Health Psychology

Are interventions theory-based? Development of a theory coding scheme.
Objective: Interventions are increasingly described as theory-based; however, the basis for this is often not clear. Advancing behavioral science requires a good understanding of how interventions are informed by, and test, theory. This study aims to develop a reliable method for assessing the extent to which behavioral interventions are theory-based. Design: The reliability, usability, and comprehensiveness of an initial coding scheme were improved in 13 iterative stages on the basis of its application to 29 papers, from a systematic review of interventions to promote physical activity and healthy eating. Results: The final Theory Coding Scheme contained 19 items, each with satisfactory interrater reliabilities, coding whether a theory or model was mentioned, how theories were used in intervention design, how intervention evaluations tested theory, and the implications of the results for future theory development. Conclusion: The Theory Coding Scheme is an important methodological innovation, providing a research tool to reliably describe the theoretical base of interventions, inform evidence syntheses within literature reviews and meta-analyses, and stimulate the use of empirical data for theory development. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
The power of positive emotions: It’s a matter of life or death—Subjective well-being and longevity over 28 years in a general population.
Objective: This study longitudinally examined Subjective Well-Being (SWB) and its components, namely, Positive Feelings (PF, including global life satisfaction [GLS]), domain life satisfaction [DLS], and positive affect [PA]) as well as Negative Feelings (NF) as predictors of longevity in a general population. Design: Data from the Alameda County Study over 28 years (1965–1993, N = 6856) were analyzed with multivariate Cox Proportional Hazard Models. Main Outcome Measures: Longevity, evaluated by risks of all-cause, natural-cause, and unnatural-cause mortality. Results: After demographic and baseline health covariates were controlled, SWB, PF, GLS, and DLS significantly predicted lowered risks of all-cause and natural-cause mortality (Relative Risk per unit predictor increase [RR] ranged .904–.989, p values ranged .000–.05). SWB, PF, and GLS also significantly predicted lowered risk of unnatural-cause mortality (RR ranged .862–.961, p values ranged .014–.05). These associations seemed partially or completely mediated by social networks. The associations were also found separately in younger (
Perceived susceptibility measures are not interchangeable: Absolute, direct comparative, and indirect comparative risk.
Objective: To provide an explanation of perceived susceptibility judgment that accounts for both inconsistencies among commonly used measures of perceived susceptibility (i.e., absolute risk, direct comparative risk, and indirect comparative risk) and their inconsistent relationships to disease risk factors. Inconsistencies are attributed to differential processing of general versus personal risk factors, coupled with the method of computation of the risk measures. Design and Measures: Study 1 characterized risk factors as general versus personal. In Studies 2 and 3, community-residing adult women (ns = 432 and 147, respectively) rated perceived susceptibility to osteoporosis, breast cancer, heart disease, and diabetes, rated risk factors, and reported personal medical history. Results: Correlations and regression analyses mainly supported our characterization of the source of inconsistencies among susceptibility measures and their relationships to risk factors. Conclusion: Perceived susceptibility measures are not interchangeable and can lead to opposite conclusions about correlates of perceived susceptibility. Researchers are cautioned against using indirect comparative measures, computed as difference scores, and are encouraged to use other methods to compel participants to consider the risk of others when making comparative judgments. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Behavioral interventions to increase HPV vaccination acceptability among mothers of young girls.
Objective: To determine the most effective ways to present human papillomavirus (HPV) vaccine risk and benefit information to mothers in Hispanic, African American, and White communities, to increase mothers’ intentions to vaccinate their daughters against HPV. Design: The study used a 3 × 2 between-subjects factorial design, involving 3 different risk presentation formats (graphical HPV statistics, nongraphical HPV statistics, or no-statistics control) and the presence or absence of rhetorical questions (RQ). Data were collected from a national sample of 471 mothers of girls ages 11–16. Main Outcome Variables: The primary outcome variable was mothers’ intention to vaccinate their daughters against HPV. Secondary outcomes included mothers’ self-reported message comprehension and perceptions of daughters’ vulnerability to HPV infection, infection severity, vaccine efficacy, and obstacles to immunization. Results and Conclusion: Results showed that both risk presentation format and RQs had an overall positive effect on mothers’ intention to vaccinate their daughters. However, the interventions appear to be more effective when used separately than when used in combination. Each of these interventions is brief and could easily be implemented by health care providers as well as in patient health communication literature. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
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 one’s 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. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
The impact of cognitive function on medication management: Three studies.
