposity, diet, and exercise in a dyadic, web-based weight loss intervention among cancer survivors and their chosen partners.

METHODS

The 24-week weight loss intervention was conducted among 56 dyads, comprised of a cancer survivor and their chosen partner (n = 112). Baseline and 6-month data on social cognitive theory constructs (self-efficacy, social support, and perceived barriers), and study outcomes of adiposity (weight and waist circumference), diet (calories and diet quality), and moderate-to-vigorous physical activity (MVPA) were used to perform moderated-mediation analyses among cohabitating (n = 25) versus non-cohabitating (n = 31) dyads.

RESULTS

The intervention was positively associated with dietary social support (path a1: 0.36, 95% CI [0.083, 0.659]) and inversely associated with perceived dietary barriers (path a1: - 10.57, 95% CI [- 19.109, - 3.091]) and perceived exercise barriers (path a1: - 11.29, 95% CI [- 22.098, - 3.500]) among those who did not cohabitate (effects not observed among cohabitating pairs). The intervention's mediating effects through perceived barriers on weight (indirect effect (ab): - 2.21, 95% CI [- 4.794, - 0.548]), waist circumference (ab: - 1.13, 95% CI [- 2.452, - 0.171]), caloric intake (ab: - 5.09 (2.86), 95% CI [- 12.602, - 0.709]), and self-reported MVPA (ab: 0.29 (0.18), 95% CI [0.019, 0.754]) also were stronger among non-cohabitating pairs.

CONCLUSIONS

These findings suggest that social support partners outside the home substantially enhance intervention impact, though relationship quality and gender dynamics warrant further exploration.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04132219.

Behavioral, cognitive and emotional determinants of getting vaccinated for COVID-19 and the mediating role of institutional trust among young adults in Cyprus

BACKGROUND

Vaccination uptake is a complex behavior, influenced by numerous factors. Behavioral science theories are commonly used to explain the psychosocial determinants of an individual's health behavior. This study examined the behavioural, cognitive, and emotional determinants of COVID-19 vaccination intention based on well-established theoretical models: Acceptance and Commitment Therapy (ACT), Capability, Opportunity, Motivation, and Behaviour (COM-B) and the Health Belief Model (HBM). Additionally, it examined the mediating role of institutional trust in the relationship between determinants of these models and vaccination intentions.

METHODS

A cross-sectional study was conducted from January to May 2022, where university students in Cyprus completed an online survey.

RESULTS

A total of 484 university students completed the online survey, with 23.8% reporting being vaccinated with fewer than three vaccination doses and/or no intention to vaccinate further. Hierarchical logistic regression analysis showed that higher scores in institutional trust, perceived severity, motivation, physical and psychological capability were significantly associated with higher odds of intending to vaccinate. Higher psychological flexibility and not being infected with COVID-19 were also associated with higher odds of vaccination intention, but not in the final model when all determinants were included. Additionally, significant indirect effects of psychological and physical capability, motivation and perceived severity on vaccination intention were found to be mediated by institutional trust.

CONCLUSIONS

When tackling COVID-19 vaccination hesitancy, behavioural, cognitive, and emotional aspects should be considered. Stakeholders and policymakers are advised to implement targeted vaccination programs in young people while at the same time building trust and improving their capabilities and motivation towards getting vaccinated.

Low Carbon Sustainable Diet Choices-An Analysis of the Driving Factors behind Plant-Based Egg Purchasing Behavior

In the face of escalating climate change, environmental pollution, and global crises, plant-based eggs are a viable solution for environmental conservation and health promotion. This study uses an integrated framework combining value-belief-norm (VBN) theory and the Theory of Planned Behavior (TPB) to explore the factors influencing Taiwanese consumers' inclination towards plant-based eggs. Through convenience sampling, 417 questionnaires were issued and 387 valid responses were received, indicating a 92.8% valid response rate. The analysis indicates that consumers' biospheric and altruistic values significantly enhance their awareness of outcomes, which, coupled with their sense of responsibility, strengthens personal norms. From the TPB perspective, perceived behavioral control is identified as a critical driver of the intention to purchase plant-based eggs, with attitudes and subjective norms playing significant roles. Subjective norms positively impact personal norms, thereby influencing consumers' behavioral intentions. The findings confirm the integrated model's theoretical and practical validity, and offer valuable insights for businesses. By developing adept marketing strategies that consider market dynamics, this study enhances the effectiveness and value of marketing efforts by boosting consumers' engagement with plant-based eggs. These insights contribute to advancing environmental sustainability goals.

Allowing time for 8+ hours of sleep: identification and validation of important beliefs using the reasoned action approach

Introduction

The present studies advance research using the Reasoned Action Approach to understand sleep behavior. Identification of the modal salient beliefs that individuals hold regarding their sleep habits is necessary to understand the attitudes, perceived normative pressure, and perceived behavioral control (PBC) that individuals hold.

Methods

Belief elicitation (Study 1) and follow-up validation (Study 2) studies of undergraduates at a Midwestern USA university were conducted to identify readily accessible and important beliefs regarding allowing time for 8+ hours of sleep each night.

Results

Important attitude relevant beliefs included positive effects on mood, thinking, health, and productivity. Important normative beliefs were perceived injunctive pressure from family, health professionals, and significant others. Because of the strong influence of PBC on intentions/behavior, most important were control beliefs about the need for good time management.

Discussion

The present studies increased our understanding why many individuals do not allow time to obtain adequate sleep. Identification of the beliefs that distinguish between those who intend to allow time for adequate sleep and those who do not is a necessary step toward the design of effective interventions to improve sleep duration. The results indicate that a focus on increasing time management skills and PBC may be an effective approach for sleep interventions.

