Enhancing Community Suicide Risk Assessment and Protective Intervention Action Plans Through a Bystander Intervention Model-Informed Video.

Aim: The effects of a bystander intervention model (BIM)-informed intervention (video) for the general community on participant risk of suicide assessment ability (ROSAA) and protective intervention ability (PIA) were compared with an active control (non-BIM-informed video). Method: Video interventions with 628 participants (Mage = 47.99, SDage = 17.34, range = 18-85 years) were conducted online. ROSAA and PIA were assessed immediately preintervention, postintervention, and at 2 months follow-up (n = 126). Results: Linear mixed model analyses indicated that the experimental and control conditions improved on both outcome variables postintervention/Time 2 (T2); however, the former yielded better outcomes than the latter (moderate ESs in both variables). Follow-up/Time 3 (T3) experimental ROSAA scores were higher than Time 1 (T1) and lower than T2 scores. Follow-up experimental PIA scores were higher than T1 and lower than T2 scores. Follow-up control ROSAA scores were higher than those of T1 and similar to T2. Follow-up control PIA scores were similar to T1 and T2 scores. Limitations: Limitations of the study include: sample homogeneity, small n at follow-up, self-report data only (no observable behavior was tested), fair inter-rater reliability, and a brief follow-up time frame. Conclusion: Current community information increased ROSAA and PIA. A BIM-informed intervention significantly enhanced these effects, which seemed to wane somewhat over time with the effect being lower at follow-up compared with postintervention. The BIM should be explored further as a basis for community suicide prevention interventions.

Health Demands Moderate the Link Between Willpower Beliefs and Physical Activity in Patients with Knee Osteoarthritis.

BACKGROUND: Regular physical activity (PA) was found to alleviate pain and improve functioning among patients with osteoarthritis of the knee (OAK). Heightened health demands due to OAK severity, body mass index (BMI), and depressive symptoms may require self-regulatory strategies to engage in more PA. Research on willpower-the capacity to exert self-control-suggests that believing that willpower is a nonlimited rather than a limited resource predicts effective self-regulation specifically when demands are high. The present study examines the association of OAK patients' willpower beliefs with their daily PA as a function of health demands. METHODS: To identify the moderating role of OAK severity (WOMAC), BMI, and depressive symptoms (CES-D) on the link between willpower beliefs and objectively assessed PA over a 7-day period, baseline data of a registered randomized controlled trial with 243 patients (Mage = 65.47 years, SD = 0.49) were examined in secondary analyses. RESULTS: Moderation analyses revealed that overall positive associations of willpower beliefs with PA were further qualified by OAK severity, BMI, and depressive symptoms. When patients faced less health demands, believing that willpower is nonlimited was associated with more PA. When health demands were higher, willpower beliefs were not associated with PA. CONCLUSION: OAK patients' willpower beliefs were associated with PA. However, facing more health demands seemed to erase this beneficial link. Improving willpower beliefs by way of intervention may help to shed more light on predictive direction and ways to overcome barriers to regular physical activity.

FOODLIT-PRO: Food Literacy Domains, Influential Factors and Determinants-A Qualitative Study.

Poor eating habits are increasing the prevalence of weight-related issues, such as diabetes and cardiovascular diseases. Given the demand to improve individuals' food knowledge and competencies aiming at healthier behaviours, the current investigation explores the concept of food literacy. Considering the lack of a shared understanding of food literacy, this study aims to explore food literacy's domains, influential factors and determinants. Using a qualitative deductive-dominant content analysis, 30 experts from food-related fields were interviewed. The obtained outcomes were compared to available food literacy frameworks. Agreement among inter-raters was nearly perfect (k = 0.82). Yielding a total of 184 codes nested within 19 categories, identified domains were Origin, Safety, Choice and Decision, Select and Acquire, Plan, Preserve, Prepare, Cook, and Knowledge; influential factors included Nutrition, Psychological, Health, Learning Contexts, Policy, Industry, Sustainability, and Social and Cultural; External determinants were "Access to Food-Related Information", "Perishable and/or Unreliable Food-Related Information", "Family Dynamic and/or Identity", and "Professionals' Unpreparedness on Food-Related Expertise", and Internal determinants included "Prioritise Food", "Convenience and Practicality", "Time and Financial Management", "Previous Food-Related Habits", and "Innate and Learned Flavour Preferences". In conclusion, more than half of the identified attributes (62.5%) are corroborated by the current literature. However, the manifested content unmatched with the current frameworks of food literacy literature express food-literacy-related fields of action, knowledge, competencies, and determinants that have not yet been explored. As such, this study provides new and useful information concerning food literacy definition and development, by identifying its domains, factors of influence, and potential determinants. Moreover, this work paves the way for new measurements and interventions within this field.

