The importance of coping appraisal in behavioural responses to pandemic flu

Objectives. Behavioural responses to influenza pandemics can significantly influence the impact on public health. Protection motivation theory (PMT) provides a framework for understanding how people respond to health threats such as pandemics. The main aim of this study was to model the relative contribution of the components of PMT (threat and coping appraisal) to intentions to perform two behaviours recommended by the UK government in a pandemic: stay at home when ill and keep going to work when well. Design. A 2×2 factorial design was used to test the effect of scenarios describing pandemic severity (low vs. high threat) and advice messages (standard government advice vs. theory‐based advice) on measures of threat and coping appraisal, and intentions to carry out the two recommended behaviours. Methods. A web‐based survey designed to assess threat appraisal, coping appraisal, and behavioural intentions was completed by 883 adults (December 2009–January 2010) drawn from University College London staff and the local community. Structural equation modelling was used to test the PMT framework. Results. Perceived pandemic severity influenced threat and coping appraisals and intentions. Structural equation modelling revealed that coping appraisal (i.e., perceptions of the costs, benefits, and feasibility of the recommended behaviours) was the principal predictor of variability in intentions for both behaviours and for both pandemic scenarios. Conclusions. Coping appraisals appear to be an important, and hitherto underresearched, predictor of how people may behave in pandemics, and our findings provide encouraging preliminary evidence that it may be possible to change these perceptions.     

Protection motivation theory and the prediction of physical activity among adults with type 1 or type 2 diabetes in a large population sample

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 (χ²/df =1.27?4.08, RMSEA=.02–.05). Self‐efficacy was a stronger predictor of intention (β=0.64–0.68) than response efficacy (β=0.14–0.16) in individuals with T1D or T2D. Severity was significantly related to intention (β=0.06) in T2D individuals only, whereas vulnerability was not significantly related to intention or PA behaviour. Self‐efficacy (β's=0.20–0.28) and intention (β'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.     

Predicting adherence to eye patching in children with amblyopia: An application of protection motivation theory

Objectives: This study reports an application of protection motivation theory (PMT) to the prediction of parental adherence to eye patching recommendations for children with amblyopia over a 2‐month period. The study also considered the role of past behaviour in PMT. Design and methods: A total of 151 parents of children with amblyopia who were attending follow‐up appointments for orthoptic treatment participated. They completed questionnaires based on PMT to assess their beliefs about amblyopia and eye patching. Of the parents, 105 were contacted again at 2‐month follow‐up to obtain a measure of adherence to the recommended treatment for their child. Results: PMT was found to be predictive of adherence intentions and behaviour at 2‐month follow‐up. Regression analyses revealed perceived vulnerability, response efficacy and self‐efficacy to be significant predictors of protection motivation, whereas perceived vulnerability and response costs were significant predictors of adherence behaviour. Past adherence behaviour was found to have a direct effect on future adherence behaviour over and above the influence of PMT. Conclusions: The results are discussed in relation to the sufficiency of PMTas a model of adherence behaviour. The practical implications for attempts to increase adherence to eye patching among children with amblyopia are outlined.     

Emotion‐related primary and secondary appraisals,adjustment and coping: Associations in women awaiting breast disease diagnosis

Objective: Different emotions are to some extent associated with different ways of coping. Cognitive processes involved in determining emotional reactions may influence coping (perhaps through directing attention or generating salient information). This study explored possible appraisal‐coping associations by examining whether a set of appraisal components identified in emotion theory were also associated with coping. Design: The study examined concurrent associations between appraisal components, emotional adjustment, and coping in 148 women with suspected breast disease. Method: Questionnaire measures of primary and secondary appraisal components identified in emotion theory, anxiety, depression, and coping were sent to women during the waiting period between GP referral and attendance at a ‘one‐stop’ breast‐disease diagnosis clinic. Results: Consistent with expectations, appraisal components were associated with both emotions and coping. Elevated anxiety was associated with appraisals of low emotion‐focused coping potential; avoidance coping was associated with motivational incongruence, self‐accountability, and pessimistic appraisal of emotion‐focused coping potential; acceptance/resignation coping was associated with self‐accountability and pessimistic appraisals of both future expectancy and emotion‐focused coping potential. Conclusion: This study presents a theoretically driven approach to exploring associations between emotions and adjustment efforts. In keeping with expectations, a number of appraisal components identified in emotion theory were found to be associated with both emotion and coping.     

