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The coronavirus pandemic has influenced many lives, particularly older adults'. Although isolation protects from infection, health behaviors like physical activity (PA) are important to reinstate after lockdown. However, fear of Covid-19 may act as a barrier, for example, by preventing people from going outside. Based on the health action process approach (HAPA), we investigated whether and why older adults' PA changed after lockdown, and whether fear of Covid-19 moderates the intention-behavior relationship. Participants of this longitudinal study aged 65+ from German-speaking Europe completed an online questionnaire about their PA, fear of Covid-19, and HAPA factors in April and May 2020. Data were analyzed using multiple linear regressions. Results showed that moderate to vigorous activity (MVPA) remained stable after lockdown and that self-efficacy most robustly influenced the intention to be active. PA was not explained by any volitional factor but was strongly related to past PA. Interestingly, the relationship of past and future MVPA was attenuated by fear of Covid-19, but this finding was not robust when outliers were removed. In conclusion, self-efficacy is the most important motivator for PA in older adults after an interruption like a lockdown. Strong physical activity habits may facilitate PA after a period of isolation.

Hand hygiene behavior is crucial to counter the spread of infectious diseases. However, its adoption during the early stages of the COVID-19 pandemic showed temporal fluctuations associated with the pandemic trajectory. Such associations can confound conclusions about the effectiveness of interventions aimed at promoting hand hygiene during a pandemic. In this study, we performed a secondary analysis of a dataset from the optimization phase of Soapp, an app to promote hand hygiene during the COVID-19. We used a longitudinal study design to test whether the associations between the pandemic trajectory and hand hygiene behavior were still present one year after the outbreak and whether they impacted conclusions about the effectiveness of Soapp. Participants (N = 216) were randomized to different versions of Soapp and used an electronic diary to self-report their hand hygiene behavior multiple times during the study. The following COVID-19 trajectory indicators were included in the analysis: total cases/deaths, increases in recent new cases/deaths, new cases/deaths, and number of administered doses of vaccine. Multilevel analysis suggested that there were no significant associations between hand hygiene and the indicators of the pandemic trajectory in the period between March and August 2021. However, models including total cases/deaths impacted the conclusions about Soapp's effectiveness. Implications from this study are that the development and evaluation of hand hygiene interventions during a pandemic context should account for the trajectory indicators to maximize their effectiveness and control for confounding effects.

Background Hand hygiene is an effective behavior for preventing the spread of the respiratory disease COVID-19 and was included in public health guidelines worldwide. Behavior change interventions addressing hand hygiene have the potential to support the adherence to public health recommendations and, thereby, prevent the spread of COVID-19. However, randomized trials are largely absent during a pandemic; therefore, there is little knowledge about the most effective strategies to promote hand hygiene during an ongoing pandemic. This study addresses this gap by presenting the results of the optimization phase of a Multiphase Optimization Strategy of Soapp, a smartphone app for promoting hand hygiene in the context of the COVID-19 pandemic. Objective This study aimed to identify the most effective combination and sequence of 3 theory- and evidence-based intervention modules (habit, motivation, and social norms) for promoting hand hygiene. To this end, 9 versions of Soapp were developed (conditions), and 2 optimization criteria were defined: the condition with the largest increase in hand hygiene at follow-up and condition with the highest engagement, usability, and satisfaction based on quantitative and qualitative analyses. Methods This study was a parallel randomized trial with 9 intervention conditions defined by the combination of 2 intervention modules and their sequence. The trial was conducted from March to August 2021 with interested participants from the Swiss general population (N=232; randomized). Randomization was performed using Qualtrics (Qualtrics International Inc), and blinding was ensured. The duration of the intervention was 34 days. The primary outcome was self-reported hand hygiene at follow-up, which was assessed using an electronic diary. The secondary outcomes were user engagement, usability, and satisfaction assessed at follow-up. Nine participants were further invited to participate in semistructured exit interviews. A set of ANOVAs was performed to test the main hypotheses, whereas a thematic analysis was performed to analyze the qualitative data. Results The results showed a significant increase in hand hygiene over time across all conditions. There was no interaction effect between time and intervention condition. Similarly, no between-group differences in engagement, usability, and satisfaction emerged. Seven themes (eg, “variety and timeliness of the task load” and “social interaction”) were found in the thematic analysis. Conclusions The effectiveness of Soapp in promoting hand hygiene laid the foundation for the next evaluation phase of the app. More generally, the study supported the value of digital interventions in pandemic contexts. The findings showed no differential effect of intervention conditions involving different combinations and sequences of the habit, motivation, and social norms modules on hand hygiene, engagement, usability, and satisfaction. In the absence of quantitative differences, we relied on the results from the thematic analysis to select the best version of Soapp for the evaluation phase. Trial Registration ClinicalTrials.gov NCT04830761; https://clinicaltrials.gov/ct2/show/NCT04830761 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2021-055971

