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Background: Population mail-out bowel cancer screening programs save lives through prevention and early detection; however, their effectiveness is constrained by low participation rates. Many non-participants are "intenders"; that is, they intend to screen but fail to do so, often forgetting or procrastinating. This study aimed to co-design interventions to increase screening participation among intenders in the Australian National Bowel Cancer Screening Program. Methods: Three semi-structured interviews, and one online cross-sectional survey, were conducted between August 2021 and December 2022. Interviews with people who had completed and returned their latest screening kit ("completers") were first conducted to identify the planning strategies they had used. Using survey data, logistic regressions were conducted to analyse strategies predictive of participants having returned their latest bowel cancer screening kit. Then, intenders were interviewed to explore their opinions of these strategies and worked with researchers to adapt these strategies into prototype interventions to facilitate screening participation. All interviews were analysed using the framework approach of codebook thematic analysis. Results: Interview participants who returned their kit shared their effective planning strategies, such as putting the kit in a visible place or by the toilet, planning a time at home to complete the kit, and using reminders. Survey participants who reported using such strategies were more likely to have completed their screening kit compared to those who did not. Prototype interventions developed and endorsed by intenders included providing a prompt to place the kit or a sticker near the toilet as a reminder, a deadline for kit return, the option to sign up for reminders, and a bag to store the sample in the fridge. Conclusions: These novel, consumer-led interventions that are built upon the needs and experience of screening invitees provide potential solutions to improve participation in population bowel cancer screening. [ABSTRACT FROM AUTHOR]

Purpose: Although there are many reported benefits of physical activity for patients with cancer (e.g., improving quality of life), many patients with cancer do not meet the recommendations of physical activity guidelines. The amount of physical activity declines after diagnosis of cancer. This study aimed to clarify the elements that contribute engagement in regular moderate-or-higher-level intensity of physical activity (MHPA), based on the Health Action Process Approach (HAPA), among patients with cancer. Methods: Two web surveys were conducted among cancer outpatients, asking them to respond to a questionnaire. Participants provided information regarding their demographics, physical activity, purpose, advantages, disadvantages, barriers, triggers, and need for support for regular MHPA. Results: Categories were obtained for purposes, advantages, disadvantages, barriers, triggers, and support needs for regular MHPA. For example, the support they considered necessary to regularly engage in MHPA were developed 9 categories, such as Improving the environment, Support for the implementation of PA (interpersonal), and Reducing the burden. Women and younger patients provided more statements about reducing their burden; younger patients also mentioned on improving the environment more among those who did not engage in MHPA. Additionally, patients with cancer who provided statements about interpersonal support reported higher barriers to physical activity. Conclusions: These findings will contribute to the development of a scale to measure the components of the HAPA on physical activity in patients with cancer. In addition, it will help develop a support system that promotes engagement in regular MHPA. [ABSTRACT FROM AUTHOR]

Background: Epidemiological research has indicated that the deleterious effects of non-communicable disease can be prevented through participation in health behaviours. The HAPA is a dual-phase model that identifies the determinants of the initiation and maintenance of health behaviour. The aim of this study was to systematically map the Health Action Process Approach (HAPA)- based interventions in non-communicable diseases in relation to the type of intervention, the target groups and the constructs of the HAPA model that are used in the study and to assess the clinical relevance of the studies. Methods: This review study complies with the Preferred Reporting Items for Systematic review and Meta-analysis (PRISMA) version 2020. The search for relevant literature involved PubMed, Sciencedirect, Willey online Library and Proquest databases for the studies published in 2000 to 2023 period. Quality of the study was assessed using CASP, and the Risk of Bias using Cochrane RoB tool. Results: In databases search, there are 912 studies. The results for eligibility resulted in 18 articles consist of 13 observational studies, and 5 experimental studies. Discussion: Physical activity, healthy diet behaviour, and medication adherence were the targeted behaviour. In the majority of the studies, the targeted intervention was physical activity and the population consisted of adult patients. Conclusion: All studies used only a selection of the HAPA constructs. Therefore, only a minority of the studies can be considered real HAPA intervention studies. [ABSTRACT FROM AUTHOR]

Physical activity is considered a fundamental component of cardiac rehabilitation programs and is recommended to improve the secondary prevention outcomes of people with acute coronary syndrome after percutaneous coronary interventions. However, the physical activity levels of this population are often low. Most research studies have primarily focused on older populations and chronic diseases. This descriptive cross-sectional study aimed to test a causal model of physical activities among adults based on the Health Action Process Approach. Four hundred twenty-four people were recruited using multi-stage sampling from the outpatient departments of seven tertiary hospitals in Thailand. Data were collected using a demographic data form, the International Physical Activity Questionnaire-Long form, the Self-Efficacy Questionnaire, the Outcome Expectation Questionnaire, the Risk Perception Questionnaire, the Behavioral Intention Questionnaire, the Planning Questionnaire, and the Action Control Questionnaire. Data were analyzed using descriptive statistics and structural equation modeling with Mplus software. The findings of our study hold significant promise for patient care. The model we tested, which accounted for 46% of the physical activity variance, underscores the crucial role of self-efficacy, planning, and action control in directly influencing physical activity. Notably, self-efficacy was found to exert the most profound effect. Outcome expectation was shown to influence physical activity indirectly through intention and planning. This highlights the potential for nurses to design interventions that foster self-efficacy, planning, and self-regulatory strategies. These strategies can empower patients to overcome challenges in cardiac rehabilitation and maintain physical activities, thereby improving their health outcomes. However, it is important to stress that our proposed intervention should be rigorously tested for effectiveness before implementation. [ABSTRACT FROM AUTHOR]

Background and objectives: Diabetes self-care leads to blood sugar control in diabetic patients. Adherence to medication is one of the methods of self-care. This research to improving medication adherence in type 2 diabetic patients in Zahedan based on the Health Action Process Approach model. Materials and Methods: In this intervention study, 210 type 2 diabetic patients referred to diabetes clinics in Zahedan city in two intervention groups (105) and control group (105) were selected from the diabetes clinics of Zahedan hospitals during June and September in 2022. Sampling was done by available methods among diabetic patients. After collecting the data, a pre-test was conducted using the medication adherence questionnaire and the model constructs questionnaire. CVI = 0.7, CVR = 0.6 and Cronbach's alpha of the questionnaire was 0.97. One and three months after the educational intervention, the questionnaire on model structures and self-care behavior was completed by the patients and collected for analysis. Data were analyzed using independent t, Chi-square, and Shapiro-Wilk tests in SPSS version 23. A significance level of 0.05 was considered. Results: The results showed that all the Health Action Process Approach model constructs including risk perception, outcome expectancies, behavioral intention, action selfefficacy, coping self-efficacy, recovery self-efficacy, action planning and coping planning, perceived barriers, perceived benefits, and self-care behavior had significant differences in one month and three months after the educational intervention (P<0.05), which indicated the effectiveness of the education in the intervention group. However, no significant difference was observed in the control group (P < 0.05). Conclusion: The intervention with the Health Action Process Approach model showed that the structures of the model after the training had a significant impact on the self-care of patients in the field of medication compliance. Appropriate programs with details in the field of automatic coping self-efficacy and action planning should be designed to promote medication adherence among patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to develop and evaluate the validity and reliability of a healthy diet and physical activity assessment tool among patients one year after bariatric surgery based on Health Action Process Approach. Methods: We compiled 53 items based on healthy diet and physical activity behaviors among patients undergone bariatric surgery through reviewing the literature. Using quantitative and qualitative methods, and a panel of experts, we evaluated the face and content validities of the tool. The reliability was evaluated by Intra-class correlation coefficient and Cronbach's alpha. Results: The content validity ratio and the content validity index were 0.62 and 0.79, respectively. Exploratory factor analysis showed seven factors, including risk perception, outcome expectations, task self-efficacy, coping, recovery self-efficacy, action planning, coping planning, and behavioral intentions. The Intra-class correlation coefficient was between 0.8 and 0.91; and Cronbach's alpha for different constructs was between 0.8 and 0.95. Conclusion: The findings showed that the constructs of the Health Action Process Approach tool regarding healthy diet and physical activity had adequate validity and reliability in bariatric surgery patients. [ABSTRACT FROM AUTHOR]

