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Background: Work-life balance is associated with health behaviors. In the face of digitalization, understanding this link requires a theory-based investigation of problematic internet use and perceived stress, which are so far unknown., Objective: On the basis of the compensatory carry-over action model, this study aimed to determine whether problematic internet use and perceived stress mediate the relationship between health behaviors and work-life balance in two groups of internet users from different environments (residents in Germany and China). We also investigated whether the place of residence was a moderator., Methods: An online questionnaire (N=877) was administered to residents from Germany (n=374) and China (n=503) in 3 languages (German, English, and Chinese). Moderated mediation analyses were run with health behaviors as the independent variable, work-life balance as the dependent variable, problematic internet use and perceived stress as the mediator variables, and place of residence as a potential moderator., Results: On a mean level, individuals in Germany reported less problematic internet use and more health behaviors than individuals in China; however, they also had lower work-life balance and higher perceived stress. Results showed that health behaviors seem to be directly related to work-life balance in both groups. Among the residents of Germany, a partial mediation was revealed (β=.13; P=.01), whereas among the residents of China, a full mediation was found (β=.02; P=.61). The mediator role of perceived stress was compared with problematic internet use in all the serial models and the parallel model. Residence moderated the relationship between health behaviors and work-life balance: The interrelation between health behaviors and work-life balance was stronger in Germany (β=.19; P<.001) than in China (β=.11; P=.01) when controlling for other variables., Conclusions: The findings of this study are in line with the compensatory carry-over action model. To promote work-life balance, individuals should perform health behaviors to help overcome problematic internet use and perceived stress. Both problematic internet use and perceived stress mediated health behaviors and work-life balance partially in German study participants and fully in Chinese study participants., (©Lingling Gao, Yiqun Gan, Amanda Whittal, Song Yan, Sonia Lippke. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 11.05.2020.)

Objectives: We investigated whether social-cognitive variables predicted physical activity behavior and whether Internet use interrelated with the mediator, across age groups. Methods: Participants (N = 466) were recruited for an online survey and path analyses were run to generate a proposed model examining late adolescents (Group 1, aged 17-20 years), young adults (Group 2, aged 21-40 years), and middle-aged adults (Group 3, aged 41-60 years). Results: Positive associations between physical activity variables were as expected: the relationships between self-efficacy and intention, self-efficacy and behavior, planning and behavior were statistically significant in Groups 1 and 2. The relationships between intention and planning were statistically significant in Groups 2 and 3. All groups showed statistically significant relationships between self-efficacy and planning. Positive associations between Internet use and physical activity emerged only in Group 1. Internet use was negatively correlated with physical activity planning only in Group 3. Conclusions: Late adolescents should be supported to enhance physical activity planning, and middle-aged adults may benefit from support in reducing the possible conflicts between physical activity planning and time spent online. Furthermore, increasing self-efficacy for all groups is key to adopting and maintaining physical activity.

Background: Web-based, theory-driven interventions effectively promote older adults' physical activity. Social-cognitive mechanisms of their effect on stage of change need to be further researched., Methods: Older adults were randomly allocated to intervention group 1 (10-week online physical activity program), intervention group 2 (same program plus activity tracker), or delayed intervention control group; n = 351 were analyzed (59.6% of originally allocated individuals). Stages of change for recommended endurance and strength training and social-cognitive predictors of physical activity were assessed using questionnaires at baseline and follow-up. Intervention effects and mediation were investigated using mixed-effects ANOVA and ordinal least squares regression., Results: Direct effects on stage of change were found for intervention group 1 regarding endurance training (b intervention group 1  = 0.44, 95% confidence interval [0.15, 0.73]), and both groups regarding strength training (b intervention group 1  = 1.02, [0.71, 1.33], b intervention group 2  = 1.24, [0.92, 1.56]). Social-cognitive predictor changes in task self-efficacy, intention, and action planning explained intervention effect on stage of change, but not to the full extent., Conclusions: The results indicate significant web-based intervention effects on physical activity stage, partly mediated by changes in task self-efficacy, intention, and action planning., (© 2019 The International Association of Applied Psychology.)

EHealth behaviour change interventions that help participants to adhere to professional physical activity recommendations can help to prevent future events of cardiovascular diseases (CVD). Therefore, identifying user groups of such interventions based on stages of health behaviour change is of great importance to provide tailored content to users instead of one-size-fits-all approaches. Our study used Latent Class Analysis (LCA) to identify underlying classes of users of an eHealth behaviour change intervention based on stages of change and associated variables. We compared participants' self-allocated stage with their latent class stage membership to display the correlation and mean differences between the two approaches. This was done by analysing baseline data of N = 310 people interested in reducing their CVD risk. LCA identified a three-class solution: (non-)intenders (19.4%), non-habituated actors (43.2%) and habituated actors (37.4%). The interrelation between self-allocated and latent class stage membership was moderate ( ρ (308) = .49, p  < .001). Significant mean differences for (non-)intenders and non-habituated actors were found in social-cognitive variables. Results showed that self-allocated stage outcomes represent a pseudo stage model - linear trends can be reported for stage-associated social-cognitive variables. The study provides information on the validity of stage measures, which can inform future interventions.

Background: Web-based and theory-based interventions for multiple health behaviors appears to be a promising approach with respect to the adoption and maintenance of a healthy lifestyle in cardiac patients who have been discharged from the hospital. Until now, no randomized controlled trials have tested this assumption among Chinese rehabilitation patients with coronary heart disease using a Web-based intervention., Objective: The study aim was to evaluate the effect of an 8-week Web-based intervention in terms of physical activity (PA), fruit and vegetable consumption (FVC), lifestyle changes, social-cognitive outcomes, and health outcomes compared with a waiting control group in Chinese cardiac patients. The intervention content was theory-based on the health action process approach. Self-reported data were evaluated, including PA, FVC, healthy lifestyle (the synthesis of PA and FVC), internal resources (combination of intention, self-efficacy, and planning), and an external resource (social support) of PA and FVC behaviors, as well as perceived health outcomes (body mass index, quality of life, and depression)., Methods: In a randomized controlled trial, 136 outpatients with coronary heart disease from the cardiac rehabilitation center of a hospital in China were recruited. After randomization and exclusion of unsuitable participants, 114 patients were assigned to 1 of the 2 groups: (1) the intervention group: first 4 weeks on PA and subsequent 4 weeks on FVC and (2) the waiting control group. A total of 2 Web-based assessments were conducted, including 1 at the beginning of the intervention (T1, N=114), and 1 at the end of the 8-week intervention (T2, N=83). The enrollment and follow-up took place from December 2015 to May 2016., Results: The Web-based intervention outperformed the control condition for PA, FVC, internal resources of PA and FVC, and an external resource of FVC, with an eta-squared effect size ranging from 0.06 to 0.43. Furthermore, the intervention effect was seen in the improvement of quality of life (F 1,79 =16.36, P<.001, η 2 =.17). When predicting a healthy lifestyle at follow-up, baseline lifestyle (odds ratio, OR 145.60, 95% CI 11.24-1886; P<.001) and the intervention (OR 21.32, 95% CI 2.40-189.20; P=.006) were found to be significant predictors. Internal resources for FVC mediated the effect of the intervention on the adoption of a healthy lifestyle (R 2 adj =.29; P=.001), indicating that if the intervention increased the internal resource of behavior, the adoption of a healthy lifestyle was more likely., Conclusions: Patients' psychological resources such as motivation, self-efficacy, planning, and social support as well as lifestyle can be improved by a Web-based intervention that focuses on both PA and FVC. Such an intervention enriches extended rehabilitation approaches for cardiac patients to be active and remain healthy in daily life after hospital discharge., Trial Registration: ClinicalTrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/6pHV1A0G1)., (©Yan Ping Duan, Wei Liang, Lan Guo, Julian Wienert, Gang Yan Si, Sonia Lippke. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 19.11.2018.)