Integrating the theory of planned behaviour and self‐determination theory in health behaviour: A meta‐analysis

Purpose A meta‐analysis of studies integrating the theory of planned behaviour (TPB) and self‐determination theory (SDT) in health contexts is presented. The analysis aimed to provide cumulative empirical support for a motivational sequence in which self‐determined motivation from SDT predicts the proximal predictors of intentions and behaviour from the TPB. Methods A literature search identified 36 integrated studies providing 45 tests of effects between TPB and SDT variables. Hunter and Schmidt's (1994) methods of meta‐analysis were used to correct the effect sizes across the studies for statistical artifacts. Age (old versus young), publication status (published versus unpublished), study design (correlational versus experimental/intervention), and behaviour type (physical activity versus other health‐related behaviours) were evaluated as moderators of the effects. A path‐analysis using the meta‐analytically derived correlations was conducted to examine the proposed motivational sequence. Results Statistically significant corrected correlations were evident among the perceived autonomy support and self‐determined motivation constructs from SDT and the attitude, subjective norms, perceived behavioural control, intention, and health‐related behaviour constructs from the TPB. Only six of the 28 effect sizes were moderated by the proposed moderators. Path analysis revealed that the significant effects of self‐determined motivation on intentions and behaviour were partially mediated by the proximal predictors from the TPB. Conclusions Evidence from this synthesis supported the theoretical integration and proposed motivational sequence. Results are discussed with reference to the complementary aspects of the TPB and SDT and the need for integrated experimental or intervention studies on a broader range of health behaviours.     

A randomized controlled trial of smoking cessation for pregnant women to test the effect of a transtheoretical model‐based intervention on movement in stage and interaction with baseline stage

Objectives. To examine whether, as predicted by the transtheoretical model (TTM), stage‐matched interventions will be more effective than stage‐mismatched interventions. Design. Randomized controlled trial of smoking cessation advice to pregnant smokers. Methods. Pregnant women currently smoking at 12 weeks gestation were enrolled in a pragmatic three‐arm trial of TTM‐based interventions to help them stop smoking. One arm constituted standard midwifery advice and a self‐help leaflet on stopping smoking, which is generally appropriate for women in preparation. Two arms were TTM‐based. Differences in positive movement in stage towards quitting from enrolment to 30 weeks gestation and 10 days post‐partum were calculated for each arm of the trial. We then examined whether, as predicted from the TTM, the relative benefit of the TTM‐based intervention was greater for women in precontemplation and contemplation, for whom the control intervention was stage‐mismatched, than for women in preparation, for whom the control intervention was stage‐matched. Results. Women in the TTM‐based arms were statistically significantly more likely to move forward in stage than were women in the control arm. Contrary to the TTM‐derived hypothesis, the greater relative benefit of the TTM‐based intervention was seen for women in preparation stage at baseline, rather than women in precontemplation and contemplation. Conclusions. The TTM‐based intervention was more effective in stage movement, but this could be due to its greater intensity. The failure to confirm that stage‐matching was important casts doubt on the validity of the TTM in explaining smoking cessation behaviour in pregnancy.     