Public Willingness to Mask and Vaccinate in the Future: Results From a 2023 Nationally Representative Survey of US Adults

The enduring spread of COVID-19 and other respiratory viruses highlights a need for greater focus on long-term public willingness to perform protective behaviors. Although COVID-19 is no longer considered a public health emergency of international concern, it is unknown whether people in the United States plan to continue protective behaviors to protect themselves and others against infection. To inform planning and communications, we used a nationally representative survey of 1,936 US adults to examine attitudes and intentions toward future vaccination and mask-wearing. A majority believed COVID-19 vaccines were safe (73%) and effective in protecting against serious illness (72%). One-third (33%) had strong intentions to get an updated COVID-19 vaccine most years in the future. Among those with weaker intentions (n=1,287), many cited concerns about safety (71%) and efficacy (64%), lack of trust in institutions (64%), or beliefs that prior vaccination or infection protected them (62%). Approximately two-thirds (69%) of respondents believed masks were effective in protecting the wearer from getting COVID-19, and a majority appeared moderately receptive to future public mask-wearing, particularly when there was proximate risk of infection from COVID-19 (67%) or other respiratory viruses (59%). Men, non-Hispanic White adults, younger adults, rural residents, and adults with higher incomes, without college degrees, and without serious medical conditions or physical limitations were more likely to indicate resistance toward future COVID-19 vaccination and/or mask-wearing. Findings support tailored messaging to address concerns and opportunities among different populations, as well as support for communications programs and community engagement to motivate future uptake.

Associations between parental civic engagement, negative beliefs toward civic engagement and youths' future civic attitudes and behaviors

INTRODUCTION

Civic engagement (CE) in adolescence is associated with a higher level of engagement in adulthood and is reported to be beneficial to youth's development and societal well-being. Parents are among the most influential factors in adolescents' lives. This study examined the associations between parents' own civic participation, their negative beliefs toward youth CE and their child's future CE. While prior research documented positive associations between parental civic behaviors and youth CE, the role of parental negative beliefs has remained unexplored and could act as an additional barrier to adolescents' CE.

METHODS

A total of 234 adolescents (65% girls; mean age = 13.77) and their parents (79% mothers; mean age = 44.20), residing in the Canadian province of Quebec from 2016 to 2019, were recruited for this cross-sectional study. Parents completed measures of their civic activities and their negative beliefs regarding youth CE. Adolescents completed measures of future civic attitudes and behaviors.

RESULTS

Hierarchical regressions revealed significant positive cross-sectional associations between parental civic behaviors and their child's future civic attitudes and behaviors. However, parental negative beliefs toward youth CE were negatively associated with youths' future civic attitudes and behaviors, even after considering parental civic behaviors and family socioeconomic status. Adolescents' age did not moderate these relationships.

CONCLUSION

These findings highlight the significant role that parents could play in shaping CE of future generations. Interventions promoting youth CE should thus target both adolescents and their parents.

The protection motivation theory as an explanatory model for intention to use alcohol protective behavioral strategies related to the manner of drinking among young adults

AIMS

This study aimed to prospectively examine the explanatory value of the protection motivation theory (PMT) for the intention to use manner of drinking protective behavioral strategies (MD PBS) and to explore its invariance across genders.

METHOD

A targeted sampling procedure was used to recruit 339 young adults in the community (Mage = 21.1; SD = 2.21; female = 50.7%) who completed baseline and 2-month follow-up measures of the PMT constructs and intentions to use each of the five MD PBS.

RESULTS

Regression analyses revealed that the coping appraisal components (response efficacy and self-efficacy) had greater explanatory power for the intention to use MD PBS than the threat appraisal components (perceived vulnerability and perceived severity). Perceived vulnerability to alcohol consequences was not prospectively associated with any specific behavioral intention or with the total MD PBS score. In contrast, perceived severity was prospectively associated with the intention to use three out of five PBS and the total MD score. Regression coefficients revealed gender invariance for all six models.

CONCLUSIONS

Our findings suggest that interventions aimed at encouraging young adults to use alcohol MD PBS would be most effective if they included components that enhance self-efficacy in using these strategies and emphasize their perceived usefulness in reducing alcohol-related consequences.

On "intent" in research misconduct

Research misconduct, broadly defined as acts of fabrication, falsification and/or plagiarism, violate the value system of science, cost significant wastage of public resources, and in more extreme cases endanger research participants or members of the society at large. Determination of culpability in research misconduct requires establishment of intent on the part of the respondent or perpetrator. However, "intent" is a state of mind, and its perception is subjective, unequivocal evidence for which would not be as readily established compared to the objective evidence available for the acts themselves. Here, we explore the concept of "intent" in research misconduct, how it is framed in criminological/legal terms, and narrated from a psychological perspective. Based on these, we propose a framework whereby lines of questioning and investigation, as defined by legislative terms and informed by the models and tools of psychology, could help in establishing a preponderance of evidence for culpable intent. Such a framework could be useful in research misconduct adjudications and in delivering sanctions.

Drivers of hospital nurse practitioner turnover: A national sample survey analysis

BACKGROUND

Hospital nurse practitioner (NP) turnover is costly and complex.

PURPOSE

Provide a pre-COVID-19 pandemic baseline of hospital NP turnover.

METHODS

A secondary analysis of NSSRN18 data on 6,558 (67,863 weighted) NPs employed in hospitals on 12/31/2017. We describe rates of turnover, intention to leave, and reasons for leaving or staying. Using multivariate logistic regression, we examine the association between individual and organizational characteristics and turnover. Survey weights and jackknife standard errors were applied to analyses.

DISCUSSION

Approximately 10% of NPs left their job the following year, and 53% of NPs that remained considered leaving at some point. The top reasons cited for leaving or staying were largely organizational factors. Regression analysis revealed not practicing to one's fullest scope, lower income, lack team-based care, and non-white race were associated with an increased likelihood to leave.

CONCLUSION

We find several modifiable factors associated with hospital NP turnover that can be used to tailor recruitment and retention strategies.

