Stability and changes in health behaviours in young adults over a one year period

Abstract

Data concerning 19 health-related behaviours and associated beliefs were collected by questionnaire from 282 students in the Netherlands on two occasions over one year. While all behaviours showed moderate stability, there were variations in the degree of change. The highest stability was reported for sleep time, tooth brushing frequency, seat belt usage and health care service utilization. The least stable behaviours included regular exercise and various dietary measures. Predictors of changes in smoking, dietary fat intake, alcohol consumption and regular exercise were analysed in detail. Beliefs assessed at year 1 in the importance of these activities for health predicted changes in behaviour over the study year independently of prior behaviour levels. Awareness of the risks associated with behaviours, and explicit wishes to modify behaviour patterns (eg stop smoking, exercise more), did not predict change from year 1 to year 2. The results indicated that health behaviours vary in their stability, and that health beliefs may predict future health behaviour changes.     

Predicting sugar-sweetened behaviours with theory of planned behaviour constructs: Outcome and process results from the SIPsmartER behavioural intervention

Objective: Guided by the theory of planned behaviour (TPB) and health literacy concepts, SIPsmartER is a six-month multicomponent intervention effective at improving SSB behaviours. Using SIPsmartER data, this study explores prediction of SSB behavioural intention (BI) and behaviour from TPB constructs using: (1) cross-sectional and prospective models and (2) 11 single-item assessments from interactive voice response (IVR) technology.

Design: Quasi-experimental design, including pre- and post-outcome data and repeated-measures process data of 155 intervention participants.

Main Outcome Measures: Validated multi-item TPB measures, single-item TPB measures, and self-reported SSB behaviours. Hypothesised relationships were investigated using correlation and multiple regression models.

Results: TPB constructs explained 32% of the variance cross sectionally and 20% prospectively in BI; and explained 13–20% of variance cross sectionally and 6% prospectively. Single-item scale models were significant, yet explained less variance. All IVR models predicting BI (average 21%, range 6–38%) and behaviour (average 30%, range 6–55%) were significant.

Conclusion: Findings are interpreted in the context of other cross-sectional, prospective and experimental TPB health and dietary studies. Findings advance experimental application of the TPB, including understanding constructs at outcome and process time points and applying theory in all intervention development, implementation and evaluation phases.     

‘I feel better when…’: An analysis of the memory-experience gap for peoples’ estimates of the relationship between health behaviours and experiences

Objective: People often overestimate how strongly behaviours and experiences are related. This memory-experience gap might have important implications for health care settings, which often require people to estimate associations, such as “my mood is better when I exercise”. This study examines how subjective correlation estimates between health behaviours and experiences relate to calculated correlations from online reports and whether subjective estimates are associated with engagement in actual health behaviour.

Design: Seven-month online study on physical activity, sleep, affect and stress, with 61 online assessments.

Main Outcome Measures: University students (N = 168) retrospectively estimated correlations between physical activity, sleep, positive affect and stress over the seven-month study period.

Results: Correlations between experiences and behaviours (online data) were small (r = ?.12–.14), estimated correlations moderate (r = ?.35–.24). Correspondence between calculated and estimated correlations was low. Importantly, estimated correlations of physical activity with stress, positive affect and sleep were associated with actual engagement in physical activity.

Conclusion: Estimation accuracy of relations between health behaviours and experiences is low. However, association estimates could be an important predictor of actual health behaviours. This study identifies and quantifies estimation inaccuracies in health behaviours and points towards potential systematic biases in health settings, which might seriously impair intervention efficacy.     

The role of affect in the decision to exercise: Does being happy lead to a more active lifestyle?

ObjectiveThis study investigated the influence of affect on individuals' intentions to engage in physical activities such as exercise. Behavior intentions were examined through the Theory of Planned Behavior (TPB).MethodAn experimental survey was conducted among 153 undergraduates randomly assigned to three conditions – positive affect, neutral, and negative affect. Key variables from the TPB were assessed across these conditions.ResultsAnalyses showed that participants in the positive affect and the negative affect conditions reported lower intentions to exercise than those in the neutral condition. Participants in the negative affect condition also reported more unfavorable attitudes toward exercise than their positive or neutral counterparts. Other TPB measures remained stable across the three conditions. In particular, perceived behavioral control and attitude were significant predictors of behavior intention in the pooled sample.ConclusionThese results underline the important role that affect, especially negative affect, plays in individuals' decision to exercise. Rational models for health behavior change, such as the TPB, should take into account the impact of affect.     

