Health Action Process Approach Research Articles

Health Action Process Approach in Non-Communicable Diseases: A Systematic Review

Health Action Process Approach in Non-Communicable Diseases: A Systematic Review

Health And Performance Promotion in Youth (HAPPY) hybrid effectiveness-implementation cluster randomised trial: comparison of two strategies to implement an injury prevention exercise programme in Danish youth handball

ObjectiveTo investigate if a combination of an online and onsite implementation strategy was superior to an online-only strategy in enhancing the use of an injury prevention exercise programme (IPEP) and...

Development and psychometric assessment of a health action process approach (HAPA) inventory for home nutritional behavior among postoperative gastric cancer patients

ObjectiveThe aim of this study was to develop and validate a health action process approach (HAPA) inventory for measuring cognitive belief factors influencing home nutritional behavior among postoperative gastric cancer patients. MethodsItem pool of the inventory was constructed based on the HAPA, literature review, and qualitative interview. Expert consultations were used for item improvement. Then postoperative gastric cancer patients (n ​= ​404) were surveyed to conduct item analysis, reliability and validity test of the inventory. Reliability was evaluated through internal, split-half, and test–retest reliability. Validity was assessed through content and construct validity. ResultsStarting with 44 items in the item pool, the final inventory comprised 23 items. The exploratory factor analysis identified six dimensions—namely, risk perception, outcome expectancy, self-efficacy, intention, action planning, coping planning. And the cumulative variance contribution rate was 70.676%. Confirmatory factor analysis showed the model fits well (χ2 ​= ​370.794, df ​= ​214, and χ2/df ​= ​1.733, root mean square of approximation error ​= ​0.054, comparative fit index ​= ​0.943, Tucker–Lewis index ​= ​0.933, and incremental fitting index ​= ​0.944). The item and scale level content validity were 0.83–1.00, and 0.98, which was considered good. The reliability was acceptable (Cronbach's α ​= ​0.922, split-half reliability ​= ​0.781, test–retest reliability ​= ​0.716). ConclusionsThe developed inventory was valid and reliable to assess HAPA-based cognitive belief factors of home nutritional behavior of postoperative gastric cancer patients. Future research is needed to examine the applicability of the inventory in patients across diverse cultural backgrounds and healthcare systems.

Application of an Adapted Health Action Process Approach Model to Predict Engagement With a Digital Mental Health Website: Cross-Sectional Study.

Digital Mental Health (DMH) tools are an effective, readily accessible, and affordable form of mental health support. However, sustained engagement with DMH is suboptimal, with limited research on DMH engagement. The Health Action Process Approach (HAPA) is an empirically supported theory of health behavior adoption and maintenance. Whether this model also explains DMH tool engagement remains unknown. This study examined whether an adapted HAPA model predicted engagement with DMH via a self-guided website. Visitors to the Mental Health America (MHA) website were invited to complete a brief survey measuring HAPA constructs. This cross-sectional study tested the adapted HAPA model with data collected using voluntary response sampling from 16,078 sessions (15,619 unique IP addresses from United States residents) on the MHA website from October 2021 through February 2022. Model fit was examined via structural equation modeling in predicting two engagement outcomes: (1) choice to engage with DMH (ie, spending 3 or more seconds on an MHA page, excluding screening pages) and (2) level of engagement (ie, time spent on MHA pages and number of pages visited, both excluding screening pages). Participants chose to engage with the MHA website in 94.3% (15,161/16,078) of the sessions. Perceived need (β=.66; P<.001), outcome expectancies (β=.49; P<.001), self-efficacy (β=.44; P<.001), and perceived risk (β=.17-.18; P<.001) significantly predicted intention, and intention (β=.77; P<.001) significantly predicted planning. Planning was not significantly associated with choice to engage (β=.03; P=.18). Within participants who chose to engage, the association between planning with level of engagement was statistically significant (β=.12; P<.001). Model fit indices for both engagement outcomes were poor, with the adapted HAPA model accounting for only 0.1% and 1.4% of the variance in choice to engage and level of engagement, respectively. Our data suggest that the HAPA model did not predict engagement with DMH via a self-guided website. More research is needed to identify appropriate theoretical frameworks and practical strategies (eg, digital design) to optimize DMH tool engagement.

