Examining direct and indirect pathways to health behaviour: The influence of cognitive and affective probability beliefs

This study aimed to extricate the influence of rational (e.g. ‘I think …’) and intuitive (e.g. ‘I feel …’) probability beliefs in the behavioural decision-making process regarding skin cancer prevention practices. Structural equation modelling was used in two longitudinal surveys (sun protection during winter sports [N?=?491]; sun protection during summer [N?=?277]) to examine direct and indirect behavioural effects of affective and cognitive likelihood (i.e. unmediated or mediated by intention), controlled for attitude, social influence and self-efficacy. Affective likelihood was directly related to sun protection in both studies, whereas no direct effects were found for cognitive likelihood. After accounting for past sun protective behaviour, affective likelihood was only directly related to sun protection in Study 1. No support was found for the indirect effects of affective and cognitive likelihood through intention. The findings underscore the importance of feelings of (cancer) risk in the decision-making process and should be acknowledged by health behaviour theories and risk communication practices. Suggestions for future research are discussed.     

The job demand-control(-support) model and physical health outcomes: A review of the strain and buffer hypotheses

Abstract

This review of the Job Demand-Control (JDC) model and the expanded Job Demand-Control-Support (JDCS) model and employees' physical health, focuses on the two prevalent views on these models. According to their view on the models researchers study different hypotheses: (a) the (iso)strain hypothesis, stating that the highest level of ill health is expected when the job is characterized by high demand and low control (and low social sup port), ot (b) the buffer hypothesis, predicting that control (and social support) can buffer the potential negative effects of high demands on physical health. It is argued that these hypotheses reflect theoretical distinct models, and that the practical implications associated with these models differ.

The review of 51 studies on the JDC(S) model reveals that the “strain” hypothesis predominates in studies of all-cause mortality, cardiovascular disease (CVD) related and specific non-CVD related health outcomes. In contrast, the “buffer” hypothesis is most prevalent in research on self-reported (psycho)somatic complaints. For the strain hypothesis as well as the buffer hypothesis the results are equivocal. Working in a high (iso)strain job appears to be associated with an elevated risk for cardiovascular disease and negative pregnancy outcomes, and increased (psycho)somatic complaints. Conclusions on other physical outcomes seem premature, considering the limited number of studies. The buffer hypothesis is supported in the few studies on CVD endpoints and in some studies on (psycho)somatic complaints.

A comparison of the validity of the two hypotheses is problematic, because they are mostly applied to a different set of outcomes. Furthermore, the analyses employed in the testing of the two hypotheses are of a different nature (non-linear versus linear).

The main recommendation for future research is to examine the validity of the strain and the buffer hypothesis concurrently, and to further explore the nature of the relationships.     

Impact of social support on health status and life satisfaction in people with a spinal cord injury

Abstract

Purpose: Assessment of the impact of received social support on functional health status and life satisfaction in people with spinal cord injury (SCI). Design: Respondents were 176 people with SCI between 18 and 65 years of age and living in the community. Mean time after injury was 3.6 years. Problem-oriented and emotion-oriented support, received from family members, friends and relatives, and professionals were assessed with the Sources of Social Support Inventory. Health status was assessed with the Sickness Impact Profile 68 and life satisfaction with the Life Satisfaction Questionnaire. Structural equation modelling with LISREL V8 was used to study relationships of different types and sources of social support with health status and life satisfaction.Results: Emotion-oriented support led to better psychological functioning and to greater life satisfaction. In addition, emotion-oriented support from the family led to greater satisfaction with relationships and emotion-oriented support from friends and acquaintances led to less satisfaction with social life. Problem-oriented support was not clearly related to health status and life satisfaction; there was only a negative relation between problem-oriented support and satisfaction with social life. Support, problem-oriented or emotion-oriented, from health-care professionals showed no relationships with health status or life satisfaction.Conclusions: Emotion-oriented support from family members and friends was most important for people with SCI. Greater problem-oriented support appears to be related to poorer life satisfaction.     

What do people think about changes in health behaviors? Differential perceptions of consequences of increases and decreases in health behaviors

Most health decision-making models posit that cost-benefit analyses underlie decisions to make changes in health-related behavioral practices. In a series of studies, participants imagined either increasing or decreasing the frequency of a variety of health behaviors and estimated the consequences of those changes. In Studies 1 and 2, individuals consistently estimated that increasing a health behavior produced greater consequences than did decreasing the behavior by an equivalent amount. The results of Study 3 demonstrated that this effect is due to differences in how individuals judge the impact of health behavior changes which involve not engaging in the behavior at all versus other types of changes. Taken together, these findings suggest that perceptions of the outcomes afforded by health behavior changes depend on both the behavioral frequency and direction of changes in behavior an individual is considering. This asymmetry has the potential to help explain patterns of behavior in a range of important health domains and may impact the effectiveness of behavior change interventions.     

Engagement with meditation as a positive health trajectory: Divergent narratives of progress in male meditators

Objective: Studying personal narratives can generate understanding of how people experience physical and mental illness. However, few studies have explored narratives of engagement in health positive behaviours, with none focusing on men specifically. Thus, we sought to examine men’s experiences of their efforts to engage in and maintain healthy behaviours, focusing on meditation as an example of such behaviour.

