Gill A. ten Hoor

Implementation intention and planning interventions in Health Psychology: Recommendations from the Synergy Expert Group for research and practice

The current article details a position statement and recommendations for future research and practice on planning and implementation intentions in health contexts endorsed by the Synergy Expert Group. The group comprised world-leading researchers in health and social psychology and behavioural medicine who convened to discuss priority issues in planning interventions in health contexts and develop a set of recommendations for future research and practice. The expert group adopted a nominal groups approach and voting system to elicit and structure priority issues in planning interventions and implementation intentions research. Forty-two priority issues identified in initial discussions were further condensed to 18 key issues, including definitions of planning and implementation intentions and 17 priority research areas. Each issue was subjected to voting for consensus among group members and formed the basis of the position statement and recommendations. Specifically, the expert group endorsed statements and recommendations in the following areas: generic definition of planning and specific definition of implementation intentions, recommendations for better testing of mechanisms, guidance on testing the effects of moderators of planning interventions, recommendations on the social aspects of planning interventions, identification of the preconditions that moderate effectiveness of planning interventions and recommendations for research on how people use plans.

A new direction in psychology and health: Resistance exercise training for obese children and adolescents

Obesity is a growing health problem globally (Swinburn et al., 2011). It is an established risk factor for chronic metabolic and cardiovascular diseases (Kelsey, Zaepfel, Bjornstad, & Nadeau, 2014;...

Reactions to threatening health messages

BackgroundThreatening health messages that focus on severity are popular, but frequently have no effect or even a counterproductive effect on behavior change. This paradox (i.e. wide application despite low effectiveness) may be partly explained by the intuitive appeal of threatening communication: it may be hard to predict the defensive reactions occurring in response to fear appeals. We examine this hypothesis by using two studies by Brown and colleagues, which provide evidence that threatening health messages in the form of distressing imagery in anti-smoking and anti-alcohol campaigns cause defensive reactions.MethodsWe simulated both Brown et al. experiments, asking participants to estimate the reactions of the original study subjects to the threatening health information (n = 93). Afterwards, we presented the actual original study outcomes. One week later, we assessed whether this knowledge of the actual study outcomes helped participants to more successfully estimate the effectiveness of the threatening health information (n = 72).ResultsResults showed that participants were initially convinced of the effectiveness of threatening health messages and were unable to anticipate the defensive reactions that in fact occurred. Furthermore, these estimates did not improve after participants had been explained the dynamics of threatening communication as well as what the effects of the threatening communication had been in reality.ConclusionsThese findings are consistent with the hypothesis that the effectiveness of threatening health messages is intuitively appealing. What is more, providing empirical evidence against the use of threatening health messages has very little effect on this intuitive appeal.

Ignoring theory and misinterpreting evidence : the false belief in fear appeals

ABSTRACT Use of fear appeals assumes that when people are emotionally confronted with the negative effects of their behaviour they will change that behaviour. That reasoning is simple and intuitive, but only true under specific, rare circumstances. Risk perception theories predict that if people will experience a threat, they want to counter that threat. However, how they do so is determined by their coping efficacy level: if efficacy is high, they may change their behaviour in the suggested direction; if efficacy is low, they react defensively. Research on fear appeals should be methodologically sound, comparing a threatening to a non-threatening intervention under high and low efficacy levels, random assignment and measuring behaviour as outcome. We critically review extant empirical evidence and conclude that it does not support positive effects of fear appeals. Nonetheless, their use persists and is even promoted by health psychology researchers, causing scientific insights to be ignored or misinterpreted.

Combating adolescent obesity: an integrated physiological and psychological perspective.

