Causal Effects of Alcohol-Related Facebook Posts on Drinking Behavior: Longitudinal Experimental Study.

BACKGROUND: Adolescents and young adults frequently post alcohol-related content (ie, alcoholposts) on social media. This is problematic because both social norms theory and social learning theory suggest that viewing alcoholposts of peers could increase drinking behavior. It is therefore paramount to understand the effects of exposure to alcoholposts on viewers. OBJECTIVE: This study aimed to investigate the causal effects of exposure to alcoholposts on alcohol consumption by using a rigorous design. METHODS: We conducted a 6-week longitudinal study during which alcoholposts were measured by a newly developed app that copied Facebook posts shared by participants (n=281) to a new social media environment. In addition, daily questionnaires assessed alcohol use. Effects of natural alcoholposts (ie, posted by the participants) were assessed in phase 1, and effects of experimental posts (ie, posted by fake participants) were explored in phase 2. RESULTS: Results showed that natural alcoholposts increased the occurrence and quantity of drinking the following day. That is, exposure to a single additional alcoholpost increased the log odds of drinking the next day by 0.27 (b=.27, credible interval [CI] .18 to .35). Furthermore, the number of natural alcoholposts had a positive (predictive) effect on the number of glasses drunk the next day (b=.21, CI .14 to .29). In phase 2 when experimental posts were also present, these effects decreased. Experimental posts themselves had hardly any effects. CONCLUSIONS: This study illustrates clear and direct effects of exposure to alcoholposts on next-day alcohol consumption and suggests that alcoholposts represent an important societal problem that interventions need to address.

Effects of a self-management training for people with intellectual disabilities.

BACKGROUND: To help people with intellectual disabilities lead a more independent life, it is important to promote their self-management. This study evaluated the effectiveness of a self-management training for people with intellectual disabilities directed at independent functioning in daily life. METHOD: In the training, 17 people with intellectual disabilities worked on personal self-management goals covering a wide range of everyday affairs. Primary outcome measures focused on goal attainment, independence and support needs. Moreover, outcomes regarding psychopathological behaviour and quality of life were explored. Data were collected before and at the start of the training, and 3, 6, 9 and 12 months later. RESULTS: The training contributed to the attainment of self-management goals and to the reduction in support needs (p < 0.01). There were no changes in independence, psychopathological behaviour and quality of life. CONCLUSIONS: Results indicate that the training supports people with intellectual disabilities to self-manage their daily affairs.

Exploring the direct or inverse association of physical activity with behavioral addictions and other self-regulation problems. / ¿Protege o predispone la actividad física a las adicciones conductuales y otros problemas de autorregulación?

This cross-sectional survey study had the aim of clarifying the relationships between leisure time physical activity (LTPA) and non-drug-re-lated self-regulation problems (non-drug-related SRPs), including behavioral addictions, and the role of impulsive personality traits therein. Spanish university students (N = 329; Mage = 21.20) completed questionnaires for each of these constructs. Fitness and Bodybuilding LTPA was negatively associated with video gaming-related SRPs, r = -.13, p = .019, 95% CI (bootstrapped) [-.23, -.02], and positively associated with sex-related SRPs, r = .16, p = .005, 95% CI (bootstrapped) [.04,  .30]. Endurance LTPA was associated with higher scores in eating-related SRPs, r = .17, p = .003, 95% CI (bootstrapped) [.02,  .31]. The proportion of participants presenting scores above the clinically significant threshold in eating-related SRPs was 2.64 times higher for respondents in an Excessive Endurance LTPA cluster compared to the other respondents, Fisher's exact test, p = .017, OR = 3.10, 95% CI [1.26, 7.63], and the proportion of participants reporting vomiting to control weight was 2.12 times higher, Fisher's exact test, p = .040, OR = 2.43, 95% CI [1.06, 5.57]. The associations were largely independent of impulsive personality traits. We identified an elevated risk of eating pathology in a subgroup of participants with anomalously high participation in endurance physical activity. This overlap is consistent with the secondary dependence hypothesis of exercise addiction.

Este estudio tuvo como objetivo aclarar las relaciones entre la actividad física de ocio (AFO) y los problemas de autorregulación (PARs) no relacionados con drogas, incluyendo las adicciones conductuales, y el papel de los rasgos de personalidad impulsiva. Estudiantes universitarios españoles (N = 329, Mage = 21,20) completaron cuestionarios para cada uno de estos constructos.La AFO de gimnasio y musculación se asoció negativamente con los PARs relacionados con videojuegos, r = -0,13, p = 0,019, 95% CI (bootstrapped) [-0,23, -0,02], y positivamente con los PARs relacionados con sexo, r = 0,16, p = 0,005, 95% CI (bootstrapped) [0,04, -0,30]. La AFO de resistencia se asoció positivamente con los PARs relacionados con la alimentación, r = 0,17, p = 0,003, 95% CI (bootstrapped) [0,02,  0,31]. La probabilidad de presentar puntuaciones potencialmente clínicas en PARs de alimentación fue 2,64 veces mayor para los encuestados en un grupo de AFO de resistencia excesiva en comparación con los otros encuestados, prueba exacta de Fisher, p = 0,017, OR = 3,10, 95% CI [1,26, 7,63], y la probabilidad de vomitar para controlar el peso fue 2,12 veces mayor en ese mismo grupo, prueba exacta de Fisher, p = 0,040, OR = 2,43, 95% CI [1,06, 5,57]. Las asociaciones fueron en gran medida independientes de los rasgos de personalidad impulsiva.Identificamos un riesgo elevado de patología alimentaria potencialmente clínica en un subgrupo de participantes con niveles anormalmente altos de actividad física de resistencia. Esta superposición es consistente con la hipótesis de dependencia secundaria en la adicción al ejercicio.

