Rainer Hornung

Dementia caregiving in spousal relationships: A dyadic perspective

Objectives: The number of couples facing a dementia diagnosis for one partner of the spousal dyad increases. Spousal caregiving can be a highly stressful experience associated with negative caregiver outcomes such as depression and poorer immune function. However, surprisingly little is known about how the illness and the required care effects patients well-being and relational changes experienced by afflicted couples. The aim of this study was to provide a literature review on how the dyadic perspective is taken into account and on how dementia effects both parts of the dyad. Methods: In order to outline findings about individual and dyadic well-being of affected couples, we conducted a literature search to review the three types of studies. First, studies focusing on one partners perspective, usually the perspective of the caregiver; second, studies including the caregivers and partially the care receivers view; third, studies directly referring to both partners’ perspectives. Results: The majority of studies neglect the individual with dementia by exclusively assessing caregiver variables or only indirectly including patients’ characteristics. Very few studies embrace dyadic and relational variables to execute how both partners experience the illness, spousal caregiving, and changes in the relationship. Despite the arguable validity of self reports of individuals with dementia, some studies demonstrated the usefulness of including both partners’ perspectives. Discussion: Results indicate the urgent need of integrating the perspective of the individual with dementia to improve the understanding of the effects of dementia caregiving. Directly assessing the dyadic perspective of affected couples provides essential information for interventions.

Restorative qualities of indoor and outdoor exercise settings as predictors of exercise frequency

Positive environmental determinants of exercise frequency remain poorly understood. Knowing that people often value exercise for psychological restoration, we investigated the restorative quality of indoor and outdoor exercise settings as predictors of exercise frequency. We surveyed 319 members of fitness centers in Zurich that offer indoor and outdoor exercise alternatives. Outdoor settings were rated as more restorative. For each type of environment, restorative quality predicted the frequency of exercise in the past 30 days, independent of socio-demographic characteristics, expectations of exercise benefits, and personal barriers. We discuss the results with regard to the provision of exercise settings for urban populations.

Bullying and Delinquency in Adolescence: Victims’ and Perpetrators’ Family and Peer Relations

This study investigated (a) the prevalence and co-occurrence of various victimisation and violence experiences among adolescents and examined (b) the quality of peer and family relationships of victims and perpetrators of bullying and violent delinquency. Self-report questionnaires were completed by 1107 Swiss adolescents (grades 7 and 9). Frequency of involvement in bully/victim problems and delinquency was used to classify pupils. Bullies and bully-victims were often also victims and/or perpetrators of violent delinquency. Sex and school type effects were found regarding involvement in bully/victim problems and delinquency. Pupils who were bullied reported lower peer acceptance than bullies and non-involved pupils. Bullies as well as perpetrators and victims of violent delinquency reported lower family support than non-involved adolescents. Implications for prevention and intervention are discussed.

Go no-go performance under psychosocial stress: Beneficial effects of implementation intentions

Acute stress has been found to have negative and implementation intentions (IIs) to have positive effects on cognitive performance. This study was the first to examine the effects of IIs on executive action control under acute psychosocial stress. Forty-two male subjects aged 21-39 years were randomly assigned to the Trier Social Stress Test (TSST) versus a rest condition. In addition, the instruction to the executive task (a go no-go task) was manipulated (IIs versus standard instruction). After the stress test, a dual-task procedure including a go no-go task was conducted. The TSST resulted in increases in cortisol response, heart rate and state anxiety compared to the rest condition. Acute stress significantly impaired go no-go performance, but only in the group without IIs. We conclude that under acute stress conditions executive functioning is reduced, but the use of IIs can be an effective strategy to overcome this negative effect.

Smoking is ok as long as I eat healthily: Compensatory Health Beliefs and their role for intentions and smoking within the Health Action Process Approach

Compensatory Health Beliefs (CHBs) are defined as beliefs that the negative consequences of unhealthy behaviours can be compensated for by engaging in healthy behaviours. CHBs have not yet been investigated within a framework of a behaviour change model, nor have they been investigated in detail regarding smoking. Thus, the aim of this study was to investigate on a theoretical basis whether smoking-specific CHBs, as a cognitive construct, add especially to the prediction of intention formation but also to changes in smoking behaviour over and above predictors specified by the Health Action Process Approach (HAPA). The sample comprised 385 adolescent smokers (mean age: 17.80). All HAPA-specific variables and a smoking-specific CHB scale were assessed twice, 4 months apart. Data were analysed using structural equation modelling. Smoking-specific CHBs were significantly negatively related to the intention to stop smoking over and above HAPA-specific predictors. Overall, 39% of variance in the intention to quit smoking was explained. For the prediction of smoking, CHBs were not able to explain variance over and above planning and self-efficacy. Thus, smoking-specific CHBs seem mainly important in predicting intentions but not behaviour. Overall, the findings contribute to the understanding of the role of smoking-specific CHBs within a health-behaviour change model.