Impact of Educational Activity Formats, Online or In-Person, on the Intention of Medical Specialists to Adopt a Clinical Behaviour: A Comparative Study

COVID-19 accelerated continuing professional development (CPD) delivered online. We aimed to compare the impact of in-person versus online CPD courses on medical specialists' behavioural intentions and subsequent behaviour. In this comparative before-and-after study, medical specialists attended in-person courses on nine clinical topics. A second group attended an adapted online version of these courses. Behavioural intention and its psychosocial determinants were measured before and immediately after the courses. Behaviour change was measured six months later. Generalised estimating equation (GEE) models were used to compare the impact of course formats. A total of 82/206 in-person registrants (mean age: 52±10 years; 50% men) and 318/506 on-line registrants (mean age: 49±12 years; men: 63%) participated. Mean intention before in-person courses was 5.99±1.31 and 6.43±0.80 afterwards (average intention gain 0.44, CI: 0.16-0.74; p=0.003); mean intention before online courses was 5.53±1.62 and 5.98±1.40 afterwards (average intention gain of 0.45, CI: 0.30-0.58; p<0.0001). Difference in intention gain between groups was not statistically significant. Behaviour reported six months later was not significantly associated with post-course intention in either group. However, the intention difference increased significantly among those who said they had adopted the targeted behaviour (paired wilcoxon test: n = 40 and p-value=0.002) while it did not increase significantly in the group of those who had not adopted a targeted behaviour (paired wilcoxon test: n = 16 and p-value=0.223). In conclusion, the increase in intention of specialists after CPD courses was similar whether the course was in-person or online. Also, an increase in intention in both groups signalled more likelihood of adoption.

Willingness of Patients With End-Stage Renal Disease to Accept a Kidney Transplant and Related Factors

BACKGROUND

The prevalence of end-stage renal disease (ESRD) in Taiwan is among the highest in the world. Although kidney transplant is the most effective treatment for ESRD, the willingness of patients with ESRD to undergo kidney transplantation is low in Taiwan. The factors associated with willingness to accept kidney transplantation remain unclear, and studies on kidney transplant willingness and associated factors among Taiwanese patients with ESRD are scarce.

PURPOSE

The aim of this study was to assess willingness to undergo a kidney transplant and related factors among patients with ESRD in Taiwan.

METHODS

A cross-sectional design was employed. Two hundred fourteen participants from a single medical center in Taiwan were recruited, and 209 valid questionnaires were collected (valid response rate: 97.7%). The study instruments included a kidney transplant knowledge scale, a kidney transplant attitude scale, and a kidney transplant willingness scale. Data were analyzed using Pearson's product-moment correlations, t tests, one-way analyses of variance, and multiple regressions.

RESULTS

The mean kidney transplant willingness in the sample was 13.23 (out of 20). Being male, younger, married, or employed; having a college education or above; and having a shorter dialysis duration were all associated with higher kidney transplant willingness. Sociodemographics, dialysis duration, knowledge, and attitudes explained 45.4% of the variance in kidney transplant willingness, with two of these, kidney transplant attitudes (β = .61, p < .001) and dialysis duration (β = -.11, p = .041), identified as significant.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings support the important role of cultivating positive attitudes in patients with ESRD to increasing willingness to undergo kidney transplantation interventions.

Exploration of parental consent for adolescent involvement in genital body image education research

Genital body image is a highly understudied concept but is important for sexual health and broader body image satisfaction. Effective genital body image interventions for adolescents have been developed, however, parental consent can be a barrier to adolescent participation. The aim of this study was to conduct a novel exploration of parental consent for genital body image education research and factors related to this consent. Participants were 125 parents of adolescents in Australia who completed an online questionnaire including measures of demographic characteristics, personality traits and attitudes, and likelihood of consent for an adolescent son and daughter participating in hypothetical genital body image education research. The vast majority of parents indicated that they definitely would consent to their adolescent sons' and daughters' involvement in this hypothetical research. There was no significant difference in likelihood of consent based on the gender of the adolescent. Parents having more conservative attitudes towards sex was the only factor tested that reduced the likelihood of providing consent. Overall, our results suggest parents are generally supportive of adolescent involvement in genital body image education research. This concept should be included in broader body image educational programs so adolescents gain exposure to this important but neglected topic.

Perceptions and Bias of Small Business Leaders in Employing People with Different Types of Disabilities

PURPOSE

Despite existing employment-related legislation and governmental programs, people with disabilities continue to face significant barriers to competitive employment. These obstacles are partially due to biases among employers regarding the contributions of people with disabilities and perceptions about accommodation costs, which can affect their hiring decisions. Existing research on employment barriers and facilitators often treats people with disabilities homogenously and focuses mainly on large companies. This study helps to fill these gaps by exploring the motivations and challenges small employers face when hiring people with disabilities and how their attitudes and willingness to hire vary based on disability type.

METHODS

We surveyed business owners and decision-makers at companies with fewer than 100 employees resulting in a sample of 393 company respondents. Through descriptive analyses, we examined variations in respondents' willingness to hire and the prevailing attitudes among the company leaders sampled. We explored how employer attitudes can either hinder or support the hiring of people with disabilities. We conducted multivariate analysis to explore the connections among attitudinal barriers, facilitators, and willingness to hire individuals with various disabilities, reflecting disability's heterogeneous nature.

RESULTS

Our findings reveal that, in terms of hiring people with disabilities, the most important concerns among employers are: inability to discipline, being unfamiliar with how to hire and accommodate, and uncertainty over accommodation costs. These concerns do not differ between employers covered by the Americans with Disabilities Act (ADA) and non-covered employers. However, ADA-coverage may make a difference as ADA-covered employers are more likely to say they would hire an applicant with a disability. We find that for small companies (less than 15 employees), the positive effect of the facilitators (positive perceptions about workers with disabilities) almost completely offsets the negative effect of the barriers. However, for the larger companies, the marginal effect for an additional barrier is significantly more predictive than for an additional facilitator. Among the disabilities we examined, employers are least likely to hire someone with blindness, followed by mental health disabilities, intellectual disabilities, deafness, and physical disabilities, underscoring that employers do not view all types of disabilities as equally desirable at work.

CONCLUSIONS

Understanding small employers' underlying concerns and effectively addressing those factors is crucial for developing effective intervention strategies to encourage small employers to hire and retain people with different disabilities. Our results suggest greater openness among ADA-covered employers to hiring people with disabilities, but the perceived barriers indicate a need for ongoing information on effective intervention strategies to increase disability hiring among all small employers.

