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.

Moderators of physical activity and healthy eating in an integrated community-based intervention for older adults.

BACKGROUND: An integrated community-based intervention was developed to stimulate physical activity (PA) and healthy eating in older adults in a socioeconomically disadvantaged area. This study aims to assess whether its short-term effects among older adults vary by sociodemographic, psychosocial and health-related variables. METHODS: The study was a controlled pre-post quasi-experimental design (intervention condition n = 430; control condition n = 213), with a baseline measurement and a 9-month follow-up measurement. The intervention consisted of a local media campaign and environmental approaches. Changes in PA and fruit and vegetable consumption (FVC) were dependent variables assessed at 9-month follow-up. Sociodemographic, psychosocial and health-related variables at baseline were tested as potential moderators of the effects of the conditions. RESULTS: We found different types of moderators in particular for transport-related PA and FVC. Regarding sociodemographic characteristics, gender was a moderator for household-related PA, and educational level for transport-related PA and FVC. Self-efficacy, as a psychosocial variable, was a moderator of transport-related PA and vegetable consumption. Concerning health-related outcomes, baseline levels of transport-related PA and fruit consumption were moderators for transport-related PA and fruit consumption. If adjusted for multiple testing, only three moderators persisted: educational level regarding vegetable consumption, and baseline levels regarding transport-related PA and fruit consumption. CONCLUSION: The effects of the community intervention vary somewhat by sociodemographic, psychosocial and health-related variables. The intervention seems to be especially beneficial to those who are most in need of more PA and healthy eating.

Reach and effectiveness of an integrated community-based intervention on physical activity and healthy eating of older adults in a socioeconomically disadvantaged community.

The aim of this study is to assess the reach and effectiveness of an integrated community-based intervention designed to promote physical activity and healthy eating among older adults in a socioeconomically disadvantaged community in the Netherlands. The intervention was evaluated with a controlled pre-post quasi-experimental design, with 430 randomly selected older adults participating in the intervention group and 213 in a control group at baseline. The intervention included a local media campaign and environmental approaches (e.g., community involvement) and was implemented during a 3-month high-intensity period, followed by a 6-month low-intensity one. Levels of physical activity and fruit and vegetable consumption were assessed at baseline and at 3 and 9 months after baseline. At the follow-up measurements, the intervention had reached respectively 68 and 69% of the participants in the intervention group. No significant differences were found between the intervention group and the control group in changes to any outcome except for transport-related PA at 3 and 9 months follow-up. The systematically developed community-based intervention reached a relatively large proportion of the participants, but had only small effects on the levels of physical activity and healthy eating in older adults in the short and medium term.

A Mobile Phone App Intervention Targeting Fruit and Vegetable Consumption: The Efficacy of Textual and Auditory Tailored Health Information Tested in a Randomized Controlled Trial.

BACKGROUND: Mobile phone apps are increasingly used to deliver health interventions, which provide the opportunity to present health information via different communication modes. However, scientific evidence regarding the effects of such health apps is scarce. OBJECTIVE: In a randomized controlled trial, we tested the efficacy of a 6-month intervention delivered via a mobile phone app that communicated either textual or auditory tailored health information aimed at stimulating fruit and vegetable intake. A control condition in which no health information was given was added. Perceived own health and health literacy were included as moderators to assess for which groups the interventions could possibly lead to health behavior change. METHODS: After downloading the mobile phone app, respondents were exposed monthly to either text-based or audio-based tailored health information and feedback over a period of 6 months via the mobile phone app. In addition, respondents in the control condition only completed the baseline and posttest measures. Within a community sample (online recruitment), self-reported fruit and vegetable intake at 6-month follow-up was our primary outcome measure. RESULTS: In total, 146 respondents (ranging from 40 to 58 per condition) completed the study (attrition rate 55%). A significant main effect of condition was found on fruit intake (P=.049, partial η(2)=0.04). A higher fruit intake was found after exposure to the auditory information, especially in recipients with a poor perceived own health (P=.003, partial η(2)=0.08). In addition, health literacy moderated the effect of condition on vegetable intake 6 months later (P<.001, partial η(2)=.11). A higher vegetable intake was found for recipients with high health literacy after exposure to the textual or auditory intervention compared to the control condition (contrasts P=.07 and P=.004, respectively). In the case of relatively low health literacy, vegetable intake was the highest in the control condition (contrasts text control: P=.03; audio control: P=.04). CONCLUSIONS: This study provides evidence-based insight into the effects of a mobile health app. The app seems to have the potential to change fruit and vegetable intake up to 6 months later, at least for specific groups. We found different effects for fruit and vegetable intake, respectively, suggesting that different underlying psychological mechanisms are associated with these specific behaviors. Based on our results, it seems worthwhile to investigate additional ways to increase fruit and vegetable intake in recipients with low health literacy. CLINICALTRIAL: International Standard Randomized Controlled Trial Number (ISRCTN): 23466915; http://www.isrctn.com/ISRCTN23466915 (Archived by WebCite at http://www.webcitation.org/6hTtfSvaz).