BACKGROUND Hand hygiene is an effective behavior for preventing the spread of the respiratory disease COVID-19, and was included in public health guidelines worldwide. Behavior change interventions addressing hand hygiene have the potential to support the adherence to public health recommendations and thereby prevent the spread of COVID-19. However, randomized trials during a pandemic are largely absent, wherefore there is little knowledge about the most effective strategies to promote hand hygiene during an ongoing pandemic. The present study addresses this gap by presenting the results of the optimization phase of a Multiphase Optimization Strategy of Soapp, a smartphone app to promote hand hygiene in the context of the COVID-19 pandemic. OBJECTIVE The goal was to identify the most effective combination and sequence of three theory- and evidence-based intervention modules (Habit, Motivation, Social Norms) to promote hand hygiene. To this aim, nine versions of Soapp were developed (conditions) and two optimization criteria were defined: i) condition with largest increase in hand hygiene at follow-up and ii) condition with highest engagement, usability and satisfaction based on quantitative and qualitative analyses. METHODS The study design was a parallel randomized trial with nine intervention conditions defined by the combination of two intervention modules and their sequence. The trial was conducted from March to August 2021 with interested participants of the Swiss general population (N = 232 randomized). Randomization was performed by Qualtrics and blinding was ensured. The duration of the intervention was 34 days. The primary outcome was self-reported hand hygiene at follow-up, assessed via an electronic diary. Secondary outcomes were user engagement, usability and satisfaction, assessed at follow-up. Participants were further invited for semi-structured exit interviews (n = 9). A set of Anovas was performed to test the main hypotheses while thematic analysis was performed to analyze the qualitative data. RESULTS Results showed a significant increase in hand hygiene over time across all conditions. There was no interaction effect of time and intervention condition. Likewise, no between-group difference in engagement, usability and satisfaction emerged. Seven themes (e.g., “variety and timeliness of the workload”, “social interaction”) were found in the thematic analysis. CONCLUSIONS The current findings evidenced no effect of intervention condition of a habit, motivation and social norms module on hand hygiene, engagement, usability and satisfaction. In the absence of quantitative differences, we relied on the results from the thematic analysis to select the best version of Soapp for the evaluation phase. CLINICALTRIAL NCT04830761 INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2021-055971

Health psychology research is inherently context specific: Different health behaviors are executed by different target groups (e.g., gender, age) in different social structures, cultures, and environments. This asks for the adaptation of research instruments to enhance specificity. For example, when using measurement scales in new contexts, translation and psychometric validation of the instruments are necessary but not sufficient if the validity of the psychological concept behind a measurement scale has not been researched. In this study, we build on existing guidelines of translation as well as psychometric validation and present four steps on how to adapt measurement scales to a new context: Step 1 asks whether the psychological concept is found in the new context. Step 2 asks whether the measurement scale and its items are understood in the new context. Step 3 asks whether a measurement scale is valid and reliable. Step 4 asks how the items of the measurement scale perform individually. Following these four steps, measurement scales are carefully translated, adapted, and validated and can therefore be transferred to very different contexts.

Unsafe sanitation practices can severely affect public health. Strengthening psychological ownership, the feeling of owning an object (e.g. the latrine) individually or collectively, may promote safe sanitation practices, e.g. decreased open defecation. This study investigated psychological ownership in communities that participated in a sanitation intervention. We used follow-up survey data of a cluster-randomised controlled trial in rural Ghana (N = 2012 households), which assessed psychological ownership, and safe sanitation outcomes. The data were analysed using multilevel modelling and generalised estimating equations. In line with our assumptions, greater psychological ownership for the latrine related to decreased open defecation. Higher individual psychological ownership for the open defecation space related to safe sanitation outcomes, whereas collective ownership related to lesser safe sanitation. The present study shows that the concept of psychological ownership may play an important role in safe sanitation. Collective and individual psychological ownership seem to distinctly relate to safe sanitation outcomes, which has high relevance for promoting communities’ health behaviour.

Daily carrying of heavy loads of domestic water, especially during pregnancy and postpartum, bears a threat to maternal health in low-income countries. Using an extended health action process approach (HAPA), we examined women's reasons for and psychosocial determinants of safe water-carrying during pregnancy and postpartum. In a mixed-methods study, trained local interviewers conducted 1001 quantitative interviews with women of reproductive age (n = 921 analyzed) and 21 qualitative interviews with women of reproductive age, in-laws, and spouses in rural Nepal. We analyzed the quantitative data with generalized estimating equations to model the HAPA-based psychosocial determinants of avoiding water-carrying during pregnancy and postpartum. Subjective perspectives were investigated with thematic analysis. Outcome expectancies (B = 0.24), self-efficacy (B = 0.20), and injunctive norms (B = 0.23) were significantly associated with the intention to avoid water-carrying. Self-efficacy (B = 0.36) and instrumental support (B = 0.05) are related to behavior (all p

Background Mediation analysis is an important tool for understanding the processes through which interventions affect health outcomes over time. Typically the temporal intervals between X, M, and Y are fixed by design, and little focus is given to the temporal dynamics of the processes. Purpose In this article, we aim to highlight the importance of considering the timing of the causal effects of a between-person intervention X, on M and Y, resulting in a deeper understanding of mediation. Methods We provide a framework for examining the impact of a between-person intervention X on M and Y over time when M and Y are measured repeatedly. Five conceptual and analytic steps involve visualizing the effects of the intervention on Y, M, the relationship of M and Y, and the mediating process over time and selecting an appropriate analytic model. Results We demonstrate how these steps can be applied to two empirical examples of health behavior change interventions. We show that the patterns of longitudinal mediation can be fit with versions of longitudinal multilevel structural equation models that represent how the magnitude of direct and indirect effects vary over time. Conclusions We urge researchers and methodologists to pay more attention to temporal dynamics in the causal analysis of interventions., Five conceptual and analytic steps are proposed to assess and better understand the causal effects of interventions on health outcomes over time.