Predicting the intention to receive the COVID-19 booster vaccine based on the health belief model

COVID-19 vaccine boosters are recommended because the protection provided by previous doses eventually decreases, posing a threat to immunity. Some people, however, remain hesitant or unwilling to get vaccinated. The present study sought to investigate factors associated with the intention to receive the COVID-19 booster vaccine based on (1) the constructs of the Health Belief Model, and (2) trust in healthcare workers and science. A sample of 165 adults with two doses of the COVID-19 vaccine were recruited using convenience sampling. Data was collected using an online survey from November 2021 to January 2022. The survey included questions about participants' socio-demographic details, health beliefs, trust, history of COVID-19 vaccination, and the intention to receive a third dose of the COVID-19 vaccine. Ordinal logistic regression analysis showed that higher perceived benefits, severity, and trust in healthcare workers, and lower perceived barriers predicted higher willingness to get a third dose of the vaccine whereas perceived susceptibility and trust in science did not. Understanding the factors and health beliefs that underlie vaccine hesitancy are vital when developing effective interventions with the aim of increasing uptake of COVID-19 booster vaccines.

Factors predicting self-care behavior of cardiovascular patients during the COVID-19 epidemic

BACKGROUND

The COVID-19 virus has had wide-ranging effects on all healthcare systems and a direct impact on all areas of human life in all countries around the world. Therefore, it is necessary to take preventive actions to reduce the prevalence and severity of the complications associated with this disease. The purpose of this study was to explain the dimensions of adopting general self-care behaviors (mask-wearing, social distancing, hand hygiene, and home quarantine) for preventing COVID-19 based on the theory of planned behavior (TPB) in cardiovascular patients.

METHODS

This was a descriptive-analytical study conducted with the participation of 420 patients referring to health and treatment centers of Ahvaz, southwest of Iran, in 2022. Sampling was done using a non-random (convenience) method. The data collection tool was a questionnaire containing items addressing demographic characteristics, questions related to the TPB, and questions dealing with the adoption of everyday self-care behaviors against contracting COVID-19. Data were analyzed using descriptive and inferential statistical methods (prevalence, mean, standard deviation, Pearson's correlation coefficient, and linear regression) in SPSS version 25.

RESULTS

The results of this study showed that the rate of adoption of self-care behaviors against COVID-19 among cardiovascular patients was moderate. The results also showed that among the constructs of the TPB, Perceived behavioral control, Subjective norms, and Perceived behavioral intention were the most important predictors of adopting self-care behaviors among cardiovascular patients with a change variance of 46%.

CONCLUSIONS

The results of the present study have implications for health and treatment policy makers as well as planners of educational and behavioral interventions aimed at promoting the adoption of self-care behaviors against COVID-19. In this respect, managing and institutionalizing desirable behaviors among cardiovascular patients could be beneficial from economic, social, and health-related aspects.

Old Habits Die Hard: Regression in Learning and Study Strategies Inventory Scores in PharmD Students

OBJECTIVE

Prior studies have demonstrated that "learning to learn" (L2L) courses can lead to significant improvements in students' Learning and Study Strategies Inventory (LASSI) scores immediately following the course. This study aimed to analyze whether improvements in LASSI scores are sustained 1 year following an L2L elective course.

METHODS

First-year pharmacy students in the classes of 2024 and 2025 completed the LASSI at the start of the fall semester and again immediately following an L2L course. One year later, during the second professional year, students completed the LASSI a third time. Repeated-measures multivariate analysis of variance was used to analyze within-participant differences in LASSI scores across each of the 10 LASSI scales. Univariate analysis of variance with Bonferroni correction was used for pairwise comparison.

RESULTS

A total of 119 students completed all 3 LASSI assessments. LASSI scores improved in all 10 scales following completion of the L2L course. However, 1 year after the completion of the course, there was a statistically significant regression in all 10 scale scores (Wilks' Λ [20,98] = 8.7). Among the 10 scales, scores for the Attitude and Concentration scales were statistically significantly lower during the second professional year relative to baseline at the start of the first professional year. Selecting Main Ideas was the only scale with a higher score during the second professional year relative to baseline.

CONCLUSION

Despite marked improvements in LASSI scores following the implementation of a "learning to learn" course for first-year pharmacy students, the improvements were not sustained after 1 year.

Induction of social contagion for diverse outcomes in structured experiments in isolated villages

Certain people occupy topological positions within social networks that enhance their effectiveness at inducing spillovers. We mapped face-to-face networks among 24,702 people in 176 isolated villages in Honduras and randomly assigned villages to targeting methods, varying the fraction of households receiving a 22-month health education package and the method by which households were chosen (randomly versus using the friendship-nomination algorithm). We assessed 117 diverse knowledge, attitude, and practice outcomes. Friendship-nomination targeting reduced the number of households needed to attain specified levels of village-wide uptake. Knowledge spread more readily than behavior, and spillovers extended to two degrees of separation. Outcomes that were intrinsically easier to adopt also manifested greater spillovers. Network targeting using friendship nomination effectively promotes population-wide improvements in welfare through social contagion.

Menopause as a window of opportunity: the benefits of designing more effective theory-driven behaviour change interventions to promote healthier lifestyle choices at midlife

Menopause is a natural developmental phase that all women go through from their early forties to mid-fifties, marking the transition from the reproductive to the non-reproductive years. This is characterised as the permanent cessation of menses due to progressive ovarian failure. Each woman's experience of the menopause is unique. Biopsychosocial changes occur during this time with some symptoms affecting up to 80 % of women and lasting for 4-5 years from the peri- to post-menopause. Reduced oestrogen may predispose some women to health issues following menopause, such as heart disease, diabetes, stroke and cognitive decline. It is vital to understand how to promote health and well-being to reduce the risk of developing chronic conditions in later life. Increased symptoms and concerns about health during the menopausal transition can be cues to action for some women to actively maintain their health. Menopause represents a window of opportunity to promote health, and to support women to make healthier lifestyle choices, part of the National Institute for Clinical Excellence guidelines for menopause management. Identifying appropriate strategies to change behaviour is less clear. Theories of behaviour change can provide frameworks to gain more insight into the facilitators and barriers to behaviour and can inform the researcher on what needs to change. This information can be used to inform the design, content, implementation and evaluation of a lifestyle intervention. This review paper will explore the impact of menopause on health and well-being generally, and the benefits of designing more effective theory-driven behaviour change interventions for menopause.

