Search

Background: Shared decision making (SDM) can be beneficial for patients and healthcare professionals, but is often not applied in practice. A clinical decision support system (CDSS) can facilitate SDM. However, CDSS acceptance rates are rather low. One context in which SDM between a general practitioner (GP) and patient regarding medication can be of great value is older patients’ medication-related fall risk. Applying user-centered design to optimally tailor the CDSS to the needs and wishes of GPs can help overcome the low CDSS-acceptance rates. The current study aims to learn GPs’ needs and wishes for a CDSS focused on diminishing medication-related fall risk.Materials and Methods: Participants were recruited through the Amsterdam Academic Network of General Practice and were sent a web-lecture as preparation. Three online focus groups with a total of 13 GPs were performed and were led by two moderators. The focus groups were recorded and transcribed verbatim. Transcripts were analyzed using Atlas.ti.Results: GPs’ views on the workflow, risk presentation and advice of the system were elicited. The fit with the GPs’ workflow was elaborately discussed, for instance how the CDSS could support the selection of patients at risk. GPs articulated a strong preference for a visual risk presentation, in the form of a gradient scale ranging from bright green to dark red. Furthermore, they preferred receiving both medication-related and non-medication-related advice, which should be presented on request.Discussion: The findings provide a valuable insight into GPs’ needs and wishes for a CDSS focused on medication-related fall prevention. This will inform the design of a first prototype of the CDSS which will be subjected to usability tests. The findings of this study can also be used to support the development of medication-related CDSSs in a broader context.

Contains fulltext : 240021.pdf (Publisher’s version ) (Open Access) A promising avenue for health behavior change is to influence conversational valence, that is, the extent to which people talk negatively or positively about health behaviors. However, no research to date has experimentally manipulated conversational valence, thereby inhibiting conclusions about causal inferences. This study aims to fill this gap by investigating the influence of conversational valence instructions on perceived conversational valence and subsequent binge drinking determinants. College students (N = 138) read either negative or positive conversational valence instructions. Subsequently, dyads engaged in a 5-min conversation about drinking, before self-reporting perceived conversational valence and binge drinking determinants (i.e., attitudes, norms, perceived behavioral control, and intentions). Results revealed that valence instructions influenced binge drinking determinants via perceived conversational valence. Those instructed to talk negatively about binge drinking reported healthier binge drinking determinants than those instructed to talk positively. Furthermore, this effect on binge drinking determinants was mediated by perceived conversational valence. These findings demonstrate that conversational valence about health can be manipulated through simple instructions and confirm the idea that conversational valence is causally linked to binge drinking determinants. Thereby, these findings show the potential that interpersonal communication in general, and conversational valence instructions, in particular, have when integrated in health interventions. 7 p.

Item does not contain fulltext Digital health interventions for sexual health promotion have evolved considerably alongside innovations in technology. Despite these efforts, studies have shown that they do not consistently result in the desired sexual health outcomes. This could be attributed to low levels of user engagement, which can hinder digital health intervention effectiveness, as users do not engage with the system enough to be exposed to the intervention components. It has been suggested that conversational agents (automated two-way communication systems e.g. Alexa) have the potential to overcome the limitations of prior systems and promote user engagement through the increased interactivity offered by bidirectional, natural language-based interactions. The present review, therefore, provides an overview of the effectiveness and user acceptability of conversational agents for sexual health promotion. A systematic search of seven databases provided 4534 records, and after screening, 31 articles were included in this review. A narrative synthesis of results was conducted for effectiveness and acceptability outcomes, with the former supplemented by a meta-analysis conducted on a subset of studies. Findings provide preliminary support for the effectiveness of conversational agents for promoting sexual health, particularly treatment adherence. These conversational agents were found to be easy to use and useful, and importantly, resulted in high levels of satisfaction, use and intentions to reuse, whereas user evaluations regarding the quality of information left room for improvement. The results can inform subsequent efforts to design and evaluate these interventions, and offer insight into additional user experience constructs identified outside of current technology acceptance models, which can be incorporated into future theoretical developments. 15 p.

People making food choices are often exposed to different cues that can activate relevant goals that influence the choice outcome. Hedonic goals are frequently primed by advertising while health policy enlists primes that activate health goals in the moment of food decision-making – e.g., healthy food labels. However, little is known about the effect of such goal-priming cues on the population level and how people respond when exposed to both types of primes simultaneously. The results of this study, based on a large, representative sample (N = 1200), show no effect of health-goal priming on healthy food choices. Being exposed to a sole hedonic prime, however, reduces healthy choices by 3%. This effect completely disappeared when both primes were presented at the same time. All effects remained insensitive to people’s gender, hunger status, level of dietary restraint, and BMI. These findings cast doubt over the effectiveness of health goal primes as a tool to increase healthy food choices but suggest a protective effect against competing hedonic primes and could thereby prevent less healthy choices.

BackgroundA medication-related Clinical Decision Support System (CDSS) is an application that analyzes patient data to provide assistance in medication-related care processes. Despite its potential to improve the clinical decision-making process, evidence shows that clinicians do not always use CDSSs in such a way that their potential can be fully realized. This systematic literature review provides an overview of frequently-reported barriers and facilitators for acceptance of medication-related CDSS.Materials and methodsSearch terms and MeSH headings were developed in collaboration with a librarian, and database searches were conducted in Medline, Scopus, Embase and Web of Science Conference Proceedings. After screening 5404 records and 140 full papers, 63 articles were included in this review. Quality assessment was performed for all 63 included articles. The identified barriers and facilitators are categorized within the Human, Organization, Technology fit (HOT-fit) model.ResultsA total of 327 barriers and 291 facilitators were identified. Results show that factors most often reported were related to (a lack of) usefulness and relevance of information, and ease of use and efficiency of the system.DiscussionThis review provides a valuable insight into a broad range of barriers and facilitators for using a medication-related CDSS as perceived by clinicians. The results can be used as a stepping stone in future studies developing medication-related CDSSs.

