Search tips
Search criteria

Results 1-25 (1404464)

Clipboard (0)

Related Articles

1.  Protection Motivation Theory in Predicting Intention to Engage in Protective Behaviors against Schistosomiasis among Middle School Students in Rural China 
Among millions of people who suffer from schistosomiasis in China, adolescents are at increased risk to be infected. However, there is a lack of theory-guided behavioral prevention intervention programs to protect these adolescents. This study attempted to apply the Protection Motivation Theory (PMT) in predicting intentions to engage in protective behaviors against schistosomiasis infection.
The participants were selected using the stratified cluster sampling method. Survey data were collected using anonymous self-reported questionnaire. The advanced structural equation modeling (SEM) method was utilized to assess the complex relationship among schistosomiasis knowledge, previous risk exposure and protective measures in predicting intentions to engage in protective behavior through the PMT constructs.
Principal Findings
Approximately 70% of participants reported they were always aware of schistosomiasis before exposure to water with endemic schistosomiasis, 6% of the participants reported frequency of weekly or monthly prior exposure to snail-conditioned water. 74% of participants reported having always engaged in protective behaviors in the past three months. Approximately 7% were unlikely or very unlikely to avoid contact with snail-conditioned water, and to use protective behaviors before exposure. Results from SEM analysis indicated that both schistosomiasis knowledge and prior exposure to schistosomiasis were indirectly related to behavior intentions through intrinsic rewards and self-efficacy; prior protective behaviors were indirectly related to behavior intentions through severity, intrinsic rewards and self-efficacy, while awareness had an indirect relationship with behavior intentions through self-efficacy. Among the seven PMT constructs, severity, intrinsic rewards and self-efficacy were significantly associated with behavior intentions.
The PMT can be used to predict the intention to engage in protective behaviors against schistosomiasis. Schistosomiasis intervention programs should focus on the severity, intrinsic rewards and self-efficacy of protection motivation, and also increase the awareness of infection, and enrich the contents of schistosomiasis education.
Author Summary
In China, millions of population suffer from schistosomiasis infection and adolescents tend to have higher infection rates than adults. The Knowledge-Attitude-Practice (KAP) Theory has traditionally been used as guidance to schistosomiasis prevention in China. However, despite increases in knowledge among residents in the epidemic areas due to KAP theory-based schistosomiasis health education, no significant reduction in water-contact behavior was evident. Therefore, it is of crucial importance to seek alternative health behavior change theories/models that are more effective than the KAP theory to promote purposeful behavioral change. The Protection Motivation Theory (PMT) as a social cognitive model may be an alternative to the KAP theory. In this study, we found that the PMT can be used to predict intention to engage in protective behaviors against schistosomiasis infection among middle school students in rural China. Based on the PMT, in addition to enhancing awareness of schistosomiasis infection, intervention programs should focus on the severity, intrinsic rewards and self-efficacy of protection motivation.
PMCID: PMC4199519  PMID: 25329829
2.  Cardiovascular risk profile: Cross-sectional analysis of motivational determinants, physical fitness and physical activity 
BMC Public Health  2010;10:592.
Cardiovascular risk factors are associated with physical fitness and, to a lesser extent, physical activity. Lifestyle interventions directed at enhancing physical fitness in order to decrease the risk of cardiovascular diseases should be extended. To enable the development of effective lifestyle interventions for people with cardiovascular risk factors, we investigated motivational, social-cognitive determinants derived from the Theory of Planned Behavior (TPB) and other relevant social psychological theories, next to physical activity and physical fitness.
In the cross-sectional Utrecht Police Lifestyle Intervention Fitness and Training (UP-LIFT) study, 1298 employees (aged 18 to 62) were asked to complete online questionnaires regarding social-cognitive variables and physical activity. Cardiovascular risk factors and physical fitness (peak VO2) were measured.
For people with one or more cardiovascular risk factors (78.7% of the total population), social-cognitive variables accounted for 39% (p < .001) of the variance in the intention to engage in physical activity for 60 minutes every day. Important correlates of intention to engage in physical activity were attitude (beta = .225, p < .001), self-efficacy (beta = .271, p < .001), descriptive norm (beta = .172, p < .001) and barriers (beta = -.169, p < .01). Social-cognitive variables accounted for 52% (p < .001) of the variance in physical active behaviour (being physical active for 60 minutes every day). The intention to engage in physical activity (beta = .469, p < .001) and self-efficacy (beta = .243, p < .001) were, in turn, important correlates of physical active behavior.
In addition to the prediction of intention to engage in physical activity and physical active behavior, we explored the impact of the intensity of physical activity. The intentsity of physical activity was only significantly related to physical active behavior (beta = .253, p < .01, R2 = .06, p < .001). An important goal of our study was to investigate the relationship between physical fitness, the intensity of physical activity and social-cognitive variables. Physical fitness (R2 = .23, p < .001) was positively associated with physical active behavior (beta = .180, p < .01), self-efficacy (beta = .180, p < .01) and the intensity of physical activity (beta = .238, p < .01).
For people with one or more cardiovascular risk factors, 39.9% had positive intentions to engage in physical activity and were also physically active, and 10.5% had a low intentions but were physically active. 37.7% had low intentions and were physically inactive, and about 11.9% had high intentions but were physically inactive.
This study contributes to our ability to optimize cardiovascular risk profiles by demonstrating an important association between physical fitness and social-cognitive variables. Physical fitness can be predicted by physical active behavior as well as by self-efficacy and the intensity of physical activity, and the latter by physical active behavior.
Physical active behavior can be predicted by intention, self-efficacy, descriptive norms and barriers. Intention to engage in physical activity by attitude, self-efficacy, descriptive norms and barriers. An important input for lifestyle changes for people with one or more cardiovascular risk factors was that for ca. 40% of the population the intention to engage in physical activity was in line with their actual physical active behavior.
PMCID: PMC3091554  PMID: 20929529
3.  Action planning as predictor of health protective and health risk behavior: an investigation of fruit and snack consumption 
Large discrepancies between people's intention to eat a healthy diet and actual dietary behavior indicate that motivation is not a sufficient instigator for healthy behavior. Research efforts to decrease this 'intention - behavior gap' have centered on aspects of self-regulation, most importantly self-regulatory planning. Most studies on the impact of self-regulatory planning in health and dietary behavior focus on the promotion of health protective behaviors. This study investigates and compares the predictive value of action planning in health protective behavior and the restriction of health risk behavior.