Analysing the Influence of Autonomous and Controlling Social Factors Within the Theory of Planned Behaviour

The aim of this study was to analyse the effects of autonomous (i.e., autonomy support from parents and peers) and controlling (i.e., social physique anxiety) social factors on future intention to exercise, integrating the distal (i.e., basic psychological needs satisfaction and self‐determined motivation) and proximal (i.e., attitudes, perceived behavioural control and subjective norms) determinants of intention defined in self‐determination theory (SDT) and the theory of planned behaviour (TPB). Self‐report questionnaires were distributed to 390 secondary school pupils (male = 218, female = 172, M_age = 15.10, standard deviation = 1.94). The results of path analysis, controlling for past behaviour of physical activity, showed that social factors predicted future intention to exercise through the influence of the distal and proximal determinants. The main contribution of the study was to provide evidence that the proximal determinants of the TPB captured the direct influence of social factors, independent of the mediating effects of psychological needs satisfaction and self‐determined motivation towards exercise. Results supported the integration of the two theories, clarifying the processes of influence of autonomous and controlling social factors within the variables of SDT and the TPB.     

An exercise in nostalgia: Nostalgia promotes health optimism and physical activity

Objective: Previous research has shown that nostalgia, a sentimental longing for the past, leads to greater feelings of optimism, with other work demonstrating that optimistic thinking (general & health-orientated) is associated with better physical and psychological health. Integrating these two lines of research, the current studies examined whether nostalgia-induced health optimism promotes attitudes and behaviours associated with better physical well-being.

Methods: Participants, in three experiments, were randomly assigned to write about either a nostalgic or ordinary event. Following this, everyone completed a measure of health optimism (Studies 1–3), measures of health attitudes (Study 2) and had their physical activity monitored over the course of 2 weeks (Study 3).

Results: The results revealed that, in comparison to control conditions, nostalgic reverie led to greater health optimism (Studies 1–3). Further, heightened health optimism following nostalgic reflection led to more positive health attitudes (Study 2), and increased physical activity over a two-week period (i.e. Fitbit activity trackers; Study 3).

Conclusions: These findings highlight the importance of nostalgia on health attitudes and behaviours. Specifically, this work suggests that nostalgia can be used as a mechanism to increase the importance, perceived efficacy and behaviour associated with better physical health.     

Sleep hygiene behaviours: An application of the theory of planned behaviour and the investigation of perceived autonomy support,past behaviour and response inhibition

This study investigated the sleep hygiene behaviour of university students within the framework of the Theory of Planned Behaviour (TPB [Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.]), and examined the predictive validity of additional variables including perceived autonomy support, past behaviour and response inhibition. A total of 257 undergraduate students from an Australian university were administered two online questionnaires at two time points. At time 1, participants completed the TPB questionnaire and the Go/NoGo task as a measure of response inhibition. A week later at time 2, participants completed a questionnaire measuring the performance of sleep hygiene behaviours. Multiple and hierarchical regression analyses showed that the TPB model significantly predicted intention and behaviour. Although intention and perceived behavioural control were statistically significant in predicting behaviour, past behaviour and response inhibition accounted for more variance when added to the TPB model. Subjective norm was found to be the strongest predictor of intention implying the importance of normative influences in sleep hygiene behaviours. Response inhibition was the strongest predictor of behaviour, reinforcing the argument that the performance of health protective behaviours requires self-regulatory ability. Therefore, interventions should be targeted at enhancing self-regulatory capacity.     

Predicting intention and behaviour following participation in a theory-based intervention to improve gluten free diet adherence in coeliac disease

Objective: To determine whether changes in theory of planned behaviour (TPB) constructs could predict intention and gluten-free diet (GFD) adherence following participation in an online theory-based intervention designed to improve adherence in coeliac disease.