Objective: Medication nonadherence has been a persistent problem over the past three decades; forgetting and being distracted from regular routines are the barriers most frequently cited by patients. Prior research on cognitive function and medication adherence has yielded mixed results. Design: This report compares findings of three studies: All were longitudinal, two were randomized controlled intervention trials, and one was descriptive. Samples of adult patients taking once daily lipid-lowering medication, diabetic patients with comorbid conditions on complex regimens, and early stage breast cancer patients on hormonal therapy completed similar batteries of standardized, valid, neuropsychological tests at baseline. Main Outcome Measures: Adherence to medication regimens, over time, was tracked with electronic event monitors. Results: Medication nonadherence was prevalent in all studies. Deficits in attention/mental flexibility and/or working memory predicted nonadherence in all studies; impaired executive function was related to poor adherence in one study. Conclusion: These findings suggest that better mental efficiency may be the key to better medication adherence with any regimen, and that targeted cognitive functions, which can be easily and quickly assessed, may identify patients at risk of poor adherence regardless of diagnosis or regimen. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Using the common sense model of illness perceptions to examine osteoarthritis change: A 6-year longitudinal study.
Objective: To examine the association between changes in common sense models and changes in functional status over a 6-year follow-up in patients with osteoarthritis. Design: At baseline and follow-up, osteoarthritis outpatients (N = 241) recruited from a university medical center completed the Illness Perception Questionnaire—Revised (IPQ-R), the Australian/Canadian Osteoarthritis Hand Index, and the Western Ontario and McMasters Universities Osteoarthritis Index. Also, their physician-assessed pain intensity, and biomedical, and clinical measures of medical severity of osteoarthritis were recorded. Main outcome measures: Functional disability, pain intensity. Results: Over 6 years, functional disability and pain intensity increased. The IPQ-R dimensions of timeline, personal control, and illness coherence became more negative, and emotional representations became less negative (i.e., more accepting). Patients identified as sharing a similar profile of negative changes on the IPQ-R had significantly worse functioning on 2 of 3 outcomes, independent of objectively measured osteoarthritis severity. Conclusions: Changes in illness perceptions were associated with changes in outcomes. Interventions to prevent increasingly negative patterns of illness perceptions over time, with an emphasis on strengthening control cognitions, may benefit functional status outcomes in patients with osteoarthritis. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Health-related quality of life in head and neck cancer survivors: Impact of pretreatment depressive symptoms.
Objective: Symptoms of depression are common in those with cancer. The authors investigated whether depressive symptoms assessed before the initiation of cancer treatment predicted diminished health-related quality of life (HRQOL) at follow-up. Design: As part of a large, prospective study of oncologic outcomes, 306 patients with head and neck cancer (HNC) were assessed on several clinical and psychosocial characteristics during a pretreatment clinic visit and then at 3- and 12-month follow-up appointments. Main Outcome Measures: Depressive symptomatology was assessed with the Beck Depression Inventory and HNC-specific HRQOL (main outcome measure) was assessed with the Head and Neck Cancer Inventory. Results: Controlling for age, gender, marital status, cancer site, stage of disease, alcohol and tobacco use, comorbidity status, and pretreatment HRQOL, simultaneous multiple regression analyses revealed that depressive symptoms present at study enrollment, before the initiation of cancer treatment, significantly predicted lower HRQOL at 3- and 12-month follow-up assessments across the 4 HNC-specific domains of speech, eating, aesthetics, and social disruption (all ps = .01). Conclusion: Results suggest that depressive symptomatology present near the time of diagnosis can have a significant, deleterious impact on HRQOL over time in HNC survivors. Thus, it may be useful to assess depression at diagnosis to identify individuals at greater risk for poor HRQOL outcomes. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
What role do social norms play in the context of men’s cancer screening intention and behavior? Application of an extended theory of planned behavior.
