Planning and self-efficacy interventions encouraging replacing energy-dense foods intake with fruit and vegetable: A longitudinal experimental study

Objective: This longitudinal experimental study compared effects of self-efficacy, planning and education-based conditions, encouraging adolescents to eat fruit and vegetable in place of energy-dense foods.

Design: Data were collected among 506 adolescents (13–18 years old) who were randomly assigned to control (n = 181), planning (n = 153) or self-efficacy (n = 172) conditions. Measurements were taken at baseline (T1), at a 2-month follow-up (T2), and at a 14-month follow-up (T3). Interventions/control group procedures were delivered at T1 and T2.

Outcome measures: Self-reports of fruit and vegetable intake (FVI) and energy-dense foods intake were collected at three times. Cognitive mediators (self-efficacy and planning) were assessed at T1 and T2. Body weight and height were objectively measured at T1 and T3.

Results and conclusions: Similar significant increases of FVI were found for planning and self-efficacy interventions (T3). The planning intervention did not influence energy-dense food intake (T3), but the self-efficacy intervention tended to result in stabilising intake (compared to an increase found in the control group). There were no effects on body weight. Similar patterns were found for the total sample and for a subsample of adolescents with overweight/obesity. The effects of interventions on FVI were mediated by respective cognitions.     

The use of commitment techniques to support weight loss maintenance in obese adolescents

Objectives: Obesity is a rising problem in adolescents related to unhealthy behaviours. Commitment devises are one type of behavioural intervention that may help people change their behaviours. The current pilot trial tests whether commitment devices delivered via text message help adolescents maintain their recent weight loss.

Methods: During a 12-week pilot trial, adolescents who attended a weight loss camp were randomly assigned to either received text messages that contained only information, i.e. advice, about weight loss management (n = 13) or asked for them to commit to following the same advise (n = 14).

Results: The BMI of the adolescents in the commitment group did not change. In contrast, the BMI of adolescents in the information group increased. A linear regression revealed that group was a significant predictor of BMI change. A logistic regression revealed that adolescents in the information group were nearly eight times more likely to regain weight than those in the commitment group.

Conclusions: This is the first study with adolescents to show weight maintenance using a commitment device. The results suggest that commitment devices can help adolescents maintain their recent weight loss.     

Dietary planning,self-efficacy,and outcome expectancies play a role in an online intervention on fruit and vegetable consumption

Objective: An online intervention to improve fruit and vegetable (FV) intake examines the role of planning, outcome expectancies, self-efficacy and gender. Women are not only expected to eat more FV than men, but they are also expected to be more responsive to nutritional advice and benefit more from treatment.

Method: A two-arm digital intervention with 269 men and 395 women (M_age = 41.2, SD_age = 11.45; range: 19–66 years) was conducted in Italy, Spain and Greece, followed up at three and six months, comparing a static with a dynamic, feedback-intensive platform.

Results: Linear mixed models yielded an increase in FV consumption in both the dynamic and the static intervention arms. In men, outcome expectancies were positively related to follow-up FV intake. Dietary planning interacted with self-efficacy on behavioural outcomes.

Conclusion: FV intake increased overall, and being a woman and involvement in planning facilitated behaviour change. Women seemed to be more engaged in the dynamic platform resulting in a higher amount of planning. Initial motivation, as indicated by outcome expectancies, seemed to be beneficial for men. Self-efficacious individuals benefitted from their engagement in planning, but self-efficacy did not compensate for failing to plan.     

Working mechanisms of a web-based self-management intervention for cancer survivors: a randomised controlled trial

Objective: The aim of this study was to investigate whether problem-solving skills and perceived personal control over cancer recovery mediated the intervention effects on depression and fatigue of a web-based computer-tailored intervention for cancer survivors – the Kanker Nazorg Wijzer (Cancer Aftercare Guide).

Design: Patients were recruited through 21 Dutch hospitals (November 2013–June 2014). The mediation model was tested in a randomised controlled trial with an intervention group (n = 231) and a waiting list control group (n = 231).

Main outcome measures: Hypothesised mediators problem-solving skills (SPSI-R) and personal control (IPQ-R) were measured at baseline and 3 months from baseline. Outcomes depression (HADS) and fatigue (CIS) were measured at baseline and 6 months from baseline.

