Situation Taxonomy and Behavioral Diagnosis Using Prospective Self-Monitoring Data: Application to Dietary Adherence in Patients with Type 1 Diabetes

The goals of this study were to create a taxonomy of problem situations for diet adherence in persons with insulin-dependent diabetes mellitus (Type 1 diabetes) and a behavioral diagnosis by grouping patients together who have similar adherence problems. In study one, 29 patients with Type 1 diabetes kept food diaries for 4 weeks. Adherence was assessed using eight behavioral measures: (1) compliance with a meal plan, (2) energy intake, (3) protein, (4) carbohydrates, (5) fat, (6) self-reported overeating, (7) self-reported undereating, and (8) ratings of impulsive eating. The occurrence of each behavior was quantified in a wide range of situational contexts including meal, social context, physical location, and mood. Cluster analysis of behaviors, situations, and behaviors-in-situations was used to create a hierarchical classification model consisting of five major categories of adherence problems: (1) compliance with meal plan, (2) undereating, (3) overeating, (4) impulsive eating, and (5) lifestyle differences. Within each category, situations were associated with everyday eating habits and special circumstances such as social events, and meals in restaurants. Grouping patients based on the similarity of their adherence problems resulted in five diagnostic groups: (1) emotional binge eaters, (2) restrained eaters, (3) unrestrained eaters, (4) undereaters, and (5) cyclical diet bingers. In study two, 28 subjects kept diaries during an intervention program designed to enhance dietary adherence. Study two results were similar to study one. Situation taxonomy and behavioral diagnosis are potentially useful ways to understand the intervention needs of those attempting maintaining dietary behavior changes.     

EFFECTS OF CALORIC LEVEL ON RUMINATING

A series of recent studies has shown that a number of dietary variables affect ruminative behavior in institutionalized retarded persons. This experiment extends an earlier study that examined the influence of the caloric level of the diet on the frequency of ruminating. Subjects consumed regular portions of food that varied between phases from normal to high caloric levels. The data show a clear but modest inverse relation between the caloric value of the diet and the rates of postmeal ruminating.     

Loneliness,eating, and body mass index in parent–adolescent dyads from the Family Life,Activity, Sun,Health, and Eating study

Loneliness is a salient risk factor for obesity, emotional eating, and poor diet. Because adolescents and parents are embedded within a family unit, their experiences of loneliness may be associated with both their own and one another's behaviors. To examine the extent to which parent and child loneliness predict body mass index (BMI) and eating in parents and adolescents, an actor–partner interdependence model of loneliness, eating, and BMI in adolescent–parent dyads was analyzed. There were actor effects among adolescents such that greater loneliness was positively associated with emotional eating and BMI‐z, and there was an actor effect among parents such that higher loneliness was positively related to emotional eating. There was a partner effect among adolescents such that greater parental loneliness was positively associated with adolescent emotional eating, and there was a partner effect among parents such that higher adolescent loneliness was positively associated with parental emotional eating. There were several actor–partner effects for loneliness and junk food in dyads with boys. Findings highlight the importance of dyadic models of loneliness in adolescent–parent dyads.     

Jolly fat rats? The effects of diet-induced obesity on territorial fighting

In experiment 1, pairs of young male rats became obese on a palatable and complex diet high in fat, sucrose, and protein. The obese pairs exhibited greater within-group weight variability and, when tested as adults, were significantly more aggressive toward an unfamiliar conspecific than chow-fed controls. The increased aggressivity of obese males was not due to the relatively larger resident-intruder weight disparities in these pairs, since weight-matched pairs of unfamiliar animals were as aggressive toward each other as pairs not matched in body weight (experiment 2). The complex and calorically dense diet may have accelerated the development of the experimental animals, producing subjects whose aggressivity was comparable to that of much older animals.     

A Randomized Controlled Pilot Study of Motivational Interviewing to Change Attitudes about Adherence to Medications for Asthma

The day-to-day management of asthma relies on patient self-care practices; in particular, adherent use of asthma medications is fundamental for asthma management. However, most persons with asthma do not use their medications to clinically acceptable standards. The purpose of this study was to test the efficacy of a brief educational intervention to enhance knowledge and skills relevant to asthma self-care, and the efficacy of motivational interviewing to improve attitudes toward taking medications as prescribed. Twenty-five adults with asthma were randomly assigned to receive a brief educational intervention alone, or education plus motivational interviewing. Over time, all participants improved their knowledge of asthma and skills using a metered dose inhaler. Participants who received education alone showed a decreased level of readiness to adhere with their medications over time, whereas participants who received motivational interviewing were more likely to show a stable or increased level of readiness to adhere over time. Among participants who described themselves as not consistently adhering with their medications at the first evaluation, those who received motivational interviewing endorsed more positive attitudes toward taking medications over time. The results are supportive of the utility of motivational interviewing in enhancing participants' attitudes toward adherent medication use. Future research should test if attitude change is reflected in change in medication use.     

A stress and coping perspective on health behaviors: theoretical and methodological considerations

Health behaviors such as eating and exercising have been linked to stress in many studies, and researchers suggest that these links are in large part due to the use of health behaviors to cope with stress. However, health behaviors in the context of coping have received relatively little research attention. In this paper, we briefly survey the literature linking stress, coping, and health behaviors, noting that very little research has explicitly examined health behaviors as coping with stress. We address critical theoretical and methodological issues that arise in applying a stress and coping perspective to health behaviors. We conclude with potential directions for interventions, including the need for conceptually solid and methodologically rigorous research and the development of new measures, and with suggestions for future research. The concepts of self-regulation and stress management and their implications in health behavior research and interventions are also discussed.     

