OBJECTIVE:Identifying modifiable determinants of parent-for-child vaccination may inform interventions for ongoing management of infectious diseases including COVID-19. We tested an integrated theoretical model in which social cognition constructs (coping appraisals, anticipated regret, moral norms) mediated effects of dispositional constructs (political orientation, conspiracy beliefs, vaccine hesitancy) on parent-for-child COVID-19 vaccination intention and behaviour. METHODS AND MEASURES:In a prospective correlational study, US parents (N = 497) with an unvaccinated child completed political orientation, conspiracy beliefs, vaccine hesitancy, and social cognition construct measures referring to COVID-19 vaccination for their child. Parents reported their vaccination behaviour for their child five weeks later. RESULTS:Consistent with predictions, we observed indirect effects of political orientation and vaccination hesitancy on intentions mediated by coping efficacy, anticipated regret, and moral norms, and sums of indirect effects of political orientation, conspiracy beliefs, and vaccine hesitancy on intention mediated by social cognition constructs. We also observed a sum of indirect effects of vaccine hesitancy on behaviour. CONCLUSION:Findings contribute to an evidence base for the effects of dispositional and social cognition constructs of parent-for-child COVID-19 vaccination intentions and behaviour and signal a candidate mechanism. Findings may provide formative evidence for developing interventions to manage childhood COVID-19 infection rates.
OBJECTIVE:To develop a measure for ego-depletion in oncology, as a foundational step for research and future interventions to reduce ego-depletion in adults coping with cancer. METHODS:Helsinki Ethical approval was granted by the ethics board of the medical centre with which the first author is affiliated. A cross-sectional field test was carried out. Based on the conceptualisation and measurement of ego-depletion, health professionals from a multidisciplinary team at a cancer centre developed items according to the content of ego-depletion and its demonstration in cancer. To validate the measure, we used the Piper Fatigue in Cancer scale, the Emotional and Functional well-being scales from the General Functional Assessment of Cancer Therapy scale, and the Busing self-regulation scale. REDCap, a web-based application, was used to capture data, structure the questionnaire, and distribute it. The final sample comprised 364 respondents. RESULTS:Descriptive statistics and item characteristics were carried out. Item reduction was performed using partial inter-item correlations and factor analyses. A three-factor structure underlying 27 items on the Ego-Depletion in Cancer Scale (EDIC) was supported. We label the first factor 'Actively Withstanding Ego-depletion,' the second factor 'Ego-depletion Ambivalence,' and the third factor 'Ego Cognitive Exhaustion.' The EDIC significantly correlated with related measures (e.g. fatigue, self-control, and positive emotions; p < .05). CONCLUSION:A full EDIC scale, three subscales of the 27 items, is presented. Correlations demonstrated convergent validity and suggested the EDIC is distinct from existing constructs. Implications and applications are discussed. A path analysis demonstrated that the EDIC scale is valid for measuring ego depletion in adults with cancer.
OBJECTIVE:Dietitians require robust behaviour change skills to promote dietary modifications to improve client outcomes. However, behaviour change education varies across institutions and placement opportunities. The aim was to develop and evaluate an online intervention to improve Australian dietitians' COM-B factors (capability, opportunity, motivation, and behaviour) for implementing behaviour change techniques. METHODS/MEASURES:Australian Accredited Practising Dietitians were recruited via social media, newsletters, and word-of-mouth to complete two online behaviour change workshops. Mixed methods surveys were administered at baseline, post-intervention, and 3-month follow-up. RESULTS:Seventy-two dietitians completed all study components. Repeated measures ANOVAs showed significant improvements in self-reported capability, opportunity, motivation, and self-reported behaviour (frequency and technique use). Pairwise comparisons revealed sustained improvements at follow-up for all constructs, with approximately two-thirds of dietitians (68%) reporting practice changes. These changes included the integration of specific techniques. Where no changes occurred, dietitians cited opportunity-based barriers or noted they were already using techniques in daily practice. CONCLUSIONS:The intervention was successful at improving dietitians' capability, opportunity, motivation, and self-reported behaviour. However, long-term skill development may require support structures to foster opportunities. Future research should explore professional development models that provide sustained learning and organisational support to embed behaviour change techniques into dietetic practice.