Background The last decade has seen a substantial increase in the use of mobile health apps and research into the effects of those apps on health and health behaviors. In parallel, research has aimed at identifying population subgroups that are more likely to use those health apps. Current evidence is limited by two issues. First, research has focused on broad health apps, and little is known about app usage for a specific health behavior. Second, research has focused on comparing current users and current nonusers, without considering subgroups of nonusers. Objective We aimed to provide profile distributions of current users, previous users, and informed nonusers, and to identify predictor variables relevant for profile classification. Methods Data were available from 1683 people who participated in a Dutch walking event in Amsterdam that was held in September 2017. They provided information on demographics, self-reported walking behavior, and walking app usage, as well as items from User Acceptance of Information Technology, in an online survey. Data were analyzed using discriminant function analysis and multinomial logistic regression analysis. Results Most participants were current walking app users (899/1683, 53.4%), while fewer participants were informed nonusers (663/1683, 39.4%) and very few were previous walking app users (121/1683, 7.2%). Current walking app users were more likely to report walking at least 5 days per week and for at least 30 minutes per bout (odds ratio [OR] 1.44, 95% CI 1.11-1.85; P=.005) and more likely to be overweight (OR 1.72, 95% CI 1.24-2.37; P=.001) or obese (OR 1.49, 95% CI 1.08-2.08; P=.005) as compared with informed nonusers. Further, current walking app users perceived their walking apps to be less boring, easy to use and retrieve information, and more helpful to achieve their goals. Effect sizes ranged from 0.10 (95% CI 0.08-0.30) to 1.58 (95% CI 1.47-1.70). Conclusions The distributions for walking app usage appeared different from the distributions for more general health app usage. Further, the inclusion of two specific subgroups of nonusers (previous users and informed nonusers) provides important information for health practitioners and app developers to stimulate continued walking app usage, including making information in those apps easy to understand and making it easy to obtain information from the apps, as well as preventing apps from becoming boring and difficult to use for goal attainment.

Cue-Exposure Therapy (CET) is considered an effective strategy to combat cigarette cravings and smoking relapses, but evidence is mixed. In this lab-based experimental study, we manipulated levels of realism for smoking scenarios in Virtual Environments (VE) and randomly exposed smokers and recent-quitters to one of two versions (low versus high realism) of these scenarios. Prior and after scenario exposure, valid measures of cigarette craving were obtained. Prior to exposure, we assessed nicotine dependence and smoking status (current smokers versus recent-quitter). Within-subject repeated measures analysis of covariance showed that there was an interaction of experimental condition with smoking status on cigarette craving. Amongst recent-quitters, high realistic scenarios produced stronger increases in craving than low realistic scenarios, but this effect was reversed in current smokers. It is concluded that VE technologies are a potentially relevant tool for smoking CET that warrant further exploration.

Background Unhealthy lifestyle behaviours such as unhealthy dietary intake and insufficient physical activity (PA) tend to cluster in adults with a low socioeconomic position (SEP), putting them at high cardiometabolic disease risk. Educational approaches aiming to improve lifestyle behaviours show limited effect in this population. Using environmental and context-specific interventions may create opportunities for sustainable behaviour change. In this study protocol, we describe the design of a real-life supermarket trial combining nudging, pricing and a mobile PA app with the aim to improve lifestyle behaviours and lower cardiometabolic disease risk in adults with a low SEP. Methods The Supreme Nudge trial includes nudging and pricing strategies cluster-randomised on the supermarket level, with: i) control group receiving no intervention; ii) group 1 receiving healthy food nudges (e.g., product placement or promotion); iii) group 2 receiving nudges and pricing strategies (taxing of unhealthy foods and subsidizing healthy foods). In collaboration with a Dutch supermarket chain we will select nine stores located in low SEP neighbourhoods, with the nearest competitor store at > 1 km distance and managed by a committed store manager. Across the clusters, a personalized mobile coaching app targeting walking behaviour will be randomised at the individual level, with: i) control group; ii) a group receiving the mobile PA app. All participants (target n = 1485) should be Dutch-speaking, aged 45–75 years with a low SEP and purchase more than half of their household grocery shopping at the selected supermarkets. Participants will be recruited via advertisements and mail-invitations followed by community-outreach methods. Primary outcomes are changes in systolic blood pressure, LDL-cholesterol, HbA1c and dietary intake after 12 months follow-up. Secondary outcomes are changes in diastolic blood pressure, blood lipid markers, waist circumference, steps per day, and behavioural factors including healthy food purchasing, food decision style, social cognitive factors related to nudges and to walking behaviours and customer satisfaction after 12 months follow-up. The trial will be reflexively monitored to support current and future implementation. Discussion The findings can guide future research and public health policies on reducing lifestyle-related health inequalities, and contribute to a supermarket-based health promotion intervention implementation roadmap. Trial registration Dutch Trial Register ID NL7064, 30th of May, 2018

Background Sitting time is associated with adverse physical and mental health outcomes, and premature mortality. Office workers sit for prolonged periods, so are at particular risk. Scientific advances in public health threats are predominantly communicated to the public through media reports. Aims This study aimed to examine office workers’ impromptu responses to media coverage of scientific evidence related to the health risks of sedentary behaviour. Methods Semi-structured interviews were run with 26 office workers (mean age 35 years), recruited from four organizations in southern England. Within the interview, each participant provided a ‘think-aloud’ narrative as they read three real-world news reports relating to sedentary behaviour. Thematic analysis was conducted on verbatim transcripts. Results Three themes were extracted from the data: gauging the personal relevance of the news reports; questioning their trustworthiness and challenging the feasibility of proposed sitting-reduction strategies. Participants voiced scepticism about the applicability of the reports to their personal circumstances, and the validity of the reports and the scientific evidence underpinning them. Conclusions Researchers, press officers and journalists should emphasise the ways in which participants in research studies represent the broader population of office workers, and offer greater transparency in reporting study methods, when reporting scientific advances in sedentary behaviour.

Good dental hygiene is key to public health. To promote dental hygiene behaviours, persuasive messages are key. Message framing is a popular theory that has seen mixed evidence. In this web-based experimental study, interaction effects of message frame, behavioural function, and risk priming were investigated on mouth rinse use and intentions in a representative sample of Dutch adults. Final included sample contained 549 participants (50.1% male, mean age = 47.4, SD = 16.1) and outcomes were immediate mouth rinse product choice, intentions to use mouth rinse, and mouth rinse behaviour at 2-week follow-up. Results demonstrated a theorized significant interaction between message frame and behavioural function were mouth rinse product choice. Two-week follow-up mouth rinse behaviour was affected by an interaction between message frame and risk prime. Message framing can thus be employed to promote dental health, but it requires attention to moderation effects which are inconsistent across behavioural outcomes.