Two longitudinal observational studies were performed simultaneously, one focusing on fruit consumption (N = 572) and one on high-caloric snack consumption (N = 585) in Dutch adults. Structural equation modeling was used to investigate and compare the predictive value of action planning in both behaviors, correcting for demographics and the influence of motivational factors and past behavior. The nature of the influence of action planning was investigated by testing mediating and moderating effects.
Action planning was a significant predictor of fruit consumption and restricted snack consumption beyond the influence of motivational factors and past behavior. The strength of the predictive value of action planning did not differ between the two behaviors. Evidence for mediation of the intention - behavior relationship was found for both behaviors. Positive moderating effects of action planning were demonstrated for fruit consumption, indicating that individuals who report high levels of action planning are significantly more likely to translate their intentions into actual behavior.
The results indicate that the planning of specific preparatory actions predicts the performance of healthy dietary behavior and support the application of self-regulatory planning in both health protective and health risk behaviors. Future interventions in dietary modification may turn these findings to advantage by incorporating one common planning protocol to increase the likelihood that good intentions are translated into healthy dietary behavior.
PMCID: PMC2770554  PMID: 19825172
4.  Prediction of Sport Adherence Through the Influence of Autonomy-Supportive Coaching Among Spanish Adolescent Athletes 
The purpose of this study was to test a motivational model of the coach-athlete relationship, based on self-determination theory and on the hierarchical model of intrinsic and extrinsic motivation. The sample comprised of 608 athletes (ages of 12-17 years) completed the following measures: interest in athlete's input, praise for autonomous behavior, perceived autonomy, intrinsic motivation, and the intention to be physically active. Structural equation modeling results demonstrated that interest in athletes' input and praise for autonomous behavior predicted perceived autonomy, and perceived autonomy positively predicted intrinsic motivation. Finally, intrinsic motivation predicted the intention to be physically active in the future. The results are discussed in relation to the importance of the climate of autonomy support created by the coach on intrinsic motivation and adherence to sport by adolescent athletes. Further, the results provide information related to the possible objectives of future interventions for the education of coaches, with the goal of providing them with tools and strategies to favor the development of intrinsic motivation among their athletes. In conclusion, the climate of autonomy support created by the coach can predict the autonomy perceived by the athletes which predicts the intrinsic motivation experienced by the athletes, and therefore, their adherence to athletic practice.
Key pointsImportance of the climate of autonomy support created by the coach on intrinsic motivation and adherence to sport by adolescent athletes.Interest in athletes' input and praise for autonomous behavior predicted perceived autonomy, and perceived autonomy positively predicted intrinsic motivation.Intrinsic motivation predicted the intention to be physically active in the future.
PMCID: PMC3737975  PMID: 24149380
Autonomy support; perceived autonomy; intrinsic motivation; sport adherence.
5.  Predicting active school travel: The role of planned behavior and habit strength 
Despite strong support for predictive validity of the theory of planned behavior (TPB) substantial variance in both intention and behavior is unaccounted for by the model’s predictors. The present study tested the extent to which habit strength augments the predictive validity of the TPB in relation to a currently under-researched behavior that has important health implications, namely children’s active school travel.
Participants (N = 126 children aged 8–9 years; 59 % males) were sampled from five elementary schools in the west of Scotland and completed questionnaire measures of all TPB constructs in relation to walking to school and both walking and car/bus use habit. Over the subsequent week, commuting steps on school journeys were measured objectively using an accelerometer. Hierarchical multiple regressions were used to test the predictive utility of the TPB and habit strength in relation to both intention and subsequent behavior.
The TPB accounted for 41 % and 10 % of the variance in intention and objectively measured behavior, respectively. Together, walking habit and car/bus habit significantly increased the proportion of explained variance in both intention and behavior by 6 %. Perceived behavioral control and both walking and car/bus habit independently predicted intention. Intention and car/bus habit independently predicted behavior.
The TPB significantly predicts children’s active school travel. However, habit strength augments the predictive validity of the model. The results indicate that school travel is controlled by both intentional and habitual processes. In practice, interventions could usefully decrease the habitual use of motorized transport for travel to school and increase children’s intention to walk (via increases in perceived behavioral control and walking habit, and decreases in car/bus habit). Further research is needed to identify effective strategies for changing these antecedents of children’s active school travel.
PMCID: PMC3419676  PMID: 22647194
Theory of planned behavior; Habit; Active school travel; Walking; Children
6.  Tablet-Based Strength-Balance Training to Motivate and Improve Adherence to Exercise in Independently Living Older People: A Phase II Preclinical Exploratory Trial 
Reaction time, coordination, and cognition performance typically diminish in older adults, which may lead to gait impairments, falls, and injuries. Regular strength–balance exercises are highly recommended to reduce this problem and to improve health, well-being, and independence in old age. However, many older people face a lack of motivation in addition to other strong barriers to exercise. We developed ActiveLifestyle, an information technology (IT)-based system for active and healthy aging aiming at improving balance and strength. ActiveLifestyle is a training app that runs on a tablet and assists, monitors, and motivates older people to follow personalized training plans autonomously at home.
The objectives were to (1) investigate which IT-mediated motivation strategies increase adherence to physical exercise training plans in older people, (2) assess the impact of ActiveLifestyle on physical activity behavior change, and (3) demonstrate the effectiveness of the ActiveLifestyle training to improve gait speed.
A total of 44 older adults followed personalized, 12-week strength and balance training plans. All participants performed the exercises autonomously at home. Questionnaires were used to assess the technological familiarity and stage of behavior change, as well as the effectiveness of the motivation instruments adopted by ActiveLifestyle. Adherence to the exercise plan was evaluated using performance data collected by the app and through information given by the participants during the study. Pretests and posttests were performed to evaluate gait speed of the participants before and after the study.
Participants were 75 years (SD 6), predominantly female (64%), held a trade or professional diploma (54%), and their past profession was in a sitting position (43%). Of the 44 participants who enrolled, 33 (75%) completed the study. The app proved to assist and motivate independently living and healthy older adults to autonomously perform strength–balance exercises (median 6 on a 7-point Likert scale). Social motivation strategies proved more effective than individual strategies to stimulate the participants to comply with the training plan, as well as to change their behavior permanently toward a more physically active lifestyle. The exercises were effective to improve preferred and fast gait speed.
