A text message programme designed to modify patients' illness and treatment beliefs improves self-reported adherence to asthma preventer medication

Objective. While effective preventative medication is readily available for asthma, adherence is a major problem due to patients’ beliefs about their illness and medication. We investigated whether a text message programme targeted at changing patients’ illness and medication beliefs would improve adherence in young adult asthma patients. Methods. Two hundred and sixteen patients aged between 16 and 45 on asthma preventer medication were recruited from pamphlets dispensed with medication and e‐mails sent to members of a targeted marketing website. Participants were randomized to receive individually tailored text messages based on their illness and medication beliefs over 18 weeks or no text messages. Illness and medication beliefs were assessed at baseline and at 18 weeks. Adherence rates were assessed by phone calls to participants at 6, 12, and 18 weeks and at 6 and 9 months. Results. At 18 weeks, the intervention group had increased their perceived necessity of preventer medication, increased their belief in the long‐term nature of their asthma, and their perceived control over their asthma relative to control group (all p's < .05). The intervention group also significantly improved adherence over the follow‐up period compared to the control group with a relative average increase in adherence over the follow‐up period of 10% (p < .001). The percentage taking over 80% of prescribed inhaler doses was 23.9% in the control group compared to 37.7% in the intervention group (p < .05). Conclusion. A targeted text message programme increases adherence to asthma preventer inhaler and may be useful for other illnesses where adherence is a major issue.     

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.     

A randomized trial of computer‐based communications using imagery and text information to alter representations of heart disease risk and motivate protective behaviour

Objective. Advances in web‐based animation technologies provide new opportunities to develop graphic health communications for dissemination throughout communities. We developed imagery and text contents of brief, computer‐based programmes about heart disease risk, with both imagery and text contents guided by the common‐sense model (CSM) of self‐regulation. The imagery depicts a three‐dimensional, beating heart tailored to user‐specific information. Design. A 2×2×4 factorial design was used to manipulate concrete imagery (imagery vs. no imagery) and conceptual information (text vs. no text) about heart disease risk in prevention‐oriented programmes and assess changes in representations and behavioural motivations from baseline to 2 days, 2 weeks, and 4 weeks post‐intervention. Methods. Sedentary young adults (N= 80) were randomized to view one of four programmes: imagery plus text, imagery only, text only, or control. Participants completed measures of risk representations, worry, and physical activity and healthy diet intentions and behaviours at baseline, 2 days post‐intervention (except behaviours), and 2 weeks (intentions and behaviours only) and 4 weeks later. Results. The imagery contents increased representational beliefs and mental imagery relating to heart disease, worry, and intentions at post‐intervention. Increases in sense of coherence (understanding of heart disease) and worry were sustained after 1 month. The imagery contents also increased healthy diet efforts after 2 weeks. The text contents increased beliefs about causal factors, mental images of clogged arteries, and worry at post‐intervention, and increased physical activity 2 weeks later and sense of coherence 1 month later. Conclusion. The CSM‐based programmes induced short‐term changes in risk representations and behaviour motivation. The combination of CSM‐based text and imagery appears to be most effective in instilling risk representations that motivate protective behaviour.     

Purpose and mastery as predictors of perceived health and substance use problems

We explored whether purpose in life and mastery predicted perceived physical health and problematic substance use among a sample of emerging adults who reported ever using alcohol or drugs. We examined perceived stress and coping as potential mediators of these associations and explored whether parental support moderated any of these associations. In a sample of emerging adults from across the United States (N = 2,564; M _age = 20.87, standard deviation = 1.75; 49.6% male), purpose in life and mastery were associated with better‐perceived health and fewer negative consequences of drug use via lower perceived stress and coping. In addition, parental support modified the relationship between purpose in life and stress and coping. The findings suggest potential health benefits associated with a greater purpose in life and mastery and indicate that parental support may enhance these associations.     

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.     

