Health Action Process Approach Model Research Articles

Attitude to Co-Administration of Influenza and COVID-19 Vaccines among Pregnant Women Exploring the Health Action Process Approach Model.

Respiratory tract diseases caused by influenza virus and SARS-CoV-2 can represent a serious threat to the health of pregnant women. Immunological remodulation for fetus tolerance and physiological changes in the gestational chamber expose both mother and child to fearful complications and a high risk of hospitalization. Vaccines to protect pregnant women from influenza and COVID-19 are strongly recommended and vaccine co-administration could be advantageous to increase coverage of both vaccines. The attitude to accept both vaccines is affected by several factors: social, cultural, and cognitive-behavioral. In Palermo, Italy, during the 2021-2022 influenza season, a cross-sectional study was conducted to evaluate pregnant women's intention to adhere to co-administration of influenza and COVID-19 vaccines. The determinants of vaccination attitude were investigated through the administration of a questionnaire and the Health Action Process Approach theory was adopted to explore the cognitive behavioral aspects. Overall, 120 pregnant women were enrolled; mean age 32 years, 98.2% (n = 118) of Italian nationality and 25.2% (n = 30) with obstetric or pathological conditions of pregnancy at risk. Factors significantly associated with the attitude to co-administration of influenza and COVID-19 vaccines among pregnant women were: high level of education (OR = 13.96; p < 0.001), positive outcome expectations (OR = 2.84; p < 0.001), and self-efficacy (OR = 3.1; p < 0.001). Effective strategies to promote the co-administration of the influenza vaccine and the COVID-19 vaccine should be based on the communication of the benefits and positive outcomes of vaccine co-administration and on the adequate information of pregnant women.

The relationship between exercise intention, behavioural plans, and exercise behaviour among Korean college students using the Health Action Process Approach (HAPA)

ABSTRACT This study was tests whether action plan mediates the relationship between exercise intention and exercise behaviour, and whether this mediation depends on the level of action self-efficacy, maintenance self-efficacy, and action control, using the HAPA model. The participants were 467 university students (269 males, 198 females, mean age 20.99 ± 2.06 years) who completed measures assessing their exercise intentions, action plan, action self-efficacy, maintenance self-efficacy, action control, and exercise behaviour. Data were analysed using hierarchical regression procedures in terms of moderated mediation. The results showed that action plan partially mediated the relationship between exercise intention and exercise behaviour. Action control × maintenance self-efficacy interaction showed that the strength of exercise intention-exercise behaviour relationship progressed linearly through levels of action plan and maintenance self-efficacy. These findings imply that exercise interventions for university students should focus on simultaneously bolstering action plan, action control, and maintenance self-efficacy.

Evaluation of Social-Cognitive Determinants of Patients’ Hand Hygiene Decisions and the Role of Mental Health in a Cross-Sectional and a Longitudinal Study of German Patients

Patients’ effective hand hygiene helps to reduce healthcare-associated infections and prevents the spread of nosocomial infections and communicable diseases, such as COVID-19. Accordingly, this study aimed to describe effective hand hygiene decisions based on the Health Action Process Approach (HAPA) and whether this pattern is invariant for mental health. Data were collected cross-sectionally from patients who had previously been admitted to a hospital (Nstudy 1 = 279; study 1) and longitudinally from psychosomatic rehabilitation patients (Nstudy 1 = 1073; study 2). The fit of the HAPA framework and changes in hand hygiene decisions regarding compliance, social-cognitive variables of the HAPA, and mental health status were examined. The results revealed that the trimmed HAPA framework fitted the data well (χ2 = 27.1, df = 12, p &lt; 0.01, CMIN/df = 2.26, CFI = 0.97, RMSEA = 0.08). According to multi-group structural equation modeling, the HAPA model with hand hygiene behavior was found to be invariant regarding mental health. To conclude, the trimmed HAPA framework was revealed to be a generic framework for explaining social-cognitive processes relating to hand hygiene decisions. Therefore, helping individuals to perform hand hygiene recommendations requires intention formation and bridging the intention–behavior gap. This can be undertaken by promoting planning and self-efficacy. All processes appear generic to participants with and without mental health challenges.

