Elise Dusseldorp

Condom use self-efficacy: effect on intended and actual condom use in adolescents.

PURPOSEnTo investigate aspects of adolescents condom use self-efficacy that affect their intended and actual condom use.nnnMETHODSnFour hundred twenty-four male and female sexually experienced and inexperienced adolescents with a mean age of 17.0 years filled out a questionnaire concerning condom use self-efficacy and intended and actual condom use. Specific condom use self-efficacy scales were constructed from 37 items on the basis of a principal component analysis. The effect of self-efficacy, both as a global measure and in terms of specific scales, on condom use intention and consistency was assessed using multiple hierarchic regression analyses.nnnRESULTSnSix specific self-efficacy scales were constructed: Technical Skills, Image Confidence, Emotion Control, Purchase, Assertiveness, and Sexual Control. In sexually inexperienced adolescents, global self-efficacy explained 48%, the six self-efficacy scales 30%, and both together 51% of the variance in intention, after statistical control for gender, age, and education level. In the sexually experienced sample, this was 40%, 50%, and 57% for intention, and 23%, 29%, and 33% for consistency of condom use. Significant predictors of intention in the final model were gender, age, global self-efficacy and purchasing skills in the inexperienced sample, and global self-efficacy, emotion control, assertiveness, image confidence, and sexual control in the experienced sample, whereas gender, age, global self-efficacy, emotion control, assertiveness, and purchase predicted consistency of condom use in the experienced sample.nnnCONCLUSIONSnCondom use self-efficacy is a multidimensional construct. Intended and actual condom use in adolescents are best predicted by self-efficacy measures that include both global and relevant specific aspects of condom use.

Lifestyle modification programmes for patients with coronary heart disease: a systematic review and meta-analysis of randomized controlled trials.

Background Lifestyle modification programmes for coronary heart disease patients have been shown to effectively improve risk factors and related health behaviours, quality of life, reincidence, and mortality. However, improvements in routine cardiac care over the recent years may offset the incremental benefit associated with older programmes. Purpose To determine the efficacy of lifestyle modification programmes for coronary heart disease patients developed over the last decade (1999–2009) by means of a systematic review and meta-analysis. Results The study included 23 trials (involving 11,085 randomized patients). Lifestyle modification programmes were associated with reduced all-cause mortality (summary OR 1.34, 95% CI 1.10–1.64), cardiac mortality (summary OR 1.48, 95% CI 1.17–1.88), and cardiac readmissions and non-fatal reinfarctions (summary OR 1.35, 95% CI 1.17–1.55). Furthermore, lifestyle modification programmes positively affected risk factors and related lifestyle behaviours at posttreatment (Mu2009=u200910.2 months), and some of these benefits were maintained at long-term follow up (Mu2009=u200933.7 months). Improvements in dietary and exercise behaviour were greater for programmes incorporating all four self-regulation techniques (i.e. goal setting, self-monitoring, planning, and feedback techniques) compared to interventions that included none of these techniques. Conclusion The evidence summarized in this meta-analysis confirms the benefits of lifestyle modification programmes – over and above benefits achieved by routine clinical care alone.

Quantitative analyses in a multivariate study of language attrition: The impact of extralinguistic factors

Most linguistic processes — acquisition, change, deterioration — take place in and are determined by a complex and multifactorial web of language internal and language external influences. This implies that the impact of each individual factor can only be determined on the basis of a careful consideration of its interplay with all other factors. The present study investigates to what degree a number of sociolinguistic and extralinguistic factors, which have been previously demonstrated or claimed to be relevant in the context of language attrition, can account for individual differences in first language (L1) proficiency. Data were collected from attriting populations with German as their L1: one in a Dutch language context (n = 53) and one in a Canadian English setting (n = 53). These groups were compared to a reference group of Germans in Germany (n = 53). Overall, the proposed outcome measures (derived from both formal tasks and a free speech task) are argued to be stable and valid indicators of attrition effects. The predictor variables under investigation are shown to fall into several reliable factor groups, for example, identification and affiliation with L1, exposure to German language and attitude towards L1. These are the factor groups that have, so far, been considered the most important for the process of L1 attrition or maintenance. However, the predictive power exercised by these factor groups in the present study is shown to be relatively weak.

