Examining determinants of self management behaviors in patients with diabetes: an application of the Theoretical Model of Effortful Decision Making and Enactment

Objective

This study examined determinants of self-monitoring of blood glucose (SMBG) in patients with diabetes based on a theoretical model. The model focuses on two equally important components of the decision process within a single framework: (1) making a decision and (2) enacting the decision.

Methods

Diabetes patients with HbA1c >7% and requiring insulin therapy were recruited from a southeastern Michigan healthcare system. Responses were elicited using a mail-in questionnaire. SMBG was measured using a two-week diary and two recall measures. The applicability of the theoretical model as it relates to SMBG wastested using structural equation modeling (SEM).

Results

The SEM analysis demonstrated that goal desire is an antecedent to goal intentions and that implementation desire and implementation intentions mediate the path between goal intentions and SMBG. Further, implementation intentions are a significant predictor of SMBG.

Conclusion

Consistent with the theoretical model, results indicated that implementation desire and implementation intentions mediate the relationship between strength of goal intention and performing specific behaviors to achieve the goal.

Practice implications

It is evident that in order to be more effective, educational programs or interventions should consider incorporating implementation and action plans to help patients translate decisions and intentions into behavior.     

Israeli soldiers' intentions and actions toward seeking mental health help: Barriers and facilitators

Background

While military settings may increase psychological distress, soldiers frequently avoid seeking professional help. This study aimed to examine barriers and facilitators associated with intentions to seek help and actually seeking help from a mental health officer (MHO) and how these differ among soldiers who had sought help in the past and those who had not.

Method

This cross-sectional study included 263 combat and noncombat soldiers. The Health Belief Model and the Help-Seeking Model were the theoretical framework used to map the potential variables associated with soldiers' decision to seek help.

Results

Stigma and administrative barriers were found to be significant barriers to both the intention to seek help and actually consulting an MHO. These findings were more definitive among combat soldiers. The belief in the effectiveness of mental health treatment was positively associated with the intention to seek help. Positive associations were found between well-being, perceived seriousness of one's condition, and belief in the effectiveness of mental health care and intention to seek MHO help. Distress and self-concealment were positively associated with actual consultation with an MHO. Public stigma about seeking help was associated with both the intention to seek mental health assistance and actually consulting an MHO.

Conclusion

Military commanders should make an effort to make soldiers feel safe to seek mental health assistance by creating a supportive organizational atmosphere to reduce the stigma associated with mental health care.     

Testing an Online,Theory-Based Intervention to Reduce Pre-drinking Alcohol Consumption and Alcohol-Related Harm in Undergraduates: a Randomized Controlled Trial

Purpose

The present study tested the efficacy of a theory-based online intervention comprising motivational (autonomy support) and volitional (implementation intention) components to reduce pre-drinking alcohol consumption and alcohol-related harm.

Method

Undergraduate students (N?=?202) completed self-report measures of constructs from psychological theories, pre-drinking alcohol consumption, and alcohol-related harm at baseline and were randomly assigned to one of four intervention conditions in a 2 (autonomy support: present/absent)?×?2 (implementation intention: present/absent) design. Participants completed follow-up measures of all variables at 4 weeks post-intervention. All participants received national guidelines on alcohol consumption and an e-mail summary of intervention content at its conclusion. Participants also received weekly SMS messages in the 4-week post-intervention period restating content relevant to their intervention condition.

Results

Neither statistically significant main effect for either the autonomy support or implementation intention intervention components nor an interaction effect was found on the outcome measures. However, statistically significant reductions in pre-drinking alcohol consumption and alcohol-related harm were observed across all groups at follow-up, when compared to baseline.

Conclusion

Reductions in outcome measures were likely related to elements common to each condition (i.e., provision of national guidelines, assessment of outcome measures, e-mail summary, and SMS messages), rather than motivational and volitional components.

