Predictors Of Behavior Change Research Articles

Validating Persuasive Experience (PX) Theory: Preliminary Results of a Case Study on a Corporate Wellness Program’s Web-based Learning Interfaces

The objective of this study is to gain a clearer understanding of the role Persuasive Experience (PX) may play in wellness-oriented Web Based Learning (WBL) platforms in forming abilities to incite healthier lifestyle (or promoting health behavior) in technology-based systems use. Specifically, individual users’ interactions with a particular corporate wellness WBL platform was examined in relation to their State of Mind and Behavior. The results of this study may assist in better predicting behavior change and sustainable adherence to increased physical activity routines that could reduce risk of behavior sensitive conditions such as cardiovascular disease and its sequelae in U.S. workplaces. The findings of this case study also offer further validation of PX Theory and insight into its potential to aid in developing and implementing more effective persuasive technologies. The hope is that PX might contribute to technological systems design that can measurably and meaningfully assist employees in changing to healthier behaviors to improve their individual health outcomes. The results of this case study also suggest the potential PX driven design for wellness oriented WBL systems may have in improving overall organizational wellbeing and outcomes related to unplanned health insurance expenditures.

Exploring predictors of change in behavioral problems over a 1-year period in preterm born preschoolers

ObjectiveAlthough predictors of the prevalence of behavioral problems in preterm-born children have been frequently studied, predictors of behavioral change in these children remain unknown. Therefore, in this study we explore predictors of short-term changes in problem behavior in preterm-born preschoolers, an age period characterized by rapid behavioral change. MethodTwo- to 5-year-old children born with a gestational age <32 weeks and/or birth weight <1500 g were eligible, because of their high risk for behavioral problems. Following screening, 59 children with a t-score ≥60 on either the internal, external or total problem scale of the Child Behavior Checklist were included in the study. Linear mixed modeling was used to investigate predictors of change in behavior over a 1-year period. ResultsHigher levels of parenting stress, parent perceived child vulnerability, and parental hostility towards the child and lower educational levels of the mother significantly predicted increases in externalizing behavior. The higher the age of the child, the more internalizing problems decreased. ConclusionsParenting stress, parent perceived child vulnerability and parental hostility towards the child were the only modifiable predictors of increases in externalizing behavior, whilst no modifiable predictors of internalizing behavior were found. There may be a reciprocal interaction between stress in parents and child externalizing problems. Furthermore, stress and worries may directly influence parents’ reports on behavioral measures, because it could cause them to be concerned by behavior otherwise perceived as normal. Therefore, future interventions for parents of preterm-born children should primarily address parental stress and concerns regarding their child.

STRESS AMONG MEDICAL STUDENTS - A GLOBAL CONCERN

Stress is any exasperating and infuriating "emotional experience accompanied by predictable biochemical, physiological and behavioral changes" [1]. At many occasions stress can be useful at times, bring into being a boost that offers the drive and energy to help individuals get through situations like exams or work deadlines. Nevertheless, a life-threatening amount of stress can have health concerns and negatively upset the immune, cardiovascular, neuroendocrine and central nervous systems [2].

Predicting behavior change from persuasive messages using neural representational similarity and social network analyses

Neural activity in medial prefrontal cortex (MPFC), identified as engaging in self-related processing, predicts later health behavior change. However, it is unknown to what extent individual differences in neural representation of content and lived experience influence this brain-behavior relationship. We examined whether the strength of content-specific representations during persuasive messaging relates to later behavior change, and whether these relationships change as a function of individuals’ social network composition. In our study, smokers viewed anti-smoking messages while undergoing fMRI and we measured changes in their smoking behavior one month later. Using representational similarity analyses, we found that the degree to which message content (i.e. health, social, or valence information) was represented in a self-related processing MPFC region was associated with later smoking behavior, with increased representations of negatively valenced (risk) information corresponding to greater message-consistent behavior change. Furthermore, the relationship between representations and behavior change depended on social network composition: smokers who had proportionally fewer smokers in their network showed increases in smoking behavior when social or health content was strongly represented in MPFC, whereas message-consistent behavior (i.e., less smoking) was more likely for those with proportionally more smokers in their social network who represented social or health consequences more strongly. These results highlight the dynamic relationship between representations in MPFC and key outcomes such as health behavior change; a complete understanding of the role of MPFC in motivation and action should take into account individual differences in neural representation of stimulus attributes and social context variables such as social network composition.

