Multiple outcome measures and mixed methods for evaluating the effectiveness of theory-based behaviour-change interventions: a case study targeting health professionals' adoption of a national suicide prevention guideline

Interest in behaviour-change interventions targeting health professionals' adoption of clinical guidelines is growing. Recommendations have been made for interventions to have a theoretical base, explore the local context and to use mixed and multiple methods of evaluation to establish intervention effectiveness. This article presents a case study of a behaviour-change intervention delivered to community mental health professionals in one Primary Care Trust, aimed at raising adherence to a national suicide prevention guideline. A discussion of how the theory-base was selected, the local context explored, and how the intervention was developed and delivered is provided. Time series analysis, mediational analysis and qualitative process evaluation were used to evaluate and explore intervention effectiveness. The time series analysis revealed that the intervention was not effective at increasing adherence to the guideline. The mediational analysis indicates that the intervention failed to successfully target the key barrier to adoption of the guidance, and the qualitative process evaluation identified certain intervention components that were well received by the health professionals, and also identified weaknesses in the delivery of the intervention. It is recommended that future research should seek to further develop the evidence-base for linking specific intervention strategies to specific behavioural barriers, explore the potential of theories that take into account broader social and organisational factors that influence health professionals' practice and focus on the process of data synthesis for identifying key factors to target with tailored interventions. Multiple and mixed evaluation techniques are recommended not only to explore whether an intervention is effective or not but also why it is effective or not.     

Obesity, cardiovascular fitness, and physically active adolescents’ motivations for activity: A self-determination theory approach

Objectives

Overweight and obesity pose significant health problems for adolescents. Rates of overweight and obesity in children have increased 45% in the last decade and have increased three-fold since 1980. Because children who are physically active are at lower risk for the development of obesity, it is important to understand some of the factors that influence children’s physical activity patterns. The purpose of this study was to examine the relationship between motivation, cardiorespiratory fitness, and weight status, defined as obese or non-obese. We predicted that the association between motivation and weight status would become non-significant when controlling for cardiorespiratory fitness.

Design

The study employed a correlational, cross-sectional design.

Method

Participants included physically active middle school students (N = 82. 51% female) of aged 12–14 years, who participated in the Teen Eating and Activity Mentoring in Schools (TEAMS) study aimed at improving health and preventing obesity among middle school students. Students completed attitudinal questionnaires about physical activity and self-determination on a computer-based system and participated in a number of fitness performance, health behavior, and anthropometric assessments.

Results

Non-obese adolescents showed higher intrinsic motivation scores than obese adolescents. Mediational analyses showed that cardiorespiratory fitness mediated the relationship between motivation and weight status.

Conclusions

The results of this study demonstrate differences in physical activity motivation as a function of adolescent weight status, but only for intrinsic motivation. As predicted, adolescents who were intrinsically motivated for physical activity were more fit and thereby less likely to be obese. The findings are consistent with self-determination theory.     

Place your bets: psychophysiological correlates of decision-making under risk

Emotions and their psychophysiological correlates are thought to play an important role in decision-making under risk. We used a novel gambling task to measure psychophysiological responses during selection of explicitly presented risky options and feedback processing. Active-choice trials, in which the participant had to select the size of bet, were compared to fixed-bet, no-choice trials. We further tested how the chances of winning and bet size affected choice behavior and psychophysiological arousal. Individual differences in impulsive and risk-taking traits were assessed. The behavioral results showed sensitivity to the choice requirement and to the chances of winning: Participants were faster to make a response on no-choice trials and when the chances of winning were high. In active-choice trials, electrodermal activity (EDA) increased with bet size during both selection and processing of losses. Cardiac responses were sensitive to choice uncertainty: Stronger selection-related heart rate (HR) decelerations were observed in trials with lower chances of winning, particularly on active-choice trials. Finally, betting behavior and psychophysiological responsiveness were moderately correlated with self-reported impulsivity-related traits. In conclusion, we demonstrate that psychophysiological arousal covaries with risk-sensitive decision-making outside of a learning context. Our results further highlight the differential sensitivities of EDA and HR to psychological features of the decision scenario.     

Malleability in communal goals and beliefs influences attraction to stem careers: evidence for a goal congruity perspective

The goal congruity perspective posits that 2 distinct social cognitions predict attraction to science, technology, engineering, or mathematics (STEM) fields. First, individuals may particularly value communal goals (e.g., working with or helping others), due to either chronic individual differences or the salience of these goals in particular contexts. Second, individuals hold beliefs about the activities that facilitate or impede these goals, or goal affordance stereotypes. Women's tendency to endorse communal goals more highly than do men, along with consensual stereotypes that STEM careers impede communal goals, intersect to produce disinterest in STEM careers. We provide evidence for the foundational predictions that gender differences emerge primarily on communal rather than agentic goals (Studies 1a and 3) and that goal affordance stereotypes reflect beliefs that STEM careers are relatively dissociated from communal goals (Studies 1b and 1c). Most critically, we provide causal evidence that activated communal goals decrease interest in STEM fields (Study 2) and that the potential for a STEM career to afford communal goals elicits greater positivity (Study 3). These studies thus provide a novel demonstration that understanding communal goals and goal affordance stereotypes can lend insight into attitudes toward STEM pursuits.     

