Robert Hurling

Can Implementation Intentions and Text Messages Promote Brisk Walking? A Randomized Trial

OBJECTIVE To test the efficacy in promoting brisk walking of two theory-based interventions that incorporate implementation intentions and text message (Short Message Service; SMS) reminders directed at ones walking-related plans or goals. DESIGN Participants (N = 149) were randomized to one of three conditions (implementation intention + SMS plan reminder, implementation intention + SMS goal reminder, control) before completing measures at baseline and follow-up 4 weeks later. At follow-up, the experimental groups were given a surprise recall task concerning their plans. All participants completed an equivalent goal recall task. MAIN OUTCOME MEASURES Validated self-report measures of physical activity and measures of implementation intention and goal recall, weight, and waist-to-hip ratio. RESULTS Both intervention groups increased their brisk walking relative to the control group, without reducing other physical activity. The goal reminder group lost the most weight. The SMS plan reminder group recalled more of their plans than the SMS goal reminder group, but the latter were more successful in goal recall. CONCLUSION Both interventions can promote brisk walking in sedentary populations. Text messages aid the recall of, and could enhance interventions that target, implementation intentions and goals.

Can the effects of implementation intentions on exercise be enhanced using text messages

Implementation intentions planning in advance the situation in which one will act, have been proposed to be an effective self-regulatory technique for changing health behaviour. Encouraging people to receive text message reminders of their implementation intentions should enhance their strength and, thus, it was predicted that this combined approach would be particularly effective in increasing exercise. Participants (N = 155) were randomly allocated to one of five conditions (implementation intentions and SMS, implementation intention, SMS or one of two control groups) then completed self-report measures of exercise behaviour and motivation. Four weeks later, they responded to similar items. Results suggested that the combined intervention increased exercise frequency significantly more than the other strategies including the implementation intention group. It is proposed, therefore, that implementation intention effects can be enhanced via plan reminders.

Internet-based exercise intervention systems: Are more interactive designs better?

Abstract The benefits of Internet-based health promotion programmes are much discussed, yet the literature on their feasibility and utility is limited. Here, we evaluate an Internet-based exercise motivation and action support system (Test system), relative to a group receiving no intervention (Reference) and another receiving a less interactive version of the same system (Control). We report results from a 10-week pilot study with 75 participants aged 23–54 years. We found that, relative to the control system and reference group, the more interactive (test) system was more engaging (better user retention), created higher expectations for exercise, greater satisfaction with motivation and increased self-perception of fitness. Seven months after the intervention, participants who used the test system reported greater levels of increase in exercise than the control or reference groups. Our study adds to the growing body of evidence on the benefits of interactive systems and the role they could play in health promotion programmes. However, it should also be noted that not all Web-based systems offer the same level of advantage; careful design is crucial to ensure that key messages are clearly communicated to attentive users. Further research is required to identify the optimum interactive system design principles, across a range of user types.

Rates and Determinants of Uptake and Use of an Internet Physical Activity and Weight Management Program in Office and Manufacturing Work Sites in England: Cohort Study

Background Internet-based physical activity (PA) and weight management programs have the potential to improve employees’ health in large occupational health settings. To be successful, the program must engage a wide range of employees, especially those at risk of weight gain or ill health. Objective The aim of the study was to assess the use and nonuse (user attrition) of a Web-based and monitoring device–based PA and weight management program in a range of employees and to determine if engagement with the program was related to the employees’ baseline characteristics or measured outcomes. Methods Longitudinal observational study of a cohort of employees having access to the MiLife Web-based automated behavior change system. Employees were recruited from manufacturing and office sites in the North West and the South of England. Baseline health data were collected, and participants were given devices to monitor their weight and PA via data upload to the website. Website use, PA, and weight data were collected throughout the 12-week program. Results Overall, 12% of employees at the four sites (265/2302) agreed to participate in the program, with 130 men (49%) and 135 women (51%), and of these, 233 went on to start the program. During the program, the dropout rate was 5% (11/233). Of the remaining 222 Web program users, 173 (78%) were using the program at the end of the 12 weeks, with 69% (153/222) continuing after this period. Engagement with the program varied by site but was not significantly different between the office and factory sites. During the first 2 weeks, participants used the website, on average, 6 times per week, suggesting an initial learning period after which the frequency of website log-in was typically 2 visits per week and 7 minutes per visit. Employees who uploaded weight data had a significant reduction in weight (−2.6 kg, SD 3.2, P< .001). The reduction in weight was largest for employees using the program’s weight loss mode (−3.4 kg, SD 3.5). Mean PA level recorded throughout the program was 173 minutes (SE 12.8) of moderate/high intensity PA per week. Website interaction time was higher and attrition rates were lower (OR 1.38, P= .03) in those individuals with the greatest weight loss. Conclusions This Web-based PA and weight management program showed high levels of engagement across a wide range of employees, including overweight or obese workers, shift workers, and those who do not work with computers. Weight loss was observed at both office and manufacturing sites. The use of monitoring devices to capture and send data to the automated Web-based coaching program may have influenced the high levels of engagement observed in this study. When combined with objective monitoring devices for PA and weight, both use of the website and outcomes can be tracked, allowing the online coaching program to become more personalized to the individual.