Systematic Development of an AI Chatbot for Physical Activity Habit Formation in Prehypertension Individual Integrating Needs, Theories, and Evidence.

Prehypertension, an early stage in the development of hypertension, impacts a substantial segment of the adult population worldwide. Addressing this issue, our study introduces HabitBot, an AI-driven chatbot tailored to encourage physical activity (PA) habits among individuals with prehypertension. HabitBot combines natural language processing with multidisciplinary approaches, drawing from both theoretical frameworks and empirical studies. The chatbot development followed a systematic, five-phase process: comprehensive needs assessment, literature review on behavior change theories, analysis for selecting effective behavior change techniques (BCTs), prototype design through intervention mapping, and refining the intervention based on user feedback. The outcome includes a prototype that integrates the Health Action Process Approach and Habit Formation Theory, utilizing twelve identified BCTs effective in fostering PA habits. User feedback further refined the chatbot across multiple dimensions such as user interface, content accessibility, and privacy. HabitBot exemplifies an innovative integration of behavior change strategies with advanced language model technology, paving the way for digital health interventions in chronic disease prevention. Future studies should assess its long-term efficacy in habit formation and explore its applicability to various demographic groups.

A generic logic model for physical activity interventions for the cardiac population using intervention mapping

Abstract Introduction Regular physical activity is important in the secondary prevention of cardiovascular disease. But many cardiac patients have difficulty establishing lifelong physical activity habits, even after completion of an exercise-based cardiac rehabilitation programme. There is a need for effective interventions to support cardiac patients' physical activity. Such interventions are often complex behaviour change interventions whose design should be grounded in programme theory, i.e., a description of how the intervention is expected to lead to its effects and under what conditions. A logic model is often used to communicate programme theory [1]. Purpose The purpose of this work was to describe a generic logic model for behaviour change interventions to increase and maintain physical activity among patients who have had an acute cardiac event. Methods We applied the Intervention Mapping approach [2] to develop a generic logic model that is both data- and theory-driven, i.e. informed by research evidence and behaviour change theory. The at-risk behaviour for the individual cardiac patient was defined as "insufficient independent long-term maintenance of heart-healthy physical activity", compounded by the environmental factor "lack of support provision for long-term independent physical activity" from the healthcare providers and people in the patient’s interpersonal environment. We defined performance objectives by asking the questions: "What do people who had an acute cardiac event need to do to increase and maintain their heart-healthy physical activity?" and "What do the healthcare providers and people in the patient’s interpersonal environment need to do to encourage and support the patient in being physically active?" The performance objectives specify what actions are required of the individuals targeted in the intervention. We selected determinants corresponding to performance objectives based on empirical evidence from systematic reviews and based on behaviour change theory such as the Reasoned Action Approach (RAA) and the Health Action Process Approach (HAPA). Results Central elements of the logic model are presented in table 1. The logic model includes 18 performance objectives and 13 determinants, supported by empirical evidence from 40 scientific publications. Conclusion The generic logic model serves as a collection of current knowledge regarding increasing and maintaining physical activity among the cardiac population and can be used for a number of purposes: as a foundation for developing new interventions; as a blueprint against which to compare and/or solidify the programme theory of existing interventions; as a conceptual framework for designing evaluations of interventions; as a current evidence map from which to identify research gaps; and as a point of reference for reflecting on one’s own health behaviour.Table 1.Elements of the logic model.

Physical Activity Interventions Framed by the Health Action Process Approach for Adults with Long-Term Conditions: A Scoping Review.

Interventions that use the Health Action Process Approach (HAPA) model show promise for increasing PA frequency, duration, and intensity. However, there is limited understanding of how HAPA model variables have been operationalized for PA interventions in chronic disease to promote behavior change and sustained PA or whether the phase or continuous form of the HAPA model was used. The aim of this scoping review is to describe how the HAPA model variables for PA interventions were operationalized and provide details of implementation. We searched five databases to identify studies published between January 1992 and March 2024. We aimed to describe (1) the characteristics of interventions including setting, delivery mode, duration, and content; (2) which HAPA variables were operationalized and the strategies used; and (3) the physical activity measures and outcome effects. The search identified 23 interventions in 30 papers (12 protocols, 3 quasi-experimental studies, and 15 randomized controlled trials (RCTs)). Seven of the 15 RCTs reported significant positive effects of the HAPA model on PA behavior outcomes. Interventions operationalized between three and nine HAPA constructs showed significant variability in how the HAPA model is used in intervention research. PA measures varied from self-report to validated objective instruments. We found a lack of clarity in decisions about which HAPA constructs were included in interventions. The wide variability in operationalized HAPA constructs made it challenging to compare interventions. Researchers should provide more detail about intervention design and implementation procedures to enhance transparency.

