BACKGROUND AND AIMS:Adopting and maintaining a healthy lifestyle-characterized by nutritious dietary patterns and regular physical activity-remains a persistent challenge for many individuals. Social support has been identified as a critical facilitator of successful lifestyle modification and long-term adherence. This study reports 6-month follow-up findings from 980 healthy adults (396 men, 584 women; median age: 43 years) residing in Italy, Spain, and Greece who participated in the Credits4Health (C4H) multicenter randomized controlled trial. We investigated whether social support and social integration moderated the efficacy of a digital health intervention designed to promote physical activity and Mediterranean diet adherence. Participants were randomized to either a dynamic platform (experimental arm: goal-setting, tailored recommendations, personalized pathways, and real-time feedback) or a static platform (control arm: general information and self-monitoring without personalization). METHODS:We employed mixed-effects ordinal and linear regression models to examine the effect of platform assignment (dynamic vs. static) on physical activity levels and Mediterranean Diet Adherence Screener (MEDAS) scores, stratified by social support and social integration subcategories. Likelihood ratio tests were conducted to assess potential interactions between social support/integration variables and platform assignment by comparing models with and without interaction terms. RESULTS:Analysis of data from 980 participants revealed no significant moderating effects of any social support or social integration subcategories on intervention efficacy for either physical activity promotion or Mediterranean diet adherence. CONCLUSION:This study found no evidence that social support or social integration moderate the efficacy of digital interventions targeting physical activity and adherence to Mediterranean diet. These null findings may reflect the study's 6-month duration or participation characteristics. Future investigations employing longer follow-up periods, enhanced participant engagement strategies, and more granular assessment of social support dimensions are warranted to better understand how social factors may influence the efficacy of digital health interventions, particularly as such technologies become increasingly prevalent in public health promotion.

The Health Action Process Approach (HAPA) is a prominent social-cognition model of health behaviour change, but its efficacy across diverse domains and populations requires systematic evaluation. This systematic review and meta-analysis evaluated the overall efficacy of HAPA-based interventions and examined potential moderators. Eligible studies were randomized controlled trials that explicitly nominated the HAPA as an intervention basis and assessed at least one health behavior outcome. Five electronic databases were searched from inception to February 2025, identifying 74 randomised controlled trials (197 effect sizes) comprising 9,115 intervention and 8,858 control participants. A random-effects multilevel meta-analysis revealed a significant overall post-intervention effect on health behaviours (d = 0.459). Significant effects emerged for physical activity (d = 0.504), fruit and vegetable consumption (d = 0.636), and other dietary behaviours (d = 0.776). Subgroup analyses identified several key moderators: interventions targeting approach behaviours yielded significant effects (d = 0.497), whereas those targeting avoidance behaviours were non-significant. Dual-phase interventions targeting both motivational and volitional constructs (d = 0.532) outperformed volitional-only (d = 0.350) or motivational-only (d = 0.289) designs. Furthermore, larger effect sizes were observed for interventions using inactive control groups (d = 0.543), delivered to clinical populations (d = 0.559), employing hybrid delivery modes (d = 0.672), and lasting 12-24 weeks (d = 0.619). These findings demonstrate that HAPA-based interventions are effective, particularly when utilising dual-phase, hybrid, and longer-term designs for clinical groups. Future research should focus on optimising intervention design and elucidating mechanisms underlying sustained behaviour change.

