Prospective prediction of health-related behaviours with the Theory of Planned Behaviour: a meta-analysis

This meta-analysis explored the efficacy of the Theory of Planned Behaviour (TPB) dependent on behaviour and methodological moderators. A lack of hierarchical analysis in previous reviews risks confounding these moderators. Here moderating roles of behaviour type, length of follow-up, sample age and behavioural measure are explored hierarchically amongst prospective tests of the TPB, controlling for past behaviour where possible. Searching identified 237 prospective tests from 206 articles. Random-effects meta-analytic procedures were used to correcting correlations for sampling and measurement error. Behaviour type moderated the model; physical activity and diet behaviours were better predicted (23.9% and 21.2% variance explained, respectively) whilst risk, detection, safer sex and abstinence from drugs were poorly predicted (between 13.8 and 15.3% variance explained). Methodological moderators were also apparent: age of sample moderated relations with student samples better predicted for physical activity, and adolescent samples better predicted for abstinence behaviours. Behaviours assessed in the shorter term, and those assessed with self-reports (compared with objective measures) were also better predicted. Both behavioural and methodological characteristics moderated relations amongst model components. The results can aid selection of appropriate targets upon which to base interventions.     

Temporal self-regulation theory: A model for individual health behavior

Abstract

Human behavior often seems “maladaptive”, “self-defeating”, or “dysfunctional” to the observer. Upon closer examination, the rationality of human behavior largely depends on the temporal frame adopted; behaviors judged to be maladaptive in the long-run are usually driven by a strongly favorable balance of immediate costs and benefits. That is, many ‘‘maladaptive’’ behaviors are associated with substantial long-term costs and few (if any) long-term benefits; however, these same behaviors are frequently associated with many benefits and few costs for the individual at the time of action. In contrast, many avoided behaviors that seem ‘‘adaptive’’ to the outside observer, are in fact associated with substantial costs (and few benefits) at the time of action, leading to the perplexing but common state of affairs where individuals know ‘‘what is good for them’’, but do not do it. We present a new theoretical framework—Temporal Self-Regulation Theory—as a way of understanding human behavior in general, and those special instances of seemingly ‘‘self-defeating’’ behavior that have important implications for physical health. This theoretical framework incorporates thinking about temporal aspects of behavioral contingencies and the biological roots of self-regulation to make sense of human behavioral patterns that seem to represent, on the surface, significant deviations from rationality.     

Procrastination and health: A longitudinal test of the roles of stress and health behaviours

Objectives

Procrastination is a common form of self-regulation failure that a growing evidence base suggests can confer risk for poor health outcomes, especially when it becomes habitual. However, the proposed linkages of chronic procrastination to health outcomes have not been tested over time or accounted for the contributions of higher-order personality factors linked to both chronic procrastination and health-related outcomes. We addressed these issues by examining the role of chronic procrastination in health outcomes over time in which the hypothesized links of procrastination to health problems operate via stress and health behaviours.

Design

Three-wave longitudinal study with 1-month intervals.

Methods

Participants (N = 379) completed measures of trait procrastination at Time 1, and measures of health behaviours, stress and health problems at each time point, in a lab setting.

Results

Procrastination and the health variables were inter-related in the expected directions across the three assessments. Chronic procrastination was positively associated with stress and negatively with health behaviours at each time point. Path analysis testing a cross-lagged longitudinal mediation model found an indirect relationship operating between procrastination and health problems via stress, after accounting for the contributions of conscientiousness and neuroticism.

Conclusions

This research extends previous work by demonstrating that the links between chronic procrastination and poor health are accounted for mainly by higher stress, after accounting for other key traits, and that these associations are robust over time. The findings are discussed in terms of the importance of addressing habitual self-regulation failure for improving health.     

