Effective Behaviour Change Interventions Research Articles

Impact of Knowledge and Attitudes on Lifestyle Practices in Preventing Type 2 Diabetes Mellitus

Diabetes mellitus is a major public health issue in Singapore. To shape healthcare policies for the primary prevention of diabetes, it is crucial to understand Singaporeans' knowledge, attitudes and practices related to diabetes and its prevention. This study aimed to assess the knowledge, attitudes and lifestyles of individuals without diabetes. A cross-sectional household survey was performed between 31 January to 3 February 2019 to examine knowledge, attitudes and practices related to diabetes. Inclusion criteria of the participants included: 1) Singaporeans/permanent residents, 2) between 30 to 64 years old, and 3) who did not have a diagnosis of diabetes. Logistic and linear regression models were used to analyse the association of knowledge and attitudes with physical activity and diet habits, respectively. Among 806 participants, 72.2% did not meet the Health Promotion Board's physical activity recommendation. Physical activity was associated with better diabetes knowledge (odds ratio [OR] 5.38, 95% confidence interval [CI] = 1.65-17.53, P = 0.049), stronger beliefs in diabetes prevention (OR 3.36, 95% CI = 1.02-11.12, P = 0.047) and lower levels of worry about diabetes (OR 0.41, 95% CI 0.17-1.00, P = 0.049). Neither knowledge nor beliefs or worries about diabetes was associated with diet. There is a need to reinforce the importance of physical activity and healthy diet in preventing diabetes. Although improving the knowledge level of diabetes may increase physical activity of the population, it is unlikely to improve dietary choices without effective behavior change interventions.

A loyalty scheme to encourage physical activity in office workers: a cluster RCT

Background Increasing physical activity in the workplace can provide physical and mental health benefits for employees and economic benefits for the employer through reduced absenteeism and increased productivity. However, there is limited evidence on effective behaviour change interventions in workplace settings that led to maintained physical activity. This study aimed to address this gap and contribute to the evidence base for effective and cost-effective workplace interventions. Objectives To determine the effectiveness and cost-effectiveness of the Physical Activity Loyalty scheme, a multicomponent intervention based on concepts similar to those that underpin a high-street loyalty card, which was aimed at encouraging habitual physical activity behaviour and maintaining increases in mean number of steps per day. Design A cluster randomised controlled trial with an embedded economic evaluation, behavioural economic experiments, mediation analyses and process evaluation. Setting Office-based employees from public sector organisations in Belfast and Lisburn city centres in Northern Ireland. Participants A total of 853 participants [mean age 43.6 years (standard deviation 9.6 years); 71% of participants were female] were randomly allocated by cluster to either the intervention group or the (waiting list) control group. Intervention The 6-month intervention consisted of financial incentives (retail vouchers), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of the workplaces allowed participants to monitor their accumulated minutes of physical activity. Main outcome measures The primary outcome was mean number of steps per day recorded using a sealed pedometer (Yamax Digiwalker CW-701; Yamax, Tasley, UK) worn on the waist for 7 consecutive days and at 6 and 12 months post intervention. Secondary outcomes included health, mental well-being, quality of life, work absenteeism and presenteeism, and the use of health-care resources. Results The mean number of steps per day were significantly lower for the intervention group than the control group [6990 mean number of steps per day (standard deviation 3078) vs. 7576 mean number of steps per day (standard deviation 3345), respectively], with an adjusted mean difference of –336 steps (95% confidence interval –612 to –60 steps; p = 0.02) at 6 months post baseline, but not significantly lower at 12 months post baseline. There was a small but significant enhancement of mental well-being in the intervention group (difference between groups for the Warwick–Edinburgh Mental Wellbeing Scale of 1.34 points, 95% confidence interval 0.48 to 2.20 points), but not for the other secondary outcomes. An economic evaluation suggested that, overall, the scheme was not cost-effective compared with no intervention. The intervention was £25.85 (95% confidence interval –£29.89 to £81.60) more costly per participant than no intervention and had no effect on quality-adjusted life-years (incremental quality-adjusted life-years –0.0000891, 95% confidence interval –0.008 to 0.008). Limitations Significant restructuring of participating organisations during the study resulted in lower than anticipated recruitment and retention rates. Technical issues affected intervention fidelity. Conclusions Overall, assignment to the intervention group resulted in a small but significant decline in the mean pedometer-measured steps per day at 6 months relative to baseline, compared with the waiting list control group. The Physical Activity Loyalty scheme was deemed not to be cost-effective compared with no intervention, primarily because no additional quality-adjusted life-years were gained through the intervention. Research to better understand the mechanisms of physical activity behaviour change maintenance will help the design of future interventions. Trial registration Current Controlled Trials ISRCTN17975376. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 15. See the NIHR Journals Library website for further project information.

