The approach of Norm Balance in predicting pharmacists' intention to collaborate with physicians to improve medication therapy.

Objective: Norm Balance is an approach under the Theory of Planned Behavior (TPB) where subjective norm is weighted by the relative importance of others and self-identity is weighted by the relative importance of self. The relative importance was measured previously by a trade-off measure. In this study, we developed separate measures for the relative importance. The study objectives were to: 1) assess the construct validity of the separate measures; 2) examine the approach of Norm Balance in predicting pharmacists' intention to collaborate with physicians to improve medication therapy; and 3) establish a modified TPB. Methods: We selected a random sample of 750 Iowa pharmacists and conducted two surveys. The first survey was to examine intention prediction, and the second survey was to examine behavior prediction by measuring behavior among respondents to the first survey. The relative importance was measured by both the trade-off measure and the separate measures. Exploratory factor analyses were performed for the relative importance of others (separate measures) and subjective norm, and for the relative importance of self (separate measures) and self-identity. Regressions for intention prediction were conducted for TPB with self-identity and the approach of Norm Balance. The same regressions were also conducted for three subgroups according to the median of the relative importance of others (trade-off measure). Moreover, another regression was conducted for behavior prediction. Results: 239 practicing pharmacists responded to the first survey, and 188 responded to the second survey. The separate measures had cross factor loadings, whereas the trade-off measure had low correlations with other constructs. Both regressions for intention prediction explained 75% of the variance, with self-efficacy and attitude being strong predictors. Self-identity was not a predictor in the TPB with self-identify, but self-identity weighted by the relative importance of self was a significant predictor in the approach of Norm Balance. Regression coefficients of subjective norm and self-identify varied across subgroups. The regression for behavior prediction explained 30% of the variance, with intention and self-efficacy being two predictors. Conclusion: The trade-off measure was better than separate measures. The approach of Norm Balance appears to be a better model than the TPB with self-identity to examine pharmacist-physician collaboration.

Factors Influencing the Participation of Shared Decision Making in Stable Coronary Artery Disease Patient: Protocol of a Mixed Methods Study.

INTRODUCTION: The "paternalistic decision-making model" is no longer well suited to the modern clinical environment, and therefore, shared decision making (SDM) has emerged as a key approach. Although the benefits of SDM have been largely reported, several studies have reported low participation in SDM in coronary artery disease (CAD) patients. The theory of planned behavior (TPB) model is one of the most frequently employed theoretical frameworks for predicting human behaviors. According to the TPB, intention is influenced by attitude, subjective norm, and perceived behavioral control, while behavior is influenced by both intention and perceived behavioral control. Therefore, we propose a mixed methods study based on TPB to investigate the status of Chinese stable coronary artery disease (SCAD) patients' participation in SDM, understand their experiences of SDM, and explore the factors that influence their participation in SDM. MATERIALS AND METHODS: An explanatory sequential mixed methods design will be used to explore the study aims, including a quantitative phase, a subsequent qualitative phase, and the final integration study. The quantitative study will use convenient sampling from the Affiliated Hospital of Hangzhou Normal University to conduct a cross-sectional survey (n ≥ 252). The qualitative study will be sampled using the maximum difference sampling method from the quantitative study results, and then the data will be collected through semi-structured interviews (n = 10-20). This study will use descriptive statistics and test hypotheses while considering a p-value of <0.05, which will be considered statistically significant. DISCUSSIONS: The study employs a mixed method approach with an explanatory sequential design, incorporating qualitative and quantitative methods to comprehensively understand the factors influencing SCAD patients' participation in SDM. Furthermore, these findings can inform the design of future intervention studies and provide healthcare providers with targeted information and communication to help SCAD patients make the most appropriate decisions. Study participants will be recruited using convenience sampling from just one single clinical setting, which may limit the findings' generalizability. ETHICS AND DISSEMINATION: This study has been approved by the Ethical Committee of the School of Nursing, Hangzhou Normal University (Approval No.: 2024013). All the participants will sign an informed consent form before participating in the survey. The corresponding results and conclusions will be disseminated in journals and conferences after the completion of the study.

Factors Influencing Nurses' Intentions to Protect Patient Privacy: A Survey-Based Study Using the Theory of Planned Behavior.