Design: Theory-based process evaluation of the mechanisms of change over the course of a six-week online intervention. Measures of GFD adherence and TPB variables were administered at baseline and follow-up (immediate post-intervention: n = 74; three-month: n = 68; six-month: n = 65). Hierarchical regression analyses using residualised change scores were conducted at each time point (dependent variables: intention and adherence).

Results: Baseline intention and GFD adherence were the strongest predictors of follow-up intention and adherence, respectively. Change in attitude accounted for significant variance in intention. Change in intention accounted for significant variance in GFD adherence immediately post-intervention; by the six-month follow-up change in perceived behavioural control was the stronger predictor.

Conclusions: Partial support for the hypotheses suggests that, for certain behaviours, the TPB may be relevant in explaining the mechanism of action responsible for changes in intention and behaviour following participation in a behaviour change intervention. Additional predictive pathways are also likely to exist and, in the area of GFD adherence, may include habit strength and actual behavioural control.     

Is anxiety about health associated with desire to exercise, physical activity, and exercise dependence?

There are significant gaps in the literature regarding the behavioural consequences of health anxiety. Although past research indicates that health anxiety is associated with distinctive maladaptive behaviours, such as reassurance seeking, the relationship between health anxiety and wellness-related behaviours, such as physical activity, has not been adequately examined. Given that health anxiety is associated with excessive attempts to ensure health and avoid illness, health anxiety could be potentially related to extreme physical activity, known as exercise dependence. Using the cognitive behavioural model of health anxiety as a framework, this exploratory study investigated the relationships between health anxiety, exercise desire, physical activity, and exercise dependence.Undergraduate university students (n = 144) completed a battery of online measures. Results indicated that only the perceptual component of health anxiety, namely hypervigilance to somatic symptoms, was related to exercise desire and components of exercise dependence. Implications of the findings are discussed and future research avenues are explored.     

Mediation,moderation, and context: Understanding complex relations among cognition,affect, and health behaviour

Objective: Researchers have historically treated cognition and affect as separate constructs in motivating health behaviour. We present a framework and empirical evidence for complex relations between cognition and affect in predicting health behaviour.

Main Outcome, Design and Results: First, affect and cognition can mediate each other’s relation to health behaviour. Second, affect and cognition can moderate the other’s impact. Third, context can change the interplay of affect and cognition. Fourth, affect and cognition may be indelibly fused in some psychological constructs (e.g. worry, anticipated regret and reactance). These four propositions in our framework are not mutually exclusive.

Conclusion: Examination of the types of complex relations described here can benefit theory development, empirical testing of theories and intervention design. Doing so will advance the understanding of mechanisms involved in regulation of health behaviours and the effectiveness of interventions to change health behaviours.     

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.     

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.     

Prospective associations between unforgiveness and physical health and positive mediating mechanisms in a nationally representative sample of older adults

Objective: This study examined the prospective association between unforgiveness and self-reported physical health and potential positive psychological mediators of this association.

Design: Participants were a national sample of 1024 USA’s adults of ages 66 years and older. Data were collected at two time points separated by three years.

Main Outcome Measures: Measures of trait unforgiveness, self-rated physical health, socio-demographics, health behaviours and positive psychological traits (e.g. life satisfaction, self-esteem) were included in a comprehensive survey known as the ‘Religion, Aging, and Health Survey.’

Results: The results indicated that unforgiveness was prospectively associated with declines in self-reported physical health three years later, and poor initial self-reported health status did not predict increases in unforgiveness across time. Furthermore, the prospective association of unforgiveness with self-reported health was mediated by a latent positive psychological traits variable.

Conclusion: These results confirm cross-sectional findings suggesting that unforgiveness is related to health. The present study also suggests that unforgiveness has a prospective, but not reciprocal, association with self-reported physical health. Unforgiveness may have its association with self-reported physical health through its interruption of other positive traits that typically confer health benefits.     

