The effectiveness of a proactive coping intervention targeting self-management in diabetes patients

Objective: The study’s aim was to investigate psychological, behavioral and medical long-term outcomes of an existing self-management intervention targeting the development of proactive coping skills (e.g. goal setting and identifying barriers) in type 2 diabetes patients. The study aimed to replicate prior research showing the intervention’s effectiveness, and to extend it by (a) adding booster sessions and (b) prolonging the period of follow-up measurement to capture long-term effects.

Design/outcome measures: A total of 141 type 2 diabetes patients were included in the intervention. The intervention employed a 5-step approach to target proactive coping skills. Psychological (e.g. proactive coping and self-efficacy) and behavioural variables (e.g. self-care, diet and physical activity) were assessed at baseline (T1), after the initial phase of the intervention (T2), after the booster phase (T3) and at follow-up (T4), comprising a total period of 15 months. Medical variables were assessed at T1 and T4.

Results: Employing piecewise Latent Growth Curve Modelling, results showed that participants improved on all psychological and behavioural variables during the initial phase and maintained these improvements over 12 months. The booster phase yielded no further improvements. Mixed findings were obtained on medical outcomes.

Conclusion: The original intervention is effective, but the added value of the booster sessions is uncertain.     

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.     

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.     

Self-efficacy and behaviour as predictors of subsequent behaviour in an assertiveness training programme

Bandura and his colleagues have offered evidence that self-efficacy measures are more accurate predictors of maintenance of behaviour change than are behavioural measures. The present article argues that their evidence is flawed by the use of inappropriate statistical techniques, and attempts to replicate these findings using alternative statistical methods. Forty-six female students participated in an Assertiveness Training Programme which ran for 6 weeks, with a follow-up 3 months later. At each session they made efficacy predictions about their performance in specific situations, and then role-played those situations. Efficacy and behavioural measures were compared as predictors of later behaviour, and it was shown that, contrary to Bandura's findings, efficacy measures were significantly less accurate than behaviours in predicting later behaviour. This result indicates that, although self-efficacy theory is a useful framework for understanding behaviour change, it may be inappropriate in some situations to rely entirely upon efficacy predictions.     

Mechanisms of behavioural maintenance: Long-term effects of theory-based interventions to promote safe water consumption

Theory-based interventions can enhance people’s safe water consumption, but the sustainability of these interventions and the mechanisms of maintenance remain unclear. We investigated these questions based on an extended theory of planned behaviour. Seven hundred and ten (445 analysed) randomly selected households participated in two cluster-randomised controlled trials in Bangladesh. Study 1 promoted switching to neighbours’ arsenic-safe wells, and Study 2 promoted switching to arsenic-safe deep wells. Both studies included two intervention phases. Structured interviews were conducted at baseline (T1), and at 1-month (T2), 2-month (T3) and 9-month (T4) follow-ups. In intervention phase 1 (between T1 and T2), commitment-based behaviour change techniques – reminders, implementation intentions and public commitment – were combined with information and compared to an information-only control group. In phase 2 (between T2 and T3), half of each phase 1 intervention group was randomly assigned to receive either commitment-based techniques once more or coping planning with reminders and information. Initial well-switching rates of up to 60% significantly declined by T4: 38.3% of T2 safe water users stopped consuming arsenic-safe water. The decline depended on the intervention. Perceived behavioural control, intentions, commitment strength and coping planning were associated with maintenance. In line with previous studies, the results indicate that commitment and reminders engender long-term behavioural change.     

Action planning and coping planning for long‐term lifestyle change: theory and assessment

Planning is regarded as highly valuable in the process of health behaviour change. It bridges the gap between behavioural intentions and health behaviour. To further develop this concept, a distinction is made between action planning and coping planning. The latter refers to the mental simulation of overcoming anticipated barriers to action. Action planning and coping planning for physical exercise were examined in a longitudinal study with 352 cardiac patients. They were approached during rehabilitation treatment and followed up at two and four months after discharge. Both planning cognitions were psychometrically identified, and it was found that they operated differently in the behavioural change process. Action plans were more influential early in the rehabilitation process, whereas coping plans were more instrumental later on. Participants with higher levels of coping planning after discharge were more likely to report higher levels of exercise four months after discharge. It is suggested to include both kinds of planning in interventions at different stages in health behaviour change. Copyright © 2005 John Wiley & Sons, Ltd.     

