Natalie Schüz

Effects of telephone health mentoring in community-recruited chronic obstructive pulmonary disease on self-management capacity, quality of life and psychological morbidity: a randomised controlled trial

Objectives To assess benefits of telephone-delivered health mentoring in community-based chronic obstructive pulmonary disease (COPD). Design Cluster randomised controlled trial. Setting Tasmanian general practices: capital city (11), large rural (3), medium rural (1) and small rural (16). Participants Patients were invited (1207) from general practitioner (GP) databases with COPD diagnosis and/or tiotropium prescription, response rate 49% (586), refused (176) and excluded (criteria: smoking history or previous study, 68). Spirometry testing (342) confirmed moderate or severe COPD in 182 (53%) patients. Randomisation By random numbers code, block stratified on location, allocation by sequentially numbered, opaque and sealed envelopes. Intervention Health mentor (HM) group received regular calls to manage illness issues and health behaviours from trained community health nurses using negotiated goal setting: problem solving, decision-making and action planning. Control: usual care (UC) group received GP care plus non-interventional brief phone calls. Outcomes Measured at 0, 6 and 12 months, the Short Form 36 (SF-36) and St George’s Respiratory Questionnaire (SGRQ, primary); Partners In Health (PIH) Scale for self-management capacity, Hospital Anxiety and Depression Scale (HADS), Center for Epidemiologic Studies-Depression (CES-D) questionnaire, Post-Traumatic Stress Disorder Checklist, Satisfaction with life and hospital admissions (secondary). Results 182 participants with COPD (age 68±8 years, 62% moderate COPD and 53% men) were randomised (HM=90 and UC=92). Mixed model regression analysis accounting for clustering, adjusting for age, gender, smoking status and airflow limitation assessed efficacy (regression coefficient, β, reported per 6-month visit). There was no difference in quality of life between groups, but self-management capacity increased in the HM group (PIH overall 0.15, 95% CI 0.03 to 0.29; knowledge domain 0.25, 95% CI 0.00 to 0.50). Anxiety decreased in both groups (HADS A 0.35; 95% CI −0.65 to −0.04) and coping capacity improved (PIH coping 0.15; 95% CI 0.04 to 0.26). Conclusions Health mentoring improved self-management capacity but not quality of life compared to regular phone contact, which itself had positive effects where decline is generally expected.

Facilitating Sunscreen Use in Women by a Theory-Based Online Intervention: A Randomized Controlled Trial

This study compares a motivational skin cancer prevention approach with a volitional planning and self-efficacy intervention to enhance regular sunscreen use. A randomized controlled trial (RCT) was conducted with 205 women (mean age 25 years) in three groups: motivational; volitional; and control. Sunscreen use, action planning, coping planning and coping self-efficacy were assessed at three points in time. The volitional intervention improved sunscreen use. Coping planning emerged as the only mediator between the intervention and sunscreen use at Time 3. Findings point to the role played by coping planning as an ingredient of sun protection interventions.

When Risk Communication Backfires: Randomized Controlled Trial on Self-Affirmation and Reactance to Personalized Risk Feedback in High-Risk Individuals

OBJECTIVE Health promotion often faces the problem that populations with high behavioral risk profiles respond defensively to health promotion messages by negating risk or reactant behavior. Self-affirmation theory proposes that defensive reactions are an attempt of the self-system to maintain integrity. In this article, we examine whether a self-affirmation manipulation can mitigate defensive responses to personalized visual risk feedback in the skin cancer prevention context (ultraviolet [UV] photography), and whether the effects pertain to individuals with high behavioral risk status (high personal relevance of tanning). METHOD We conducted a full-factorial randomized controlled trial (N = 292; age 11-71) following a 2 * 2 design (UV photo yes/no, self-affirmation yes/no). Follow-up period was 2 weeks. Subsequent tanning behavior, sun avoidance intentions, and risk perception. RESULTS A multivariate analysis of variance (MANOVA) revealed a three-way interaction between risk feedback, the self-affirmation manipulation, and risk status for the three outcome measures. Follow-up analyses of variance (ANOVAs) indicated that high-risk individuals receiving only the risk feedback intervention reacted defensively and reported higher exposure. A self-affirmation manipulation mitigates this reactance effect both on the level of cognitions and behavior. CONCLUSION Self-affirmation has influential implications not only for Social Psychology but also for health prevention measures. The findings support the effectiveness of self-affirmation in reducing reactant and defensive reactions to personalized visual risk feedback. Interactions with health risk status indicate that self-affirmation might increase the effectiveness of health promotion messages in high-risk populations.