Network meta-analysis in health psychology and behavioural medicine: a primer

Progress in the science and practice of health psychology depends on the systematic synthesis of quantitative psychological evidence. Meta-analyses of experimental studies have led to important advances in understanding health-related behaviour change interventions. Fundamental questions regarding such interventions have been systematically investigated through synthesising relevant experimental evidence using standard pairwise meta-analytic procedures that provide reliable estimates of the magnitude, homogeneity and potential biases in effects observed. However, these syntheses only provide information about whether particular types of interventions work better than a control condition or specific alternative approaches. To increase the impact of health psychology on health-related policy-making, evidence regarding the comparative efficacy of all relevant intervention approaches – which may include biomedical approaches – is necessary. With the development of network meta-analysis (NMA), such evidence can be synthesised, even when direct head-to-head trials do not exist. However, care must be taken in its application to ensure reliable estimates of the effect sizes between interventions are revealed. This review paper describes the potential importance of NMA to health psychology, how the technique works and important considerations for its appropriate application within health psychology.     

A meta-analysis of the effects of measuring theory of planned behaviour constructs on behaviour within prospective studies

Measurement reactivity effects, such as the mere measurement effect, have been proposed as a reason for behavioural changes in a number of theory of planned behaviour intervention studies. However, it is unclear whether such changes are the result of the mere measurement effect or of other artefacts of intervention study design. The aim of this study is to determine the size and direction of changes in health behaviours from baseline to follow-up in prospective studies using the theory of planned behaviour. Electronic databases were searched for the theory of planned behaviour studies which measured health behaviours at two or more time points. Change in behaviour was calculated for all studies. Sixty-six studies were included. Mean effect sizes across all studies were small and negative (d = ?.03). Effect size was moderated by behaviour, behaviour type and follow-up length. Subgroup analyses showed significant decreases in socially undesirable behaviour (d = ?.28), binge drinking (d = ?.17), risk driving (d = ?.20), sugar snack consumption (d = ?.43) and sun-protective behaviour (d = ?.18). Measurement of intention at baseline resulted in significant decreases in undesirable behaviour. Changes in undesirable behaviours reported in other studies may be the result of the mere measurement effect.     

The consideration of future consequences and health behaviour: a meta-analysis

ABSTRACT

The aim of this meta-analysis was to quantify the direction and strength of associations between the Consideration of Future Consequences (CFC) scale and intended and actual engagement in three categories of health-related behaviour: health risk, health promotive, and illness preventative/detective behaviour. A systematic literature search was conducted to identify studies that measured CFC and health behaviour. In total, 64 effect sizes were extracted from 53 independent samples. Effect sizes were synthesised using a random-effects model. Aggregate effect sizes for all behaviour categories were significant, albeit small in magnitude. There were no significant moderating effects of the length of CFC scale (long vs. short), population type (college students vs. non-college students), mean age, or sex proportion of study samples. CFC reliability and study quality score significantly moderated the overall association between CFC and health risk behaviour only. The magnitude of effect sizes is comparable to associations between health behaviour and other individual difference variables, such as the Big Five personality traits. The findings indicate that CFC is an important construct to consider in research on engagement in health risk behaviour in particular. Future research is needed to examine the optimal approach by which to apply the findings to behavioural interventions.     

The efficacy of internet-based cognitive behavioural therapy for social anxiety disorder: A systematic review and meta-analysis

Social anxiety disorder (SAD) is one of the most common lifelong anxiety disorders. Although cognitive behavioural therapy (CBT) has proven to be effective in treating people with SAD, it may not be available for a considerable proportion of patients. Internet-based CBT (ICBT) is more accessible than face-to-face treatment. This meta-analysis evaluated the efficacy of ICBT in patients with SAD. We searched five databases, PubMed, Cochrane Central Register of Controlled Trials, Health Management Information Consortium, Ovid MEDLINE and EMBASE, and identified 20 eligible randomized controlled trials published from inception to 25 July 2020, with the outcome data from 1,743 participants. The results indicated that ICBT had a significant positive effect on patients with SAD compared with the control groups (g = −0.55). A subgroup analysis revealed that ICBT and CBT had an equal effect on treating patients with SAD (g = −0.18). There was also no difference between ICBT and ICBT plus other therapies in the treatment of patients with SAD (g = −0.07). The effect size of ICBT on patients with SAD was maintained at the 6-month follow-up (g = −0.08) and at the 12-month follow-up (g = −0.17). The findings of this review demonstrated that ICBT can significantly reduce SAD symptoms and that ICBT and face-to-face CBT produce equivalent effects. The results of this meta-analysis contributed to the literature on ICBT for the treatment of patients with SAD, although numerous aspects of ICBT were identified for future investigations.     