The effect of nutritional education based on the health action process approach (HAPA) on the pregnancy outcomes among malnourished pregnant mothers

ObjectiveTo examine the effectiveness of nutritional education based on the health action process approach (HAPA) on pregnancy outcomes among malnourished pregnant mothers utilizing nutritional support.MethodsIn a randomized controlled trial, 234 malnourished pregnant women under nutritional support from the fourth month of pregnancy participated. Participants were randomly allocated in study groups by the balance block randomization method. Data were collected using a socio-demographic and pregnancy outcomes checklist as well as self-devised questionnaire assessing the constructs of the HAPA model before and three months after the educational intervention. The framework of the educational intervention was based on the constructs of the HAPA and included three one-hour training sessions through lectures, group discussions, ‘question and answer’ sessions, and the use of educational tools. Data were analyzed using analysis of covariance (ANCOVA) and SPSS software.ResultsPregnancy outcomes including optimal weight gain during pregnancy (p = 0.47), neonate’s birth weight (p = 0.58), gestational age at delivery (p = 0.83), type of delivery (p = 0.48) gestational anemia (p = 0.22), diabetes (p = 0.59) and hypertension (p = 0.29) were not significantly different in the intervention and control groups. The results showed that the educational intervention produced a significant increase in the total score (24 points) in the intervention group. Improvement of scores in the intervention group compared to the control was observed in all of the model constructs except outcome expectation (0.68 decrease). The educational intervention in the present study had a large measure of effect in total (SMD: 2.69, partial eta2: 0.664).ConclusionA nutritional education intervention based on the HAPA model for malnourished pregnant women increased behavioral intention and planning for action to have better nutritional behavior. However, the intervention did not change the pregnancy outcomes significantly.Practice implicationsNutritional education based on the HAPA model can be used to improve nutritional behaviors of malnourished pregnant women.

Coaches of youth field sports as delivery agents of injury prevention programmes: how are we training the trainers? A scoping review

ObjectiveTo systematically map the coach education (CE) component of injury prevention programmes (IPPs) for youth field sports by identifying and synthesising the design, content and facilitation strategies used to address...

A Menu-based Nursing Intervention Using the Health Action Process Approach Model on the Stress Response and Postoperative Rehabilitation after Liver Cancer Surgery

We investigated the effects of a menu-based nursing intervention using the health actionprocess approach (HAPA) model on patient stress response and postoperative rehabilitation after livercancer surgery. Methods: We randomly assigned 120 patients with liver cancer to intervention (N=60)or control groups (N=60). Intervention patients received a menu-based nursing intervention using theHAPA model; control patients received routine care. We measured physiological and psychological stressresponses using C-reactive protein (CRP) and cortisol (Cor) levels and the Hamilton anxiety rating scale(HAMA) and the Hamilton depression rating scale (HAMD). Results: Intervention group HAMA and theHAMD scores were lower than the control group’s (p &lt; .05). Postoperative intervention group CRP andCor levels were lower than control group levels at 1 and 3 days (p &lt; .05). Those in the intervention grouphad a shorter time until their first exhaust and meal and a shorter hospital stay than those in the controlgroup (p &lt; .05). Self-management ability and quality of life scores of the intervention group were higherthan for the control group (p &lt; .05). Conclusion: The menu-based nursing intervention using the HAPAmodel can reduce postoperative stress response and complications and accelerate postoperative recovery.

Social cognitive predictors of regular dental visits and mouth self-examination behaviors among the elderly population: An application of the health action process approach model.

