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

Objectives. To investigate the utility of the protection motivation theory (PMT) for explaining physical activity (PA) in an adult population with type 1 diabetes (T1D) and type 2 diabetes (T2D). Design. Cross‐sectional and 6‐month longitudinal analysis using PMT. Methods. Two thousand three hundred and eleven individuals with T1D (N =697) and T2D (N =1,614) completed self‐report PMT constructs of vulnerability, severity, response efficacy, self‐efficacy, and intention, and PA behaviour at baseline and 6‐month follow‐up. Multi‐group structural equation modelling was conducted to: (1) test the fit of the PMT structure; (2) determine the similarities and differences in the PMT structure between the two types of diabetes; and (3) examine the explained variance and compare the strength of association of the PMT constructs in predicting PA intention and behaviour. Results. The findings provide evidence for the utility of the PMT in both diabetes samples (χ²/df =1.27?4.08, RMSEA=.02–.05). Self‐efficacy was a stronger predictor of intention (β=0.64–0.68) than response efficacy (β=0.14–0.16) in individuals with T1D or T2D. Severity was significantly related to intention (β=0.06) in T2D individuals only, whereas vulnerability was not significantly related to intention or PA behaviour. Self‐efficacy (β's=0.20–0.28) and intention (β's=0.12–0.30) were significantly associated with PA behaviour. Conclusions. Promotion of PA behaviour should primarily target self‐efficacy to form intentions and to change behaviour. In addition, for individuals with T2D, severity information should be incorporated into PA intervention materials in this population.     

The protection motivation theory within the stages of the transtheoretical model – Stage‐specific interplay of variables and prediction of exercise stage transitions

Objective Two different theories of health behaviour have been chosen with the aim of theory integration: a continuous theory (protection motivation theory, PMT) and a stage model (transtheoretical model, TTM). This is the first study to test whether the stages of the TTM moderate the interrelation of PMT‐variables and the mediation of motivation, as well as PMT‐variables' interactions in predicting stage transitions. Design Hypotheses were tested regarding (1) mean patterns, stage pair‐comparisons and nonlinear trends using ANOVAs; (2) prediction‐patterns for the different stage groups employing multi‐group structural equation modelling (MSEM) and nested model analyses; and (3) stage transitions using binary logistic regression analyses. Method Adults (N=1,602) were assessed over a 6 month period on their physical activity stages, PMT‐variables and subsequent behaviour. Results (1) Particular mean differences and nonlinear trends in all test variables were found. (2) The PMT adequately fitted the five stage groups. The MSEM revealed that covariances within threat appraisal and coping appraisal were invariant and all other constrains were stage‐specific, i.e. stage was a moderator. Except for self‐efficacy, motivation fully mediated the relationship between the social‐cognitive variables and behaviour. (3) Predicting stage transitions with the PMT‐variables underscored the importance of self‐efficacy. Only when threat appraisal and coping appraisal were high, stage movement was more likely in the preparation stage. Conclusions Results emphasize stage‐specific differences of the PMT mechanisms, and hence, support the stage construct. The findings may guide further theory building and research integrating different theoretical approaches.     

Self-regulation predictors of medication adherence among ethnically different pediatric patients with renal transplants.

OBJECTIVE: To predict medication adherence among ethnically different pediatric patients with renal transplants between the ages of 6 and 20 years old, using self-regulation variables including motivation, perceived control and responsibility, and perceived support. METHODS: Twenty-six African American children and 42 Caucasian children were verbally administered the Self-Regulation of Medication Adherence Battery to assess their (1) motivation to be medication adherent, (2) perceived control of and responsibility for medication adherence, and (3) perceived support of medication adherence from their primary caregiver. Four measures were used to assess medication adherence: self-ratings, nephrologists' ratings, cyclosporine levels, and pill count/refill histories. RESULTS: For the African American patients, regression analyses revealed that responses to motivation and perceived control questions that focused on self-efficacy were unique predictors of medication adherence as rated by their primary nephrologist. For the Caucasian patients, one motivation question regarding how often they forget to take their medication predicted their self-reported adherence. CONCLUSIONS: Facilitating their beliefs that they can regularly take their medications may help promote medication adherence among African American children with renal transplants, whereas for Caucasian children, providing cues and reminders to take their medications may help. We discuss implications of the results for multimodal assessment of medication adherence and for ethnic group-specific medication adherence research and interventions.     

