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Abstract. Aim: The effects of a bystander intervention model (BIM)-informed intervention (video) for the general community on participant risk of suicide assessment ability (ROSAA) and protective intervention ability (PIA) were compared with an active control (non-BIM-informed video). Method: Video interventions with 628 participants ( Mage = 47.99, SDage = 17.34, range = 18–85 years) were conducted online. ROSAA and PIA were assessed immediately preintervention, postintervention, and at 2 months follow-up ( n = 126). Results: Linear mixed model analyses indicated that the experimental and control conditions improved on both outcome variables postintervention/Time 2 (T2); however, the former yielded better outcomes than the latter (moderate ESs in both variables). Follow-up/Time 3 (T3) experimental ROSAA scores were higher than Time 1 (T1) and lower than T2 scores. Follow-up experimental PIA scores were higher than T1 and lower than T2 scores. Follow-up control ROSAA scores were higher than those of T1 and similar to T2. Follow-up control PIA scores were similar to T1 and T2 scores. Limitations: Limitations of the study include: sample homogeneity, small n at follow-up, self-report data only (no observable behavior was tested), fair inter-rater reliability, and a brief follow-up time frame. Conclusion: Current community information increased ROSAA and PIA. A BIM-informed intervention significantly enhanced these effects, which seemed to wane somewhat over time with the effect being lower at follow-up compared with postintervention. The BIM should be explored further as a basis for community suicide prevention interventions.

Suicide is a global epidemic. This review assessed the scope and effectiveness of suicide prevention programs. Systematic literature searches were conducted using PsycINFO, ERIC and MEDLINE to retrieve articles published between January 2007 and March 2017 and fulfilled inclusion criteria (studies evaluating the efficacy of theory/model-informed suicide prevention programs in increasing participant knowledge or skills when presented with a peer at risk of suicide). The review is informed by PRISMA guidelines. Of 1398 studies identified, 25 were reviewed and most: targeted professionals; were 1-4-day workshops; were underpinned by 21 different theories; taught less detail to the community than professionals; and improved target outcomes. Current programs, although effective, are limited by their inaccessibility, narrow content for the community and substantial variability in theory base. Future suicide prevention programs will benefit from being informed by a more specific theory, delivered through technology, targeting more of the community and improving methodological rigour.

Abstract. Background: The public health sector has advocated for more innovative, technology-based, suicide prevention education for the community, to improve their ability to detect and respond to suicide risk. Emerging evidence suggests addressing the bystander effect through the Bystander Intervention Model (BIM) in education material may have potential for suicide prevention. Aims: The current study aimed to assess whether BIM-informed tools can lead to improved readiness, confidence and intent in the community to detect and respond to suicide risk in others. Method: A sample of 281 adults recruited from the community participated in a randomized controlled trial comprising a factsheet designed according to the BIM (intervention group) and a standard factsheet about suicide and mental health (control group). Participants' self-reported detecting and responding to suicide risk readiness, confidence, and intent when presented with a suicidal peer was tested pre- and postintervention and compared across time and between groups. Results: The intervention group had significantly higher levels of detecting and responding to suicide risk readiness, confidence, and intent than the control group at postintervention (all p < .001) with moderate-to-large effect sizes. Limitations: The study was limited by a homogenous sample, too low numbers at follow-up to report, and self-report data only. Conclusion: This study demonstrates BIM-informed suicide prevention training may enhance the community's intervention readiness, confidence, and intent better than current standard material. Further testing in this area is recommended. While results were statistically significant, clinical significance requires further exploration.

BACKGROUND: We examined the social cognition determinants of parental supervised toothbrushing guided by the health action process approach (HAPA). METHODS: In a prospective correlational survey study, participants (N = 185, 84.3% women) completed HAPA social cognition constructs at an initial time point (T1), and 12 weeks later (T2) self-reported on their parental supervised toothbrushing behaviour, toothbrushing habit, and action control. RESULTS: Structural equation models exhibited adequate fit with the data when past behaviour and habit were either excluded or included. Intention, self-efficacy, planning, and action control were predictors of parental supervised toothbrushing; intention predicted action planning and coping planning; and self-efficacy and attitude were predictors of intention. Indirect effects of social cognition constructs through intentions, and intentions through planning constructs were also observed. Inclusion of past behaviour and habit attenuated model effects. CONCLUSION: Results indicate that parental supervised toothbrushing is a function of motivational and volitional processes. This knowledge can be used to inform behaviour change interventions targeting parental supervised toothbrushing.

