The relative efficacy of telephone and email reminders to elicit blood donation.

The aim of the study was to test the relative efficacy of telephone and email reminders to trigger blood donation. A sample of 3454 donors was randomized to one of three conditions: phone only (n = 1176), email only (n = 1091) and phone + email (n = 1187). There was a higher proportion of donors who registered to give blood in the phone + email condition (18·45%) compared to the other two conditions (phone: 15·73%, P < 0·05; email: 13·20%; P < 0·001); this effect was apparent only in men. The phone and email conditions did not differ significantly (P = 0·16), suggesting equivalent efficacy.

Behavioural determinants of salt consumption among hypertensive individuals.

BACKGROUND: High salt consumption among populations remains a challenge for health professionals dealing with prevention and control of hypertension. The present study aimed to identify the psychosocial predictors of salt consumption among hypertensive individuals, based on an extended version of the Theory of Planned Behaviour (TPB). Three salt consumption behaviours were studied: Behaviour 1- using <4 g of salt per day during cooking; Behaviour 2- avoiding adding salt/table salt use to the prepared foods; and Behaviour 3- avoiding the consumption of foods with high salt content. METHODS: At baseline (n = 108), TPB and additional variables (self-efficacy, habit, past behaviour, hedonic determinant, self-perceived diet quality) were measured. At 2-month follow-up (n = 95), the three behaviours were assessed. Behaviour and intention were sequentially regressed on the study variables, using polytomous logistic regression and hierarchical linear regression with rank transformation, respectively. RESULTS: Behaviour 1 was predicted by intention [odds ratio (OR) = 6.23; 95% confidence interval (CI) = 1.81-21.52], whereas self-efficacy and habit predicted intention. Behaviour 2 exhibited high score mean and low variation and was predicted by self-perceived diet quality (OR = 2.56; 95% CI = 1.03-6.36). Behaviour 3 was predicted by the hedonic determinant (OR = 1.42; 95% CI = 1.01-1.98). CONCLUSIONS: The results indicate that salt-related behaviours are explained by a variety of determinants. Among these determinants, special consideration should be given to motivational and hedonic aspects.

Determinants of condom use among HIV-positive men who have sex with men.

The main objectives of this study were to identify the determinants of condom use among HIV-positive men having anal sex with HIV-negative men or men of unknown HIV status and moderators of the intention-behaviour relationship. A cohort of 237 sexually active HIV-positive men having sex with men was followed over a period of six months. The cognitive variables measured were guided by an extended version of the theory of planned behaviour. Results indicated that past behaviour (odds ratio [OR] = 9.75; 95% confidence interval [CI]: 4.48-21.26), intention (OR = 3.13; 95% CI: 1.25-7.81), self-efficacy (OR = 3.62; 95% CI: 1.40-9.37) and use of sex drugs (OR = 0.16; 95% CI: 0.06-0.45) contributed to the prediction of 100% condom use. Self-efficacy also interacted with intention as a significant moderator of the intention-behaviour relationship (OR = 20.96; 95% CI: 2.90-151.51). Interventions promoting condom use should increase self-efficacy to use condoms and target users of sex drugs.

The effect of theory-based interventions on physical activity participation among overweight/obese individuals: a systematic review.

Little attention has been paid to the evaluation of the long-term impact of theory-based interventions on physical activity participation among overweight/obese individuals after the interventions have ended. The primary aim of this systematic review was to investigate the long-term effectiveness of theory-based interventions increasing physical activity and identify the most effective techniques for behaviour change among overweight/obese individuals. The secondary aim was to investigate the effect of these interventions on theoretical variables. Eighteen studies were reviewed. Among these studies, three reported significant short-term and two long-term effects of interventions on physical activity participation. Most of the studies observed a significant short- or long-term effect of time on this behaviour. Theoretical frameworks most often applied included the Behavioural Model and the Social Learning/Cognitive Theory. However, few of the studies reported any impact on theoretical variables. The most prevalent techniques consisted of providing opportunities for social comparison and instruction as well as self-monitoring. Leading techniques differentiating the experimental group from the control group included prompting practice and intentions formation and barriers identification. Although the combination of these three techniques appears successful, the long-term impact of theory-based interventions remains ambiguous.