OBJECTIVE:Physical education (PE) plays a vital role in promoting students' physical activity (PA), yet the impact of achievement emotions in PE remains underexplored, particularly regarding their dynamic influence and mediating mechanisms. This study examines the effects of achievement emotions in PE on university students' PA and the mediating role of self-efficacy through cross-sectional and longitudinal analyses. METHODS:The study was conducted in Shanghai, China, and involved two rounds of surveys: the first round was a cross-sectional survey involving 740 students from three universities, and the second round was a seven-week, two-phase longitudinal survey focusing on 439 students from a single university. RESULTS:Cross-sectional analysis showed that positive achievement emotions in PE significantly predicted PA, whereas negative emotions had an adverse effect. Self-efficacy mediated the effects of both positive (33.09%) and negative (33.46%) achievement emotions on PA. The longitudinal study confirmed that achievement emotions and self-efficacy significantly influenced PA after seven weeks, with self-efficacy serving as a longitudinal mediator. CONCLUSIONS:The findings contribute to the theoretical understanding of emotion and behaviour change in PE and provide empirical support for designing interventions to enhance PA among university students by addressing achievement emotions and self-efficacy.
OBJECTIVE:Health behaviour change can be facilitated by the use of self-directed situational strategies that assist with the management of alternative behaviours that potentially compete with, and disrupt, health goal-directed behaviour performance. The strategies are likely especially efficacious for highly-rewarding alternative behaviours instigated by strongly-associated cues. However, theoretical accounts describing the determinants of self-directed strategy use and the implicated mechanisms remain underdeveloped in scholarly literature. METHODS:The proposed DP2 model adopts a dual-phase, dual-process perspective and offers a comprehensive account of how individuals deploy self-directed strategies to promote goal-directed health behaviour performance through management of alternative competing behaviours. Drawing from nascent conceptual work on strategy use and extant behavioural theory, the model outlines the determinants and processes implicated in formation of health goal intention and self-directed situational strategy use intention; the application of self-regulatory procedures for strategy identification, selection, and implementation; and the effects of strategy use on goal intention enactment. Goal importance and resource availability are candidate moderators of these processes. Illustrative applications, salient caveats, and boundary conditions are outlined. CONCLUSION:The model advances knowledge on the processes governing self-directed situational strategy use for health behaviour change and is expected to guide research testing its predictions and inform intervention design.
OBJECTIVE:Migration involves adapting to new cultural settings while retaining one's culture, which can lead to acculturative stress, a risk factor for migrant health and identity. METHODS:We investigated the interplay between acculturative stress, well-being, cultural identity, and the protective role of physical activity using a 7-day-diary-methodology with 266 participants with migration history (1,473 observations). RESULTS:Daily acculturative stress was associated with lower well-being (positive affect: β = -0.05, p = 0.011; negative affect: β = 0.05, p = 0.014) and lower national (β = -0.07, p < 0.001) but not ethnic (p = 0.343) identity. Physical activity was linked to higher well-being (positive affect: β = 0.15, p < 0.001, negative affect: β = -0.12, p < 0.001) and showed a tendency to buffer negative affect associated with acculturative stress (β = -0.04, p = 0.066). Being physically active was not associated with ethnic identity (p = 0.196) but in tendency with national identity (β = 0.02, p = 0.072). Supporting social identity theory, exploratory analyses indicated that stronger cultural identity correlated with higher well-being. Cultural identity did not buffer effects of acculturative stress on well-being but exacerbated them. Analyses controlled for general stress. CONCLUSIONS:The findings identify acculturative stress as an additional burden for migrant populations, highlighting the buffering potential of physical activity. Interventions might consider cultural identity and target physical activity to promote migrant health.
