Sonia Lippke

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.

Mechanisms of health behavior change in persons with chronic illness or disability: the Health Action Process Approach (HAPA).

OBJECTIVE The present article presents an overview of theoretical constructs and mechanisms of health behavior change that have been found useful in research on people with chronic illness and disability. A self-regulation framework (Health Action Process Approach) serves as a backdrop, making a distinction between goal setting and goal pursuit. Risk perception, outcome expectancies, and task self-efficacy are seen as predisposing factors in the goal-setting (motivational) phase, whereas planning, action control, and maintenance/recovery self-efficacy are regarded as being influential in the subsequent goal-pursuit (volitional) phase. The first phase leads to forming an intention, and the second to actual behavior change. Such a mediator model serves to explain social-cognitive processes in health behavior change. By adding a second layer, a moderator model is provided in which three stages are distinguished to segment the audience for tailored interventions. Identifying persons as preintenders, intenders, or actors offers an opportunity to match theory-based treatments to specific target groups. Numerous research and assessment examples, especially within the physical activity domain, serve to illustrate the application of the model to rehabilitation settings and health promotion for people with chronic illness or disability. CONCLUSIONS/IMPLICATIONS The theoretical developments and research evidence for the self-regulation framework explain the cognitive mechanisms of behavior change and adherence to treatment in the rehabilitation setting.

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 as a moderator of the planning–behaviour relationship in interventions designed to promote physical activity

Individuals who lack perceived self-efficacy may benefit less from planning interventions because they fail to apply their plans when encountering situations that appear challenging. Thus, self-efficacy may operate as a moderator in relation to the effects of planning interventions on behaviour. This article reports from two experimental studies using cluster randomisation. Study 1 included 58 patients with diabetes who received a face-to-face action planning intervention to improve their physical activity levels. Study 2 targeted the roles of planning and self-efficacy for the maintenance of regular running and for relapse prevention in 187 active individuals over a 2-year period. The email-delivered intervention prompted specific goal setting and facilitated planning to mobilise social support to secure relapse prevention. Results of the two studies were consistent with a moderating effect of self-efficacy in relation to the planning–behaviour relationship. Individuals with high self-efficacy benefited from planning interventions. If a person lacks self-efficacy, planning may not effectively promote physical activity.

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.

Intervention effects of exercise self-regulation on physical exercise and eating fruits and vegetables: a longitudinal study in orthopedic and cardiac rehabilitation.

OBJECTIVE The primary objective of this study was to unveil the mechanisms by which an exercise self-regulation intervention affects physical exercise in a rehabilitation context. The second aim was to investigate whether the intervention led to changes in fruit and vegetable intake that was not targeted in the intervention. Finally, it was tested whether changes in exercise habit strength may explain such a transfer effect. METHOD A quasi-experimental design was conducted in Germany between 2009 and 2011 with 725 rehabilitation patients. Patients received either a self-regulation intervention or an online questionnaire. Six weeks after discharge, self-reported changes in exercise and dietary behaviors, exercise habit strength, and cognitions were measured. QUANTITATIVE RESULTS: The exercise self-regulation intervention led to a higher increment in exercise behavior, exercise habit strength, and fruit and vegetable intake than the control condition. Changes in physical exercise were mediated by changes in action control (slope=0.04; 99% CI=0.01 to 0.06) and satisfaction (slope=0.05; 99% CI:=0.02 to 0.08), but not in action planning. Changes in fruit and vegetable intake were mediated by changes in exercise habit strength (slope=0.05; 99% CI=0.01 to 0.08). CONCLUSION Interventions could be optimized if they aim at fostering exercise habits. This in turn may also facilitate transfer effects from one health behavior to the other.