Health Behavior Change Theories Research Articles

Health Behavior and Health Behavior Change—Theories and Evidence

Health Behavior and Health Behavior Change—Theories and Evidence

Answering the “What Works?” Question in Health Behavior Change

Answering the “What Works?” Question in Health Behavior Change

Predicting transitions from preintentional, intentional and actional stages of change

Stage theories of health behavior change assume that individuals pass through qualitatively different stages on their way to the adoption of health behaviors. Three common stages (preintention, intention and action) can be defined by stage transitions included in current stage theories and supported by evidence. The present study examines whether transitions between these stages can be predicted by social cognition variables derived from prevailing health behavior theories. At two points in time, the motivation for interdental hygiene behaviors and oral self-care was assessed in 288 participants recruited in dental practices. Stage progression and regression over time were analyzed using discriminant function analysis. Progression from preintention to intention was predicted by action planning, whereas coping planning and self-efficacy predicted transitions from intention. Regression from action was predicted by self-efficacy. Results support the distinction of three common stages. Findings are discussed in terms of their contribution to health behavior theory.

Understanding the Characteristics of Effective Mass Media Campaigns for Back Pain and Methodological Challenges in Evaluating Their Effects

Workshop at the Low Back Pain Forum VIII: Primary Care Research on Low Back Pain held in Amsterdam in June 2006. The aim of the workshop was to 1) describe and compare characteristics and outcomes of back pain media campaigns that have taken place internationally; 2) examine general theories of health behavior change from the mass media literature to determine whether it is possible to develop a theoretical framework to explain the observed outcomes; 3) describe the outcome of discussion and expert consensus around lessons learned from these campaigns that may inform the planning and evaluation of future campaigns; and 4) identify priorities for future research. Mass media campaigns designed to alter societal views about back pain have now been performed in several countries. Although these types of campaigns are an established strategy for delivering preventive health messages, there is limited empirical understanding of the characteristics of effective (or ineffective) health campaigns. We reviewed the content and outcome of back pain mass media campaigns conducted in Australia, Norway, and Canada using the Cochrane Effective Practice and Organization of Care Review Group data collection checklist. We also reviewed models of health behavior change that could be used to guide the design, planning, and evaluation of future campaigns. The draft article was reviewed by a group of international back pain experts before forming the basis for discussion at the workshop. Expert comments and those of workshop participants were synthesized and incorporated into the final manuscript. The outcome of discussion and expert consensus around lessons learned from these campaigns are described. Our article may help to inform the planning and evaluation of future campaigns and identify priorities for future research.

Predicting short-term weight loss using four leading health behavior change theories

BackgroundThis study was conceived to analyze how exercise and weight management psychosocial variables, derived from several health behavior change theories, predict weight change in a short-term intervention. The theories under analysis were the Social Cognitive Theory, the Transtheoretical Model, the Theory of Planned Behavior, and Self-Determination Theory.MethodsSubjects were 142 overweight and obese women (BMI = 30.2 ± 3.7 kg/m2; age = 38.3 ± 5.8y), participating in a 16-week University-based weight control program. Body weight and a comprehensive psychometric battery were assessed at baseline and at program's end.ResultsWeight decreased significantly (-3.6 ± 3.4%, p < .001) but with great individual variability. Both exercise and weight management psychosocial variables improved during the intervention, with exercise-related variables showing the greatest effect sizes. Weight change was significantly predicted by each of the models under analysis, particularly those including self-efficacy. Bivariate and multivariate analyses results showed that change in variables related to weight management had a stronger predictive power than exercise-specific predictors and that change in weight management self-efficacy was the strongest individual correlate (p < .05). Among exercise predictors, with the exception of self-efficacy, importance/effort and intrinsic motivation towards exercise were the stronger predictors of weight reduction (p < .05).ConclusionThe present models were able to predict 20–30% of variance in short-term weight loss and changes in weight management self-efficacy accounted for a large share of the predictive power. As expected from previous studies, exercise variables were only moderately associated with short-term outcomes; they are expected to play a larger explanatory role in longer-term results.