A Cross-Sectional Study of Psychological Comparison Processes That May Underlie the Acceptance of Chronic Pain.

Acceptance of chronic pain varies between patients but may also be expected to develop and change within patients. In this latter framework, the present study explored three psychological processes that may contribute to changes in acceptance: social comparisons, temporal comparisons and counterfactual comparisons. In general, these comparisons are used to cope with negative life events, and they may also play a role in acceptance of pain. In this study, the two subscales of the Chronic Pain Acceptance Questionnaire (Activity Engagement and Pain Willingness) were complemented with a scale of Affective Acceptance. Using linear regression analyses, data from these three acceptance scales were regressed on three scales of temporal comparison processes, four scales of social comparison processes and one scale of counterfactual comparisons. The results showed that the comparison processes explained up to 37% of the variance in acceptance, especially a higher frequency of thinking of one's present condition in relation to a condition in the past, and feeling bad when comparing with others who are doing better, were consistently related to lower acceptance. These explorative results may inspire experimental studies to influence comparison processes and, eventually, to address those comparison processes in interventions for patients with chronic pain to improve acceptance. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: In addition to beliefs indicating Activity Engagement and Pain Willingness, Affective acceptance of pain may also be a relevant dimension and manifestation of acceptance Social comparisons, temporal comparisons and counterfactual comparisons are related to acceptance of pain In patients with pain psychological comparison processes can be relevant in diagnosing possible causes of non-optimal acceptance of chronic pain Practitioners may try to influence each of the three types of psychological comparison processes in individuals and observe the effects.

A survey on HIV-related health-seeking behaviors among transgender individuals in Jakarta, based on the theory of planned behavior.

BACKGROUND: Male-to-female transgender (waria) individuals are at high risk for HIV. This study aims at mapping the psychological determinants of four HIV-related health-seeking behaviors. This knowledge can be used to develop effective interventions to prevent the spread of HIV/AIDS. METHODS: The study involved 209 waria from five districts in Jakarta, selected with a cluster sampling procedure. Cross-sectional data were gathered through structured interviews. The four examined behaviors are, visiting sexually transmitted infections (STIs) services regularly, adherence to STI treatment, taking an HIV test and picking up the result of HIV test. For all four behaviors, specific measures of the psychological determinants as defined by the Theory of Planned Behavior were developed: attitudes, subjective norms and perceived behavioral control (PBC). Logistic regression analyses were conducted with these three psychological measures as independent variables and the behaviors as dependent variables. RESULTS: Of the 209 waria, 20.6 % had never visited STI services in the last 6 months, while 56.5 % had visited the services once or twice, and 23 % had visited the service three or more times. A HIV test had been taken by 90.4 % of the waria, and of those, 64.6 % had picked up the results. About 85 % of the waria who did a HIV test had been tested for HIV one or two times in the last 6 months and 10 % had been tested three to four times. The variance in behaviors that was explained by the concepts defined in the Theory of Planned Behavior ranged from 15 to 70 %; PBC was the most powerful predictor. Furthermore, the results showed that in several cases the relationships of attitudes or subjective norms with the dependent variable were mediated by one or both other independent variables. CONCLUSIONS: The results regarding the prominent role of PBC suggest that interventions should increase waria's control over the behavior: Engaging in specific desired behaviors should be made easier for them. Besides, waria's attitudes and subjective norms should be addressed, by education, but possibly also by providing waria with a positive experience with the behavior, for example, by designing a professional and friendly health care system.