Psychological mechanisms in a digital intervention to improve physical activity: A multicentre randomized controlled trial.

OBJECTIVES: The randomized controlled trial examined factors that might be responsible for individual differences in physical activity change among men and women who participated in a lifestyle intervention. The main purpose of the analyses regarded the role of psychological mechanisms involving motivation, planning, self-monitoring, and habit strength. DESIGN: A two-arm digital intervention was conducted in Italy, Spain, and Greece to improve physical activity levels, with follow-ups at 3 and 6 months after baseline assessment. METHODS: Participants were 1,564 adults at baseline, n = 638 at 6-month follow-up. Linear mixed models examined the intervention effects, and a two-group longitudinal structural equation model explored which psychological constructs (motivation, planning, self-monitoring, habit strength) were associated with changes in physical activity. RESULTS: In addition to an overall increase in self-reported activity, there were interactions between time and sex and between time and experimental groups, and a triple interaction between time, sex, and experimental groups, indicating that men reported an increase in activity independent of groups, whereas women in the active control group did not benefit from the intervention. Planning, self-monitoring, and habit strength mediated sequentially between initial motivation and follow-up physical activity. CONCLUSIONS: Although the intervention produced overall improvements in physical activity, the time-by-treatment interaction emerged only for women. The mechanism included a sequence leading from motivation via planning, self-monitoring, and habit strength towards physical activity. Statement of contribution What is already known on this subject? Digital lifestyle interventions can be effective in terms of physical activity performance gains. Men are on average more physically active than women. Long-term adherence rates to digital interventions are usually low. What does this study add? Giving users of an online platform more interactive options did not make a difference. Women gained more than men from adaptive, dynamic online platform content. Individual characteristics (motivation, planning, self-monitoring, habit) were more important than online treatment features.

Validity of self-reported concentration and memory problems: Relationship with neuropsychological assessment and depression.

BACKGROUND: This study investigated the validity of self-reported concentration and memory problems (CMP) in residents environmentally exposed to manganese (Mn). METHOD: Self-report of CMP from a health questionnaire (HQ) and the Symptom Checklist-90-Revised (SCL-90-R) was compared to neuropsychological assessment (Trails A&B; Digit Span; Digit Symbol; Similarities; Auditory Consonant Trigrams, ACT; NAB Memory; Rey-Osterrieth, Rey-O, Delayed). Participants included 146 residents from Ohio exposed to air-Mn, with a modeled average concentration of 0.55 µg m-3 (range = 0.01-4.58). RESULTS: Residents were primarily White (94.5%), aged 30-64 years (M = 51.24), with a minimum of 10 years of residence (range = 10-64). Ninety-four (65.3%) participants reported concentration problems, and 107 residents (73.3%) reported memory problems. More participants endorsed CMP on the SCL-90-R than on the HQ. The prevalence of self-reported CMP was higher for women than for men (88.4% vs. 68.3%). Point-biserial and Pearson's correlations between self-reported CMP and neuropsychological test scores were nonsignificant and weak for both the HQ (rpb = -.20 to rpb = .04) and the SCL-90-R (r = -.12 to r = .007). Greater levels of depression, anxiety, and female sex predicted having more self-reported CMP on both the HQ and the SCL-90-R. Air-Mn and blood-Mn were not associated with self-reported CMP. Residential distance from the Mn source accounted for a small proportion of variance (sr2 = .04), although depression remained the largest predictor (sr2 = .21). CONCLUSION: These results indicate that self-report of CMP in Mn-exposed residents appear to be invalid when compared to neuropsychological test scores. The participants' misperception of having CMP is associated with less education and higher levels of depression. Neuropsychological assessment is recommended to attain valid results.

Revisiting self-regulatory techniques to promote physical activity in older adults: null-findings from a randomised controlled trial.

