Changes In Behavioral Intentions Research Articles

The challenge of change: understanding the role of habits in university students’ self-regulated learning

AbstractStudy habits drive a large portion of how university students study. Some of these habits are not effective in fostering academic achievement. To support students in breaking old, ineffective habits and forming new, effective study habits, an in-depth understanding of what students’ study habits look like and how they are both formed and broken is needed. Therefore, in this study, we explored these aspects among first-year university students in six focus group discussions (N = 29). Using a thematic analysis approach, we clustered the data in five themes: Goals Matter, Balancing Perceived Efficiency and Effectiveness when Studying, Navigating Student Life: from Structured Routines to Self-Regulation Challenges, the Quest for Effective Habits with Trying to Break Free From the Screen as subtheme, and the Motivation Roller Coaster. Findings suggest that students had different study habits depending on their goals. Students had quite accurate metacognitive knowledge about effective learning strategies for long-term learning, but often used other learning strategies they deemed most efficient in reaching their goals. Students indicated intentions to change, but did not prioritize change as their current habits enabled them to pass exams and change was not perceived as adding value. Fluctuations in motivation and transitioning to a self-regulated life hampered students’ intentions to form new and break old habits. Next to insights into factors affecting students’ behavioral change intentions, the findings suggest the importance of aligning assessment methods with life-long learning and supporting students in their long-term academic goal setting to prioritize study habits which target lasting learning to optimally foster their self-regulated learning.

Predicting health behaviors during the COVID-19 pandemic: A longitudinal study.

We investigated the social, emotional, and cognitive predictors of adherence to four health behaviors (handwashing, mask wearing, social contact limitations, and physical distancing) during one critical phase of the COVID-19 pandemic. We collected data (N = 5803, mean age = 53; 57% women) in Belgium at five time points between April and July 2021, a time during which infections evolved from high (third wave of the pandemic) to low numbers of COVID-19 cases. The results show that the social, emotional, and cognitive predictors achieved high levels of explained variance (R2 > .60). In particular, the central components of behavioral change (attitudes, intentions, control, habits, norms, and risk) were the strongest and most consistent predictors of health behaviors over time. Likewise, autonomous motivation and empathetic emotions (e.g., attentive, compassionate) had a positive impact on health behavior adherence, whereas it was the opposite for lively emotions (e.g., active, enthusiastic). These results offer policymakers actionable insights into the most potent and stable factors associated with health behaviors, equipping them with effective strategies to curtail the spread of future infectious diseases.

Knowledge and practices related to antibiotics among poultry producers and veterinarians in two Indian states

BackgroundAntibiotics are frequently utilized in livestock, particularly poultry, for therapy and growth promotion, resulting in antimicrobial resistance. Multidrug-resistant bacteria are frequent in poultry samples from India. The purpose of this study was to better understand main antibiotic consumption patterns in poultry value chains, as well as antibiotic knowledge and practices among the stakeholders. MethodsA cross-sectional survey was conducted in Assam and Karnataka, India. The poultry farmers were interviewed on antibiotic usage, antibiotic knowledge, feeding practices, and preventive measures on the farm. Poultry farmers reported their veterinarians, and we also interviewed them on knowledge and practices related to antimicrobial use in poultry and antimicrobial resistance. Item response theory (IRT) was used to assess the association between the answers and demographic factors. ResultsThis survey interviewed 62 poultry farmers and 11 veterinarians. Small poultry farms with fewer than 4000 birds were owned by 51.6% of farmers. Most poultry farmers had heard about antibiotics, and 62.9% thought they cured all diseases. If one chicken is sick, 72.6% said others should be given antibiotics to prevent the disease. All veterinarians utilized tetracyclines, aminoglycosides, and cephalexin on the poultry farms. Over half (54.5%) stated antibiotics prevent diseases, and 72.7% said they treat and prevent diseases. Some (45.5%) said antibiotics boost growth. IRT analysis showed that 8 questions assessed a knowledge scale well. Univariable analysis showed that Assam farmers and women were likely to have have more knowledge. ConclusionThe poultry farmers were mostly unaware of the relation between antibiotic use and antimicrobial resistance. Despite being aware, the veterinarians agreed with use antibiotics as a prophylactic measure. It is vital that these stakeholders understand the repercussions of such widespread antibiotic use. In order to increase knowledge, frequent trainings and antimicrobial stewardship programmes with effective communication and incentives for behaviour change should be conducted.