Contains fulltext : 160641.pdf (Publisher’s version ) (Open Access) Health-promoting messages can be framed in terms of the beneficial consequences of healthy behaviour (gain-framed messages) or the detrimental consequences of unhealthy behaviour (loss-framed messages). An influential notion holds that the perceived risk associated with the recommended behaviour determines the relative persuasiveness of gain- and loss-framed messages. This 'risk-framing hypothesis', which was derived from prospect theory, has been central to health message-framing research for the better part of two decades and has enduring appeal to researchers and practitioners. It has found its way into several health communication handbooks and is communicated to the general public. The present article examines the validity of the risk-framing hypothesis anew by providing a review of the health message-framing literature. In spite of its ongoing appeal, we conclude that the hypothesis has severe theoretical flaws. In addition, we find that the empirical evidence in favour of the hypothesis is weak and inconsistent. It seems that, in applying prospect theory's tenets to a health-promotion context, some of the theory's key aspects have been lost in translation. At the close of the article, we offer a research agenda for the future, arguing that, above all, new methodology is needed to bring the message-framing literature further. 13 p.

Although research has demonstrated that interpersonal communication about alcohol influences drinking behaviors, this notion has mainly been examined in offline contexts with familiar conversation partners. The present study investigated how communication mode and familiarity influence conversational valence (i.e., how negatively or positively people talk) and binge drinking norms. During a 2 (offline vs. online communication) × 2 (unfamiliar vs. familiar conversation partner) lab experiment, participants (N = 76) were exposed to an anti–binge drinking campaign, after which they discussed binge drinking and the campaign. Binge drinking norms were measured 1 week before and directly after the discussion. Results revealed that conversations between unfamiliar conversation partners were positive about the campaign, especially in offline settings, subsequently leading to healthier binge drinking norms. We recommend that researchers further investigate the influence of communication mode and familiarity on discussion effects, and we suggest that health promotion attempts might benefit from eliciting conversations about anti–binge drinking campaigns between unfamiliar persons.

Health campaign effects may be improved by taking interpersonal communication processes into account. The current study, which employed an experimental, pretest-posttest, randomized exposure design (N = 208), investigated whether the emotions induced by anti-alcohol messages influence conversational valence about alcohol and subsequent persuasion outcomes. The study produced three main findings. First, an increase in the emotion fear induced a negative conversational valence about alcohol. Second, fear was most strongly induced by a disgusting message, whereas a humorous appeal induced the least fear. Third, a negative conversational valence elicited healthier binge drinking attitudes, subjective norms, perceived behavioral control, intentions, and behaviors. Thus, health campaign planners and health researchers should pay special attention to the emotional characteristics of health messages and should focus on inducing a healthy conversational valence.

The present study experimentally investigated the interplay between interpersonal communication and health message exposure in relation to alcohol consumption intentions. Participants were 174 students who took part in a study on the effects of an antialcohol message. At baseline, the authors assessed intention to refrain from binge drinking. At the second wave (2 weeks later), participants were assigned to the conditions of a 2 (antialcohol message or no-alcohol message) × 2 (alcohol conversation or control conversation) between-subjects design, after which intention was again assessed. Results showed that when participants talked about alcohol (instead of the control topic) and were not exposed to an antialcohol message, they were less inclined to refrain from binge drinking, an effect that was not visible when participants talked about alcohol after viewing an antialcohol message. These findings suggest that health campaign exposure moderates the influence of interpersonal communication on health variables.

To study the effects of framed messages on exercise intention and resolve.Two (type of frame: gain or loss) × 2 (type of kernel state: desirable or undesirable outcome) post-test study.Participants were recruited online and questioned about their previous exercise behaviour and their exercise risk perception. After this, they were randomly allocated to one of four messages that were different in terms of positive or negative outcomes (type of frame) and in terms of attained or avoided outcomes (type of kernel state). After reading the message, participants indicated their intention and resolve to engage in sufficient exercise.No effects were found for intention. For resolve, there was a significant interaction between type of frame, type of kernel state, and exercise adherence. Those who did not adhere to the exercise guideline and read the loss-framed message with attained outcomes reported significantly higher resolve than all other participants.This study indicates the relevance of including attained outcomes in message framing exercise interventions as well as a focus on exercise resolve.What is already known on this subject? Message framing is commonly used to increase exercise intentions and behaviour. Meta-analyses do not provide consistent support for this theory. Very little attention has been paid to resolve and message factors on framing effects. What does this study add? Framed messages have an effect on exercise resolve, but not on intention. Loss-framed messages with attained outcomes are most persuasive for those who do not adhere to exercise guidelines. Exercise framing studies should include behavioural resolve next to intention. .

Contains fulltext : 127707pre.pdf (Author’s version preprint ) (Open Access) Health-promoting messages can be framed in terms of the beneficial consequences of healthy behaviour (gain-framed messages) or the detrimental consequences of unhealthy behaviour (loss-framed messages). An influential notion holds that the perceived risk associated with the recommended behaviour determines the relative persuasiveness of gain- and loss-framed messages. This 'risk-framing hypothesis', as we call it, was derived from prospect theory, has been central to health message framing research for the last two decades, and does not cease to appeal to researchers. The present paper examines the validity of the risk-framing hypothesis. We performed six empirical studies on the interaction between perceived risk and message framing. These studies were conducted in two different countries and employed framed messages targeting skin cancer prevention and detection, physical activity, breast self-examination and vaccination behaviour. Behavioural intention served as the outcome measure. None of these studies found evidence in support of the risk-framing hypothesis. We conclude that the empirical evidence in favour of the hypothesis is weak and discuss the ramifications of this for future message framing research. 17 p.