Objective: Individuals experiencing higher stress levels tend to consume fewer fruits and vegetables compared to their less stressed counterparts. Thus, to promote fruit and vegetable (FV) consumption, action planning has been proven effective in translating behavioral intentions into actual dietary behaviors. This study aims to evaluate a 7-day intervention designed to improve FV planning and intake, while also examining the role of stress. Methods: The trial employed a 3 (time: pretest, post-test, and follow-up) * 2 (group: intervention vs. control) between-participant factorial design. A total of 99 young Chinese adults (age = 23.84 years 4.63, 26 men) who had formed an explicit intention to consume more fruit and vegetables, participated in a 7-day online randomized controlled trial. Results: The intervention successfully enhanced FV planning as well as FV intake. Furthermore, a moderated mediation model revealed that FV planning mediated the relationship between experimental conditions and FV intake, with stress moderating this mediation. Specifically, planning facilitated FV intake for individuals with low stress levels, while this effect was not observed for those with high stress levels. Conclusion: These findings confirm the positive impact of the planning intervention on improving FV intake, particularly for individuals with low stress levels, and highlight stress as a barrier to health behavior change that warrants further attention in future studies. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Background The rising burden of disease associated with mental disorders calls for evidence-based psychological interventions that can be swiftly scaled up. Blending smartphone-based mental health apps (MHapps) for delivering ecological momentary interventions (EMIs) with traditional in-person interventions may have the benefits of improving treatment adherence, facilitating the application of learned techniques into everyday life, and, in turn, enhancing clinical response. However, previous work has shown that most existing MHapps were developed for specific research studies or for profit, thereby making them difficult to adapt, particularly in time-limited and resource-constrained settings. Objective This study aimed to demonstrate how a person-centered and theory-informed MHapp could be developed in a timely and low-cost manner for use as part of blended care, using a phased approach. Given the scarcity of digital mental health interventions for older adults, we adopted a participatory research approach to co-design the blended intervention with 2 groups of older adults. Methods In Phase 1, we reviewed existing MHapps with consideration of whether they could be adapted by individual researchers or clinicians, their key functions, and whether their efficacy had been tested. “No-code” app builders were additionally reviewed, which may be alternatives if no MHapp can be used. In Phase 2, following the IDEAS (Integrate, Design, Assess, and Share) framework, we built a prototype according to users’ needs, with its content informed by theories of cognitive behavioral therapy (CBT) and the Health Action Process Approach. The prototype was then tested and refined over 2 rounds of 3-session co-design workshops with peer supporters (n=8) and service users (n=5) from a stepped-care intervention for older adults with depressive symptoms. Usability testing was conducted with both stakeholder groups in Phase 3. Results Of the 149 MHapps identified, only 43 (28.9%) can be publicly downloaded. Four (8.3%) of them can be partially adapted, although no new content can be directly added. We therefore developed the MHapp using m-Path (a spin-off from KU Leuven's Faculty of Psychology), which was the only existing no-code app development platform designed for mental health interventions. A prototype incorporating CBT-based homework and behavior change techniques informed by the Health Action Process Approach was built, with its refined version rated as highly easy to use and acceptable by both stakeholder groups. Conclusions By integrating CBT with EMI, we demonstrated the feasibility and acceptability of a novel blended care model for reference in future work. Preliminary findings suggest high usability and clinical relevance, highlighting the potential of leveraging no-code platforms to facilitate scalable, theory-driven interventions that extend mental health support beyond traditional settings. Grounding the blended intervention in evidence-based psychological and health behavior change theories, coupled with user involvement throughout the design process, may improve clinical efficacy and reduce implementation barriers, which are areas for further investigation in future work.

Self-Efficacy and Health Lisa Marie Warner, Health Psychology, Freie Universität Berlin, Berlin, GermanySearch for more papers by this authorRalf Schwarzer, Health Psychology, Freie Universität Berlin, Berlin, Germany Health Psychology, Australian Catholic University, Melbourne, Victoria, AustraliaSearch for more papers by this author Lisa Marie Warner, Health Psychology, Freie Universität Berlin, Berlin, GermanySearch for more papers by this authorRalf Schwarzer, Health Psychology, Freie Universität Berlin, Berlin, Germany Health Psychology, Australian Catholic University, Melbourne, Victoria, AustraliaSearch for more papers by this author Book Editor(s):Kate Sweeny, Search for more papers by this authorMegan L. Robbins, Search for more papers by this authorLee M. Cohen, Search for more papers by this author First published: 02 September 2020 https://doi.org/10.1002/9781119057840.ch111 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Summary Perceived self-efficacy is the sense of control over novel or difficult situations or challenges by means of one's own competent behavior. Highly self-efficacious individuals choose more ambitious goals, put more effort into attaining them, and feel more capable. Self-efficacy beliefs hence affect people's feelings, thoughts, and actions. Therefore, the construct of self-efficacy has become an indispensable part of most theories of health behavior change. This chapter describes how self-efficacy beliefs can be distinguished from related constructs, explains the role of a positive attributional style, and gives examples for the measurement of self-efficacy. The associations of self-efficacy beliefs with health behaviors and health outcomes as well as techniques how to increase self-efficacy in psychological interventions are highlighted with several research examples. The Wiley Encyclopedia of Health Psychology RelatedInformation

