The Role of Compensatory Beliefs in Rationalizing Environmentally Detrimental Behaviors.

Compensatory green beliefs (CGBs) reflect the idea that a pro-environmental behavior (e.g., recycling) can off-set the negative effects of an environmentally detrimental behavior (e.g., driving). It is thought that CGBs might help explain why people act in ways that appear to contradict their pro-environmental intentions, and inconsistently engage in pro-environmental behaviors. The present study sought to investigate the nature and use of CGBs. A series of interviews suggested that participants endorsed CGBs to (a) reduce feelings of guilt with respect to (the assumed or actual) negative environmental impact of their actions and (b) defend their green credentials in social situations. Participants also justified detrimental behaviors on the basis of higher loyalties (e.g., family's needs), or the perceived difficulty of performing more pro-environmental actions. In addition to shedding light on how, when, and why people might hold and use CGBs, the research also provides new insight into how CGBs should be assessed.

The assessment of depression in people with multiple sclerosis: a systematic review of psychometric validation studies.

BACKGROUND: The prevalence of depression in people with multiple sclerosis (PwMS) is high; however, symptoms common to both conditions makes measurement difficult. There is no high quality overview of validation studies to guide the choice of depression inventory for this population. METHODS: A systematic review of studies validating the use of generic depression inventories in people with MS was conducted using MEDLINE and PsycINFO. Studies validating the use of depression inventories in PwMS and published in English were included; validation studies of tests for cognitive function and general mental health were excluded. Eligible studies were then quality assessed using the COSMIN checklist and findings synthesised narratively by instrument and validity domain. RESULTS: Twenty-one studies (N = 5,991 PwMS) evaluating 12 instruments were included in the review. Risk of bias varied greatly between instrument and validity domain. CONCLUSIONS: The review of validation studies was constrained by poor quality reporting and outcome reporting bias. Well-conducted evaluations of some instruments are unavailable for some validity domains. This systematic review provides an evidence base for trade-offs in the selection of an instrument for assessing self-reported symptoms of depression in research or clinical practice involving people with MS. We make detailed and specific recommendations for where further research is needed. TRIAL REGISTRATION: PROSPERO CRD42014010597.

Are diet-specific compensatory health beliefs predictive of dieting intentions and behaviour?

Compensatory Health Beliefs (CHBs) - beliefs that an unhealthy behaviour can be compensated for by healthy behaviour - are hypothesised to be activated automatically to help people resolve conflicts between their desires (e.g. eat chocolate) and their long-term goals (e.g. dieting). The aim of the present research was to investigate diet-specific CHBs within the context of a theoretical framework, the Health Action Process Approach (HAPA), to examine the extent to which diet-specific CHBs contribute to dieting intentions and dietary intake. Seventy-five dieting women were recruited in Switzerland and England and were asked to complete measures of diet-specific CHBs, risk perception, outcome expectancies, self-efficacy, intention, and behaviour. Path modelling showed that, overall, diet-specific CHBs were not related to dieting intentions (ß=.10) or behaviour (ß=.06) over and above variables specified in the HAPA. However, risk perception moderated the relationship between diet-specific CHBs and intention (ß=.26). Diet-specific CHBs positively predicted intention in women with high risk perception, but not in women with low risk perception. This positive relationship might be explained by the assumption that CHBs play different roles at different stages of the health-behaviour change process. Future studies should further examine moderators and stage-specific differences of the associations between CHBs, intention and health-behaviour change.

Capability, Opportunity, and Motivation Model for Behavior Change in People With Asthma: Protocol for a Cross-Sectional Study.

BACKGROUND: Asthma is a common lung condition that cannot be cured, but it can usually be effectively managed using available treatments. Despite this, it is widely acknowledged that 70% of patients do not adhere to their asthma treatment. Personalizing treatment by providing the most appropriate interventions based on the patient's psychological or behavioral needs produces successful behavior change. However, health care providers have limited available resources to deliver a patient-centered approach for their psychological or behavioral needs, resulting in a current one-size-fits-all strategy due to the nonfeasible nature of existing surveys. The solution would be to provide health care professionals with a clinically feasible questionnaire that identifies the patient's personal psychological and behavioral factors related to adherence. OBJECTIVE: We aim to apply the capability, opportunity, and motivation model of behavior change (COM-B) questionnaire to detect a patient's perceived psychological and behavioral barriers to adherence. Additionally, we aim to explore the key psychological and behavioral barriers indicated by the COM-B questionnaire and adherence to treatment in patients with confirmed asthma with heterogeneous severity. Exploratory objectives will include a focus on the associations between the COM-B questionnaire responses and asthma phenotype, including clinical, biological, psychosocial, and behavioral components. METHODS: In a single visit, participants visiting Portsmouth Hospital's asthma clinic with a diagnosis of asthma will be asked to complete a 20-minute questionnaire on an iPad about their psychological and behavioral barriers following the theoretical domains framework and capability, opportunity, and motivation model. Participants' data are routinely collected, including demographics, asthma characteristics, asthma control, asthma quality of life, and medication regime, which will be recorded on an electronic data capture form. RESULTS: The study is already underway, and it is anticipated that the results will be available by early 2023. CONCLUSIONS: The COM-B asthma study will investigate an easily accessible theory-based tool (a questionnaire) for identifying psychological and behavioral barriers in patients with asthma who are not adhering to their treatment. This will provide useful information on the behavioral barriers to asthma adherence and whether or not a questionnaire can be used to identify these needs. The highlighted barriers will improve health care professionals' knowledge of this important subject, and participants will benefit from the study by removing their barriers. Overall, this will enable health care professionals to use effective individualized interventions to support improved medication adherence while also recognizing and meeting the psychological needs of patients with asthma. TRIAL REGISTRATION: ClinicalTrials.gov NCT05643924; https://clinicaltrials.gov/ct2/show/NCT05643924. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44710.