ObjectivesIn the action control framework, intention-behaviour discordance is studied around public health guidelines. Although this framework has been applied to physical activity behaviours, it has only seen very limited attention regarding fruit intake. The purpose of this study was therefore to investigate distributions and predictors of fruit intake intention-behaviour discordance.DesignProspective correlational design.MethodsData were obtained from undergraduate students (n = 413) using validated questionnaires. Variables from the theory of planned behaviour, automaticity, and action planning were assessed at baseline, and fruit intake was assessed 2 weeks later. Data were analysed using discriminant function analyses and analyses of variance.ResultsThe proportion of unsuccessful intenders ranged from 39.2% to 80.8%. There was a larger proportion of fruit intake intenders amongst those who reported strong automatic fruit intake. Action control was predicted by fruit intake automaticity and affective attitudes, but the strongest predictor was perceived behavioural control. No action planning items were related to fruit intake action control.ConclusionsThere is considerable asymmetry in the intention-fruit intake relationship. An application of the action control framework may stimulate debate on the applicability of intention-based models at the public health level.Statement of contributionWhat is already known on this subject?Intention is theorized to be a key construct in fruit intake.Studies in the physical activity domain indicate that nearly half of the people with positive intentions fail to subsequently act.What does this study add?The proportion of unsuccessful intenders ranged from 39.2% to 80.8%.Holding positive intentions is not sufficient to consume fruit at suggested public health guidelines.Perceived behavioural control is the most important predictor of fruit intake action control.

Evidence to date suggests heterogeneity in the effects of implementation intentions on health behaviour, including diet. Additional variables and study designs may impact on their effectiveness. Preparatory action, such as making sure fruits are available for consumption, may be an important additional variable. Likewise, most implementation intention research has focused on changes in general intake, yet implementation intention instructions typically require participants to consider behaviour in specific situations. Little is known on how implementation intentions impact situation-specific intake. The present study sought to add to the evidence base by comparing (1) the effects of action planning instructions versus preparatory planning instructions on (2) both situation-specific (as formulated in the implementation intention instruction) and general intake of fruits and in-between meal snack intake frequency. Fruit intake was assessed in average pieces per day, whereas snacking intake was assessed as average frequency in days per week. Using non-probability sampling, 243 undergraduate students who intended to have a healthy diet were randomized to either a standard information control condition, an action planning condition, or a preparatory planning condition. Planning manipulations were based on previous work. Two weeks later, general and situation-specific intake was assessed again in 181 participants. Data were analysed using 2 (time) x 3 (conditions) analyses of variance. Results showed that both planning manipulations were successful in decreasing snack intake frequency in the specified situation, with larger effect sizes for the action planning condition than for the preparatory planning condition. No effects were found on general snack intake frequency or fruit intake. Future planning interventions should more explicitly compare changes in situational and general intake, as well as simultaneously assessed decreases in unhealthy intake and increases in healthy intake. (C) 2016 Published by Elsevier Ltd.

Message framing is a persuasive strategy that has seen mixed evidence for promoting fruit intake intentions, potentially because framed messages for fruit intake have not (a) explicitly compared short-term consequences versus long-term consequences, (b) considered individual-level differences in time perspective, and (c) used alternative measures of fruit intake intentions. In the present online study, the effects of persuasive messages created from temporal context (short term vs. long term) and message frame (gain framed vs. loss framed) were investigated on fruit intake intentions and resolve among a sample of Dutch adults who were categorized as either present oriented or future oriented. For intention and resolve, results showed a significant Type of Frame × Type of Temporal Context interaction, such that gain-framed messages were more persuasive when combined with long-term consequences and loss-framed messages were more persuasive when combined with short-term consequences. The effect sizes for these differences were similar for resolve and intention, but only differences for intentions were significant. No other effects were found. These results demonstrate that message framing theory may usefully consider the inclusion of temporal context of outcomes and alternative motivation measures to maximize their persuasive effects.

There is ample evidence to suggest that a significant part of daily eating behaviours consists of habits. In line with this, the concept of habit is increasingly incorporated into studies investigating the behavioural and psychosocial determinants of food choice, yielding evidence that habit is one of the most powerful predictors of eating behaviour. Research shows that habitual behaviour is fundamentally different from non-habitual behaviour: when behaviour is habitual, people require little information to make decisions, intentions are poor predictors of behaviour, and behaviour is triggered by situational cues. These insights have vast implications for research in the food domain that are only just beginning to be addressed. Also, theorizing on habits has important implications for behaviour change interventions, yet few interventions that are based on habit theory have been tested in a food context. The present article provides an overview of habit research and discusses possibilities to increase our knowledge of the role of habits in eating behaviour. It is shown that interventions targeting habitual behaviour can try to (i) change the situation that triggers the habitual behaviour, (ii) promote or inhibit the habitual response and (iii) change relevant contingencies. These insights can act as a starting point for future intervention research.

In the context of health campaigns, interpersonal communication can serve at least 2 functions: (a) to stimulate change through social interaction and (b) in a secondary diffusion process, to further disseminate message content. In a 3-wave prospective study of 1,079 smokers, the authors demonstrate that mass media messages (antismoking campaigns and news coverage relevant to smoking cessation) have an indirect effect on smoking cessation intention and behavior via interpersonal communication. Exposure to campaigns and news coverage prompts discussion about the campaigns, and, in turn, about smoking cessation. Interpersonal communication regarding smoking cessation then influences intention to quit smoking and attempts to quit smoking. The study finds evidence not only for the social interaction function of interpersonal communication, but also for the secondary diffusion function. A substantial number of smokers who are not directly exposed to the antismoking campaigns are nevertheless indirectly exposed via communication with people who have seen these campaigns. These results imply that encouragement of interpersonal communication can be an important campaign objective.

The purpose of this study was to explore the role of habit in predicting physical activity with the theory of planned behavior (TPB). The study extended previous research by (a) including a measure of temporal intention stability in the regression equation, and (b) unpacking the intention × behavior × habit relationship. Participants were 153 undergraduate students who completed a habit measure and measures of the TPB at Time 1 followed by measures of intention and behavior 2 weeks later. Results using regression analysis demonstrated that habit explained 7% additional variance after accounting for the TPB and temporal stability of intention and its interaction with intention. Follow-up analyses showed considerable asymmetry in the three-way relationship between intention, behavior, and habit, where high habit participants were composed primarily of intenders (i.e., intended to be active >3 times/week at 30 min) who engaged in regular physical activity (70%, n = 28) and low habit participants were inactive nonintenders (i.e., did not intend to be active >3 times/week at 30 min and were subsequently not active; 69%, n = 25). The results support the notion that some properties of physical activity may have an automatic component and that habits may be important to physical activity action control.

