Communication rules regarding support seeking in patients with a physical illness, according to people with a Surinamese or a Dutch cultural background.

Objective: People with different cultural backgrounds can evaluate the appropriateness of direct and indirect support seeking differently. In this study we explored how direct and indirect communication rules for verbal support seeking by patients with diabetes were perceived among Dutch and Surinamese female participants, and whether the appropriateness differed for the ingroup, outgroup and intercultural support seeker-support provider interactions. Methods: The study applied a 2 (direct versus indirect support seeking) X 2 (Surinamese patient versus Dutch patient) X 2 (Surinamese support provider versus Dutch support provider)-design. Dutch and Surinamese participants (N = 686) were randomly assigned to one of the eight conditions in which they were provided with a depiction of the patient, the direct or indirect request for help, and the help provider. The main outcome was the rated appropriateness of the help-seeking request in the specific context. Results: The results revealed a significant main effect of communication style: both, Surinamese and Dutch participants evaluated the direct help-seeking as more appropriate compared to indirect help-seeking, independent of patient or provider culture. This effect was particularly strong in participants who scored high on the individual difference in independent self, as shown by a significant interaction. Discussion: Literature usually identifies that Surinamese and Dutch populations have different cultural backgrounds and values that express themselves in different attitudes, in general more collectivistic and more individualistic, respectively. However, with regard to help seeking preferences the study results did not verify this expectation. These findings underscore the importance of the support providers' role in assessing and understanding the individuals' communication style with regard to help-seeking, rather than assuming communication preferences on the basis of cultural background.

Residential Treatment Exclusively for Tobacco Use Disorder: A Narrative Review.

INTRODUCTION: Tobacco use disorder is a major public health issue, and novel smoking cessation approaches are urgently needed. Residential treatment programs have been suggested as a potentially effective treatment for tobacco use disorder. However, there is limited literature on residential treatment programs for patients who are exclusively dependent on nicotine. AIM: The aim of this study is to review the literature on residential treatment programs for patients admitted exclusively for tobacco use disorder. METHODS: A literature search was conducted in PubMed with the aim of identifying relevant articles on residential treatment exclusively for tobacco use disorder from inception until February 2023. References in retrieved articles were screened for additional relevant articles. RESULTS: Fourteen studies on residential treatment programs for tobacco use disorder were identified. The duration of the residential cessation programs ranged from 3 days to 3 weeks. Individualized or group cognitive behavioral therapy and tailored pharmacotherapy were the key components of the programs. Eligibility criteria for the programs included moderate to severe tobacco use disorder as measured by Fagerström or Diagnostic and Statistical Manual of Mental Disorders (DSM), consistent relapses, smoking-related comorbidities (eg, cardiovascular or pulmonary diseases), and daily use of (smokeless) tobacco. The 6- and 12-month 7-day point prevalence rate ranged from 58% to 26%, whereas the 6- and 12-month continuous abstinence rate ranged from 52% to 29%. CONCLUSIONS: Based on the literature we reviewed, residential smoking cessation programs targeted exclusively at individuals with tobacco use disorder have shown effectiveness, particularly for those who are highly dependent on tobacco and have a history of relapse. However, more research is needed to further explore the effectiveness of these programs and to determine the optimal program components and duration.

The working memory approach of persuasion: Induced eye movements lead to more social media self-control behaviours.

In the framework of prevention of social media addiction, persuasive messages can be used to stimulate people to engage in social media self-control behaviours. However, the effects of these messages may be weakened by defensive reactions. In the Working Memory account of Persuasion, these defensive self-regulatory actions in the Working Memory (WM) are activated to lower a given threat. Because the WM has limited capacity, and these defensive processes take WM capacity, they can be inhibited by inducing eye movements (EMi). Adults (N = 117) from the general population listened in an online experiment to an auditory message on the negative consequences of social media use (SMU). Half of the participants were randomly assigned to the EMi condition; they were asked to keep watching a moving red square on their screen during the exposure to the auditory message. SMU self-control behaviour was the outcome measure, assessed by self-report 2 weeks later. The effects of EMi on SMU self-control behaviour were moderated by individual differences, indicating defensive self-regulatory actions: EMi significantly increased behaviour in participants who scored low on Cognitive Self-affirmation Inclination, high on SMU-control-failure, and, unexpectedly, low in SMU. This study detected defensive reactions towards persuasive information concerning SMU, using the EMi research paradigm.