OBJECTIVE:A health action process approach (HAPA)-based intervention was designed to support moderate-to-vigorous physical activity (MVPA) in individuals with osteoarthritis of the knee (OAK). In secondary analyses of the randomized controlled trial "preventing the impairment of primary osteoarthritis by high-impact long-term physical exercise regimen-psychological adherence program," we examined long-term effects of the intervention on HAPA determinants and MVPA, and explored the former as mediators of change. METHOD:N = 241 individuals with OAK (63% women, aged 44-80 years) were randomly assigned to the 12-month intervention condition (IC) or active control condition (CC). Between 2016 and 2020, self-reported HAPA determinants (action and coping planning, maintenance and recovery self-efficacy, action control) and collaborative planning were assessed at 0, 6, 12, 18, and 24 months, accelerometer-assessed MVPA at 0, 12, and 24 months. Multilevel and manifest path models were fit. RESULTS:Compared to the CC, action planning was higher in the IC at 6, 12, and 24 months. Maintenance and recovery self-efficacy were stable in the IC but decreased in the CC. MVPA decreased in both conditions. More action planning in the IC at 12 months was related to higher MVPA at 24 months, but, as in all other models, the indirect effect was nonsignificant. CONCLUSIONS:The intervention partly stabilized or enhanced HAPA determinants but did not increase MVPA in a Western, highly-educated sample with OAK. Future work might use blended-care approaches enriched by mobile applications for continuous MVPA support. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Within the transactional framework of stress, resilience may be conceptualized as a dynamic process wherein individuals, when confronted with adversity, utilize both internal and external coping resources. This article focuses on two resources, namely self-efficacy and social support, examining their roles in the context of war, terrorism, and forced migration. These resources are perceived as protective factors capable of mitigating the impact of adversity and aiding in the recovery from traumatic experiences. They facilitate individuals in reshaping their perspectives and engaging in cognitive restructuring as integral components of the coping process, ultimately leading to a rebound from adversity or even the development of higher levels of functioning post trauma.When scrutinizing the trajectories of coping resources over time, distinct mechanisms may come to the fore. A causation model posits a positive effect of resources on recovery outcomes, while an erosion model elucidates the wear and tear that ongoing adversity may inflict upon these resources.In exploring the interplay between self-efficacy and social support within the resilience process, diverse mechanisms may emerge. These include the enabling effect, where support enhances self-efficacy, and the cultivation effect, wherein self-efficacy contributes to the development of robust social networks.

Fear of falling might result in overprotection by one's social environment. In turn, feeling dependent could increase fear of falling. However, the association between fear of falling and perceived overprotection and its temporal order is unknown. This longitudinal study explores this potential mutual longitudinal association. This study presents secondary analyses from a larger trial. We tested the association between fear of falling and perceived overprotection in a cross-lagged path model controlled for falls, health-related quality of life, age, gender, and trial condition. N = 310 participants (M = 70 years, range: 64-92) completed self-reports at Time 1, 7 (Time 2), and 11 weeks (Time 3) after baseline assessment. We found a positive association from fear of falling to perceived overprotection (β = .12, 95% CI[0.02, 0.21], p = .02; β = .10; [0.01, 0.18], p = .03). The reversed cross-lagged paths were not significant. Findings suggest higher fear of falling translates into perceived overprotection, which may in turn increase loss of independence in old age.

Background This primary analysis evaluated the “PREVenting the impairment of primary Osteoarthritis by high-impact long-term Physical exercise regimen—Psychological Adherence Program” (PrevOP-PAP), designed to support patients with osteoarthritis of the knee (OAK) to engage in regular moderate-to-vigorous physical activity (MVPA) to reduce OAK symptoms (WOMAC scores). Theory-based on the health action process approach (HAPA), the intervention targeted volitional precursors of MVPA change: action and coping planning, maintenance and recovery self-efficacy, action control, and social network formation. We hypothesized that compared to an active control condition, increases in MVPA at the end of the 12-month intervention would translate into lower WOMAC scores at 24 months in the intervention condition. Methods Participants with radiographically verified moderate OAK ( N = 241; 62.66% female; M(SD) = 65.60(7.61) years) were randomly assigned to the intervention (51%) or the active control condition. WOMAC scores (24 months) were the primary -, accelerometer-assessed MVPA (12 months) the key secondary outcomes. The PrevOP-PAP was a 12-month intervention with computer-assisted face-to-face and phone-based sessions designed to increase HAPA-proposed volitional precursors of MVPA change (up to 24 months; secondary outcomes). Intent-to-treat analyses included multiple regression and manifest path models. Results MVPA (12 months) did not mediate effects of the PrevOP-PAP on WOMAC scores (24 months). Compared to the active control condition, WOMAC scores (24 months) were lower in the intervention condition, but this effect did not remain stable in sensitivity analyses ( b ( SE ) = -8.41(4.66), 95%-CI [-17.53; 0.71]). However, exploratory analyses revealed significantly stronger reductions in WOMAC-pain (24 months) in the intervention condition ( b ( SE ) = -2.99(1.18), 95%-CI [-5.36; -0.63]). Groups did not differ in MVPA at 12 months ( b ( SE ) = -3.78(3.42), 95%-CI [-10.80; 2.58]). Of the proposed precursors of MVPA change, action planning was higher in the intervention than in the control condition (24 months; b ( SE ) = 0.64(0.26), 95%-CI [0.14; 1.15]). Conclusions Compared to an active control condition, the PrevOP-PAP did not produce reliable effects on WOMAC scores and none on preceding MVPA. Of the HAPA-proposed volitional precursors, only action planning was sustainably increased. Future interventions should use m-health applications to digitally support long-term changes in proposed volitional precursors of MVPA change. Trial registration German Clinical Trials Register; https://drks.de/search/de/trial/DRKS00009677 ; also available at http://apps.who.int/trialsearch/ ; registration number: DRKS00009677; date of registration: 26/01/2016.

