Treatment confidence and patient participation in multidisciplinary tumor conferences: A structural equation modeling approach.

OBJECTIVE: Multidisciplinary tumor conference (MTC) is a key instrument in multidisciplinary cancer care. In recent years, if and how patient participation in MTC can contribute to a more patient-centered care have been scientifically discussed. This study aimed to identify determinants of treatment confidence in the context of patient participation in MTC. Therefore, the association among health literacy-sensitive communication, trust in health-care providers (HCP), and treatment confidence is examined. METHODS: This study used data from the multicenter, observational study "PINTU" on patient participation in MTC. Data were collected from November 2018 to February 2020. Validated scales for treatment confidence, health literacy-sensitive communication, and trust in providers were included in the structural equation modeling (SEM) analysis. RESULTS: A total of 95 patients participated in MTC. The sample compromised n = 80 completed datasets. The SEM fit measures indicated good fit of the proposed model. The analysis showed a positive association between health literacy-sensitive communication and treatment confidence when adding the mediating effect of trust in providers. CONCLUSION: Patient-centered communication during MTC in combination with a trustful relationship between participating patients and health-care providers is positively associated with treatment confidence. The results indicated the relevance of a trustful doctor-patient communication and relationship. Trainings for physicians targeting patient-centered communication could be a promising approach to strengthen patient participation.

Decision-making under stress: A psychological and neurobiological integrative model.

Understanding the impact of stress on cognitive processes, particularly decision-making, is crucial as it underpins behaviors essential for survival. However, research in this domain has yielded disparate results, with inconsistencies evident across stress-induction paradigms and drug administration protocols designed to investigate specific stress pathways or neuromodulators. Building upon empirical studies, this research identifies a multifaceted matrix of variables contributing to the divergent findings. This matrix encompasses factors such as the temporal proximity between stressors and decision tasks, the nature of stressors and decision contexts, individual characteristics including psychobiological profiles and affective states at the time of decision-making and even cultural influences. In response to these complexities, we propose a comprehensive model that integrates these relevant factors and their intricate interplay to elucidate the mechanisms governing decision-making during stressful events. By synthesizing these insights, our model not only refines existing paradigms but also provides a framework for future study designs, offering avenues for theoretical advancements and translational developments in the field of stress's impact on cognitive functions. This research contributes to a deeper understanding of the nuanced relationship between stress and decision-making, ultimately advancing our knowledge of cognitive processes under challenging conditions.

Multi-omics integrative modelling for stereotactic body radiotherapy in early-stage non-small cell lung cancer: clinical trial protocol of the MONDRIAN study.

BACKGROUND: Currently, main treatment strategies for early-stage non-small cell lung cancer (ES-NSCLC) disease are surgery or stereotactic body radiation therapy (SBRT), with successful local control rates for both approaches. However, regional and distant failure remain critical in SBRT, and it is paramount to identify predictive factors of response to identify high-risk patients who may benefit from more aggressive approaches. The main endpoint of the MONDRIAN trial is to identify multi-omic biomarkers of SBRT response integrating information from the individual fields of radiomics, genomics and proteomics. METHODS: MONDRIAN is a prospective observational explorative cohort clinical study, with a data-driven, bottom-up approach. It is expected to enroll 100 ES-NSCLC SBRT candidates treated at an Italian tertiary cancer center with well-recognized expertise in SBRT and thoracic surgery. To identify predictors specific to SBRT, MONDRIAN will include data from 200 patients treated with surgery, in a 1:2 ratio, with comparable clinical characteristics. The project will have an overall expected duration of 60 months, and will be structured into five main tasks: (i) Clinical Study; (ii) Imaging/ Radiomic Study, (iii) Gene Expression Study, (iv) Proteomic Study, (v) Integrative Model Building. DISCUSSION: Thanks to its multi-disciplinary nature, MONDRIAN is expected to provide the opportunity to characterize ES-NSCLC from a multi-omic perspective, with a Radiation Oncology-oriented focus. Other than contributing to a mechanistic understanding of the disease, the study will assist the identification of high-risk patients in a largely unexplored clinical setting. Ultimately, this would orient further clinical research efforts on the combination of SBRT and systemic treatments, such as immunotherapy, with the perspective of improving oncological outcomes in this subset of patients. TRIAL REGISTRATION: The study was prospectively registered at clinicaltrials.gov (NCT05974475).