Owner's Anthropomorphic Perceptions of Cats' and Dogs' Abilities Are Related to the Social Role of Pets, Owners' Relationship Behaviors, and Social Support.

BACKGROUND: For sustainable and healthy relationships with pets, attributing some degree of human abilities to the pet (anthropomorphization) might be necessary. We hypothesize that the tendency to anthropomorphize pet animals is related to relationship behaviors (communication and making up) and the experience of social support. Perceiving the pet in a human social role (e.g., family member or friend) might mediate this relationship. METHOD: Associations were tested in a mixed sample of cat and dog owners by means of multiple linear regression, moderation, and (moderated) mediation analyses. The differences between cat and dog owners were examined with pet type as the moderator in a moderated mediation analysis. RESULTS: Dog owners anthropomorphize their pets more than cat owners. The social role of the pet mediates the association between anthropomorphization and relationship behavior and social support. The mediation effects were stronger for cat owners than for dog owners. Moreover, our newly developed comparative anthropomorphism measure was a better predictor than the commonly used general anthropomorphism measure (IDAQ).

Measuring Adherence to Pulmonary Rehabilitation: A Prospective Validation Study of the Dutch Version of the Rehabilitation Adherence Measure for Athletic Training (RAdMAT-NL).

Purpose: Measuring exercise adherence is important in patients with chronic obstructive pulmonary disease (COPD). For this, the Rehabilitation Adherence Measure for Athletic Training (RAdMAT) seems to be a promising instrument, and a Dutch version (RAdMAT-NL) is available. The aim of this study was to explore the dimensionality and construct validity of the RAdMAT-NL in patients with COPD. Secondly, we examined whether the items of the RAdMAT-NL could be summed to a single score. Patients and Methods: This prospective study included 193 patients with COPD from 53 primary physiotherapy practices in The Netherlands and Belgium. Patients and their physiotherapist provided data including the RAdMAT-NL, at one, two, and three months after inclusion. Horn's parallel analysis and exploratory factor analysis (EFA) were used to assess the dimensionality of the RAdMAT-NL. Fit to the dichotomous Rasch model for measurement was used to confirm the unidimensionality of the extracted RAdMAT-NL subscales and total scale. To evaluate construct validity, Spearman correlations with other indicators of adherence were calculated, including SIRAS score, percentage attendance and change in exercise skills. Results: EFA identified two dimensions of the RAdMAT-NL, "Participation" (13 items) and "Communication" (3 items), explaining 50.8% of the total variance. Rasch analysis confirmed the unidimensionality of the two dimensions. The unidimensional Rasch model was rejected for a summed score of all 16 RAdMAT-NL items. Medium to large significant positive correlations between the RAdMAT-NL subscale participation and different measures of adherence supported its convergent validity. Conclusion: The RAdMAT-NL exhibited two subscales that fitted the unidimensional Rasch model for objective measurement. Construct validity was supported by convergence with other established measures of adherence.

Feasibility, effectiveness and safety of self-management in pulmonary rehabilitation: a study protocol using a hybrid type 1 effectiveness-implementation design.

Background: As population ageing accelerates worldwide, chronic diseases will place an increasing burden on society and healthcare systems. Self-management interventions may become a key strategy for addressing chronic disease burden and healthcare costs, also in pulmonary rehabilitation (PR). One of the challenges here is long-term adherence. Understanding the level of adherence to PR may help inform clinical decision-making to focus more on self-management and less on clinical supervision. For this reason, a prediction model (PATCH) was developed. The presented protocol concerns a study that aims 1. to evaluate the safety and effectiveness of self-management within pulmonary rehabilitation (PR) on health outcomes in patients with chronic obstructive pulmonary disease (COPD), 2. to evaluate the predictive validity of the PATCH tool, and 3. to evaluate feasibility and acceptability of self-management and the PATCH tool by patients and physiotherapists. Methods and analysis: This is a protocol of a hybrid type 1 effectiveness-implementation design, performed in primary physiotherapy practices in The Netherlands. The aim is to include 108 patients with COPD who have already followed PR for at least six weeks (maintenance stage of PR). According to the Dutch KNGF Guideline COPD, physiotherapists should reduce the number of supervised treatments after the maintenance phase and support self-management. In practice, this does not (always) happen. This protocol is based on implementing guideline advice: clinical supervision will be halved but patients are stimulated to engage in self-management by exercising unsupervised, leading to no change in the total planned exercise frequency. During the supervised sessions physiotherapists will assess and stimulate self-management. At baseline, and after 3, 6, 9 and 12 months, health outcomes (including adherence) will be evaluated as the primary outcome of this study. At each measurement, the physiotherapist will decide on the basis of individual scores whether the patient needs more clinical supervision or not. Secondary outcomes are the discriminatory power of the PATCH tool (can patients be correctly classified as adherent or non-adherent), and feasibility and acceptability of self-management and the PATCH tool by patients and physiotherapists. Questionnaires and semi-structured interviews will be used for assessment of the outcomes.Trial registration number: METc 2023/074.