Exploration of helpful elements contributing to engage in physical activity in patients with cancer

PurposeAlthough there are many reported benefits of physical activity for patients with cancer (e.g., improving quality of life), many patients with cancer do not meet the recommendations of physical activity guidelines. The amount of physical activity declines after diagnosis of cancer. This study aimed to clarify the elements that contribute engagement in regular moderate-or-higher-level intensity of physical activity (MHPA), based on the Health Action Process Approach (HAPA), among patients with cancer.MethodsTwo web surveys were conducted among cancer outpatients, asking them to respond to a questionnaire. Participants provided information regarding their demographics, physical activity, purpose, advantages, disadvantages, barriers, triggers, and need for support for regular MHPA.ResultsCategories were obtained for purposes, advantages, disadvantages, barriers, triggers, and support needs for regular MHPA. For example, the support they considered necessary to regularly engage in MHPA were developed 9 categories, such as Improving the environment, Support for the implementation of PA (interpersonal), and Reducing the burden. Women and younger patients provided more statements about reducing their burden; younger patients also mentioned on improving the environment more among those who did not engage in MHPA. Additionally, patients with cancer who provided statements about interpersonal support reported higher barriers to physical activity.ConclusionsThese findings will contribute to the development of a scale to measure the components of the HAPA on physical activity in patients with cancer. In addition, it will help develop a support system that promotes engagement in regular MHPA.

Effect of an Intervention Based on the Health Action Process Approach Model on Mobile Phone Addiction in Adolescents

Background: Mobile phone addiction in adolescents is a serious social problem that not only negatively affects physical and mental health but also hinders social stability and development. However, studies on interventions for mobile phone addiction in adolescents are still few. Therefore, exploring interventions for mobile phone addiction in adolescents and scrutinizing the corresponding mechanism of action are crucial. Methods: A questionnaire survey was conducted on 800 adolescents who were recruited using random sampling from communities in Hubei Province, China in 2023, and 232 of them were identified to have mobile phone addiction. Then, they were randomly divided into the experiment group, comprising 119 members, and the control group, composed of 113 members. The experiment group was given a 3-month intervention under the Health Action Process Approach (HAPA) model, whereas the control group was given no intervention. Results: This intervention significantly reduced the level of mobile phone addiction in adolescents (P&lt;0.05). It also significantly improved self-efficacy in adolescents with mobile phone addiction (P&lt;0.05). The intervention can significantly improved life satisfaction in adolescents with mobile phone addiction (P&lt;0.05). Self-efficacy and life satisfaction had a chain mediating effect (P&lt;0.001). Conclusion: The HAPA model is conducive to alleviating mobile phone addiction. It further enhances the intervention effect by improving self-efficacy and life satisfaction in adolescents.

Validation of an improved questionnaire assessing the social cognitive constructs of the Health Action Process Approach among parents regarding brushing their children's teeth.

The Health Action Process Approach (HAPA) describes social cognitive constructs related to behaviour change. A validated questionnaire is needed to measure these constructs in paediatric dentistry. The aim of this study was to improve an existing HAPA-based questionnaire for parents regarding brushing their children's teeth and to assess its validity and reliability in a population of parents of high caries risk children. Parents of high caries risk children of 3-10 years filled out the adjusted HAPA-based questionnaire. Mokken scale analysis, graded response model analyses, factor analyses and reliability analyses were performed according to the protocol of Dima. Discriminant validity was assessed by comparing the mean scores of the HAPA constructs between two groups of participants, based on different levels of caries experience, brushing frequency and education level of the mother. The Mokken scale analysis and factor analyses indicated a multidimensional eight factor scale. The graded response model did not fit our data. The subscale action control could be identified as a two-factor subscale. Reliability indices from the Dima protocol varied, for instance Cronbach alpha ranged from 0.73 to 0.96. The constructs coping self-efficacy, action planning and action control discriminated between brushing frequencies. The adjusted HAPA-based questionnaire is an improved, valid and reliable instrument that could be used to evaluate HAPA-based interventions to improve children's oral health.

