Process evaluations of health-promotion interventions in sports settings: a systematic review.

Sports settings have been identified as an ideal place to conduct complex multi-level health-promotion interventions, with the potential to engage a broad audience. Whilst the benefits of delivering health-promotion interventions in sports settings are well documented, such interventions' real-world implementation and success must be better understood. Process evaluations can be conducted to provide information related to an intervention's fidelity, replication, scaling, adoption, and the underlying mechanisms driving outcomes. This systematic review summarizes how process evaluations of health-promotion interventions are conducted in sports settings and highlight facilitators and barriers to health-promotion intervention delivery using narrative synthesis. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, searches included original peer-reviewed articles from inception-January 2023. We searched eight electronic databases: Academic Search Complete; MEDLINE, PsycARTICLES; PsycINFO; SPORTSDiscus with Full Text; MEDLINE; SCOPUS; Pub Med, and Pro Quest Central. Thirty-two studies were included. Findings suggest that most process evaluations of health-promotion interventions have acknowledged the inherent complexity of sports settings, and investigated factors that explain their intervention's success (e.g. trust building, engagement). However, poor use of process evaluation frameworks or guidelines resulted in wide variations of how process evaluations are conducted and reported, which made findings difficult to integrate and standardize with consistency. Accordingly, this review provides a guide on how future process evaluations can be conducted to improve health-promotion interventions' transparency, replicability and reliability in real-world settings.

A call for action: Educating pharmacists and pharmacy students in behaviour change techniques.

The increasing impact of chronic disease, including cancer and heart disease on mortality signifies a need for the upskilling of health professionals in health behaviour change. Solely providing education and information to patients is generally not sufficient to change behaviour, and for any change to be sustained. The nature of pharmaceutical practice allows pharmacists to have frequent contact with patients in the community. Historically, pharmacists have often effectively engaged with patients to assist with behaviour change initiatives related to smoking cessation, weight loss or medication adherence. Unfortunately, such initiatives do not work for everyone, and more tailored and varied interventions are urgently needed to reduce the effects of chronic disease. In addition, with greater inaccessibility to hospitals and GP's (e.g., appointment wait times), it is imperative that pharmacists are upskilled in providing opportunistic health behaviour change techniques and interventions. Pharmacists need to practice to their full scope consistently and confidently, including the use of behavioural interventions. The following commentary therefore describes and provides recommendations for the upskilling of pharmacists and pharmacy students in opportunistic behaviour change. We outline nine key evidence-based behaviour change techniques, the active-ingredients of a behaviour change intervention, that are relevant to common encounters in professional practice by pharmacists, such as improving adherence to medications/treatments and health promotion initiatives. These include social support (practical and emotional), problem solving, anticipated regret, habit formation, behaviour substitution, restructuring the environment, information about others' approval, pros and cons, and monitoring and providing feedback on behaviour. Recommendations are then provided for how this upskilling can be taught to pharmacists and pharmacy students, as well as how they can use these techniques in their everyday practice.

Understanding the predictors of hand hygiene using aspects of the theory of planned behaviour and temporal self-regulation theory.

OBJECTIVE: Adherence to proper hand hygiene practice is relatively low and is particularly salient in light of the current COVID-19 pandemic. Having a greater understanding of the psychosocial predictors of engaging in proper hand hygiene is warranted. One way to do this is through the application of a combined theory of planned behaviour and temporal self-regulation theory model. DESIGN: A prospective two-part study was conducted between May - November 2020, with N = 232 Australians. At time one, variables from both the theory of planned behaviour (attitude, subjective norm, perceived behavioural control, and intention) and temporal self-regulation theory (habit, environmental cues, and planning) were completed. MAIN OUTCOME MEASURES: One week later, engagement in proper hand hygiene behaviour over the previous week was assessed. RESULTS: Two hierarchical multiple regressions were conducted, with 47% of variance accounted for in intention, with subjective norm being the strongest predictor, and 38% of variance accounted for in hand hygiene behaviour, with intention being the strongest predictor. Environmental cues also moderated the relationship between intention and behaviour. CONCLUSIONS: To increase intention, incorporating subjective norm messages in advertisements may be helpful. Incorporating environmental cues in places where hand washing is recommended may assist in increasing hand hygiene.

Utility of temporal self-regulation theory in health and social behaviours: A meta-analysis.

