Carina Ka Yee Chan

Promoting physical activity with goal-oriented mental imagery : A randomized controlled trial

Self-regulation theory and research suggests that different types of mental imagery can promote goal-directed behaviors. The present study was designed to compare the efficacy of approach imagery (attainment of desired goal states) and process imagery (steps for enacting behavior) in promoting physical activity among inactive individuals. A randomized controlled trial was conducted with 182 inactive adults who received one of four interventions for generating mental images related to physical activity over a 4-week period, with Approach Imagery (approach versus neutral) and Process Imagery (process versus no process) as the intervention strategies. Participants received imagery training and practiced daily. Repeated measures ANOVAs revealed that Approach Imagery: (1) increased approach motivations for physical activity at Week 4; (2) induced greater intentions post-session, which subsequently induced more action planning at Week 4; (3) enhanced action planning when combined with process images at post-session and Week 1; and (4) facilitated more physical activity at Week 4 via action planning. These findings suggest that inducing approach orientation via mental imagery may be a convenient and low-cost technique to promote physical activity among inactive individuals.

Religiosity and Spirituality and the Intake of Fruit, Vegetable and Fat : A Systematic Review

Objectives. To systematically review articles investigating the relationship between religion and spirituality (R/S) and fruit, vegetable, and fat intake. Methods. PubMed, CINAHL, and PsycInfo were searched for studies published in English prior to March 2013. The studies were divided into two categories: denominational studies and degree of R/S studies. The degree of R/S studies was further analyzed to (1) determine the categories of R/S measures and their relationship with fruit, vegetable, and fat intake, (2) evaluate the quality of the R/S measures and the research design, and (3) determine the categories of reported relationship. Results. Thirty-nine studies were identified. There were 14 denominational studies and 21 degree of R/S studies, and 4 studies were a combination of both. Only 20% of the studies reported validity and 52% reported reliability of the R/S measures used. All studies were cross-sectional, and only one attempted mediation analysis. Most studies showed a positive association with fruit and vegetable intake and a mixed association with fat intake. Conclusion. The positive association between R/S and fruit and vegetable intake may be one possible link between R/S and positive health outcome. However, the association with fat intake was mixed, and recommendations for future research are made.

Perfectionism and eating disorder symptomatology in Chinese immigrants: Mediating and moderating effects of ethnic identity and acculturation

Three hundred and one Chinese drawn from the University of Auckland and local communities in New Zealand completed an anonymous questionnaire consisting of the Eating Disorder Inventory (EDI), the Positive and Negative Perfectionism Scale (PANPS), the Multigroup Ethnic Identity Measure (MEIM) and the short form of the Marlowe–Crowne Social Desirability Scale (MCSDS). Negative Perfectionism significantly predicted more eating disorder symptoms as measured by the EDI. A strong positive evaluation of other ethnic groups together with high Positive Perfectionism predicted lower body dissatisfaction and drive for thinness, whereas the opposite was true for a more negative evaluation of other groups and high Positive Perfectionism. A strong sense of belonging and attachment towards the Chinese culture and valuing other ethnic groups were found to mediate the relationship between Positive Perfectionism and eating disorder symptoms, predicting a lower sense of interpersonal distrust. Immigrant Chinese showed better adaptation with strong ethnic attachment as well as valuing the mainstream culture. Results also suggest that promoting Positive Perfectionism together with strong ethnic identification and values towards the mainstream culture may be advantageous to Chinese immigrants.

A Web-Based Dietary Intervention for People with Type 2 Diabetes: Development, Implementation, and Evaluation

BackgroundDiabetes is becoming a very important health issue in rapidly developing nations and there is an urgent need to improve overall diabetes self-management education in these countries. Although e-health is an emerging theme, only a few successful web-based studies on diabetes self-management have been reported.PurposeWe describe the development, implementation, and process evaluation of an Internet-delivered dietary intervention program (myDIDeA) for diabetic patients in a developing country.MethodSpecific dietary components to be included in the intervention module were first identified through a comprehensive review of literature and guidelines. The lesson plans and the study website were then developed based on the evidence, Transtheoretical Model’s Stages of Change and user-centered design approach. Finally, the effectiveness of the website was tested through a randomized-controlled trial to promote dietary change in patients with type 2 diabetes. The participants in the intervention group (nu2009=u200966) were given access to myDIDeA for 6xa0months. Process evaluation in form of intervention adherence and program reception were conducted at post intervention.ResultsThe response rate for the process evaluation was 89xa0%. On average, each participant logged in at least once for each lesson plan and spent almost 12xa0min on the site. The participants’ content satisfaction, acceptability, and usability scores were satisfactory. The primary outcome of the trial, Dietary Knowledge, Attitude, and Behavior score was strongly correlated with content satisfaction (ru2009=u20090.826, pu2009<u20090.001), acceptability (ru2009=u20090.793, pu2009<u20090.001) and usability of the website (ru2009=u20090.724, pu2009<u20090.001), and moderately correlated with frequency of log-in (ru2009=u20090.501, pu2009<u20090.05) and duration spent in the website (ru2009=u20090.399, pu2009<u20090.05).ConclusionThe process evaluation of myDIDeA demonstrates its feasibility, and future studies should identify the possibility of extending the use of Internet-based intervention programs to other health behaviors and issues related to self-management of chronic conditions. In addition, interactivity, peer support via social media, and other means to stimulate the interest of participants can be explored.