Background and Purpose: Patient privacy and confidentiality are fundamental ethical principles in healthcare. Protecting patient privacy, which is accepted as a patient's right, is one of the responsibilities of nurses. Few studies on patient privacy among nurses have used social cognitive approaches. The purpose of this study is to examine nurses' intentions to protect patient privacy using the theory of planned behavior (TPB). Methods: This is a cross-sectional and correlational design study. The study sample consisted of 202 nurses working in the emergency departments, operating rooms, inpatient wards, and intensive care units of the hospitals. Research data were collected using a face-to-face questionnaire that included TPB components on patient privacy. The proposed research model was tested using structural equation modeling. Results: Attitude (ß = .238, p < .05), subjective norm (ß = .295, p < .05), and moral norm (ß = .337, p < .05) toward patient privacy are positive predictors of intention. The moral norm is the most effective component of intention. Perceived behavioral control is not a significant predictor of intention (ß = .049, p > .05). Implications for Practice: Norms that create a sense of moral obligation in nurses are a significant determinant in increasing the intention to protect patient privacy. Interventions that improve moral norms, attitudes, and subjective norms will increase the intention to protect privacy. Nurse managers should provide nurses with adequate skills, resources, and an appropriate work environment to ensure perceived behavioral control regarding patient privacy.

Influencing factors of health screening among retirees: an extended TPB approach.

Background: Health screenings are promoted worldwide as they help detect and prevent overall health issues. Despite expanding coverage, the participation rate among the retired population has not significantly increased. Given the special role of health screenings in promoting health and healthy aging, understanding the behavioral intentions, and influencing factors of retirees' voluntary participation in health screenings is crucial. This study aims to explore the participation intentions in health screenings among the Chinese retired population by integrating the Theory of Planned Behavior (TPB) and Self-Efficacy (SE). Methods: This study used a cross-sectional design to conduct an online questionnaire among 311 retirees in 2023. The questionnaire, tailored for the Chinese retired population, combines the TPB theory and Self-Efficacy theory, including demographic structure, the basic structure of TPB, and SE. Results: A Structural Equation Modeling (SEM) approach was used to identify factors related to health screening behaviors. Of the respondents, 311 completed the survey (88.9% response rate). The most crucial determinant of health examination behavior was behavioral intention, with a correlation score of (1.524, p < 0.001). Significant correlates of behavioral intention included Subjective Norms (SN) and Self-Efficacy (SE), followed by Perceived Behavioral Control (PBC) and Attitude (AT), with correlation scores of (0.401, p < 0.001), (0.339, p < 0.001), (0.082, p < 0.001), and (0.060, p < 0.05), respectively. Conclusion: This study provides insights for enhancing the willingness and behavior of retirees to participate in health screenings.

Using the theory of planned behavior to predict parents' disclosure of donor conception to their children: a longitudinal study.

STUDY QUESTION: Can the application of the theory of planned behavior (TPB) help predict heterosexual parents' disclosure of donor conception to their children? SUMMARY ANSWER: Parents with a stronger will to act in accordance with social norms favoring disclosure were more likely to start the disclosure process within the next 5-9 years. WHAT IS KNOWN ALREADY: In contrast to single mothers by choice and same-sex couples, heterosexual couples need to make an active decision to disclose their use of donor conception to their child. While disclosure at an early age is encouraged by international guidelines, many heterosexual-couple parents struggle with this. A previous study has found an association between parental scores of TPB factors and disclosure intention, but so far, no study has applied the TPB to predict parents' disclosure behavior. STUDY DESIGN, SIZE, DURATION: The present study is based on the fourth and fifth waves of data collection (T4 and T5) in a nation-wide longitudinal study. Participating parents had conceived through identity-release oocyte donation (n = 68, response rate 65%) and sperm donation (n = 62, response rate 56%) as part of a heterosexual couple. PARTICIPANTS/MATERIALS, SETTING, METHODS: The present study is part of the prospective longitudinal Swedish Study on Gamete Donation (SSGD). Consecutive recruitment of couples starting oocyte or sperm donation treatment was conducted at all seven fertility clinics providing gamete donation in Sweden during a 3-year period (2005-2008). Participants were requested to complete postal surveys at five time points. The present study includes heterosexual-couple parents following oocyte or sperm donation who participated at the two latest time points when their children were 7-8 years old (T4), and 13-17 years old (T5). At T4, participants completed the study-specific TPB Disclosure Questionnaire (TPB-DQ) measuring attitudes and intentions to disclose the donor conception to the child, and disclosure behavior was assessed at both T4 and T5. Data from those participants who had not yet disclosed at T4 were analyzed using survival analysis with Cox regressions. MAIN RESULTS AND THE ROLE OF CHANCE: Forty participants had not disclosed the donor conception to their children at T4 and, out of these, 13 had still not disclosed at T5. We found a significant association between scores of the TPB factor Subjective norms at T4 and their subsequent disclosure behavior at T5 (HR = 2.019; 95% CI: 1.36-3.01). None of the other factors were significantly associated with disclosure behavior. LIMITATIONS, REASONS FOR CAUTION: The present study concerns heterosexual-couple parents with children conceived following treatment with gametes from open-identity donors, which limits the generalizability of our findings to other groups and contexts. Other limitations include the risk of systematic attrition due to the longitudinal study design and decreased statistical power due to few participants. WIDER IMPLICATIONS OF THE FINDINGS: Our findings highlight the importance of perceived subjective norms for parents' disclosure behavior and indicate that the co-parent's opinion about disclosure is of particular relevance in this regard. Counselors should focus on supporting prospective parents to initiate and maintain a healthy and open dialogue about concerns around building a family with donor conception. STUDY FUNDING/COMPETING INTEREST(S): The study was funded by the Swedish Research Council. The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER: N/A.

