How planning facilitates behaviour change: Additive and interactive effects of a randomized controlled trial

Planning interventions have proven effective to change behaviour. However, less is known about their underlying mechanisms. To better understand the processes by which planning interventions unfold their effects, a combined action planning and coping planning intervention was tested in a field setting, with the focus on mediating and moderating effects of theory‐derived social‐cognitive variables. In a randomized controlled trial, 374 employees of a logistics company were asked to participate in either a combined action planning and coping planning intervention or an active control group. Four weeks later, self‐reported changes in fruit and vegetable intake, action planning, coping planning, intentions and self‐efficacy were measured. Single and simultaneous mediating effects on behaviour were tested with intention‐to‐treat analyses, along with interaction effects between planning processes. Action planning and coping planning mediated intervention effects on fruit and vegetable intake not only separately, but also simultaneously (multiple mediation). Action planning and coping planning had main and interactive effects on behaviour change (moderation). Action planning and coping planning may exert both additive and synergistic effects on health behaviour change. Volitional interventions should include both action planning and coping planning components and stimulate the use of planning in everyday life. Copyright © 2009 John Wiley & Sons, Ltd.     

Adoption and maintenance of physical activity: Planning interventions in young, middle-aged, and older adults

Young, middle-aged, and older adults in orthopaedic outpatient rehabilitation (N?=?373) were randomly assigned to either an interviewer-assisted or a standard-care self-administered planning intervention. Physical activity planning consisted of specifying action plans to facilitate action initiation, and coping plans to overcome barriers. The interviewer-assisted condition led to more complete action plans and a longer duration of physical activities up to six months after discharge. Regarding coping planning, older and middle-aged adults benefited more from interviewer-assisted planning while younger adults benefited more from self-administered planning. Planning as such was found to be an effective tool for enactment irrespective of chronological age. The delayed effect of coping planning on enactment suggests that coping planning is important for long-term maintenance.     

The role of action and coping planning in the relationship between intention and physical activity: A moderated mediation analysis

Objective: Using a moderated mediation model, the present study investigated whether the mediation of intention into physical activity (PA) behaviour via action planning depends on the level of coping planning.

Method: A four-month prospective study was conducted among 157 French adults, who were recruited through a web-based survey. They were administrated measures of behavioural intention and sociodemographic variables at baseline and action and coping planning and PA four months later.

Results: Action planning partially mediated the contribution of intention on PA level. However, this indirect effect was conditional on the level of coping planning, insofar as action planning acted as a mediator of the intention–PA relationship only for individuals with high level of coping planning.

Conclusion: The results highlight the complexity of the relationship between intention and behaviour and provide evidence for the distinct role of both forms of planning.     

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.     

Bridging the intention–behaviour gap: Planning,self-efficacy,and action control in the adoption and maintenance of physical exercise

Although some people may develop an intention to change their health behaviour, they might not take any action. This discrepancy has been labelled the “intention–behaviour gap.” Detailed action planning, perceived self-efficacy, and self-regulatory strategies (action control) may mediate between intentions and behaviour. This was examined in a longitudinal sample of 307 cardiac rehabilitation patients who were encouraged to adopt or maintain regular exercise. At the first time point, the predictors of intention and intention itself were assessed. Two months and four months later, the mediators and outcomes were measured. Results confirmed that all the three factors (planning, maintenance self-efficacy, and action control) served to mediate between earlier exercise intentions and later physical activity, each of them making a unique contribution. The results have implications for research on the “intention–behaviour gap,” and indicate that planning, maintenance self-efficacy and action control may be important volitional variables.     

Concordance between patients' information preferences and general practitioners' perceptions

Brief planning interventions, usually delivered within paper and pencil questionnaires, have been found to be effective in changing health behaviours. Using a double-blind randomised controlled trial, this study examined the efficacy of two types of planning interventions (action plans and coping plans) in increasing physical activity levels when they are delivered via the internet. Following the completion of self-reported physical activity (primary outcome) and theory of planned behaviour (TPB) measures at baseline, students (N = 1273) were randomised into one of four conditions on the basis of a 2 (received instructions to form action plans or not) × 2 (received instructions to form coping plans or not) factorial design. Physical activity (primary outcome) and TPB measures were completed again at two-month follow-up. An objective measure (attendance at the university's sports facilities) was employed 6 weeks after a follow-up for a duration of 13 weeks (secondary outcome). The interventions did not change self-reported physical activity, attendance at campus sports facilities or TPB measures. This might be due to low adherence to the intervention protocol (ranging from 58.8 to 76.7%). The results of this study suggest that the planning interventions under investigation are ineffective in changing behaviour when delivered online to a sample of participants unaware of the allocation to different conditions. Possible moderators of the effectiveness of planning interventions in changing health behaviours are discussed.     

