Psychometric assessment of the processes of change scale for sun protection

The fourteen-factor Processes of Change Scale for Sun Protection assesses behavioral and experiential strategies that underlie the process of sun protection acquisition and maintenance. Variations of this measure have been used effectively in several randomized sun protection trials, both for evaluation and as a basis for intervention. However, there are no published studies, to date, that evaluate the psychometric properties of the scale. The present study evaluated factorial invariance and scale reliability in a national sample (N = 1360) of adults involved in a Transtheoretical model tailored intervention for exercise and sun protection, at baseline. Invariance testing ranged from least to most restrictive: Configural Invariance (constraints only factor structure and zero loadings); Pattern Identity Invariance (equal factor loadings across target groups); and Strong Factorial Invariance (equal factor loadings and measurement errors). Multi-sample structural equation modeling tested the invariance of the measurement model across seven subgroups: age, education, ethnicity, gender, race, skin tone, and Stage of Change for Sun Protection. Strong factorial invariance was found across all subgroups. Internal consistency coefficient Alpha and factor rho reliability, respectively, were .83 and .80 for behavioral processes, .91 and .89 for experiential processes, and .93 and .91 for the global scale. These results provide strong empirical evidence that the scale is consistent, has internal validity and can be used in research interventions with population-based adult samples.     

Reliability and validity of the Japanese language version of Pro‐Change's decisional balance measure for effective stress management1

This study aimed to develop the Japanese language version of Pro‐Change's decisional balance measure for effective stress management (PDSM). Effective stress management refers to activities that are practiced, for at least 20 min per day, to reduce a person's perceived stress. Six hundred and sixty‐five female and 456 male Japanese university and college students participated in this study, which consists of two surveys. Through exploratory and confirmatory factor analyses, the Japanese language version of the PDSM was developed, which contains 12 items and consists of two factors, the Pros and the Cons. The levels of internal consistency are acceptable (Pros = 0.78 and Cons = 0.64). The scores for the Pros and the Cons subscores were not affected by social desirability (Pros = ?0.04 and Cons = ?0.12). We confirmed the construct validity of the Japanese language version of PDSM with theoretically predicted relationships between the decisional balance and the stage of change for effective stress management. The Japanese language version of the PDSM with construct validity and reliability was developed.     

Sun protective behaviour,optimism bias,and the transtheoretical model of behaviour change

This study investigated the relationship between sun protective behaviours and three psychological variables influencing health behaviour: decisional balance, optimism bias, and the transtheoretical model of behaviour change. Two hundred participants completed the ‘Readiness to Alter Sun Protective Behaviour’ questionnaire, and a short questionnaire investigating optimism bias, decisional balance, attitudes, and experiences of sun protection and skin cancer. Participants were evenly distributed between the precontemplation, contemplation, and action stages. Participants in the action stage were significantly more likely to endorse the perceived advantages associated with sun protective behaviour than participants in the precontemplation and contemplation stages. They also reported sunbathing significantly less—and being more concerned about contracting skin cancer—than participants in the earlier stages. Decisional balance and optimism bias scores varied systematically across the stages of change; however, decisional balance was the only significant psychological predictor of sun protective behaviours. Optimism bias was greatest in the precontemplation stage, whereas the action stage was characterised by more positive attitudes to sun protection. This suggests that knowledge of the real risks of skin cancer might be a precursor to behaviour change, but only a change in attitudes results in a move to the action stage and measurable behaviour change.     

Development and validation of an appearance motivation attitudes scale for sun protection

A reliable two-factor instrument measuring appearance motivation attitudes for sun protection was developed using a longitudinal sample of beachgoers. At baseline, data on sun protection and appearance motivation attitudes were collected on 2324 individuals. Principal components analyses (PCA) indicated a two-factor solution measuring attitudes toward tan attractiveness and skin protection with only 2 items loading on the skin protection factor. At 12-months, the instrument was revised and shortened but including 3 new skin protection items. Split-half analyses were conducted to further refine and develop the instrument. PCA on half of the sample revealed a two-factor solution, which was confirmed using structural equation modeling on the remaining half. This resulted in a two correlated-factor, 10-item measure. Each factor was summed to create two scales. Both scales were internally consistent and demonstrated good external validity, correlating with sun protection specific Transtheoretical model variables. The tan attractiveness attitudes scale significantly improved prediction of sun protection outcomes over 24 months, over and above TTM variables.     

