Health Maintenance Behaviors Research Articles

Social network interventions for health behaviour change: a systematic review

BackgroundWe are all embedded in social networks, and evidence demonstrates that our embeddedness in these networks has a substantial impact on our health behaviours. However, we know little about how to harness them in health behaviour change interventions. The aim of this study was to investigate the effects of social network interventions for health behaviour change. MethodsEight databases (Medline, EMBASE, Web of Knowledge, Scopus, PsycINFO, ERIC, IBSS, and Sociological Abstracts were searched independently by two reviewers for articles published in English between Jan 1, 2000, and March 1, 2017. Eligibility criteria included a social network intervention for health behaviour change, a primary outcome measure of health behaviour change, and a comparator group. Evidence was synthesised by the network intervention approach based on a predefined taxonomy (Individual—using network data to identify certain individuals; Segmentation—directed towards groups of people clustered in a network; Induction—activation of existing social ties to diffuse healthy behaviours; Alteration—changing the structure of the network by the addition of new members or breaking existing ties. Studies were described as providing strong evidence if at least 80% of included studies demonstrated a significant intervention effect (p<0·05 vs control). FindingsOf the 23 234 publications identified, 39 were included. Overall, there was strong evidence for a significant intervention effect (82%, 32 of 39 studies) and maintained intervention effect (88%, 29/33) for social network interventions. There was strong evidence demonstrating a significant intervention effect and maintained intervention effect for the Individuals (8/8 studies), Segmentation (5/5), and Alteration (3/3) network approaches, and promising evidence to support an intervention effect (68%, 15/22) for Induction approaches. InterpretationThis review provides strong evidence of the effectiveness of social network interventions for health behaviour change and maintenance. Most existing interventions continue to focus on individual-level behaviour and fail to address the influential role of individuals' social systems and environments. There has been a parallel and growing interest in understanding the effects of social networks on health-related behaviour and the reframing of non-communicable conditions as being socially transmitted; a particular backdrop to this has been the emerging prominence of complexity science public health. FundingRH is funded by a Career Development Fellowship from the National Institute for Health Research.

A Behavior Change Framework of Health Socialization and Identity

An individual's identity related to health is critically important in terms of the adoption and maintenance of health behaviors, and guides approaches to health change across the lifespan. This article presents a review of the literature and proposes a health socialization and health identity framework, which may be used to clarify challenges in health behavior changes and also guide intervention efforts. Numerous classic theories of human development, cognition and motivation are reviewed, and suggestions for optimal health identity development are offered.

Abstract P149: Maintenance of Optimal Health Behaviors Over 25 Years and Cumulative Blood Pressure Burden: Prospective Data From the Coronary Artery Risk Development in Young Adults Study

Introduction: Healthy behaviors lower blood pressure (BP) in short-term randomized trials. Hypothesis: Maintaining healthy behaviors for 25 years will be associated with low cumulative BP burden. Methods: In 1985-86, the Coronary Artery Risk Development in Young Adults (CARDIA) study enrolled 5115 adults 18-30 years old. BP and health behaviors were measured at 8 exams over 25 years. Optimal health behaviors were body mass index (BMI) &lt; 25 kg/m 2 , never smoking, moderate / vigorous physical activity ≥ 150 minutes weekly, no / moderate alcohol intake (women / men: 0-7 / 0-14 drinks weekly) and Dietary Approaches to Stop Hypertension (DASH) adherence score ≥ 15. Also, maintaining ≥ 4 optimal behaviors was assessed. Using Proc Traj in SAS, 4630 adults who had ≥ 1 optimal behavior at baseline and attended ≥ 3 exams were grouped by change in mid-BP with age. Odds ratios (OR) were calculated for each higher level of BP burden associated with maintaining versus not maintaining optimal behaviors at all exams. Results: Those who did versus did not maintain optimal BMI were less likely to have moderate-stable, elevated-stable or moderate / elevated-increasing versus low-stable BP burden ( Figure, Panel A ). There was a non-statistically significant lower OR for the highest versus low-stable BP burden in adults who maintained optimal smoking and alcohol intake ( Figure, Panels B-C ). Optimal physical activity and DASH diet were not associated with mid-BP burden ( Figure, Panels D-E ). The OR (95% CI) for moderate / elevated-increasing versus low-stable BP burden in those maintaining ≥ 4 optimal behaviors was 0.73 (0.39 - 1.38). Conclusion: Maintaining optimal BMI into middle age preserves low BP burden.