Gender differences in social cognitive determinants of exercise adoption

Gender differences in lifestyle-related mortality and morbidity suggest a need to investigate gender-specificity of health behaviour change process and factors influencing it. We tested whether changes in self-efficacy beliefs and planning, as well as the level of social support predict change in exercise. Finnish men and women, aged 50–65 years, at an increased risk for type 2 diabetes were recruited from health care centres to participate in the Good Ageing in Lahti Region (GOAL) Lifestyle Implementation Trial. Psychosocial factors were measured with questionnaires and exercise with 7-day physical activity diaries at baseline and at 3 months. At baseline, no gender differences were found in self-efficacy and planning, but men reported receiving more social support than women. At 3 months, women reported having formed more action plans for changing their exercise routines than men. Among women, increase in self-efficacy and planning predicted increase in exercise. Among men, changes in planning played a less significant role. The more salient role of planning for women than for men, and the fact that women receive less social support, may reflect life circumstances allowing less spontaneous lifestyle decisions and a lower acceptance of lifestyle changes by their social environment.     

Reducing car use by volitional strategy of action and coping planning enhancement

Personalized travel plans have been regarded as potentially effective soft measures in mobility management. This research conducted a randomized social experiment aiming at citizen car-use reduction, and examined the effect of implementing two personalized travel plans: action plans and coping plans. The two types of plans were designed respectively for enhancing action planning and coping planning as the volitional factors of behavior change. The results supported the effectiveness of the combined action-plus-coping plan intervention in reducing car use, but not of the action plan alone intervention. In addition, the influence of intervention on behavioral intention, action planning, and coping planning, were also presented.     

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.     

Adoption of community-based cardiac rehabilitation programs and physical activity following phase III cardiac rehabilitation in Scotland: A prospective and predictive study

Little is known about levels of physical activity and attendance at phase IV community-based Cardiac Rehabilitation (CR) programs following completion of exercise-focussed, hospital-based phase III CR. This study aims to test, compare and combine the predictive utility of the Common-Sense Self-Regulation Model (CS-SRM) and the extended Theory of Planned Behaviour (TPB) with action planning for two rehabilitation behaviours: physical activity and phase IV CR attendance. Individuals diagnosed with coronary heart disease (n = 103) completed baseline measures of illness perceptions, intentions, perceived behavioural control (PBC), action planning and past physical activity in the last week of a phase III CR program, and 95 participants completed follow-up measures of physical activity and attended phase IV CR (objectively confirmed) 2 months later. Only one predictor (PBC/cyclical timeline) significantly predicted levels and change of physical activity. While illness perceptions were not predictive of phase IV CR attendance, the extended TPB model showed good predictive power with action planning and intention as the most powerful predictors. Amongst participants who planned when and where to attend phase IV CR at the end of phase III rehabilitation, 65.9% subsequently attended a phase IV CR program compared to only 18.5% of those who had not made a plan. This study adds to our understanding of cardiac rehabilitation behaviour after completion of health service delivered programs. Comparing theoretical models and rehabilitation behaviours contributes to the development of behaviour theory.     

Effects of action planning and coping planning within the theory of planned behaviour: A physical activity study of patients undergoing haemodialysis

Objective

Patients on dialysis have low physical activity levels. The aim of the study was to examine the validity of action planning and coping planning within the theory of planned behaviour framework, for predicting physical activity behaviour of patients on haemodialysis.

Design

This is a prospective study design.

Methods

One hundred and forty-four patients who were undergoing haemodialysis were selected from dialysis centres. The mean age of the patients was 56.61 (SD = 11.38) years. The patients completed a questionnaire including variables from the theory of planned behaviour, action planning and coping planning. Physical activity was prospectively assessed at 4-weeks with the validated International Physical Activity Questionnaire self-report measure. A hierarchical regression analysis was performed to examine the effects of action planning and coping planning on physical activity behaviour.

Results

There was a main effect for coping planning but not for action planning. Moreover, the analyses resulted in a significant amount of incremental variance accounted for by the interaction of coping planning and intention.

Conclusion

Results suggest the combination of high levels of coping planning and intention is associated with increases in physical activity.     

Cognitive mediation of intervention effects on physical exercise: Causal models for the adoption and maintenance stage

Objective: To investigate how the effects of a group-based intervention program (MoVo-LISA) on exercise behaviour were mediated by cognitive variables. Different causal models mapping the short-term (adoption) and long-term (maintenance) intervention effects were tested using path analyses.

Design: N?=?220 in-patients of a rehabilitation clinic were assigned to an usual care or intervention group (quasi-experimental design). Questionnaire-based assessment was conducted at baseline; discharge; and at six weeks, six months and 12 months post discharge.