Stellen Kondome einen potenten Schutz sowohl vor HIV als auch von anderen sexuell ubertragbaren Infektionen (STIs) dar, und besteht auserdem ein barrierefreier Zugang zur HIV-Postexpositionsprophylaxe (PEP) (z. B. nach Kondom-Fatigue), muss prazise sondiert werden, wann die sich zunehmend etablierende HIV-Praexpositionsprophylaxe (PrEP) die bessere Wahl darstellt. Vor dem Hintergrund einer generalisierten everyone at risk-Annahme uber MSM wird die PrEP zunehmend zu einem standard of care. Zwar kann kein Zweifel daran bestehen, dass dies fur bestimmte MSM mit einem bestimmten Risikoprofil wunschenswert ist. Es ist aber von Variabilitaten (z. B. casual condomless sex versus random condomless sex) auszugehen, die zur Vermeidung einer unverhaltnismasigen Medikalisierung berucksichtigt werden mussen. Im Spannungsfeld von hochpotenter HIV-Pravention und Medikalisierung insbesondere von Mannern, die Sex mit Mannern praktizieren, soll im Sinn einer Guterabwagung gefragt werden, wann genau eine PrEP (dauerhaft oder on demand) mehr Vorteile und weniger Nachteile bietet als der Gebrauch von Kondom oder PEP. Dazu gehort ein Fokus auf den aktuellen Stand der klinischen Forschung und ein Fokus auf die medizinethische Debatte. Die Medizingeschichte der Pravention und der HIV-Erkrankung erweist sich dabei als relevanter Erorterungszusammenhang fur die weitgehend noch ausstehende ethische Untersuchung der PrEP. Methodisch basiert diese Arbeit auf einer Auswertung der interdisziplinaren Fachliteratur uber die HIV-Praexpositionsprophylaxe im Besonderen und uber HIV-Pravention im Allgemeinen. Basierend auf den PRISMA (Prefered Reporting Items for Systematic Reviews and Meta-Analyses) Guidelines wurden aus der Datenbank PubMed/MEDLINE solche Studien ausgewahlt, die die aktuelle klinische Praxis der PrEP oder eine medizinethische Diskussion der PrEP zum Gegenstand haben. Auf der Basis dieser Literatur erfolgt eine diskursive Erorterung und Abwagung der verfugbaren Pros und Cons zur PrEP. Praventionsmasnahmen treten regelmasig als ambivalente Instrumente der Gesundheitsforderung zwischen Liberalisierung und Restringierung des Individuums hervor. Insgesamt bietet daher die PrEP on demand gegenuber der kontinuierlichen PrEP im Sinne der Personalisierung die Option einer individuellen Anpassung an konkretes Risikoverhalten. Auch im Sinne einer Guterabwagung hat die PrEP gewichtige Vorteile gegenuber der kontinuierlichen PrEP und gegenuber einer PEP, wenn kein dauerhaft gleichhohes Risiko vorliegt. In dieser medizinethischen Untersuchung wird darauf hingewiesen, dass es sich bei MSM um eine heterogene Gruppe handelt, deren individuelles Sexualverhalten eine ebenfalls individualisierte HIV-Praventions-Strategie benotigt. Diese Studie argumentiert daher fur ein stark personalisiertes decision making bei moglicher Indikation fur eine PrEP bei MSM. Damit soll ein wesentlicher Faktor zur Vermeidung einer Medikalisierung von MSM dargestellt werden.

Recent developments in high- and middle-income countries have exhibited a shift from conventional urban water systems to alternative solutions that are more diverse in source separation, decentralization, and modularization. These solutions include nongrid, small-grid, and hybrid systems to address such pressing global challenges as climate change, eutrophication, and rapid urbanization. They close loops, recover valuable resources, and adapt quickly to changing boundary conditions such as population size. Moving to such alternative solutions requires both technical and social innovations to coevolve over time into integrated socio-technical urban water systems. Current implementations of alternative systems in high- and middle-income countries are promising, but they also underline the need for research questions to be addressed from technical, social, and transformative perspectives. Future research should pursue a transdisciplinary research approach to generating evidence through socio-technical "lighthouse" projects that apply alternative urban water systems at scale. Such research should leverage experiences from these projects in diverse socio-economic contexts, identify their potentials and limitations from an integrated perspective, and share their successes and failures across the urban water sector.

© 2022 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/), Background: In times of unprecedented infectious disease threats, it is essential to understand how to increase individual protective behaviors and support for collective measures. The present study therefore examines factors associated with individual and collective pathways. Methods: Data was collected through an online survey from 4483 participants (70.8% female, M = 41.2 years) across 10 countries from April 15, 2020 to June 2, 2020 as part of the "EUCLID" project (https://euclid.dbvis.de). Structural equation modeling was used to examine individual and collective pathways across and within countries. Results: Overall, the adoption of individual protective behaviors and support for collective measures were high. Risk perception on the individual level and perceived effectiveness at the collective level were positively associated with both individual protective behaviors and support for collective measures. Furthermore, the model explained considerable variance in individual (40.7%) and collective protective behaviors (40.8%) and was largely replicated across countries. Conclusions: The study extends previous research by demonstrating that individual risk perception and perceived effectiveness of collective measures jointly affect individual protective health behaviors and support for collective measures. These findings highlight the need to jointly consider a variety of behavioral actions against infectious disease threats, acknowledging interactions between individual and collective pathways., This study was funded by Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany's Excellence Strategy – EXC 2117–422037984 (the Centre for the Advanced Study of Collective Behaviour), and under FOR 2374 (RiskDynamics), and by the Bundesministerium für Bildung und Forschung (BMBF, Federal Ministry of Education and Research) under 01EL1820A (SMARTACT).

OBJECTIVE: Habitual behaviours are triggered automatically, with little conscious forethought. Theory suggests that making healthy behaviours habitual, and breaking the habits that underpin many ingrained unhealthy behaviours, promotes long-term behaviour change. This has prompted interest in incorporating habit formation and disruption strategies into behaviour change interventions. Yet, notable research gaps limit understanding of how to harness habit to change real-world behaviours. METHODS: Discussions among health psychology researchers and practitioners, at the 2019 European Health Psychology Society 'Synergy Expert Meeting', generated pertinent questions to guide further research into habit and health behaviour. RESULTS: In line with the four topics discussed at the meeting, 21 questions were identified, concerning: how habit manifests in health behaviour (3 questions); how to form healthy habits (5 questions); how to break unhealthy habits (4 questions); and how to develop and evaluate habit-based behaviour change interventions (9 questions). CONCLUSIONS: While our questions transcend research contexts, accumulating knowledge across studies of specific health behaviours, settings, and populations will build a broader understanding of habit change principles and how they may be embedded into interventions. We encourage researchers and practitioners to prioritise these questions, to further theory and evidence around how to create long-lasting health behaviour change. publishedVersion