OBJECTIVE: A randomised controlled trial (RCT) was conducted to evaluate a three-hour face-to-face physical activity (PA) intervention in community-dwelling older German adults with four groups: The intervention group (IG) received behaviour change techniques (BCTs) based on the health action process approach plus a views-on-ageing component to increase PA. The second intervention group 'planning' (IGpl) contained the same BCTs, only substituted the views-on-ageing component against an additional planning task. An active control group received the same BCTs, however, targeting volunteering instead of PA. A passive control group (PCG) received no intervention. DESIGN: The RCT comprised 5 time-points over 14 months in N = 310 participants aged 64+. MAIN OUTCOME MEASURES: Self-reported as well as accelerometer-assessed PA. RESULTS: Neither PA measure increased in the IG as compared to the other groups at any point in time. Bayes analyses supported these null-effects. CONCLUSION: A possible explanation for this null-finding in line with a recent meta-analysis is that some self-regulatory BCTs may be ineffective or even negatively associated with PA in interventions for older adults as they are assumed to be less acceptable for older adults. This interpretation was supported by observed reluctance to participate in self-regulatory BCTs in the current study.

Regional resources buffer the impact of functional limitations on perceived autonomy in older adults with multiple illnesses.

Retaining perceptions of autonomy is a key component of successful aging. Perceived autonomy refers to the capacity to make and enact self-directed decisions. These perceptions are often threatened in older adults with multiple illnesses, when functional limitations resulting from these illnesses impede the enactment of self-directed decisions. Regional resources (in Germany specifically at the level of administrative districts) might counteract these impediments of autonomy. Economically stronger districts can provide more-concrete support resources for older adults, buffering the negative effect of functional limitations on self-perceived autonomy. This study assessed participants aged over 65 with 2 or more chronic conditions. In total, N = 287 provided data (Mage = 73.3, SD = 5.07), and n = 97 were women. Gross domestic product (GDP) per capita was used as a proxy measure of administrative district wealth in Germany. Hierarchical multilevel regression analyses with cross-level interactions were conducted. Results suggest that the detrimental effect of functional limitations on perceived autonomy is less pronounced for participants residing in higher GDP districts. Conversely, for participants in lower GDP districts, the effect is exacerbated. This finding suggests that districts with greater financial resources might be better able to invest in supports that promote and facilitate autonomy and, thus, provide a buffer against threats to individual perceived autonomy.

A Computerized Lifestyle Application to Promote Multiple Health Behaviors at the Workplace: Testing Its Behavioral and Psychological Effects.

BACKGROUND: Preventive health behaviors, such as regular physical activity and healthy nutrition, are recommended to maintain employability and to facilitate the health of employees. Theory-based workplace health promotion needs to include psychological constructs and consider the motivational readiness (so-called stages of change) of employees. According to the stages, people can be grouped as nonintenders (not motivated to change and not performing the goal behavior), intenders (decided to adopt the goal behavior but not started yet), or actors (performing the goal behavior already). The tailoring to these stages can be done computer based and should make workplace health promotion more effective. OBJECTIVE: It was tested whether a parsimonious computer-based health promotion program implemented at the workplace was effective in terms of lifestyle changes and psychological outcomes as well as body weight. We hypothesized that the stage-matched intervention would outperform the one-size-fits-all active control condition (standard care intervention). METHODS: In a randomized controlled trial, a total of 1269 employees were recruited by a trained research assistant at their workplace during a routine medical examination. After excluding noneligible employees, 560 completed Time 1 (T1), and 384 also completed Time 2 (T2), achieving a retention rate of 68.6%. Two fully automated computer-based treatments were adopted: (1) an active control condition with information about benefits of exercise and healthy nutrition (n=52), or (2) a stage-matched multiple-behavior intervention that provided different psychological treatments to 9 subgroups, addressing stages of change (nonintenders, intenders, and actors per behavior; n=332). Baseline assessments (T1) on behavior, psychological constructs, and body weight were repeated after 4 weeks (T2). RESULTS: The stage-matched intervention outperformed the active control condition for lifestyle changes containing physical activity and nutrition (χ(2) 1=3.5; P=.04, for N=384) as well as psychological variables (physical activity intention, P=.04; nutrition intention, P=.03; nutrition planning, P=.02; and general social support to live healthily, P=.01). When predicting a healthy lifestyle at follow-up, baseline lifestyle (odds ratio, OR, 2.25, 95% CI 1.73-2.92; P<.01) and the intervention (OR 1.96, 95% CI 1.00-3.82; P=.05) were found to be significant predictors. Physical activity planning mediated the effect of the intervention on the adoption of an overall healthy lifestyle (consisting of activity and nutrition, R(2) adj=.08; P<.01), indicating that if the stage-matched intervention increased planning, the adoption of a healthy lifestyle was more likely. CONCLUSIONS: Matching an intervention to the motivational readiness of employees can make a health promotion program effective. Employees' motivation, planning, social support, and lifestyle can be supported by a stage-matched intervention that focuses on both physical activity and healthy nutrition. Occupational settings provide a potential to implement parsimonious computer-based health promotion programs and to facilitate multiple behavior change.