The present study aimed to identify the social cognitive predictors of regular dental visits and mouth self-examination behaviors among the elderly population, based on the Health Action Process Approach (HAPA) model. Regular dental visits and mouth self-examination can prevent oral and dental problems among the elders. Little information is available regarding the social cognitive predictive factors of these two behaviors. A cross-sectional study was conducted in 24 municipality centers in Tehran, Iran in 2021. The centers were selected randomly using a multi-stage cluster sampling method and 301 elderly attendants aged 60≥years participated in the study. Data collection was done using a researcher-made questionnaire including demographic characteristics and the HAPA model constructs for two target behaviors. Data were analyzed using the Smart-PLS version 3.3.9 via correlation and PLS-SEM analysis. The mean age of the participants was 65.3±5.33 years and 79.7% were female. The SEM analysis showed that Action Self-Efficacy [b (SD) = 0.595 (0.065), P< 0.001] and Risk Perception [b (SD) = 0.218 (0.070), P< 0.002] were predictors of Intention for mouth self-examination but only Action Self-Efficacy [b (SD) = 0.651 (0.043), P< 0.001] was predictor of Intention for regular dental visits. Recovery Self-Efficacy and Planning directly contributed to the prediction of Mouth Self-Examination. The relationship between Maintenance Self-Efficacy and both behaviors is mediated by Planning. Also, the mediating role of Planning between Intention and target behaviors was confirmed. Action self-efficacy predicted the intention for regular dental visits and mouth self-examination behaviors. The relationship between intention and both behaviors was mediated by Planning. Emphasis on improving Action Self-Efficacy and Intention formation will enhance the effectiveness of interventions aiming at promoting the oral health of the elderly population.

Effects of a Web-Based Behavioral Activation Intervention on Depressive Symptoms, Activation, Motivation, and Volition: Results of a Randomized Controlled Trial

Introduction: Behavioral activation (BA) is effective for the treatment of depression. The Health Action Process Approach (HAPA), which is derived from health psychology, can provide a motivational-volitional framework of BA. Objective: This study investigated the efficacy of a HAPA-based internet-delivered BA intervention (iBA; called InterAKTIV) in individuals with depression, also assessing HAPA-based motivational and volitional outcomes. Methods: In a two-arm randomized controlled efficacy trial with a parallel design, 128 participants with a major depressive episode were randomly allocated to the intervention group (IG; TAU + immediate access to iBA) or control group (CG; TAU + access to iBA after follow-up). The primary outcome of clinician-rated depressive symptoms and secondary outcomes were assessed at baseline (T1), 8 weeks (T2), 6-month after randomization (T3). Data were analyzed on an intention-to-treat basis. Results: Linear mixed model analyses revealed a significant group*time interaction effect on clinician-rated depressive symptoms favoring the IG (F_{2, 156.0} = 7.40; p < 0.001, d = 0.79 at T2, d = 0.25 at T3). The IG was also superior regarding self-rated depressive symptoms, BA, most motivational, and all volitional outcomes. Conclusion: This study shows that HAPA-based iBA can significantly improve clinician-rated depressive symptoms, as well as outcomes used in the HAPA model in people with depression. Building on these efficacy results, in the next step, the relationship between BA interventions and activity levels should be investigated, taking into account motivation and volition as potential mediators.

Effectiveness of Theory-Based Intervention on Knowledge Level, Psychological Constructs, Metabolic Index and Physical Activity Status in Patients with Type 2 Diabetes: Application of the Health Action Process Approach (HAPA) Model

Effectiveness of Theory-Based Intervention on Knowledge Level, Psychological Constructs, Metabolic Index and Physical Activity Status in Patients with Type 2 Diabetes: Application of the Health Action Process Approach (HAPA) Model

Covariates of a healthy diet and physical activity self-management one year after Bariatric surgery: A cross-sectional study.

Healthy diet and physical activity self-management is important in maintaining weight loss and preventing weight regain after bariatric surgery. We aimed at evaluating covariates of healthy diet and physical activity self-management among patients undergone bariatric surgery using Health Action Process Approach (HAPA) model. In this cross-sectional study, 272 patients with a history of bariatric surgery were selected from the data registry of Tehran Obesity Treatment Study (TOTS). Data were collected using bariatric surgery self-management standard questionnaire (BSSQ), and items based on HAPA model for healthy diet and physical activity self-management. Data were analyzed using Path analysis and AMOS version 24. The mean score of self-management was (32 ± 10SD). Coping planning construct (β = 0.22; p<0.001) and risk perception (β = 0.02; p<0.01) in dietary self-management and action planning (β = 0.16; p = 0.001) and risk perception (β = 0.001; p = 0.17) in physical activity self-management had the highest and lowest effect powers, respectively. Coping planning (β = 0.22; p<0.001) and action planning (β = 0.17; p<0.03) in diet, and action planning (β = 0.16; p = 0.010) in physical activity were significantly related to self-management. Also, task-coping self-efficacy (β = 0.28; and p<0.001), outcome expectancies (β = 0.37; p<0.001), risk perception (β = 0.13; p = 0.015) in diet and coping self-efficacy (β = 0.50; p<0.001), outcome expectancies (β = 0.12; p = 0.021) in physical activity were significantly related to behavioral intention. The values of CFI = 0.939 and RMSEA = 0.052 for diet and CFI = 0.948 and RMSEA = 0.048 for physical activity indicated adequate fit. HAPA was applicable as a framework for interventions promoting healthy diet and physical activity self-management in patients who have undergone bariatric surgery.