Time to task failure of trunk extensor muscles differs with load type

Time to task failure of trunk extensor muscles during seated submaximal isometric exertions was assessed in 18 healthy participants using 2 different load types. One required supporting an inertial load (position-matching task) whereas the 2nd required maintaining an equivalent torque against a rigid restraint (force-matching task). Time to task failure was significantly longer for position-matching tasks compared to the force-matching tasks. This finding is opposite to that reported for the appendicular muscles. A subset of 4 individuals completed a 2nd experiment to test the time to task failure of the elbow flexors in the position- and force-matching tasks. Time to task failure of the elbow flexors was significantly longer for the force-matching tasks compared to position matching. Thus, the same population shows that the effects of load type on time to task failure are opposite for the appendicular and axial muscles. This could be an important issue in understanding the mechanisms of task failure, and the endurance capacity of the trunk extensor muscles.     

Sociosexual orientation, commitment, and infidelity: a mediation analysis

Individuals with an unrestricted sociosexual orientation (SO) are less committed to their romantic relationships and more likely to engage in infidelity. Furthermore, commitment is negatively associated with tendencies to cheat. However, no previous research has examined the possible mediating role of commitment in the relationship between SO and infidelity. The current study examined whether commitment mediated the relationship between SO and willingness to engage in three types of cheating behaviors (Ambiguous, Deceptive, and Explicit). Results suggested that commitment partially mediated the relationship between SO and infidelity, such that unrestricted individuals had lower commitment, which in turn led to a greater likelihood of cheating. Implications of this association and directions for future research are discussed.     

The gray area: exploring attitudes toward infidelity and the development of the Perceptions of Dating Infidelity Scale

Prior research has distinguished between emotional versus sexual infidelity. Two studies examined the development of the Perceptions of Dating Infidelity Scale (PDIS) to assess attitudes toward specific behaviors that constitute these types of infidelity in romantic relationships. Exploratory and confirmatory factor analyses indicated three factors to the scale: Ambiguous, Deceptive, and Explicit behaviors. In both studies, there were gender differences on ratings of the behaviors. The construct validity of the scale was assessed with measures of sociosexual orientation, guilt, and coping with unwanted sexual situations. It was found that the Ambiguous behaviors were positively correlated with avoidance of unwanted sexual situations, while the Deceptive and Explicit scales were positively correlated with guilt and avoidance and negatively associated with an unrestricted sociosexual orientation and acting on attractions toward friends.     

Adult age and gender differences in perceptions of facial attractiveness: beauty is in the eye of the older beholder

The authors examined ratings of facial attractiveness, rankings of faces and reasons given by young, middle-aged, and older men and women for young, middle-aged, and older male and female face attractiveness. No support for predictions derived from similarity, interest, and cohort hypotheses was obtained. In support of the expertise hypothesis, young and middle-aged adults rated younger faces as more attractive than old faces, whereas older adults rated all aged faces equally. In support of the crone hypothesis, older female faces were rated the lowest of all faces. Theoretical implications and real-world applications are discussed.     

Diagnostic efficiency of several methods of identifying socially rejected children and effect of participation rate on classification accuracy

Social rejection is associated with a wide variety of negative outcomes. Early identification of social rejection and intervention to minimize its negative impact is thus important. However, sociometric methods, which are considered high in validity for identifying socially rejected children, are frequently not used because of (a) procedural challenges, (b) community apprehension, and (c) sensitivity to missing data. In a sample of 316 students in grades K through 8, we used receiver operating characteristics (ROC) analyses to compare the diagnostic efficiency of several methods for identifying socially rejected children. When not using least-liked nominations, (a) most-liked nominations yielded the greatest diagnostic efficiency (AUC = .96), (b) peer ratings were more efficient (AUC = .84 to .99) than teacher ratings (AUC = .74 to .81), and (c) teacher report of social status was more efficient (AUC = .81) than scores from teacher behavior rating scales (AUC = .74 to .75). We also examined the effects of nominator non-participation on diagnostic efficiency. At participation as low as 50%, classification of sociometric rejection (i.e., being rejected or not rejected) was quite accurate (κ = .63 to .77). In contrast, at participation as high as 70%, classification of sociometric status (i.e., popular, average, unclassified, neglected, controversial, or rejected) was significantly less accurate (κ = .50 to .59).