Measures: The potential mediator variables were outcome expectations, self-efficacy, strength of goal intention (intention strength), self-concordance, action planning and barrier management.

Results: Observed intervention effects on exercise behaviour (p?<?0.05) were mediated by intention strength at the adoption and maintenance stages, by action planning only at the adoption, and by barrier management only at the maintenance stage. Self-efficacy and outcome expectations were only indirectly involved in these mediations by affecting intention strength and self-concordance.

Conclusion: This is the first study to track the cognitive mediation processes of intervention effects on exercise behaviour over a long time-period by differentiating the adoption and maintenance stages of behaviour change. The findings emphasise the importance of deconstructing intervention effects (modifiability vs. predictive power of a mediator) to develop more effective interventions.     

Changes in self-regulatory cognitions as predictors of changes in smoking and nutrition behaviour

Most longitudinal, correlational studies on health-behaviour change examine effects of Time1 social-cognitive predictors on subsequent behaviour. In contrast, our research focusses on associations between changes in predictors with change in behaviour. The Health Action Process Approach (HAPA) distinguishes between motivational predictors for intention formation and volitional predictors for behavioural change and served as theoretical basis. Two online-studies were launched targeting different behaviours (low-fat diet, smoking), different samples (Study 1: N = 469; Study 2: N = 441) and different time spans (Study 1: 3 months, Study 2: 4 weeks). Data were analysed by means of structural equation modelling with latent difference scores. Both studies resulted in almost parallel prediction patterns. Change in risk awareness and change in outcome expectancies did not result in change in intentions, whereas change in self-efficacy was of crucial importance. Change in behaviour was associated with change in action planning and action control over and above the effects of intentions. In one study, increases in self-efficacy yielded increases in behaviour change. Results demonstrate that change in action planning and especially action control was of great importance for behaviour change across two different behaviours. Analysing change in social-cognitive predictors allows drawing precise conclusions for interventions.     

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.     

Dyadische Planungsintervention nach Prostatektomie

Background

Prostate cancer is one of the most prevalent forms of cancer in men. One treatment for localized prostate cancer is radical prostatectomy. Patients and partners have to deal with stressors associated with the diagnosis, the surgery and its consequences (e.g. incontinence). Dyadic planning prepares for the coping process with illness consequences in order to enhance self-regulation and reduce anxiety. Dyadic planning means generating plans together with a partner specifying when, where and how the target person wants to initiate a health behavior.

Patients and methods

In this longitudinal randomized controlled trial (RCT) 112 prostatectomy patients and their spouses were invited to participate in a dyadic planning intervention. Participants were randomly allocated to a dyadic pelvic floor exercise (pfe) planning group or one of three control groups (i.e., individual pfe planning, dyadic or individual nutrition planning). Patients and partners received questionnaires at baseline, 2 weeks and 6 months after surgery.

Results

Patients in the dyadic pfe planning group reported higher dyadic pfe planning 2 weeks after surgery than patients in the nutrition planning groups. No such differential effects were found in partners. Additionally, there were no group differences in patient reports on anxiety 6 months after surgery, whereas partners in the dyadic pfe planning group reported lower anxiety levels compared to partners in the individual pfe planning group. Self-reported pfe planning did not, however, mediate the effects of the intervention on partners?? anxiety.

Conclusion

Economical dyadic planning interventions may not only support change of health-relevant behaviour in target persons but also emotional adjustment of their partners.     

Predicting changes in planning behaviour and physical activity among adults

Though the effect of action planning upon behavioural enactment is becoming well-established, adherence to planning interventions are modest. Motivations specific to action planning may predict planning behaviour. The primary purpose of the present study was to determine if theory of planned behaviour constructs operationalized for planning could predict change in planning behaviour. The secondary purpose was to determine if planning behaviour predicted changes in physical activity. Participants (n = 337, M_age = 31 ± 5) were adults with intentions to be more active who completed measures of affective and instrumental attitudes towards planning, subjective norms towards planning, perceived behavioural control over planning, intentions to plan, self-reported planning behaviour, intentions to be active and self-reported physical activity at baseline (T1) and after four weeks (T2). Affective attitudes towards planning (β = 0.10, p < .05), instrumental attitudes towards planning (β = 0.22; p < .01) subjective norms over planning (β = 0.12, p < .01) and perceived behavioural control over planning (β = 0.53, p < .01) predicted intentions to plan (adj. R² = 0.66). Intentions to plan (β = 0.16, p < .05) and intentions to be active (β = −0.25, p < .05) predicted change in planning behaviour (R²_change = 0.03). Planning behaviour (β = 0.27, p < .05) predicted change in physical activity (R²_change = 0.07). Planning behaviour appears to have its own motivations distinct from those of physical activity. Future interventions should target planning behaviour along with its motivations and control beliefs to increase rates of planning. The theoretical underpinnings of the TPB are of value for understanding both planning behaviour and physical activity.     

