Mediators of behavior change in two tailored physical activity interventions for adolescent girls

ObjectivesIt has been suggested that the lack of knowledge regarding the mechanisms responsible for behavior change may be responsible for the low levels of effectiveness in physical activity interventions among youth. While it is common for physical activity interventions to cite a theoretical framework, few test the validity of their constructs using an established mediation analysis technique. The purpose of this study was to identify mediators of physical activity behavior change in two tailored interventions for adolescent girls.DesignThis study involved an experimental design.MethodsParticipants (N=161) were randomly allocated to a control (CON) group, an intervention based on the Health Promotion (HP) Model or an intervention developed from the HP Model that included two processes from the Transtheoretical Model (THP). Both interventions included school-based education sessions, individual counseling sessions, and two physical activity sessions completed with the participants' mothers. Measures were assessed prior to the intervention, at post-intervention and at a 6-month follow-up. The following constructs were included in the mediation analyses: perceived benefits, perceived barriers, self-efficacy, exposure to models, social support, interpersonal norms, planning, stimulus control, and counterconditioning.ResultsPerceived benefits, perceived barriers, self-efficacy, and commitment to planning satisfied the criteria for mediation in the THP intervention. Self-efficacy and commitment to planning were identified as mediators in the HP intervention.ConclusionThe results of this study provide evidence that both interventions were successful in increasing physical activity through changes in the theoretical constructs.     

Beyond good intentions: The role of proactive coping in achieving sustained behavioural change in the context of diabetes management

This study examines the effectiveness of a brief self-management intervention to support patients recently diagnosed with type-2 diabetes to achieve sustained improvements in their self-care behaviours. Based on proactive coping, the intervention emphasizes the crucial role of anticipation and planning in maintaining self-care behaviours. In a randomised controlled trial among recent screen-detected patients, participants who received the intervention were compared with usual-care controls, examining changes in proximal outcomes (intentions, self-efficacy and proactive coping), self-care behaviour (diet, physical activity and medication) and weight over time (0, 3 and 12 months). Subsequently, the contribution of proactive coping in predicting maintenance of behavioural change was analysed using stepwise hierarchical regression analyses, controlling for baseline self-care behaviour, patient characteristics, and intentions and self-efficacy as measured after the course. The intervention was effective in improving proximal outcomes and behaviour with regard to diet and physical activity, resulting in significant weight loss at 12 months. Furthermore, proactive coping was a better predictor of long-term self-management than either intentions or self-efficacy. Proactive coping thus offers new insights into behavioural maintenance theory and can be used to develop effective self-management interventions.     

A combined planning and self-efficacy intervention to promote physical activity: a multiple mediation analysis

Many individuals are motivated to improve their physical activity levels, but often fail to act upon their intention. Interventions fostering volitional strategies, such as action planning, coping planning, and self-efficacy beliefs, can help to translate intentions into behavior. This study examines the effectiveness and the mechanisms of a combined planning and self-efficacy intervention to promote physical activity among motivated individuals. Participants (N = 883) were randomly assigned to the intervention or to a waiting-list control condition. Multivariate analysis of variance revealed that the intervention resulted in significantly more physical activity, higher levels of action planning, coping planning, and volitional self-efficacy beliefs (p < 0.01). In addition, multiple mediation analysis showed that action planning, coping planning, and volitional self-efficacy mediate between the intervention and physical activity. The study shows that the intervention successfully fostered physical activity and unfolds the underlying self-regulatory mechanisms of the intervention's effectiveness.     

Nonnormality and divergence in posttreatment alcohol use: reexamining the Project MATCH data "another way."

Alcohol lapses are the modal outcome following treatment for alcohol use disorders, yet many alcohol researchers have encountered limited success in the prediction and prevention of relapse. One hypothesis is that lapses are unpredictable, but another possibility is the complexity of the relapse process is not captured by traditional statistical methods. Data from Project Matching Alcohol Treatments to Client Heterogeneity (Project MATCH), a multisite alcohol treatment study, were reanalyzed with 2 statistical methodologies: catastrophe and 2-part growth mixture modeling. Drawing on previous investigations of self-efficacy as a dynamic predictor of relapse, the current study revisits the self-efficacy matching hypothesis, which was not statistically supported in Project MATCH. Results from both the catastrophe and growth mixture analyses demonstrated a dynamic relationship between self-efficacy and drinking outcomes. The growth mixture analyses provided evidence in support of the original matching hypothesis: Individuals with lower self-efficacy who received cognitive behavior therapy drank far less frequently than did those with low self-efficacy who received motivational therapy. These results highlight the dynamical nature of the relapse process and the importance of the use of methodologies that accommodate this complexity when evaluating treatment outcomes.     

