Health Behavior Theories Research Articles

Contextual and Affective Precursors of Physical Activity Intention and Enactment Examined Through Ecological Momentary Assessment.

Regular physical activity (PA) provides numerous health benefits, which is why many people intend to lead an active lifestyle. Yet, internal and external states and barriers can hinder the translation of such intentions into actual behavior. This study prospectively studied such barriers, namely, the temporal relationship between the independent variables momentary affect (stress, emotions), and the dependent variables PA intentions and subsequent PA behavior. The variables were measured using Ecological Momentary Assessment (EMA) at the within-person level. A total of 41 healthy participants (aged 19-67) completed 4 daily EMA prompts over three weeks on their smartphones, capturing data on momentary affective states (happy, active, irritated, tired, concerned, nervous, relaxed, energetic), anticipated contextual barriers (i.e., PA-incompatible external circumstances), prospective PA intentions, and PA behavior (retrospective, since the last prompt). We applied generalized linear mixed effect models to examine the influence of momentary affect and contextual barriers onto a) PA intentions, b) their consecutive enactment, and c) directly onto PA behavior. Individuals were more likely to form PA intentions when feeling happy, active, or energetic, but less likely when external/contextual barriers were high or when they felt tired. Furthermore, only PA intentions were significant precursors of subsequent PA behavior, while neither contextual barriers, nor momentary affect directly affected PA behavior. Interventions for fostering PA, such as Just-in-Time Adaptive Interventions, should address and 'stabilize' intentions through addressing external barriers and positive affects (happy, active, energetic). The present results call for more temporally sensitive and dynamic health behavior theories of PA.

Development and validation of the Behavioral Determinants of Deprescribing Questionnaire (BDDQ)

Abstract Background Deprescribing is a strategy to optimize medication use. While health behaviour can successfully be predicted by health behavior theories, the literature on deprescribing relies almost exclusively on questionnaires that measure attitudes only, such as the Beliefs about Medicines Questionnaire and the Patients Attitudes Towards Deprescribing, resulting in poor predictive validity. The aim of this study was to develop a new tool to measure the psychological determinants of deprescribing among people aged over 60, based on concepts derived from health behaviour theories. Methods A draft self-report questionnaire was developed consisting of 64 questions measuring 11 dimensions representing determinants of deprescribing. As well as previous deprescribing experience, current deprescribing behaviour and willingness to deprescribe. Face validity was assessed by asking 10 health professionals and 13 of older people to complete the questionnaire and comment in a small group discussion, resulting in the removal of 18 items. Construct validity was assessed on a sample of 103 participants aged over 60, using exploratory factor analysis (EFA). Internal consistency was assessed via Cronbach’s alpha. Results The EFA could confirm 11 dimensions explaining 70,5% of the total variance, but revealed poor loadings for several items and inadequate alphas (<.50) for two factors. Removal of items and these two dimensions resulted in 26 items measuring 9 dimensions, all showing acceptable internal consistencies (between .52 and .77): perceived risk; relatives’ involvement; deprescribing concerns; attitudes; medication beliefs; healthcare support; perceived difficulties; motivation to comply; communication accessibility. Conclusions This study produced a conceptually based and psychometrically validated questionnaire to assess behavioural determinants of deprescribing. It provides for a more comprehensive investigation of deprescribing intentions and behaviour of older adults. Key messages • A conceptually sound, psychometrically validated questionnaire (BDDQ) was developed. • BDDQ can be used for a more comprehensive study of de-prescribing in older people.

Beyond perceived risk: COVID-19 vaccination more strongly linked to individual risk perception in wheat areas than rice areas

Vaccines save lives, but vaccine hesitancy remains a global health challenge. That makes it critical to explore the factors that influence whether people get vaccinated. Perceived risk is a pivotal factor in traditional theories of health behavior, such as the Risk Perception Attitude framework and the Health Belief Model. However, studies have found that these models are less predictive of COVID-19 vaccination in some cultures. Studies that test culture by comparing nations are useful, but nations have different healthcare systems and policies that are hard to equate and control for. We addressed this question by testing regional cultural differences in China. Drawing on the rice theory, we compared residents in China's historical rice-farming areas (which are more interdependent) with those in wheat-farming areas (which are more independent). Our survey data from 1872 participants in 29 provinces found that models of perceived risk explained COVID-19 vaccination mainly in historically wheat-farming areas. Conversely, in historically rice-farming areas, perceived risk did not explain vaccination behavior. These findings suggest that cultural factors that are rooted in historical farming practices influence vaccination behaviors. By comparing regions within the same country, we can rule out confounds of national policy and healthcare systems. These insights could help policymakers understand how to tailor vaccination campaigns to people from different cultures.