Players are positive regarding injury prevention exercise programmes, but coaches need ongoing support: a survey-based evaluation using the Health Action Process Approach model across one season in amateur and youth football

ObjectivesImplementation of injury prevention exercise programmes (IPEPs) in sports is challenging, and behaviour change among players and coaches is essential for success. The aim was to describe players’ and coaches’...

The effects of a web-based 24-hour movement behavior lifestyle education program on mental health and psychological well-being in parents of children with autism spectrum disorder: A randomized controlled trial

Background and purposeCompared with parents of neurotypical children or children diagnosed with other disabilities, parents of children with autism spectrum disorder (ASD) often experience poorer mental health, greater stress, and more depression and anxiety symptoms. This study aimed to assess the effects of a web-based 24-h movement behavior lifestyle education program on mental health and psychological well-being in parents of children with ASD. MethodsThis study employed a randomized controlled trial utilizing the Health Action Process Approach (HAPA) as a theoretical framework. A total of 318 parents of children with ASD were enrolled and randomly assigned to the experimental or control group. The experimental group received an 8-week web-based 24-h movement behavior lifestyle education program, while the control group followed their usual routine. Two instruments, the Depression Anxiety and Stress Scale (DASS-21) and the Satisfaction With Life Scale (SWLS), were used to measure mental health and psychological well-being, respectively. The data were collected at two time points—at the beginning and the end of the intervention. ResultsCompared with the baseline and control groups, the experimental group demonstrated significant improvements in all outcome measures (p < 0.01). There were significant differences in the DASS-21 and SWLS scores between the two groups before and after the intervention (p ≤ 0.01). ConclusionThis study represents the first randomized controlled trial involving a web-based 24-h movement behavior lifestyle education program specifically designed to address the mental health and psychological well-being of parents of children with ASD. The findings confirm the potential impact of 24-h movement behavior lifestyle education as a functional and effective strategy for parents of children with ASD.

Impact of an Adaptive Worksite Diabetes Prevention Trial on Health Action Process Approach Outcomes regarding Dietary Intake and Physical Activity

Impact of an Adaptive Worksite Diabetes Prevention Trial on Health Action Process Approach Outcomes regarding Dietary Intake and Physical Activity

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.

A global survey exploring tackle training knowledge, attitudes and practices of women's rugby union coaches

The coaching and performance context in women's rugby is not well understood, despite growing popularity worldwide. The aim of this study was to describe the knowledge, attitudes and tackle training practices of women's rugby coaches in relation to tackle safety and performance. A globally distributed online survey exploring coaches’ knowledge, attitudes and practices towards tackling women's rugby was completed by 357 coaches (mean age 41 ± 0.6 years) from 58 countries. The cross-sectional survey was distributed from March 2023 to June 2023. Survey development was guided by the Health Action Process Approach and informed by coaching experts, research evidence synthesis, and guidelines for international tackle safety programmes. Coaches believed that the risk of tackle injury in women's rugby is high and that proper tackle technique for safety is very important. More than 75% of coaches had never completed a tackle-specific training course, with only 39% aware of the availability of such courses. Time spent on controlled-contact and full-contact activities varied from 0 to 40+ min per week, averaging 10–20 min for both types of training. Barriers to the effectiveness of tackle training related to sociocultural factors, coach knowledge gaps, training environments, and player training considerations. Coach education, improved infrastructures, and physical development were ranked the highest priorities for improving tackle safety and performance. These findings inform future implementation strategies for tackle safety and performance in the context of women's rugby, highlighting the need to involve coaches in providing practical solutions, and the role of education and institutional/organisational support in facilitating such improvements.

Assessing teachers' intervention-related expectations and self-efficacy: An examination of the factor structure of the implementation beliefs assessment.