Visually detected NREM Stage 2 sleep spindles in kindergarten children are associated with current and future emotional and behavioural characteristics

Sleep electroencephalogram spindles are associated with efficient cortical–subcortical connectivity, and intellectual and learning abilities. In the present study, we assessed healthy preschoolers with a twofold aim: (i) to explore associations of non‐rapid eye movement S2 spindles with emotional/behavioural characteristics cross‐sectionally; and (ii) longitudinally. A total of 43 children who were 5 years old underwent objective sleep electroencephalogram monitoring in their homes. Emotional and behavioural dimensions were assessed by parents and teachers with the Strengths & Difficulties Questionnaire at baseline and at follow‐up 1 year later. Non‐rapid eye movement S2 spindles were visually scored and compared with Strengths & Difficulties Questionnaire dimensions. High non‐rapid eye movement S2 spindle density was associated with less internalizing behaviour, more prosocial behaviour and a low total problem score. In girls, high non‐rapid eye movement S2 spindle density was related to low hyperactivity, while in boys it was associated with less internalizing behaviour, more externalizing behaviour and more hyperactivity. Longitudinally, a higher number of non‐rapid eye movement S2 spindles at 5 years old predicted fewer peer problems 12 months later. In kindergarten children, high non‐rapid eye movement S2 spindle density is associated with observable current and future favourable emotional/behavioural patterns. However, gender differences were also found, as should be taken into account in future studies.     

Adherence to anti-hypertensive medication: proposing and testing a conceptual model

Objectives. A conceptual model of the psychological factors underpinning adherence to anti‐hypertensive medication is proposed and tested. The model suggests that adherence is influenced by three sets of variables: demography, health status, and perceived effects of medication; cognitions and motivation; and intention to adhere. Methods and Design. Patients with known hypertension were recruited from three primary care practices in South‐East England and were asked to complete a postal questionnaire. A total of 1,070 responses were received. The questionnaire asked about the three sets of predictor variables, and adherence. Eight weeks after the first questionnaire, a second was posted to all respondents, this time asking about adherence over the intervening period. Results. The three sets of predictor variables were treated as blocks in a hierarchical model, so that each successive block added to the variance in adherence explained by the previous blocks. The data were analysed by hierarchical multiple regression. The predictors accounted for 19% of the variance in adherence at Time 1, and 34% at Time 2. The leading individual predictors at Time 1 were age, gender, conscientiousness, hypertensive identity, perceived behavioural control, and intention. At Time 2, they were the same, except that gender made way for adherence at Time 1. Conclusions. The model offers a parsimonious account, and the findings suggest a number of approaches to designing interventions to modify behaviour.     

Determinants of condom use among a random sample of single heterosexual adults

Objectives. The aim of this study was to identify the determinants of single heterosexuals' use of condoms during each sexual intercourse. Design. Cohort of individuals followed over a period of 2 years. Methods. Respondents were 574 single heterosexual individuals who answered questions during a telephone interview. Results. Attitude, perceived behavioural control, self‐efficacy and moral norm explained 65% of the variance in intentions to use condoms (p <.0001). The determinants of condom use at 1 year follow‐up (27% explained variance) were perceived behavioural control, past behaviour, and the interaction between intention and intention stability. At 2 years follow‐up, the significant determinants were past behaviour and intention by intention stability. In the present study, intentions to use condoms which remained stable across time were strong predictors of condom use (at 1 year: β=.42, p <.0001; at 2 years: β=.39, p <.003), while unstable intentions were not (at 1 year: β=.02, ns; at 2 years: β=.19, ns). Conclusion. Intention stability is a major determinant of the accuracy of intention for the prediction of subsequent behaviour.     