Goal desires moderate intention - behaviour relations

Models such as the Extended Model of Goal-Directed Behaviour and the Theory of Planned Behaviour imply that the impact of ones goals on behaviour is mediated by more proximal determinants. We hypothesize that goals can have a broader and more dynamic impact on behaviour and, specifically, that goal desires can moderate the effect of intentions on behaviour. Four studies addressed this issue by examining the direct and moderated effects of goal desires on behaviour. All of the studies required participants to complete baseline measures and then a follow-up indicator of behaviour. In Study 1 (N=119) that focused on fruit intake, Study 2 (N=123) and Study 3 (N=96) concerned with drinking alcohol and Study 4 (N=109) regarding snack consumption, behavioural intentions were more reliably related to behaviour when goal desires were strong. The results of Study 3 suggested that goal desire stability increases the likelihood of this moderator effect emerging and Study 4 revealed that this effect was not suppressed by intention stability. The findings suggest that goals and behavioural intentions can operate simultaneously and jointly influence action, a view that contradicts predictions that the effects of goals are fully mediated by more proximal behavioural determinants.

The moderator role of intuitive versus deliberative decision making for the predictive validity of implicit and explicit measures

The Preference for Intuition and Deliberation (PID) scale aims at capturing stable general individual differences in terms of intuitive versus deliberative preferences in decision making. A study examined the psychometric properties of the English version of the PID, investigated whether the two subscales moderate the validity of implicit and explicit measures for incidental and deliberative evaluations and behaviours concerning fizzy soft drinks, and compared the predictive validity of two new implicit measures (ST‐IAT and ID‐EAST) and an explicit measure. Results showed an asymmetric weak double dissociation pattern only for behaviours. Additionally, a moderation effect suggested that the ST‐IAT better predicted sensory evaluation for people high in intuition and explicit attitudes better predicted benefit evaluation for people high in deliberation. Copyright

Implicit shopping: Attitudinal determinants of the purchasing of healthy and unhealthy foods

Implicit attitudes, evaluations that can occur without effort, quickly and without conscious intent, have been shown to predict self-reported diets and objectively measured food choices within the laboratory. We present two studies which extend the literature by demonstrating that implicit attitudes predict objective purchasing of healthy and unhealthy foods. Both Study 1 (N = 40) and Study 2 (N = 36) utilised an online shopping paradigm and concerned purchasing of fruit and chocolate. In both studies, implicit attitudes predicted purchases. Explicit attitudes towards buying or eating fruit versus chocolate did not predict purchase behaviour. These studies represent an original test of whether implicit attitudes predict healthy consumer behaviour, which involves participants paying for products. This research provides the strongest evidence yet that implicit attitudes play a role in predicting health food purchases. A comprehensive model of health behaviour should take into account the role of implicit attitudes.

Exploring the question-behaviour effect: Randomized controlled trial of motivational and question-behaviour interventions

