Health Behavior Decisions Research Articles

The partisan pandemic: Applying the reasoned action approach to understand the effects of politicizing a public health crisis

AbstractIt is well‐established that news outlets cater to audiences with particular political leanings and present news about important events, such as disease outbreaks, differently. However, the mechanisms through which selected media exposure influences behavior are not well established. Two surveys examined the roles of attitudes and social norms as pathways through which political predispositions (political ideology, partisanship) and news media choices influence health behavior decisions. Using early Covid‐19 as a case study, both studies (a student sample [n = 315]; an adult sample [n = 518]) found liberal news viewing was related to positive attitudes and norms about health prevention and subsequently more enacted preventive behaviors among liberals but not conservatives. Interestingly, watching conservative news outlets was not associated with attitudes and norms about health prevention, nor was it related to behavior. Partisanship, but not political ideology, directly predicted participants’ preventive behavior. These findings suggest that party identification serves as a heuristic for conservatives’ and Republicans’ attitudes and behavior, which are not influenced by news media choice. Partisan differences in media preferences influenced the adoption of preventive behavior via the reasoned action pathways for Democrats but not Republicans, suggesting distinct messaging strategies for health communication based on political leaning.

Maternal COVID vaccination and breastfeeding during a pandemic: Habitus and health behavior decision making.

To examine the influence of habitus on women's health behavior regarding breastfeeding and subsequent COVID-19 vaccination. A qualitative descriptive design, guided by Pierre Bourdieu's concept of habitus. Eighteen women who were postpartum, breastfeeding, and vaccinated against COVID- 19 either during pregnancy or while breastfeeding postpartum. Individual semi-structured interviews. Two major themes shaped participants' habitus: health-focused knowledge, and attitudes and beliefs. Attitudes and beliefs included five subthemes: (1) exposure/acceptance/expectations from family, (2) community acceptance of breastfeeding and COVID-19 vaccination, (3) socioeconomic status, (4) easily accessed support, and (5) outside experiences and exposure. An individual's habitus impacts one's knowledge, attitudes, and beliefs and interacts with past behaviors when discussing options for infant feeding and health promoting behaviors such as vaccinations. A better understanding of how health care providers assess and utilize habitus in clinical management is needed.

Differences in health beliefs and behavior compliance of the patients with chronic renal failure

Health belief is about a patient’s belief that vulnerability and treatment efficacy can affect health behavior decisions. This research investigated the difference in behavior compliance of patients with chronic renal failure based on gender and health beliefs' contribution to it. The sample of this research was 30 male and 30 female renal failure patients at Brigjend H. Hasan Basry Hospital. Data was collected by behavior compliance scale and health belief scale. Multivariate analysis was used to analyze the data. The results show a significant relationship between male and female patients' health beliefs and behavior compliance. The health belief of male patients is higher than female patients, while the behavior compliance of female patients is higher than males. It can be concluded that health and gender are factors affecting behavior compliance. Therefore, paramedics may increase patients' health beliefs to enhance behavior compliance, especially among female patients with chronic renal failure.

Disrupting the COVID-19 Misinfodemic With Network Interventions: Network Solutions for Network Problems.

Amid the COVID-19 global pandemic, a highly troublesome influx of viral misinformation threatens to exacerbate the crisis through its deleterious effects on public health outcomes and health behavior decisions.This "misinfodemic" has ignited a surge of ongoing research aimed at characterizing its content, identifying its sources, and documenting its effects. Noticeably absent as of yet is a cogent strategy to disrupt misinformation.We start with the premise that the diffusion and persistence of COVID-19 misinformation are networked phenomena that require network interventions. To this end, we propose five classes of social network intervention to provide a roadmap of opportunities for disrupting misinformation dynamics during a global health crisis. Collectively, these strategies identify five distinct yet interdependent features of information environments that present viable opportunities for interventions.

Parent Perspectives on Implementing Health Behavior Recommendations for Their Infants

Little is known about the influence of parental values, preferences, and child achievement and health expectations on parent choices for their child’s rearing practices. We aimed to explore parents’ perceptions of immediate and future impact of health behavior decisions for their child and to understand factors associated with child-specific health behavior decisions. This pilot study included interviews with 25 parents of 9–24-month-old children attending well child care visits at a primary care practice. Questions assessed parental perceptions and attitudes in making health behavior changes now for their child’s future health. Themes suggest parents perceive many factors are involved, and intricately connected, in health behavior decision-making. Although almost all parents believed there is a connection between the foods they feed their child and achieving their goals, only half are willing to make a change. In addition, parents failed to consider the impact of the health practices they currently have with their children to influence the future acquisition of life skills and of healthy versus obesogenic behaviors. Our results add to the understanding of the process of health behavior change through anticipatory guidance. Study findings will be used to guide next steps towards refining our understanding of health and lifestyle change decisions made by parents.