Objectives: Decisions about reproductive health are often influenced by women's female family members, particularly in low‐resource contexts. However, previous research has focused primarily on individual behavioural determinants. We investigated the interrelatedness of female family members' reproductive health behaviour with a dyadic version of an extended health action process approach. We investigated this for carrying heavy loads during pregnancy and postpartum, a risk factor for reproductive health in many low‐income countries such as Nepal. Design: This cross‐sectional study included dyads of daughters‐in‐law and mothers‐in‐law in rural Nepal (N = 476, nested in 238 dyads). Methods: Dyads of daughters‐ and mothers‐in‐law were surveyed about avoiding carrying heavy loads during pregnancy and postpartum. The effects of a woman's cognitions and her female dyadic partner's cognitions on their intention and behaviour about avoiding carrying loads were estimated using linear mixed models. Results: The results showed that a mother‐in‐law's cognitions were related to her daughter‐in‐law's intentions and vice versa. The mother‐in‐law's cognitions were also related to the daughter‐in‐law's behaviour. The mother‐in‐law's self‐efficacy and injunctive norms related to the daughter‐in‐law's intention and behaviour over and above the daughter‐in‐law's own self‐efficacy and injunctive norms. Conclusion: Female Nepali family members' cognitions about carrying heavy loads during pregnancy and postpartum are interrelated. Including female family members in interventions to help women manage their reproductive health in low‐resource populations seems promising. These novel findings add to the growing body of research indicating the importance of including a dyadic perspective when understanding and changing health behaviour. [ABSTRACT FROM AUTHOR]

Introduction: Physical exercise is considered a useful non-pharmacological adjunctive treatment for promoting recovery from substance use disorders (SUD). However, adherence to physical exercise treatments is low, and little is known about what factors are associated with the initiation and maintenance of physical exercise behaviors. The aim of this study was to explore the psychosocial factors underlying these behaviors in individuals with SUD using an integrated theoretical model based on the health action process approach (HAPA) and the theory of planned behavior (TPB). Methods: A total of 1,197 individuals with SUDs (aged 37.20  ±  8.62  years) were recruited from 10 compulsory isolation drug rehabilitation centers in Zhejiang Province via convenience sampling according to a set of inclusion criteria. Selfreported data were collected to assess task self-efficacy (TSE), maintenance self-efficacy (MSE), recovery self-efficacy (RSE), outcome expectations (OE), action planning (AP), coping planning (CP), social support (SS), subjective norms (SN), attitude behavior (AB), behavioral intention (BI), perceived behavioral control (PBC), risk perception (RP), exercise stage, and exercise behavior in this integrated model. ANOVA and structural equation modeling (SEM) were used to evaluate this model. Results: One-way ANOVA revealed that the majority of the moderating variables were significantly different in the exercise phase. Further SEM showed that the model fit the data and revealed several important relationships. TSE, RP, SS, AB, and SN were indirectly associated with physical exercise behavior in individuals with SUD through the BI in the SUD initiation stage. In addition, PBC was directly related to physical exercise behavior in individuals with SUD. In the maintenance stage, MSE, AP, CP and exercise behavior were significantly related. Moreover, AP and CP were mediators of BI and MSE. Conclusion: This study is the first attempt to integrate patterns of physical exercise behavior in individuals with SUD. The HAPA-TPB integration model provides a useful framework for identifying determinants of physical exercise behavioral intentions and behaviors in individuals with SUD and for explaining and predicting the initiation and maintenance of physical exercise behaviors in these individuals. Moreover, the model provides scientific guidance for the enhancement of physical exercise adherence in individuals with SUD. [ABSTRACT FROM AUTHOR]

Patients' effective hand hygiene helps to reduce healthcare-associated infections and prevents the spread of nosocomial infections and communicable diseases, such as COVID-19. Accordingly, this study aimed to describe effective hand hygiene decisions based on the Health Action Process Approach (HAPA) and whether this pattern is invariant for mental health. Data were collected cross-sectionally from patients who had previously been admitted to a hospital (Nstudy 1 = 279; study 1) and longitudinally from psychosomatic rehabilitation patients (Nstudy 1 = 1073; study 2). The fit of the HAPA framework and changes in hand hygiene decisions regarding compliance, social-cognitive variables of the HAPA, and mental health status were examined. The results revealed that the trimmed HAPA framework fitted the data well (χ2 = 27.1, df = 12, p < 0.01, CMIN/df = 2.26, CFI = 0.97, RMSEA = 0.08). According to multi-group structural equation modeling, the HAPA model with hand hygiene behavior was found to be invariant regarding mental health. To conclude, the trimmed HAPA framework was revealed to be a generic framework for explaining social-cognitive processes relating to hand hygiene decisions. Therefore, helping individuals to perform hand hygiene recommendations requires intention formation and bridging the intention–behavior gap. This can be undertaken by promoting planning and self-efficacy. All processes appear generic to participants with and without mental health challenges. [ABSTRACT FROM AUTHOR]

Patients’ effective hand hygiene helps to reduce healthcare-associated infections and prevents the spread of nosocomial infections and communicable diseases, such as COVID-19. Accordingly, this study aimed to describe effective hand hygiene decisions based on the Health Action Process Approach (HAPA) and whether this pattern is invariant for mental health. Data were collected cross-sectionally from patients who had previously been admitted to a hospital (Nstudy 1 = 279; study 1) and longitudinally from psychosomatic rehabilitation patients (Nstudy 1 = 1073; study 2). The fit of the HAPA framework and changes in hand hygiene decisions regarding compliance, social-cognitive variables of the HAPA, and mental health status were examined. The results revealed that the trimmed HAPA framework fitted the data well (χ2 = 27.1, df = 12, p < 0.01, CMIN/df = 2.26, CFI = 0.97, RMSEA = 0.08). According to multi-group structural equation modeling, the HAPA model with hand hygiene behavior was found to be invariant regarding mental health. To conclude, the trimmed HAPA framework was revealed to be a generic framework for explaining social-cognitive processes relating to hand hygiene decisions. Therefore, helping individuals to perform hand hygiene recommendations requires intention formation and bridging the intention–behavior gap. This can be undertaken by promoting planning and self-efficacy. All processes appear generic to participants with and without mental health challenges.