Purpose/objective: After rehabilitation, it is important to maintain adopted target behaviors such as physical activity and physical exercise. By generating detailed behavioral plans, rehabilitants may translate their intentions into actual behavior. The aim of this study was to investigate whether Conscientiousness would further facilitate this mechanism in a way that rehabilitants who are more conscientious would be more likely to act upon their plans. Research Method/Design: The study presents secondary analyses from a larger intervention in cardiac and orthopedic rehabilitation. N = 136 rehabilitants were surveyed via online questionnaires during treatment (Time 1 [T1]) and with computer-assisted telephone interviews (CATIs) 6 weeks (Time 2 [T2]) and 6 months (Time 3 [T3]) after discharge from the clinic. Intention, planning, Conscientiousness, and behavior were measured. A conditional process analysis examined whether Conscientiousness moderates the intention-planning-physical activity chain., Results: Planning had a mediating effect on intentions and physical activity. Moreover, this mediation effect was conditional on the level of Conscientiousness: Highly conscientious rehabilitants were more successful in translating their plans into behavior than their less conscientious counterparts., Conclusions/implications: Self-regulatory mechanisms such as action-facilitating planning strategies may be more efficient in conscientious rehabilitants. Conscientiousness reflects dispositional self-regulation and can be supportive when it comes to maintain difficult behaviors. Lack of Conscientiousness needs to be compensated by more intense support of rehabilitation patients, in order to plan appropriately and to act upon these plans in the face of barriers. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Purpose: The study investigated differences in motivational and volitional correlates of physical activity in persons who reported currently having hypertension, had hypertension in the past, or had no hypertension by using the health action process approach as a theoretical background., Method: Self-reported data from 512 participants (71.9% women; M age  = 46.83 years; SD age  = 13.77; M BMI  = 24.89; SD BMI  = 4.71) were analyzed using multivariate analysis of variance (MANOVA), analysis of variance (ANOVA), and post hoc comparisons of groups to determine differences in motivational and volitional correlates for physical activity between groups followed by analysis of covariance (ANCOVA). Additionally, χ 2 statistic was used to analyze differences in the distribution of behavioral stages between groups., Results: Participants with hypertension reported a higher perceived vulnerability (d = 0.99) and lower action planning (d = 0.32) and self-efficacy (d = 0.30) compared to those who indicated no hypertension. Their perceived vulnerability was also higher compared to those who indicated past hypertension on the mean level (d = 0.60). Significant main effects for all independent variables were found when controlling for gender and HAPA stages with main effects for perceived vulnerability, action planning, and self-efficacy. Participants with current hypertension were more prominent in the intender stage, whereas participants with past hypertension were more likely to be in the actor stage. Participants with no hypertension at all were equally distributed across the intender and actor stages., Conclusion: The study contributes to the understanding of differences in motivational and volitional correlates of physical activity in persons who reported different hypertension statuses.

In this study, we draw attention to time-competing activities and psychological variables as impeding or enabling factors of physical activity behavior in 55- to 70-year-old Germans. Cross-sectional data was used (n = 4,891). Results indicate that paid work has a negative relationship with sufficient physical activity. Persons who provide nursing care seem to be motivated to achieve sufficient physical activity behavior, but do not meet established recommendations. Active citizenship positively relates to higher physical activity levels. The investment of energy in life domains and a distinct internal locus of control characterize motivated underachievers. Those sufficiently physically active show higher values in conscientiousness. This suggests that time-consuming and strongly externally determined activities like nursing care and paid work hinder a sufficient level of physical activity, even if the motivation is existent. Active citizenship and physical activity seem to be linked processes.

Recommendations for physical activity and for fruit and vegetable intake are often not translated into action due to deficits in self-regulatory strategies. The present study examines the interplay of intention, intergoal facilitation, action and coping planning and self-regulation in facilitating physical activity and healthy nutrition. In an online study, intentions and behaviours were assessed at baseline, intergoal facilitation and planning at 4-week follow-up, self-regulation, physical activity and nutrition at 6-month follow-up in a non-clinical sample. The final sample (n = 711) consisted of 27.2% men, the age ranged from 16 to 78 years. Sequential mediations were tested. Intergoal facilitation, planning and self-regulation mediated the link from intention to physical activity and nutrition; the specific indirect effects were significant. Findings suggest that intergoal facilitation and self-regulation can facilitate behaviour change, in addition to planning. Cross-behavioural mechanisms might facilitate lifestyle change in several domains.

Objective: Although it has been confirmed that physical exercise improves orthopedic conditions, many individuals fail to maintain a regular exercise regimen after being discharged from medical rehabilitation. The present study examines the role of intention, social support, self-determination, planning, and self-efficacy in facilitating strength and endurance training., Design: In a 7-year observational study, intention, received social support and self-determination were assessed at baseline, self-efficacy and planning at 6-month follow-up, and physical exercise at 1-year, 3-year, and 7-year follow-up. Study participants were recruited from an orthopedic rehabilitation center, N = 641 participated in the survey at baseline, n = 495 at 6-month follow-up, n = 373 at 1-year follow-up, n = 330 at 3-year follow-up, and n = 191at 7-year follow-up. Path analyses were applied to investigate whether personal and social resources contribute to long-term physical activity., Results: Self-determination and planning mediated the link from intention and from social support to physical exercise at 1-, 3- and 7-year follow-ups. Self-efficacy facilitated planning and bridged the intention-behavior relationship in the domain of strength training after 1 year. An inverse direct relationship between social support and strength training was also found for all follow-ups., Conclusions: Findings indicate that intention, received social support and self-determination act as crucial resources in the long-term management of exercise. Planning can bridge the intention-behavior gap on a long-term basis. Behavior change interventions should replenish personal and social resources to empower individuals to maintain a healthy lifestyle (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Background: Ample evidence demonstrates that university students are at high risk for sedentary behaviors and inadequate fruit and vegetable intake (FVI). Internet-based interventions for multiple health behavior appear to be promising in changing such unhealthy habits. Limited randomized controlled trials have tested this assumption among Chinese university students., Objective: Our objective was to test the efficacy of an 8-week Web-based intervention compared with a control group condition to improve physical activity (PA) and FVI in Chinese university students. The intervention content was based on the health action process approach, and developed on the basis of previous evidence from the Western hemisphere. We evaluated self-reported data including PA and FVI, stages of change for PA and FVI, and motivational (risk perception, outcome expectancies, self-efficacy), volitional (action planning, coping planning, social support), and distal (intention, habit) indicators for PA and FVI, as well as perceived mental health outcomes (quality of life, depression)., Methods: In a randomized controlled trial, we recruited 566 university students from one university in the central region of China during their general physical education class. After random allocation and exclusion of unsuitable participants, we assigned 493 students to 1 of 2 groups: (1) intervention group: first 4 weeks on PA and subsequent 4 weeks on FVI, (2) control group. We conducted 3 Web-based assessments: at the beginning of the intervention (T1, n=493), at the end of the 8-week intervention (T2, n=337), and at a 1-month follow-up after the intervention (T3, n=142). The entire study was conducted throughout the fall semester of 2015., Results: Significant time ⨯ group interactions revealed superior intervention effects on FVI; motivational, volitional, and distal indicators of FVI; and PA behavior changes, with an effect size (η 2 ) ranging from .08 to .20. In addition, the overall intervention effects were significant for stage progression to the action group from T1 to T2 in PA (χ 2 1 =11.75, P=.001) and FVI (χ 2 1 =15.64, P=.03). Furthermore, the intervention effect was seen in the improvement of quality of life (F 3,492 =1.23, η 2 =.03, P=.02)., Conclusions: This study provides evidence for the efficacy of a Web-based multiple health behavior intervention among Chinese university students tested with different outcome variables. Future research should address the high dropout rate and optimize the most effective components of this intervention., Trial Registration: Clinicaltrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/6pHV1A0G1)., (©Yan Ping Duan, Julian Wienert, Chun Hu, Gang Yan Si, Sonia Lippke. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 10.04.2017.)