PURPOSE: Temporal self-regulation theory was developed to address an observed intention-behaviour gap across behaviours. However, a synthesis of studies has not yet been conducted to investigate the theory's utility to explain behaviour and bridge the intention-behaviour gap. This review aimed to evaluate the predictive ability of temporal self-regulation theory to understanding behaviour and pre-registered at PROSPERO (ID: CRD42021253174). METHOD: Forward citation searches on the original theory publication through Google Scholar until May 2021 identified 37 eligible articles, including, 12,555 participants assessing at least two of the three theory constructs. Random-effects meta-analyses assessed the strength of associations between theory constructs on behaviour and random effects meta-regressions assessed moderators of behaviour. RESULTS: Findings provide support for temporal self-regulation theory to explain behaviour with very weak (self-regulatory capacity r = .039, CI = .00, -.07) to moderate (intention r = .331, CI = .26, .40; behavioural pre-potency r = .379, CI = .32, .44) effect sizes. Further, the strength of associations varied across behaviour types and contexts. However, there was high heterogeneity across studies and some moderating effects could not be assessed due to insufficient numbers of studies assessing interactions. CONCLUSIONS: We urge researchers to assess and report interactions for better understanding of the drivers of behaviour to develop effective interventions for positive behaviour change.

Can temporal self-regulation theory and its constructs predict medication adherence? A systematic review and meta-analysis.

The relationships between temporal self-regulation theory (TST) constructs (intention, behavioural prepotency and self-regulatory capacity) and medication adherence should be established before further applying the theory to adherence. Searches of PsychINFO, Medline, EMBASE, CINAHL and Web of Science were conducted in 2019 (updated November 2021). Studies had to be original quantitative research, assessed the relationship between one of the constructs and adherence in one illness, and used an adult population. The risk of bias was assessed using the NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Three meta-analyses were conducted using R. Moderation analyses were also conducted. A total of 57 articles (60 studies) with 13,995 participants were included, with 7 studies included in more than one analysis. Results identified significant correlations between intention (r = .369, [95% CI: .25, .48]), behavioural prepotency (r = .332, [95% CI: .18, .48]), self-regulatory capacity (r = .213, [95% CI: .10, .32]) and adherence. There was some evidence of publication bias and no significant moderators. No studies explored the interactions in the theory, so whilst the constructs adequately predict adherence, future research should apply the theory to adherence in a specific illness to assess these relationships. Pre-registered on Prospero: CRD42019141395.

A Systems Theory of Mental Health in Recreational Sport.

The focus on mental health outcomes in sport, including the ways in which mental health can be protected and promoted, has become a major international priority for all sports, including the recreational sports system. The aim of this paper is to outline a systems theory of mental health care and promotion that is specific to needs of the recreational sport system so that context-specific, effective policies, interventions, and models of care can be articulated and tested. Based on general systems theory, we offer a preliminary theory and accompanying postulates that outline the general principles that explain mental health in recreational sports. Namely: one of the purposes of the recreational sport system is to protect and promote the mental health of all involved; the recreational sport system is comprised of components (individuals, groups, organisations, communities, society); the role and function of those components vary by context; the purpose of the system is achieved through coordinated and reciprocal relationships between its components; and, the system should be regulated from within to ensure that mental health is protected and promoted. We have also outlined the ways in which the subcomponents of the system interact, their potential influence on mental health in recreational sports, and the ways in which they may be regulated. This information provides a theoretical foundation upon which research, programming, and policy can be based to protect and promote the mental health of all involved in recreational sports.

Behavior Change Training for Health Professionals: Evaluation of a 2-Hour Workshop.

