Do behavioural health intentions engender health behaviour change? A study on the moderating role of self‐affirmation on actual fruit intake versus vegetable intake

Objectives. The purpose of this persuasion research was to show that self‐affirmation (SA) increases intentions in the advocated direction and that these intentions predict actual health behaviour change. That is, these intentions not only serve the function of short‐term relief of the threat caused by the persuasive message. We proposed that the effect of SA depends on the level of value‐involvement. Design. Participants were randomly assigned to one of two conditions (no SA vs. SA) of a between‐subjects design. After the SA manipulation, all participants read a threatening health text about the consequences of insufficient fruit and vegetable intake. At pre‐test, value‐involvement was determined. Methods. Participants included were undergraduate students. The SA manipulation consisted of a writing exercise. After reading the health message, participants reported their intention to eat sufficient fruit and vegetables (N= 537). After 1 week (N= 293) and 4 weeks (N= 261), participants completed self‐reports of fruit and vegetable intake. Results. No main effect was found for SA on any outcome measure. We did find that involvement moderated the effect of SA on cooked vegetables consumption. This effect was not present for raw vegetables/salad consumption or for fruit consumption. The moderated effect on cooked vegetable consumption was most evident after 1 week and the effect was mediated by the immediate intentions of participants. Conclusions. SA can lead to genuine intentions that predict actual behaviour, but the effect of SA depends on the type of behaviour and people's value‐involvement.     

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.     

Role of anticipated regret,intentions and intention stability in adolescent smoking initiation

Objectives To examine the impact of anticipated regret within the theory of planned behaviour (TPB) on intentions of adolescents to initiate smoking. To examine the moderating role of anticipated regret and intention stability on the relationship between intentions and smoking initiation in adolescents. Methods We conducted two studies measuring anticipated regret within the TPB applied to adolescent smoking initiation. In the first study, 347 non‐smoking adolescents (between 11 and 12 years of age) completed the TPB and anticipated regret measures about smoking initiation. In the second study, 675 non‐smoking adolescents (between 11 and 12 years of age) completed the TPB, anticipated regret, and intention stability measures in relation to smoking initiation. Smoking was assessed objectively by carbon monoxide breath monitor 9 months later. Results In Studies 1 and 2, regret significantly added to predictions of intentions over and above components of the TPB (p <.001). In Study 2, smoking behaviour was predicted by intentions and the relationship of intentions to behaviour was moderated by regret and intention stability. Conclusions Regret and intention stability were shown to be important variables within the TPB in understanding intentions and behaviour of smoking initiation in adolescents.     

A controlled trial of personal construct psychotherapy for deliberate self‐harm

Evidence for the effectiveness of psychological therapies for people who self‐harm is limited. Personal construct theory provides a model of self‐harm and a framework for therapeutic intervention, which was evaluated in the present study. Sixty‐four adults presenting to Accident and Emergency departments following self‐harm were allocated to a personal construct psychotherapy or a ‘normal clinical practice’ condition. They completed various measures at assessment points pre‐ and post‐therapy. Repetition of self‐harm was assessed over a 3‐year period. Participants in the intervention condition showed significantly greater reduction in suicidal ideation, hopelessness and depression post‐treatment than the control group; and significantly more reconstruing at this point and 6‐month follow‐up. There was some evidence suggestive of a lower frequency of repetition of self‐harm in the intervention than in the control group. It is concluded that brief personal construct psychotherapy may be effective for people who self‐harm and merits further exploration.     

Can safer‐sex promotion leaflets change cognitive antecedents of condom use? An experimental evaluation

An experimental evaluation of a safer sex promotion leaflet was undertaken to assess its capacity to change antecedent cognitions of condom use. The leaflet was identified in a previous study as addressing research‐based cognitive antecedents of condom use. A pre‐post‐test experimental study including three conditions was conducted: (a) presentation of the leaflet; (b) presentation of the leaflet plus incentive for systematic processing; (c) no‐leaflet control. The leaflet was evaluated in terms of its capacity to change eight cognitive correlates of condom use identified in a recent meta‐analysis. The sample consisted of 230 tenth‐grade students. Following baseline assessments, leaflet‐induced change was measured immediately following the intervention and at a follow up 4 weeks post‐intervention. The target leaflet alone did not result in significant changes in the cognitive antecedents of condom use compared with the control condition. However, in combination with an incentive for systematic processing, the target leaflet had a greater impact on cognitive antecedents than the no‐leaflet control condition. The findings are discussed with regard to the development and evaluation of research‐based health‐promotion materials.     

