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1.  Combining Users’ Needs With Health Behavior Models in Designing an Internet- and Mobile-Based Intervention for Physical Activity in Cardiac Rehabilitation 
JMIR Research Protocols  2014;3(1):e4.
Internet-based physical activity interventions have great potential in supporting patients in cardiac rehabilitation. Health behavior change theories and user input are identified as important contributors in the effectiveness of the interventions, but they are rarely combined in a systematic way in the design of the interventions.
The aim of this study is to identify the appropriate theoretical framework, along with the needs of the users of a physical activity intervention for cardiac rehabilitation, and to combine them into an effective Internet- and mobile-based intervention.
We explain the theoretical framework of the intervention in a narrative overview of the existing health behavior change literature as it applies to physical activity. We also conducted a focus group with 11 participants of a cardiac rehabilitation program and used thematic analysis to identify and analyze patterns of meaning in the transcribed data.
We chose stage-based approaches, specifically the transtheoretical model and the health action process approach as our main framework for tailoring, supplemented with other theoretical concepts such as regulatory focus within the appropriate stages. From the thematic analysis of the focus group data, we identified seven themes: (1) social, (2) motivation, (3) integration into everyday life, (4) information, (5) planning, (6) monitoring and feedback, and (7) concerns and potential problems. The final design of the intervention was based on both the theoretical review and the user input, and it is explained in detail.
We applied a combination of health behavioral theory and user input in designing our intervention. We think this is a promising design approach with the potential to combine the high efficacy of theory-based interventions with the higher perceived usefulness of interventions designed according to user input.
Trial Registration NCT01223170; (Archived by WebCite at
PMCID: PMC3913925  PMID: 24413185
focus group; design methodology; user involvement; user needs; health behavior models; tailoring; SMS; Internet; cardiac rehabilitation; smoking cessation; physical activity
2.  Efficacy of a Text Message-Based Smoking Cessation Intervention for Young People: A Cluster Randomized Controlled Trial 
Smoking prevalence remains high, particularly among adolescents and young adults with lower educational levels, posing a serious public health problem. There is limited evidence of effective smoking cessation interventions in this population.
To test the efficacy of an individually tailored, fully automated text messaging (short message service, SMS)–based intervention for smoking cessation in young people.
A 2-arm cluster randomized controlled trial, using school class as the randomization unit, was conducted to test the efficacy of the SMS text messaging intervention compared to an assessment-only control group. Students who smoked were proactively recruited via online screening in vocational school classes. Text messages, tailored to demographic and smoking-related variables, were sent to the participants of the intervention group at least 3 times per week over a period of 3 months. A follow-up assessment was performed 6 months after study inclusion. The primary outcome measure was 7-day smoking abstinence. Secondary outcomes were 4-week smoking abstinence, cigarette consumption, stage of change, and attempts to quit smoking. We used regression models controlling for baseline differences between the study groups to test the efficacy of the intervention. Both complete-case analyses (CCA) and intention-to-treat analyses (ITT) were performed. Subgroup analyses were conducted for occasional and daily smokers.
A total of 2638 students in 178 vocational school classes in Switzerland participated in the online screening. Overall, 1012 persons met the inclusion criteria for study participation, and 755 persons (74.6%) participated in the study (intervention: n=372; control: n=383). Of the 372 program participants, 9 (2.4%) unsubscribed from the program during the intervention period. Six-month follow-up data were obtained for 559 study participants (74.0%). The 7-day smoking abstinence rate at follow-up was 12.5% in the intervention group and 9.6% in the control group (ITT: P=.92). No differences between the study groups were observed in 4-week point prevalence abstinence rates. The decrease in the mean number of cigarettes smoked per day from baseline to follow-up was higher in the intervention group than in the control group (ITT: P=.002). No differences between the groups were observed in stage of change (ITT: P=.82) and quit attempts (ITT: P=.38). The subgroup analyses revealed lower cigarette consumption in both occasional and daily smokers in the intervention group compared to the control group. Occasional smokers in the intervention group made more attempts to quit smoking than occasional smokers in the control group.
This study demonstrated the potential of an SMS text message–based intervention to reach a high proportion of young smokers with low education levels. The intervention did not have statistically significant short-term effects on smoking cessation; however, it resulted in statistically significant lower cigarette consumption. Additionally, it resulted in statistically significant more attempts to quit smoking in occasional smokers.
Trial Registration
International Standard Randomized Controlled Trial Number (ISRCTN): 19739792; (Archived by WebCite at
PMCID: PMC3757913  PMID: 23956024
smoking cessation; text messaging (SMS); young people; school; students
3.  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
4.  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
5.  Assessing Attention Control in Goal Pursuit: A Component of Dispositional Self-Regulation 
Journal of personality assessment  2006;86(3):306-317.
We examined the psychometric properties of the Self-Regulation Scale (SRS; Schwarzer, Diehl, & Schmitz, 1999), a measure of attention control in goal pursuit, in 2 independent studies. Study 1 included young adults (N = 443), whereas Study 2 included young, middle-aged, and older adults (N = 330). In both studies, the SRS showed good internal consistency. In Study 1, the SRS also showed satisfactory test–retest reliability over a 6-week period. We found support for the criterion validity of the SRS in terms of positive correlations with measures of general and domain-specific self-efficacy, proactive coping, and positive affect and in terms of negative correlations with depressive symptoms and negative affect. Hierarchical regression analyses showed that attention control accounted for unique portions of variance in relevant outcome variables above and beyond measures of self-efficacy and proactive coping.
PMCID: PMC2442651  PMID: 16740114

Results 1-5 (5)