Abstract Background For approximately one in five children who have social, emotional, and behavioral (SEB) challenges, accessible evidence-based prevention practices (EBPPs) are critical. In the USA, schools are the primary setting for children’s SEB service delivery. Still, EBPPs are rarely adopted and implemented by front-line educators (e.g., teachers) with sufficient fidelity to see effects. Given that individual behavior change is ultimately required for successful implementation, focusing on individual-level processes holds promise as a parsimonious approach to enhance impact. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a pragmatic, multifaceted pre-implementation strategy targeting volitional and motivational mechanisms of educators’ behavior change to enhance implementation and student SEB outcomes. This study protocol describes a hybrid type 3 effectiveness-implementation trial designed to evaluate the main effects, mediators, and moderators of the BASIS-T implementation strategy as applied to Positive Greetings at the Door, a universal school-based EBPP previously demonstrated to reduce student disruptive behavior and increase academic engagement. Methods This project uses a blocked randomized cohort design with an active comparison control (ACC) condition. We will recruit and include approximately 276 teachers from 46 schools randomly assigned to BASIS-T or ACC conditions. Aim 1 will evaluate the main effects of BASIS-T on proximal implementation mechanisms (attitudes, subjective norms, self-efficacy, intentions to implement, and maintenance self-efficacy), implementation outcomes (adoption, reach, fidelity, and sustainment), and child outcomes (SEB, attendance, discipline, achievement). Aim 2 will examine how, for whom, under what conditions, and how efficiently BASIS-T works, specifically by testing whether the effects of BASIS-T on child outcomes are (a) mediated via its putative mechanisms of behavior change, (b) moderated by teacher factors or school contextual factors, and (c) cost-effective. Discussion This study will provide a rigorous test of BASIS-T—a pragmatic, theory-driven, and generalizable implementation strategy designed to target theoretically-derived motivational mechanisms—to increase the yield of standard EBPP training and support strategies. Trial registration ClinicalTrials.gov ID: NCT05989568. Registered on May 30, 2023.

Abstract Objective To examine the effectiveness of nutritional education based on the health action process approach (HAPA) on pregnancy outcomes among malnourished pregnant mothers utilizing nutritional support. Methods In a randomized controlled trial, 234 malnourished pregnant women under nutritional support from the fourth month of pregnancy participated. Participants were randomly allocated in study groups by the balance block randomization method. Data were collected using a socio-demographic and pregnancy outcomes checklist as well as self-devised questionnaire assessing the constructs of the HAPA model before and three months after the educational intervention. The framework of the educational intervention was based on the constructs of the HAPA and included three one-hour training sessions through lectures, group discussions, ‘question and answer’ sessions, and the use of educational tools. Data were analyzed using analysis of covariance (ANCOVA) and SPSS software. Results Pregnancy outcomes including optimal weight gain during pregnancy (p = 0.47), neonate’s birth weight (p = 0.58), gestational age at delivery (p = 0.83), type of delivery (p = 0.48) gestational anemia (p = 0.22), diabetes (p = 0.59) and hypertension (p = 0.29) were not significantly different in the intervention and control groups. The results showed that the educational intervention produced a significant increase in the total score (24 points) in the intervention group. Improvement of scores in the intervention group compared to the control was observed in all of the model constructs except outcome expectation (0.68 decrease). The educational intervention in the present study had a large measure of effect in total (SMD: 2.69, partial eta2: 0.664). Conclusion A nutritional education intervention based on the HAPA model for malnourished pregnant women increased behavioral intention and planning for action to have better nutritional behavior. However, the intervention did not change the pregnancy outcomes significantly. Practice implications Nutritional education based on the HAPA model can be used to improve nutritional behaviors of malnourished pregnant women.

Objective: To examine the effectiveness of nutritional education based on the health action process approach (HAPA) on pregnancy outcomes among malnourished pregnant mothers utilizing nutritional support. Methods: In a randomized controlled trial, 234 malnourished pregnant women under nutritional support from the fourth month of pregnancy participated. Participants were randomly allocated in study groups by the balance block randomization method. Data were collected using a socio-demographic and pregnancy outcomes checklist as well as self-devised questionnaire assessing the constructs of the HAPA model before and three months after the educational intervention. The framework of the educational intervention was based on the constructs of the HAPA and included three one-hour training sessions through lectures, group discussions, 'question and answer' sessions, and the use of educational tools. Data were analyzed using analysis of covariance (ANCOVA) and SPSS software. Results: Pregnancy outcomes including optimal weight gain during pregnancy (p = 0.47), neonate's birth weight (p = 0.58), gestational age at delivery (p = 0.83), type of delivery (p = 0.48) gestational anemia (p = 0.22), diabetes (p = 0.59) and hypertension (p = 0.29) were not significantly different in the intervention and control groups. The results showed that the educational intervention produced a significant increase in the total score (24 points) in the intervention group. Improvement of scores in the intervention group compared to the control was observed in all of the model constructs except outcome expectation (0.68 decrease). The educational intervention in the present study had a large measure of effect in total (SMD: 2.69, partial eta2: 0.664). Conclusion: A nutritional education intervention based on the HAPA model for malnourished pregnant women increased behavioral intention and planning for action to have better nutritional behavior. However, the intervention did not change the pregnancy outcomes significantly. Practice implications: Nutritional education based on the HAPA model can be used to improve nutritional behaviors of malnourished pregnant women. [ABSTRACT FROM AUTHOR]

Background: For approximately one in five children who have social, emotional, and behavioral (SEB) challenges, accessible evidence-based prevention practices (EBPPs) are critical. In the USA, schools are the primary setting for children's SEB service delivery. Still, EBPPs are rarely adopted and implemented by front-line educators (e.g., teachers) with sufficient fidelity to see effects. Given that individual behavior change is ultimately required for successful implementation, focusing on individual-level processes holds promise as a parsimonious approach to enhance impact. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a pragmatic, multifaceted pre-implementation strategy targeting volitional and motivational mechanisms of educators' behavior change to enhance implementation and student SEB outcomes. This study protocol describes a hybrid type 3 effectiveness-implementation trial designed to evaluate the main effects, mediators, and moderators of the BASIS-T implementation strategy as applied to Positive Greetings at the Door, a universal school-based EBPP previously demonstrated to reduce student disruptive behavior and increase academic engagement. Methods: This project uses a blocked randomized cohort design with an active comparison control (ACC) condition. We will recruit and include approximately 276 teachers from 46 schools randomly assigned to BASIS-T or ACC conditions. Aim 1 will evaluate the main effects of BASIS-T on proximal implementation mechanisms (attitudes, subjective norms, self-efficacy, intentions to implement, and maintenance self-efficacy), implementation outcomes (adoption, reach, fidelity, and sustainment), and child outcomes (SEB, attendance, discipline, achievement). Aim 2 will examine how, for whom, under what conditions, and how efficiently BASIS-T works, specifically by testing whether the effects of BASIS-T on child outcomes are (a) mediated via its putative mechanisms of behavior change, (b) moderated by teacher factors or school contextual factors, and (c) cost-effective. Discussion: This study will provide a rigorous test of BASIS-T—a pragmatic, theory-driven, and generalizable implementation strategy designed to target theoretically-derived motivational mechanisms—to increase the yield of standard EBPP training and support strategies. Trial registration: ClinicalTrials.gov ID: NCT05989568. Registered on May 30, 2023. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the feasibility and effects of a simple-to-implement multicomponent intervention to reduce sedentary time of office workers. Methods: Six groups of eight to ten office workers took part in the two-week Leicht Bewegt intervention. Participants completed questionnaires at baseline (T0, n = 52), after 2 weeks (T1, n = 46), and after 5 weeks (T2, n = 38), including subjective sedentary measures and social-cognitive variables based on the health action process approach (HAPA). Objective sedentary measures were obtained using activPAL trackers. Results: The intention to reduce sedentary behavior during work increased significantly from T0 to T1. Participants' objective and subjective sitting time decreased significantly from T0 to T1, corresponding to an average decrease per 8-h-workday of 55 min (d = −.66) or 74 min (d = − 1.14), respectively. This reduction persisted (for subjective sitting time) at T2 (d = − 1.08). Participants indicated a high satisfaction with the intervention. Conclusions: The Leicht Bewegt intervention offers a feasible and effective opportunity to reduce sedentary behavior at work. Randomized controlled trials including longer follow-up time periods are needed to validate its benefits in different workplaces. [ABSTRACT FROM AUTHOR]