ActiveLifestyle assisted and motivated independently living and healthy older people to autonomously perform strength–balance exercises over 12 weeks and had low dropout rates. The social motivation strategies were more effective to stimulate the participants to comply with the training plan and remain on the intervention. The adoption of assistive technology devices for physical intervention tends to motivate and retain older people exercising for longer periods of time.
PMCID: PMC3742406  PMID: 23939401
motivation; exercises; aged; tablet; mobility; delivery of health care
7.  Adolescents demonstrate improvement in obesity risk behaviors following completion of Choice, Control, and Change, a curriculum addressing personal agency and autonomous motivation 
The rapid increase of obesity and diabetes risk beginning in youth, particularly those from disadvantaged communities, calls for prevention efforts.
To examine the impact of a curriculum intervention, Choice, Control, and Change (C3), on the adoption of the energy balance related behaviors of decreasing sweetened drinks, packaged snacks, fast food, and leisure screen time, and increasing water, fruits and vegetables, and physical activity, and on potential psychosocial mediators of the behaviors.
Ten middle schools in low-income New York City neighborhoods were randomly assigned within matched pairs to either intervention or comparison/ delayed control conditions during the 2007–2008 school year.
562 inner city seventh grade students in the intervention condition, and 574 in the comparison condition.
Students received the 24 C3 lessons that used science inquiry-based investigations to enhance motivation for action, and social cognitive and self-determination theories to increase personal agency and autonomous motivation to take action.
Main outcome measures
Self-report instruments to measure energy balance related behaviors targeted by the curriculum, and potential psychosocial mediators of the behaviors.
ANCOVA with group (intervention/control) as a fixed factor and pre-test as covariate.
Students in intervention schools compared to the delayed intervention controls reported consumption of significantly fewer sweetened drinks and packaged snacks, smaller sizes of fast food, increased intentional walking for exercise, and decreased leisure screen-time, but showed no increases in their intakes of water, fruits, and vegetables. They showed significant increases in positive outcome expectations about the behaviors, self-efficacy, goal intentions, competence, and autonomy.
The C3 curriculum was effective in improving many of the specifically targeted behaviors related to reducing obesity risk, indicating that combining inquiry-based science education and behavioral theory is a promising approach.
PMCID: PMC3016947  PMID: 21111093
8.  Efficacy of a Computerized Simulation in Promoting Walking in Individuals With Diabetes 
Regular walking is a recommended but underused self-management strategy for individuals with type 2 diabetes mellitus (T2DM).
To test the impact of a simulation-based intervention on the beliefs, intentions, knowledge, and walking behavior of individuals with T2DM. We compared two versions of a brief narrated simulation. The experimental manipulation included two components: the presentation of the expected effect of walking on the glucose curve; and the completion of an action plan for walking over the next week. Primary hypotheses were (1) intervention participants’ walking (minutes/week) would increase more than control participants’ walking, and (2) change in outcome expectancies (beliefs) would be a function of the discrepancy between prior beliefs and those presented in the simulation. Secondary hypotheses were that, overall, behavioral intentions to walk in the coming week and diabetes-related knowledge would increase in both groups.
Individuals were randomly assigned to condition. Preintervention measures included self-reported physical activity (International Physical Activity Questionnaire [IPAQ] 7-day), theory of planned behavior-related beliefs, and knowledge (Diabetes Knowledge Test). During the narrated simulation we measured individuals’ outcome expectancies regarding the effect of exercise on glucose with a novel drawing task. Postsimulation measures included theory of planned behavior beliefs, knowledge, and qualitative impressions of the narrated simulation. The IPAQ 7-day was readministered by phone 1 week later. We used a linear model that accounted for baseline walking to test the main hypothesis regarding walking. Discrepancy scores were calculated between the presented outcome and individuals’ prior expectations (measured by the drawing task). A linear model with an interaction between intervention status and the discrepancy score was used to test the hypothesis regarding change in outcome expectancy. Pre–post changes in intention and knowledge were tested using paired t tests.
Of 65 participants, 33 were in the intervention group and 32 in the control group. We excluded 2 participants from analysis due to being extreme outliers in baseline walking. After adjustment for baseline difference in age and intentions between groups, intervention participants increased walking by 61.0 minutes/week (SE 30.5, t 58 = 1.9, P = .05) more than controls. The proposed interaction between the presented outcome and the individual’s prior beliefs was supported: after adjustment for baseline differences in age and intentions between groups, the coefficient for the interaction was –.25, (SE 0.07, t 57 = –3.2, P < .01). On average participants in both groups improved significantly from baseline in intentions (mean difference 0.66, t 62 = 4.5, P < .001) and knowledge (mean difference 0.38, t 62 = 2.4, P = .02).
This study suggests that a brief, Internet-ready, simulation-based intervention can improve knowledge, beliefs, intentions, and short-term behavior in individuals with T2DM.
PMCID: PMC3799542  PMID: 22576226
Computer simulation; type 2 diabetes mellitus; physical activity; blood glucose
9.  Self-determined motivation towards physical activity in adolescents treated for obesity: an observational study 
Within the Self-Determination Theory (SDT) framework, the first major study aim was to investigate the SDT tenets in an obese adolescent population by examining the factor structure of the Behavioural Regulation in Exercise Questionnaire-2 (BREQ-2) and by investigating associations between physical activity (PA) and motivation in obese adolescents. The second aim was to study differences in motivation according to adolescents' educational level, since lower educated obese adolescent are a sub-risk group for lower PA levels among the obese adolescents. The third aim was to investigate whether attending a residential obesity treatment program could lead to an increase in autonomous motivation towards PA and to see if the treatment effect on motivation was different in low versus high educated youth.
For the first study aim, the sample comprised 177 obese adolescents at the start of a 10-month multidisciplinary residential obesity treatment program (BMI = 35.9 ± 6.0 kg/m2, 15.1 ± 1.5 years, 62% girls). A subsample of 65 adolescents (stratified by educational level) were divided into low (n = 34) versus high educated (n = 31) as part of the second and third study aim. Motivation was assessed using the BREQ-2 and PA using the Flemish Physical Activity Questionnaire.