Coping with ovarian cancer risk: The moderating effects of perceived control on coping and adjustment

Objective. Although perceived control and coping have been studied across various health conditions, these relationships have been less well studied in the context of coping with cancer risk over time. The present study was a longitudinal study of the effects of perceived control and problem‐focused coping on changes in psychological adjustment and behavioural outcomes among women at increased risk for ovarian cancer. Design and methods. Eighty women enrolled in a familial cancer risk assessment programme participated in this study. Assessments of problem‐focused coping, perceived control and distress were collected upon entry into the programme and again at 3‐month follow‐up. Behavioural adherence to screening during the 12‐month period following programme entry was obtained from clinic records. Results. Using hierarchical regression analysis, we observed a significant interaction between perceived control and problem‐focused coping for psychological distress, β = 0.94, p <.05. Specifically, problem‐focused coping was associated with increasing distress over time among women who perceived high control. A significant control by coping interaction was also observed for behavioural adherence to pelvic ultrasound and CA125 screening, such that women who perceived high control and utilized problem‐focused coping were less likely to undergo screening. Conclusions. Under conditions of high perceived control, problem‐focused coping was associated with increasing distress as well as poorer behavioural adherence. Thus, perceived control and problem‐focused coping may not always yield positive psychological or behavioural health outcomes. These findings contribute to a greater understanding of how problem‐focused coping and perceived control may influence the course of adjustment to cancer risk over time.     

Exergame Use as a Gateway to the Adoption of and Adherence to Sport‐Specific and General Physical Activity

To explore methods of promoting physical activity, research was conducted to determine whether exergame use could serve as a gateway to future physical activity and to test its efficacy as an intervention. Undergraduates (n = 103) received introductory training during weeks 0–4 through a racquetball videogame (exergame), traditional training, or no‐exposure (control group). All groups then participated in the same, traditional training for weeks 5–8. No differences existed between the exergame and traditional training groups for most outcomes. Both groups increased over time in most outcomes and showed greater skills test performance at post‐intervention assessments than the control group. However, baseline physical activity moderated these outcomes. These results provide partial support for a gateway mechanism and guidelines for future research.     

Effects of personality on self‐rated health in a 1‐year randomized controlled trial of chronic illness self‐management

Objective. Personality factors moderate self‐efficacy enhancing effects of some illness self‐management interventions, but their influence on self‐rated health is unclear. This study examined whether high neuroticism and low conscientiousness, extraversion, and agreeableness (the distressed personality profile) moderated the effects of the homing in on health (HIOH) illness self‐management intervention on mental and physical health status. Design. Analysis of data from 384 subjects completing a randomized controlled trial of HIOH. Methods. Regression analyses examined effects of NEO‐five factor inventory scores on SF‐36 mental component summary (MCS‐36) and physical component summary (PCS‐36) scores (baseline; 2, 4, and 6 weeks; 6 months; 1 year), adjusting for age, gender, and study group. Results. Baseline MCS‐36 scores were worse in those with the distressed personality profile relative to others: high neuroticism (13.3 points worse, 95% confidence interval (CI)=11.0, 15.7) and low conscientiousness (6.6 points worse, 95% CI=4.1, 9.2), extraversion (10.1 points worse, 95% CI=7.7, 12.5) and agreeableness (4.2 points worse, 95% CI=1.6, 6.8). Intervention subjects had better MCS‐36 scores at 4 and 6 weeks, and benefits were confined to participants with low conscientiousness (4 weeks – 3.7 points better, 95% CI=0.2, 71; 6 weeks – 5.0 points better, 95% CI=1.57, 8.4). There were no intervention or personality effects on PCS‐36 scores. Conclusions. Chronically ill self‐management intervention recipients with the distressed personality profile had worse self‐rated mental health, and conscientiousness moderated the short‐term effects of the intervention on self‐rated mental health. Measuring personality may help identify individuals more likely to benefit from self‐management interventions.     

The extended health belief model applied to the experience of diabetes in young people

Objectives The experience of diabetes in young people was investigated within the theoretical framework of the extended health belief model (EHBM). It was anticipated that participant reports of high internal locus of control, high diabetes related empowerment, coping with hypoglycaemia, and diabetes related social support would be associated with good patient adherence to the self‐care regime. Method 118 participants aged 16–25 years with Type 1 diabetes mellitus were sent a set of questionnaires incorporating previously published scales measuring all variables of the EHBM. Results High levels of family support and low locus of control beliefs in powerful others to control their diabetes reduce the young person's perception of severity and vulnerability to diabetes related complications. High internal locus of control beliefs and high levels of self‐efficacy predicted the benefits of adhering to the self‐care regime as outweighing the costs of doing so. Adherence to self‐care regime was predicted by high levels of family support. Conclusion The final model explained 12% of the variance in the young person's adherence to diabetes self‐care regime. It is proposed that the EHBM is an adequate model for understanding the socio‐psychological factors present in the young person's appraisal of their diabetes, which, in turn, influences adherence to the diabetes self‐care regime.     