The Role of Optimistic Bias and Affect on Social Media Searches About COVID-19

ABSTRACT The preventive health behavior people adopt is partly a result of the risk they perceive from the threat, and health behavior theory has shown that risk communication is a critical part of that outcome. But risk to self and risk to others are often judged differently. Optimistic bias, which describes an unrealistic level of optimism about a threat, is a well described and frequently observed phenomenon in the study of health behavior. Traditional measurements of this construct have typically used the difference in self and other risk levels, which may obscure the impact. This study used a moderated mediation path with other-risk as a moderator of self-risk to study how optimistic bias and emotion about a rapidly changing risk may impact information seeking about it through social medial channels, which represent a still nascent but evolving media for credible health information. Results showed that optimistic bias about developing symptoms of COVID was indeed present and that the effect of perceived self-risk was mediated by fear and anxiety to predict social media searches about the threat. Further, affect and social media search behavior decreased with increasing levels of perceived other risk, indicating optimistic bias served to dampen a person’s motivation to seek information. The implications of the results on health behavior theory, risk communication, and public health practice are discussed.

Wearable Technology for Health Monitoring and Diagnostics

Purpose: The general objective of this study was to investigate wearable technology for health monitoring and diagnostics. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to wearable technology for health monitoring and diagnostics. The advancement of wearable technology in health monitoring and diagnostics transformed the healthcare landscape by enabling continuous, real-time data collection and analysis, empowering individuals to manage their health proactively. Despite its benefits, challenges such as data privacy, device accuracy, and user adherence needed addressing. Ensuring robust data protection, validating device accuracy in diverse environments, and understanding barriers to sustained use were essential. Addressing the digital divide was also vital for equitable access. Overall, wearable technology held significant promise for preventive care and early diagnosis, but required ongoing research and collaboration to maximize its impact. Unique Contribution to Theory, Practice and Policy: The Technology Acceptance Model (TAM), Health Belief Model (HBM) and Unified Theory of Acceptance and Use of Technology (UTAUT) may be used to anchor future studies on wearable technology for health monitoring and diagnostics. The study recommended integrating technology acceptance and health behavior theories to provide a comprehensive understanding of adoption factors, emphasizing user-centered design for enhanced engagement, and advocating for stringent data privacy and security standards. It highlighted the importance of integrating wearable technology into healthcare systems for better clinical decisions, promoting equitable access, and using wearables in public health initiatives. The study also called for collaboration between technology developers, healthcare providers, and policymakers to address challenges and maximize the benefits of wearable health technology.

Factors predicting primary and booster COVID-19 vaccination in a community sample of African American men and women in the United States Midwest

COVID-19 has disproportionately burdened impoverished minority communities. This study recruited an age- and gender-diverse community sample of 541 Black adults in a United States Midwestern city with large racial health disparities, with the aim of examining factors associated with COVID-19 vaccination. All participants completed measures assessing their COVID-19 vaccination status (unvaccinated, received primary vaccination, or received primary plus booster vaccination) as well as demographic characteristics, socioeconomic factors, health and health system factors, and health behavior theory constructs related to vaccination. In this predominantly low-income sample, 55% of participants had received primary COVID-19 vaccination and 31% of the sample had received a booster dose. Multiple regression analyses established that having primary vaccination was significantly predicted by older age, political identification as Democrat, education beyond high school, barriers to accessing health care, as well as higher trust of vaccine benefits, less preference for natural immunity, stronger social norms favoring vaccination, and perceiving higher levels of collective responsibility. Surprisingly, higher global medical mistrust and difficulty with healthcare access were associated with vaccination. The model explained 76% of the variance in primary COVID-19 vaccination. Having received a COVID-19 booster was predicted by older age, previous COVID-19 infection, higher trust in vaccine benefits, and fewer worries about unforeseen future effects of vaccination. Study findings identified factors associated with COVID-19 vaccine uptake in racial minority communities, and support the benefits of interventions that harness social network supports for vaccination, address community vaccine concerns, and appeal to collective responsibility to promote vaccine uptake.