Brief cognitive‐behavioural treatment for anxiety‐disordered children exhibiting school refusal

This study evaluated the efficacy of a brief intervention programme for 20 anxiety‐disordered children exhibiting school refusal. Treatment consisted of individual child cognitive‐behaviour therapy and parent/teacher training. Children underwent a comprehensive assessment before and after treatment, and at a 3‐month follow‐up. Marked improvements were evident on nearly all measures, including school attendance. The findings signal the need for a controlled evaluation in order to establish the efficacy of this cost‐efficient intervention. Copyright © 1999 John Wiley & Sons, Ltd.     

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

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

Gender power imbalance and differential psychosocial correlates of intended condom use among male and female adolescents from Venda,South Africa

Objectives. In South Africa, a gender power imbalance exists which may prevent women from negotiating safe sexual encounters. In this study we tested which constructs from Protection Motivation Theory (PMT) and the Theory of Planned Behavior (TPB) under these circumstances were most related to condom use intention. We hypothesized that in a situation of gender power imbalance self‐efficacy would be a more salient correlate of intended condom use for females, while for males attitude to condoms and subjective norm would be more important. Design. This study employed a cross‐sectional questionnaire design. Method. Male participants (N = 94) and female participants (N = 101) from Venda, South Africa completed standard, multi‐item, reliable measures of TPB constructs (condom‐related attitude, subjective norm, perceived behavioural control, intention) and PMT constructs (vulnerability, severity, fear, response‐efficacy, self‐efficacy) and reported their past condom use behaviour. Results. Regression analysis indicated that among males attitude to condoms and subjective norm were significantly related to intended condom use. Among females attitude and self‐efficacy were significantly related to intended condom use. Conclusion. The findings indicate that in a situation of gender power imbalance psychosocial correlates of intended condom use differ for males and females. Gender‐specific analysis of determinants of condom use may be more appropriate in a situation of gender power imbalance.     

Improving haemodialysis patients' understanding of phosphate‐binding medication: A pilot study of a psycho‐educational intervention designed to change patients' perceptions of the problem and treatment

Objectives. To evaluate a psycho‐educational intervention aimed to improve understanding of the need for phosphate control, provide a rationale for phosphate‐binding medication (PBM) and explain its mode of action. Design. A controlled intervention study comparing the effect of a self‐regulatory theory‐based psycho‐educational intervention versus standard care control on knowledge of phosphate control and beliefs about PBM. Method. End‐stage renal disease (ESRD) patients were assigned to either an intervention group (N = 19) or control group (N = 20). Both groups were assessed at baseline, at 1‐month post‐intervention and at 4‐month post‐intervention. The intervention group was also assessed immediately post‐intervention. Results. The intervention had an immediate impact post‐intervention on all outcome variables examined. It was also successful in improving knowledge, treatment coherence, medication outcome efficacy beliefs, and general understanding of treatment in the intervention group in comparison to the control group, an effect which was sustained through to the second follow‐up. Conclusions. A simple intervention was successful in changing patients' understanding and some beliefs around treatment thought to influence adherence behaviour. Further research is needed to inform the design of a more complex intervention targeting the specific beliefs influencing behaviour in order to facilitate treatment adherence.     

A Group‐Mediated Cognitive‐Behavioral intervention for Increasing Adherence to Physical Activity in Older Adults1

This study examined the efficacy of a group‐mediated cognitive behavioral intervention (GMCB) on adherence rates to physically active lifestyles in older adults. Sixty older adults were randomized to I of 3 groups: waiting list control (WLC), a standard physical activity program (SPA), or GMCB. The SPA and GMCB involved 6 months of combined center‐ and home‐based activity. Contact with participants was then terminated with a follow‐up assessment at 9 months. Results revealed that, at the 9‐month follow‐up the GMCB group had a higher frequency of weekly physical activity than the SPA group. At 6 months, both groups were more active, had higher aerobic power, and improved HRQL when compared with the control group.     