Explaining the experience of breastfeeding in women with gestational diabetes and designing and implementing an educational program based on planned behavior theory: a combined exploratory study protocol.

BACKGROUND: Gestational diabetes is a type of carbohydrate intolerance that is diagnosed for the first time during pregnancy. Researches have shown that gestational diabetes is associated with many negative prenatal and birth outcomes. Because of the complications such as infant death, several diabetics' mothers plan to stop breastfeeding. Research findings indicate a decrease in breastfeeding in mothers with gestational diabetes/ or contradictory tissues regarding the factors affecting the breastfeeding behavior of mothers with gestational diabetes and a special program to promote breastfeeding for these mothers based on the social and cultural conditions of Iranian society. The present study aims to design an interventional program with a mixed qualitative study based on the theory of planned behavior (PBT) to prevent the decrease of breastfeeding in diabetic mothers. METHODS/DESIGN: A mixed methods exploratory design will be used to conduct this study in 3 phases. The first phase (qualitative): The purpose of the first phase is to understand the experience of breastfeeding mothers who had gestational diabetes, which will be done using the directed content analysis method. The purposive sampling will be used on pregnant mothers with gestational diabetes 30-34 weeks and mothers with infants (up to 6 months) with a history of gestational diabetes. The second phase include designing and implementing an educational program based on the PBT: Education will be conducted based on the needs assessment of the qualitative phase, the opinions of the focus group, and the literature review, then the breastfeeding behavior will be measured using the survey tool of "breastfeeding drop". The third phase: Interventional quantitative phase: The sample size will be carried out by a pilot study, then a designed program as an educational intervention for teaching breastfeeding behavior based on the PBT for 30-34 weeks pregnant mothers with gestational diabetes will be implemented during 3-4 sessions and breastfeeding behavior will be evaluated after delivery. DISCUSSION: This is the first mixed-method study in Iran that led to implement an interventional program based on the theory of planned behavior. Because of the complications such as infant death, several diabetics' mothers plan to stop breastfeeding. We hope that the result of this research will be a step in solving breastfeeding problems in mothers with gestational diabetes.

Gestational diabetes is a type of carbohydrate intolerance diagnosed for the first time during pregnancy. The rate of gestational diabetes has increased along with the increase in the prevalence of diabetes risk factors. It is associated with multiple prenatal and birth outcomes. Despite the incomparable benefits of breastfeeding providing health to gestational diabetes mothers, the rate of breastfeeding is low. This is the first study in Iran using a mixed method approach in 3 phases to implement an educational interventional program with a qualitative study directed by theory of planned behavior (TPB) to prevent the decrease of breastfeeding in mothers with gestational diabetes. The purpose of first phase of study (qualitative) is to understand women's experience of gestational diabetes, which will be done using the directed content analysis method. The purposive sampling will be used for pregnant mothers with gestational diabetes at 30­34 weeks and mothers with infants (up to 6 months). The second phase is designing and implementing an educational program based on the PBT: Educational aims and content will be prepared based on the need achieved in the qualitative phase, the opinions of the focus group with experts? Mothers? Whom? And the literature review, then the breastfeeding behavior will be measured using the survey tool "breastfeeding drop". The third phase includes: Interventional quantitative phase an educational program will be implemented for training breastfeeding behavior based on the theory of PBT for 30­34 weeks pregnant mothers with gestational diabetes. This program will be administered as an educational intervention during 3­4 sessions and breastfeeding behavior will be evaluated after delivery.