Developing cue-behavior association for habit formation: A qualitative study to explore the role of avatar in hypertension.

Electronic health (eHealth) has been widely adopted in chronic disease management. Prior studies focused on time-based reminders as a cue to facilitate behavior change intentions, ignoring the development of automatic cue-behavior associations via other cue types. Hence, this study utilized avatar appearance as a visual-based cue to help establish the automatic association between appearance transformation and health behavior to form habits without intention. To better understand users' attitudes and experiences toward applying changes in avatar appearance to develop cue-behavior associations for hypertensive patients. Fifteen participants were recruited in a 14-day experiment. After excluding one participant who dropped out of the experiment, others were randomly assigned to two groups. One group consisted of a visual-based cue (a virtual plant) and basic behavior change techniques (BCTs). The other group only included basic BCTs. Attitudes and experience outcomes were collected by interview, and qualitative data were analyzed using thematic analysis. 57% of participants had been diagnosed with hypertension for more than five years, and more than 50% of participants have experience using mobile apps or wearables. 66% of participants did physical activity more than three times every week. The result shows that tailored time-based reminders, blood pressure monitoring, and daily dietary intake were the most attractive features. Additionally, hypertensive participants have positive attitudes toward avatar appearance as a visual-based cue to develop cue-behavior association, which enhances self-management motivation. This study proposes a visual-based cue design for habit formation and conducts a qualitative method to explore hypertensive patients' perceptions. The findings offer insights from user's perspectives into hypertensive patients' attitudes toward visual-based cues and perception of the connection between avatar appearance and health behavior for self-management. Subsequent discussions present eHealth design guidelines of habit formation from intention, automatic cue-behavior association, and self-management perspectives.

Brief Report: Determinants of Potential Sexual Activity Reduction in the Face of the Mpox Epidemic.

The current mpox epidemic is most prevalent among men-who-have-sex-with-men (MSM). Vaccination programs are being rolled-out to curb the epidemic. Behavioural measures have been called for as well, for example, by the WHO and national public health authorities to reduce the number of sexual partners and sexual activity. We investigated intentions and determinants among Dutch MSM to follow such behavioural measures. Early in July 2022, in the context of a dynamic ongoing epidemic, 394 MSM answered an online questionnaire investigating concepts such as perceived mpox risk, vaccination and behavioural change intentions and collecting socio-demographic and sexual behaviour information. The overall intentions to reduce number of partners and sexual activity were high, but only a minority had developed definite intentions. Determinant analysis revealed that dating/open relationship status was a positive predictor; vaccination intentions did not predict sexual behaviour change; those not on PrEP were more likely to change their sexual behaviour. Mpox infection concern was the main predictor for behaviour change intentions. Our results show that behavioural measures to avoid an mpox infection are present in majority of participants in our survey, but high intentions are held by a minority. Taking the historic complexity of behavioural change pleas among MSM into account sensitive, additional public health measures are necessary to reach and to inform MSM about potential benefits of sexual behaviour change.

Responding to feedback about implicit bias

AbstractProviding people with feedback about their intergroup biases is a central part of many diversity training and other bias‐education efforts. Although this practice may increase self‐awareness, people sometimes respond negatively to learning about their own biases. In the present review, we provide a framework for understanding when feedback about intergroup bias should lead to behavior change intentions, and when it can work against that goal. Specifically, we suggest that feedback about performance on measures of bias (e.g., the Implicit Association Test) will cause psychological discomfort to the extent that feedback about intergroup bias is: (1) discrepant from self‐reported attitudes, and (2) more personally or socially unacceptable than self‐reported attitudes. We then suggest two possible routes stemming from that psychological discomfort: If people accept personal responsibility for feedback, they will respond to psychological discomfort with compunction and direct efforts toward behavior and attitude change. By contrast, if people reject personal responsibility for feedback, they will respond defensively, derogating the feedback and trying to prove that the results are inaccurate. We use responses to feedback about implicit bias as a test case to demonstrate our model and discuss the current state of the literature on responding to IAT feedback. We also discuss interventions that can move people from defensiveness to compunction and open our metaphorical “file drawer” to discuss lessons learned.

