Some habits are more work than others: Deliberate self-regulation strategy use increases with behavioral complexity, even for established habits.

OBJECTIVE: We tested the hypothesis that complex behaviors are commonly supported by self-regulation strategies, even when those behaviors are supported by strong instigation habits. BACKGROUND: Goal-directed and habit-mediated processes arise from separable systems that have been suggested to seldomly interact. RESULTS: Self-regulation strategy use was lower for habitually instigated simple behaviors compared to nonhabitually instigated simple behaviors. However, participants' use of self-regulation strategies increased with the increasing complexity of behaviors, even when complex behaviors were habitually instigated. The difference in the extent of strategy use between habitually and nonhabitually instigated actions was absent when behavioral complexity was particularly high. CONCLUSION: These results point to a qualitative distinction-while simple behaviors may progress in a relatively automatic and unthinking manner, complex behaviors receive frequent support from self-regulation strategies, even if they are instigated habitually.

Psychometric validation of four-item exercise identity and healthy-eater identity scales and applications in weight loss maintenance.

BACKGROUND: Identifying as someone who engages in health promoting behaviors like healthy eating and exercising may be associated with sustained engagement in those behaviors, but reliable and valid instruments are needed to improve the rigor of this research. Two studies were conducted to (1) examine the psychometric properties of a four-item exerciser identity measure (4-EI) and an adapted healthy-eater identity measure (4-HEI) and (2) examine differences in identity strengths across categories of weight loss success. METHODS: Data from 1,709 community dwelling adults in the International Weight Control Registry (IWCR) were used. A random half of the sample was used to assess the proposed unidimensional factor structure of the 4-EI and 4-HEI and examine convergent and discriminant validity using Spearman rank-order correlations. One-way ANOVA was used in the other random half of the sample to compare 4-EI and 4-HEI scores (-3 to + 3) across three self-defined weight loss categories ('Successful', 'Regain', and 'Unsuccessful') and those maintaining ≥ 5% weight loss for > 1 year vs. not. RESULTS: Results support the unidimensional factor structure with all four items (eigenvalue scores > 2.89) as well as convergent and discriminant validity for both measures. Exercise identity was strongly correlated with self-reported physical activity (r (735) = 0.52, p <.001) and measures of autonomous motivation. Healthy eating identity was moderately correlated with cognitive restraint in eating (r (744) = 0.42, p <.001) and other measures predictive of eating behavior. 4-EI and 4-HEI are stronger in Successful (4-EI: M = 0.90, SD = 1.77; 4-HEI: M = 1.56 SD = 1.37) vs. Regain (4-EI: M=-0.18, SD = 1.68; 4-HEI: M =.57, SD = 1.48) and Unsuccessful (4-EI:M=-0.28, SD = 1.62; 4-HEI: M = 0.51, SD = 1.33) and those maintaining ≥ 5% weight loss (4-EI:M = 0.47, SD = 1.78; 4-HEI: M = 1.13, SD = 1.49) vs. not (4-EI:M=-0.27, SD = 1.66; 4-HEI: M = 0.53, SD = 1.47), p's < 0.001. CONCLUSIONS: The 4-EI and 4-HEI have acceptable psychometric properties and can advance understanding of the role of identity in exercise and dietary behaviors and weight loss maintenance. TRIAL REGISTRATION: The parent observational study, International Weight Control Registry (IWCR), for these sub-studies is registered in ClinicalTrials.gov (NCT04907396).

Predicting implicit and explicit exercise identity from descriptive social norms regarding exercise.

OBJECTIVES: Exercise identity may promote exercise maintenance. However, less is known about factors that affect exercise identity. Whether descriptive social norms are potential intervention targets for identity development was evaluated. DESIGN: A cross-sectional design using data from the Attitudes, Identities, and Individual Differences (AIID) study was employed - with additional cases collected to increase sample size and power - to evaluate whether descriptive social norms regarding exercise are related to implicit and explicit exercise identities. MAIN OUTCOME MEASURES: Participants completed measures of proximal and distal descriptive social norms regarding exercise, explicit and implicit exercise identity, physical activity behavior, and demographics. Multiple regression was used to assess whether social norms regarding exercise predict exercise identities. RESULTS: Only proximal descriptive social norms were significantly associated with explicit exercise identity, whereas neither proximal nor distal descriptive social norms were associated with implicit exercise identity. The slopes for explicit and implicit identity differed when predicted by distal (but not proximal) descriptive social norms. CONCLUSIONS: Proximal descriptive social norms may be associated with explicit exercise identity and may be a worthy intervention targeting alongside identity to influence change in exercise behavior. More research is needed to further understand these relationships.

