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.     

Sex,germs, and health: pathogen-avoidance motives and health-protective behaviour

Objective: Recent work suggests that the psychology of pathogen-avoidance has wide-reaching effects on how people interact with the world. These processes – part of what has been referred to as the behavioural immune system – are, in a way, our ‘evolved’ health psychology. However, scholars have scarcely investigated how the behavioural immune system relates to health-protective behaviours. The current research attempts to fill this gap.

Design: Across two cross-sectional studies (N = 386 and 470, respectively), we examined the relationship between pathogen-avoidance motives and health-protective behaviour.

Outcome Measures: The studies used self-reported measures of attitude and intention as indicators of health-protective behaviour.

Results: Data collected in Study 1 revealed that pathogen-avoidance motivation related to participants’ attitude and intention towards sexually transmitted infections screening. High levels of pathogen-avoidance motivation were also related to having had fewer sexual partners, which partially mediated the effect of pathogen-avoidance variables on testing motivation. Study 2 extended these findings by showing moderate associations between pathogen-avoidance motivation and a broad range of health-protective behaviours, including but not limited to pathogen-related health concerns.

Conclusion: We argue that understanding and targeting pathogen-avoidance psychology can add novel and important understanding of health-protective behaviour.     

Social cognition models and health behaviour: A structured review

Abstract

A number of social cognition models have been developed to account for socio-demographic variations in health behaviour. This paper distinguishes between: (a) motivational, (b) behavioural enaction, and (c) multi-stage models of health behaviour. The models are evaluated in terms of advancement of existing knowledge and - where appropriate - predictive utility. Common themes that appear within- and between- these categories are discussed, with consideration of ways in which theory may be advanced by future research. Each approach has associated strengths and weaknesses, suggesting that a “consensus” approach to the study of health behaviour may prove fruitful. Identification of the key constructs across different model types would allow coherent integration and promote further understanding of the psycho-social determinants of health behaviour.     

Constructs to describe individual knowledge / Constructos para describir el conocimiento individual

Abstract

The basic unit of any cognitive model that attempts to describe individual knowledge and its manifestations must be chosen carefully, as the resulting position on learning, teaching and, in general, of the psychological research subject depends largely on this choice. The objective is to assess and contrast two constructs of enormous significance in cognitive psychology that have been used as cognitive units under different theoretical contexts: the concept in its classical sense, and the scheme in its organismic version. Arguments are presented to show that the latter is more consistent with constructivist assumptions and is more respectful of psychological data such as the Gestalt and prototype effects or the existence of procedural and implicit knowledge.     

Psychological intervention with couples coping with breast cancer: A systematic review

Objective: Information about psychological intervention with couples coping with breast cancer is not well-disseminated. This can be explained, at least in part, by the absence of knowledge about the efficacy of this kind of intervention. The aim of the present systematic review is to identify and describe psychological interventions for couples coping with breast cancer and evaluate their efficacy.

Design: Studies identified by a searching multiple literature databases related to health and psychology between 1975 and 2013. Rigorous inclusion and exclusion criteria were utilised.

Results: Of 129 abstracts, 13 were extracted for further analysis and a final ten studies were deemed eligible for inclusion. Data were extracted from each study regarding study sample characteristics, design, results and methodological limitations. The results obtained were mixed in regard to efficacy, although the overwhelming majority of studies (eight studies) found benefits for both women and their partners in some dimensions, such as quality of life, psychological distress, relationship functioning and physical symptoms associated with cancer.

Conclusion: Psychological interventions for couples coping with breast cancer appear to be effective for both women and their partners. However, further studies are needed to evaluate the efficacy of couple-based interventions and, to identify for whom and how they are more effective.     

Feeling bad about progress does not lead people want to change their health behaviour

Objective: When do people decide to do something about problematic health behaviours? Theoretical models and pragmatic considerations suggest that people should take action when they feel bad about their progress – in other words, when they experience negative progress-related affect. However, the impact of progress-related affect on goal striving has rarely been investigated.

Design and Methods: Study 1 (N = 744) adopted a cross-sectional design and examined the extent to which measures of progress-related affect were correlated with intentions to take action. Study 2 (N = 409) investigated the impact of manipulating progress-related affect on intentions and behaviour in an experimental design.