OBJECTIVE:Some employees tend to eat less healthy food when under work stress, while others tend to maintain a healthy diet. The factors underlying these different dietary choices are not yet clear. Individual differences in people's reactions to environmental stress may help explain this phenomenon. This study proposed a Gene × Stress interaction model of dietary choice, suggesting that different dietary choices under stress may be related to DRD2 genes, which moderate the reward circuitry and have been associated with habitual use of alcohol, obesity, and eating behaviors. METHOD:12,269 employees completed genotyping of their saliva samples and questionnaires on work stress, healthy dietary intentions, and healthy dietary behaviors. Nonlinear multiple regressions were used to test the hypothesized interaction of DRD2 genes and work stress on healthy dietary intentions and healthy dietary behaviors. RESULTS:Individuals with higher work stress reported lower healthy dietary intentions, whereas healthy dietary behaviors exhibited an inverted U shape. DRD2 genes significantly moderated this relationship, and the above relationship was only detected among C allele carriers, whereas for the AA genotype, work stress was not associated with healthy dietary intentions or behaviors. CONCLUSIONS:Healthy dietary intentions and healthy dietary behaviors showed different patterns of association with work stress. The DRD2 genes helped explain the individual differences in dietary choice under work stress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

RATIONALE:The associations between the number of COVID-19 cases/deaths and subsequent uptake of protective behaviors may reflect cognitive and behavioral responses to threat-relevant information.OBJECTIVE:Applying protection motivation theory (PMT), this study explored whether the number of total COVID-19 cases/deaths and general anxiety were associated with cross-situational handwashing adherence and whether these associations were mediated by PMT-specific self-regulatory cognitions (threat appraisal: perceived vulnerability, perceived illness severity; coping appraisal: self-efficacy, response efficacy, response costs).METHOD:The study (#NCT04367337) was conducted in March-September 2020 among 1256 adults residing in 14 countries. Self-reports on baseline general anxiety levels, handwashing adherence across 12 situations, and PMT-related constructs were collected using an online survey at two points in time, four weeks apart. Values of COVID-19 cases and deaths were retrieved twice for each country (one week prior to the individual data collection).RESULTS:Across countries and time, levels of adherence to handwashing guidelines were high. Path analysis indicated that smaller numbers of COVID-19 cases/deaths (Time 0; T0) were related to stronger self-efficacy (T1), which in turn was associated with higher handwashing adherence (T3). Lower general anxiety (T1) was related to better adherence (T3), with this effect mediated by higher response efficacy (T1, T3) and lower response cost (T3). However, higher general anxiety (T1) was related to better adherence via higher illness severity (T1, T3). General anxiety was unrelated to COVID-19 indicators.CONCLUSIONS:We found a complex pattern of associations between the numbers of COVID-19 cases/deaths, general anxiety, PMT variables, and handwashing adherence at the early stages of the pandemic. Higher general anxiety may enable threat appraisal (perceived illness severity), but it may hinder coping appraisal (response efficacy and response costs). The indicators of the trajectory of the pandemic (i.e., the smaller number of COVID-19 cases) may be indirectly associated with higher handwashing adherence via stronger self-efficacy.

Technological innovations may have the potential to improve health behavior interventions at the workplace. Using a robot as a health communicator who interacts with target individuals may be sometimes superior to human change agents. Embedded in a health behavior theory that accounts for motivational and volitional processes, an innovative study has been designed to explore operating principles and intervention effects in the domains of dietary habits, tobacco consumption, physical inactivity, and stress and anxiety. A single-arm intervention with two assessment points in time, one month apart, has been conducted with 37 employees. They were confronted with a robot that delivered a supportive interaction with the study participants addressing one of the four behavioral domains. The intervention content was pre-tested and inspired by the health action process approach (HAPA). Self-report measures of all social-cognitive constructs such as self-efficacy, outcome expectancies, risk perception, behavioral intentions, and planning were applied. Pre-post comparisons confirmed the assumption of improved scores on motivational and volitional outcome variables. Moreover, mediation analyses underscored the pivotal role of behavioral intentions that translated motivational antecedents into volitional outcomes. The intervention study highlighted the innovative potential that robots may have when it comes to design theory-based health promotion strategies at the workplace. Moreover, results also confirmed basic assumptions of the health action process approach.