Social Drinking on Social Media: Content Analysis of the Social Aspects of Alcohol-Related Posts on Facebook and Instagram.

BACKGROUND: Alcohol is often consumed in social contexts. An emerging social context in which alcohol is becoming increasingly apparent is social media. More and more young people display alcohol-related posts on social networking sites such as Facebook and Instagram. OBJECTIVE: Considering the importance of the social aspects of alcohol consumption and social media use, this study investigated the social content of alcohol posts (ie, the evaluative social context and presence of people) and social processes (ie, the posting of and reactions to posts) involved with alcohol posts on social networking sites. METHODS: Participants (N=192; mean age 20.64, SD 4.68 years, 132 women and 54 men) gave researchers access to their Facebook and/or Instagram profiles, and an extensive content analysis of these profiles was conducted. Coders were trained and then coded all screenshotted timelines in terms of evaluative social context, presence of people, and reactions to post. RESULTS: Alcohol posts of youth frequently depict alcohol in a positive social context (425/438, 97.0%) and display people holding drinks (277/412, 67.2%). In addition, alcohol posts were more often placed on participants' timelines by others (tagging; 238/439, 54.2%) than posted by participants themselves (201/439, 45.8%). Furthermore, it was revealed that such social posts received more likes (mean 35.50, SD 26.39) and comments than nonsocial posts (no people visible; mean 10.34, SD 13.19, P<.001). CONCLUSIONS: In terms of content and processes, alcohol posts on social media are social in nature and a part of young people's everyday social lives. Interventions aiming to decrease alcohol posts should therefore focus on the broad social context of individuals in which posting about alcohol takes place. Potential intervention strategies could involve making young people aware that when they post about social gatherings in which alcohol is visible and tag others, it may have unintended negative consequences and should be avoided.

Prevalence and Psychosocial Correlates of Party-Drug Use and Associated Problems among University Students in the Netherlands.

BACKGROUND: Recent developments in drug use patterns call for an investigation of current party-drug use and associated problems among college students, who appear to be an important target population for harm reduction interventions. OBJECTIVES: In addition to reporting on party-drug use prevalence, we investigated whether initial use and continuation of party-drug use among students was associated with demographic, personality and psychosocial factors. METHODS: An online questionnaire was administered to 446 students from a Dutch university, inquiring about party-drug use, demographic characteristics, social norms and personality (big five, impulsiveness, aggression). Univariate and multivariate bootstrapped linear regression analyses were used. RESULTS: Of all students, 22.9% indicated having used party-drugs at least once, with a notable sex difference (39.2% of men vs. 16.2% of women). In contrast to the reported trends in Dutch nightlife, GHB was used rarely (lifetime 1.6%) and new psychoactive substances (NPS; 6.7%) appeared almost equally popular as amphetamines (7.6%) and cocaine (7%). Mild health/psychosocial problems (e.g., doing embarrassing things, feeling unwell) were common (65%), whereas serious problems (e.g., being hospitalized) were rare. Neuroticism, extraversion, conscientiousness and impulsiveness were associated with lifetime but not regular party-drug use. Of all predictors, lifetime and regular party-drug use were most strongly related to lenient injunctive and descriptive norms in friends, and a low motivation to comply with parents. CONCLUSIONS: Our findings indicate that harm reduction/preventive interventions might profit from focusing on social norms, and targeting students who are highly involved in a pro-party-drug environment while experiencing less parental influence.

Training staff to promote self-management in people with intellectual disabilities.

BACKGROUND: People with intellectual disabilities have increasing difficulties managing their daily affairs. This study examined the effectiveness of a staff training, which teaches staff to promote self-management in people with intellectual disabilities. METHOD: Effectiveness was assessed with questionnaires addressing clients' (n = 26) independence and self-reliance, support needs and challenging behaviour, using a pre-posttest control group design. Additionally, focus groups were conducted with trained staff members 6 months after the training. RESULTS: In the long term, the intervention group showed a significant increase in independence and self-reliance, in contrast to the comparison group. No effect was found on support needs and challenging behaviour. Trained staff members reported limited benefits of the training, but had noticed changes in their attitude and method of working afterwards. CONCLUSIONS: Further self-management research is required to investigate how independence and self-reliance can be promoted more effectively in this population. Future trainings should carefully consider their content, format, and implementation.

