Explaining the experience of breastfeeding in women with gestational diabetes and designing and implementing an educational program based on planned behavior theory: a combined exploratory study protocol

BACKGROUND

Gestational diabetes is a type of carbohydrate intolerance that is diagnosed for the first time during pregnancy. Researches have shown that gestational diabetes is associated with many negative prenatal and birth outcomes. Because of the complications such as infant death, several diabetics' mothers plan to stop breastfeeding. Research findings indicate a decrease in breastfeeding in mothers with gestational diabetes/ or contradictory tissues regarding the factors affecting the breastfeeding behavior of mothers with gestational diabetes and a special program to promote breastfeeding for these mothers based on the social and cultural conditions of Iranian society. The present study aims to design an interventional program with a mixed qualitative study based on the theory of planned behavior (PBT) to prevent the decrease of breastfeeding in diabetic mothers.

METHODS/DESIGN

A mixed methods exploratory design will be used to conduct this study in 3 phases. The first phase (qualitative): The purpose of the first phase is to understand the experience of breastfeeding mothers who had gestational diabetes, which will be done using the directed content analysis method. The purposive sampling will be used on pregnant mothers with gestational diabetes 30-34 weeks and mothers with infants (up to 6 months) with a history of gestational diabetes. The second phase include designing and implementing an educational program based on the PBT: Education will be conducted based on the needs assessment of the qualitative phase, the opinions of the focus group, and the literature review, then the breastfeeding behavior will be measured using the survey tool of "breastfeeding drop". The third phase: Interventional quantitative phase: The sample size will be carried out by a pilot study, then a designed program as an educational intervention for teaching breastfeeding behavior based on the PBT for 30-34 weeks pregnant mothers with gestational diabetes will be implemented during 3-4 sessions and breastfeeding behavior will be evaluated after delivery.

DISCUSSION

This is the first mixed-method study in Iran that led to implement an interventional program based on the theory of planned behavior. Because of the complications such as infant death, several diabetics' mothers plan to stop breastfeeding. We hope that the result of this research will be a step in solving breastfeeding problems in mothers with gestational diabetes.

Effects of the theory of planned behavior and nudge strategy-based intervention on the adherence to anticoagulation treatment in patients with non-valvular atrial fibrillation

BACKGROUND

Non-valvular atrial fibrillation is associated with the incidence of thromboembolism. Current guidelines recommend preferential use of novel oral anticoagulants(NOAC) in patients with nonvalvular atrial fibrillation. Oral anticoagulation medication adherence rate was relatively low among discharged patients with non-valvular atrial fibrillation.

AIM

To investigate the effects of the anticoagulation programs based on the theory of planned behavior and nudge strategy among patients with non-valvular atrial fibrillation.

METHODS

130 patients with non-valvular atrial fibrillation were randomized to the intervention group or control group, 72 patients in the intervention group, and 58 patients in the control group with a 6-month follow-up. Medication adherence,intention,attitude, perceived behavioral control and subjective norm and quality of life were assessed.

RESULTS

There were significantly differences in the attitude and subjective norm between the two groups at one month,three months and six months follow-up(P <0.01).There were significantly differences in the perceived behavioral control between the two groups at six months follow-up(P <0.01).There were significantly differences in the intention scale between the two groups at three months follow-up(P <0.01). The medication adherence scale score was higher in the intervention group than in the control group at six months follow-up.However, there were no differences in quality of life between the two groups at six months follow-up.

CONCLUSIONS

The program based on the theory of planned behavior and nudge strategy can improve medication adherence in patients with non-valvular atrial fibrillation.