© 2022 Elsevier Ltd. 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.

Objectives: For most populations, implementation intentions (IIs) facilitate physical activity (PA). However, for older adults, previous studies found mixed evidence for the effectiveness of this behaviour change technique (BCT). To examine which characteristics of IIs predict successful enactment, the content of older participants’ IIs formed within a self-regulatory intervention to prompt PA was analysed. Design: A sample of N = 126 German speaking adults aged 64 and older formed up to six IIs for PA and reported their enactment five weeks later. Methods: Controlling for age and sex, multilevel models tested associations between characteristics of IIs (e.g., chronological rank of II, hetero- and homogeneity, specificity, presence of certain cues) and enactment. Results: Significantly related to enactment were: the chronological rank of an II (first IIs superior to last IIs), greater heterogeneity in activities, greater specificity of when-cues, and greater use of pre-existing routines. Conclusions: Participants were more likely to enact their IIs five weeks later if they planned different (heterogeneous) activities, created IIs with more specific when-cues (e.g., on Monday at 9 am), and in particular a routine (e.g., after breakfast). They also enacted the first three IIs (chronological rank of II) more often than the last three IIs. Future experimental studies should test whether providing instructions to create IIs based on the above significant characteristics lead to more effective health behaviour change among older adults.

Preserving Quality of Life (QoL) in old age gains in importance, but Fear of Falling (FoF) considerably limits QoL. The aim of our study was to understand how physical mediators may translate FoF to QoL. At Time 1, FoF, subjective leg strength, balance, QoL, and objective gait speed were assessed. QoL was reassessed after 6 months, at Time 2 ( n = 125). A sequential mediation analysis examined whether the relationship between FoF and QoL could be mediated by leg strength, balance, and gait speed. FoF was directly associated with QoL (β = −.27; 95% CI [−0.007, −0.001]) as well as indirectly via leg strength, balance, and gait speed (specific sequential indirect effect: β = −.03; 95% CI [−0.06, −0.001]; R2 = .40 in QoL; controlled for age, QoL at Time 1). An intervention approach could be to address FoF and foster physical functioning and gait speed to maintain QoL.

Objectives Behavioural intentions as well as action planning can facilitate the adoption and maintenance of physical activity under certain conditions. The present study examined levels of plan-specific self-efficacy and habit strength as possible conditions that may modify this relationship. Design As a secondary analysis of a larger randomized trial to improve physical activity, n = 225 recipients of a planning intervention were followed up at five measurement points over one year. Methods Two-level models were fit. Within-person levels, that is, fluctuations of intention and action planning around person means, were modelled to predict self-reported moderate-to-vigorous physical activity. Moreover, between-person, that is, average person, levels of self-efficacy and habit strength were specified as putative moderators of this relationship. Results The within-person intention-activity relationship was moderated by between-person levels of habit strength, yielding a compensatory effect: higher-than-usual intention predicted physical activity only when average activity habit levels were low. The within-person planning-activity relationship was moderated by between-person levels of self-efficacy, yielding a synergistic effect: higher-than-usual planning combined with high average self-efficacy resulted in highest physical activity levels. Conclusion Higher-than-usual intention may only be required in the presence of low activity habits. Moreover, high self-efficacy seems to be required to translate higher-than-usual action planning into augmented physical activity because self-efficacious individuals may invest more efforts to enact their plans.