Understanding the influence of resilience for people with a lived experience of mental illness: A self‐determination theory perspective

Behaviors associated with resilience can be seen as tantamount to coping with stress and vulnerability. This is important for people who live with mental illness. This study aimed to determine whether key basic psychological needs influence resilience among people with a lived experience of mental illness. A total of 159 consumers with a lived experience of mental illness completed self‐report surveys measuring resilience and the basic psychological needs (autonomy, competence, and relatedness) espoused in self‐determination theory. A 2‐step analysis was conducted, including Pearson product correlations and stepwise multiple regression. Higher levels of relatedness significantly predicted resilience. Competence and autonomy did not have a significant influence on resilience. Reconnecting or establishing social relationships within ones community is important for people living with mental illness. The link between resilience and relatedness ought to be considered in treatment plans.     

Better understanding the influence and complexity of beliefs on medication adherence in asthma

Objective: The aim was to better understand how beliefs influence medication adherence in asthma.Methods: All participants were prescribed an inhaled corticosteroid for a diagnosis of asthma. Each participant completed a survey consisting of: Beliefs about Medicines Questionnaire (BMQ), Brief-Illness Perception Questionnaire (B-IPQ) and Multi-dimensional Health Locus of Control Scale (MHLCS). Adherence to inhaled corticosteroids was elicited using the Medication Adherence Report Scale (MARS). Multiple linear regression with interaction effects was used to identify significant predictors of medication adherence and interactions between beliefs.Results: A total of 198 participants completed the survey. The mean(±SD) MARS score was 19.2(±4.5). A multivariable model (adjusted R²?=?0.39) predicted adherence using: age, asthma hospitalisation, timeline (B-IPQ) subscale, necessity and concern (BMQ) subscales, doctor (MHLCS) subscale and the two interaction effects (concerns [BMQ] moderated by chance [MHLCS] and treatment control [B-IPQ] moderated by understanding [B-IPQ]).Conclusion: The findings of this study contribute to a better understanding of the role of beliefs in medication adherence in asthma. Certain beliefs meaningfully interrelate and change the relationship they have with medication adherence.Practice Implications: If these beliefs are causally related to medication adherence and can be intervened upon, the findings are useful for providing targets to personalise adherence support.     

Health beliefs and communication in the travel clinic consultation as predictors of adherence to malaria chemoprophylaxis

Objectives: The objectives were, first, to determine whether adherence to malaria prophylaxis could be predicted by (i) health beliefs specified by the Health Belief Model and the Theory of Planned Behaviour, and (ii) communication during the consultation in a travel clinic; and secondly, to examine the impact of the consultation in changing travellers' health beliefs. Design: A prospective study using regression analysis. Methods: The participants were 130 consecutive travellers attending a travel medicine clinic. Health beliefs were measured pre‐ and post‐consultation. The consultations were coded from audiotape using the Roter Interaction Analysis System and a content analysis method recording discussion about malaria and prophylaxis. Adherence was assessed by a follow‐up telephone interview. Results: Perceived susceptibility to malaria, perceived benefits of medication and intentions to adhere increased significantly as a result of the consultation, and the perceived permanent nature of side effects reduced significantly. At follow‐up (N = 107), 62% reported full adherence, 25% partial adherence and 12% poor/no adherence. A multinomial logistic regression analysis revealed that perceived benefits of medication, length of stay, health professional discussion about adherence and travellers' questions and statements independently predicted reported adherence. Conclusions: Health beliefs and communication significantly predicted adherence in this setting. The findings also suggested qualitative differences between travellers who adhered fully, partially or poorly. Although the clinic consultation had a positive impact, emphasizing benefits of medication and resolving potential barriers to adherence could improve adherence in the population.     