Spontaneous implementation intentions and impulsivity: Can impulsivity moderate the effectiveness of planning strategies?

Objective. Self‐initiated plans relating to when, where, and how behaviour will be performed have been shown to be effective in promoting goal progress. The current study (N =256) explored whether any impact of self‐initiated implementation intentions on the avoidance of snacking was moderated by impulsivity. Design and methods. The study employed a prospective design. At Time 1, participants reported the extent to which they had formed self‐initiated implementation intentions to avoid eating high‐calorie snacks. At Time 2, participants reported their snack consumption over the preceding 2 weeks and completed a measure of impulsivity. Results. Impulsivity (urgency) moderated the effect of self‐initiated implementation intentions on snack consumption. Specifically, self‐initiated implementation intentions benefited the avoidance of snacking most for those low in impulsivity and least for those high in impulsivity. Conclusion. The findings suggest that impulsivity might form an important boundary condition to the effectiveness of self‐initiated implementation intention formation in relation to snacking.     

Disclosure of cardiac variants of uncertain significance results in an exome cohort

This study examined the impact of disclosing subclassifications of genetic variants of uncertain significance (VUS) on behavioral intentions. We studied return of VUS results to 79 individuals with a cardiomyopathy‐associated VUS, subclassified into VUS‐high or VUS‐low. Primary outcomes were perceived risk (absolute and comparative), perceived severity, perceived value of information, self‐efficacy, decision regret, and behavioral intentions to share results and change behaviors. There was no significant difference between the 2 subclasses in overall behavioral intentions (t = 0.023, P = .982) and each of the individual items on the behavioral intentions scale; absolute (t = ?1.138, P = .259) or comparative (t = ?0.463, P = .645) risk perceptions; perceived value of information (t = 0.582, P = .563) and self‐efficacy (t = ?0.733, P = .466). Decision regret was significantly different (t = 2.148, P = .035), with VUS‐low (mean = 17.24, SD = 16.08) reporting greater regret. Combining the subclasses, perceived value of information was the strongest predictor of behavioral intentions (β = 0.524, P < .001). Participants generally understood the meaning of a genetic VUS result classification and reported satisfaction with result disclosure. No differences in behavioral intentions were found, but differences in decision regret suggest participants distinguish subclasses of VUS results. The perceived value of VUS may motivate recipients to pursue health‐related behaviors.     

The impact of job strain on the predictive validity of the theory of planned behaviour: An investigation of exercise and healthy eating

Objectives. This study examined the impact of the job strain model on exercise and healthy eating within the framework of the Theory of Planned Behaviour. Design. Participants completed a questionnaire measuring the components of the Theory of Planned Behaviour and the job strain model. A follow‐up questionnaire a week later measured behaviour. Method. The questionnaires were completed by e‐mail. The initial questionnaire was completed by 331 employees, and 286 follow‐up questionnaires were returned. Results. Job demands affected exercise indirectly by lowering perceptions of behavioural control over exercise. However, variables from the job strain model were not related to exercise intentions or behaviour. In contrast, employees in passive jobs intended to eat more sweets and snack foods and employees in low strain jobs were more likely to realize their intentions to eat more sweets and snack foods. However, variables from the job strain model did not influence consumption of fruit and vegetables. Conclusions. While people may consider the impact of job strain on exercise whilst making decisions about whether or not to exercise, job strain has a more direct impact on healthy eating. However, job strain may only affect consumption of so‐called ‘high density’ foods, rather than foods such as fruit and vegetables.     