We tested whether the relationship between subjective physical age and physical activity is mediated by planning. Participants came from a broad age range (25-78 years, M = 39.57, standard deviation = 10.75) and reported relatively good health ( M = 3.36, standard deviation = 0.90). The model supported the suggested mediation ( β = -.01, standard error = .01, p = .042). Feeling physically younger is associated with higher planning to adopt higher levels of physical activity and more planning is associated with more subsequent physical activity. Results open avenues for interventions that help people to become more active by focusing on subjective age. One way to do so might be tailoring approaches for interventions.

Non-communicable diseases (i.e., chronic diseases including cardiovascular disease, cancer, chronic respiratory disease, diabetes and obesity) result in 36 million deaths each year. Individuals' habitual participation in a single health-risk behaviors substantially contribute to morbidity and mortality (e.g., tobacco use, daily fast food intake, etc.); however, more concerning is the impact of typically co-occurring or clustering of multiple health-risk behaviors. This burden can be minimized through successful cessation of health-risk behaviors and adoption of healthy behaviors; namely healthy lifestyle adoption or multiple health behavior change (MHBC). MHBC is a developing field and future research recommendations are provided to advance MHBC research. A valid measure of MHBC (i.e., lifestyle) is warranted to provide the needed basis for MHBC investigations and evaluations. MHBC is thought to occur through shared co-variation of underlying motivating mechanisms, but how these relationships influence behavior remains unclear. A better understanding of the relationship between behaviors and the related motivating mechanisms (and potential cross-relationship of influences) is needed. Future research should also aim to improve lifestyles through understanding how to change multiple health behaviors. Finally, MHBC research should target the development of sustainable interventions which result in lasting effects (e.g., capacity, systems, policy and environmental changes), with dissemination considered during development. Focusing MHBC research in these areas will increase our understanding and maximize the impact on the health of populations.

Background: Visual analogue scales (VASs) have been shown to be valid measurement instruments and a better alternative to Likert-type scales in Internet-based research, both empirically and theoretically [1,2]. Upsides include more differentiated responses, better measurement level, and less error. Their feasibility and properties in the context of eHealth, however, have not been examined so far., Objective: The present study examined VASs in the context of a lifestyle study conducted online, measuring the impact of VASs on distributional properties and non-response., Method: A sample of 446 participants with a mean age of 52.4 years (standard deviation (SD) = 12.1) took part in the study. The study was carried out as a randomized controlled trial, aimed at supporting participants over 8 weeks with an additional follow-up measurement. In addition to the randomized questionnaire, participants were further randomly assigned to either a Likert-type or VAS response scale version of the measures., Results: Results showed that SDs were lower for items answered via VASs, 2P (Y ≥ 47 | n=55, P=.5) < .001. Means did not differ across versions. Participants in the VAS version showed lower dropout rates than participants in the Likert version, odds ratio = 0.75, 90% CI (0.58-0.98), P=.04. Number of missing values did not differ between questionnaire versions., Conclusions: The VAS is shown to be a valid instrument in the eHealth context, offering advantages over Likert-type scales. The results of the study provide further support for the use of VASs in Internet-based research, extending the scope to senior samples in the health context., Trial Registration: Clinicaltrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/6h88sLw2Y).

Background: In order to improve the transition from an intention to a change in health behaviour, action planning is a frequently used behavioural change method. The quality of action plans in terms of instrumentality and specificity is important in terms of supporting a successful change in health behaviour. Until now, little has been known about the predictors of action plan generation and the predictors of high quality action plans and, therefore, the current study investigates these predictors., Method: A randomised controlled trial was conducted to improve physical activity (PA) and fruit and vegetable (FV) consumption using a web-based computer tailored intervention. During the 8-week intervention period, participants in the intervention arm (n = 346) were guided (step-by-step) to generate their own action plans to improve their health behaviours. Demographic characteristics, social cognitions, and health behaviour were assessed at baseline by means of self-reporting. Whether participants generated action plans was tracked by means of server registrations within two modules of the intervention., Results: The action planning component of the intervention regarding physical activity and fruit and vegetable consumption was used by 40.9 and 20.7 % of the participants, respectively. We found that participants who were physically active at baseline were less likely to generate action plans concerning physical activity. With regards to generating fruit and vegetable action plans, participants with a high risk perception and a strong intention to eat fruit and vegetables on a daily basis made more use of the action planning component for this behaviour. Finally, the large majority of the action plans for physical activity (96.6 %) and fruit and vegetable consumption (100 %) were instrumental and about half of the action plans were found to be highly specific (PA = 69.6 %/FV = 59.7 %). The specificity of the action plans is associated with having a relationship and low levels of negative outcome expectancies., Conclusion: Risk perception and intention are predictors of using the application of action planning. Increasing the motivation to change behaviour should be prioritised in interventions concerning changes in health behaviour before participants are asked to generate action plans. This would also make the intervention suitable for unmotivated people. For those participants who already perform the desired health behaviour prior to the intervention, action plans might be less relevant. Nevertheless, using a guided step-by-step approach to generate action plans resulted in highly instrumental and specific action plans and might be integrated into other interventions concerning changes in health behaviour., Trial Registration: Netherlands Trial Register: NTR 3706, ClinicalTrials.gov: NCT01909349 .