BACKGROUND: Rates of noncommunicable diseases continue to rise worldwide. Many of these diseases are a result of engaging in risk behaviors. Without lifestyle and behavioral intervention, noncommunicable diseases can worsen and develop into more debilitating diseases. Behavioral interventions are an effective strategy to reduce the burden of disease. Behavior change techniques can be described as the "active ingredients" in behavior change and address the components that need to be altered in order for the target behavior to change. Health professionals, such as pharmacists and nurses, can engage in opportunistic behavior change with their patients, to encourage positive health behaviors. OBJECTIVE: We aimed to develop, implement, and evaluate a behavior change workshop targeted at health professionals in Australia, with the goal of increasing knowledge of behavior change techniques and psychological variables. METHODS: A prospective study design was used to develop and evaluate a 2-hour behavior change workshop targeted at health professionals. The workshop was developed based on the Capability, Opportunity, Motivation, and Behavior Model and had five core objectives: (1) to detail the role of health professionals in delivering optimal care, (2) to demonstrate opportunities to change behavior, (3) to describe principles of behavior change, (4) to explain behavior change techniques, and (5) to determine the most appropriate behavior change techniques to use and when to use them. A total of 10 workshops were conducted. To evaluate the workshops and identify any potential long-term changes in behavior, we collected pre- and postworkshop data on knowledge and psychological constructs from the attendees. RESULTS: A final sample of 41 health professionals comprising general practitioners, nurses, and pharmacists completed the pre- and postworkshop surveys. Following the workshops, there were significant improvements in knowledge of behavior change techniques (t40=-5.27, P<.001), subjective norms (t40=-3.49, P=.001), descriptive norms (t40=-3.65, P<.001), perceived behavioral control (t40=-3.30, P=.002), and intention (t36=-3.32, P=.002); each had a large effect size. There was no significant difference in postworkshop attitude (t40=0.78, P=.44). The participants also found the workshops to be highly acceptable. CONCLUSIONS: A 2-hour, theoretically informed workshop designed to facilitate the use of behavior change techniques by health professionals was shown to be largely effective. The workshops resulted in increases in knowledge, descriptive and subjective norms, perceived behavioral control, and intention, but not in attitude. The intervention was also shown to be highly acceptable, with the large majority of participants deeming the intervention to be needed, useful, appropriate, and applicable, as well as interesting and worth their time. Future research should examine the lasting impacts of the workshop on health professionals' practices.

Exploring quality of life in Australian adults during a pandemic.

Many aspects of society changed due to the COVID-19 pandemic. As a result, many individuals experienced the introduction of travel bans and restrictions, COVID-19 related anxiety, greater risk to their health and an increased need for adaptive coping. Research has shown health-related quality of life was negatively affected during the time. However, the influence that these restrictions and experiences had on other various quality of life domains (physical, psychological, environmental, and social) is not yet known. Therefore, we aimed to examine the relationships between COVID-19-related variables, health variables, psychological variables and five domains of quality of life in Australian adults. Data was collected via cross-sectional online surveys from 264 Australian participants (M age = 29.76 years, SD = 12.40). Five hierarchical multiple regression analyses were conducted. The findings showed better adaptive coping, decreased COVID-19 anxiety, and lower perceived health risk were all associated with better quality of life during this time. Neither having travel plans during 2020-2021 nor engaging in compensatory behaviours were associated with quality of life. During times of uncertainty, such as pandemics, natural disasters or war, providing anxiety-reducing coping strategies may be beneficial for reducing the negative impacts on quality of life. In line with these findings and similar research, we have provided several directions and recommendations for governments and media organisations for when future events, similar to COVID-19, occur.

Protocol for national mental health guidelines for community sport in Australia.

Organised sports are the most common settings for sports participation. Despite a range of documented benefits from participation, these positive outcomes are not always guaranteed. Emotional distress from pressure and injuries can mean some participants experience negative outcomes. To ensure organised sports are well equipped to promote the mental health of their members, evidence-based guidelines for them are required. Using a Community-Based Participatory Research framework, mental health guidelines for community sport will be developed. In Phase One, community sport stakeholders will participate in focus groups. The aim is to understand their preferences of the content, purpose and scope of the guidelines. In Phase Two, an e-Delphi study will be conducted with experts in mental health and sport in Australia to gather recommendations on the purpose and scope of the guidelines. In Phase Three, a national consensus meeting with an Expert Guideline Development Committee will be held to draft the guidelines. In Phase Four, follow-up focus groups will be held with community sport stakeholders to understand the usability and acceptability of the draft guidelines. In Phase Five, a second e-Delphi study will be conducted to provide feedback on the revised guidelines after community stakeholder review. In Phase Six, implementation case studies will assess the implementation of the guidelines in community sport clubs. These mental health guidelines will answer an urgent call for action by experts. The guidelines will be based on sector needs and preferences, be acceptable and useable, and be able to be implemented by community sport clubs globally by 2025.

Investigating the role of morningness/eveningness in physical activity engagement.

Objective: Despite being aware of the positive health-related outcomes of physical activity, many people remain inactive. The aim of this study is to apply a combination of constructs from the health action process approach and self-determination theory, as well as habit and morningness/eveningness, to predict physical activity engagement. Methods: A prospective design was used to collect data from 136 participants (16-64 years old), at two-time points, one week apart. The sample consisted of 99 women, 36 men and 1 individual who identified as non-binary. Participants preferred time-of-day was measured using the Morningness-Eveningness Stability Scale (MESSi), while physical activity engagement was measured using the International Physical Activity Questionnaire (short-version). Two hierarchical, multiple regressions were conducted, to predict motivation to engage and to directly predict physical activity engagement. Furthermore, a mediation analysis was conducted to determine the effect of planning on physical activity engagement. Results: Results showed that younger individuals and those with greater self-efficacy were more motivated to engage while planning directly predicted physical activity engagement. However, morningness/eveningness did not significantly predict engagement. Additionally, planning was found to mediate the motivation-engagement relationship. Conclusion: This study demonstrates how planning influences individuals' physical activity engagement, as well as the role self-efficacy and age play in their motivation to engage. Even though morningness/eveningness was not an important predictor, behaviour change techniques related to action planning and the use of multi-component approaches to behaviour change, could be used in interventions focused on increasing individuals' physical activity engagement.