Corrigendum: Evaluating behavior change factors over time for a simple vs. complex health behavior.

[This corrects the article DOI: 10.3389/fpsyg.2022.962150.].

Evaluating behavior change factors over time for a simple vs. complex health behavior.

Background: Researchers are working to identify dynamic factors involved in the shift from behavioral initiation to maintenance-factors which may depend on behavioral complexity. We test hypotheses regarding changes in factors involved in behavioral initiation and maintenance and their relationships to behavioral frequency over time, for a simple (taking a supplement) vs. complex (exercise) behavior. Methods: Data are secondary analyses from a larger RCT, in which young adult women, new to both behaviors, were randomly assigned to take daily calcium (N = 161) or to go for a daily, brisk walk (N = 171), for 4-weeks. Factors (intentions, self-efficacy, intrinsic motivation, self-identity, habit strength) were measured weekly. Multi-level modeling evaluated their change over time. Bivariate correlations and multiple regression determined the relationships between factors and the subsequent-week behavioral frequency (self-report and objective). Finding: Results were partly in-line with expectations, in that individuals' intentions and self-efficacy predicted initial behavioral engagement for both behaviors, and habit strength increased for both behaviors, becoming a significant predictor of behavioral frequency in later weeks of the study in some analyses. However, results depended on whether the outcome was self-reported or objectively measured and whether analyses were bivariate or multivariate (regression). Discussion: The factors theorized to play a role in behavioral maintenance (intrinsic motivation, self-identity, and habit strength) started to develop, but only habit strength predicted behavioral frequency by study-end, for both behaviors. Differences in initiation and maintenance between behaviors of differing complexity may not be as stark as theorized, but longer follow-up times are required to evaluate maintenance factors.

The utility of the integrated behavior change model as an extension of the theory of planned behavior.

Introduction: There are several widely used theories of health behavior change, which mostly utilize the social cognitive approach. These theories tend to posit that intention is a direct predictor of behavior, do not include automatic influences on behavior, and propose a one-size-fits-all theory for both initiators and maintainers. However, the intention-behavior gap is a well-observed phenomenon, researchers have highlighted that both automatic and reflective factors promote behavioral engagement, and predictors of behavior have been shown to differ between initiators and maintainers-three issues that necessitate theory advancement. To that end, the present research compares the utility of the Integrated Behavior Change Model (IBCM) - a social cognitive model that includes automatic factors involved in behavioral engagement and a moderator of the intention-behavior gap - to its theoretical predecessor, the Theory of Planned Behavior (TPB). Further, the relevance of the IBCM factors for predicting exercise behavior is compared in initiators versus maintainers. Method: Participants were 494 US undergraduates. Participants reported on variables from the IBCM (and TPB) at baseline and reported on their exercise behavior in two surveys at seven- and 14-days post-baseline. Results: Findings supported the first hypothesis that the IBCM would be more relevant for initiators in comparison with maintainers, using structural equation modeling. Specifically, only the paths between intrinsic motivation and affective attitude, affective attitude and intention, and intention and behavior were reliably found for maintainers. For initiators, the aforementioned paths were also reliably supported and the additional following paths were also supported: intrinsic motivation and perceived behavioral control, perceived behavioral control and intention, and intention and action planning. However, results did not support the second hypothesis that the IBCM would predict significantly more variance in behavior than its theoretical predecessor, the TPB. Specifically, the addition of action planning, implicit attitude, implicit motivation, and the interaction between intention and action planning only predicted an additional 0.3% (p < 0:05) of the variance in exercise behavior above and beyond intention. Conclusion: Results highlight the continued need for theoretical refinement in terms of delineating mechanisms of initiation and maintenance and the need for further development in terms of improving upon current predictions of behavior engagement and change.

Developing Scotland's First Green Health Prescription Pathway: A One-Stop Shop for Nature-Based Intervention Referrals.