Shared decision making and advance care planning: a systematic literature review and novel decision-making model.

BACKGROUND AND AIMS: Shared decision making (SDM) and advance care planning (ACP) are important evidence and ethics based concepts that can be translated in communication tools to aid the treatment decision-making process. Although both have been recommended in the care of patients with risks of complications, they have not yet been described as two components of one single process. In this paper we aim to (1) assess how SDM and ACP is being applied, choosing patients with aortic stenosis with high and moderate treatment complication risks such as bleeding or stroke as an example, and (2) propose a model to best combine the two concepts and integrate them in the care process. METHODS: In order to assess how SDM and ACP is applied in usual care, we have performed a systematic literature review. The included studies have been analysed by means of thematic analysis as well as abductive reasoning to determine which SDM and ACP steps are applied as well as to propose a model of combining the two concepts into one process. RESULTS: The search in Medline, Cinahl, Embase, Scopus, Web of science, Psychinfo and Cochrane revealed 15 studies. Eleven describe various steps of SDM while four studies discuss the documentation of goals of care. Based on the review results and existing evidence we propose a model that combines SDM and ACP in one process for a complete patient informed choice. CONCLUSION: To be able to make informed choices about immediate and future care, patients should be engaged in both SDM and ACP decision-making processes. This allows for an iterative process in which each important decision-maker can share their expertise and concerns regarding the care planning and advance care planning. This would help to better structure and prioritize information while creating a trustful and respectful relationship between the participants. PROSPERO 2019. CRD42019124575.

Relationship Maintenance among Military Couples.

A burgeoning body of research on the relationship maintenance of military couples over the past two decades suggests the time is right to organize, assimilate, and critique the literature. We conducted a systematic review informed by the integrative model of relationship maintenance (Ogolsky et al., 2017) that considered issues of intersectionality (Crenshaw, 1991). Our literature search identified 81 relevant journal articles representing 62 unique samples. With respect to theory, 59.3% of the journal articles employed one or more formal theoretical frameworks. In terms of research design, 88.7% of the studies focused on the U.S. military, 83.9% of the studies recruited convenience samples, 54.8% of the studies utilized quantitative methods, and 30.6% of the studies collected longitudinal data. Among the studies reporting sample demographics, 96.8% of participants were married, 77.2% of participants identified as non-Hispanic White, and only one same-sex relationship was represented. Our narrative synthesis integrated findings about relationship maintenance from studies examining (a) relationship maintenance overtly, (b) communicating to stay connected across the deployment cycle, (c) disclosure and protective buffering, (d) support from a partner, (e) dyadic coping, and (f) caregiving and accommodating a partner's symptoms. We interpret our results with an eye toward advancing theory, research, and practice.

Media Multitasking in Medical Students: A Theory-Based Approach to Understanding this Behavior.

PHENOMENON: While technology is useful and encouraged in medical school, the effect of media multitasking on academic performance remains concerning. Past research has investigated performance and cognitions associated with college students' in-class media multitasking behavior, but the extent and correlates among medical students is relatively unknown. APPROACH: We surveyed medical students at our institution to quantify media multitasking behaviors and related beliefs, and we collected corresponding course grades. Our research applies the Integrative Model of Behavioral Prediction theory to analyze course and cognitive factors influencing media multitasking behavior in medical students. Correlation of media multitasking behavior with average and block grades assessed potential academic impact of the behavior. FINDINGS: Media multitasking was common among medical students. Reported extent of media multitasking among medical students (N = 119) was not related to course grades but was driven by an interplay of beliefs about the behavior and specific course factors. Based on our hierarchical regression model, concerns about boredom appear to be the major cognitive belief underlying behavior. INSIGHTS: Our findings, in the context of the Integrative Model of Behavioral Prediction theory, show influential factors that impact medical students' behavior regarding media multitasking. A campaign targeting these factors influencing behavior may be the most effective approach to limit students' media multitasking and its potential impact on performance. Though our research did not find an association between the extent of media multitasking and course grades, our study was limited by self-report of media multitasking and relatively crude measures of academic performance. Further research is required to measure these behaviors and potential outcomes.Supplemental data for this article is available online at.

The response set theory of hypnosis reconsidered: toward an integrative model.