Factors influencing the intention to use the ICD-11 among medical record officers (MROs) and assistant medical record officers (AMROs) in Ministry of Health, Malaysia

The transition of ICD has never been a straightforward initiative. As nations transition to ICD-11, ensuring its acceptance among the users is essential. To our knowledge, there are limited studies about the instrument and ICD-11 adoption. Therefore, the purpose of this study was to design an instrument and investigate the factors influencing the intention to use the ICD-11 among medical record officers (MROs) and assistant medical record officers (AMROs) at Ministry of Health (MOH) Malaysia facilities. Based on the current literature, a model based on the decomposed theory of planned behaviour (DTPB) was proposed. The model consisted of 13 dimensions and 12 hypotheses identified from previous studies. Using PLS-SEM, 185 survey data points were analysed. The study findings showed that ten factors have a significant impact on the suggested model. Users' subjective norm was the most influential factor in their intention to use ICD-11. Unexpectedly, perceived usefulness and was found to have no significant influence. This study is important for policymakers in strategising ICD-11 implementation efforts. This study's novelty lies in applying a DTPB theory model in the context of the intention to use ICD-11.

Evidence-based health messages increase intention to cope with loneliness in Germany: a randomized controlled online trial

Loneliness poses a formidable global health challenge in our volatile, post-pandemic world. Prior studies have identified promising interventions to alleviate loneliness, however, little is known about their effectiveness. This study measured the effectiveness of educational entertainment ("edutainment") and/or evidence-based, written health messages in alleviating loneliness and increasing intention to cope with loneliness. We recruited 1639 German participants, aged 18 years or older. We compared three intervention groups who received: (A) edutainment and written health messages, (B) only edutainment, or (C) only written health messages, against (D) a control group that received nothing. The primary outcomes were loneliness and intention to cope with loneliness. Participants were also invited to leave comments about the interventions or about their perception or experiences with loneliness. We found a small (d = 0.254) but significant effect of the written messages on increased intention to cope with loneliness (b = 1.78, t(1602) = 2.91, P = 0.004), while a combination of edutainment and written messages significantly decreased loneliness scores (b = -0.25, t(1602) = -2.06, P = 0.04) when compared with the control, even after adjusting for covariables including baseline values, self-esteem, self-efficacy, and hope. We also observed significantly higher self-esteem scores after exposure to a combination of edutainment and written messages (b = 0.821, t(1609) = 1.76, one-tailed P = 0.039) and significantly higher hope scores after exposure to edutainment-only (b = 0.986, t(1609) = 1.85, one-tailed P = 0.032) when compared with the control group. Our study highlights the benefits of using written messages for increasing intention to cope with loneliness and a combination of edutainment and written messages for easing loneliness. Even in small "doses" (less than 6 min of exposure), edutainment can nurture hope, and edutainment combined with written messages can boost self-esteem.

The mediating role of pro-environmental attitude and intention on the translation from climate change health risk perception to pro-environmental behavior

Climate change is a serious environmental issue appearing in China. As a public service institution operating around the clock, the negative impact of hospitals on the environment is evident, promoting their workers' pro-environmental behavior (PEB) through increasing climate change health risk perception (CHRP) is an effective method to protect the environment and achieve sustainable development. This study investigates how CHRP shapes pro-environmental attitude (PEA), pro-environmental intention (PEI), and pro-environmental behavior (PEB) among hospital workers. Using structural equation modeling (SEM) to determine the chain of causation from CHRP to PEB among hospital workers. The result shows that CHRP positively affects PEA and PEI, and PEI positively affects their PEB. In addition, although CHRP has no significant direct effect on PEB, it can play a crucial indirect effect through the mediating role of PEI. Moreover, the result of multiple regression shows that there are significant differences regarding PEA, PEI, and PEB.

Retention in Junior Giants, a sport-based youth development program: what factors are associated with intentions to return?

Introduction

While evaluation research shows that physical activity-based youth development (PA-PYD) programs can have a positive impact on social and emotional growth, less is known about which participants return year after year and what factors are associated with their continued participation. The Junior Giants is a sport-based youth development program for 5-18-year-old boys and girls that is non-competitive and free to participate. The 8-week program uses baseball and softball as platforms for teaching life skills and fostering social emotional competencies. This mixed-methods study evaluated quantitative factors associated with intentions to return to the program the following year and qualitative reasons why parents/caregivers intended not to re-enroll their child.

Method

Parents/caregivers of Junior Giants participants (N = 8,495) completed online surveys about their child's demographics, social emotional climate and learning, character development, and intentions to return the following year.

Results

Descriptive data illustrated that parents/caregivers reported quite positive outcomes and experiences for their child. Chi-square and t-test analyses revealed significant differences (p < .001) between intended returners (n = 7,179, 84.5%) and those who reported no/undecided on returning (n = 1,316, 15.5%). Intended returners were significantly more likely to be identified as Latino and be in their second year of participation. Significant predictors of a binomial logistic regression [χ2 (df = 22) = 1,463.25, p < .001] included age, race/ethnicity, years played, character development, reading, league experiences, physical activity, and perceived support, with small to medium effect sizes. Using responses from a subset of 217 parents/caregivers who reported their child would not return to the program, a thematic analysis resulted in seven themes: Lack of Organization and Communication; Dissatisfied with Coaching, Didn't Learn Baseball/Softball, Not Competitive Enough, Skill Levels Not Matched, Aged Out, and Non-Program Related Reasons.

Discussion

Quantitative results contribute to the literature on predictors of retention in youth development programs, while qualitative findings echo common motives cited for dropout in youth sport. Both provide opportunities for reflection and potential changes to future programming.

Influence of Disease-Related Stigma on Patients' Decisions to Upload Medical Reports to the German Electronic Health Record: Randomized Controlled Trial

BACKGROUND

The rollout of the electronic health record (EHR) represents a central component of the digital transformation of the German health care system. Although the EHR promises more effective, safer, and faster treatment of patients from a systems perspective, the successful implementation of the EHR largely depends on the patient. In a recent survey, 3 out of 4 Germans stated that they intend to use the EHR, whereas other studies show that the intention to use a technology is not a reliable and sufficient predictor of actual use.