The additive and interactive effect of habit strength in the explanation of young adults’ fruit consumption was studied within the context of the theory of planned behaviour (TPB). Additionally, behavioural and control beliefs were modelled as predictors of profile membership based on current fruit consumption, motivation and habit strength towards fruit consumption. Cross-sectional data were available from undergraduate students (n = 538; mean age = 21.19; S.D. = 2.57) who completed measures of fruit consumption, habit strength, TPB-concepts, and behavioural and control beliefs. Data were analyzed using stepwise regression analysis, simple slope analysis, and discriminant function analysis. Results showed that, based on a significant intention × habit interaction (β = .13), the intention-fruit consumption relationship was more than twice as strong at low levels of habit strength (β = .39) than at high levels of habit strength (β = .16). Furthermore, beliefs regarding health and weight management were relatively unable to distinguish profiles created from motivation, habit strength and current fruit consumption. Rather, beliefs about controllability of fruit consumption were amongst the most consistent discriminating beliefs. Findings suggest that stronger fruit consumption habits make fruit consumption less intentional and that interventions aiming to increase fruit consumption may need to develop persuasive messages focusing on situational beliefs, rather than emphasizing health outcomes.

The present study explored the influence of the Big Five dimensions extroversion and conscientiousness on action control regarding both moderate and vigorous physical activity within the framework of the theory of planned behavior (TPB). Prospective data were available from 186 respondents, who completed measures of intention, cognitive and affective attitude, subjective norm, perceived behavioral control, extroversion, conscientiousness, and physical activity at T1. Four weeks later, physical activity was assessed again. Respondents were grouped into four profiles: nonintenders, successful nonintenders, unsuccessful intenders, and successful intenders. Logistic regression analyses revealed that successful enactment in moderate physical activity was associated with extroversion, subjective norm, and affective attitude, whereas successful enactment in vigorous physical activity was associated with conscientiousness. Findings illustrate the differential role played by personality dimensions and TPB concepts in the explanation of moderate and vigorous physical activity action control.

Clustering refers to the co-occurrence of behaviour and may be particularly relevant in light of the present obesity epidemic. Since evidence regarding clustering of motivational and habitual constructs within the framework of the Theory of Planned Behaviour (TPB) is limited, clustering effects of TPB cognitions and habit strength regarding soft drink consumption and television viewing were studied in a sample of Dutch adolescents (n = 312; mean age = 14.62; SD = 1.62) using cross-sectional data. Results showed that not only soft drink consumption and television viewing cluster (r = .42), but also their intentional (r = .36) and habitual (r = .37) constructs. Furthermore, unmediated effects were found between habit strength and its respective behaviour, whereas habit strength was associated with its clustered behaviour through decreased perceptions of controllability. Our findings suggest that interventions that aim to change habitual soft drink consumption and television viewing may need to incorporate an environmental component, as well as explore the potential usefulness of synergistic effects of incorporating multiple clustered behaviours, as well as their corresponding beliefs and habits in health behaviour change interventions.

Objective: To examine the effect of two types of self-identity on attempts to quit smoking: self-identity in terms of smoking and self-identity in terms of quitting. Design: A prospective survey among an initial sample of 3,411 smokers. Smoking history variables and psychosocial variables from the theory of planned behavior are also measured. Main Outcome Measures: Intention to quit smoking and smoking cessation attempts 4 months later. Results: Both smoking identity and quitting identity matter, but they appear to play different roles in explaining intention to quit and in predicting actual attempts to quit. Quitting identity is particularly important for intention to quit, whereas both quitting identity and smoking identity are important for actually trying to quit. Recent attempts to quit slightly attenuate the negative effect of smoking identity on attempts to quit. Conclusion: A broader interpretation of self-identity in terms of both current and aspired behavior offers a better understanding of when people might change health-relevant behavior.

Item does not contain fulltext Adolescent hearing loss is a public health problem that has eluded effective intervention. A persuasive message strategy was tested for its effectiveness on adolescents’ intention to listen to music at a reduced volume. The messages manipulated both type of message frame [positive consequences of listening to music at a reduced volume (gain-framed) versus negative consequences of not listening to music at a reduced volume (loss-framed)] and type of temporal context (short-term versus long-term consequences). Participants were recruited from four vocational and secondary education schools in the Netherlands and message exposure took place online during class hours. Two weeks prior to message exposure, adolescents provided data on intention and risk perception towards hearing loss and use of (digital) music players. After message exposure, 194 adolescents (mean age = 14.71 years, SD = 1.00, 37.8% males) provided immediate follow-up data on intention. Results revealed that intention to listen to music at a reduced volume increased in those exposed to a loss-framed message with short-term consequences. No changes were found in the other conditions. Messages that emphasize negative short-term consequences of not listening to music at a moderate volume have the ability to influence adolescents’ intention towards hearing loss prevention. 10 p.

To decrease the prevalence and the amount of alcohol consumption among students, health messages advocating responsible alcohol behavior can be used. However, it is unclear whether responsible drinking messages are most effective when they use a gain frame, presenting the advantages of responsible drinking, or a loss frame, presenting the disadvantages of irresponsible drinking. This study tests the effects of framing and the moderating role of involvement with the issue of responsible drinking. A three-wave, between-subjects, experimental study was conducted, in which participants (N = 90) were exposed to either a gain- or loss-framed message about responsible drinking behavior at Wave 2. At all three waves, attitudes, intentions and behavior toward responsible drinking were measured. Results showed that for participants with low issue- involvement, a gain frame led to more positive attitudes and intentions toward responsible alcohol use, whereas a loss frame did not have any effects for them. For participants with high issue involvement, a loss frame led to more positive attitudes and intentions toward responsible alcohol use, whereas a gain frame did not have an effect on attitude and only a delayed effect on intention. However, there were no effects of frame and issue involvement on adhering to the guideline of responsible alcohol use and average drinking behavior.

Personality is regarded as a distal determinant of health behavior and has been found to be associated with health behavior in young adults. Research investigating the association between personality and health behaviors in adolescents, however, is lacking. The present study explored the direct associations between Big Five personality dimensions with fruit and vegetable consumption and physical activity (PA) in two Dutch adolescent samples [Sample 1: n = 504; mean age = 14.5 years (SD = 1.7); response rate 20%; Sample 2: n = 476; mean age = 14.9 (SD = 2.0); response rate 17%]. Behavioral outcomes and personality were assessed with validated self-administered questionnaires. Bivariate correlations and multiple regression analyses were conducted, and Cohen's effect sizes were used to interpret the associations found. Agreeableness was positively associated with vegetable consumption, while Openness to Experience was positively associated with fruit consumption and vegetable consumption. Extraversion was positively associated with sports-related PA. Standardized regression coefficients for personality dimensions ranged from 0.09 to 0.13, explaining 3-6% of variance in behavior, indicating small effect sizes. Our results suggest that personality dimensions are associated with fruit and vegetable consumption and sports-related PA in adolescents. Future research should explore possible mediators between personality and health behavior in adolescents.

