The implementation of multiple lifestyle interventions in two organizations: a process evaluation.

OBJECTIVE: To evaluate the implementation of a multicomponent lifestyle intervention at two different worksites. METHODS: Data on eight process components were collected by means of questionnaires and interviews. Data on the effectiveness were collected using questionnaires. RESULTS: The program was implemented partly as planned, and 84.0% (max 25) and 85.7% (max 14) of all planned interventions were delivered at the university and hospital, respectively. Employees showed high reach (96.6%) and overall participation (75.1%) but moderate overall satisfaction rates (6.8 ± 1.1). Significant intervention effects were found for days of fruit consumption (ß = 0.44 days/week, 95% CI: 0.02 to 0.85) in favor of the intervention group. CONCLUSIONS: The study showed successful reach, dose, and maintenance but moderate fidelity and satisfaction. Mainly relatively simple and easily implemented interventions were chosen, which were effective only in improving employees' days of fruit consumption.

Predictors of HPV vaccination uptake: a longitudinal study among parents.

To assess among parents longitudinal predictors of human papillomavirus (HPV) vaccination uptake for their daughters, random samples of parents were identified via municipal services and sent baseline questionnaires in June 2009 and follow-up questionnaires in November 2011 after their uptake decision. Hierarchical logistic regression analysis was used to assess whether demographic characteristics, and affective and social cognitive factors, predicted uptake at follow-up. Response rates of the baseline and follow-up questionnaire were 29.8% (1762/5918) and 74.3% (793/1067), respectively. Uptake was predicted by a later (2011) versus earlier (2010) decision about uptake as HPV vaccination implementation [odds ratio (OR) 2.48; 95% confidence interval (CI) 1.11-5.52], anticipated regret about no uptake (OR 1.43; 95% CI 1.08-1.89) and intention (OR 2.61; 95% CI 1.47-4.61). There was an interaction between ambivalence and attitude (OR 1.68; 95% CI 1.14-2.47); parents with a positive attitude and a high ambivalence toward vaccination were more likely to have their daughter vaccinated than parents with a positive attitude and a low ambivalence. An informed choice about uptake (5/7 correct items) was made by 44%. In conclusion, uptake was predicted by intention, a later (2011) versus earlier (2010) decision and by anticipated regret about no uptake. Decisions regarding new vaccines are difficult to make, we recommend a well-balanced implementation process.

Social-cognitive and socio-cultural predictors of hepatitis B virus-screening in Turkish migrants, the Netherlands.

Hepatitis B virus (HBV) is an important health problem in the Turkish Dutch. Screening is necessary for detection and prevention of HBV. We aimed to identify social-cognitive and socio-cultural determinants of HBV-screening intention among Turkish Dutch. A cross-sectional survey was carried out amongst 335 Turkish Dutch, aged 16-40 years. Respondents showed favorable scores for the potential determinants of HBV-screening. Attitude, perceived behaviour control, social support and social norm, and the level of satisfaction with Dutch health care proved to be directly associated with screening intention. Relevant socio-cultural beliefs were shame, stigma, the association of screening with sexuality and family values. Persons with lower screening intentions had lower scores for attitude, perceived behaviour control, social support and subjective norms, but scored higher for feelings of shame and stigma regarding hepatitis B. This study shows how cultural values and social-cognitive factors are related to HBV-screening intention.

Unhealthy behaviour is contagious: an invitation to exploit models for infectious diseases.

We argue that the spread of unhealthy behaviour shows marked similarities with infectious diseases. It is therefore interesting and challenging to use infectious disease methodologies for studying the spread and control of unhealthy behaviour. This would be a great addition to current methods, because it allows taking into account the dynamics of individual interactions and the social environment at large. In particular, the application of individual-based modelling holds great promise to address some major public health questions.

From weight management goals to action planning: identification of a logical sequence from goals to actions and underlying determinants.