OBJECTIVES Physical activity is an important health behaviour especially for older adults. Forming implementation intentions is an effective strategy to implement physical activity in daily life for young and middle-aged adults. However, evidence for older adults is inconclusive. This study explored the thoughts of older adults about implementation intentions and potential barriers and facilitators while formulating them. METHODS Three samples of older adults from the United Kingdom (n = 8), Germany (n = 9) and Switzerland (n = 17) were prompted to think aloud while formulating implementation intentions to be more physically active. After the task, semi-structured interviews were conducted. Data were analysed thematically. RESULTS Participants expressed pre-established thoughts about implementation intentions (e.g. they feel too restrictive). During the formulation of implementation intentions, several barriers to creating them were reported (e.g. problems with finding cues due to absence of recurring daily routines), but participants also mentioned that forming implementation intentions acted as a facilitator for physical activity (e.g. cues as useful reminders to be active, task itself triggering self-reflection about physical activity). After the task, participants reflected on circumstances that decrease the likelihood of enacting implementation intentions (e.g. spontaneous alternative activities, weather, health-related barriers, Covid-19-related barriers), which triggered spontaneous coping planning. CONCLUSIONS The results on barriers and facilitators of implementation intentions and physical activity from older adults' perspectives provide starting points for improving instructions for older adults on how to create implementation intentions for physical activity. Future studies are needed to investigate whether the findings extend to implementation intentions for other behaviours.

Handwashing with soap effectively prevents diarrhoea, a leading cause of death in infants. Theory-based interventions are expected to promote handwashing more successfully than standard approaches. The present article investigates the underlying change processes of theory-based handwashing interventions. A nonrandomised field study compared a standard approach to two theory-based interventions that were tailored to the target population, the inhabitants of four villages in southern Ethiopia (N = 408). Data were collected before and after interventions by structured interviews and analysed by mediation analysis. In comparison to the standard approach (i.e., education only), education with public commitment and reminder was slightly more effective in changing social-cognitive factors and handwashing. Education with an infrastructure promotion and reminder was most effective in promoting handwashing through enhancing social-cognitive factors. The results confirm the relevance of testing interventions' underlying change processes.

Over a million people in Peru may be exposed to lead (Pb) due to past or present mining‐related activities; however, neither soil Pb nor blood Pb are routinely monitored throughout the country. Because little is known about Pb contamination in smaller mining‐impacted towns, soil Pb was mapped in four such towns with a portable X‐ray fluorescence analyzer in 2015. The roadside mapping delineated hotspots of highly contaminated soil (1,000–6,000 mg/kg Pb) in two of the towns. The local health department, provided with a LeadCare II analyzer, then measured blood‐Pb levels >5 in 65% and >10 μg/dL in 15% of children (n = 200) up to 6 years of age in these same four communities. There were no clear relations between child blood‐Pb levels and Pb levels in soil samples collected inside (n = 50) or outside the home (n = 50). Increased child blood Pb was associated with decreased level of cleanliness of parent clothing (n = 136) and shoes (n = 138), linking a possible behavioral factor for transferring contaminated soil and dust to children. In order to explore individual exposure and variations in soil Pb, 10 parents of children with blood Pb >10 μg/dL and 10 parents of children with blood Pb, Key Points Parents in four small mining‐impacted towns in Peru successfully collected soil samples from areas where their children playParents analyzed samples with trained help using a field procedure that led to the identification of a new hotspot of Pb contaminationChild blood‐Pb was associated with parent shoe and clothing cleanliness as well as education level, but not with Pb in soil

In March 2020, the Your COVID-19 Risk tool was developed in response to the global spread of SARS-CoV-2. The tool is an online resource based on key behavioural evidence-based risk factors related to contracting and spreading SARS-CoV-2. This article describes the development of the tool, the produced resources, the associated open repository, and initial results. This tool was developed by a multidisciplinary research team consisting of more than 150 international experts. This project leverages knowledge obtained in behavioural science, aiming to promote behaviour change by assessing risk and supporting individuals completing the assessment tool to protect themselves and others from infection. To enable iterative improvements of the tool, tool users can optionally answer questions about behavioural determinants. The data and results are openly shared to support governments and health agencies developing behaviour change interventions. Over 60 000 users in more than 150 countries have assessed their risk and provided data.

Many women in low-income countries carry heavy loads of drinking water for their families in difficult terrain. This can adversely affect their health and well-being. The present study is the first to investigate the physical burden of water carrying and women’s psychosocial well-being, and how this relationship is moderated by environmental and health conditions. Trained local interviewers conducted interviews with 1001 women across five rural communities in Nepal. In addition, objective measurement was used to assess the weight carried and distance from the water source. The physical burden of water carrying was calculated from weight, distance, and frequency of trips. Its association with psychosocial well-being was modeled using generalized estimating equations. Two additional models included the terrain and uterine prolapse as moderators. The physical burden of water carrying is directly related to higher emotional distress and reduced daily functioning. This correlation was exacerbated for women carrying in hilly versus flat terrain, and for those who had uterine prolapse. Our results underline the importance of adequate water access for women’s psychosocial well-being, especially for vulnerable populations such as women with impaired health (e.g., uterine prolapse) or those living in hilly terrain. The results further highlight the interconnectedness of the Sustainable Development Goal (SDG) 6: water access, SDG 3: health and well-being, and SDG 5: gender equality.