Compliance with an EMA monitoring protocol and its relationship with participant and smoking characteristics.

INTRODUCTION Arguably, the greatest advantage of ecological momentary assessment (EMA) studies is that data are collected repeatedly in real-time and real-world situations, which reduces recall and situational biases and thus improves the accuracy and validity of the data collected. However, the validity of EMA data is contingent upon compliance rates. If participant characteristics are related to missing data, analyses should control for these factors, or they should be targeted in EMA training sessions. This study evaluates the impact of demographic and smoking-related participant characteristics on compliance to an EMA smoking study protocol. METHODS Prequit-day data were taken from the control arm of an ongoing randomized controlled trial of a smoking-cessation program. After training, 119 participants were asked to carry a mobile device with them at all times for ~6 days and to log every cigarette they smoked in addition to completing randomly scheduled assessments. Different types of compliance were assessed: the percentage of completed random prompts (signal-contingent compliance), the percentage of logged cigarettes per day compared to a timeline follow-back measure, and the correlation between logged cigarettes and a carbon monoxide assessment 2 hr later (both event-contingent compliance). RESULTS Overall compliance rates were 78.48% for event-contingent and 72.17% for signal-contingent compliance. None of the demographic or smoking-related participant characteristics predicted signal-contingent compliance; however, female participants showed higher event-contingent compliance than male participants, and Caucasian participants showed higher event-contingent compliance than non-Caucasian participants. CONCLUSIONS Compliance did not depend on smoking-related characteristics. EMA is a valid method for assessing smoking behavior in real-time and real-world settings.

Enhancing planning strategies for sunscreen use at different stages of change

To promote sun safety by implementing different plans for sunscreen use, different psychological interventions are compared. Self-regulatory strategies such as action planning and coping planning are seen as proximal predictors of actual behavior. The study compares a pure planning intervention with a broader resource communication and examines differential effects at different stages of change. A sun safety online study was designed with two intervention groups (resource communication versus planning) and one control group at two assessment points, 2 weeks apart. Participants (N = 292) were grouped post hoc according to their stage of change, resulting in 51 pre-intenders (no intention to use sunscreen), 102 intenders (high intention but no regular use of sunscreen) and 139 actors (sunscreen use on a regular basis). No overall treatment effects on planning, but an interaction between time, stage and intervention emerged. The resource communication was more effective for pre-intenders, whereas the planning intervention proved more effective for intenders. A planning treatment was more beneficial in motivated individuals, whereas a broader approach was better for unmotivated ones. Findings highlight the potential that stage-matched interventions might have in the context of sun safety promotion.

Risk perception moderates how intentions are translated into sunscreen use

Planning is supposed to mediate between intention and behavior. The study examines whether such a mediation also exists in the context of sunscreen use. Moreover, the question is raised whether health risk perception might moderate such a mechanism. A longitudinal online study was conducted with three measurement points in time. Sunscreen use, intention, planning, and risk perception were assessed. A sample of 154 individuals was analyzed by hierarchical regression procedures in terms of moderated mediation. Planning partially mediated the intention-behavior relationship, and risk perception operated as a moderator. The moderator effect was negative, implying that low risk perception in conjunction with high intention was a prerequisite for planning, and, thus, for the mediation by planning. Low risk perception reflects health-specific optimism which can be a facilitator of health behavior change, in this case the change of sunscreen use from Time 1 to Time 3.