Transition to Self-Management among Adolescents with Polycystic Ovary Syndrome: Parent and Adolescent Perspectives

PurposePolycystic ovary syndrome (PCOS) is the most common endocrine disorder among females. The foundation of PCOS self-management is engaging in healthy lifestyle habits, however, there is limited literature regarding adolescents' transition to PCOS self-management. The purpose of this study, therefore, is to explore parental and adolescent views of the transition to PCOS self-management. Design and methodsA qualitative descriptive approach was used through focus groups (N = 4) with adolescents diagnosed with PCOS and their parents. ResultsA total of seven adolescents and eight parents participated in two focus groups each. The primary theme from the parent groups was Concerns for Transition to Self-Care with the subthemes of facilitation versus direction and recognition of personal habits. The primary theme identified from the adolescent groups was Taking Control with subthemes of managing symptoms, cognitive dissonance, support, and balance. Conclusions: Study findings provide insight into the experiences of adolescents with PCOS and their parents as they navigate both a family-level transition in health habits and anticipate the adolescent transition to self-management as an emerging adult. Practice implicationsNurses and other health care providers can help facilitate transition to self-management among adolescents with PCOS by encouraging increased independence in health behavior decisions while they are still living at home. Middle and older adolescents who begin to take ownership of their physical activity, nutritional choices, and sleep hygiene will have a firm foundation on which to build as they transition into life beyond high school.

MHealth Technology and Nurse Health Coaching to Improve Health in Diabetes: Protocol for a Randomized Controlled Trial.

BackgroundChronic diseases, including diabetes mellitus, are the leading cause of mortality and disability in the United States. Current solutions focus primarily on diagnosis and pharmacological treatment, yet there is increasing evidence that patient-centered models of care are more successful in improving and addressing chronic disease outcomes.ObjectiveThe objective of this clinical trial is to evaluate the impact of a mobile health (mHealth) enabled nurse health coaching intervention on self-efficacy among adults with type-2 diabetes mellitus.MethodsA randomized controlled trial was conducted at an academic health system in Northern California. A total of 300 participants with type-2 diabetes were scheduled to be enrolled through three primary care clinics. Participants were randomized to either usual care or intervention. All participants received training on use of the health system patient portal. Participants in the intervention arm received six scheduled health-coaching telephone calls with a registered nurse and were provided with an activity tracker and mobile application that integrated data into the electronic health record (EHR) to track their daily activity and health behavior decisions. All participants completed a baseline survey and follow-up surveys at 3 and 9 months. Primary and secondary outcomes include diabetes self-efficacy, hemoglobin A1c (HbA1c), and quality of life measures.ResultsData collection for this trial, funded by the Patient-Centered Outcomes Research Institute, will be completed by December 2017. Results from the trial will be available mid-2018.ConclusionsThis protocol details a patient-centered intervention using nurse health coaching, mHealth technologies, and integration of patient-generated data into the EHR. The aim of the intervention is to enhance self-efficacy and health outcomes by providing participants with a mechanism to track daily activity by offering coaching support to set reasonable and attainable health goals, and by creating a complete feedback loop by bringing patient-generated data into the EHR.Trial RegistrationClinicalTrials.gov NCT02672176; https://clinicaltrials.gov/ct2/show/NCT02672176 (Archived by WebCite at http://www.webcitation.org/6xEQXe1M5)

Improving Medical Decision Making and Health Promotion through Culture-Sensitive Health Communication: An Agenda for Science and Practice.

This review introduces the concept of culture-sensitive health communication. The basic premise is that congruency between the recipient's cultural characteristics and the respective message will increase the communication's effectiveness. Culture-sensitive health communication is therefore defined as the deliberate and evidence-informed adaptation of health communication to the recipients' cultural background in order to increase knowledge and improve preparation for medical decision making and to enhance the persuasiveness of messages in health promotion. To achieve effective health communication in varying cultural contexts, an empirically and theoretically based understanding of culture will be indispensable. We therefore define culture, discuss which evolutionary and structural factors contribute to the development of cultural diversity, and examine how differences are conceptualized as scientific constructs in current models of cultural differences. In addition, we will explicate the implications of cultural differences for psychological theorizing, because common constructs of health behavior theories and decision making, such as attitudes or risk perception, are subject to cultural variation. In terms of communication, we will review both communication strategies and channels that are used to disseminate health messages, and we will discuss the implications of cultural differences for their effectiveness. Finally, we propose an agenda both for science and for practice to advance and apply the evidence base for culture-sensitive health communication. This calls for more interdisciplinary research between science and practice but also between scientific disciplines and between basic and applied research.