Therapeutic processes in group therapy: Intersections between general change mechanisms and motivational stages of change from patient perspective

Intersections between Grawe’s General Psychotherapy and Prochaska’s Transtheoretical Model were investigated in group therapy in a longitudinal design. It was assumed that general change mechanisms have an impact on patients’ stages of change. Specifically, the main hypotheses were that experiential change mechanisms (ECM; clarification of meaning, problem actuation, emotional bond and group cohesion) should be especially relevant for early stages of change (precontemplation and contemplation), whereas behavioral change mechanisms (BCM; resource activation, mastery/coping and task and goals) should be especially relevant for late stages of change (action and maintenance). Therefore, 140 outpatients attending different types of group therapy, with a typical duration of 8 sessions, were investigated. Patients completed the Form for the Evaluation of Therapeutic Processes in Group Therapy (FEPiG), the University of Rhode Island Change Assessment, short version (URICA-S) and several symptomatology measures (BDI-II, BSCL and IIP-32) at two measuring times. Intersections were analysed through correlational analyses, cross-lagged panels and a path-analytic model, supporting the hypotheses. Specifically, results suggested that experiencing ECM at t1 predicted higher levels of reported contemplation at t2. Patients experiencing higher levels of BCM at t1 reported higher levels of action at t2. Clinical implications of the results are discussed.     

The use of implementation intentions and the decision balance sheet in promoting exercise behaviour

Although increasing exercise and fitness has often been associated with positive health outcomes, infrequent exercise participation has remained a problem. Since two distinct motivational and volitional phases to goal pursuit have been proposed, a combined motivational (decision balance sheet, DBS) and volitional (implementation intentions) intervention was predicted to be more effective in increasing exercise behaviour than a control or either strategy alone. A total of 86 students were randomly assigned to one of the four conditions, and were all asked to try to exercise two more times a week than they currently did, over a four week period. Their fitness levels were measured through fitness tests conducted pre- and post-intervention. A priori orthogonal contrasts indicated that the experimental strategies produced a greater increase in exercise frequency and total time spent exercising per week and accordingly showed greater fitness improvements than the control group. Moreover, the volitional groups taken together produced greater increase in time spent exercising and a marginally greater improvement in frequency than the DBS alone. The combined intervention led to improvements in fitness and marginal increases in frequency over the implementation intention alone group. It is proposed that for the combined group the DBS may have aided recall of the implementation intention or increased commitment to it, as remembering and then acting on the plan, in the stated place and time, mediated the implementation intention–behaviour relationship. The combined intervention produced the greatest fitness improvements, indicating that this strategy can lead to important health benefits.     

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.     

Neuroticism,conscientiousness and fruit consumption: Exploring mediator and moderator effects in the theory of planned behaviour

Integrating the theory of planned behaviour (TPB) with the five-factor model (FFM) of personality may provide insight into the cognitive and motivational mechanisms linking personality with health behaviour, but this issue has received very little attention regarding fruit consumption. Mediator effects of TPB concepts in the personality–fruit consumption link, as well as moderator effects of personality in the intention–fruit consumption link, were therefore investigated in the present study. Data on fruit consumption, TPB concepts and FFM dimensions were gathered among 405 respondents in face-to-face interviews using questionnaires. Structural equation modelling was used to investigate the mediator and moderator effects. The direct effect of conscientiousness on fruit consumption was mediated by attitude and perceived behavioural control, while no direct effect of neuroticism on fruit consumption was found. Neuroticism moderated the intention–fruit consumption relationship with the weakest relationship for those scoring high on neuroticism. Conscientiousness did not moderate the intention–fruit consumption relationship. TPB variables are mediators in the conscientiousness–fruit consumption link. Whether fruit consumption is intentional may be dependent upon the personality dimension neuroticism. Personality dimensions may be a useful addition to the TPB and should be considered in health behaviour change interventions.     