A Theory of Physical Activity Maintenance

Regular physical activity is related to numerous psychological and physical benefits. Physical activity interventions have had varying degrees of success with adoption; however, maintenance over the long term is even more difficult to achieve, as the majority of individuals who start a physical activity program drop out or relapse. Although the physical activity maintenance literature is scant, there is evidence that the predictors of adoption are different from those of maintenance. Thus, it follows that physical activity adoption and maintenance require unique approaches. The explanatory power of such predictors, however, is limited by the absence of a cogent theoretical framework. Therefore, this paper presents the Physical Activity Maintenance (PAM) theory, which incorporates individual psychosocial variables (goal-setting, motivation, and self-efficacy), and contextual variables of the environment and life stress (triggers of relapse). Goal-setting is framed as satisfaction, attainment, and commitment; motivation as self-motivation and expectations; and self-efficacy as both barrier and relapse. The contextual variables may facilitate or impede physical activity maintenance directly and indirectly via the individual psychosocial variables. The PAM is presented to stimulate research on physical activity maintenance and advance our understanding of how and why people do and do not maintain physical activity long term.     

Dynamics in Self-Regulation: Plan Execution Self-Efficacy and Mastery of Action Plans

This study investigated whether an individual's plan execution self-efficacy precedes mastery of the respective action plan or vice versa. Study participants were 122 cardiac rehabilitation patients. Plan execution self-efficacy and mastery of a personal action plan on physical activity were assessed each week for 6 weeks after discharge from rehabilitation. Physical exercise was assessed 2 months after discharge. Multilevel cross-lagged panel analyses resulted in a positive effect of mastery on subsequent self-efficacy, whereas self-efficacy did not predict subsequent mastery at the within-person level. At the between-person level, however, self-efficacy predicted following physical exercise. Thus, the predictive power of self-efficacy was developed in relation to mastery of personal action plans over time. Implications for behavior change interventions are discussed.     

Translating intentions into nutrition behaviors via planning requires self-efficacy: evidence from Thailand and Germany

A first step towards the improvement of daily dietary behaviors is forming an intention to change one's nutrition. However, an intention by itself is not sufficient for successful action. Rather, to translate intentions into behavior, careful planning is recommended. Thus, planning constitutes a mediator between the intention and the behavior. However, if a person lacks self-efficacy, this mediation might fail. Previous research in Costa Rica and South Korea has identified perceived self-efficacy as a moderator of the intention-planning-behavior relationship. To examine further the moderator role of self-efficacy, two additional studies were designed in Thailand and Germany. Study 1 surveyed 1718 Thai university students in terms of a low-fat diet; Study 2 surveyed 1140 German internet users in terms of their fruit and vegetable consumption at two measurement points in time, 6 months apart. Intentions served as predictor, planning as mediator, self-efficacy as moderator, and behaviors as outcomes. First, intentions were translated into nutrition behaviors by planning. Second, self-efficacy moderated this mediation in both studies: The strength of the mediated effect increased along with levels of self-efficacy, even when accounting for baseline behaviors. For planning to mediate the intention-behavior relation, people must not harbor self-doubts. If they lack self-efficacy, intentions are not well translated into nutrition behavior through planning.     

Worry about health in smoking behaviour change

Many smokers and ex-smokers worry about their health. Given that worry keeps attention focused on the threat, it was expected that worrying about health in smokers would motivate them to quit and in ex-smokers may prevent relapse. Furthermore, worry was expected to influence the process of smoking cessation in interaction with self-efficacy, which is a measure of control over smoking, and with disengagement beliefs, which distorts the threatening meaning of potential motivating information. In the present study 380 smokers and 324 ex-smokers were recruited to join a prospective study with a follow-up of eight months. At T1, smoking/quitting behavior, worry and the other psychological constructs were assessed. At T2 quitting activity in smokers and relapse in ex-smokers were assessed. As expected, smokers who worried about the health effects of smoking reported higher quitting activity at T2. The three-way interactions between worry, self-efficacy and disengagement beliefs in the prospective prediction of quitting activity and relapse were significant: Among smokers with high self-efficacy combined with strong disengagement beliefs, worry led to more quitting activity. Among ex-smokers with low self-efficacy combined with strong disengagement beliefs, worry led to more relapse. The present results suggest new ways of approaching the stimulation of quitting and the prevention of relapse.     