Prognostic factors of adherence to home-based exercise therapy in patients with chronic diseases: A systematic review and meta-analysis.

Background: Patients with a chronic disease may have an increased risk of non-adherence to prescribed home-based exercise therapy. We performed a systematic review with the aim to identify variables associated with adherence to home-based exercise therapy in patients with chronic diseases and to grade the quality of evidence for the association between these prognostic factors and adherence. Methods: Cohort studies, cross-sectional studies and the experimental arm of randomized trials were identified using a search strategy applied to PubMed, Embase, PsychINFO and CINAHL from inception until August 1, 2022. We included studies with participants ≥18 years with a chronic disease as an indication for home-based exercise therapy and providing data on prognostic factors of adherence to home-based exercise. To structure the data, we categorized the identified prognostic factors into the five WHO-domains; (1) Patient-related, (2) Social/economic, (3) Therapy-related, (4) Condition-related, and (5) Health system factors. Risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool. Prognostic factors of adherence were identified and the quality of the evidence between the prognostic factors and adherence were graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework for predictor studies. We performed a meta-analysis of the obtained information. Results: A total of 57 studies were included. Within patient-related factors moderate- and high-quality evidence suggested that more self-efficacy, exercise history, motivation and perceived behavioral control predicted higher adherence. Within social-economic factors moderate-quality evidence suggested more education and physical health to be predictive of higher adherence and within condition-related factors moderate- and low-quality evidence suggested that less comorbidities, depression and fatigue predicted higher adherence. For the domains therapy-related and health-system factors there was not enough information to determine the quality evidence of the prognostic factors. Conclusion: These findings might aid the development of future home-based exercise programs as well as the identification of individuals who may require extra support to benefit from prescribed home-based exercise therapy. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=277003, identifier PROSPERO CRD42021277003.

Lowering Red Meat and Processed Meat Consumption With Environmental, Animal Welfare, and Health Arguments in Italy: An Online Experiment.

Introduction: In addition to being a source of valuable nutrients, meat consumption has several negative consequences; for the environment, for animal welfare, and for human health. To persuade people to lower their meat consumption, it is assumed that the personal relevance of the topic of lowering meat consumption is important as it determines how people perceive the quality of the arguments. Method: In an experimental exploratory field study (n = 139), participants recruited from the general Italian population were randomized to one of the four conditions with a text with pictures on the environmental, animal welfare, or health consequences of meat consumption, or a text on mustard (the control condition). The dependent variables were self-reported consumption of red meat and processed meat after 2 weeks. Personal relevance was assessed in the pre-test with self-reported meat consumption and intention. Results: The interaction between pre-test meat consumption and condition was significant: In participants who scored high on pre-test meat consumption, the self-reported red meat consumption after 2 weeks in the health argument condition was significantly lower compared to the control condition and the environmental argument condition. The effects of pre-test intention as a moderator were less certain. Discussion: The persuasive effects of the different arguments made a difference only in people who ate a relatively high level of meat in pre-test, and the type of arguments made a difference. Although the present outcomes are caused by the specific formulations of the arguments in this study, the results do show that it is relevant to choose the arguments carefully to ensure effectiveness.

A Mediation Model on How Conspiracy Beliefs Concerning the Corona-Crisis Are Related to Corona-Related Behaviours.

