Predicting vaccination using numerical and affective risk perceptions: the case of A/H1N1 influenza.

During the 2009 A/H1N1 flu pandemic, German health authorities recommended vaccination; however, the efficacy of such programs largely depends on individuals' risk perception. Risk perceptions are commonly determined through numerical-cognitive estimates such as the perceived likelihood and severity of the hazard. Instead, we argue that risk perceptions, which include more affect-related aspects such as worry and threat, are more powerful predictors of protective behaviors. Moreover, vaccines are often perceived as double-edged since they offer protection but also involve adverse side-effects. As such, in the context of the A/H1N1 vaccine uptake, risk perception is not only disease-related (A/H1N1 infection) but also vaccine-related (A/H1N1 vaccine). The present longitudinal study was conducted during the run-up to the German A/H1N1 vaccination campaign and measured cognitive and affective risk perceptions associated with both the A/H1N1 infection and its vaccine (T1, October 2009, N=397) in order to assess their impact on (self-reported) A/H1N1 vaccination eight weeks later (T2, December 2009; N=285). As assumed, greater perceived likelihood and severity of infection were associated with greater affective risk perception at T1. The more threatened and worried people felt, the more they intended to get vaccinated; however, the greater the perceived likelihood and severity of vaccine adverse side-effects, the greater the amount of vaccine related affective risk perception, impeding vaccination intention. Finally, vaccination intention predicted vaccination eight weeks later at T2 (OR=2.2). The results suggest that numerical-cognitive risk perceptions, which are typically the target of public vaccination campaigns, do not impact preventive intention directly; instead, they facilitate affect-related risk perceptions, which motivate protective action.

Synergistic effects of planning and self-efficacy on physical activity.

Many individuals are motivated to improve their physical activity levels but often fail to act on their good intention. This study examines the roles of planning and self-efficacy in the prediction of physical activity. A total of 290 participants (77% women, mean age = 41.9 years) were surveyed three times. Intentions, planning, and physical activity were specified as a mediator chain. Results reveal that intentions were partly translated into physical activity by planning. Self-efficacy moderated this mediation, reflected by a planning × self-efficacy interaction (p < .05) on physical activity accounting for 16% of the variance in behavior. If a person is self-efficacious, planning seems more likely to be translated into physical activity.

Health Behavior Education, e-research and a (H1N1) Influenza (Swine Flu): Bridging the Gap between Intentions and Health Behavior Change.

This study examined relations between risk perception/self-efficacy and handwashing intentions/behaviors during the A (H1N1) pandemic influenza. Data were collected from a longitudinal sample of Costa Ricans (NT1/T2 = 449/97). Results revealed that males and females presented a different social cognitive pattern in reaction to A (H1N1) pandemic. In females, the effects of risk perception/self-efficacy on handwashing behaviors were fully mediated by handwashing intentions. In males, self-efficacy influenced both directly and indirectly on handwashing behaviors, and risk perceptions showed no significant effect on handwashing behaviors. These results suggest that gender oriented protocols should be adopted by public health authorities in order to educate males and females in preventing both A (H1N1) and seasonal influenza.

Who takes precautionary action in the face of the new H1N1 influenza? Prediction of who collects a free hand sanitizer using a health behavior model.

BACKGROUND: In order to fight the spread of the novel H1N1 influenza, health authorities worldwide called for a change in hygiene behavior. Within a longitudinal study, we examined who collected a free bottle of hand sanitizer towards the end of the first swine flu pandemic wave in December 2009. METHODS: 629 participants took part in a longitudinal study assessing perceived likelihood and severity of an H1N1 infection, and H1N1 influenza related negative affect (i.e., feelings of threat, concern, and worry) at T1 (October 2009, week 43-44) and T2 (December 2009, week 51-52). Importantly, all participants received a voucher for a bottle of hand sanitizer at T2 which could be redeemed in a university office newly established for this occasion at T3 (ranging between 1-4 days after T2). RESULTS: Both a sequential longitudinal model (M2) as well as a change score model (M3) showed that greater perceived likelihood and severity at T1 (M2) or changes in perceived likelihood and severity between T1 and T2 (M3) did not directly drive protective behavior (T3), but showed a significant indirect impact on behavior through H1N1 influenza related negative affect. Specifically, increases in perceived likelihood (ß = .12), severity (ß = .24) and their interaction (ß = .13) were associated with a more pronounced change in negative affect (M3). The more threatened, concerned and worried people felt (T2), the more likely they were to redeem the voucher at T3 (OR = 1.20). CONCLUSIONS: Affective components need to be considered in health behavior models. Perceived likelihood and severity of an influenza infection represent necessary but not sufficient self-referential knowledge for paving the way for preventive behaviors.

Changes in intentions, planning, and self-efficacy predict changes in behaviors: an application of latent true change modeling.

Can latent true changes in intention, planning, and self-efficacy account for latent change in two health behaviors (physical activity as well as fruit and vegetable intake)? Baseline data on predictors and behaviors and corresponding follow-up data four weeks later were collected from 853 participants. Interindividual differences in change and change-change associations were analyzed using structural equation modeling. For both behaviors, similar prediction patterns were found: changes in intention and self-efficacy predicted changes in planning, which in turn corresponded to changes in behavior. This evidence confirms that change predicts change, which is an inherent precondition in behavior change theories.

Differential effects of planning and self-efficacy on fruit and vegetable consumption.