OBJECTIVE

Controlling for patients' intention to use the EHR, we investigated whether disease-specific risk perceptions related to the time course of the disease and disease-related stigma explain the additional variance in patients' decisions to upload medical reports to the EHR.

METHODS

In an online user study, 241 German participants were asked to interact with a randomly assigned medical report that varied systematically in terms of disease-related stigma (high vs low) and disease time course (acute vs chronic) and to decide whether to upload it to the EHR.

RESULTS

Disease-related stigma (odds ratio 0.154, P<.001) offset the generally positive relationship between intention to use and the upload decision (odds ratio 2.628, P<.001), whereas the disease time course showed no effect.

CONCLUSIONS

Even if patients generally intend to use the EHR, risk perceptions such as those related to diseases associated with social stigma may deter people from uploading related medical reports to the EHR. To ensure the reliable use of this key technology in a digitalized health care system, transparent and easy-to-comprehend information about the safety standards of the EHR are warranted across the board, even for populations that are generally in favor of using the EHR.

Influencing factors of health screening among retirees: an extended TPB approach

Background

Health screenings are promoted worldwide as they help detect and prevent overall health issues. Despite expanding coverage, the participation rate among the retired population has not significantly increased. Given the special role of health screenings in promoting health and healthy aging, understanding the behavioral intentions, and influencing factors of retirees' voluntary participation in health screenings is crucial. This study aims to explore the participation intentions in health screenings among the Chinese retired population by integrating the Theory of Planned Behavior (TPB) and Self-Efficacy (SE).

Methods

This study used a cross-sectional design to conduct an online questionnaire among 311 retirees in 2023. The questionnaire, tailored for the Chinese retired population, combines the TPB theory and Self-Efficacy theory, including demographic structure, the basic structure of TPB, and SE.

Results

A Structural Equation Modeling (SEM) approach was used to identify factors related to health screening behaviors. Of the respondents, 311 completed the survey (88.9% response rate). The most crucial determinant of health examination behavior was behavioral intention, with a correlation score of (1.524, p < 0.001). Significant correlates of behavioral intention included Subjective Norms (SN) and Self-Efficacy (SE), followed by Perceived Behavioral Control (PBC) and Attitude (AT), with correlation scores of (0.401, p < 0.001), (0.339, p < 0.001), (0.082, p < 0.001), and (0.060, p < 0.05), respectively.

Conclusion

This study provides insights for enhancing the willingness and behavior of retirees to participate in health screenings.

Should we stop referring to the pandemic of antimicrobial resistance as silent?

Background

Referring to the ongoing antimicrobial resistance crisis as a 'silent' pandemic has gained popularity, but there are mixed views on whether such a phrase should be used in public health communication. Some researchers have argued that using the term 'silent pandemic' may lower the perceived threat and hinder mobilization efforts to tackle the problem.

Objectives

I investigated the impact of the phrase 'silent pandemic' on perceived threat levels and mobilization intentions.

Methods

In three experiments (n = 1677), participants from the UK's general adult population were randomly allocated to either a 'pandemic' or 'silent pandemic' condition, where the different terms were embedded in statements (Experiment 1) or brief information materials (Experiments 2 and 3). The term 'silent pandemic' was also presented with a brief description of its intended meaning (Experiment 3). The participants expressed their perception of the threat and their mobilization intentions.

Results

In Experiments 1 and 2, referring to the pandemic as silent did not significantly affect the perceived threat (Cohen's d = -0.06; Cohen's d = 0.08, respectively) or mobilization intentions (Cohen's d = -0.07; Cohen's d = 0.11, respectively). However, in Experiment 3, the term 'silent pandemic' decreased the perceived threat and mobilization intentions (Cohen's d = 0.27; Cohen's d = 0.35, respectively).

Conclusions

Describing the pandemic as 'silent' yielded no measurable effects on perceived threat and mobilization intentions but it showed depreciating effects when accompanied by its intended meaning. Taken together, it is advisable to avoid the term.

Does Intention Strength Moderate the Intention-Health Behavior Relationship for Covid-19 Protection Behaviors?

BACKGROUND AND PURPOSE

The present research tests whether intention strength moderates intention-health behavior relations and the extent to which this is accounted for by the moderating effects of intention stability, goal priority, and goal conflict.

METHODS

In a prospective multi-behavior study, a representative sample of UK adults (N = 503) completed measures of past behavior, intention, intention strength, goal priority, and goal conflict in relation to eight Covid-19 protection behaviors at time 1. Intention and self-reported behavior were assessed at time 2 (2 months later). Intention stability was assessed over 2 months.

RESULTS

Intention strength was a significant moderator of the intention-behavior relationship (controlling for past behavior). Controlling for the moderating effects of intention stability attenuated the moderating effect of intention strength, while also controlling for the moderating effects of goal priority and goal conflict reduced the moderating effects of intention strength to nonsignificance.

CONCLUSIONS

The present findings indicate that intention strength is a significant moderator of the intention-health behavior relationship. They also suggest that the moderating effect of intention strength is explained by effects on intention stability, goal priority, and goal conflict. Tests of interventions to manipulate intention strength as a means to strengthen intention stability and intention-behavior relations are warranted.

The theory of planned behavior and alcohol protective behavioral strategies: a prospective study examining the role of habit and gender invariance

OBJECTIVES

Alcohol Protective Behavioral Strategies (PBS) have consistently shown to be effective in reducing alcohol use and its associated consequences. We aimed to examine the explanatory value of the Theory of Planned Behavior (TPB) for using five PBS, studying the role of habit, and its potential variation across genders.

METHODS

Targeted sampling was used to recruit 339 young adults in the community (women = 50.7%; mean age = 2.21[SD = 2.21]), who completed baseline and 2-month follow-up questionnaires.

