Using the Theory of Planned Behavior to predict pregnant women's intention to engage in regular exercise.

OBJECTIVE: the objectives of this study were to use the Theory of Planned Behavior (TPB) in order to determine to what degree pregnant women intended to exercise regularly during pregnancy, and then to evaluate the TPB model fit. DESIGN: this study was based on a cross-sectional survey with a tool which was developed specifically for this study. SETTING: we identified and invited pregnant women from two medical center hospitals and one certified prenatal center in northern Taiwan to participate. PARTICIPANTS: using purposive sampling, we selected participants who were in at least the 12th week of gestation and did not have a high-risk pregnancy. 621 completed the instrument, their mean age was 31.76 (SD=3.87). METHODS: a self-administered instrument was used to determine the firmness of participants' intention to engage in regular exercise during pregnancy. The data were analyzed using SPSS 19.0 software and LISREL 8.72 software. FINDINGS: of the pregnant women in our study, 64.2% were found to be likely to exercise regularly up until delivery. The TPB was used to arrive at specific findings with regard to "intention to exercise regularly during pregnancy." Our participants demonstrated a positive intention to exercise regularly, a positive attitude (ATT), positive subjective norms (SN) and positive perceived behavioral controls (PBC) during pregnancy. The most influential factor in determining the participants' positive intention to exercise was found to be PBC (ß=0.68, p<0.01), followed by the SN (ß=0.12, p<0.01). The participants' ATT did not significantly influence their intention. Overall, the final model explained 59% of the variation in "intention to exercise regularly." KEY CONCLUSION AND IMPLICATION FOR PRACTICE: the most important factor in determining the participants' intention to exercise regularly was PBC, followed by the SN. Medical staff members should be able to help pregnant women overcome obstacles to regular exercise, for example, by assisting in providing appropriate resources.

Lifestyle and Addictive Behaviors Among Chinese Adolescents in Hong Kong, Macau, Taipei, Wuhan, and Zhuhai-a First Cross-subculture Assessment.

PURPOSE: This study aimed at assessing the differences in prevalence rates of common health behavior among adolescents in the five Chinese cities and the influential factors at the contextual and individual levels. METHOD: We compared the standardized rates of three lifestyle behaviors (sedentary, dietary, and physical activity) and three addictive behaviors (cigarette smoking, alcohol consumption, and participation in gambling) among a sample of 13,950 adolescents. The sample was randomly selected from five cities, including Hong Kong, Macau, Taipei, Zhuhai, and Wuhan. Population size, GDP per capita, and literacy at the city level as well as parental monitoring and school performance at the student's level were assessed. Multi-level mixed effect models were used to examine the interaction of individual level factors with study sites. RESULTS: The six health behaviors differed significantly across sites with the highest rates of alcohol consumption in Hong Kong (39.5 %), of cigarette smoking in Macau (9.8 %), and of gambling in Taipei (37.1 %) and Hong Kong (35.9 %). The city-level measures were associated with only a few behavioral measures. Relative to Hong Kong, parental monitoring had stronger association with the three addictive behaviors in the other sites. CONCLUSION: Findings suggest that although the study sites share similar Chinese culture, students in the five cities differed from each other with regard to levels of health behaviors. Relative to the broad socioeconomic development, differences in parental monitoring played a significant role in explaining the observed difference.

Examining the causal model linking health literacy to health outcomes of asthma patients.

AIMS AND OBJECTIVES: To explore health literacy status in asthma patients and to examine the causal model linking health literacy to health outcome-related factors via mediator and moderator variables. BACKGROUND: Understanding how low health literacy may influence health outcomes is important. DESIGN: This is a cross-sectional survey study. METHODS: A total of 326 asthma patients aged 20 years and older (average: 51 ± 18·3 years) were recruited by purposive sampling from pulmonary medicine outpatient departments at three medical centres and a regional teaching hospital in northern Taiwan. Data were collected via structured questionnaires, including measures of socio-demographic and disease characteristics; medical decision-making; asthma knowledge, attitudes and self-efficacy; healthcare experience and health outcome-related factors (metered-dose inhaler/dry-powder inhaler usage proficiency, medical use, self-management behaviour). Three hundred patients who met the inclusion criteria and completed the questionnaire survey were analysed. RESULTS: Overall, 217 subjects (72·3%) had adequate functional health literacy, 42 (14%) had inadequate functional health literacy, and 41 (13·7%) had marginal functional health literacy. Subjects' average asthma knowledge, attitudes and self-efficacy scores were 7·23 ± 2·69, 51·46 ± 6·18 and 58·31 ± 8·10, respectively. Health literacy correlated positively with asthma knowledge (r = 0·605), attitudes (r = 0·192) and medical decision-making (r = 0·413). CONCLUSIONS: Health literacy is positively associated with proficiency in metered-dose inhaler usage, asthma knowledge, attitudes and medical decision-making, but is not significantly associated with medical care use and self-management behaviour. Health literacy had an indirect effect on self-management behaviour through the mediation effect of asthma attitudes. No moderator was found for the effect of health literacy on health outcome-related factors. RELEVANCE TO CLINICAL PRACTICE: Results of this study may help to develop adequate intervention strategies to improve the health outcomes of asthma patients.