Exploring the Influence of Public Perception of Mass Media Usage and Attitudes towards Mass Media News on Altruistic Behavior.

Based on the cultivation theory and the theory of planned behavior, this study determined how people's perceptions of mass media news and their attitudes towards it impact their altruistic behavior by examining the factors that influence perception. The study collected data from 435 individuals with access to mass media in Taiwan, which were analyzed using SEM. The results revealed that media exposure, credibility, and social influence were critical factors that influenced individuals' perceptions of mass media news, with media exposure having a more significant influence. Surprisingly, the findings demonstrated that perception was negatively related to attitudes, inconsistent with the proposed hypothesis. Thus, perceptions and attitudes were positively associated with altruistic behavior, and attitude was found to mediate the relationship between perceptions about mass media news and altruistic behavior. The study also provides important implications for theory and practice, especially in mass media entities, in developing and adopting practices that promote trust among the audience by encouraging altruistic behaviors through news coverage of various issues.

Factors Associated with Handwashing Behaviors During the COVID-19 Pandemic: An Analysis of the Community Health Survey in Korea.

Introduction: Handwashing is the most effective preventive behavior for coronavirus disease-19 (COVID-19) infection. However, research has shown the lower handwashing behaviors among Korean adults. Objectives: This study aims to analyze factors associated with handwashing as a preventive behavior for COVID-19 infection based on the health belief model (HBM) and the theory of planned behavior (TPB) behavioral theories. Methods: This secondary data analysis utilized the Community Health Survey developed by Disease Control and Prevention Agency conducted in 2020. Sampling method was stratified and targeted 900 people living in the territory of each community public health center. In total, 228,344 cases were used in the analysis. Handwashing behavior, perceived susceptibility, perceived severity, subjective norm, and influenza vaccine uptake were used in the analysis. Regression analysis using weighing strategy by stratification and domain analysis was used. Results: Less washing hand was associated with older age (B = 0.01, p < .001), males (B = 0.42, p < .001), not receiving an influenza vaccine (B = 0.09, p < .001), perceived susceptibility (B = 0.12, p < .001), subjective norm (B = 0.05, p < .001), and perceived severity (B = -0.04, p < .001). Conclusion: While perceived susceptibility and social norm had positive association, perceived severity had a negative association with handwashing. Considering the Korean culture, creating a shared norm for frequent handwashing could be beneficial to promote handwashing rather than emphasizing the disease and its consequences.

Establishing the Approach of Norm Balance toward Intention Prediction across Six Behaviors under the Theory of Planned Behavior.

Background: An innovative approach of Norm Balance is proposed under the Theory of Planned Behavior (TPB). In this approach, the measurement score of subjective norm is weighted by the relative importance of others, and the measurement score of self-identity is weighted by the relative importance of self. The study objective was to examine the effect of Norm Balance to predict behavioral intentions in two groups of college students. Methods: Cross-sectional surveys were used in two studies. For 153 business undergraduates, Study 1 examined three common intentions: eating a low-fat diet, exercising regularly, and dressing business-like. For 176 PharmD students, Study 2 examined three pharmacy-related intentions: informing relatives about counterfeit medications, buying prescription medications online, and completing a pharmacy residency. The relative importance of others vs. self was measured by asking study subjects to allocate 10 points between important others and oneself. Two sets of regressions were conducted and compared across six intentions using the traditional model and the Norm Balance model. Results: The 12 regressions explained 59-77% of intention variance. The variance explained by the two models was similar. When subjective norm or self-identity was non-significant in the traditional model, the corresponding Norm Balance component was significant in the Norm Balance model, except for eating a low-fat diet. When both subjective norm and self-identity were significant in the traditional model, the two Norm Balance components were significant in the Norm Balance model with increased coefficients. Conclusions: The proposed approach of Norm Balance provides a different view about the significance and coefficients of subjective norm and self-identity toward intention prediction.

Applying the theory of planned behavior to investigate type 2 diabetes patients' intention to receive injection therapy.