OBJECTIVE:This study examines how vertical (institutional) and horizontal (in-group social) trust relate to post-pandemic resilience through threat appraisals (perceived severity and loss-based negative emotions) and coping appraisal (self-efficacy), and whether these associations remain stable across health-crisis contexts and over time. METHODS AND MEASURES:Structural equation modelling was conducted using three Hong Kong datasets: the post-pandemic cross-sectional COVID-19 (N = 1,913) and the respiratory infectious disease sample (N = 1,498), and a two-wave COVID-19 panel spanning the intra- to post-pandemic period (N = 694). RESULTS:Across the two cross-sectional datasets, vertical trust was positively associated with resilience through self-efficacy, whereas horizontal trust was positively associated with resilience through self-efficacy but negatively associated through threat appraisals. Equality-constraint tests across two datasets further showed that horizontal trust had stronger associations with resilience and both appraisals than vertical trust, and that its direct and coping appraisals to resilience were more stable across health-crisis contexts. Longitudinally, only intra-pandemic horizontal trust remained positively associated with post-pandemic resilience through coping appraisal, whereas vertical trust showed a limited long-term association. CONCLUSION:The effect of horizontal trust on resilience appears more robust across contexts and time, particularly through self-efficacy, whereas vertical trust appears more contemporaneous and less durable.
OBJECTIVE:Do post-program motivational regulations mediate the intervention effect of the SDT-based European Fans in Training (EuroFIT) program on self-esteem, well-being and vitality at 12-months follow-up? METHODS:A causal mediation analysis of data from the randomised controlled trial of the EuroFIT program that recruited 1113 overweight, male football fans in England, Norway, Portugal and the Netherlands. RESULTS:We found evidence of indirect effects of autonomous motivation on vitality (b=.487, 95% CI: .229, .767, p<.001) well-being (b=.063, 95% CI: .003, .131, p=.038) and self-esteem (b=.491, 95% CI: .278, .701, p<.001), but not controlled motivation, at 12-months follow-up in the EuroFIT trial. We also found that reductions in amotivation at post-program partly explained positive increases across outcomes at 12-months follow-up. When controlling for increases in outcome variables at post-program, only the mediating effect of autonomous motivation on self-esteem remained significant, whereas the indirect pathway through reductions in amotivation remained significant for all outcomes. None of the indirect effects were robust to potential mediator-outcome confounding. CONCLUSION:EuroFIT program produced small-to-moderate improvements in vitality, well-being, and self-esteem at 12-month follow-up that were partly explained by post-program increases in autonomous motivation and reductions in amotivation. All indirect effects estimates were sensitive to potential mediator-outcome confounding.
OBJECTIVE:Chronic illness is interpreted not only in terms of personal symptoms, but also through broader systems of meaning concerning family continuity and future generations. The present research introduces Intergenerational Taint Perception (ITP), a psychological meaning system through which individuals understand their illness as having symbolic and relational implications for their family line and descendants, independent of confirmed biological transmission. METHODS AND MEASURES:Across three studies with patient samples in China (total N = 942), we examined the emergence, structure, and behavioral consequences of ITP using qualitative, psychometric, and experimental methods. Study 1 used qualitative interviews with individuals living with Parkinson's disease to identify recurring intergenerational concerns in illness narratives. Study 2 developed and validated a 12-item ITP scale and examined its factor structure and discriminant validity from internalized stigma and attributional beliefs. Study 3 experimentally examined ITP across Parkinson's disease, type 2 diabetes, and ischaemic stroke, assessing protective buffering and willingness to seek formal support. RESULTS:Study 1 identified recurring concerns regarding descendants, family continuity, and anticipated burden in illness narratives. Study 2 supported a stable two-factor structure of ITP and demonstrated discriminant validity from internalized stigma and attributional beliefs. Study 3 showed that family-focused attention selectively increased ITP under conditions of perceived hereditary ambiguity. Elevated ITP predicted greater protective buffering and reduced willingness to seek formal support, and accounted for experimental effects beyond internalized stigma. CONCLUSION:These findings identify ITP as a distinct form of intergenerational illness meaningmaking that shapes health behavior. The results highlight the importance of family- and future-oriented interpretations of illness and suggest new targets for intervention in family-centerd health contexts.
