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.     

Social cognitive determinants of physical activity among retired older individuals: An application of the health action process approach

Objective. The identification of the determinants of physical activity (PA) among older adults is an important avenue of research. To date, although the health action process approach (HAPA) has proven to be a valid framework for the prediction of PA among heterogeneous sample of both middle‐aged and older adults in rehabilitation and work settings, no studies have specifically considered its predictive value among older adults in their retirement years. Therefore, drawing upon the HAPA, the present study aimed to identify the social cognitive determinants of PA involvement among retired older adults. Design. A 6‐month prospective design was employed. Method. Participants were retired older individuals (N= 120), members of a French university‐based organization, aged from 53 to 83 years (Mean = 65.38 years; SD= 5.63). They were administrated measures of risk perception, action self‐efficacy, outcome expectancies, and PA intention at baseline (T1) and of planning, coping self‐efficacy, and PA behaviour 6 months later (T2). Results. Path analyses revealed that, in the motivational phase, action self‐efficacy and risk perception, but not outcome expectancies, were positively related to PA intention. In the volitional phase, PA intention and coping self‐efficacy, but not planning, were positive predictors of PA behaviour. Conclusion. The present study contributes to existing knowledge as the first to apply the HAPA for the prediction of PA among retired older adults. It confirms that it provides a useful framework for the understanding of the social cognitive processes underlying this behaviour for this age group.     

Adherence to physical and mental activity interventions: coping plans as a mediator and prior adherence as a moderator

Objective. Adherence to behavioural intervention programmes is a necessary condition for beneficial outcomes to be achieved. This study tested whether social cognitive variables and coping plans predict adherence. Design and methods. Adherence was examined in a randomized controlled trial with healthy older women (age range: 70–93 years), who were randomized to a physical (N= 86) or a mental (N= 85) activity intervention. Intentions, self‐efficacies, coping plans, and objectively measured adherence levels were assessed. A moderated mediation analysis evaluated the power of coping plans to translate intention into behaviour, depending on levels of prior adherence. Results. Adherence to the physical activity programme (65%) was significantly lower than adherence to the mental activity programme (84%, p < .001). Intentions (β= .22) weakly predicted adherence in the initiation period of the physical activity programme (6 weeks); pre‐action self‐efficacy predicted adherence in the initiation period of the mental activity programme (β= .35). In both groups, coping plans predicted mid‐period adherence (10 weeks) and long‐term adherence (20 weeks), moderated by prior adherence (all ps < .01). Coping plans mediated the relationship between intentions and behaviour only in the exercise condition. Conclusions. Instructing older individuals to generate coping plans facilitated their adherence to physical and mental activity programmes. This effect was larger for participants with lower levels of prior adherence – and may have prevented them from dropping out of the programme.     

What is the best way to change self‐efficacy to promote lifestyle and recreational physical activity? A systematic review with meta‐analysis

Purpose. Increasing self‐efficacy is an effective method to increase physical activity. Despite this, the evidence concerning the most effective techniques to increase self‐efficacy in physical activity interventions has not been systematically reviewed. The aim of the present research is to systematically gather, and meta‐analyse, intervention studies which aimed to increase self‐efficacy for physical activity; to estimate the association between intervention techniques used, and change in self‐efficacy achieved. Methods. A systematic database search was conducted for papers reporting lifestyle or recreational physical activity interventions. Published intervention studies explicitly targeting self‐efficacy in order to change physical activity behaviour in ‘healthy’ adults were eligible for inclusion. Results. The search strategy identified 27 unique physical activity intervention studies, with a total of 5,501 participants. A significant, yet small, relationship between the interventions and changes in self‐efficacy was found (mean d =0.16, p <.001). Owing to significant heterogeneity, moderator analyses were conducted, examining the association of changes in self‐efficacy with whether or not specific intervention techniques were used. Interventions that included feedback on past or others' performance produced the highest levels of self‐efficacy found in this review. Vicarious experience was also associated with higher levels of self‐efficacy. Persuasion, graded mastery, and barrier identification were associated with lower levels of self‐efficacy. Conclusions. This meta‐analysis forms an evidence base for which psychological techniques are most effective in increasing self‐efficacy for physical activity. The results are presented in terms of recommendations for those developing interventions and directions for future research.     

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.     