Factors Influencing Intention on Condom Use During Sexual Intercourse With Regular Female Partners Among Men Who Have Sex With Men in Western China: A Structural Equation Modeling Analysis.

Given the rapid rise in HIV infection among men who have sex with men (MSM) in China, they may be a potential bridge for HIV transmission to the general female population, and increasing condom use is an important protective measure. This study aimed to explore factors that influence the intention of condom use during sexual intercourse with regular female partners among MSM in Western China, based on the Health Action Process Approach model. This study used a baseline sample from a cohort study of the National Science and Technology Major Project. A nonprobability sampling method was adopted to recruit MSM from western China. Information on sociodemographic characteristics, HIV-related characteristics, sexual behavior, and constructs of the Health Action Process Approach model was collected through structured questionnaires, and the data were analyzed using a structural equation model. Among 232 participants, 62.9% (146 of 232) intended to use condoms every time they had sex with their regular female partners during the following 3 months. The results of the structural equation model showed that self-efficacy had the greatest influence on behavioral intention (β = 0.398, P < 0.001), followed by negative outcome expectancy (β = -0.303, P < 0.05). In addition, risk perception (β = 0.206, P < 0.05) and positive outcome expectancy (β = 0.270, P < 0.01) had indirect effects on intention, whereas self-efficacy played a mediating role in these indirect influencing factors. Risk perception, outcome expectancy, and self-efficacy are predictors of condom use intention, with self-efficacy in particular serving as a significant medium for future interventions. These findings could provide a reference for future targeted interventions to reduce the likelihood of HIV transmission from MSM to the female population.

Dietary behaviour change intervention for managing sarcopenic obesity among community-dwelling older people: a pilot randomised controlled trial

BackgroundThe effects of dietary intervention in managing sarcopenic obesity are controversial, and behavior change techniques are lacking in previous studies which are important for the success of dietary intervention. This study aimed to evaluate the feasibility and preliminary effects of a dietary behaviour change (DBC) intervention on managing sarcopenic obesity among community-dwelling older people in the community.MethodsA two-armed, RCT was conducted. Sixty community-dwelling older adults (≥ 60 years old) with sarcopenic obesity were randomised into either the experimental group (n = 30), receiving a 15-week dietary intervention combined with behaviour change techniques guided by the Health Action Process Approach model, or the control group (n = 30), receiving regular health talks. Individual semi-structured interviews were conducted with 21 experimental group participants to determine the barriers and facilitators of dietary behaviour changes after the intervention.ResultsThe feasibility of the DBC intervention was confirmed by an acceptable recruitment rate (57.14%) and a good retention rate (83.33%). Compared with the control group, the experimental group significantly reduced their body weight (p = 0.027, d = 1.22) and improved their dietary quality (p < 0.001, d = 1.31). A positive improvement in handgrip strength (from 15.37 ± 1.08 kg to 18.21 ± 1.68 kg), waist circumference (from 99.28 ± 1.32 cm to 98.42 ± 1.39 cm), and gait speed (from 0.91 ± 0.02 m/s to 0.99 ± 0.03 m/s) was observed only in the experimental group. However, the skeletal muscle mass index in the experimental group decreased. The interview indicated that behaviour change techniques enhanced the partcipants’ compliance with their dietary regimen, while cultural contextual factors (e.g., family dining style) led to some barriers.ConclusionThe DBC intervention could reduce body weight, and has positive trends in managing handgrip strength, gait speed, and waist circumference. Interestingly, the subtle difference between the two groups in the change of muscle mass index warrants futures investigation. This study demonstrated the potential for employing dietary behaviour change interventions in community healthcare.Trial registrationRegistered retrospectively on ClinicalTrailas.gov (31/12/2020, NCT04690985).