A randomised controlled trial of the effects of implementation intentions on women's walking behaviour

The combination of low physical activity rates and increased cardiovascular deaths indicate the overwhelming need for behaviour change interventions that can effectively promote physical activity among sedentary women. This 11-week randomised controlled trial examined the effects of an implementation intentions intervention on sedentary women's walking behaviour. Seventy-five women (M age = 48.17) were randomly assigned to either a control group where they were required to self-monitor their daily pedometer-determined step count or to an experimental group where they were asked to form specific walking plans (i.e. implementation intentions) every 6 weeks and to self-monitor their daily pedometer-determined step count. Measures of exercise intentions, perceived behavioural control, scheduling and barrier self-efficacy were administered at baseline, week 6 and week 11. Analyses indicated higher step counts over the first 6 weeks for women in the experimental condition (p < 0.02). Furthermore, higher self-efficacy to schedule (p < 0.01) and overcome walking barriers (p < 0.03), as well as higher perceptions of behavioural control (p < 0.02) were found at week 11 for women in the experimental versus control condition. However, none of the control beliefs were found to mediate the effects of the intervention on the women's walking behaviour. Furthermore, the intervention did not have any effect on the strength of the goal intention–behaviour relationship. The findings suggest implementation intentions are an effective strategy for initiating leisure-time walking within sedentary women.     

Testing the bi‐dimensional effects of attitudes on behavioural intentions and subsequent behaviour

Attitudes are typically treated as unidimensional predictors of both behavioural intentions and subsequent behaviour. On the basis of previous research showing that attitudes comprise two independent, positive and negative dimensions, we hypothesized that attitudes would be bi‐dimensional predictors of both behavioural intentions and subsequent behaviour. We focused on health‐risk behaviours. We therefore also hypothesized that the positive dimension of attitude (evaluations of positive behavioural outcomes) would better predict both behavioural intentions and subsequent behaviour than would the negative dimension, consistent with the positivity bias/offset principle. In Study 1 (cross sectional design), N = 109 university students completed questionnaire measures of their intentions to binge‐drink and the positive and negative dimensions of attitude. Consistent with the hypotheses, both attitude dimensions independently predicted behavioural intentions and the positive dimension was a significantly better predictor than was the negative dimension. The same pattern of findings emerged in Study 2 (cross sectional design; N = 186 university students) when we predicted intentions to binge‐drink, smoke and consume a high‐fat diet. Similarly, in Study 3 (prospective design; N = 1,232 speed limit offenders), both the positive and negative dimensions of attitude predicted subsequent (6‐month post‐baseline) speeding behaviour on two different road types and the positive dimension was the better predictor. The implications for understanding the motivation of behaviour and the development of behaviour‐change interventions are discussed.     

Regulation of behaviour in pursuit of health goals

Abstract

Prediction of health related behaviours and the specification of cognitive processes which might guide development of effective interventions may be promoted by the identification of processes which mediate between intentions and health behaviour. The present commentary addresses theoretical developments concerning the role of cognitive and personality processes in volitional pursuit of health related goals and in the maintenance of behavioural change.     

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.     

The effect of message framing on self-management of chronic pain: a new perspective on intervention?