Help‐seeking intentions for breast‐cancer symptoms: A comparison of the self‐regulation model and the theory of planned behaviour

Purpose: Delays in seeking help for symptoms have been found to be associated with poorer outcome in breast‐cancer patients. This study explores symptom perceptions and health beliefs as predictors of intentions to seek medical help in a general female population. The utility of the self‐regulation model of illness cognition and the theory of planned behaviour were examined in predicting help‐seeking intentions for potential symptoms of breast cancer in a general population sample. Methods: A general population sample of 546 women completed a postal questionnaire comprising items examining components of the self‐regulation model and the theory of planned behaviour. Help‐seeking intention was determined by asking participants to rate the likelihood of visiting their GP for a range of breast symptoms. Results: Hierarchical multiple regression analysis revealed that the cognitive component of the self‐regulation model accounted for approximately 22% of the variance in help‐seeking intention. Identity (β = 0.45, p < .001) emerged as a significant predictor of intention to seek help. Inclusion of the components of the theory of planned behaviour accounted for an additional 7% of the variance; the significant predictors were attitude to help‐seeking (β = 0.19, p <.001) and perceived behavioural control (β = 0.12, p <.01). Conclusions: Intention to seek medical help for a potential breast‐cancer symptom may be mediated, partly, by cognitive representations of the identity and consequences of breast cancer and by attitudes towards help‐seeking and perceived behavioural control. Although less than one‐third of the variance was accounted for, these results have important implications for future research (in terms of identifying which variables should be examined) and for the development of a model of help‐seeking behaviour in women with breast‐cancer symptoms.     

Managing exercise with another highly valued and conflicting leisure time goal

Research has identified concurrent self‐regulatory efficacy as a consistent exercise predictor when adults pursue another non‐exercise leisure time goal. Although intergoal conflict is an inconsistent exercise predictor, prior research did not ensure that goals were sufficiently highly valued to truly conflict. Other possible exercise predictors have not been examined among concurrent goals. The purpose was to examine whether intergoal conflict and outcome expectations (likelihood; value) predicted moderate‐vigorous exercise over 1 month, beyond concurrent self‐regulatory efficacy, when adults held highly valued, conflicting exercise and non‐exercise goals concurrently. Eighty‐seven adult exercisers pursuing highly valued and conflicting exercise and non‐exercise goals completed online surveys assessing (1) concurrent self‐regulatory efficacy, intergoal conflict, and outcome expectations at Time 1 and (2) exercise over the prior month at Time 2. A hierarchical multiple regression (R² adjusted = 0.24, p < .001) revealed intergoal conflict and outcome expectations accounted for a significant additional 13% of exercise variance, beyond self‐regulatory efficacy. Future research should examine these social cognitions across adults who vary in their exercise levels (i.e., beginner, irregular, regular exercisers). Valuable information about which social cognitions should be targeted to improve exercise levels among each group to that of regular exercisers would result.     

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

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

When is pain related to emotional distress and daily functioning in fibromyalgia syndrome? The mediating roles of self‐efficacy and sleep quality

Objectives. Fibromyalgia (FM) is a chronic pain syndrome associated with adverse symptoms of cognitive, behavioural, and emotional dysfunction. Accumulating evidence supports the notion that sleep dysfunction, which affects almost all FM patients, has a reciprocal influence on pain. Yet, little is known about the relationship between sleep and other FM symptoms. The present study analysed the role of sleep dysfunction as a mediator of the impact of pain intensity on anxiety, depression, and daily functioning, comparing them with the mediating role of self‐efficacy. Design. A cross‐sectional design was used. Methods. A sample of 104 women with FM and 86 healthy control women completed a semi‐structured interview and self‐reported measures of pain, sleep quality, anxiety, depression, and daily functioning. Multiple mediation models were proposed and a bootstrapping approach was used to test these models. Results. Women diagnosed with FM had more dysfunctional scores on the variables examined than control participants, and there were significant relationships between all the variables examined in the mediation models for the FM group. The mediation analyses suggested that sleep quality and self‐efficacy significantly mediated the relationship between pain and emotional distress. Additionally, self‐efficacy was a significant mediator and sleep quality a likely mediator that was marginally significant in the relationship between pain and functioning. Conclusions. Sleep dysfunction is importantly related to FM symptoms and deserves more attention in both research and clinical practice. Our results suggest that, in addition to the usual treatment of FM, improving sleep could optimize the current management of the syndrome.     

