Predictors Of Behavior Change Research Articles

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

Theoretical Integration and the Psychology of Sport Injury Prevention

Integrating different theories of motivation to facilitate or predict behaviour change has received an increasing amount of attention within the health, sport and exercise science literature. A recent review article in Sports Medicine, by Keats, Emery and Finch presented an integrated model using two prominent theories in social psychology, self-determination theory (SDT) and the theory of planned behaviour (TPB), aimed at explaining and enhancing athletes' adherence to sport injury prevention. While echoing their optimistic views about the utility of these two theories to explain adherence in this area and the virtues of theoretical integration, we would like to seize this opportunity to clarify several conceptual principles arising from the authors' integration of the theories. Clarifying the theoretical assumptions and explaining precisely how theoretical integration works is crucial not only for improving the comprehensiveness of the integrated framework for predicting injury prevention behaviour, but also to aid the design of effective intervention strategies targeting behavioural adherence. In this article, we use the integration of SDT and TPB as an example to demonstrate how theoretical integration can advance the understanding of injury prevention behaviour in sport.

Theoretical Integration and the Psychology of Sport Injury Prevention

Integrating different theories of motivation to facilitate or predict behaviour change has received an increasing amount of attention within the health, sport and exercise science literature. A recent review article in Sports Medicine, by Keats, Emery and Finch presented an integrated model using two prominent theories in social psychology, self-determination theory (SDT) and the theory of planned behaviour (TPB), aimed at explaining and enhancing athletes' adherence to sport injury prevention. While echoing their optimistic views about the utility of these two theories to explain adherence in this area and the virtues of theoretical integration, we would like to seize this opportunity to clarify several conceptual principles arising from the authors' integration of the theories. Clarifying the theoretical assumptions and explaining precisely how theoretical integration works is crucial not only for improving the comprehensiveness of the integrated framework for predicting injury prevention behaviour, but also to aid the design of effective intervention strategies targeting behavioural adherence. In this article, we use the integration of SDT and TPB as an example to demonstrate how theoretical integration can advance the understanding of injury prevention behaviour in sport.

Beyond the usual suspects: target group- and behavior-specific factors add to a theory-based sun protection intervention for teenagers

Sun protection standards among teenagers are low while sun exposure peaks in this age group. Study 1 explores predictors of adolescent protection intentions and exposure behavior. Study 2 tests the effectiveness of an intervention based on these predictors. Study 1(cross-sectional, N = 207, ages 15-18) and Study 2 (RCT, N = 253, ages 13-19) were conducted in schools. Path models were used to analyze data. Self-efficacy (β = .26, p < .001) and time perspective (β = .17, p = .014) were the strongest predictors of intentions; appearance motivation (β = .54, p < .001) and intention (β = -.18, p = .015) predicted behavior. The intervention effected changes in all predictors except self-efficacy. Changes in outcome expectancies (β = .19, p < .001) and time perspective (β = .09, p = .039) predicted changes in intention, while changes in intention (β = -.17, p = .002) and appearance motivation (β = .29, p < .001) predicted behavior changes. Target group- and behavior-specific intervention components are as important for changes in intentions and behavior as components derived from common health behavior theories.

Does change talk during brief motivational interventions with young men predict change in alcohol use?

Client change talk (CT) during motivational interviewing and brief motivational interventions (BMIs) have been described as predictors of behavior change, but these links have not been clearly evaluated in research on young people. Within 127 BMIs with 20-year-old men with at-risk alcohol consumption, each CT utterance was categorized and given a strength rating using the Motivational Interviewing Skill Code 2.1. Several ways of categorizing and measuring CT were tested using stepwise regression procedures. Overall CT measures were not significantly related to changes in drinking at 6-month follow-up. Regarding CT sub-dimensions, the frequency of ability/desire/need to change and of ability/desire/need not to change, as well as the average strength of ability/desire/need, predicted significant change in the expected direction. CT length was not significantly linked to outcome. The frequency and strength with which some CT sub-dimensions are expressed during BMI seemed to be important predictors of change in drinking among young men and might thus be especially important for clinicians to notice.

The Impact of a Community‐Based Oral, Head and Neck Cancer Screening for Reducing Tobacco Consumption