Objectives: This study applied the theory of planned behavior (TPB) in shared decision making (SDM) to understand behavioral intention in patients with type 2 diabetes with regard to injection therapy for blood sugar control. Methods: A cross sectional study was conducted. Two hundred and fifty-four patients with type 2 diabetes participated this study and were interviewed by pharmacists in different clinics. A patient decision aid (PDA) entitled "Should I receive injection therapy regarding my type 2 diabetes condition?" was developed for this study and served as interview agenda which comprised 18 items to inquire their willingness to use injection therapy and related considerations during the SDM process. Results: The questionnaires were revised using item analysis, exploratory factor analysis, and a criteria of Cronbach's α > 0.7. This resulted in three constructs for all questionnaires that fit the TPB model. Attitude (ß = 0.432; P < 0.001) and PBC (ß = 0.258; P < 0.001) were directly correlated with intention. TPB explained 35.2% of the variance in intention toward the use of injection therapy. Conclusions: Attitude and PBC toward injection therapy positively and significantly influence the patients' intention to use injection therapy. Practical implications: These findings identify a key association for understanding behavioral intention in patients with type 2 diabetes with regard to blood sugar control during SDM.

Effects of the theory of planned behavior and nudge strategy-based intervention on the adherence to anticoagulation treatment in patients with non-valvular atrial fibrillation.

BACKGROUND: Non-valvular atrial fibrillation is associated with the incidence of thromboembolism. Current guidelines recommend preferential use of novel oral anticoagulants (NOAC) in patients with nonvalvular atrial fibrillation. Oral anticoagulation medication adherence rate was relatively low among discharged patients with non-valvular atrial fibrillation. AIM: To investigate the effects of the anticoagulation programs based on the theory of planned behavior and nudge strategy among patients with non-valvular atrial fibrillation. METHODS: 130 patients with non-valvular atrial fibrillation were randomized to the intervention group or control group, 72 patients in the intervention group, and 58 patients in the control group with a 6-month follow-up. Medication adherence, intention, attitude, perceived behavioral control and subjective norm and quality of life were assessed. RESULTS: There were significantly differences in the intention, attitude and subjective norm between the two groups at one month, three months and six months follow-up (P <0.01). There were significantly differences in the perceived behavioral control between the two groups at three months and six months follow-up (P <0.01). The medication adherence scale score was higher in the intervention group than in the control group at three months and six months follow-up. However, there were no differences in quality of life between the two groups at one month, three months and six months follow-up. CONCLUSIONS: The program based on the theory of planned behavior and nudge strategy can improve medication adherence in patients with non-valvular atrial fibrillation.

Understanding self-protective behaviors during COVID-19 Pandemic: Integrating the theory of planned behavior and O-S-O-R model.

Adopting health preventive actions is one of the most effective ways to combat the COVID-19 pandemic. Based on the theory of planned behavior and the orientation-stimulus-orientation-response model, this study investigated the mechanisms by which health information exposure influenced individuals to adopt self-protective behaviors in the context of infectious disease. In this research, a convenience sampling was used and 2265 valid samples (Male = 843, 68.9% of participants aged range from 18 to 24) were collected in China. Structural equation modeling analysis was performed, and the analysis showed that health consciousness positively influenced the subsequent variables through interpersonal discussions and social media exposure to COVID-19-related information. The interaction between interpersonal discussion and social media exposure was found to be positively associated with the elements of the theory of planned behavior and risk perception. The findings also revealed that self-protective behavior was positively predicted by the components of the theory of planned behavior and risk perceptions, with subjective norms serving as the main predictor, followed by attitudes and self-efficacy.

A comparative study of eight COVID-19 protective measures and their impact on Swiss tourists' travel intentions.

A comparative vignette-based experimental survey design incorporating various socio-psychological factors, linked to the Theory of Planned Behavior (TPB), the Health Belief Model (HBM) and the Domain-Specific Risk-Taking scale (DOSPERT) was carried out to test variations in eight travel-related COVID-19 protective measures on Swiss tourists' travel intentions. Among the tested measures, vaccination passports, surgical masks and quarantining are those that stand out the most, with surgical masks having the greatest acceptance and willingness to adopt while traveling. Quarantining, on the other hand, appears to have a deterrent influence on travel intentions, and vaccination passports have the lowest perceived barriers during travel, but the highest perceived benefits in mitigating the spread of the infection. The discussion of individual differences has specific implications for tourism management against the background of our empirical findings.