Key beliefs for targeted interventions to increase physical activity in children: analyzing data from an extended version of the theory of planned behaviour.

Given the high prevalence of overweight and low levels of physical activity among children, a better understanding of physical activity behaviour is an important step in intervention planning. This study, based on the theory of planned behaviour, was conducted among 313 fifth graders and their parents. Children completed a computer-based questionnaire to evaluate theoretical constructs and behaviour. Additional information was obtained from parents by means of a questionnaire. Correlates of children's physical activity were intention and self-identity. Determinants of intention were self-efficacy, self-identity, and attitude. Parental variables were mediated through cognitions. Among girls, practicing sedentary activities was an additional negative determinant of intention. Key beliefs of boys and girls were related to time management and difficulties associated with physical activity. For girls, social identification as an active girl was another important belief related to positive intention. This study provides theory-based information for the development of more effective interventions aimed at promoting physical activity among children.

[Psychosocial determinants of drug users to use a new syringe]. / Déterminants psychosociaux d'utilisateurs de drogues d'utiliser une seringue neuve.

BACKGROUND: A limited number of injection drug users are hard to reach through needle-exchange programs. They obtain their injection material from drug-using peers. This dependence on others can make them more at risk of contracting HIV through sharing non-sterile syringes. The aim of this study is to identify determinants of the intention to systematically resort to use of a new syringe by injection drug users rarely or never involved in needle-exchange programs in Quebec. METHODS: A cross-sectional survey was conducted in Québec city by means of a questionnaire measuring variables from the theory of planned behavior and past behavior. Participants (n=97) were recruited by acquaintances who kept regular contacts with the local needle-exchange programs. Multiple linear regression was used to identify the psychosocial determinants of the intention, and beliefs underlying those determinants were identified using multiple logistic regression. RESULTS: Half of participants reported using a new syringe for each injection in the last month. In multivariate analyses, this past behavior together with theory of planned behavior constructs explained 70% of the variation in participants intent to use a new syringe for each injection (control beliefs: beta=0.39; past behavior: beta=0.27; attitude: beta=0.21; perceived behavioral control: beta=0.20; subjective norm: beta=0.12). In logistic regression, six important beliefs were identified. CONCLUSION: This study resulted in the development of a predictive model of intention to use always a new syringe for each injection among a population of injection drug users in Quebec. Study results could serve as the foundation for the development of interventions to promote this behavior.

Associations between dietary patterns and obesity phenotypes.

OBJECTIVE: To examine whether dietary patterns are associated with obesity phenotypes. DESIGN: Cross-sectional study. SUBJECTS: We recruited 664 participants aged between 18 and 55 years. Dietary data were collected from a food frequency questionnaire. A factor analysis was performed to derive dietary patterns. Body mass index (BMI), weight and waist girth were recorded using standard procedures. Fat mass and fat-free mass were assessed by electrical bioimpedance. Obesity was defined as having a BMI> or =30 kg m(-2) and a positive FHO (FHO+) as having at least one obese first-degree relative. RESULTS: Two dietary patterns were identified; Western and Prudent. The Western pattern was mainly characterized by a higher consumption of refined grains, French fries, red meats, condiments, processed meats and regular soft drinks whereas the Prudent pattern was mainly characterized by a higher consumption of non-hydrogenated fat, vegetables, eggs and fish and seafood. Subjects in the top tertile of the Western pattern had higher BMI, weight, waist girth, waist-to-hip ratio and fat mass than those in the lower tertile. In contrast, subjects in the top tertile of the Prudent pattern had lower BMI, weight, waist girth, fat mass, HDL-cholesterol levels, and lower triglyceride levels than those in the lowest tertile. Individuals in the upper tertile of the Western pattern were more likely to be obese (obesity was defined as having a BMI> or =30 kg m(-2)) (OR=1.82, 95% CI 1.16-2.87) whereas those in the upper tertile of the Prudent pattern were less likely to be obese (OR=0.62, 95% CI 0.40-0.96). These latter significant associations were only observed among those with FHO+. No such association was observed among FHO- individuals. CONCLUSION: Individuals having a high score of Western pattern were more likely to be obese and those having a high score of the Prudent pattern were less likely to be obese, and this is particularly among individuals with an FHO+.