Adopting health behavior change theory throughout the clinical practice guideline process

Adopting a theoretical framework throughout the clinical practice guideline (CPG) process (development, dissemination, implementation, and evaluation) can be useful in systematically identifying, addressing, and explaining behavioral influences impacting CPG uptake and effectiveness. This article argues that using a theoretical framework should increase the utility and probably the implementation of a CPG. A hypothetical scenario is provided using the theory of planned behavior (TPB) to aid in our explanation. While other theories may be viable, the TPB is chosen because it accounts for a wide spectrum of behavioral factors known to influence physician behavior, and because its flexibility allows it to be used for different populations (e.g., specialists), behaviors, and contexts (e.g., hospital, private clinic). In addition, evidence has indicated that the TPB can influence physician behavior. Empirical research examining whether CPG utility can be significantly improved by appropriately selecting and implementing theory throughout the CPG process is warranted.

Mobile eHealth interventions for obesity: a timely opportunity to leverage convergence trends.

Obesity is often cited as the most prevalent chronic health condition and highest priority public health problem in the United States. There is a limited but growing body of evidence suggesting that mobile eHealth behavioral interventions, if properly designed, may be effective in promoting and sustaining successful weight loss and weight maintenance behavior changes.This paper reviews the current literature on the successes and failures of public health, provider-administered, and self-managed behavioral health interventions for weight loss. The prevailing theories of health behavior change are discussed from the perspective of how this knowledge can serve as an evidence base to inform the design of mobile eHealth weight loss interventions. Tailored informational interventions, which, in recent years, have proven to be the most effective form of conventional health behavior intervention for weight loss, are discussed. Lessons learned from the success of conventional tailored informational interventions and the early successes of desktop computer–assisted self-help weight management interventions are presented, as are design principles suggested by Social Cognitive Theory and the Social Marketing Model.Relevant computing and communications technology convergence trends are also discussed. The recent trends in rapid advancement, convergence, and public adoption of Web-enabled cellular telephone and wireless personal digital assistant (PDA) devices provide timely opportunities to deliver the mass customization capabilities, reach, and interactivity required for the development, administration, and adoption of effective population-level eHealth tailored informational interventions for obesity.

Caregiver Knowledge and Adherence in Children With Sickle Cell Disease: Knowing is Not Doing

Though the impact of disease knowledge on adherence to medical recommendations has long been the focus of research, little of this research has focussed on sickle cell compliance in the child and adolescent population. The present study examined the relationship of caregiver knowledge of sickle cell disease (SCD) and children's adherence to prescribed behaviors. Though caregivers with high levels of knowledge of SCD were more likely to report higher levels of adherence, knowledge test score did not predict adherence for the majority of participants (72%). The effect of caregiver knowledge on reported adherence was greater among preadolescents (age ≤ 11) than adolescents (age ≥12). The relationship between knowledge and adherence may not be as strong or direct as is assumed in many theories of health behavior change.

Measuring tobacco dependence treatment outcomes: A perspective from the behavior change consortium

The Behavior Change Consortium (BCC) served as a consortium of 15 National Institutes of Health-funded trials intended to link theories of health behavior change to outcomes related to improved diet, exercise, and/or tobacco cessation. Five sites developed and tested interventions aimed at changing tobacco use behaviors, and the remaining 10 focused on changing diet and/or physical activity. The BCC's tobacco dependence workgroup functioned to identify measures of tobacco use and dependence for use across the 15 BCC trials. The BCC tobacco intervention trials described herein were categorized by type of trial; theory(ies) on which each was based; and the "thickness," or intensity, of the intervention. Between-site differences across these parameters posed conceptual and analytic challenges for combining data for cross-site analyses, which were integral to the BCC mission of identifying mechanisms of health behavior change. The lessons learned by the BCC tobacco dependence workgroup regarding the measurement and analysis of tobacco outcomes among BCC trials are discussed, including the challenges and the opportunities regarding the preparation for cross-site analyses. The workgroup concludes that trials should report both assessment of a prolonged period of abstinence of 6 months or longer, in addition to the traditional 7-day point prevalence outcome.

Yours, Mine, and Ours: The Importance of Scientific Collaboration in Advancing the Field of Behavior Change Research

The Behavior Change Consortium (BCC) has provided a unique opportunity to combine and explore resources, data, processes, and knowledge as a means of strengthening the validity, reliability, and outcomes that compose the field of behavioral science. The workgroups of the BCC were able to transcend disciplinary boundaries by developing a collaborative framework that fused scholarship and creativity to explore research problems in the area of health behavior change theory and intervention. We have identified seven common elements that emerged from each workgroup and fostered inclusion, progress, and ultimately results. These elements were (a) establishing communication channels, (b) identifying objectives, (c) utilizing common measures, (d) obtaining financial support, (e) seeking outside feedback, (f) engaging "big picture" thinking, and (g) bridging theory to practice. In this article we describe the various processes involved in the creation and sustainability of the BCC, including internal and external communications, leadership, workgroup roles, private and public partnerships, and issues associated with data sharing. We also discuss why, in the case of the BCC, the whole is far greater than the sum of its parts. We present this example of unparalleled multibehavioral research collaboration as a model to other collaborative efforts that will be spawned by the new National Institutes of Health Roadmap initiative.