Coping with coronary heart disease : A longitudinal study

This longitudinal study evaluated the effects of two types of coping strategies, approach and avoidance, on anxiety, depression, and well-being in patients with coronary heart disease. Measurements were made at three timepoints: 1 month, 3 months, and 12 months after the cardiac event. Both cross-sectional and longitudinal relations were explored. At all three measurement points significant negative cross-sectional relations were found between approach and well-being, and significant positive cross-sectional relations were found between approach, on the one hand, and anxiety and depression, on the other. At the first measurement point, avoidance showed a positive association with well-being, and a negative association with anxiety. Longitudinal analyses, however, revealed a negative relationship between approach at the first measurement points and anxiety and depression at later measurement points. Likewise, there was a positive association between approach at the first two measurement points and well-being at later measurement points. The results of this study demonstrate the importance of facing and working through the trauma of the coronary event. Although unfavorable in the short term, working through the trauma can attenuate long-term emotional distress. These results suggest that assessment of the psychological consequences of coronary heart disease and development of interventions should not be based only on cross-sectional data, but should take into account longitudinal relations between coping and psychosocial outcome measures.

Combination Treatment for Acute Depression Is Superior Only when Psychotherapy Is Added to Medication

Background: Although several forms of effective therapy exist for outpatients suffering from major depressive disorder, many patients do not profit from treatment. Combining psychotherapy and medication may be an effective strategy. However, earlier studies have rarely found a clear advantage for the combination. Where an advantage was found, a possible placebo effect of adding 2 types of treatment could not be ruled out as cause for the superior effect of the combination. Methods: A total of 353 patients were screened, of whom 193 were randomized over 4 conditions: nefazodone plus clinical management, interpersonal psychotherapy (IPT), the combination of the two or the combination of IPT and pill-placebo. All patients suffered from major depressive disorder and had a score of at least 14 on the 17-item Hamilton Rating Scale (HAMD). The patients were treated for 12–16 weeks. At baseline, at 6 weeks and on completion of treatment, ratings were performed by independent raters. The primary outcome measure was the HAMD, and the Montgomery-Asberg Depression Rating Scale (MADRS) the secondary outcome measure. Results: Of the 193 patients included, 138 completed the trial. All treatments were effective. Using a random regression model, no differences between treatments were found on the HAMD. On the MADRS, however, the combination of medication with psychotherapy was more effective in reducing depressive symptoms compared to medication alone, but not to psychotherapy alone or IPT with pill-placebo. Conclusions: The results of this study yield support for the use of combining medication with psychotherapy instead of using medication only in the treatment of depressed outpatients. Combination treatment does not have an advantage over psychotherapy alone in the present study.

Combinations of Techniques That Effectively Change Health Behavior: Evidence From Meta-CART Analysis

OBJECTIVEnMany health-promoting interventions combine multiple behavior change techniques (BCTs) to maximize effectiveness. Although, in theory, BCTs can amplify each other, the available meta-analyses have not been able to identify specific combinations of techniques that provide synergistic effects. This study overcomes some of the shortcomings in the current methodology by applying classification and regression trees (CART) to meta-analytic data in a special way, referred to as Meta-CART. The aim was to identify particular combinations of BCTs that explain intervention success.nnnMETHODnA reanalysis of data from Michie, Abraham, Whittington, McAteer, and Gupta (2009) was performed. These data included effect sizes from 122 interventions targeted at physical activity and healthy eating, and the coding of the interventions into 26 BCTs. A CART analysis was performed using the BCTs as predictors and treatment success (i.e., effect size) as outcome. A subgroup meta-analysis using a mixed effects model was performed to compare the treatment effect in the subgroups found by CART.nnnRESULTSnMeta-CART identified the following most effective combinations: Provide information about behavior-health link with Prompt intention formation (mean effect size ḡ = 0.46), and Provide information about behavior-health link with Provide information on consequences and Use of follow-up prompts (ḡ = 0.44). Least effective interventions were those using Provide feedback on performance without using Provide instruction (ḡ = 0.05).nnnCONCLUSIONSnSpecific combinations of BCTs increase the likelihood of achieving change in health behavior, whereas other combinations decrease this likelihood. Meta-CART successfully identified these combinations and thus provides a viable methodology in the context of meta-analysis.

Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research

BackgroundTo improve the implementation of innovations in healthcare settings, it is important to understand factors influencing healthcare professionals’ behaviors. We aimed to develop a generic questionnaire in English and in Dutch assessing the 14 domains of behavioral determinants from the revised TDF (Cane et al., 2012) that can be tailored to suit different targets, actions, contexts, and times of interest, and to investigate questionnaire items’ discriminant content validity.MethodsWe identified existing questionnaires including items assessing constructs within TDF domains and developed new items where needed. Nineteen judges allocated 79 items to one or more TDF domains. One-sample t-tests were used to examine the discriminant content validity of each item, i.e., whether items measured intended domains or whether items measured a combination of domains.ResultsWe identified items judged to discriminately measure 11 out of 14 domains. Items measuring the domains Reinforcement, Goals, and Behavioral regulation were judged to measure a combination of domains.ConclusionsWe have developed a questionnaire in English and in Dutch able to discriminately assess the majority of TDF domains. The results partly support Cane et al.’s (2012) 14-domain validation of the TDF and suggest that Michie et al.’s (2005) 12-domain original version might be more applicable in developing a TDF-based questionnaire. The identified items provide a robust basis for developing a questionnaire to measure TDF-based determinants of healthcare professionals’ implementation behaviors to suit different targets, actions, contexts, and times. Future research should investigate the concurrent and predictive validity and reliability of such a questionnaire in practice.