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Appropriate parental HIV disclosures (i.e., parents living with HIV [PLH] tell their HIV diagnosis to their children) benefit parents, children, and family relations. Psychosocial factors could influence the decision-making process of parental HIV disclosure. Using the Health Action Process Approach to frame stages (pre-intention, intention, and action) in the decision-making process, this study aimed to investigate how psychosocial factors predict HIV disclosure stage transitions among PLH in China. Data were collected from a randomized clinical trial of a theory-based parental HIV disclosure intervention among 791 PLH. The predictive effects of psychosocial factors on disclosure stage transitions were examined using a Markov chain model matrix. Results showed that action self-efficacy and action planning were significant predictors of parental HIV disclosure stage transitions. Considering stage-specific psychosocial predictors may contribute to effective interventions to promote appropriate HIV disclosure among PLH in China. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether a novel intervention improves the adherence to guideline-based preventive measures in asplenic patients at risk of post-splenectomy sepsis (PSS). Methods: We used a prospective controlled, two-armed historical control group design to compare a novel, health action process approach (HAPA)-based telephonic intervention involving both patients and their general practitioners to usual care. Eligible patients were identified in cooperation with the insurance provider AOK Baden-Wuerttemberg, Germany. Patients with anatomic asplenia (n = 106) were prospectively enrolled and compared to a historical control group (n = 113). Comparisons were done using a propensity-score-based overlap-weighting model. Adherence to preventive measures was quantified by the study-specific 'Preventing PSS score' (PrePSS score) which includes pneumococcal and meningococcal vaccination status, the availability of a stand-by antibiotic and a medical alert card. Results: At six months after the intervention, we estimated an effect of 3.96 (95% CI 3.68–4.24) points on the PrePSS score scale (range 0–10) with mean PrePSS scores of 3.73 and 7.70 in control and intervention group, respectively. Substantial improvement was seen in all subcategories of the PrePSS score with the highest absolute gains in the availability of stand-by antibiotics. We graded the degree of participation by the general practitioner (no contact, short contact, full intervention) and noted that the observed effect was only marginally influenced by the degree of physician participation. Conclusions: Patients who had received the intervention exhibited a significantly higher adherence to guideline-based preventive measures compared to the control group. These data suggest that widespread adoption of this pragmatic intervention may improve management of asplenic patients. Health insurance provider-initiated identification of at-risk patients combined with a patient-focused intervention may serve as a blueprint for a wide range of other preventive efforts leading to patient empowerment and ultimately to better adherence to standards of care. [ABSTRACT FROM AUTHOR]

目的 探讨基于健康行动过程取向（health action process approach，HAPA）理论的罗盘式护理模式在中青年首发卒中患者中的应用效果。 方法 前瞻性、连续入组2021年6—12月首都医科大学附属北京天坛医院收治的18～45岁的首次卒中患者，将患者随机分为对照组和干预组。对照组实施常规护理及延续性护理，干预组在对照组基础上实施基于HAPA理论的罗盘式护理模式3个月，比较两组患者干预后的卒中自我管理行为量表各维度得分及总分、卒中专用生活质量量表总分、焦虑自评量表总分、抑郁自评量表总分的改善情况。 结果 共计104例中青年首发卒中患者入组，脱落6例，最终干预组、对照组各纳入49例。干预组卒中自我管理行为量表总分、卒中专用生活质量量表总分均高于对照组（P

This study examined the applicability of the health action process approach (HAPA) to walking duration in older adults and the added value of extending the HAPA by intrinsic motivation. Self-reports from older adults (N = 309; Mage = 78.7, 70–95 years) regarding activity-related intrinsic motivation and HAPA variables were collected at the baseline of a fall prevention intervention study. Walking duration at ≥3 metabolic equivalents of task was measured for 7 days via body-worn accelerometers. Two structural equation models with walking duration as a manifest outcome were specified. In both models, the model fit was acceptable, but intention and planning were not associated with walking duration. Intrinsic motivation was significantly related to most HAPA variables and walking duration. Variance explained for walking duration was R2 =.14 in the HAPA and R2 =.17 in the extended model. For explaining older adults' walking duration, intrinsic motivation, but not HAPA-based intention and planning, seemed to be important. [ABSTRACT FROM AUTHOR]

Abstract Background The postmenopausal period can represent an opportunity for women to improve their health and well-being. The Active and Healthy Ageing in Women during early postmenopause (AHAWOMEN) study aims to identify the key determinants of an active lifestyle among middle-aged women, with a focus on the stages and the social-cognitive variables outlined in the Health Action Process Approach (HAPA) model, a theoretical framework for understanding health behaviour change. We expected that HAPA factors and processes of intention creation (motivational phase) and action adoption (volitional phase) will be significant predictors of exercise initiation and maintenance, supporting both the HAPA tenets and the efficacy of HAPA-based interventions. Methods/design This study was approved by the authors’ Institutional Review Committee. Postmenopausal women aged between 45 and 65 years will voluntarily participate. The participants will be allocated to one of three groups: Intervention-Initiators (n = 100, random allocation), Control-Sedentary (n = 100, random allocation) or Control-Active (n = 100, non-random allocation). The intervention group will engage in a supervised exercise programme lasting at least 3 months, supplemented with a HAPA-based intervention for behaviour change. The sedentary control group will not receive any intervention to change their physical activity, while the active control group will consist of women who are already regularly adhering to an active lifestyle. Study variables will be measured at baseline and postintervention phases, as well as at 1, 3, 6 and 12-month follow-ups. The predictors of exercise behaviour in the different phases of the behavioural change process will be explored and compared within and between groups throughout the study. These analyses will help identify the factors that determine the adoption of a healthy active behaviour. Additionally, the effectiveness of the model and the intervention for changing active behaviour will be evaluated. Discussion This paper describes the rationale, development and methods used in the AHAWOMEN project. Supporting women who intend to become active can help them to translate their goals into sustainable action. Verifying that the HAPA predictions are applicable to postmenopausal women’s adoption of exercise would provide the basis for designing effective interventions for promoting healthy and active ageing that are also tailored to the experiences of middle-aged women. Trial registration ISRCTN16251361. Registration date: 01/06/2023 (retrospectively registered).