Body Image Satisfaction Among Blacks.

Satisfaction with body image is a factor related to health outcomes. The purpose of this study is to examine the relationship between body image satisfaction and body size perception in an urban, Black community sample in New Orleans, Louisiana. Only 42.2% of respondents were satisfied with their body image and 44.1% correctly perceived their body size. Most respondents chose an ideal image in the normal body mass index range with over half choosing an ideal image smaller than their actual size. Misperception was greatest among the heaviest respondents. Females, those who overestimated their size, those with an education beyond high school, and those who were active in order to lose weight were less likely to be satisfied ( p < .001). Those who were active but not trying to lose weight were more likely to be satisfied ( p < .001). This suggests that perception of and satisfaction with body size may play a role in health behavior decisions.

The Tripartite Model of Risk Perception (TRIRISK): Distinguishing Deliberative, Affective, and Experiential Components of Perceived Risk.

Although risk perception is a key predictor in health behavior theories, current conceptions of risk comprise only one (deliberative) or two (deliberative vs. affective/experiential) dimensions. This research tested a tripartite model that distinguishes among deliberative, affective, and experiential components of risk perception. In two studies, and in relation to three common diseases (cancer, heart disease, diabetes), we used confirmatory factor analyses to examine the factor structure of the tripartite risk perception (TRIRISK) model and compared the fit of the TRIRISK model to dual-factor and single-factor models. In a third study, we assessed concurrent validity by examining the impact of cancer diagnosis on (a) levels of deliberative, affective, and experiential risk perception, and (b) the strength of relations among risk components, and tested predictive validity by assessing relations with behavioral intentions to prevent cancer. The tripartite factor structure was supported, producing better model fit across diseases (studies 1 and 2). Inter-correlations among the components were significantly smaller among participants who had been diagnosed with cancer, suggesting that affected populations make finer-grained distinctions among risk perceptions (study 3). Moreover, all three risk perception components predicted unique variance in intentions to engage in preventive behavior (study 3). The TRIRISK model offers both a novel conceptualization of health-related risk perceptions, and new measures that enhance predictive validity beyond that engendered by unidimensional and bidimensional models. The present findings have implications for the ways in which risk perceptions are targeted in health behavior change interventions, health communications, and decision aids.

Mobile Phone and Social Media Use and Preferences for a Secondary Prevention mHealth Intervention Among Youth Living With HIV

Purpose: Adolescents and Young Adults account for nearly 40% of new HIV infections each year and are significantly less likely than their adult counterparts to achieve viral suppression. Individuals living with chronic disease like HIV spend approximately 5,000 waking hours per year outside the doctor’s office in which they make health behavior decisions. Youth constantly consume mobile technology which represents a tremendous opportunity to provide support for adherence to HIV+ youth in the real places and times they need it as they go about their daily lives. The purpose of this study was to (1) understand frequency and patterns of mobile phone and social media use among youth living with HIV and (2) determine youth preferences for a mobile phone based application targeted at improving medication adherence and reducing sexual risk behavior. Methods: The study employed a mixed methods design including (1) a Computer-Assisted Self-Interview (CASI) administered via REDCap on an iPad to determine mobile phone and social media use patterns and frequency and (2) two focus groups were conducted using nominal group technique to determine youth preferences for app features. Participants were asked to list features of a mobile phone app that they felt would be most helpful to increase medication adherence and reduce sexual risk behavior. They were then shown wireframes (drawings of the design, flow, and features) of a potential app developed by the multidisciplinary study team based on their clinical experience including game/app designers, an adolescent medicine physician who provides care for youth living with HIV, and an HIV+ young adult. Finally they were asked to rank the most important feature from their suggestions and those presented by the study team. Results: N1⁄410. Mean age was 21. Participants were 90% male, 80% African American, 60% Android users, and on average spent 13.7 hours per day on their smartphones. The key features identified in the 2 focus groups were (1) medication reminders, (2) a calendar showing adherence progress, (3) panic button, (4) resources and information on medication, housing, insurance, (5) STI testing and condom locator, (6) gaming functions including avatars and team support, (7) message boards and personal stories, (8) pill cam, (9) daily fun facts or inspiringmessages, and (10) direct link tomedical provider. Conclusions: HIV+ youth consume mobile technology frequently and identified key features for a potential mHealth secondary prevention intervention. Next steps include professional app development, usability testing, and a 3-month pilot feasibility trial that will collect data on satisfaction, usage, adherence to medication and other care outcomes. Sources of Support: NIH K23MH102128-01A1 (Dowshen); University of Pennsylvania Center for AIDS Research Pilot Award P30AI45008 (Hoxie). 155.

