Jochen P. Ziegelmann

Adoption and maintenance of four health behaviors: Theory-guided longitudinal studies on dental flossing, seat belt use, dietary behavior, and physical activity

Background: Adoption and maintenance of health behaviors are often poorly predicted by behavioral intentions. To bridge the gap between intentions and behavior, strategic planning and recovery self-efficacy have been suggested as proximal predictors.Purpose: The aim was to examine the usefulness of a prediction model that includes planning and self-efficacy as postintentional mediator variables.Methods: Four longitudinal studies were conducted on dental flossing (Study I, N = 157), seat belt use (Study II, N = 298), dietary behaviors (Study III, N = 700), and physical activity (Study IV, N = 365). Dental flossing and seat belt use were assessed in students by paper-and-pencil questionnaires, whereas dietary behavior and physical activity inventories were presented to the general public in the internet.Results: By structural equation modeling, it was found that one common model fits all four data sets well. Results differed in terms of variance accounted for, but the overall patterns of estimated parameters were similar across samples.Conclusions: Self-efficacy and planning seemed to be functional as proximal predictors of health behaviors, whereas health risk perception appeared to be a negligible factor. When predicting health behaviors, self-regulatory variables should be used in addition to the behavioral intention.

Adoption and maintenance of physical activity: Planning interventions in young, middle-aged, and older adults

Young, middle-aged, and older adults in orthopaedic outpatient rehabilitation (N = 373) were randomly assigned to either an interviewer-assisted or a standard-care self-administered planning intervention. Physical activity planning consisted of specifying action plans to facilitate action initiation, and coping plans to overcome barriers. The interviewer-assisted condition led to more complete action plans and a longer duration of physical activities up to six months after discharge. Regarding coping planning, older and middle-aged adults benefited more from interviewer-assisted planning while younger adults benefited more from self-administered planning. Planning as such was found to be an effective tool for enactment irrespective of chronological age. The delayed effect of coping planning on enactment suggests that coping planning is important for long-term maintenance.

Social-cognitive predictors of physical exercise adherence : Three longitudinal studies in rehabilitation

OBJECTIVE Levels of physical exercise adherence are not predicted well by behavioral intentions. Therefore, action planning and recovery self-efficacy were specified as proximal predictors to bridge the gap between intentions and adherence. The prediction model was examined in 3 studies with participants who were enrolled in cardiac rehabilitation (Study 1, N = 353; Study 2, N = 114) or orthopedic rehabilitation (Study 3, N = 368). MAIN OUTCOME MEASURE Each study included 3 measurement points in time, covering a period between 4 and 12 months. Intentions, planning, self-efficacy, and exercise levels were assessed. RESULTS Structural equation modeling revealed that 1 common model fit all 3 data sets well. Results differed in terms of variance accounted for, but the overall patterns of estimated parameters were similar. CONCLUSIONS Although health risk perception appeared to be a negligible factor, action planning and recovery self-efficacy were effective predictors of physical exercise adherence.

Initiation and Maintenance of Physical Exercise: Stage-Specific Effects of a Planning Intervention

Achieving a recommended level of physical exercise is a difficult self-regulatory task for many patients in rehabilitation. Psychological interventions are designed to improve initiation and maintenance of exercise. A challenging research question is whether such interventions can be tailored to the special needs of patients at different stages of behavioral change. In particular, this article investigates whether action planning is beneficial for those patients who have the intention to exercise but do not perform physical activities at the recommended level. In a longitudinal (4 waves) study with 560 rehabilitation patients, a planning intervention was evaluated. Action plans and exercise behaviors were higher in the experimental planning group than in the no-treatment control group. Patients with the intention to exercise but who have been inactive benefited more from the planning intervention than patients without the intention to act or patients who had been active before. The results suggest that matching treatments to people in a particular stage is a promising procedure. Moreover, if patients formed intentions and action plans, they were more likely to adhere to the recommended level of exercise.

Validity of stage assessment in the adoption and maintenance of physical activity and fruit and vegetable consumption.

OBJECTIVE Stage assessments are examined to develop and test refined measurements that can be used for classifying individuals. DESIGN Stages were assessed in 1,850 persons in terms of their physical activity and dietary behaviors. MAIN OUTCOME MEASURES Stages for both behaviors were compared to behavior and other test variables. Misclassification, sensitivity, specificity, receiver-operation-curves, and discontinuity patterns were computed. Discontinuity patterns were tested with trends across stages and planned contrasts between adjacent stages. RESULTS In comparison to previous studies, sensitivity (70% to 80%) and specificity (80% to 87%) were high. When using lower level criteria (such as less intensive activity), sensitivity was lower, whereas specificity was higher. When behavioral maintenance was assessed, results suggested that the temporal cut-off point between action and maintenance was equally optimal at different cut-off points. Applying contrast analyses, nonlinear trends across the stages and a match of 87% of predictions of stage differences resulted. CONCLUSION Stage assumptions are supported in general, and refined stage assessment in particular. Levels of psychological variables (e.g., easiness, habit) may discriminate stages as well as or even better than temporal stage definitions.