Consumer risk perception and behavior change intentions

This manuscript addresses behavior change intentions and consumer risk perceptions in the context of uncertainty and crisis such as the Covid-19 pandemic. Based on the theory of planned behavior and health behavior theories, a conceptual framework is developed that focuses on the role of attitudes toward the Covid-19 pandemic, their determinants in the context of the public campaign conducted, and the resulting behavior change intentions. The empirical study, based on an actual campaign and a representative nationwide sample in a developing country, is conducted to test the developed hypotheses. The results suggest that information search is relevant to predicting attitudes and intention to change behavior. At the same time, exposure to the campaign is directly relevant to motivating the target audience to change their behavior. There is also a gap between attitude and behavior, but it is bridged by perceived risk, which plays a vital moderating role when rated high or low. Finally, in the presence of this moderating effect, an indirect effect of information search on behavior change intention is confirmed by attitudes toward the Covid-19 pandemic. Overall, this study provides valuable insights for research in health behavior and crisis management.

Increasing the uptake of plant-based diets: An analysis of the impact of a CO2 food label

Reducing the environmental footprint of the global food system significantly depends on shifting to more plant-based diets. However, deep-rooted eating habits and a general lack of awareness about food-related emissions hinder large-scale dietary shifts. Demand-side food policies can accelerate this transition towards plant-based diets. One policy instrument that may increase awareness of diet-related emissions and facilitate climate-friendly food consumption choices is a CO2 food label. The success of such demand-side food policies depends on socio-political and market acceptance. However, there is a lack of empirical evidence regarding the socio-political (i.e., feasibility) and market acceptance (i.e., effectiveness at changing behavioral intentions) of CO2 food labels. We also require more knowledge about the potential spillover effects of CO2 food labels on support for more ambitious demand-side food policies. The paper presents evidence from a survey experiment with a sample of Swiss residents (N = 2372) who were randomly provided with information about an established CO2 food label. The survey experiment was embedded in a cooperation throughout a larger long-term project with the second-largest Swiss retailer, which launched one of the world's first CO2 food labels in 2021. Findings show that providing information on a CO2 food label strengthens individuals' behavioral change intentions and support for a mandatory governmental CO2 food label. However, no spillover effect on support for other food policy instruments is identified, which also means that the study finds no crowding out effect by voluntary CO2 labelling initiatives on the support of governmental food policy measures. The results imply that a CO2 food label enjoys high market and socio-political acceptance.

Hypothetical e-liquid flavor ban and opinions among vape shop retailers in the Greater Los Angeles Area.

Evaluating anticipated responses to flavor bans in the context of vape shops is needed to inform legislation and enforcement. This cross-sectional study examined vape shop retailers' opinions about the potential impacts of an e-liquid flavor ban on shop sales and customer behavior-change intentions. From December 2019 to October 2020 we conducted structured interviews over the phone with 46 brick-and-mortar vape shop retailers in the Greater Los Angeles Area. Most participants were managers (43.5%), followed by owners (26.1%) and clerks (26.1%). More than half (52.2%) reported that sales would drop a lot if flavored e-liquids were banned in all vape shops. Controlling for store position, multivariable linear regression showed that opposition to a hypothetical ban on non-tobacco flavored e-liquids was associated with participants' opinions that customers would likely not purchase tobacco flavored e-liquids (b= -0.44, p<0.01), and would likely use combustible tobacco products (b=0.47, p<0.05). In this cross-sectional study, vape shop retailers in the Greater Los Angeles Area reported that if a ban on non-tobacco e-liquid flavors occurred, they would oppose strongly, and that a ban would have a negative impact on their shop (e.g. loss in sales) and customer behavior (e.g. would replace vaping with smoking combustible tobacco products). Implications for research and practice are discussed.