Development and Validation of the Narrative Quality Assessment Tool.

The use of storytelling in health promotion has grown over the past 2 decades, showing promise for moving people to initiate healthy behavior change. Given the increasingly prevalent role of storytelling in health promotion research and the need to more clearly identify what storytelling elements and mediators may better predict behavior change, there is a need to develop measures to specifically assess these factors in a cultural community context. The purpose of this study is to develop and preliminarily validate a narrative quality assessment tool for measuring elements of storytelling that are predicted to affect attitude and behavior change (i.e., narrative characteristics, identification, and transportation) within a cultural community setting using a culture-centric model. Reliability and validity of these scales were assessed with repeated administrations among 74 Latino men and women with a mean age of 39.6 years (SD = 11.47 years). The confirmatory factor analysis in addition to internal consistency tests revealed preliminary evidence for reliability and validity of the narrative characteristics, identification, and transportation scales. Cronbach's alpha ranged from .92 to .94. Items revealed adequate factor loadings (.85-.98) and good model fit. The new scales provide the first step in moving the assessment of narrative quality into a culturally relevant context for evaluation of story use in health promotion. The results present valuable information for nurse researchers to guide the development and testing of culturally grounded storytelling interventions' potential to predict attitude and behavior change for patients.

Personality Factors as Determinants of the Stress Experienced By the Adolescents

Adolescence is an age of opportunity for children, and a pivotal time for us to build on their development in the first decade of life, to help them navigate risks and vulnerabilities, and to set them on the path to fulfilling their potential. During adolescents there are high rates of drug abuse, suicides, social withdrawals, alcohol abuse or sudden angry outbursts. The present study aims at investigating the personality factors as determinants of the stress experienced by the adolescents. Anything that poses threat to our wellbeing is a stress for us. Stress is experienced by everyone from time to time. Not all stress is bad, thus, there is both eustress and distress. According to Baum (1990), stress is any uncomfortable emotional experience accompanied by predictable biochemical, physiological and behavioral changes. Hans Selye defined stress as a non-specific response of the body to any demand for change. Adolescence has been considered, almost by definition, a period of heightened stress (Spear, 2000) due to the many changes experienced concomitantly, including physical maturation, drive for independence, increased salience of social and peer interactions, and brain development (Blakemore, 2008; Casey, Getz, &amp; Galvan, 2008a; Casey, Jones, &amp; Hare, 2008b). Although new-found independence can be stimulating it may also lead to feelings of being overwhelmed by change, which has historically led some researchers to characterize adolescence as ridden with ‘storm and stress’ (Hall, 1904). Thus, being pushed under the pressure of increased competition mostly in career opportunities, parent/ peer/ teacher’s pressure, there is lot of stress among adolescents and there is high need to focus on this issue amongst them. Many factors affect stress, personality is one major amongst them. Specific inherited characteristics, early experience in life, and particular, learned cognitive predispositions make individuals more or less susceptible to the effects of stressors. Intensity of stress response are greatly dependable on age, gender, intelligence, and numerous characteristics of personality, such as hardiness, locus of control, self-efficacy, self-esteem, optimism, hostility (component of type A personality) and type D traits (negative affectivity and social inhibition). The increasing number of suicide rates indicates that there is stress among adolescents, so we can work on the personality traits which help in reduction of stress amongst adolescents such as resilience, hardiness etc. Thus, to understand the relation between personality and stress, it is essential to recognize the impact of individual differences on stress. Quantitative method is being used by the researcher. Appropriate data analysis will be done.

