Health Behavior Change Process Research Articles

Reconceptualizing health behavior change - comment on Hohberg et al.

This brief commentary addresses three points. First, social-cognitive theories are often misunderstood as being purely cognitive, ignoring affective factors in the health behavior change process. It is argued that, at the phenomenal level, the involved psychological constructs are rather holistic, and that the separation of their cognitive and emotional components are artificial and emerge only as a result of the verbal assessment procedure. Second, health behavior change can be better understood by explicitly considering it as a process that may be subdivided into two or more phases such as motivation vs. volition or the adoption phase vs. the maintenance phase. Third, with such phases in mind, digital interventions may improve tailoring of treatment options to individual differences as they fluctuate during the health behavior change process, monitoring affective as well as cognitive responses and providing just-in-time feedback.

Parent Perspectives on Implementing Health Behavior Recommendations for Their Infants

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

Geri Çekildi: SAĞLIK DAVRANIŞLARININ DEĞİŞTİRİLMESİNDE TRANSTEORETİK MODEL KULLANIMI

Sağlık davranış değişikliği sürecini geliştirmek ve en etkili sağlık davranış değişikliğini elde etmek için günümüzde yaygın olarak Transteoretik Model (TTM) kullanılmaktadır. Bireyin içinde bulunduğu değişim aşamasına uygun girişim oluşturan TTM davranış değişimini kolaylaştıran bir rehber olarak kullanılmaktadır. Transteoretik Model bireyin herhangi bir davranış değişikliğinin bir anda olmadığını, davranış değişikliğinin birbirinden farklı aşamaları ve süreçleri içerdiğini kabul eden bilişsel davranışçı bir modeldir. Bu derlemenin amacı Transteoretik Model kullanımıyla davranış değişim aşamalarını tanımlayarak, modeli kullanacak araştırmacılara, hemşirelere ve diğer sağlık çalışanlarına temel bilgi ve davranış değişikliği gerçekleştirebilmek üzere kaynak sunmaktır.Bu makale 22-02-2021 tarihinde geri çekildi. https://dergipark.org.tr/tr/pub/inonusaglik/issue/60575/894859

Sex differential mediation effects of planning within the health behavior change process

ObjectivePrevious research demonstrates that planning mediates the relationship between intention and health behavior change, but evidence is inconclusive, and possible sex differences within the intention-planning-behavior-chain are understudied so far. The current study, therefore, aims to disentangle this by addressing potential sex differences in the mediating role of planning in the health behavior change process. MethodThree longitudinal studies were conducted in Germany between 2009 and 2011 (Study 1: 245 women, 216 men; Study 2: 156 women, 37 men; Study 3: 82 women, 84 men). In each study, intention (predictor), planning (mediator), and sex (moderator) were assessed to predict changes in (1) fruit and vegetable intake, (2) physical activity, and (3) sun protection. A moderated mediation model was specified to test whether the conditional direct effect of intention on health behavior change and/or the conditional indirect effect of intention on health behavior change through planning was different for men and women. ResultsSimilar patterns of sex differential effects emerged within the intention-planning-behavior-chain across all three studies. The conditional indirect effect of intention on health behavior change through planning was meaningful for men but not for women for all three health behaviors. Thus, planning acted as a mediator between intention and health behavior change only for men. ConclusionThe study contributes to the understanding of the inconclusive evidence on the role of planning as mediator between intention and health behavior change and sheds some light of possible sex differences that qualify this mediation. The findings suggest that women and men may not similarly benefit from health behavior change modification techniques involving planning strategies. Future theoretical developments and interventions should take this into account.