Exploratory factor analysis showed sufficient validations with the original factor for 17 out of 19 BREQ-2 items. Significant positive correlations were found between PA and the composite score of relative autonomy (r = 0.31, p < 0.001), introjected (r = 0.23, p < 0.01), identified (r = 0.31, p < 0.001) and intrinsic regulation (r = 0.38, p < 0.001). Higher educated adolescents scored higher on the composite score of relative autonomy, introjected, identified and intrinsic regulation at the start of treatment (F = 3.68, p < 0.001). The composite score of relative autonomy, external, identified and intrinsic regulation significantly increased during treatment for all adolescents (F = 6.65, p < 0.001). Introjected regulation significantly increased for lower educated adolescents (F = 25.57, p < 0.001).
The BREQ-2 can be used in an obese adolescent population. Higher levels of autonomous motivation towards PA were related to higher PA levels. Adolescents had increases in both autonomous and controlled forms of motivation during treatment. Special attention for lower educated adolescents during treatment is needed, as they have a lower autonomous motivation at the start of treatment and an increase in introjected regulation during treatment.
PMCID: PMC3189862  PMID: 21923955
10.  Factors influencing fast food consumption behaviors of middle-school students in Seoul: an application of theory of planned behaviors 
Nutrition Research and Practice  2011;5(2):169-178.
Fast food is popular among children and adolescents; however, its consumption has often been associated with negative impacts on nutrition and health. This study examined current fast food consumption status among middle school students and explored factors influencing fast food consumption by applying Theory of Planned Behavior. A total of 354 (52.5% boys) students were recruited from a middle school. The subjects completed a pre-tested questionnaire. The average monthly frequency of fast food consumption was 4.05 (4.25 for boys, 3.83 for girls). As expected, fast food consumption was considered to be a special event rather than part of an everyday diet, closely associated with meeting friends or celebrating, most likely with friends, special days. The Theory of Planned Behavior effectively explained fast food consumption behaviors with relatively high R2 around 0.6. Multiple regression analyses showed that fast food consumption behavior was significantly related to behavioral intention (b = 0.61, P < 0.001) and perceived behavioral control (b = 0.19, P < 0.001). Further analysis showed that behavioral intention was significantly related to subjective norm (b = 0.15, P < 0.01) and perceived behavioral control (b = 0.56, P < 0.001). Attitude toward fast food consumption was not significantly associated with behavioral intention. Therefore, effective nutrition education programs on fast food consumption should include components to change the subjective norms of fast food consumption, especially among peers, and perceived behavioral control. Further studies should examine effective ways of changing subjective norms and possible alternatives to fast food consumption for students to alter perceived behavioral control.
PMCID: PMC3085807  PMID: 21556232
Fast food consumption; middle school students; theory of planned behavior
11.  A cluster randomised controlled trial of an intervention to promote healthy lifestyle habits to school leavers: study rationale, design, and methods 
BMC Public Health  2014;14:221.
Physical inactivity and a poor diet predict lifestyle diseases such as diabetes, cardiovascular disease, and certain types of cancer. Marked declines in physical activity occur during late adolescence, coinciding with the point at which many young people leave school and enter the workforce and begin to take greater control over their lifestyle behaviours. The work outlined within this paper sought to test a theoretically-informed intervention aimed at supporting increased engagement in physical activity and healthy eating habits in young people at the point of transition from school to work or work-based learning. As actively engaging young people in initiatives based on health messages is challenging, we also tested the efficacy of financial incentives in promoting initial engagement with the programme.
A three-arm cluster-randomised design was used. Participants were school pupils from Year 11 and 13 (i.e., in their final year of study), aged 16–18 years. To reduce contamination effects, the unit of randomisation was school. Participants were randomly allocated to receive (i) a 12-week behavioural support intervention consisting of six appointments, (ii) a behavioural support intervention plus incentives (totalling £40), or (iii) an information-only control group. Behavioural support was provided by fitness advisors at local leisure centres following an initial consultation with a dietician. Sessions focused on promoting habit formation through setting implementation intentions as part of an incremental goal setting process. Consistent with self-determination theory, all advisors were trained to provide guidance in an autonomy-supportive manner so that they were equipped to create a social context supportive of autonomous forms of participant motivation. The primary outcome was objectively assessed physical activity (via GT1M accelerometers). Secondary outcome measures were diet, motivation and habit strength. Data were collected at baseline, post-intervention (12 weeks) and 12 months.
Findings of this trial will provide valuable insight into the feasibility of promoting autonomous engagement in healthy physical activity and dietary habits among school leavers. The research also provides much needed data and detailed information related to the use of incentives for the initial promotion of young peoples’ behaviour change during this important transition.
Trial registration
The trial is registered as Current Controlled Trials ISRCTN55839517.
PMCID: PMC3944885  PMID: 24592967
Motivation; Physical activity; Diet; Health; Well-being; Habit; Communication; Self-determination theory; Adolescent; Modifiable risk factors
12.  Explaining clinical behaviors using multiple theoretical models 
In the field of implementation research, there is an increased interest in use of theory when designing implementation research studies involving behavior change. In 2003, we initiated a series of five studies to establish a scientific rationale for interventions to translate research findings into clinical practice by exploring the performance of a number of different, commonly used, overlapping behavioral theories and models. We reflect on the strengths and weaknesses of the methods, the performance of the theories, and consider where these methods sit alongside the range of methods for studying healthcare professional behavior change.
These were five studies of the theory-based cognitions and clinical behaviors (taking dental radiographs, performing dental restorations, placing fissure sealants, managing upper respiratory tract infections without prescribing antibiotics, managing low back pain without ordering lumbar spine x-rays) of random samples of primary care dentists and physicians. Measures were derived for the explanatory theoretical constructs in the Theory of Planned Behavior (TPB), Social Cognitive Theory (SCT), and Illness Representations specified by the Common Sense Self Regulation Model (CSSRM). We constructed self-report measures of two constructs from Learning Theory (LT), a measure of Implementation Intentions (II), and the Precaution Adoption Process. We collected data on theory-based cognitions (explanatory measures) and two interim outcome measures (stated behavioral intention and simulated behavior) by postal questionnaire survey during the 12-month period to which objective measures of behavior (collected from routine administrative sources) were related. Planned analyses explored the predictive value of theories in explaining variance in intention, behavioral simulation and behavior.