Habit and Identity: Behavioral, Cognitive, Affective, and Motivational Facets of an Integrated Self.

Two studies investigated associations between habits and identity, in particular what people consider as their “true self.” Habit-identity associations were assessed by within-participant correlations between self-reported habit and associated true self ratings of 80 behaviors. The behaviors were instantiations of 10 basic values. In Study 1, significant correlations were observed between individual differences in the strength of habit-identity associations, measures of cognitive self-integration (prioritizing self-relevant information), self-esteem, and an orientation toward an ideal self. Study 2 further tested the assumption that habits are associated with identity if these relate to important goals or values. An experimental manipulation of value affirmation demonstrated that, compared to a control condition, habit-identity associations were stronger if participants explicitly generated the habit and true self ratings while indicating which values the behaviors would serve. Taken together, the results suggest that habits may serve to define who we are, in particular when these are considered in the context of self-related goals or central values. When habits relate to feelings of identity this comes with stronger cognitive self-integration, higher self-esteem, and a striving toward an ideal self. Linking habits to identity may sustain newly formed behaviors and may thus lead to more effective behavior change interventions.

Factors Leading Municipal Authorities to Implement Preventive Interventions for Lyme Disease.

The aim of this study is to document climate change adaptation interventions targeting Lyme disease at the municipal level in the province of Quebec (Canada). This exploratory study relies on the theory of planned behavior and certain constructs from the health belief model to identify the factors leading municipal authorities to implement preventive interventions for Lyme disease (PILD). Data were obtained from an online survey sent, during the summer of 2018, to municipal officers in 820 municipalities in Quebec, in all health regions where the population is at risk of contracting Lyme disease (response rate = 36%). The questionnaire was used to measure the implementation of PILD, the intention to implement these interventions, attitudes, perceived social pressure, perceived control (levers and barriers) over interventions, perceived effectiveness of preventive measures, risk, and perceived vulnerability. Results of structural equation analyses showed that attitudes were significantly associated with municipal authorities’ intention to implement PILD, while the intention to implement PILD was a significant predictor of the implementation of PILD. Additional analyses showed that perceived barriers added a moderating effect in the intention-implementation relationship. The prediction of behaviors or practices that municipal authorities could implement to prevent Lyme disease will enable the evaluation over time of the evolution of Quebec municipalities’ adaptation to Lyme disease. Moreover, the examination of the associations of specific psychosocial factors revealed important implications for the design of effective behavior-change interventions, which would allow health officials doing awareness work to create personalized interventions better suited to municipal officers and their specific contexts.