Construction of a questionnaire based on the Health Action Process Approach for psycho-social cognitive determinants of parents in brushing children's teeth in the Netherlands.

The health action process approach (HAPA) model is promising to increase the frequency of brushing children's teeth by parents to improve their children's oral health. A validated HAPA questionnaire is needed as one of the measures of the effects of such an intervention. The aim of this study was to evaluate whether our data, based on a translated and adopted version of the Health Action Process Approach (HAPA)-based questionnaire on dental flossing, supported the constructs of the HAPA model. If so, a next aim was to assess whether these constructs could be measured reliably. In this cross-sectional study, 269 questionnaires filled out in dental offices by parents of children 1-10 years old were analysed. Scale validation was performed according to the 6-step protocol of Dima, including Mokken scale analyses (MSA), graded response model (GRM), factor analyses and reliability measures. Pearson correlation coefficients were calculated to identify divergent validity and test-retest reliability. MSA showed a unidimensional, medium total scale. Three items were removed based on this analysis. The total scale with the remaining 26 items did not fit the GRM. Factor analysis extracted five factors and two components for the total scale. The separate subscales, except the 'intention' construct, fitted the MSA and did not fit the GRM. The data fitted a seven-factor model better than a one-factor model. Reliability measures varied from acceptable to excellent, but were poor for 'action control'. Test-retest reliability (r's 0.60-0.83) was questionable to good. Our results did not fully support the constructs of the HAPA model. To support the HAPA constructs, modification to the subscales risk perceptions, intention, action planning, action control and self-reported behaviour are suggested. With these adjustments, the reliability and validity of the questionnaire could be significantly improved".

Health action process approach: promoting physical activity, and fruit and vegetable intake among Australian adults.

Based on the health action process approach (HAPA) this study examined whether changes in social cognition constructs could predict change in physical activity and fruit and vegetable intake for adult participants in My health for life, an Australian health promotion behaviour change program. Variance-based structural equation modelling was used to analyse data obtained from Australian adult program participants (n = 167) at baseline (T1), week 14 (T2), week 26 (T2), and 6-month post-program (T4). Change scores were calculated for the social cognition constructs and behaviour. Changes in action self-efficacy and outcome expectancies positively predicted changes in intentions. Action self-efficacy changes also predicted changes in maintenance self-efficacy which, in turn, mediated the effect of action self-efficacy on recovery self-efficacy and planning. Planning was predicted by changes in intentions and maintenance self-efficacy. Findings support the use of the HAPA model in designing complex health behaviour change interventions to achieve sustained behaviour change.

The AHAWOMEN project: study protocol of a multi-design research for exploring HAPA predictors of exercise in postmenopausal women

BackgroundThe postmenopausal period can represent an opportunity for women to improve their health and well-being. The Active and Healthy Ageing in Women during early postmenopause (AHAWOMEN) study aims to identify the key determinants of an active lifestyle among middle-aged women, with a focus on the stages and the social-cognitive variables outlined in the Health Action Process Approach (HAPA) model, a theoretical framework for understanding health behaviour change. We expected that HAPA factors and processes of intention creation (motivational phase) and action adoption (volitional phase) will be significant predictors of exercise initiation and maintenance, supporting both the HAPA tenets and the efficacy of HAPA-based interventions.Methods/designThis study was approved by the authors’ Institutional Review Committee. Postmenopausal women aged between 45 and 65 years will voluntarily participate. The participants will be allocated to one of three groups: Intervention-Initiators (n = 100, random allocation), Control-Sedentary (n = 100, random allocation) or Control-Active (n = 100, non-random allocation). The intervention group will engage in a supervised exercise programme lasting at least 3 months, supplemented with a HAPA-based intervention for behaviour change. The sedentary control group will not receive any intervention to change their physical activity, while the active control group will consist of women who are already regularly adhering to an active lifestyle. Study variables will be measured at baseline and postintervention phases, as well as at 1, 3, 6 and 12-month follow-ups. The predictors of exercise behaviour in the different phases of the behavioural change process will be explored and compared within and between groups throughout the study. These analyses will help identify the factors that determine the adoption of a healthy active behaviour. Additionally, the effectiveness of the model and the intervention for changing active behaviour will be evaluated.DiscussionThis paper describes the rationale, development and methods used in the AHAWOMEN project. Supporting women who intend to become active can help them to translate their goals into sustainable action. Verifying that the HAPA predictions are applicable to postmenopausal women’s adoption of exercise would provide the basis for designing effective interventions for promoting healthy and active ageing that are also tailored to the experiences of middle-aged women.Trial registrationISRCTN16251361. Registration date: 01/06/2023 (retrospectively registered).

