Capitalizing on the potential of mobile health applications as behavioral interventions: A research agenda for calorie-tracking and activity-tracking applications

Mobile health applications (mHealth apps) are widely used tools that provide support for people seeking help managing their health in a particular behavioral domain (e.g., physical activity). Despite their popularity, evidence for the effectiveness of mHealth apps as stand-alone behavioral interventions is limited. Psychological and behavioral scientists can play a critical role in addressing this gap by pursuing programs of research that leverage basic behavioral science principles to test links between key features of mHealth apps (e.g., goal setting, feedback) and behavior change. To demonstrate this approach to evaluating mHealth apps, we systematically examine five key features of popular calorie-tracking and activity-tracking apps, explain how these features align with established behavior change techniques, discuss the evidence base for the effectiveness of these techniques within each behavioral domain, and situate predictions about how individual app features may promote behavior change in a conceptual model. Through this work, researchers can guide the design of mHealth apps and optimize them for facilitating sustained health behavior change.     

The role of personality factors in predicting the reported physical health symptoms of Turkish college students

This study investigates the role of optimism, health control beliefs, perceived health competence, and medical help-seeking variables in predicting the frequency of reported physical symptoms. A total of 345 college students (207 male and 138 female) were presented with the Life Orientation Test, Multidimensional Health Locus of Control, Perceived Health Competence Scale, and Physical Symptom Checklist. Separate stepwise multiple regression analyses were applied to the data obtained from males, females, and the total group of students. Results showed that optimism, medical help seeking, chance health locus of control, and internal health locus of control predicted the reported physical symptom scores of the total sample. Also revealed were the different patterns for males and females. While optimism and internal health locus of control best predicted physical health for males, optimism and chance health locus of control best predicted the physical health symptoms of females.     

Assessment of irrational health beliefs: relation to health practices and medical regimen adherence.

The purpose of the present research was to provide initial validation of the 20-item Irrational Health Belief Scale (IHBS). Study 1 included 392 undergraduate psychology students. Results from Study 1 suggested that the IHBS total score is internally consistent and stable over an 18-month time period. Greater health-related cognitive distortion (higher IHBS scores) was associated with weaker internal health locus of control beliefs, lower positive affectivity, stronger chance health locus of control beliefs, and greater negative affectivity. Most important, greater cognitive distortion was uniquely and significantly associated with a less positive pattern of health practices. Study 2 involved 107 individuals with Type I diabetes mellitus. Results indicated that higher IHBS scores were significantly associated with both objective (hemoglobin HbA1) and self-reported diabetic regimen adherence independent of trait neuroticism and conscientiousness.     

Matching health messages to health locus of control beliefs for promoting mammography utilization

This field experiment examined the persuasiveness of matching health messages to individuals’ health locus of control beliefs in an effort to promote screening mammography. Women (N = 499) who called the New England regional office of the Cancer Information Service were stratified by their health locus of control and randomly assigned to receive a telephone message and follow-up print materials matched to either an internal or external health locus of control orientation. As expected, women who received information consistent with their health locus of control beliefs generally were more likely to obtain a mammogram 6 and 12 months after the intervention than women who received information that was not consistent with their health locus of control orientation.     

Health locus of control and health behaviour: results from a nationally representative survey

The present study aims to examine the association between sociodemographic variables and health locus of control (HLC) as well as HLC and health behaviour. Data from a representative sample of the German adult population, the Telephone Health Survey 2006 (GSTel06; N=5542), were used. A German version of the MHLC (multidimensional HLC) scales was used. Associations between sociodemographic variables and three dimensions of HLC (internal, powerful others and chance) and between HLC and health behaviour were calculated. In particular, higher age, low socioeconomic status and migration background were associated with higher HLC scores on the powerful others and chance dimension. Subjects scoring high on the chance dimension did less sports activity (OR: 0.8; CI: 0.7-0.9), had less medical teeth protection (0.7; 0.6-0.9), fewer health courses (0.8; 0.7-0.9) and conducted less systematic information-seeking (0.8; 0.6-0.9), while results regarding internal and powerful others HLC remained mainly insignificant. High chance HLC can be regarded as risk factor of adequate health behaviour. The associations between high chance HLC, low socioeconomic status and migration background emphasise the need for treatments and prevention programmes tailored to modify the high chance HLC of socially disadvantaged populations.     