Self-efficacy Moderates the Mediation of Intentions Into Behavior via Plans

OBJECTIVE To examine the putative moderating role of self-efficacy in the intention-planning-behavior relationship. METHODS In N=812 individuals, intentions (independent variable) were assessed at baseline, whereas action plans (mediator), self-efficacy (moderator), and physical activity (dependent variable) were measured again 4 weeks later. We examined a moderated-mediation model. RESULTS Self-efficacy moderates the mediation process: the strength of the mediated effect increased along with levels of self-efficacy. The results remain valid after accounting for baseline physical activity. CONCLUSIONS For plans to mediate the intention-behavior relation, people must hold sufficiently high levels of self-efficacy. If they lack self-efficacy, planning may be in vain.

Are Goal Intentions or Implementation Intentions Better Predictors of Health Behavior? A Longitudinal Study in Orthopedic Rehabilitation

Objective: To compare the predictive power of goal intentions and implementation intentions. Design: Both constructs were expected to explain physical exercise at 3 points in time (with follow-ups at 6 and 12 months) in a sample of 368 persons participating in orthopedic rehabilitation. Results: Goal intentions and implementation intentions predicted exercise during rehabilitation. In contrast, goal intentions failed to predict exercise at later points in time, whereas implementation intentions continued to be associated with exercise 12 months later. Conclusions: Implementation intentions rather than goal intentions predict behavior as it becomes routine. As automatic processes such as behavior elicited by planning are largely age invariant, strengthening those processes might help to overcome volitional problems across all age groups represented in rehabilitation settings.

Medication beliefs predict medication adherence in older adults with multiple illnesses

OBJECTIVE To examine factors preventing medication nonadherence in community-dwelling older adults with multiple illnesses (multimorbidity). Nonadherence threatens successful treatment of multimorbidity. Adherence problems can be intentional (e.g., deliberately choosing not to take medicines or to change medication dosage) or unintentional (e.g., forgetting to take medication) and might depend on a range of factors. This study focused in particular on the role of changes in beliefs about medication to explain changes in adherence. METHODS Longitudinal study with N = 309 individuals aged 65-85 years with two or more diseases at three measurement points over six months. Medication adherence and beliefs about medicines were assessed by questionnaire. Hierarchical weighted least squares regression analyses were used to predict individual intentional and unintentional nonadherence. RESULTS Changes in intentional nonadherence were predicted by changes in specific necessity beliefs (B = -.19, P<.01), after controlling for sociodemographic factors, health status and number of prescribed medicines. Changes in unintentional nonadherence were predicted by changes in general overuse beliefs (B = .26, P<.01), controlling for the same covariates. CONCLUSION Beliefs about medication affect both intentional and unintentional adherence to medication in multimorbid older adults. This points to the importance of addressing medication beliefs in patient education to improve adherence.

How do negative self-perceptions of aging become a self-fulfilling prophecy?

Recent studies have provided considerable evidence on long-term effects of self-perceptions of aging (SPA) on indicators of successful aging such as health or life satisfaction. To date, little is known about the mechanisms underlying these effects. This study therefore examined whether negative SPA impair the use of self-regulation strategies that include selection, optimization, and compensation (SOC) in case of a serious health event and thus turn into self-fulfilling prophecies for health and life satisfaction. Based on a longitudinal nationwide study with 2 measurement points over a 6-month period in 309 older people (65+ years of age) with multiple illnesses, 2 major findings emerged: First, the occurrence of a serious health event predicted increased use of SOC strategies, which in turn predicted higher self-rated health and life satisfaction. Second, this effect was moderated by negative SPA, that is, in case of a serious health event, the perception that aging is associated with physical losses led to lower use of SOC strategies promoting a healthy lifestyle (B = -0.43, SE = 0.15, p < .01). These findings contribute to a better understanding of the underlying mechanisms of SPA on health by showing that negative SPA as associated with physical losses might impair health-related strategies that are important for maintaining a healthy lifestyle. Future intervention studies could attempt to challenge negative SPA to support effective strategy use in older adults with serious illnesses.

The Transplant Effects Questionnaire (TxEQ): The development of a questionnaire for assessing the multidimensional outcome of organ transplantation — example of end stage renal disease (ESRD)

OBJECTIVES: To develop a questionnaire to assess the responses of transplant recipients to the receipt of an organ, including their self-care behaviour. DESIGN: Following a literature review, open-ended interviews and a focus group, a transplant questionnaire was developed. Two studies (Study 1: N = 231, Study 2: N = 105) were conducted to evaluate its psychometric properties. METHODS: A pool of 51 items was derived from themes identified in published studies and from interviews and a focus group discussion with renal transplant recipients. These were constructed into a questionnaire and were then administered to two renal transplant out-patients populations. Item responses of study sample 1 were subjected to principal components analysis (PCA) using varimax rotation to examine the structure of responses. In order to investigate the stability of the factor structure found in Study 1, item responses of the second sample were subjected to confirmatory factor analysis (CFA) using structural equation modelling. RESULTS: PCA indicated six factors that accounted for 64.2% of the variance. With extraneous items omitted, the final questionnaire derived from Study 1 has 24 items clustered around five conceptual coherent factors: worry about transplant (22.1%), guilt regarding donor (11.9%), disclosure (9.58%), medication adherence (8.73%), and responsibility (6.63%). CFA on the final 24-item version of the TxEQ revealed that the resulting model was a good fit for the Study 2 data (RMSEA = 0.08, pclose =.005). CONCLUSIONS: The TxEQ has potential application as a measure in the area of transplantation research. CFA demonstrated that the factor structure of the TxEQ is consistent across different renal transplant out-patients populations. Further research is currently in progress to assess other groups of transplant recipients and to examine its relationship to other measures.