Behavioral Intention Scale for End-of-life DiscussionsReliability and Validity Using a Web-based Survey

Purpose: The purpose of this study was to examine the reliability and validity of the behavioral intention scale for end-of-life discussions. Methods: The scale items were developed according to the Theory of Planned Behavior. The drafts of the scale were created by Item-Level Content Validity Index (I-CVI) and a preliminary test. In the main study, we administered a cross-sectional questionnaire on the web to the participants 20–79 years of age (n=860), living in Tokyo and six surrounding prefectures, and a retest one week later (n=665). We examined item analysis, calculation of a reliability coefficient (intraclass correlation coefficient, Cronbach's alpha coefficient), construct validity, and concurrent validity of the scale. Results: Six factors identified by an exploratory factor analysis were; outcome evaluation, perceived power, control beliefs, motivation to comply, normative beliefs, and behavioral beliefs. The alpha coefficient of the overall scale was .96. The effect size that was determined based on known-groups validity and the correlation coefficient determined on the basis of concurrent validity were moderate. Conclusions: The reliability and validity of the scale were generally confirmed.

Examining continuance intention of online learning during COVID-19 pandemic: Incorporating the theory of planned behavior into the expectation-confirmation model.

COVID-19 pandemic has tremendously affected many industries in the world, including higher education. To cope with changes in the pandemic, online learning has become a prevalent means for university students to receive education. Based on the expectation-confirmation model (ECM) and the theory of planned behavior (TPB), this study aims to develop an integrated model, consisting of confirmation, perceived usefulness, satisfaction, perceived enjoyment, subjective norm, perceived behavioral control, and continuance intention instruments, to predict Chinese university students' continuance intention toward online learning. Using convenience sampling, we enrolled full-time university students who have used online-learning platforms in November 2020. Data collected from 493 Chinese university students were analyzed by confirmatory factor analysis (CFA) and structural equation model (SEM) to test the model and hypotheses. All measurements of constructs used in this study are adapted by previous studies. The results show that perceived satisfaction, subjective norms, and perceived behavioral control were significantly associated with the continuance intention of online learning. Furthermore, the two components of the expectation-confirmation model (ECM), perceived usefulness and perceived enjoyment, have a significant impact on the satisfaction of online learning. Notably, although confirmation of expectations had no direct impact on satisfaction, it was positively associated with perceived usefulness and perceived enjoyment. Implications and limitations were discussed.

Predicting Chinese older adults' intention to live in nursing homes using an integrated model of the basic psychological needs theory and the theory of planned behavior.

The growing number of aging populations has become a major problem worldwide. Nursing homes play an essential role in the later life of older adults. Previous research indicated potential associations between external factors and older adults' intention to live in nursing homes. However, intrinsic motivation has yet to be fully understood. This article addresses an academic void that integrated the Basic Psychological Needs Theory (BPNT) and the Theory of Planned Behavior (TPB) to explore older adults' intentions to live in nursing homes. More specifically, it tested the effects of autonomy, competence, and relatedness needs satisfaction as defined in the BPNT on attitudes, subjective norms, perceived behavioral control, and live-in intentions toward nursing homes in the TPB. An online survey provided quantitative data from 425 aging people. The results indicated that the higher the satisfaction of the basic psychological needs (i.e., autonomy needs, competence needs, and relatedness needs) of the older adults, the lower their intention to live in nursing homes. Furthermore, social pressure partially mediates this relationship. That is, the higher the satisfaction of the basic psychological needs of older adults, the lower the pressure from society. Thus, they should be admitted to the nursing home, and the lower their intention to live in nursing homes. The results contribute to a better understanding of the deep psychological motivation of the older adults' intention to live in nursing homes and support further development of the BPNT-TPB model in older adults' health research.

Factors influencing patients' opt-in intention of exchanging health information.