Background: The endorsement of Conspiracy Beliefs concerning corona (CBc) may make people reject information from the general media, leading them to not follow recommendations on prevention behaviours, getting tested, and getting vaccinated. The aim of the present study was to understand the relationship between CBc and engaging in these corona-related behaviours. Method: Two samples of participants (N = 1,004 and N = 159) were recruited independently. Participants filled in a survey that assessed four indicators of the three behaviours, four general psychological determinants (e.g., the seriousness of COVID-19), five behaviour-specific psychological determinants (e.g., test reliability, vaccine effectiveness), and CBc. Results: The explained variances of the different models with regard to the four indicators of behaviour ranged from 3.9 to 75%. Mediation analyses using Hayes PROCESS model 4 showed significant mediation by general determinants in both samples, and mediation by several behaviour-specific determinants in one sample. Discussion: Conspiracy Beliefs concerning corona may lead to rejection of general media information, and this may lead to states of psychological determinants that do not stimulate to engage in prevention behaviours, testing, or vaccination. The present study shedS some light on how CBc could be related to corona-related behaviours.

A cross-sectional study of lactation room quality and Dutch working mothers' satisfaction, perceived ease of, and perceived support for breast milk expression at work.

BACKGROUND: The challenge of combining professional work and breastfeeding is a key reason why women choose not to breastfeed or to stop breastfeeding early. We posited that having access to a high-quality lactation room at the workplace could influence working mothers' satisfaction and perceptions related to expressing breast milk at work, which could have important longer term consequences for the duration of breastfeeding. Specifically, we aimed to (1) develop a checklist for assessing the quality of lactation rooms and (2) explore how lactation room quality affects lactating mothers' satisfaction and perceptions. Drawing on social ecological insights, we hypothesized that the quality of lactation rooms (operationalized as any space used for expressing milk at work) would be positively related to mothers' satisfaction with the room, perceived ease of, and perceived support for milk expression at work. METHODS: We conducted two studies. In Study 1 we developed a lactation room quality checklist (LRQC) and assessed its reliability twice, using samples of 33 lactation rooms (Study 1a) and 31 lactation rooms (Study 1b). Data were collected in the Northern part of the Netherlands (between December 2016 and April 2017). Study 2 comprised a cross-sectional survey of 511 lactating mothers, working in a variety of Dutch organizations. The mothers were recruited through the Facebook page of a popular Dutch breastfeeding website. They completed online questionnaires containing the LRQC and measures aimed at assessing their satisfaction and perceptions related to milk expression at work (in June and July 2017). RESULTS: The LRQC was deemed reliable and easy to apply in practice. As predicted, we found that objectively assessed higher-quality lactation rooms were associated with increased levels of satisfaction with the lactation rooms, perceived ease of milk expression at work, and perceived support from supervisors and co-workers for expressing milk in the workplace. CONCLUSIONS: The availability of a high-quality lactation room could influence mothers' decisions regarding breast milk expression at work and the commencement and/or continuation of breastfeeding. Future studies should explore whether and how lactation room quality affects breastfeeding choices, and which aspects are most important to include in lactation rooms.

Family Member, Best Friend, Child or 'Just' a Pet, Owners' Relationship Perceptions and Consequences for Their Cats.

Describing the relationship with one's cat in human terms might reflect an underlying anthropomorphic view of the relationship which might be associated with an owner's behavior towards their cat and the cat's living environment. Owners self-categorized the relationship with their cat as either a 'member of the family', 'as a child', 'best friend', or 'a pet animal'. The extent to which owner- and cat-related factors influence these four relationship descriptions are examined in survey data of approximately 1800 cat owners. Differences in outdoor access, care during absence of the owner, and access to the bedroom are examined between the four relationship perceptions. The owner's age and household composition, ideas about their cat's equality, support, and dependency, and whether their cat is a pedigree were significantly associated with relationship description and explained 46% of the variance. Owners who perceive their cat as a child or best friend see their cat as loyal, empathetic, equal to family, and dependent on them for love and care. Their cats are less often left in the care of others, are allowed more often in the bedroom and have less often (unrestricted) outdoor access. Moreover, cats perceived as children are more likely to live in a multi-cat household. Our results provide insight in the factors that are related to different (anthropomorphic) perceptions of the human-cat relationship and how perceptions relate to the living environment of cats.

Expectations versus Reality: Long-Term Research on the Dog-Owner Relationship.