Satisfaction with health services for STIs, HIV, AIDS among a high-risk population in West Africa.

The goal of this study was to develop an instrument and assess the degree of satisfaction regarding HIV/STIs services for women working in, associated with, or living in or nearby, prostitution environments. This study took place in seven West-African countries (Benin, Burkina Faso, Ghana, Mali, Niger, Senegal, Togo) participating in the West Africa Aids Program (AIDS3). A validated six-dimension questionnaire was used to interview 698 women. The main inclusion criterion was having had recourse to adapted services offered through the AIDS3 program in the last six months. Results showed that women surveyed are satisfied overall. Two dimensions scored low: 'Technical skills perceived' and 'Accessibility'. Regression analyses showed that those most satisfied were women who had used the adapted services many times and women connected with community groups. Although these results are consistent with results published previously in other contexts, they now allow the AIDS3 program to consider the voices of women rarely listened to: West-African women living and working in prostitution environments.

Factors explaining the intention to give blood among the general population.

BACKGROUND AND OBJECTIVES: The aim of this study was to identify factors explaining the intention to donate blood. MATERIALS AND METHODS: A random sample of 4000 respondents drawn from the general population received a questionnaire by mail. This questionnaire assessed variables as defined by the most prominent social cognitive theories. RESULTS: Overall, the respondents expressed a neutral mean level of intention to give blood in the next 6 months (2.84 on a five-point scale); 56.2% had never given blood in the past. The variables explaining 74% of the variance of intention were: perceived behavioural control (beta = 0.39; P < 0.001); factors facilitating taking action (beta = 0.25; P < 0.001); anticipated regret (beta = 0.16; P < 0.001); moral norm (beta = 0.11; P < 0.001); attitude (beta = 0.08; P < 0.01); level of education (beta = -0.03; P < 0.05); and past experience in giving blood (beta = 0.09; P < 0.001). Nonetheless, the predictive power of perceived behavioural control and moral norm was higher among the ever donors (both at P < 0.01) compared to the never donors, whereas the reverse was observed for attitude (P < 0.05). CONCLUSIONS: People's intentions are mainly determined by perceived barriers and obstacles regarding blood donations. This suggests that promotional strategies should focus on the elimination of barriers to action as well as the development of a higher perception of control. Also, messages should be adapted to the targeted population, based on their previous blood donation behaviour (i.e. never donors vs. ever donors).

Prediction of adherence to antiretroviral therapy: a one-year longitudinal study.

The aim of this longitudinal study was to identify the determinants of adherence to antiretroviral therapy (ART) in HIV patients over a period of 12 months. A total of 376 individuals living with HIV treated with ART participated in the study. Data were collected at baseline and at three, six, nine and 12 months. Variables assessed were adherence, attitude, outcome expectancies, self-efficacy, patient satisfaction with the relationship with their physician, provision of social support, optimism, CD4 cell count, viral load and side effects. Predictors of adherence in the Generalized Estimated Equation (GEE) were: high perception of self-efficacy (OR=1.68; 95%CI 1.27-2.22), positive attitude towards taking medication (OR=1.56; 95%CI 1.18-2.06), not living alone (OR=1.47; 95%CI 1.04-2.08) and being a male (OR=2.81; 95%CI 1.47-5.34). Subsequent analysis showed that a positive attitude towards taking medication was associated with a high level of patient satisfaction with their physician, high perceived social support, being optimistic, living with HIV for five years or less and experiencing no side effects. Also, a strong sense of self-efficacy was associated with positive perception of social support, high level of patient satisfaction with their physician and not living alone. These results suggest that interventions aimed at improving adherence to ART should focus on reinforcing self-efficacy and developing a positive attitude towards taking medication.