Predicting and explaining transtheoretical model stage transitions in relation to condom‐carrying behaviour

Objectives The stages of change component of the transtheoretical model have been applied to safe sex behaviours in cross‐sectional analyses, but have not yet been subject to prospective analysis. It was predicted that: (a) cross‐sectional analyses would demonstrate good discrimination between the stages of change; (b) prospective analyses would allow for the identification of predictors of stage transitions; and (c) implementation intentions would explain progression from the preparation stage. Design This study employed an experimental longitudinal design. Participants were randomly assigned to the experimental (implementation intention) or control conditions and completed questionnaires at baseline and at 2‐month follow‐up. Methods Five hundred and twenty‐five adolescents who were broadly representative of the UK population completed questionnaires at baseline and follow‐up (N=393) measuring: demographic variables; stage of change; theory of planned behaviour constructs; anticipated regret; and moral norm in relation to condom‐carrying behaviour. The experimental condition completed a self‐generated implementation intention to carry condoms at the end of the baseline questionnaire. Results Discriminant function analyses indicated that the stages of change could be accurately discriminated from one another cross‐sectionally and that, longitudinally, the measured variables were able to predict transitions between most stages. Implementation intentions caused people to progress from the preparation stage. Conclusions Transitions between most stages were reliably predicted, thereby providing potential targets for intervention. The brief implementation intention intervention was effective and could easily be utilized and expanded to encompass a broader range of sexual health behaviours.     

Testing an integrated model of the theory of planned behaviour and self‐determination theory for different energy balance‐related behaviours and intervention intensities

Objectives The aim of the study was to test the relations between constructs from the self‐determination theory (autonomous and controlled motivation), the theory of planned behaviour (attitudes, self‐efficacy, and intentions), and behaviour change within a theoretically integrated model. Additionally, the aim was to test if these relations vary by behaviour (physical activity or dietary behaviour) or intervention intensity (frequency). Design. It was a randomized controlled trial with a ‘usual care’ condition (medical screening only) and an intervention condition (medical screening+access to a website and coaching). Participants in the latter condition could freely determine their own intervention intensity. Methods. Participants (N= 287) completed measures of the theoretical constructs and behaviour at baseline and after the first intervention year (N= 236). Partial least squares path modelling was used. Results. Changes in autonomous motivation positively predicted changes in self‐efficacy and intentions towards a healthy diet. Changes in controlled motivation positively predicted changes in attitudes towards physical activity, changes in self‐efficacy, and changes in behavioural intentions. The intervention intensity moderated the effect of self‐efficacy on intentions towards physical activity and the relationship between attitude and physical activity. Changes in physical activity were positively predicted by changes in intentions whereas desired changes in fat intake were negatively predicted by the intervention intensity. Conclusions Important relations within the theoretically integrated model were confirmed but others were not. Moderation effects were found for behaviour and intervention intensity.     

Stages of change or changes of stage? Predicting transitions in transtheoretical model stages in relation to healthy food choice

Relatively little research has examined factors that account for transitions between transtheoretical model (TTM) stages of change. The present study (N = 787) used sociodemographic, TTM, and theory of planned behavior (TPB) variables, as well as theory-driven interventions to predict changes in stage. Longitudinal analyses revealed that sociodemographic, TPB, and 1 of the interventions predicted transitions between most stages of change. In fact, only progression from the preparation stage was not predictable. However, given that this change of stage marks the transition between cognition and actual behavior, the identification of variables that bridge this gap is crucial for the development of interventions to promote stage transitions.     

Understanding the coping process from a self‐determination theory perspective

Purpose To explore conceptual links between the cognitive‐motivational‐relational theory (CMRT) of coping ( Lazarus, 1991 ) and self‐determination theory (SDT) of motivation ( Deci & Ryan, 1985 ). Method We present a very brief overview of the two theories. We also discuss how components from the two theories can be examined together to facilitate research in the health/exercise domain. To this effect, we offer a preliminary integrated model of stress, coping, and motivation, based on the two aforementioned theories, in an attempt to illustrate and instigate research on how motivational factors are implicated in the coping process. Conclusion We believe that the proposed model can serve as a platform for generating new research ideas which, besides their theoretical relevance, may have important applied implications.     

