Tim Kuhlmann

Designing a theory- and evidence-based tailored eHealth rehabilitation aftercare program in Germany and the Netherlands: study protocol.

BackgroundCardiac rehabilitation programs aim to improve health status and to decrease the risk of further cardiac events. Persons undergoing rehabilitation often have difficulties transferring the learned health behaviors into their daily routine after returning home and maybe to work. This includes physical activity as well as fruit and vegetable consumption. Computer-based tailored interventions have been shown to be effective in increasing physical activity as well as fruit and vegetable consumption. The aim of this study is, to support people in transferring these two learned behavior changes and their antecedents into their daily life after cardiac rehabilitation.MethodsThe study will have a randomized controlled design and will be conducted among German and Dutch people who participated in cardiac rehabilitation. The study will consist of one intervention group which will be compared to a waiting list control group. During the eight week duration of the intervention, participants will be invited to participate in the online after-care program once per week. The intervention encourages participants to define individual health behavior goals as well as action, and coping plans to reach these self-determined goals. The effectiveness of the program will be compared between the intervention condition and the control group in terms of behavior change, antecedents of behavior change (e.g., self-efficacy), ability to return to work and increased well-being. Further, subgroup-differences will be assessed including differences between the two countries, socioeconomic inequalities and across age groups.DiscussionThe present study will make a contribution to understanding how such an online-based tailored interventions enables study participants to adopt and maintain a healthy lifestyle. Implications can include how such an online program could enrich cardiac rehabilitation aftercare further.Trial registrationNTR 3706, NCT01909349

Testing principle working mechanisms of the health action process approach for subjective physical age groups

This study investigated differences in social-cognitive predictors and self-regulatory planning, as proposed by the health action process approach (HAPA), across three different subjective physical age groups for physical activity. With a cross-sectional design, 521 participants across the chronological age span from 25 to 86 years (M = 48.79; SD = 12.66) were separated into three groups: those who feel physically younger than they are in terms of chronological age, the same perceived and chronological age, and feeling physically older compared to their chronological age. Participants were assessed regarding their perceived vulnerability, outcome expectancies, general intentions, planning, self-efficacy, and stages of physical activity (non-intenders, intenders, and actors). Data were analysed via mean comparison and multigroup structural equation modelling. Mean differences for all but one construct were eminent in all groups, generally showing that those feeling physically younger also report better social-cognitive predictors of physical activity (e.g. lower perceived vulnerability) in comparison to those who feel the same age or older. The model showed that basic working mechanisms of the HAPA can be applied to all groups. With that, the results provide for the first time evidence that principle working mechanism of the HAPA can be applied to all subjective physical age groups. These may be used to tailor health promoting interventions according to participants’ needs as a more suitable proxy than chronological age.

Are tattooed adults really more aggressive and rebellious than those without tattoos

One stereotype of people with tattoos is that they are more aggressive and rebellious than people without tattoos. However, studies examining differences in these traits between tattooed and non-tattooed individuals are dated and have returned equivocal results. To re-examine this issue, we asked 378 adults from London, UK, to complete self-report measures of aggression and rebelliousness, and to report the number of tattoos they possessed. Of this sample, 25.7% possessed at least one tattoo, with no sex difference in the distribution of tattoo status. We found that tattooed adults had significantly higher reactive rebelliousness, anger, and verbal aggression than non-tattooed adults. However, effect sizes were small and there were also no significant between-group differences in terms of proactive rebelliousness, physical aggression, and hostility. These results suggest that, while stereotypes may contain a kernel of truth, they likely present an outmoded picture of tattooed adults.

Brief report: Compensatory health beliefs are negatively associated with intentions for regular fruit and vegetable consumption when self-efficacy is low

Compensatory health beliefs (the beliefs that an unhealthy behaviour can be compensated by a healthy behaviour) can interfere with adherence to fruit and vegetable consumption recommendations. Fruit and vegetable consumption, social cognitive variables and compensatory health beliefs were investigated via self-report at baseline (T0) and 8-week follow-up (T1) in N = 790 participants. Self-efficacy predicted fruit and vegetable consumption intentions. Planning mediated between intentions and T1 fruit and vegetable consumption. Compensatory health beliefs negatively predicted intentions at low self-efficacy levels only. The results propose the use of self-efficacy interventions to diminish the negative effects of compensatory health beliefs when forming fruit and vegetable consumption intentions and foster planning to translate intentions into behaviour.

