Mental imagery-based self-regulation: Effects on physical activity behaviour and its cognitive and affective precursors over time.

OBJECTIVES: (1) Test whether a mental imagery-based self-regulation intervention increases physical activity behaviour over 90 days; (2) Examine cognitive and affective precursors of change in physical activity behaviour. DESIGN: A randomized control trial with participants (N = 500) randomized to one of six intervention conditions in a 3 (risk communication format: bulleted list, table, risk ladder) x 2 (mental imagery behaviour: physical activity, active control [sleep hygiene]) factorial design. METHODS: After receiving personalized risk estimates via a website on a smartphone, participants listened to an audiorecording that guided them through a mental imagery activity related to improving physical activity (intervention group) or sleep hygiene behaviour (active control). Participants received text message reminders to complete the imagery for 3 weeks post-intervention, 4 weekly text surveys to assess behaviour and its cognitive and affective precursors, and a mailed survey 90 days post-baseline. RESULTS: Physical activity increased over 90 days by 19.5 more minutes per week (95%CI: 2.0, 37.1) in the physical activity than the active control condition. This effect was driven by participants in the risk ladder condition, who exercised 54.8 more minutes (95%CI 15.6, 94.0) in the physical activity condition than participants in the active control sleep hygiene group. Goal planning positively predicted physical activity behaviour (b = 12.2 minutes per week, p = 0.002), but self-efficacy, image clarity, and affective attitudes towards behaviours did not (p > 0.05). CONCLUSIONS: Mental imagery-based self-regulation interventions can increase physical activity behaviour, particularly when supported by personalized disease risk information presented in an easy-to-understand format.

The Genomic Medicine Integrative Research Framework: A Conceptual Framework for Conducting Genomic Medicine Research.

Conceptual frameworks are useful in research because they can highlight priority research domains, inform decisions about interventions, identify outcomes and factors to measure, and display how factors might relate to each other to generate and test hypotheses. Discovery, translational, and implementation research are all critical to the overall mission of genomic medicine and prevention, but they have yet to be organized into a unified conceptual framework. To fill this gap, our diverse team collaborated to develop the Genomic Medicine Integrative Research (GMIR) Framework, a simple but comprehensive tool to aid the genomics community in developing research questions, strategies, and measures and in integrating genomic medicine and prevention into clinical practice. Here we present the GMIR Framework and its development, along with examples of its use for research development, demonstrating how we applied it to select and harmonize measures for use across diverse genomic medicine implementation projects. Researchers can utilize the GMIR Framework for their own research, collaborative investigations, and clinical implementation efforts; clinicians can use it to establish and evaluate programs; and all stakeholders can use it to help allocate resources and make sure that the full complexity of etiology is included in research and program design, development, and evaluation.

Health Communication in Social Media: Message Features Predicting User Engagement on Diabetes-Related Facebook Pages.

BACKGROUND: Social media provides unprecedented opportunities for enhancing health communication and health care, including self-management of chronic conditions such as diabetes. Creating messages that engage users is critical for enhancing message impact and dissemination. PURPOSE: This study analyzed health communications within ten diabetes-related Facebook pages to identify message features predictive of user engagement. METHOD: The Common-Sense Model of Illness Self-Regulation and established health communication techniques guided content analyses of 500 Facebook posts. Each post was coded for message features predicted to engage users and numbers of likes, shares, and comments during the week following posting. RESULTS: Multi-level, negative binomial regressions revealed that specific features predicted different forms of engagement. Imagery emerged as a strong predictor; messages with images had higher rates of liking and sharing relative to messages without images. Diabetes consequence information and positive identity predicted higher sharing while negative affect, social support, and crowdsourcing predicted higher commenting. Negative affect, crowdsourcing, and use of external links predicted lower sharing while positive identity predicted lower commenting. The presence of imagery weakened or reversed the positive relationships of several message features with engagement. Diabetes control information and negative affect predicted more likes in text-only messages, but fewer likes when these messages included illustrative imagery. Similar patterns of imagery's attenuating effects emerged for the positive relationships of consequence information, control information, and positive identity with shares and for positive relationships of negative affect and social support with comments. CONCLUSIONS: These findings hold promise for guiding communication design in health-related social media.

A Randomized Control Trial for Evaluating Efficacies of Two Online Cognitive Interventions With and Without Fear-Appeal Imagery Approaches in Preventing Unprotected Anal Sex Among Chinese Men Who Have Sex with Men.