The transactional perspective on occupation: A way to transcend the individual in health promotion interventions and research

ABSTRACTTen years after its introduction, the role of the transactional perspective in occupational science has grown. Although the perspective has been used for a variety of purposes, application remains primarily associated with qualitative modes of inquiry and within the domain of occupational science. We argue that the perspective has broader potential in empirical occupational science as well as in the fields of population health, health promotion, and intervention science. In this paper, we present one such opportunity for the transactional perspective to contribute substantially to science, namely, the problem of how best to theorize and ground empirical research on health behavior change and maintenance. The science of health behavior change and maintenance has suffered from a reliance on theories that privilege individual agency while neglecting how contextual influences shape health behavior. In this paper, we discuss how the issue of health behavior change and maintenance is a relevant problem for occupational science, especially if using a transactional perspective. We provide an overview of the perspective inclusive of key principles—continuity and change, habits, problematic situations and inquiry. We follow by suggesting how the perspective provides the theoretical tools to better connect persons and situations in the context of health behavior change and maintenance and how it can inform intervention design. We conclude with a discussion of potential challenges of applying the perspective to health behavior change and maintenance, and about the significance of these potentialities for the larger project of occupational science and transdisciplinary contributions.

Starting Off on the Best Foot: A Review of Message Framing and Message Tailoring, and Recommendations for the Comprehensive Messaging Strategy for Sustained Behavior Change

ABSTRACTHealth promotion programs represent a salient means through which physical activity promoters can cultivate positive health behavior change and maintenance. The messages communicated within these programs serve as an essential component as they are often used to convey valuable information, resources, or tools that facilitate health behavior initiation and sustained engagement. Identifying the most effective way to communicate health promotion information is, therefore, of considerable importance to ensuring that people not only attend to these messages, but also connect with and internalize the information conveyed within them. This paper was written to (1) summarize and evaluate the most prominent reviewed research approaches of message framing and tailoring to message design; and (2) offer a comprehensive messaging strategy to promote sustained health behavior change. A review of the literature demonstrated that a messaging strategy that has consistently led to healthy behavior change has yet to be identified. Furthermore, scholars have articulated that a multi-theoretical approach that places emphasis on facilitating motivation and healthy behavior change needs to be employed. Thus, this paper proposes and provides recommendations for employing the Comprehensive Messaging Strategy for Sustained Behavior Change (CMSSBC), which advocates tailoring messages to peoples’ stage of change and framing them to focus on self-determined motives and intrinsic goals.

Validation for the Children Health Promotion Scale: Development and Psychometric Testing

BACKGROUND: Several investigators have developed health promoting lifestyle instruments for adult population. However, few instruments in Taiwan have focused on health-promoting lifestyle measurements from the perspective of children.METHODS: The Children Health Promotion scale (CHP) was developed to focus on health promotion among children. The content validity was supported on the observations of a 6-member panel of experts. Here, based on the responses of 681 Taiwanese children, we examined the construct validity and reliability of the CHP as well as its psychometric properties through factor analysis and reliability measures.RESULTS: The results of Kaiser-Meyer-Olkin (KMO) and Bartlett’s sphericity tests indicated that our sample fulfilled the factor analysis criteria. Moreover, the factor analysis yielded a 6-factor instrument, explaining 52.5% of variance in all 32 items; the 6 factors were myopia prevention, stress management, health maintenance behaviors, nutritional behaviors, physical activities, and basic health-promoting behaviors. The Cronbach’s alpha reliability coefficient for the total scale was 0.92 and alpha coefficients for the subscales ranged from 0.71 to 0.85.CONCLUSION: The results of this study indicate that the CHP has satisfactory construct validity and reliability for Taiwanese children. School health providers can therefore use the CHP for children’s health promotion efforts.