Regulatory focus and adherence to self-care behaviors among adults with type 2 diabetes

The aims of this study were, first, to test the association between regulatory focus of adults with type 2 diabetes and their adherence to two types of self-care behaviors – lifestyle change (e.g. physical activity and diet) and medical care regimens (blood-glucose monitoring, foot care and medication usage). Second, to explore whether a fit between the message framing and patients’ regulatory focus would improve their intentions to adhere specifically when the type of behavior fits the patients’ regulatory focus as well. A cross-sectional study was conducted among 130 adults with type 2 diabetes who were hospitalized in an academic medical center. The patients completed a set of questionnaires that included their diabetes self-care activities, regulatory focus, self-esteem and demographic, socioeconomic and clinical data. In addition, participants were exposed to either a gain-framed or a loss-framed message, and were then asked to indicate their intention to improve adherence to self-care behaviors. A multivariable linear regression model revealed that promoters reported higher adherence to lifestyle change behaviors than preventers did (B = .60, p = .028). However, no effect of regulatory focus on adherence to medical care regimens was found (B = .46, p = .114). In addition, preventers reported higher intentions to adhere to medical care behaviors when the message framing was congruent with prevention focus (B = 1.16, p = .023). However, promoters did not report higher intentions to adhere to lifestyle behaviors when the message framing was congruent with promotion focus (B = ?.16, p = .765). These findings justify the need to develop tailor-made interventions that are adjusted to both patients’ regulatory focus and type of health behavior.     

Végétarisme,végétalisme,véganisme : des comportements (alimentaires) au service de l’identité ? Une étude qualitative en population française

IntroductionThese last years have been marked by an evolution as to how people feed themselves, highlighting a growing interest for vegetarian food. Vegetarianism at large refers to several types of food that are characterized by the partial or total exclusion of animal foods. This study aims at relating various elements associated to vegetarianism, such as eating motives, behaviors, self-perception and others’ perception, in relation with the notion of identity.MethodParticipants were recruited via vegetarian and vegan (for food and for lifestyle) groups on Facebook, once their agreement was obtained. Six interviews were conducted by a clinical psychologist around the notion of being and identity related to food, as well as the food history of the individual and his/her family. The use of retrospective investigation makes possible to establish a continuity between the past and the current eating behavior. These interviews, once manually transcribed, were the subject of a complex semantic analysis via TROPES software (version 8.4).ResultsThe results showed a major use of state's and identity's verbs (being, becoming, “I”) and the personal pronoun “we”, referring to a construction of both individual and collective identity around the diet. The commitment to vegetarian/vegan diet has been primarily motivated by ethical concern. And, positive feelings have emerged following the adoption of this type of diet, such as pride, inner purity and a sense of being healthy and holy. Despite the fact that their diet is ethically focused, participants spontaneously addressed the issue of weight and body image.Discussion/conclusionWhatever the food's history of participants, identifications to disorders related to body image or identifications to weight categories have preceded the identification to a specific diet. And the following of a vegetarian/vegan diet appears at the base of positive feelings toward oneself and a better self-esteem. So, we can assume that adopting a vegetarian/vegan diet could improve self-perception. Otherwise, the ethical choice mentioned by the participants, may be an acceptable sociable justification to control more or less the fate of their body (inside and outside). More research is needed to better understand the underlying mechanisms of vegetarian/vegan diet, to explore the personality profiles of individuals and their relation to the body.     

The common sense of counseling psychology: introducing the Common-Sense Model of self-regulation

Abstract

The goal of therapy is typically to improve clients’ self-management of their problems, not only during the course of therapy but also after therapy ends. Although it seems obvious that therapists are interested in improving clients’ self-management, the psychotherapy literature has little to say on the topic. This article introduces Leventhal’s Common-Sense Model of Self-Regulation, a theoretical model of the self-management of health, and applies the model to the therapeutic process. The Common-Sense Model proposes that people develop illness representations of health threats and these illness representations guide self-management. The model has primarily been used to understand how people self-manage physical health problems, we suggest it may also be useful to understand self-management of mental health problems. The Common-Sense Model’s strengths-based perspective is a natural fit for the work of counseling psychologists. The model has important practical implications for addressing how clients understand mental health problems over the course of treatment and self-manage these problems during and after treatment.     

Multiple illness perceptions in older adults: Effects on physical functioning and medication adherence

Objective: Previous research on illness perceptions has focused on single illnesses, but most adults over 65 suffer from multiple illnesses (multimorbidity). This study tests three competing operationalisations of multiple illness perceptions in predicting physical functioning and adherence: (1) main effects and interactions model; (2) peak model with effects of the most prominent illness perception; and (3) combined model with averaged illness perceptions over multiple illnesses.

Design: Longitudinal study in N?=?215 individuals (65–86?years) with multimorbidity at two measurement points over six months. Participants filled in two Brief Illness Perception Questionnaires (B-IPQ) on their two most severe illnesses.

Main outcome measures: Physical functioning, medication adherence.

Results: Factor analyses suggest that the B-IPQ contains three dimensions; consequences, control and timeline. Multiple regression models fit the data best for (1) and (3). Timeline (β?=??.18) and control (β?=?.21) predict adherence in (1); consequences (β?=?.16) and control (β?=?.20) in (3). Physical functioning was significantly predicted by interacting control beliefs in (1; β?=?.13), by peak consequences in (2; β?=??.14) and by consequences (β?=??.15) in (3).

Conclusions: Individuals with multimorbidity hold both distinct and combined perceptions about their illnesses. To understand individual responses to multimorbidity, perceptions about all illnesses and multimorbidity as entity should be examined.