Abstract P361: Body Image Dissatisfaction Influences Cardiovascular Health in Overweight and Obese African American Women

Introduction: African American women are 5 times less likely than white women to meet at least 5 or more ideal cardiovascular health metrics as defined by the American Heart Association Life’s Simple 7 (LS7) components (smoking, diet, physical activity, BMI, blood pressure, total cholesterol, and glucose). There are few studies probing the influence of sociocultural factors, such as body image dissatisfaction (BID), on these disparities. A better understanding of the impact of BID on cardiovascular health could assist in the design of more effective behavior change interventions for African American women. Hypothesis: We hypothesized that BID would have a negative association with cardiovascular health in overweight and obese African American women. Methods: We enrolled 32 women (mean age 49 years [SD 12.9]), from 5 predominantly African American churches participating in a larger community-based participatory study (FAITH! App Pilot Study) of a mobile health lifestyle intervention among African American women and men. We conducted a cross-sectional analysis of baseline data to evaluate the association between BID and both cardiovascular health and select psychosocial factors (e.g. motivation for healthy eating, diet self-regulation). A LS7 composite score was calculated as a measure of overall cardiovascular health (range 0-14). The Pulvers scale, consisting of images of women across the BMI spectrum, was used to measure perceived current and goal body size (rating of figures, 1-9; underweight to very obese). A BID score was calculated as the difference between perceived current and desired body image (range -8-8; BID < 0 [desire to be heavier], BID > 0 [desire to be thinner], BID = 0 [no dissatisfaction]). The BID score range for our cohort was 0-4. Thus, we categorized BID as no/low BID (BID score 0-1) or high BID (BID score 2-4). Results: Twenty-two percent (7/32) of women were overweight (BMI 25-29.9) and 78% (25/32) were obese (BMI (≥ 30). Forty-four percent (14/32) had no/low BID and 56% (18/32) had high BID. Those with high BID were more likely to be obese as compared to no/low BID (94% (17/18) versus 57% (8/14), p=0.03). Although not statistically significant, the mean LS7 composite score was 1 point higher among those with no/low BID, versus high BID (8.83 versus 7.76, p=0.25). Compared to women with high BID, those with no/low BID were more likely to have greater: intrinsic motivation (P=0.01) and integrated regulation for healthy eating (P=0.007), and self-regulation to reduce fat and caloric intake (P=0.01). Conclusion: Ultimately, although small, our study suggests that African-American women with obesity are more likely to have high BID. High BID was associated with lower motivation and self-regulation, which predict cardiovascular health. BID and other psychosocial factors for behavior change are potential targets for culturally-tailored lifestyle interventions in this group.

Examining the theory-effectiveness hypothesis: Asystematic review of systematic reviews.

Health interventions based on theory may be more effective than those that are not. This review of reviews synthesizes all published randomized controlled trial (RCT) meta-analytic evidence from the last decade to examine whether theory-based interventions were found to be associated with more effective adult health behaviour change interventions. Systematic reviews including meta-analyses were identified by searching Medline, CINAHL, PsycINFO, and CDSR. A narrative synthesis was used to summarize and analyse the evidence. Only reviews including RCTs of health behaviour change interventions with adults aged 18+ published from 2007 to 2017 were included. Of 8,659 articles, nine systematic reviews met inclusion criteria. The majority of reviews (n=8) suggested no increased effectiveness for theory-based compared to non-theory-based interventions for effectiveness of outcomes relating to health behaviour. Less than half of the RCTs included in the reviews reported the use of theory (85/183). Two reviews suggested interventions based on control theory, motivational interviewing, or self-determination theory were associated with greater effectiveness for physical activity and/or dietary interventions and outcomes. Methodological and reporting issues limit the conclusions. Theory-based interventions as currently operationalized in systematic reviews were not found to be more effective than non-theory-based interventions. Methodological and reporting issues at study and review level may not reflect the true utility of theory use within health behaviour interventions. The promotion of theory use may benefit from using a multifaceted argument, rather than a narrow focus of increased effectiveness. Statement of contribution What is already known on this subject? Theory use is regularly promoted by claiming that it will lead to more effective behaviour change interventions. Theory use has been frequently linked to effectiveness within systematic reviews of behaviour change interventions. The theory-effectiveness hypothesis has not been systematically examined at the systematic review level. What does this study add? Theory use as operationalized by systematic review authors was not associated with increased effectiveness within systematic reviews examining randomized controlled trials of behaviour change interventions in adults. Interventions based on control theory, motivational interviewing, or self-determination theory were associated with greater effectiveness for physical activity and/or dietary interventions and outcomes. Theory use should be promoted using a multifaceted argument, and assertions for increased effectiveness of theory-based interventions should only be used in domains where specific evidence exists to support this claim.