Examine the usefulness of large-scale community-based head and neck cancer screening for reducing tobacco use in an at-risk population. Questions answered: (1) Is participating in a community-based head and neck cancer screening related to a reduction in tobacco usage? (2) Do differing factors between participants predict behavior change? Survey based with a longitudinal follow-up component. Atlanta Motor Speedway during a National Association of Stock Car Auto Racing (NASCAR) race event. Recruited NASCAR fans (n = 620). Initial screening and 11-question survey for 6-month telephone follow-up. One hundred fifty-six participants (25%) required medical follow-up. Chi-square analysis indicated a significantly higher proportion of smokers (13%) evidenced positive findings compared to nonsmokers (8%) or past smokers (6%). Kruskal-Wallis analysis followed by Dunn's multiple comparison post hoc test indicated smokers were from a significantly lower socioeconomic status background compared to nonsmokers. Analysis of variance indicated contacted participants reported smoking significantly fewer cigarettes per day 6 months postscreening compared to the number of cigarettes smoked at the baseline. Forty-four (59%) participants reported reducing the number of cigarettes smoked per day, and 11 participants reported quitting smoking. The authors have demonstrated that large-scale community-based head and neck cancer screenings can be effectively implemented in nonmedical venues. This study demonstrated that targeting education for reduction of risk factors in the NASCAR population positively affected tobacco cessation.

The Impact of Ethnic Identity on Changes in High Risk HIV Behaviors in Sexually Active Migrant Workers

Among migrant workers (MWs) in the US, HIV/AIDS prevalence may be as high as 13.5%. This serial cross-sectional study examines associations between Ethnic Identity (EI) in African American and Hispanic MWs and short-term changes in high-risk sexual behaviors. Baseline and 3-month follow-up data was collected from a larger HIV intervention study among MWs in Immokalee, Florida (n = 119) who reported unprotected sex in the past 30 days. The Multigroup Identity Measure was used to assess EI. A high EI score indicates less acculturation to one's new surroundings. Females had higher levels of positive behavior change. Lower EI was associated with higher levels of positive change in relation to HIV/AIDS risk behavior. Among Hispanics, education was negatively correlated with EI. Education was a predictor of behavior change. Future interventions should focus on reducing acculturation stress, which may prompt harmful coping behaviors, such as high-risk sex and substance abuse.

The Influence of Operational Sex Ratio on the Intensity of Competition for Mates

The evolution and maintenance of secondary sexual characteristics and behavior are heavily influenced by the variance in mating success among individuals in a population. The operational sex ratio (OSR) is often used as a predictor of the intensity of competition for mates, as it describes the relative number of males and females who are ready to mate. We investigate changes in aggression, courtship, mate guarding, and sperm release as a function of changes in the OSR using meta-analytic techniques. As the OSR becomes increasingly biased, aggression increases as competitors attempt to defend mates, but this aggression begins to decrease at an OSR of 1.99, presumably due to the increased costs of competition as rivals become more numerous. Sperm release follows a similar but not significant trend. By contrast, courtship rate decreases as the OSR becomes increasingly biased, whereas mate guarding and copulation duration increase. Overall, predictable behavioral changes occur in response to OSR, although the nature of the change is dependent on the type of mating behavior. These results suggest considerable flexibility of mating system structure within species, which can be predicted by OSR and likely results in variation in the strength of sexual selection.

Neural activity during health messaging predicts reductions in smoking above and beyond self-report.

The current study tested whether neural activity in response to messages designed to help smokers quit could predict smoking reduction, above and beyond self-report. Using neural activity in an a priori region of interest (a subregion of medial prefrontal cortex [MPFC]), in response to ads designed to help smokers quit smoking, we prospectively predicted reductions in smoking in a community sample of smokers (N = 28) who were attempting to quit smoking. Smoking was assessed via expired carbon monoxide (CO; a biological measure of recent smoking) at baseline and 1 month following exposure to professionally developed quitting ads. A positive relationship was observed between activity in the MPFC region of interest and successful quitting (increased activity in MPFC was associated with a greater decrease in expired CO). The addition of neural activity to a model predicting changes in CO from self-reported intentions, self-efficacy, and ability to relate to the messages significantly improved model fit, doubling the variance explained (R²self-report = .15, R²self-report + neural activity = .35, R²change = .20). Neural activity is a useful complement to existing self-report measures. In this investigation, we extend prior work predicting behavior change based on neural activity in response to persuasive media to an important health domain and discuss potential psychological interpretations of the brain-behavior link. Our results support a novel use of neuroimaging technology for understanding the psychology of behavior change and facilitating health promotion.

Cognitive Biases to Healthy and Unhealthy Food Words Predict Change in BMI

The current study explored the predictive value of cognitive biases to food cues (assessed by emotional Stroop and dot probe tasks) on weight change over a 1-year period. This was a longitudinal study with undergraduate students (N = 102) living in shared student accommodation. After controlling for the effects of variables associated with weight (e.g., physical activity, stress, restrained eating, external eating, and emotional eating), no effects of cognitive bias were found with the dot probe. However, for the emotional Stroop, cognitive bias to unhealthy foods predicted an increase in BMI whereas cognitive bias to healthy foods was associated with a decrease in BMI. Results parallel findings in substance abuse research; cognitive biases appear to predict behavior change. Accordingly, future research should consider strategies for attentional retraining, encouraging individuals to reorient attention away from unhealthy eating cues.