Fear appeal approach has been used in health promotion, but its effectiveness has been mixed. It has not been well applied to HIV prevention among men who have sex with men (MSM). The present study developed and evaluated the relative efficacy of three online interventions (SC: STD-related cognitive approach, SCFI: STD-related cognitive plus fear appeal imagery approach, Control: HIV-related information based approach) in reducing prevalence of unprotected anal intercourse (UAI) among 396 MSM using a randomized controlled trial design. Participants' levels of fear-related emotions immediately after watching the assigned intervention materials were also assessed. Participants were evaluated at baseline and 3 months after the intervention. Results showed that participants in the SCFI scored significantly higher in the instrument assessing fear after the watching the intervention materials. However, no statistically significant differences were found across the three groups in terms of UAI at Month 3. Some significant within-group reductions in some measures of UAI were found in three groups. Further studies are warranted to test the role of fear appeal in HIV prevention.

Using mental imagery to deliver self-regulation techniques to improve sleep behaviors.

BACKGROUND: Poor sleep habits and insufficient sleep represent significant workplace health issues. PURPOSE: Applying self-regulation theory, we conducted a randomized, controlled trial testing the efficacy of mental imagery techniques promoting arousal reduction and implementation intentions to improve sleep behavior. METHOD: We randomly assigned 104 business employees to four imagery-based interventions: arousal reduction, implementation intentions, combined arousal reduction and implementation intentions, or control imagery. Participants practiced their techniques daily for 21 days. They completed online measures of sleep quality, behaviors, and self-efficacy at baseline and Day 21; and daily measures of sleep behaviors. RESULTS: Participants using implementation intention imagery exhibited greater improvements in self-efficacy, sleep behaviors, sleep quality, and time to sleep relative to participants using arousal reduction and control imagery. CONCLUSIONS: Implementation intention imagery can improve sleep behavior for daytime employees. Use of arousal reduction imagery was unsupported. Self-regulation imagery techniques show promise for improving sleep behaviors.

Promoting physical activity with goal-oriented mental imagery: a randomized controlled trial.

Self-regulation theory and research suggests that different types of mental imagery can promote goal-directed behaviors. The present study was designed to compare the efficacy of approach imagery (attainment of desired goal states) and process imagery (steps for enacting behavior) in promoting physical activity among inactive individuals. A randomized controlled trial was conducted with 182 inactive adults who received one of four interventions for generating mental images related to physical activity over a 4-week period, with Approach Imagery (approach versus neutral) and Process Imagery (process versus no process) as the intervention strategies. Participants received imagery training and practiced daily. Repeated measures ANOVAs revealed that Approach Imagery: (1) increased approach motivations for physical activity at Week 4; (2) induced greater intentions post-session, which subsequently induced more action planning at Week 4; (3) enhanced action planning when combined with process images at post-session and Week 1; and (4) facilitated more physical activity at Week 4 via action planning. These findings suggest that inducing approach orientation via mental imagery may be a convenient and low-cost technique to promote physical activity among inactive individuals.

A randomized trial of computer-based communications using imagery and text information to alter representations of heart disease risk and motivate protective behaviour.

OBJECTIVE: Advances in web-based animation technologies provide new opportunities to develop graphic health communications for dissemination throughout communities. We developed imagery and text contents of brief, computer-based programmes about heart disease risk, with both imagery and text contents guided by the common-sense model (CSM) of self-regulation. The imagery depicts a three-dimensional, beating heart tailored to user-specific information. DESIGN: A 2 × 2 × 4 factorial design was used to manipulate concrete imagery (imagery vs. no imagery) and conceptual information (text vs. no text) about heart disease risk in prevention-oriented programmes and assess changes in representations and behavioural motivations from baseline to 2 days, 2 weeks, and 4 weeks post-intervention. METHODS: Sedentary young adults (N= 80) were randomized to view one of four programmes: imagery plus text, imagery only, text only, or control. Participants completed measures of risk representations, worry, and physical activity and healthy diet intentions and behaviours at baseline, 2 days post-intervention (except behaviours), and 2 weeks (intentions and behaviours only) and 4 weeks later. RESULTS: The imagery contents increased representational beliefs and mental imagery relating to heart disease, worry, and intentions at post-intervention. Increases in sense of coherence (understanding of heart disease) and worry were sustained after 1 month. The imagery contents also increased healthy diet efforts after 2 weeks. The text contents increased beliefs about causal factors, mental images of clogged arteries, and worry at post-intervention, and increased physical activity 2 weeks later and sense of coherence 1 month later. CONCLUSION: The CSM-based programmes induced short-term changes in risk representations and behaviour motivation. The combination of CSM-based text and imagery appears to be most effective in instilling risk representations that motivate protective behaviour.

Do parents have any influence over how young people appraise tobacco images in the media?