A social-cognitive model of climate change behavioral adaption in Tonga: Relationships among indigenous knowledge, social media use, norms, values, and spiritual beliefs

This study develops a social-cognitive model of climate change behavioral intention in the Kingdom of Tonga in the South Pacific. Tonga ranks as the third most vulnerable nation in the world to climate change. Warming ocean temperatures due to climate change are intensifying the destructive potential of cyclones, adversely impacting marine ecosystems, and raising sea level which threatens low lying islands and coastal communities. The model considers the relationships among indigenous knowledge, climate change knowledge, social media use, social norms, values, and spiritual beliefs concerning protecting the environment with climate change behavioral intention. The participants represent a community sample of 335 people (183 women, 152 men; age: M = 37, SD = 14) on the island of Tongatapu who completed surveys assessing the constructs. Structural equation modeling shows four pathways to climate change behavioral intentions. In the first pathway, indigenous environmental knowledge, social norms, values, and spiritual beliefs each were associated with climate change knowledge, and climate change knowledge was associated with climate change behavioral intentions. The second, third, and fourth pathways show social media, values, and social norms were each directly associated with behavioral change intentions. The findings support and extend a psychological model of climate change behavioral adaptation. Implications of the findings are discussed.

Can emotional forgiveness promote a decision to forgive? Evidence from a six-wave random-intercept cross-lagged panel study of Pakistani Muslims during Ramadan

ABSTRACT We examined the degree to which an extended religious experience during Ramadan might promote interpersonal forgiveness. With six waves of data from a sample of N = 215 Pakistani Muslim students, we used random-intercept cross-lagged panel modeling to examine the associations between decisional and emotional forgiveness from before to after Ramadan in 2020. We observed three key findings. First, we demonstrated the strong cross-time measurement invariance of both the Decision to Forgive and the Emotional Forgiveness scales. Second, both decisional and emotional forgiveness remained relatively stable during the holy month of Ramadan. Third, there was evidence supporting positive bidirectional temporal relations between decisional and emotional forgiveness, such that each construct demonstrated at least one positive lagged association with the other. We discuss some implications of the findings, including the potential for positive emotional changes to evoke positive changes in behavioral intentions towards transgressors.

Risk perceptions among high-risk pregnant women in an aspirational district of India: a qualitative study

Background: Attitude and behavior towards health seeking decisions are affected by one’s risk perceptions. This formed a key component in many health behavior-change theories and is responsible for reduction of perinatal mortality. A woman’s perception of risk affects her decisions about seeking obstetric care. This study explored the perceptions of high-risk pregnancy among women with high risk factors. Methods: A qualitative study was conducted in an aspirational district of India. Participants included pregnant women in third trimester with high risk factors. In-depth interviews were conducted with 34 participants using semi-structured interview schedule. Results: Three main themes emerged in this study: (i) knowledge of risk (ii) attitude towards risk (iii) adoption behavior. The study found out women’s lack of understanding on high-risk conditions during pregnancy, especially among younger age group. Majority denied the risk factor and normalized delivery on one’s faith. Conclusions: The findings of this study provide a glimpse into how women perceived risk and the reasons that lead them to deny the risks. Women must understand their risk in the same way as their healthcare providers. If an event is not appraised as severe, there will be no change in behavioral intentions inspite of all the efforts put by the government for reducing perinatal mortality.