Change in physical and psychological health over time in patients with cardiovascular disease: on the benefits of being self-determined, physically active, and eating well

This study tested a longitudinal model examining the roles of motivation and perceived competence in the prediction of physical activity (PA) and healthy eating (HE) in individuals with cardiovascular diseases, and the effects of adopting these behaviors on individuals’ health. Participants completed measures of global motivation (baseline), contextual motivation and perceived competence for PA and HE (3 months), and self-reports of PA and HE behaviors (6 months). Physiological indicators and life satisfaction were assessed at the baseline and at 12 months. Structural equation modeling supported that individuals with self-determined motivation (SDM) were more likely to feel competent in changing their lifestyle and to engage in moderate and strenuous (vs. mild) exercise and HE behaviors, which had beneficial effects on individuals’ physiological and psychological health. This research confirms the respective roles of SDM and perceived competence in the health behavior change process and emphasizes the key function of SDM in the adherence of healthy behaviors over time.

The other 23 hours: a qualitative study of fitness provider perspectives on social support for health promotion for adults with mental illness.

Current efforts to reduce the increased risk of premature death from preventable cardiovascular disease among adults with serious mental illness (SMI) through lifestyle change have had limited success. Engaging informal support systems to promote healthy behaviors in everyday life may increase the effectiveness of health promotion interventions targeting this at-risk population. In-depth semistructured interviews were conducted with 10 fitness trainers serving adults with SMI in a health promotion program at community mental health centers to explore their perspectives on the potential of enlisting support from significant others for health behavior change. Trainers reported that the majority of participants had a relative or significant other who influenced their health behaviors, and they saw potential value in involving them in efforts to improve health outcomes by extending support into participants' daily lives. They did not feel qualified to work with families of individuals with mental illness, but they were willing to partner with providers who had experience in this area. Social workers who practice with families could play a critical role on health promotion teams addressing cardiovascular risk in adults with SMI by using their skills and experiences to engage families in supporting a relative through the process of health behavior change.

Associations between poor sleep quality and stages of change of multiple health behaviors among participants of employee wellness program

ObjectiveUsing the Transtheoretical Model of behavioral change, this study evaluates the relationship between sleep quality and the motivation and maintenance processes of healthy behavior change. MethodsThe current study is an analysis of data collected in 2008 from an online health risk assessment (HRA) survey completed by participants of the Kansas State employee wellness program (N=13,322). Using multinomial logistic regression, associations between self-reported sleep quality and stages of change (i.e. precontemplation, contemplation, preparation, action, maintenance) in five health behaviors (stress management, weight management, physical activities, alcohol use, and smoking) were analyzed. ResultsAdjusted for covariates, poor sleep quality was associated with an increased likelihood of contemplation, preparation, and in some cases action stage when engaging in the health behavior change process, but generally a lower likelihood of maintenance of the healthy behavior. ConclusionsThe present study demonstrated that poor sleep quality was associated with an elevated likelihood of contemplating or initiating behavior change, but a decreased likelihood of maintaining healthy behavior change. It is important to include sleep improvement as one of the lifestyle management interventions offered in EWP to comprehensively reduce health risks and promote the health of a large employee population.

The roles of self-efficacy and motivation in the prediction of short- and long-term adherence to exercise among patients with coronary heart disease.

Poor adherence to regular exercise is a documented challenge among people with heart disease. Identifying key determinants of exercise adherence and distinguishing between the processes driving short- and long-term adherence to regular exercise is a valuable endeavor. The purpose of the present study was to test a model of exercise behavior change, which incorporates motivational orientations and self-efficacy for exercise behavior, in the prediction of short- and long-term exercise adherence. Male and female patients (N = 801) hospitalized for coronary heart disease were recruited from 3 tertiary care cardiac centers and followed for a period of 1 year after hospital discharge. A prospective, longitudinal design was used to examine the roles of motivation and self-efficacy (measured at recruitment and at 2 and 6 months after discharge) in the prediction of exercise behavior at 6 and 12 months. Baseline measures of exercise and clinical and demographic covariates were included in the analyses. Structural equation modeling showed that both autonomous motivation and self-efficacy were important determinants of short-term (6-month) exercise behavior regulation, but that only autonomous motivation remained a significant predictor of long-term (12-month) exercise behavior. Self-efficacy partially mediated the relationship between motivation for exercise and 6-month exercise behavior. This research confirmed the roles of autonomous motivation and self-efficacy in the health behavior change process and emphasized the key function of autonomous motivation in exercise maintenance. Theoretical and cardiac rehabilitation program applications of this research are discussed.