More than a third of women in Nepal have to carry water from source to home to satisfy their families' daily needs. A cross-sectional study was carried out in a hilly area in Nepal to assess water-carrying practices and their association with women's health. Quantitative interviews were conducted with 1001 women of reproductive age and were complemented with health surveys carried out by health professionals and structured observations of water carrying. Multivariate mixed logistic regression models were used to assess the associations between water-carrying-related risk factors and health issues for women. Around 46% of women faced considerably increased to excessive physical stress due to water carrying during the dry season. Women suffered from a disproportionately high prevalence of back pain (61%), with about 18% of this pain being horrible to excruciating; pain in the knees (34%); uterine prolapse (11.3%); and at least one spontaneous abortion (9%). The risk category of water carrying was significantly associated with uterine prolapse (OR = 1.44, 95%CI = 1.12-1.85, p = 0.031) and pain in the hips (OR = 1.69, 95%CI = 1.27-2.26, p0.001). Receiving help with water carrying during pregnancy and during the first three months after delivery was associated with reduced odds ratios for uterine prolapse (OR = 0.10, 95% CI = 0.01-0.87, p = 0.037), and strong back pain (OR = 0.32, 95% CI = 0.12-0.87, p = 0.026). Improvements to water supply infrastructure and the promotion of social support for carrying water during pregnancy and after delivery are recommended to reduce water-carrying-related health risks.

Abstract. Increasing demands on ecosystems, decreasing biodiversity, and climate change are among the most pressing environmental issues of our time. As changing weather conditions are leading to increased vector-borne diseases and heat- and flood-related deaths, it is entering collective consciousness: environmental issues are human health issues. In public health, the field addressing these issues is known as environmental health. This field addresses both the effects people have on their environment as well as the effects of the environment on people. Psychology, as a discipline concerned with explaining, predicting, and changing behavior has much to contribute to these issues because human behavior is key in promoting environmental health. To date, however, an integrative view of environmental health in psychology is lacking, hampering urgently needed progress. In this paper, we review how the environment and human health are intertwined, and that much can be gained through a systemic view of environmental health in psychology. Based on a review of the literature, we suggest that psychologists unite efforts to promote an integrative science and practice of environmental health psychology, and jointly address environmental-health related behavior. The research agenda for this field will include integrating behavior change theory and intervention approaches. Thereby, psychology can potentially make an important contribution to sustained environmental health for generations to come.

Compensatory health beliefs (CHBs) are beliefs that an unhealthy behavior (unhealthy eating) can be compensated for by engaging in a healthy behavior (physical activity). Previous research focused on CHBs as rather stable beliefs (trait). Some studies indicated that situation-specific CHBs (state) might be important in situations, in which people are confronted with an unhealthy snack. This study aims to investigate the association between CHBs and unhealthy snack consumption in daily life with a special focus on the distinction between trait and state CHBs. Overall, N = 45 participants (66.7% female; age: 18-45 years, M = 21.9) received a link to an online questionnaire five times daily for seven consecutive days (n = 1575 possible diary entries). They reported unhealthy snack consumption, state and trait CHBs concerning the compensation with subsequent eating behavior and physical activity. The results showed that trait and state CHBs were significantly positively related to unhealthy snack consumption in daily life. Different effects appeared for CHBs concerning the compensation with subsequent eating behavior compared to the compensation with physical activity. This study demonstrates that both, state and trait CHBs are important for unhealthy snack consumption in daily life. Findings emphasize the need for further daily diary approaches to understand the temporal sequence of state CHBs that could further explain the use of CHBs as a maladaptive strategy for unhealthy eating.

Conventional pesticides are associated with numerous human and environmental health risks. Nevertheless, an increasing number of smallholder farmers in low- and middle-income countries are using conventional pesticides. Adopting safer pest management requires farmers to obtain new information. However, little is known how farmers develop an information need, seek, and use pest management related information, and whether this process differs for organic and conventional pest management strategies. In this qualitative study, we investigated pest-related information behavior in depth, from farmers’ own perspective. Using an ethnographic approach, we conducted 46 semi-structured interviews, 15 on-farm observations and 302 structured questionnaire interviews with farmers in Wakiso District, Uganda, in 2017. Our results indicated that farmers develop information needs when adopting new farming practices, or when presented with disruptive information (e.g. when new pests emerged). This prompted farmers to seek information actively, or they received passive information. Whether farmers used the new information depended on successful trial of the new pest management strategy, and on the credibility of the source. Most revealing, our results suggested important differences in information behavior between conventional and organic pest management strategies. Sources of information for conventional pesticides were well-integrated into farmers’ daily lives and comprised pesticide dealers and fellow farmers. Conversely, information on organic strategies was provided through external sources (e.g. NGOs), and was not available at times when farmers developed an information need. Our results imply that farmers are most likely receptive to organic pest management information at times when they develop an information need (e.g. when encountering a new pest). To promote safer pest management, information about organic and integrated pest management should be made continuously available in farmers’ lives. Furthermore, we recommend leveraging established information channels (e.g. dealers) among pesticide users to promote safer use practices., Journal of Cleaner Production, 257, ISSN:0959-6526

Abstract. This study tested the effects of exercise on eating behavior. The transfer hypothesis proposes that exercise leads to a generalization of healthy behavior and therefore an improved diet. The compensation hypothesis assumes that exercise leads to increased caloric intake in order to “compensate” for the energy expenditure. We tested these hypotheses for actual as well as imagined exercise. Female university employees or students (N = 227) were randomly assigned to three experimental groups: actual exercise vs. imagined exercise vs. control. After baseline data had been obtained, the participants engaged in a 5-minute experimental task and were then left alone with unhealthy snacks. Participants who had imagined themselves exercising (M = 101 kcal, SD = 128 kcal) consumed significantly fewer calories than did controls (M = 129 kcal, SD = 142 kcal), consistent with a transfer effect. Participants who had engaged in actual exercise, but had been distracted from thinking about exercise, consumed quantities (M = 127 kcal, SD = 111 kcal) similar to those consumed by controls. This study suggests that transfer effects are underpinned by psychological processes, such as goal activation, which should be investigated in the future.