Comprehending Health Behavior Change and Maintenance: A Systematic Review and Meta-Synthesis of Behavior Theories

ABSTRACT Background Health behaviors exhibit diverse characteristics and types, leading to health behavior theories with varied focuses. However, an integrated framework elucidating the intrinsic mechanisms of different behavior types is notably absent. Purpose This study aimed to establish such a framework offering a comprehensive basis for explanations and behavior interventions. Methods A systematic review and meta-synthesis of qualitative research concerning health behavior change and maintenance were conducted. Results A total of 556 records were identified and screened, with 170 meeting the inclusion criteria. Thematic synthesis, a form of meta-synthesis, generated 23 themes, with the qualitative relationships between them presented in a conceptual model, forming an integrated framework. Discussion This framework provides a dynamic and hierarchical platform that enables the interpretation and analysis of various health behaviors within a unified structure. Furthermore, the recognition of the dynamicity of constructs and the multiplicity of behavior routes offers certain implications for intervention design, including behavior setting guidance, immediate benefits provision, and behavior interactions utilization. Translation to Health Education Practice The study provides an integrated framework for health educators/promoters. It offers a comprehensive view of health behavior change mechanisms from multiple perspectives and provides insights for the design, implementation and evaluation of behavior intervention practices.

EPH126 A Systematic Review of the Application of Health Behavioral Theories in Drug Disposal and Reuse

EPH126 A Systematic Review of the Application of Health Behavioral Theories in Drug Disposal and Reuse

Effects of Food Bioactive Compounds on Human Health and Disease Prevention in Botswana

Purpose: The aim of the study was to evaluate effects of food bioactive compounds on human health and disease prevention in Botswana. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: The study found that bioactive compounds found in a variety of foods, including fruits, vegetables, grains, and herbs, have been extensively studied for their potential health benefits, including antioxidant, anti-inflammatory, and anti-cancer properties. In Botswana, where NCDs such as diabetes, hypertension, and cardiovascular diseases are major public health concerns, integrating bioactive-rich foods into the diet plays a crucial role in reducing the prevalence and impact of these conditions. Unique Contribution to Theory, Practice and Policy: Nutritional Epidemiology Theory, Pharmacological Theory of Food Bioactive Compounds & Health Behavior Theory may be used to anchor future studies on effects of food bioactive compounds on human health and disease prevention in Botswana. Promote public awareness and education campaigns to highlight the importance of incorporating bioactive compounds into daily diets for health maintenance and disease prevention. This can include disseminating accessible information about bioactive-rich foods and their health benefits. Advocate for the inclusion of dietary guidelines that emphasize the consumption of bioactive-rich foods in national nutrition policies. This can involve collaborating with policymakers to integrate evidence-based recommendations into dietary guidelines and public health initiatives.

Factors influencing clinician-educators' assessment practice in varied Southern contexts: a health behaviour theory perspective.

In many contexts, responsibility for exit-level assessment design and implementation in undergraduate medical programmes lies with individuals who convene clinical clerkships. Their assessment practice has significant consequences for students' learning and the patients and communities that graduates will serve. Interventions to enhance assessment must involve these assessors, yet little is known about factors influencing their assessment practice. The purpose of this study was to explore factors that influence assessment practice of clerkship convenors in three varied low-and-middle income contexts in the global South. Taking assessment practice as a behaviour, Health Behaviour Theory (HBT) was deployed as a theoretical framework to explore, describe and explain assessor behaviour. Thirty-one clinician-educators responsible for designing and implementing high-stakes clerkship assessment were interviewed in South Africa and Mexico. Interacting personal and contextual factors influencing clinician-educator assessment intention and action were identified. These included attitude, influenced by impact and response appraisal, and perceived self-efficacy; along with interpersonal, physical and organisational, and distal contextual factors. Personal competencies and conducive environments supported intention to action transition. While previous research has typically explored factors in isolation, the HBT framing enabled a systematic and coherent account of assessor behaviour. These findings add a particular contextual perspective to understanding assessment practice, yet also resonate with and extend existing work that predominantly emanates from high-income contexts in the global North. These findings provide a foundation for the planning of assessment change initiatives, such as targeted, multi-factorial faculty development.