An exploration of the motivation of pregnant women to perform pelvic floor exercises using the revised theory of planned behaviour

Objectives. To investigate the motivation of pregnant women towards the practice of pelvic floor exercises during pregnancy using the revised Theory of Planned Behaviour (RTPB), incorporating measures of past behaviour. Design. Longitudinal cohort study. Methods. Women (n= 289) attending antenatal clinics in the North‐East of Scotland were interviewed in the third trimester of pregnancy regarding their practice of pelvic floor exercises. Beliefs and attitudes about the exercises were investigated by self‐administered questionnaire using the RTPB as a framework. A follow‐up postal questionnaire was sent between 6 and 12 months after delivery. Results. TPB variables (attitude, subjective norm, and self‐efficacy) explained 53.1% of the variance in intention to practise pelvic floor exercises during pregnancy. Perceived vulnerability to incontinence (attitude to the current behaviour) had no relationship with intention. Measures of past behaviour significantly improved the percentage of explained variance in intention. Confidence in ability to perform pelvic floor exercises correctly (self‐efficacy) reliably predicted subsequent practice. Conclusions. Future compliance with pelvic floor exercises may be enhanced by effective instruction to enhance confidence in ability to contract the correct muscles and promotion of measures to help establish a habit of exercising the pelvic floor muscles.     

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.     

Good long‐term adherence to continuous positive airway pressure therapy in patients with resistant hypertension and sleep apnea

Although adequate adherence is paramount in achieving the beneficial effects of continuous positive airway pressure therapy in patients with obstructive sleep apnea, long‐term adherence and the variables involved in continuous positive airway pressure compliance in patients with resistant hypertension and obstructive sleep apnea are yet unknown. We conducted a prospective, multicentre, observational study in 177 patients recruited from hypertensive units with resistant hypertension confirmed by means of 24‐hr blood pressure monitoring (blood pressure ≥ 130 and/or ≥ 80 mmHg, despite taking at least three antihypertensive drugs or < 130/80 mmHg with > 3 drugs) and obstructive sleep apnea (apnea–hypopnea index ≥ 5 in a respiratory polygraph) who were prescribed continuous positive airway pressure treatment. Good adherence was defined as an average cumulative continuous positive airway pressure use of ≥ 4 hr per night at the end of the follow‐up. A multivariate Cox regression analysis was performed to identify independent predictors of continuous positive airway pressure adherence. Patients were followed for a median of 57.6 (42–72) months after initiating continuous positive airway pressure therapy. At the end of the follow‐up, the median continuous positive airway pressure use was 5.7 (inter‐quartile range 3.9–6.6) hr per night, and 132 patients (74.5%) showed good continuous positive airway pressure adherence. The only baseline variable associated with poor adherence was the presence of previous stroke (hazard ratio 4.00, 95% confidence interval 1.92–8.31). Adequate adherence at 1 month also predicted good adherence at the end of the follow‐up (hazard ratio 14.4, 95% confidence interval 4.94–56). Both variables also predicted adherence at a threshold of 6 hr per night. Our results show that good continuous positive airway pressure adherence is an achievable and feasible goal in patients with resistant hypertension and obstructive sleep apnea. Previous stroke and short‐term adherence predicted long‐term adherence.     

Long-term study of fluticasone propionate aqueous nasal spray in acute and maintenance therapy of nasal polyposis

Background: Topical steroids are first‐line medication to control nasal polyposis (NP), a disease with long‐term clinical course. Objective: The aim of this study was to evaluate the efficacy and safety of fluticasone propionate aqueous nasal spray (FPANS) 200 μg twice a day (bd) after 1 month of treatment, and to compare FPANS 200 μg bd and FPANS 200 μg once a day (od) in maintenance and long‐term treatment. Methods: Double‐blind, placebo‐controlled, 8‐month study with three treatment periods (1‐month acute period followed with 1‐month maintenance period and 6‐month follow‐up period) was carried out. Group 1 received FPANS 200 μg bd, during acute, maintenance and follow‐up periods, Group 2 received FPANS 200 μg bd during acute period and FPANS 200 μg od during maintenance and follow‐up periods, and Group 3 received placebo during acute and maintenance periods and FPANS 200 μg bd during follow‐up period. Endpoints were change from baseline in clinic peak nasal inspiratory flow (PNIF), domiciliary evening PNIF, intensity of symptoms and polyposis grade. Results: After acute period and maintenance periods, FPANS 200 μg bd was significantly more effective than placebo on all endpoints and more effective than FPANS 200 μg od after 1‐month maintenance period on clinic PNIF, evening PNIF, obstruction, percentage of days with no sense of smell and percentage of nights with no disturbances. The two doses were similar on other endpoints. After the 6‐month follow‐up period, there was no difference between the two doses of FPANS at all efficacy endpoints. The safety profile of FPANS did not highlight any new or unanticipated adverse events. Conclusion: The study demonstrated the efficacy of FPANS 200 μg bd in acute treatment and FPANS 200 μg od as a sufficient dose to maintain a long‐term efficacy in the treatment for NP.     