Chronic probable PTSD in police responders in the world trade center health registry ten to eleven years after 9/11.

BACKGROUND: Police enrolled in the World Trade Center Health Registry (WTCHR) demonstrated increased probable posttraumatic stress disorder (PTSD) after the terrorist attack of 9/11/2001. METHODS: Police enrollees without pre-9/11 PTSD were studied. Probable PTSD was assessed by Posttraumatic Stress Check List (PCL). Risk factors for chronic, new onset or resolved PTSD were assessed using multinomial logistic regression. RESULTS: Half of police with probable PTSD in 2003-2007 continued to have probable PTSD in 2011-2012. Women had higher prevalence of PTSD than men (15.5% vs. 10.3%, P = 0.008). Risk factors for chronic PTSD included decreased social support, unemployment, 2+ life stressors in last 12 months, 2+ life-threatening events since 9/11, 2+ injuries during the 9/11 attacks, and unmet mental health needs. CONCLUSION: Police responders to the WTC attacks continue to bear a high mental health burden. Improved early access to mental health treatment for police exposed to disasters may be needed.

Mothers improve their daughters' vegetable intake: a randomized controlled trial.

The increasing prevalence of childhood overweight makes children an important target for health promotion programmes. An intervention was designed for mothers to provide more vegetables to their daughters' diet. A randomized controlled trial compared a self-regulation condition with a control condition in 155 mothers aged 25-50 years. Dependent variable was children's (aged 6-11 years) vegetable consumption which was reported by their mothers at three points in time. After baseline (Time 1), the intervention group received theory-based instructional leaflets to promote self-regulatory skills for providing a healthy nutrition for children. Changes were assessed after two weeks (Time 2) and at three-month follow-up (Time 3). The self-regulation intervention in mothers led to an increase in vegetable intake among their daughters at Time 2 but not at Time 3. However, maintenance of vegetable consumption at Time 3 was mediated by the amount of vegetable intake at Time 2. Engaging mothers in self-regulatory health promotion programmes may be a feasible strategy to facilitate more vegetable intake among their daughters.

A brief intervention increases fruit and vegetable intake. A comparison of two intervention sequences.

BACKGROUND AND PURPOSE: To evaluate the effectiveness of two subsequent intervention components (motivational and self-regulatory components), placed in different order, to promote fruit and vegetable (FV) intake. METHODS: After baseline assessment, university students (N=205, aged 18-26 years) were allocated to two groups. One group received a motivational intervention (outcome expectancies, risk perception, and task self-efficacy) followed by a self-regulatory intervention (planning and dietary self-efficacy) after 17 days. The second group received the same intervention conditions in the opposite order. Follow-up assessments were done after another 17 days. RESULTS: Both intervention sequences yielded gains in terms of FV intake and self-efficacy. However, this gain was only due to the self-regulatory component whereas the motivational component did not contribute to the changes. Moreover, changes in intention and self-efficacy mediated between intervention sequence and follow-up behavior, suggesting that improving these proximal predictors of FV intake was responsible for the behavioral gains. CONCLUSIONS: Findings highlight the superiority of a self-regulatory intervention over a motivational intervention when it comes to dietary changes in this sample of young adults. Moreover, changes in dietary self-efficacy may drive nutritional changes.

Self-efficacy, action control, and social support explain physical activity changes among Costa Rican older adults.

BACKGROUND: Self-efficacy, action control, and social support are considered to influence changes in physical activity levels in older adults. This study examines the relationship among these variables and explores the putative mediating and moderating mechanisms that might account for activity changes. METHODS: A longitudinal study with 54 older adults (≥ 50 years of age) was carried out in Costa Rica. In a moderated mediation analysis, action control was specified as a mediator between self-efficacy and physical activity, whereas social support was specified as a moderator between self-efficacy and action control. Baseline physical activity, age, and sex were specified as covariates. RESULTS: Action control mediated between self-efficacy and physical activity. An interaction between social support and self-efficacy on action control pointed to a synergistic effect at the first stage of the mediating process. CONCLUSIONS: The effect of self-efficacy on physical activity was partly explained by action control, providing evidence of action control as a proximal mediator of physical activity. Moreover, the moderator role of social support was confirmed: high social support appeared to compensate for low levels of self-efficacy.