Effectiveness and cost-effectiveness of a loyalty scheme for physical activity behaviour change maintenance: a cluster randomised controlled trial

BackgroundThe workplace is ideal to encourage habitual physical activity, but little evidence exists on effective behaviour change interventions that lead to sustained behaviour. We aimed to address this gap by evaluating the effectiveness and cost-effectiveness of a loyalty-based intervention on physical activity in public sector employees. MethodsWe conducted a cluster randomised wait-list controlled trial in public sector organisations in Northern Ireland, UK. We randomly assigned clusters (1:1) using a computer-generated random sequence. Researchers were masked to allocation, but participants were not. Employees aged 18–65 years with no medical contraindications to physical activity were included. The Physical Activity Loyalty scheme intervention was based on high-street loyalty cards where participants earned points for minutes of activity (monitored via remote sensing) that could be redeemed for rewards (1 min=about £0·03), complemented by evidence-based behaviour change techniques. The primary outcome was objectively measured mean steps per day at 6 months using a validated pedometer (Digi-Walker CW-701, Yamax, Japan) measured during 7 days, assessed with intention-to-treat analysis. Secondary outcomes used for economic analyses, nested within the study, included self-reported health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of health-care resources. Cost-effectiveness, cost-benefit, and mediation analyses were conducted. This trial is registered with the ISRCTN Registry, number ISRCTN17975376. FindingsBetween Sept 1, 2014, and Oct 31, 2015, we recruited and randomly assigned 37 clusters and 853 participants (71% female, mean age 43·6 years [SD 9·6]) to the intervention (19 clusters, 457 participants) or control group (18, 396). Primary outcome data were available for 249 (54·4%) intervention and 236 (59·6%) control participants. Mean steps per day were significantly lower in the intervention group at 6 months (adjusted mean difference −336, 95% CI −612 to −60; p=0·02). The intervention was not cost-effective. There was a 60% probability of the intervention being cost-saving from an employer's perspective arising from reduced absenteeism. InterpretationOur mixed results pose challenges that are too infrequently exposed in public heath intervention trials. Our incentive level might have been too low to incentivise change, even though it was designed a priori by a contingent valuation survey. Also, major re-structuring of several organisations presented substantial implementation challenges. FundingNational Institute for Health Research Public Health Research (PHR) Programme.

Co-Designing a Device for Behaviour-Based Energy Reduction in a Large Organisation

Decreasing our demand for energy is an important component of the global effort to reduce carbon emissions. Energy consumption, both at home and in the workplace, is greatly influenced by human behaviour. Our research investigates how technological interventions could support behaviour-based energy reduction. This paper reports a Living Lab study on the co-design of a device for improving energy efficiency via behaviour change in a large public-sector organisation. We emphasise the importance of taking a broad view of organisational behaviour, highlighting the complex and indirect ways that it influences energy use. Methods and findings are reported from a series of insight and innovation workshops that we held with staff, and which led to the development of a prototype device - LILEE: The Little Interface for Lab Equipment Efficiency. We describe LILEE and discuss how it embodies wider lessons for the design of effective energy-related behaviour change interventions.