How to lose weight bias fast! Evaluating a brief anti-weight bias intervention

Objectives. Although experiencing weight bias is associated with poor physical and psychological health, health professionals often stigmatize overweight and obese clients. The objective of this study was to evaluate a brief educational intervention that aimed to reduce weight bias among Australian pre‐service health students by challenging beliefs about the controllability of weight. Design. Non‐equivalent group comparison trial. Methods. Undergraduate psychology students were assigned to an intervention (n= 30), control (n= 35), or comparison (n= 20) condition. The intervention condition received a lecture on obesity, weight bias, and the multiple determinants of weight; the comparison condition received a lecture on obesity and the behavioural determinants of weight; and the control condition received no lecture. Beliefs about the controllability of weight and attitudes towards overweight and obese people were assessed 1 week pre‐intervention, immediately post‐intervention, and 3 weeks post‐intervention. Results. After receiving the lecture, participants in the intervention group were less likely to believe that weight is solely within individual control and were also less likely to hold negative attitudes towards overweight and obese people and rate them as unattractive. These changes were maintained 3 weeks post‐intervention. There were no such changes in the control or comparison groups. Disparagement of overweight and obese peoples’ social character increased over time for participants in the control condition but did not change in the comparison or intervention groups. Conclusions. This study provides evidence that brief, education‐based anti‐weight bias interventions show success in challenging weight controllability beliefs and reducing weight bias among pre‐service health students.     

Self‐management training for people with chronic disease: An exploratory study

Objective: To determine the effectiveness of a community‐based Chronic Disease Self‐management Course (CDC) for UK participants with a range of chronic diseases. Design: The study was a multiple baseline, pre‐test post test design with a sample of 185 participants who attended a CDC delivered in community settings by lay tutors, in the UK. Method: Data were collected by self‐completed questionnaires before attendance and at four‐month follow‐up. Results: The sample comprised 72% women (mean age = 53 years, mean disease duration = 16 years). The main chronic diseases included endometriosis, depression, diabetes, myalgic encephalomyelitis, osteoporosis and polio. Adjusting for baseline values and gender, small to moderate increases were found on cognitive symptom management, self‐efficacy (disease and symptoms) and communication with physician. A similar sized decrease was found on fatigue, and small decreases were evident on anxious and depressed moods, and health distress. There were no changes in the use of health care resources, or on self‐reported exercise behaviour. Conclusion: The results of this exploratory study suggest that self‐management training for people with chronic diseases can offer benefits in terms of enhanced self‐efficacy, greater use of cognitive behavioural techniques, and improvement in some aspects of physical and psychological well‐being.     

Increasing children's consumption of fruit and vegetables: does the type of exposure matter?

This study sought to determine how eight days of home exposure to information about healthful foods and eating behaviors in the form of children's books and a variety of fruit and vegetables interacted to affect 4- to 8-year-old children's (N=59) consumption of fruit and vegetables. Before and after the home exposure, children participated in a task in which their consumption of a variety of fruit and vegetables that ranged in familiarity was measured. Results indicated that exposure to food and books were both effective at increasing consumption of fruit, but not vegetables. Additionally, children who were exposed to books consumed more of an infrequently consumed fruit presented during the post-test, but only if they had not been exposed to food during the home exposure. Overall, children's fruit consumption increased more if their mothers did not pressure them to eat, and those who were less neophobic were more likely to try a novel fruit or vegetable during the post-test. These findings suggest that information and food variety both can be effective for increasing acceptance of fruit, and highlight the need for more research that investigates the efficacy of intervention strategies that promote vegetable consumption in young children.     

Cognitive–behavioural,pharmacological and psychosocial predictors of outcome during tapered discontinuation of benzodiazepine

Eighty‐six participants wishing to stop benzodiazepine and who met DSM‐IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed. American Psychological Association, 1994) criteria for anxiety disorder or insomnia were assessed pre‐ and post‐taper on clinical, pharmacological and psychosocial measures. An initial cohort of 41 participants received treatment as usual (taper only) plus physician counselling in the same clinic setting. A second cohort of 45 participants were randomly allocated to group cognitive–behavioural therapy (CBT) plus taper, or group support (GS) plus taper. At 3 months follow‐up, the outcomes in both the CBT and the GS subgroups were equivalent. Intention to treat analysis revealed a slight advantage to the CBT over the GS group and the CBT group showed higher self‐efficacy post‐taper. Over all 86 participants, a high‐baseline level of psychological distress, anxiety and dosage predicted a poor outcome, but increase in self‐efficacy contributed to a successful outcome particularly in those with initially poor baseline predictors. Although there was a decrease in positive affect during preliminary stages of tapered discontinuation compared to baseline, there was no significant overall increase in negative affect. Copyright © 2008 John Wiley & Sons, Ltd.     

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.     