A longitudinal application of three health behaviour models in the context of skin protection behaviour in individuals with occupational skin disease

Occupational skin disease (OSD) is common, associated with poor prognosis and poses a significant burden to the individual and society. We applied the theory of planned behaviour (TPB), the prototype-willingness model (PWM) and the health action process approach (HAPA) to the prediction and explanation of occupationally relevant skin protection behaviour in individuals with OSD. We used a longitudinal design. In this study, 150 individuals participating in a 3-week inpatient tertiary prevention programme completed measures assessing the constructs of the TPB, PWM and HAPA at admission (T?0), discharge (T?1) and once the individual had returned to work and worked for 4 consecutive weeks (T?2) (n?=?117). Intention was measured at T?0 and skin protection behaviour at T?2. Path analysis was used to assess the longitudinal associations of the models’ constructs with intention and skin protection behaviour. TPB as well as PWM variables accounted for 30% of variance in behaviour, HAPA variables for 33%. While not all predictions were confirmed by the data, all three models are able to inform us about the formation of skin protection intention and behaviour in individuals with OSD. The findings are discussed in light of future interventions and research.     

Eating disorders in the course of life: A qualitative approach to vital change

Eating disorders (EDs) have become one of the biggest mental-health problems in the last decades, especially among youth and women. The present study aims to analyse the suitability of Prochaska and DiClemente’s Transtheoretical Model of Change when applied to the living experiences of people diagnosed with ED and their carers. For this purpose, we applied a narrative biographic approach to the ways in which people face their problems and vital development in the ED domain. Through the narrative analysis of these autobiographies, we aimed to study the patients’ own notions of ‘change’, ‘problem’ and ‘vital trajectory’. We focused on five autobiographic interviews of persons diagnosed as ED (four women and a man). The analysis yields three discourses which organize and give sense to our participants’ vital transitions: a discourse of functional adaptation to events and experiences; one that pays attention to random events and people entering your life; and one that has the personal initiative and agency of an individual agent at its core. It also illuminates particular ways of understanding determination, contemplation and pre-contemplation. These ways of understanding change are shown to extend the possible ways of thinking about people’s lives and ED patients’ perspectives.     

叙事医学在日本医疗纠纷调解中的应用及启示

探讨叙事医学理论在日本医疗纠纷调解制度中的应用特点以及对我国的启示。日本医疗纠纷调解制度以叙事医学为理论基础, 不同于我国现阶段运用准法律性手段来进行医疗纠纷调解的思路。建议我国在医疗纠纷调解中, 建立和加强以叙事医学为支撑的前期调解工作, 让医生树立起与患者对话的本身就是治疗过程中不可分割的一部分, 医疗纠纷调解就是让患方接受突如奇来的严酷现实的过程, 医疗纠纷调解的目的不是"息诉罢访", 而是良好医患关系的修复。     

"仁"——医德的元德

医德是医学道德的简称,具言之,它是指医务人员在医疗卫生服务的职业活动中应该具备的仁爱、救死扶伤等的品德,是道德德目在医务人员身上的内化,也是对医务人员必须具备的最起码的要求.我们评价一个医生,首先是直面他的医德,医德是医生形象的体现,没有医德的医生即使技艺再高超,也算不上一个完整意义上的医生,"无德不成医".事实上一个医德低下的医生,他的技艺也不会高超的.     

The relationship among the transtheoretical model of behavioral change,psychological distress,and diet attitudes in obesity: Implications for primary care intervention

Obesity is prevalent but undertreated in primary care. Family practice volunteer outpatients (N=454) were administered the Stage of Change for Weight (URICA), the Brief Symptom Inventory (BSI), and the Diet Readiness Test (DRT) to assess the relationship between these variables and obesity. The body mass index (BMI) was used to classify obesity revealing 197 patients with elevated BMI's. There was no significant difference between the obese and the nonobese on any of the psychological measures. The obese reported significantly more difficulty setting diet goals and less control over their eating, ate more to emotional situations, and exercised less than the nonobese. The obese sample (46.7%) reported being in the Action stage of change for weight management. Implications for intervention in primary care include targeting attitudes (DRT) and dispelling physician attitudes that obese individuals have increased levels of psychological distress. Addressing Stage of Change for weight management can facilitate tailoring the appropriate intervention when used in concert with the DRT variables.     

Predicting sun-protective intentions and behaviours using the theory of planned behaviour: a systematic review and meta-analysis

Objective: To synthesise theory of planned behaviour (TPB) relationships, using meta-analysis, and test the predictive utility of the model for sun protection behaviour.

Design: Thirty-eight samples were identified via database/manual searches and academic society posts based on the criteria: measuring sun-protective intentions and/or prospective behaviour; using the TPB/theory of reasoned action as a basis of measurement; and providing bivariate correlations for at least one relevant TPB association.