Changing behaviour \u2018more or less\u2019\u2014do theories of behaviour inform strategies for implementation and de-implementation? A critical interpretive synthesis

BackgroundImplementing evidence-based care requires healthcare practitioners to do less of some things (de-implementation) and more of others (implementation). Variations in effectiveness of behaviour change interventions may result from failure to consider a distinction between approaches by which behaviour increases and decreases in frequency. The distinction is not well represented in methods for designing interventions. This review aimed to identify whether there is a theoretical rationale to support this distinction.MethodsUsing Critical Interpretative Synthesis, this conceptual review included papers from a broad range of fields (biology, psychology, education, business) likely to report approaches for increasing or decreasing behaviour. Articles were identified from databases using search terms related to theory and behaviour change. Articles reporting changes in frequency of behaviour and explicit use of theory were included. Data extracted were direction of behaviour change, how theory was operationalised, and theory-based recommendations for behaviour change. Analyses of extracted data were conducted iteratively and involved inductive coding and critical exploration of ideas and purposive sampling of additional papers to explore theoretical concepts in greater detail.ResultsCritical analysis of 66 papers and their theoretical sources identified three key findings: (1) 9 of the 15 behavioural theories identified do not distinguish between implementation and de-implementation (5 theories were applied to only implementation or de-implementation, not both); (2) a common strategy for decreasing frequency was substituting one behaviour with another. No theoretical basis for this strategy was articulated, nor were methods proposed for selecting appropriate substitute behaviours; (3) Operant Learning Theory makes an explicit distinction between techniques for increasing and decreasing frequency.DiscussionBehavioural theories provide little insight into the distinction between implementation and de-implementation. Operant Learning Theory identified different strategies for implementation and de-implementation, but these strategies may not be acceptable in health systems. Additionally, if behaviour substitution is an approach for de-implementation, further investigation may inform methods or rationale for selecting the substitute behaviour.

The Norwegian Healthy Life Centre Study: A pragmatic RCT of physical activity in primary care.

The aim of this study was to evaluate the effect of behaviour change interventions at Norwegian Healthy Life Centres (HLCs) on participants' moderate to vigorous intensity physical activity (MVPA) six months after baseline. We also explore predictors of change in MVPA, and if level of education and MVPA at baseline modify the effect. A randomised controlled trial with inclusion criteria age ⩾ 18 years and ability to participate in group-based physical activity. Participants were randomised to either behaviour change interventions or a waiting list (control). Objective recordings of physical activity were the main outcome, analysed with simple and multiple linear regression. We recruited 118 participants from six HLCs. Participants with mental, musculoskeletal, or chronic somatic disease were more likely to drop out. We revealed no differences in MVPA or sedentary time between the groups. Types of motivation or several characteristics of disadvantage at baseline could not explain changes in MVPA. Across both groups, 83% achieved the recommended 150 minutes of MVPA per week, and participants with a lower level of education were less likely to improve. Participants in the intervention group who were least active at baseline significantly increased their MVPA. The study revealed that the intervention had no short-term effect on time spent on MVPA or sedentary. This study does not support a strong emphasis on behaviour change on an individual level as a way of targeting general health and risk reduction at a population level. Although less active people benefitted more from the HLC intervention, the intervention was unable to counteract widening of inequity across educational groups.

An international, Delphi consensus study to identify priorities for methodological research in behavioural trials: A study protocol

Background: Effective behaviour change interventions are needed to impact important health outcomes, including morbidity and mortality. However, the uptake and impact of behavioural interventions have been limited by methodological challenges. The International Behavioural Trials Network (IBTN) was established in 2013 to facilitate global improvement in methodological quality of behavioural trials. There has been no formal process, within the network or in the broader literature, to define the most important research priorities to achieve this aim. In this project, we will conduct an international, Delphi consensus study to identify and achieve consensus on priorities for methodological research in behavioural trials among IBTN members. Methods: Fifteen core members of IBTN, who are experts in the field of behavioural intervention research, will be invited to generate a list of all items they consider priority areas for methodological research in trials of behavioural interventions. The IBTN Research Prioritisation team (the authors) will review all items generated, removing duplicates and merging similar topics, and generate a ‘long-list’ of items. This long-list will be sent to the 15 IBTN core members for approval. We will then administer two online Delphi surveys to all IBTN members. In the first survey, respondents will be asked to rate the importance of each item on a nine-point scale and rank their top five priorities. In the second survey, respondents will receive feedback on others’ responses and a reminder of their own responses in survey 1, and will be asked to re-rate items and re-select their ‘top five’. Discussion: Findings from the project will be used to inform the research agenda of the IBTN and to make recommendations for future research.