The who,what, and why of research participants’ intentions to request a broad range of secondary findings in a diagnostic genomic sequencing study

PurposeIn a diagnostic exome sequencing study (the North Carolina Clinical Genomic Evaluation by Next-Generation Exome Sequencing project, NCGENES), we investigated adult patients’ intentions to request six categories of secondary findings (SFs) with low or no medical actionability and correlates of their intentions.MethodsAt enrollment, eligible participants (n = 152) completed measures assessing their sociodemographic, clinical, and literacy-related characteristics. Prior to and during an in-person diagnostic result disclosure visit, they received education about categories of SFs they could request. Immediately after receiving education at the visit, participants completed measures of intention to learn SFs, interest in each category, and anticipated regret for learning and not learning each category.ResultsSeventy-eight percent of participants intended to learn at least some SFs. Logistic regressions examined their intention to learn any or all of these findings (versus none) and interest in each of the six individual categories (yes/no). Results revealed little association between intentions and sociodemographic, clinical, or literacy-related factors. Across outcomes, participants who anticipated regret for learning SFs reported weaker intention to learn them (odds ratios (ORs) from 0.47 to 0.71), and participants who anticipated regret for not learning these findings reported stronger intention to learn them (OR 1.61–2.22).ConclusionIntentions to request SFs with low or no medical actionability may be strongly influenced by participants’ desire to avoid regret.     

Factors influencing NCGENES research participants- requests for non-medically actionable secondary findings

PurposeGenomic sequencing can reveal variants with limited to no medical actionability. Previous research has assessed individuals- intentions to learn this information, but few report the decisions they made and why.MethodsThe North Carolina Clinical Genomic Evaluation by Next Generation Exome Sequencing (NCGENES) project evaluated adult patients randomized to learn up to six types of non-medically actionable secondary findings (NMASF). We previously found that most participants intended to request NMASF and intentions were strongly predicted by anticipated regret. Here we examine discrepancies between intentions and decisions to request NMASF, hypothesizing that anticipated regret would predict requests but that this association would be mediated by participants- intentions.ResultsOf the 76% who expressed intentions to learn results, only 42% made one or more requests. Overall, only 32% of the 155 eligible participants requested NMASF. Analyses support a plausible causal link between anticipated regret, intentions, and requests.ConclusionsThe discordance between participants- expressed intentions and their actions provides insight into factors that influence patients- preferences for genomic information that has little to no actionability. These findings have implications for the timing and methods of eliciting preferences for NMASF and suggest that decisions to learn this information have cognitive and emotional components.     

A randomized group intervention trial to enhance mood and self‐efficacy in people with multiple sclerosis

Objectives To document mood, self‐efficacy, and resiliency in people with multiple sclerosis (MS) following a brief group psychological intervention, and to examine whether benefits were greater than those derived from provision of education or group social interaction. Design A randomized controlled intervention trial assessing outcomes at five time points over a 1‐year follow‐up. Methods Participants with MS were assigned to one of three groups: one receiving brief group psychological intervention (PG) comprising three 90 minute cognitive behavioural sessions supported by an Information Booklet dealing with mental and emotional issues relating to MS; a group provided only with educational material – the information booklet group (IBG); and a group who not only received the booklet but also participated in non‐structured social discussion (SDG) sessions similar in length and number to PG participants. Outcomes were documented using questionnaires. Results Outcomes were assessed using area under the curve (AUC) analysis: a summary measure that considers individual changes serially over time to provide a more meaningful picture than the one based on single time points. Ninety participants were followed up over the 12‐month post‐intervention, and their data are included in the analysis. Analyses indicated benefits in all outcome dimensions for the psychotherapeutic (PG) and social discussion groups (SDG) relative to the IBG group, but no differences between PG and SDG. Conclusion The study indicates benefits from psychosocial intervention compared with bibliotherapy, with some additional benefit from psychological intervention compared with a social discussion group. Results suggest that much of the benefit may derive from non‐specific therapeutic components. Without psychosocial intervention, the psychological status of people with MS worsened over time.     