BACKGROUND: Weight gain prevention (WGP) among adults who are overweight is an important target in the prevention of obesity. However, little is known about the process from WGP as a goal to successful weight-management. The present study aimed to: (i) gain more insight into this process; (ii) identify cognitive predictors of intention for WGP; and (iii) examine WGP as a potential predictor for the intention to change weight-related behaviours [dietary intake (DI) and physical activity (PA)] and specific action planning. METHODS: In this cross-sectional study, overweight adults [n = 510; body mass index 25-30 kg m(-2); mean (SD) age 48 (9.5) years; 30.8% male] completed an online questionnaire, assessing goal intention for WGP, behavioural intention for DI and PA, planning for change in DI and PA and socio-cognitive correlates. Ordinal regression analyses were used to analyse the data. RESULTS: In 89% of the sample, (parts of) the proposed sequence from goal intention (for WGP), behavioural intention (for DI/PA) and planning (for DI/PA) was observed. Attitude, social norm and perceived control towards WGP, and perceived weight status and risk perception, were associated with intention for WGP. Behaviour-specific perceived control and preferences were more strongly associated with intention to change DI or PA and planning for change than intention for WGP was. CONCLUSIONS: Intention for WGP is important in the process toward weight-management because, for most people, intention for WGP precedes behavioural intention, which precedes planning. Intention for WGP is associated with behavioural intention but behaviour-specific factors are the strongest correlates of behavioural intention and planning.

Predicting preparatory behaviours for condom use in female undergraduate students: a one-year follow-up study.

The objective of this study is to investigate whether the Theory of Planned Behaviour (i.e. attitude, subjective norm, perceived behavioural control and intention), fluctuations in motivation over time, and variables from the Prototype-Willingness Model (i.e. behavioural expectation and behavioural willingness to have unprotected sex) predict preparatory behaviours for condom use. Sixty-two female undergraduates completed baseline and one-year follow-up questionnaires. Having condoms at home and carrying condoms were predicted by behavioural willingness to have unsafe sex at baseline. Having bought condoms was predicted by the behavioural expectation to use condoms with new partners at baseline. Intention and fluctuations in motivation did not emerge as significant predictors of preparatory actions. Female undergraduates, who are more willing to have unprotected sex under risk-conducive circumstances, are also less likely to prepare adequately for condom use, and thereby increase their chances of encountering such situations. Overall, the findings are in support of the Prototype-Willingness Model.

Psychological determinants of the intention to educate patients about benzodiazepines.

OBJECTIVE: General practitioners and pharmacists do not properly educate their patients about the disadvantages of benzodiazepines. In order to increase and improve education, this study will investigate which psychological factors (i.e., beliefs, outcome expectation, social norm and self-efficacy) predict the intention to educate. METHODS: A cross-sectional survey study was conducted in which 339 general practitioners and 149 pharmacists in the Netherlands completed a questionnaire. RESULTS: The Results show that the above-mentioned factors play an important role in forming intentions to educate. However, differences exist between general practitioners and pharmacists. CONCLUSION: General practitioners and pharmacists intend to educate in cases where they think that benzodiazepines have well-defined disadvantages, when the education they undertake leads to success, when they feel pressure to educate from their surroundings and when they are capable of educating. Implications for practice These findings contribute to a better understanding of patient education and are of great value in developing new interventions to improve education.

A randomized clinical trial of a targeted intervention to moderate alcohol use and alcohol-related problems in at-risk adolescents.

This study investigated the effectiveness of a targeted intervention program aimed at at-risk adolescents in a randomized clinical trial design (N=107). This program combined intervention methods which have been proven effective in reducing drinking in young adults, such as an expectancy challenge, cognitive behavioral skill training and brief motivational feedback. Additionally, this intervention contained the new element of discussing biological, cognitive and social risk factors for developing alcohol problems. We investigated whether this seven session program was successful in changing cognitive determinants of drinking behavior and consequently in moderating alcohol use and the development of alcohol-related problems in at-risk adolescents. The intervention was effective in changing several of the targeted cognitive determinants. However, despite the changes in these cognitive determinants of drinking, the experimental group did not show a significant difference in decrease of drinking at posttest compared with the control group. The results did not yield support for any differential long term effects of the intervention. We concluded that although the present intervention successfully changed important cognitive determinants of drinking more is needed to change subsequent drinking behavior in at-risk adolescents.