Interventions to Promote Healthy Eating, Physical Activity and Smoking in Low-Income Groups: a Systematic Review with Meta-Analysis of Behavior Change Techniques and Delivery/Context

PurposeHealthy eating, physical activity and smoking interventions for low-income groups may have small, positive effects. Identifying effective intervention components could guide intervention development. This study investigated which content and delivery components of interventions were associated with increased healthy behavior in randomised controlled trials (RCTs) for low-income adults.MethodData from a review showing intervention effects in 35 RCTs containing 45 interventions with 17,000 participants were analysed to assess associations with behavior change techniques (BCTs) and delivery/context components from the template for intervention description and replication (TIDieR) checklist. The associations of 46 BCTs and 14 delivery/context components with behavior change (measures of healthy eating, physical activity and smoking cessation) were examined using random effects subgroup meta-analyses. Synergistic effects of components were examined using classification and regression trees (meta-CART) analyses based on both fixed and random effects assumptions.ResultsFor healthy eating, self-monitoring, delivery through personal contact, and targeting multiple behaviors were associated with increased effectiveness. Providing feedback, information about emotional consequences, or using prompts and cues were associated with reduced effectiveness. In synergistic analyses, interventions were most effective without feedback, or with self-monitoring excluding feedback. More effective physical activity interventions included behavioral practice/rehearsal or instruction, focussed solely on physical activity or took place in home/community settings. Information about antecedents was associated with reduced effectiveness. In synergistic analyses, interventions were most effective in home/community settings with instruction. No associations were identified for smoking.ConclusionThis study identified BCTs and delivery/context components, individually and synergistically, linked to increased and reduced effectiveness of healthy eating and physical activity interventions. The identified components should be subject to further experimental study to help inform the development effective behavior change interventions for low-income groups to reduce health inequalities.

Digital Behaviour Change Interventions to Break and Form Habits

Digital behaviour change interventions, particularly those using pervasive computing technology, hold great promise in supporting users to change their behaviour. However, most interventions fail to take habitual behaviour into account, limiting their potential impact. This failure is partly driven by a plethora of overlapping behaviour change theories and related strategies that do not consider the role of habits. We critically review the main theories and models used in the research to analyse their application to designing effective habitual behaviour change interventions. We highlight the potential for Dual Process Theory, modern habit theory, and Goal Setting Theory, which together model how users form and break habits, to drive effective digital interventions. We synthesise these theories into an explanatory framework, the Habit Alteration Model, and use it to outline the state of the art. We identify the opportunities and challenges of habit-focused interventions.

Interventions Developed with the Intervention Mapping Protocol in Work Disability Prevention: A Systematic Review of the Literature.

Purposes Intervention mapping (IM) is a protocol for developing effective behavior change interventions. It has been used for 10years to develop work disability prevention (WDP) interventions, but it is not known to what extent and with what success. The main objective of this study was to review the effectiveness of these interventions. Secondary objectives were to review their fidelity to the IM protocol, their theoretical frameworks and their content. Methods A search strategy was conducted in MEDLINE, Web of Science, PsycINFO, Pascal, Francis, and BDSP. All titles and abstracts were reviewed. A standardized extraction form was developed. All included studies were reviewed by two reviewers blinded to each other. Results Eight WDP interventions were identified aimed at return to work (RTW; n = 6) and self-management at work (n = 2). RTW interventions targeted workers with stress-related mental disorders (n = 1), low back pain (n = 1), musculoskeletal disorders (n = 1), cancer (n = 2) and gynecological surgery (n = 1). The fidelity to the IM protocol was weaker for the participatory planning group. Matrices of change, change methods, and applications were systematically reported. The main theoretical frameworks used were the attitude-social influence-self efficacy model (n = 4) and the theory of planned behavior (n = 2). Half of the interventions included a workplace component (n = 4). Two interventions were reported as effective, and one partially effective. Conclusion The IM protocol is used in WDP since 2007. The participative dimension appears underused. Few theoretical frameworks were used. Implications are to better consider the stakeholders involvement, and mobilize theoretical frameworks with greater attempts to intervene on the work environment.