Breakfast skipping and its relation to BMI and health-compromising behaviours among Greek adolescents.

OBJECTIVE: The increasing prevalence of obesity worldwide is a major health concern. Our study, which is part of the First National Epidemiological Study of Obesity in Greece, aimed to assess (i) breakfast habits and their relationship to BMI in Greek adolescents, as well as (ii) breakfast skipping in relation to other health behaviours. DESIGN: Epidemiological survey throughout Greece. Participants completed a questionnaire concerning breakfast habits and many lifestyle parameters. SETTING: The survey was conducted in schools throughout Greece. SUBJECTS: Anthropometric measurements were performed on 6500 boys and 7778 girls, aged 13-19 years, from schools throughout Greece. RESULTS: Among both boys and girls, breakfast consumers had a lower BMI than breakfast skippers. Moreover, breakfast skippers among both boys and girls were found to smoke more than breakfast consumers. The proportion of boys and girls who ate breakfast was found to be greater among those who had never been on a diet than among those who had already experienced dieting. Leisure-time activity was greater in breakfast consumers than breakfast skippers; among boys, 71.8 % of breakfast consumers walked compared with 66.4 % of breakfast skippers, whereas 38.4 % and 35.0 %, respectively, exercised. Among girls, these percentages were 73.1 % v. 68.7 % for walking and 36.7 % v. 31.5 % for exercising. CONCLUSIONS: We found that breakfast skipping can be part of a constellation of several unhealthy lifestyle parameters and is related to higher BMI in Greek adolescents.

Marital status and educational level associated to obesity in Greek adults: data from the National Epidemiological Survey.

BACKGROUND: Obesity is an important public health issue and its prevalence is reaching epidemic proportions in both developed and developing countries. The aim of the present study was to determine associations of overweight (OW), obesity (OB) and abdominal obesity (AO) with marital status and educational level in Greek adults of both genders based on data from the National Epidemiological Survey on the prevalence of obesity. METHODS: The selection was conducted by stratified sampling through household family members of Greek children attending school during 2003. A total of 17,341 Greek men and women aged from 20 to 70 years participated in the survey and had anthropometric measurements (height, weight, and waist circumference) for the calculation of prevalence of OW, OB and AO. WHO cut-offs were used to define overweight and obesity categories. Waist circumference of more than 102 cm in men and 88 cm in women defined AO. Marital status and educational level were recorded using a specially designed questionnaire and were classified into 4 categories. RESULTS: The overall prevalence of OB was 22.3% (25.8% in men, 18.4% in women), that of OW 35.2% (41.0% in men, 29.8% in women) and that of AO 26.4% in men and 35.9% in women. A higher risk of OB was found in married men (OR: 2.28; 95% CI: 1.85-2.81) and married women (OR: 2.31; 95% CI: 1.73-3.10) than in the respective unmarried ones. Also, a higher risk of AO was found in married men (OR: 3.40; 95% CI: 2.86-4.03) and in married women (OR: 2.40; 95% CI 2.00-2.88) compared to unmarried ones. The risk for being obese was lower among educated women (primary school, OR: 0.76; 95% CI: 0.60-0.96, high school, OR: 0.58; 95% CI: 0.46-0.74 and University, OR: 0.64; 95% CI: 0.49-0.81) than among illiterates. No significant differences were found among men. CONCLUSIONS: In Greek adults, marital status was significantly associated with obesity and abdominal obesity status in both genders while educational level was inversely associated with obesity status only in women.

A further look into compensatory health beliefs: a think aloud study.