BACKGROUND: Although many people intend to eat healthily, they often fail to do so. We report the first randomised trial testing whether smartphone-based support groups can enhance healthy eating. METHODS: Adults (N = 203) were randomised to the support or control condition (information), and to one of two eating goals (increasing fruit and vegetable/decreasing unhealthy snack consumption). After baseline, participants received information on their assigned eating goal, and completed a 13-day electronic diary. During Days 4-10, support participants were asked to support each other in achieving their eating goal in smartphone-based groups. The primary outcome was daily servings of fruit/vegetables or unhealthy snacks. Maintenance of intervention effects was assessed on Days 11-13, and at 1-month and 2-month follow-ups. RESULTS: Support participants showed a gradual increase in healthy eating over time, and ate 1.4 fruits and vegetables more, 95% CI [0.3, 2.6], or 0.8 unhealthy snacks less, 95% CI [-1.4, -0.2] than controls on Day 10. Most effects were not maintained at follow-ups. CONCLUSIONS: Smartphone-based groups can promote fruit and vegetable consumption and decrease unhealthy snack intake. This study extends previous findings of the benefits of support groups, and sheds light on the temporal dynamics of behavior change.

Compensatory Health Beliefs (CHBs), defined as beliefs that an unhealthy behavior can be compensated for by engaging in another healthy behavior, are assumed to hinder health behavior change. The aim of the present study was to investigate the role of CHBs for two distinct eating behaviors (increased fruit and vegetable consumption and eating fewer unhealthy snacks) with a mixed method approach. Participants (N = 232, mean age = 27.3 years, 76.3% women) were randomly assigned to a fruit and vegetable or an unhealthy snack condition. For the quantitative approach, path models were fitted to analyze the role of CHBs within a social-cognitive theory of health behavior change, the Health Action Process Approach (HAPA). With a content analysis, the qualitative approach investigated the occurrence of CHBs in smartphone chat groups when pursuing an eating goal. Both analyses were conducted for each eating behavior separately. Path models showed that CHBs added predictive value for intention, but not behavior over and above HAPA variables only in the unhealthy snack condition. CHBs were significantly negatively associated with intention and action planning. Content analysis revealed that people generated only a few CHB messages. However, CHBs were more likely to be present and were also more diverse in the unhealthy snack condition compared to the fruit and vegetable condition. Based on a mixed method approach, this study suggests that CHBs play a more important role for eating unhealthy snacks than for fruit and vegetable consumption.

Highlights • CLTS intervention communities were 11 times less likely to practice open defecation at follow-up compared to controls. • Intervention communities with higher average social identification showed lower open defecation rates. • In control communities, higher open defecation rates were connected with higher social identificatio. • The results highlight the need of considering the social context when planning and implementing sanitation campaigns., Unsafe sanitation practices are a major source of environmental pollution and are a leading cause of death in countries of the Global South. One of the most successful campaigns to eradicate open defecation is “Community-Led Total Sanitation” (CLTS). It aims at shifting social norms towards safe sanitation practices. However, the effectiveness of CLTS is heterogeneous. Based on social identity theory, we expect CLTS to be most effective in communities with stronger social identification, because in these communities individuals should rather follow social norms. We conducted a cluster-randomized controlled trial with 3,216 households in 132 communities in Ghana, comparing CLTS to a control arm. Self-reported open defecation rates and social identification were assessed pre-post. Generalized Estimating Equations showed that CLTS achieved lower open defecation rates compared to controls. This effect was significantly stronger for communities with stronger average social identification. The results confirm the assumptions of social identity theory. They imply that pre-existing social identification needs to be considered for planning CLTS, and strengthened beforehand if needed.

Aim: Arsenic contamination of drinking water is a public health crisis. Since its detection in Bangladesh, the world's most arsenic-affected country, organizations involved (i.e., stakeholders) have made great efforts by testing wells and installing safe water options. Yet, 20 million Bangladeshi are still at risk. It has been suggested that the discrepancy between stakeholders' and end users' preferences of arsenic mitigation options is one reason for the slow progress. Therefore, this study aimed at comparing stakeholders' and end users' preferences. Subjects and methods: Three investigations were conducted in Bangladesh: a series of qualitative interviews with 22 stakeholders and two end user surveys with a total of 1,268 randomly selected households living in six arsenic-affected districts of Bangladesh. Results: Stakeholders mostly preferred rural piped water supplies and deep tubewells, while their least preferred options were dug wells and arsenic removal filters. End users mostly preferred deep tubewells, well-sharing and rural piped water supplies, while dug wells were least preferred. End users identified several disadvantages of mitigation options, including long distances, great effort to collect water and difficult social situations. They further demonstrated moderate willingness to pay for a rural piped water supply, deep tubewells and pond sand filters, but lower willingness for other options. Conclusion: Stakeholders' and end users' preferences converged for deep tubewells and rural piped water supplies, while well-sharing was preferred by end users, but not by stakeholders. The results suggest installing deep tubewells and rural piped water supplies with greater priority. Furthermore, stakeholders' preferences to promote well-sharing should be enhanced.

Theories of behaviour change and health behaviour change interventions are most often evaluated in between-person designs. However, behaviour change theories apply to individuals not groups and behavioural interventions ultimately aim to achieve within-person rather than between-group change. Within-person methodology, such as N-of-1 (also known as single case design), can circumvent this issue, though has multiple design-specific challenges. This paper provides a conceptual review of the challenges and potential solutions for undertaking N-of-1 studies in health psychology. Key challenges identified include participant adherence to within-person protocols, carry-over and slow onset effects, suitability of behaviour change techniques for evaluation in N-of-1 experimental studies, optimal allocation sequencing and blinding, calculating power/sample size, and choosing the most suitable analysis approach. Key solutions include involving users in study design, employing recent technologies for unobtrusive data collection and problem solving by design. Within-person designs share common methodological requirements with conventional between-person designs but require specific methodological considerations. N-of-1 evaluation designs are appropriate for many though not all types of interventions. A greater understanding of patterns of behaviours and factors influencing behaviour change at the within-person level is required to progress health psychology into a precision science. Video abstract: Supplementary Material 1.