© The Author(s) 2021. Published by Oxford University Press on behalf of the Society of Behavioral Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/ licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited., 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., The study was supported by grant number 2020/01/0/HS6/00059 from the National Science Centre, Poland, awarded to Aleksandra Luszczynska

Dietary quality and sustainability are central matters to the international community, emphasised by the burden of the COVID-19 pandemic. To promote healthier and more sustainable food-related practices, the protocol of a web-based intervention to enhance adults’ food literacy is presented. The FOODLIT-Trial is a two-arm, parallel, experimental, and single-blinded randomised controlled trial delivered over 11 weeks. Based on the Food Literacy Wheel framework and supported by the Health Action Process Approach (HAPA) and the Behaviour Change Techniques Taxonomy, weekly content with customised behaviour change techniques (experimental group) is hypothesised to be more effective to promote food behaviour change when compared to a single-time and non-customised delivery of food-related international guidelines, with no theoretically informed approaches (comparison group). Primary outcome is food literacy, including food-related knowledge, skills, and behaviours, assessed with the FOODLIT-Tool; a secondary outcome includes psychological mechanisms that efficaciously predict change in participants’ food literacy, measured with HAPA-driven items. Enlisted through online sources, participants will be assessed across five time points (baseline, post-intervention, and 3-, 6-, and 9-month follow-ups, i.e., T0–T4). A randomisation check will be conducted, analyses will follow an intention-to-treat approach, and linear two-level models within- (T0–T4) and between-level (nested in participants) will be computed, together with a longitudinal mediation analysis. If effective, the FOODLIT-Trial will provide for a multidimensional and cost-effective intervention to enable healthier and more sustainable food practices over the long term. Fundação para a Ciência e Tecnologia - FCT info:eu-repo/semantics/publishedVersion

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.

Facing multiple anthropogenic challenges and considering the current global pandemic, food sustainability is stated as threatened by major intergovernmental agencies. Given the heterogeneity of food systems, the need to enhance food-related behaviours by promoting the acquisition of knowledge and competencies, and the demand to involve stakeholder's diversity, this study aims to develop and validate an instrument that measures food literacy (FL), its determinants and its influential factors in an adult sample. Based on the Food Literacy Wheel (FLW) framework and integrated within the FOODLIT-PRO - Food Literacy Project, this study has three phases and a total of 2406 participants: (1) item development and content validity, (2) instrument development entailing item reduction strategies, factor extraction methodologies (exploratory and confirmatory analyses) and sensitivity testing, with two samples of a total of 1447 adults, and (3) instrument validation encompassing tests of dimensionality (confirmatory factor analysis), reliability (composite reliability) and validity (convergent and discriminant validity), and measure invariance testing, with 959 adults. Concerning statistical and psychometric properties, (1) a pool of 40 items (26 for FL; single items: five for determinants and nine for influential factors) was developed with inductive and deductive methodologies and reflected the FLW, (2) a 5-factor structure was explored, demonstrated acceptable model fit, and good sensitivity indices, and (3) a 5-dimensional reliable structure with 24 items was validated, configural invariance was achieved, and convergent and discriminant validity were significant in most dimensions. The FOODLIT-Tool contributes with an innovative measure of FL in adults that allows for a tailored assessment when approaching food-related issues within global food systems, providing a multidisciplinary tool that can be cross-widely applied to promote food-related behaviour change. Fundação para a Ciência e Tecnologia - FCT info:eu-repo/semantics/publishedVersion

© The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data., Background: The COVID-19 pandemic has affected people's engagement in health behaviors, especially those that protect individuals from SARS-CoV-2 transmission, such as handwashing/sanitizing. This study investigated whether adherence to the World Health Organization's (WHO) handwashing guidelines (the outcome variable) was associated with the trajectory of the COVID-19 pandemic, as measured by the following 6 indicators: (i) the number of new cases of COVID-19 morbidity/mortality (a country-level mean calculated for the 14 days prior to data collection), (ii) total cases of COVID-19 morbidity/mortality accumulated since the onset of the pandemic, and (iii) changes in recent cases of COVID-19 morbidity/mortality (a difference between country-level COVID-19 morbidity/mortality in the previous 14 days compared to cases recorded 14-28 days earlier). Methods: The observational study (#NCT04367337) enrolled 6064 adults residing in Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Data on handwashing adherence across 8 situations (indicated in the WHO guidelines) were collected via an online survey (March-July 2020). Individual-level handwashing data were matched with the date- and country-specific values of the 6 indices of the trajectory of COVID-19 pandemic, obtained from the WHO daily reports. Results: Multilevel regression models indicated a negative association between both accumulation of the total cases of COVID-19 morbidity (B = -.041, SE = .013, p = .013) and mortality (B = -.036, SE = .014 p = .002) and handwashing. Higher levels of total COVID-related morbidity and mortality were related to lower handwashing adherence. However, increases in recent cases of COVID-19 morbidity (B = .014, SE = .007, p = .035) and mortality (B = .022, SE = .009, p = .015) were associated with higher levels of handwashing adherence. Analyses controlled for participants' COVID-19-related situation (their exposure to information about handwashing, being a healthcare professional), sociodemographic characteristics (gender, age, marital status), and country-level variables (strictness of containment and health policies, human development index). The models explained 14-20% of the variance in handwashing adherence. Conclusions: To better explain levels of protective behaviors such as handwashing, future research should account for indicators of the trajectory of the COVID-19 pandemic., The study was supported by grant number 2020/01/0/HS6/00059 from the National Science Centre, Poland.