Contextualizing chronicity: a perspective from Malaysia

The increasing prevalence of chronic Non Communicable Disease (NCD) around the world is well documented and projections suggest a frightening increase in prevalence around the world. The majority of new patients with chronic disease are expected to occur in developing countries. n nEffective management of chronic disease is a complex process that involves a proactive health care team working within an integrated healthcare delivery system supporting a well informed and confident patient skilled in self-management of the condition. n nThere is increasing evidence especially from western countries that methods of implementation that use these principles work. n nWidespread and not contextualized dissemination of these approaches especially to less developed countries, however, would pose particular challenges. These challenges relate to a number of factors; a lack of resources, poorly functioning healthcare systems and their ability to cope, the rise of private financing for healthcare with increasing out-of-pocket payments for accessing healthcare, rapid industrialization and urbanization with attendant breakdown in support relationships and the general lack of support services including a social support model. n nWe discuss some of these health system issues, using diabetes as the indicator condition, and the relating this to the Malaysian health system to illustrate the challenges of translating evidence from better resourced countries. Malaysia is a middle-income country with a well-functioning public health system designed primarily for control of communicable disease and Maternal and Child health. While a population approach in dealing with NCDs is key, we have highlighted an individual high-risk approach in this commentary. n nA number of patient support systems by professionals have been tested successfully in developed countries. In most developing countries, individuals especially the elderly depend on families to provide support. This and support from peers may be areas that may require further study especially in the area of self-management.

Advancing the Science of Dissemination and Implementation in Behavioral Medicine: Evidence and Progress

The enormous time lag between the discovery of new knowledge and its implementation poses a significant challenge to improving public health because of the very slow uptake into policy and practice. The field of dissemination and implementation research in behavioral medicine is receiving increased attention because of the keen interest in accelerating knowledge transfer from relevant research to improve the health and wellbeing of populations in many different settings, contexts, and countries around the world. This is particularly important in high-risk populations, resource-poor and developing regions of the world where the difference in health systems, languages, and cultures very significantly influences the translation of evidence into policy and practice. Moreover, demonstrating the broader societal and economic value of behavioral interventions in settings where they are implemented can further support the sustainability, uptake, and implementation of these findings in other settings and contexts. This special issue presents a series of empirical studies, reviews, and case studies that address dissemination, implementation, and translation issues in both developed and developing countries. Specifically, the learnings from the application of many and varied theories and research methodologies are very relevant for bridging the current division between research findings and their translation and uptake into policy and practice.

Behavioral Interventions for Prevention and Management of Chronic Disease

This chapter reviews the existing evidence base for behavioral interventions in relation to the prevention and management of chronic diseases. We focus primarily on the key lifestyle and self-care behaviors – dietary behaviors, exercise, smoking, and disease management behaviors – that are causally linked to circulatory and related conditions, including cardiovascular disease, diabetes, and respiratory conditions. The review is conducted in three steps. First, we consider the evidence for the effectiveness for behavioral interventions by considering the systematic reviews in this field. Second, we supplement these findings with issues and findings from relevant narrative reviews. Finally, we discuss the implications of these findings for future research and practice in the field, especially on issues related to intervention delivery and broader uptake of interventions and their sustainability.

Moderating Effects of Media Exposure on Associations between Socioeconomic Position and Cancer Worry

Reducing fear of cancer is significant in developing cancer screening interventions, but the levels of fear may vary depending on the degrees of media exposure as well as individuals socioeconomic positions (SEP). However, few studies have examined how the SEP influences the fear of cancer under the moderating process of general and specific forms of media exposure. We investigated the moderating effect of media exposure on the relationship between SEP and the level of fear of cancer by assuming that cancer knowledge is a covariate between those two. In particular, this study examined how exposure to both general and specific media changes the series of processes from SEP to fear of cancer. We conducted path analyses with three types of media--television, radio and the Internet--using data from a health communication survey of 613 adults in Massachusetts in the United States. We found that SEP influences cancer knowledge directly and fear of cancer indirectly, as moderated by the level of media exposure. Health-specific exposure, however, had a more consistent effect than general media exposure in lowering the fear of cancer by increasing knowledge about cancer. A higher level of health-specific exposure and greater amount of cancer knowledge lessened the fear of cancer. In addition, the more people were exposed to health information on television and the Internet, the lower the level of fear of cancer as a result. These findings indicate a relationship between SEP and fear of cancer, as moderated by the level and type of media exposure. Furthermore, the findings suggest that for early detection or cancer prevention strategies, health communication approaches through mass media need to be considered.

Religiosity, dietary habit, intake of fruit and vegetable, and vegetarian status among Seventh-Day Adventists in West Malaysia.

Religion has been shown to be salutary on health, and a possible link between religion and positive health outcomes is diet. Research has shown that religiosity is associated with better diet but most studies were conducted in a multi-denominational context, which might be confounded with theological differences. This study examined the relationship between religiosity and diet within a homogenous group of believers. Data from survey of 574 Seventh-Day Adventists residing in West Malaysia, aged 18–80, were analyzed using multiple regressions. While none of the religious variables were significantly associated with fruit and vegetable intake, a higher level of religiosity was associated with a better dietary habit and vegetarian status. The mixed relationship between religiosity and diet suggest that further research is needed to explore how religion might influence the diet of adherents.

Overview of Types of Disease, Their Epidemiology, and Treatments

Behavioral medicine addresses the full range of diseases that affect humans. This chapter provides an overview of some major types of diseases and health problems that have strong behavioral component in their etiology and management. These include obesity, cardiovascular disease, cancer, diabetes, chronic obstructive pulmonary disease, HIV/AIDS, tuberculosis, suicide, and mental disorders (depression, anxiety disorders, and psychotic disorders). The etiology, presenting complaints, epidemiology, prevention, and treatment of these health conditions are discussed, and the roles played by behaviors are highlighted. The multifactorial nature of these conditions, including the roles played by genetics, psychological and social factors, and their interactions, is emphasized.