RESULTS

The explained variance of the TPB ranged from 58-68% for intention to use PBS, and 18-50% for behavior. The inclusion of habit produced increases of 17-26% in explained variance in intention, while explained variance in behavior remained similar. Habit was the strongest predictor of intention to use PBS, followed by attitude. Except for one behavior (drinking slowly), habits did not moderate the intention-behavior relationship, and the explanatory value of the TPB did not differ across genders.

CONCLUSIONS

Our findings support the utility of the TPB as an explanatory model of alcohol PBS, along with the need to include habits within the framework of dual-process models. Interventions aimed at promoting alcohol PBS could be optimized by targeting attitudes towards PBS and habits.

Is the practice of autonomy support the missing element in teacher training at university? A study on the effects of an intervention based on self-determination theory on biology preservice teachers' knowledge, beliefs, and intentions

Teacher education at universities often lacks practice although preservice teachers should be equipped with effective teaching methods. We conducted an intervention to convey and practice autonomy-supportive teaching behavior (ASTB) with 63 preservice teachers. The first control group (n = 76) did not receive any information on ASTB. A second control group (n = 54) had their regular seminar on ASTB without practicing what they had learned. Significant differences in the participants’ (Mage = 24.18 ± 3.26 years; Msemester = 7.61 ± 1.84; 63% female) knowledge, beliefs, and intentions were found. Participants of the intervention had higher theoretical and practical knowledge regarding ASTB and a higher level of perception that ASTB is easy to implement than a seminar without information on ASTB (first control group) and the regular seminar (second control group). That is, their knowledge acquisition and their belief about the ease of implementation were positively affected by the intervention in comparison to both control groups. Although no significant differences were found, preservice teachers in the intervention group also showed the highest level of agreement with the belief about the effectiveness of ASTB and the most pronounced intention to implement ASTB. The results of our study show that the developed intervention based on self-determination theory had a positive impact on preservice teachers’ knowledge and beliefs about ASTB as well as their intention to apply it in the future. Since teacher education at university often lacks practice, the development of such effective theory- and practice-based interventions for preservice teachers is especially important. The practical skills acquired in our study are of particular importance for one central challenge teachers face in their profession: the need to counteract the decreasing trend of student motivation during secondary schooling.

Predictive factors of ergonomic behaviors based on social cognitive theory among women workers on assembly lines: application of Bayesian networks

BACKGROUND

This study focuses on identifying the key factors associated with ergonomic behaviors (ERBE) among women workers on assembly lines (WwAL) to prevent musculoskeletal disorders (MSDs) caused by repetitive motions and unfavorable body postures. To achieve this objective, this study employed Bayesian networks (BN) analysis based on social cognitive theory (SCT).

METHODS

A cross-sectional study was conducted to examine the predictive factors of ERBE among 250 WwAL from six different industries located in Neyshabur, a city in northeastern Iran. The study used a two-stage cluster sampling method for participant selection and self-report questionnaires to collect data on demographic characteristics, variables associated with SCT, ERBE, and the standard Nordic questionnaire. The collected data were analyzed using Netica and SPSS version 21, which involved statistical analyses such as independent t-tests, Pearson correlation, and ANOVA tests at a significance level of p < 0.05. BN analysis was conducted to identify the important factors that impact ERBE.

RESULTS

The majority of individuals reported experiencing chronic pain in their back, neck, and shoulder areas. Engaging in physical activity, consuming dairy products, and attaining a higher level of education were found to be significantly associated with the adoption of ERBE p < 0.05. Among the various SCT constructs, observational learning, intention, and social support demonstrated the highest levels of sensitivity towards ERBE, with scores of 4.08, 3.82, and 3.57, respectively. However, it is worth noting that all SCT constructs exhibited a certain degree of sensitivity towards ERBE.

CONCLUSIONS

The research findings demonstrate that all constructs within SCT are effective in identifying factors associated with ERBE among WwAL. The study also highlights the importance of considering education levels and variables related to healthy lifestyles when promoting ERBE in this specific population.

The influence of health literacy and knowledge about smoking hazards on the intention to quit smoking and its intensity: an empirical study based on the data of China's health literacy investigation

OBJECTIVE

This study explored the relationship between smokers' health literacy, knowledge of smoking hazards, and their intention to quit.

METHODS

Based on data from the 2019 Health Literacy and Tobacco Use Surveillance among residents of a city in Zhejiang Province, 1120 male smokers were screened. Differential tests were used to analyze whether smokers with varying levels of health literacy and knowledge about smoking hazards differed in their intention to quit smoking and the intensity of their intention. A multi-factor logistic regression model was constructed to explore the extent of these differences.

RESULTS

Only 24.8% of smokers had higher health literacy. Among smokers, those with an intention to quit had a higher health literacy level compared to those without such intention (32.7% vs. 17.0%, p < 0.001). Health literacy levels did not differ significantly between groups with different intensity of intention to quit (34.2% vs. 31.9% vs. 30.1%, p = 0.435). About 48.7% of the smokers a higher level of knowledge about smoking hazards. It was more prevalent in the intent to quit group compared to the no intent to quit group (54.0% vs. 43.4%, p < 0.001), and the low intent to quit group had lower knowledge compared to the moderate and high intent to quit groups (49.1% vs. 56.6% vs. 63.4%, p = 0.011). After adjusting for other influences, smokers with lower health literacy were less likely to have intention to quit (OR = 0.659, p = 0.016). And the association between knowledge about smoking hazards and whether smokers have the intention to quit is no longer significant, but it significantly affects the intensity of the intention to quit among smokers who already have the intention (OR = 0.623, p = 0.005).

CONCLUSION

General health literacy may play a role in facilitating smokers' progression from the stage of no intent to quit to one of intent to quit, but a more specific understanding of the harms of smoking may be needed to increase the strength of intent to quit.

Understanding the Sociocognitive Determinants Underlying Intentions to Exercise for Postconcussion Symptom Relief: An Application of the Theory of Planned Behavior

CONTEXT

This study investigated individual sociocognitive factors from the theory of planned behavior and their relationship to exercise for postconcussion recovery.

DESIGN AND METHODS

Four hundred and fifty-nine Australian adults, two-thirds of whom had no concussion history (66%), completed an online survey of their beliefs and attitudes toward exercise for postconcussion recovery. Secondary questions evaluated program design features that could affect engagement (eg, session frequency).