Flax fibers – epoxy with embedded nanocomposite sensors to design lightweight smart bio-composites

Lightweight smart bio-composites with damage sensing ability have been designed. Conductive polymer nanocomposites-based quantum resistive sensors (sQRS) have been embedded in a unidirectional flax fibers – epoxy bio-composite samples using a spray layer by layer process to monitor their structural health and eventually anticipate their failure. The in situ piezo-resistive responses of sQRS under monotonic and incremental cyclic tensile tests were analyzed to learn more about the damage mechanisms and predict behavior changes in the laminated bio-composites. sQRS signals were found to be well correlated with the typical mechanical traces of flax fibers/epoxy composites, thus allowing reliable conclusions about structural changes taking place in the core of the bio-composite under strain. In particular, the analysis of sQRS gauge factor evolution with strain level proved to be helpful to assess the probability of damage. This new contribution to the understanding of flax fiber-based composites’ mechanical behavior is expected to be of special interest as the sliding of fibrils weakly assembled in bundles makes it difficult to approach.

Analyzing Exercise Behaviors during the College Years: Results from Latent Growth Curve Analysis.

The objective of this study is to analyze changes in the predictors of physical activity behavior among college students. The Theory of Planned Behavior served as its theoretical framework. Methods: Among an initial sample of 417 college students, 195 participants completed a validated questionnaire measuring attitudes, subjective norms, perceived control, intentions and self-reported physical activity, at the beginning and end of each of 3 college semesters. Latent growth curve modeling analyses were conducted to examine the relationships between the trajectories of changes in PA, intentions, attitudes, subjective norms, and perceived control. Results: Good fit indices supported the validity of the proposed longitudinal model (CFI > .97, RMSEA < .05). Changes in perceived control (γ = 0.57) were significantly linked with changes in intentions (p < .05). Perceived control (γ = 0.28) and intention growth (γ = 0.36) predicted behavior changes (p < .05). No gender differences were observed on attitudes, subjective norms and perceived control (p > .10). However, girls tend to have higher growth parameters on intentions and physical activity (p < .05). In summary, intentions and physical activity has significantly increased over 3 college semesters (growth parameters significant at p < .05). Conclusions: This study demonstrated that attitudes and perceived control are key determinants regarding the intentions of being active. On a longer term perspective, future physical activity interventions should focus on the enhancement of students’ perceived control. Such educational context should help in promoting the adoption of an active lifestyle during college.

Predicting Individual Action Switching in Covert and Continuous Interactive Tasks Using the Fluid Events Model.

The Fluid Events Model is aimed at predicting changes in the actions people take on a moment-by-moment basis. In contrast with other research on action selection, this work does not investigate why some course of action was selected, but rather the likelihood of discontinuing the current course of action and selecting another in the near future. This is done using both task-based and experience-based factors. Prior work evaluated this model in the context of trial-by-trial, independent, interactive events, such as choosing how to copy a figure of a line drawing. In this paper, we extend this model to more covert event experiences, such as reading narratives, as well as to continuous interactive events, such as playing a video game. To this end, the model was applied to existing data sets of reading time and event segmentation for written and picture stories. It was also applied to existing data sets of performance in a strategy board game, an aerial combat game, and a first person shooter game in which a participant’s current state was dependent on prior events. The results revealed that the model predicted behavior changes well, taking into account both the theoretically defined structure of the described events, as well as a person’s prior experience. Thus, theories of event cognition can benefit from efforts that take into account not only how events in the world are structured, but also how people experience those events.

Prioritizing multiple health behavior change research topics: expert opinions in behavior change science.

Multiple health behavior change (MHBC) approaches are understudied. The purpose of this study is to provide strategic MHBC research direction. This cross-sectional study contacted participants through the Society of Behavioral Medicine email listservs and rated the importance of 24 MHBC research topics (1 = not at all important, 5 = extremely important) separately for general and underserved populations. Participants (n = 76) were 79% female; 76% White, 10% Asian, 8% African American, 5% Hispanic, and 1% Native Hawaiian/Pacific Islander. Top MHBC research priorities were predictors of behavior change and the sustainability, long-term effects, and dissemination/translation of interventions for both populations. Recruitment and retention of participants (t(68) = 2.17, p = 0.000), multi-behavioral indices (t(68) = 3.54, p = 0.001), and measurement burden (t(67) = 5.04, p = 0.001) were important for the underserved. Results identified the same top research priorities across populations. For the underserved, research should emphasize recruitment, retention, and measurement burden.