Results: The intervention effects in decreasing depression and fatigue were mediated by personal control. Problem-solving skills did not mediate the intervention effects on depression and fatigue.

Conclusion: While personal control in the control group decreased in the first three months after baseline, levels of personal control within the intervention group were maintained. This effect partially explained the intervention effects on depression and fatigue. The results provide evidence for the relevance of addressing personal control in web-based interventions in order to improve psychosocial well-being in early cancer survivors.     

A meta-analysis of children’s self-reports of dietary intake

Objective: Although research studies increasingly use children as primary reporters in dietary assessments, it is unclear how well children’s self-reported intake correlates with independently validated reports of their intake; this meta-analysis assesses that correlation.

Design: Moderators of the correlation between self-reported and independently validated intake were predicted a priori: type of dietary intake assessment (24 h recall, food diary and food frequency questionnaires), validation measures, parental assistance and age. Online databases were searched for articles published from 1990 to 2014 that compared children’s self-reports of dietary intake to validated observations of food intake in children age 4–16.

Main outcome measures: Summary effect size Pearson r between children’s self-reported dietary intake and independently validated dietary intake were calculated.

Results: In k = 32 samples from 23 studies, a statistically significant correlation (r = .48, Z = 7.26, p < .001) was found between children’s self-reported dietary intake and independently validated reports of dietary intake. Validation method (Q = 17.49, df = 2, p < .001) and parental assistance (Z = 2.03, p = .042) were significant moderators of this correlation. Self-report methodology (Q = 3.95, df = 2, p = .139) and age (Q = .02, p = .879) were not significant moderators of the distribution of effect sizes.

Conclusion: Together, these results provide baseline information about children’s recall in dietary intake assessments conducted with children as primary reporters.     

3-D bone models to improve treatment initiation among patients with osteoporosis: A randomised controlled pilot trial

Objective: To investigate the efficacy of 3-D printed bone models as a tool to facilitate initiation of bisphosphonate treatment among individuals who were newly diagnosed with osteoporosis.

Design: Fifty eight participants with estimated fracture risk above that at which guidelines recommend pharmacological intervention were randomised to receive either a standard physician interview or an interview augmented by the presentation of 3-D bone models.

Main outcome measures: Participants’ beliefs about osteoporosis and bisphosphonate treatment, initiation of bisphosphonate therapy assessed at two months using self-report and pharmacy dispensing data.

Results: Individuals in the 3-D bone model intervention condition were more emotionally affected by osteoporosis immediately after the interview (p = .04) and reported a greater understanding of osteoporosis at follow-up (p = .04), than the control group. While a greater proportion of the intervention group initiated an oral bisphosphonate regimen (alendronate) (52%) in comparison with the control group (21%), the overall initiation of medication for osteoporosis, including infusion (zoledronate), did not differ significantly (intervention group 62%, control group 45%, p = .19).

Conclusion: The presentation of 3-D bone models during a medical consultation can modify cognitive and emotional representations relevant to treatment initiation among people with osteoporosis and might facilitate commencement of bisphosphonate treatment.     

Revisiting self-regulatory techniques to promote physical activity in older adults: null-findings from a randomised controlled trial

Objective. A randomised controlled trial (RCT) was conducted to evaluate a three-hour face-to-face physical activity (PA) intervention in community-dwelling older German adults with four groups: The intervention group (IG) received behaviour change techniques (BCTs) based on the health action process approach plus a views-on-ageing component to increase PA. The second intervention group ‘planning’ (IGpl) contained the same BCTs, only substituted the views-on-ageing component against an additional planning task. An active control group received the same BCTs, however, targeting volunteering instead of PA. A passive control group (PCG) received no intervention.

Design. The RCT comprised 5 time-points over 14 months in N = 310 participants aged 64+.

Main outcome measures. Self-reported as well as accelerometer-assessed PA.

Results. Neither PA measure increased in the IG as compared to the other groups at any point in time. Bayes analyses supported these null-effects.