We investigated the relations of self-rated omission errors (i.e., forgetting to take one's medication) and commission errors (i.e., unnecessary repetitions of medication intake because of forgetting that it has already been taken) in medication adherence in multimorbidity to prospective and retrospective memory performance. Moreover, we examined whether these relations were moderated by the number of medications that had to be taken. Eighty-four patients with multimorbidity (aged 28–84 years, M = 62.4) reported medication adherence regarding the last seven days and the number of medications they had to take. In addition, we administered psychometric tests on prospective memory (PM) and retrospective memory performance. We found that reported omission errors in medication adherence were related significantly to lower PM performance. This relationship was increased in individuals with a lower number of medications. In comparison, reported commission errors in medication adherence were related significantly to lower retrospective memory performance. This relationship was increased in individuals with a larger number of medications. Present data suggest that omission errors in medication adherence in multimorbidity may reflect primarily PM errors, particularly if few medications have to be taken, while commission errors may reflect mainly retrospective memory failures, especially with a large number of medications that need to be taken as prescribed. From an applied neuropsychological perspective, these results underline the importance of trying to enhance PM and retrospective memory performance in patients with multimorbidity.

More than 100 million people globally are estimated to be exposed to arsenic in drinking water that exceeds the World Health Organization guideline of 10 µg/L. In an effort to develop and test a low-cost sustainable approach for water arsenic testing in Bangladesh, we conducted a randomized controlled trial which found arsenic educational interventions when combined with fee-based water arsenic testing programs led to nearly all households buying an arsenic test for their drinking water sources (93%) compared with only 53% when fee-based arsenic testing alone was offered. The aim of the present study was to build on the findings of this trial by investigating prospectively the psychological factors that were most strongly associated with switching to arsenic-safe wells in response to these interventions. Our theoretical framework was the RANAS (risk, attitude, norm, ability, and self-regulation) model of behavior change. In the multivariate logistic regression model of 285 baseline unsafe well users, switching to an arsenic-safe water source was significantly associated with increased instrumental attitude (odds ratio [OR] = 9.12; 95% confidence interval [CI] = [1.85, 45.00]), descriptive norm (OR = 34.02; 95% CI = [6.11, 189.45]), coping planning (OR = 11.59; 95% CI = [3.82, 35.19]), and commitment (OR = 10.78; 95% CI = [2.33, 49.99]). In addition, each additional minute from the nearest arsenic-safe drinking water source reduced the odds of switching to an arsenic-safe well by more than 10% (OR = 0.89; 95% CI = [0.87, 0.92]). Future arsenic mitigation programs should target these behavioral determinants of switching to arsenic-safe water sources.

Rationale Open defecation is connected to poor health and child mortality, but billions of people still do not have access to safe sanitation facilities. Community-Led Total Sanitation (CLTS) promotes latrine construction to eradicate open defecation. However, the mechanisms by which CLTS works and how they can be improved remain unknown. The present study is the first to investigate the psychosocial determinants of CLTS in a longitudinal design. Furthermore, we tested whether CLTS can be made more effective by theory- and evidence-based interventions using the risks, attitudes, norms, abilities, and selfregulation (RANAS) model. Methods A cluster-randomized controlled trial of 3216 households was implemented in rural Ghana. Communities were randomly assigned to classic CLTS, one of three RANAS-based interventions, or to the control arm. Prepost surveys at 6-month follow-up included standardized interviews assessing psychosocial determinants from the RANAS model. Regression analyses and multilevel mediation models were computed to test intervention effects and mechanisms of CLTS. Results Latrine coverage increased pre-post by 67.6% in all intervention arms and by 7.9% in the control arm (p, Highlights • Randomized-controlled trial examined Community-Led Total Sanitation (CLTS) in Ghana. • CLTS increased latrine coverage by 67.6%. • CLTS achieved changes in psychosocial determinants based on a psychosocial model. • Changes in psychosocial determinants explain success of CLTS. • Changes in factors such as social norms explain why participants construct latrines.

Consistent hand washing with soap can reduce the risk of diarrhea, but changing hand-washing behavior is difficult. Systematic behavior change approaches promise to enhance hand washing with soap effectively, and allow the identification of active intervention ingredients using mediation analysis. This knowledge can then be used to derive hypotheses for systematically refining the intervention.We demonstrate this at the example of a behavior change intervention to promote hand washing with soap based on the RANAS approach (risk, attitudes, norms, ability, and self-regulation).Sixteen wards of Masvingo province in Zimbabwe were randomly allocated to the RANAS-based intervention or a wait-list control group. Hand washing at baseline and follow-up was observed for 224 randomly selected caregivers of young children. They additionally participated in quantitative face-to-face interviews assessing psychosocial factors.At baseline, hand washing with soap was3% on average, and did not differ between groups (p = .526). At follow-up, intervention participants washed hands with soap more frequently than controls (in 29.4% vs. 8.2% of all stool- and food-related situations, B = 1.88, SE = 0.32, OR = 6.6, p .001). Mediation analyses revealed that the intervention enhanced several of the targeted psychosocial factors; return, descriptive and injunctive norms, action knowledge, action self-efficacy, maintenance self-efficacy, action planning, and remembering. The intervention effect was mediated through increased remembering.This study supports the efficacy of a systematic approach to behavior change to promote hand washing with soap. The analyses of the mechanisms revealed important insights into the active ingredients of the intervention, which will facilitate its future refinement.