Measuring determinants of implementation behavior: psychometric properties of a questionnaire based on the theoretical domains framework

BackgroundTo be able to design effective strategies to improve healthcare professionals’ implementation behaviors, a valid and reliable questionnaire is needed to assess potential implementation determinants. The present study describes the development of the Determinants of Implementation Behavior Questionnaire (DIBQ) and investigates the reliability and validity of this Theoretical Domains Framework (TDF)-based questionnaire.MethodsThe DIBQ was developed to measure the potential behavioral determinants of the 12-domain version of the TDF (Michie et al., 2005). We identified existing questionnaires including items assessing constructs within TDF domains and developed new items where needed. Confirmatory factor analysis was used to examine whether the predefined structure of the TDF-based questionnaire was supported by the data. Cronbach’s alpha was calculated to assess internal consistency reliability of the questionnaire, and domains’ discriminant validity was investigated.ResultsWe developed an initial questionnaire containing 100 items assessing 12 domains. Results obtained from confirmatory factor analysis and Cronbach’s alpha resulted in the final questionnaire consisting of 93 items assessing 18 domains, explaining 63.3% of the variance, and internal consistency reliability values ranging from .68 to .93. Domains demonstrated good discriminant validity, although the domains ‘Knowledge’ and ‘Skills’ and the domains ‘Skills’ and ‘Social/professional role and identity’ were highly correlated.ConclusionsWe have developed a valid and reliable questionnaire that can be used to assess potential determinants of healthcare professional implementation behavior following the theoretical domains of the TDF. The DIBQ can be used by researchers and practitioners who are interested in identifying determinants of implementation behaviors in order to be able to develop effective strategies to improve healthcare professionals’ implementation behaviors. Furthermore, the findings provide a novel validation of the TDF and indicate that the domain ‘Environmental context and resources’ might be divided into several environment-related domains.

Effects of a cognitive behavioral self-help program and a computerized structured writing intervention on depressed mood for HIV-infected people: A pilot randomized controlled trial

OBJECTIVEnThe aim of the present study was to examine whether low-resource, cost-effective intervention programs can be effective in improving depressed mood in people with HIV. The efficacy of a cognitive-behavioral self-help program (CBS) and a computerized structured writing intervention (SWI) were tested in a pilot randomized controlled trial.nnnMETHODSnParticipants were members of a patient organization. They completed a pretest and posttest. The questionnaire included the HADS. Participants were randomly allocated to CBS (n=24), SWI (n=25) or a waiting list condition (WLC, n=24). To evaluate changes in the continuous outcome measure, a 3 x 2 (group x time) repeated measures ANCOVA was performed. Also, an ANCOVA was performed using change scores.nnnRESULTSnRespondents who followed the CBS improved significantly compared to the WLC. However, for people in the SWI condition no significant improvement on depression was found.nnnCONCLUSIONnThis pilot study suggests that a low-resource, cost-effective CBS program seems to be effective in reducing depressed mood in people living with HIV.nnnPRACTICE IMPLICATIONSnBecause self-help programs can be delivered through regular mail or the internet, a high number of people could be reached while overcoming geographical and social barriers to treatment.

Goal processes in relation to goal attainment: predicting health-related quality of life in myocardial infarction patients.

Goal theory suggests that both goal attainment and psychological processes concerning goal pursuit can influence a patient’s (health-related) quality of life (HRQL) (e.g. Carver & Scheier, 1999). In the present longitudinal study, 46 MI patients completed questionnaires shortly after hospitalization and four months later, assessing a health, social and individual goal for the coming year, goal conflict, goal self-efficacy, goal attainment and HRQL. The results of a multiple regression analysis suggest that both goal conflict and goal self-efficacy predict goal attainment. Furthermore, goal self-efficacy appeared to be an independent predictor of physical and social HRQL. Goal attainment had a medium effect on social HRQL, but its effect was mediated by goal conflict and goal self-efficacy. A goal theory perspective seems to offer additional insights into HRQL after an MI.