A study on the behavior intention of university students participating in winter sports

This study explored the relationship between university students' exercise efficacy and behavioral intention to participate in winter sports. Using a self-efficacy scale, exercise motivation scale, satisfaction with life scale, and the theory of planned behavior questionnaire, the intentions and behaviors of 862 university students were investigated. Based on the Health Action Process Approach (HAPA) model and customer satisfaction theories, a model of the relationship between university students' exercise efficacy and behavioral intention was constructed. The results showed that there was a significantly positive correlation between sports efficacy, motivation, satisfaction, experience perception, and behavioral intention. Sports efficacy had a direct and positive effect on university students' behavioral intention to participate in winter sports (SE = 0.052, Z = 10.673 > 1.96, P = 0.000); The indirect effect of sports efficacy on behavioral intention via motivation and satisfaction was 0.077 (SE = 0.016, Z = 4.813 > 1.96, P = 0.000); the indirect effect of sports efficacy on behavioral intention via experience perception, motivation, and satisfaction was 0.037 (SE = 0.009, Z = 4.111 > 1.96, P = 0.000). Our results not only verify and expand on the HAPA and customer satisfaction theories but also highlight the need for interventions targeting university students' behavioral intention of participating in winter sports from the perspective of improving their sports efficacy, improving the perception of winter sports participation experience, and enhancing their motivation for engaging in exercise and satisfaction with exercise.

Retracted: Effect of Rehabilitation Nursing under the Guidance of the Health Action Process Approach Model on Perioperative Nursing Effect of Artificial Hip Arthroplasty: Effect on Promoting Quality of Life and Postoperative Rehabilitation.

[This retracts the article DOI: 10.1155/2022/1247002.].

Effects of comprehensive care measures based on the HAPA model on self-care, neurotransmitters and clinical outcomes in cerebral infarction patients.

Cerebral infarction is induced by cerebral artery occlusion, resulting in ischemia, hypoxia, necrosis of brain cells in the corresponding blood supply area, and then dysfunction. Health action process approach (HAPA) model emphasizes the proposal and practice of health behavior as a whole and uses self-monitoring and encouraging ultimately developed health behavior. The present study explores the effects of comprehensive nursing measures of HAPA model on neurotransmitters, self-care ability and clinical outcomes of cerebral infarction patients. One hundred and ten patients with cerebral infarction diagnosed and treated in our hospital from July 2020 to February 2022 were included as the subjects. The subjects were randomly grouped as the control (55 patients) and the study group (55 patients) and received conventional nursing measures and additional comprehensive nursing measures of HAPA model, respectively. The patients were tested for changes in self-care ability, nerve damage [myelin basic protein (MBP), S100B, glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE)] and neurotransmitter indexes [acid-soluble protein (Asp), neuropeptide Y (NPY), substance P (SP), glutamate (Glu)], respectively. The patients were considered as the good prognosis group (47 cases) and poor prognosis group (63 cases) according to the prognosis after comprehensive care. The logistic regression model was used to analyze the risk factors affecting the poor prognosis of patients with cerebral infarction. After nursing, China Stroke Scale (CSS) score, the Fugl Meyer Rating Scale (FMA) score and Barthel index were significantly higher in both groups than before nursing, and all indexes were significantly higher in the study group than in the control group (p< 0.05). The length of hospital stay was significantly shorter in the study group than in the control group (p< 0.05). Compared with before nursing, the health knowledge, self-care skills, self-responsibility and self-concept of two groups were strongly increased after nursing, and the study group had much higher indexes than the control group (p< 0.05). After nursing, the levels of MBP, S100B, GFAP, NSE, Asp, NPY, SP and Glu in both groups were largely decreased, and more significant decrease was found in the study group (p< 0.05). Age, body mass index (BMI), hypertension history, coronary heart disease history and National Institutes of Health Stroke Score (NIHSS) score after treatment were significantly different between the good and poor prognosis groups (p< 0.05). The prognosis of patients in the study group was 52.73%, which was significantly higher than 32.73% in the control group (p< 0.05). Age, hypertension history, and post-treatment NIHSS score were independent risk factors related to poor prognosis by logistic multiple regression analysis (p< 0.05). Comprehensive care measures of HAPA model may be used with advantage to improve the self-care ability, reduce the degree of neurological damage, and improve neurological function in cerebral infarction patients. Age, hypertension history, and NIHSS score after treatment were all risk factors related to poor prognosis.