Irving Kirsch is a leading figure in the field of psychological science who has advanced our understanding of hypnosis in key respects that have withstood the tests of time and replication. We honor his prodigious contributions over his distinguished career and extend his response expectancy theory in an integrative model that encompasses predictive coding. We review the construct of expectancies that he articulated and championed for decades and extended in response set theory. We propose novel hypotheses to align his innovative contributions with the most current findings in psychological science and to acknowledge the heuristic value of his work. We especially focus on (I) how the response set theory can be conceptualized in terms of the predictive coding model and (II) psycho-social constructs that need to be considered to better understand the effects of expectancies on hypnotic phenomena in an open and evidence-based integrative model of hypnosis.

Applying the Integrative Model to Predict Intention to Use Corporal Punishment Among Low-income Parents.

Child corporal punishment (CP) is associated with child physical abuse, which is a public health problem in the United States. Informed by the integrative model of behavioral prediction, this study surveyed low-income Black, Hispanic, and White parents who had children younger than 6 years old (N = 260) to identify major risk factors that determined intention to use CP to discipline children. Structural equation modeling revealed that attitudes, descriptive norms, and perceived efficacy of alternative discipline strategies were associated with intention to use CP. Additionally, parents' childhood CP frequency and past use of CP with their own children were influential distal variables that indirectly predicted CP intention. Results indicated the utility of the model in this behavioral context. Communication intervention programs targeting low-income parents should leverage perceived norms, perceived efficacy of alternative discipline strategies, and attitudes to change CP behavior.

Choosing among correlative, mechanistic, and hybrid models of species' niche and distribution.

Different models are available to estimate species' niche and distribution. Mechanistic and correlative models have different underlying conceptual bases, thus generating different estimates of a species' niche and geographic extent. Hybrid models, which combining correlative and mechanistic approaches, are considered a promising strategy; however, no synthesis in the literature assessed their applicability for terrestrial vertebrates to allow best-choice model considering their strengths and trade-offs. Here, we provide a systematic review of studies that compared or integrated correlative and mechanistic models to estimate species' niche for terrestrial vertebrates under climate change. Our goal was to understand their conceptual, methodological, and performance differences, and the applicability of each approach. The studies we reviewed directly compared mechanistic and correlative predictions in terms of accuracy or estimated suitable area, however, without any quantitative analysis to support comparisons. Contrastingly, many studies suggest that instead of comparing approaches, mechanistic and correlative methods should be integrated (hybrid models). However, we stress that the best approach is highly context-dependent. Indeed, the quality and effectiveness of the prediction depends on the study's objective, methodological design, and which type of species' niche and geographic distribution estimated are more appropriate to answer the study's issue.

Meaning in Life among Older Adults: An Integrative Model.

Meaning in life (MIL) among older adults has a significant physical and mental health impact. This study aimed to present an integrative model of factors that contribute to variability in MIL among older adults, including background characteristics (gender, age, employment status, religiosity), personality characteristics (locus of control, self-efficacy, optimism), and psycho-social factors (psychological distress and loneliness). Participants (751 older adults, Mage = 72.27, SD = 6.28; 446 female, 305 male) responded to a questionnaire in-person or online. Measures included: demographic variables, Short Scale for the Assessment of Locus of Control, New General Self-Efficacy Scale, Life Orientation Test-Revised, Kessler Psychological Distress Scale, and Hughes Short Scale for Measuring Loneliness. Hierarchical regression revealed that younger and religious older adults reported higher MIL levels than older and non-religious older adults. Internal locus of control, higher self-efficacy, and higher optimism were linked to higher MIL levels. Higher psychological distress and loneliness were associated with lower MIL levels, with psychological distress contributing the most of all variables in the study model to explain the variance in MIL among older adults. Employed older old adults reported lower MIL levels than those unemployed. The study emphasizes the importance of an integrative approach in the examination of MIL among older adults.

Strategic communication as planned behavior for science and risk communication: A theory-based approach to studying communicator choice.