Investigating mechanisms for recruiting and retaining volunteers: The role of habit strength and planning in volunteering engagement.

Volunteering rates in high-income countries are declining. Most research into understanding volunteering engagement has focused on conscious processes (e.g., motives), with little exploration of non-conscious antecedents of volunteering engagement. Adopting a new line of investigation, this research used temporal self-regulation theory to investigate the influence of both rational and automatic processes on volunteering engagement. Two related studies using different methodologies were conducted to investigate the influence of intention, planning, and habit strength on volunteering engagement. In both studies, intention and habit strength were significant predictors of volunteering engagement, with planning only significantly predicting volunteering engagement in Study 1. It was also found, in Study 2, that habit strength moderated the intention-behavior relationship. These findings highlight that both rational and automatic processes play a part in volunteering engagement and have implications for recruiting and retaining volunteers.

Understanding the predictors of medication adherence: applying temporal self-regulation theory.

OBJECTIVE: This study aimed to explore the applicability of temporal self-regulation theory (TST) in adherence to medication, using two self-report measures of behaviour. DESIGN: Recruited through TurkPrime, 191 US adults completed a two-part study. MAIN OUTCOME MEASURES: TST constructs of intention, behavioural prepotency (past behaviour, habit, cues), self-regulation (self-control, planning) with regimen complexity, and side effects were measured at time one. At time two, adherence behaviour over the previous week was measured using a revised medication adherence rating scale and an adapted timeline follow-back. RESULTS: Constructs of TST accounted for 51.5% of variance in adherence as assessed by the rating scale. Past behaviour and cues were significant. Habit and planning moderated the intention-adherence relationship. Similarly, the TST constructs accounted for 20.6% of variance when measured by the timeline follow-back. Intention, cues and self-control were significant predictors. Interestingly, cues was the only common significant predictor. CONCLUSION: TST was partially supported and the role of both rational and automatic factors was supported, however findings differed depending on the type of measure. Future developers of interventions may consider targeting cues to improve medication adherence. Future research also needs to further explore the role of intention, past behaviour, self-control, habit and planning in medication adherence.

A Qualitative Application of Temporal Self-Regulation Theory to Understand Adherence to Simple and Complex Medication Regimens.

Medication adherence is a global health concern, and variables of temporal self-regulation theory (TST) have been shown to be important in improving adherence. This qualitative study aims to explore how TST can help explain medication adherence in people's daily lives, and whether there are differences in the adherence to simple and complex medication regimens. Twenty-nine participants from Australia engaged in semi-structured interviews based on TST (intention, behavioural prepotency, self-regulation), and other variables important to adherence. Interviews were analysed using thematic analysis. Six themes were identified (Routines, External Supports, Cost, Sense of Agency, Adverse Outcomes, and Weighing Up Pros and Cons), with partial support for TST (specifically intention, past behaviour, cues and planning). Four themes not related to TST were also identified. Individuals with more complex medication regimens spoke of the importance of routines, planning, and knowledge-seeking, whereas those with simpler regimens spoke of the importance of visual cues. TST may be useful for identifying some variables important in medication adherence, however, additional factors were also identified. For simple regimens, future research should focus on the manipulation of visual cues. For complex regimens, health professionals should consider supporting the use of medication management apps to assist in planning and ensuring a consistent routine.

A Habit-Based Randomised Controlled Trial to Reduce Sugar-Sweetened Beverage Consumption: the Impact of the Substituted Beverage on Behaviour and Habit Strength.