Determinants Influenced by COVID-19 Vaccine: Employing the Health Action Process Approach and the Belief in Conspiracy Theories.

Vaccination is considered a practical approach to improving individuals' health behavior to fight against the COVID-19 pandemic. However, the currently manufactured COVID-19 vaccines can only work for a limited time. Thus, continuous vaccination intention is crucially essential. The current study explores critical factors influencing citizens' continuous vaccination intentions for COVID-19 vaccines, based on the modified health action process approach (HAPA) model and belief in a conspiracy theory. A questionnaire survey was used to collect data from people living in Taiwan. Three hundred ninety responses were employed for the final investigation. The findings suggest that openness to experience, government communication, and pandemic knowledge significantly influence vaccination intention, but the COVID-19 threat is insignificant. Second, descriptive norms play a significant role in promoting vaccination intention. Third, a belief in conspiracy theories negatively influences vaccination intention. Fourth, vaccination behavior positively influences both perceived benefits and value co-creation. Fifth, perceived benefits positively impact value co-creation and continuous vaccination behavior. Finally, value co-creation has a significant influence on continuous vaccination behavior. The proposed model, the key contributor to the current study, confirms citizens' continuous vaccination intentions in a three-stage procedure: motivation to volitional, volitional to behavior, and volitional to continuous vaccination intention.

Factors influencing adherence to lifestyle prescriptions among patients with nonalcoholic fatty liver disease: A qualitative study using the health action process approach framework.

Lifestyle modifications aimed at weight loss have been introduced as a cornerstone of nonalcoholic fatty liver disease (NAFLD) management. However, very few patients follow the doctor's prescription to change their lifestyle to achieve weight loss in the real world. The purpose of this study was to use the Health Action Process Approach (HAPA) model to examine the factors that affect adherence to lifestyle prescriptions among patients with NAFLD. Semi-structured interviews were conducted with patients with NAFLD. Reflexive thematic analysis and framework analysis were used to determine naturally identified themes and allocate them to theoretically driven domains. Thirty adult patients with NAFLD were interviewed, and the identified themes were mapped directly onto the constructs of the HAPA model. This study revealed that key barriers to adhering to lifestyle prescriptions are related to the coping strategy and outcome expectation constructs of the HAPA model. For physical activity, conditional limits, lack of time, symptoms such as fatigue and poor physical fitness, and fear of sports injury are the primary barriers. Barriers to diet are mainly diet environment, mental stress, and food cravings. Key facilitators for adherence to lifestyle prescriptions include developing simple and specific action plans, coping strategies to flexibly deal with obstacles and difficulties, receiving regular feedback from doctors to improve self-efficacy, and using regular tests and behavior recording to enhance action control. Future lifestyle intervention programs should pay particular attention to the planning, self-efficacy, and action control-related constructors of the HAPA model to promote the adherence of patients with NAFLD to lifestyle prescriptions.