Implementation intentions (if-then plans) are an evidence-based behavior change strategy designed to translate behavioral intentions into habits [1]. Despite extensive evidence of its potential utility, this behavior change strategy is underutilized and under-researched in high-need healthcare contexts within the United States (U.S.) which face high rates of chronic conditions and barriers to care such as rurality, lack of resources, and cognitive strain from mental health and neurological conditions [2,3]. Implementation intentions have demonstrated efficacy in promoting many health behaviors proven to mitigate chronic conditions, namely physical activity, healthy diet, and substance use reduction [4-6]. In addition, the accessible, adaptable, and self-driven nature of implementation intentions allow the technique to meet many of the individual and system-level priorities of these high-need care contexts. By being patient-driven, proactive, and personalized, implementation intentions can help these patients cultivate healthy habits as part of their everyday lives. At the systems-level, implementation intentions' inexpensiveness, scalability, and compatibility with telemedicine platforms allow them to be integrated easily into existing healthcare system infrastructure [7,8]. This review describes these concepts in detail, and uses the Veterans Affairs (VA) healthcare system as an exemplar to provide concrete examples of how and where implementation intentions could be integrated in a healthcare system, within some existing programs, to benefit both the system and individual patients.

BACKGROUND:Self-control is generally defined as the capacity to override impulses and is a robust predictor of health behaviors. This paper integrates trait, reasoned action, and habit approaches to develop and test a mechanistic account of how self-control influences health actions.PURPOSE:We tested five potential pathways from self-control to behavior, termed the valuation, prioritization, habituation, translation, and inhibition routes.METHODS:At baseline, participants (N = 663 adults) completed survey measures of reasoned action approach variables and habits in relation to eight health behaviors and the Brief Self-Control Scale. Three months later, participants reported their behavior. Multi-level modeling was used to test pathways across behaviors.RESULTS:Supporting the valuation route, affective attitude, cognitive attitude, descriptive norms, and perceived behavioral control mediated the self-control-intention relation, and intentions and perceived behavioral control mediated the relationship between self-control and health behaviors. Self-control also predicted the priority accorded to different considerations during intention formation. Higher self-control was associated with stronger prediction by cognitive attitudes and perceived behavioral control and weaker prediction by habits and injunctive norms. Self-control predicted habit formation, and habits mediated the self-control-behavior relation. Finally, self-control was associated with the improved translation of intentions into health behaviors and with greater inhibition of affective and habitual influences. Findings for the different pathways were not moderated by whether approach (health-protective behaviors) or avoidance responses (health-risk behaviors) were at issue.CONCLUSIONS:The present research offers new insights into why self-control promotes health behavior performance, and how deficits in self-control might be offset in future behavior-change interventions.

BACKGROUND/PURPOSE:We address four questions about interventions to promote physical activity in cancer survivors: (a) How often is both the adoption and maintenance of behavior change tested in trials? (b) How often do interventions generate adoption-plus-maintenance of behavior change? (c) Are intervention strategies specifically geared at promoting maintenance of behavior change deployed in trials? and (d) Which intervention strategies distinguish trials that promote both the adoption and maintenance of physical activity from trials that promote adoption-only or generate no behavioral changes?METHODS:Computerized literature searches identified 206 reports of randomized trials that measured physical activity in the wake of the intervention.RESULTS:Only 51 reports (24%) measured both behavioral adoption (postintervention) and behavioral maintenance (≥3 months follow-up). The 51 reports included 58 tests of interventions; 22% of tests observed both adoption and maintenance of physical activity, 26% reported adoption-only, and 52% found no change in behavior. Change techniques designed to promote behavioral maintenance were used much less frequently than adoption techniques or adoption and maintenance techniques. Interventions that aimed to improve quality of life, used supervised exercise sessions, were undertaken in community centers, and deployed fewer behavior change techniques were associated with adoption-plus-maintenance of physical activity in cancer survivors.CONCLUSIONS:The present findings offer new insights into the adoption and maintenance of physical activity and highlight the need to routinely assess these forms of behavior change in future trials. More extensive testing of intervention strategies specifically geared at maintenance of behavior change is warranted.