Encouraging young males to perform testicular self‐examination: A simple,but effective,implementation intentions intervention

Objectives: The objective of this study was to examine the effectiveness of a simple psychological intervention known as ‘implementation intentions’ to promote performance of testicular self‐examination (TSE) in a sample of young males. Method: A prospective, randomized controlled design measured knowledge of testicular cancer, prior experience with TSE and intention to perform TSE within a 3‐week period. Participants in the intervention group were instructed to formulate specific plans for when and where they would perform TSE. Three weeks later, a second questionnaire assessed self‐reported performance of TSE during the study period and future intention to perform TSE. One hundred and fifty‐nine male undergraduates aged between 18 and 35 were assigned, at random, to an intervention or non‐intervention group. Men over 35 were excluded so that the sample reflected the highest risk age group for testicular cancer. Just under half the original participants (76/159) completed the study. We measured performance of TSE and future intention to perform TSE. Results: Responders and non‐responders did not differ on any of the measures assessed at Time 1. At Time 2, 30 (65%) participants in the intervention reported performing TSE compared with 12 (40%) in the control condition, and chi‐squared analyses revealed that the difference was significant. Conclusions: The implementation intentions intervention procedure, which encourages the use of environmental and contextual ‘cues’ to prompt a desired behaviour, appears to offer a promising strategy for encouraging the performance of TSE.     

Field experiment of a very brief worksite intervention to improve nutrition among health care workers

Despite the potential of worksite interventions to boost productivity and save insurance costs, they tend to be costly and tested in nonrandomized trials. The aim of the present study was to test the ability of a very brief worksite intervention based on implementation intentions to improve nutrition among health care workers. Seventy-nine health care workers were randomly allocated to a control condition or to form implementation intentions using standard instructions or with a supporting tool. Fruit intake and metacognitive processing (operationalized as awareness of standards, self-monitoring and self-regulatory effort) were measured at baseline and follow-up. Participants who formed implementation intentions ate significantly more fruit and engaged in significantly more metacognitive processing at follow-up than did participants in the control condition (ds > .70). The findings support the efficacy of implementation intentions for increasing fruit intake in health care workers and preliminary support for the utility of a tool to support implementation intention formation.     

Showing smokers with vascular disease images of their arteries to motivate cessation: A pilot study

Objectives. To examine the potential impact of visual personalized biomarker feedback on intention to stop smoking and to evaluate possible underlying causal pathways. Design. This study is a pilot for a randomized controlled trial. Outcome measures were assessed immediately after the intervention and at 4 weeks follow‐up. Method. Twenty‐three smokers attending a cardiovascular outpatient clinic in London were randomly allocated to one of two groups: to either receive a print‐out of an ultrasound image of their carotid artery showing atherosclerotic plaque alongside an image of a disease‐free artery, or to receive routine verbal feedback. Results. The intervention significantly increased perceptions of susceptibility to smoking‐related diseases (Cohen's h = 0.99) and led to increases both in engagement in smoking cessation behaviours (Cohen's h = 0.79) and intentions to stop smoking (Cohn's d = 0.44). The latter was moderated by self‐efficacy: the intervention increased intention to stop smoking only in people with higher levels of self‐efficacy with regard to stopping smoking. Conclusion. This study provides preliminary support for the potential effectiveness of personalized biomarker feedback to increase intentions to stop smoking. It also highlights the need to target and increase self‐efficacy in smoking cessation interventions.     

A case series to pilot cognitive behaviour therapy for women with urinary incontinence

Objective. Psychological factors have been identified with respect to female urinary incontinence. However, there is limited research regarding psychological interventions. The effectiveness of cognitive behaviour therapy (CBT) as a treatment for women with urinary incontinence was investigated. Design. The study adopted an AB case series design with a follow‐up phase. Methods. Ten women with urinary incontinence each attended individual sessions. The Hospital anxiety and depression scale (HADS) and Incontinence Quality of Life (I‐QOL) were administered pre‐treatment, post‐treatment, and 3‐months post‐treatment. Participants kept weekly records of bladder functioning. An unstandardized client satisfaction questionnaire was administered at 3‐months post‐treatment. Results. Anxiety and depression, as measured by the HADS did not show any significant changes. Improvements in incontinence‐related quality of life reached statistical significance at the post‐treatment administration and were maintained at the 3‐months post‐treatment follow‐up. Significant changes in bladder functioning were not apparent until the 3‐month post‐treatment follow‐up. The satisfaction questionnaires suggest that the participants found the intervention of value. Conclusions. The findings of this study tentatively suggest that incontinence‐related quality of life might be improved by involvement in a CBT intervention. Some modest improvements occurred in bladder functioning. Further research is required to confirm these findings.