Predicting alcohol consumption and binge drinking in company employees: an application of planned behaviour and self-determination theories

Objectives. This study tested an integrated model of the psychosocial determinants of alcohol‐related behaviour among company employees from four nations. A motivational sequence was proposed in which motivational orientations from self‐determination theory influenced intentions to consume alcohol within guideline limits and alcohol‐related behaviour via the mediation of the theory of planned behaviour variables of attitude, subjective norms, and perceived behavioural control (PBC). Design. A three‐wave prospective design using self‐reported psychological and behavioural measures. Methods. Company employees (N= 486, males = 225, females = 261; M age = 30.41, SD= 8.31) from four nations (Estonia, Finland, Sweden, and UK) completed measures of autonomous and controlled motivation from self‐determination theory, attitudes, subjective norms, PBC, intentions from the theory of planned behaviour, and self‐reported measures of past alcohol consumption and binge‐drinking occasions at the first time point (time 1). Follow‐up psychological and behavioural measures were taken one month later (time 2) and follow‐up behavioural measures taken a further 2 months later (time 3). Results. Path analyses supported the motivational sequence with identified regulation (time 1), predicting intentions (time 1), and alcohol units consumed (time 2). The effects were indirect via the mediation of attitudes and PBC (time 1). A similar pattern of effects was found for the effect of time 2 psychological variables on time 3 units of alcohol consumed. There was little support for the effects of the psychological variables on binge‐drinking behaviour. Conclusions. Findings provide new information on the psychosocial determinants of alcohol behaviour in company employees and the processes involved. Results may provide impetus for the development of interventions to reduce alcohol consumption.     

Protection Motivation Variables in HIV Testing: The Function of Motivational Factors

Most previous studies on HIV/AIDS using Rogers' protection motivation theory (PMT) have focused on primary prevention. This study examined the utility of PMT for predicting HIV testing, a form of secondary prevention. Cross-sectional survey data from 243 young adults was assessed. It was hypothesized that motivational factors, notably fear and maladaptive coping, reliably predict testing over and beyond variation attributable to cognitive appraisals. Hierarchical logistic regression analysis showed that testing was not influenced by cognitive appraisals. As expected maladaptive coping produced a significant improvement in model fit after accounting for threat- and coping appraisals. Interestingly, fear was not significant. Controlling for past risk behavior and demographic variables at an earlier step failed to negate the salience of maladaptive coping, which again significantly improved model fit. Use of rationalizations (to discount personal risk) was the key maladaptive response that reliably distinguished between testers and nontesters. Testing was associated with less use of rationalizations and higher levels of prior risk behavior. However, overall less than 20% of testers were correctly classified, suggesting that PMT components overall have limited explanatory value in this context. Implications for promoting HIV testing are considered.     

Reflective and non‐reflective antecedents of health‐related behaviour: Exploring the relative contributions of impulsivity and implicit self‐control to the prediction of dietary behaviour

Objectives. This study (N= 139) explored whether two measures that capture non‐reflective processing (viz. a self‐report measure of impulsivity and a behavioural measure of implicit self‐control) would contribute to the prediction of dietary behaviour over and above cognitive predictors specified by the theory of planned behaviour (TPB). Methods. Four dimensions of impulsivity were measured at Time 1. Implicit self‐control was measured at Time 2, alongside TPB predictors relating to the avoidance of high‐calorie snacks. At Time 3, participants reported their snacking behaviour over the previous 2 weeks. Results. Results revealed that both impulsivity and implicit self‐control significantly contributed to the prediction of snacking behaviour over and above the TPB predictors. Conclusions. It was concluded that the predictive utility of models such as the TPB might be augmented by the inclusion of variables that capture non‐reflective information processing.     