Promoting participation in physical activity using framed messages: An application of prospect theory

Objectives Messages designed to motivate participation in physical activity usually emphasize the benefits of physical activity (gain‐framed) as well as the costs of inactivity (loss‐framed). The framing implications of prospect theory suggest that the effectiveness of these messages could be enhanced by providing gain‐framed information only. We compared the effectiveness of gain‐, loss‐, and mixed‐framed messages for promoting moderate to vigorous physical activity. Design Randomized trial. Method Sedentary, healthy callers to the US National Cancer Institute's Cancer Information Service (N=322) received gain‐, loss‐, or mixed‐framed messages on three occasions (baseline, Week 1, and Week 5). Social cognitive variables and self‐reported physical activity were assessed at baseline, Week 2, and Week 9. Separate regression analyses were conducted to examine message effects at each assessment point. Results At Week 2, gain‐ and mixed‐framed messages resulted in stronger intentions and greater self‐efficacy than loss‐framed messages. At Week 9, gain‐framed messages resulted in greater physical activity participation than loss‐ or mixed‐framed messages. Social cognitive variables at Week 2 did not mediate the Week 9 framing effects on physical activity participation. Conclusions Using gain‐framed messages exclusively may be a means of increasing the efficacy of physical activity materials.     

Predictors of Native American children's perceived status of health and physical shape

To increase our understanding of predictors of healthy behavior patterns in Native American children. Children from the Southwest (N  = 145) United States were administered a questionnaire with predictors of healthy living behaviors (i.e., perceived health status and perceived physical shape [fitness]). Using structural equation modeling, significant path estimates were present for self‐efficacy in predicting beliefs, for (removing) barriers, and for adult/peer support. Further, belief, barriers, and peer social support significantly predicted goals/intentions to be physically active. For children's perceived physical shape (fitness), similar results were found except with no significant relationship between self‐efficacy and (removing) barriers. Efforts focusing on increasing support systems and improving experiences (leading to positive efficacy/beliefs) can lead to significantly greater goals/intentions and perhaps the adoption of healthy behavior patterns by children.     

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.     

Stages of motivational readiness for physical activity: A comparison of different algorithms of classification

Objective: The aim of this study was to compare two approaches to classify individuals into stages of motivational readiness for physical activity and test which one was better explained by attitude and perceived behavioural control, as defined by Ajzen (1991). Design: A survey of 20430 respondents from a population‐based sample. Methods: The relevant variables were assessed in a self‐administered questionnaire. The cluster approach consisted of combining both intention and behaviour in order to determine clusters of individuals; such clusters correspond to different stages of motivational readiness. The stage of change (SC) approach consisted of grouping the same individuals by using the SC variable of the Transtheoretical Model (TTM). Results: The SC and cluster‐solution approaches were replicated across four subsamples of the total number of respondents. Attitude and perceived behavioural control were more strongly associated with stage membership derived from four‐cluster solution than with stage membership in the five categories assessed by the SC method. Conclusion: Stage of motivational readiness for physical activity, and possibly for other health‐related behaviours, may usefully be characterized when both recent past behaviour and intention in the near future are simultaneously and explicitly taken into consideration.     

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.     

Integrating the theory of planned behaviour and self‐determination theory in health behaviour: A meta‐analysis

Purpose A meta‐analysis of studies integrating the theory of planned behaviour (TPB) and self‐determination theory (SDT) in health contexts is presented. The analysis aimed to provide cumulative empirical support for a motivational sequence in which self‐determined motivation from SDT predicts the proximal predictors of intentions and behaviour from the TPB. Methods A literature search identified 36 integrated studies providing 45 tests of effects between TPB and SDT variables. Hunter and Schmidt's (1994) methods of meta‐analysis were used to correct the effect sizes across the studies for statistical artifacts. Age (old versus young), publication status (published versus unpublished), study design (correlational versus experimental/intervention), and behaviour type (physical activity versus other health‐related behaviours) were evaluated as moderators of the effects. A path‐analysis using the meta‐analytically derived correlations was conducted to examine the proposed motivational sequence. Results Statistically significant corrected correlations were evident among the perceived autonomy support and self‐determined motivation constructs from SDT and the attitude, subjective norms, perceived behavioural control, intention, and health‐related behaviour constructs from the TPB. Only six of the 28 effect sizes were moderated by the proposed moderators. Path analysis revealed that the significant effects of self‐determined motivation on intentions and behaviour were partially mediated by the proximal predictors from the TPB. Conclusions Evidence from this synthesis supported the theoretical integration and proposed motivational sequence. Results are discussed with reference to the complementary aspects of the TPB and SDT and the need for integrated experimental or intervention studies on a broader range of health behaviours.     