An international, Delphi consensus study to identify priorities for methodological research in behavioural trials: A study protocol

Background: Effective behaviour change interventions are needed to impact important health outcomes, including morbidity and mortality. However, the uptake and impact of behavioural interventions have been limited by methodological challenges. The International Behavioural Trials Network (IBTN) was established in 2013 to facilitate global improvement in methodological quality of behavioural trials. There has been no formal process, within the network or in the broader literature, to define the most important research priorities to achieve this aim. In this project, we will conduct an international, Delphi consensus study to identify and achieve consensus on priorities for methodological research in behavioural trials among IBTN members. Methods: Fifteen core members of IBTN, who are experts in the field of behavioural intervention research, will be invited to brainstorm a complete list of all items they consider priority areas for methodological research in trials of behavioural interventions. The IBTN Research Prioritisation team (the authors) will review all items generated, removing duplicates and merging similar topics, and generate a ‘long-list’ of items. This long-list will be sent to the 15 IBTN core members for approval. We will then administer two online Delphi surveys to all IBTN members. In the first survey, respondents will be asked to rate the importance of each item on a nine-point scale and rank their top five priorities. In the second survey, respondents will receive feedback on others’ responses and a reminder of their own responses in survey 1, and will be asked to re-rate items and re-select their ‘top five’. Discussion: Findings from the project will be used to develop the research agenda of the IBTN and to make recommendations for future research.

Bayesian evaluation of behavior change interventions: a brief introduction and a practical example

ABSTRACTIntroductionEvaluating effects of behavior change interventions is a central interest in health psychology and behavioral medicine. Researchers in these fields routinely use frequentist statistical methods to evaluate the extent to which these interventions impact behavior and the hypothesized mediating processes in the population. However, calls to move beyond the exclusive use of frequentist reasoning are now widespread in psychology and allied fields. We suggest adding Bayesian statistical methods to the researcher’s toolbox of statistical methods.ObjectivesWe first present the basic principles of the Bayesian approach to statistics and why they are useful for researchers in health psychology. We then provide a practical example on how to evaluate intervention effects using Bayesian methods, with a focus on Bayesian hierarchical modeling. We provide the necessary materials for introductory-level readers to follow the tutorial.Conclusion:Bayesian analytical methods are now available to researchers through easy-to-use software packages, and we recommend using them to evaluate the effectiveness of interventions for their conceptual and practical benefits.

Relationship of Self-Determination Theory Constructs and Physical Activity and Diet in a Mexican American Population in Nueces County, Texas

Due to disparities in stroke risk among U.S. Hispanics, the need for culturally tailored, theory based effective health behavior change interventions persists. The purpose of this study was to examine self-determination theory (SDT) constructs related to cardiovascular disease (CVD) risk factors in a predominantly Mexican American population. The Stroke Health and Risk Education (SHARE) project was a cluster-randomized, faith-based behavioral intervention trial that enrolled Mexican Americans (MAs) and non-Hispanic whites (NHWs) from Catholic Churches in Nueces County, Texas. Data regarding SDT constructs and dietary and physical activity behaviors were collected via computer-assisted interviews using standardized instruments at the baseline assessment. Of the 801 subjects who consented, 760 completed baseline interviews. After eliminating cases with missing data, 733 participants (617 MA and 116 NHW) were included in the analyses. Participants were predominantly Mexican American (84%) and female (64%), and had a median age of 53 years. There were no significant ethnic differences in any of the baseline SDT scale scores with the exception of higher autonomous motivation scores for exercise among MAs (7.00 vs. 6.67, p = 0.01). Demographic differences in mean SDT scale scores were identified for sex, age, and income. Perceived competence and autonomous motivation were both significant predictors of diet and physical activity behaviors. This study increases our understanding of SDT constructs relative to diet and physical activity in a large, predominantly Mexican American sample. The results indicate that SDT is an appropriate framework to address CVD behavioral risk factors in a predominantly Hispanic population.