Illness representations, coping, and illness outcomes in people with cancer: a systematic review and meta‐analysis

Cancer is associated with negative health and emotional outcomes in those affected by it, suggesting the need to better understand the psychosocial determinants of illness outcomes and coping. The common sense model is the leading psychological model of self‐regulation in the face of illness and assumes that subjective illness representations explain how people attempt to cope with illness. This systematic review and meta‐analysis examines the associations of the common sense models illness representation dimensions with health and coping outcomes in people with cancer.

Situational Cues and Momentary Food Environment Predict Everyday Eating Behavior in Adults With Overweight and Obesity.

Objectives: Individual eating behavior is a risk factor for obesity and highly dependent on internal and external cues. Many studies also suggest that the food environment (i.e., food outlets) influences eating behavior. This study therefore examines the momentary food environment (at the time of eating) and the role of cues simultaneously in predicting everyday eating behavior in adults with overweight and obesity. Method: Intensive longitudinal study using ecological momentary assessment (EMA) over 14 days in 51 adults with overweight and obesity (average body mass index = 30.77; SD = 4.85) with a total of 745 participant days of data. Multiple daily assessments of eating (meals, high- or low-energy snacks) and randomly timed assessments. Cues and the momentary food environment were assessed during both assessment types. Results: Random effects multinomial logistic regression shows that both internal (affect) and external (food availability, social situation, observing others eat) cues were associated with increased likelihood of eating. The momentary food environment predicted meals and snacking on top of cues, with a higher likelihood of high-energy snacks when fast food restaurants were close by (odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.22, 2.93) and a higher likelihood of low-energy snacks in proximity to supermarkets (OR = 2.29, 95% CI = 1.38, 3.82). Conclusions: Real-time eating behavior, both in terms of main meals and snacks, is associated with internal and external cues in adults with overweight and obesity. In addition, perceptions of the momentary food environment influence eating choices, emphasizing the importance of an integrated perspective on eating behavior and obesity prevention.

Novel Technologies to Study Smoking Behavior: Current Developments in Ecological Momentary Assessment

Ecological momentary assessment (EMA) methods for the capture of real-world data in real time have seen significant advances, both in popularity and application, over the past few years. As a research methodology, EMA offers considerable advantages and has proven to be particularly suited to the study of substance dependence research. Using EMA, research participants can record information about events, symptoms, situations, thoughts, feelings, and behaviors as they occur. Moreover, when used in concert with other technologies, such as geospatial software, EMA becomes a tool with which researchers can gather rich data about individuals’ daily lives. This review aims to introduce the reader to EMA and to the rationale behind its use. We discuss the applications for which EMA can be used, and the many advantages they offer, with a particular focus on the study of smoking behaviors.

Patient Anxiety and Depression Moderate the Effects of Increased Self-management Knowledge on Physical Activity: A Secondary Analysis of a Randomised Controlled Trial on Health-Mentoring in COPD

Abstract Objective. Anxiety and depression are common comorbidities in people with chronic obstructive pulmonary disease (COPD). While these comorbidities could potentially lead to a higher motivation to learn about self-management, they could also inhibit patients from translating this knowledge into appropriate self-management behaviours. This paper explores the moderating effects of anxiety and depression on a health-mentoring intervention, focusing on mechanisms of change (mediation). Methods. 182 COPD patients participated in an RCT, with anxiety and depression assessed by the Hospital Anxiety and Depression Scale (HADS), self-management knowledge by the Partners in Health Scale, and spontaneous physical activity using accelerometers, all measured at baseline, 6 and 12 months. The moderated mediation model tested the interventions effect on physical activity, mediated via changes in self-management knowledge, at different levels of anxiety and depression. Results. Knowledge mediated the effect of the intervention on changes in physical activity only for participants reporting low levels of anxiety or depression. Both acted as moderators: Increased knowledge led to more physical activity among participants reporting low anxiety or depression and to less activity among highly anxious or depressed participants. Conclusion. Although health-mentoring interventions can be an effective tool to increase knowledge and physical activity among COPD patients, it is essential to take anxiety and depression into account, as increased knowledge may have detrimental effects in highly anxious or depressed participants. This suggests that patients with elevated anxiety or depression may need to be treated appropriately before engaging in chronic disease self-management interventions.