Seek or destroy? Examining value creation and destruction in behaviour maintenance in social marketing

ABSTRACTThis article presents an empirical investigation of how behaviour maintenance is supported or hindered through value creation and destruction in social marketing. Using a longitudinal, netnographic approach, we identify and examine the key facilitators and barriers encountered during the maintenance of physical and mental health behaviours. Data were collected over a 12-week observation period via Twitter from a sample of 242 participants. A total of 5212 tweets were analysed using content and thematic analysis facilitated by NVivo software program. The findings identify key barriers to and facilitators of behaviour maintenance at the individual level (downstream), meso level (midstream), and policy level (upstream) that have an influence on value creation and destruction in social marketing. These findings demonstrate the importance of employing a strategic and integrated approach to social change management.

Evidence-based adaptation and scale-up of a mobile phone health information service.

The research base recommending the use of mobile phone interventions for health improvement is growing at a rapid pace. The use of mobile phones to deliver health behavior change and maintenance interventions in particular is gaining a robust evidence base across geographies, populations, and health topics. However, research on best practices for successfully scaling mHealth interventions is not keeping pace, despite the availability of frameworks for adapting and scaling health programs. m4RH-Mobile for Reproductive Health-is an SMS, or text message-based, health information service that began in two countries and over a period of 7 years has been adapted and scaled to new population groups and new countries. Success can be attributed to following key principles for scaling up health programs, including continuous stakeholder engagement; ongoing monitoring, evaluation, and research including extensive content and usability testing with the target audience; strategic dissemination of results; and use of marketing and sustainability principles for social initiatives. This article investigates how these factors contributed to vertical, horizontal, and global scale-up of the m4RH program. Vertical scale of m4RH is demonstrated in Tanzania, where the early engagement of stakeholders including the Ministry of Health catalyzed expansion of m4RH content and national-level program reach. Ongoing data collection has provided real-time data for decision-making, information about the user base, and peer-reviewed publications, yielding government endorsement and partner hand-off for sustainability of the m4RH platform. Horizontal scale-up and adaptation of m4RH has occurred through expansion to new populations in Rwanda, Uganda, and Tanzania, where best practices for design and implementation of mHealth programs were followed to ensure the platform meets the needs of target populations. m4RH also has been modified and packaged for global scale-up through licensing and toolkit development, research into new business/distribution models, and serving as the foundation for derivative NGO and quasi-governmental mHealth platforms. The m4RH platform provides an excellent case study of how to apply best practices to successfully scale up mobile phone interventions for health improvement. Applying principles of scale can inform the successful scale-up, sustainability, and potential impact of mHealth programs across health topics and settings.

Does Stress Result in You Exercising Less? Or Does Exercising Result in You Being Less Stressed? Or Is It Both? Testing the Bi-directional Stress-Exercise Association at the Group and Person (N of 1) Level.

Psychosocial stress contributes to heart disease in part by adversely affecting maintenance of health behaviors, while exercise can reduce stress. Assessing the bi-directional relationship between stress and exercise has been limited by lack of real-time data and theoretical and statistical models. This lack may hinder efforts to promote exercise maintenance. We test the bi-directional relationship between stress and exercise using real-time data for the average person and the variability-individual differences-in this relationship. An observational study was conducted within a single cohort randomized controlled experiment. Healthy young adults, (n=79) who reported only intermittent exercise, completed 12months of stress monitoring by ecological momentary assessment (at the beginning of, end of, and during the day) and continuous activity monitoring by Fitbit. A random coefficients linear mixed model was used to predict end-of-day stress from the occurrence/non-occurrence of exercise that day; a logistic mixed model was used to predict the occurrence/non-occurrence of exercise from ratings of anticipated stress. Separate regression analyses were also performed for each participant. Sensitivity analysis tested all models, restricted to the first 180days of observation (prior to randomization). We found a significant average inverse (i.e., negative) effect of exercise on stress and of stress on exercise. There was significant between-person variability. Of N=69, exercise was associated with a stress reduction for 15, a stress increase for 2, and no change for the remainder. We also found that an increase in anticipated stress reported the previous night or that morning was associated with a significant 20-22% decrease (OR=0.78-0.80) in the odds of exercising that day. Of N=69, this increase in stress reduced the likelihood of exercise for 17, increased the odds for 1, and had no effect for the remainder. We were unable to identify psychosocial factors that moderate the individual differences in these effects. The relationship of stress to exercise can be uni- or bi-directional and varies from person to person. A precision medicine approach may improve exercise uptake.