Understanding self-protective behaviors during COVID-19 Pandemic: Integrating the theory of planned behavior and O-S-O-R model

Adopting health preventive actions is one of the most effective ways to combat the COVID-19 pandemic. Based on the theory of planned behavior and the orientation-stimulus-orientation-response model, this study investigated the mechanisms by which health information exposure influenced individuals to adopt self-protective behaviors in the context of infectious disease. In this research, a convenience sampling was used and 2265 valid samples (Male = 843, 68.9% of participants aged range from 18 to 24) were collected in China. Structural equation modeling analysis was performed, and the analysis showed that health consciousness positively influenced the subsequent variables through interpersonal discussions and social media exposure to COVID-19-related information. The interaction between interpersonal discussion and social media exposure was found to be positively associated with the elements of the theory of planned behavior and risk perception. The findings also revealed that self-protective behavior was positively predicted by the components of the theory of planned behavior and risk perceptions, with subjective norms serving as the main predictor, followed by attitudes and self-efficacy.

Factors associated with patient delay for older adults with benign prostatic hyperplasia: A descriptive qualitative study

Based on the theory of planned behavior, the aim of this study was to describe the influencing factors of patient delay intentions and behaviors in benign prostatic hyperplasia (BPH) patients and to provide a reference for the development of a patient delay intention scale. This study was carried out over 4 months in 2021 in Daqing, Heilongjiang, China. The participants were 20 patients with BPH who were aged 60 to 82 years and experienced patient delay; participants were selected through a purposive sampling method. The data were collected via face-to-face semistructured interviews. Five main themes emerged from the interviews, including an insufficient understanding of symptoms, experiences of coping instead of seeking health care, negative attitudes toward care-seeking, the influence of others on decision-making for care-seeking, and obstacles to seeking health care. In conclusion, the patient delay intentions and behaviors of BPH patients are the result of a combination of many factors.

Psychological distress and smoking behaviors of Chinese college students: mediating effects of the dimensions of learning burnout

Objectives

Smokers or never smokers exposed to environmental tobacco use are usually associated with various diseases and cancers. In order to better help college students prevent the tobacco use and thus lower the incidence of avoidable diseases, this study explored the predictive power of different variables including demographic and psychological variables in relation to smoking behaviors.

Methods

Maslach Burnout Inventory-Student Survey and Kessler Psychological Distress Scale (K10) were used in this study.

Results

There were 1449 college students participating in the study with 1340 pieces of valid data left, the effective ratio was 92.48%. The valid data included 37.1% male and 62.9% female aged 18.83 on average with 1.55 standard deviation. The multivariate logistic regression indicated that college students who were male (versus female, OR = 9.55), majoring in medicine and sports (versus nursing, OR_medicine = 2.19, OR_sports = 2.81), born in the non-singleton family (versus singleton family, OR = 0.63) with higher family income (versus lower family income, OR = 0.45), surrounded with smoking friends (versus without smoking friends, OR = 0.18), were more vulnerable to smoke. In addition, combined with the theory of planned behavior, the dimensions of learning burnout had full mediation effects between psychological distress and smoking behavior.

Conclusions

Psychological distress can only indirectly affect smoking behavior via learning efficacy, cynicism and emotional exhaustion. Adjustments from different dimensions of learning burnout such as avoiding cynicism about learning, enhancing learning efficacy and emotion exhaustion will help college students better prevent the tobacco use.

How to effectively promote interprofessional collaboration? - a qualitative study on physicians' and pharmacists' perspectives driven by the theory of planned behavior

BACKGROUND

Ajzen's theory of planned behavior (TPB) postulates that individuals' behavioral intention is influenced by their attitudes, subjective norms, and perceived behavioral control. Therefore, it can be used to broaden the understanding of particular behaviors, including healthcare workers' professional activities.

METHODS

In this study, we used TPB as a theoretical framework to evaluate semi-structured interviews with pharmacists and physicians to build an understanding of the interprofessional collaboration between them. Sixteen semi-structured interviews were conducted with pharmacists and eleven with physicians. The sample of participants comprised a diverse group with varying work experience and workplaces. Data were analyzed independently by two researchers following the thematic analysis method using ATLAS.ti software. Data saturation was set in the absence of new issues arising during the interviews.