This essay argues that we should treat science and risk communicators' choices about tactics, objectives, and goals as behaviors to advance both research and practice. Doing so allows for a discussion about how to use theories about behavior change and trust-building to help foster more strategic communication choices. The essay also seeks to anticipate and respond to potential arguments against using behavior change theories to encourage more strategic communication choices. We argue that it is possible to use behavior change tactics ethically if those tactics are aimed at increasing the likelihood that all participants in communication-including decisions makers like risk scientists-meaningfully engage with true, relevant information. Under the right conditions, such engagement is what should allow for the development of new knowledge, as well as a range of evidence-based evaluative beliefs, feelings, and frames. Being strategic when making choices about communication should also help with identifying situations in which justice, equity, diversity, or inclusion issues require additional attention. The essay concludes by noting that the difficulty of efficient and effective science and risk communication may require increased emphasis on getting experts such as scientists to collaborate with expert communication advisors. It may also be necessary to increase the capacity of science- and risk-focused communication practitioners.

Combined tumor and immune signals from genomes or transcriptomes predict outcomes of checkpoint inhibition in melanoma.

Immune checkpoint blockade (CPB) improves melanoma outcomes, but many patients still do not respond. Tumor mutational burden (TMB) and tumor-infiltrating T cells are associated with response, and integrative models improve survival prediction. However, integrating immune/tumor-intrinsic features using data from a single assay (DNA/RNA) remains underexplored. Here, we analyze whole-exome and bulk RNA sequencing of tumors from new and published cohorts of 189 and 178 patients with melanoma receiving CPB, respectively. Using DNA, we calculate T cell and B cell burdens (TCB/BCB) from rearranged TCR/Ig sequences and find that patients with TMBhigh and TCBhigh or BCBhigh have improved outcomes compared to other patients. By combining pairs of immune- and tumor-expressed genes, we identify three gene pairs associated with response and survival, which validate in independent cohorts. The top model includes lymphocyte-expressed MAP4K1 and tumor-expressed TBX3. Overall, RNA or DNA-based models combining immune and tumor measures improve predictions of melanoma CPB outcomes.

Testing the empirical integration of threat-deprivation and harshness-unpredictability dimensional models of adversity.

Recent dimensional models of adversity informed by a neurobiological deficit framework highlights threat and deprivation as core dimensions, whereas models informed by an evolutionary, adaptational and functional framework calls attention to harshness and unpredictability. This report seeks to evaluate an integrative model of threat, deprivation, and unpredictability, drawing on the Fragile Families Study. Confirmatory factor analysis of presumed multiple indicators of each construct reveals an adequate three-factor structure of adversity. Theory-based targeted predictions of the developmental sequelae of each dimension also received empirical support, with deprivation linked to health problems and cognitive ability; threat linked to aggression; and unpredictability to substance use and sexual risk-taking. These findings lend credibility to utility of the three-dimensional integrative framework of adversity. It could thus inform development of dimensional measures of risk assessment and exploration of multidimensional adversity profiles, sensitive to individual differences in lived experiences, supporting patient-centered, strength-based approaches to services.

Perceived facilitators and barriers to intentions of receiving the COVID-19 vaccines among elderly Chinese adults.

Elderly adults hold different beliefs regarding vaccination and are at higher risks for COVID-19 related illnesses and deaths. The current study aims to explore elderly (aged 65 or above) Chinese adults' intentions to get vaccinated against COVID-19 and the facilitators and barriers to vaccination intentions. We conducted in-depth interviews with 35 elderly adults in China through the lens of the integrative model of behavioral prediction. The results identified a number of facilitators, including convenience (both individual and collective), psychological and physiological wellbeing, collective wellbeing, supportive normative referents, and trust in the government, and some barriers, including vaccine ineffectiveness, side effects, safety, unsupportive normative referents, and the accessibility, affordability, and availability of COVID-19 vaccines. In addition, the results revealed participants' decision-making process: collective wellbeing and trust in the government overrode perceived barriers and perceived individual-level risks, which eventually overwhelmingly led to a high level of intentions to get vaccinated. Practical implications related to vaccine promotion and trust in the government were discussed.

Prefrontally modulated vagal neuroimmunomodulation is associated with telomere length.

