David M. Williams

Outcome Expectancy and Self-Efficacy: Theoretical Implications of an Unresolved Contradiction

According to self-efficacy theory, self-efficacy—defined as perceived capability to perform a behavior—causally influences expected outcomes of behavior, but not vice versa. However, research has shown that expected outcomes causally influence self-efficacy judgments, and some authors have argued that this relationship invalidates self-efficacy theory. Bandura has rebutted those arguments saying that self-efficacy judgments are not invalidated when influenced by expected outcomes. This article focuses on a contradiction in Bandura’s rebuttal. Specifically, Bandura has argued (a) expected outcomes cannot causally influence self-efficacy, but (b) self-efficacy judgments remain valid when causally influenced by expected outcomes. While the debate regarding outcome expectancies and self-efficacy has subsided in recent years, the inattention to this contradiction has led to a disproportionate focus on self-efficacy as a causal determinant of behavior at the expense of expected outcomes.

Social cognitive mediators of change in a group randomized nutrition and physical activity intervention: social support, self-efficacy, outcome expectations and self-regulation in the guide-to-health trial.

In an evaluation of the theoretical foundations of behavior change, the current study examined whether social cognitive (SCT) variables mediated treatment effects on physical activity and nutrition in the recently reported Guide-to-Health trial (GTH). Adults (N = 661) were assessed at baseline, seven months and 16 months to examine whether treatment-related changes in SCT variables at seven months mediated change in nutrition and physical activity at 16 months. GTH treatment effects were mediated by self-efficacy, self-regulation and social support; self-regulation mediated self-efficacy. Social-cognitive variables explained only part of the treatment effects suggesting future investigations evaluate the environmental-selection and affective processes of behavior change.

MEDIATORS OF PHYSICAL ACTIVITY BEHAVIOR CHANGE: A MULTIVARIATE APPROACH

OBJECTIVE Using a multivariate extension of the Baron and Kenny (1986) mediation framework, we examined the simultaneous effect of variables hypothesized to mediate the relationship between a motivationally tailored physical activity intervention, and 6-month physical activity behavior in 239 healthy, underactive adults (M age = 47.5; 82% women). DESIGN Participants were randomly assigned to (a) print-based feedback; (b) telephone-based feedback; or (c) contact control. MAIN OUTCOME MEASURES Psychosocial variables, including self-efficacy, decisional balance, and processes of change. RESULTS All mediation criteria were satisfied for both intervention arms. A moderate indirect effect of print (0.39, 95% CI = 0.21, 0.57) was found due to increases in behavioral processes (0.54, 95% CI = 0.29, 0.80) being attenuated by decreases due to cognitive processes (-0.17, 95%CI = 0.31,-.03). A moderate indirect effect was observed for telephone (0.47, 95% CI = 0.28, 0.66), with increases due to behavioral processes (0.61, 95% CI = 0.34, 0.87) attenuated by decreases due to cognitive processes (0.15, 95% CI = -0.27, -0.02); self-efficacy and decisional balance mediational paths did not attain statistical significance. CONCLUSIONS These findings highlight the importance of studies that deconstruct the theoretical components of interventions to determine which combination produces the greatest behavior changes at the lowest cost.

A Review of TV Viewing and Its Association With Health Outcomes in Adults

Observational studies of the relationship between TV viewing and health outcomes (overweight/obesity, cholesterol/lipids, blood pressure/hypertension, type 2 diabetes, and metabolic syndrome) in adults are reviewed. Studies indicate that in adults, greater amounts of TV viewing are consistently associated with increased overweight risk, both cross-sectionally and longitudinally, but that results are mixed regarding the relationship between adult TV viewing and other health outcomes. It is theorized that greater TV viewing is related to increased weight status and poorer health outcomes by reducing energy expenditure, predominantly through reducing time spent in physical activity, and increasing energy intake. No randomized trials that manipulated TV viewing time measured the effects of this manipulation on diet and physical activity and then measured future health outcomes in adults. However, experimental studies, predominantly conducted in children, show relationships between TV viewing, energy intake, physical activity, and weight status, which follow the hypothesized mechanisms. Interventions targeting TV viewing in adults appear to be justified, and proposed methods for conducting these interventions, as well as potential barriers to implementing these interventions, are discussed.

Interventions to increase walking behavior

Walking is the most prevalent and preferred method of physical activity for both work and leisure purposes, thus making it a prime target for physical activity promotion interventions. We identified 14 randomized controlled trials, which tested interventions specifically targeting and assessing walking behavior. Results show that among self-selected samples, intensive interventions can increase walking behavior relative to controls. Brief telephone prompts appear to be as effective as more substantial telephone counseling. Although more research is needed, individual studies support prescriptions to walk 5-7 versus 3-5 d.wk and at a moderate (vs vigorous) intensity pace, with no differences in total walking minutes when single or multiple daily walking bouts are prescribed. Mediated interventions delivering physical activity promotion materials through non-face-to-face channels may be ideal for delivering walking promotion interventions and have shown efficacy in promoting overall physical activity, especially when theory-based and individually tailored. Mass media campaigns targeting broader audiences, including those who may not intend to increase their physical activity, have been successful at increasing knowledge and awareness about physical activity but are often too diffuse to successfully impact individual behavior change. Incorporating individually tailored programs into broader mass media campaigns may be an important next step, and the Internet could be a useful vehicle.

Yoga as a complementary treatment for smoking cessation in women.