BACKGROUND: Excess sugar consumption has been linked to numerous negative health outcomes, such as obesity and type II diabetes. Reducing sugar-sweetened beverage (SSB) consumption may reduce sugar intake and thus improve health. The aim of the study was to test the impact of the potentially different rewarding nature of water or diet drinks as replacements for SSB, using a habit and implementation intention-based intervention. METHOD: An online randomised, two-arm parallel design was used. One hundred and fifty-eight participants (mainly from the UK and USA) who regularly consumed SSBs (Mage = 31.5, 51% female) were advised to create implementation intentions to substitute their SSB with either water or a diet drink. Measures of SSB consumption, habit strength and hedonic liking were taken at baseline and at 2 months. Water or diet drink consumption was only measured at 2 months. RESULTS: There was a large and significant reduction in SSB consumption and self-reported SSB habits for both the water and diet drink groups, but no difference between groups. There were no differences in hedonic liking for the alternative drink, alternative drink consumption and alternative drink habit between the two groups. Reduction in SSB hedonic liking was associated with reduced SSB consumption and habit. CONCLUSION: This study demonstrates that an implementation intention-based intervention achieved substantial reductions in SSB consumption and habits. It also indicates that hedonic liking for SSBs and alternative drinks are associated with changes in consumption behaviour. Substituting SSBs with water or diet drinks was equally as effective in reducing SSB consumption.

Motivations for volunteering time with older adults: A qualitative study.

Improved health, wellbeing and quality of life are associated with older adults living well at home. Enabling older adults to remain at home requires organisations to consider different workforce models to support these initiatives. Volunteers are often used by organisations providing such services. However, given the changing nature of the volunteer industry, volunteer recruitment and retention practices must be better understood. This study sought to understand individuals' motivations to volunteer in aged care home support. Eighteen volunteers were recruited from not-for-profit aged support organisations in Perth, Western Australia. Semi-structured interviews were conducted, and five themes were thematically interpreted: What's Important to Me?, Learning and Growth, Somewhere to Belong, Meet Me in the Middle, and Not Just a Number. Fulfilling volunteers' desires for interest, social connection, self-growth, recognition, and support appeared conducive to positive volunteering experiences. These findings may suggest avenues to capture and retain volunteers in aged care home support.

Exploring Medication Adherence Amongst Australian Adults Using an Extended Theory of Planned Behaviour.

BACKGROUND: This study examined the psychological predictors of general prescription medication adherence using an extended theory of planned behaviour (i.e. adding habit strength). The addition of habit strength to the model aimed to close the gap between intention and behaviour to further understand the psychological predictors of adherence. METHOD: In this prospective study, self-report data was collected online at two time points, 1 week apart, from 114 Australian adults and was used to explore the role of the theory of planned behaviour variables (attitude, subjective norm, perceived behavioural control and intention), and habit strength in predicting medication adherence. Hierarchical multiple regression analysis was used to explore the relationships between variables. RESULTS: Results showed that collectively attitude, subjective norm and perceived behavioural control were unable to significantly predict intention to adhere. A ceiling effect was identified in intention. Perceived behavioural control was the only significant predictor of adherence behaviour (ß = .41, p < .001). Habit strength was not found to be a significant predictor of adherence in this sample. CONCLUSION: The findings of this study show partial support for the predictive ability of the theory of planned behaviour in predicting intentions and medication adherence. It also adds to the growing literature showing the importance of perceived behavioural control in health behaviours. Behaviour change techniques related to enhancing self-efficacy, such as self-monitoring of the behaviour or keeping a diary, could be of use in interventions tailored to increase medication adherence.

Adherence to the oral contraceptive pill: the roles of health literacy and knowledge.

OBJECTIVE: The oral contraceptive pill is the most widely used method of contraception and when adhered to perfectly is 99% effective at preventing pregnancy. However, adherence to the pill is relatively low. Knowledge has shown to be important in continuation of the pill, and previous research shows the importance of health literacy in adhering to medication in chronic illnesses, but its role has yet to be explored in this behavior. METHODS: This cross-sectional study examined the associations between health literacy, knowledge of the pill and adherence, as well as the predictive ability of these two variables and their interaction, in predicting adherence. Recruited through CloudResearch, 193 women (M age = 32.63 years, SD = 5.98) residing in the United States completed the Health Literacy Skills Instrument - Short Form, a previously validated measure of oral contraceptive pill knowledge and the Medication Adherence Report Scale. RESULTS: Results showed a strong positive correlation between health literacy and adherence (r = .76) and moderate associations between health literacy and knowledge (r = .42), and knowledge and adherence (r = .42). The final model of the hierarchical multiple regression accounted for 59.8% of variance in adherence, with health literacy (ß = .69) and length of time taking the pill (ß = .13) the only significant predictors of adherence. CONCLUSION: Family planning clinics should consider assessing the patient's health literacy skills before prescribing the pill to ensure patients fully understand the requirements.