Temporal Aspects of Psychosocial Predictors of Increased Fruit and Vegetable Intake in Adults with Severe Obesity: Mediation by Physical Activity

Effective and reliable obesity treatments are lacking because of a poor understanding of the health behavior change process. Community-based organizations with the capacity to train existing staff members are particularly well-positioned to implement evidence-based treatment protocols to impact obesity-related behaviors such as unhealthy eating and lack of physical activity. The aim of this study was to assess temporal aspects of psychosocial predictors (self-regulation, mood, and self-efficacy) on increased fruit and vegetable intake in adults with severe obesity, while also accounting for mediation by physical activity volume. A 6-month, randomized field investigation was conducted. Severely obese adults volunteered for behavioral support of physical activity coupled with nutrition education (n = 73) or cognitive-behavioral methods for nutrition change (n = 71). Improvements in self-regulation, mood, self-efficacy, fruit and vegetable intake (FV), and physical activity (PA) were significant, with significantly greater self-regulation at month 6 for the cognitive-behavioral group. Increase in FV was predicted by changes in the above psychosocial variables over 6 months, with mood change over 3 months also a significant predictor. Change in PA mediated the above relationships, with a reciprocal effect between changes in PA and FV. Findings have implications for the large-scale behavioral treatment of obesity.

Testing two principles of the Health Action Process Approach in individuals with type 2 diabetes.

The Health Action Process Approach (HAPA) proposes principles that can be translated into testable hypotheses. This is one of the first studies to have explicitly tested HAPA's first 2 principles, which are (1) health behavior change process can be subdivided into motivation and volition, and (2) volition can be grouped into intentional and action stages. The 3 stage groups are labeled preintenders, intenders, and actors. The hypotheses of the HAPA model were investigated in a sample of 1,193 individuals with Type 2 diabetes. Study participants completed a questionnaire assessing the HAPA variables. The hypotheses were evaluated by examining mean differences of test variables and by the use of multigroup structural equation modeling (MSEM). Findings support the HAPA's 2 principles and 3 distinct stages. The 3 HAPA stages were significantly different in several stage-specific variables, and discontinuity patterns were found in terms of nonlinear trends across means. In terms of predicting goals, action planning, and behavior, differences transpired between the 2 motivational stages (preintenders and intenders), and between the 2 volitional stages (intenders and actors). Results indicate implications for supporting behavior change processes, depending on in which stage a person is at: All individuals should be helped to increase self-efficacy. Preintenders and intenders require interventions targeting outcome expectancies. Actors benefit from an improvement in action planning to maintain and increase their previous behavior. Overall, the first 2 principles of the HAPA were supported and some evidence for the other principles was found. Future research should experimentally test these conclusions.

A qualitative assessment of COPD patients' experiences of pulmonary rehabilitation and guidance by healthcare professionals

The present study aimed to assess COPD patients' experiences during an in-patient pulmonary rehabilitation program and the guidance provided by healthcare professionals. A third aim regarded examining ways to anticipate the transfer to the home environment after completion of the program. Focus groups and semi-structured interviews were used to collect data from seven COPD patients at the beginning and six other COPD patients at the end of an in-patient pulmonary rehabilitation program, supplemented by a focus group and semi-structured interviews with 14 healthcare professionals of the involved disciplines. Data were analyzed using a phenomenological approach. Starting out, patients displayed trouble with acceptance of their disease, they had insufficient knowledge, and showed difficulties in setting specific realistic goals. Seeing fellow patients struggle with similar problems and tailored counseling by healthcare professionals helped them to overcome these barriers. During rehabilitation, patients became more confident in exercising and managing their daily life activities. Many patients evolved a desire to self-regulate their lives. Incorporating health-enhancing behaviors after returning home into their usual daily routines was anticipated to be tough. Patients undergoing pulmonary rehabilitation experience a complex health behavior change process, in which healthcare professionals fulfill a major contributing role. Therefore, guiding patients through this health behavior change process is a vital component of healthcare professionals' work, regarding which the present study made practical implications such as applying a personalized approach by giving tailored advices, applying an autonomy-supportive counseling style, teaching self-management skills, and referring patients to local exercise facilities.