Learning to lead: evaluating leadership and organizational learning

PurposeThis paper aims to evaluate leadership diffusion in a federal agency within the context of organizational learning and culture change.Design/methodology/approachUsing an innovative 360 degree survey assessment method, the impact of the United States Geological Survey (USGS) Leadership Program (LP) was examined. A series of statistical tests was performed to analyze the role of familiarity and exposure in predicting leadership behavior and to compare the level of leadership behavior among co‐workers based on exposure to the LP.FindingsThe findings indicate that familiarity is a critical predictor of behavior change across all co‐worker subgroups. Increased exposure to the LP results in stronger, more consistent predictive models. Finally, co‐workers with higher exposure to the LP have increased levels of leadership behavior.Research limitations/implicationsThe results in the study suggest that, in order to promote leadership and organizational learning, familiarity with leadership skills is essential. Furthermore, the greater the familiarity with leadership through at‐work interaction, the more likely co‐workers are to learn and apply leadership techniques.Originality/valueThe study is especially unique and valuable due to the advanced 360 degree assessment which acts as a tool to measure the diffusion of leadership principles from LP participants to co‐workers, while also analyzing the role of participant interaction with co‐workers following their participation in a leadership class.

Predicting Persuasion-Induced Behavior Change from the Brain

Although persuasive messages often alter people's self-reported attitudes and intentions to perform behaviors, these self-reports do not necessarily predict behavior change. We demonstrate that neural responses to persuasive messages can predict variability in behavior change in the subsequent week. Specifically, an a priori region of interest (ROI) in medial prefrontal cortex (MPFC) was reliably associated with behavior change (r = 0.49, p < 0.05). Additionally, an iterative cross-validation approach using activity in this MPFC ROI predicted an average 23% of the variance in behavior change beyond the variance predicted by self-reported attitudes and intentions. Thus, neural signals can predict behavioral changes that are not predicted from self-reported attitudes and intentions alone. Additionally, this is the first functional magnetic resonance imaging study to demonstrate that a neural signal can predict complex real world behavior days in advance.

Beyond pain: predictors of postoperative maladaptive behavior change in children

OBJECTIVES & AIM: Using well-validated measures and controlling for potential confounding variables such as pain and surgical and anesthetic technique, the goal of this project was to identify the incidence of and risk factors for the development of behavior change in children after surgery. Although researchers have described maladaptive behavior change following surgery, many previous studies are limited by potential confounding variables, including postoperative pain, type of surgery, and surgical and anesthetic procedure. Participants included 260 children undergoing tonsillectomy and adenoidectomy. Baseline and demographic data were collected prior to surgery and pain and behavioral recovery were recorded for 2 weeks following surgery. A standardized approach to anesthesia and surgical procedure was implemented and well-validated assessment measures were used. On the first day at home following surgery, 80.4% of children exhibited negative behavior change. Nearly one-third of children continued to exhibit behavior changes 2 weeks after surgery. Logistic regression analyses that controlled for pain severity identified several predictors of behavior change: preexisting somatic and anxious/depressed problems predicted new onset postoperative general anxiety, chi(2) (8) = 20.10, P = 0.010; younger age predicted separation anxiety, chi(2) (4) = 20.41, P < 0.01; and inhibited temperament predicted postoperative sleep disturbance, chi(2) (2) = 9.19, P = 0.010. Individual child factors above and beyond pain predict maladaptive postoperative behavior change; identification of these predictors may be helpful in both preventing and ameliorating difficulties with behavioral recovery following surgery.

Treatment fidelity as a predictor of behaviour change in parents attending group‐based parent training

Change in parenting skills, particularly increased positive parenting, has been identified as the key component of successful evidence-based parent training (PT), playing a causal role in subsequent child behaviour change for both prevention and treatment of Conduct Disorder. The amount of change in parenting skills observed after PT varies and may be accounted for by both the content of the programme and by the level of PT implementer process skills. Such variation in implementer skills is an important component in the assessment of treatment fidelity, itself an essential factor in successful intervention outcome. To establish whether the Leader Observation Tool, a reliable and valid process skills fidelity measure, can predict change in parenting skills after attendance on the Incredible Years PT programme. Positive leader skills categories of the Leader Observation Tool significantly predicted change in both parent-reported and independently observed parenting skills behaviour, which in turn, predicted change in child behaviour outcome. Delivering an intervention with a high level of treatment fidelity not only preserves the behaviour change mechanisms of the intervention, but can also predict parental behaviour change, which itself predicts child behaviour change as a result of treatment.