Introduction: Behavioral activation (BA) is effective for the treatment of depression. The Health Action Process Approach (HAPA), which is derived from health psychology, can provide a motivational-volitional framework of BA. Objective: This study investigated the efficacy of a HAPA-based internet-delivered BA intervention (iBA; called InterAKTIV) in individuals with depression, also assessing HAPA-based motivational and volitional outcomes. Methods: In a two-arm randomized controlled efficacy trial with a parallel design, 128 participants with a major depressive episode were randomly allocated to the intervention group (IG; TAU + immediate access to iBA) or control group (CG; TAU + access to iBA after follow-up). The primary outcome of clinician-rated depressive symptoms and secondary outcomes were assessed at baseline (T1), 8 weeks (T2), 6-month after randomization (T3). Data were analyzed on an intention-to-treat basis. Results: Linear mixed model analyses revealed a significant group*time interaction effect on clinician-rated depressive symptoms favoring the IG (F2, 156.0 = 7.40; p < 0.001, d = 0.79 at T2, d = 0.25 at T3). The IG was also superior regarding self-rated depressive symptoms, BA, most motivational, and all volitional outcomes. Conclusion: This study shows that HAPA-based iBA can significantly improve clinician-rated depressive symptoms, as well as outcomes used in the HAPA model in people with depression. Building on these efficacy results, in the next step, the relationship between BA interventions and activity levels should be investigated, taking into account motivation and volition as potential mediators. [ABSTRACT FROM AUTHOR]

Background: The route into the body for many pathogens is through the eyes, nose and mouth (i.e., the 'T‐zone') via inhalation or fomite‐based transfer during face touching. It is important to understand factors that are associated with touching the T‐zone to inform preventive strategies. Purpose: To identify theory‐informed predictors of intention to reduce facial 'T‐zone' touching and self‐reported 'T‐zone' touching. Methods: We conducted a nationally representative prospective questionnaire study of Canadians. Respondents were randomized to answer questions about touching their eyes, nose, or mouth with a questionnaire assessing 11 factors from an augmented Health Action Process Approach at baseline: intention, outcome expectancies, risk perception, individual severity, self‐efficacy, action planning, coping planning, social support, automaticity, goal facilitation and stability of context. At 2‐week follow‐up, we assessed HAPA‐based indicators of self‐regulatory activities (awareness of standards, effort, self‐monitoring) and self‐reported behaviour (primary dependent variable). Results: Of 656 Canadian adults recruited, 569 responded to follow‐up (87% response rate). Across all areas of the 'T‐zone', outcome expectancy was the strongest predictor of intention to reduce facial 'T‐zone' touching, while self‐efficacy was a significant predictor for only the eyes and mouth. Automaticity was the strongest predictor of behaviour at the 2‐week follow‐up. No sociodemographic or psychological factors predicted behaviour, with the exception of self‐efficacy, which negatively predicted eye touching. Conclusion: Findings suggest that focusing on reflective processes may increase intention to reduce 'T‐zone' touching, while reducing actual 'T‐zone' touching may require strategies that address the automatic nature of this behaviour. [ABSTRACT FROM AUTHOR]

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Background: Physical activity during retirement is one of the health promotion determinants in this group. This study was conducted to determine the effect of an educational intervention based on the health action process approach (HAPA) on the levels of physical activity among retired female employees. Methods: This quasi-experimental study was conducted among 97 retired women, selected through a simple random sampling technique, and divided into two groups. The primary instruments employed for data collection included the International Standard Physical Activity Behavior Questionnaire (IPAQ) and a researcher-made questionnaire based on the HAPA. Data analysis was performed using SPSS version 20, incorporating a range of statistical tests, namely Spearman's correlation, independent and paired t-tests, the Willcoxon signed-rank test, and the Mann-Whitney U test. Results: After the educational intervention, the average score of different levels of physical activity has increased significantly (p < 0.05). In addition, three months after the intervention, the score of all the constructs of the HAPA model except for the structure of action planning and coping planning, was significantly increased (p < 0.05). Conclusion: The implementation of an intervention based on the HAPA can improve the level of physical activity in middle-aged women. Therefore, it is suggested that future studies based on this approach be conducted in other target groups to promote physical activity. [ABSTRACT FROM AUTHOR]

Purpose: To assess the social cognitive constructs of the Health Action Process Approach (HAPA) of parents of high caries risk children to be treated under intravenous sedation (IVS) or with behavioural guidance techniques (BGT), and to assess the changes in these constructs for each treatment group after treatment. Design: In this cohort study, 160 children aged 3–10 years were allocated by their paediatric dentist to either IVS (77.4%) or BGT. Their parents filled out a HAPA questionnaire, before (T1, n = 160), immediately (T2, n = 108) and three months (T3, n = 71) after their children's dental rehabilitation. Results: Before treatment, all parents had high scores on all social cognitive constructs. There were no differences in mean HAPA scores between the treatment groups (p > 0.05). After treatment, mean scores changed in both groups. In the BGT group, action self-efficacy changed from 3.64 (T1) to 3.36(T2) (p = 0.027) and to 3.13 (T3) (p = 0.021) and coping self-efficacy changed from 3.63 (T1) to 3.23 (T2) (p = 0.015). In the IVS group, action planning changed from 3.25 (T1) to 3.05(T3) (p = 0.036) and action control changed from 2.58 (T1) to 2.82 (T2) (p = 0.012) and to 2.87 (T3) (p = 0.006). Conclusions: High scores on social cognitive constructs of parents of children referred to a paediatric dentist showed that they seem to be motivated to brush their children's teeth, irrespective of the treatment group. Small changes were observed in the HAPA constructs, however, these are not considered clinically relevant. [ABSTRACT FROM AUTHOR]

BackgroundThis study examined the social cognition determinants of social distancing behavior during the COVID-19 pandemic in samples from Australia and the US guided by the health action process approach (HAPA).MethodsParticipants (Australia: N = 495, 50.1% women; US: N = 701, 48.9% women) completed HAPA social cognition constructs at an initial time-point (T1), and one week later (T2) self-reported their social distancing behavior.ResultsSingle-indicator structural equation models that excluded and included past behavior exhibited adequate fit with the data. Intention and action control were significant predictors of social distancing behavior in both samples, and intention predicted action and coping planning in the US sample. Self-efficacy and action control were significant predictors of intention in both samples, with attitudes predicting intention in the Australia sample and risk perceptions predicting intention in the US sample. Significant indirect effects of social cognition constructs through intentions were observed. Inclusion of past behavior attenuated model effects. Multigroup analysis revealed no differences in model fit across samples, suggesting that observed variations in the parameter estimates were relatively trivial.ConclusionResults indicate that social distancing is a function of motivational and volitional processes. This knowledge can be used to inform messaging regarding social distancing during COVID-19 and in future pandemics.