PURPOSE Measuring intentions and other cognitions to perform a behaviour can promote performance of that behaviour (the question-behaviour effect, QBE). It has been suggested that this effect may be amplified for individuals motivated to perform the behaviour. The present research tested the efficacy of combining a motivational intervention (providing personal risk information) with measuring intentions and other cognitions in a fully crossed 2 × 2 design with an objective measure of behaviour in an at-risk population using a randomized controlled trial (RCT). METHODS Participants with elevated serum cholesterol levels were randomized to one of four conditions: a combined group receiving both a motivational intervention (personalized cardiovascular disease risk information) and a QBE manipulation (completing a questionnaire about diet), one group receiving a motivational intervention, one group receiving a QBE intervention, or one group receiving neither. All participants subsequently had the opportunity to obtain a personalized health plan linked to reducing personal risk for coronary heart disease. RESULTS Neither the motivational nor the QBE manipulations alone significantly increased rates of obtaining the health plan. However, the interaction between conditions was significant. Decomposition of the interaction indicated that the combined condition (motivational plus QBE manipulation) produced significantly higher rates of obtaining the health plan (96.2%) compared to the other three groups combined (80.3%). CONCLUSIONS The findings provide insights into the mechanism underlying the QBE and suggest the importance of motivation to perform the behaviour in observing the effect. STATEMENT OF CONTRIBUTION What is already known on this subject? Research has indicated that merely asking questions about a behaviour may be sufficient to produce changes in that or related behaviours (referred to as the question-behaviour effect; QBE). Previous studies have suggested that the QBE may be moderated by the individuals motivation to change the behaviour, i.e., the QBE will only produce increases in the behaviour among those with strong motivation to perform the behaviour. However, no study has directly tested this prediction by manipulating motivation and examining impacts on the QBE. What does this study add? The present study tested the individual and combined effects of a motivational and a QBE intervention in a fully crossed design using a randomized controlled trial (RCT) and showed that: a combined intervention significantly increased behaviour. effect partially mediated by cognitions.

Exploratory Study of Web-Based Planning and Mobile Text Reminders in an Overweight Population

Background Forming specific health plans can help translate good intentions into action. Mobile text reminders can further enhance the effects of planning on behavior. Objective Our aim was to explore the combined impact of a Web-based, fully automated planning tool and mobile text reminders on intention to change saturated fat intake, self-reported saturated fat intake, and portion size changes over 4 weeks. Methods Of 1013 men and women recruited online, 858 were randomly allocated to 1 of 3 conditions: a planning tool (PT), combined planning tool and text reminders (PTT), and a control group. All outcome measures were assessed by online self-reports. Analysis of covariance was used to analyze the data. Results Participants allocated to the PT (meansat urated fat 3.6, meancopingplanning 3) and PTT (meansaturatedfat 3.5, meancopingplanning 3.1) reported a lower consumption of high-fat foods (F 2,571 = 4.74, P = .009) and higher levels of coping planning (F 2,571 = 7.22, P < .001) than the control group (meansat urated f at 3.9, meancopingplanning 2.8). Participants in the PTT condition also reported smaller portion sizes of high-fat foods (mean 2.8; F 2, 569 = 4.12, P = .0) than the control group (meanportions 3.1). The reduction in portion size was driven primarily by the male participants in the PTT (P = .003). We found no significant group differences in terms of percentage saturated fat intake, intentions, action planning, self-efficacy, or feedback on the intervention. Conclusions These findings support the use of Web-based tools and mobile technologies to change dietary behavior. The combination of a fully automated Web-based planning tool with mobile text reminders led to lower self-reported consumption of high-fat foods and greater reductions in portion sizes than in a control condition. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 61819220; http://www.controlled-trials.com/ISRCTN61819220 (Archived by WebCite at http://www.webcitation.org/63YiSy6R8)

Effects of written emotional disclosure on implicit self-esteem and body image

OBJECTIVES Negative body image has a significant impact on self-esteem, disordered eating, and general health. Writing about distressing events and experiences has been found to have beneficial effects on psychological and physical health outcomes. This study investigated whether a written self-disclosure intervention, compared to a writing about body image success stories (WSS) intervention, had beneficial effects on self-esteem and body image. DESIGN AND METHODS One hundred and fifty-eight women (aged 18-22 years) were allocated to either: written emotional disclosure (WED); WSS; or a control, non-emotional writing condition. All measures were completed at baseline and at follow-up 4 weeks later. RESULTS A condition by time interaction was observed for implicit self-esteem, such that levels of self-esteem were improved 4 weeks later in the WED condition. Implicit self-esteem was also found to be greater following WED compared to the control condition, but not following WSS. CONCLUSIONS This is the first study to demonstrate that WED has beneficial effects on implicit outcome measures such as self-esteem indicating that the positive effects of expressive writing may initially operate by influencing automatically activated attitudes towards the self. The impact of WED on implicit self-esteem may have implications for future health.