Background: Web-based computer-tailored interventions for multiple health behaviors can improve the strength of behavior habits in people who want to reduce their cardiovascular risk. Nonetheless, few randomized controlled trials have tested this assumption to date., Objective: The study aim was to test an 8-week Web-based computer-tailored intervention designed to improve habit strength for physical activity and fruit and vegetable consumption among people who want to reduce their cardiovascular risk. In a randomized controlled design, self-reported changes in perceived habit strength, self-efficacy, and planning across different domains of physical activity as well as fruit and vegetable consumption were evaluated., Methods: This study was a randomized controlled trial involving an intervention group (n=403) and a waiting control group (n=387). Web-based data collection was performed in Germany and the Netherlands during 2013-2015. The intervention content was based on the Health Action Process Approach and involved personalized feedback on lifestyle behaviors, which indicated whether participants complied with behavioral guidelines for physical activity and fruit and vegetable consumption. There were three Web-based assessments: baseline (T0, N=790), a posttest 8 weeks after the baseline (T1, n=206), and a follow-up 3 months after the baseline (T2, n=121). Data analysis was conducted by analyzing variances and structural equation analysis., Results: Significant group by time interactions revealed superior treatment effects for the intervention group, with substantially higher increases in self-reported habit strength for physical activity (F1,199=7.71, P=.006, Cohen's d=0.37) and fruit and vegetable consumption (F1,199=7.71, P=.006, Cohen's d=0.30) at posttest T1 for the intervention group. Mediation analyses yielded behavior-specific sequential mediator effects for T1 planning and T1 self-efficacy between the intervention and habit strength at follow-up T2 (fruit and vegetable consumption: beta=0.12, 95% CI 0.09-0.16, P<.001; physical activity: beta=0.04, 95% CI 0.02-0.06, P<.001)., Conclusions: Our findings indicate the general effectiveness and practicality of Web-based computer-tailored interventions in terms of increasing self-reported habit strength for physical activity and fruit and vegetable consumption. Self-efficacy and planning may play major roles in the mechanisms that facilitate the habit strength of these behaviors; therefore, they should be actively promoted in Web-based interventions. Although the results need to take into account the high dropout rates and medium effect sizes, a large number of people were reached and changes in habit strength were achieved after 3 months., Trial Registration: Clinicaltrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/6g5F0qoft) and Nederlands Trial Register NTR3706 http://www.trialregister.nl/ trialreg/admin/rctview.asp?TC=3706 (Archived by WebCite at http://www.webcitation.org/6g5F5HMLX).

Background: The study examined the measurement quality of a stage algorithm measuring the Four steps from Inactivity to activity Theory (FIT Model)., Methods: In a cross-sectional study, stages were assessed in 1012 Chinese university students in terms of physical activity, social-cognitive variables and health outcomes. Main outcome measures were stages of change, self-reported physical activity, perceived barriers, intrinsic motivation, plans, fitness and health satisfaction. Misclassification, sensitivity, specificity, receiver operating characteristic (ROC) curves, nonlinear trends, and planned comparison were computed., Results: Compared to previous studies, sensitivity was at the average level (64 %-71 %), and specificity was comparably higher (76%-89%). When using higher PA intensity criteria (moderate and strenuous intensities), sensitivity was higher, whereas specificity was lower in comparison to the lower PA intensity criteria (also including mild activity). After running contrast and trend analyses, nonlinear trends for all indicative variables across the stages and a match of 77 % of predictions of stage differences were confirmed., Conclusion: The measurement quality of the stage algorithm was supported in a young adult sample.

This study investigated differences in social-cognitive predictors and self-regulatory planning, as proposed by the health action process approach (HAPA), across three different subjective physical age groups for physical activity. With a cross-sectional design, 521 participants across the chronological age span from 25 to 86 years (M = 48.79; SD = 12.66) were separated into three groups: those who feel physically younger than they are in terms of chronological age, the same perceived and chronological age, and feeling physically older compared to their chronological age. Participants were assessed regarding their perceived vulnerability, outcome expectancies, general intentions, planning, self-efficacy, and stages of physical activity (non-intenders, intenders, and actors). Data were analysed via mean comparison and multigroup structural equation modelling. Mean differences for all but one construct were eminent in all groups, generally showing that those feeling physically younger also report better social-cognitive predictors of physical activity (e.g. lower perceived vulnerability) in comparison to those who feel the same age or older. The model showed that basic working mechanisms of the HAPA can be applied to all groups. With that, the results provide for the first time evidence that principle working mechanism of the HAPA can be applied to all subjective physical age groups. These may be used to tailor health promoting interventions according to participants' needs as a more suitable proxy than chronological age.

Background: Preventive health behaviors, such as regular physical activity and healthy nutrition, are recommended to maintain employability and to facilitate the health of employees. Theory-based workplace health promotion needs to include psychological constructs and consider the motivational readiness (so-called stages of change) of employees. According to the stages, people can be grouped as nonintenders (not motivated to change and not performing the goal behavior), intenders (decided to adopt the goal behavior but not started yet), or actors (performing the goal behavior already). The tailoring to these stages can be done computer based and should make workplace health promotion more effective., Objective: It was tested whether a parsimonious computer-based health promotion program implemented at the workplace was effective in terms of lifestyle changes and psychological outcomes as well as body weight. We hypothesized that the stage-matched intervention would outperform the one-size-fits-all active control condition (standard care intervention)., Methods: In a randomized controlled trial, a total of 1269 employees were recruited by a trained research assistant at their workplace during a routine medical examination. After excluding noneligible employees, 560 completed Time 1 (T1), and 384 also completed Time 2 (T2), achieving a retention rate of 68.6%. Two fully automated computer-based treatments were adopted: (1) an active control condition with information about benefits of exercise and healthy nutrition (n=52), or (2) a stage-matched multiple-behavior intervention that provided different psychological treatments to 9 subgroups, addressing stages of change (nonintenders, intenders, and actors per behavior; n=332). Baseline assessments (T1) on behavior, psychological constructs, and body weight were repeated after 4 weeks (T2)., Results: The stage-matched intervention outperformed the active control condition for lifestyle changes containing physical activity and nutrition (χ(2) 1=3.5; P=.04, for N=384) as well as psychological variables (physical activity intention, P=.04; nutrition intention, P=.03; nutrition planning, P=.02; and general social support to live healthily, P=.01). When predicting a healthy lifestyle at follow-up, baseline lifestyle (odds ratio, OR, 2.25, 95% CI 1.73-2.92; P<.01) and the intervention (OR 1.96, 95% CI 1.00-3.82; P=.05) were found to be significant predictors. Physical activity planning mediated the effect of the intervention on the adoption of an overall healthy lifestyle (consisting of activity and nutrition, R(2) adj=.08; P<.01), indicating that if the stage-matched intervention increased planning, the adoption of a healthy lifestyle was more likely., Conclusions: Matching an intervention to the motivational readiness of employees can make a health promotion program effective. Employees' motivation, planning, social support, and lifestyle can be supported by a stage-matched intervention that focuses on both physical activity and healthy nutrition. Occupational settings provide a potential to implement parsimonious computer-based health promotion programs and to facilitate multiple behavior change.

This study aimed to examine the interrelation of physical activity and fruit and vegetable intake. The influence of stage congruence between physical activity and fruit and vegetable intake on multiple behavior change was also investigated. Health behaviors, social-cognitions, and stages of change were assessed in 2693 adults at two points in time. Physical activity and fruit and vegetable intake were assessed 4 weeks after the baseline. Social-cognitions, stages as well as stage transitions across behavior domains were positively interrelated. Stage congruence was not related to changes in physical activity and fruit and vegetable intake. Physical activity and nutrition appear to facilitate rather than hinder each other. Having intentions to change both behaviors simultaneously does not seem to overburden individuals., (© The Author(s) 2015.)

Purpose: Motivational processes can be set in motion when positive consequences of physical exercise are experienced. However, relationships between positive exercise experience and determinants of the motivational and the volitional phases of exercise change have attracted only sparse attention in research., Method: This research examines direct and indirect associations between positive experience and motivational as well as volitional self-efficacy, intention, action planning, and exercise in two distinct longitudinal samples. The first one originates from an online observational study in the general population with three measurement points in time (N = 350) and the second one from a clinical intervention study in a rehabilitation context with four measurement points (N = 275)., Results: Structural equation modeling revealed the following: Positive experience is directly related with motivational self-efficacy as well as intentions in both samples. In the online sample only, positive experience is associated with volitional self-efficacy. In each sample, experience is indirectly associated with action planning via motivational self-efficacy and intentions. Moreover, action planning, in turn, predicts changes in physical exercise levels., Conclusions: Findings suggest a more prominent role of positive experience in the motivational than in the volitional phase of physical exercise change. Thus, this research contributes to the understanding of how positive experience is involved in the behavior change process., (© 2014 Society for Public Health Education.)