Sedentary behaviours and health-related quality of life. A systematic review and meta-analysis

Researchers have speculated that sedentary behaviour may reduce health-related quality of life (HRQOL), but the extent to which this is true remains unknown. Our study sought to systematically review and synthesise research on the relationship between sedentary behaviours and HRQOL and to investigate if these relationships are moderated by age, health status, and HRQOL domain. The review was registered with PROSPERO (no. CRD42016036342). We searched six electronic databases. The selection process resulted in including k?=?27 original studies; k?=?18 were included in a meta-analysis. Data were synthesised twice, using the methods of systematic review and meta-analysis, in order to reduce biases related to a small number of included studies. Both the systematic review and meta-analytical methods indicated that lower levels of sedentary behaviours were associated with higher physical HRQOL (estimate of average effect: r?=??.140; 95% CI ?.191, ?.088). Moderator analyses indicated that associations between the physical HRQOL domain and sedentary behaviours may be similar in strength across age- and health status groups. Causal inferences could not be drawn as most studies were cross-sectional. Concluding, sedentary behaviours were related to better physical HRQOL but not reliably to mental and social HRQOL.     

Relationship of health locus of control with specific health behaviours and global health appraisal: a meta-analysis and effects of moderators

Health locus of control (HLOC) refers to beliefs regarding how one’s health is influenced by oneself, others, or fate. This meta-analysis investigated whether three HLOC dimensions (internality/I-HLOC, powerful others/P-HLOC, chance/C-HLOC) were related to both specific health behaviours and global health appraisal, and whether these relationships were moderated by gender and age compositions, individualism, and power distance. Three-level mixed-effects meta-analysis was performed on studies examining the associations of HLOC with specific health behaviour (k?=?76, N?=?76,580, 57% women, M_age?=?43.75) and global health appraisal (k?=?95, N?=?12,068, 57% women, M_age?=?45.44), respectively. For specific health behaviour, the averaged correlations with the HLOC dimensions were generally weak (r’s?=??.07 to .10). However, the links between P-HLOC and exercise were moderated by all four demographic moderators, and gender composition and individualism moderated the association between the HLOC dimensions and diet. For global health appraisal, all of the averaged correlations were statistically significant (r’s?=??.16 to .21), except that between P-HLOC and mental quality of life. The results further showed individualism and power distance to moderate the links between the HLOC dimensions and both mental and physical quality of life, and gender composition to moderate those between these dimensions and two indicators of emotional problems (depression and anxiety).     

Application of health behaviour theory to sleep health improvement

Although sleep hygiene is often used for broad sleep health promotion efforts, sleep hygiene education programmes are largely ineffective. These programmes are limited by their lack of a theoretical foundation. Health behaviour theory (HBT) has been used for decades to successfully predict and modify many health behaviours, but its use in the study of sleep health is rare. The purpose of this review is threefold. First, four dominant HBTs will be introduced. Second, the brief literature on HBT and sleep health will be reviewed. Lastly, a translational research agenda will be proposed. The present review concludes that HBT shows potential in both the prediction and modification of sleep health, and that there are several short‐ and long‐ term research goals to advance these efforts.     