Locus of control in aging research: a case for multidimensional and domain-specific assessment

Do locus of control beliefs change in later life? Is locus of control related to aging-relevant outcomes involving intelligence and health? In past research on these topics, the use of unidimensional and generalized measures of locus of control has led to a set of inconsistent findings. Three studies were conducted to examine the usefulness of multidimensional and domain-specific measures of locus of control for examining age differences and correlates. College students and elderly adults were compared on Levenson's multidimensional and generalized (internal, chance, and powerful others) locus of control scales and two domain-specific versions related to intelligence and health. As predicted, no age differences were found with generalized measures, but the elderly were more external on intelligence- and health-specific locus of control dimensions. Age differences were found most often on the chance and powerful others control dimensions, suggesting that the elderly acknowledge the importance of external sources of control and at the same time preserve their sense of internal control. In addition, the domain-specific scales were better predictors of behavioral outcomes within their respective domains for the elderly but not for the young. The findings suggest that multidimensional and domain-specific conceptions of control are advantageous for aging research.     

Some correlates of health locus of control among multicultural individuals

The relationship of locus of control to depression, anxiety, hostility, and physical health was assessed in a sample of multicultural college students (N = 162). Powerful Others Health Locus of Control was correlated with depression, anxiety, hostility, and recent physical symptoms while Chance Health Locus of Control (CHLC) was correlated with all of the above as well as chronic physical symptoms and major health problems. When controlling for a variety of health risk factors (viz., age, sex, body mass, exercise, smoking, salt, alcohol, and caffeine), only CHLC remained significant in the physical health models. Results support the cognitive model of mental health which emphasize the importance of adaptive beliefs. Specifically, they suggest that issues about control are related to negative affect and indicate that the often-cited relationship of an external locus of control to depression and anxiety also holds for hostility. The findings do not, however, support the view that anxiety and depression are associated with different types of external locus of control but rather suggest a unified set of locus of control beliefs underlying the three types of negative affect. In addition, evidence is provided for the external validity of the Multidimensional Health Locus of Control (MHLC) Scales with respect to mental health. Further, the results indicate that belief about one’s health may play a significant role in one’s physical health and that the health behavior model of the relationship between locus of control and physical health is insufficient to explain the relationship. As the Chance and Powerful Others MHLC scales were not related to health habits in this sample but were related to mental health (viz., depression, anxiety, and hostility), locus of control beliefs may be related to physical health via their relationship with mental health.     

Ethical and Legal Issues Addressing the Use of Mobile Health (mHealth) as an Adjunct to Psychotherapy

mHealth refers to the rapidly evolving use of mobile devices for health care treatment purposes, particularly the use of apps and texting as adjuncts to psychotherapy. Although there is currently an extensive literature on issues related to telehealth, to date little guidance has been developed to help professionals function ethically in the rapidly emerging area of mHealth. This article identifies the major ethical considerations that need attention and proposes several recommendations to address mHealth use as an adjunct to psychotherapy, including the pressing need for relevant American Psychological Association practice guidelines to assist mental health providers in the ethical implementation of mHealth.     

Is There an App for That? A Review of Popular Apps for Depression,Anxiety, and Well-Being

Smartphone apps for mental health (MH apps) and wellness reach millions of people and have the potential to reduce the public health burden of common mental health problems. Thousands of MH apps are currently available, but real-world consumers generally gravitate toward a very small number of them. Given their widespread use and the lack of empirical data on their effects, understanding the content within MH apps is an important public health priority. An overview of the content within these apps could be an important resource for users, clinicians, researchers, and experts in digital health. Here, we offer summaries of the content within highly popular MH apps. Our aim is not to provide comprehensive coverage of the MH app space. Rather, we sought to describe a small number of highly popular MH apps in three common categories: meditation and mindfulness, journaling and self-monitoring, and AI chatbots. We downloaded the two most popular apps in each of these categories (respectively: Calm, Headspace; Reflectly, Daylio; Replika, Wysa). These six apps accounted for 83% of monthly active users of MH apps. For each app, we summarize information in four domains: intervention content, features that may contribute to engagement, the app’s target audience, and differences between the app’s free version and its premium version. In the years ahead, rigorous evaluations of highly popular MH apps will be needed. Until then, we hope that this overview helps readers stay up-to-date on the content within some of the most widely used digital mental health interventions.     