Response rates across the five surveys ranged from 21% to 48%; we achieved the target sample size for three of the five surveys. For the predictor variables, the mean construct scores were above the mid-point on the scale with median values across the five behaviors generally being above four out of seven and the range being from 1.53 to 6.01. Across all of the theories, the highest proportion of the variance explained was always for intention and the lowest was for behavior. The Knowledge-Attitudes-Behavior Model performed poorly across all behaviors and dependent variables; CSSRM also performed poorly. For TPB, SCT, II, and LT across the five behaviors, we predicted median R2 of 25% to 42.6% for intention, 6.2% to 16% for behavioral simulation, and 2.4% to 6.3% for behavior.
We operationalized multiple theories measuring across five behaviors. Continuing challenges that emerge from our work are: better specification of behaviors, better operationalization of theories; how best to appropriately extend the range of theories; further assessment of the value of theories in different settings and groups; exploring the implications of these methods for the management of chronic diseases; and moving to experimental designs to allow an understanding of behavior change.
PMCID: PMC3500222  PMID: 23075284
13.  Sedentary Behavior as a Daily Process Regulated by Habits and Intentions 
Sedentary behavior is a health risk but little is known about the motivational processes that regulate daily sedentary behavior. This study was designed to test a dual-process model of daily sedentary behavior, with an emphasis on the role of intentions and habits in regulating daily sedentary behavior.
College students (N = 128) self-reported on their habit strength for sitting and completed a 14-day ecological momentary assessment study that combined daily diaries for reporting motivation and behavior with ambulatory monitoring of sedentary behavior using accelerometers.
Less than half of the variance in daily sedentary behavior was attributable to between-person differences. People with stronger sedentary habits reported more sedentary behavior on average. People whose intentions for limiting sedentary behavior were stronger, on average, exhibited less self-reported sedentary behavior (and marginally less monitored sedentary behavior). Daily deviations in those intentions were negatively associated with changes in daily sedentary behavior (i.e., stronger than usual intentions to limit sedentary behavior were associated with reduced sedentary behavior). Sedentary behavior also varied within-people as a function of concurrent physical activity, the day of week, and the day in the sequence of the monitoring period.
Sedentary behavior was regulated by both automatic and controlled motivational processes. Interventions should target both of these motivational processes to facilitate and maintain behavior change. Links between sedentary behavior and daily deviations in intentions also indicate the need for ongoing efforts to support controlled motivational processes on a daily basis.
PMCID: PMC4134884  PMID: 23477579
sitting; inactivity; goal; perception-behavior link
14.  A Daily Process Analysis of Intentions and Physical Activity in College Students 
Social-cognitive theories, such as the theory of planned behavior, posit intentions as proximal influences on physical activity (PA). This paper extends those theories by examining within-person variation in intentions and moderate-vigorous physical activity (MVPA) as a function of the unfolding constraints in people’s daily lives (e.g., perceived time availability, fatigue, soreness, weather, overeating). College students (N = 63) completed a 14-day diary study rating daily motivation, contextual constraints, and PA over the internet. Key findings from multilevel analyses were that (1) between-person differences represented 46% and 33% of the variability in daily MVPA intentions and behavior, respectively, (2) attitudes, injunctive norms, self-efficacy, perceptions of limited time availability, and weekend status predicted daily changes in intention strength, and (3) daily changes in intentions, perceptions of limited time availability, and weekend status predicted day-to-day changes in MVPA. Embedding future motivation and PA research in the context of people’s daily lives will advance understanding of individual PA change processes.
PMCID: PMC4104787  PMID: 24197717
self-regulation; planned behavior; intraindividual
15.  Click “Like” to Change Your Behavior: A Mixed Methods Study of College Students’ Exposure to and Engagement With Facebook Content Designed for Weight Loss 
Overweight or obesity is prevalent among college students and many gain weight during this time. Traditional face-to-face weight loss interventions have not worked well in this population. Facebook is an attractive tool for delivering weight loss interventions for college students because of its popularity, potential to deliver strategies found in successful weight loss interventions, and ability to support ongoing adaptation of intervention content.
The objective of this study was to describe participant exposure to a Facebook page designed to deliver content to overweight/obese college students in a weight loss randomized controlled trial (N=404) and examine participant engagement with behavior change campaigns for weight loss delivered via Facebook.
The basis of the intervention campaign model were 5 self-regulatory techniques: intention formation, action planning, feedback, goal review, and self-monitoring. Participants were encouraged to engage their existing social network to meet their weight loss goals. A health coach moderated the page and modified content based on usage patterns and user feedback. Quantitative analyses were conducted at the Facebook post- and participant-level of analysis. Participant engagement was quantified by Facebook post type (eg, status update) and interaction (eg, like) and stratified by weight loss campaign (sequenced vs nonsequenced). A subset of participants were interviewed to evaluate the presence of passive online engagement or “lurking.”
The health coach posted 1816 unique messages to the study’s Facebook page over 21 months, averaging 3.45 posts per day (SD 1.96, range 1-13). In all, 72.96% (1325/1816) of the posts were interacted with at least once (eg, liked). Of these, approximately 24.75% (328/1325) had 1-2 interactions, 23.39% (310/1325) had 3-5 interactions, 25.13% (333/1325) had 6-8 interactions, and 41 posts had 20 or more interactions (3.09%, 41/1325). There was significant variability among quantifiable (ie, visible) engagement. Of 199 participants in the final intervention sample, 32 (16.1%) were highly active users and 62 (31.2%) never visibly engaged with the intervention on Facebook. Polls were the most popular type of post followed by photos, with 97.5% (79/81) and 80.3% (386/481) interacted with at least once. Participants visibly engaged less with posts over time (partial r=–.33; P<.001). Approximately 40% of the participants interviewed (12/29, 41%) reported passively engaging with the Facebook posts by reading but not visibly interacting with them.
Facebook can be used to remotely deliver weight loss intervention content to college students with the help of a health coach who can iteratively tailor content and interact with participants. However, visible engagement with the study’s Facebook page was highly variable and declined over time. Whether the level of observed engagement is meaningful in terms of influencing changes in weight behaviors and outcomes will be evaluated at the completion of the overall study.
PMCID: PMC4090380  PMID: 24964294
overweight; obesity; students; social networking; behavior; social behavior
16.  The role of action planning and plan enactment for smoking cessation 
BMC Public Health  2013;13:393.