The present study aimed to adapt the Teacher Self-Efficacy Scale (TSES) developed by Schwarzer et al. (1999) into Italian and to test its validity and reliability. In a group of teachers ( N = 683; 83% female), the factor structure (Confirmatory Factor Analyses), construct validity (latent relations with burnout variables), measurement invariance and reliability (internal consistency) of the Italian version of TSES (TSES-Ita) were tested. Support for a one-factor solution for the TSES-Ita was found. The one-factor model was found to be factorially invariant across gender, teaching experience and teaching level. Moreover, the scale demonstrated good reliability (α = .88). As expected, TSES-Ita was negatively associated with emotional exhaustion and with depersonalization, and positively associated with personal accomplishment. Our results provide evidence that the Italian version of the TSES-Ita is reliable, valid, and thus, potentially useful for research on occupational stress and burnout in the teaching profession.

Research on the longitudinal relationship between posttraumatic stress disorder (PTSD) and social support among survivors of large-scale trauma is limited. This study assessed bidirectional relationships between PTSD and perceived social support in a large sample of the 9/11-exposed cohort over a 14-year follow-up. We used data from 23,165 World Trade Center Health Registry (WTCHR) enrollees who were exposed to the 9/11 attacks and participated in the first four WTCHR surveys (Wave 1 (2003–2004) to Wave 4 (2015–2016)). PTSD symptoms were measured using the 17-item PTSD Checklist. Perceived social support was measured using the five-item version of the Modified Social Support Survey. We used a cross-lagged panel analysis and found an inverse relationship between PTSD symptoms and social support. PTSD at Wave 2 (W2) predicted less social support at Wave 3 (W3) (β = −0.10, p < 0.01), and PTSD at W3 predicted less social support at W4 (β = −0.05, p < 0.01). Conversely, social support at W3 buffered PTSD symptoms at W4 (β = −0.03, p < 0.05). Sub-analyses by types of perceived social support suggest greater effects of PTSD on emotional support than tangible support and in community members than rescue/recovery workers. Our findings suggest a bidirectional effect between PTSD symptoms and social support in a longitudinal study of 9/11-exposed populations.

This brief commentary addresses three points. First, social-cognitive theories are often misunderstood as being purely cognitive, ignoring affective factors in the health behavior change process. It is argued that, at the phenomenal level, the involved psychological constructs are rather holistic, and that the separation of their cognitive and emotional components are artificial and emerge only as a result of the verbal assessment procedure. Second, health behavior change can be better understood by explicitly considering it as a process that may be subdivided into two or more phases such as motivation vs. volition or the adoption phase vs. the maintenance phase. Third, with such phases in mind, digital interventions may improve tailoring of treatment options to individual differences as they fluctuate during the health behavior change process, monitoring affective as well as cognitive responses and providing just-in-time feedback.

Abstract Background Patterns of protective health behaviors, such as handwashing and sanitizing during the COVID-19 pandemic, may be predicted by macro-level variables, such as regulations specified by public health policies. Health behavior patterns may also be predicted by micro-level variables, such as self-regulatory cognitions specified by health behavior models, including the Health Action Process Approach (HAPA). Purpose This study explored whether strictness of containment and health policies was related to handwashing adherence and whether such associations were mediated by HAPA-specified self-regulatory cognitions. Methods The study (NCT04367337) was conducted among 1,256 adults from Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Self-report data on cross-situational handwashing adherence were collected using an online survey at two time points, 4 weeks apart. Values of the index of strictness of containment and health policies, obtained from the Oxford COVID-19 Government Response Tracker database, were retrieved twice for each country (1 week prior to individual data collection). Results Across countries and time, levels of handwashing adherence and strictness of policies were high. Path analysis indicated that stricter containment and health policies were indirectly related to lower handwashing adherence via lower self-efficacy and self-monitoring. Less strict policies were indirectly related to higher handwashing adherence via higher self-efficacy and self-monitoring. Conclusions When policies are less strict, exposure to the SARS-CoV-2 virus might be higher, triggering more self-regulation and, consequently, more handwashing adherence. Very strict policies may need to be accompanied by enhanced information dissemination or psychosocial interventions to ensure appropriate levels of self-regulation.