Applying novel technologies and methods to inform the ontology of self-regulation

Self-regulation is a broad construct representing the general ability to recruit cognitive, motivational and emotional resources to achieve long-term goals. This construct has been implicated in a host of health-risk behaviors, and is a promising target for fostering beneficial behavior change. Despite its clear importance, the behavioral, psychological and neural components of self-regulation remain poorly understood, which contributes to theoretical inconsistencies and hinders maximally effective intervention development. We outline a research program that seeks to define a neuropsychological ontology of self-regulation, articulating the cognitive components that compose self-regulation, their relationships, and their associated measurements. The ontology will be informed by two large-scale approaches to assessing individual differences: first purely behaviorally using data collected via Amazon's Mechanical Turk, then coupled with neuroimaging data collected from a separate population. To validate the ontology and demonstrate its utility, we will then use it to contextualize health risk behaviors in two exemplar behavioral groups: overweight/obese adults who binge eat and smokers. After identifying ontological targets that precipitate maladaptive behavior, we will craft interventions that engage these targets. If successful, this work will provide a structured, holistic account of self-regulation in the form of an explicit ontology, which will better clarify the pattern of deficits related to maladaptive health behavior, and provide direction for more effective behavior change interventions.

The psychological construal of health behaviors

IntroductionIn order to optimize the effectiveness of behavior change interventions, we need to understand how the construal level – how we mentally represent or construe events or behaviors – influences health-related choices. ObjectiveTo examine the impact of mental construal on health decisions. Based on the Construal Level Theory, we predicted that people would give more weight to “cognitive considerations” when making a choice after being primed with the high-level perspective, whereas they would give higher weights to “sensory considerations” after being primed with the low-level perspective. MethodIn the first experiment, ninety-nine participants were primed with either high-level or low-level perspective across decision scenarios about vaccination and physical safety. The second experiment investigated nutrition decisions, which asked seventy participants to taste food that either had no label or was labelled “organic”. Organic label should prime high-level construal as it implies outcomes (e.g., product quality and healthiness) that are more distant in time and uncertain, in contrast with sensory dimensions (e.g. taste and appearance), which are immediately present. Participants rated cognitive and sensory considerations as well as action intentions. ResultsThe first study revealed that after the priming with the high-level construal, cognitive considerations became more important than sensory considerations in predicting protective action intentions, whereas after priming with the low-level construal, sensory considerations became more important. The second study revealed that only sensory considerations predicted decisions to consume the non-labelled product and only the cognitive score predicted decisions to consume the organic-labelled product. ConclusionWe demonstrated a moderating effect of construal-level mindset in health-protective decisions. We also discuss the implications for health promotion and policy, such as optimizing the effectiveness of behavior change interventions.

Methodology for identification of healthstyles for developing effective behavior change interventions

Aim The health of the Hungarian population is not as good as it could be according to the socioeconomic development of the country. Since unhealthy behavior is widespread in the population, behavior change seems to be an appropriate tool to improve health in Hungary. To develop effective interventions, it is first necessary to identify homogeneous groups of people from the point of view of behavior change, i.e., healthstyles. Our aim was to develop a suitable survey methodology and segmentation procedure for identifying healthstyles in Hungary. In this article we present the results of our methodological developments.