BACKGROUND: The prevalence of obesity has reached epidemic proportions in many countries and is largely due to behavioral factors that disrupt the energy balance. The purpose of the study was to test how well our conceptual model, combining features from the Theory of Planned Behavior and the Theory of Triadic Influence, explained two behaviors related to the energy balance, namely bicycle use for transportation and snacking behavior in a Dutch adolescent sample.METHODS: Data was gathered in an 1997 cross-sectional sample of adolescents (n = 3,859; mean age 14.8 years SD = 1.6) on snacking behavior, bicycle use, demographics, and potential environmental, cognitive and psychological determinants. Data was analyzed using bivariate correlations, multiple linear and binary logistic regression analyses.RESULTS: Less snacking behavior was associated with female gender and a more positive intention, a more positive attitude, and stronger perceived behavioral control towards restricting snacking. Students who used their bicycle for transportation were more likely to attend secondary education, to be native Dutch, to go to school in a less-urbanized city, to be younger, had a more positive intention and perceived stronger behavioral control and subjective norm towards bicycle use.CONCLUSIONS: The inclusion of environmental factors increased our understanding of bicycle use for transportation and snacking behavior in adolescents. The environmental factors are suggested to be taken into account in interventions aimed at changing these behaviors in more healthy directions.

BackgroundHabit formation has been proposed as a way to maintain behaviour over time. PurposeRecent evidence suggests that constructs additional to repeated performance may predict physical automaticity, but no research has yet explored possible direct impacts of intention, planning, affect, and perceived behavioural control (PBC) on automaticity. MethodIn a prospective study over a 2-week period amongst 406 undergraduate students (M age=21.5 years [SD=2.59], 27.4 % males), we investigated main and interaction effects of past exercise behaviour, PBC, intention, planning, and affect on exercise automaticity. ResultsResults showed that — controlling for past behaviour — PBC, affect, and planning were significant and positive predictors of exercise automaticity. Decomposing a significant interaction between PBC and planning when to exercise re-vealed that planning became less predictive of exercise auto-maticity at higher levels of PBC. ConclusionFindings show that exercise automaticity is pre-dicted by repeated performance and social-cognitive constructs. Further, interactions between social-cognitive predictors may be different for behavioural automaticity than for behavioural frequency.

The physical activity (PA) intention-behaviour gap is a topic of considerable contemporary research, given that most of our models used to understand physical activity suggest that intention is the proximal antecedent of behavioural enactment. The purpose of this study was to quantify the intention-PA gap at public health guidelines with a meta-analysis of the action control framework.Systematic review and meta-analysis.Literature searches were conducted in July 2012 among five key search engines. This search yielded a total of 2,865 potentially relevant records; of these, 10 studies fulfilled the full eligibility criteria (N = 3,899).Random-effects meta-analysis procedures with correction for sampling bias were employed in the analysis for estimates of non-intenders who subsequently did not engage in physical activity (21%), non-intenders who subsequently performed physical activity (2%), intenders who were not successful at following through with their PA (36%), and successful intenders (42%). The overall intention-PA gap was 46%.These results emphasize the weakness in early intention models for understanding PA and suggest this would be a problem during intervention. Contemporary research that is validating and exploring additional constructs (e.g., self-regulation, automaticity) that augment intention or improving the measurement of motivation seems warranted.What is already known on this subject? Intention is considered the proximal antecedent of behaviour in many popular models. Intention is also an established correlate of physical activity behaviour, yet discordance is considerable in experimental research. What does this study add? This meta-analysis of studies that have assessed concordance/discordance of physical activity intention and behaviour at public health guidelines shows the intention-behaviour gap at 48% and the discordance is from intenders who do not act. The results demonstrate that discordance is not just from extreme levels of intention or behaviour (e.g., intend to exercise six times but only exercise five), but from levels that are relevant to health promotion.

Although research has shown that whether people talk about health issues influences health campaign effects, no evidence exists on whether conversational valence fulfils a mediating role within health campaign effects. In the context of alcohol consumption, this two-wave experimental research studies the effects of exposure to an anti-alcohol message on conversational valence about alcohol. Further, it investigates whether valence subsequently affects alcohol consumption intentions.Eighty-four undergraduate students, in dyads, were randomly assigned to one of two conditions (anti-alcohol message vs. no alcohol message exposure).A baseline measure of the intention to refrain from binge drinking was assessed in advance. Two weeks later, half of the participants were exposed to an anti-alcohol message, after which all pairs engaged in a conversation about alcohol and binge drinking followed by an assessment of conversational valence and again the intention to refrain from binge drinking.An indirect effect of health message exposure on the intention to refrain from binge drinking through conversational valence was revealed. When participants viewed an anti-alcohol message, they reported significantly more negative conversations about alcohol. Subsequently, a more negative conversational valence about alcohol increased the intention to refrain from binge drinking.These findings suggest that conversational valence is relevant for health campaign effects. By demonstrating that health messages can influence this valence, important implications arise in terms of health promotion. Future research should focus on how to design effective health campaigns that are able to guide conversational valence in the desired direction.

Repeated action can lead to the formation of habits and identification as 'the kind of person' that performs the behaviour. This has led to the suggestion that identity-relevance is a facet of habit. This study explores conceptual overlap between habit and identity, and examines where the two constructs fit into an extended Theory of Planned Behaviour (TPB) model of binge-drinking among university students.Prospective, questionnaire-based correlational design.A total of 167 UK university students completed baseline measures of past behaviour, self-identity, the Self-Report Habit Index (SRHI), and TPB constructs. One week later, 128 participants completed a follow-up behaviour measure.Factor analyses of the SRHI and four identity items revealed two correlated but distinct factors, relating to habit and identity, respectively. Hierarchical regression analyses of intention and behaviour showed that identity contributed over and above TPB constructs to the prediction of intention, whereas habit predicted behaviour directly, and interacted with intentions in predicting behaviour. Habits unexpectedly strengthened the intention-behaviour relation, such that strong intenders were more likely to binge-drink where they also had strong habits.Identity and habit are conceptually discrete and impact differently on binge-drinking. Findings have implications for habit theory and measurement. Recommendations for student alcohol consumption reduction initiatives are offered.