移动健康的理论基础与效果评估

移动健康(mHealth)本质上是基于移动信息技术而开发的移动健康技术。在对电子健康(eHealth)和移动健康做出区分的基础上, 通过一系列实证研究的回顾, 总结出了移动健康技术的五大理论基础, 即认知行为理论、社会支持理论、行为转变理论、行为学习理论和扎根理论。进一步分析发现, 移动健康技术在心理问题解决、生理疾病管理、健康行为促进方面具有一定效果, 但仍需要更加坚实的证据。未来研究要着重探讨移动健康干预的有效性影响因素, 进一步找出影响干预有效性的作用机制, 为实现人性化的以及良好的干预效果提供证据支撑。     

Health Beliefs and Attitudes Toward People Living With HIV/AIDS

The present study was concerned with the relationship between health beliefs and attitudes toward people living with HIV/AIDS. Measures of attitudes toward people with HIV/AIDS, beliefs about the transmission of HIV, and health locus of control beliefs were completed by 128 undergraduate students. In general, subjects who believed that HIV was transmitted through normal social contact wanted to avoid contact with people with HIV/AIDS, and showed other negative attitudes, such as lack of sympathy and blame. They also believed that their health was influenced by powerful others and chance. The findings are discussed in terms of fear of contracting HIV and the tendency to blame the victim.     

Perceived Risks and Benefits in a Text Message Study of Substance Abuse and Sexual Behavior

To inform ethical procedures for human subjects research using mobile health (mHealth), we examined perceived risks and benefits of study participation among emerging adults (N = 54) with drug use who completed text message assessments of substance use and sexual behaviors. Most participants reported comfort with participation and some reported perceived benefits, such as improved relationships. Perceived risks were infrequently reported, including negative emotions and legal or financial concerns. In conclusion, participants from a vulnerable population reported few perceived harms of participation in longitudinal mHealth assessments of sensitive behaviors. Researchers should continue characterizing participants’ perspectives on ethical aspects of mHealth research.     

Role of health locus of control beliefs and expectations of treatment efficacy in adjustment to cancer

We examined the effects of health locus of control beliefs (self-, doctor, and chance control) and expectations of treatment efficacy on short-term psychological adjustment in a sample of newly diagnosed cancer patients. The role of these beliefs and expectations in moderating the relation between (perceived and actual) disease severity and depression was also examined. The data were collected within one week of diagnosis. The relation between perceptions of disease severity and depression was weaker for those who believed that they could personally control their health and for those who held positive expectations about the effects of complying with medical treatment. Similar patterns were found when disease severity was defined in terms of prognosis for survival. Strong negative correlations between self-control/treatment expectations and depression were found for those who perceived that their illness was very severe. The results for chance and doctor control were less consistent. The stability of health control beliefs and treatment expectations over the course of a serious long-term illness is discussed.     

基于网络干预的心理健康素养提升有效性研究

研究旨在探索中国文化背景下心理健康素养干预的有效性,以及心理健康素养的提升对专业心理求助意愿、心理健康和幸福感的影响。研究采用实验组对照组前后测设计。结果表明:1.基于网络教育的干预方法能够有效提升心理健康素养,进而促进专业心理求助意愿,改善心理健康状况。但是对大学生的幸福感没有产生明显影响; 2.心理健康素养可以通过专业心理求助意愿分别影响心理健康状况和幸福感,且专业求助意愿和心理健康在心理健康素养和幸福感之间起着完全链式中介作用。总的来说,心理健康素养的有效提升不仅可以改善专业心理求助意愿,提高人们的心理健康水平,还可能增添生活幸福感。     

From self-reliers to expert-dependents: identifying classes based on health-related need for autonomy and need for external control among mobile users

ABSTRACT

Mobile health apps are seen as promising tools to support autonomous consumers in their quest for better health. However, individual differences in the need for autonomy and need for external control may impact the degree to which individuals perceive mobile health apps to be useful in their daily life. Using data from a representative sample of the Dutch population (N = 1,027), we applied latent class analysis to identify subtypes among mobile users based on their need for autonomy and need for external control, and to examine differences among these subtypes. We identified four subgroups: the self-reliers, confirmation-seekers, expert-dependents, and indifferents. Next to demographic differences, self-reliers and confirmation-seekers were generally more e-health literate and expressed more privacy concerns than the expert-dependents and indifferents. Our findings demonstrate that subgroups of people express different degrees of health-related need for autonomy and need for external control, which should be taken into account in online and mobile health communication efforts.     

Psychological predictors for health-related quality of life and disability in persons with chronic obstructive pulmonary disease (COPD)

Objective: Individuals with chronic obstructive pulmonary disease (COPD) exhibit low physical and mental health-related quality of life (HRQL) and high susceptibility to disability. We investigated the influence of psychological factors on HRQL and disability in COPD individuals recruited from the general population. In line with Leventhal’s common sense model, we expected psychological factors to be associated with HRQL and disability even after controlling for medical status.