     

A meta-analytic review of the effect of implementation intentions on physical activity

Abstract

Implementation intentions are a powerful strategy to promote health-related behaviours, but mixed results are observed regarding physical activity. The primary aim of this study was to systematically and quantitatively review the literature on the effectiveness of implementation intentions on physical activity. The second aim was to identify conditions under which effectiveness is optimal. A literature search was performed in several databases for published and non-published reports. The inverse variance method with random effect model was used for the meta-analysis of results. Effect sizes were reported as standard mean differences. Twenty-six independent studies were included in the systematic review. The overall effect size of implementation intentions was 0.31, 95% confidence intervals (CI) [0.11, 0.51] at post-intervention and 0.24, 95% CI [0.13, 0.35] at follow-up. The duration of follow-up had no significant effect on effect size (F(1, 18) = 0.21, p=0.66. This strategy was more effective among student and clinical samples, and when barrier management was part of implementation intentions. The present meta-analysis provides support for the use of implementation intentions to promote physical activity, even though the effect size is small to medium.     

Health e-Cards as a Means of Encouraging Help Seeking for Depression Among Young Adults: Randomized Controlled Trial

Background

There is a need to identify interventions that increase help seeking for depression among young adults.

Objective

The aim was to evaluate a brief depression information intervention employing health e-cards (personalized emails containing links to health information presented on a Web page).

Methods

A randomized controlled trial was carried out with 348 19- to 24-year-olds drawn from the community. Participants were randomized to receive one of three conditions, all of which delivered a short series of health e-cards. Two active conditions involved the delivery of depression information designed to increase help-seeking behavior and intentions and to improve beliefs and knowledge associated with help seeking. A control arm delivered information about general health issues unrelated to depression. The primary outcome was help-seeking behavior. Secondary outcomes were help-seeking intentions; beliefs about the efficacy of depression treatments and help sources; ability to recognize depression; knowledge of the help-seeking process; and depressive symptoms. The study’s primary focus was outcomes relating to formal help seeking (consultation with a general practitioner or mental health professional) but also targeted behaviors, intentions, and beliefs relating to informal help seeking.

Results

Relative to the control condition, depression health e-cards were not associated with an increase in formal help-seeking behavior, nor were they associated with improved beliefs about depression treatments; ability to recognize depression; knowledge of the help-seeking process; or depressive symptoms. Depression e-cards were associated with improved beliefs about the overall efficacy of formal help sources (z = 2.4, P = .02). At post-intervention, participants in all conditions, relative to pre-intervention, were more likely to have higher intentions of seeking help for depression from a formal help source (t ₆₄₁ = 5.8, P < .001) and were more likely to rate interpersonal psychotherapy as being helpful (z = 2.0, P = .047). Depression e-cards were not associated with any significant changes in informal help-seeking behavior, intentions, or beliefs.

Conclusions

The study found no evidence that providing depression information in the form of brief e-cards encourages help seeking for depression among young adults. Involvement in the study may have been associated with increased help-seeking intentions among participants in all conditions, suggesting that mechanisms other than depression information may increase help seeking.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN98406912; http://www.controlled-trials.com/ISRCTN98406912/ISRCTN98406912 (Archived by WebCite at http://www.webcitation.org/5k221KiMi)     

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.     

The general facilitation effect of implementation intentions on prospective memory performance in patients with schizophrenia

ABSTRACT

Introduction: Prospective memory (PM) refers to remembering to execute a planned intention in the future. It can be divided into event- and time-based, according to the nature of the PM cue. Event-based PM cues can be classified as focal or non-focal. Patients with schizophrenia (SCZ) have been found to be impaired in both event- and time-based PM. PM has been found to be improved by implementation intentions, which is an encoding strategy in the format of “if X then Y”. This study examined the effect of implementation intentions on a non-focal event-based and a time-based PM task in patients with SCZ.Methods: Forty-two patients with SCZ and 42 healthy controls were allocated to either an implementation intention or a control PM instruction condition and were asked to complete two PM tasks. Results: Implementation intentions was found to improve performance in both the non-focal event-based and time-based PM tasks in patients with SCZ and healthy controls, with no costs to the ongoing task. The improvement in time-based PM performance in the implementation intentions condition was partially mediated by the frequency of clock checking behaviour. Conclusions: Implementation intentions can facilitate PM performance in patients with SCZ and has the potential to be used as a clinical intervention tool.     