OBJECTIVE:The primary study aim is to evaluate the impact of app-based mobile Health (mHealth) interventions on physical activity in healthy populations and examine whether personalisation moderates their effectiveness. The secondary aim is to explore the potential moderating role of social features. METHODS AND MEASURES:A systematic review and meta-analysis examined the effect of mHealth apps on physical activity, measured by step count, moderate-to-vigorous physical activity (MVPA), or total activity. A total of 16,257 articles were identified via five databases in November 2023. After screening, 20 studies (n = 2,159 participants) were included with 23 total comparisons between postintervention and control groups. RESULTS:Random effects model results for all eligible studies showed a small-to-medium effect of mHealth apps in increasing physical activity compared to controls (g = 0.42, 95% CI [0.1540, 0.6874]; p = 0.002). Personalisation p = 0.22), social features (p = 0.12), and intervention duration p = 0.99) did not predict physical activity. However, a sensitivity analysis for step count only showed a negative effect of social features on step count (β=-0.50, p = 0.02). CONCLUSION:While mHealth interventions increase physical activity, personalisation features do not significantly influence their effectiveness. Additional research is needed to elucidate the impact of mHealth social features and potential individual difference factors on intervention effectiveness.
OBJECTIVE:This research examined the effects of power distance belief (PDB) on patients' response to doctors with different consultation lengths. DESIGN:The effect of PDB on patients' response to doctors with different consultation lengths was investigated through a cross-country study (Study 1; N = 338) and a field study (Study 2; N = 302). Study 3 (N = 404) tested the serial mediation role of arousal and time perception by manipulating PDB through the viewpoint argumentation task. Study 4 (N = 370) explored the moderating role of providing reasons (vs. feelings) by manipulating PDB using the sentence unscrambling task. RESULTS:Study 1 demonstrated a significant effect of country on willingness to revisit (η2 = .24). Study 2 revealed a significant effect of PDB on patient satisfaction (B = -.41, p < .001). Study 3 identified the serial mediation role of arousal and time perception (long: 95% CI = [-1.02, -.46]; short: 95% CI = [.56, .99]). Study 4 highlighted the significant moderating role of providing reasons (vs. feelings) (η2 = .03). CONCLUSION:PDB impacts patients' response to doctors with different consultation lengths through arousal and time perception.
BACKGROUND:Many women experience psychological challenges during the transition to motherhood. The recent COVID-19 pandemic was a period of high uncertainty, particularly for vulnerable people such as women in postpartum. METHODS:Following the Self-Determination Theory, this study, spanning over 34 months, examined the relationships between the timeline of preventive health measures in which women had their children and their Basic Psychological Needs (BPN), as well as the role played by the fear of contracting the COVID-19 virus in these postpartum women. Participants were 1031 mothers living in Portugal. FINDINGS:Results indicate that women who gave birth during the initial stages of the pandemic showed lower fear levels of being infected than their counterparts in the later stages; moreover, the latter showed lower satisfaction and higher frustration of BPN. Moreover, fear moderated the relationship between the COVID-19 pandemic restrictions at the time points when mothers delivered their children and the satisfaction or frustration of the BPN for competence and relatedness needs, but not for autonomy. DISCUSSION:Globally, findings suggest that using COVID-19 preventive restrictions timeline data may provide a preliminary basis for setting future guidelines that would help enhance women's postpartum BPN in situations of high uncertainty.
Trait mindfulness refers to one's natural tendency to be aware of and attentive to present experiences. Although the trait has been associated with physical health, most studies have been cross-sectional and failed to account for confounding variables. The present study tested the longitudinal relationship between trait mindfulness and physical health symptoms. Undergraduate student participants completed four surveys over a period of 3 months, in which they reported their trait mindfulness, physical symptoms (e.g. fatigue, stomachache), and cold symptoms (sore throat, congestion). Additionally, participants answered questions to assess general health, recent perceived stress, and trait neuroticism. Initial enrolment included 409 participants with 288 at Time 2, 218 at Time 3, and the final wave including 172 participants. Findings indicated that those higher in trait mindfulness reported fewer symptoms across all time points, regardless of general health, recent stress, or neuroticism, t(395) = -6.75, p < 0.001. By examining associations across time and covarying related variables, this study underscores the importance of trait mindfulness in predicting health outcomes. It is the largest longitudinal investigation of trait mindfulness and physical health symptoms in emerging adults. Future studies should explore pathways through which mindfulness influences symptoms.