Conclusion. A possible explanation for this null-finding in line with a recent meta-analysis is that some self-regulatory BCTs may be ineffective or even negatively associated with PA in interventions for older adults as they are assumed to be less acceptable for older adults. This interpretation was supported by observed reluctance to participate in self-regulatory BCTs in the current study.     

Motivational interviewing and self-determination theory in a web-based computer tailored physical activity intervention: A randomized controlled trial

Objective: This study explores whether a web-based physical activity (PA) intervention grounded in self-determination theory (SDT) and motivational interviewing (MI) is more effective and better appreciated than a traditional web-based PA intervention.

Design: A randomized controlled trial was conducted, comparing (1) I Move; a web-based PA intervention based on SDT and MI, (2) Active Plus; a traditional web-based PA intervention and (3) a waiting list control condition.

Main outcome measures: Weekly minutes of moderate to vigorous PA and weekly days with ≥30 min PA were measured through self-report at baseline and at 3 and 6 months from baseline.

Results: I Move achieved a small, but significant increase in weekly minutes of moderate to vigorous PA, while Active Plus did not have a significant impact on this outcome. Both interventions were effective in increasing weekly days with ≥30 min PA, whereas Active Plus yielded a greater effect on this outcome.

Conclusion: Overall, the web-based PA intervention grounded in SDT and MI did not outperform the traditional web-based PA intervention. Further research should reveal whether this type of intervention is profitable for long-term maintenance of PA levels.     

Effects of tailoring ingredients in auditory persuasive health messages on fruit and vegetable intake

Objective: Health messages can be tailored by applying different tailoring ingredients, among which personalisation, feedback and adaptation. This experiment investigated the separate effects of these tailoring ingredients on behaviour in auditory health persuasion. Furthermore, the moderating effect of self-efficacy was assessed.

Design: The between-participants design consisted of four conditions. A generic health message served as a control condition; personalisation was applied using the recipient’s first name, feedback was given on the personal state, or the message was adapted to the recipient’s value.

Main outcome measures: The study consisted of a pre-test questionnaire (measuring fruit and vegetable intake and perceived difficulty of performing these behaviours, indicating self-efficacy), exposure to the auditory message and a follow-up questionnaire measuring fruit and vegetable intake two weeks after message exposure (n = 112).

Results: ANCOVAs showed no main effect of condition on either fruit or vegetable intake, but a moderation was found on vegetable intake: When self-efficacy was low, vegetable intake was higher after listening to the personalisation message. No significant differences between the conditions were found when self-efficacy was high.

Conclusion: Individuals with low self-efficacy seemed to benefit from incorporating personalisation, but only regarding vegetable consumption. This finding warrants further investigation in tailoring research.     

Motivational interviewing or reminders for glaucoma medication adherence: Results of a multi-site randomised controlled trial

Objective: Nonadherence reduces glaucoma treatment efficacy. Motivational interviewing (MI) is a well-studied adherence intervention, but has not been tested in glaucoma. Reminder interventions also may improve adherence.

Design: 201 patients with glaucoma or ocular hypertension were urn-randomised to receive MI delivered by an ophthalmic technician (OT), usual care or a minimal behavioural intervention (reminder calls).

Main Outcome Measures: Outcomes included electronic monitoring with Medication Event Monitoring System (MEMS) bottles, two self-report adherence measures, patient satisfaction and clinical outcomes. Multilevel modelling was used to test differences in MEMS results by group over time; ANCOVA was used to compare groups on other measures.

Results: Reminder calls increased adherence compared to usual care based on MEMS, p = .005, and self-report, p = .04. MI had a nonsignificant effect but produced higher satisfaction than reminder calls, p = .007. Treatment fidelity was high on most measures, with observable differences in behaviour between groups. All groups had high baseline adherence that limited opportunities for change.

Conclusion: Reminder calls, but not MI, led to better adherence than usual care. Although a large literature supports MI, reminder calls might be a cost-effective intervention for patients with high baseline adherence. Replication is needed with less adherent participants.     