In the framework of the early prevention of problems in the owner-dog relationship, it is important to have a broad perspective on the development of this relationship over time, starting before people actually acquire a dog. People who currently (or previously) own(ed) a dog can rely on their experiences when considering a new dog, while this knowledge is unavailable to first time dog-owners. In this study, we explore how self-efficacy, social comparison, perceptions about the (dis)advantages of ownership and commitment to the dog (so-called social cognitive factors), problematic canine behaviors, perceived costs, and satisfaction with the dog change over time. We examine changes from the motivational phase of relationship development (before acquisition of the dog) into the experience phase (six and twelve months after acquisition of the dog). We explore if patterns are different in experienced (previous (n = 73) and current (n = 80)) versus unexperienced (first time (n = 30) dog owners. The respondents filled in three online questionnaires-once before and twice after acquisition of their dog. From T0 (before acquisition of the dog) to T1 (having the dog for six months) participants (especially those with no ownership experience) had to adjust their perceptions about dogs and dog ownership. Experiencing the relationship for an additional year (from T1 to T2) barely changed the social cognitive factors, satisfaction, and perceived costs. A small decline in problematic canine behaviors was present among the experienced dog owners between T1 and T2. To conclude, perceptions about dogs and dog ownership change over time, but after testing these perceptions with reality, they become stable after about six months.

Detecting and Preventing Defensive Reactions Toward Persuasive Information on Fruit and Vegetable Consumption Using Induced Eye Movements.

Objective: Persuasive messages regarding fruit and vegetable consumption often meet defensive reactions from recipients, which may lower message effectiveness. Individual differences in emotion regulation and gender are expected to predict these reactions. In the working memory account of persuasion, inducing voluntary eye movements during the processing of the auditory persuasive information might prevent defensiveness and thereby increase message effectiveness. Methods: Participants in two independently recruited samples from the general population (n = 118 and n = 99) listened to a negatively framed auditory persuasive message advocating fruit and vegetable consumption. Half of them were asked to keep following a regularly moving stimulus on their screen with their eyes. At pretest, the individual differences of cognitive self-affirmation inclination (CSAI) and gender were assessed to predict defensive reactions. Results: In Study 1, induced eye movements significantly increased self-reported consumption after 2 weeks when CSAI was low, but only in males, as indicated by a significant three-way interaction (p < 0.001). With negative self-evaluative emotions as dependent variable, this three-way interaction was also significant (p < 0.05), suggesting that induced eye movements prevented defensiveness in low CSAI males. Study 2 did not assess consumption but replicated the latter three-way interaction (p < 0.05). Conclusion: The studies replicated our earlier findings regarding the moderating effects of individual differences in emotion regulation (i.e., CSAI) on persuasion, but they also revealed gender differences in persuasion that are related to the working memory. The working memory account of persuasion provides new theoretical as well as practical angles on persuasion to target individuals in persuasion to increase fruit and vegetable consumption.

A Cross-sectional Analysis of Motivation and Decision Making in Referrals to Lifestyle Interventions by Primary Care General Practitioners: A Call for Guidance.

AIM: To explore (1) general practitioners' (GPs') motivations to refer to lifestyle interventions and to investigate the association between GPs' own lifestyle behaviors and their referral behavior and (2) patient indicators in the decision-making process of the GPs' referral to lifestyle interventions. METHOD: A cross-sectional study was conducted among 99 Dutch primary care GPs. Their motivation to refer was assessed by beliefs regarding lifestyle interventions. GPs' referral behaviors were assessed-considering referral and self-reported actual referral-as well as their own lifestyle behaviors (physical activity, dieting, being overweight). Decision making regarding referring patients to lifestyle interventions was assessed by imposed patient indicators, spontaneously suggested decisive patient indicators, and case-based referring (vignettes). RESULTS: A substantial group of GPs was not motivated for referral to lifestyle interventions. GPs' referral behavior was significantly associated with their perceived subjective norm, behavioral control, and their own physical activity and diet. Most important, patient indicators in referral to lifestyle interventions were somatic indicators and patients' motivation for lifestyle interventions. CONCLUSIONS: GPs' motivation and referral behavior might be improved by providing them with tailored resources about evidence-based lifestyle interventions, with support from allied health professionals and with official guidelines for a more objective and systematic screening of patients.

Eye movement inductions influence health behaviour: the working memory account of persuasion.