Dimensions and profiles of the generalized health‐related self‐concept

Objectives We explore the significance of health as a potentially self‐relevant category from the perspective of dynamic self‐concept theory. Our intention was to describe the dimensional structure of the generalized health‐related self‐concept, to identify particular prototypes of health‐related self‐definition, and to see if these prototypes would differ with respect to appraisals of health behaviour and subjective health. Design We conducted a cross‐sectional questionnaire study involving 545 college students (23.3% male) at the mean age of 22 years. Methods The self‐administered questionnaire assessed a relevant spectrum of health‐related cognitions denoting their generalized declarative knowledge about their health (the generalized health‐related self‐concept). Additionally, participants rated their multiple health behaviour, their perceived health, and their anticipated vulnerability. Results A principal components analysis of the health‐related cognitions revealed the following five dimensions: health‐protective dispositions, health‐protective motivation, vulnerability, health‐risky habits, and external, avoidant motivation. A two‐step cluster analysis of the five components identified six profiles of health‐related self‐concept: careless/carefree, omnipotents, risk‐takers, mentally affected, reluctant‐avoidant, and medically fragile. These prototypes could be successfully reclassified (97.6%). The six profiles differed with respect to their health behaviour and subjective health appraisals. Conclusions The dimensional structure represents both resources and deficits with respect to an individual's health‐related self‐concept. An individual's profile of these dimensions might correspond to a characteristic set of particular health needs and motivations. Successful health communications should follow a complementary strategy of affirming the self‐concept.     

Stages of motivational readiness for physical activity: A comparison of different algorithms of classification

Objective: The aim of this study was to compare two approaches to classify individuals into stages of motivational readiness for physical activity and test which one was better explained by attitude and perceived behavioural control, as defined by Ajzen (1991). Design: A survey of 20430 respondents from a population‐based sample. Methods: The relevant variables were assessed in a self‐administered questionnaire. The cluster approach consisted of combining both intention and behaviour in order to determine clusters of individuals; such clusters correspond to different stages of motivational readiness. The stage of change (SC) approach consisted of grouping the same individuals by using the SC variable of the Transtheoretical Model (TTM). Results: The SC and cluster‐solution approaches were replicated across four subsamples of the total number of respondents. Attitude and perceived behavioural control were more strongly associated with stage membership derived from four‐cluster solution than with stage membership in the five categories assessed by the SC method. Conclusion: Stage of motivational readiness for physical activity, and possibly for other health‐related behaviours, may usefully be characterized when both recent past behaviour and intention in the near future are simultaneously and explicitly taken into consideration.     

The Role of Illness, Resources, Appraisal, and Coping Strategies in Adjustment to HIV/AIDS: The Direct and Buffering Effects

This study examined the utility of a stress and coping model of adjustment to HIV/AIDS. A total of 114 HIV-infected gay or bisexual men were interviewed and they completed self-administered scales. Predictors included illness variables (disease stage and number of symptoms), coping resources (optimism and social support), appraisal (threat, challenge, and controllability), and coping strategies (problem- and emotion-focused). Adjustment outcomes were depression, global distress, social adjustment, and subjective health status. Results from hierarchical regression analyses indicated that better adjustment was related to an asymptomatic illness stage, fewer HIV-related symptoms, greater social support, challenge and controllability appraisals, problem-focused coping, and lower threat appraisals and reliance on emotion-focused coping. There was limited support for the stress-buffering effects of optimism. Findings support the utility of a stress and coping model of adjustment to HIV/AIDS.     

Modelling change in adolescent smoking behaviour: Stability of predictors across analytic models

Objectives The current paper examined the variability of predictors of changes in adolescent smoking across linear and nonlinear analytic models. Design Three analytic models typically used to model adolescent smoking behaviour were tested: one linear model of change (standard linear), one static linear model (pre‐post linear) and one nonlinear model of change (cusp catastrophe). Variability in model composition was assessed by examining the pattern of variables achieving statistical significance and proportion of variance explained. Methods Model testing was conducted on data from Australian adolescents successfully tracked through a 12‐month longitudinal study of smoking (N = 779). The survey measured demographics, self‐reported smoking, smoking among friends and family, self‐esteem, neuroticism, coping, stress and risk taking. Results The results indicated that while predictors of change were invariant across analytic models explanatory power varied markedly. Models of change in smoking that included simple, interacted or polynomial forms of initial conditions (past behaviour) explained more than four times the variance of models without. Conclusions These results justified confidence in the predictors of change in adolescent smoking across analytic models. A secondary implication was that more research into past behaviour's role in the context of dynamical models of adolescent smoking and other health behaviour is needed.     