The impact of the transmission dynamics of the HIV/AIDS epidemic on sexual behaviour: a new hypothesis to explain recent increases in risk taking-behaviour among men who have sex with men.

Increases in sexually transmitted infections and related high-risk behaviours have been reported among men who have sex with men (MSM) in industrialised countries when effective antiretroviral therapy against HIV infection has become widely available, in the mid-nineties. The reasons for these increases are not fully understood and often conflicting. Prevention fatigue, relapses to unsafe sex, as well as optimism toward the risk of developing AIDS among people living with HIV are not unique to the era of antiretroviral therapy (ART). This has led researchers to highlight the need to investigate other potential reasons that could explain the increase in high-risk taking following the ART introduction. We put forward the hypothesis that the change in the transmission dynamics of the HIV/AIDS epidemic before and after the introduction of ART has contributed to this change in high-risk behaviour. It is suggested that a decline in sexual risk activities has occurred at the population-level following the initial spread of the HIV/AIDS epidemic because AIDS mortality and severe morbidity disproportionately depleted the pool of high-risk taking individuals. As a result, non-volitional changes may have occurred at the individual-level over time because the depletion of this pool of high-risk individuals made it more difficult for the remaining high-risk taking individuals to find partners to engage in risky sex with. Following its introduction, ART has facilitated the differential replenishment of the pool of individuals willing to engage in high-risk taking behaviours because ART reduces AIDS mortality, and morbidity. Consequently, high-risk taking individuals who had previously reduced their level of risky sex non-volitionally (i.e., as a result of the reduced availability of high-risk partners) were able to resume their initial high-risk practices as the pool of high-risk taking individuals replenished over time. Thus, a fraction of the recently reported increase in high-risk sexual activities may be secondary to the fact that those MSM who were unable to engage in their desired high-risky sexual activities (because of reduced availability) are now able to revert to them as the availability of men willing to engage in risky sexual behaviours increases partly due to ART. Therefore, we suggest that a fraction of the changes in individual behaviour are non-volitional and can be explained by a change in "sexual partner availability" due to the transmission dynamics of HIV/AIDS before and after ART. The hypothesis is formulated and explained using simple social network diagrams and the Theory of Planned Behaviour. We also discuss the implication of this hypothesis for HIV prevention.

Evaluation of a theoretically based AIDS/STD peer education program on postponing sexual intercourse and on condom use among adolescents attending high school.

The effectiveness of an intervention based upon the theories of Ajzen and Triandis was evaluated among 698 junior and 306 senior high school students. The intervention to juniors was offered by senior students who were trained during a course integrated into the school curriculum. Respondents in the control and experimental groups completed a questionnaire at baseline and 9 months after the program. Compared to junior respondents in the control group, those in the experimental group positively modified their attitude, perceived behavioral control, personal normative beliefs, perceived role beliefs, anticipated regret and intention with respect to postponing sexual intercourse and with respect to condom use, as well as perceived self-efficacy to negotiate both behaviors. Compared to senior respondents in the control group, those in the experimental group showed a significant positive modification of all the above variables except perceived behavioral control (indirect measure), anticipated regret and intention with respect to postponing sexual intercourse. At post-test, seniors in the experimental group were more likely to use condoms on a regular basis than those in the control group. Program effects occurred among both sexes, but a few differences in response were observed among males and females. Results suggest this type of theory-based program is effective in modifying psychosocial variables related to postponing sexual intercourse and related to condom use among adolescents. Personal involvement in designing intervention appears to be effective in modifying the behavior of peer educators.

Influence of a persuasive strategy on nursing students' beliefs and attitudes toward provision of care to people living with HIV/AIDS.