Book reviews and books received

Seeking convergence SAVICKAS, M.L. & LENT, R. W. (Eds), 1994 Convergence in Career Development Theories: Implications for Science and Practice Palo Alto, CA: CPP Books ISBN 0-89106-066-9 $32

Reviewed by John Killeen, University of Hertfordshire and National Institute for Careers Education and Counselling

Careers in the classroom BARNES, A. & ANDREWS, D. (Eds), 1995 Developing Careers Education and Guidance in the Curriculum London: Fulton ISBN 1-85346-323-X £13.99

Reviewed by Sheila M. Sloney, National Foundation for Educational Research

Painful questions LAGO, C. & THOMPSON, J. 1996 Race, Culture and Counselling Milton Keynes: Open University Press ISBN 0-335-19294-7 £12.99

Reviewed by Alan Home, Principal Psychotherapist, Central Manchester Healthcare Trust

Skills training INSKIPP, F. 1996 Skills Training for Counsellors London: Cassell ISBN 0-304-32920-7 (hardback); 0-304-32918-5 (paperback) £35 (hardback); £11.99 (paperback)

Reviewed by Maggie Robson, School of Education, University of Durham

Therapy for psychosis CHADWICK, B. BIRCHWOOD, N. & TROWER, P. 1996 Cognitive Therapy for Delusions, Voices and Paranoia Chichester: Wiley ISBN 0-71-96173-6 £15.99

Reviewed by Frank Margison, Consultant Psychotherapist, Manchester Royal Infirmary

Demonstrating REBT DRYDEN, W. 1996 Rational Emotive Behaviour Therapy: Learning from Demonstration Sessions London: Whurr ISBN 1-897-635-443 £12.95

Reviewed by Michael Gopfert, Consultant Psychotherapist, Liverpool Psychotherapy and Consultation Service, Mossley Hill Hospital, Liverpool

Promoting mental health TUDOR, K. 1996 Mental Health Promotion: Paradigms and Practice London: Routledge ISBN 0-415-10106-9 £16.99

Reviewed by Mike McNulty, Department of Primary Health Care, University College of St Martin, Carlisle

Incest therapy COURTOIS, C.A. 1988 Healing the Incest Wound: Adult Survivors in Therapy New York: Norton ISBN 0-393-31356-5 £13.95

Reviewed by Helen Bridges, Senior Lecturer in Counselling and Psychology, University College of St Martin, Lancaster     

The interplay between feelings and beliefs about condoms as predictors of their use

Objective: Negative feelings about condoms are a key barrier to their use. Using the behavioural affective associations model, we examined the joint effects of affective associations and cognitive beliefs about condoms on condom use.

Design: In Study 1 (N = 97), students completed measures of their affective associations and cognitive beliefs about sex and condoms, sexual activity and condom use. In Study 2 (N = 171), a measure of behavioural intentions and condom selection task were added.

Main outcome measures: Condom use measured in Study 1 as (1) current condom use, and (2) willingness to use condoms; in Study 2 as: (1) behavioural intentions, (2) number of condoms selected.

Results: Affective associations with sex and condoms were behaviour-specific, were directly associated with the respective behaviour, and mediated the relations of cognitive beliefs to behaviour, ps < .05. In Study 2, affective associations were associated with behavioural intentions and the number of condoms selected, ps < .05; cognitive beliefs were indirectly associated with these outcomes through affective associations, indirect effects: ps < .05.

Conclusions: Affective associations are a behaviour-specific and proximal predictor of condom use, mediating the effect of cognitive beliefs, suggesting they may be a particularly viable intervention target.     

The positive eating scale: relationship with objective health parameters and validity in Germany,the USA and India

Objective: The prevailing focus regarding eating behaviour is on restriction, concern, worry and pathology. In contrast, the purpose of the present studies was to focus on a positive relationship with eating in non-clinical samples from Germany, the USA and India.

Design: In Study 1, the Positive Eating Scale (PES) was tested and validated in a large longitudinal sample (T1: N = 772; T2: N = 510). In Study 2, the PES was tested in online samples from the USA, India and Germany (total N = 749).

Main Outcome Measures: Health risk status was measured in Study 1 with objective health parameters (fasting serum glucose, triglycerides, high-density lipoprotein cholesterol, blood pressure, waist circumference, BMI).