This study examines framed messages as a novel approach to promote self-management of chronic pain. Primary care patients reporting chronic pain (pain rated ≥?4 on 0-10 NRS-I for ≥3 months) were randomly assigned to receive a gain- or loss-framed message promoting self-management of pain. Impact of the framed message on behavioural self-management (including communicating with providers, relaxation, activity pacing, pleasant activities and healthy lifestyle) was assessed. Post-message, individuals in the loss-frame condition reported significantly greater interest in and more knowledge gained from the information presented in the message (p≤0.03). Loss-frame participants were significantly more likely to express confidence that they would practice relaxation (p≤0.03). Pain readiness to change, pain self-efficacy and message frame independently influenced motivation to engage in relaxation as a self-management strategy. Across all behaviours assessed, there were no observed interactions between message frame and either pain self-efficacy or pain readiness to change (p>0.05). Framing may be useful to promote pain self-management; larger trials are needed to fully evaluate its potential and to further assess the applicability of framed communication to impact a broader range of chronic conditions.     

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.     

Examining predictors of physical activity among inactive middle-aged women: an application of the health action process approach

This study tested several relationships predicted by the Health Action Process Approach (HAPA) in a sample of 175 generally healthy, inactive, middle-aged women (40-65 yrs old) over a 12 week period. Participants' physical activity, risk perceptions, outcome expectancies, action self-efficacy and intention were measured at baseline. Planning and maintenance self-efficacy were measured 4 weeks later. Physical activity behaviour was measured 12 weeks after baseline. The HAPA relationships were examined using a structural equation model. The data fit the model well and revealed several significant relationships. Action self-efficacy was the best predictor of intention. Maintenance self-efficacy was the best predictor of planning and behaviour. Contrary to the tenets of HAPA and to past research, planning did not predict behaviour. Overall, HAPA provides a useful framework for identifying determinants of physical activity intentions and behaviour within a group of inactive, middle-aged women.     

Predictors of physical activity,healthy eating and being smoke-free in teens: A theory of planned behaviour approach

This paper elicited context specific underlying beliefs for physical activity, fruit and vegetable consumption and smoke-free behaviour from the Theory of Planned Behaviour (TPB), and then determined whether the TPB explained significant variation in intentions and behaviour over a 1 month period in a sample of grade 7–9 (age 12–16 years) adolescents. Eighteen individual interviews and one focus group were used to elicit student beliefs. Analyses of this data produced behavioural, normative and control beliefs which were put into a TPB questionnaire completed by 183 students at time 1 and time 2. The Path analyses from the main study showed that the attitude/intention relationship was moderately large for fruit and vegetable consumption and small to moderate for being smoke free. Perceived behavioural control had a large effect on being smoke free and a moderately large effect for fruit and vegetable consumption and physical activity. Intention had a large direct effect on all three behaviours. Common (e.g. feel better, more energy) and behaviour-specific (e.g., prevent yellow fingers, control my weight) beliefs emerged across the three health behaviours. These novel findings, to the adolescent population, support the importance of specific attention being given to each of the behaviours in future multi-behavioural interventions.     

The effect of message framing on self-management of chronic pain: A new perspective on intervention?

This study examines framed messages as a novel approach to promote self-management of chronic pain. Primary care patients reporting chronic pain (pain rated?≥?4 on 0–10 NRS-I for ≥3 months) were randomly assigned to receive a gain- or loss-framed message promoting self-management of pain. Impact of the framed message on behavioural self-management (including communicating with providers, relaxation, activity pacing, pleasant activities and healthy lifestyle) was assessed. Post-message, individuals in the loss-frame condition reported significantly greater interest in and more knowledge gained from the information presented in the message (p?≤?0.03). Loss-frame participants were significantly more likely to express confidence that they would practice relaxation (p?≤?0.03). Pain readiness to change, pain self-efficacy and message frame independently influenced motivation to engage in relaxation as a self-management strategy. Across all behaviours assessed, there were no observed interactions between message frame and either pain self-efficacy or pain readiness to change (p?>?0.05). Framing may be useful to promote pain self-management; larger trials are needed to fully evaluate its potential and to further assess the applicability of framed communication to impact a broader range of chronic conditions.     