Brain, Mind, and Media

Brain, Mind, and Media

Brain Activity in Self- and Value-Related Regions in Response to Online Antismoking Messages Predicts Behavior Change.

In this study, we combined approaches from media psychology and neuroscience to ask whether brain activity in response to online antismoking messages can predict smoking behavior change. In particular, we examined activity in subregions of the medial prefrontal cortex linked to self- and value-related processing, to test whether these neurocognitive processes play a role in message-consistent behavior change. We observed significant relationships between activity in both brain regions of interest and behavior change (such that higher activity predicted a larger reduction in smoking). Furthermore, activity in these brain regions predicted variance independent of traditional, theory-driven self-report metrics such as intention, self-efficacy, and risk perceptions. We propose that valuation is an additional cognitive process that should be investigated further as we search for a mechanistic explanation of the relationship between brain activity and media effects relevant to health behavior change.

Magnitude and determinants of change in objectively-measured physical activity, sedentary time and sleep duration from ages 15 to 17.5y in UK adolescents: the ROOTS study.

BackgroundSelf-reported physical activity (PA) and sleep duration (SLP) change markedly throughout adolescence. We sought to quantify changes in objectively-measured PA, sedentary time (ST) and SLP through adolescence, and to investigate baseline body composition and baseline activity levels as determinants of change.MethodsIndividually calibrated combined heart rate and movement sensing was used to estimate PA energy expenditure (PAEE), SLP, daily ST and time in light (LPA), moderate (MPA), vigorous (VPA), and moderate-to-vigorous physical activity (MVPA) in 144 adolescents (50 % boys) of mean age 15.1(±0.3)y at baseline and 17.5(±0.3)y at follow-up. Changes in PA (ΔPA), ST (ΔST) and SLP (ΔSLP) were calculated as follow-up minus baseline values. Waist circumference (WC) was measured at baseline and follow-up, as was fat mass index (FMI) and fat-free mass index (FFMI) by a pooled estimation method including bio-impedance. Comparison of baseline and follow-up activity was made by mixed-model ANOVA. Linear regression adjusted for baseline demographics, total and weekend hours of monitor wear time and the seasons of activity measurements, was used to investigate baseline body composition as determinants of ΔPA, ΔST and ΔSLP. A further model adjusted for baseline of the outcome assessed baseline activity as a predictor of behaviour change, and investigated associations for baseline body composition independent of the baseline level of the outcome.ResultsFrom baseline to follow-up levels of MPA and VPA declined (p ≤ 0.039). The annual decline in MVPA was equivalent to -4.5 and -3.0 min/d in boys and girls, respectively. Baseline FMI, FFMI and WC were positively associated with ΔLPA and negatively associated with ΔST in boys when adjusted for baseline of the outcome (p ≤ 0.037 for all). SLP increased from baseline to follow-up (p = 0.004) but ΔSLP was not associated with baseline body composition (p ≥ 0.13). For all variables, higher baseline levels were associated with greater declines over time (p ≤ 0.003).ConclusionsLevels of higher-intensity PA decline from mid-to-late adolescence, whereas the duration of sleep increases. Changes in LPA and ST may be associated with baseline body composition, but the baseline level of the outcome is consistently the strongest predictor of changes in adolescent activity.

Beyond silence: protocol for a randomized parallel-group trial comparing two approaches to workplace mental health education for healthcare employees.