Treatment appraisals and beliefs predict adherence to complementary therapies: A prospective study using a dynamic extended self‐regulation model

Objectives Complementary and alternative medicine (CAM) is used by large numbers of the general public and is increasingly becoming integrated into the mainstream. An understanding of why people use CAM in general has been developed in the literature, but relatively little is known specifically about adherence to CAM. We tested hypotheses (derived from a dynamic extended version of Leventhal's common‐sense model) that patients' beliefs about treatment, perceptions of illness, and treatment appraisals would predict adherence to CAM. Design A prospective self‐report questionnaire study was carried out with a 3‐month follow‐up period. Methods A total of 240 patients from five CAM clinics completed self‐report questionnaire measures of treatment beliefs, illness perceptions, and treatment appraisals at baseline. Three months later, they completed self‐report measures of adherence to therapists' recommendations concerning attendance, remedy use, and life‐style changes. Results Logistic regression analyses showed that positive perceptions of one's therapist and belief that mental factors do not cause illness independently predicted adherence to appointments. Positive beliefs in holistic health and finding it difficult to travel to appointments predicted adherence to remedy use. Using homeopathy was the only independent predictor of adherence to life‐style changes. Conclusions Treatment appraisals, treatment beliefs, and illness perceptions explain modest proportions of the variance in adherence to CAM. This study highlights the value of operationalizing the appraisal element of the common‐sense model when investigating adherence to treatment.     

Application of a chronic illness model as a means of understanding pre‐operative psychological adjustment in coronary artery bypass graft patients

Objectives. To increase understanding of the factors associated with pre‐operative psychological adjustment in coronary artery bypass graft (CABG) patients by assessing the utility of a chronic illness model developed by Scharloo, Kaptein, Weinman, Willems, and Rooijmans (2000) . Design. A cross‐sectional design was employed. Method. Elective CABG patients (N = 119) completed self‐report measures of illness representation, self‐rated health, social support, coping methods, and pre‐operative adjustment (depression and post‐traumatic stress disorder (PTSD) symptomatology) an average of 30 days prior to surgery. Hierarchical multiple regression was used to assess the mediational relationships proposed by the chronic illness model. Results. Five 3‐variable mediational chains were assessed. In all instances, the results conformed to the relationships suggested by the chronic illness model where the strength of the relationship between the independent and dependent variables was reduced when the mediator variable was controlled. However, a significant reduction of this relationship was found in three of the five chains examined. The most rigorous support for the model occurred, where increased use of avoidance coping mediated the relationship between poorer self‐rated health and increased PTSD symptomatology, and also where increased use of avoidance coping partially mediated the relationship between a more negative illness representation and increased PTSD symptomatology, and poorer self‐rated health and increased depression. Conclusions. The chronic illness model of Scharloo and colleagues shows potential in explaining pre‐operative adjustment in CABG patients. Longitudinal examination of the model is recommended.     

A crossover trial evaluating an educational-behavioural joint protection programme for people with rheumatoid arthritis

Joint protection (JP) is a self-management technique widely taught to people with rheumatoid arthritis (RA). JP education aims to enable people with RA to reduce pain, inflammation, joint stress and reduce risks of deformity through using assistive devices and alternative movement patterns of affected joints to perform everyday activities. Previous studies evaluating JP education methods common in the UK have identified JP adherence is poor. A group education programme was developed using the Health Belief Model and Self-efficacy Theory. Strategies used to maximise JP adherence included goal-setting, contracting, modelling, homework programmes, motor learning theory, recall enhancing methods and mental practice. A crossover trial (n = 35) was conducted. Adherence with JP was measured using an objective observational test (the Joint Protection Behaviour Assessment). Significant improvements in use of JP were recorded at 12 and 24 weeks post-education (P < 0.01). No significant changes in measures of pain, functional disability, grip strength, self-efficacy or helplessness occurred post-education, although this may have been due to the small sample size recruited. In conclusion, JP adherence can be facilitated through the use of educational-behavioural strategies, suggesting this approach should be more widely adopted in clinical practice.     

Four years comparative follow‐up evaluation of community‐based,step‐down,and residential specialist psychodynamic programmes for personality disorders

Although the fulcrum of service provision for personality disorder (PD) has shifted from hospital‐based to psychodynamically‐ and cognitively‐oriented outpatient programmes, very few studies have attempted to compare specialist moderate intensity outpatient programmes with specialist high‐intensity residential models, or to explore whether a period of inpatient treatment may be necessary to improve outcome and prognosis. In this article, we prospectively compare changes over a 4‐year period in 3 groups of patients with personality disorders (N  = 162) treated in a specialist community‐based (CBP, N  = 30), a step‐down (RT‐CBP, N  = 87), and a specialist residential programme (RT, N  = 45) in psychiatric distress, deliberate self‐injury, and suicide attempt using multilevel modelling and multivariate logistic regression analyses. The results showed that percentages of early‐dropout were significantly different (p  = .0001) for the 3 programmes (CBP = 13.4%, RT‐CBP = 10.2%, and RT = 41.4%). A significant interaction between treatment model and time was found for psychiatric distress (p  = .001), with CBP and RT‐CBP achieving more marked changes (g  = 1.20 and g  = 0.68, respectively) compared to RT (g  = 0.30) at 48‐month follow‐up. CBP and RT‐CBP were found to significantly reduce impulsive behaviour (deliberate self‐injury and suicide attempt) compared to RT. Severity of presentation was not found to be a significant predictor of outcome. Long‐term RT showed no advantage over long‐term CBP, either as stand‐alone or as step‐down treatment. Replication may be needed to confirm generalizability of results, and a number of limitations in the study design may moderate the inferences that can be drawn from the results.     