Using Visual Analogue Scales in eHealth: Non-Response Effects in a Lifestyle Intervention

Background Visual analogue scales (VASs) have been shown to be valid measurement instruments and a better alternative to Likert-type scales in Internet-based research, both empirically and theoretically [1,2]. Upsides include more differentiated responses, better measurement level, and less error. Their feasibility and properties in the context of eHealth, however, have not been examined so far. Objective The present study examined VASs in the context of a lifestyle study conducted online, measuring the impact of VASs on distributional properties and non-response. Method A sample of 446 participants with a mean age of 52.4 years (standard deviation (SD) = 12.1) took part in the study. The study was carried out as a randomized controlled trial, aimed at supporting participants over 8 weeks with an additional follow-up measurement. In addition to the randomized questionnaire, participants were further randomly assigned to either a Likert-type or VAS response scale version of the measures. Results Results showed that SDs were lower for items answered via VASs, 2P (Y ≥ 47 | n=55, P=.5) < .001. Means did not differ across versions. Participants in the VAS version showed lower dropout rates than participants in the Likert version, odds ratio = 0.75, 90% CI (0.58-0.98), P=.04. Number of missing values did not differ between questionnaire versions. Conclusions The VAS is shown to be a valid instrument in the eHealth context, offering advantages over Likert-type scales. The results of the study provide further support for the use of VASs in Internet-based research, extending the scope to senior samples in the health context. Trial Registration Clinicaltrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/6h88sLw2Y)

Investigating measurement equivalence of visual analogue scales and Likert-type scales in Internet-based personality questionnaires

Visual analogue scales (VASs) have shown superior measurement qualities in comparison to traditional Likert-type response scales in previous studies. The present study expands the comparison of response scales to properties of Internet-based personality scales in a within-subjects design. A sample of 879 participants filled out an online questionnaire measuring Conscientiousness, Excitement Seeking, and Narcissism. The questionnaire contained all instruments in both answer scale versions in a counterbalanced design. Results show comparable reliabilities, means, and SDs for the VAS versions of the original scales, in comparison to Likert-type scales. To assess the validity of the measurements, age and gender were used as criteria, because all three constructs have shown non-zero correlations with age and gender in previous research. Both response scales showed a high overlap and the proposed relationships with age and gender. The associations were largely identical, with the exception of an increase in explained variance when predicting age from the VAS version of Excitement Seeking (B10 =1318.95, ΔR 2 =.025). VASs showed similar properties to Likert-type response scales in most cases.

Latent user groups of an eHealth physical activity behaviour change intervention for people interested in reducing their cardiovascular risk

ABSTRACT EHealth behaviour change interventions that help participants to adhere to professional physical activity recommendations can help to prevent future events of cardiovascular diseases (CVD). Therefore, identifying user groups of such interventions based on stages of health behaviour change is of great importance to provide tailored content to users instead of one-size-fits-all approaches. Our study used Latent Class Analysis (LCA) to identify underlying classes of users of an eHealth behaviour change intervention based on stages of change and associated variables. We compared participants’ self-allocated stage with their latent class stage membership to display the correlation and mean differences between the two approaches. This was done by analysing baseline data of N = 310 people interested in reducing their CVD risk. LCA identified a three-class solution: (non-)intenders (19.4%), non-habituated actors (43.2%) and habituated actors (37.4%). The interrelation between self-allocated and latent class stage membership was moderate (ρ(308) = .49, p < .001). Significant mean differences for (non-)intenders and non-habituated actors were found in social-cognitive variables. Results showed that self-allocated stage outcomes represent a pseudo stage model − linear trends can be reported for stage-associated social-cognitive variables. The study provides information on the validity of stage measures, which can inform future interventions.