Objective: This study tested the applicability of the Health Action Process Approach (HAPA) in a sample of obese adults in the context of physical activity., Method: Physical activity was assessed along with motivational and volitional variables specified in the HAPA (motivational self-efficacy, outcome expectancies, risk perception, intention, maintenance self-efficacy, action planning, coping planning, recovery self-efficacy, social support) in a sample of 484 obese men and women (body mass index ≥ 30 kg/m2)., Results: Applying structural equation modeling, the fit of the HAPA model was satisfactory-χ²(191) = 569.93, p < .05, χ²/df = 2.98, comparative fit index = .91, normed-fit index = .87, and root mean square error of approximation = .06 (90% CI = .06, .07)-explaining 30% of the variance in intention and 18% of the variance in physical activity. Motivational self-efficacy, outcome expectancies, and social support were related to intention. An association between maintenance self-efficacy and coping planning was found. Recovery self-efficacy and social support were associated with physical activity. No relationships were found between risk perception and intention and between planning and physical activity. The assumptions derived from the HAPA were partly confirmed and the HAPA may, therefore, constitute a theoretical backdrop for intervention designs to promote physical activity in adults with obesity., (PsycINFO Database Record (c) 2014 APA, all rights reserved.)

Objective: Long-term rehabilitation success depends on regular exercise and healthy nutrition. The present study introduces a new framework to explain this association on a psychosocial level. The exercise-nutrition relationship was investigated by exploring the sequential mediation of habit strength and transfer cognitions., Design: Analyses were performed at two measurement points in time (at 12 and 18 months after rehabilitation), involving 470 medical rehabilitation patients who participated in an exercise intervention., Main Outcome Measures: Patients filled in paper-pencil questionnaires assessing exercise (t1) and habit strength, transfer cognitions and healthy nutrition at follow-up (t2)., Results: Habit strength and transfer cognitions mediated the relationship between exercise and nutrition., Conclusion: Findings suggest that habit strength and transfer cognitions are important factors underlying the relationship between exercise and nutrition.

Objective: The Health Action Process Approach (HAPA) proposes principles that can be translated into testable hypotheses. This is one of the first studies to have explicitly tested HAPA's first 2 principles, which are (1) health behavior change process can be subdivided into motivation and volition, and (2) volition can be grouped into intentional and action stages. The 3 stage groups are labeled preintenders, intenders, and actors., Method: The hypotheses of the HAPA model were investigated in a sample of 1,193 individuals with Type 2 diabetes. Study participants completed a questionnaire assessing the HAPA variables. The hypotheses were evaluated by examining mean differences of test variables and by the use of multigroup structural equation modeling (MSEM)., Results: Findings support the HAPA's 2 principles and 3 distinct stages. The 3 HAPA stages were significantly different in several stage-specific variables, and discontinuity patterns were found in terms of nonlinear trends across means. In terms of predicting goals, action planning, and behavior, differences transpired between the 2 motivational stages (preintenders and intenders), and between the 2 volitional stages (intenders and actors)., Conclusions: Results indicate implications for supporting behavior change processes, depending on in which stage a person is at: All individuals should be helped to increase self-efficacy. Preintenders and intenders require interventions targeting outcome expectancies. Actors benefit from an improvement in action planning to maintain and increase their previous behavior. Overall, the first 2 principles of the HAPA were supported and some evidence for the other principles was found. Future research should experimentally test these conclusions., (2014 APA, all rights reserved)

Objectives: Experiencing positive consequences of one's physical activity is supposed to facilitate further activity. This motivational outcome might be generated by an increase in perceived self-efficacy. In addition to such a mediator effect, we examine whether this applies generally or only under conditions of volitional control. For this purpose, perceived action control was considered as a putative moderator., Design and Method: N = 193 students participated in a study with three measurement points in time. At baseline, positive experience with previous physical activity was measured as a predictor of physical activity. Two weeks later, self-efficacy and action control variables were assessed as putative mediator and moderator, respectively. After another 2 weeks, physical activity was measured as the outcome. A moderated mediation model was specified with baseline physical activity and sex as covariates., Results: Self-efficacy was found to mediate between initial positive experience and later physical activity, and this mediation was moderated by action control., Conclusions: Participants' perceptions of positive experience were associated with their subsequent self-efficacy fostering physical activity. However, persons with low levels of action control did not translate positive experience into physical activity via self-efficacy., Statement of Contribution: What is already known on this subject? Numerous studies have shown that exercise-specific self-efficacy predicts subsequent physical activity. Prior positive experience with physical activity is suggested to be associated with exercise-specific self-efficacy. Furthermore, action control was found to be beneficial for the maintenance of physical activity. What does this study add? This study unveils the mechanisms between these social-cognitive determinants: our longitudinal results suggest that the mediation of positive experience and subsequent physical activity via self-efficacy is moderated by action control. Persons with low levels of action control did not translate positive experience into physical activity via self-efficacy., (© 2012 The British Psychological Society.)

Fruit and vegetable consumption represents a nutritional goal to prevent obesity and chronic illness. To change dietary behaviors, people must be motivated to do so, and they must translate their motivation into actual behavior. The present experiment aims at the psychological mechanisms that support such changes, with a particular focus on dietary self-efficacy and planning skills. A randomized controlled trial compared a theory-based psychological intervention with a health education session in 114 participants. Dependent variables were fruit and vegetable consumption, intention to consume more fruit and vegetables, planning to consume more, and dietary self-efficacy, assessed before the intervention, 1 week afterwards, and at 6-week follow up. Significant group by time interactions for all four dependent variables documented superior treatment effects for the psychological intervention group, with substantially higher scores at posttest and follow-up for the experimental group, although all students benefited from participation. To identify the contribution of the main intervention ingredients (self-efficacy and planning), regression analyses yielded mediator effects for these two factors. A social-cognitive intervention to improve fruit and vegetable consumption was superior to a knowledge-based education session. Self-efficacy and planning seem to play a major role in the mechanisms that facilitate dietary changes.

To test whether forming and memorizing more action plans has larger effects than generating fewer plans. In a randomized controlled trial with five intervention groups and one control group, 478 participants were asked to form one, two, three, four, or five action plans, or to complete questionnaires only (control group). One week later, behavior change was measured and participants of the intervention groups completed a free recall task. Outcome measures are daily intake of fruit and vegetables as well as recall of plans. Fruit and vegetable intake increased with higher numbers of plans, and was significantly larger in groups that formed four (d = 0.36) or five plans (d = 0.48) as compared to controls. The sum of recalled plans reflected the number of generated plans, but was unrelated to behavior change. Generating multiple plans benefits behavior change, but to be implemented they need not be recalled.

