Changes In Behavioural Determinants Research Articles

The 20-Year Trends in Caries and Associated Determinants among Adults in Post-Soviet Lithuania: Repeated Cross-Sectional Studies

Aim: The aim of the study was to examine the 20-year trend in dental caries and associated determinants among adults in Lithuania after the country restored its independence. Material and Methods: Data from two cross-sectional national surveys included samples of 35–44-year-olds (adults) and 65–74-year-olds (early elderly). The 1997/1998 survey (first survey) recruited a stratified random sample of 569 individuals from 10 selected areas in Lithuania (response rate 52%), and the 2017/2019 survey (second survey) recruited a stratified random sample of 723 individuals from 5 biggest Lithuanian cities and one randomly selected peri-urban/rural area from each of 10 Lithuanian counties (response rate 53%). The information about the social (sex, residence, education) and behavioral (toothbrushing frequency, use of fluoridated toothpaste, and last dental visit) determinants was collected via self-reports using the World Health Organization (WHO) Oral Health Questionnaire for Adults questions. Information about the fluoride level in the drinking water was retrieved from the water suppliers. Dental caries was recorded at the surface level following the WHO criteria by two calibrated examiners, one at each of the national surveys. Bivariate and multivariate analyses were used. Results: According to multivariable negative binomial regression analysis, in adults, 67% lower DS scores (IRR 0.33, 95% CI 0.26–0.42) and in early elderly 47% lower DS scores (IRR 0.53, 95% CI 0.38–0.74) were observed in the second survey. Adults in the second survey (vs. first survey) had 62% lower MT scores (IRR 0.38, 95% CI 0.32–0.46), and the early elderly had 19% lower MT scores (IRR 0.81, 95% CI 0.72–0.92). Adults in the second survey had 21% lower DMFT scores (IRR 0.79, 95% CI 0.73–0.85). The changes in behavioral determinants were observed over the 20-year period. Conclusion: An improvement in dental health during the 20-year period, mainly related to reduction in untreated caries and missing teeth, was observed in adults and early elderly. However, early elderly still had high numbers of missing teeth. The decrease in total caries experience during the 20 years was significant only in adults. Our findings support an urgent need to design and implement national oral health promotion and prevention programs with increased focus on oral self-care and fluoridated toothpaste use.

Exploring changes, and factors associated with changes, in behavioural determinants from a low-cost, scalable education intervention about knee osteoarthritis: An observational cohort study

ObjectiveTo explore the relationships between participant characteristics, perceptions of a short educational video about osteoarthritis and its management, and immediate changes in behavioural determinants for effective self-management behaviours.MethodsSeventy-eight participants with knee OA (77% female, mean age 63.0 ± 8.7) watched the 9-min video that included evidence-based content and was designed to foster empowerment to self-manage effectively. Data were collected by online questionnaire at baseline and immediately after watching the video. Associations were tested between baseline health and information processing characteristics (health literacy, need for cognition), perceptions of the video (enjoyment, helpfulness, believability, novelty and relevance) and pre-post changes in behavioural determinants (self-efficacy for managing arthritis, attitude to self-management or ‘activation’, and importance/confidence for physical activity).ResultsAll behavioural determinants improved immediately after watching the video. Positive perceptions were associated with greater improvements in self-efficacy for arthritis (Spearman’s rho, ρ = 0.26–0.47). Greater perceived relevance was associated with increased self-rated importance of being physically active (ρ = 0.43). There were small positive associations between health literacy domains related to health information and positive viewer perceptions of the video. People with higher need for cognition may achieve greater improvement in confidence to be physically active (ρ = 0.27).ConclusionThe educational video may help achieve outcomes important for increasing self-management behaviours in people with knee osteoarthritis. Positive perceptions appear to be important in achieving these improvements. People with lower health literacy and lower need for cognition may respond less well to this information about knee osteoarthritis delivered in this way.

What makes people leave LESS food? Testing effects of smaller portions and information in a behavioral model

To contribute to a better understanding of consumer food leftovers and to facilitate their reduction in out-of-home settings, our study analyzes the effects of two common intervention strategies for reducing leftovers in a holistic behavioral model. Based on a quasi-experimental baseline-intervention design, we analyzed how the display of information posters and the reduction of portion sizes take an effect on personal, social and environmental determinants in a structural equation model. Applying data from online surveys and observations among 880 guests (503 baseline, 377 intervention) during two weeks in a university canteen, the suggested model allows to assign effects from the two interventions on plate leftovers to specific changes in behavioral determinants. Portion size reductions for target dishes are found to relate to lower levels of plate waste based on conscious perception, represented in smaller portion size ratings. Effects from seeing information posters are found to base on changed personal attitudes, subjective norms and perceived behavioral control. However, depending on how an individual reacts to the information (by only making an effort to finish all food or by making an effort and additionally choosing a different dish in the canteen) there are opposite effects on these determinants and consequently also on plate leftovers. Overall, the differentiated results on intervention effects strongly support the benefits of more holistic and in-depth analyses of interventions to reduce plate leftovers and therefore to contribute to more sustainable food consumption in out-of-home settings.