Developing content for a virtual reality scenario that motivates quit attempts in adult smokers: A focus group study with art-based methods.

Virtual reality (VR) could be used to deliver messages to smokers that encourages them to attempt quitting. For a VR smoking cessation intervention to be effective, the target population must find the content engaging, relevant, inoffensive, and compelling. Informed by health behaviour theory and narrative transportation theory, this study used focus groups combined with art-based methods (participant sketches) to inform the development of VR content that will appropriately address smokers' beliefs about quitting smoking. Data were analysed using reflexive thematic analysis. Four in-person focus groups (N = 21) were held between July and August 2023. Just under half the sample were from an ethnic minority (42.8%) and women (42.9%), and the mean age was 33.6 years (standard deviation = 15.9). More than half the sample had a low motivation to quit (61.0%). We developed six themes concerning: the VR content suggested by participants, the rationale behind it, its technological execution and potential widescale implementation. Many participants downplayed the health consequences of smoking, prioritising the immediate rewards of smoking over quitting's long-term benefits. Therefore, participants suggested content set in the future, showing the benefits of cessation or the negative consequences of continued smoking. Family members were recommended as supporting VR characters to increase the contents' emotional salience. Participants also suggested graphic content that would trigger anxiety about smoking, suggesting that fear appeals were welcome. Participants wanted a truly novel intervention- not a leaflet about smoking statistics presented through VR. Participants suggested healthcare locations (e.g., doctors' offices) for implementation, as home ownership of VR headsets is low. Also, this would make the VR appear more legitimate as a health intervention (rather than casual entertainment) and could complement in-person advice. Future research will refine the participant-generated ideas with experts in VR design and smoking cessation.

Effectiveness of a self-help guide during a temporary alcohol abstinence challenge: a randomized controlled trial.

The popularity of temporary abstinence challenges (TACs) concerning alcohol consumption is increasing. Support is found to be essential for participants to help them get through a challenge. This study aimed to evaluate the additional effect of a self-help guide, based on health behaviour theories and behaviour change techniques, on (i) successful completion of a TAC and (ii) changes in drinking refusal self-efficacy (DRSE), behavioural automaticity, craving, and alcohol consumption. A randomized controlled trial was performed (OSF registries: OSF.IO/B95VU). NoThanks participants received a questionnaire before the TAC (T0) and 8months after the TAC (T1). Out of a subgroup of 1308 respondents who were interested in additional support, 652 were randomly assigned to receive the guide (experimental group), and 656 did not receive any additional support (control group). Logistic regressions and (generalized) linear mixed model analyses were used. After 8months, all participants showed a significant decrease in behavioural automaticity, craving, and alcohol consumption, irrespective of group assignment. No significant changes were observed in the DRSE. This degree of change over time in behavioural automaticity, craving, and alcohol consumption did not differ between the experimental and control group. Sensitivity analyses with participants in the experimental group, who differed in exposure to the guide, did not show differences either. The self-help guide, and how it was designed, added no value to the TAC. Future research should focus on more bottom-up, customized support and explore what (different subgroups of) participants think they need as extra support during a TAC.

COVID-19 vaccine hesitancy among adults in India: A primary study based on health behavior theories and 5C psychological antecedents model.

Despite the significant success of India's COVID-19 vaccination program, a sizeable proportion of the adult population remains unvaccinated or has received a single dose of the vaccine. Despite the recommendations of the Government of India for the two doses of the COVID-19 vaccine and the precautionary booster dose, many people were still hesitant towards the COVID-19 full vaccination. Hence, this study aimed to identify the primary behavioral and psychological factors contributing to vaccine hesitancy. Cross-sectional data was collected via a multi-stage sampling design by using a scheduled sample survey in the Gorakhpur district of Uttar Pradesh, India, between 15 July 2022 to 30 September 2022. This study has utilized three health behavior models-the Health Belief Model (HBM), the Theory of Planned Behavior (TPB), and the 5C Psychological Antecedents of vaccination, and employed bivariate and multivariable binary logistic regression model to assess the level of vaccine hesitancy and predictive health behavior of the respondents. Results indicate that among the constructs of the HBM and 5C Antecedents models, "perceived benefits", "confidence" and "collective responsibility" showed a lesser likelihood of COVID-19 vaccine hesitancy. However, in the TPB model constructs, a 'negative attitude towards the vaccine' showed a four times higher likelihood of COVID-19 vaccine hesitancy. From the future policy perspective, this study suggested that addressing the issue of 'negative attitudes towards the vaccine' and increasing the trust or confidence for the vaccine through increasing awareness about the benefits of the vaccination in India may reduce vaccine hesitancy.