BackgroundMental illness is a significant and growing problem in Canadian healthcare organizations, leading to tremendous personal, social and financial costs for individuals, their colleagues, their employers and their patients. Early and appropriate intervention is needed, but unfortunately, few workers get the help that they need in a timely way due to barriers related to poor mental health literacy, stigma, and inadequate access to mental health services. Workplace education and training is one promising approach to early identification and support for workers who are struggling. Little is known, however, about what approach is most effective, particularly in the context of healthcare work. The purpose of this study is to compare the impact of a customized, contact-based education approach with standard mental health literacy training on the mental health knowledge, stigmatized beliefs and help-seeking/help-outreach behaviors of healthcare employees.Methods/DesignA multi-centre, randomized, two-group parallel group trial design will be adopted. Two hundred healthcare employees will be randomly assigned to one of two educational interventions: Beyond Silence, a peer-led program customized to the healthcare workplace, and Mental Health First Aid, a standardized literacy based training program. Pre, post and 3-month follow-up surveys will track changes in knowledge (mental health literacy), attitudes towards mental illness, and help-seeking/help-outreach behavior. An intent-to-treat, repeated measures analysis will be conducted to compare changes in the two groups over time in terms of the primary outcome of behavior change. Linear regression modeling will be used to explore the extent to which knowledge, and attitudes predict behavior change. Qualitative interviews with participants and leaders will also be conducted to examine process and implementation of the programs.DiscussionThis is one of the first experimental studies to compare outcomes of standard mental health literacy training to an intervention with an added anti-stigma component (using best-practices of contact-based education). Study findings will inform recommendations for designing workplace mental health education to promote early intervention for employees with mental health issues in the context of healthcare work.Trial registrationMay 2014 - ClinicalTrials.gov: NCT02158871.

Does Knowledge of Coronary Artery Calcium Affect Cardiovascular Risk Perception, Likelihood of Taking Action, and Health-Promoting Behavior Change?

Evidence indicates that a healthy lifestyle can reduce cardiovascular disease risk, yet many people engage in unhealthy behaviors. New technologies such as coronary artery calcium (CAC) screening detect atherosclerosis before clinical disease is manifested. Knowledge of an abnormal finding could provide the "teachable moment" to enhance motivation for change. The aim of this study was to examine how knowledge of CAC score affects risk perception, likelihood of taking action, and health-promoting behavior change in persons at high risk for cardiovascular disease. This study used a descriptive prospective design with 174 high-risk adults (≥3 major risk factors) recruited at a radiology center offering CAC scans. Baseline self-report surveys using the Perception of Risk of Heart Disease Scale, the Benefits and Barriers Scale, the Quality of Life Index, and the Health-Promoting Lifestyle Profile II were completed immediately after a screening CAC scan but before results were known. Follow-up occurred 3 months later using mailed packets. Participants' mean age was 58 years; 62% were men, 89% were white, and most were well educated. There was no significant change in risk perception scores over time or between groups, except for a positive interaction in the moderate-risk group (CAC scores of 101-400) (P = .004). Quality of life remained unchanged. Health-promoting behavior changes increased in all groups over time (P < .001). McNemar χ² analysis indicated that risk reduction medication use increased in all groups, with a significant increase in statin (P < .001) and aspirin (P < .001) intake. Predictors of behavior change were perceived barriers (β = -.41; P < .001) and quality of life (β = .44; P < .001). Knowledge of CAC score does impact risk perception for some at-risk groups. This knowledge does enhance motivation for behavior change. Knowledge of CAC score does not impact quality of life. It is hoped that through improved understanding of the effect of CAC scoring on behavior change, nurses can better assist patients to modify behaviors during teachable moments.

Abstract 5057: The role of health locus of control and self-efficacy beliefs in sunscreen use: Evidence from 2012 Health Information National Trends Survey