Purpose of reviewOptimizing the approach to combat childhood obesity, we emphasize the importance of combining both biological and psychological knowledge. In such an approach, strength exercises might be an important aspect in the treatment and prevention of childhood obesity. Recent findingsRecent evidence indicates plausible effects of the role of resistance exercise in combating the negative health effects of childhood obesity. When looking at body composition, overweight youngsters do not only have a higher fat mass, but also a higher muscle mass compared with their normal-weight counterparts. With that, they are also stronger and better in exercises wherein the focus is on absolute strength, making them – under the right circumstances – more motivated to engage in resistance exercise and ultimately maintain a physically active lifestyle. SummaryMore and more children are obese, and obese children become obese adults. One reason that overweight youngsters are not physically active is that they are outperformed by normal-weight youngsters, and one reason they are overweight is because they are not physically active. To combat childhood obesity, strength exercise might be a solution to break the vicious cycle.

The Influence of Two Different Invitation Letters on Chlamydia Testing Participation: Randomized Controlled Trial

Background In the Netherlands, screening for chlamydia (the most prevalent sexually transmitted infection worldwide) is a relatively simple and free procedure. Via an invitation letter sent by the public health services (PHS), people are asked to visit a website to request a test kit. They can then do a chlamydia test at home, send it anonymously to a laboratory, and, within two weeks, they can review their test results online and be treated by their general practitioner or the PHS. Unfortunately, the participation rates are low and the process is believed to be not (cost-) effective. Objective The objective of this study was to assess whether the low participation rate of screening for chlamydia at home, via an invitation letter asking to visit a website and request a test kit, could be improved by optimizing the invitation letter through systematically applied behavior change theories and evidence. Methods The original letter and a revised letter were randomly sent out to 13,551 citizens, 16 to 29 years old, in a Dutch municipality. Using behavior change theories, the revised letter sought to increase motivation to conduct chlamydia screening tests. The revised letter was tailored to beliefs that were found in earlier studies: risk perception, advantages and disadvantages (attitude), moral norm, social influence, and response- and self-efficacy. Revisions to the new letter also sought to avoid possible unwanted resistance caused when people feel pressured, and included prompts to trigger the desired behavior. Results No significant differences in test package requests were found between the two letters. There were also no differences between the original and revised letters in the rates of returned tests (11.80%, 581/4922 vs 11.07%, 549/4961) or positive test results (4.8%, 23/484 vs 4.1%, 19/460). It is evident that the new letter did not improve participation compared to the original letter. Conclusions It is clear that the approach of inviting the target population through a letter does not lead to higher participation rates for chlamydia screening. Other approaches have to be developed and pilot tested.

The psychological effects of strength exercises in people who are overweight or obese: a systematic review

BackgroundOverweightness and obesity represent a high burden on well-being and society. Strength training has positive effects on body composition and metabolic health for people who are overweight or obese. The evidence for psychological effects of strength exercises is unclear.ObjectiveThe aim of this study was to assess the psychological effects of strength exercises for people who are overweight or obese.MethodsRelevant literature was identified by use of the PubMed and PsycINFO databases. For each study, effect sizes and corresponding variance estimates were extracted or calculated for the main effects of strength exercises on psychological outcomes.ResultsSeventeen studies were included. There was almost no overlap among the various measures of psychological constructs. The constructs were ordered into eight broad categories. Meta-analytical techniques revealed substantial heterogeneity in effect sizes, and combined with the low number of effect size estimates for each outcome measure, this precluded meta-analysis. Organization of the data showed that the evidence base so far does not show convincing effects of strength training on psychological outcome measures. Some weak effects emerged on self-efficacy, self-esteem, inhibition, and psychological disorders (e.g., anxiety and depression). No additional or comparable effects to other interventions were found for mood, outcome expectations, quality of life, and stress.DiscussionThe main finding of this review is that despite a strong theoretical basis for expecting positive effects of strength training on psychological outcomes, the literature shows a large gap in this area. The existing research does not show a clear picture: some positive results might exist, but there is a strong need to accumulate more evidence before drawing conclusions.