Seeking Education, Equity, and Diversity (SEED)

Introduction Health care work cultures that embrace diversity, equity, and inclusion (DEI) foster innovations, synergy, and appreciation for differences. To promote DEI, health care systems have encouraged professional development on cultural humility, which is awareness of one’s values, beliefs, and social position, given the current cultural context while mindful of history. The national SEED Project (Seeking Educational Equity and Diversity) is a professional development program that prompts reflection and perspective shifting about workplace culture and systemic change. However, reports that examine the SEED learning experience and the participants’ intention for behavior change are lacking. The purpose of our study was to examine: (a) The SEED learning experience, (b) How personal views can foster cultural humility, and (c) The impact of SEED on intentions to effect change. Methods A purposive sample of eight (N = 8) faculty and staff from a SEED cohort at an academic health science center, with regional programs, participated in in-depth interviews to explore their personal views of how to foster cultural humility in health care and the impact of SEED to prompt intentions for behavior change. The investigators conducted a thematic analysis using an inductive, iterative method. Independently, they read each transcript and created codes for each comment. Subsequently, they compared findings, developed a coding frame, and grouped codes into potential themes. They then individually applied the coding frame to the data and considered themes. Finally, they built consensus on codes and synthesized codes into themes. Results Thematic analysis indicated the participants had a profound learning experience, which prompted them to develop cultural humility by re-framing cultural experiences and resolving to become more proactive about DEI in the workplace. They found small group discussions were insightful and provocative. These discussions led to new perspectives and behavior change or intentions for behavior change. Our analysis generated three themes: (1) Connecting with diverse perspectives, (2) Developing new perspectives, and (3) Being proactive with advocacy and new strategies. Conclusion Health care professionals and organizations can use our findings to encourage professional development that potentially stimulates behavior change, the ultimate goal of professional development, related to DEI. Future studies should examine the impact of this professional development within their organization and in the delivery of health care.

How information, social norms, and experience with novel meat substitutes can create positive political feedback and demand-side policy change

The food system causes more than a third of the global anthropogenic greenhouse gas emissions, of which half are from livestock. Shifting towards plant-based diets could significantly reduce deforestation, protect biodiversity, and contribute to achieving the Sustainable Development Goals and Paris climate targets. Arguably, large-scale shifts in meat consumption require ambitious policy change. Yet, deep-rooted eating habits, pleasure, cultural status, and personal freedom are just a few of many obstacles to adopt ambitious demand-side policies and reduce meat consumption. Here, we hypothesize that technological innovation in meat substitutes, if effectively combined with social norm and factual informational triggers for behavioral changes, can foster positive political feedback to transform the food system. To test our hypothesis, we conducted survey experiments with citizens (N = 2590) in China and the US – the globally largest meat markets – and analyzed data using different machine learning methods. Our findings show that personal experience with novel plant-based meat substitutes strongly predicts individuals’ intentions to reduce their meat consumption, eat more substitutes, and support public policies to catalyze a transition to more plant-based diets. We also find that in both countries factual and social norm information about the benefits of more plant-based diets can increase citizens’ behavioral change intentions and support for meat reduction policies. Overall, however, social norm information had no significant additional effects on the outcomes compared to the simple factual information treatments. In the US, prior experience with innovative meat substitutes potentially can boost the positive effects of informational campaigns on public support for meat reduction policies. The results offer promising implications for a policy sequencing strategy to create positive political feedback and enable socio-technical tipping dynamics for sustainable food system transformation.

Courage to Quit® rolling group: Implementation in an urban medical center in primarily low-income Black smokers

BackgroundContinuous “rolling” tobacco group treatments may help reduce cessation disparities by increasing access among underserved people who smoke cigarettes. We evaluated the implementation of a rolling enrollment adaptation of an evidence-based tobacco treatment group intervention, Courage to Quit®-Rolling (CTQ®-R). MethodsThe 4-session CTQ®-R incorporating psychoeducation, motivational enhancement, and cognitive behavioral skills was evaluated by examining feasibility and preliminary program outcomes with a pre-post design using the SQUIRE method in a sample of 289 primarily low-income, Black people who smoke. Feasibility was measured by examining program retention. Paired t-tests evaluated changes in behavioral intentions and knowledge about smoking cessation and differences in average daily cigarettes smoked from first to last session attended. ResultsCTQ-R was feasible to implement in an urban medical center program enrolling primarily low-income Black people who smoke, with 52% attending at least 2 sessions and 24% completing the full program. Participants demonstrated improvements in knowledge of smoking cessation strategies and confidence in quitting (ps < .004). Preliminary effectiveness analyses showed a 30% reduction in average daily cigarette use, with group completers reporting greater reduction than non-completers. ConclusionsCTQ®-R is feasible and showed preliminary effectiveness for increasing knowledge about stop smoking skills and reducing cigarette smoking. ImplicationsA rolling enrollment smoking group treatment is feasible and may be effective among people who smoke who face historical and systemic barriers to tobacco treatment engagement. Evaluation in other settings and over longer periods of time is needed.