A preliminary study of negative appraisals and dysfunctional coping associated with post‐traumatic stress disorder symptoms following myocardial infarction

Objectives . To investigate associations between post‐traumatic stress disorder (PTSD) symptoms following myocardial infarction (MI) and subjective experience of MI, negative perception of consequences, negative appraisals of symptoms, and use of dysfunctional coping strategies, as described by Ehlers and Clark's (2000) model of PTSD. Design . Cross‐sectional questionnaire study of people who experienced a MI within the previous 12 weeks (N = 74; 51% response rate). Methods . Participants completed questionnaires assessing PTSD symptoms, subjective experience of MI, perception of consequences, appraisal of symptoms, and dysfunctional coping strategies. Results . Of the participants, 16% met DSM‐IV criteria for PTSD and a further 18% reported moderate to severe PTSD symptoms. People with PTSD symptoms also had more somatic symptoms, anxiety, depression, and social dysfunction. PTSD symptoms were associated with perceived severity and danger of MI, a history of psychological problems, previous trauma, negative appraisal of symptoms, perceived severe consequences, and dysfunctional coping strategies. These variables were entered into a regression with MI and past history variables on Step 1, and appraisal and coping variables on Step 2. This showed that perceived consequences and dysfunctional coping were strongly associated with PTSD symptoms after controlling for MI and past history variables. Conclusion . The results of this preliminary study suggest perception of consequences and dysfunctional coping may be important in PTSD symptoms following MI.     

A validity and reliability study of the coping self‐efficacy scale

Objectives. Investigate the psychometric characteristics of the coping self‐efficacy (CSE) scale, a 26‐item measure of one's confidence in performing coping behaviors when faced with life challenges. Design. Data came from two randomized clinical trials (N1 = 149, N2 = 199) evaluating a theory‐based Coping Effectiveness Training (CET) intervention in reducing psychological distress and increasing positive mood in persons coping with chronic illness. Methods. The 348 participants were HIV‐seropositive men with depressed mood who have sex with men. Participants were randomly assigned to intervention and comparison conditions and assessed pre‐ and post‐intervention. Outcome variables included the CSE scale, ways of coping, and measures of social support and psychological distress and well‐being. Results. Exploratory (EFA) and confirmatory factor analyses (CFA) revealed a 13‐item reduced form of the CSE scale with three factors: Use problem‐focused coping (6 items, α = .91), stop unpleasant emotions and thoughts (4 items, α = .91), and get support from friends and family (3 items, α = .80). Internal consistency and test–retest reliability are strong for all three factors. Concurrent validity analyses showed these factors assess self‐efficacy for different types of coping. Predictive validity analyses showed that residualized change scores in using problem‐ and emotion‐focused coping skills were predictive of reduced psychological distress and increased psychological well‐being over time. Conclusions. The CSE scale provides a measure of a person's perceived ability to cope effectively with life challenges, as well as a way to assess changes in CSE over time in intervention research.     

Examining Psychobiological Responses to an Anticipatory Body Image Threat in Women

The present study extended the applicability of social self‐preservation theory (SSPT) to an anticipatory body image threat. Women (n = 80) were randomized into either a control or threat group (anticipating having a body composition assessment). Participants completed measures of body shame and social physique anxiety (self‐conscious outcomes), and body dissatisfaction (a non‐self‐conscious outcome), and provided a sample of saliva (to assess cortisol levels) at baseline and immediately following their condition. Findings showed that for the threat condition, body image variables were significantly more negative pre‐ to post‐condition. Findings also showed that self‐conscious outcomes were more sensitive than the non‐self‐conscious outcome. There was not a significant group‐by‐time interaction for cortisol. Findings support SSPT's applicability to the anticipation of a social‐evaluative body‐related threat.