BACKGROUND Tobacco smoking remains the leading preventable cause of death among American women. Aerobic exercise has shown promise as an aid to smoking cessation because it improves affect and reduces nicotine withdrawal symptoms. Studies outside the realm of smoking cessation have shown that yoga practice also reduces perceived stress and negative affect. METHODS This pilot study examines the feasibility and initial efficacy of yoga as a complementary therapy for smoking cessation. Fifty-five women were given 8-week group-based cognitive behavioral therapy for smoking cessation and were randomized to a twice-weekly program of Vinyasa yoga or a general health and wellness program (contact control). The primary outcome measure was 7-day point prevalence abstinence at the end of treatment validated by saliva cotinine testing. Longitudinal analyses were also conducted to examine the effect of intervention on smoking cessation at 3- and 6-month follow-up. We examined the effects of the intervention on potential mediating variables (e.g., confidence in quitting smoking, self-efficacy), as well as measures of depressive symptoms, anxiety, and perceived health (SF-36). RESULTS At end of treatment, women in the yoga group had a greater 7-day point-prevalence abstinence rate than controls (odds ratio [OR], 4.56; 95% CI, 1.1-18.6). Abstinence remained higher among yoga participants through the six month assessment (OR, 1.54; 95% CI, 0.34-6.92), although differences were no longer statistically significant. Women participating in the yoga program also showed reduced anxiety and improvements in perceived health and well-being when compared with controls. CONCLUSIONS Yoga may be an efficacious complementary therapy for smoking cessation among women.

Initiating and maintaining resistance training in older adults: a social cognitive theory-based approach

Numerous research studies performed in “lab-gyms” with supervised training have demonstrated that simple, brief (20–30 min) resistance training protocols performed 2–3/week following the American College of Sports Medicine’s guidelines positively affect risk factors associated with heart disease, cancers, diabetes, sarcopenia and other disabilities. For more than a decade, resistance training has been recommended for adults, particularly older adults, as a prime preventive intervention, and increasing the prevalence of resistance training is an objective of Healthy People 2010. However, the prevalence rate for resistance training is only estimated at 10–15% for older adults, despite the leisure time of older adults and access to facilities in developed countries. The reasons that the prevalence rate remains low include public health policy not emphasising resistance training, misinformation, and the lack of theoretically driven approaches demonstrating effective transfer and maintenance of training to minimally supervised settings once initial, generally successful, supervised training is completed. Social cognitive theory (SCT) has been applied to physical activity and aerobic training with some success, but there are aspects of resistance training that are unique including its intensity, progression, precision, and time and place specificity. Social cognitive theory, particularly with a focus on self-regulation and response expectancy and affect within an ecological context, can be directly applied to these unique aspects of resistance training for long-term maintenance.

The Impact of Incentives on Exercise Behavior: A Systematic Review of Randomized Controlled Trials

BackgroundThe effectiveness of reinforcing exercise behavior with material incentives is unclear.PurposeThis study aims to conduct a systematic review of existing research on material incentives for exercise, organized by incentive strategy.MethodsTen studies conducted between January 1965 and June 2013 assessed the impact of incentivizing exercise compared to a non-incentivized control.ResultsThere was significant heterogeneity between studies regarding reinforcement procedures and outcomes. Incentives tended to improve behavior during the intervention while findings were mixed regarding sustained behavior after incentives were removed.ConclusionsThe most effective incentive procedure is unclear given the limitations of existing research. The effectiveness of various incentive procedures in promoting initial behavior change and habit formation, as well as the use of sustainable incentive procedures should be explored in future research.

User attitudes towards physical activity websites in a randomized controlled trial

OBJECTIVE To better understand the mixed findings regarding the efficacy of Internet-based physical activity interventions, we examined the use and usefulness of particular website components that may lead to improvements in intervention efficacy. METHOD Participants were sedentary individuals from a 12-month randomized controlled physical activity trial conducted in Providence, Rhode Island and Pittsburgh, Pennsylvania from 2003-2006. The present study included participants from the Tailored Internet arm (n=81; instantaneous web-based tailored feedback to participants) or the Standard Internet arm (n=82; websites currently available to the public). We obtained objective data via the intervention websites and subjective usefulness data via questionnaires. RESULTS The Tailored Internet arm logged onto their website significantly more times than the Standard Internet arm (median 50 vs. 38; p<.05). Among participants in the Tailored Internet arm, the self-monitoring feature (i.e., logging) followed by goal setting were rated as the most useful website components. CONCLUSION Logins in the current study were substantially higher compared to previous studies. Participants endorsed goal setting and self-monitoring as being most useful, which are critical components for health behavior change. Future studies should continue to examine these features and improve the perceived usefulness of other theory-based strategies.

The confounded self-efficacy construct: conceptual analysis and recommendations for future research

Self-efficacy is central to health behaviour theories due to its robust predictive capabilities. In this paper, we present and review evidence for a self-efficacy-as-motivation argument in which standard self-efficacy questionnaires – i.e., ratings of whether participants ‘can do’ the target behaviour – reflect motivation rather than perceived capability. The potential implication is that associations between self-efficacy ratings (particularly those that employ a ‘can do’ operationalisation) and health-related behaviours simply indicate that people are likely to do what they are motivated to do. There is some empirical evidence for the self-efficacy-as-motivation argument, with three studies demonstrating causal effects of outcome expectancy on subsequent self-efficacy ratings. Three additional studies show that – consistent with the self-efficacy-as-motivation argument – controlling for motivation by adding the phrase ‘if you wanted to’ to the end of self-efficacy items decreases associations between self-efficacy ratings and motivation. Likewise, a qualitative study using a thought-listing procedure demonstrates that self-efficacy ratings have motivational antecedents. The available evidence suggests that the self-efficacy-as-motivation argument is viable, although more research is needed. Meanwhile, we recommend that researchers look beyond self-efficacy to identify the many and diverse sources of motivation for health-related behaviours.