BACKGROUND: Socio-cultural factors, including media and family, play an important role in introducing and reinforcing pro-smoking intentions. Tendencies to appraise smokers in media in positive, negative, and empathic ways may play a role in the social and familial dynamics influencing smoking intentions. OBJECTIVE: This study assessed: (1) social group differences in appraisals of pro- and antismoking imagery in media; (2) whether parental antismoking expectations are associated with less positive appraisals; and (3) whether these appraisal tendencies mediate the relationship between parental antismoking expectations and smoking intentions. METHODS AND MATERIALS: Adolescents (N = 515, ages 11-13, M = 11.5 years) from Auckland, New Zealand completed a multimedia, computer-based questionnaire assessing media exposure of smoking imagery in four media clips as well as media exposure, parental attitudes toward smoking, and smoking intentions. RESULTS: Appraisals of smoking imagery in the media clips and media consumption were patterned on the basis of gender, ethnic group, school economic status, and peer and parent smoking behaviors. Positive appraisals of the smoking images were found to mediate the relationship between weaker parental antismoking expectations and greater smoking intentions. CONCLUSION: Parents may have significant influence over how adolescents perceive smoking imagery in media by presenting clear and unambiguous expectations about tobacco use at home. These expectations may shape how adolescents respond to smoking images by effectively "tainting" the image.

Differences between older and younger cancer survivors in seeking cancer information and using complementary/alternative medicine.

OBJECTIVE: The purpose of this study was to describe the differences between younger and older cancer survivors in seeking cancer information, using complementary and alternative medical (CAM) services, and using conventional support services. DESIGN AND METHODS: Participants were 836 survivors of adult cancers (6 months-43 years since completion of primary cancer treatment) in New Zealand who answered a mailed questionnaire between April 2007 and January 2008. RESULTS: Younger survivors (aged <60 years at diagnosis) were more likely to seek information from sources beyond their physicians and used different sources for that information, compared to older survivors. Older and younger survivors used similar conventional support services, but different CAM services. In logistic regression analyses, information-seekers were 5.9 times more likely to use CAM than those who did not seek cancer information (p = 0.02), but the association between information-seeking and CAM use depended on age (p = 0.02). Older cancer survivors who did not seek information from sources beyond that provided by physicians were less likely to use CAM. IMPLICATIONS: Physicians should consider talking to older cancer survivors about their use of information sources or CAM therapies. A conversation between physician and patient may uncover inaccurate information or CAM use that has potential for adverse effects, while allowing the physician to encourage CAM that is potentially useful. Even a brief conversation may be sufficient to encourage older cancer survivors to take action themselves to find services that support their recovery from cancer and cancer treatment.

Illness risk representations and motivations to engage in protective behavior: the case of skin cancer risk.

This study evaluates the contents of representations of skin cancer risk and their associations with risk appraisals, worry, and protection intentions and behaviors. The Assessment of Illness Risk Representations (AIRR) was used to measure conceptual and imagery contents of risk representations, as delineated by the Common-Sense Model. University students (N = 120) completed the AIRR; measures of likelihood and severity appraisals, and worry; and measures of skin self-examination, clinical skin examination, and sun protection intentions and behaviors. Beliefs about identity, causal, and timeline risk were positively associated with likelihood appraisals, whereas consequences and timeline risk beliefs were positively associated with severity appraisals. Identity and timeline risk independently predicted worry. Representational attributes, including imagery vividness and valence, independently predicted intentions and behaviors, whereas likelihood and severity appraisals did not. Symptom imagery interacted with worry to predict detection and prevention intentions: worry predicted greater intentions for participants with symptom imagery but not for those without symptom imagery. The findings support the utility of the AIRR for assessing risk representations and identify ways in which risk representations may guide protective behavior.

Changes in emotion regulation and psychological adjustment following use of a group psychosocial support program for women recently diagnosed with breast cancer.

This study assesses the efficacy of a group intervention in altering emotion regulation processes and promoting adjustment in women with breast cancer. Using a design with 10 alternating phases of availability of the intervention versus standard care, we assessed women participating in one of three conditions: a 12-week group intervention (N = 54); a decliner group who refused the intervention (N = 56), and a standard care group who were not offered the intervention (N = 44). The intervention included training in relaxation, guided imagery, meditation, emotional expression, and exercises promoting control beliefs and benefit-finding. Emotion regulation processes and adjustment were assessed at baseline (following diagnosis), 4 months (corresponding with the end of the intervention), 6 months, and 12 months. At 4 months, intervention participants (compared to decliners and standard care participants) reported greater increases in use of relaxation-oriented techniques, perceived control, emotional well-being, and coping efficacy, and, greater decreases in perceived risk of recurrence, cancer worry, and anxiety. Intervention participants also reported relatively greater decreases in emotional suppression from baseline to 12 months, suggesting that the intervention had a delayed impact on these tendencies. The findings suggest an emotion regulation intervention can beneficially influence emotional experiences and regulation over the first year following diagnosis.