Predicting condom use with casual and steady sex partners among drug users.

In many Western societies, drug users are accountable for heterosexual transmission of HIV. Although various studies have shown that safe sex is not a common practice among drug users, we still have little understanding of the factors that determine their use of condoms in their sexual relationships with steady or casual partners. The objective of this study is to gain more insight into the determinants of drug users' condom use with steady and casual sex partners. In a study conducted among 103 Dutch drug users, the participants indicated their intentions, vulnerability, attitude, personal norms, subjective norms, descriptive norms, self-efficacy and response efficacy regarding condom use with steady and casual partners. The results showed that some drug users had borrowed used syringes and that most drug users practise unsafe sex, especially with steady partners. Most drug users were hardly motivated to start using condoms. The study further showed that antecedents of condom use differ with regard to steady sex partners and casual sex partners. Self-efficacy and subjective norms were predictors of intentions to use condoms with steady partners; intention to use condoms with casual partners was only predicted by self-efficacy. These differences should be taken into account when designing AIDS prevention interventions to encourage use of condoms.

The additional value of anticipated regret and psychopathology in explaining intended condom use among drug users.

Abstract In this study we examine determinants of intended condom use with casual and steady sex partners among drug users. Our aim was to find out whether anticipated regret and psychopathology represent additional factors in explaining condom use behaviour, on top of the constructs defined in traditional psychosocial models of behaviour. A questionnaire measuring intentions, attitude, beliefs, personal norm, subjective norm, descriptive norm, self-efficacy and anticipated regret toward condom use with steady and casual sex partners, and the Symptom Checklist '90 (to measure dimensions of psychopathology) were handed out to 150 Dutch drug users. The results showed that intended condom use with steady sex partners was mainly predicted by self-efficacy, personal norm and anticipated regret (total R2 = 0.41). Lower feelings of hostility and a more positive personal norm, subjective norm and attitude significantly predicted intended condom use with casual sex partners (total R2 = 0.24). The results also showed that intended condom use with steady sex partners seems to result from anticipating possible barriers, whereas condom use with casual sex partners is largely a matter of having safe sex norms. Practical implications of this study for Aids-preventive campaigns are also discussed.

Emotional Reactions to the Outcomes of Decisions: The Role of Counterfactual Thought in the Experience of Regret and Disappointment.

Regret and disappointment are emotions that can be experienced in response to an unfavorable outcome of a decision. Previous research suggests that both emotions are related to the process of counterfactual thinking. The present research extends this idea by combining it with ideas from regret and disappointment theory. The results show that regret is related to behavior-focused counterfactual thought in which the decision-maker's own actions are changed, whereas disappointment is related to situation-focused counterfactual thought in which aspects of the situation are changed. In Study 1 participants (N = 130) were asked to recall an autobiographical episode of either a regretful or a disappointing event. When asked to undo this event, regret participants predominantly changed their own actions, whereas disappointment participants predominantly changed aspects of the situation. In Study 2 all participants (N = 50) read a scenario in which a person experiences a negative event. Participants who were instructed to undo the event by changing the person's actions reported more regret than disappointment, while participants who were instructed to undo the event by changing aspects of the situation reported more disappointment than regret. Study 3 (N = 140) replicated the findings from Study 2 with a different scenario, and a design in which regret and disappointment were measured between rather than within subjects. In the discussion we address the relation among counterfactual thinking, attributions and affective reactions to decision outcomes, and the implications for decision research. Copyright 1998 Academic Press.