The Prospective Association of Youth Assets With Tobacco Use in Young Adulthood

Background: Youth assets protect adolescents from tobacco use, but their influence in young adulthood is unknown. Purpose: To determine the prospective influence of assets possessed in young adulthood with tobacco use the following year. Methods: Data from waves 4 and 5 from the Youth Asset Study (n = 450, ages 18-22 at wave 5) were used. Logistic regression was used to prospectively examine associations between 10 wave 4 assets with wave 5 tobacco use by gender. Results: Parental monitoring was significantly associated with wave 5 tobacco use in the youngest group of males (odds ratio [OR] = 10.00). The non-parental adult role model (OR = 2.57) and general self-confidence (OR = 2.41) assets were significantly associated with wave 5 tobacco use in females. Family communication (OR = 5.77) was significantly associated with wave 5 tobacco use for the oldest females, and positive peer role models (OR = 2.83) only for females in 2-parent homes. Discussion: Youth assets continue to positively influence health behavior decisions in emerging adulthood, but males and females also benefit from different assets. Translation to Health Education Practice: Understanding how youth assets impact tobacco use in young adults could lead to more effective tobacco use prevention programs and indicate where future efforts should be focused.

Health Behavior Decision-making in African-American Adults Diagnosed with Schizophrenia

Little is known about the factors that influence health behavior decision-making among people with schizophrenia. The purpose of this qualitative study was to describe the processes used by 10 African-American adults with schizophrenia when making health behavior decisions and identification of perceived barriers and facilitators to health. Three phases of health behavior decision-making were identified: Recognizing Complex Components of Health, Personalizing Components of Health, and Tracking Health Status. Findings may guide clinicians’ efforts to improve the health status of patients, as well as influence future research in understanding health behavior decision-making among vulnerable populations.

Public engagement with scientific evidence in health: A qualitative study among primary-care patients in an urban population.

The purpose of this study is to explore the experience and perspective of patients regarding scientific evidence in health and the degree that this information impacts health behavior and medical decision making. A focus group study was conducted. Participants were recruited from an urban primary-care practice. The focus group discussions were audio-recorded, transcribed verbatim, and coded by two independent investigators. Emergent themes were identified. Participants (n = 30) ranged in age from 30 to 79 years, 60% were female, 77% were black, and 50% had at least some college experience. Three thematic areas informed a wide range in level of interest regarding scientific study design and result information: (1) scientific literacy, (2) medical decision making style, and (3) impact of culture and community on decision making. Our findings indicate that communication strategies that incorporate key elements of scientific study design, methods, and results will most effectively translate findings from comparative effectiveness research to patient-informed decision making regarding evidence-based health interventions.

Integration of the Interaction Model of Client Health Behavior and Transactional Model of Stress and Coping as a Tool for Understanding Retention in HIV Care Across the Lifespan

Retaining people living with HIV (PLWH) in care over the lifespan is critical to quality and longevity of life. Individual health behavior decisions that affect care retention are complicated and multifactorial. Current health behavior theories are inadequate in isolation to guide retention in care research. Two existing models, Cox's Interaction Model of Client Health Behavior, and Lazarus and Folkman's Transactional Model of Stress and Coping have both guided research with PLWH, although not related to retention in care. Integration of these models may more comprehensively inform care retention research and practice across the lifespan as it incorporates not only intra- and inter-personal characteristics and relationships but also the stress and coping experiences inevitable when living with a chronic illness such as HIV.

Time perspective and exercise, obesity, and smoking: moderation of associations by age.

Time perspective, a psychological construct denoting subjective orientation to either present or future concerns, has been inconsistently associated with healthy behaviors in adults. We hypothesized that associations would be stronger in young adults, who are first developing independent attitudes, than in older adults. Cross-sectional survey. The study was conducted in three cities in the Mid-Atlantic region. Subjects were 790 patrons of barber and beauty shops. Measures used were the Zimbardo Time Perspective Inventory future, present-fatalistic, and present-hedonistic subscales and current smoking, days per week of recreational exercise, and height and weight, by self-report. We tested if associations between time perspective and exercise, obesity, and current smoking differed by age group (18-24 years, 25-34 years, and 35 years and older) using analysis of variance and logistic regression. Higher future time perspective scores, indicating greater focus on future events, was associated with more frequent exercise, whereas higher present-fatalistic time perspective scores, indicating more hopelessness, was associated with less frequent exercise in 18- to 24-year-olds, but not in older individuals. Lower future time perspective scores, and higher present-hedonistic time perspective scores, indicating interest in pleasure-seeking, were also associated with obesity only in 18- to 24-year-olds. Current smoking was not related to time perspective in any age group. Time perspective has age-specific associations with exercise and obesity, suggesting stages when time perspective may influence health behavior decision making.