Methods: Individuals with COPD (n = 502; 59.7 years old; GOLD grades were I: 3%, II: 17%, III: 34%, IV: 46%) were assessed through an online survey administered via COPD patient organisations in Germany. Individuals filled in the Short Form Health Survey (SF-12), COPD Assessment Test, Patient Health Questionnaire (modules: GAD-2, PHQ-15, PHQ-9), Brief Illness Perception Questionnaire, a questionnaire that assesses causal illness attributions, and the internal illness-related locus of control scale of the ‘KKG questionnaire for the assessment of control beliefs about illness and health’. Multiple linear regressions were calculated.

Results: The investigated factors explained high variances (disability = 56%, physical HRQL = 28%, mental HRQL = 63%, p ≤ .001). Better mental health, more optimistic illness perceptions, attribution to psychological causes, and stronger internal locus of control were associated with lower disability and better HRQL. Comorbid somatic symptoms contributed to high disability and low quality of life.

Conclusion: Psychological factors, such as illness perception, attribution and internal locus of control, were associated with disability and HRQL. These factors should be considered when designing treatments for individuals with COPD, and adequate interventions should be provided to enhance illness understanding and self-management skills.     

Predicting adolescent health complaints by personality and Behaviors

Abstract

In a sample of 97 male adolescents, individual differences in health complaints were predicted by personality traits and by self-reported health/risk behaviors. Anxiety and loneliness were measured at Times 1 and 2, and health locus of control, various behaviors and health complaints were assessed at the end of the two-year study. A causal model was specified, employing anxiety and loneliness as distal predictors, health locus of control and behaviors as proximal predictors of health complaints. It turned out that anxiety was the most powerful single predictor, and that loneliness exerted a direct effect on health locus of control and behaviors and an indirect effect on health complaints. Risk behavior as well as health behavior were related to complaints. Social integration facilitated not only health behavior but also risk behavior.     

Resisting temptation: alcohol specific self-efficacy mediates the impacts of compensatory health beliefs and behaviours on alcohol consumption

Awareness of health risks linked with excessive alcohol consumption appears to have little influence on how much some people drink. Compensatory health beliefs (CHBs), in which the consequences of unhealthy behaviour are considered to be neutralised by additional healthy behaviours, are one way of justifying poor health choices. Currently, the role of CHBs within the context of drinking behaviour is not well understood. This research examined associations between alcohol specific compensatory health beliefs (ACH-Beliefs) and behaviours (ACH-Behaviours), alcohol consumption and alcohol specific self-efficacy (ASE), via an online survey completed by 249 participants, aged 18 + years (63.1% female; M age = 41.62 years; SD = 14.80). Higher ACH-Beliefs were associated with increases in ACH-Behaviours. While both predicted alcohol consumption, a greater proportion of variance was explained by ACH-Behaviours. ASE was a significant mediator of those relationships, suggesting that those with higher ASE may be better equipped to regulate drinking behaviour. Recommendations for future research include measuring both CHBs and behaviours within an experimental design, and further investigation of related cognitions such as compensatory behaviour intentions. Alcohol misuse interventions may wish to consider the potential roles of CHBs and behaviours in facilitating maladaptive coping strategies, and how addressing these may reduce harms.     

Gender and health behaviours of hypertensive patients: mediating role of control beliefs

Previous studies have reported gender differences in patients’ health behaviours but few studied hypertensive patients. The potential underlying factors that may mediate gender influences on health behaviours is also a more critical area worthy of investigation. This study examined health locus of control (HLC) as a pathway of gender effects on health behaviours of hypertensive patients. The Multidimensional HLC Scale (Form C) and Wellness behaviour subscale of Health Behaviour Checklist were completed by 400 hypertensive outpatients in two Nigerian hospitals: Enugu State University Teaching Hospital, Park Lane, Enugu, and Bishop Shanahan Specialist Hospital, Nsukka. Hierarchical multiple regression results showed that gender significantly predicted health behaviours. Gender also significantly predicted internal HLC, chance HLC, and other people HLC, but did not predict doctor HLC. The association between gender and health behaviours was fully mediated by internal HLC, chance HLC and other people HLC. Understanding the explanatory mechanisms linking socio-demographic factors and health behaviours is considered of great importance for future research and healthcare intervention.     

Relationships between locus of control,health value,and preventive health behaviors among women

This study examines the relationships between locus of control expectancies, rated health value, and reported participation in preventive health behaviors among a healthy sample of undergraduate women. The prediction that participation in preventive health behaviors would be a joint function of an internal health-related locus of control belief and holding health in high value was not supported. Instead, individuals who valued their health reported participating in a greater number of health-enhancing behaviors compared to those who valued their health less. Respondents' scores on a health value scale in combination with their rated health status proved to be better predictors of health behaviors than their locus of control beliefs. Limitations of locus of control research with young, healthy individuals are discussed and further investigation into the utility and validity of health value scales is recommended.