Examining the Handling of Stunting in The Osing Tribe as An Effort to Banyuwangi Zero Stunting

Background: Handling stunting in the Gitik Community Health Center working area can reduce stunting rates significantly. Objective: This research aims to examine the handling of stunting in the Osing tribe as an effort to create zero stunting in Banyuwangi. Method: The research design uses qualitative with a phenomenological approach. By using a purposive sampling technique, 9 participants were obtained, namely mothers who had stunted-free children and mothers who had stunted children. Data collection was carried out using semi-structured interviews. Data analysis used the Colaizzi method with the help of Nvivo 12 software. Result: 5 themes and 13 subthemes were analyzed for the main participants in this research; 1) Grieving; 2) Information; 3) Individual Motivation; 4) Social motivation; 5) Behavioral skills. Conclusion : Handling stunting among the Osing tribe in the Gitik Health Behavior (IMB) theory. Handling stunting by providing information Center Working Area is by the Information Motivation Skills with health education to mothers, so that mothers have personal motivation, supported by social motivation in handling stunting and maternal behavioral skills in caring for and providing parenting to children

Behavioral Intention of Receiving Monkeypox Vaccination and Undergoing Monkeypox Testing and the Associated Factors Among Young Men Who Have Sex With Men in China: Large Cross-Sectional Study.

The worldwide human monkeypox (mpox) outbreak in 2022 mainly affected men who have sex with men (MSM). In China, young men who have sex with men (YMSM) were at a potential high risk of mpox infection due to their sexual activeness and the eased COVID-19 restrictions at the end of 2022. This study aimed to investigate the behavioral intention of receiving mpox vaccination and undergoing mpox testing in 4 different scenarios and explore their associations with background and behavioral theory-related factors among Chinese YMSM. An online cross-sectional survey was conducted among YMSM aged 18-29 years from 6 representative provinces of China in September 2022. Participants recruited (recruitment rate=2918/4342, 67.2%) were asked to self-administer an anonymous questionnaire designed based on prior knowledge about mpox and classic health behavior theories. Data on the participants' background, mpox knowledge and cognition, mpox vaccination and testing cognition, and the behavioral intention of receiving mpox vaccination and undergoing mpox testing were collected. Descriptive analysis and univariate and multivariate linear regressions were performed. Geodetector was used to measure the stratified heterogeneity of behavioral intention. A total of 2493 YMSM with a mean age of 24.6 (SD 2.9) years were included. The prevalence of having a behavioral intention of receiving mpox vaccination ranged from 66.2% to 88.4% by scenario, varying in epidemic status and cost. The prevalence of having an mpox testing intention was above 90% in all scenarios regardless of the presence of symptoms and the cost. The positive factors related to vaccination intention included mpox knowledge (ba=0.060, 95% CI 0.016-0.103), perceived susceptibility of mpox (ba=0.091, 95% CI 0.035-0.146), perceived severity of mpox (ba=0.230, 95% CI 0.164-0.296), emotional distress caused by mpox (ba=0.270, 95% CI 0.160-0.380), perceived benefits of mpox vaccination (ba=0.455, 95% CI 0.411-0.498), self-efficacy of mpox vaccination (ba=0.586, 95% CI 0.504-0.668), and having 1 male sex partner (ba=0.452, 95% CI 0.098-0.806), while the negative factor was perceived barriers to vaccination (ba=-0.056, 95% CI -0.090 to -0.022). The positive factors related to testing intention were perceived severity of mpox (ba=0.283, 95% CI 0.241-0.325), perceived benefits of mpox testing (ba=0.679, 95% CI 0.636-0.721), self-efficacy of mpox testing (ba=0.195, 95% CI 0.146-0.245), having 1 male sex partner (ba=0.290, 95% CI 0.070-0.510), and having in-person gatherings with MSM (ba=0.219, 95% CI 0.072-0.366), while the negative factor was emotional distress caused by mpox (ba=-0.069, 95% CI -0.137 to -0.001). Among Chinese YMSM, the intention of undergoing mpox testing is optimal, while the mpox vaccination intention has room for improvement. A future national response should raise YMSM's mpox knowledge, disseminate updated information about mpox and preventive measures, improve preventive service accessibility and privacy, and provide advice on positively coping with the associated emotional distress.