A Two-Level Confirmatory Factor Analysis of a Modified Rosenberg Self-Esteem Scale

Classical factor analysis assumes independent and identically distributed observations. Educational data, however, are often hierarchically structured, with, for example, students being nested within classes. In this study, data on self-esteem gathered in a sample of 1,107 students within 72 school classes in Switzerland were analyzed using two-level confirmatory factor analysis. Considering a sequence of two-level confirmatory factor models, the results indicate that a one-factor model of self-esteem with an additional orthogonal method or response-style factor of negatively worded items adequately described within-class (individual) differences in self-esteem. By contrast, at the between-class level, a general factor of self-esteem was sufficient to capture school class differences in self-esteem. Thus, apart from other influences, for students, the social context (school class) seems to matter in forming their self-esteem. At the same time, the findings imply that studies examining self-esteem using samples of clustered observations should account for multiple levels of analysis (i.e., separate within- and between-class variances).

Testing Phase-Specific Self-Efficacy Beliefs in the Context of Dietary Behaviour Change

BACKGROUND Self-efficacy is an important predictor of health behaviour change. Within the health action process approach (HAPA; Schwarzer, 2008), motivational and volitional self-efficacy can be distinguished. Motivational self-efficacy is assumed to serve as predictor of intention formation whereas volitional self-efficacy should be relevant for behaviour change. This study examined these assumptions in a sample with overweight and obese individuals. Moreover, we tested whether behavioural intentions moderate the association between volitional self-efficacy and behaviour. METHODS Overall, 373 overweight and obese individuals completed a baseline and six months later a follow-up questionnaire on HAPA variables and dietary behaviour. RESULTS A factor analysis confirmed the phase-specific separation of self-efficacy. Motivational self-efficacy emerged as predictor for behavioural intentions over and above other HAPA variables after six months, whereas volitional self-efficacy did not. Volitional self-efficacy interacted with intention in the prediction of behaviour, indicating that volitional self-efficacy is only beneficial for individuals with high levels of intentions. CONCLUSIONS The results provide evidence for the phase-specific distinction of self-efficacy in the context of dietary change in an overweight or obese sample. Thus, differentiating between motivational and volitional self-efficacy beliefs should be considered when developing future interventions of dietary change.

Does social support really help to eat a low‐fat diet? Main effects and gender differences of received social support within the Health Action Process Approach.

BACKGROUND Most theories of health-behavior change focus exclusively on individual self-regulation without taking social factors, such as social support, into account. This studys first aim was to systematically test the added value of received instrumental and emotional social support within the Health Action Process Approach (HAPA) in the context of dietary change. In the social support literature, gender effects emerge with regard to the effectiveness of social support. Thus, a second aim was the examination of gender differences in the association of social support with dietary behavior. METHODS Participants were 252 overweight and obese individuals. At baseline and 12 months later, participants completed questionnaires on HAPA variables; diet-specific received social support and low-fat diet. RESULTS For the prediction of intentions 12 months later, instrumental support was more beneficial for men than for women over and above individual self-regulation. In terms of dietary behavior at T2, a moderate main effect of instrumental support emerged. Moreover, received emotional social support was beneficial for men, but not for women in terms of a low-fat diet 12 months later. CONCLUSIONS Effects of received instrumental social support found in this study provide new evidence for the added value of integrating social support into the HAPA.

Responders and non-responders in a study on medical end-of-life decisions in Denmark, the Netherlands, Sweden and Switzerland.