An age-tailored intervention sustains physical activity changes in older adults: a randomized controlled trial.

BACKGROUND: A randomized controlled trial compared an age-tailored intervention to increase physical activity levels in older adults to an age-neutral intervention. PURPOSE: Both interventions communicated activity planning strategies and messages to improve self-efficacy. On top of this, the age-tailored intervention also included two lifespan components that targeted present orientation and emotional focus, and fostered strategies of selection, optimization, and compensation. METHOD: A total of 386 German older adults (aged 60-95 years) were randomized to receive either the age-tailored intervention (age-specific strategy training and short-term emotional focus) or the age-neutral intervention. Physical activity was measured by questionnaires at baseline (T1) and at 6-month (T2) and 12-month follow-ups (T3). Latent true change modeling was applied by creating latent change scores (T2 - T1 and T3 - T2). RESULTS: After controlling for gender, age, and physical and mental health, allocation to the age-tailored intervention predicted a latent physical activity difference at T3 - T2, but not at T2 - T1. CONCLUSION: Compared to the age-neutral intervention, the age-tailored intervention led to superior maintenance of physical activity within these older adults.

Promoting exercise maintenance: how interventions with booster sessions improve long-term rehabilitation outcomes.

OBJECTIVE: Follow-up intervention boosters are supposed to promote exercise maintenance beyond initial treatment. The current quasi-experimental study investigated the benefits of adding telephone-delivered intervention boosters to a self-management exercise intervention for rehabilitants. Psycho-social mechanisms by which the intervention boosters promote exercise maintenance were examined. RESEARCH DESIGN: Between 2009 and 2011, individuals in cardiac and orthopedic rehabilitation (N = 1,166) were allocated to either a self-management exercise intervention or a control group (i.e., questionnaire only). In addition to standard rehabilitation, participants in the intervention group were offered a series of telephone-delivered intervention boosters after 6 weeks and again after 6 months. Self-efficacy, action planning, and satisfaction with previous exercise outcomes were reassessed 12 months after discharge. Habit strength and exercise were measured 18 months after rehabilitation. RESULTS: The intervention with boosters promoted the maintenance of planning, self-efficacy, satisfaction, exercise, and habit strength. Changes in exercise were simultaneously mediated by changes in planning, self-efficacy, and satisfaction. Changes in habit strength were sequentially mediated by planning and exercise. CONCLUSIONS: Interventions with boosters that focus on action planning, self-efficacy, and satisfaction help to maintain self-directed postrehabilitation exercise. Frequent exercise performance, in turn, can strengthen exercise habits.

A dietary planning intervention increases fruit consumption in Iranian women.

The study examined whether a dietary planning intervention would help increase fruit consumption among Iranian women focusing on self-regulatory mechanisms in behavior change. We conducted a randomized controlled trial to compare a planning intervention with a control condition in 165 Iranian women (aged 17-48years). Dependent variable was fruit intake, and dietary planning served as the mediator. After baseline assessment (T1) the intervention group received a leaflet on fruit consumption with a planning sheet. Changes were assessed at 3-weeks (T2) and at 3-months follow-ups (T3). Findings showed that the dietary planning intervention led to an increase in fruit intake. Age moderated this mediation. Changes in dietary planning mediated between intervention and fruit consumption in middle aged women. Dietary planning seems to play a role in the mechanism that facilitates fruit intake among Iranian women. This mediation by planning was found in middle aged women (30-48 years old), but not in young adult women (17-29 years old).

'I do not need a flu shot because I lead a healthy lifestyle': compensatory health beliefs make vaccination less likely.

Compensatory health beliefs, a self-defence strategy, were examined in a theory-guided intervention promoting influenza vaccination at the workplace. In total, 851 employees were randomised to one group aimed at enhancing intention formation (standard group) or to another one assisting self-regulation (intervention group). Assessments took place after the intervention and 5 months later, investigating whether the intervention would interfere with compensatory health beliefs. The intervention generated an indirect effect via planning on vaccination. Compensatory health beliefs mediated between intention and behaviour. An interaction between intervention group and compensatory health beliefs on behaviour transpired. At low compensatory health belief levels, the intervention group resulted in more vaccinations than the standard group.

Contextual and individual predictors of physical activity: Interactions between environmental factors and health cognitions.