OBJECTIVES: Compensatory health beliefs are hypothesized to be a means by which people compensate for the negative effects of performing an unhealthy behaviour by engaging in a health-protective behaviour (Knäuper, Rabiau, Cohen, & Patriciu, 2004). However, the measurement of compensatory health beliefs has proven problematic (e.g., Radtke, Scholz, Keller, Perren, & Hornung, 2010) and so the aims of the present study are to identify: (a) the kinds of difficulties that people experience when completing compensatory health belief scales; and (b) what steps will be required to develop a future reliable and valid measure of compensatory health beliefs. DESIGN: Cross-sectional survey. METHODS: Forty-three participants (M = 34.98 years, SD = 13.94) completed the compensatory health beliefs questionnaire while thinking aloud. Participants' responses to the compensatory health beliefs scale were coded using French, Cooke, McLean, Williams, and Sutton's (2007) schedule. RESULTS: Consistent with prior research, the full compensatory health beliefs scale showed evidence of internal reliability, and face validity. Participants identified several conceptual ambiguities, most notably: (a) between belief- and behaviour-based compensation (i.e., participants did not believe in the compensatory health belief, but still engaged in the affiliated compensatory behaviour), and (b) the 'effectiveness' of the beliefs (i.e., participants talked about engaging in the compensatory behaviour, but acknowledged that it was only a partial solution). CONCLUSIONS: Although the compensatory health belief subscales lack reliability, the measure as a whole possesses face validity. Further work is required to refine the compensatory health beliefs scale by discriminating between compensatory health beliefs and compensatory health behaviours. STATEMENT OF CONTRIBUTION: What is already known on this subject? Although the idea that people use compensatory health beliefs as a strategy to continue engaging in unhealthy behaviours is an appealing one, attempts to measure compensatory health beliefs has produced mixed findings (see Kaklamanou & Armitage, ; Knäuper et al., ; Nooijer, Puijk-Hekman, & Assema, ; Radtke et al., ). What does this study add? The present study, using a 'think aloud technique', suggests ways to improve reliability of the compensatory health beliefs scale. We suggest that three sub-strategies underpin the 'activate Compensatory Health Beliefs' strategy. We propose a new construct that we call 'compensatory health behaviours'.

Association of physical activity and sedentary lifestyle patterns with obesity and cardiometabolic comorbidities in Greek adults: data from the National Epidemiological Survey.

OBJECTIVE: To investigate the association between physical activity (PA) and sedentary lifestyle (SL) patterns with overweight (OW), obesity (OB), abdominal obesity (AO) and cardiometabolic comorbidities in Greek adults based on data from the National Epidemiological Survey for the prevalence of obesity. DESIGN: Cross-sectional epidemiological survey. Participants were selected via stratified sampling. 17,887 men and women, 20-70 years old, underwent anthropometric measurements for the estimation of OW, OB and AO prevalence. Assessment of PA, SL patterns and metabolic comorbidities was performed using an in-home questionnaire allowing self-evaluation of diverse activities and self-report for the presence of hypercholesterolemia (HCE), type 2 diabetes mellitus (T2DM) or hypertension (HTN). RESULTS: In men, even small amounts of walking were associated with decreased risk of being OW and AO, while larger amounts were associated with decreased risk of being OB. In women, engagement in entertainment activities for more than 4 hours per week was associated with less risk of being OW. Concerning cardiometabolic comorbidities, substantial improvement was evident mainly for men, e.g. signfiicantly reduced risk for HCE, T2DM and HTN by frequent engagement in exercise. On the other hand, frequent TV watching and long hours of office work significantly increased the risk of HCE and HTN in men. CONCLUSIONS: In Greek adults, and men in particular, walking activity was significantly associated with lower risk for obesity. In addition, frequent exercise and less sedentary behaviour were associated with reduced risk for cardiometabolic factors, mainly hypercholesterolemia and hypertension.

Testing compensatory health beliefs in a UK population.

Compensatory health beliefs, beliefs that healthy behaviours can compensate or neutralise unhealthy behaviours, have been proposed as one way of understanding why people engage in health-risk behaviours (Knäuper, B., Rabiau, M., Cohen, O., & Patriciu, N. (2004). Compensatory health beliefs scale development and psychometric properties. Psychology and Health, 19, 607-624). However, measuring compensatory health beliefs has proved a challenge, with several recent studies being unable to replicate the psychometric properties of Knäuper et al.'s (2004) scales. The aims of this study were to: (1) test the factor structure of the compensatory health beliefs scale in the UK, (2) examine the predictive validity of the scale by testing the relationships between compensatory health beliefs and health behaviours over a six-month time interval and (3) assess the 6-month test-retest reliability of the scale. A total of 393 participants completed measures of compensatory health beliefs and health behaviours at two time points separated by six months. The findings were potentially problematic for research into compensatory health beliefs: the factor structure was not confirmed, there was little evidence of predictive validity, and test-retest reliability was poor. Further research is required to understand the operation of compensatory health beliefs and to develop the measurement of compensatory health beliefs.