RESULTS

Structured equation modeling found that subjective norms were the strongest significant predictor of intention to participate in exercise for postconcussion recovery. Perceived behavioral control was also a significant predictor of intention to participate but to a lesser extent. Attitude did not predict participation intention. The design features identified as key were personalization and being supervised during the program.

CONCLUSIONS

This study found that people's intention to participate in a program of exercise postconcussion recovery is shaped by individual psychological factors and identified program design features that could be adjusted for increased engagement. Program success could be maximized through strategies such as supporting individuals to have a stronger sense of control over their participation through the choice of session timing or frequency and harnessing the influence of significant others via supportive messaging from key professionals.

Evaluating the impact of continuing professional development courses on physician behavioral intention: a pre-post study with follow-up at six months

BACKGROUND

Continuing professional development (CPD) for health professionals includes educational activities to maintain or improve skills. We evaluated the impact of a series of CPD courses by identifying factors influencing physicians' intention to adopt targeted behaviors and assessing self-reported behavior adoption six months later.

METHODS

In this pre-post study, eligible participants attended at least one in-person course at the Fédération des Médecins Spécialistes du Québec annual meeting in November 2019. Before and afterwards, participants completed CPD-REACTION, a validated questionnaire based on Godin's integrated model for health professional behavior change that measures intention and psychosocial factors influencing intention. We used Wilcoxon signed-rank test to compare pre- and post-course intention scores and linear regression analyses to identify factors influencing intention. We also compared the post-course intention scores of participants reporting a behavior change six months later with the scores of those reporting no behavior change six months later. Qualitative data was collected only six months after courses and responses to open-ended questions were analyzed using the Theoretical Domains Framework.

RESULTS

A total of 205/329 course attendees completed CPD-REACTION (response rate 62.3%). Among these participants, 158/329 (48%) completed the questionnaire before CPD courses, 129/329 (39.2%) only after courses and 47/329 (14.3%) at 6 months. Study population included 192 physicians of whom 78/192(40.6%) were female; 59/192(30.7%) were between 50 and 59 years old; and 72/192 (37.5%) were surgical specialist physicians. Mean intention scores before (n = 158) and after (n = 129) courses were 5.74(SD = 1.52) and 6.35(SD = 0.93) respectively. Differences in mean (DM) intention before and afterwards ranged from - 0.31(p = 0.17) to 2.25(p = 0.50). Multivariate analysis showed that beliefs about capabilities (β = 0.15, p = 0.001), moral norm (β = 0.75, p < 0.0001), and beliefs about consequences (β = 0.11, p = 0.04) influenced post-course intention. Post-course intention was correlated with behavior six months later (DM = 0.63; p = 0.02). Qualitative analysis showed that facilitators to behavior adoption after six months were most often related to the TDF domains of beliefs about capabilities. Most frequent barriers to adoption related to lack of resources.

CONCLUSIONS

Overall, scores for intention to adopt targeted behaviors increased after the courses. CPD providers could increase participants' intention by including interventions that emphasize beliefs about capabilities, moral norm and beliefs about consequences.

Changes in Confidence, Feelings, and Perceived Necessity Concerning COVID-19 Booster

The COVID-19 booster first became available to all adults in the U.S. in November 2021 and a bivalent version in September 2022, but a large population remains booster-hesitant; only 17% of Americans have obtained the updated vaccine as of June 2023. We conducted two cross-sectional surveys in 2021 and 2022 (n = 1889 and 1319) to determine whether changes in booster-related feelings or perceptions had occurred and whether they altered vaccination rates over time. We found that both positive and negative emotions had grown stronger between the two years, with the prevalence of annoyance increasing the most (21.5% to 39.7%). The impact of trust on booster intention more than doubled (OR = 7.46 to 16.04). Although perceived risk of infection decreased, more participants in 2022 indicated uncertainty or unwillingness to obtain a new booster than in 2021, while the proportion refusing a booster remained constant at 22.5%. Confidence in the COVID-19 vaccine and feelings of hope from the booster motivated acceptance; both were stronger predictors of booster receptivity than prior vaccination history. Our findings signal a need to rebuild trust by informing people of their continued risk and appealing to positive, especially optimistic emotions to encourage booster uptake. Future research should explore longitudinal trends in behavior and feelings toward new booster doses and the impact of prolonged vaccine hesitancy on infection rates.

How Do We Learn About Error? A Cross-Sectional Study of Urology Trainees

OBJECTIVE

This qualitative descriptive study aims to explore trainees' experiences of error disclosure (ED) during their surgical postgraduate training and the factors influencing the intention-behavior gap for ED.

DESIGN

This study employs an interpretivist methodology and a qualitative descriptive research strategy. Data were collected using focus group interviews. Data coding was performed by the principal investigator using Braun and Clarke's reflexive thematic analysis. Themes were developed from the data in a deductive manner. Analysis was carried out using NVivo 12.6.1.

SETTING

All participants were at various stages of an 8-year specialist program under the auspices of the Royal College of Surgeons in Ireland. The training program involves clinical work in a teaching hospital under the supervision of senior doctors in their specialist field. Trainees attend mandatory communication skills training days throughout the program.

PARTICIPANTS

Study participants were recruited using purposive sampling from a sampling frame of 25 urology trainees on a national training scheme. Eleven trainees participated in the study.

RESULTS

Participants' stage of training ranged from first to final year. Seven key themes emerged from the data relating to the trainees' experiences of error disclosure and the intention-behavior gap for ED. These themes include observed positive and negative practice in the workplace, impact of stage of training, importance of interpersonal interactions, perceived blame/responsibility for multifactorial error or recognized complication, lack of formal training in ED, cultural aspects of the training environment and medicolegal issues around ED.

CONCLUSIONS

While trainees recognize the importance of ED, personal psychological factors, negative environmental culture, and medicolegal concerns are significant barriers to the practice of ED. A training environment that focuses on role-modelling and experiential learning with adequate time for reflection and debriefing is paramount. Areas for further research include broadening the scope of this study of ED across different medical and surgical subspecialties.