Storytelling for Promoting Colorectal Cancer Screening among Underserved Latina Women: A Randomized Pilot Study

In a low socioeconomic-status population of Latina women, we evaluated the potential of storytelling (ST) as a culturally aligned narrative method to promote colorectal cancer (CRC) prevention and screening, compared to a risk tool (RT)-based intervention. Seventy-eight women were randomized in this pilot study to one of two brief interventions to communicate CRC risk reduction options: ST or an RT. Measures of behavioral intentions relative to CRC prevention and screening were obtained following the intervention. Mean scores for intent to obtain and recommend endoscopy to others were significantly better for participants receiving ST than RT (P = .038 and P = .011, respectively). All participants expressed intent to increase fruit and vegetable consumption and physical activity in response to interventions. Post-intervention perceptions of cancer risk and fear of CRC were not significantly different for participants receiving ST compared with RT. Pre- to post-intervention perceptions of risk increased in ST and decreased in RT, while decreases in fear were similar across both intervention groups. Storytelling may be an effective approach for changing CRC risk-related behavioral intentions among Latinas. Mediating factors (such as perceived risk or fear) often used to predict behavior change may not adequately explain the potential persuasive mechanisms of storytelling.

Theory‐Based Health Behavior Change: Developing, Testing, and Applying Theories for Evidence‐Based Interventions

Theories are needed to explain and predict health behavior, as well as for the design and evaluation of interventions. Although there has been a history of developing, testing, applying, and refining health behavior theories, debates and limitations in evidence exist: The component of theories which, for example, predicts change should be better elaborated so that we can more easily understand what actually drives behavior change. Theories need to be empirically testable in two ways. Theories need to specify a set of changeable predictors to describe, explain, and predict behavior change, and they should enable us to design an effective intervention that produces exactly those changes in behavior that are predicted by the relevant theory. To make this possible, theories need to be specified in such a way that they can be rigorously tested and falsified. Moreover, for the design of theory‐based interventions it must be possible to derive change techniques from the theory and to use them to generate changes in behavior. Based on eight state‐of‐the‐science articles that make conceptual and empirical contributions to the current debate on health behavior theories, various approaches are discussed to gain further insights into explaining and changing health behaviors and the iterative process of theory development.

Prediction of Behaviour vs. Prediction of Behaviour Change: The Role of Motivational Moderators in the Theory of Planned Behaviour

Research has identified moderating variables of the cognition–behaviour relationship in the Theory of Planned Behaviour (TPB). These include intention certainty, affective–cognitive congruence of attitudes, attitudinal ambivalence, and past behaviour. It has not yet been systematically tested if these moderators apply in similar ways to the prediction of behaviour and behaviour change (when past behaviour is controlled). A sample of 1,418 university students completed measures of the direct predictors of the TPB (perceived behavioural control; PBC and intention), intention certainty, affective–cognitive congruence of attitudes, attitudinal ambivalence, and the Godin Leisure Time Physical Exercise Questionnaire at the beginning of the academic year and two months later. Data were analysed using moderated hierarchical linear regressions. Without controlling for baseline behaviour, intention certainty and affective–cognitive congruence moderated both the intention–behaviour and PBC–behaviour relationships and showed additional main effects. Attitudinal ambivalence did not contribute to the prediction. When past behaviour was controlled, the main effects were attenuated and only the intention certainty* PBC interaction remained significant. Predictors of behaviour do not necessarily predict behaviour change. The TPB‐related moderators studied here weakly contributed to the prediction of behaviour change. Proposals for increasing the predictive power of TPB for behaviour change are discussed.

Screening and Brief Intervention Enter Their 5th Decade

SUMMARY About 40 years since the first controlled study, screening and brief intervention (SBI) are being disseminated into practice. But many unanswered questions remain. Studies in this special issue address what we know and don't know about alcohol and drug SBI, cost-effectiveness, patient preferences, education for clinicians, quality performance measures, “no-contact” SBI, predictors of behavior change, and methodological concerns with the SBI literature. The best evidence for efficacy of SBI is that it can lead to decreased consumption in primary care patients with non-dependent unhealthy alcohol use. But further research is needed on brief drug screening tools, efficacy of SBI for drugs, effectiveness in real world settings, integration of SBI for alcohol and drugs with other health behaviors, effects of SBI on alcohol and drug consequences, effects on dependence among those not seeking help, and on how to best disseminate the efficacious elements of SBI into practice.

Reactions of Men of Color to a Commonly Used Rape Prevention Program: Attitude and Predicted Behavior Changes

African American, Latino, and Asian first-year college men (36) saw The Men’s Program, an all-male rape prevention workshop, and wrote answers to four open-ended questions to determine how men from non-white groups react to a commonly used rape prevention program. Using a multi-stage inductive analysis, participant responses fell into five main themes including reinforced current beliefs and/or no changes, increased awareness of rape and its effects on survivors, increased understanding of consent, plans to intervene if a rape might occur, and plans to change behavior in their own intimate situations. Participants mentioned specific ways in which they planned to change personal behavior, and ways in which they planned to intervene if they saw potentially dangerous situations.