The improvement of dietary behaviors among Iranian adolescent girls: a theory-based randomized controlled trial.

This study aims to evaluate the impact of a social cognitive theory (SCT)-based intervention on dietary behaviors and behavioral determinants. A randomized controlled trial was conducted with 230 adolescent girls (13-15 years old) in the intervention (n=115), and control group (n = 115), in Isfahan, Iran. Interventions were focused on changing SCT determinants including, knowledge, self-efficacy, intention, situation, self-regulation, social support, outcome expectations and expectancies. The intervention program included multicomponent intervention packages for adolescents, parents and teachers. A self-report questionnaire was used to assess dietary behaviors and SCT determinants at 3- and 6-month follow-ups. At 3- and 6-month follow-ups, differences between the intervention and control groups were reported in terms of the changes in all behavioral determinants and dietary behaviors. The changes in most behavioral determinants were significantly associated with the changes in dietary behaviors. The results showed that the nutrition education intervention based on SCT is effective in improving adolescents' dietary behaviors but dietary behaviors of adolescents in this study not yet reached to ideal status.

The effect of the \u201cFollow in my Green Food Steps\u201d programme on cooking behaviours for improved iron intake: a quasi-experimental randomized community study

BackgroundNutritional iron deficiency is one of the leading factors for disease, disability and death. A quasi-experimental randomized community study in South-West Nigeria explored whether a branded behaviour change programme increased the use of green leafy vegetables (greens) and iron-fortified bouillon cubes in stews for improved iron intake.MethodsA coinflip assigned the intervention to Ile-Ife (Intervention town). Osogbo (Control town) received no information. At baseline 602 mother-daughter pairs (daughters aged 12–18) were enrolled (Intervention: 300; Control: 302). A Food Frequency Questionnaire assessed the addition of cubes and greens to stews, the primary outcome. Secondary outcomes were the addition of cubes and greens to soups and changes in behavioural determinants measured using the Theory of Planned Behaviour. Structural Equation Modelling (SEM) evaluated the impact of the intervention on behavioural determinants and behaviour.ResultsThe data of 527 pairs was used (Intervention: 240; Control: 287). The increase in greens added to stews was larger in the Intervention town compared to the Control town (MIntervention = 0.3 [SE = 0.03]; MControl = 0.0 [SE = 0.04], p < 0.001, r = 0.36). Change in iron-fortified cubes added to stews did not differ between towns (p = 0.07). The increase in cubes added to soups was larger in the Intervention town compared to the Control Town (MIntervention = 0.9 [SE = 0.2] vs MControl = 0.4 [SE = 0.1], p < .0001, r = 0.20). Unexpectedly, change in greens added to soups was larger in the Control town compared to the Intervention town (MIntervention = − 0.1 [SE = 0.1]; MControl = 0.5 [SE = 0.1], p = 0.003, r = 0.15). The intervention positively influenced awareness of anaemia and the determinants of behaviour in the Intervention town, with hardly any change in the Control town. Baseline SEMs could not be established, so no mediation analyses were done. Post-intervention SEMs highlighted the role of habit in cooking stews.ConclusionsThe behaviour change programme increased the amount of green leafy vegetables added to stews and iron-fortified cubes added to soups. Future research should assess the long-term impact and the efficacy of the programme as it is scaled up and rolled out.

Feasibility and Effectiveness of Nutritional Telemonitoring for Home Care Clients: A Pilot Study.

Undernutrition has unfavorable consequences for health and quality of life. This pilot study aimed to evaluate the feasibility of a telemonitoring intervention to improve the nutritional status of community-dwelling older adults. The study involved a one-group pretest post-test design, complemented by a qualitative study. The 3-month intervention included 20 Dutch home care clients aged >65 years and consisted of nutritional telemonitoring, television messages, and dietary advice. A process evaluation provided insight into intervention delivery and acceptability. Changes in behavioral determinants, diet quality, appetite, nutritional status, physical functioning, and quality of life were assessed. Researchers and health care professionals implemented the intervention as intended and health care professionals accepted the intervention well. However, 9 participants dropped out, and participants' acceptance was low, mainly due to the low usability of the telemonitoring television channel. Adherence to the telemonitoring measurements was good, although participants needed more help from nurses than anticipated. Participants increased compliance to several Dutch dietary guidelines and no effects on nutritional status, physical functioning, and quality of life were found. Successful telemonitoring of nutritional parameters in community-dwelling older adults starts with optimal usability and acceptability by older adults and their health care professionals. This pilot study provides insight into how to optimize telemonitoring interventions for older adults for maximum impact on behavior and health.

