Nelli Hankonen

Type 2 Diabetes Prevention in the Real World: Three-year results of the GOAL Lifestyle Implementation Trial

OBJECTIVE We study the effectiveness of the GOAL Lifestyle Implementation Trial at the 36-month follow-up. RESEARCH DESIGN AND METHODS Participants (n = 352, type 2 diabetes risk score FINDRISC = 16.2 ± 3.3, BMI 32.6 ± 5.0 kg/m2) received six lifestyle counseling sessions over 8 months. Measurements were at baseline, 12 months (88.6%), and 36 months (77.0%). RESULTS Statistically significant risk reduction at 12 months was maintained at 36 months in weight (−1.0 ± 5.6 kg), BMI (−0.5 ± 2.1 kg/m2), and serum total cholesterol (−0.4 ± 1.1 mmol/l). CONCLUSIONS Maintenance of risk reduction in this “real world” trial proves the interventions potential for significant public health impact.

Gender differences in social cognitive determinants of exercise adoption

Gender differences in lifestyle-related mortality and morbidity suggest a need to investigate gender-specificity of health behaviour change process and factors influencing it. We tested whether changes in self-efficacy beliefs and planning, as well as the level of social support predict change in exercise. Finnish men and women, aged 50–65 years, at an increased risk for type 2 diabetes were recruited from health care centres to participate in the Good Ageing in Lahti Region (GOAL) Lifestyle Implementation Trial. Psychosocial factors were measured with questionnaires and exercise with 7-day physical activity diaries at baseline and at 3 months. At baseline, no gender differences were found in self-efficacy and planning, but men reported receiving more social support than women. At 3 months, women reported having formed more action plans for changing their exercise routines than men. Among women, increase in self-efficacy and planning predicted increase in exercise. Among men, changes in planning played a less significant role. The more salient role of planning for women than for men, and the fact that women receive less social support, may reflect life circumstances allowing less spontaneous lifestyle decisions and a lower acceptance of lifestyle changes by their social environment.

Type 2 Diabetes Prevention in the Real World Three-year results of the GOAL Lifestyle Implementation Trial

OBJECTIVE We study the effectiveness of the GOAL Lifestyle Implementation Trial at the 36-month follow-up. RESEARCH DESIGN AND METHODS Participants (n = 352, type 2 diabetes risk score FINDRISC = 16.2 ± 3.3, BMI 32.6 ± 5.0 kg/m2) received six lifestyle counseling sessions over 8 months. Measurements were at baseline, 12 months (88.6%), and 36 months (77.0%). RESULTS Statistically significant risk reduction at 12 months was maintained at 36 months in weight (−1.0 ± 5.6 kg), BMI (−0.5 ± 2.1 kg/m2), and serum total cholesterol (−0.4 ± 1.1 mmol/l). CONCLUSIONS Maintenance of risk reduction in this “real world” trial proves the interventions potential for significant public health impact.

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.

Dynamic psychological and behavioral changes in the adoption and maintenance of exercise

OBJECTIVE Although health cognitions are regarded as key determinants for health behavior change, they are rarely studied from a dynamic perspective, evaluating the impact of changes in cognitions on changes in behavior. In the present study, we examine how changes in phase-specific and generic health cognitions influence first, the adoption of exercise and later, the maintenance of the newly acquired behavior. METHODS Participants were middle-aged, Finnish adults participating in a lifestyle intervention to prevent Type 2 diabetes (N = 389). Health cognitions and exercise were measured at baseline (preintervention) and twice after a lifestyle intervention took place (at 3 months and after 1 year). RESULTS The results show that both phase-specific and generic health cognitions changed during the intervention. However, these changes were most pronounced within those participants who started at a lower level to begin with. Most important, evidence for the dynamic interplay between changes in health cognitions and health behavior was observed: Phase-specific health cognitions facilitated the adoption as well as the maintenance of behavior changes. CONCLUSIONS Thus, health cognitions are amenable to change, and these changes are adaptive in terms of initiating and maintaining health behavior change. This has implications both for practical intervention research, as well as for theory development.

A systematic review of school-based interventions targeting physical activity and sedentary behaviour among older adolescents

ABSTRACT Lack of physical activity (PA) and high levels of sedentary behaviour (SB) have been associated with health problems. This systematic review evaluates the effectiveness of school-based interventions to increase PA and decrease SB among 15–19-year-old adolescents, and examines whether intervention characteristics (intervention length, delivery mode and intervention provider) and intervention content (i.e. behaviour change techniques, BCTs) are related to intervention effectiveness. A systematic search of randomised or cluster randomised controlled trials with outcome measures of PA and/or SB rendered 10 results. Risk of bias was assessed using the Cochrane risk of bias tool. Intervention content was coded using Behaviour Change Technique Taxonomy v1. Seven out of 10 studies reported significant increases in PA. Effects were generally small and short-term (Cohens d ranged from 0.132 to 0.659). Two out of four studies that measured SB reported significant reductions in SB. Interventions that increased PA included a higher number of BCTs, specific BCTs (e.g., goal setting, action planning and self-monitoring), and were delivered by research staff. Intervention length and mode of delivery were unrelated to effectiveness. More studies are needed that evaluate long-term intervention effectiveness and target SBs among older adolescents.