Use of Health Behavior Change Theories to Guide Urinary Incontinence Research

Urinary incontinence in adults has been the focus of researchers for over 40 years. Health behavior change theories, predominantly operant conditioning, have guided much of the intervention research. In recent years cognitive theories have been used to guide behavioral interventions for urinary incontinence. Most research has focused on individual rather than group or community behavior. Few, if any, health behavior change theories have been tested on population-based interventions. To explore urinary incontinence research guided by health behavior change theories. Existing literature on health behavior change theories was analyzed to generate a plan for future research. Gaps in knowledge are identified and discussed and recommendations for future research are made. The development and testing of new theories will guide the next generation of incontinence researchers and ultimately lead to reducing the incidence and prevalence of incontinence.

Planning and Self-Efficacy in the Adoption and Maintenance of Breast Self-Examination: A Longitudinal Study on Self-Regulatory Cognitions

Many women may be reluctant to perform breast self-examination (B.S.E.) regularly due to motivational or self-regulatory deficits. The Health Action Process Approach (Schwarzer, R. (1992). Self-efficacy in the adoption and maintenance of health behaviors: theoretical approaches and a new model. In: Schwarzer, R. (Ed.), Self-efficacy: Thought Control of Action , pp. 217-243. Hemisphere, Washington DC; Schwarzer, R. (2001). Social-cognitive factors in changing health-related behavior. Current Directions in Psychological Science , 10 , 47-51.), a health behavior change model that advocates the separation of motivation and action phases, such as goal setting and goal pursuit, was applied to data from 418 young women whose risk perceptions, outcome expectancies, self-efficacy, intention to perform B.S.E., planning, and reported examination behaviors were examined at two points in time. Risk perception was found to have a negligible influence in a path analysis, whereas self-efficacy emerged as the best predictor of intention and planning. Planning, in turn, appeared to be the best predictor of B.S.E. behaviors, followed by self-efficacy. The results point to the influential role that self-regulatory strategies (such as planning) play in translating goals into action. The study contributes to the current debate on stage theories of health behavior change and the orchestration of self-beliefs and strategies in the context of goal-directed behaviors.

Farmer Health Beliefs About an Occupational Illness that Affects Farmworkers: The Case of Green Tobacco Sickness

Latino migrant and seasonal farmworkers, like all agricultural workers, experience high rates of occupational illness and injury. Interventions to reduce occupational injury among farmworkers must attend to the health beliefs of agricultural employers as well as employees, as employers control many aspects of the work environment. Occupational safety programs for Latino migrant and seasonal farmworkers must also be conceptually based in health behavior change and health disparities theories. We examine health beliefs of tobacco farmers about green tobacco sickness (GTS) to show the importance of delineating employer beliefs in agricultural safety. GTS is a highly prevalent occupational illness among tobacco workers that results from nicotine poisoning through dermal absorption of nicotine during cultivation and harvesting. We use qualitative methods structured by the Explanatory Models of Illness approach to identify farmer beliefs about the etiology, onset, pathophysiology, course, and treatment of GTS. Data were collected through semi-structured in-depth interviews with 15 North Carolina tobacco farmers. A computer-assisted, systematic qualitative analysis framework was applied to the interview transcripts. While tobacco farmers were generally knowledgeable about GTS, their explanatory models for this occupational illness often mis-identified its causes (heat and bending rather than nicotine) and minimized its seriousness. These models included methods of prevention that are not proven (e.g., use of anti-nausea drugs) or are more harmful than GTS (smoking cigarettes). The need for medical treatment was also discounted. Addressing each of these beliefs is important in any program to prevent GTS among farmworkers. Documenting and understanding the beliefs and knowledge of agricultural employers is an important undertaking in our efforts to reduce occupational injury and illness among farmworkers.

Psychosocial Factors Impacting Condom Use Among Adolescents

ABSTRACT This article reviews published research studies that have examined the impact of psychosocial factors on condom use among adolescents, and offers recommendations regarding the examination of psychosocial variables in future research and HIV prevention program development for adolescents. The review includes a critical analysis of methodological issues, and significant psychosocial predictors are discussed within the context of health behavior change theories. Findings suggest that HIV prevention programs for adolescents should address sexual pleasure and eroticization of condom use within the context of dyadic sexual relationships. Future research on adolescent condom use should attempt to address methodological concerns of prior research by using prospective cohort designs, combining qualitative and quantitative methods, and improving the measurement of psychosocial factors.