Effect of goal attainment theory based education program on cardiovascular risks, behavioral modification, and quality of life among patients with first episode of acute myocardial infarction: Randomized study

Effect of goal-attainment-theory-based education program on cardiovascular risks, behavioral modification, and quality of life among patients with first episode of acute myocardial infarction: randomized study BackgroundThe behavioral modification strategies should be explored at the time of admission to lead the maximum effect of cardiovascular risk management. AimsThis randomized study aimed to elucidate the effects of a nurse-led theory-based education program in individuals with a first episode of acute myocardial infarction on cardiovascular risks, health behaviors, and quality of life over 6 months. MethodsThe study involved a convenience sample of 64 patients with acute myocardial infarction who were randomly assigned to either the education group or the control group. The goal-attainment-based education program was designed to set the mutually agreed goals of risk management and the behavioral modification strategies for achieving those goals. Those in the control group received routine management only. The participants in both groups were contacted at 6–8 weeks and at 6 months after discharge to measure outcome variables. Repeated measure ANOVA was conducted using SPSSWIN (version 20.0) to determine the significance of differences in outcome variables over 6 months between the groups. ResultsBoth groups showed significant positive changes in cardiovascular risks, health behaviors, and quality of life over 6 months. The 2-year risk of cardiovascular disease was significantly reduced in both study groups, but with no significant interaction effect (F=2.01, p=0.142). The performance and maintenance of health behaviors (F=3.75, p=0.029) and the mental component of quality of life (F=4.03, p=0.020) were significantly better in the education group than the control group. ConclusionApplying a goal-oriented education program at an early stage of hospital management improved and maintained blood glucose, health behaviors, and mental component of the quality of life up to six months in individuals with a first episode of myocardial infarction. Further studies are warranted to explore the role of behavioral modification mediating between cardiovascular risk management and quality of life in this population.

Primate Self-Medication, Passive Prevention and Active Treatment - A Brief Review

Parasites and pathogens are a source of diseases that can affect the health, behavior and reproductive fitness of an individual. The study of animal self-medication as a science is relatively new, but traditional societies have long looked to animals for clues to nature’s medicine cabinet. Evidence of self-medication is widespread throughout the animal kingdom. To date, research has classified health maintenance and self-medicative behaviors into five levels: 1) ‘sick behaviors’; 2) behavioral avoidance or reduction of the possibility for disease transmission; 3) dietary selection of items with a preventative or health maintenance effect; 4) ingestion of a substance for the curative treatment of a disease or the symptoms thereof, and; 5) application of a substance to the body or a living space for the treatment or control of vectors or external health condition. Among the groups of animals studied to date, primates have provided the most details for level 3 and 4 behaviors, exemplified by such diverse dietary selection and behaviors as bitter pith chewing and whole leaf swallowing behaviors, used directly in response to increased levels of parasite infection. KEYWORDS: Animal self-medication, primates, medicinal plants, disease control, homeostasis

Impact of Integrated Care on patient satisfaction, perceived health behaviour and health maintenance in ´Gesundes Kinzigtal´: Interim results of a trend study