Background: Limitations in perceived lifetime can undermine long-term goal striving. Planning is supposed to translate intentions into health behaviors and to operate as a compensatory strategy to overcome goal striving deficits associated with a limited time perspective., Purpose: Two longitudinal studies were conducted examining the compensatory role of planning: an online survey on fruit and vegetable consumption (N = 909; 16-78 years; follow-up at 4 months) and a questionnaire study on physical exercise in older adults (N = 289; 60-95 years, over a half-year period)., Methods: Intentions, planning, and behavior were measured in a behavior-specific, future time perspective in a generic manner., Results: Planning mediated between intentions and both health behaviors. Time perspective operated as a moderator, indicating that in individuals with a more limited time perspective, a stronger effect of planning on health behaviors emerged., Conclusions: Planning as a self-regulatory strategy may compensate for a limited time perspective.

Many individuals are motivated to improve their physical activity levels but often fail to act on their good intention. This study examines the roles of planning and self-efficacy in the prediction of physical activity. A total of 290 participants (77% women, mean age = 41.9 years) were surveyed three times. Intentions, planning, and physical activity were specified as a mediator chain. Results reveal that intentions were partly translated into physical activity by planning. Self-efficacy moderated this mediation, reflected by a planning × self-efficacy interaction (p < .05) on physical activity accounting for 16% of the variance in behavior. If a person is self-efficacious, planning seems more likely to be translated into physical activity.

Background: Co-occurrence of different behaviors was investigated using the theoretical underpinnings of the Transtheoretical Model, the Theory of Triadic Influence and the concept of Transfer., Purpose: To investigate relationships between different health behaviors' stages of change, how behaviors group, and whether study participants cluster in terms of their behaviors., Method: Relationships across stages for different behaviors were assessed in three studies with N = 3,519, 965, and 310 individuals from the USA and Germany by telephone and internet surveys using correlational analyses, factor analyses, and cluster analyses., Results: Consistently stronger correlations were found between nutrition and physical activity (r = 0.16-0.26, p < 0.01) than between non-smoking and nutrition (r = 0.08-0.16, p < 0.03), or non-smoking and physical activity (r = 0.01-0.21). Principal component analyses of investigated behaviors indicated two factors: a "health-promoting" factor and a "health-risk" factor. Three distinct behavioral patterns were found in the cluster analyses., Conclusion: Our results support the assumption that individuals who are in a higher stage for one behavior are more likely to be in a higher stage for another behavior as well. If the aim is to improve a healthy lifestyle, success in one behavior can be used to facilitate changes in other behaviors--especially if the two behaviors are both health-promoting or health-risky. Moreover, interventions should be targeted towards the different behavioral patterns rather than to single behaviors. This might be achieved by addressing transfer between behaviors.

Background: Sun safety behaviors to prevent skin cancer, such as sunscreen use, are difficult to adopt and maintain., Purpose: Most social-cognitive theories assume that the intention to change a behavior is the best predictor of actual change. But unforeseen barriers emerge, or people give in to temptations, such as getting a tan despite their initial good intentions. The Health Action Process Approach proposed by Schwarzer (Appl Psychol 57:1-29, 1) is used to explore the self-regulatory mechanisms of sunscreen use., Method: An international longitudinal survey was conducted with 524 individuals. Intentions, positive outcome expectancies, distal self-efficacy, and risk perception were assessed at time 1, whereas intention, planning, and proximal self-efficacy were measured 2 weeks later at time 2. Sunscreen use was reported at 3-month follow-up (time 3)., Results: A structural equation model fit the data well. Positive outcome expectancies, risk perception, and self-efficacy predicted the behavioral intention. Self-efficacy and planning predicted sunscreen use, and planning mediated the relation between intended and performed sunscreen use., Conclusion: The findings contribute to the understanding of psychological mechanisms in health behavior change. They also point to the particular role of mediator variables in the context of sun protection behaviors, which may have implications for designing skin cancer preventive interventions.

The study examines whether self-efficacy mediates between intention and behavior, and whether appearance norms and self-efficacy are additive or synergistic predictors of sunscreen use. At two measurement points in time, 14 weeks apart, 154 individuals responded to an online questionnaire. Moderated mediation was tested by hierarchical regression analyses. Self-efficacy mediated the intention-behavior relationship, whereas appearance norms emerged as a moderator of the self-efficacy-sunscreen use relationship. The model accounted for 22% of the behavior variance at time 2. For individuals who believe that they would look more attractive with a tan, self-efficacy did not have a strong effect on behavior. Thus, for skin-protection motivation to become effective, self-efficacy is needed in conjunction with less positive appearance norms. Implications for public health promotion and mass media sunscreen use campaigns are discussed.

Planning is supposed to mediate between intention and behavior. The study examines whether such a mediation also exists in the context of sunscreen use. Moreover, the question is raised whether health risk perception might moderate such a mechanism. A longitudinal online study was conducted with three measurement points in time. Sunscreen use, intention, planning, and risk perception were assessed. A sample of 154 individuals was analyzed by hierarchical regression procedures in terms of moderated mediation. Planning partially mediated the intention-behavior relationship, and risk perception operated as a moderator. The moderator effect was negative, implying that low risk perception in conjunction with high intention was a prerequisite for planning, and, thus, for the mediation by planning. Low risk perception reflects health-specific optimism which can be a facilitator of health behavior change, in this case the change of sunscreen use from Time 1 to Time 3.

Objectives: To investigate the utility of the protection motivation theory (PMT) for explaining physical activity (PA) in an adult population with type 1 diabetes (T1D) and type 2 diabetes (T2D)., Design: Cross-sectional and 6-month longitudinal analysis using PMT., Methods: Two thousand three hundred and eleven individuals with T1D (N=697) and T2D (N=1,614) completed self-report PMT constructs of vulnerability, severity, response efficacy, self-efficacy, and intention, and PA behaviour at baseline and 6-month follow-up. Multi-group structural equation modelling was conducted to: (1) test the fit of the PMT structure; (2) determine the similarities and differences in the PMT structure between the two types of diabetes; and (3) examine the explained variance and compare the strength of association of the PMT constructs in predicting PA intention and behaviour., Results: The findings provide evidence for the utility of the PMT in both diabetes samples (chi(2)/df=1.27-4.08, RMSEA=.02-.05). Self-efficacy was a stronger predictor of intention (beta=0.64-0.68) than response efficacy (beta=0.14-0.16) in individuals with T1D or T2D. Severity was significantly related to intention (beta=0.06) in T2D individuals only, whereas vulnerability was not significantly related to intention or PA behaviour. Self-efficacy (beta's=0.20-0.28) and intention (beta's=0.12-0.30) were significantly associated with PA behaviour., Conclusions: Promotion of PA behaviour should primarily target self-efficacy to form intentions and to change behaviour. In addition, for individuals with T2D, severity information should be incorporated into PA intervention materials in this population.

Health education interventions can be tailored toward stages of change. This strategy is based on theories that predict at which stage which variables are indicative of subsequent behavior change processes. For example, planning is regarded as being effective in intenders. However, rather few studies have tested whether matched interventions are more successful for stage transitions than mismatched ones. Also very few previous studies have identified specific variables as targets of stage-matched interventions. A 2 (condition) x 2 (stages) experimental study tested the effects of stage-matched interventions for 226 participants. The stage-matched intervention moved significantly more individuals forward to action than did the control condition. Stage-specific effects were found to corroborate 78% of the assumptions. Multiple mediator analyses revealed stage-specific mechanisms, indicating that intention and planning facilitated behavior change in intenders. Thus, health behavior interventions should take stages of change into account.