Abstract Sun exposure has been identified as a cause of skin cancer (Armstrong &amp; Kricker, 2001). Extensive empirical evidence shows that sunscreen use was associated with lower skin cancer incidence (Green et al., 1999, 2011). However, only 32% U.S. adults used sunscreen regularly (NCI, 2010); the percentage was even lower (21.7%) among adolescents (Eaton et al., 2012). To reduce skin cancer burden, sunscreen use promotion should be enhanced. Locus of control, the extent to which people believe they have control over their lives with external and internal dimensions (Rotter, 1954), is a significant predictor of behavioral changes (Bundek et al., 1993). Internal locus of control, i.e., beliefs that reinforcements are dependent upon one's own behavior, is positively related with behavioral changes, e.g., weight loss (O'Bryan, 1972) and health information seeking (Wallston &amp; Maides, 1976), etc. Self-efficacy, the extent to which one believes to be capable of performing the recommended behavior (Bandura, 1977), is a robust predictor for behavioral changes including smoking cessation (Norman, 1994) and AIDS prevention (Yzer, 1998), etc. However, little research focuses on the role of locus of control and self-efficacy in promoting sunscreen use by using nationally representative cross-sectional data. The present study bridges this gap by examining the following two hypotheses: H1: People with high external locus of control were less likely to use sunscreen. H2: People with high health self-efficacy were more likely to use sunscreen. Results show that people high in external locus of control were less likely to use sunscreen (B=-0.160, p=0.001) and people high in health self-efficacy were more likely to use sunscreen (B= 0.331, p=0.046), both of which were statistically significant. Males, Pacific Islanders, homemakers, and non-immigrants were more likely to use sunscreen. The findings attest to the necessity of enhancing people's internal locus of control and self-efficacy with the purpose of promoting sunscreen use. Public health efforts could be allocated based on the socio-demographic findings. Citation Format: Xiaofei He. The role of health locus of control and self-efficacy beliefs in sunscreen use: Evidence from 2012 Health Information National Trends Survey. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5057. doi:10.1158/1538-7445.AM2014-5057

Predictors of health-related behaviour change in parents of overweight children in England

ObjectiveProviding parents with information about their child's overweight status (feedback) could prompt them to make lifestyle changes for their children. We assessed whether parents of overweight children intend to or change behaviours following feedback, and examined predictors of these transitions. MethodsWe analysed data from a cohort of parents of children aged 4–5 and 10–11years participating in the National Child Measurement Programme in five areas of England, 2010–2011. Parents of overweight children (body mass index ≥91st centile) with data at one or six months after feedback were included (n=285). The outcomes of interest were intention to change health-related behaviours and positive behaviour change at follow-up. Associations between respondent characteristics and outcomes were assessed using logistic regression analysis. ResultsAfter feedback, 72.1% of parents reported an intention to change; 54.7% reported positive behaviour change. Intention was associated with recognition of child overweight status (OR 11.20, 95% CI 4.49, 27.93). Parents of older and non-white children were more likely to report behaviour changes than parents of younger or white children. Intention did not predict behaviour change. ConclusionsParental recognition of child overweight predicts behavioural intentions. However, intentions do not necessarily translate into behaviours; interventions that aim to change intentions may have limited benefits.

Predictors of change in objectively measured and self-reported health behaviours among individuals with recently diagnosed type 2 diabetes: longitudinal results from the ADDITION-Plus trial cohort.

BackgroundThere is limited evidence about predictors of health behaviour change in people with type 2 diabetes. The aim of this study was to assess change in health behaviours over one year and to identify predictors of behaviour change among adults with screen-detected and recently clinically diagnosed diabetes.MethodsADDITION-Plus was a randomised controlled trial of a behaviour change intervention among 478 patients (40–69 years). Physical activity and diet were measured objectively (physical activity at 1 year) and by self-report at baseline and one year. Associations between baseline predictors and behaviour change were quantified using multivariable linear regression.ResultsParticipants increased their plasma vitamin C and fruit intake, reduced energy and fat intake from baseline to follow-up. Younger age, male sex, a smaller waist circumference, and a lower systolic blood pressure at baseline were associated with higher levels of objectively measured physical activity at one year. Greater increases in plasma vitamin C were observed in women (beta-coefficient [95% CI]: beta = −5.52 [−9.81, -1.22]) and in those with screen-detected diabetes (beta = 6.09 [1.74, 10.43]). Younger age predicted a greater reduction in fat (beta = −0.43 [−0.72, -0.13]) and energy intake (beta = −6.62 [−13.2, -0.05]). Patients with screen-detected diabetes (beta = 74.2 [27.92, 120.41]) reported a greater increase in fruit intake. There were no significant predictors of change in self-reported physical activity. Beliefs about behaviour change and diabetes did not predict behaviour change.ConclusionsOlder patients, men and those with a longer duration of diabetes may need more intensive support for dietary change. We recommend that future studies use objective measurement of health behaviours and that researchers add predictors beyond the individual level. Our results support a focus on establishing healthy lifestyle changes early in the diabetes disease trajectory.