RESULTS

The content analysis allowed for the determination of six main themes: the relationship between previous experiences and attitudes towards collaboration, pharmacist's role in collaboration, mutual reluctance toward collaboration, the role of decision- and policy-makers, knowledge and qualifications gaps regarding collaboration, and lack of organizational paths.

CONCLUSIONS

Despite both physicians and pharmacists displaying positive attitudes towards collaboration may foster their intention to establish a professional partnership, subjective norms (e.g., the lack of appropriate legal regulations) and perceived behavioral control (physicians' lack of awareness about pharmacists' qualifications and the low level of interpersonal skills) might impede the process.

Evaluating the effect of an educational program on increasing cervical cancer screening behavior among women in Fasa, Iran

Background

Cervical cancer is the second most common cancer and the fifth deadliest cancer among women in Iran. Educational interventions based on the proper behavior promoting models can lead to early diagnosis of cervical cancer.This study aimed to investigate the effects of educational intervention on performing Pap smear tests based on the Theory of Planned Behavior among women living in Fasa, Iran.

Methods

A cross-sectional study was conducted on 700 participants. Thereafter, the educational intervention based on the results of cross-sectional study was conducted in a workshop form for 50 women as the intervention group and 50 women as the control group. Afterward, the data were entered into the SPSS statistical software and then analyzed via logistic regressions analysis, paired t test, independent t test, chi-square test, and McNemar test.

Result

According to the results, 45.7% of the patients had a history of performing a Pap smear test, and 20.7% of them regularly performed this test. The knowledge, attitude, subjective norms, and perceived behavioral control were the predictors of intention and behavior of Pap smear test among the women (P < 0.05). These components accounted for 57.4% and 31.6% of the intention and behavior variances, respectively. After the intervention, a significant increase was observed in the means of attitude, subjective norms, and perceived behavioral control in the intervention group compared to the control group. The results reveal no significant difference between these two groups regarding the behavioral intention (p = 0.41) and performance of the Pap smear test (p = 0.583). The number of the participants undergone the Pap smear test has increased from 10 to 26 in the intervention group by passing 3 months from the intervention. The results of McNemar test indicated that this difference was statistically significant.

Conclusion

The results indicated an increase in the women’s performance of the Pap smear screening test by appropriate planning, provision of educational packages based on the women’s needs, and using effective subjective norms.

Trial Registration: Current Controlled Trials IRCT20160830029608N3:12/31/2018. “Retrospectively registered”.

The impact of behavioral reference on tourists' responsible environmental behaviors

Human behavior is affected not only by individuals' own psychological factors but also by the surrounding environment and the behaviors of others. Existing studies on tourists' responsible environmental behaviors tend to focus only on tourists' own psychological and environmental factors while ignoring the referential role of other people's behavior. The behavioral reference of others in tourist destinations is an important situational factor that affects tourists' responsible environmental behaviors and has important research value. Based on the theory of planned behavior and taking the Zhongshan Mausoleum Scenic Area as an example, this paper explores the influence of other people's behavioral reference on tourists' responsible environmental behaviors by using the multi-group analysis method of structural equation modelling. The results show the following: (1) Tourists' attitudes toward environmental behavior and subjective norms have a significant positive impact on their responsible environmental behavioral intention, perceived behavioral control has a significant positive impact on their responsible environmental behavioral intention and their responsible environmental behaviors, and responsible environmental behavioral intention has a significant positive impact on responsible environmental behaviors. (2) Tourist destination behavioral reference plays a positive regulatory role in the relationship between tourists' responsible environmental behavioral intention and responsible environmental behaviors. Accordingly, this paper proposes relevant countermeasures and suggestions for the high-quality management and development of tourist destinations.