To change dietary behaviors, people must be motivated to do so. But intentions often do not translate into behavior. Strategic planning (as a mediator) is expected to move people from intention to action. However, individuals who lack perceived self-efficacy might fail to apply their plans when encountering challenging situations. Thus, self-efficacy might operate as a moderator variable when it comes to studying the mediator effects of planning on behaviors. This study examines the interactive role of planning and self-efficacy in the context of dietary changes. A longitudinal sample of 411 employees was surveyed twice in terms of their fruit and vegetable consumption over a 4-week interval. Intentions, planning, and fruit and vegetable consumption were specified as a mediator chain with self-efficacy as a moderator at two stages of the putative change process. Baseline behavior served as a covariate in the model. Intentions were translated into dietary behavior by planning. Self-efficacy moderated this mediation at the second stage, reflected by a planning x self-efficacy interaction on fruit and vegetable consumption. The strength of the mediated effect increased along with levels of self-efficacy. Individuals with very low self-efficacy did not benefit from planning. If a person lacks self-efficacy, planning does not seem to translate intentions into fruit and vegetable consumption., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Maintaining behavior change is one of the major challenges in weight management and long-term weight loss. We investigated the impact of the cognitive complexity of eating rules on adherence to weight management programs. We studied whether popular weight management programs can fail if participants find the rules too complicated from a cognitive perspective, meaning that individuals are not able to recall or process all required information for deciding what to eat. The impact on program adherence of participants' perceptions of eating rule complexity and other behavioral factors known to influence adherence (including previous weight management, self-efficacy, and planning) was assessed via a longitudinal online questionnaire given to 390 participants on two different popular weight management regimens. As we show, the regimens, Weight Watchers and a popular German recipe diet (Brigitte), strongly differ in objective rule complexity and thus their cognitive demands on the dieter. Perceived rule complexity was the strongest factor associated with increased risk of quitting the cognitively demanding weight management program (Weight Watchers); it was not related to adherence length for the low cognitive demand program (Brigitte). Higher self-efficacy generally helped in maintaining a program. The results emphasize the importance of considering rule complexity to promote long-term weight management., (2009 Elsevier Ltd. All rights reserved.)

Consuming a diet lower in total fat is important for the prevention of many chronic diseases. Individual and population-based programs targeting this behavior must be theoretically grounded and consider the context within which dietary behavior change may be attempted. To identify the factors differentiating stage of readiness to follow a low-fat diet, a sample (N=1216) of adults was surveyed using 4 different staging algorithms to assess stages of change and associated social-cognitive variables (pros, cons, and temptation). Approximately 75% of the sample occupied the Action/Maintenance stages for all staging algorithms. In general, pros increased and cons decreased with higher stage occupation. Temptation decreased from the early pre-action to the action stages for the different staging algorithms. When developing programs to decrease dietary-fat intake, social-cognitive variables associated with stage transition for behaviors related to consuming a low-fat diet may have relevance to researchers and clinicians.

Objective: Planning has been hypothesized to operate as a mediator linking intentions to health behaviors. To explore the temporal variation of these constructs and their interrelationships, a long-term study of intentions, planning, and physical activity was conducted., Method: A sample of 328 individuals in orthopedic rehabilitation provided data at five measurement occasions over 3 years after their discharge from rehabilitation. A process-oriented approach combining mediation analysis and latent growth curve (LGC) modeling was applied., Results: The orthopedic rehabilitation led to an initial increase in planning and behavior, followed by a decrease after 6 months and stabilization for the next 2.5 years. Intention revealed a slight but constant decrease for 6 months and remained stable up to 3 years after rehabilitation. The mediation model confirmed planning as mediator between intention and physical activity in former rehabilitation participants., Conclusions: Prior evidence on the mediating role of planning in the intention-behavior relation is corroborated and extended by the present findings at the level of long-term processes. Planning can and should be integrated in rehabilitation treatment programs to facilitate sustainable recovery.

Stage theories propose that individuals pass through different stages on their way toward behavior change. The present study examines stage-specific prediction patterns of social-cognitive variables (risk perception, outcome expectancies, perceived self-efficacy, action planning and social support) regarding transitions between the three stages of the Health Action Process Approach (HAPA; preintention, intention and action stage). In an online study (n = 494) on fruit and vegetable intake, social-cognitive variables and stages were assessed at baseline and stage transitions 4 weeks later. Transitions between the preintention, intention and action stage were predicted by social-cognitive variables using binary and multinomial logistic regression analyses. Stage-specific prediction patterns emerged for stage progression and stage regression. Outcome expectancies predicted progression from the preintention stage, whereas social support predicted progression to the action stage. Low levels of planning were associated with relapse to the preintention and the intention stage. Self-efficacy emerged as a universal predictor of stage transitions. Findings support not only the usefulness of the stage construct for describing health behavior change but also the validity of the HAPA variables as predictors of stage transitions. Stage-matched interventions targeting the variables identified as stage-specific predictors might support stage progression toward the goal behavior.

Objective: Two different theories of health behaviour have been chosen with the aim of theory integration: a continuous theory (protection motivation theory, PMT) and a stage model (transtheoretical model, TTM). This is the first study to test whether the stages of the TTM moderate the interrelation of PMT-variables and the mediation of motivation, as well as PMT-variables' interactions in predicting stage transitions., Design: Hypotheses were tested regarding (1) mean patterns, stage pair-comparisons and nonlinear trends using ANOVAs; (2) prediction-patterns for the different stage groups employing multi-group structural equation modelling (MSEM) and nested model analyses; and (3) stage transitions using binary logistic regression analyses., Method: Adults (N=1,602) were assessed over a 6 month period on their physical activity stages, PMT-variables and subsequent behaviour., Results: (1) Particular mean differences and nonlinear trends in all test variables were found. (2) The PMT adequately fitted the five stage groups. The MSEM revealed that covariances within threat appraisal and coping appraisal were invariant and all other constrains were stage-specific, i.e. stage was a moderator. Except for self-efficacy, motivation fully mediated the relationship between the social-cognitive variables and behaviour. (3) Predicting stage transitions with the PMT-variables underscored the importance of self-efficacy. Only when threat appraisal and coping appraisal were high, stage movement was more likely in the preparation stage., Conclusions: Results emphasize stage-specific differences of the PMT mechanisms, and hence, support the stage construct. The findings may guide further theory building and research integrating different theoretical approaches.

Objectives: Health-behaviour change is not predicted well by behavioural intentions alone. Action planning and coping planning are two self-regulatory strategies that may help bridge the gap between intentions and behaviour. Action planning comprises the when, where and how of implementing a behaviour. Coping planning involves the anticipation of barriers and ways to overcome them. The study examines whether the inclusion of these two planning constructs would improve the overall prediction of physical activity. The main research question is which kind of planning would be beneficial for the initiation of behaviour and which one for its maintenance. Moreover, it is examined whether intentions moderate the planning-behaviour relationship., Methods: A 5-week longitudinal on-line study was conducted with 354 participants. Differences in prediction patterns between formerly active and formerly inactive individuals were compared using multigroup structural equation modelling. Moderating effects of intentions were tested by means of latent interactions., Results: Inclusion of the two planning factors accounted for substantially more behaviour variance than intention alone did. Coping planning mediated the intention-behaviour relationship only in formerly active, but not in formerly inactive participants. Moreover, intentions moderated the effects of both types of planning on behaviour., Conclusions: Action planning appears to predict behaviour only when intentions are high. For actors, coping planning represents a critical self-regulation strategy to maintain their physical activity levels.