OBJECTIVE: Although health behavior theories assume a role of the context in health behavior self-regulation, this role is often weakly specified and rarely examined. The two studies in this article test whether properties of the environment (districts) affect if and how health-related cognitions are translated into physical activity. METHODS: Multilevel modeling was used to examine the assumed cross-level interactions. Study 1 is a large-scale survey representative of the German adult population (N = 6,201). Gross domestic product (GDP) on the level of administrative districts was used to indicate environmental opportunities and barriers. Study 2 examined cross-level interactions of proximal predictors of physical activity (intentions, action planning, and coping planning) in older adults with multiple illnesses (N = 309), a high-risk group for health deteriorations. RESULTS: Study 1 showed that on the individual level, health attitudes (B = .11) and education (B = .71) were significantly associated with physical activity. GDP moderated the attitudes-behavior relation (B = .01), with higher attitude-behavior relations in districts with higher GDP. Study 2 finds that intention (B = .16), action planning (B = .17), and coping planning (B = .13) significantly predict activity. In addition, district-level GDP significantly moderated the relations between action planning and coping planning, but not intention, on physical activity. CONCLUSIONS: Results suggest that the effects of health attitudes and planning on physical activity are moderated by environmental factors. Districts with higher GDP provide better contextual opportunities for the enactment of concrete if-then plans for physical activity. This has implications for both theory and health promotion.

Facilitating sunscreen use in women by a theory-based online intervention: a randomized controlled trial.

This study compares a motivational skin cancer prevention approach with a volitional planning and self-efficacy intervention to enhance regular sunscreen use. A randomized controlled trial (RCT) was conducted with 205 women (mean age 25 years) in three groups: motivational; volitional; and control. Sunscreen use, action planning, coping planning and coping self-efficacy were assessed at three points in time. The volitional intervention improved sunscreen use. Coping planning emerged as the only mediator between the intervention and sunscreen use at Time 3. Findings point to the role played by coping planning as an ingredient of sun protection interventions.

Changes in social-cognitive variables are associated with stage transitions in physical activity.

When it comes to the adoption or maintenance of physical activity, individuals can be placed along a continuum or into stages of change. The Health Action Process Approach proposes three such stages: non-intentional, intentional and actional. Intraindividual differences are reflected by stage transitions: either progression or regression. The present study examines social-cognitive factors of stage transitions: outcome expectancies, self-efficacy and planning. In an online study on physical activity, 660 adults completed questionnaires at baseline and approximately 3 weeks later. Social-cognitive factors were converted into standardized residual change scores to account for changes in outcome expectancies, self-efficacy and planning within the observation period. Discriminant function analyses revealed stage-specific patterns: progression out of non-intentional stage was associated with self-efficacy increases. Out of intentional stage, regression was correlated with decreases in planning, whereas progression was linked to increases in self-efficacy and planning. Regression from action stage was associated with decreases in self-efficacy. Physical activity promotion should focus on improving self-efficacy for non-intending, intending and acting individuals, whereas planning interventions are recommended for intending individuals. Interventions may be more effective by considering specific mechanisms instead of providing generic interventions for all individuals at different stages.

Mechanisms of health behavior change in persons with chronic illness or disability: the Health Action Process Approach (HAPA).

OBJECTIVE: The present article presents an overview of theoretical constructs and mechanisms of health behavior change that have been found useful in research on people with chronic illness and disability. A self-regulation framework (Health Action Process Approach) serves as a backdrop, making a distinction between goal setting and goal pursuit. Risk perception, outcome expectancies, and task self-efficacy are seen as predisposing factors in the goal-setting (motivational) phase, whereas planning, action control, and maintenance/recovery self-efficacy are regarded as being influential in the subsequent goal-pursuit (volitional) phase. The first phase leads to forming an intention, and the second to actual behavior change. Such a mediator model serves to explain social-cognitive processes in health behavior change. By adding a second layer, a moderator model is provided in which three stages are distinguished to segment the audience for tailored interventions. Identifying persons as preintenders, intenders, or actors offers an opportunity to match theory-based treatments to specific target groups. Numerous research and assessment examples, especially within the physical activity domain, serve to illustrate the application of the model to rehabilitation settings and health promotion for people with chronic illness or disability. CONCLUSIONS/IMPLICATIONS: The theoretical developments and research evidence for the self-regulation framework explain the cognitive mechanisms of behavior change and adherence to treatment in the rehabilitation setting.