Introduction : 'Gesundes Kinzigtal' (GK) is a population-based integrated care pilot in Germany and is commonly rated a ‚flagship project‘ among Germany’s integrated care approaches. Founded in 2006, GK is managed by Gesundes Kinzigtal Ltd., in which the local physicians’ network has the majority of shares. GK cooperates with two statutory health insurers, AOK and LKK, whose insurants (about 33.000 people) are entitled to enroll into GK Integrated Care. About 10.000 insureds have enrolled into GK until now as active members. Besides GK’s general emphasis on prevention and health promotion, an important focus of GK’s strategy is to activate and empower patients. Correspondingly, the majority of GK members participate in preventive or health management programs offered by GK, and members are encouraged to agree on individual health or treatment goals with their respective doctors of trust. Since 2013, a trend study surveys GK members’ satisfaction every two years. In this contribution we will give interim answers to the following questions: 1) How do GK members assess some key features of GK Integrated Care? 2) What is the level of global patient satisfaction with GK, i.e. in what degree would GK members recommend others to become a member? 3) To which degree do these parameters change over time? Methods : The first survey of the trend study was conducted in 2013, the first follow-up survey in 2015. In 2013, 3.034 GK members were randomly selected and received a standardized questionnaire by mail (in which they were asked to participate in the survey). In 2015, 3.471 members were asked to participate. Participating members sent their completed questionnaire to an independent research institution. Target variables in the questionnaire were: Satisfaction with the doctor of trust (Weisse-Liste-Arzte questionnaire), patient activation (PAM-13-D), health-related quality of life (EQ-5D, EQ-VAS), satisfaction with GK (3 self-developed items), perceived health maintenance and health behaviour (2 self-developed items). In the following we present bivariate analyses of variables indicating patient satisfaction with GK, perceived change of overall care quality, perceived change of health behaviour and health maintenance. Results : The response rates (evaluable response) amounted to 23 % (n=711) in the first survey and to 25 % (n=863) in the first follow-up survey. Among the responders, women and older people were slightly over-represented. In 2013, 39.9 % (95% CI: 36.2 – 44.1) of the respondents felt “somewhat” or “considerably better cared for“ after they had enrolled into GK; in 2015 this proportion amounted to 41.1 % (95% CI: 37,5 - 44,3). When adjusted for age and sex, the results amount to 39.0% (95% CI: 35.4 - 42.7) in 2013 and 41.5% (95% CI: 38.1 - 45.0) in 2015. The proportion of respondents who indicated that they knew now “better how to maintain or improve“ their own health, compared to the time prior to their enrollment, practically remained the same (2013: 57,4%; 2015: 57,7 %; adjusted for age and sex: 56.9% in 2013 vs. 58.1% in 2015). The proportion of those who indicated a more effective health behaviour after their enrollment (2013: 26.1%, 95% CI: 22.8 – 29.8) increased remarkably in the first follow-up survey (2015: 30.6%, 95% CI: 27.3 – 33.7). When adjusted for age and sex, these proportions amount to 25.6% (95% CI: 22.3 - 28.9) in 2013 vs. 30.7% (95% CI: 27.6 - 34.0) in 2015; this increase is statistically significant (p Discussion and conclusion : Members‘ global satisfaction with GK Integrated Care seems to be fairly high: more than 90% would recommend also their friends or relatives to become a member of GK. High global satisfaction values are a very common phenomenon. Therefore the changes of the respective parameters over time seem to provide more valid insights than the levels of these parameters at a given point of time. Our interim results show a largely stable satisfaction with GK Integrated Care over time. This is not surprising after only one follow-up survey. Nonetheless, one parameter displays a noteworthy increase between the first and the second survey: Members’ self-reported health behaviour has significantly improved between 2013 and 2015 (when adjusted for age and sex). This might be attributed to GK’s attempts to activate and empower their members. Biannual surveys will assess future trends of the above-mentioned indicators.

Identifying Key Elements to Inform the Development of an HIV Health Behavior Maintenance Intervention.

To collect information that will inform the development of an intervention to support the maintenance of HIV-related health-promoting behaviors. Focused, in-depth individual and group interviews. The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) and DOHMH-funded community-based organizations that primarily serve low-income people living with HIV within the five boroughs of NYC. A total of 42 individuals who had participated in The Positive Life Workshop-an HIV self-management intervention adapted and implemented by the NYC DOHMH. Purposive sampling was used to recruit study participants. Five 60- to 90-minute focus groups (n = 38) and 4 individual interviews were conducted to assess motivations for and barriers to maintaining HIV-related health-promoting behaviors and to elicit feedback on the content and format for the proposed maintenance intervention. Thematic analysis was used to summarize the data. Participants reported that relationships with family, a responsibility to protect others from HIV, and faith/spirituality supported the maintenance of health-promoting behaviors. Barriers to behavior maintenance included substance use and mental health issues. Meeting in small groups was also highlighted as a motivator to sustaining health behaviors, particularly in decreasing isolation and receiving affirmation from others. Participants identified several factors that could be incorporated into an intervention to support HIV-related health-promoting behavior maintenance that could supplement existing HIV self-management interventions.