Introduction: Lifestyle modifications are part of comprehensive treatment plans to help manage the symptoms of pre-existing chronic conditions. However, behavior change is notoriously difficult as patients often lack the necessary support. The present manuscript outlines the development of a Green Health Prescription pathway that was designed to link patients with appropriate lifestyle interventions (i.e., nature-based interventions) and to support attendance. Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was undertaken in three focus groups (i.e., National Health Service healthcare professionals, service-users, and nature-based intervention delivery partners) to highlight areas of strength and weakness within the proposed pathway prior to delivery. The SWOT analyses revealed that the pathway was supported by all three focus groups. Weaknesses and threats were identified including sustainability of nature-based interventions in terms of funding, the need to connect patients with appropriate interventions based on their physical and mental health needs, and the requirement to have a "one-stop shop" for information to ensure that the pathway was accessible for all service-users and healthcare professionals. Results were addressed and considered throughout the development of the pathway. Discussion: The Green Health Prescription pathway was launched in 2019 and gave patients the ability to receive a prescription from a healthcare professional, community service, or to self-refer. The pathway allows patients to contact a consultant, via a telephone service, who is trained to match them with a programme that the patient believes will be enjoyable and that fits their treatment needs. Data collection to assess the efficacy of the pathway is ongoing.

Contrasting constructs or continuum? Examining the dimensionality of body appreciation and body dissatisfaction.

Individuals experiencing body dissatisfaction have poorer health outcomes in part due to engaging in less physical activity. Body appreciation is protective of health behaviors and proposed to be conceptually different from body dissatisfaction. Two studies evaluated whether body appreciation and dissatisfaction represented two distinct dimensions, and whether body appreciation and dissatisfaction would interact in their effect on activity-related motivation and behavior. Study 1 (n = 313) was prospective and utilized a self-report measure of physical activity whereas Study 2 (n = 123) was prospective and used an objective measure. All hypotheses and analyses were pre-registered. A multiverse approach was taken to demonstrate the robustness of results. In exploratory factor analyses, body appreciation and dissatisfaction did not represent two distinct dimensions of body image as both loaded onto the same factor. This result was largely supported by latent profile analyses, which revealed that participants scored high, moderate, or low on both body satisfaction and appreciation. Additionally, body appreciation did not buffer the negative impact of body dissatisfaction on activity-related motivation and behavior. This study provides the first statistical evaluation of the theoretical proposition that body appreciation and dissatisfaction may be distinct constructs with distinct relationships to outcomes.

Examining self-affirmation as a tactic for recruiting inactive women into exercise interventions.

Recruitment of insufficiently active individuals into exercise interventions is difficult due to many different barriers, including motivational barriers and negative body image. The present study provided an initial conceptual test of whether self-affirmation can help increase recruitment of insufficiently active women to an exercise intervention. Emerging adult women were randomly assigned to complete a self-affirmation or control task prior to reading the same message concerning the consequences of inactivity. In addition to completing demographic and body image measures at baseline, U.S. undergraduate participants (N = 254) indicated their interest in registering for an intervention and their intention to exercise after the experimental manipulation. Data did not support hypotheses that (1) self-affirmed women would find the message less threatening and less manipulative, (2) self-affirmed women would have higher intentions to exercise, (3) self-affirmed women would be more likely to register interest for a future exercise intervention, and (4) condition and body dissatisfaction would interact such that the intervention would be particularly beneficial for women with high body dissatisfaction. Results revealed that 70% of participants were unwilling to register for an exercise intervention, which indicates that other novel exercise intervention recruitment techniques need to be tested.

Source-Orientation and Avoidance/Approach-Orientation are Important Components of Introjected Regulation for Leisure-Time Physical Activity.

Introjected regulation has been inconsistently linked to physical activity, which may be due to it being an umbrella construct for different types of introjected regulation that have the potential to be differentially related to behavior. We evaluated (1) whether self-oriented approach, self-oriented avoidance, other-oriented approach, and other-oriented avoidance were distinct constructs from one another and from identified regulation, and (2) whether the following were related to physical activity engagement from strongest to weakest: self-oriented approach, self-oriented avoidance, other-oriented approach, and other-oriented avoidance. Behavioral regulations were measured at baseline, physical activity was measured via self-report at baseline and follow-up, and using daily diaries (N = 336). A factor analysis revealed a four-factor solution: general approach, self-oriented avoidance, other-oriented avoidance, and identified regulation. Self-oriented avoidance was the strongest predictor of physical activity, followed by general approach, and other-oriented avoidance. Including measures that capture these subdimensions of introjected regulation in future research has the potential to clarify inconsistent relationships in the literature.

The influence of body dissatisfaction on cardiovascular and strength-based physical activity by gender: a self-determination theory approach.