Toward a better understanding of the influences on physical activity: The role of determinants, correlates, causal variables, mediators, moderators, and confounders

Background: For research on physical activity interventions to progress systematically, the mechanisms of action must be studied. In doing so, the research methods and their associated concepts and terminology become more complex. It is particularly important to clearly distinguish among determinants, correlates, mediators, moderators, and confounder variables used in physical activity research. This article examines the factors that are correlated with and that may have a causal relationship to physical activity. Methods and Results: We propose that the term “correlate” be used, instead of “determinant,” to describe statistical associations or correlations between measured variables and physical activity. Studies of the correlates of physical activity are reviewed. The findings of these studies can help to critique existing theories of health behavior change and can provide hypotheses to be tested in intervention studies from which it is possible to draw causal inferences. Mediator, moderator, and confounder variables can act to influence measured changes in physical activity. Intervening causal variables that are necessary to complete a cause-effect pathway between an intervention and physical activity are termed “mediators.” The relationship between an intervention and physical activity behaviors may vary for different groups; the strata by which they vary are levels of “moderators” of the relationship. Other factors may distort or affect the observed relationships between program exposure and physical activity, and are known as “confounders.” Conclusions: Consistent use of terms and additional research on mediators and moderators of intervention effects will improve our ability to understand and influence physical activity.

The Culture of Adolescence

This article focuses on the culture of adolescence from the social constructionist view and stages of development as described by the experts in developmental theory. Issues are explored regarding the self-concept and "voice" of the adolescent and implications for the home health care professional. Suggestions for the use of health behavior change theory are briefly outlined.

A Theoretically Based Evaluation of HIV / AIDS Prevention Campaigns Along the Trans-Africa Highway in Kenya

Print HIV / AIDS prevention campaign materials ( e . g ., posters , pamphlets , stickers ) from 10 public health organizations in Kenya were evaluated according to the Extended Parallel Process Model ( EPPM ), a health behavior change theory based on the fear appeal literature , at various sites along the Trans - Africa Highway in Kenya . Three groups each of commercial sex workers ( CSW s ), truck drivers ( TDs ) and their assistants ( ASSTs ), and young men ( YM ) who live and work at the truck stops participated in focus group discussions where reactions to the campaign materials were gathered according to this theoretical base . Reactions to campaign materials varied substantially , according to the poster or pamphlet viewed . Overall , most participants wanted more detailed information about ( a ) the proper way to use condoms , ( b ) ideas for how to negotiate condom use with reluctant partners , and ( c ) accurate information on symptoms of AIDS and what to do once one contracted HIV . Both quantitative and qualitative analyses of the campaign materials are reported .

Helping hospitalized smokers quit: new directions for treatment and research.

To date, relatively little work has been done to develop or evaluate effective inpatient quit-smoking treatment programs. However, there is growing interest in programs that motivate and assist the hospitalized smoker to quit smoking and remain abstinent. This article presents the rationale for hospital-based smoking treatment programs and introduces a practical minimal-contact treatment model based on extensive studies of primary-care-based and self-help interventions, on a limited number of inpatient studies, and on several prominent theories of health behavior change. Recent controlled and exploratory studies of inpatient interventions are reviewed, including programs for the general medical population and programs for special patient groups such as patients hospitalized for cardiovascular disease, pulmonary disease, cancer, and drug or alcohol dependency. Major findings are summarized, and recommendations are given for future treatment and research.

An experiential program to reduce AIDS risk among female sex partners of injection-drug users.

This article describes the development and implementation of an acquired immune deficiency syndrome (AIDS) intervention program for female sex partners of male injection-drug users. Four psychoeducational workshops were designed to motivate personal risk reduction, provide participants with necessary cognitive and behavioral skills, and enhance participants' perceived ability to enact positive changes in their lives. The development of the workshop modules was guided by traditional theories of health behavior change and social learning. Also included in the intervention are referral and advocacy services, personal risk reduction counseling, and human immunodeficiency virus (HIV) antibody testing. Preliminary results indicate that the program has made a significant impact on the AIDS risk of participants--91 percent of women who completed the program reported that they had made positive changes in their lives to reduce their risk of HIV infection.