Objective: Our research investigated the role of social norms in an extended theory of planned behavior (TPB) in the explanation of prostate/colorectal cancer screening (CS) intention and the prediction of CS uptake among men. Design: A cross-sectional study (Study 1) assessed sociodemographic and TPB variables (extended by descriptive norm) in 2,426 German men (mean age 56.3 years) who differed in their past CS behavior. A subsample of Study 1 (former nonattenders and irregular attenders, n = 1,032) were followed up 12 months later (Study 2). Main Outcome Measures: The authors measured cross-sectionally the intention to undergo a CS examination within the next 12 months (Study 1), and longitudinally self-reported uptake of prostate and/or colorectal CS within the last 12 months (Study 2). Results: When sociodemographic variables were controlled, TPB variables predicted a substantial amount of CS-intention (?R2 = .49). Descriptive norm explained variance beyond the classic TPB variables and interacted significantly with subjective norm. Significant predictors of CS uptake were intention and subjective norm with the latter having a different effect in the two subgroups: a high subjective norm (assessed at T1) was associated with higher CS attendance in (former) nonattenders but lower CS attendance in irregular attenders in the following 12 months. Conclusion: Social norms play an important role in men’s CS intention and behavior. For intention formation, descriptive norm is influential in addition to subjective norm. The fact that a high subjective norm resulted in a lower likelihood of screening among irregular attenders suggests possible reactance effects. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Longitudinal relationships between family routines and biological profiles among youth with asthma.
Objective: To investigate whether longitudinal trajectories of inflammatory markers of asthma can be predicted by levels of family routines in youth with asthma. Design: Family routines were assessed through parent questionnaires and peripheral blood samples obtained from youth every 6 months throughout the 18-month study period. Longitudinal relationships were evaluated using hierarchical linear modeling. Main Outcome Measures: Mitogen-stimulated production of cytokines implicated in asthma, specifically IL-4, IL-5, and IL-13. Results: Youth with more family routines in their home environment showed decreases in IL-13 (but not IL-4 or IL-5) over the course of the study period. In turn, within-person analyses indicated that at times when stimulated production of IL-13 was high, asthma symptoms were also high, pointing to the clinical relevance of changes in IL-13 over time. A variety of child and parent psychosocial as well as child behavioral characteristics could not explain these effects. However, medication use eliminated the relationship between family routines and stimulated production of IL-13. Conclusion: Our study suggests that family routines predict asthma outcomes at the biological level, possibly through influencing medication use. Considering daily family behaviors when treating asthma may help improve both biological and clinical profiles in youth with asthma. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Lifestyle interventions for youth who are overweight: A meta-analytic review.
Objective: Clear evidence suggests that lifestyle interventions can be helpful in the treatment of youth who are overweight, but translational research is needed to address the gap between treatment research and clinical care. Design: This meta-analysis integrated the results of 66 treatment–control comparisons and 59 alternate treatment comparisons evaluating lifestyle interventions for children and adolescents who were overweight. Main Outcome Measures: Between-groups differences in weight-related outcomes and other health-related behaviors at the end of treatment. Results: Lifestyle interventions were effective in a range of settings and with a range of participants. Even relatively brief programs had benefits apparent months after the end of treatment. A key component appeared to be the expectation that parents would be actively involved in treatment. Program benefits included not only better weight management but also better eating habits. Conclusion: The results suggest that lifestyle interventions can be effective under a wide range of conditions not limited to the highly controlled conditions of efficacy studies. Parent involvement is associated with significantly better results. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Herzog’s (2008) criteria for evaluating TTM.
Comments on an article by T. A. Herzog (see record 2008-13168-006). Herzog applied 14 criteria to transtheoretical model (TTM)-based smoking cessation studies, and concluded that "no study in the existing smoking cessation literature provides a true and full test of the TTM." But a few examples are provided that show how his list of unvalidated criteria can be fundamentally flawed. Herzog’s conclusion in the abstract is “The transtheoretical model applied to smoking cessation does not satisfy the criteria required of a valid stage model.” But, Herzog concluded that the studies were not adequate to test TTM. Does he believe his review proved the null hypothesis based on inadequate studies? Did all researchers apply TTM inadequately or are his criteria inadequate? (PsycINFO Database Record (c) 2009 APA, all rights reserved)
A welcomed and overdue debate.
Replies to comments by J. Prochaska (see record 2010-00152-002) to the author's original critique (see record 2008-13168-006) on the transtheoretical model and smoking cessation. Herzog is disappointed that Prochaska elected not to address the central point of the critique: that the stages of change (SOC) are not qualitatively distinct categories, and that the SOC algorithm systematically underestimates motivation to quit among smokers. All major hypotheses of the TTM depend on the subsidiary hypothesis that the SOC algorithm is a valid measure of motivation to quit smoking. If the SOC is not a valid measure, then the TTM can be expected to produce unsatisfactory results. As for the issues that Prochaska does raise, most of these already are refuted in the critique itself. Herzog did not, as Prochaska suggests, attempt to “prove the null hypothesis.” Rather, his straightforward position is that the TTM as a stage model is not well supported by empirical evidence. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Health Psychology - Vol 29, Iss 1