Introduction: Health information exchange (HIE) exhibits tremendous benefits in improving the quality of healthcare and reducing healthcare costs. However, it also poses challenges related to data security, data privacy, patient engagement, etc. Objective: This study aimed to explore the factors affecting patients' opt-in intention to HIE by using an empirical study based on the theory of planned behavior. Methods: A Web-based survey was conducted involving 501 valid participants in China (69% validity rate). Results: Information sensitivity and perceived HIE transparency affected the patients' opt-in intention to HIE through the mediation of perceived behavior control and trust in HIE. Information sensitivity negatively influenced perceived behavior control (-0.551, P < 0.001) and trust in HIE (-0.489, P < 0.001). Perceived transparency of HIE positively influenced perceived behavior control (0.396, P < 0.001) and trust in HIE (0.471, P < 0.001). Moreover, patients' opt-in intention to HIE can be positively affected by perceived HIE transparency (0.195, P < 0.001) and trust in HIE (0.294, P < 0.001). In addition, the moderating effect of health status was positive and significant between trust in HIE and opt-in intention to HIE but not between the perceived behavior control and opt-in intention to HIE. Conclusion: This study contributes to the theory of planned behavior and enriches the literature on HIE efforts. HIE administrators should design personalized health services on the basis of these different health statuses to successfully achieve patients' opt-in intention to HIE.

NAM and TPB Approach to Consumers' Decision-Making Framework in the Context of Indoor Smart Farm Restaurants.

The movement toward smart farming, which has productivity and eco-friendly roles, is emerging in the foodservice industry in the form of indoor smart farm restaurants. The purpose of this study was to investigate the consumer decision-making processes in the context of indoor smart farm restaurants. The investigational framework was designed around the norm activation model (NAM) and the theory of planned behavior (TPB), with the moderating role of age. In particular, this study merged NAM and TPB to assess the effect of awareness of consumption consequences on consumers' attitudes as well as the role played by subjective norms in the formation of personal norms. Data were collected from 304 respondents in South Korea. As a result of structural equation modeling, the proposed hypotheses of causal relationships were generally supported, excluding only the relationship between subjective norm and behavioral intention. The moderating role of age was identified in the relationships between (1) subjective norm and attitude, and (2) personal norm and behavioral intention. This study presents not only theoretical contributions as the first empirical study on consumer behavior in the context of indoor smart farm restaurants but also presents practical suggestions from the perspective of green marketing.

Determinants of Telehealth Continuance Intention: A Multi-Perspective Framework.

Owing to the COVID-19 pandemic, many countries' physicians in the world have used telehealth to visit patients via telehealth. The study aimed to integrate the theory of planned behavior (TPB), the technology acceptance model (TAM), and self-determination theory (SDT) to explore the adoption behavior of a telehealth system. A convenient sample of residents was drawn from the population of Nantou County in Taiwan and analyzed via structural equation modeling. The findings revealed that attitude, perceived behavioral control, perceived usefulness, and perceived autonomy support jointly have significantly positive effects on continuance intention. Results also confirmed that perceived autonomy support, perceived ease of use, and perceived usefulness jointly have significantly positive effects on attitude. Furthermore, this study also showed that a crucial mediators' role is played by perceived ease of use, perceived usefulness, and attitude. The conclusions and practical implications of the research will hopefully provide health organizations and institutions with some innovative insights and foresights, which in turn will promote better practices and services of telehealth technology.

The Role of the Theory of Planned Behavior in Explaining the Energy-Saving Behaviors of High School Students with Physical Impairments.

People with physical impairments can help solve energy problems by participating in diverse energy-saving behaviors, such as switching off lights or turning off an air conditioner when not in use; however, they may struggle to participate in some behaviors due to mobility impairments. This study aims to examine factors that impact the energy-saving behaviors of high school students with physical impairments. The theory of planned behavior (TPB) was used to test whether attitudes towards energy-saving behaviors, subjective norms, and perceived behavioral control could affect intentions, which then leads to performance of energy-saving behaviors. The participants were 330 high school students with physical impairments in Thailand. A questionnaire was employed to measure energy-saving behaviors and TPB constructs. A confirmatory factor analysis (CFA) was performed to validate all study variables; structural equation modeling (SEM) was then used to test causal relationships among TPB constructs and energy-saving behaviors. The results showed that the TPB could be used to explain the energy-saving behaviors of students with physical impairments, that subjective norms were the most significant predictor of behavioral intentions, and that intentions significantly impacted energy-saving behaviors. While perceived behavioral control did not have a direct effect on behaviors, it had a significant effect on intentions. Under the TPB construct, of the studied variables, attitude had the lowest power to predict students' intentions to perform the concerned behaviors; however, the impact of attitude was still statistically significant. The results suggest that all TPB variables can predict energy-saving behaviors of high school students with physical impairments, but their power to predict the behaviors is different. To promote student participation in energy-saving behaviors, it is important to create subjective norms and eliminate obstacles that students with physical impairments might face when performing energy-saving behaviors.