BACKGROUND: Coping planning, the formation of plans to overcome behavioral barriers is assumed to promote health behavior maintenance, but the literature on this is inconsistent. In this study, we aimed to investigate the mechanisms of a coping planning intervention that adversely affected maintained safe water consumption. We also explored perceived behavioral difficulty as a potential moderator of coping planning interventions. METHODS: In the second phase of a cluster-randomised trial, households (N = 177 analyzed) were randomly allocated to a coping planning intervention or a comparison group (repetition of interventions from first intervention phase). Safe water consumption, the mechanisms of coping planning, and perceived difficulty were measured pre-post. The data were analyzed using mediation and moderated mediation analysis. RESULTS: Changes in behavioral intention mediated the intervention effects on behavioral maintenance (b = -0.36, 95% CI [-0.91, -0.03]). Changes in perceived coping planning (b = 0.08, 95% CI [-0.12, 0.34]), and maintenance self-efficacy (b = -0.13, 95% CI [-0.45, 0.01]) did not mediate the effects. Prior perceived difficulty moderated the coping planning intervention effects on maintenance via intention. CONCLUSIONS: Coping planning may decrease motivation for health behavior maintenance for persons who experienced few barriers prior to the planning intervention.

Background Health behavior change theories usually claim to be universally and individually applicable. Most research has tested behavior change theories at the interindividual level and within young-to-middle-aged populations. However, associations at the interindividual level can differ substantially from associations at the intraindividual level. This study examines the applicability of the Health Action Process Approach (HAPA) at the inter- and the intraindividual level among older adults. Methods Two intensive longitudinal studies examined the HAPA model covering two different health behaviors and two different time spans: Study 1 (physical activity, N = 52 × 6 monthly observations) and Study 2 (medication adherence, N = 64 × 30 daily observations). The HAPA constructs (risk awareness, outcome expectancy, self-efficacy, intention, action planning, action control), and self-reported behaviors were assessed. Results Overall, at the interindividual level, results of both studies largely confirmed the associations specified by the HAPA. At the intraindividual level, results were less in line with the HAPA. Only action control emerged as consistent predictor of behavior. Conclusions This study emphasises the importance of examining health behavior change theories at both, the inter- and the intraindividual level.

Engaging in regular physical activity requires substantial self-regulatory effort such as action control (e.g., continuously monitoring and evaluating an ongoing behavior with regard to one's standards).The present study examined the effectiveness of an ecological momentary action control intervention for promoting daily physical activity. Also, we tested whether a dyadic compared to an individual intervention displayed an additional benefit.121 overweight and obese individuals and their partners were randomly allocated to an intervention (n = 60; information + action control text messages) or a control group (n = 61; information only). The intervention was delivered in a dyadic vs. individual version of action control. Allocation ratio was 1:1:2 for the dyadic, individual, and control groups, respectively. Daily physical activity was assessed with triaxial accelerometers during a 14-day intervention phase and a 14-day follow-up phase.Participants in the intervention group showed a higher probability (36.5%) to achieve the recommended daily activity levels (≥30 min of moderate-to-vigorous physical activity per day performed in bouts of at least 10 min) during the intervention and follow-up phase compared to those in the control group (23.0%). The intervention and control group did not differ in terms of daily moderate-to-vigorous physical activity (40.7 vs. 38.6 min per day, p = 0.623).Interventions facilitating action control via text messages seem to be an effective tool for increasing adherence to physical activity guidelines in everyday life. The comparable effects for the dyadic and individual intervention suggest that automated text messages may be just as effective as personalized messages from the romantic partner. Further investigation is needed to examine the usefulness of a dyadic conceptualizing of action control. (controlled-trials.com ISRCTN15705531).

More than 100 million people globally are estimated to be exposed to arsenic in drinking water that exceeds the World Health Organization guideline of 10 µg/L. In an effort to develop and test a low-cost sustainable approach for water arsenic testing in Bangladesh, we conducted a randomized controlled trial which found arsenic educational interventions when combined with fee-based water arsenic testing programs led to nearly all households buying an arsenic test for their drinking water sources (93%) compared with only 53% when fee-based arsenic testing alone was offered. The aim of the present study was to build on the findings of this trial by investigating prospectively the psychological factors that were most strongly associated with switching to arsenic-safe wells in response to these interventions. Our theoretical framework was the RANAS (risk, attitude, norm, ability, and self-regulation) model of behavior change. In the multivariate logistic regression model of 285 baseline unsafe well users, switching to an arsenic-safe water source was significantly associated with increased instrumental attitude (odds ratio [OR] = 9.12; 95% confidence interval [CI] = [1.85, 45.00]), descriptive norm (OR = 34.02; 95% CI = [6.11, 189.45]), coping planning (OR = 11.59; 95% CI = [3.82, 35.19]), and commitment (OR = 10.78; 95% CI = [2.33, 49.99]). In addition, each additional minute from the nearest arsenic-safe drinking water source reduced the odds of switching to an arsenic-safe well by more than 10% (OR = 0.89; 95% CI = [0.87, 0.92]). Future arsenic mitigation programs should target these behavioral determinants of switching to arsenic-safe water sources.

BACKGROUND: Despite their good intentions people often do not eat healthily. This is known as the intention behavior gap. Although the intention behavior relationship is theorized as a within person process most evidence is based on between person differences. PURPOSE: The purpose of the present study is to investigate the within person intention behavior association for unhealthy snack consumption. METHODS: Young adults (N?=?45) participated in an intensive longitudinal study. They reported intentions and snack consumption five times daily for 7 days (n?=?1068 observations analyzed). RESULTS: A within person unit difference in intentions was associated with a halving of the number of unhealthy snacks consumed in the following 3 h (CI95 27 70 ). Between person differences in average intentions did not predict unhealthy snack consumption. CONCLUSIONS: Consistent with theory the intention behavior relation for healthy eating is best understood as a within person process. Interventions to reduce unhealthy snacking should target times of day when intentions are weakest.