Baseline predictors of maintenance of intervention-induced changes in physical activity and sitting time among diabetic and pre-diabetic patients: a descriptive case series

BackgroundThe aim of this study was to explore the predictive value of baseline characteristics in relation to changes in physical activity (PA) and sedentary behaviour among diabetic and pre-diabetic patients participating in a primary care based exercise intervention. We used a descriptive case series among diabetic and pre-diabetic patients (n = 119, 50.8% male, mean age 65.5 (SD = 7.8)). Measurements took place with questionnaires at baseline and two years after the start of the intervention. Predictor variables included demographic factors, Body Mass Index, baseline PA and sitting time, and baseline socio-cognitive profile.ResultsAt follow-up, respondents spent more time being physically active than at baseline. For the total group, the average sitting time remained almost unchanged between the two measurements. Further exploration showed that respondents who had relatively high levels of PA at the start of the intervention, increased their total sitting time, while respondents with relatively low levels of PA at the start decreased their sitting time. The socio-cognitive profile did not predict behaviour change. The intervention appeared to be suitable for people with a low-education level, but the results should be interpreted in view of the limitations of the study such as the non-controlled design, self-reported outcomes and selective drop-out of participants.ConclusionsInterventions for this specific target group may need to put more emphasis on the prevention of increased sitting time. The finding that the socio-cognitive profile did not predict behaviour change may underline the proposition that decisions to initiate and maintain PA behaviour change are to a large extend non-linear events. Acknowledging the possible non-linearity of the relationship between socio-cognitive determinants and behaviour change will help our understanding of this complex and dynamic process.

Abstract 1356: Promoting dietary change in the care of long term cancer survivors: Perspectives of the clinical care team.

Abstract Improvements in the prognosis of cancer patients attributable to advances in early detection and treatment have resulted in a large number of cancer survivors who are living longer lives. There are approximately 11.7 million cancer survivors in the United States, of whom 64% survive five or more years post-diagnosis. Cancer survivors are at increased risk of cancer recurrence, a second incidence of cancer, development of other chronic diseases, and report poorer health than adults who have not had cancer. Interventions seeking to promote behavior change, such as a healthy diet or regular physical activity, have been proposed as one strategy for improving the health outcomes and quality of life of long-term cancer survivors. Although a physician recommendation has consistently been found to be an important predictor of behavior change, there is limited research exploring current practices for addressing behavior change in the care of post-treatment cancer survivors or on the clinical perceptions of the importance of promoting behavior change. We conducted in-depth, semi-structured interviews with 32 clinicians (e.g., oncologists, primary care providers, nurses, dieticians, social workers) from two clinical settings (one academic and one community) who care for prostate, breast, and/or non-Hodgkin lymphoma cancer survivors. Interview questions focused on how diet is currently addressed in care of cancer survivors and perceptions of the importance of promoting dietary change among cancer survivors. Interviews were audio recorded, transcribed verbatim and analyzed using a constant comparison approach. Varying perspectives were elicited on the relevance of behavior change in caring for cancer survivors by clinician type (e.g., primary care providers compared to oncologists) and cancer type. Among clinicians who believed that promoting a healthy diet was an important component of caring for cancer survivors, some recommended dietary change as a strategy for reducing risk of recurrence, while others recommended it to promote overall health. The majority of clinicians who thought it was important to recommend dietary changes to their patients identified someone else as a more appropriate person to provide details about healthy diet or effective intervention strategies. Oncologists presented both lack of time and lack of expertise as barriers to addressing diet with their patients. Primary care providers (PCPs) were often mentioned as appropriate clinicians to handle dietary concerns, although they too cited similar barriers to care provision. These findings suggest that while many clinicians perceive value in promoting behavior change in cancer survivors, it does not fall neatly within the remit of any core member of the current cancer care team, nor are resources for nutrition expertise easily identified. Intervention strategies should address this gap. Citation Format: Katherine C. Smith, Kisha Coa, Ann C. Klassen, Laura Caulfield, Lillie Shockney, Kathy J. Helzlsouer. Promoting dietary change in the care of long term cancer survivors: Perspectives of the clinical care team. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1356. doi:10.1158/1538-7445.AM2013-1356