The aim of the study was to explore the well-being trajectories of adaptation to retirement in relation to individual and cultural differences, with a particular focus on gender. The sample consisted of 596 retirees (330 German, 266 Polish, 59% female) assessed four times within 12 months. Subjective well-being was evaluated with a multivariate approach that accounted for satisfaction with life, depression and subjective health. As potential correlates of well-being trajectories, age- and context-relevant psychological resources were examined, specifically, generalized self-efficacy, meaning in life, autonomy, religiousness and Schwartz’s values. Latent class growth curve modelling revealed four trajectories per well-being domain. After cross-tabulation, two groups that constantly had the best and worst well-being profiles were identified. One group mainly comprised German men, and another mainly comprised Polish women, who additionally reported the least pronounced socioeconomic and psychological resources. The main predictors of group membership were self-enhancement values (power and achievement), which were higher for the worst well-being group. These values may compensate for a lack of relevant psychological and social resources. Further studies are needed to examine whether this effect is observable in other socially disadvantaged groups.

Background: Behavioral interventions based on psychological theory can facilitate continued recovery after discharge from cardiac or orthopedic rehabilitation. For example, health professionals can encourage patients to engage in coping planning to support the maintenance of physical activity. Telephone-based interviews or web-based interventions are two promising delivery modes to provide such after-care services from a distance (telerehabilitation). However, previous evaluations of such behavioral interventions lack a detailed description of the specific content, and its connection to psychosocial antecedents and health outcomes. Therefore, the primary aim of this study was to (i) describe the content of user-specified coping plans. Second, we aimed to identify (ii) coping plan characteristics associated with health outcomes post-rehabilitation and (iii) socio-demographic and psychosocial variables associated with coping plan characteristics. Methods: This was a secondary analysis from a larger behavioral intervention study, using remote delivery modes, within orthopedic and cardiac rehabilitation. Two raters evaluated the content, quality and number of coping plans from 231 participants. Physical activity and quality of life (health outcomes) were measured via self-reports at the end of rehabilitation and six months after discharge. We used linear regression analyses to examine the relationship between plan characteristics and health outcomes. Results: Content analyses of participants’ coping plans emphasized that physical barriers such as pain or other health limitations presented major obstacles for engagement in physical activity post-rehabilitation. The most frequently identified external barriers to physical activity were workload, family obligations or bad weather. There was a statistically significant difference in quality of life and physical activity for participants who formulated highly instrumental coping plans (higher quality of life and activity) compared with participants with coping plans of lower quality (lower quality of life and activity). The number of plans (quantity) was not related with outcomes. Conclusion: Generating coping plans can be a useful theory-based approach for inclusion in telerehabilitation to facilitate the maintenance of physical activity and quality of life. It is important to encourage adults and older adults to engage in coping planning and, specifically, to formulate strategies that support tenacious plan pursuit.