Background: Accumulated senescent cells are proposed to be one of the main drivers of age-related pathology such as dementia and cancer through disruption of tissue structure and function. We recently proposed the Neuro-Immuno-Senescence Integrative Model (NISIM), which relates prefrontally modulated vagal tone and subsequent balance between vagal and sympathetic input to the spleen to inflammatory responses leading to generation of reactive oxygen species and oxidative telomere damage. Aim: In this study, we assess inflammation as a mediator in the relationship between prefrontally modulated vagal tone and leukocyte telomere length (LTL). We also assess the relationship between a recently proposed index of vagal neuroimmunomodulation (vagal tone/inflammation ratio; NIM index) and telomere length. Methods: This study uses participant data from a large nationally representative longitudinal study since 1974 with a total of 45,000 Norwegian residents so far. A sub-sample of 131 participants from which ultrashort recordings (30 s) of vagal tone, c reactive protein, and LTL could be obtained were included in the study. Relationships were analyzed with Pearson's correlations and hierarchical multiple linear regression using either vagal tone and CRP or the NIM index to predict telomere length. Results: Vagal tone was a significant positive predictor of telomere length but this was not mediated by c reactive protein, even after controlling for confounders. The NIM index was a significant positive predictor of telomere length, also when controlling for confounders. In a follow-up analysis simultaneously comparing telomere length between groups with high and low values of vagal tone, and between groups with high and low NIM index values, telomere length was only significantly different between NIM index groups. Conclusion: This is the first study suggesting that prefrontally modulated vagal neuroimmunomodulation is associated with telomere length thus supporting the NISIM. Results indicate that the NIM index is a more sensitive indicator of vagal neuroimmunomodulation than vagal tone and CRP in isolation.

Prioritising Organisational Factors Impacting Cloud ERP Adoption and the Critical Issues Related to Security, Usability, and Vendors: A Systematic Literature Review.

Cloud ERP is a type of enterprise resource planning (ERP) system that runs on the vendor's cloud platform instead of an on-premises network, enabling companies to connect through the Internet. The goal of this study was to rank and prioritise the factors driving cloud ERP adoption by organisations and to identify the critical issues in terms of security, usability, and vendors that impact adoption of cloud ERP systems. The assessment of critical success factors (CSFs) in on-premises ERP adoption and implementation has been well documented; however, no previous research has been carried out on CSFs in cloud ERP adoption. Therefore, the contribution of this research is to provide research and practice with the identification and analysis of 16 CSFs through a systematic literature review, where 73 publications on cloud ERP adoption were assessed from a range of different conferences and journals, using inclusion and exclusion criteria. Drawing from the literature, we found security, usability, and vendors were the top three most widely cited critical issues for the adoption of cloud-based ERP; hence, the second contribution of this study was an integrative model constructed with 12 drivers based on the security, usability, and vendor characteristics that may have greater influence as the top critical issues in the adoption of cloud ERP systems. We also identified critical gaps in current research, such as the inconclusiveness of findings related to security critical issues, usability critical issues, and vendor critical issues, by highlighting the most important drivers influencing those issues in cloud ERP adoption and the lack of discussion on the nature of the criticality of those CSFs. This research will aid in the development of new strategies or the revision of existing strategies and polices aimed at effectively integrating cloud ERP into cloud computing infrastructure. It will also allow cloud ERP suppliers to determine organisations' and business owners' expectations and implement appropriate tactics. A better understanding of the CSFs will narrow the field of failure and assist practitioners and managers in increasing their chances of success.

Neural substrates of the executive function construct, age-related changes, and task materials in adolescents and adults: ALE meta-analyses of 408 fMRI studies.

To explore the neural substrates of executive function (EF), we conducted an activation likelihood estimation meta-analysis of 408 functional magnetic resonance imaging studies (9639 participants, 7587 activation foci, 518 experimental contrasts) covering three fundamental EF subcomponents: inhibition, switching, and working memory. Our results found that activation common to all three EF subcomponents converged in the multiple-demand network across adolescence and adulthood. The function of EF with the multiple-demand network involved, especially for the prefrontal cortex and the parietal regions, could not be mature until adulthood. In adolescents, only working memory could be separable from common EF, whereas in adults, the three EF subcomponents could be separable from common EF. However, findings of switching in adolescents should be treated with substantial caution and may be exploratory due to limited data available on switching tasks. For task materials, inhibition and working memory showed both domain generality and domain specificity, undergirded by the multiple-demand network, as well as different brain regions in response to verbal and nonverbal task materials, respectively. In contrast, switching showed only domain generality with no activation specialized for either verbal or nonverbal task materials. These findings, taken together, support and contribute to the unitary-diverse nature of EF such that EF should be interpreted in an integrative model that relies on the integration of the EF construct, development, and task materials.