Objective: Because the working memory (WM) has a limited capacity, the cognitive reactions towards persuasive information in the WM might be disturbed by taxing it by other means, in this study, by inducing voluntary eye movements (EMi). This is expected to influence persuasion. Methods: Participants (N = 127) listened to an auditory persuasive message on fruit and vegetable consumption, that was either framed positively or negatively. Half of them was asked to keep following a regularly moving dot on their screen with their eyes. At pretest, cognitive self-affirmation inclination (CSAI) was assessed as individual difference to test possible moderation effects. Results: The EMi significantly lowered the quality of the mental images that participants reported to have of the persuasive outcomes. With regard to self-reported fruit and vegetable consumption after two weeks, EMi significantly lowered consumption when CSAI was high but it significantly increased consumption when CSAI was low. Conclusions: The results verify our earlier findings that induced EM can influence persuasion. Although it remains unclear whether the effects of EMi were caused by disturbing mental images of persuasive outcomes or self-regulative reactions to these images, or both, the WM account may provide new theoretical as well as practical angles on persuasion.

Developing a community-based intervention for Dutch older adults in a socioeconomically disadvantaged community.

Unhealthy eating and low levels of physical activity are major health risks, especially for older adults and people with a low socioeconomic status. The aim of this article is to describe the development of a community-based intervention aimed at promoting physical activity and healthy eating among people aged 55 years and over, in a socioeconomically disadvantaged community. The Intervention Mapping protocol was used to develop the intervention. We conducted a literature search, consultation with community partners and inhabitants, and a quantitative study, in order to obtain insight into the determinants of the target population and to identify appropriate theory-based methods and practical strategies for behavioural change. An assessment was performed of the problem with respect to health behaviour and the underlying determinants. Findings were translated into program, performance and change objectives which specify determinants related to behavioural change. Theory-based methods and practical applications were selected, resulting in a plan for adoption and implementation. The intervention included a local media campaign, social environmental approaches and physical environmental activities in the community, with an intermediating role for inhabitants and health professionals in the promotion of the campaign. An evaluation plan was produced to evaluate the effectiveness of the intervention. The Intervention Mapping protocol was a helpful instrument in developing a feasible, theory and evidence-based intervention tailored to a specific target population in the area of health promotion. The systematic and structured approach provided insight into the relationship between the objectives, methods and strategies used to develop the comprehensive intervention.

Barrier-belief lifestyle counseling in primary care: A randomized controlled trial of efficacy.

OBJECTIVE: Intervening on barrier beliefs (BBs) may inhibit the role of barriers as mediating factors in lifestyle behavior. The aim of this study was to analyze the effects of a barrier-belief counseling intervention (BBCI) on physical activity (PA) and healthy food intake. METHODS: An RCT was conducted in a primary care setting among adults (aged 18-70), with two interventions: a BBCI (n = 123) and a standardized lifestyle group intervention (SLI) (n = 122). A non-treated hanging control group (n = 36) received no intervention. Outcomes on PA (accelerometer and SQUASH) and fruit and vegetable intake (self-report) were measured with follow-ups at 6, 12 and 18 months, and analyzed using multiple regression. RESULTS: The BBCI was more effective on PA compared with the SLI (p < .01): in the short term all PA outcomes improved (p < .05), in the long term moderate-to-vigorous PA outcomes improved (p < .05), all with small effect sizes. No differences between interventions were found on fruit and vegetable intake. None of the outcomes in the control group changed over time. CONCLUSIONS: BBCI in primary care improves PA compared with SLI. PRACTICE IMPLICATIONS: The customized BB approach seems promising for implementation in healthcare practice to stimulate PA.

An experimental test to reveal negative side-effects of high treatability information on preventative health behaviour.

OBJECTIVES: When the course of a disease can be positively changed by health professionals the disease can be indicated as 'highly treatable'. This 'high treatability information' (HTI) may have negative side-effects on people's preventative motivation. This study examined the effects of HTI regarding skin cancer on preventative motivation. DESIGN: This study employed a 2 (high treatability (HTI) versus low treatability (LTI)) × 2 (high versus low susceptibility)-experiment with a hanging control group. (family) History and self-efficacy were assessed as moderators. Participants (N = 309) were randomly assigned to one of the five conditions. MAIN OUTCOME MEASURES: The main outcome was intention to engage in preventative actions regarding skin cancer. RESULTS: HTI significantly lowered the intention compared to LTI, under the condition of high susceptibility in people with low self-efficacy. In addition, in people with a (family) history of skin cancer, HTI significantly lowered the intention compared to the no-information group. CONCLUSION: HTI regarding skin cancer can cause a drop in the preventative motivation. The effects can be conceptualised as negative side-effects of HTI. As substantial proportions of the general population have a (family) history of skin cancer or low self-efficacy, the side-effects may be widespread, possibly increasing the incidence of skin cancer.