Improving adolescent contraceptive use: evaluation of a theory-driven classroom-based intervention

The aim of the research was to evaluate the impact of intervention materials, designed to enhance self-efficacy and anticipated regret, on contraceptive behaviour and antecedents of contraceptive use in a sample of adolescents. It was hypothesised that materials designed to enhance self-efficacy and anticipated regret would lead to improvements in outcome measures compared with controls. A 4(intervention condition) × 3(time) mixed design was used to assess the impact of intervention materials. Participants (N = 414) were recruited from five secondary schools in the north of England. They were assigned to an active control group, an anticipated regret (AR) manipulation, a self-efficacy (SE) manipulation or both AR and SE manipulations. Outcome measures included psychological antecedents of contraceptive behaviour change, intentions and behaviour. Multivariate analysis of variance (MANOVA) revealed increases across several outcome measures over time (F[14,287] = 8.99, P < 0.001, η(p)(2) = 0.305) including intentions, but these did not differ by condition (F[42,852] = 1.35, P = 0.07, η(p)(2) = 0.062). There was evidence that the questionnaires may have caused reactivity in participants. Amongst sexually active participants with relatively low levels of intention to use contraception at the outset, increases in several outcome measures including intention and behaviour were observed (F[3,35] = 10.359, P < 0.001, η(p)(2) = 0.47). Findings support the potential for effective delivery of behaviour change theory-driven interventions in classroom settings. The possibility that the questionnaires may have acted as a form of intervention contributes to recent discussion of this issue in the literature, and the findings also strengthen the case for post-decisional and behavioural skills interventions to enhance behaviour amongst those already motivated to use contraception.     

Self-efficacy,planning, and preparatory behaviours as joint predictors of physical activity: A conditional process analysis

Objective: Planning can bridge the gap between intentions and action, but what bridges the gap between planning and action? This study helps to answer the question by disentangling the interrelationships between self-efficacy, planning and preparatory behaviours in predicting physical activity. Preparatory behaviours are tested as a working mechanism of planning. Moreover, it is tested whether the utility of preparatory behaviours depends on an individual’s level of self-efficacy.

Methods: A survey assessed planning, self-efficacy and preparatory behaviours for physical activity. Adults (N = 166) provided data at two measurement points. In a longitudinal model, preparatory behaviours were specified as a mediator between planning and physical activity. Self-efficacy was specified as a possible moderator at two points in the model.

Results: Preparatory behaviours mediated the relationship between planning and physical activity. An interaction between self-efficacy and preparatory behaviours on physical activity was found, indicating that individuals with low self-efficacy beliefs were more active if they engaged more frequently in preparatory behaviours.

Conclusion: Planning seems to stimulate preparatory behaviours, which in turn make future physical activity more likely. Furthermore, as performing preparatory behaviours represent a step forward towards the enactment of behavioural goals, preparatory behaviours may be particular beneficial for individuals afflicted by self-doubts regarding physical activity.     

Predicting Potentially Harmful Psychological and Physical Behaviours by Parental Caregivers toward Children with Autism Spectrum Disorder

Mistreatment of dementia patients by spousal care providers is fairly common. Caregivers’ characteristics, particularly their psychosocial, physical and cognitive functioning, and coping behaviours, predict reports of elder mistreatment. Parental caregivers of children with autism spectrum disorder (ASD) however, despite the similarities they share with dementia caregivers, have not been studied in this context. A sample of N?=?95 caregivers of children with ASD completed an online survey assessing: (a) psychosocial, physical and cognitive functioning, and (b) coping behaviours. Caregivers also: (c) rated the extent to which they used potentially harmful psychological (e.g., screamed at the child) and physical (e.g., slapped the child) behaviours to cope with caregiving challenges over the last 12 months. Rates of potentially harmful psychological and physical behaviours were extremely low. However, 95% of caregivers reported using at least one potentially harmful psychological behaviour at some point in the last 12 months, and almost 38% reported using at least one potentially harmful physical behaviour. Mediation analysis yielded an indirect effect of psychological distress on potentially harmful psychological behaviours through disengaged coping. In conclusion, rates of potentially harmful behaviours appear to be low in the context of caring for a child with ASD. Caregivers reporting increased psychological distress were more likely to use potentially harmful psychological behaviours, and this effect was partially mediated by greater use of disengaged coping.