Results: Study 1 found that, while engaging in health behaviours had the expected affective consequences (e.g. people felt bad when they were not eating healthily, exercising regularly or limiting their alcohol consumption), it was feeling good rather than bad about progress that was associated with stronger intentions. Study 2 replicated these findings. Participants induced to feel good about their eating behaviour had marginally stronger intentions to eat healthily than participants led to feel bad about their eating behaviour.

Conclusion: The findings have implications for interventions designed to promote changes in health behaviour, as well as theoretical frameworks for understanding self-regulation.     

Using doctor-patient communication to affect patients' lifestyles. theoretical and practical implications

Abstract

Physicians very often do not perceive themselves as being efficient in affecting patients' life style. The aim of this article is to elucidate theoretical constructs and models in health education and their practical implications for individual health counselling in daily work as a guidance for physicians. The current most commonly used strategies are giving information and exhorting people, which have a limited ability to change peoples' behaviour. Derived from current behavioural constructs and models in health education - such as the health belief model, social learning theory, health beliefs, self-efficacy, self-determination theory - principles for successful strategies are described: to use patient-centredness instead of directing, to encourage patients to reflect and decide on their behavior, to find out the patient's readiness to change, to present knowledge as neutral facts instead of valuations, to focus on the actual behaviour instead of information-giving, to highlight patients' health beliefs and to discuss the advantages and disadvantages which the patients experience with their life style. The article concludes with a comprehensive model for individual health counselling in consecutive steps.     

Emotions–Adaptive Standards And/Or Primitive Constructs: A Reply to Mascolo and Mancuso

Abstract

In replying to Mascolo & Mancuso's paper, I have contrasted their functionalist approach to emotional states and experience with my position on emotions as epigenetically-available primitive constructs. Biologically, Mascolo & Mancuso treat emotions as mobilizaiton in the face of discrepancies. My proposal of a four-dimensional model provides a biological grounding for the marvellous diverisyt of human emotional experience. Where Mascolo & Mancuso treat emotions as discrete entities and highlight emotion knowledge, J have suggested emotions operate as bipolar constructs, and I have highlighted experience. We should attend to emotions in terms of both knowledge and experience, but it is important to maintain the distinction     

‘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.     

Understanding behavioural clusters: Identifying differences between clusters of health behaviours on key constructs

Objective: To uncover the rationale underlying the perceived distinction between clusters of health behaviours by identifying cognitive constructs that differentiate among them, and creating a ‘cognitive profile’ for each behavioural cluster. Thus, different determinants and characteristics of health behaviours (e.g. ‘perceived behavioural control’, ‘impact on health’, ‘effort’, ‘non-health rewards’, ‘habit’) were used to compare health behaviour meta-clusters (physical and psychosocial) and clusters (e.g. nutrition behaviours, substance abuse, medical practices).

Methods: A sample of lay people (N = 1956) judged items representing behavioural clusters delineated in the Health Behaviour Taxonomy on 14 constructs.

Results: Significant differences emerged between the physical and psychosocial meta-clusters, as well as among their sub-clusters. For example, physical behaviours were higher on ‘perceived behavioural control’ and ‘impact on health’ compared to psychosocial behaviours, and nutrition was perceived highest on ‘effort’ and ‘non-health rewards’ compared to the other clusters of the physical meta-cluster.

Conclusion: The findings increase our understanding of the logic underlying lay people’s cognitive schema of health behaviour clusters. ‘Cognitive profiles’ that explain differences between the clusters were identified, which can be used to design health messages and interventions targeting multiple health behaviours.     

Panning for the gold in health research: Incorporating studies’ methodological quality in meta-analysis

Background: Systematic reviews now routinely assess methodological quality to gauge the validity of the included studies and of the synthesis as a whole. Although trends from higher quality studies should be clearer, it is uncertain how often meta-analyses incorporate methodological quality in models of study results either as predictors, or, more interestingly, in interactions with theoretical moderators.

Objective and methods: We survey 200 meta-analyses in three health promotion domains to examine when and how meta-analyses incorporate methodological quality.

Results: Although methodological quality assessments commonly appear in contemporary meta-analyses (usually as scales), they are rarely incorporated in analyses, and still more rarely analysed in interaction with theoretical determinants of the success of health promotions. The few meta-analyses (2.5%) that did include such an interaction analysis showed that moderator results remained significant in higher quality studies or were present only among higher quality studies. We describe how to model quality interactively with theoretically derived moderators and discuss strengths and weaknesses of this approach and in relation to current meta-analytic practice.