Test-retest reproducibility and validity of the back-leg-chest strength measurements

BACKGROUND: A single measure to characterize overall muscle strength is advantageous because it saves time and costs of evaluation. For this reason, the back-leg-chest (BLC) strength might be an appropriate single measure in characterizing total body strength. OBJECTIVE: To assess the test-retest reproducibility and smallest real difference (SRD) of the BLC dynamometer in healthy adults and adolescents and to examine whether handgrip, knee-extensor and knee-flexor strength predict BLC strength in healthy adults. METHODS: Forty-five adults and 58 adolescents were recruited. In a first session back-leg-chest strength, handgrip strength, and additionally, in adults, isometric knee-extensor strength, and knee-flexor strength were measured. In a second session, 2–5 days later, BLC strength was measured again for test-retest reproducibility. RESULTS: Inter-session correlations of BLC strength were high (all r’s and ICC’s > 0.92). Bland-Altman-plots showed high agreement. The SRD and SRD% were between 14–26, and 19% and 26% respectively. Strength variables (handgrip, kneeextensor, and knee-flexor strength) explained 87% of the variance in BLC strength. A stepwise linear regression showed that dominant knee extensor and flexor strength were the most important significant predictors of BLC strength (r 2 = 0.86). CONCLUSIONS: This study demonstrated that the BLC dynamometer has reasonably high test-retest reproducibility and hence may serve in some pertinent situations to be an appropriate tool for clinical, basic and applied research.

Zijn er alternatieven voor angstaanjagende voorlichting? Gebruik Intervention Mapping!

In onze vorige bijdrage1hebben we uitgelegd dat angstaanjagende voorlichting nog veel wordt gebruikt, maar niet effectief is. Kort samengevat: onze metaanalyse2 toont aan dat hoge dreiging alleen tot gedragsverandering leidt bij hoge waargenomen effectiviteit (‘efficacy’), en hoge effectiviteit alleen tot gedragsverandering leidt bij hoge dreiging. Zorgwekkend is het effect van dreiging bij lage effectiviteit: het effect is weliswaar slechts marginaal significant, maar negatief. In lijn met de theorie zien we dat bij lage effectiviteit angstaanjagende voorlichting averechtse effecten kan hebben. Juist die combinatie komt veel voor.AbstractAre there alternatives for threatening communications? Apply Intervention Mapping!Recently we explained why threatening communications are popular but not effective. One reason threatening communications are used is a perceived lack of alternatives. In this contribution we will present a way to find possible alternatives: applying Intervention Mapping (IM). IM is a 6-step protocol for developing health promotion programs based on available evidence and theory. IM especially helps program planners 1) with selecting the relevant determinants of behavior and environments and 2) with the use of theories in identifying and applying appropriate methods for change. There are enough trained professionals in the Netherlands able to use IM; give them a chance.

Validation of the VitaBit Sit-Stand Tracker : Detecting Sitting, Standing, and Activity Patterns

Sedentary behavior (SB) has detrimental consequences and cannot be compensated for through moderate-to-vigorous physical activity (PA). In order to understand and mitigate SB, tools for measuring and monitoring SB are essential. While current direct-to-customer wearables focus on PA, the VitaBit validated in this study was developed to focus on SB. It was tested in a laboratory and in a free-living condition, comparing it to direct observation and to a current best-practice device, the ActiGraph, on a minute-by-minute basis. In the laboratory, the VitaBit yielded specificity and negative predictive rates (NPR) of above 91.2% for sitting and standing, while sensitivity and precision ranged from 74.6% to 85.7%. For walking, all performance values exceeded 97.3%. In the free-living condition, the device revealed performance of over 72.6% for sitting with the ActiGraph as criterion. While sensitivity and precision for standing and walking ranged from 48.2% to 68.7%, specificity and NPR exceeded 83.9%. According to the laboratory findings, high performance for sitting, standing, and walking makes the VitaBit eligible for SB monitoring. As the results are not transferrable to daily life activities, a direct observation study in a free-living setting is recommended.