Theoretical, Critical, and Practical Reflections on the Long-Term Maintenance of Health Behavior Change.

This commentary is in response to Joseph, Daniel, Thind, Benitez and Pekmezi (2014). They reviewed randomized controlled trials (RCTs) that included long-term follow-up assessments at least 6 months post-intervention. Their main purpose was to understand which theory or model used by researchers could help explain the long-term maintenance of health behaviors once the intervention was withdrawn in trials focused on physical activity, dietary behavior, and excessive alcohol consumption. Results showed that social cognitive theory (SCT) and transtheoretical model (TTM) were used most often and associated with long-term behavior change compared to self-determination theory (SDT), theory of planned behavior (TPB), or the social-ecological model (SEM). SDT showed encouraging findings while the evidence was unclear for the TPB and the SEM. Here it is argued that scientists should continually reflect on the utility of theory over time and the efforts by Joseph and colleagues should be commended. It is also useful to distinguish theories, which are more specified and offer more generalized statements, than models. Models, such as the TPB and SEM, have incorporated elements of other theories but are typically viewed as tools to characterize behavior. For instance, in 10 studies reviewed by Joseph and colleagues the SCT and TTM were used in an integrative manner. An example of an integrated model is presented that incorporates elements of SDT, TPB, and SCT in an effort to highlight how integrating elements from multiple theories may be useful.

Applying Psychological Theories to Promote Long-Term Maintenance of Health Behaviors.

Behavioral health theory provides a framework for researchers to design, implement, and evaluate the effects of health promotion programs. However, limited research has examined theories used in interventions to promote long-term maintenance of health behaviors. The purpose of this review was to evaluate the available literature and identify prominent behavioral health theories used in intervention research to promote maintenance of health behaviors. We reviewed theories used in intervention research assessing long-term maintenance (≥ 6 months post-intervention) of physical activity, weight loss, and smoking cessation. Five prominent behavioral theories were referenced by the 34 studies included in the review: Self-Determination Theory, Theory of Planned Behavior, Social Cognitive Theory, Transtheoretical Model, and Social Ecological Model. Descriptions and examples of applications of these theories are provided. Implications for future research are discussed.

Influence of mother′s oral health care knowledge on oral health status of their preschool child

Aim: Children under 5 years of age generally spend most of their time with parents or guardians, especially mothers. Parents play a central role in giving children the information and encouragement needed for healthy lives. Parental oral health knowledge, belief and attitudes influence the oral health maintenance, dietary habits and healthy behavior of their children. The aim of this study was to assess the mothers oral health care knowledge and to assess the oral health status of their child. Materials and Methods: A total of 386 mothers along with their child of 1-6 years were randomly selected for the study. A 22-point questionnaire including parent's literacy levels, socioeconomic status, dietary practices and oral hygiene practices, was designed to assess the knowledge of the mothers regarding oral health of their child. Oral examination of the children was done by World Health Organization criteria for recording children's oral health status. Results: About 87% of the mothers agreed that intake of food with excessive sugars can cause cavities, and 95.8% admitted that chocolates cause the most decay. 80.5% agreed to the fact that leaving a milk bottle all night increases the risk for tooth decay, however, 59.3% mothers were of the opinion that dental visit is must only in the presence of decay. 59.3% mothers were unaware about the optimal fluoride content. 71.7% mothers agreed that caries in deciduous teeth are a matter of concern. The average decayed score of the children was 2.9 and 77.9% of the children had a fair to good oral hygiene status. Conclusion: Instead of the fact that most of the health care knowledge that the mothers had was primarily from the family elders, they were aware of caries risk factors, tooth brushes and amount of toothpaste and bacteria from mother's cavities can infect child. This could be observed by less number of decayed teeth and good oral hygiene status of the children. However, parents knowledge, attitudes and few beliefs regarding dental care need to be improved.

Habitual exercise instigation (vs. execution) predicts healthy adults' exercise frequency.