Purpose: This study investigated the interplay of exercise strategy use (i.e., strategies of selection, optimization, and compensation) and perceived loss of exercise resources in individuals prescribed to engage in physical exercise., Method: Specifically, 368 individuals (18 to 80 years) were assessed during orthopedic rehabilitation and 6 and 12 months thereafter. Exercise, orthopedic outcome, and subjective well-being served as indicators of successful development., Results: There was no evidence for an interaction of age and strategy use. There was also no support for an interaction between resource loss and strategy use but rather for a mediating role of strategy use between resource loss and exercise. The effect of strategy use on orthopedic outcome and subjective well-being was mediated by exercise., Discussion: Strategy use seems to be beneficial for exercise regardless of age. In addition, strategy use seems to enhance resources and is not only associated with exercise but also with orthopedic outcome and subjective well-being.

Background: Adoption and maintenance of health behaviors are often poorly predicted by behavioral intentions. To bridge the gap between intentions and behavior, strategic planning and recovery self-efficacy have been suggested as proximal predictors., Purpose: The aim was to examine the usefulness of a prediction model that includes planning and self-efficacy as postintentional mediator variables., Methods: Four longitudinal studies were conducted on dental flossing (Study I, N = 157), seat belt use (Study II, N = 298), dietary behaviors (Study III, N = 700), and physical activity (Study IV, N = 365). Dental flossing and seat belt use were assessed in students by paper-and-pencil questionnaires, whereas dietary behavior and physical activity inventories were presented to the general public in the internet., Results: By structural equation modeling, it was found that one common model fits all four data sets well. Results differed in terms of variance accounted for, but the overall patterns of estimated parameters were similar across samples., Conclusions: Self-efficacy and planning seemed to be functional as proximal predictors of health behaviors, whereas health risk perception appeared to be a negligible factor. When predicting health behaviors, self-regulatory variables should be used in addition to the behavioral intention.

Objectives: To identify demographic, health, and behavioral factors associated with smoking behavior in adults with diabetes., Methods: Canadian adults 18+ years with type 1 (n=697) or type 2 (n=1621) were investigated. Logistic regression analyses were conducted separately for both diabetes subgroups., Results: When comparing never versus ever smokers, never versus current smokers, and former smokers who quit versus current smokers, similarities and differences for demographic, health, and behavioral factors were found for the 2 diabetes subgroups., Conclusions: Diabetes type, demographic, health, and behavioral factors should be considered when tailoring smoking cessation and prevention programs.

Exercise-related strategy use and planning were investigated in younger (18-49 years) and older individuals (50-80 years) in orthopedic rehabilitation who were supposed to adhere to a strict exercise regimen. As part of a longitudinal study, N=368 individuals completed questionnaires assessing the amount of physical activities performed pre-rehabilitation and 6 and 12 months after discharge. In addition, the extent of strategy use (selection, optimization, and compensation) and planning after discharge was assessed. Planning was subdivided into two constructs: action planning (planning when, where, and how to exercise) and coping planning (planning how to exercise in the face of barriers). Two-sample structural equation modeling was used. For both age groups, strategy use improved prediction of exercise goal attainment on top of planning, while strategy use mediated the relationship between coping planning and goal attainment. Interventions fostering strategy use as well as planning might enhance exercise adherence across age groups.

The purpose of this study was to evaluate the Multi-Stage Model (MSM). The MSM proposes eight different stages that are distinguished by cognitions and behavior and concepts of habituation as well. The MSM stages were assessed in 835 rehabilitation patients with a questionnaire. People in the different stages were compared and trends across the means of individuals in the different stages were evaluated to test for discontinuity patterns. Discontinuity patterns across the stages were found in social-cognitive variables such as intention, self-efficacy, outcome expectancies and social support. Most predictions according to stage differences were empirically found. This supported the validity of the MSM. Implications for further investigations and stage-specific interventions are discussed.

Stage-matched interventions can only be more effective than "one-size-fits-all" interventions if they target participants' specific needs. Therefore, individuals must be allocated to a stage that truly reflects their mindsets. Various criteria for stage allocation exist. This study's objective was to demonstrate the impact of different classification criteria on stage allocation, and which criterion yields the best reflection of individuals' mindsets. The sample consists of 569 internet users. Physical activity, intention to change, and four stages of change (Non-Intender, Intender, Maintaining Actor, and Changing Actor) were assessed. Staging was based on two criteria: individual criteria and externally imposed criteria (30 min of physical activity on at least 4 days of the week). Hypotheses were tested by multivariate analyses and validity tests. As predicted, the different criteria affected stage allocation, and staging based on the individual criterion seemed to reflect individuals' intention to change and behavior better than staging based on the external standard. (Contains 8 tables and 1 footnote.)

This study was designed to test the validity of a transtheoretical model's physical activity (PA) stage measure with intention and different intensities of behavior in a large population-based sample of adults living with diabetes (Type 1 diabetes, n = 697; Type 2 diabetes, n = 1,614) and examine different age groups. The overall "specificity" (classified correctly as inactive) for Type 1 diabetes was 69.3% based on the percentage of individuals in precontemplation, contemplation, and preparation not meeting Canada's PA guidelines. "Sensitivity" (classified correctly as active) was 82.5% based on the proportion of active participants in action and maintenance. In the Type 2 diabetes group, the overall specificity and sensitivity was 63.9% and 88.2%, respectively. No significant differences were found between the diabetes groups for stage distribution patterns, and sensitivity and specificity values. The majority of the study hypotheses related to intention and behaviors were confirmed, providing further supportive evidence for the utility of this PA staging measure for the diabetes population. (Contains 2 figures, 4 tables and 2 footnotes.)

(1) Background: Preventing pregnancy complications and maternal deaths and helping women stay healthy before, during, and after pregnancy by means of sexual health and behavior is imperative. Previous research demonstrated that a lack of social support and perceived discrimination have adverse effects on pregnancy outcomes. These determinants may impact health behavior as an important mediator of pregnancy outcomes. To better understand this relation, the Compensatory Carry-Over Action Model (CCAM) was applied. The research question was: how do predictors of health behavior, specifically intention, planning, self-efficacy, social support, and discrimination, interrelate with different health behaviors during pregnancy? (2) Methods: By means of qualitative interviews with ten pregnant women (20–39 years, mean = 28.6) from different cultural backgrounds, the predictors of health behaviors and experiences with pregnancy, including racial discrimination, were investigated. (3) Results: Not all women changed their unhealthy behaviors even though their higher-level goal was to ensure their baby's and their own health. This appeared partially due to lack of social support, racial discrimination, and unexpected pregnancy side effects. The women who previously performed health behaviors revealed a healthier pattern with maintaining or even expanding their health behaviors, while those performing no health behavior in the past reported more obstacles with a healthy lifestyle. (4) Conclusions: Pregnant women appear to be having difficulties translating good intentions into behavior. The reasons include lack of support, fear, and insecurity, which impact self-efficacy and planning. Improvements in health behaviors were facilitated by specific circumstances, such as working from home. Policy and practice should take these aspects into account and help mobilize support and overcome discrimination by means of more rights and support for pregnant women while also empowering the individuals. [ABSTRACT FROM AUTHOR]