Background: The COVID-19 pandemic has affected people’s engagement in health behaviors, especially those that protect individuals from SARS-CoV-2 transmission, such as handwashing/sanitizing. Associations between the pandemic’s trajectory and engagement in the protective behavior of handwashing are unclear. This study investigated whether adherence to the World Health Organization’s (WHO) handwashing guidelines is associated with (i) total cases of COVID-19 morbidity/mortality accumulated since the onset of the pandemic, (ii) recent cases (country-level COVID-19 morbidity/mortality in the 14 days prior to data collection), (iii) increases/acceleration in recent cases (country-level COVID-19 morbidity/mortality in the previous 14 days minus cases recorded 14-28 days earlier), and (iv) stringency of the national containment-and-health policies (in the 7 days prior to data collection).Methods: The observational study (#NCT04367337) enrolled 6,064 adults residing in Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Data on cross-situational handwashing adherence were collected via an online survey (March–July 2020). Individual data were matched with the WHO daily reports of COVID-19 and indices of containment-and-health policies. Country-level human development index and sociodemographic variables were controlled.Results: Multilevel regression models indicated that as the total cases of COVID-19 morbidity and mortality grew higher, handwashing adherence decreased. As increases in recent cases of COVID-19 morbidity and mortality occurred, handwashing adherence increased. Higher levels of containment-and-health policy index were associated with lower handwashing.Conclusions: Research investigating protective behaviors should account for indicators of fluctuations of COVID-19 morbidity/mortality, besides accounting for time since the beginning of the pandemic.Trial Registration: Clinical Trials.Gov, #NCT04367337, first registration date: 29/04/2020

Consequences of prenatal maternal depressive symptoms on infant health are well established. But the results of infants' sex differences of such consequences are mixed. The current study examines whether any association exists between prenatal maternal depressive symptoms and infant physical health different for the sex of newborns. A sample of 84 women pregnant with twins reported depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) in the late gestational stage. The Apgar scores of newborns were assessed by healthcare providers at 1, 5, and 10 minutes after birth. The relationship of maternal prenatal depressive symptoms and newborns' physical health was moderated by infant sex. Higher depressive symptoms were associated with a lower Apgar index among newborn boys but not girls. Fetus environment or biomarkers related to sex may be a key mechanism of the effect of prenatal depression symptoms on newborns' health. Tailored interventions targeting maternal depression symptoms may be warranted.

BACKGROUND People spend large parts of their everyday life using their smartphones. Despite various advantages of the smartphone for daily life, problematic forms of smartphone use exist that are related to negative psychological and physiological consequences. To reduce problematic smartphone use, existing interventions are oftentimes app-based and include components that help users to monitor and restrict their smartphone use by setting timers and blockers. These kinds of digital detox interventions, however, fail to exploit psychological resources, such as through promoting self-efficacious and goal-directed smartphone use. OBJECTIVE The aim of this study is to evaluate the theory-based smartphone app “Not Less But Better” that was developed to make people aware of psychological processes while using the smartphone and to support them in using their smartphone in accordance with their goals and values. METHODS In a randomized controlled trial, effects of a 20-day intervention app consisting of five 4-day training modules to foster a goal-directed smartphone use were evaluated. In the active control condition (treatment as usual), participants received a digital detox treatment and planned daily time-outs of at least 1 hour per day. Up to a 3-week follow-up, self-reported problematic smartphone use, objectively measured daily smartphone unlocks, time of smartphone use, self-efficacy, and planning towards goal-directed smartphone use were assessed repeatedly. Linear 2-level models tested intervention effects. Mediation models served to analyze self-efficacy and planning as potential mechanisms of the intervention. RESULTS Out of 232 enrolled participants, 110 (47.4%; 55 participants in each condition) provided data at postintervention and 88 (37.9%; 44 participants in each condition) at 3-week follow-up. Both conditions manifested substantial reductions in problematic smartphone use and in the amount of time spent with the smartphone. The number of daily unlocks did not change over time. Further, modelling changes in self-efficacy as a mediator between the intervention and problematic smartphone use at follow-up fit well to the data and showed an indirect effect (b=–0.09; 95% bias-corrected bootstrap CI –0.26 to –0.01), indicating that self-efficacy was an important intervention mechanism. Another mediation model revealed an indirect effect from changes in planning via smartphone unlocks at postintervention on problematic smartphone use at follow-up (b=–0.029, 95% bias-corrected bootstrap CI –0.078 to –0.003). CONCLUSIONS An innovative, theory-based intervention app on goal-directed smartphone use has been found useful in lowering problematic smartphone use and time spent with the smartphone. However, observed reductions in both outcomes were not superior to the active control condition (ie, digital detox treatment). Nonetheless, the present findings highlight the importance in promoting self-efficacy and planning goal-directed smartphone use to achieve improvements in problematic smartphone use. This scalable intervention app appears suitable for practical use and as an alternative to common digital detox apps. Future studies should address issues of high attrition by adding just-in-time procedures matched to smartphone users’ needs. CLINICALTRIAL German Clinical Trials Register DRKS00017606; https://tinyurl.com/27c9kmwy

Background: Pregnancy-related stress in women who are pregnant with twins, may increase the risk of adverse emotional outcomes such as depressive symptoms and anxiety. Possible protective coping re...