METHODS:A dyadic design was used, with partners from 86 couples filling a self-report questionnaire at cardiac rehabilitation admission. FINDINGS:Results from path analysis showed that patient activation was higher when the partner's illness perception was less pessimistic, when the partner was less overprotective, and the couple was more able to cope together. Also, patient activation was higher the better the patient's relationship with the medical staff and the less the partner reported to have a good relationship with the patient's doctor. No associations were found between patient activation and partner's hostility, partner support to patient activation, and dyadic stress appraisal. Finally, no associations were found between patient activation and clarity of information received at intake. DISCUSSION:Research and interventions should take advantage of dyadic and team-based approaches to better understand relational drivers of patient activation and effectively leverage their different roles.
OBJECTIVE:Informing individuals about the nocebo effect, termed nocebo education, can minimise the experience of side effects. One untested possibility is that nocebo education promotes behaviour change, such that it decreases the likelihood one actively gathers treatment side-effect information. Decreasing the acquisition of side-effect information should reduce awareness of potential side effects, a key cause of nocebo effects. METHODS:Three pre-registered online experiments with diverse community samples tested the hypothesis that nocebo education reduces the behavioural pursuit of side-effect information. In each study, participants were randomised to watch either a nocebo education video or a control video. Following this between-subjects manipulation, participants in Studies 1 (N = 181) and 2 (N = 183) were informed about a specific treatment and then given the opportunity to select among treatment-relevant information to read. In Study 3 (N = 185), participants self-generated two questions they wanted to ask about the treatment. RESULTS:In all three experiments, nocebo education reduced behaviours associated with acquiring treatment side-effect information. Two of the three studies found evidence that the effect of nocebo education was statistically mediated by the self-reported desire to avoid side-effect information. Finally, receiving nocebo education did not reduce satisfaction with the acquired treatment information, did not increase side-effect expectations, and did not increase treatment anxiety. CONCLUSIONS:Nocebo education deters the pursuit of additional side-effect information, which could be a novel and useful approach for avoiding adverse nocebo effects.
OBJECTIVE:The objective of this study was to understand symptom experiences, illness narratives, and help-seeking behaviours in women living with systemic symptoms associated with their breast implants (SSBI) and seeking explant surgery. METHODS AND MEASURES:Patients for this study were recruited from a larger prospective comparative study on SSBI over a 3-year period. Semi-structured qualitative interviews using an adapted version of the McGill Illness Narrative Interview method were undertaken with Australian women seeking explant surgery. An inductive reflexive thematic approach was used to analyse the data and produce a chronology of the phases women go through in their journey with SSBI. RESULTS:Twenty-four interviews were conducted online, generating seven themes: 1) Making (constrained) choices around breast implants, 2) Being subjected to clinical authority, 3) Bearing the symptoms alone, 4) A lone quest for information and support - searching for a causative agent, 5) Explant surgery as an imperfect solution, 6) A recovery of agency through social connections, and 7) Agitating for change. CONCLUSION:Our study highlighted that women living with SSBI undergo a physical and psychological journey with barriers to accessing appropriate care, help and support. Better psychological and clinical support for women making the decision to have breast implants, from implantation through to explantation and recovery is required.
BACKGROUND:Many one-month alcohol-free challenges (AFCs) have been established to encourage and support lower alcohol intake. Completion of AFCs is known to be influenced by characteristics of individuals. This study explored the relative importance of individual characteristics compared to use of support provided by the AFC, and social factors including interactions with drinkers. METHODS:We conducted a prospective study with a one-month follow-up. The link to the online survey was sent to people who registered for 'the Dry January® challenge'. Baseline data were provided by 634 adults, of whom 410 (65%) completed the follow-up. The follow-up questionnaire assessed completion and collected qualitative data on suggested improvements to support for participants. RESULTS:In multivariate analysis, completing the AFC was predicted by: greater drink refusal self-efficacy; planning to stop drinking after the AFC; not living with other drinkers; and doing the AFC with others. In qualitative analysis, many suggestions for improving support for participants focused on the social impacts of AFC participation. DISCUSSION:A novel contribution made by this study was identifying the importance of the social contexts in which individuals undertake AFCs. Organisers of AFCs should be aware of the influence of both individual and social factors, and tailor support accordingly.