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.     

Protection motivation theory and adolescent drug trafficking: relationship between health motivation and longitudinal risk involvement

OBJECTIVE: To assess health protection motivation as explained by the constructs of protection motivation theory (PMT) and its association with drug trafficking over 2 years. METHODS: The sample included 817 African American youth (13-16 years old) participating in an adolescent risk-reduction program. We developed an instrument measuring the level of health protection motivation (LHPM) using factor analysis. Changes in LHPM over time were examined among drug traffickers, abstainers, initiators, and nonrisk youths. RESULTS: In sum, 151 participants reported selling and/or delivering drugs during the study period. The significant inverse correlation between drug-trafficking intention and health protection motivation was consistent with PMT. Changes in LHPM were strongly associated with the dynamics of behavior over 2 years. CONCLUSIONS: Adolescent drug trafficking can be predicted by an overall level of health protection motivation. PMT and related theories should be considered in the design of drug-trafficking prevention intervention.     

With a little help from my goals: Integrating intergoal facilitation with the theory of planned behaviour to predict physical activity

Objective . Integration of a multiple goal theory approach into the theory of planned behaviour (TPB) to investigate how the perceived facilitating and conflicting relationships in multiple goal pursuit predict performance of a health‐related behaviour. Design . Prospective design with 8‐week follow‐up. Methods . At baseline, perceived intergoal facilitation and intergoal conflict were measured using personal projects analysis supplemented with standard TPB measures for physical activity (PA). Self‐reported PA was measured at follow‐up 8 weeks later. N=137 participants completed measures at both time points (55.4% response rate at follow‐up). Results . Hierarchical regression showed that perceived intergoal facilitation, but not intergoal conflict, directly predicted PA beyond intention and perceived behavioural control (PBC), accounting for more than 4% of additional variance in PA. Intergoal facilitation had an indirect effect on intention through attitude and PBC, and intention partially mediated the effect of intergoal facilitation on behaviour. Conclusion . The perceived facilitating effect of pursuing other personal goals predicts the performance of a health‐related behaviour over and above single behaviour‐focused social cognitions.     

Cognitive and behavioural correlates of non‐adherence to HIV anti‐retroviral therapy: Theoretical and practical insight for clinical psychology and health psychology

This cross‐sectional study identified variables associated with protease inhibitor (PI) non‐adherence in 179 patients taking anti‐retroviral therapy. Univariate analyses identified 11 variables associated with PI non‐adherence. Multiple logistic regression modelling identified three predictors of PI non‐adherence: low adherence self‐efficacy and seriousness of non‐adherence and HIV (p < .001), perceived absence of HIV associated illness (p < .01), and use of more than one type of recreational drug (p = .001). The model correctly classified 83.9% of the sample, offers psychologists insight into psychological barriers to treatment adherence to guide interventions for improving adherence, and supports a modified version of the reformulated health belief model.     

The theory of planned behaviour and binge drinking: Assessing the moderating role of past behaviour within the theory of planned behaviour

A sample of 398 undergraduate students completed questionnaires assessing the main constructs of the theory of planned behaviour (TPB) in relation to binge drinking, as well as past binge drinking behaviour. Of these, 273 were followed up at 1 week. Regression analyses revealed attitude, self‐efficacy, and perceived control (negative relationship) to be predictive of binge drinking intentions. Intention and self‐efficacy were, in turn, predictive of binge drinking at 1‐week follow‐up. Past behaviour was found to explain additional variance in intention and behaviour. In addition, past behaviour was found to moderate the attitude–intention and intention–behaviour relationships, such that weaker relationships were observed with increasing frequency of past behaviour. The results are discussed in relation to the need to develop and test alternative measures of habit. The implications of the findings for interventions to encourage more appropriate drinking behaviour are outlined.