[Applying health beliefs to mothers who join in newborn hearing screening].

This study explores the potential of applying health belief models to studies of mothers who participate in newborn hearing screening (NHS) in order to establish a reference for the future research. The study was designed prospectively, with 653 effective samples enrolled between November 1991 and April 1992 and data collected using a self-constructed questionnaire. The return rate for the questionnaire was 68.6%. Main conclusions include: (1) the decision to participate in newborn hearing screening correlates in a significant manner with potential participant backgrounds and actions clues; (2) "knowledge of NHS" and "perceived benefits of action in NHS" were the most important factors in this study associated with NHS participation; (3) subjects who participated in the NHS demonstrated significantly higher scores in "knowledge of NHS" and "perceived benefits of action in NHS" than those who did not participate. Significant negative correlation was identified between education level and perceived barriers to joining NHS. Significant positive correlation was observed between education level and NHS knowledge. Also, a significant positive relationship was identified between "perceived benefits of action in NHS" and both "clues of inner action" and "knowledge of NHS". However, "perceived barriers to NHS action" was found to share no significant relationship with any of the others. A positive relationship was also identified between "perceived benefits of action in NHS" and both "clues of outer action" and "amount of information resources"; and (4) "clues of outer action", "NHS knowledge", and "perceived benefits of NHS action" were found to be the most important indicators affecting study subjects' decision regarding whether or not to join NHS.

Gender differences in predictors of drinking behavior in adolescents.

This study explored the differences in the risk factors associated with alcohol use, problem drinking, and related consequences between male and female high school students in eastern Taiwan. A total of 771 10th grade students, including 327 boys (42.4%) and 444 girls (57.6%), from four randomly selected high schools in eastern Taiwan were included in the survey. Multiple logistic regression analyses were performed. In conclusion, paternal drinking was found to be an important factor for the development of alcohol use in adolescent boys but had less impact on girls when compared with maternal drinking. Peer norms and peer relationships had greater effects on drinking behavior in female than in male adolescents. Alcohol use appeared to be much more closely related to family relationships in female than in male adolescents. In adolescent boys, deviant self-image was the real factor causing problem drinking. Therefore, preventive intervention for boys should focus on managing psychological distress and strengthening positive self-image, while correcting peer drinking norms, learning of drinking refusal self-efficacy, establishing friendships without drinking, and positive parent-child communication should be enhanced for girls.

Alcohol use and problem drinking in Taiwanese adolescents: comparison of the Han and indigenous populations.

The population of Taiwan is 98% Han and 2% indigenous. Taiwanese Hans are, ethnically, an immigrant Chinese population. Traditionally, indigenous families make wine and, just like tea to the Hans or coffee in Western social settings, wine is served to entertain the guests in the indigenous culture. Alcohol drinking is a way of delivering a message of their conviviality. It also has a central role in traditional harvest festivals, ancestor worship and wedding ceremonies (Historical Research Commission of Taiwan Province, 1996).

Comparison of the predictors of alcohol use and misuse among Han and aboriginal students in Taiwan.

The objective of this study was to compare the predictors of alcohol usage between the Han and aboriginal students in Taiwan. Results showed a significant gender difference for alcohol use and problematic drinking in both Han and aboriginal adolescents, with males having a higher prevalence of these problems than females in both groups. Aboriginal adolescents did not show gender differences in alcohol-related negative consequences. Male, paternal drinking, single-parent household, peer drinking, and peer relationships are the significant predictors for the Hans adolescents' problematic drinking. Gender, paternal drinking, and peer drinking are the significant predictors for aboriginal adolescents' problematic drinking. If the father drinks frequently, odds ratio is 6.48 likely for aboriginal adolescents to have problematic drinking. If peers drink frequently, odds ratio is 6.26 likely for aboriginal adolescents to have alcohol-related negative consequences. Frequent peer drinking was associated with a 6.26 odds ratio of have alcohol-related negative consequences.