Applying health psychological theories can improve communication interventions to empower pregnant women and ensure safe births. The aim was to test a short digital communication intervention based on the health action process approach. A randomized‐controlled trial was conducted with pregnant women at two German university hospitals. The intervention group (NT1 = 225; NT2 = 142) received a 2.5 h online training focusing on communication planning, self‐efficacy and communicating personal needs and preferences under difficult circumstances. This group was compared with a passive control group (NT1 = 199; NT2 = 144). Data from the N = 286 women with complete datasets were used for multilevel analyses. Data from all recruited N = 424 women were used for intention‐to‐treat analyses with multiple imputation. Both groups improved regarding communication behavior, quality of birth, action planning, coping planning and coping self‐efficacy after birth, which was more pronounced in the intervention group. The intention‐to‐treat analyses confirmed the higher improvement for communication behavior, perceived quality of birth and coping planning. The intervention was related to improvements in pregnant women's communication behavior and quality of birth. Hence, future research and practice should apply and evaluate health psychological theories when targeting communication and empowerment. [ABSTRACT FROM AUTHOR]

Based on the health action process approach (HAPA) this study examined whether changes in social cognition constructs could predict change in physical activity and fruit and vegetable intake for adult participants in My health for life, an Australian health promotion behaviour change program. Variance-based structural equation modelling was used to analyse data obtained from Australian adult program participants (n  = 167) at baseline (T1), week 14 (T2), week 26 (T2), and 6-month post-program (T4). Change scores were calculated for the social cognition constructs and behaviour. Changes in action self-efficacy and outcome expectancies positively predicted changes in intentions. Action self-efficacy changes also predicted changes in maintenance self-efficacy which, in turn, mediated the effect of action self-efficacy on recovery self-efficacy and planning. Planning was predicted by changes in intentions and maintenance self-efficacy. Findings support the use of the HAPA model in designing complex health behaviour change interventions to achieve sustained behaviour change. [ABSTRACT FROM AUTHOR]

Background: The postmenopausal period can represent an opportunity for women to improve their health and well-being. The Active and Healthy Ageing in Women during early postmenopause (AHAWOMEN) study aims to identify the key determinants of an active lifestyle among middle-aged women, with a focus on the stages and the social-cognitive variables outlined in the Health Action Process Approach (HAPA) model, a theoretical framework for understanding health behaviour change. We expected that HAPA factors and processes of intention creation (motivational phase) and action adoption (volitional phase) will be significant predictors of exercise initiation and maintenance, supporting both the HAPA tenets and the efficacy of HAPA-based interventions. Methods/design: This study was approved by the authors' Institutional Review Committee. Postmenopausal women aged between 45 and 65 years will voluntarily participate. The participants will be allocated to one of three groups: Intervention-Initiators (n = 100, random allocation), Control-Sedentary (n = 100, random allocation) or Control-Active (n = 100, non-random allocation). The intervention group will engage in a supervised exercise programme lasting at least 3 months, supplemented with a HAPA-based intervention for behaviour change. The sedentary control group will not receive any intervention to change their physical activity, while the active control group will consist of women who are already regularly adhering to an active lifestyle. Study variables will be measured at baseline and postintervention phases, as well as at 1, 3, 6 and 12-month follow-ups. The predictors of exercise behaviour in the different phases of the behavioural change process will be explored and compared within and between groups throughout the study. These analyses will help identify the factors that determine the adoption of a healthy active behaviour. Additionally, the effectiveness of the model and the intervention for changing active behaviour will be evaluated. Discussion: This paper describes the rationale, development and methods used in the AHAWOMEN project. Supporting women who intend to become active can help them to translate their goals into sustainable action. Verifying that the HAPA predictions are applicable to postmenopausal women's adoption of exercise would provide the basis for designing effective interventions for promoting healthy and active ageing that are also tailored to the experiences of middle-aged women. Trial registration: ISRCTN16251361. Registration date: 01/06/2023 (retrospectively registered). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

BACKGROUND: Type 2 diabetes is the most common type of diabetes, and dietary adherence is a self-care practice. This research aims to improve dietary adherence among type 2 diabetics in Zahedan using the HAPA model. METHODS: In this cross-sectional study, a total of 210 type 2 diabetics admitted to hospital clinics in Zahedan during summer 2022 were selected. The intervention group (n = 105) and the control group (n = 105) were from hospitals in Zahedan. Samples were selected by the simple random sampling method among the diabetics. After data collection using the demographic characteristics questionnaire and the Dietary Adherence Questionnaire and the HAPA model constructs questionnaire, the pre-test analysis was performed. One and three months after the educational intervention, the questionnaires on HAPA model constructs and self-care behavior were filled out by the patients. Next, data were analyzed using independent t-test, chi-square test, and the Shapiro-Wilk test in SPSS 23. RESULTS: The results showed that all of the HAPA model constructs had significant differences, one and three months after the educational intervention (P = 0.001), indicating the effectiveness of education in the intervention group. However, there was no significant difference in the control group (P = 0.009). CONCLUSION: After the intervention using the HAPA model, the model's constructs had a significant impact on the patients' selfcare of dietary adherence following the training. [ABSTRACT FROM AUTHOR]

Objective　Help stable patients with coronary heart disease effectively improve exercise compliance after discharge, and achieve self-health management for patients with coronary heart disease. Methods　70 patients with stable coronary heart disease were divided into control group （35 cases) and intervention group (35 cases) by random number table method. The control group recieved cardiac rehabilitation nursing, while the intervention group recieved a “ HAPA quantitative exercise management model based on excellent care platform” in cardiac rehabilitation nursing care. The effect of "HAPA quantified exercise management mode based on excellent care platform on exercise compliance of patients in 2 groups was compared and analyzed. Results　After 12 weeks of intervention, the exercise frequency in the intervention group was significantly higher than that in the control group (P < 0.05). After 12 weeks of intervention, the exercise time in the intervention group was longer than that in the control group, with a statistically significant difference (P < 0.05). Repeated measurement ANOVA was performed on the weekly exercise time of the two groups, and the time effect, inter-group effect and interaction effect were statistically significant (P < 0.01). At 6 weeks and 12 weeks after intervention, the weekly exercise duration in the intervention group was better than that in the control group, with statistical significance (P < 0.05). The duration of exercise per week in the intervention group was better than that in the control group as time progressed. Conclusion　HAPA quantitative exercise management based on the excellence care platform" can effectively improve the exercise compliance of patients with stable coronary heart disease. The quantified FITT exercise management solution fits patients’ exercise preferences while promoting safe, regular exercise. According to different behavioral stages of patients, HAPA implements corresponding quantitative exercise management measures to promote the transformation of patients’ motor behavior intentions into external behaviors. The use the excellent care platform to supervise and guide the quantitative exercise management of HAPA effectively guarantees the generation and maintenance of exercise behavior in patients with coronary heart disease. [ABSTRACT FROM AUTHOR]

Objective: Hand washing and sleep hygiene are two important health behaviors. The purpose of the current study was to identify the motivational and volitional antecedents of college students' hand washing and sleep hygiene behaviors based on an integrated model of behavior that combined social-cognition constructs from the Theory of Planned Behavior (TPB) and Health Action Process Approach (HAPA). Methods: Using a prospective design, college students (N = 1106) completed a survey assessing the motivational constructs of action self-efficacy, attitudes, subjective norm, perceived behavioral control, intentions, and behaviors of hand washing and sleep hygiene at Time 1. Demographic variables were also collected. One month later, at Time 2, college students (N = 524) self-reported on their volitional factors of maintenance self-efficacy, action planning, coping planning, and behaviors of hand washing and sleep hygiene. A further 2 months later, at Time 3, college students (N = 297) were asked to self-report on their hand washing and sleep hygiene behaviors over the past month. Findings: Data were analyzed using variance-based structural equation modelling. Results showed significant direct effects of attitudes, subjective norm, and perceived behavioral control on intentions; significant direct effects of action self-efficacy on maintenance self-efficacy; and significant direct effects of maintenance self-efficacy on action planning and coping planning. Significant direct effects of intention on action planning (sleep hygiene only), and significant direct effects of intention, maintenance self-efficacy (hand washing only), action and coping planning on behavior were also observed. Action planning also moderated the intention-behavior relationship, but only for hand washing. There were also significant total indirect effects of action self-efficacy on behavior mediated by maintenance self-efficacy, action planning, and coping planning for both behaviors, and significant total indirect effects of subjective norm and perceived behavioral control on behavior mediated by intention for sleep hygiene. When past behavior was included in the integrated model predicting all the psychological variables and behavior, all of the structural relations were attenuated. Discussion: Current findings indicate that college students' hand washing and sleep hygiene behaviors are a function of both motivational and volitional factors. Findings also indicate that the TPB and HAPA pathways might differ for the two health behaviors. Implications of the current findings for future health interventions aimed at improving college students' hand washing and sleep hygiene are discussed.