Seeking Education, Equity, and Diversity (Seed)

Introduction Health care work cultures that embrace diversity, equity, and inclusion (DEI) foster innovations, synergy, and appreciation for differences. To promote DEI, health care systems have encouraged professional development on cultural humility, which is awareness of one’s values, beliefs, and social position, given the current cultural context while mindful of history. The national SEED Project (Seeking Educational Equity and Diversity) is a professional development program that prompts reflection and perspective shifting about workplace culture and systemic change. However, reports that examine the SEED learning experience and the participants’ intention for behavior change are lacking. The purpose of our study was to examine: (a) The SEED learning experience, (b) How personal views can foster cultural humility, and (c) The impact of SEED on intentions to effect change. Methods A purposive sample of eight (N = 8) faculty and staff from a SEED cohort at an academic health science center, with regional programs, participated in in-depth interviews to explore their personal views of how to foster cultural humility in health care and the impact of SEED to prompt intentions for behavior change. The investigators conducted a thematic analysis using an inductive, iterative method. Independently, they read each transcript and created codes for each comment. Subsequently, they compared findings, developed a coding frame, and grouped codes into potential themes. They then individually applied the coding frame to the data and considered themes. Finally, they built consensus on codes and synthesized codes into themes. Results Thematic analysis indicated the participants had a profound learning experience, which prompted them to develop cultural humility by re-framing cultural experiences and resolving to become more proactive about DEI in the workplace. They found small group discussions were insightful and provocative. These discussions led to new perspectives and behavior change or intentions for behavior change. Our analysis generated three themes: (1) Connecting with diverse perspectives, (2) Developing new perspectives, and (3) Being proactive with advocacy and new strategies. Conclusion Health care professionals and organizations can use our findings to encourage professional development that potentially stimulates behavior change, the ultimate goal of professional development, related to DEI. Future studies should examine the impact of this professional development within their organization and in the delivery of health care.

The effects of efficacy framing in news information and health anxiety on coronavirus-disease-2019-related cognitive outcomes and interpretation bias.

Within the coronavirus-disease-2019 (COVID-19) pandemic, disease-related information is omnipresent in the media, whereas information about how to manage the pandemic is less often covered. Under the context where threat is present, this study investigated whether and how the strength of efficacy framing (i.e., the perspective adopted by a communicating text that emphasizes one's possibilities to cope with an external threat) of COVID-19-related news, as well as its interaction with trait health anxiety under the COVID-19 context, related to people's COVID-19-related cognitive outcomes. One hundred and ninety-three participants reported demographics, trait health anxiety, and COVID-19-related behaviors (e.g., precautionary measures, information-seeking behaviors). They then either read high-efficacy (n = 112; e.g., cure rate) or low-efficacy (n = 81; e.g., mortality rate) information about COVID-19. Afterward, their tendency to interpret illness- and COVID-19-related information more negatively, and other COVID-19-related cognitions (e.g., risk perception, behavioral change intentions) were assessed. High-efficacy framing resulted in lower-risk perception and marginally weaker COVID-19-related interpretation bias, compared with low-efficacy framing. There was some evidence of an interaction with health anxiety such that high-efficacy framing, compared with low-efficacy framing, was associated with greater intention to adopt protective behaviors, particularly for individuals with higher levels of health anxiety. Media framing of COVID-19 information affects how people respond to the pandemic; a high-efficacy communication style might more effectively encourage healthy behaviors than a low-efficacy narrative, particularly for people who are already anxious about their health. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Evaluation of a Web-based Information Platform for Youths on Mental Health During the COVID-19 Pandemic.