Age differences in motivational orientation toward physical activity: an application of social-cognitive theory

According to social-cognitive theory, an individual's motivation to engage in physical activity is based on three postulates: self-efficacy, outcome expectations, and self-evaluated satisfaction or dissatisfaction. The purpose of the present study was to examine age, gender, level of education, and level of activity in relation to those postulates in 2,298 Australians aged between 18 and 78. The authors conducted regression analyses for self-efficacy and for outcome expectations as dependent variables; age, gender, education level, and level of physical activity served as independent variables. Chi-square analyses assessed differences in the health incentive to exercise, the perceived level of activity, and the perceived level of fitness. Results indicated significant age differences on all variables. The older individual felt lower self-efficacy in relation to physical activity and expected fewer benefits from participating in physical activity. However, older individuals who engaged in physical activity rated themselves as more active and fit than nonexercisers of their same age and gender. Physical activity and level of education were positively correlated with self-efficacy, and men were more efficacious than women were. The implications are that interventions aimed at increasing participation in physical activity should take into consideration differences in incentives.     

The effects of a brief time perspective intervention for increasing physical activity among young adults

Past research has demonstrated that health behavior is correlated with time perspective: long-term thinkers are more likely than short-term thinkers to engage in health protective behaviors and less likely to engage in health damaging behaviors. To date, however, no research has experimentally demonstrated that time perspective is causally related to health behavior. We designed a brief (three 1/2-h weekly sessions) time perspective intervention to enhance long-term thinking about physical activity and examined its efficacy among two samples of young adults who signed up for fitness classes at a university recreational facility. Participants were assigned to one of three conditions: time perspective intervention, goal-setting control intervention, and no-treatment control. In Study 1, physical activity levels were assessed at preintervention, at postintervention (3 weeks later), and at 10-week follow-up (7 weeks after completion of the intervention). Controlling for preintervention physical activity levels, time perspective participants reported increased levels of physical activity relative to both other groups at postintervention, and relative to the no-treatment group at 10-week follow-up. This study provides the first experimental evidence that the effects of health behavior interventions may be enhanced by increasing participants’ long-term time perspective, and that time perspective is causally associated with health behavior. Study 2 replicated some of the effects of Study 1 using a larger sample, a six-month follow-up interval, and improved measurement of outcome. Together Studies 1 and 2 suggest that time perspective is an important ingredient in interventions designed to promote physical activity.     

Design of the Steps to Health Study of Physical Activity in Survivors of Endometrial Cancer: Testing a Social Cognitive Theory Model

Physical activity has been shown to benefit cancer survivors' physical functioning, emotional well-being, and symptoms. Physical activity may be of particular benefit to survivors of endometrial cancer because they are more likely to be obese and sedentary than the general population, as these are risk factors for the disease, and thus experience a number of related co-morbid health problems. However, there is little research systematically studying mechanisms of physical activity adherence in cancer survivor populations. This paper describes the design of the Steps to Health study, which applies a Social Cognitive Theory-based model of endometrial cancer survivors' adoption and maintenance of exercise in the context of an intervention to increase walking or other moderate intensity cardiovascular activity. In Steps to Health we will test the influence of self-efficacy and outcome expectations on adherence to exercise recommendations, as well as studying the determinants of self-efficacy. Endometrial cancer survivors who are at least 6 months post-treatment are provided with an intervention involving print materials and telephone counseling, and complete assessments of fitness, activity, self-efficacy and outcome expectations, and determinants of self-efficacy every two months for a six month period. In addition to testing an innovative model, the Steps to Health study employs multiple assessment methods, including ecological momentary assessment, implicit tests of cognitive variables, and ambulatory monitoring of physical activity. The study results can be used to develop more effective interventions for increasing physical activity in sedentary cancer survivors by taking into account the full complement of sources of self-efficacy information and outcome expectations.     

Comorbidity of substance dependence and depression: role of life stress and self-efficacy in sustaining abstinence.

The authors examined life stress and self-efficacy as predictors of time to relapse for 113 adults with comorbid major depressive disorder and alcohol and/or substance dependence in a randomized clinical trial comparing 2 psychotherapy interventions (integrated cognitive- behavioral therapy and 12-step facilitation therapy). Life stress, self-efficacy, and substance use were assessed at treatment entry, 12 weeks (mid-treatment), and 24 weeks (end of treatment). Time to relapse was defined as the number of days from treatment initiation until first alcohol and/or drug use. Half of the sample relapsed within the study period of 24 weeks. There was no significant difference between treatment groups. Individuals experiencing life stressors were more likely to relapse early than those not experiencing life stressors. Lower self-efficacy also predicted earlier relapse. Chronic stress levels and self-efficacy were stable across time for most individuals. In contrast, acute stress events occurred at differing times, and survival analyses provided evidence of heightened relapse risk in the month following acute stressors. The interaction of self-efficacy and life stress was not significant. The results highlight the significance of life stress and self-efficacy as predictors of early relapse.     