Abstract Background This study aimed to determine the predictors of colorectal cancer screening intention based on the integrated theory of planned behavior among average -risk individuals in Urmia. Identifying these predictors will help design and implement various interventions, including educational interventions, according to the needs of this group, thereby taking a step towards improving the colorectal cancer screening index. Methods The present cross-sectional study was performed on 410 individuals at average risk of colorectal cancer referring to the comprehensive health services centers of Urmia in Iran. The data collection tool was a researcher-made questionnaire consisting of two parts. The first part captured the demographic information and medical history of the participants. The second part involved questions designed based on constructs of motivational phase of health action process approach, and theory of planned behavior, as well as behavioral intent to perform colorectal cancer screening. Data analysis was performed using SPSS software. Results Outcome expectancies, risk perception, action self-efficacy, and normative beliefs, respectively had the largest impact and were significant and positive predictors of colorectal cancer screening intention. The study’s conceptual framework explained about 36% of the variance of behavioral intention among the average-risk individuals in Urmia. Conclusions Constructs of motivational phase of health action process approach, and theory of planned behavior are valuable and appropriate to identify the factors affecting the intention to undergo colorectal cancer screening as well as to design and implement educational interventions in this field. The four constructs of outcome expectancies, risk perception, action self-efficacy, and normative beliefs are suggested to be integrated into all educational interventions designed and implemented to improve the colorectal cancer screening index.

Vaccination is considered a practical approach to improving individuals' health behavior to fight against the COVID-19 pandemic. However, the currently manufactured COVID-19 vaccines can only work for a limited time. Thus, continuous vaccination intention is crucially essential. The current study explores critical factors influencing citizens' continuous vaccination intentions for COVID-19 vaccines, based on the modified health action process approach (HAPA) model and belief in a conspiracy theory. A questionnaire survey was used to collect data from people living in Taiwan. Three hundred ninety responses were employed for the final investigation. The findings suggest that openness to experience, government communication, and pandemic knowledge significantly influence vaccination intention, but the COVID-19 threat is insignificant. Second, descriptive norms play a significant role in promoting vaccination intention. Third, a belief in conspiracy theories negatively influences vaccination intention. Fourth, vaccination behavior positively influences both perceived benefits and value co-creation. Fifth, perceived benefits positively impact value co-creation and continuous vaccination behavior. Finally, value co-creation has a significant influence on continuous vaccination behavior. The proposed model, the key contributor to the current study, confirms citizens' continuous vaccination intentions in a three-stage procedure: motivation to volitional, volitional to behavior, and volitional to continuous vaccination intention. [ABSTRACT FROM AUTHOR]

Personal hygiene including wearing facemask and washing hands are instrumental to reduce transmission of COVID-19. The present study applied the health action process approach (HAPA) to examine the process from intention to protective behaviors in the early stages of the COVID-19 pandemic. A longitudinal online survey study was conducted among 229 individuals (61.6% females; Mage = 25.37 years, SDage = 8.34 years) living in Hubei province, China. Action self-efficacy, outcome expectancy, risk perception, intention, planning and action control regarding facemask wearing and hand washing were assessed at baseline (Time 1), and behaviors were assessed a week later (Time 2). Data were collected from 30 January to 16 February 2020. Two structural equation models were specified to test the theory-driven determinants of the facemask wearing and hand washing respectively. The results showed that action self-efficacy predicted intentions to wear facemasks and wash hands. Intention and action control predicted both behaviors at Time 2. Associations between planning and behaviors were mixed. Mediation analyses revealed that action control significantly mediated the relationship between intention and both behaviors (facemask wearing: 90% CI [0.01, 0.12]; hand washing: 95% CI [0.01, 0.21]). Planning did not mediate the relationship between intention and the two behaviors. The findings illustrate that action self-efficacy is positively associated with intention to facemask wearing and hand washing, and action control contributes to bridging intention to behaviors. Both motivational and volitional factors warrant consideration in interventions to improve adherence to facemask wearing and hand washing in COVID-19. [ABSTRACT FROM AUTHOR]

OBJECTIVE:Consumption of excess added sugar in the form of sugar-sweetened beverages (SSBs) contributes to a wide range of health concerns in adolescents. Identification of modifiable determinants of SSB consumption based on behavioral theory may inform development of interventions aimed at reducing SSB consumption. The aim of the current study was to test the efficacy of an extended version of the Health Action Process Approach to predict adolescent SSB consumption. METHODS:Using a prospective design, adolescent students (N = 450) self-reported their outcome expectancies, perceived behavioral control, intentions, habit, action, maintenance, and recovery self-efficacy, action and coping planning, perceived affordability, and past behavior with respect to SSB consumption. One month later, participants self-reported their SSB consumption. RESULTS:A structural equation model revealed significant direct effects of action self-efficacy, outcome expectancies, and perceived behavioral control on intentions to reduce SSB consumption. Significant direct effects of action self-efficacy on maintenance self-efficacy, and maintenance self-efficacy on recovery self-efficacy, were also identified. There were significant direct effects of intentions and maintenance self-efficacy on action and coping planning. Only intentions and perceived affordability had significant direct effects on SSB consumption. There were also indirect effects of outcome expectancy and perceived behavioral control on SSB consumption mediated by intentions. Inclusion of past behavior attenuated model effects, with past behavior the only remaining predictor of SSB consumption. CONCLUSIONS:Findings indicate that adolescent SSB consumption is predicted by intentions and perceived affordability, but effects were extinguished by the inclusion of past behavior. The pervasive effects of past behavior point to the importance of identifying potential mediators of past behavior in future research, and that interventions targeting non-conscious rather than intentional processes may be most effective in reducing SSB consumption.