Understanding Advance Care Planning as a Process of Health Behavior Change

To explore whether models of health behavior change can help to inform interventions for advance care planning (ACP). Qualitative cross-sectional study. Community. Sixty-three community-dwelling persons aged 65 and older and 30 caregivers with experience as surrogate decision-makers. In focus groups conducted separately with older persons and caregivers, participants were asked to discuss ways they had planned for future declines in health and why they had or had not engaged in such planning. Transcripts were analyzed using grounded theory. Four themes illustrated the potential of applying models of health behavior change to improve ACP. (1) Participants demonstrated variable readiness to engage in ACP and could be in different stages of readiness for different components of ACP, including consideration of treatment goals, completion of advance directives, and communication with families and physicians. (2) Participants identified a wide range of benefits of and barriers to ACP. (3) Participants used a variety of processes of change to progress through stages of readiness, and ACP was only one of a broader set of behaviors that participants engaged in to prepare for declines in their health or for death. (4) Experience with healthcare decision-making for loved ones was a strong influence on perceptions of susceptibility and engagement in ACP. The variability in participants' readiness, barriers and benefits, perceptions of susceptibility, and use of processes to increase readiness for participating in each component of ACP suggests the utility of customized, stage-specific interventions based on individualized assessments to improve ACP.

The Face of Wellness: Aspirational Vision of Health, Renewing Health Behavior Change Process and Balanced Portfolio Approach to Planning Change Strategies

Health promotion needs to be made more practical and more memorable so that practitioners are not confused or overwhelmed by the theoretical and technical aspects of assuring the effectiveness of programming efforts. In this edition of The Art of Health Promotion the Editor-in-Chief of the American Journal of Health Promotion presents a planning strategy consisting of an aspirational model of health, a renewing behavior change process and a portfolio balancing approach to strategy planning.

Relations of Sex Differences in Initial Body Mass Index and Physical Activity with Observed Changes over 12 Weeks among Children in the Youth Fit for Life After-School Care Intervention

Relations of changes in Body Mass Index and voluntary physical activity, with sex, were assessed in children participating in the Youth Fit For Life after-school care program. Consistent with previous reviews and meta-analyses on children, the present physical activity effect sizes for improvements in Body Mass Index and voluntary moderate-to-vigorous physical activity were greater for girls (n = 75) than for boys (n = 60; overall M(age) = 9.8 yr., SD = 0.8). The girls also had significantly higher Body Mass Index and fewer days of physical activity than the boys at baseline. When scores at baseline were controlled, correlations for sex with changes in the preceding measures over 12 wk. were not significant (r(12.3) = .06 and .15, respectively). Further study of the implications of children's sex in the health behavior-change process was suggested.

Order is needed to promote linear or quantum changes in nutrition and physical activity behaviors: a reaction to 'A chaotic view of behavior change' by Resnicow and Vaughan

Recently, Drs. Ken Resnicow and Roger Vaughan published a thought-provoking paper in the International Journal of Behavioral Nutrition and Physical Activity (IJBNPA). They argue that the most often used social-cognition theories in behavioral nutrition and physical activity are of limited use. These models describe behavior change as a linear event, while Resnicow and Vaughan posit that behavior change is more likely to occur in quantum leaps that are impossible to predict. They introduce Chaos Theory into the behavioral nutrition and physical activity domain as a more valid framework to study the complex process of health behavior change. The present paper is a commentary on Resnicow and Vaughan's article by Resnicow's opponent in a recent debate-session at the annual meeting of the International Society of Behavioral Nutrition and Physical Activity. The chair of that meeting, Prof. Tom Baranowski, provides a separate commentary on Resnicow and Vaughan's paper also published recently in the IJBNPA. In the present commentary I relate Resnicow and Vaughan's paper to the other contributions to the Theory debate in the IJBNPA. I recognize the limited success of social cognition models, and, next to a better application of these models and more thorough research to test these model, also support research to further test the quantum and chaotic character of health behavior change. However, if such research supports the chaotic and quantum nature of health behavior change, the implications for behavioral nutrition and physical activity interventions may be limited, because even if behavior change is quantum rather than linear, the social cognition models are still relevant to inform interventions to promote quantum leaps in behavior change.

