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author:("lipke, Sonia")
1.  Evaluating brief motivational and self-regulatory hand hygiene interventions: a cross-over longitudinal design 
BMC Public Health  2015;15:79.
Frequent handwashing can prevent infections, but non-compliance to hand hygiene is pervasive. Few theory- and evidence-based interventions to improve regular handwashing are available. Therefore, two intervention modules, a motivational and a self-regulatory one, were designed and evaluated.
In a longitudinal study, 205 young adults, aged 18 to 26 years, were randomized into two intervention groups. The Mot-SelfR group received first a motivational intervention (Mot; risk perception and outcome expectancies) followed by a self-regulatory intervention (SelfR; perceived self-efficacy and planning) 17 days later. The SelfR-Mot group received the same two intervention modules in the opposite order. Follow-up data were assessed 17 and 34 days after the baseline.
Both intervention sequences led to an increase in handwashing frequency, intention, self-efficacy, and planning. Also, overall gains were found for the self-regulatory module (increased planning and self-efficacy levels) and the motivational module (intention). Within groups, the self-regulatory module appeared to be more effective than the motivational module, independent of sequence.
Self-regulatory interventions can help individuals to exhibit more handwashing. Sequencing may be important as a motivation module (Mot) first helps to set the goal and a self-regulatory module (SelfR) then helps to translate this goal into actual behavior, but further research is needed to evaluate mechanisms.
PMCID: PMC4323073  PMID: 25649150
Motivation; Self-regulation; Handwashing; Intention; Self-efficacy; Planning; Young adults
2.  Designing a theory- and evidence-based tailored eHealth rehabilitation aftercare program in Germany and the Netherlands: study protocol 
BMC Public Health  2013;13:1081.
Cardiac rehabilitation programs aim to improve health status and to decrease the risk of further cardiac events. Persons undergoing rehabilitation often have difficulties transferring the learned health behaviors into their daily routine after returning home and maybe to work. This includes physical activity as well as fruit and vegetable consumption. Computer-based tailored interventions have been shown to be effective in increasing physical activity as well as fruit and vegetable consumption. The aim of this study is, to support people in transferring these two learned behavior changes and their antecedents into their daily life after cardiac rehabilitation.
The study will have a randomized controlled design and will be conducted among German and Dutch people who participated in cardiac rehabilitation. The study will consist of one intervention group which will be compared to a waiting list control group. During the eight week duration of the intervention, participants will be invited to participate in the online after-care program once per week. The intervention encourages participants to define individual health behavior goals as well as action, and coping plans to reach these self-determined goals. The effectiveness of the program will be compared between the intervention condition and the control group in terms of behavior change, antecedents of behavior change (e.g., self-efficacy), ability to return to work and increased well-being. Further, subgroup-differences will be assessed including differences between the two countries, socioeconomic inequalities and across age groups.
The present study will make a contribution to understanding how such an online-based tailored interventions enables study participants to adopt and maintain a healthy lifestyle. Implications can include how such an online program could enrich cardiac rehabilitation aftercare further.
Trial registration
NTR 3706, NCT01909349
PMCID: PMC3840618  PMID: 24245493
Cardiac rehabilitation aftercare; Physical exercise; Fruit and vegetable consumption; Multiple behavior changes; Internet based intervention; Tailored feedback; Cardiovascular diseases
3.  Efficacy of a text messaging (SMS) based smoking cessation intervention for adolescents and young adults: Study protocol of a cluster randomised controlled trial 
BMC Public Health  2012;12:51.
Particularly in groups of adolescents with lower educational level the smoking prevalence is still high and constitutes a serious public health problem. There is limited evidence of effective smoking cessation interventions in this group. Individualised text messaging (SMS) based interventions are promising to support smoking cessation and could be provided to adolescents irrespective of their motivation to quit. The aim of the current paper is to outline the study protocol of a trial testing the efficacy of an SMS based intervention for smoking cessation in apprentices.
A two-arm cluster-randomised controlled trial will be conducted to test the efficacy of an SMS intervention for smoking cessation in adolescents and young adults compared to an assessment only control group. A total of 910 daily or occasional (≥ 4 cigarettes in the preceding month and ≥ 1 cigarette in the preceding week) smoking apprentices will be proactively recruited in vocational school classes and, using school class as a randomisation unit, randomly assigned to an intervention group (n = 455) receiving the SMS based intervention or an assessment only control group (n = 455). Individualised text messages taking into account demographic data and the individuals' smoking behaviours will be sent to the participants of the intervention group over a period of 3 months. Participants will receive two text messages promoting smoking cessation per week. Program participants who intend to quit smoking have the opportunity to use a more intensive SMS program to prepare for their quit day and to prevent a subsequent relapse. The primary outcome measure will be the proportion of participants with 7-day point prevalence smoking abstinence assessed at 6-months follow-up. The research assistants conducting the baseline and the follow-up assessments will be blinded regarding group assignment.