An implicit association test (IAT) was used to investigate how habit strength, implicit attitudes and fruit consumption interrelate. Fifty-two participants completed a computerized IAT and provided measures of fruit consumption and related habit strength. Implicit attitudes moderated the habit strength—fruit consumption relationship; stronger relationships were observed when implicit attitudes were more positive. Amongst those with strong fruit habits, more positive associations with fruit were found for those who had recently consumed sufficient fruits compared to those who had not. Findings demonstrate the relevance of implicit positive associations in understanding the relationship between fruit consumption habits and subsequent fruit consumption.

Health behaviour models typically neglect habitual action. The Self-Report Habit Index (SRHI) permits synthesis of evidence of the influence of habit on behaviour. The purpose of this study is to review evidence around mean habit strength, habit–behaviour correlations, and habit × intention interactions, from applications of the SRHI to dietary, physical activity, and active travel behaviour. Electronic database searches identified 126 potentially relevant papers. Twenty-two papers (21 datasets) passed eligibility screening. Mean scores and correlations were meta-analysed using fixed, random and mixed effects, and interactions were synthesised via narrative review. Twenty-three habit–behaviour correlations and nine habit × intention interaction tests were found. Typical habit strength was located around the SRHI midpoint. Weighted habit–behaviour effects were medium-to-strong (fixed: r + = 0.44; random: r + = 0.46). Eight tests found that habit moderated the intention–behaviour relation. More comprehensive understanding of nutrition and activity behaviours will be achieved by accounting for habitual responses to contextual cues.

Purpose. Habits may be a mechanism linking environmental variables with active commuting. This study investigated the role of habit strength in the explanation of active commuting across profiles based on current active commuting, motivation, and habit strength within the framework of the theory of planned behavior (TPB). Design. Cross-sectional survey using validated questionnaires. Setting. Undergraduate students who participated for course credits. Subjects. Five hundred and thirty-eight students (mean age = 21.19 [SD = 2.57]; 28.45% males; response rate = 86.36%). Measures. Questionnaire included TPB items, underlying beliefs, and a validated measure of habit strength. Active commuting was assessed with relevant items from the International Physical Activity Questionnaire. Analysis. Hierarchical regression and interaction analyses, discriminant function analysis, and analyses of variance. Results. Habit strength was the strongest correlate of active commuting and interacted with intention: at low and medium levels of habit strength, the intention–bicycle use relationship was more than twice as strong as at high levels. Beliefs regarding situational barriers were amongst the most discriminating beliefs, whereas beliefs regarding health benefits did not distinguish profiles. Conclusions. Stronger active commuting habits are associated with a lower association between intention and bicycle use. Persuasive health campaigns might more usefully instill a sense of confidence in various commuting situations rather than merely emphasizing health benefits of active commuting. (Am J Health Promot 2011;25[3]:e27–e36.)

The purpose of this study was to examine the predictive capability of a habit construct, controlling for intention and perceived behavioral control, with moderate and strenuous intensity physical activity. This approach was expanded through an examination of whether conscious deliberation in the initiation of physical activity would attenuate these findings and a test of the intention-habit interaction. Participants were 337 undergraduate students who completed the habit measure and measures of intention, deliberation, and perceived behavioral control phrased in either moderate or vigorous intensities at time 1. This was followed by a measure of behaviour 2 weeks later. Results using stacked structural equation models (moderate and vigorous intensity) demonstrated the direct effect of habit and accounted for a significant effect on physical activity after controlling for intention and perceived behavioral control; this effect was invariant to intensity and conscious deliberation. A 3-way interaction, however, was identified for the habit X intention relationship and intensity. In the moderate intensity condition, individuals who reported higher habits showed a lower intention-behavior relationship when compared with those who reported modest or low habits. By contrast, individuals who reported high habit levels in the vigorous physical activity condition demonstrated a larger intention-behavior relationship than their modest and low habit counterparts. The results support the notions that some properties of physical activity may have an automatic component and that habits may be important to physical activity action initiation.

Background: Knowing patients’ needs is a prerequisite to ensure high quality cancer care. This study describes the development and psychometric properties of a patient-centred instrument to measure needs and actual experiences with communication preceding chemotherapy treatment: QUOTEchemo. QUOTE-questionnaires (Quality Of care Through the patients’ Eyes) are widely used to gain insight into unmet needs, but no validated, standardised questionnaire combining patients’ needs and experiences surrounding chemotherapy treatment is available yet.Methods: To evaluate the psychometric properties of the QUOTEchemo, content validity, internal structure and convergent validity were investigated amongst 345 cancer patients, new to chemotherapy, from 10 different hospitals.Results: Literature study, focus group discussions and a categorisation procedure of 67 relevant topics revealed seven main themes: Treatment-related information, Prognosis information, Rehabilitation information, Coping information, Interpersonal communication, Tailored communication and Affective communication. Confirmatory factor analysis using structural equation modelling indicated that the measurement model provided good fit to the data with factor loadings ranging from .43 to .77. The seven QUOTEchemo dimensions captured relevant issues of concern with good internal consistency (α .72-.92), satisfactory item-total correlations (.35-.79) and satisfactory convergent validity. Affective communication, Treatment-related information and Rehabilitation information were perceived most important by patients. The instrument also appeared to be able to determine which aspects need improvement to ensure high quality care. The highest need for improvement was found for communicating Prognosis information and Rehabilitation information and for Interpersonal communication.Conclusions: These findings provide preliminary evidence of the reliability and validity of the QUOTEchemo for use in cancer care surrounding chemotherapy treatment. Researchers and health care providers can use the instrument to measure patients’ needs and experiences with communication to identify aspects that need improvement.