Development of a training programme for home health care workers to promote preventive activities focused on a healthy lifestyle: an intervention mapping approach.

BACKGROUND: Lifestyle is an important aspect in maintaining good health in older adults, and home health care (HHC) workers can play an important role in promoting a healthy lifestyle. However, there is limited evidence in the literature regarding how to develop an effective training programme to improve the physical activity level and fruit and vegetable consumption of older adults within a HHC setting. The aim of this paper is to describe how Intervention Mapping (IM) was used to develop a training programme to promote preventive activities of HHC workers relating to the physical activity and fruit and vegetable intake of older adults living at home. METHODS: IM, a systematic theory and evidence-based approach was used to develop, implement and evaluate the training programme. This entailed a literature search, a survey, semi-structured interviews and consultation with HHC workers and various field experts, and a pilot training session. RESULTS: The determinants associated with the provision of preventive activities were identified, and an overview was created of those objectives, matching methods and practical applications that could influence these determinants. The performance objectives for the HHC workers were early detection and monitoring, promoting a healthy lifestyle, informing colleagues, continuing allocated preventive activities and referring to other experts and facilities. Findings were translated into a comprehensive training programme for HHC workers focused on motivating older adults to adopt and maintain a healthier lifestyle. CONCLUSIONS: IM was a useful tool in the development of a theory-based training programme to promote preventive activities by HHC workers relating to fruit and vegetable intake and physical activity of older adults.

The effectiveness of the Allen Carr smoking cessation training in companies tested in a quasi-experimental design.

BACKGROUND: The Allen Carr training (ACt) is a popular one-session smoking cessation group training that is provided by licensed organizations that have the permission to use the Allen Carr method. However, few data are available on the effectiveness of the training. METHODS: In a quasi-experimental design the effects of the existing practice of providing the ACt to smokers (n = 124) in companies on abstinence, were compared to changes in abstinence in a cohort of similar smokers in the general population (n = 161). To increase comparability of the smokers in both conditions, smokers in the control condition were matched on the group level on baseline characteristics (fourteen variables) to the smokers in the ACt. The main outcome measure was self-reported continuous abstinence after 13 months, which was validated using a CO measurement in the Act condition. RESULTS: Logistic regression analyses showed that when baseline characteristics were comparable, significantly more responding smokers were continuously abstinent in the ACt condition compared to the control condition, Exp(B) = 6.52 (41.1% and 9.6%, respectively). The all-cases analysis was also significant, Exp(B) = 5.09 (31.5% and 8.3%, respectively). CONCLUSION: Smokers following the ACt in their company were about 6 times more likely to be abstinent, assessed after 13 months, compared to similar smokers in the general population. Although smokers in both conditions did not differ significantly on 14 variables that might be related to cessation success, the quasi-experimental design allows no definite conclusion about the effectiveness of the ACt. Still, these data support the provision of the ACt in companies.

The eye movement desensitization and reprocessing procedure prevents defensive processing in health persuasion.

In the present study, the method of eye movement desensitization and reprocessing (EMDR) is studied to understand and prevent defensive reactions with regard to a negatively framed message advocating fruit and vegetable consumption. EMDR has been shown to tax the working memory. Participants from a university sample (n = 124) listened to the persuasive message in a randomized laboratory experiment. In the EMDR condition, they were also instructed to follow with their eyes a dot on the computer screen. The dot constantly moved from one side of the screen to the other in 2 seconds. In addition, a self-affirmation procedure was applied in half of the participants. EMDR led to a significant increase in persuasion, only in recipients in whom the persuasive message could be expected to activate defensive self-regulation (in participants with a moderate health value and in participants with low self-esteem). In those with a moderate health value, EMDR increased persuasion, but only when recipients were not affirmed. In addition, EMDR increased persuasion only in recipients with low self-esteem, not in those with high self-esteem. These results showed that EMDR influenced persuasion and in some way lowered defensive reactions. The similarities and differences in effects of EMDR and self-affirmation further increased our insight into the psychology of defensiveness.

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.