Understanding Beliefs, Intention, and Behavior on Daily PrEP Uptake Among MSM in California and New York.

Pre-exposure prophylaxis (PrEP) is an effective daily prevention medicine to reduce the risks of HIV infections. Even though the number of PrEP users has been rapidly growing in the United States since 2012, only approximately 5% of the men who have sex with men (MSM) population is currently taking PrEP. This study examined PrEP uptake among MSM using the integrative model of behavioral prediction (IMBP) as the theoretical framework. The authors conducted formative elicitation interviews and a cross-sectional survey with MSM. Among the survey respondents, half of them were PrEP takers and half were not. The path modeling results showed that attitudes and norms predicted behavioral intention, and intention predicted PrEP uptake among MSM. The results also identified the strongest attitudinal predictors and normative referents of PrEP uptake. The study offers practical implications in helping professionals and scholars to understand PrEP uptake among MSM in a theoretically grounded way.

Examining an Integrative Cognitive Model of Predicting Health App Use: Longitudinal Observational Study.

BACKGROUND: Specifying the determinants of using health apps has been an important research topic for health scholars as health apps have proliferated during the past decade. Socioeconomic status (SES) has been revealed as a significant determinant of using health apps, but the cognitive mechanisms underlying the relationship between SES and health app use are unknown. OBJECTIVE: This study aims to examine the cognitive mechanisms underlying the relationships between SES and use of health apps, applying the integrative model of behavioral prediction (IM). The model hypothesizes the indirect influences of SES on intentions to use health apps, which in turn predict actual use of health apps. The relationships between SES and intentions to use health apps were assumed to be mediated by proximal variables (attitudes, perceived behavioral control [PBC], injunctive norms, and descriptive norms). METHODS: We conducted path analyses using data from a two-wave opt-in panel survey of Korean adults who knew about health apps. The number of respondents was 605 at baseline and 440 at follow-up. We compared our model with two alternative theoretical models based on modified IM to further clarify the roles of determinants of health app use. RESULTS: Attitudes (ß=.220, P<.001), PBC (ß=.461, P<.001), and injunctive norms (ß=.186, P<.001) were positively associated with intentions to use health apps, which, in turn, were positively related to actual use of health apps (ß=.106, P=.03). Income was positively associated with intentions to use health apps, and this relationship was mediated by attitudes (B=0.012, 95% CI 0.001-0.023) and PBC (B=0.026, 95% CI 0.004-0.048). Education was positively associated with descriptive norms (ß=.078, P=.03), but descriptive norms were not significantly related to intentions to use health apps. We also found that PBC interacted with attitudes (B=0.043, SE 0.022, P=.046) and jointly influenced intentions to use health apps, whereas the results did not support direct influences of education, income, and PBC on health app use. CONCLUSIONS: We found that PBC over using health apps may be the most important factor in predicting health app use. This suggests the necessity of designing and promoting health apps in a user-friendly way. Our findings also imply that socioeconomic inequalities in using health apps may be reduced by increasing positive attitudes toward, and boosting PBC over, health app use among individuals with low income.

Why people follow a gluten-free diet? An application of health behaviour models.

PURPOSE: To understand factors affecting adherence to GFD by celiac and non-celiac people through the application of behavioural theories, Integrative Model (IM) and Multi Theory Model (MTM). METHODS: Analyses were conducted for a sample of 308 subjects, majority females, celiac and non-celiac. Adherence to GFD was measured considering two scales, self-declared adherence and scored adherence, in order to discern possible inconsistencies between what subjects believe and what they really do. Subsequently, adherence to GFD was modelled by considering constructs of MTM and IM. Moreover, the constructs were designed based on literature review. Ordered logit (OL) model was used to test the IM and MTM theoretical models. RESULTS: The findings show that adherence to GFD is affected mainly by attitudes towards GFD, self-efficacy, injunctive norms, knowledge about GFD and health conditions. Between the two models, IM and MTM, results show that all constructs of IM explain the behaviour. Contrary, for MTM, results indicate only some constructs of the MTM explain adherence to GFD. CONCLUSIONS: Results of this study should be considered for improving the adherence to GFD for celiac people. Furthermore, it is important to consider the non-celiac people's perceptions for GFD and GF products. In other words an accurate information about the diet and products it is relevant for supporting people to make healthier food choices. Finally, as the results show, IM explain adherence to GFD better than MTM.