Poor eating habits are increasing the prevalence of weight-related issues, such as diabetes and cardiovascular diseases. Given the demand to improve individuals&rsquo, food knowledge and competencies aiming at healthier behaviours, the current investigation explores the concept of food literacy. Considering the lack of a shared understanding of food literacy, this study aims to explore food literacy&rsquo, s domains, influential factors and determinants. Using a qualitative deductive-dominant content analysis, 30 experts from food-related fields were interviewed. The obtained outcomes were compared to available food literacy frameworks. Agreement among inter-raters was nearly perfect (k = 0.82). Yielding a total of 184 codes nested within 19 categories, identified domains were Origin, Safety, Choice and Decision, Select and Acquire, Plan, Preserve, Prepare, Cook, and Knowledge, influential factors included Nutrition, Psychological, Health, Learning Contexts, Policy, Industry, Sustainability, and Social and Cultural, External determinants were &ldquo, Access to Food-Related Information&rdquo, &ldquo, Perishable and/or Unreliable Food-Related Information&rdquo, Family Dynamic and/or Identity&rdquo, and &ldquo, Professionals&rsquo, Unpreparedness on Food-Related Expertise&rdquo, and Internal determinants included &ldquo, Prioritise Food&rdquo, Convenience and Practicality&rdquo, Time and Financial Management&rdquo, Previous Food-Related Habits&rdquo, Innate and Learned Flavour Preferences&rdquo, In conclusion, more than half of the identified attributes (62.5%) are corroborated by the current literature. However, the manifested content unmatched with the current frameworks of food literacy literature express food-literacy-related fields of action, knowledge, competencies, and determinants that have not yet been explored. As such, this study provides new and useful information concerning food literacy definition and development, by identifying its domains, factors of influence, and potential determinants. Moreover, this work paves the way for new measurements and interventions within this field.

Background Regular physical activity (PA) was found to alleviate pain and improve functioning among patients with osteoarthritis of the knee (OAK). Heightened health demands due to OAK severity, body mass index (BMI), and depressive symptoms may require self-regulatory strategies to engage in more PA. Research on willpower—the capacity to exert self-control—suggests that believing that willpower is a nonlimited rather than a limited resource predicts effective self-regulation specifically when demands are high. The present study examines the association of OAK patients’ willpower beliefs with their daily PA as a function of health demands. Methods To identify the moderating role of OAK severity (WOMAC), BMI, and depressive symptoms (CES-D) on the link between willpower beliefs and objectively assessed PA over a 7-day period, baseline data of a registered randomized controlled trial with 243 patients (Mage = 65.47 years, SD = 0.49) were examined in secondary analyses. Results Moderation analyses revealed that overall positive associations of willpower beliefs with PA were further qualified by OAK severity, BMI, and depressive symptoms. When patients faced less health demands, believing that willpower is nonlimited was associated with more PA. When health demands were higher, willpower beliefs were not associated with PA. Conclusion OAK patients’ willpower beliefs were associated with PA. However, facing more health demands seemed to erase this beneficial link. Improving willpower beliefs by way of intervention may help to shed more light on predictive direction and ways to overcome barriers to regular physical activity.

There is a growing recognition that social support can potentially exert consistent or opposing effects in influencing health behaviours. The present paper presents a cross-sectional study, including 2,064 adults from Italy, Spain and Greece, who were participants in a multi-centre randomised controlled trial (C4H study), aiming to examine whether social support is correlated with adherence to a healthy Mediterranean diet and physical activity. Social support data were available for 1,572 participants. The majority of the sample reported emotional support availability (84·5 %), financial support availability (72·6 %) and having one or more close friends (78·2 %). Mediterranean diet adherence was significantly associated with emotional support (P = 0·009) and social network support (P = 0·021). No statistically significant associations were found between participant physical activity and the social support aspects studied. In conclusion, emotional and social network support may be associated with increased adherence to the Mediterranean diet. However, further research is needed to evaluate the role of social support in adherence to healthy Mediterranean diet.