It is expected that the program offers an effective and inexpensive way to promote smoking cessation among adolescents and young adults including those with lower educational level and independent of their motivation to quit.
Trial registration number
PMCID: PMC3280161  PMID: 22260736
4.  Who Participates in Seasonal Influenza Vaccination? Past Behavior Moderates the Prediction of Adherence 
Background. Vaccination effectively prevents seasonal influenza. To promote vaccination adherence, it is necessary to understand the motivational process that underlies vaccination behavior. This was examined along with the moderating influence of past behavior on intention formation. Methods. German employees (N = 594) completed questionnaires at baseline and at 7-month followup. Regression analyses were conducted for mediation and moderated mediation. Results. Intention at Time 1 mediated the effect of risk perception, and positive and negative outcome expectancies on Time 2 vaccination. Past behavior moderated this effect: there was a mediation effect for risk perception and outcome expectancies only for those individuals who did not participate annually. Conclusions. Risk perception and outcome expectancies influenced intentions to receive vaccination, which in turn predicted participation. Hence, these social-cognitive variables could be targeted in vaccination campaigns to increase intentions. However, vaccination experience affected the formation of intentions and should be accounted for when developing interventions.
PMCID: PMC3168914  PMID: 21991430
5.  The Importance of Autonomous Regulation for Students' Successful Translation of Intentions into Behavior Change via Planning 
Physical activity has a high prevention potential in adolescents. This study investigated the relations between physical activity and intention, autonomous regulation, and planning. We hypothesized that planning mediates the relationship between intention and behavior and that this mediation should depend on the level of autonomous regulation. Stratified randomization sampling method was administered to assemble a sample of N = 534 students among two schools in China. To test the hypothesis, autonomous regulation, intention, and physical activity were assessed at baseline as well as planning and follow-up physical activity four weeks after the pretest. A moderated mediation model confirmed that planning mediated the intention-behavior relation with the effect of planning being moderated by autonomous regulation. Study results demonstrated that autonomous regulation facilitated the translation of intention into behavior change via planning. To promote physical activity among adolescents, interventions targeting planning and autonomous regulation might facilitate successful translation of intentions into behavior change.
PMCID: PMC3170742  PMID: 21991441
6.  Health-Promoting and Health-Risk Behaviors: Theory-Driven Analyses of Multiple Health Behavior Change in Three International Samples 
Co-occurrence of different behaviors was investigated using the theoretical underpinnings of the Transtheoretical Model, the Theory of Triadic Influence and the concept of Transfer.
To investigate relationships between different health behaviors' stages of change, how behaviors group, and whether study participants cluster in terms of their behaviors.
Relationships across stages for different behaviors were assessed in three studies with N = 3,519, 965, and 310 individuals from the USA and Germany by telephone and internet surveys using correlational analyses, factor analyses, and cluster analyses.
Consistently stronger correlations were found between nutrition and physical activity (r = 0.16–0.26, p < 0.01) than between non-smoking and nutrition (r = 0.08–0.16, p < 0.03), or non-smoking and physical activity (r = 0.01–0.21). Principal component analyses of investigated behaviors indicated two factors: a “health-promoting” factor and a “health-risk” factor. Three distinct behavioral patterns were found in the cluster analyses.
Our results support the assumption that individuals who are in a higher stage for one behavior are more likely to be in a higher stage for another behavior as well. If the aim is to improve a healthy lifestyle, success in one behavior can be used to facilitate changes in other behaviors—especially if the two behaviors are both health-promoting or health-risky. Moreover, interventions should be targeted towards the different behavioral patterns rather than to single behaviors. This might be achieved by addressing transfer between behaviors.
PMCID: PMC3277822  PMID: 21234735
Transfer; Stage; Nutrition; Physical exercise; Non-smoking
7.  Validity of Stage Assessment in the Adoption and Maintenance of Physical Activity and Fruit and Vegetable Consumption 
Stage assessments are examined to develop and test refined measurements that can be used for classifying individuals.
Stages were assessed in 1,850 persons in terms of their physical activity and dietary behaviors.
Main Outcome Measures
Stages for both behaviors were compared to behavior and other test variables. Misclassification, sensitivity, specificity, receiver-operation-curves, and discontinuity patterns were computed. Discontinuity patterns were tested with trends across stages and planned contrasts between adjacent stages.
In comparison to previous studies, sensitivity (70% to 80%) and specificity (80% to 87%) were high. When using lower level criteria (such as less intensive activity), sensitivity was lower, whereas specificity was higher. When behavioral maintenance was assessed, results suggested that the temporal cut-off point between action and maintenance was equally optimal at different cut-off points. Applying contrast analyses, nonlinear trends across the stages and a match of 87% of predictions of stage differences resulted.
Stage assumptions are supported in general, and refined stage assessment in particular. Levels of psychological variables (e.g., easiness, habit) may discriminate stages as well as or even better than temporal stage definitions.
PMCID: PMC2939463  PMID: 19290710
stages; misclassification; specificity; sensitivity; health behavior

Results 1-7 (7)