Long-term adherence to a physical activity intervention: The role of telephone-assisted vs. self-administered coping plans and strategy use

Objective: This study investigated the role of coping plans and the use of selection, optimisation and compensation (SOC) strategies within an experimental evaluation of a 26-week physical exercise intervention.

Methods: Older women (N?=?86, M _age?=?73.7 years) were randomly assigned to a telephone-assisted or a self-administered coping planning intervention after 6 weeks’ participation in an exercise programme. The number of different coping plans formulated, exercise-specific SOC strategy use and their interaction were used to predict objectively measured long-term adherence to the intervention.

Results: The number of coping plans formulated (β?=?0.28) and goal-pursuit strategies reported (sum score of optimisation and compensation strategies, β?=?0.39) predicted adherence to the exercise programme over 20 weeks. The predictive strength of coping plans increased with decreasing numbers of goal-pursuit strategies (β?=??0.21). Women supported via telephone reported significantly more coping plans than did women in the self-administered coping planning group, F(1,80)?=?9.47, p?=?0.003.

Conclusion: Coping plans have a buffering effect on adherence levels when use of SOC strategies is low. Older women's adherence to physical activities may be improved if they are given direct support in generating coping plans involving strategies of selection, optimisation and compensation.     

Predicting short and long-term exercise intentions and behaviour in patients with coronary artery disease: A test of protection motivation theory

The purpose of this study was to examine the utility of protection motivation theory (PMT) in the prediction of exercise intentions and behaviour in the year following hospitalisation for coronary artery disease (CAD). Patients with documented CAD (n?=?787), recruited at hospital discharge, completed questionnaires measuring PMT's threat (i.e. perceived severity and vulnerability) and coping (i.e. self-efficacy, response efficacy) appraisal constructs at baseline, 2 and 6 months, and exercise behaviour at baseline, 6 and 12 months post-hospitalisation. Structural equation modelling showed that the PMT model of exercise at 6 months had a good fit with the empirical data. Self-efficacy, response efficacy, and perceived severity predicted exercise intentions, which, in turn predicted exercise behaviour. Overall, the PMT variables accounted for a moderate amount of variance in exercise intentions (23%) and behaviour (20%). In contrast, the PMT model was not reliable for predicting exercise behaviour at 12 months post-hospitalisation. The data provided support for PMT applied to short-term, but not long-term, exercise behaviour among patients with CAD. Health education should concentrate on providing positive coping messages to enhance patients’ confidence regarding exercise and their belief that exercise provides health benefits, as well as realistic information about disease severity.     

Examination stress and changes in mood and health related behaviours

Abstract

The present exploratory study evaluated the effect of stress (an examination period) on changes in mood and health related behaviours. 83 medical students completed measures of mood and health related bchaviours at baseline and four weeks later either during their examinations period (the stress condition) or after a comparative control period (the control condition). All subjects also completed ratings of stress mediating variables: social support, perceived control and coping style at baseline. The results showed deterioration in mood in terms of increases in depression and anxiety and changes in health related behaviours in terms of increased numbers of subjects who identified thcmsehes as smokers, and dcmascs in alcohol consumption, exercise and food intake in subjects in the stress condition. The results also suggest that social support moderated the effects of the examination stress and was related to greater decreases in smoking, decrcases in alcohol craving and increases in eating behaviour. In addition, an avoidance coping style (problem avoidance, wishful thinking) was related to greater decreases in eating behaviour. 'Ihe nsults an discussed in the context of the stress/illness link and the role of behavioural change.     

Health messages to promote fruit and vegetable consumption at different stages: A match-mismatch design

Objective: To examine the effectiveness of matching health messages promoting fruit and vegetable intake to the Health Action Process Approach stages of change.

Design: In a randomised controlled trial, 205 undergraduate students (non-intenders n = 123; intenders n = 82) were exposed to one of three health messages, targeted at non-intenders, intenders and controls.

Main outcome measures: Three longitudinal assessments of stage, fruit and vegetable intake, and social-cognitive determinants were obtained.

Results: Stage-specific effects of the interventions were confirmed. For self-efficacy, a stage by health message crossover interaction emerged, with both non-intenders and intenders in the matched conditions scoring higher in self-efficacy. Furthermore, in line with predictions, non-intenders in the matched condition showed higher risk perception, outcome expectancies, intention, and stage progression immediately after message exposure, and lower levels of action planning and coping planning a week later in the mismatched condition, but for these outcomes no differences across conditions were obtained among intenders. Multiple mediation analyses confirmed the facilitating role of self-efficacy and behavioural intention among non-intenders.

Conclusions: Stages should be considered when designing health messages, although more interactive interventions for intenders and extended measurement time frames may be required.