Physical activity and self‐rated health: Interactive effects of activity in work and leisure domains

Objectives. This longitudinal study examined the effects of physical activity on self‐rated health (SRH); specifically, predicted interactions between leisure activity and job activity, and between leisure activity and age, were evaluated in relation to SRH. Methods. Survey data on age and leisure activity together with relevant covariates (education, body mass index, smoking and negative affectivity) were collected from oil industry employees. Three job activity levels were identified (sedentary, active and strenuous). At 5‐year follow‐up, SRH, body mass index and smoking were reassessed. Hierarchical regression was used to analyse the longitudinal data (N = 314). Results. The job activity ×leisure activity interaction (controlled for baseline SRH and covariates) predicted follow‐up SRH (p <.025). Individuals in sedentary jobs benefited disproportionately from leisure activity; active and strenuous jobs were associated with lower SRH, irrespective of leisure activity. The age ×leisure activity interaction was also significant (p <.025); leisure activity was significantly and positively associated with SRH only among younger individuals. Changes in body mass index and smoking contributed additively to the model, but did not mediate physical activity effects. Conclusions. These findings highlight the importance of leisure physical activity for employees in sedentary jobs, but suggest that other factors (such as adverse environmental conditions) may underlie the lower SRH associated with physically demanding work. The results also indicate that, irrespective of job activity level, younger individuals benefit more from leisure physical activity than older ones. Thus, the study informs interventions designed to improve the health of employees through increased physical activity.     

Beyond behavioural intentions: Planning mediates between intentions and physical activity

Objectives Health‐behaviour change is not predicted well by behavioural intentions alone. Action planning and coping planning are two self‐regulatory strategies that may help bridge the gap between intentions and behaviour. Action planning comprises the when, where and how of implementing a behaviour. Coping planning involves the anticipation of barriers and ways to overcome them. The study examines whether the inclusion of these two planning constructs would improve the overall prediction of physical activity. The main research question is which kind of planning would be beneficial for the initiation of behaviour and which one for its maintenance. Moreover, it is examined whether intentions moderate the planning–behaviour relationship. Methods A 5‐week longitudinal on‐line study was conducted with 354 participants. Differences in prediction patterns between formerly active and formerly inactive individuals were compared using multigroup structural equation modelling. Moderating effects of intentions were tested by means of latent interactions. Results Inclusion of the two planning factors accounted for substantially more behaviour variance than intention alone did. Coping planning mediated the intention–behaviour relationship only in formerly active, but not in formerly inactive participants. Moreover, intentions moderated the effects of both types of planning on behaviour. Conclusions Action planning appears to predict behaviour only when intentions are high. For actors, coping planning represents a critical self‐regulation strategy to maintain their physical activity levels.     

The association between physical activity and hot flash severity,frequency, and duration in mid‐life women

The value of physical activity to reduce vasomotor symptoms has yet to be determined conclusively. As a result, we used a cross‐sectional population‐based design to examine the association between self reported physical activity level and hot flash symptoms in 45–54‐year‐old women. Participants (n = 603) completed a detailed survey to report physical activity level at work, home, and leisure as well as a detailed history of the frequency and severity of hot flash symptoms. Results showed that higher levels of physical activity were significantly associated with increasing odds of moderate or severe hot flashes (P for trend = 0.02). These findings suggest that there is a positive relation between physical activity and moderate or severe hot flash symptoms but no relation between physical activity and the reporting of any hot flashes, daily hot flashes, or hot flashes experienced for greater than 1 year. Am. J. Hum. Biol., 2009. © 2008 Wiley‐Liss, Inc.     

Sustaining self‐regulatory efficacy and psychological outcome expectations for postnatal exercise: Effects of a group‐mediated cognitive behavioural intervention

Objective . The objective of the current investigation was to examine if the effects of a group‐mediated cognitive behavioural counselling plus exercise intervention were superior to the effects of a standard exercise care condition on postnatal mothers' self‐regulatory efficacy (SRE), outcome expectations (OEs) and self‐directed physical activity (PA). Design . The design of the study consisted of two intervention conditions; group‐mediated cognitive behavioural counselling plus exercise (GMCB) and standard exercise (SE). Each condition consisted of two phases; a 4‐week supervised, centre‐based intensive exercise training phase followed by a 4‐week home‐based phase. Methods . Participants were 57 postnatal women randomly assigned to conditions (SE: N = 31; GMCB: N = 26). Measures of SRE and OEs were assessed prior to and following the centre‐based aspect of the intervention. Physical activity was measured following the intensive exercise training phase as well as the home‐based phase. Results . GMCB participants' SRE and OEs were sustained during the intervention whereas those of SE participants declined. GMCB participants also reported significantly greater time spent engaging in self‐directed PA at the conclusion of the intensive and home‐based phases. Mediation analysis revealed that SRE partially mediated the relationship between intervention condition and post home‐based PA as confirmed by a significant sobel test. Conclusions . These findings suggest that a theory‐based GMCB counselling plus exercise intervention is superior to the SE condition in sustaining SRE and OEs, and in promoting greater self‐directed PA. SRE partially mediated the relationship between intervention condition and post home‐based PA supporting the targeting of that variable for change as part of the intervention.