Determinants of lifestyle behavior change to prevent type 2 diabetes in high-risk individuals

BackgroundAlthough there are many effective lifestyle interventions for type 2 diabetes (T2DM) prevention, insight into effective intervention pathways, especially of long-term interventions, is often lacking. This study aims to provide insight into the effective intervention pathways of the SLIMMER diabetes prevention intervention using mediation analyses.MethodsIn total, 240 participants at increased risk of T2DM were included in the analyses over 18 months. The intervention was a combined lifestyle intervention with a dietary and a physical activity (PA) component. The primary and secondary outcomes were change in fasting insulin (pmol/L) and change in body weight (kg) after 18 months, respectively. Firstly, in a multiple mediator model, we investigated whether significant changes in these outcomes were mediated by changes in dietary and PA behavior. Secondly, in multiple single mediator models, we investigated whether changes in dietary and PA behavior were mediated by changes in behavioral determinants and the participants’ psychological profile. The mediation analyses used linear regression models, where significance of indirect effects was calculated with bootstrapping.ResultsThe effect of the intervention on decreased fasting insulin was 40% mediated by change in dietary and PA behavior, where dietary behavior was an independent mediator of the association (34%). The effect of the intervention on decreased body weight was 20% mediated by change in dietary and PA behavior, where PA behavior was an independent mediator (17%). The intervention significantly changed intake of fruit, fat from bread spread, and fiber from bread. Change in fruit intake was mediated by change in action control (combination of consciousness, self-control, and effort), motivation, self-efficacy, intention, and skills. Change in fat intake was mediated by change in action control and psychological profile. No mediators could be identified for change in fiber intake. The change in PA behavior was mediated by change in action control, motivation, and psychological profile.ConclusionThe effect of the SLIMMER intervention on fasting insulin and body weight was mediated by changes in dietary and PA behavior, in distinct ways. These results indicate that changing dietary as well as PA behavior is important in T2DM prevention.

Changes in insurance physicians' attitudes, self-efficacy, intention, and knowledge and skills regarding the guidelines for depression, following an implementation strategy.

Introduction To improve guideline adherence by insurance physicians (IPs), an implementation strategy was developed and investigated in a randomized controlled trial. This implementation strategy involved a multifaceted training programme for a group of IPs in applying the guidelines for depression. In this study we report the impact of the implementation strategy on the physicians’ attitude, intention, self-efficacy, and knowledge and skills as behavioural determinants of guideline adherence. Any links between these self-reported behavioural determinants and levels of guideline adherence were also determined. Methods Just before and 3 months after the implementation of the multifaceted training, a questionnaire designed to measure behavioural determinants on the basis of the ASE (attitude, social norm, self-efficacy) model was completed by the intervention (n = 21) and the control group (n = 19). Items of the questionnaire were grouped to form scales of ASE determinants. Internal consistency of the scales was calculated using Cronbach’s alphas. Differences between groups concerning changes in ASE determinants, and the association of these changes with improvements in guideline adherence, were analyzed using analysis of covariance. Results The internal consistency of the scales of ASE determinants proved to be sufficiently reliable, with Cronbach’s alphas of at least 0.70. At follow-up after 3 months, the IPs given the implementation strategy showed significant improvement over the IPs in the control group for all ASE determinants investigated. Changes in knowledge and skills were only weakly associated with improvements in guideline adherence. Conclusions The implementation strategy developed for insurance physicians can increase their attitude, intention, self-efficacy, and knowledge and skills when applying the guidelines for depression. These changes in behavioural determinants might indicate positive changes in IPs’ behaviour towards the use of the guidelines for depression. However, only changes in knowledge and skills related to the use of the guidelines were associated with improvements in IPs’ actual performance when applying the guidelines.Electronic supplementary materialThe online version of this article (doi:10.1007/s10926-012-9378-9) contains supplementary material, which is available to authorized users.

Web-based tailored nutrition education: results of a randomized controlled trial

There is ample evidence that printed, computer-tailored nutrition education is a more effective tool for motivating people to change to healthier diets than general nutrition education. New technology is now providing more advanced ways of delivering tailored messages, e.g. via the World Wide Web (WWW). Before disseminating a tailored intervention via the web, it is important to investigate the potential of web-based tailored nutrition education. The present study investigated the immediate impact of web-based computer-tailored nutrition education on personal awareness and intentions related to intake of fat, fruit and vegetables. A randomized controlled trial, with a pre-test-post-test control group design was conducted. Significant differences in awareness and intention to change were found between the intervention and control group at post-test. The tailored intervention was appreciated better, was rated as more personally relevant, and had more subjective impact on opinion and intentions to change than the general nutrition information. Computer literacy had no effect on these ratings. The results indicate that interactive, web-based computer-tailored nutrition education can lead to changes in determinants of behavior. Future research should be aimed at longer-term (behavioral) effects and the practicability of distributing tailored interventions via the WWW.

A developmental perspective on behavioral determinants

This paper presents a developmental perspective on behavioral determinants which integrates some aspects of the Piagetian and Gibsonian theories as well as some basic postulates of AI theories. This developmental model is summarized in a series of assertions and illustrated by examples of various kinds of behavior. It assumes that three qualitatively different changes in behavioral determinants take place between birth and 18 years; this assumption means that the link between sensory information and action undergoes several transformations during development. Moreover, within each stage, behavior is determined by the degree of development of the subject's representation of objects and of himself. The initial state of behavior at birth is particularly discussed in this paper, with regard to imitation ability and auditory-visual coordination. The issue is whether or not development begins from a differentiated or non-differentiated subject-object relationship.