Physical activity-or lack thereof-is one behaviour that may help explain why individuals who are dissatisfied with their bodies experience poor health outcomes. OBJECTIVE: The purpose of the present study was to examine the mediating role of behavioural regulations (i.e., autonomous and controlled) in the relation between body dissatisfaction and physical activity and to determine whether this mediated relationship was moderated by gender. Additionally, this relation was examined for both cardiovascular and strength-based physical activity. DESIGN: A two-week daily-diary study was conducted. MEASURES: The Body Shape Satisfaction Questionnaire, the Behavioural Regulation in Exercise Questionnaire - 3, and the International Physical Activity Questionnaire were used to test the main hypotheses. RESULTS: For men and women, body dissatisfaction was related to less frequent cardiovascular and strength-based activity due to lower levels of intrinsic regulation. In women, the relation between body dissatisfaction and activity (cardiovascular and strength-based) was partially mediated by controlled regulations (i.e., external and introjected). That is, women who were dissatisfied exercised more because they were more likely to feel that they had to appease others or themselves. CONCLUSION: The present study provides direction for targeting physical activity behaviours in college students who are dissatisfied with their bodies.

Experimental test of a planning intervention for forming a 'higher order' health-habit.

Objective: Habit-formation interventions may help individuals initiate and maintain behaviour change. This paper proposes and empirically tests the idea that it is possible for individuals to form 'higher-order habits', or behaviours that can be executed in more than one way, and still be habitual. Design: Participants (N = 82) were healthy adults randomly assigned to an action-and-coping-planning intervention for forming a 'higher-order habit' of filling half of their dinner plates with fruits and vegetables or a control condition. Key measures were collected at baseline and 1, 2 and 3 weeks post-baseline. Participants submitted 3 pictures per week of their dinner plates via snapchat/email. Main Outcome Measures: Intrinsic motivation, habit strength and behavioural frequency for filling half their dinner plates with fruits and vegetables. Results: Intervention participants reported significantly greater habit strength at each follow-up time point. Controls did show some degree of habit formation, despite not fully forming a habit. Behavioural automaticity increased despite consuming a variety of fruits/vegetables; results did not depend on participants' intrinsic motivation to consume fruits/vegetables. Conclusion: It may be possible for individuals to form 'higher-order' habits, which may be particularly important in health contexts, in which many target behaviours are complex and can be seen as higher-order.

Do measures of country-level safety predict individual-level health outcomes?

Health is not only a result of biological conditions, but of psychological, economic, and social circumstances. Both proximal factors, which impact daily life, and distal factors, which are further removed from everyday life, can influence a person's wellbeing. However, traditionally these distal factors have been overlooked in public discourse and government policy. OBJECTIVE: In the present study we examined whether measures of country-level safety predict the health of their residents. Additionally, we examined whether socioeconomic status (SES; approximated by income) interacts with other proximal factors to predict health. METHODS: Participants were 81,415 individuals residing in 58 countries. Multilevel modeling was used to determine the influence of distal and proximal factors on health. RESULTS: Findings indicated that both country-level safety and SES predict health regardless of the country of residence. Additionally, SES interacted with other proximal variables (e.g., life satisfaction and access to food) to predict health. CONCLUSIONS: In addition to everyday living conditions, health is contingent upon circumstances that do not directly impact daily life. This indicates that preventive measures are needed to secure the health of individuals impacted not only by negative proximal factors, but negative distal factors as well. In light of these findings, more translational research is needed to highlight the importance of the biopsychosocial model of health to both policymakers and the public. In this article, we suggest two research avenues relating to country-level safety that could provide specific recommendations for policy change.

Evaluating the potential roles of body dissatisfaction in exercise avoidance.

Body dissatisfaction is linked to poor physical health, even after actual markers of health have been controlled for. This link is likely due to body dissatisfaction influencing health behaviors-more specifically, cardiovascular exercise. Modifiable reasons for this link have yet to be determined. We conducted a prospective study to evaluate whether active avoidance of exercise may explain the association of body dissatisfaction with exercise, and, if so, whether perceived barriers to exercise account for the association of body dissatisfaction and exercise avoidance. Baseline measures were collected via survey; physical activity was measured over time, via self-report. As expected, avoidance mediated the prospective relationship between dissatisfaction and exercise. Additionally, the relationship between body dissatisfaction and avoidance was mediated by embarrassment and fatigue. Interventions that boost body satisfaction and/or address perceptions of fatigue and embarrassment may be needed for individuals with body dissatisfaction to be more likely to participate in exercise-related programs.