Based on the theory of planned behavior and the elaboration likelihood model, the aim of this study was to verify the effect of persuasive messages on nursing students' beliefs and attitudes regarding provision of care to people living with HIV/AIDS. The assumption was that a persuasive communication strategy induces a constructive change in beliefs and attitudes regarding provision of care. Baseline data collection was performed among a group of 74 nursing students (experimental group = 27; control group = 47). The questionnaire assessed the variables of the theory of planned behavior (i.e., beliefs, attitudes, perceived behavioral control). The results confirmed that persuasive messages generated a change in beliefs and attitudes of the nursing students concerning providing care to people living with HIV/AIDS. It appears that this strategy of modifying behavioral predispositions is effective and generates cognitive and affective changes. Therefore, educational programs should take these observations into consideration to ensure that future nurses are better prepared to provide appropriate care to people living with HIV/AIDS.

Correctional officers' intention of accepting or refusing to make HIV preventive tools accessible to inmates.

The aim of this study was to identify the factors which explain correctional officers' intention of accepting or refusing to make HIV preventive tools (condoms, bleach, tattooing equipment, and syringes) accessible to inmates. A total of 957 officers completed a questionnaire that took into account determinants from several social-cognitive behavior theories. The results indicated that only 21.4% of officers were favorable toward making accessible all of the preventive tools. The theoretical model explained 87% of the intention variance, p < .0001. Self-efficacy (beta = .35), personal normative belief (beta = .29), social determinants (beta = .21) and the affective dimension of attitude (beta = .19) were significant determinants. Moreover, officers with a high level of intention differed from those with a low level of intention on several points of the theoretical model. In conclusion, the results clearly indicated that several difficulties must be overcome before HIV preventive tools as a whole can be made accessible to inmates.

Correctional officers and prevention of HIV transmission among prisoners.

The problem of HIV transmission in prisons in Québec and elsewhere is increasingly urgent and requires the attention of federal and provincial authorities. Prison officers are among the key players who should be kept in mind when preventive measures are being developed. We reprint the executive summary of a study conducted in federal and provincial prisons in Québec. The goal of the study was to identify the factors influencing prison officers, with respect to whether they would agree or refuse to make accessible the tools needed for the prevention of HIV transmission among inmates (i.e., condoms, bleach, tattooing equipment, and needles). Among the factors studied are officers' perceptions and beliefs as well as their attitudes, perceived social norms, emotions, and perceived barriers with respect to making preventive tools accessible.

Determinants of nurses' adherence to universal precautions for venipunctures.

OBJECTIVES: The aim of this study was to predict and explain nurses' adherence to Universal Precautions (UPs) when performing venipunctures. METHODS: Data were gathered from 156 registered nurses working at a regional hospital. A self-administered questionnaire assessing the psychosocial variables (intention, attitude, subjective norm, perceived control, etc) was completed at baseline, and behavior was self-reported 3 months later. RESULTS: The regression of intention on the variables yielded an adjusted R(2) of 0.68, with perceived barriers (beta =.62, P <.001), social norm (beta =.17, P <.01), and personal normative belief (beta =.19, P <.01) being the significant variables. With respect to the 3-month follow-up, 28% of the variance associated with UPs adherence was explained by intention (beta =.37, P <.001) and perceived behavioral control (beta =.23, P <.05). Moreover, high (n = 116) and low intenders (n = 40) differed on several normative beliefs (P =.0003) and perceived barriers (P =.0001). CONCLUSIONS: It is suggested that perception of control, assessed either globally or by means of a belief-based measure, is a key factor in adherence. Specifically, the perceived difficulties associated with adherence to UPs appear to be related to a nurse's training on UPs and to the existence of suboptimal working conditions.

The impact of new antiretroviral treatments on college students' intention to use a condom with a new sexual partner.