Several studies have reemphasized the role of action planning. Yet, little attention has been paid to the role of plan enactment. This study assesses the determinants and the effects of action planning and plan enactment on smoking cessation.
One thousand and five participants completed questionnaires at baseline and at follow-ups after one and six months. Factors queried were part of the I-Change model. Descriptive analyses were used to assess which plans were enacted the most. Multivariate linear regression analyses were used to assess whether the intention to quit smoking predicted action planning and plan enactment, and to assess which factors would predict quitting behavior. Subsequently, both multivariate and univariate regression analyses were used to assess which particular action plans would be most effective in predicting quitting behavior. Similar analyses were performed among a subsample of smokers prepared to quit within one month.
Smokers who intended to quit smoking within the next month had higher levels of action planning than those intending to quit within a year. Additional predictors of action planning were being older, being female, having relatively low levels of cigarette dependence, perceiving more positive and negative consequences of quitting, and having high self-efficacy toward quitting. Plan enactment was predicted by baseline intention to quit and levels of action planning. Regression analysis revealed that smoking cessation after six months was predicted by low levels of depression, having a non-smoking partner, the intention to quit within the next month, and plan enactment. Only 29% of the smokers who executed relatively few plans had quit smoking versus 59% of the smokers who executed many plans. The most effective preparatory plans for smoking cessation were removing all tobacco products from the house and choosing a specific date to quit.
Making preparatory plans to quit smoking is important because it also predicts plan enactment, which is predictive of smoking cessation. Not all action plans were found to be predictive of smoking cessation. The effects of planning were not very much different between the total sample and smokers prepared to quit within one month.
PMCID: PMC3644281  PMID: 23622256
Smoking cessation; Action planning; Preparatory planning; Plan enactment; Planned quit attempts
17.  Psychological theory in an interdisciplinary context: psychological, demographic, health-related, social, and environmental correlates of physical activity in a representative cohort of community-dwelling older adults 
Physical activity (PA) in older adults is influenced by a range of environmental, demographic, health-related, social, and psychological variables. Social cognitive psychological models assume that all influences on behaviour operate indirectly through the models constructs, i.e., via intention and self-efficacy. We evaluated direct, indirect, and moderating relationships of a broad range of external variables with physical activity levels alongside intention and self-efficacy.
We performed a cross-sectional survey of a representative and stratified (65–80 and 80+ years; deprived and affluent) sample of 584 community-dwelling people, resident in Scotland. Objectively measured physical activity and questionnaire data were collected.
Self-efficacy showed unique relationships with physical activity, controlling for demographic, mental health, social, environmental, and weather variables separately, but the relationship was not significant when controlling for physical health. Overall, results indicating support for a mediation hypothesis, intention and self-efficacy statistically mediate the relationship of most domain variables with physical activity. Moderation analyses show that the relationship between social cognitions and physical activity was stronger for individuals with better physical health and lower levels of socio-economic deprivation.
Social cognitive variables reflect a range of known environmental, demographic, health-related and social correlates of physical activity, they mediate the relationships of those correlates with physical activity and account for additional variance in physical activity when external correlates are controlled for, except for the physical health domain. The finding that the social cognition-physical activity relationship is higher for participants with better health and higher levels of affluence raises issues for the applicability of social cognitive models to the most disadvantaged older people.
PMCID: PMC3847689  PMID: 24011129
Physical activity; Older adults; Social ecological model
18.  Predictors of healthcare professionals' intention and behaviour to encourage physical activity in patients with cardiovascular risk factors 
BMC Public Health  2011;11:246.
Healthcare professionals can play a crucial role in optimizing the health status of patients with cardiovascular risk factors (abdominal obesity, high blood pressure, low HDL cholesterol, elevated triglycerides and elevated blood glucose). In order to do this, it is imperative that we understand the social-cognitive determinants (including habits) that underlie healthcare professionals' intention and the corresponding behavior of actually encouraging patients with cardiovascular risk factors to engage in physical activity.
In this longitudinal Professionals' Intention and Behavior (PIB) study, healthcare professionals (N = 278, aged 20-61 years with approximately 60% having attained an education level exceeding bachelor's degree, types of healthcare professionals 60% in physiotherapy and 40% in nursing) completed online surveys measuring the social-cognitive determinants of healthcare professionals' intention and the corresponding behavior of actually encouraging patients with cardiovascular risk factors to engage in physical activity.
Social-cognitive determinants accounted for 41% (p < .001) of the variance in healthcare professionals' intention to encourage physical activity among cardiovascular patients. Important correlates of intention were attitude (β = .443, p < .001), subjective norms (β = .201, p < .001) and perceived behavioral control (β = .137, p < .01). With respect to the self-reported behavior of encouraging patients, social-cognitive determinants accounted for 29% (p < .001) of the variance. Intentions (β = .311 p < .001), habit (β = .163 p < .01), and barriers (β = -.239 p < .001) were significant correlates of professionals' behavior of encouraging patients to engage in physical activity.
We explored the congruence between healthcare professionals' intention to encourage patients and the self-reported behavior of encouraging patients. We found that intention and behavior were congruent in 39.7% of the healthcare professionals. Additionally, the intention to encourage and the corresponding behavior of encouraging was incongruent in 31.7% of the healthcare professionals.
In the prevention of cardiovascular disease, healthcare professionals' intention to encourage physical activity among patients and subsequent behavior of encouraging patients is important for the improvement of patients' cardiovascular risk profiles. We found that the intentions and self-reported behavior of healthcare professionals working with patients with cardiovascular risk factors can be predicted by social-cognitive determinants thus implying that efforts to change and strengthen the intention-behavior relationship of healthcare professionals may have beneficial effects for cardiovascular risk patients (Trial ID: ECP-92).
PMCID: PMC3104375  PMID: 21504566
19.  Application of the Protection Motivation Theory in Predicting Cigarette Smoking Among Adolescents in China 
Addictive behaviors  2013;39(1):181-188.