A Mixed-Methods Approach to Develop a Combined Model of U.S. College Student Alcohol-Associated Condomless Sex.

Unhealthy alcohol use and sexually transmitted infections (STIs) are significant public health concerns for US college students. Because alcohol use and condomless sex often co-occur in this population, alcohol-associated condomless sex has been identified as a behavioral intervention target. Existing theoretical frameworks have not garnered sufficient empirical support to serve as the foundation for interventions. The primary goal of the current study was to use a mixed-methods approach to develop a model of college student alcohol-associated condomless sex that combines elements from well-established health behavior theories. In Aim 1, multilevel modeling was used to predict condomless vaginal sex in a sample of heterosexual college student drinkers (N = 53). Aim 2 consisted of in-depth interviews (n = 18) to gather perceptions about the role of alcohol in sexual activity and identify supplemental constructs omitted from theories in Aim 1. The multilevel model explained a significant proportion of variance in condomless vaginal sex at the between- and within-person level. Themes derived from the in-depth interviews identified complementary elements of condom use decision-making. Findings from both aims were synthesized to construct a combined model of alcohol-associated condomless sex. This model can be further refined and ultimately serve as the foundation of an alcohol-STI prevention-intervention.

Determinants of health poverty vulnerability in rural areas of Western China in the post-poverty relief era: an analysis based on the Anderson behavioral model

BackgroundAlthough China has eliminated absolute poverty, the effects of sickness still pose a threat to the prospect of returning to poverty in western rural areas. However, poverty governance extends beyond solving absolute poverty, and should enhance the family’s ability to resist risks, proactively identify the existence of risks, and facilitate preventive measures to reduce the probability of falling into poverty again. This study aimed to assess the health poverty vulnerability of rural households in western China and decompose its determinants.MethodsBased on survey data from 2022, the three-stage feasible generalized least squares method was used to calculate the health poverty vulnerability index. Then, Anderson’s health behavior theory model was extended to analyse various influencing factors using binary logistic regression, and the contribution of each influencing factor was decomposed using the Shapley index. Finally, Tobit regression and the censored least absolute deviations estimation (clad) method were used to test the model’s robustness.ResultsA total of 5455 families in the rural Ningxia region of western China were included in the study. The health poverty vulnerability index of the sample population in 2022 was 0.3000 ± 0.2223, and families with vulnerability ≥0.5 accounted for 16.9% of the sample population. From the Anderson behavioral model, the three models including propensity, enabling, and demand factors had the best fit, and the AIC and BIC values were the smallest. The Shapley decomposition showed that the dimensions of the propensity factor, number of residents, age and educational level of the household head, and dependency ratio were the most important factors influencing vulnerability to health poverty. Tobit regression and the clad method proved the reliability of the constructed model through a robustness test.ConclusionRural areas still face the risk of becoming poor or falling into poverty owing to residents’ health problems. Health poverty alleviation should gradually change from a focus on treatment to prevention, and formulate a set of accurate and efficient intervention policies from a forward-looking perspective to consolidate the results of health poverty alleviation and prevent widescale poverty return.

Consumer risk perception and behavior change intentions

This manuscript addresses behavior change intentions and consumer risk perceptions in the context of uncertainty and crisis such as the Covid-19 pandemic. Based on the theory of planned behavior and health behavior theories, a conceptual framework is developed that focuses on the role of attitudes toward the Covid-19 pandemic, their determinants in the context of the public campaign conducted, and the resulting behavior change intentions. The empirical study, based on an actual campaign and a representative nationwide sample in a developing country, is conducted to test the developed hypotheses. The results suggest that information search is relevant to predicting attitudes and intention to change behavior. At the same time, exposure to the campaign is directly relevant to motivating the target audience to change their behavior. There is also a gap between attitude and behavior, but it is bridged by perceived risk, which plays a vital moderating role when rated high or low. Finally, in the presence of this moderating effect, an indirect effect of information search on behavior change intention is confirmed by attitudes toward the Covid-19 pandemic. Overall, this study provides valuable insights for research in health behavior and crisis management.