An experimental COVID-19 messaging study in a representative sample of the Scottish population: Increasing physical distancing intentions through self-efficacy

Objectives

Self-efficacy is important for adherence to transmission-reducing behaviours (e.g., physical distancing) as also shown in the CHARIS project. We aimed to show that a theory-based short message can increase physical distancing self-efficacy and intentions to keep physical distance.

Design

Structured telephone surveys with a randomly selected nationally representative sample of adults in Scotland (N = 497).

Methods

Participants were randomly assigned to one of two experimental conditions: message condition (short message to increase self-efficacy via vicarious experiences, verbal persuasion and emotional arousal) or control condition (no message). Followed by measures for self-efficacy and intention for physical distancing on 4-point scales. Adherence to physical distancing was assessed on a 5-point frequency scale (never – always).

Results

Using mediation analyses with bootstrapping procedures, we first confirmed that self-efficacy was associated indirectly with adherence, via higher intentions in a partial mediation (unstandardized indirect effect .21, 95% CI .18–.25). The message increased self-efficacy; participants receiving the message reported higher self-efficacy (M = 4.23, SD = .80) compared to participants in the control condition (M = 4.08, SD = .77; standardized regression coefficient = .19, p < .05) and self-efficacy affected intention (.48, p < .001). There was a small significant indirect effect of the message on intention via self-efficacy (unstandardized indirect effect .07, CI .01–.14).

Conclusions

Increasing self-efficacy for physical distancing with a short message can successfully increase intention to physical distance via increased self-efficacy. As both self-efficacy and intentions are important predictors of adherence to transmission-reducing behaviours short messages have potential to limit the spread of COVID-19.     

Emotion self-stigma as a unique predictor of help-seeking intentions: A comparative analysis of early adolescents and young adults

Objectives

There has been limited consideration of the role emotion self-stigma (i.e. beliefs that experiencing and expressing so called ‘negative’ emotions are unacceptable) may play in help-seeking for emotional distress. This study is the first to investigate whether emotion self-stigma uniquely predicts help-seeking intentions across two key emotion vulnerability periods in development: (a) early adolescence and (b) young adulthood.

Methods and Design

Cross-sectional data were collected from secondary school (n = 510; M age = 13.96 years) and university students (n = 473; M age = 19.19 years) residing in Australia. Both samples completed measures online examining demographic characteristics, emotional competence, mental health and help-seeking stigma, emotion self-stigma, and help-seeking intentions. The Data were analysed using hierarchical multiple regression.

Results

Emotion self-stigma was a significant unique predictor of help-seeking intentions in young adults but not adolescents. The strength of the relationship between increased emotion self-stigma and lowered help-seeking intentions was similar for both males and females, regardless of developmental period.

Conclusions

Addressing emotion self-stigma alongside mental illness and help-seeking stigma may be useful to improve help-seeking outcomes, particularly as young people transition into early adulthood.     

Mental contrasting for health behaviour change: a systematic review and meta-analysis of effects and moderator variables

Mental contrasting is a self-regulation imagery strategy that involves imagining a desired future and mentally contrasting it with the present reality, which is assumed to prompt the individual to realise that action is required to achieve the desired future. Research has combined mental contrasting with implementation intentions (MCII) (‘if-then’ plans), which is hypothesised to strengthen the effects. A systematic review was conducted to evaluate the effectiveness of mental contrasting for improving health-related behaviours. A meta-analysis (N =?1528) using random effects modelling found a main effect of mental contrasting on health outcomes, adjusted Hedges’ g?=?0.28 (SE = .07), 95% CI [0.13–0.43], p?k?=?5), g?=?0.38 (SE = 0.6), CI [0.20–0.55], p?.001. The combination of mental contrasting with implementation intentions (MCII; k?=?7) showed a similar effect, g?=?0.28, CI [0.14–0.42], p?相似文献   

The self-harm inventory (SHI): Development of a scale for identifying self-destructive behaviors and borderline personality disorder