Predicting Physical Exercise in Cardiac Rehabilitation: The Role of Phase-Specific Self-Efficacy Beliefs

During the process of health behavior change, individuals pass different phases characterized by different demands and challenges that have to be mastered. To overcome these demands successfully, phase-specific self-efficacy beliefs are important. The present study distinguishes between task self-efficacy, maintenance self-efficacy, and recovery self-efficacy. These phase-specific beliefs were studied in a sample of 484 cardiac patients during rehabilitation treatment and at follow-up 2 and 4 months after discharge to predict physical exercise at 4 and 12 months follow-up. The three phase-specific self-efficacies showed sufficient discriminant validity and allowed for differential predictions of intentions and behavior. Persons in the maintenance phase benefited more from maintenance self-efficacy in terms of physical exercise than persons not in the maintenance phase. Those who had to resume their physical exercise after a health related break profited more from recovery self-efficacy in terms of physical exercise than persons who were continuously active. Implications for possible interventions are discussed.

Exercise psychology predicting physical exercise in cardiac rehabilitation: the role of phase-specific self-efficacy beliefs

During the process of health behavior change, individuals pass different phases characterized by different demands and challenges that have to be mastered. To overcome these demands successfully, phase-specific self-efficacy beliefs are important. The present study distinguishes between task self-efficacy, maintenance self-efficacy, and recovery self-efficacy. These phase-specific beliefs were studied in a sample of 484 cardiac patients during rehabilitation treatment and at follow-up 2 and 4 months after discharge to predict physical exercise at 4 and 12 months follow-up. The three phase-specific self-efficacies showed sufficient discriminant validity and allowed for differential predictions of intentions and behavior. Persons in the maintenance phase benefited more from maintenance self-efficacy in terms of physical exercise than persons not in the maintenance phase. Those who had to resume their physical exercise after a health related break profited more from recovery self-efficacy in terms of physical exercise than persons who were continuously active. Implications for possible interventions are discussed.

Chapter 4: School-Based Research on Health Behavior Change: The Stanford Adolescent Heart Health Program as a Model for Cardiovascular Disease Risk Reduction

Schools provide an attractive setting for health behavior change instruction. The mandatory presence of students in schools offers an excellent opportunity for longitudinal research. School interventions are potentially cost-effective. Treatment programs can be integrated into the general educational curriculum so that large numbers of individuals may be influenced without heavy investments of professional resources. Maintenance of behavior change may be enhanced because school-based programs allow greater environmental support to foster and sustain behavior change. However, the transfer of health behavior change curricula from the laboratory or clinic to the school setting has proven to be a difficult task. A principal goal of this chapter is to discuss the conceptual framework, design, implementation, and evaluation of a successful school-based health behavior change intervention. We begin by presenting a conceptual model of the health behavior change process to illustrate linkages between behavior change theory and intervention practice. Next, we discuss program development, taking for our text our own school-based investigations with a multiple-factor cardiovascular disease risk reduction curriculum. We will summarize results of this work as an introduction to a discussion of design and evaluation problems of particular con

A systems model of health behavior change

The modeling in this paper is at the level of the individual, in relation to the subsystem of health behavior. It integrates social, environmental, psychological, and physiological factors to describe the health behavior change process. It is not intended to be quantitatively predictive of behavior change, since further development of this model is needed to determine the mathematical form of the relationships between variables. The model is innovative in several ways. First, it includes health-related variables and a rich feedback structure. In contrast, attitude behavior change models often cannot explain health behavior adequately, because they do not incorporate physiological variables. Second, the model can be easily used by educators to help identify important variables for developing health education curricula. Consequently, program developers are helped in determining program intents, teaching strategies, and learning activities, and evaluative strategies which are congruent with the attitude behavior change process.