Assessment of Knowledge, Attitudes, and Practices Associated with Chronic Kidney Disease in Pakistan

Purpose: Chronic kidney disease has been recognized as a leading public health problem worldwide. The global estimated prevalence of CKD is 13.4%, whereas in Pakistan it is 21.2%. It is a growing health threat therefore understanding knowledge, attitudes, and practices associated with kidney diseases are vital for forming optimal policy and public health responses in the region.
 Materials and Methods: This cross-sectional study was conducted nationwide. A total of 922 participants were enrolled in this study using convenience sampling technique. Data were obtained using a structured questionnaire in both English and Urdu languages. The questionnaire was designed in four sections, collecting information for demographic data, knowledge assessment, attitudes and practices related to kidney diseases. Descriptive statistics were used to describe demographic characteristics, mean and standard deviation were used for continuous variables. Scores more than 50 percent were classified as satisfactory knowledge about CKD.
 FINDINGS: Based on the findings of this study majority of the participants (87%) had adequate knowledge regarding the risk factors and common causes of kidney diseases like hypertension, diabetes and excessive use of pain killers. However, knowledge about the proper diagnosis of Kidney diseases was lacking and more than half of the participants (58%) were of the opinion that urine’s color, smell and quality is enough to detect kidney disease and lab test for detection is not exclusively needed for the diagnosis.
 The thought of developing kidney disease was a concern for most of the participants, and even the participants in the well-earned subgroup of working professionals were concerned about the cost of treating kidney disease. A larger proportion of participants (41%) were worried about revealing their diagnosis of kidney disease within the community and up to 89.2% of the participants considered kidney diseases diagnosis as a risk factor for losing their jobs. Regarding the practices, 95.7 % of the participants were willing to visit medical doctor if they were diagnosed with kidney disease and were prepared to prefer medical treatment over Hakeem, homeopathy and home remedies. Overall, participants who are males, middle aged, postgraduate and those with no known co-morbidities and a professional job showed most adequate knowledge related to CKD
 Implications to Theory Practice and Policy: Our study draws upon the Health Belief Model, a health behavior theory, and its validation is evident in the results obtained. The findings highlight a discernible disparity in chronic kidney disease (CKD) knowledge across diverse demographic groups. Notably, a substantial level of ignorance was identified among participants concerning the diagnosis of kidney diseases. Addressing this knowledge gap is imperative for enhancing the overall health of our general population.

Conceptual replication and extension of health behavior theories' predictions in the context of COVID‐19: Evidence across countries and over time

AbstractVirus mitigation behavior has been and still is a powerful means to fight the COVID‐19 pandemic irrespective of the availability of pharmaceutical means (e.g., vaccines). We drew on health behavior theories to predict health‐protective (coping‐specific) responses and hope (coping non‐specific response) from health‐related cognitions (vulnerability, severity, self‐assessed knowledge, efficacy). In an extension of this model, we proposed orientation to internal (problem‐focused coping) and external (country capability) coping resources as antecedents of health protection and hope; health‐related cognitions were assumed as mediators of this link. We tested these predictions in a large multi‐national multi‐wave study with a cross‐sectional panel at T1 (Baseline, March‐April 2020; N = 57,631 in 113 countries) and a panel subsample at two later time points, T2 (November 2020; N = 3097) and T3 (April 2021; N = 2628). Multilevel models showed that health‐related cognitions predicted health‐protective responses and hope. Problem‐focused coping was mainly linked to health‐protective behaviors (T1‐T3), whereas country capability was mainly linked to hope (T1‐T3). These relationships were partially mediated by health‐related cognitions. We conceptually replicated predictions of health behavior theories within a real health threat, further suggesting how different coping resources are associated with qualitatively distinct outcomes. Both patterns were consistent across countries and time.