To change dietary behaviors, people must be motivated to do so. But intentions often do not translate into behavior. Strategic planning (as a mediator) is expected to move people from intention to action. However, individuals who lack perceived self-efficacy might fail to apply their plans when encountering challenging situations. Thus, self-efficacy might operate as a moderator variable when it comes to studying the mediator effects of planning on behaviors. This study examines the interactive role of planning and self-efficacy in the context of dietary changes. A longitudinal sample of 411 employees was surveyed twice in terms of their fruit and vegetable consumption over a 4-week interval. Intentions, planning, and fruit and vegetable consumption were specified as a mediator chain with self-efficacy as a moderator at two stages of the putative change process. Baseline behavior served as a covariate in the model. Intentions were translated into dietary behavior by planning. Self-efficacy moderated this mediation at the second stage, reflected by a planning x self-efficacy interaction on fruit and vegetable consumption. The strength of the mediated effect increased along with levels of self-efficacy. Individuals with very low self-efficacy did not benefit from planning. If a person lacks self-efficacy, planning does not seem to translate intentions into fruit and vegetable consumption.

Planning bridges the intention-behaviour gap: age makes a difference and strategy use explains why.

OBJECTIVE: This study examines age-differential association patterns between intentions, planning and physical activity in young and middle-aged individuals. The effectiveness of planning to bridge the intention-behaviour gap is assumed to increase with advancing age. We explore the use of behaviour change strategies that include selection, optimisation and compensation (SOC) as underlying mechanisms for age differences. METHODS: In N = 265 employees of a national railway company (aged 19-64 years), intentions, planning, SOC strategy use and physical activity were assessed at baseline (Time 1) and again 1 month later (Time 2). Hypotheses were tested in two different path models. RESULTS: Age moderates the extent to which planning mediates the intention-behaviour relation due to an increasing strength of the planning-behaviour link. As a possible psychological mechanism for these age differences, we identified SOC strategy use as a mediator of the age by planning interaction effect on physical activity. CONCLUSION: These findings suggest differential mechanisms in behaviour regulation in young and middle-aged individuals.

Translating intentions into nutrition behaviors via planning requires self-efficacy: evidence from Thailand and Germany.

A first step towards the improvement of daily dietary behaviors is forming an intention to change one's nutrition. However, an intention by itself is not sufficient for successful action. Rather, to translate intentions into behavior, careful planning is recommended. Thus, planning constitutes a mediator between the intention and the behavior. However, if a person lacks self-efficacy, this mediation might fail. Previous research in Costa Rica and South Korea has identified perceived self-efficacy as a moderator of the intention-planning-behavior relationship. To examine further the moderator role of self-efficacy, two additional studies were designed in Thailand and Germany. Study 1 surveyed 1718 Thai university students in terms of a low-fat diet; Study 2 surveyed 1140 German internet users in terms of their fruit and vegetable consumption at two measurement points in time, 6 months apart. Intentions served as predictor, planning as mediator, self-efficacy as moderator, and behaviors as outcomes. First, intentions were translated into nutrition behaviors by planning. Second, self-efficacy moderated this mediation in both studies: The strength of the mediated effect increased along with levels of self-efficacy, even when accounting for baseline behaviors. For planning to mediate the intention-behavior relation, people must not harbor self-doubts. If they lack self-efficacy, intentions are not well translated into nutrition behavior through planning.

Long-term relations between intentions, planning, and exercise: a 3-year longitudinal study after orthopedic rehabilitation.

OBJECTIVE: Planning has been hypothesized to operate as a mediator linking intentions to health behaviors. To explore the temporal variation of these constructs and their interrelationships, a long-term study of intentions, planning, and physical activity was conducted. METHOD: A sample of 328 individuals in orthopedic rehabilitation provided data at five measurement occasions over 3 years after their discharge from rehabilitation. A process-oriented approach combining mediation analysis and latent growth curve (LGC) modeling was applied. RESULTS: The orthopedic rehabilitation led to an initial increase in planning and behavior, followed by a decrease after 6 months and stabilization for the next 2.5 years. Intention revealed a slight but constant decrease for 6 months and remained stable up to 3 years after rehabilitation. The mediation model confirmed planning as mediator between intention and physical activity in former rehabilitation participants. CONCLUSIONS: Prior evidence on the mediating role of planning in the intention-behavior relation is corroborated and extended by the present findings at the level of long-term processes. Planning can and should be integrated in rehabilitation treatment programs to facilitate sustainable recovery.

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.

Prediction of stage transitions in fruit and vegetable intake.

Stage theories propose that individuals pass through different stages on their way toward behavior change. The present study examines stage-specific prediction patterns of social-cognitive variables (risk perception, outcome expectancies, perceived self-efficacy, action planning and social support) regarding transitions between the three stages of the Health Action Process Approach (HAPA; preintention, intention and action stage). In an online study (n = 494) on fruit and vegetable intake, social-cognitive variables and stages were assessed at baseline and stage transitions 4 weeks later. Transitions between the preintention, intention and action stage were predicted by social-cognitive variables using binary and multinomial logistic regression analyses. Stage-specific prediction patterns emerged for stage progression and stage regression. Outcome expectancies predicted progression from the preintention stage, whereas social support predicted progression to the action stage. Low levels of planning were associated with relapse to the preintention and the intention stage. Self-efficacy emerged as a universal predictor of stage transitions. Findings support not only the usefulness of the stage construct for describing health behavior change but also the validity of the HAPA variables as predictors of stage transitions. Stage-matched interventions targeting the variables identified as stage-specific predictors might support stage progression toward the goal behavior.