Main outcome measures: Sun-protective intentions and behaviours.

Results: The sample-weighted average effects were moderate-to-strong with attitudes showing the strongest association with intention (r+ = 0.494), followed by perceived behavioural control (PBC; r+ = 0.451), and subjective norm (r+ = 0.419). Intentions showed a stronger association with prospective behaviour (r+ = 0.486) compared to PBC (r+ = 0.314). A total of 39% of variance in intentions and 25% of variance in behaviour were explained. Publication bias was not evident. Moderator analyses showed that TPB associations were stronger when measures specified the Target, Action, Context and Time; in non-student samples; and when follow-up exceeded two weeks.

Conclusion: Despite recent criticism, this review shows that the TPB explains a large amount of variance in sun protection and that TPB associations are robust across different populations.     

A psychosocial model of sun protection and sunbathing in young women: the impact of health beliefs, attitudes, norms, and self-efficacy for sun protection.

A psychosocial model of sun protection and sunbathing as distinct behaviors was developed on 202 young Caucasian women and replicated in an independent sample (n = 207). Proximal outcomes were intention to sun protect and intention to sunbathe; distal outcomes included sun protection and sunbathing behavior measured 5 months later. Objective risk for skin cancer plus 4 classes of psychosocial variables (sun-protective health beliefs, self-efficacy for sun protection, attitudes toward sunbathing, and norms for sunbathing and sun protection) served as predictors. Sun-protective norms and self-efficacy for sun protection predicted only intention to sun protect; sunbathing norms predicted only intention to sunbathe. Susceptibility and advantages of tanning predicted both intention constructs, which, in turn, predicted behavior. These findings distinguish sun protection from sunbathing and provide a basis for intervention design.     

Loglinear Rasch models for the analysis of stability and change

Loglinear unidimensional and multidimensional Rasch models are considered for the analysis of repeated observations of polytomous indicators with ordered response categories. Reparameterizations and parameter restrictions are provided which facilitate specification of a variety of hypotheses about latent processes of change. Models of purely quantitative change in latent traits are proposed as well as models including structural change. A conditional likelihood ratio test is presented for the comparison of unidimensional and multiple scales Rasch models. In the context of longitudinal research, this renders possible the statistical test of homogeneity of change against subject-specific change in latent traits. Applications to two empirical data sets illustrate the use of the models.The author is greatly indebted to Ulf Böckenholt, Rolf Langeheine, and several anonymous reviewers for many helpful suggestions.     

Supervisor Support for Employee Performance in Australia: Mediating Role of Work‐Life Balance,Job, and Life Attitude

Drawing on the job‐demands resources model, we investigated the relationship between supervisor support and employee performance and the mediating effects of work‐life balance (WLB), job and life satisfaction, and organizational commitment in a sample of 305 financial‐sector employees in Sydney, Australia. Results reveal that supervisor support is positively related to employee performance, WLB, job and life satisfaction, and organizational commitment. In turn, WLB, job and life satisfaction, and organizational commitment are positively linked to employee performance. The findings indicate a significant mediation between supervisor support and employee performance only through WLB and organizational commitment. Implications for theory and practice are discussed.     

Mediation analysis of the association between use of NRT for smoking reduction and attempts to stop smoking

Objectives: Use of nicotine replacement therapy (NRT) for smoking reduction (SR) is linked to higher quit attempt rates than SR without NRT. This study aimed to assess the possible mediating roles of confidence in ability to quit, enjoyment of smoking and motivation to quit in this association.

Design: Cross-sectional survey.

Main outcome measures: Smokers were asked if they were currently attempting SR, and if they were, whether they were using NRT. Motivation to stop, enjoyment of smoking, confidence in ability to stop, and previous quit attempts, were also assessed.

Results: There was no evidence that confidence in ability to quit or enjoyment of smoking mediated the association between the use of NRT for SR and attempts to quit. Only motivation to stop partially mediated between the use of NRT for SR and attempts to stop (indirect effect: odds ratio 1.08, p?<?0.001).

Conclusion: Although this study is limited by its cross-sectional design, the findings point towards the possibility that the use of NRT to aid SR may promote attempts to stop through increasing motivation to quit but not by increasing confidence or by reducing enjoyment of smoking. Longitudinal studies are required to draw firmer conclusions about the possible mediating effects of motivation to quit.