Does Engaging in a Group-Based Intervention Increase Parental Self-efficacy in Parents of Preschool Children? A Systematic Review of the Current Literature

As the preschool years are a formative period for long-term physical and mental health, this period is recognised as an important window for early effective intervention. Parenting behaviour is a key factor to target in order to optimise child development. Group-based interventions for parents are considered efficient and cost effective methods of early intervention and have been found to improve child behaviour and adjustment. Self-efficacy is key to behaviour change and as such parental self-efficacy should be a consideration in interventions aimed at influencing parenting behaviour. Therefore, the purpose of this systematic review was to examine the impact of group-based early interventions for parents of preschool children on parental self-efficacy. Nine databases were searched (ASSIA, CINAHL, EMBASE, Maternity and Infant Care, Ovid Medline, PsycINFO, Pubmed, Science Direct and Web of Science). Studies were included if they were a randomised controlled trial of a group-based intervention for parents of preschool children and measured change in parental self-efficacy. Fifteen studies were identified. Although changes in parental self-efficacy following a group-based intervention were noted in the majority of studies reviewed, the methodological quality of the studies included in the review means these findings have to be interpreted with caution; only seven studies were rated to be methodologically adequate. Further research is needed to understand the mechanisms by which these interventions may improve parental self-efficacy. Studies specifically examining the impact of such interventions on paternal self-efficacy are also warranted.     

Relations of age with changes in self-efficacy and physical self-concept in preadolescents participating in a physical activity intervention during afterschool care

An inference from Piaget's theory of cognitive development suggests that preadolescents of different ages who participate in a physical activity intervention may respond differently on measures of their physical self and self-efficacy, so a field investigation was conducted to assess effects. In a sample of 105 children ages 8 to 12 yr. (42% boys, overall M(age) = 10.1 yr., SD = 0.9), participation in a physical activity intervention during afterschool care, based on social cognitive theory and incorporating instruction in self-management and self-regulatory skills, was associated with significant improvements in measures of exercise-related self-efficacy, perceived physical appearance, and physical self-concept over 12 wk. Analyses suggested, however, no difference in changes on these factors was associated with participants' age or children being in either the concrete operations or formal operations stage of cognitive development. After replication, implications for design of physical activity interventions for preadolescents were suggested.     

The Association Between Number of Homework Assignments Completed during a Lifestyle Physical Activity Intervention and Scores on Transtheoretical Measures

An assumption of theory-based physical activity interventions is that active participation positively affects the theoretical constructs upon which the intervention is based. This assumption is rarely tested. This study assessed whether participation, defined as completion of homework, in a lifestyle physical activity intervention was associated with changes over 6 months in constructs the homework addressed: the behavioral and cognitive processes of change, self-efficacy, and decisional balance (the pros and cons). Participants were 244 sedentary adults aged 25 to 75 years. They completed an average of 12 of 20 homework assignments. Those completing at least two-thirds of the homework (n = 113) had greater changes in the theoretical constructs from pretest to posttest than those completing less (n = 90). Post-hoc analyses suggest that completing theory-based homework may impact the processes of change and self-efficacy in lifestyle physical activity interventions and, therefore, are warranted in future interventions.     

Parents’ Planning for Physical Activity for their Pre-School Aged Children: The Role of Psycho-Social Mediators and Moderators

Despite the childhood benefits gained from engaging in adequate physical activity, Australian preschool-aged children are reported to spend little time being physically active. Parental planning is important to engaging preschool-aged children in physical activity. Behavioral barriers, normative support, and self-efficacy have been identified as key determinants of parental decision making. However, the interplay among these factors is not well understood. The aim of this study was to examine the role of these psycho-social variables on parents’ planning and behavior for their preschool-aged children’s physical activity. A survey at two points in time was conducted in 208 Australian parents (n?=?139 mothers, M _age?=?36.43 years, SD?=?5.04; n?=?69 fathers, M _age?=?36.33 years, SD?=?6.5) of children aged between 2 and 5 years. A conditional process analysis was conducted that integrates mediation and moderation analyses. The results showed that planning and behavioral barriers predicted behavior, with a moderation effect also identified; more planning helped compensate for barriers. Normative support predicted both planning and behavior. In addition, an interaction between normative support and self-efficacy emerged. Parents with high self-efficacy engaged in high levels of planning, independent of normative support. Low self-efficacy with low normative support resulted in the lowest amount of planning; however, in the absence of normative support a high level of self-efficacy could compensate for it. Current findings provide avenues for future research to develop interventions to test the efficacy of these mechanisms in promoting parents’ ability to ensure preschool-aged children are active.     