Results: Study 1 revealed acceptable psychometric properties of the PES, internal consistency (α = .87), as well as test–retest reliability after six months (r = .67). Importantly, a positive relationship with eating was associated with decreased health risk factors six months later. In Study 2, the structure of the PES was confirmed for German, Indian and US-American adults, suggesting validity across remarkably different eating environments.

Conclusion: A positive relationship with eating might be a fruitful starting point for prevention and intervention programmes promoting physical and psychological health.     

Affect and between-meal snacking in daily life: the moderating role of gender and age

Objective: Affect-related energy intake from snacks remains relatively unexplored in daily life. This study examines the associations between momentary positive affect (PA) and momentary negative affect (NA) and subsequent energy intake from snacks. In addition, the moderating role of BMI, gender, age and level of education is investigated.

Design: Adults (N = 269), aged 20–50, participated in this study. Demographics were assessed in an online composite questionnaire. An experience sampling smartphone application was used to map momentary NA/PA and energy intake (kilocalories) from snacks in the context of daily life.

Main outcome measures: Energy intake from moment-to-moment self-reported snacks in real-life settings.

Results: A significant negative main effect of momentary NA on moment-to-moment energy intake was found. The higher the momentary NA, the lower the subsequent amount of kilocalories consumed. There was no main effect with regard to PA. Interaction analyses showed that men decreased their energy intake after experiencing NA, and increased their intake after experiencing PA. No associations were found in women. Additionally, young adults (20–30) increased their energy intake after experiencing PA. No associations were found in the other age groups.

Conclusion: Interventions aiming at reducing energy intake might also address PA-related snacking in young adults and men.     

Meta-analysis of psychosocial interventions on survival time in patients with cancer

Objective: This study was to evaluate the effects of psychosocial interventions on survival in adult patients with cancer.

Method: MEDLINE via PubMed, Cochrane Library CENTRAL, CINAHL, and Korean electronic databases (September 2014) were searched. Methodological quality was assessed using Cochrane’s Risk of Bias for randomized studies. The RevMan 5.3 program of the Cochrane library was used for data analysis.

Results: Fifteen randomized controlled trials met the inclusion criteria, with a total of 2940 participants. Overall, psychosocial interventions was not associated with better survival (HR = .83, 95% CI [.68, 1.10], p = .06, I² = 64%). In subgroup analysis, based on six trials with 1448 subjects, psychoeducational interventions for cancer patients with non-metastatic at intervention implementation resulted in a 41% reduction in the risk of dying of cancer (HR = .59, 95% CI [.49, .71], p < .001, I² = 0%). For psychoeducational intervention, significant survival benefit were found when health staff delivered the intervention and at a follow-up time of more than 10 years.

Conclusions: Use of psychoeducational interventions for cancer patients at early stage appeared to have beneficial effects on survival, preferably for delivering of health staff. However, conduct of further psychosocial studies with adequate power will lead to better understanding of the effects of treatments on survival outcome.     

I’m still standing: A longitudinal study on the effect of a default nudge

Objective: This study assessed the effect of a default nudge to reduce sedentary behaviour at work over time.

Design and main outcome measures: A field study was conducted at a governmental organisation. In the present study, the default setting of sit–stand desks (SSDs) was changed from sitting to standing height during a two-week intervention. Stand-up working rates were calculated based on observations that were done prior to, during, two weeks after and two months after the intervention. Additionally, a pre-measure survey (n = 606) and post-measure survey (n = 354) were completed. Intention and social norms concerning stand-up working were compared for the 183 employees who completed both pre- and post-assessments (45.4% female, M_age = 44.21).

Results: Stand-up working rates raised from 1.82% in the baseline to 13.13% during the intervention. After the nudge was removed the percentage was 10.01% after two weeks and 7.78% after two months. A multilevel analysis indicated a significant increase in both intention and social norms after the nudge intervention.

Conclusions: This study shows that a default nudge can increase stand-up working rates in offices with SSDs at least until two months after the nudge intervention.     

A pilot randomised controlled trial of a home-based writing intervention for individuals with seizures

Objective: We investigated the feasibility, acceptability and preliminary effectiveness of a writing intervention for individuals with epilepsy or psychogenic nonepileptic seizures.