A meta-analysis of techniques to promote motivation for health behaviour change from a self-determination theory perspective

A systematic review and meta-analysis was conducted of the techniques used to promote psychological need satisfaction and motivation within health interventions based on self-determination theory (SDT; Ryan &; Deci, 2017. Self-determination theory: Basic psychological needs in motivation, development, and wellness. New York, NY: Guilford Press). Eight databases were searched from 1970 to 2017. Studies including a control group and reporting pre- and post-intervention ratings of SDT-related psychosocial mediators (namely perceived autonomy support, need satisfaction and motivation) with children or adults were included. Risk of bias was assessed using items from the Cochrane risk of bias tool. 2496 articles were identified of which 74 met inclusion criteria; 80% were RCTs or cluster RCTs. Techniques to promote need supportive environments were coded according to two established taxonomies (BCTv1 and MIT), and 21 SDT-specific techniques, and grouped into 18 SDT based strategies. Weighted mean effect sizes were computed using a random effects model; perceived autonomy support g?=?0.84, autonomy g?=?0.81, competence g?=?0.63, relatedness g?=?0.28, and motivation g?=?0.41. One-to-one interventions resulted in greater competence satisfaction than group-based (g?=?0.96 vs. 0.28), and competence satisfaction was greater for adults (g?=?0.95) than children (g?=?0.11). Meta-regression analysis showed that individual strategies had limited independent impact on outcomes, endorsing the suggestion that a need supportive environment requires the combination of multiple co-acting techniques.     

Computer-delivered interventions for reducing alcohol consumption: meta-analysis and meta-regression using behaviour change techniques and theory

The current aim was to examine the effectiveness of behaviour change techniques (BCTs), theory and other characteristics in increasing the effectiveness of computer-delivered interventions (CDIs) to reduce alcohol consumption. Included were randomised studies with a primary aim of reducing alcohol consumption, which compared self-directed CDIs to assessment-only control groups. CDIs were coded for the use of 42 BCTs from an alcohol-specific taxonomy, the use of theory according to a theory coding scheme and general characteristics such as length of the CDI. Effectiveness of CDIs was assessed using random-effects meta-analysis and the association between the moderators and effect size was assessed using univariate and multivariate meta-regression. Ninety-three CDIs were included in at least one analysis and produced small, significant effects on five outcomes (d₊?=?0.07–0.15). Larger effects occurred with some personal contact, provision of normative information or feedback on performance, prompting commitment or goal review, the social norms approach and in samples with more women. Smaller effects occurred when information on the consequences of alcohol consumption was provided. These findings can be used to inform both intervention- and theory-development. Intervention developers should focus on, including specific, effective techniques, rather than many techniques or more-elaborate approaches.     

The impact of positive affect on health cognitions and behaviours: a meta-analysis of the experimental evidence

Several reviews suggest that positive affect is associated with improved longevity, fewer physical symptoms, and biological indicators of good health. It is possible that positive affect could influence these outcomes by promoting healthful cognitions and behaviours. The present review identified conceptual pathways from positive affect to health cognitions and behaviour, and used random effects meta-analysis to quantify the impact of positive affect inductions (versus neutral affect conditions) on these outcomes. Literature searches located 54 independent tests that could be included in the review. Across all studies, the findings revealed no reliable effects on intentions (d₊ = ?.12, 95% CI = ?.32 to .08, k = 15) or behaviour (d₊ = .15, 95% CI = ?.03 to .33, k = 23). There were four reliable effects involving specific cognitions and behaviours, but little clear evidence for generalised benefits or adverse effects of positive emotions on health-related cognitions or actions. Conclusions must be cautious given the paucity of tests available for analysis. The review offers suggestions about research designs that might profitably be deployed in future studies, and calls for additional tests of the impact of discrete positive emotions on health cognitions and behaviour.     