Objective Previous research demonstrates that planning mediates the relationship between intention and health behavior change, but evidence is inconclusive, and possible sex differences within the intention-planning-behavior-chain are understudied so far. The current study, therefore, aims to disentangle this by addressing potential sex differences in the mediating role of planning in the health behavior change process. Method Three longitudinal studies were conducted in Germany between 2009 and 2011 (Study 1: 245 women, 216 men; Study 2: 156 women, 37 men; Study 3: 82 women, 84 men). In each study, intention (predictor), planning (mediator), and sex (moderator) were assessed to predict changes in (1) fruit and vegetable intake, (2) physical activity, and (3) sun protection. A moderated mediation model was specified to test whether the conditional direct effect of intention on health behavior change and/or the conditional indirect effect of intention on health behavior change through planning was different for men and women. Results Similar patterns of sex differential effects emerged within the intention-planning-behavior-chain across all three studies. The conditional indirect effect of intention on health behavior change through planning was meaningful for men but not for women for all three health behaviors. Thus, planning acted as a mediator between intention and health behavior change only for men. Conclusion The study contributes to the understanding of the inconclusive evidence on the role of planning as mediator between intention and health behavior change and sheds some light of possible sex differences that qualify this mediation. The findings suggest that women and men may not similarly benefit from health behavior change modification techniques involving planning strategies. Future theoretical developments and interventions should take this into account.

Purpose/objective Self-efficacy forms key modifiable personal resources influencing illness management, rehabilitation participation, and their outcomes such as perceived health-related quality of life (HRQOL) among people with a cardiovascular disease (CVD). Yet, an overarching research synthesis of the self-efficacy-HRQOL association in the CVD context is missing. This systematic review and meta-analysis of research on the self-efficacy-HRQOL relationship among people with CVD investigates whether the strength of associations depends on conceptualizations of self-efficacy and HRQOL (general vs. specific), presence of cardiovascular surgery, the type of CVD diagnosis, and patients' age (up to 60 vs. older than 60). Research Method/Design: We searched the following databases: PsycINFO, PsycARTICLES, Academic Search Complete, Health Source: Nursing/Academic Edition, and MEDLINE. This search resulted in 17 original studies (k = 18 samples) included in the meta-analysis. Results Findings suggested that stronger self-efficacy was associated with better HRQOL (r = .37; 95% CI [.29, .44]). Moderator analyses indicated stronger associations when HRQOL was measured in a general way (compared to CVD-specific) and when self-efficacy was measured in a general or exercise-specific way (as opposed to CVD symptom-specific). Self-efficacy-HRQOL associations were similar in strength across age groups, regardless of presence of cardiovascular surgery, and among patients diagnosed with different forms of CVD. Conclusions/implications General and exercise-specific self-efficacy are moderately related with HRQOL among people with CVD after surgery or during rehabilitation. Results need to be interpreted with caution due to heterogeneity of original research and the dominance of cross-sectional designs. (PsycINFO Database Record

Objectives With 60-90% of children worldwide reportedly experiencing dental caries, poor oral health in the younger years is a major public health issue. As parents are important to children's oral hygiene practices, we examined the key self-regulatory behaviours of parents for supervising their children's toothbrushing using the health action process approach. Design and method Participants (N = 281, 197 mothers) comprised Australian parents of 2- to 5-year-olds. A longitudinal design was used to investigate the sequential mediation chain for the effect of intention (Time 1) on parental supervision for their youngest child's toothbrushing (Time 3), via self-efficacy and planning (Time 2), and action control (Time 3). Results A latent-variable structural equation model, controlling for baseline behaviour and habit, revealed significant indirect effects from intention via self-efficacy and action control and intention via planning and action control, on parental supervision behaviour. The model was a good fit to the data, explaining 74% of the variance in parents' supervising behaviour for their children's toothbrushing. Conclusion While national recommendations are provided to guide parents in promoting good oral hygiene practices with their children, current results show the importance of going beyond simple knowledge transmission to support parents' intentions to supervise their children's toothbrushing actually materialize. Current findings make a significant contribution to the cumulative empirical evidence regarding self-regulatory components in health behaviour change and can inform intervention development to increase parents' participation in childhood oral hygiene practices, thus helping to curb rising oral health conditions and diseases. Statement of contribution What is already known on this subject? Self-regulatory skills are important to translate intentions into behaviour. Self-efficacy, planning, and action control are key self-regulatory skills for behaviour change. What does this study add? Self-regulatory skills are needed for parents to supervise their children's toothbrushings. Self-efficacy, planning, and action control are important self-regulatory skills in this context. Future interventions should map these self-regulatory predictors onto behaviour change techniques.