OBJECTIVE:The effectiveness of physical activity interventions is typically evaluated using null hypothesis significance testing or conventional interpretations of effect size (i.e., "small," "medium," or "large"). As these criteria have recently attracted criticism, we conducted a quantitative integration of meta-analyses (a metasynthesis) in order to provide precise, numerical estimates of intervention effectiveness. The research aimed to specify the percentile distribution of effect sizes in meta-analyses of physical activity trials, and their corresponding values for different types of activity (i.e., steps per day, minutes of moderate/vigorous physical activity [MVPA], meeting World Health Organization (WHO) physical activity guidelines).METHOD:Computerized searches identified 104 meta-analyses incorporating findings from 2,762 trials that met the inclusion criteria for the metasynthesis.RESULTS:The median effect size across all meta-analyses was d+ = .21, equivalent to an increase of 1,320 steps per day, 15.6 additional minutes of daily MVPA, and a 4.3% increase in the proportion of participants meeting WHO guidelines. Separate percentile distributions were computed for different samples (e.g., children, older adults, cancer survivors), measures of physical activity (i.e., objective vs. self-report), settings (e.g., schools, workplace), and follow-up periods (3+, 6+, and 12+ months).CONCLUSIONS:Conventional interpretations of effect size gravely misrepresent the effectiveness of interventions to promote physical activity. The percentile values for effect sizes, steps per days, minutes of MVPA, and percentage meeting guidelines reported here can be used to benchmark the effectiveness of future trials and should enable more informed judgments about trade-offs between effectiveness and considerations such as reach, burden, and cost. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

OBJECTIVE Despite abundant observational and experimental tests, it is not yet clear whether enhancing autonomous motivation or perceived competence leads to health behavior change. We identified interventions that aimed to change these constructs and quantified the magnitude of changes in behavior observed when interventions generated increases in autonomous motivation, perceived competence, or both. METHOD Computerized searches and additional strategies identified 67 articles that yielded 135 effect sizes relevant to our research questions. Random effects meta-analyses were conducted via STATA. RESULTS Interventions increased autonomous motivation and perceived competence in 31% and 38% of tests, respectively. Increasing autonomous motivation led to a medium change in health behaviors (d+ = .47, 95% CI [.44, .83]) and increasing perceived competence generated a small-to-medium change (d+ = .34, 95% CI [.22, .47]). Interventions that failed to generate significant improvements in autonomous motivation and perceived competence had much smaller effects on behavior change (d+ = .13 and .10, respectively). There was little evidence of synergistic effects. Changing both autonomous motivation and perceived competence (d+ = .42) did not lead to a larger effect on behavior compared with changing autonomous motivation on its own (d+ = .61), but had a larger effect compared with changing perceived competence on its own (d+ = .21). CONCLUSION The present review suggests that autonomous motivation and perceived competence are valid targets for interventions to promote health behavior change but also indicates that research is warranted to ensure that interventions more effectively engage these targets. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: Skin cancer is the most frequently diagnosed cancer and rates are increasing because of global warming. This article reports a meta-analysis of randomized controlled trials of behavioral interventions to reduce exposure to ultraviolet radiation (UVR). The review aimed to (a) quantify the magnitude of intervention effects on indoor tanning, sun exposure, and sunscreen use, and (b) determine which intervention strategies maximize behavior change. Method: Out of 17,437 records identified via literature searches, 190 independent tests (N = 89,365) met the inclusion criteria. Sample, intervention, and methodological characteristics, and change techniques were coded, and random effects meta-analyses and metaregressions were conducted. Results: The sample-weighted average effect size across all studies was d+ = .193 (95% confidence interval, CI [.161, .226]), and there were significant effects on indoor tanning, sun exposure, and sunscreen use (d+ = .080, .149, and .196, respectively). However, there was evidence of publication bias, and trim and fill analyses indicated that the corrected effects for sun exposure and sunscreen use were of very small magnitude (d+ ~ .06) and were not significantly different from zero for indoor tanning (d+ = -.011, 95% CI [-.096, .074]). Metaregression analyses identified several intervention strategies that predicted effect sizes. For instance, interventions delivered individually that promoted alternatives to tanning were associated with larger effect sizes for indoor tanning. Conclusion: Interventions to date have had only a modest impact on behavioral exposure to UVR. The present findings offer new insights into how the effectiveness of future interventions can be improved. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective: We conducted a meta-analysis of randomized controlled trials (RCTs) to promote health behavior change based on self-determination theory (SDT). The review aimed to (a) quantify the impact of SDT interventions on health behaviors, (b) test mediation by theoretically specified variables (autonomous motivation and perceived competence), and (c) identify moderators of intervention effectiveness. Method: Computerized searches and additional strategies identified 56 articles that yielded 65 independent tests of SDT interventions. Random effects meta-analysis and metaregressions were conducted via STATA; meta-analytic structural equation modeling (MASEM) was used to test mediation. Results: The sample-weighted average effect size for SDT interventions was d(+) = .23, and there were significant effects for physical activity, sedentary behavior, diet, alcohol consumption, and smoking cessation (.16 > d(+) > .29). Effect sizes exhibited both publication bias and small sample bias but remained significantly different from zero, albeit of smaller magnitude, after correction for bias (d(+) >= .15). MASEM indicated that autonomous motivation and perceived competence mediated intervention effects on behavior. Metaregression analyses indicated that features of the sample, intervention, or methodology generally did not moderate effect sizes. Conclusion: The present review indicates that SDT interventions have a significant but small effect on health behavior change and suggests several directions for future research.