Facilitating progress in health behaviour theory development and modification: the reasoned action approach as a case study

This paper explores the question: what are barriers to health behaviour theory development and modification, and what potential solutions can be proposed? Using the reasoned action approach (RAA) as a case study, four areas of theory development were examined: (1) the theoretical domain of a theory; (2) tension between generalisability and utility, (3) criteria for adding/removing variables in a theory, and (4) organisational tracking of theoretical developments and formal changes to theory. Based on a discussion of these four issues, recommendations for theory development are presented, including: (1) the theoretical domain for theories such as RAA should be clarified; (2) when there is tension between generalisability and utility, utility should be given preference given the applied nature of the health behaviour field; (3) variables should be formally removed/amended/added to a theory based on their performance across multiple studies and (4) organisations and researchers with a stake in particular health areas may be best suited for tracking the literature on behaviour-specific theories and making refinements to theory, based on a consensus approach. Overall, enhancing research in this area can provide important insights for more accurately understanding health behaviours and thus producing work that leads to more effective health behaviour change interventions.     

Carrots,sticks and health behaviours: a framework for documenting the complexity of financial incentive interventions to change health behaviours

Financial incentive interventions are increasingly used as a method of encouraging healthy behaviours, from attending for vaccinations to taking part in regular physical activity. There is a growing body of research on the effectiveness of financial incentive interventions for health behaviours. Wide variations in the nature of these interventions make it difficult to draw firm conclusions about what makes an effective incentive, for whom and under what circumstances. Whilst there has been some recognition of the theoretical complexity of financial incentive interventions for health behaviours, there is no framework that categorises these interventions. This limits the research community's ability to clearly establish which components of financial incentives interventions are more and less effective, and how these components might interact to enable behavioural change. We propose a framework for describing health-promoting financial incentive interventions. Drawing on our experience of a recently completed systematic review, we identify nine domains that are required to describe any financial incentive intervention designed to help individuals change their health behaviours. These are: direction, form, magnitude, certainty, target, frequency, immediacy, schedule and recipient. Our framework should help researchers and policy-makers identify the most effective incentive configurations for helping individuals adopt healthy behaviours.     

Reasoned versus reactive prediction of behaviour: a meta-analysis of the prototype willingness model

The prototype willingness model (PWM) was designed to extend expectancy-value models of health behaviour by also including a heuristic, or social reactive pathway, to better explain health-risk behaviours in adolescents and young adults. The pathway includes prototype, i.e., images of a typical person who engages in a behaviour, and willingness to engage in behaviour. The current study describes a meta-analysis of predictive research using the PWM and explores the role of the heuristic pathway and intentions in predicting behaviour. Eighty-one studies met inclusion criteria. Overall, the PWM was supported and explained 20.5% of the variance in behaviour. Willingness explained 4.9% of the variance in behaviour over and above intention, although intention tended to be more strongly related to behaviour than was willingness. The strength of the PWM relationships tended to vary according to the behaviour being tested, with alcohol consumption being the behaviour best explained. Age was also an important moderator, and, as expected, PWM behaviour was best accounted for within adolescent samples. Results were heterogeneous even after moderators were taken into consideration. This meta-analysis provides support for the PWM and may be used to inform future interventions that can be tailored for at-risk populations.     

幽默风格与心理健康关系的meta分析

目的:运用meta分析来了解不同幽默风格与心理健康积极和消极指标的关系以及文化背景(东方、西方)在其中的作用.方法:通过系统检索CNKI数据库、万方数据检索系统、Web of Science、Springer Link、Google学术和读秀等中英文数据库,收集有关幽默风格与心理健康相关联的东西方研究.通过计算相关系数的点估计及其95％ CI分析不同幽默风格包括自强型、嘲讽型、自贬型和亲和型4种类型与心理健康积极和消极指标的关系.结果:共纳入34项相关研究,时间跨度为2003-2013年,样本量为12573人,涉及幽默风格与心理健康积极指标的研究16项,涉及幽默风格与心理健康消极指标的研究24项.自强型、嘲讽型、自贬型、亲和型风格与心理健康积极指标的相关系数(95％ CI)分别为0.32 (0.35～0.28)、0.03(0.05～-0.12)、0.19(-0.12～-0.27)和0.21 (0.24 ～0.16),与消极指标的相关系数(95％ CI)分别为0.23 (0.24～0.31)、0.12 (0.18～0.07)、0.24 (0.27～0.19)和0.27(-0.22～-0.31).文化背景对幽默风格与积极指标无调节作用,但对嘲讽型幽默与消极指标间的关系有调节作用(Q=9.55,P＜0.001).结论:本研究提示不同幽默风格与心理健康积极、消极指标存在关联,文化背景能影响嘲讽型幽默风格与心理健康消极指标之间的关系.     