Community participation in mosquito breeding site control: an interdisciplinary mixed methods study in Curaçao.

BACKGROUND: As the arboviral diseases dengue, chikungunya and Zika emerge in the Americas, so does the need for sustainable vector control policies. To successfully achieve mosquito control, joint efforts of both communities and governments are essential. This study investigates this important, but by-and-large neglected topic. METHODS: In June and July 2015, a cross-sectional mixed methods study applying a survey questionnaire (response rate of 82.5%; n = 339), in-depth interviews (n = 20) and focus group discussions (n = 7; 50 participants) was performed in Curaçao. The study was designed based on an integrated theoretical framework of the Health Belief Model and the Theory of Planned Behaviour. RESULTS: Participants showed a good knowledge of, and a high-level performance of mosquito breeding site control (MBSC) practices. Personal protection against mosquitoes (e.g. topical repellents) was perceived as relatively less effective thus practiced to lower extent compared to MBSC practices (i.e. larval source management). A lower intention to perform MBSC was independently associated with: (i) satisfaction on governmental MBSC (P = 0.012); (ii) barriers to perform MBSC practices, i.e. 'Government doesn't control other breeding sites' (P = 0.005), 'Don't know how to control breeding sites' (P = 0.041), and 'a mosquito does not transmit dengue' (P = 0.016), (iii) attitudes towards MBSC (P = 0.001) and self-efficacy (person's perceived ability to act) to perform MBSC (P = 0.002). Mixed-methods evidence highlights three possible ways of improving community participation in MBSC. First, it highlights the need for ongoing media coverage, targeting (i) communities' perceptions on transmission routes of dengue and chikungunya, and (ii) presence of car tires in yards. Secondly, it shows that promotion of governmental activities in MBSC can enhance MBSC of communities, if people develop a sense of responsibility to perform MBSC at their own properties. Thirdly, this study describes the presence of key persons in communities, who could be engaged in mosquito control policies to improve MBSC in neighbourhoods. CONCLUSION: This study reveals gaps between policy and communities' lived realities. These gaps might be overcome with the proposed interventions, resulting in a higher performance of MBSC in the community in Curaçao. Furthermore, this study shows how interdisciplinary mixed methods research can provide important, comprehensive, and in-depth insights to inform mosquito control policies.

Targeting hardcore smokers: The effects of an online tailored intervention, based on motivational interviewing techniques.

OBJECTIVES: Hardcore smokers have smoked for many years and do not intend to quit. They also seem unreceptive to information about smoking cessation. We developed a 30-min, tailored web-based intervention that includes motivational interviewing principles. It aims to increase hardcore smokers' intention to quit and their receptivity to information about smoking cessation. DESIGN: In a two-arm experiment, we compared outcome scores of the experimental intervention (n = 346) with those of a control intervention (n = 411). METHODS: Our main outcomes were receptivity to information about quitting, intention to quit, quitting self-efficacy, and interest in a subsequent online intervention. Our secondary outcomes were cigarettes smoked per day and quit attempts. All outcomes were measured directly post-experiment (t1 ), after 2 weeks (t2 ), and after 2 months (t3 ). RESULTS: At t1 , hardcore smokers in the intervention condition were more receptive to information about quitting than controls. At both t2 and t3 , those in the experimental group had reduced the number of cigarettes more than those in the control group. At t2 , but not t3 , more participants in the experimental group had reduced their cigarette consumption by at least 50% than among controls. We found no significant differences in intention to quit, quitting self-efficacy, interest in a subsequent online quitting intervention, and number of quit attempts. CONCLUSIONS: The intervention increased hardcore smokers' receptivity to information about smoking cessation and decreased their cigarette consumption by about 1 cigarette per day. Although the results are positive, the clinical relevance may be limited. We recommend further developing this intervention for practical use in health care settings. Statement of contribution What is already known on this subject? Hardcore smokers have smoked for many years and do not intend to quit. There are currently no online interventions for hardcore smokers. What does this study add? This study tested an online intervention for hardcore smokers. The intervention increased hardcore smokers' receptivity to information about quitting. It also helped to reduce the number of cigarettes per day.