Predicting changes in lifestyle and clinical outcomes in preventing diabetes: the Greater Green Triangle Diabetes Prevention Project.

OBJECTIVES To analyse how psychosocial determinants of lifestyle changes targeted in the Greater Green Triangle Diabetes Prevention Project conducted in Southeast Australia in 2004-2006 predict changes in dietary behaviour and clinical risk factors. METHODS A longitudinal pre-test and post-test study design was used. The group program was completed by 237 people at high risk of type 2 diabetes. Associations between changes in the variables were examined by structural equation modelling using a path model in which changes in psychological determinants for lifestyle predicted changes in dietary behaviours (fat and fibre intake), which subsequently predicted changes in waist circumference and other clinical outcomes. Standardised regression weights are presented, with β=±0.1 and β=±0.3 representing small and medium associations, respectively. RESULTS Improvements in coping self-efficacy and planning predicted improvements in fat (β=-0.15, p<0.05 and β=-0.32, p<0.001, respectively) and fibre intake (β=0.15, p<0.05 and β=0.23, p<0.001, respectively) which in turn predicted improvements in waist circumference (β=0.18, p<0.01 and β=-0.16, p<0.05, respectively). Improvements in waist circumference predicted improvements in diastolic blood pressure (β=0.13, p<0.05), HDL (β=-0.16, p<0.05), triglycerides (β=0.17, p<0.01), and fasting glucose (β=0.15, p<0.05). CONCLUSIONS Psychological changes predicted behaviour changes, resulting in 12-month biophysical changes. The findings support the theoretical basis of the interventions.

Toward Identifying a Broader Range of Social Cognitive Determinants of Dietary Intentions and Behaviors

BACKGROUND Measurement of social cognitive variables is often restricted to long-term and health-related outcomes. A more comprehensive measurement of cognitive determinants would enable evidence-based design of health behavior interventions with a focus on the most relevant targets. The purpose of this study was to examine the relative impact of different social cognitive determinants on fruit and vegetable (FV) and fast food consumption. METHODS Finnish male conscripts (N = 855, age M = 20) filled in questionnaires on social cognitive factors when entering the military service, and on food consumption frequency after two months. The data were analysed using structural equation modeling. RESULTS Physical well-being expectation and bad taste expectation were most strongly related to both FV and fat avoidance intentions. Perceived weight gain risk predicted fat avoidance intention, whereas perceived risk for other health problems predicted FV intention. Social self-efficacy was associated with FV intention only. Consumption of both FV and fast food was predicted by action planning and intention. CONCLUSIONS A more careful evaluation of subtypes of social cognitions sheds light on the specific content behind motivation. Such understanding might help in designing more effective intervention messages.

Why Do People High in Self-Control Eat More Healthily? Social Cognitions as Mediators

BackgroundTrait self-control and social cognitions both predict dietary behaviors, but whether self-control is associated with more beneficial diet-related cognitions, and the effect of self-control on diet mediated by them, has rarely been examined.PurposeWe hypothesized that the effect of self-control on healthy diet is explained by more proximal diet-related social cognitive factors.MethodsAltogether, 854 military conscripts (age M = 20) completed questionnaires on trait self-control and social cognitive factors (self-efficacy, outcome expectations, risk perceptions, intentions and planning) upon entering the service and a food frequency questionnaire after 8 weeks.ResultsTrait self-control was associated with more positive cognitions regarding healthy diet. The mediation hypothesis received support for fruit and vegetable but only partially for fast food consumption.ConclusionIndividuals high in trait self-control eat more healthily because they have higher self-efficacy, more positive taste expectations, stronger intentions and more plans, compared to those low in self-control.

Why share expertise? A closer look at the quality of motivation to share or withhold knowledge

Purpose The purpose of this study is to investigate the role of motivation for knowledge sharing (KS) by assessing how four qualitatively different motivation types, as per self-determination theory (SDT), predict KS, its quality and its undesirable counterpart, knowledge withholding. Design/methodology/approach The study was carried out as a survey (n = 200) in an expert organization. The analyses were conducted using structural equation modeling. Findings Autonomous type of extrinsic motivation (identified motivation) was the strongest predictor of KS (in work meetings) and its quality, whereas the other motivation types (intrinsic, introjected and external) had no independent contribution to variance in KS. Knowledge withholding was negatively associated with identified and positively with external KS motivation. Research limitations/implications Single organization limits the generalizability of the results. Future studies should further investigate the role of identified motivation for various KS behaviors. Practical implications The findings suggest that autonomy-supportive management practices known to facilitate self-determined behavior can improve KS. Fostering external motivation by incentivizing KS may be both ineffective and have undesirable consequences. Originality/value Few prior studies investigate KS motivation beyond external and intrinsic motivation or apply SDT to KS using SDT-based scales. This study distinguishes between four different motivation types and is the first to investigate their differential impact on KS and its quality. It is also the first to demonstrate the importance of identified motivation for KS. It further elucidates how the quality of KS motivation is reflected in knowledge withholding, an overall underinvestigated behavior.