OBJECTIVE:We conducted a meta-analysis of randomized controlled trials designed to promote smoking cessation among cancer survivors to (a) assess how effective interventions are at increasing quit rates, and (b) determine which intervention strategies are associated with effect sizes.METHODS:Out of 10,848 records that were located using computerized searches and informal sources, 21 interventions met the inclusion criteria for the review. We developed a bespoke taxonomy of 36 categories of techniques designed to change smoking behavior, and coded sample, intervention, and methodological characteristics. Random effects meta-analysis and metaregressions were conducted.RESULTS:The sample-weighted average effect size for smoking cessation was d+ = .030, and was not significantly different from zero (95%CI = -.042 to .101). Effect sizes exhibited both publication bias and small sample bias. Metaregressions indicated that, out of the many potential moderators that were tested, just a single intervention feature was associated with effect sizes. Interventions delivered solely by nurses exhibited larger effects compared to interventions from other sources.CONCLUSION:The present review indicates that current smoking cessation interventions for cancer survivors are ineffective. High-quality and effective interventions are needed. We offer suggestions regarding promising intervention strategies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

OBJECTIVE:We conducted a meta-analysis of physical activity interventions among cancer survivors to (a) quantify the magnitude of intervention effects on physical activity and (b) determine what combination of intervention strategies maximizes behavior change.METHOD:Out of 32,626 records that were located using computerized searches, 138 independent tests (N = 13,050) met the inclusion criteria for the review. We developed a bespoke taxonomy of 34 categories of techniques designed to promote psychological change, and categorized sample, intervention, and methodological characteristics. Random effects meta-analysis and metaregressions were conducted; effect size data were also submitted to meta-analysis with classification and regression trees (i.e., meta-CART).RESULTS:The sample-weighted average effect size for physical activity interventions was d+ = .35, equivalent to an increase of 1,149 steps per day. Effect sizes exhibited both publication bias and small sample bias but remained significantly different from zero, albeit of smaller magnitude (d+ ≥ .20), after correction for bias. Meta-CART indicated that the major difference in effectiveness was attributable to supervised versus unsupervised programs (d+ = .49 vs. .26). Greater contact time was associated with larger effects in supervised programs. For unsupervised programs, establishing outcome expectations, greater contact time, and targeting overweight or sedentary participants each predicted greater program effectiveness, whereas prompting barrier identification and providing workbooks were associated with smaller effect sizes.CONCLUSION:The present review indicates that interventions have a small but significant effect on physical activity among cancer survivors and offers insights into how the effectiveness of future interventions might be improved. (PsycINFO Database Record (c) 2019 APA, all rights reserved).