Reducing tobacco use among adolescents in China represents a significant challenge for global tobacco control. Existing behavioral theories developed in the West – such as the Protection Motivation Theory (PMT) – may be useful tools to help tackle this challenge. We examined the relationships between PMT factors and self-reported cigarette smoking behavior and intention among a random sample of vocational high school students (N = 553) in Wuhan, China. Tobacco-related perceptions were assessed using the PMT Scale for Adolescent Smoking. Among the total sample, 45% had initiated cigarette smoking, and 25% smoked in the past month. Among those who never smoked, 15% indicated being likely or very likely to smoke in a year. Multiple regression modeling analysis indicated the significance of the seven PMT constructs, the four PMT perceptions and the two PMT pathways in predicting intention to smoke and actual smoking behavior. Overall, perceived rewards of smoking, especially intrinsic rewards, were consistently positively related to smoking intentions and behavior, and self-efficacy to avoid smoking was negatively related to smoking. The current study suggests the utility of PMT for further research examining adolescent smoking. PMT-based smoking prevention and clinical smoking cessation intervention programs should focus more on adolescents’ perceived rewards from smoking and perceived efficacy of not smoking to reduce their intention to and actual use of tobacco.
PMCID: PMC3966196  PMID: 24157424
Protection Motivation Theory; Adolescents; Cigarette smoking; China
20.  Exploring Nurses’ Intention to Use a Computerized Platform in the Resuscitation Unit: Development and Validation of a Questionnaire Based on the Theory of Planned Behavior 
In emergency department resuscitation units, writing down information related to interventions, physical examination, vital signs, investigations, and treatments ordered is a crucial task carried out by nurses. To facilitate this task, a team composed of emergency physicians, nurses, and one computer engineer created a novel electronic platform equipped with a tactile screen that allows systematic collection of critical data. This electronic platform also has medical software (ReaScribe+) that functions as an electronic medical record and a clinical decision support system.
To develop and validate a questionnaire that can help evaluate nurses’ intention to use a novel computerized platform in an emergency department resuscitation unit, based on Ajzen’s theory of planned behavior (TPB).
The sample for this study was composed of 87 nurses who worked in the resuscitation unit of a tertiary trauma center. We held three focus groups with nurses working in the resuscitation unit to identify the salient modal beliefs regarding their intended use of a new electronic medical charting system for the care of trauma patients. The system included a clinical decision support tool. We developed a questionnaire in which salient modal beliefs were used as items to evaluate the TPB constructs. We also added 13 questions to evaluate nurses’ computer literacy. The final questionnaire was composed of 46 questions to be answered on a 7-point Likert scale. All nurses in the resuscitation unit and present during a regular work shift were individually contacted by the principal investigator or a research assistant (phase 1). A subsample of the nurses who completed the questionnaire was invited to complete it a second time 2 weeks later (phase 2).
In phase 1, we received 62 of the 70 questionnaires administered (89% response rate). Of the 27 questionnaires administered in phase 2 (retest phase), 25 were completed (93% response rate). The questionnaire showed very good internal consistency, as Cronbach alpha was higher than .7 for all constructs. Temporal stability was acceptable with intraclass correlations between .41 and .66. The intention to use the electronic platform to chart the resuscitation of trauma patients was very high among the respondents. In the logistic regression model, the only construct that predicted nurses’ intention to adopt the computerized platform was the professional norm (odds ratio 3.31, 95% confidence interval 1.41–7.78).
We developed and validated a questionnaire that can now be used in other emergency departments prior to implementation of the computerized platform. The intention to adopt was very high among the respondents, which suggests that the implementation of this innovation could be successful at our institution.
PMCID: PMC3626134  PMID: 23611903
Primary care nurses; adoption of new behavior; intention; theory of planned behaviour; emergency department; trauma care; electronic health record; clinical decision support system
21.  Mediated, moderated and direct effects of country of residence, age, and gender on the cognitive and social determinants of adolescent smoking in Spain and the UK: a cross-sectional study 
BMC Public Health  2009;9:173.
European trans-national adolescent smoking prevention interventions based on social influences approaches have had limited success. The attitudes-social influences-efficacy (ASE) model is a social cognition model that states smoking behaviour is determined by smoking intention which, in turn, is predicted by seven ASE determinants; disadvantages, advantages, social acceptance, social norms, modelling, perceived pressure, self-efficacy. Distal factors such as country of residence, age and gender are external to the model. The ASE model is, thus, closely related to the Theory of Planned Behaviour. This study assessed the utility of the ASE model using cross-sectional data from Spanish and UK adolescents.
In 1997, questionnaires were simultaneously administered to Spanish (n = 3716) and UK adolescents (n = 3715) who were considered at high risk of smoking. Participants' age, gender, smoking intentions and ASE determinant scores were identified and linear regression analysis was used to examine the mediated, moderated and direct effects of country of residence, age and gender on participants' smoking intentions.
All UK participants were aged 12 or 13 and most Spanish participants were aged between 12 and 14 (range 12–16 years). Amongst 12 and 13 year olds, regular smoking was more common in Spain. Almost half the participants were female (47.2% in Spain; 49.9% in the UK). Gender did not vary significantly according to age.
The distribution of ASE determinant scores varied by country and predicted intention. The influence of each ASE determinant on intention was moderated by country. Country had a large direct influence on intention (1.72 points on a 7 point scale) but the effects of age and gender were mediated by the ASE determinants.
The findings suggest resisting peer pressure interventions could potentially influence smoking amongst UK adolescents but not Spanish adolescents. Interventions that promote self-efficacy, on the other hand, would possibly have a greater influence on smoking amongst Spanish adolescents.
The ASE model may not capture important cultural factors related to adolescent smoking and the relative contribution of particular ASE determinants to adolescent smoking intentions may differ between countries. Future European trans-national adolescent smoking prevention programmes may benefit from greater undestanding of country-level cultural norms.
PMCID: PMC2700103  PMID: 19497119
22.  Determinants of Fast Food Consumption among Iranian High School Students Based on Planned Behavior Theory 
Journal of Obesity  2013;2013:147589.