Background: Medication adherence is an indispensable prerequisite for the long-term management of many chronic diseases. However, published literature suggests that non-adherence is widely prevalent. Health behavior change theories can help understand the underlying processes and allow the accumulation of knowledge in the field. The present study applied the health action process approach (HAPA) in an intensive longitudinal research design to investigate medication adherence in patients after discharge from inpatient cardiac rehabilitation. Method: In total, n = 139 patients (84.9% male, Mage = 62.2 years) completed n = 2,699 daily diaries in the 22 days following discharge from inpatient cardiac rehabilitation. Patients' intentions to take medication and predictors were assessed in daily end-of-day questionnaires. Adherence to medication was measured subjectively (self-report) and objectively. Multilevel modeling was applied to disentangle the between- and within-person level. Results: Higher levels of risk awareness and self-efficacy were positively associated with intentions to take medication at both levels of analysis. Contrary to theoretical assumptions, positive outcome expectations were not associated with intention, neither between- nor within-person. In contrast to published literature, patients showed very high medication adherence (95.2% self-report, 92.2% objectively). Conclusion: In line with the theoretical assumptions, the results showed that risk awareness and self-efficacy are promising modifiable factors that could be targeted to motivate patients to take medication as prescribed. Daily measurements revealed that patients took their medication as prescribed; thus, future studies should make every effort to recruit patients vulnerable to non-adherence to avoid ceiling effects. [ABSTRACT FROM AUTHOR]

The coronavirus pandemic has influenced many lives, particularly older adults'. Although isolation protects from infection, health behaviors like physical activity (PA) are important to reinstate after lockdown. However, fear of Covid‐19 may act as a barrier, for example, by preventing people from going outside. Based on the health action process approach (HAPA), we investigated whether and why older adults' PA changed after lockdown, and whether fear of Covid‐19 moderates the intention–behavior relationship. Participants of this longitudinal study aged 65+ from German‐speaking Europe completed an online questionnaire about their PA, fear of Covid‐19, and HAPA factors in April and May 2020. Data were analyzed using multiple linear regressions. Results showed that moderate to vigorous activity (MVPA) remained stable after lockdown and that self‐efficacy most robustly influenced the intention to be active. PA was not explained by any volitional factor but was strongly related to past PA. Interestingly, the relationship of past and future MVPA was attenuated by fear of Covid‐19, but this finding was not robust when outliers were removed. In conclusion, self‐efficacy is the most important motivator for PA in older adults after an interruption like a lockdown. Strong physical activity habits may facilitate PA after a period of isolation. [ABSTRACT FROM AUTHOR]

Objective: The Lifestyle-integrated Functional Exercise (LiFE) intervention has been shown to promote physical activity in fall-prone older adults. However, the underlying mechanisms of how LiFE functions remain unclear. This study compares the effects of the individual and group-based LiFE formats on psychological determinants of behavior change derived from the health action process approach, habit formation theory, and self-determination theory. Methods: Secondary analysis on basis of the randomized, non-inferiority LiFE-is-LiFE trial were performed. Questionnaire data on psychological determinants were obtained from older adults (M = 78.8 years, range 70–95) who took part in either the individual (n = 156) or the group-based (n = 153) LiFE intervention. Measurement points varied from three to six times, and from baseline (T1) up to a 12-month follow-up (T6). A generalized linear mixed model was specified for each determinant. Results: Both LiFE and gLiFE participants reported lower levels of motivational determinants at T6. LiFE participants showed significantly higher values of action planning and coping planning at T6. Participants in both formats showed increased levels of action control at T6, whereas participants' habit strength decreased post-intervention but then stabilized over time. LiFE participants showed higher levels of autonomy, competence, and relatedness throughout the study, but levels of intrinsic motivation did not differ between formats and from T1 to T6. Conclusion: In both formats, but especially in the individual LiFE, the behavior change techniques used affected volitional rather than motivational or general determinants of behavior change. Habit strength as an important indicator of the sustainability of the LiFE exercises stabilized over time, indicating that participants, at least partly, sustained their formed habits long-term. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to systematically map the Health Action Process Approach (HAPA)‐based interventions in dentistry in relation to the type of intervention, the target groups and the constructs of the HAPA model that are used in the study and to assess the clinical relevance of the studies. Methods: A search in the databases of the National Library of Medicine (MEDLINE‐PubMed), PsychINFO and Cochrane‐CENTRAL was conducted. A quality assessment to estimate the risk of bias and a qualitative descriptive analysis were performed. The overall gathered evidence was graded. Results: Ten randomized controlled trials and three observational studies thus in total 13 studies were included. Flossing was the targeted behaviour in ten studies. The target groups consisted of students, adolescents and dental patients. Overall, all nine HAPA constructs were used, but only one study used all HAPA constructs. Six studies presented the used behavioural change techniques according to the BCT taxonomy. Based on the number of the used constructs, only two studies were classified as HAPA intervention studies. The most frequently used constructs were action control as an intervention and behaviour as an outcome measure. The overall evidence was graded with moderate certainty. Conclusion: In the majority of the studies, the targeted intervention was flossing and the population consisted of students, adolescents and dental patients. All studies used only a selection of the HAPA constructs. Therefore, only a minority of the studies can be considered real HAPA intervention studies. [ABSTRACT FROM AUTHOR]

Background: Medical internet interventions such as asynchronous apps and synchronous digital live seminars can be effective behavior change interventions. The research question of this study was whether digital interventions based on the Health Action Process Approach can improve pregnant women's safe communication and patient safety in obstetric care. Objective: This study aims to compare a digital live seminar with a web-based application intervention and a passive control group and to identify which social cognitive variables determine safe communication behavior and patient safety. Methods: In total, 657 pregnant women were recruited, and hereof, 367 expectant mothers from 2 German university hospitals participated in the pre-post study (live seminar: n=142; web-based app: n=81; passive control group: n=144). All interventions targeted intention, planning, self-efficacy, and communication of personal preferences. The 2.5-hour midwife-assisted live seminar included exercises on empathy and clear communication. The fully automated web-based application consisted of 9 consecutive training lessons with the same content as that of the live seminar. Results: Controlled for sociodemographic characteristics, repeated measures analyses of covariance revealed that pregnant women significantly improved their self-reported communication behavior in all groups. The improvement was more pronounced after the digital live seminar than after the web-based application (P<.001; ηp²=0.043). Perceived patient safety improved more for pregnant women participating in the live seminar than for those participating in the web-based application group (P=.03 ηp²=0.015). A regression analysis revealed that social cognitive variables predicted safe communication behavior. Conclusions: Overall, the web-based application intervention appeared to be less effective than the digital live training in terms of communication behavior. Application interventions addressing communication behaviors might require more face-to-face elements. Improving intention, coping planning, and coping self-efficacy appeared to be key drivers in developing safe communication behavior in pregnant women. Future research should include social learning aspects and focus on the practical application of medical internet interventions when aiming to improve pregnant women's communication and patient safety in obstetrics. [ABSTRACT FROM AUTHOR]

Adherence to the use of child restraint system (CRS) can greatly reduce child casualties in road traffic accidents. This study aims to develop the behavior maintenance model of CRS use based on the health action process approach (HAPA) theory to explore the maintenance mechanisms, suggesting appropriate intervention strategies. Adopting the multi-stage stratified cluster random sampling method, a cross-sectional survey for guardians recruited from kindergarten and primary school was conducted using the questionnaire developed based on the HAPA theory in Nanjing, China, and 1135 valid samples were finally obtained. Rigorous analysis procedures of the partial least squares structural equation modeling (PLS-SEM) method were applied by using SmartPLS3.3.2 software. The results confirmed that action self-efficacy (β = 0.479, P < 0.001) and negative outcome expectancy (β = −0.187, P < 0.001) were valid predictors of intention in the non-intentional stage, intention (β = 0.488, P < 0.001) and maintenance self-efficacy (β = 0.334, P < 0.001) contributed significantly to action planning in the intentional stage, while action planning (β = 0.470, P < 0.001) and recovery self-efficacy (β = 0.256, P < 0.001) jointly determined behavior maintenance in the action stage. It was also revealed that action planning fully mediated the relation between intention and behavior maintenance (β = 0.229, P < 0.001). Based on the above mechanisms, interventions aimed at the stages of non-intention, intention, and action should be designed and implemented, with the participation of the government, automobile dealers, and communities to promote the maintenance of improved CRS use behavior. [ABSTRACT FROM AUTHOR]