During the corona pandemic, youths were confronted with substantial challenges and in urgent need of information on how to prevent mental health problems. This experimental pre-post-follow-up study examined the efficacy and reception of an innovative website (www.corona-und-du.info) containing evidence-based information for youths on how to overcome psychological distress during the pandemic. 34 youths aged 11–18 years were presented domains of the website in the laboratory. Standardized questionnaires were applied to assess changes in knowledge, the reception of the website, and changes in behavioral intention to seek psychological help. For all content domains, we found a significant knowledge gain with large effect sizes from pre to post, and from pre to follow-up. The reception of the website was very positive, and participants indicated increased intention to seek psychological support when needed. The results constitute an important basis for future attempts to promote mental health information in youths in times of crisis.The online version contains supplementary material available at 10.1007/s10578-022-01425-5.

How is the NHS Low-Calorie Diet Programme expected to produce behavioural change to support diabetes remission: An examination of underpinning theory.

In 2020, the National Health Service Low-Calorie Diet Programme (NHS-LCD) was launched, piloting a total diet (TDR) replacement intervention with behaviour change support for people living with Type 2 Diabetes (T2D) and excess weight. Four independent service providers were commissioned to design and deliver theoretically grounded programmes in localities across England. 1) to develop a logic model detailing how the NHS-LCD programme is expected to produce changes in health behaviour, and (2) to analyse and evaluate the use of behaviour change theory in providers' NHS-LCD Programme designs. A documentary review was conducted. Information was extracted from the NHS-LCD service specification documents on how the programme expected to produce outcomes. The Theory Coding Scheme (TCS) was used to analyse theory use in providers' programme design documents. The NHS-LCD logic model included techniques aimed at enhancing positive outcome expectations of programme participation and beliefs about social approval of behaviour change, to facilitate programme uptake and behaviour change intentions. This was followed by techniques aimed at shaping knowledge and enhancing the ability of participants to self-regulate their health behaviours, alongside a supportive social environment and person-centred approach.Application and type of behaviour change theory within service providers' programme designs varied. One provider explicitly linked theory to programme content; two providers linked 63% and 70% of intervention techniques to theory; and there was limited underpinning theory identified in the programme design documents for one of the providers. The nature and extent of theory use underpinning the NHS-LCD varied greatly amongst service providers, with some but not all intervention techniques explicitly linked to theory. How this relates to outcomes across providers should be evaluated. It is recommended that explicit theory use in programme design and evidence of its implementation becomes a requirement of future NHS commissioning processes.

Modifying the Pattern of Tendency to Health-related Behaviors in Adolescent Boys

Background and Objectives Physical activity is one of the main lifestyle variables related to health. This study aims to investigate the effectiveness of an educational program based on the theory of planned behavior (TPB) in improving the attitude and intention of male adolescents regarding physical activity. Subjects and Methods In the present study, 40 male high school students were divided into two groups of intervention (n=20) and control (n=20). The educational package was designed and provided to them at 10 sessions. Two 18-item TPB-based questionnaires related to attitude towards physical activity and intention to participate in sports activities were used. Results The educational program explained 0.238% of changes in attitudes, 0.189% of changes in knowledge, 0.247% of changes in subjective norms, 0.071% of changes in perceived behavioral control, 0.261% of changes in behavioral intentions. In total, it explained 0.458% of changes in intention to participate in/attitude towards sports activities. The educational program explained 0.609% of changes in attitude, 0.363% of changes in knowledge, 0.017% of changes in perceived behavioral control, and 0.015% of changes in behavioral intention. In total, it explained 0.731% of changes in students’ intention to participate in/attitude towards sports events. Conclusion The TPB-based educational program is effective in promoting high school students’ attitude towards physical activity and their intention to participate in sports events and thus improve their health.