A daily diary study of internalised weight bias and its psychological,eating and exercise correlates

Objective: The current investigation extends ecological momentary assessment (EMA) and daily diary weight stigma research in internalised weight bias (IWB). This investigation used daily diaries to examine the relationship between IWB, mood, coping, body appreciation, exercise behaviours and eating behaviours. Design: The study sample consisted of individuals who were overweight or obese (85% female) with M_BMI?=?36.0, SD_BMI?=?6.2. Participants completed a daily diary each evening and wore a Fitbit for 30 days. Main Outcome Measures: Participants reported on IWB, mood, coping, body appreciation, exercise behaviours and eating behaviours.

Results: Both within- and between-subjects IWB were significantly related to positive affect, negative affect, several coping responses, body appreciation, eating behaviours and the urge to avoid exercise. Exploratory analyses indicated that positive and negative affect mediated many of the associations between IWB and coping responses, body appreciation, and eating and exercise behaviours.

Conclusion: This investigation provides evidence that IWB experiences have daily impacts on psychological well-being, body appreciation, coping, eating and exercise behaviours. Also, this study raises awareness about IWB and its potential impact on psychological well-being and health behaviours.     

Positive affective processes underlie positive health behaviour change

Positive health behaviours such as physical activity can prevent or reverse many chronic conditions, yet a majority of people fall short of leading a healthy lifestyle. Recent discoveries in affective science point to promising approaches to circumvent barriers to lifestyle change. Here, we present a new theoretical framework that integrates scientific knowledge about positive affect with that on implicit processes. The upward spiral theory of lifestyle change explains how positive affect can facilitate long-term adherence to positive health behaviours. The inner loop of this spiral model identifies nonconscious motives as a central mechanism of behavioural maintenance. Positive affect experienced during health behaviours increases incentive salience for cues associated with those behaviours, which in turn, implicitly guides attention and the everyday decisions to repeat those behaviours. The outer loop represents the evidence-backed claim, based on Fredrickson’s broaden-and-build theory, that positive affect builds a suite of endogenous resources, which may in turn amplify the positive affect experienced during positive health behaviours and strengthen the nonconscious motives. We offer published and preliminary evidence in favour of the theory, contrast it to other dominant theories of health behaviour change, and highlight attendant implications for interventions that merit testing.     

Effects of exercise on anxiety: A review

Abstract

The focus of this review is physical exercise and its possible effectiveness as a means of reducing anxiety. This review is based on English language literature and covers the time period from 1958 to 1988. It provides an overview of the results of research studies carried out in the area of physical fitness and psychological health, more specifically anxiety. In doing so, it draws attention to methodological limitations associated with a number of these research studies. In addition, it describes the level of exercise considered necessary to achieve improved cardio-respiratory fitness (training effect). Conclusions are made which suggest mild support for the positive effect of exercise with some individuals for reducing anxiety. Some speculative explanations as to why exercise may be effective in reducing levels of state anxiety are discussed.     

Predicting physical activity in adolescents: The role of compensatory health beliefs within the Health Action Process Approach

Objective: Compensatory health beliefs (CHBs), defined as beliefs that healthy behaviours can compensate for unhealthy behaviours, may be one possible factor hindering people in adopting a healthier lifestyle. This study examined the contribution of CHBs to the prediction of adolescents’ physical activity within the theoretical framework of the Health Action Process Approach (HAPA).

Design: The study followed a prospective survey design with assessments at baseline (T1) and two weeks later (T2).

Method: Questionnaire data on physical activity, HAPA variables and CHBs were obtained twice from 430 adolescents of four different Swiss schools. Multilevel modelling was applied.

Results: CHBs added significantly to the prediction of intentions and change in intentions, in that higher CHBs were associated with lower intentions to be physically active at T2 and a reduction in intentions from T1 to T2. No effect of CHBs emerged for the prediction of self-reported levels of physical activity at T2 and change in physical activity from T1 to T2.

Conclusion: Findings emphasise the relevance of examining CHBs in the context of an established health behaviour change model and suggest that CHBs are of particular importance in the process of intention formation.     