Conclusions: In large literatures exhibiting heterogeneous effects, meta-analyses can incorporate methodological quality and generate conclusions that enable greater confidence not only about the substantive phenomenon but also about the role that methodological quality itself plays.     

Self-regulation and protective health behaviour: How regulatory focus and anticipated regret are related to vaccination decisions

Objective: We examined how individual motivational orientations and anticipated regret are related to the protective health decision of vaccination behaviour.

Design: The proposed relations were examined in a large-scale sample (N = 3168) and three medium-sized samples (N = 151, N = 194, N = 208). Questionnaires were applied to assess regulatory focus, anticipated regret and vaccination behaviour.

Results: Increased prevention-focused self-regulation – which is represented by concerns about security-related goals, responsibilities and obligations – was related to a greater likelihood of vaccination. Prevention-focused individuals’ higher likelihood of getting vaccinated seems at least in part to be a consequence of anticipated regret for not vaccinating. Study 3 suggests that regulatory focus is less related to vaccination decisions when regret is increased by the decision-making context; that is, when information highlighting vaccination effectiveness and a low likelihood of adverse responses is provided.

Conclusion: Prevention-focused self-regulation is related to a greater likelihood of engaging in health-protective behaviour. This can be explained by prevention-focused individuals’ greater tendency to anticipate regret about getting ill as a consequence of not adopting protective measures. If people perceive a protective measure such as a vaccination as highly effective, anticipated regret for not adopting it is generally increased, and individual differences in regulatory focus no longer predict the decision.     

The role of risk perception in explaining parental sunscreen use

Objective: This study assessed: (1) whether risk perceptions about skin cancer were related to parent's use of sunscreen on their children; (2) which combination of assessments susceptibility and severity best explain parental sunscreen protection behaviours and (3) whether risk perceptions influence behaviour directly through intentions or through attitudes, subjective norms and self-efficacy.

Design: Two longitudinal studies assessed sunscreen protection behaviours of parents for their toddlers (N?=?391) and young children (N?=?436).

Main outcome measure: Parent's use of sunscreen on their children.

Results: Risk perceptions correlated with future sunscreen protection behaviours of parents but were lower than those of attitude, social influence and self-efficacy. Treating susceptibility and severity as an additive function resulted in the best model fit. Risk perceptions were related with future intention and future sunscreen protection behaviour, but the effects were mediated through attitude, social influence and self-efficacy.

Conclusions: Our path analyses suggest treating susceptibility and severity as an additive function. A multiplicative model without main effects – although often used – had the poorest fit. Risk perceptions influence behaviour by influencing attitudinal and self-efficacy beliefs. Addressing risk perceptions in health communication programs is relevant when the purpose is to increase awareness and to influence attitudes and self-efficacy.     

Positive psychology,the classification of character strengths and virtues,and issues of measurement

ABSTRACT

This essay raises concerns about positive psychology’s classification of character strengths and virtues and issues of measurement. Part I examines the process whereby the classification was compiled. Part II turns to issues of measurement and questions about positive psychologists’ sensitivity to variations in the meanings of the constructs they purport to measure, both within and across cultures. I argue that attempts to find a ‘deep structure’ of the character strengths and virtues should proceed hand in hand with efforts to render positive psychology and its measurement tools more sensitive to variability in character strengths and virtues across and within cultures. The essay concludes with suggestions for future research.     

The relationship between dietary restraint and deficits in reasoning about causes of obesity

Abstract

Objective: Increased levels of dietary restraint are associated with deficits on many cognitive tasks. Less is known about how individual differences in restraint influences complex cognition such as reasoning which is the focus of this research.

Design: Two experimental studies are reported. In study 1, participants (n?=?158) completed a causal conditional reasoning task with statements about weight-related and general causal relationships. Study 2 replicated and extended study 1. Participants (n?=?108) completed a causal conditional reasoning task focusing on behavioural causes of weight change or general statements.

Main outcome measure: Causal conditional reasoning task performance.

Results: In study 1, levels of dietary restraint were negatively associated with reasoning abilities for weight-related statements only. Study 2 replicated the negative association between dietary restraint and reasoning finding the effect in both weight-related, and general, causal judgements.