Racial discrimination,John Henryism coping,and behavioral health conditions among predominantly poor,urban African Americans: Implications for community‐level opioid problems and mental health services

The current study examined the relationship between John Henryism Active Coping (JHAC), experiences of racial discrimination, and behavioral health outcomes in a community sample of 319 Black adults. Assessments included primary health care screenings as well as self‐reported survey questions to assess JHAC, experiences of discrimination, and self‐reported behavioral health. Logistic regression models, adjusted for control variables, found a significant relationship between JHAC and having an opioid problem (odds ratio [OR] = 0.95, p = 0.003) and needing mental health services (OR = 0.95, p < 0.001), such that higher levels of coping were associated with lower odds of reporting an opioid problem and needing mental health services. Notably, racial discrimination was not significantly independently associated with behavioral health. Implications for interventions and community programming are discussed.     

The Relationship of Self‐Efficacy and Self‐Identity to Long‐Term Maintenance of Vigorous Physical Activity1

This study examines whether task and self‐regulatory self‐efficacy (scheduling and barriers), and self‐identity predict maintenance physical activity. Sixty‐seven maintenance runners completed self‐efficacy and self‐identity measures and, 4 weeks later, recalled their physical activity. Two multiple regression analyses indicated that when combined with self‐identity in independent models, both forms of self‐regulatory self‐efficacy predicted running frequency. A model consisting of task self‐efficacy and self‐identity significantly predicted running duration. In an extreme self‐identity group MANOVA, the high group showed more favorable social cognitions and behavior than the low group. These findings suggest that self‐efficacy theory is useful for studying maintenance physical activity. Self‐identity may be a useful predictor of maintenance physical activity and may relate to differences in social cognitions and behavior.     

Pre‐adolescent gender differences in associations between temperament,coping, and mood

Relationships between temperament, coping, depressive and aggressive mood in 8–12‐year‐old boys (n = 185) and girls (n = 219) were investigated, with a focus on gender differences. Children completed two self‐report questionnaires: the Early Adolescent Temperament Questionnaire‐Revised and Children's Coping Strategies Checklist‐Revised1. Comparing boys and girls on three temperament dimensions, positive affectivity, negative affectivity and effortful control, girls scored higher than boys on the first two dimensions. Girls also scored higher than boys on avoidant coping and depressive mood. For both boys and girls, aggressive and depressive mood were predicted by negative affectivity. Coping did not add towards this prediction. Gender specific models of temperament, coping and depressive mood were tested. For girls, both effortful control and active problem solving, accounted for the variability in depressive mood. For boys, only effortful control accounted for variance in depressive mood. Results showed that gender specific vulnerability to depression in girls is apparent before adolescence and can be linked to temperament and coping. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message:

• Pre‐adolescent girls are more vulnerable to depression than boys. Interventions focussing on self‐control, emotion regulation and active coping are tailored towards vulnerabilities in temperament and coping in girls.

     

Emotional approach coping and self‐efficacy moderate the effects of written emotional disclosure and relaxation training for people with migraine headaches

Objectives. We tested whether emotional skills and headache management self‐efficacy (HMSE) moderated effects of written emotional disclosure (WED) compared with control writing and a different intervention, relaxation training (RT). Design/methods. Undergraduates with migraine headaches reported emotional approach coping (EAC) and HMSE; were randomized to WED, RT, or control; and assessed on health measures at baseline and 3‐month follow‐up. Results. Greater EAC predicted improvement following WED compared with RT and control, whereas low HMSE predicted improvement following both WED and RT, compared with control. Conclusions. Emotional skill may specifically – and low health management self‐efficacy may generally – predict positive responses to WED.