Methods: Individuals were randomised to write about potentially ‘therapeutic’ topics (n = 43) or about their daily events (n = 25). Participants were asked to write on four separate occasions for at least 20 min. Repeated-measures analysis of variance was used to investigate change in measures of health-related quality of life (NEWQoL-6D), depression (NDDI-E), anxiety (GAD-7) and illness perception (B-IPQ) from baseline to one and three-month follow-ups. Qualitative and quantitative data taken from a Writing Task Questionnaire was analysed between the two conditions.

Results: Recruitment was acceptable with 52% of those randomised completing the full writing intervention. In both conditions, participants wrote for longer than 20 min suggesting those who completed the study engaged well with the procedure. Greater benefits were observed in the ‘therapeutic’ condition (p < 0.05), which was associated with an improvement in health-related quality of life at one-month follow-up (p = 0.02). No differences were found in the other measures.

Conclusions: A writing intervention is acceptable in this population. Self-reported benefits were modest, suggesting therapeutic writing may be more suitable as a supplement to other therapies rather than a stand-alone therapeutic intervention.     

Zooming into daily life: within-person associations between physical activity and affect in young adults

Objective: Negative affect in daily life is linked to poorer mental and physical health. Activity could serve as an effective, low-cost intervention to improve affect. However, few prior studies have assessed physical activity and affect in everyday life, limiting the ecological validity of prior findings. This study investigates whether daily activity is associated with negative and positive evening affect in young adults.

Design: Young adults (N = 189, Mdn = 23.00) participated in an intensive longitudinal study over 10 consecutive days.

Main Outcome Measures: Participants wore accelerometers to objectively assess moderate-to-vigorous physical activity continuously throughout the day and reported their affect in time-stamped online evening diaries before going to sleep.

Results: On days when participants engaged in more activity than usual, they reported not only less depressed and angry evening affect but also more vigour and serenity in the evening.

Conclusion: Young adults showed both less negative and more positive affect on days with more activity. Physical activity is a promising health promotion strategy for physical and mental well-being.     

The effectiveness of narrative versus informational smoking education on smoking beliefs,attitudes and intentions of low-educated adolescents

Objective: This study tests the effectiveness of narrative versus informational smoking education on smoking beliefs, attitudes and intentions of low-educated adolescents.

Design: A field experiment with three waves of data collection was conducted. Participants (N = 256) were students who attend lower secondary education. At the first and third waves, they completed a questionnaire. At the second wave, 50.8% of the participants read a smoking education booklet in narrative form and 49.2% read a booklet in informational form. After reading, all participants also completed a questionnaire at wave 2.

Main outcome measures: Beliefs about negative consequences of smoking, attitudes towards smoking and intentions to smoke were measured.

Results: Repeated measures analyses with time as a within-subjects factor and condition as a between-subjects factor showed that beliefs about smoking were more negative at Wave 2 compared to Wave 1, irrespective of condition. However, attitudes towards smoking were more positive at Wave 3 compared to Wave 1 when participants had read the narrative version.

Conclusion: These results show that narrative smoking education is not more effective than informational smoking education for low-educated adolescents and can even have an unintended effect for this target group by making attitudes towards smoking more positive.     

Personality traits and body mass index: Modifiers and mechanisms

Objective: To identify how demographic factors (sex, age, ethnicity) modify the association between personality traits and body mass index (BMI) and to test the extent that diet and physical activity account for the personality-BMI relations.

Design: Cross-sectional study with a diverse sample (N = 5150, 50% female, 19% African American, 15% Hispanic). Participants completed a measure of the five major dimensions of personality and reported on their physical activity, diet and food intake behaviour, and height and weight.

Main Outcome Measures: BMI and obesity (BMI ≥ 30).

Results: High Neuroticism was associated with higher BMI and risk for obesity, whereas Conscientiousness and, to a lesser extent, Extraversion and Openness were protective. These associations were generally stronger among women and older participants; there was less evidence for ethnicity as a moderator. Personality had similar relations with the behavioural factors, and physical activity, diet and regular meal rhythms accounted for approximately 50% of the association between Neuroticism and Conscientiousness and BMI.

Conclusion: This study supports the links between personality traits and BMI and suggests that physical activity, more than diet, is a key factor in these associations.