Habit is thought to be conducive to health behavior maintenance, because habits prompt behavior with minimal cognitive resources. The precise role of habit in determining complex behavioral sequences, such as exercise, has been underresearched. It is possible that the habit process may initiate a behavioral sequence (instigation habit) or that, after instigation, movement through the sequence is automated (execution habit). We hypothesized that exercise instigation habit can be empirically distinguished from exercise execution habit and that instigation habit strength is most predictive of future exercise and reflective of longitudinal exercise behavior change. Further, we evaluated whether patterned exercise action-that is, engaging in the same exercise actions from session to session-can be distinct from exercise execution habit. Healthy adults (N = 123) rated their exercise instigation and execution habit strengths, patterned exercise actions, and exercise frequency in baseline and 1-month follow-up surveys. Participants reported exercise engagement via electronic daily diaries for 1 month. Hypotheses were tested with regression analyses and repeated-measures analyses of variance. Exercise instigation habit strength was the only unique predictor of exercise frequency. Frequency profiles (change from high to low or low to high, no change high, no change low) were associated with changes in instigation habit but not with execution habit or patterned exercise action. Results suggest that the separable components of exercise sessions may be more or less automatic, and they point to the importance of developing instigation habit for establishing frequent exercise.

Do health maintenance behaviors differ across insomnia patients as a function of objective sleep duration?

Do health maintenance behaviors differ across insomnia patients as a function of objective sleep duration?

Beyond the 'teachable moment' - A conceptual analysis of women's perinatal behaviour change.

Midwives are increasingly expected to promote healthy behaviour to women and pregnancy is often regarded as a 'teachable moment' for health behaviour change. This view focuses on motivational aspects, when a richer analysis of behaviour change may be achieved by viewing the perinatal period through the lens of the Capability-Opportunity-Motivation Behaviour framework. This framework proposes that behaviour has three necessary determinants: capability, opportunity, and motivation. To outline a broader analysis of perinatal behaviour change than is afforded by the existing conceptualisation of the 'teachable moment' by using the Capability-Opportunity-Motivation Behaviour framework. Research suggests that the perinatal period can be viewed as a time in which capability, opportunity or motivation naturally change such that unhealthy behaviours are disrupted, and healthy behaviours may be adopted. Moving away from a sole focus on motivation, an analysis utilising the Capability-Opportunity-Motivation Behaviour framework suggests that changes in capability and opportunity may also offer opportune points for intervention, and that lack of capability or opportunity may act as barriers to behaviour change that might be expected based solely on changes in motivation. Moreover, the period spanning pregnancy and the postpartum could be seen as a series of opportune intervention moments, that is, personally meaningful episodes initiated by changes in capability, opportunity or motivation. This analysis offers new avenues for research and practice, including identifying discrete events that may trigger shifts in capability, opportunity or motivation, and whether and how interventions might promote initiation and maintenance of perinatal health behaviours.

Low self-efficacy is associated with decreased emergency department use in underserved men with prostate cancer

BackgroundSelf-efficacy has been strongly associated with health behavior and health maintenance. We examined the relationship between patient-provider self-efficacy and emergency department usage in low-income, underinsured, or uninsured patients with prostate cancer. MethodsWe prospectively analyzed quality of life, behavior, and self-efficacy data from men enrolled in a state-funded program providing free prostate cancer care. We summarized patient characteristics stratified by self-efficacy scores (high, mid, and low) and by emergency department visit (any vs. none). We conducted a multivariate repeated measures regression analysis with negative binomial distribution to calculate predicted counts of emergency department visits over time across the self-efficacy strata. ResultsOur cohort included 469 men with a maximum follow-up time of 84 months. Of these men, 70 had visited the emergency department during their enrollment for a total of 118 unique visits. The regression analysis demonstrated a decreasing number of emergency department visits over time for the low (P = 0.0633) and mid (P = 0.0450) self-efficacy groups but not for the high self-efficacy group (P = 0.1155). Pain (22.9%), urinary retention (18.6%), and fever (5.9%) were the most common reasons for emergency department visits. ConclusionsPatients with low and mid self-efficacy had a decreasing number of emergency department usage over time. Those with high self-efficacy did not follow these trends. Interventions to improve communication between patients and primary treatment teams could prove beneficial in avoiding excess emergency department use.