Individual-level determinants are hypothesized to enable or prevent successful implementation of evidence-based practices, yet there are limited options for measuring theory-informed, individual-level determinants that influence teachers' and other implementers' delivery of school-based interventions. The goal of this study was to develop a self-report scale that measures variables that have been associated with initial and sustained behavior change related to school-based intervention implementation according to the health action process approach (HAPA). Participants were a nationally representative sample of kindergarten through Grade 12 public school teachers, stratified by grade level and geographical region. Item generation was based on a systematic review of the literature on outcome expectations and self-efficacy, the core constructs related to initiating and sustaining behavior change from the HAPA and in consultation with the theory developer. The sample was randomly split; half of the sample was used for exploratory factor analysis (EFA), and the other half was used for confirmatory factor analysis (CFA). The EFA resulted in a final factor structure of three dimensions of the Implementation Beliefs Assessment (IBA): (a) implementation self-efficacy, (b) positive outcome expectations, and (c) negative outcome expectations. This structure was supported in the other half of the sample using CFA. Additional analyses supported the reliability of IBA data. The IBA represents a step forward toward psychometrically sound measurement of factors associated with initial and sustained behavior change. Implications for future research are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Understanding physical exercise among individuals with substance use disorders using an integrated theoretical perspective of the health action process approach and theory of planned behavior.

Physical exercise is considered a useful non-pharmacological adjunctive treatment for promoting recovery from substance use disorders (SUD). However, adherence to physical exercise treatments is low, and little is known about what factors are associated with the initiation and maintenance of physical exercise behaviors. The aim of this study was to explore the psychosocial factors underlying these behaviors in individuals with SUD using an integrated theoretical model based on the health action process approach (HAPA) and the theory of planned behavior (TPB). A total of 1,197 individuals with SUDs (aged 37.20 ± 8.62 years) were recruited from 10 compulsory isolation drug rehabilitation centers in Zhejiang Province via convenience sampling according to a set of inclusion criteria. Self-reported data were collected to assess task self-efficacy (TSE), maintenance self-efficacy (MSE), recovery self-efficacy (RSE), outcome expectations (OE), action planning (AP), coping planning (CP), social support (SS), subjective norms (SN), attitude behavior (AB), behavioral intention (BI), perceived behavioral control (PBC), risk perception (RP), exercise stage, and exercise behavior in this integrated model. ANOVA and structural equation modeling (SEM) were used to evaluate this model. One-way ANOVA revealed that the majority of the moderating variables were significantly different in the exercise phase. Further SEM showed that the model fit the data and revealed several important relationships. TSE, RP, SS, AB, and SN were indirectly associated with physical exercise behavior in individuals with SUD through the BI in the SUD initiation stage. In addition, PBC was directly related to physical exercise behavior in individuals with SUD. In the maintenance stage, MSE, AP, CP and exercise behavior were significantly related. Moreover, AP and CP were mediators of BI and MSE. This study is the first attempt to integrate patterns of physical exercise behavior in individuals with SUD. The HAPA-TPB integration model provides a useful framework for identifying determinants of physical exercise behavioral intentions and behaviors in individuals with SUD and for explaining and predicting the initiation and maintenance of physical exercise behaviors in these individuals. Moreover, the model provides scientific guidance for the enhancement of physical exercise adherence in individuals with SUD.

Health Action Process Approach and Spinal Cord Injury: A Scoping Review

Health Action Process Approach and Spinal Cord Injury: A Scoping Review

Exploring the Influence of YouTube on Digital Health Literacy and Health Exercise Intentions: The Role of Parasocial Relationships.

The purpose of this study was to analyze the mediating role of digital health literacy and the moderating effect of parasocial relationships on the relationship between the viewing experience of health exercise-related YouTube content and the intention for health exercise behavior. Based on the health action process approach, this study established a foundational theoretical model to analyze how digital health literacy mediates the impact of media viewing experience on health exercise behavior intention. Additionally, this study examined the moderating effect of parasocial relationships with YouTube creators. For empirical analysis, variables were measured using a self-administration method among 409 randomly sampled consumers of YouTube health exercise content. The collected data were analyzed using a structural equation model incorporating mediation parameters, and a multigroup model analysis was conducted to understand differences based on parasocial relationships. The results revealed that increased YouTube viewing experience enhanced cognitive, skill, and evaluative components of digital health literacy, which were significant factors in increasing health exercise behavior intention. Notably, the mediating effect of cognition played a crucial role, and the strengthening effect of parasocial relationships on this relationship was confirmed. These findings can be utilized as practical foundational data for designing digital health communication strategies, particularly in developing motivational mechanisms that encourage consumers to engage voluntarily and consistently in health behaviors based on online health information.

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.