What influences tourists' intention to participate in the Zero Litter Initiative in mountainous tourism areas: A case study of Huangshan National Park, China

The Zero Litter Initiative (ZLI) of bringing self-generated litter down the mountain is a new attempt to reduce tourism litter generation on climbing trails in China. The extended theory of planned behavior (TPB) was used to analyze the influencing factors of tourists' environmentally responsible behavioral intention to participate in the ZLI, including three additional explaining variables of personal norms (moral obligation to do ZLI), past behavior, and incentive measures, as well as three control variables of gender, age, and educational level. A total of 372 valid questionnaires were collected from tourists in Huangshan National Park. The results of the hierarchical regression analysis showed that: (1) the extended TPB model had stronger predictive power than the original TPB model; (2) tourists' intention to participate in the ZLI was significantly and positively influenced by their attitude toward the behavior (positive or negative opinions), subjective norms (perceived social pressures from referents), perceived behavioral control (perceived ease or difficulty), past behavior, and the strongest predictor of personal norms; (3) incentive measures mainly referred to economic incentives (e.g., lower ticket prices) and non-economic incentives (e.g., a gift and honorary title), which had no significant influences on tourists' intention, and there may be a "crowding-out effect" on intrinsic motivations for collective action in public space; (4) gender had significant influences on tourists' intention, which showed females had stronger participation intention than males. Age had significant and positive influences on tourists' intention, which indicated older tourists were more willing to participate in the ZLI than younger tourists. However, the educational level had significant and negative influences on tourists' intention. Lastly, the study presented practical suggestions for enhancing tourism litter management and achieving sustainable development in mountainous tourism areas.

Factors influencing tourists' litter management behavior in mountainous tourism areas in China

Bringing self-generated litter down the mountain is an emerging pro-environmental behavior to solve the problem of trail's litter management in China. This study is the first attempt to explore a theoretical explanation model that explicates tourists' complex intention-forming process for engaging in it. The study extended the Theory of Planned Behavior model, including three additional explaining variables (environmental theory knowledge, environmental practice knowledge, and incentive measures), as well as a moderator of travel companions between subjective norm and the behavioral intention. The data were collected in questionnaire survey samples of 372 tourists in Huangshan National Park (HNP) and analyzed by the method of the structural equation model. The results showed that (1) attitude toward the behavior, subjective norm, perceived behavioral control and incentive measures significantly affected the behavioral intention; (2) environmental theory knowledge and environmental practice knowledge had indirect effects on the behavioral intention via the mediator of attitude toward the behavior; and (3) the strength of the relationship for the family group between subjective norm and the behavioral intention was significantly greater than the non-family group. Finally, we presented several effective suggestions to improve tourists' intention of bringing self-generated litter down the mountain.

The theory of planned behavior, materialism, and aggressive driving

PURPOSE

Aggressive driving is a growing problem worldwide. Previous research has provided us with some insights into the characteristics of drivers prone to aggressiveness on the road and into the external conditions triggering such behavior. Little is known, however, about the personality traits of aggressive drivers. The present study proposes planned behavior and materialism as predictors of aggressive driving behavior.

DESIGN/METHODOLOGY

Data was gathered using a questionnaire-based survey of 220 individuals from twelve large industrial organizations in Israel. Our hypotheses were tested using structural equation modeling.

FINDINGS

Our results indicate that while planned behavior is a good predictor of the intention to behave aggressively, it has no impact on the tendency to behave aggressively. Materialism, however, was found to be a significant indicator of aggressive driving behavior.

RESEARCH LIMITATIONS

Our study is based on a self-reported survey, therefore might suffer from several issues concerning the willingness to answer truthfully. Furthermore, the sampling group might be seen as somewhat biased due to the relatively high income/education levels of the respondents.

ORIGINALITY/VALUE

While both issues, aggressive driving and the theory of planned behavior, have been studied previously, the linkage between the two as well as the ability of materialism to predict aggressive behavior received little attention previously. The present study encompasses these constructs providing new insights into the linkage between them.