Design: We recruited 30 male meditators, using principles of maximum variation sampling, and conducted two in-depth interviews with each, separated by a year. Main outcome measures: We sought to elicit men’s narratives of their experiences of trying to maintain a meditation practice.

Results: We identified an overall theme of a ‘positive health trajectory,’ in particular, making ‘progress’ through meditation. Under this were six main accounts. Only two articulated a ‘positive’ message about progress: Climbing a hierarchy of practitioners, and progress catalysed in other areas of life. The other four reflected the difficulties around progress: Progress being undermined by illness; disappointment with progress; progress ‘forgotten’ (superseded by other concerns); and progress re-conceptualised due to other priorities.

Conclusion: Men’s narratives reveal the way they experience and construct their engagement with meditation – as an example of health behaviour – in terms of progress.     

Predicting short and long-term exercise intentions and behaviour in patients with coronary artery disease: A test of protection motivation theory

The purpose of this study was to examine the utility of protection motivation theory (PMT) in the prediction of exercise intentions and behaviour in the year following hospitalisation for coronary artery disease (CAD). Patients with documented CAD (n?=?787), recruited at hospital discharge, completed questionnaires measuring PMT's threat (i.e. perceived severity and vulnerability) and coping (i.e. self-efficacy, response efficacy) appraisal constructs at baseline, 2 and 6 months, and exercise behaviour at baseline, 6 and 12 months post-hospitalisation. Structural equation modelling showed that the PMT model of exercise at 6 months had a good fit with the empirical data. Self-efficacy, response efficacy, and perceived severity predicted exercise intentions, which, in turn predicted exercise behaviour. Overall, the PMT variables accounted for a moderate amount of variance in exercise intentions (23%) and behaviour (20%). In contrast, the PMT model was not reliable for predicting exercise behaviour at 12 months post-hospitalisation. The data provided support for PMT applied to short-term, but not long-term, exercise behaviour among patients with CAD. Health education should concentrate on providing positive coping messages to enhance patients’ confidence regarding exercise and their belief that exercise provides health benefits, as well as realistic information about disease severity.     

How optimists face skin cancer information: Risk assessment,attention, memory,and behavior

The purpose of the present study was to investigate how optimists process health-related information. Sixty-five young adults (ages 18–35) reported skin cancer-related knowledge and behaviors, and read slides of information on skin and skin cancer. Visual attention to the slides was recorded using eye tracking, and their memory for the information was measured. Additionally, participants’ self-reported skin cancer-relevant behavior was assessed prospectively in the months following the lab component of the study. Results show that individuals low in dispositional optimism or high in health-related optimism paid more attention when they were at high objective risk of developing skin cancer; and individuals high in dispositional optimism or high in health-related optimism were more likely to perform adaptive, health-promoting behaviors. In addition, optimistic beliefs were found not to be related with unrealistic optimism. Dispositional and health-related optimism therefore appear to predict health-related cognition and behavior in distinct ways.     

The interplay of received social support and self-regulatory factors in smoking cessation

Objective: In smoking cessation, individual self-regulation and social support have both proven to be useful. However, the roles of self-regulatory processes and social support are mostly examined separately. The present study aims at examining the unique and joint interactive effects of self-regulation as specified in the health action process approach (HAPA) and social support on smoking cessation. The study tested whether social support can compensate for low levels of self-regulation or whether synergistic effects emerge.

Design & Measures: Around a self-set quit date, 99 smokers completed baseline questionnaires on HAPA-variables, smoking-specific received social support and smoking cessation (continuous abstinence and point prevalence), with a follow-up Cpproximately 29?days after the quitdate.

Results: Social support moderated the association between volitional self-efficacy and smoking, as well as coping planning and smoking but not between action planning and smoking. No compensatory effect of social support for lower levels of individual regulation emerged but the combination of high levels of the individual variables and social support was related to successful smoking cessation, indicating a synergistic effect.

Conclusions: The results confirm the importance of examining both self-regulation and social factors in smoking cessation. This should be considered when developing future interventions for smoking cessation.     

Do behavioural self-blame and stigma predict positive health changes in survivors of lung or head and neck cancers?

Survivors of lung or head and neck cancers often change tobacco and alcohol consumption after diagnosis, but few studies have examined other positive health changes (PHCs) or their determinants in these groups. The present study aims to: (a) document PHCs in survivors of lung (n?=?107) or head and neck cancers (n?=?99) and (b) examine behavioural self-blame and stigma as determinants of PHCs. We hypothesised that: (a) survivors would make a variety of PHCs; (b) behavioural self-blame for the disease would positively predict making PHCs; and (c) stigma would negatively predict making PHCs.

Methods: Respondents self-administered measures of PHC, behavioural self-blame, and stigma. Hierarchical multiple regression analysis tested the hypotheses.

Results: More than 65% of respondents reported making PHCs, the most common being changes in diet (25%), exercise (23%) and tobacco consumption (16.5%). Behavioural self-blame significantly predicted PHCs but stigma did not. However, both behavioural self-blame and stigma significantly predicted changes in tobacco consumption.

Conclusions: Many survivors of lung or head and neck cancers engage in PHCs, but those who do not attribute the disease to their behaviour are less likely to do so. Attention to this problem and additional counselling may help people to adopt PHCs.