OBJECTIVE:Since 2008, routine psychosocial assessment of young people with chronic conditions has been recommended in Australia. However, routine psychosocial screening across Australian health settings remains varied. This study examined clinicians' perceptions about the use of the 'Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicidal Ideation and Safety' (HEEADSSS) and digital e-HEEADSSS. METHODS AND MEASURES:Nine clinicians from an adolescent and young adult hospital clinic were interviewed. Participants met the inclusion criteria of not previously using e-HEEADSSS. Deductive coding guided by the Consolidated Framework for Implementation Research 2.0 was employed. RESULTS:Participants reported that the HEEADSSS may be favourable to the e-HEEADSSS due to rapport-building. The e-HEEADSSS was perceived to be advantageous due to timesaving and a potential increase in disclosure of sensitive or embarrassing information from youth. Concerns for the e-HEEADSSS included assessment frequency and appropriate timely escalation. Participants suggested that services should introduce the e-HEEADSSS so clinicians could choose whether to use the traditional or digital psychosocial assessment, which may allow for increased uptake and service-appropriate screening of youth. CONCLUSION:Participants who had not used the e-HEEADSSS recognised potential benefits for increasing the proportion of young people with chronic conditions to complete a psychosocial assessment screening during clinic visits.
OBJECTIVE:Financial incentive programs for COVID-19 vaccination were widely implemented, with limited success. This study examines how the provision of a financial incentive affects people's perceptions of and attitudes towards COVID-19 booster vaccines and incentive programs. METHODS AND MEASURES:We conducted two cross-sectional studies in the U.S. via Prolific in April 2023 (N = 353) and May 2024 (N = 431). In each, participants were randomised to view a hypothetical incentive (posters with $100 incentive) or no-incentive (posters only) campaign and completed measures assessing perceptions of the COVID-19 vaccine and the incentive. RESULTS:Across both studies, response efficacy for, risks of, and positive attitude towards vaccination did not vary by incentive condition, but norms for COVID-19 vaccines and for accepting an incentive were higher in the incentive condition. The perceived value of $100 was higher when framed as an incentive. Serious prior experience with COVID-19 emerged as a significant moderator of the effect of the incentive manipulation on people's perceptions, but only in Study 1. CONCLUSION:Findings suggest financial incentives may influence people's perceptions of social norms for accepting a vaccination and an incentive. Future research is needed to specify whether these constructs mediate the effect of financial incentives on behaviour.
OBJECTIVE:Mindfulness meditation apps are associated with significant health benefits, yet many new app subscribers have low engagement and are unlikely to attain these benefits.This study examined the user characteristics that predict meditation app usage during the first eight weeks after subscribing. METHODS & MEASURES:New meditation app subscribers (N = 304) completed a baseline survey which measured demographics, personality traits, intrinsic motivation for meditation, and symptoms of stress, anxiety, and depression, and objective app usage data were collected over eight weeks. Negative binomial, logistic, and ordinary least squares linear regression models assessed associations between user characteristics and five different outcomes 1) days with any session, 2) average min/day of any session, 3) completing any meditation session, 4) days with any meditation sessions, and 5) average min/day of meditation. RESULTS:Strong intrinsic motivation was associated with greater odds of completing any meditation session (OR = 3.63, p < .01), more days with meditation sessions (IRR = 1.75, p < .01), and greater average min/day of meditation (B = 0.32, p < .01). The effort and pressure subdomains of intrinsic motivation were also significant predictors of app usage. Men had more meditation days (IRR = 2.13, p < .01) than women, and a mental health diagnosis was associated with longer daily meditation durations (B = 0.41, p = .038). CONCLUSION:Intrinsic motivation is an important mechanism for maintaining an app-based meditation practice, along with gender and chronic health diagnoses. App developers and researchers should consider tailoring content or providing additional support to users based on these characteristics.