Summary.Objectives: To determine the direction and magnitude of participation bias in end-of-life research. Methods: Within the framework of a European survey on medical end-of-life decisions, a non-response study was conducted among physicians in Denmark, the Netherlands, Sweden and Switzerland. People were asked about their attitudes and experiences in the area of medial end-of-life decision. The response rates ranged from 12.8% (Netherlands) to 39.4% (Switzerland). The responders (n = 5 403) and the non-responders (n = 866) were compared regarding socio-demographic characteristics, experiences with terminal patients and agreement with attitudes towards “end-of-life decisions”. The reasons for non-participation to the study were analyzed. Results: Non-response did not cause socio-demographic distortion, but non-responders had statistically significantly fewer terminal patients than responders. Agreement rates were statistically significantly higher among responders than among non-responders for euthanasia, non-treatment decision and life-preserving statements. Neutral answers were statistically significantly more frequent among non-responders than among responders for life-preserving and euthanasia statements. The most commonly mentioned reason for non-participation was “lack of time”. Conclusion: Non-participation does cause an overestimation of proponents of life-shortening, as well as of life-preserving end-of-life decisions. Non-responders more often have ambiguous attitudes towards end-of-life decisions than responders.Zusammenfassung.Antwortende und Nicht-Antwortende in einer Studie zu medizinischen Entscheidungen am Lebensende in Dänemark, Holland, Schweden und der SchweizFragestellung: Richtung und Ausmaß von Teilnahmeverzerrungen in der Sterbehilfeforschung sollen bestimmt werden. Methoden: Im Rahmen eines europäischen Forschungsprojektes zu medizinischen Entscheidungen am Lebensende wurde bei ärztinnen und ärzten in Dänemark, Holland, Schweden und in der Schweiz eine Non-response Studie durchgeführt. Die Personen wurden nach ihren Einstellungen zu und Erfahrungen mit medizinischen Entscheidungen am Lebensende befragt. Der Rücklauf reichte von 12.8% in Holland bis zu 39.4% in der Schweiz. Antwortende (n = 5 403) und Nichtantwortende (n = 866) wurden hinsichtlich soziodemographischer Merkmale, Erfahrungen mit sterbenden Patientinnen und Patienten und der Zustimmung zu Einstellungen gegenüber Entscheidungen am Lebensende verglichen. Im Weiteren wurden die Gründe für die Nicht-Teilnahme an der Hauptbefragung untersucht. Ergebnisse: Nicht-Teilnahme führt zu keinen soziodemographischen Verzerrungen, jedoch betreuten die Nichtantwortenden in Holland, der Schweiz und allen vier Ländern zusammen signifikant weniger sterbende Patientinnen und Patienten als die Antwortenden. Die Zustimmung zu den Statements über aktive Sterbehilfe und über passive Sterbehilfe wie auch zum Statement zur Lebenserhaltung unter allen Umständen fiel unter den Antwortenden signifikant höher aus als unter den Nichtantwortenden. Hinsichtlich der Lebenserhaltung unter allen Umständen sowie der aktiven Sterbehilfe waren neutrale Antworten unter den Nichtantwortenden signifikant häufiger als bei den Antwortenden. Als häufigster Grund für die Nicht-Teilnahme wurde “Zeitmangel” genannt. Schlussfolgerung: Die Nicht-Teilnahme führt zu einer überrepräsentation der Befürwortenden sowohl von lebensverkürzenden als auch von lebenserhaltenden Entscheidungen. Nichtantwortende haben häufiger unklare Einstellungen gegenüber Entscheidungen am Lebensende als Antwortende.Résumé.Répondants et non-répondants dans une étude sur les décisions médicales en fin de vie au Danemark, aux Pays-Bas, en Suède et en SuisseObjectifs: Déterminer la nature et l’importance de biais de participation dans la recherche sur l’euthanasie. Méthode: Dans le cadre d’une recherche européenne sur les décisions médicales euthanasiques, une étude des non-réponses a été réalisée auprès de médecins au Danemark, aux Pays-bas, en Suède et en Suisse. Les questions abordaient les attitudes et l’expérience des médecins face à des décisions euthanasiques. Les taux de réponses varient de 12.8 (Pays-Bas) à 39.4% (Suisse). Les répondants (n = 5 403) et les non-répondants (n = 866) ont été comparés selon leurs caractéristiques socio-démographiques, leurs expériences avec des patients en phase terminale et leurs attitudes face à l’euthanasie. Les raisons d’une non-participation à l’étude ont été analysées. Résultats: Les non-réponses n’ont pas causé de déformation socio-démographique, cependant la catégorie des non-répondants compte de manière statistiquement significative moins de patients en phase terminale que la catégorie des répondants aux Pay-bas, en Suisse et dans l’ensemble des quatre pays. Le taux d’approbation d’affirmations sur le thème de l’euthanasie active et passive et du maintien de la vie était significativement plus élevé parmi les répondants que parmi les non-répondants. Les réponses neutres sur le thème du maintien de la vie et de l’euthanasie étaient plus souvent apportées par les non-répondants. Le «manque de temps» a été la cause de non-participation la plus souvent invoquée. Conclusion: La non-participation induit une surestimation des partisans de l’euthanasie, aussi bien que des partisans du maintien de la vie. Plus souvent que les répondants, les nonrépondants ont des points de vue ambigus envers les décisions d’euthanasie.

Measurement Invariance of the Abridged Sense of Coherence Scale in Adolescents

In the present study, the factorial structure and the degree of measurement invariance of the short form of the Sense of Coherence Scale (SOCS-13) were examined across two groups of adolescents. The sample comprised 1107 Swiss students (535 aged 14 or younger and 572 aged 15 or older). Considering a sequence of confirmatory factor models and using robust parameter estimation, results indicate that a two-factor model of sense of coherence adequately described the data. The first factor encompassed Comprehensibility and Manageability items, whereas the second factor reflected Meaningfulness. Strict measurement invariance could be established, i.e., factor loadings, latent intercepts of the manifest indicators, and residual variances were found to be equal in both age groups. In the end, students from the older age group, on average, had higher factor scores in Comprehensibility-Manageability. These findings provide support for a two-dimensional structure and complete unbiasedness of the SOCS-13 in adolescen...