Intentional self-harm behavior is an important clinical phenomenon that appears highly related to borderline personality disorder (BPD). Self-harm behavior in the context of borderline personality probably exists along a continuum from graphic, self-harm behavior to milder forms of self-sabotaging behavior that might be viewed as self-defeating. Relatively little attention has been paid to developing a self-report measure of intentional self-harm, particularly as a screening device for detecting BPD. In Study 1, an initial list of self-harm behaviors encountered in clinical practice was narrowed to those behaviors related to BPD in a sample comprised of adults from both a mental health and non–mental health setting. All participants (N = 221) underwent a semistructured diagnostic interview for BPD. Using a cut-off score of 5 on the resulting 22-item Self-Harm Inventory (SHI), 83.7% of research participants were correctly classified as having BPD or not. In Study 2, women (N = 285) sampled from an outpatient medical setting completed the SHI and a widely used self-report measure of BPD. The SHI cut-off score resulted in correct classification of 87.9% of the individuals. In Study 3, using a sample of adults involuntarily hospitalized for psychiatric reasons (N = 32), the SHI performed at least as well as another self-report measure of BPD in diagnosing participants (the final diagnosis was based on a semistructured interview). The results are discussed with regard to potential advantages and utility of the SHI and need for further validation. © 1998 John Wiley & Sons, Inc. J Clin Psychol 54: 973–983, 1998.     

How well does the theory of planned behaviour predict alcohol consumption? A systematic review and meta-analysis

This study aimed to quantify correlations between theory of planned behaviour (TPB) variables and (i) intentions to consume alcohol and (ii) alcohol consumption. Systematic literature searches identified 40 eligible studies that were meta-analysed. Three moderator analyses were conducted: pattern of consumption, gender of participants and age of participants. Across studies, intentions had the strongest relationship with attitudes (r₊ = .62), followed by subjective norms (r₊ = .47) and perceived behavioural control (PBC; r₊ = .31). Self-efficacy (SE) had a stronger relationship with intentions (r₊ = .48) compared with perceived control (PC; r₊ = ?.10). Intention had the strongest relationship with alcohol consumption (r₊ = .54), followed by SE (r₊ = .41). In contrast, PBC and PC had negative relationships with alcohol consumption (r₊ = ?.05 and ?.13, respectively). All moderators affected TPB relationships. Patterns of consumption with clear definitions had stronger TPB relations, females reported stronger attitude–intention relations than males, and adults reported stronger attitude–intention and SE–intention relations than adolescents. Recommendations for future research include targeting attitudes and intentions in interventions to reduce alcohol consumption, using clear definitions of alcohol consumption in TPB items to improve prediction and assessing SE when investigating risk behaviours.     

Exploring barriers and enablers to the delivery of Making Every Contact Count brief behavioural interventions in Ireland: A cross-sectional survey study

Objectives

The public health impact of the Irish Making Every Contact Count (MECC) brief intervention programme is dependent on delivery by health care professionals. We aimed to identify enablers and modifiable barriers to MECC intervention delivery to optimize MECC implementation.

Design

Online cross-sectional survey design.

Methods

Health care professionals (n = 4050) who completed MECC eLearning were invited to complete an online survey based on the Theoretical Domains Framework (TDF). Multiple regression analysis identified predictors of MECC delivery (logistic regression to predict delivery or not; linear regression to predict frequency of delivery). Data were visualized using Confidence Interval-Based Estimates of Relevance (CIBER).

Results

Seventy-nine per cent of participants (n = 283/357) had delivered a MECC intervention. In the multiple logistic regression (Nagelkerke's R² = .34), the significant enablers of intervention delivery were ‘professional role’ (OR = 1.86 [1.10, 3.15]) and ‘intentions/goals’ (OR = 4.75 [1.97, 11.45]); significant barriers included ‘optimistic beliefs about consequences’ (OR = .41 [.18, .94]) and ‘negative emotions’ (OR = .50 [.32, .77]). In the multiple linear regression (R² = .29), the significant enablers of frequency of MECC delivery were ‘intentions/goals’ (b = 10.16, p = .02) and professional role (b = 6.72, p = .03); the significant barriers were ‘negative emotions’ (b = −4.74, p = .04) and ‘barriers to prioritisation’ (b = −5.00, p = .01). CIBER analyses suggested six predictive domains with substantial room for improvement: ‘intentions and goals’, ‘barriers to prioritisation’, ‘environmental resources’, ‘beliefs about capabilities’, ‘negative emotions’ and ‘skills’.