An Examination of Direct and Indirect Effects of Exposure and Attention to Health Media on Intentions to Avoid Unprotected Sun Exposure

Skin cancer is the most commonly diagnosed cancer in the United States, accounting for more than 2 million diagnoses and more than 9,000 deaths annually. A regional online survey of students enrolled at institutions of higher education (N = 1,251) examined (a) associations between health media use and intentions to avoid unprotected sun exposure and (b) theoretically derived health behavior constructs that may mediate the relationship between media use and individuals’ decisions to avoid unprotected sun exposure. Individuals with greater exposure and attention to health information in television, magazines, and newspapers had higher intentions to avoid unprotected sun exposure. Multiple mediation models indicated that health behavior constructs collectively mediated the relationship between television use and sun-protective behavioral intentions. Both cumulative and specific indirect mediating effects were observed for the relationship between magazine use and sun-protective behavioral intentions. However, the direction of effects was opposite to the hypothesized direction, due primarily to the association of magazine use with less favorable attitudes about sun protection and reduced behavioral control to avoid unprotected sun exposure. This study provides preliminary evidence for the interrelationships among media use, internal psychological states and cognitions, and health behavior decision making. Future studies should further explicate the mediating processes that account for the relationships between media and health behavior.

Hails From the Crypt

Interfacing the terror management health model with the meaning transfer model, we offer novel hypotheses concerning the effectiveness of celebrity and medical endorsements for consumer products and health behavior decisions. Studies 1 and 2 revealed that, compared with control topic primes, death thoughts in focal attention increased the effectiveness of health-oriented (doctor) endorsers but not culture-oriented (celebrity) endorsers, whereas death thoughts outside of focal attention increased the effectiveness of culture-oriented endorsers but not health-oriented endorsers. Studies 3 and 4 then focus more specifically on the valence and specificity of culture-oriented endorsements, revealing that death thoughts outside focal attention increase the effectiveness of culture-oriented endorsers only on the behaviors specifically endorsed and only when the endorser is characterized as possessing cultural value. Discussion focuses on everyday management of existential concerns and implications for persuasive communications in the health domain.

L’entretien motivationnel dans la promotion des comportements de santé : une approche de la relation médecin/malade

Many situations in common medical practice, especially in chronic diseases, require patients to be mobilized for health behavior decisions: for daily intake of an antihypertensive drug, performing a mammography for cancer screening, as well as adopting new diet habits in diabetes. Ability to initiate a health behavior depends on several parameters. Some of them are related to the patient, his personality, his illness and treatment's perception; others directly rely on the physician, his attitude and his communication style during the visit, independently of patient's level of resistance to change. Motivational interviewing (MI) is a communication technique, first developed for patients presenting a substance abuse disorder, to explore their ambivalence, overcome their resistances and give them the willingness of a better self-care. Its general principles and basic techniques can be applied by every practitioner and deserve to be better known, given that scientific literature provides evidence for generalizing it in a variety of medical conditions, in structured patient education programs as well as in usual follow-up, for which time is generally restricted. This article provides an overview of MI recent applications and argues for its diffusion in everyday medical practice.

Health Promotion in Adolescent and Young Adult Cancer Survivors

With rising cure rates of childhood cancer, nurse practitioners have an increased chance of encountering a large survivor cohort in practice. A variety of late effects programs exist; however, funding is limited for these programs and is not accessible for all patients. Primary providers may increasingly act as a medical home for childhood cancer survivors (CCS). Understanding the inherent risks of cytotoxic treatment and the progressive consequences of late effects is vital to limit morbidity and mortality. Adolescent and young adult survivors (AYA) are particularly apt to make health behavior decisions that create risks for comorbidities. Developmentally appropriate experimentation with drug, alcohol, or tobacco use and increased ultraviolet ray exposure intensifies the risk for secondary malignancies and novel diseases. The paucity of evidence-based surveillance guidelines and survivor-specific health promotion programs cumulatively widen the gap in noncompliance and misinformation. This article overviews the risk profile of CCS. It explores health practices, as well as emerging health promotion techniques, within the AYA survivor population and the role nurse practitioners have in enhancing health maintenance.