Objective. This study was conducted to identify some factors (beliefs and norms) which are related to fast food consumption among high school students in Isfahan, Iran. We used the framework of the theory planned behavior (TPB) to predict this behavior. Subjects & Methods. Cross-sectional data were available from high school students (n = 521) who were recruited by cluster randomized sampling. All of the students completed a questionnaire assessing variables of standard TPB model including attitude, subjective norms, perceived behavior control (PBC), and the additional variables past behavior, actual behavior control (ABC). Results. The TPB variables explained 25.7% of the variance in intentions with positive attitude as the strongest (β = 0.31, P < 0.001) and subjective norms as the weakest (β = 0.29, P < 0.001) determinant. Concurrently, intentions accounted for 6% of the variance for fast food consumption. Past behavior and ABC accounted for an additional amount of 20.4% of the variance in fast food consumption. Conclusion. Overall, the present study suggests that the TPB model is useful in predicting related beliefs and norms to the fast food consumption among adolescents. Subjective norms in TPB model and past behavior in TPB model with additional variables (past behavior and actual behavior control) were the most powerful predictors of fast food consumption. Therefore, TPB model may be a useful framework for planning intervention programs to reduce fast food consumption by students.
PMCID: PMC3723084  PMID: 23936635
23.  Effect of educational intervention on physical activity-related knowledge, attitude and behavior of among first-grade students of male high schools 
Regular physical activity has positive effects on physical, mental and social aspects of individual and community health. Considering the prevalence of noncommunicable diseases such as primary hypertension, osteoporosis and cardiovascular diseases for which sedentary lifestyle is a responsible factor, health policy makers have planned to encourage people to do more physical activities. Development of beneficial health habits during childhood and early adolescence are very important because the behaviors, which start at adolescence tend to continue into adulthood, too. This study aimed to determine the effect of educational intervention on physical activity-related knowledge, attitude and behavior of the first grade students in male high schools of Bavanat in 2010.
Materials and Methods:
In this prospective experimental study, after selecting two qualified schools from five high schools, all students of one school (two classes including 42 individuals) were randomly assigned to the experimental group and all the students of another high school (two classes including 43 individuals) were randomly assigned to the control group. The data gathering tool was a 4-section questionnaire which included demographic questions, knowledge- and attitude-related questions and the questionnaire of physical activity performance. The first three sections of the questionnaire were the researcher-designed and validated by face and content validity. Test-retest and internal consistency (Cronbach's Alpha) methods were used to determine the reliability of knowledge questionnaire and attitude questionnaire, respectively. For the measurement of physical activity behavior, a self-reporting questionnaire (valid and reliable Garcia scale) was used in this study. After conducting the pretest, the educational intervention was done for the experimental group. Post-tests were conducted immediately and 1 month after intervention. The collected data were analyzed using SPSS18 statistical software (independent t-test, paired t-test, chi-square, Mann-Whitney test and repeated measures ANOVA). The participants voluntarily and consciously participated in this study.
The findings indicated no significant differences between the groups in terms of mean scores of knowledge (P = 0.934), attitude (P = 0.155) and behavior (P = 0.387) before the intervention. There was a significant difference between mean scores of knowledge in the immediate follow-up (P< 0.001) and 1 month after intervention follow-up (P < 0.001), and also between mean scores of attitude immediately (P < 0.001) and 1 month after intervention (P = 0.01) follow-ups in the experimental group compared with the control one. Mean scores of physical activity 1 month after the intervention in both experimental and control groups significantly increased (P < 0.001, P = 0.01, respectively), but the mean scores of physical activity between two groups were not significantly different (P = 0.390).
Discussion and Conclusion:
The results indicated the effectiveness of educational intervention, consequently increased knowledge and improved attitude of students, in the experimental group compared with the control one in terms of physical activities; thus, physical activity behavior of intervention group increased. Although the mean scores of physical activity in the control group significantly increased, other studies should be done which can control and consider confounding variables.
PMCID: PMC3778575  PMID: 24083254
Attitude; behavior; knowledge; physical activity
24.  Physician Communication Regarding Smoking and Adolescent Tobacco Use 
Pediatrics  2011;127(6):e1368-e1374.
Physician advice increases quit rates 1% to 3% above unassisted quit rates among adults, an increase sufficient to be ranked as a high-priority, evidence-based preventive service. However, there is little research on the potential impact of physician advice on adolescent smoking.
The purpose of this study was to examine the association between recalled physician communication and adolescents' attitudes toward smoking, knowledge about smoking, intentions to smoke, tobacco use, and quitting behaviors.
This study was a retrospective observational study of 5154 students (82.9% black, 17.1% white) from an urban, mid-South school system. Outcome variables included adolescents' self-rated attitudes toward smoking, knowledge about smoking, intentions to smoke, tobacco use, and quitting behaviors.
Physician advice and the combination of screening and advice were associated with healthier attitudes about smoking. Physician screening and advice were also associated with a more accurate knowledge regarding tobacco-related damage. Among current smokers, recalled physician advice was also associated with reduced intentions to smoke in 5 years. Importantly, advised teens were more likely to plan to quit smoking in 6 months. Furthermore, teens who were screened by their physician reported significantly more quit attempts than those who were neither screened nor advised (P = .007).
Physician's tobacco-related interactions with adolescents seemed to positively impact their attitudes, knowledge, intentions to smoke, and quitting behaviors. Brief physician interventions have the potential to be a key intervention on a public health level through the prevention, cessation, and reduction of smoking and smoking-related disease.
PMCID: PMC3103271  PMID: 21576307
smoking; adolescent; counseling; physician's role
25.  Prediction of leisure-time walking: an integration of social cognitive, perceived environmental, and personality factors 
Walking is the primary focus of population-based physical activity initiatives but a theoretical understanding of this behaviour is still elusive. The purpose of this study was to integrate personality, the perceived environment, and planning into a theory of planned behaviour (TPB) framework to predict leisure-time walking.
Participants were a random sample (N = 358) of Canadian adults who completed measures of the TPB, planning, perceived neighbourhood environment, and personality at Time 1 and self-reported walking behaviour two months later.
Analyses using structural equation modelling provided evidence that leisure-time walking is largely predicted by intention (standardized effect = .42) with an additional independent contribution from proximity to neighbourhood retail shops (standardized effect = .18). Intention, in turn, was predicted by attitudes toward walking and perceived behavioural control. Effects of perceived neighbourhood aesthetics and walking infrastructure on walking were mediated through attitudes and intention. Moderated regression analysis showed that the intention-walking relationship was moderated by conscientiousness and proximity to neighbourhood recreation facilities but not planning.
Overall, walking behaviour is theoretically complex but may best be addressed at a population level by facilitating strong intentions in a receptive environment even though individual differences may persist.
PMCID: PMC2174941  PMID: 17974022

Results 1-25 (1404464)