Development of the Generic Multifaceted Automaticity Scale (GMAS) and preliminary validation for physical activity

ObjectivesThis article presents the validation of a Generic Multifaceted Automaticity Scale (GMAS) assessing the automatic properties of habitual behaviours.DesignA quantitative approach was adopted within various adult samples in order to confirm the internal and external validity of the GMAS pertaining to Physical Activity (PA).MethodStudy 1 investigated the content validity of a series of items among experts (N = 13) and respondents (N = 26). Study 2 examined the scale's construct validity for PA (N = 293). Study 3 tested the GMAS external validity (N = 161). Study 4 evaluated the internal consistency and predictive validity for the GMAS applied to transportation modes (N = 167). Study 5 used a 1-week prospective design and included Theory of Planned Behaviour (TPB; Ajzen, 2012) variables in order to test the predictive validity of the GMAS for active transportation (N = 125).ResultsStudy 1 supported the fact that the 9 items primarily reflected one facet of automaticity. Study 2 validated the hierarchical structure of the scale. In Study 3, convergent validity was confirmed regarding PA through significant correlations with the Self-Report Behavioural Automaticity Index (SRBAI; Gardner et al., 2012) and predictive validity was supported by significant correlations with self-report PA behaviour. Study 4 confirmed its internal consistency and predictive validity. Study 5 demonstrated that the scores derived from the GMAS significantly predicted active transportation behaviour, above and beyond TPB constructs.DiscussionThe GMAS appears as a valid instrument for research on everyday PA behaviours.     

The role of emotion in bridging the intention–behaviour gap: The case of sports participation

ProblemPsychological models of sports participation frequently draw on the Theory of Planned Behaviour (TPB) in order to predict health-behaviour-related intentions. While these models commonly show high predictive power with respect to intention, they often fall short in the prediction of behaviour (the ‘intention–behaviour gap’). The present study contends that integrating emotional processes into TPB can substantially improve the model's predictive power over and above traditional cognitive predictors.MethodIn a longitudinal study structural equation modelling was employed to test a traditional model (based on TPB) and an extended model including emotion associated with the intention to exercise as a mediator variable. A community sample (N = 237) completed a questionnaire measuring the components of a traditional TPB model. Prior to each of 16 expected exercise sessions (over 8 weeks) intention to exercise and emotion associated with the intention were measured.ResultsResults confirmed a substantial increase of 17% in explained variance of exercise frequency and 20% in exercise duration for the extended model. Emotional appraisal of the intention to exercise thus appears to mediate the traditional intention–behaviour relationship, suggesting that emotionally based interventions aimed at increasing sports participation may be helpful.ConclusionIt is concluded that emotion variables should be added to traditional TPB models in order to predict health behaviour more fully.     

When ‘fit’ leads to fit,and when ‘fit’ leads to fat: How message framing and intrinsic vs. extrinsic exercise outcomes interact in promoting physical activity

A unique aspect of exercise is that people may choose to engage in it to achieve a variety of outcomes, ranging from extrinsic (appearance, health) to intrinsic (satisfaction, enjoyment). We examined how the impact of gain- vs. loss-framed messages depends on the type of outcome emphasised. Drawing from regulatory focus theory (Higgins, E.T. (1997). Beyond pleasure and pain. American Psychologist, 52, 1280–1300; Higgins, E.T. (2000). Making a good decision: Value from fit. American Psychologist, 55, 1217–1230), we predicted that gain-framed messages would ‘fit’ with intrinsic outcomes and loss-framed messages would ‘fit’ with extrinsic outcomes, but the effect of such fit on physical activity would depend on the participants’ need for cognition (NC). We tested these hypotheses with a sample of 176 sedentary young adults who read an exercise message with randomly assigned frame (gain/loss) and outcome (intrinsic/extrinsic). Participants provided daily reports of exercise over the following week. The predicted interaction between frame, outcome and NC was found (p?=?0.001) such that a ‘fit’ message promoted somewhat, but not significantly, greater exercise for those with high NC, but a ‘non-fit’ message promoted significantly greater exercise for those with low NC. Furthermore, differences in physical activity were partially mediated by attitudes towards exercise. Findings shed light on how the outcomes and motivations associated with physical activity shape people's behavioural responses to framed health communications.