Many health behaviors have a history of repetition and, as a result, may become habitual. Because including a measure of habit strength may add depth to current theoretical models on health behavior, the present study explored the issue of habit strength within the context of the theory of planned behavior regarding adult bicycle use as a means of transportation.Cross-sectional data were gathered in a Dutch adult sample (n=317; mean age=42.09 years; 46.7% men) in 2006 using self-administered questionnaires. Variables for the theory of planned behavior were assessed regarding bicycle use as a means of transportation; habit strength regarding bicycle use as a means of transportation was assessed with the validated Self-Reported Habit Index. Hierarchical regression analyses and interaction analyses using simple slope analyses were conducted.After controlling for variables for the theory of planned behavior, habit strength was the strongest predictor of bicycle use. In addition, simple slope analyses based on a significant interaction term, intention x habit, showed that intention was a significant predictor of bicycle use among those at low levels of habit strength for bicycle use (beta=0.67, p0.001) but a weaker and nonsignificant predictor at high levels of habit strength (beta=0.10, p=0.136).Habit strength is a moderator of the intention-behavior relationship regarding bicycle use, with intention becoming less relevant when bicycle use increases in habit strength. Future determinant and intervention studies on physical activity may benefit from including a measure of habit strength--for instance, by identifying the differential effects of informational and environmental interventions.

The additive and interactive effects of habit strength in the explanation of saturated fat intake were explored within the framework of the Theory of Planned Behaviour (TPB). Cross-sectional data were gathered in a Dutch adult sample (n = 764) using self-administered questionnaires and analyzed using hierarchical regression analyses and simple slope analyses. Results showed that habit strength was a significant correlate of fat intake (beta = -0.11) and significantly increased the amount of explained variance in fat intake (R2-change = 0.01). Furthermore, based on a significant interaction effect (beta = 0.11), simple slope analyses revealed that intention was a significant correlate of fat intake for low levels (beta= -0.29) and medium levels (beta = -0.19) of habit strength, but a weaker and non-significant correlate for high levels (beta = -0.07) of habit strength. Higher habit strength may thus make limiting fat intake a non-intentional behaviour. Implications for information and motivation-based interventions are discussed. (c) 2008 Elsevier Ltd. All rights reserved.

The current ecological approach in health behaviour research recognises that health behaviour needs to be understood in a broad environmental context. This has led to an exponential increase in the number of studies on this topic. It is the aim of this systematic review to summarise the existing empirical evidence pertaining to environmental influences on fruit and vegetable (FV) consumption. The environment was defined as 'all factors external to the individual'. Scientific databases and reference lists of selected papers were systematically searched for observational studies among adults (18-60 years old), published in English between 1 January 1980 and 31 December 2004, with environmental factor(s) as independent factor(s), and fruit intake, vegetable intake or FV intake combined as one outcome measure as dependent factor(s). Findings showed there was a great diversity in the environmental factors studied, but that the number of replicated studies for each determinant was limited. Most evidence was found for household income, as people with lower household incomes consistently had a lower FV consumption. Married people had higher intakes than those who were single, whereas having children showed mixed results. Good local availability (e.g. access to one's own vegetable garden, having low food insecurity) seemed to exert a positive influence on intake. Regarding the development of interventions, improved opportunities for sufficient FV consumption among low-income households are likely to lead to improved intakes. For all other environmental factors, more replicated studies are required to examine their influence on FV intake.

Adolescent obesity is positively associated with soft drink consumption. We investigated the association of social-environmental and individual-level factors with soft drink consumption in a Dutch adolescent sample. Data were gathered in a longitudinal Dutch adolescent sample (n = 208, 62% girls). Soft drink consumption, social cognitions from the Theory of Planned Behaviour and parenting practices towards limited soft drink intake, and Big Five personality dimensions were assessed. Data were analyzed using three-step linear regression analyses. Effect sizes were used as the informational source for the explanatory value of the model. Interaction terms were computed to test the individual-environment interaction. Attitude and subjective norm were significantly associated with soft drink consumption. When controlling for social cognitions, the distal variables parenting practices and the personality dimension Agreeableness remained significantly associated with soft drink consumption. Agreeableness moderated the association of parenting practices with adolescent soft drink consumption. Standardized regression coefficients ranged from 0.16 to 0.24 and explained 14% of the variance in soft drink consumption, indicating a medium effect size. Stricter parenting practices were associated with less soft drink consumption and these effects were moderated by adolescent personality. The direct effects of practices and personality are noteworthy from a theoretical perspective. Implications for obesity prevention interventions are discussed.

Both habit strength and action planning have been found to moderate the intention-exercise behaviour relationship, but no research exists that has investigated how habit strength and action planning simultaneously influence this relationship. The present study was designed to explore this issue in a prospective sample of undergraduate students (N = 415): action planning, habit strength, intention, attitudes, subjective norms and perceived behavioural control were assessed at baseline and exercise behaviour was assessed 2 weeks later. Both habit strength and action planning moderated the intention-exercise relationship, with stronger relationship at higher levels of planning or habit strength. Decomposing a significant action planning × habit strength × intention interaction showed that the strength of the intention-exercise relationship progressed linearly through levels of action planning and habit strength. These novel results show that action planning strengthens the intention-habit strength interaction in the exercise domain: exercise interventions should therefore focus on simultaneously bolstering action planning and habit strength.

Background The twelve-item Self-Report Habit Index (SRHI) is the most popular measure of energy-balance related habits. This measure characterises habit by automatic activation, behavioural frequency, and relevance to self-identity. Previous empirical research suggests that the SRHI may be abbreviated with no losses in reliability or predictive utility. Drawing on recent theorising suggesting that automaticity is the ‘active ingredient’ of habit-behaviour relationships, we tested whether an automaticity-specific SRHI subscale could capture habit-based behaviour patterns in self-report data. Methods A content validity task was undertaken to identify a subset of automaticity indicators within the SRHI. The reliability, convergent validity and predictive validity of the automaticity item subset was subsequently tested in secondary analyses of all previous SRHI applications, identified via systematic review, and in primary analyses of four raw datasets relating to energy‐balance relevant behaviours (inactive travel, active travel, snacking, and alcohol consumption). Results A four-item automaticity subscale (the ‘Self-Report Behavioural Automaticity Index’; ‘SRBAI’) was found to be reliable and sensitive to two hypothesised effects of habit on behaviour: a habit-behaviour correlation, and a moderating effect of habit on the intention-behaviour relationship. Conclusion The SRBAI offers a parsimonious measure that adequately captures habitual behaviour patterns. The SRBAI may be of particular utility in predicting future behaviour and in studies tracking habit formation or disruption.