A randomized, controlled trial of massage therapy as a treatment for migraine.

BACKGROUND: Migraine is a distressing disorder that is often triggered by stress and poor sleep. Only one randomized controlled trial (RCT) has assessed the effects of massage therapy on migraine experiences, which yielded some promising findings. PURPOSE: An RCT was designed to replicate and extend the earlier findings using a larger sample, additional stress-related indicators, and assessments past the final session to identify longer-term effects of massage therapy on stress and migraine experiences. METHODS: Migraine sufferers (N = 47) who were randomly assigned to massage or control conditions completed daily assessments of migraine experiences and sleep patterns for 13 weeks. Massage participants attended weekly massage sessions during Weeks 5 to 10. State anxiety, heart rates, and salivary cortisol were assessed before and after the sessions. Perceived stress and coping efficacy were assessed at Weeks 4, 10, and 13. RESULTS: Compared to control participants, massage participants exhibited greater improvements in migraine frequency and sleep quality during the intervention weeks and the 3 follow-up weeks. Trends for beneficial effects of massage therapy on perceived stress and coping efficacy were observed. During sessions, massage induced decreases in state anxiety, heart rate, and cortisol. CONCLUSIONS: The findings provide preliminary support for the utility of massage therapy as a nonpharmacologic treatment for individuals suffering from migraines.

The influence of smoking imagery on the smoking intentions of young people: testing a media interpretation model.

PURPOSE: To assess a theoretical model of adolescents' exposure to films, perceptions of smoking imagery in film, and smoking intentions. METHODS: A structured questionnaire was completed by 3041 Year 8 (aged 12 years) and Year 12 (aged 16 years) students from 25 schools in Auckland, New Zealand. The survey assessed the relationships among exposure to films, attitudes about smoking imagery, perceptions of smoking prevalence and its acceptability, and expectations of smoking in the future. Measures included exposure to films, perceived pervasiveness of, and nonchalant attitudes about smoking imagery, identification of positive smoker stereotypes in films, perceived smoking prevalence, judgment of smoking acceptability, and smoking expectations. Path analytic techniques, using multiple regression analyses, were used to test the pattern of associations identified by the media interpretation model. RESULTS: Hierarchical regression analyses revealed that film exposure predicted higher levels of perceived smoking prevalence, perceived imagery pervasiveness, and nonchalant attitudes about smoking imagery. Nonchalant attitudes, identification of positive smoker stereotypes, and perceived smoking prevalence predicted judgments of smoking acceptability. Acceptability judgments, identification of positive stereotypes, and perceived smoking prevalence were all positively associated with smoking expectations. The media interpretation model accounted for 24% of the variance in smoking expectations within the total sample. CONCLUSIONS: Smoking imagery in film may play a role in the development of smoking intentions through inflating the perception of smoking prevalence and presenting socially attractive images.

Interpretations of smoking in film by older teenagers.

Research testifies that images of tobacco use in popular films are highly pervasive and typically glamorised. There are concerns that these images may promote motivations to smoke in adolescents, but little is known about how these images are interpreted by members of this age group. A qualitative study was conducted to explore how older teenagers interpret and decode smoking imagery in film. This study builds on earlier work with a younger age group (12 and 13 years) to explore how various interpretations of smoking imagery shape and support common understandings about smoking among older teenagers. Data were collected through focus groups. Eighty-eight 16 and 17 year old students were interviewed at school. Participants discussed their recollections of and responses to recently viewed films. Older teens were receptive to smoking imagery when it was used in a credible manner to portray an emotional state, sub-culture affiliation, and lifestyle. Experience as a smoker appeared to inflate the credibility of realistic smoking images, particularly those presented in gritty realism/drama film. Older teens perceived realistic images, as opposed to stereotypical images, as a salient reference to their own lives. Stereotypical images were also readily recalled and appeared to perform an important role in supporting misconceptions about smoking and contributing to popular ideologies about tobacco use. Stereotypical images presented in comedy and action genre also serve to present paradoxical and contradictory messages about tobacco use. In particular, participants recalled tobacco use in film as associated with stress and anxiety, drug use, and seduction. Film images of tobacco use in specific contexts appear to hold specific and significant meanings for older teens. Realistic images offered salient representations of the perceived reality of smoking for this group. Pervasive and credible smoking scenes in film may offer support and reassurance to older teens who currently smoke or hold ambivalent views about smoking. Consistent with younger adolescents, older teens presented a predominantly nonchalant response to smoking imagery in film, which is a powerful indicator of the pervasiveness and acceptability of smoking in general. In contrast with younger adolescent, older teens tend to draw upon their own experience with tobacco use when interpreting smoking images in film.