Trauma exposure,posttraumatic stress,and preventive health behaviours: a systematic review

Psychological trauma has implications for many aspects of physical health, including preventive health behaviours (PHBs). However, whether trauma exposure additionally contributes to PHBs above and beyond the effects of posttraumatic stress disorder (PTSD) symptoms remains unclear. In this systematic review, 32 studies were analysed to characterise: (1) the relationships between trauma exposure and PHBs, (2) the relationships between PTSD symptoms and PHBs, (3) the unique associations between trauma exposure and PHBs, independent of PTSD symptoms, and (4) the unique associations between PTSD symptoms and PHBs, independent of trauma exposure. Findings were variable across the three examined PHBs (physical activity, diet, medical screening) when only trauma exposure or PTSD symptoms were taken into account. Clearer relationships emerged between trauma exposure and PHBs when PTSD symptoms were taken into account, demonstrating that trauma exposure is related to PHB engagement above and beyond the effects of PTSD symptoms. Additionally, PTSD symptoms shared unique associations with physical activity and screening frequency, which were not explained by trauma exposure. Our review reveals that teasing apart the effects of trauma exposure and PTSD symptoms on PHBs brings greater clarity to the strength and direction of these associations.     

Changes in attitudes toward seeking mental health services: A 40-year cross-temporal meta-analysis

Although rates of treatment seeking for mental health problems are increasing, this increase is driven primarily by antidepressant medication use, and a majority of individuals with mental health problems remain untreated. Helpseeking attitudes are thought to be a key barrier to mental health service use, although little is known about whether such attitudes have changed over time. Research on this topic is mixed with respect to whether helpseeking attitudes have become more or less positive. The aim of the current study was to help clarify this issue using a cross-temporal meta-analysis of scores on Fischer and Turner's (1970) helpseeking attitude measure among university students (N = 6796) from 1968 to 2008. Results indicated that attitudes have become increasingly negative over time, r(44) = − 0.53, p < 0.01, with even stronger negative results when the data are weighted (w) for sample size and study variance, r(44) = − 0.63, p < .001. This disconcerting finding may reflect the greater emphasis of Fischer and Turner's scale toward helpseeking for psychotherapy. Such attitudes may be increasingly negative as a result of the unintended negative effects of efforts in recent decades to reduce stigma and market biological therapies by medicalizing mental health problems.     

Meaning in life and physical health: systematic review and meta-analysis

This systematic review and meta-analysis aimed to clarify the associations between meaning in life and physical health using random-effects models. Conceptualisation of meaning (order in world vs. purpose in life), type of health indicators, participants’ health status, and age issues were investigated as moderators. Systematic searches of six databases resulted in inclusion of k?=?66 studies (total N?=?73,546). Findings indicated that meaning in life and physical health formed weak-to-moderate associations (the overall estimate of the average effect?=?0.258). Conceptualisation of meaning, participants’ health status, and their age did not moderate these associations. Operationalisation of health moderated the relationship between meaning in life and health. The strongest associations were found for subjective indicators of physical health. Significant albeit weak associations between meaning in life and objective indices of health were found. Furthermore, stronger effects were observed when the measures of meaning combined items referring to meaning in life and meaning-related sense of harmony, peace, and well-being, compared to measures focusing solely on meaning in life. Overall, the results point to the potential role of meaning in life in explaining physical health.