From intentions via planning and behavior to physical exercise habits

ObjectivesIndividuals who enact a health behavior effortlessly with minimal conscious deliberation can be assumed to have formed a healthy habit. This can be reflected by increases in self-reported habit strength of a behavior. We examined whether physical exercise intentions facilitate changes in exercise habit strength by increasing the use of action planning and exercise.DesignTwo field studies investigated the effect of behavioral intentions on changes in habit strength through a sequential path from action planning to exercise.MethodExercise intentions, action planning, habit strength, and exercise were assessed at two measurement points in time in 231 university students (Study 1), and at four points in time in 134 rehabilitation patients (Study 2).ResultsIn multiple-step mediation models in both samples, there were indirect effects of intentions on habit strength through action planning and behavior.ConclusionAction planning and behavior operated as sequential mediators to bridge the gap between intentions and habit strength. Exercise habit strength may increase as a result of conscious action planning and frequent behavior enactment. Including these constructs jointly into behavior change models may improve the understanding of the mechanisms involved in behavior maintenance.     

Approaching Environmental Sustainability: Perceptions of Self-Efficacy and Changeability

This paper describes a model focused on the role of self-efficacy and belief in changeability of behavior in motivating environmentally sustainable behavior. The model was tested in two studies. The first study found that participants who had greater self-efficacy for sustainability behavior and a greater belief in their changeability of sustainability behavior had a higher level of approach motivation toward sustainability behavior and reported more such actual behavior. The second study investigated the effect of brief interventions intended to increase perception of self-efficacy for sustainability-related purchasing and changeability of sustainability-related purchasing. The intervention that focused on enhancing self-efficacy for making sustainability-related purchases had the strongest impact on intention to purchase. These findings have implications for interventions intended to change behavior related to environmental sustainability.     

Internet-delivered physical activity intervention for college students with mental health disorders: a randomized pilot trial

The prevalence of mental health disorders among college students is rising and the increasing rates of anxiety and depression have important societal implications. Physical activity has been proposed as an adjuvant to traditional treatment approaches (i.e. psychotherapy or pharmacotherapy), and the internet is a potentially useful means of delivering physical activity information to the college-aged population. This randomized pilot trial examined the effects of an internet-based physical activity intervention on physical activity, self-efficacy, depression, and anxiety in college students (n?=?47) receiving mental health counseling. Physical activity, depression, anxiety, exercise self-efficacy, and barriers self-efficacy were assessed at baseline and post-intervention. There was a significant time effect for physical activity, with both groups increasing their physical activity levels across the 10-week intervention but with a larger increase in the intervention condition (d?=?0.68) than the control condition (d?=?0.05). Exercise and barriers self-efficacy declined across the intervention, but more so in the control than intervention condition. Effects on depression and anxiety were nonsignificant. Finally, correlation analyses showed increases in physical activity were associated with increases in exercise self-efficacy (r?=?0.62) and barriers self-efficacy (r?=?0.63) and decreases in depression (r?=?-0.44) in the intervention condition, but not in the control condition. These results suggest that an internet-delivered physical activity intervention may be a promising approach to promoting physical activity among college students undergoing mental health counseling.     

Time for change: using implementation intentions to promote physical activity in a randomised pilot trial

Objective: A common barrier to exercise is a perceived lack of time. The current pilot study examined the effects of an implementation intention intervention to enhance exercise self-efficacy, increase confidence to exercise when facing time constraints, and increase physical activity in middle-aged adults (n?=?63, aged 35–69). Design: Participants received a pedometer (Fitbit) to objectively measure activity and were randomly assigned to either a control or intervention condition. After a 1-week baseline, the intervention condition received instructions to plan how, where, and when they would add steps to their daily routine to meet their step goal, using personalised schedules and maps. Both groups were contacted nightly via email. Main Outcome Measures: Physical activity (steps and time spent in moderate-to-vigorous activity), goal achievement, exercise self-efficacy, time-relevant exercise self-efficacy and affect. Results: Compared to the control, the intervention condition significantly increased in steps, time spent in moderate-to-vigorous activity, and time-relevant exercise self-efficacy. Goal achievement was related to greater time-relevant exercise self-efficacy and more positive affect at the daily level. Conclusion: Findings suggest that the personalised planning intervention increased physical activity and confidence in achieving physical activity goals under time constraints. Avenues for future directions, especially for producing more sustained effects, are discussed.