Conclusion: The novel findings show that individual differences in dietary restraint have a wider relationship with cognition than previously demonstrated. Results tentatively support theoretical explanations of a reduction in cognitive capacity, rather than differences in belief, explaining reasoning deficits. These findings open an interesting avenue for research and might have implications for effective decision making about personal health behaviours, such as food choice.     

Why does asking questions change health behaviours? The mediating role of attitude accessibility

Objective: The question-behaviour effect (QBE) refers to the finding that measuring behavioural intentions increases performance of the relevant behaviour. This effect has been used to change health behaviours. The present research asks why the QBE occurs and evaluates one possible mediator – attitude accessibility.

Design: University staff and students (N = 151) were randomly assigned to an intention measurement condition where they reported their intentions to eat healthy foods, or to one of two control conditions.

Main outcome measures: Participants completed a response latency measure of attitude accessibility, before healthy eating behaviour was assessed unobtrusively using an objective measure of snacking.

Results: Intention measurement participants exhibited more accessible attitudes towards healthy foods, and were more likely to choose a healthy snack, relative to control participants. Furthermore, attitude accessibility mediated the relationship between intention measurement and behaviour.

Conclusion: This research demonstrates that increased attitude accessibility may explain the QBE, extending the findings of previous research to the domain of health behaviour.     

Self-efficacy versus perceived enjoyment as predictors of physical activity behaviour

Objective: Self-efficacy and physical activity (PA) enjoyment are related to PA behaviour, but it is unclear which is more important and how they interrelate. The purpose of this study was to examine how these two constructs interrelate to influence PA behaviour.

Design: Participants were low-active adults (n = 448) participating in a RCT examining the effect of a PA promotion intervention. Participants completed physical activity, enjoyment and self-efficacy measures at baseline, six and 12 months.

Results: Self-efficacy and enjoyment at both baseline and six months predicted PA at 12 months. However, enjoyment was a stronger predictor than self-efficacy, in that self-efficacy no longer predicted PA behaviour when included alongside enjoyment. In follow-up mediation analyses, enjoyment at six months did not mediate the effect of baseline self-efficacy on 12-month PA; however, six-month self-efficacy mediated the effect of baseline enjoyment on 12-month PA.

Conclusion: Our results indicate that interventions should perhaps initially focus on increasing enjoyment of physical activity. Greater PA enjoyment appears to influence individuals’ self-reported ability to engage in regular PA (i.e. higher self-efficacy ratings). Additional research is needed to better understand the interrelationships between self-efficacy and enjoyment and how these constructs affect PA.     

Emotional processes in risky and multiattribute health decisions

Objective: Here, we develop an integrative account of the roles of emotion in decision-making. In Part I, we illustrate how emotional inputs into decisions may rely on physiological signals from emotions experienced while making the decision, and we review evidence suggesting that the failure to represent the emotional meaning of options can often reduce decision quality. We propose that health-related decrements in the ability to generate emotional reactions lead people to inaccurately represent emotional responses and compromise decisions, particularly about risk. Part II explores complex decisions in which choice options involve trade-offs between positive and negative attributes. We first review evidence showing that difficult trade-off decisions generate negative affect and physiological arousal. Next, we propose that medical decision-making will be linked to short- and long-term stress and health outcomes.

Conclusion: In sum, this article proposes and reviews initial evidence supporting the effective use and management of emotional inputs as important to both clinical and non-clinical populations. Our approach will contribute to the understanding of patient-centred emotional decision-making and will inform medical decision aids.     

New nonlinear and dynamic avenues for the study of work and organizational psychology: an introduction to the special issue

ABSTRACT

Nonlinear and dynamic approaches are two main principles of complex systems. The work and organizational psychology field has recently applied these concepts to understand human behaviour at work. In this introductory paper, we describe how human behaviour at work can be understood from a nonlinear and dynamic perspective, developing and applying the advantages of this approach to continue moving beyond the frontiers of our knowledge. We focus on the theoretical, methodological, and epistemological implications of the nonlinear dynamic approach in the field. Then, we present the five papers included in this special issue. These papers have applied nonlinear and dynamic concepts to understand a wide range of phenomena: subordinates-supervisors relationships, team behaviour, deviant workplace behaviour, transformational leadership, and training transfer. Overall, these papers demonstrate the utility of nonlinear dynamics in our field and how we can create more time-sensitive and complex knowledge by paying special attention to when and how phenomena happen and how such phenomena interrelate over time.