The aim of this study was to evaluate possible changes in predisposing factors in sexual preventive behaviors that could result from the availability of an efficient new antiretroviral therapy. A total of 136 young adults were randomly assigned a vignette to read describing AIDS as a lethal or chronic disease. After reading the vignette, the participants completed a self-administered questionnaire assessing the psychosocial determinants of intention to use a condom with a new sexual partner. The variables were measured according to Ajzen's (1985, 1988, 1991) theory of planned behavior and Triandis's (1977) theory of interpersonal behavior. The experimental manipulation was more successful when the disease was described as lethal (66 of the 68 subjects) rather than chronic (30 of the 68 subjects). For the 96 participants who correctly identified the expected outcome of the disease presented in the vignette, a significant difference in intention was found between the two experimental situations (p < .05). Regression of intention to use condoms on the psychosocial variables yielded an adjusted R2 of .62. Perceived behavioral control, social norms, personal normative belief and anticipated affective reaction were the significant variables explaining this intention. The results suggest that intention to use condoms with a new sexual partner is likely to be modified by the expected outcome of the disease, that is, whether lethal or chronic. Thus, it is suggested that interventions aimed at young adults take into account the impacts the new antiretroviral treatments are likely to have on preventive behaviors.

Seeking medical advice if HIV symptoms are suspected. Qualitative study of beliefs among HIV-negative gay men.

OBJECTIVE: To identify beliefs associated with seeking medical advice promptly when symptoms of HIV infection are suspected among HIV-negative gay men. DESIGN: Qualitative study of beliefs among focus group participants. SETTING: Quebec city, Que, metropolitan area. PARTICIPANTS: Referred sample of 20 HIV-negative gay men 18 to 45 years old who attended bars, university, or gay associations in Quebec city. METHOD: Three focus groups of five to seven subjects were formed and each 2-hour session was tape-recorded. MAIN OUTCOME FINDINGS: Participants thought that seeking medical advice promptly when symptoms of HIV are suspected would help them be informed about their health status and would eliminate unnecessary anxiety and fear, but would force them to face reality and make major changes. Barriers were the quality of the relationship with their physicians and concern about discussing their sexual lives. Normative beliefs were sought from members of community groups, circles of close friends, health providers, and the media. CONCLUSIONS: Several beliefs could influence the motivation of seronegative gay men to seek medical advice promptly when symptoms of HIV infection are suspected. These beliefs should be integrated into programs promoting early consultation with physicians and into clinical counseling, as integration could facilitate early treatment and care. Physicians should give special attention to establishing relationships of trust with these patients.

Determinants of the intention to adopt hormone replacement therapy among premenopausal women.

OBJECTIVE: To identify the psychosocial factors that influence the intention to adopt hormone replacement therapy (HRT) at menopause. METHODS: Random Digit Dialing was used to recruit 644 premenopausal non-hysterectomized women aged 45-54. Data were collected using a telephone questionnaire previously developed according to the theory of planned behaviour. Variables measured were: intention to adopt HRT (INT); attitude towards HRT (Aact); perceived social norm (SN); perceived behavioural control (PBC); and personal normative belief (PNB). Socio-demographic data were also obtained. RESULTS: Stepwise multiple regression of INT on the theoretical variables yielded an R(2) of 0.70. The determinants were Aact (beta=0.39, P<0.001), PNB (beta=0.25, P<0.001), PBC (beta=0.23, P<0.001) and SN (beta=0.12, P<0.001). Women with a strong intention to adopt HRT represented 25% of the sample. These women were more likely to believe that adopting HRT would have the following positive consequences: an improvement in general well-being, the prevention of health problems, an improvement in interpersonal relationships, an increase in productivity, the regulation of mood swings and a reduction of hot flashes. They were also more likely to believe in the following negative consequences: side-effects, an increased risk of cancer, the likelihood of weight gain, and interference in the natural course of menopause (all at P<0.001). CONCLUSION: Actions that target behaviourial beliefs regarding HRT and perceived barriers to its adoption are most likely to influence adoption of HRT.