Conclusion

Implementation interventions to enhance MECC delivery should target intentions and goals, beliefs about capabilities, negative emotions, environmental resources, skills and barriers to prioritization.     

Implementation of patient education software in an anticoagulation clinic to decrease visit times for new patient appointments

Objective

Patient education on high-risk medications such as warfarin is important, and they require quick follow-up after initiation to maximize efficacy and safety. In our Anticoagulation Clinic, two 60-minute new patient appointments are available each day, contributing to prolonged lead-time. We instituted standardized warfarin video education to shorten in-clinic-room visit time, to potentially increase new patient appointments.

Effects of Self-Efficacy on Healthy Eating Depends on Normative Support: a Prospective Study of Long-Haul Truck Drivers

Purpose

Fruit and vegetable intake (FV) is insufficient in industrialized nations and there is excess of discretionary food choices (DC; foods high in fat, sugar, and salt). Long-haul truck drivers are considered a particularly at-risk group given the limited food choices and normatively reinforced eating habits at truck rest-stops. Self-efficacy and normative support are key determinants of eating behavior yet the processes underlying their effects on behavior are not well understood. We tested the direct and interactive effects of self-efficacy and normative support on healthy eating behaviors in long-haul truck drivers in a prospective correlational study.

Method

Long-haul truck drivers (N = 82) completed an initial survey containing self-report measures of behavioral intentions, perceived normative support, and self-efficacy for their FV and DC behaviors. Participants completed a follow-up survey 1 week later in which they self-reported their FV and DC behavior.

Results

A mediated moderation analysis identified an interactive effect of self-efficacy and normative support on behavior mediated by intention for FV and DC behavior. Specifically, we confirmed a compensation effect in which self-efficacy was more likely to have an effect on FV and DC behavior through intentions in participants with low normative support.

Conclusion

Results indicate the importance of self-efficacy in predicting FV and DC intentions and behavior in the absence of a supportive normative environment. The compensatory effect of self-efficacy beliefs on behavior through intentions when normative support is low should be confirmed using experimental methods.

     

Evidence that implementation intentions promote transitions between the stages of change

A dietary change intervention based on Gollwitzer's (1993) concept of implementation intentions was used to see whether transitions between transtheoretical model stages could be induced in a field experiment. Participants (N=554) were randomized to receive either questionnaire-only or questionnaire-plus-implementation intention. Results showed that, controlling for variables from the theory of planned behavior, implementation intentions helped a significantly greater number of people to progress through the stages of change than did receiving the questionnaire alone. However, the implementation intention intervention did not prevent regression from the stages of change. The discussion focuses on the importance of targeting implementation intention interventions and on the future use of health professional-led analyses of critical situations and precise identification of appropriate responses to prevent regression.     

A brief compassion focused therapy intervention can help self-critical parents and their children: A randomised controlled trial

Background

Parents can be highly self-critical of their own parenting, which can negatively impact parenting style and child outcomes.

Aims

The aim of this randomised controlled trial (RCT) was to examine the efficacy of a brief 2-hour Compassion Focused Therapy intervention (CFT) for parents to determine if it can reduce self-criticism, improve parenting and improve child social, emotional and behavioural outcomes.

Materials & Methods

In total, 102 parents (87 mothers) were randomised to either a CFT intervention (n = 48) or waitlist control group (n = 54). Participants were measured at pre-, 2-week post-intervention and the CFT group again at 3-month follow-up.

Results

At 2-week post-intervention parents in the CFT group compared to waitlist control had significantly reduced levels of self-criticism, significant reductions in child emotional and peer problems, but no changes in parental style. At 3-month follow-up, these outcomes improved, with self-criticism further decreasing, parental hostility and verbosity decreasing, as well as a range of childhood improvements.

Conclusion

The results from this first RCT evaluation of a brief 2-hour CFT intervention for parents show promise for not only improving how parents relate to themselves with self-criticism and self-reassurance, but also for improving parenting styles and child outcomes.