Objective Fruit and vegetable (FV) intake was examined among men and women who participated in an online intervention. The psychological constructs involved were outcome expectancies, behavioral intention, planning, and self-efficacy. One purpose of the analyses was the evaluation of a self-efficacy treatment component. The other purpose of the analyses regarded the role of psychological mechanisms that might be responsible for individual differences in the process of behavior change. Design A two-arm online intervention with a standard and an enhanced intervention group focusing on FV planning was conducted to improve FV intake, followed up at two and four weeks. The intervention groups differed by the additional inclusion of a self-efficacy ingredient in the enhanced intervention. Linear mixed models examined the intervention effects, and a longitudinal structural equation model explored which psychological constructs were associated with changes in FV intake. Participants were N = 275 adults of whom n = 148 completed the four-week follow-up. Their age range was 18–81 years (Mage = 32.50, SDage = 14.00). Results Analyses yielded an overall increase in self-reported FV intake. Moreover, a triple interaction between time, sex, and experimental groups on self-efficacy emerged, indicating that men, independent of treatment conditions, reported an increase in their confidence to improve FV intake, whereas women developed higher FV self-efficacy when being in the enhanced group instead of the standard group. Planning, self-efficacy, and intention mediated between outcome expectancies, and follow-up FV intake. Conclusion Both intervention arms produced overall improvements in FV intake. The enhanced intervention resulted in a steeper increase in self-efficacy in women compared to men, and compared to the standard intervention. A psychological mechanism transpired that included a sequence leading from initial outcome expectancies via planning, self-efficacy, and intention towards FV intake.

Self-efficacy has long been viewed as an important determinant of academic performance. A counter-position is that self-efficacy is merely a reflection of past performance. Research in the area is limited by unidirectional designs which cannot address reciprocity or the comparative strength of directional effects. This systematic review and meta-analysis considered both directions of the relationship simultaneously, pooling data from longitudinal studies measuring both academic self-efficacy and academic performance over two waves. Pooled correlations (k = 11, N = 2688) were subjected to cross-lagged path analysis that provided support for a reciprocal effects model. Performance had a net positive effect on subsequent self-efficacy (β = 0.205, p

“Nudge” policies are increasingly popular, seeking to modify health-related decisions by affecting response to available options. Thus, critical appraisals of the effectiveness of health-related nudging interventions could help health policy makers in making evidence-based decisions with regards to which of these interventions should be incorporated into policy. The aim of the present effort was to systematically appraise the evidence on nudging interventions on healthy diet and physical activity (PA). A systematic review was performed using Pubmed, Web of Science Core Collection citation index and the Cochrane Controlled Register of Trials (CENTRAL). Interventional studies were included if they quantitatively assessed healthy diet and/or PA interventions that were explicitly related to a nudging context. Methodological assessment was performed using the Cochrane collaboration’s risk of bias tool and the Research Triangle Institute item bank. Sixty-four studies were included with varying degrees of bias. Sixty studies investigated healthy diet interventions, three studied PA interventions and one studied interventions pertaining to both. Overall, specific types of interventions such as proximity and presentation alterations can be effective in encouraging people towards the adoption of healthier diet choices, whereas labelling, availability, prompting, functional design and sizing “nudge” interventions provide inconclusive results so far. Nudging interventions improving convenience seem to be effective in encouraging people towards making healthier diet choices, whereas evidence on PA is limited. Further conceptual development and research is needed to optimally determine the type, intensity and circumstances that make nudge-related interventions more effective, particularly regarding PA.