Factors influencing the introduction of physical activity interventions in primary health care: a qualitative study.

BACKGROUND: The introduction of efficacious physical activity (PA) interventions in routine primary health care (PHC) is a complex process. Understanding factors influencing the process can enhance the development of successful introduction strategies. PURPOSE: The aim of this qualitative study was to explore stakeholders' perceptions on factors influencing the introduction, i.e., adoption, implementation, and continuation, of PA interventions in PHC. METHOD: Twenty-eight semistructured interviews were held with intervention managers, PHC advisors, intervention providers, and referring general practitioners of five PA interventions delivered in PHC. A theoretical framework on the introduction of innovations in health care was used to guide the data collection. Influencing factors were identified using thematic analysis. RESULTS: Stakeholders reported preconditions for the introduction of PA interventions in PHC (e.g., support, resources, and networks and collaborations), in addition to characteristics of PA interventions (e.g., compatibility, flexibility, and intervention materials) and characteristics of PHC professionals (e.g., knowledge, positive attitudes, and beliefs about capabilities) perceived to enhance the introduction process. Furthermore, they proposed strategies for the development of PA interventions (e.g., involvement of future stakeholders, full development, and refinement) and strategies to introduce PA interventions in PHC (e.g., training, assistance, and reinforcement). The majority of the influencing factors were discussed specifically in relation to one or two stages. CONCLUSION: This study presents an overview of factors that are perceived to influence the introduction of PA interventions in PHC. It underscores the importance of taking these factors into account when designing introduction strategies and of giving special attention to the distinct stages of the process.

Factors influencing primary health care professionals' physical activity promotion behaviors: a systematic review.

BACKGROUND: Despite the promising findings related to the efficacy of interventions aimed at promoting physical activity (PA) in primary health care (PHC), the translation of these interventions to PHC practice does not always happen as desired. PURPOSE: To help understand why efficacious PHC-based PA interventions are not effectively translated to practice, this study systematically reviewed the literature on factors influencing PHC professionals' PA promotion practices. METHOD: Literature searches were conducted in Web of Science, PubMed, and PsycINFO for peer-reviewed articles published in English from 1990 onwards. Studies were included that met the following criteria: (1) involving PHC-based PA interventions, and (2) reporting factors influencing PHC professionals' PA promotion behaviors. Two researchers independently screened studies and extracted data. A narrative synthesis using thematic analysis was conducted to identify factors. RESULTS: Of the 4,469 identified articles, 59 were included in the review. Factors were identified by qualitative methods, barrier/facilitator ratings, and the examination of the relationship between factors and PA promotion, and the effectiveness of introduction strategies. Many factors related to the development, delivery, and effects of the innovation, the sociopolitical and organizational culture, resources, and support, patient and PHC professional characteristics, and innovation strategies were identified as potential influences on PHC professionals' PA promotion practices. However, the lack of evidence on the relationship between factors and PA promotion indicated insufficient evidence on PA promotion determinants. CONCLUSION: This extensive overview of potential factors can inform intervention developers and implementers on which factors may play a role when introducing PA interventions in PHC. Future research should further investigate relationships between factors and PA promotion, which should be guided by qualitative in-depth knowledge on influencing factors.

Goal linking and everyday worries in clinical work stress: A daily diary study.

OBJECTIVES: In this study, we tested whether high levels of daily worrying are associated with linking, a tendency to overvalue the attainment of specific lower level goals for attaining higher level goals, and more specifically the attainment of experiencing happiness. METHODS: Thirty-two patients suffering from work stress complaints and awaiting a stress management treatment and 31 healthy adults, who formed the comparison group, filled in a goal linking questionnaire and two widely used trait worry questionnaires. Subsequently, they reported the frequency and duration of worry during 14 consecutive days and nights. RESULTS: The patients suffering from work stress complaints scored higher on the linking questionnaire and worried almost twice as much as the healthy comparison group, especially during the night-time. Furthermore, goal linking was a stronger predictor of the frequency and duration of worry in daily life than the trait worry questionnaires and this was independent of the observed group differences in daily worry. CONCLUSIONS: These findings provide evidence that people who believe that their happiness is strongly dependent on the attainment of specific lower level goals worry frequently in daily life. Linking seems to be at least partly responsible for the excessive worry found in high work stress. PRACTITIONER POINTS: Worry is elevated in patients seeking professional help for work stress complaints, compared to healthy controls The higher levels of worry in the patient group were related to elevated tendencies to overvalue the attainment of specific lower level goals as a means to attain higher level goals ('linking'). It could be beneficial for high worriers to learn how to reduce linking tendencies. No strong inferences on the direction of the association between worry and linking can be made, as we relied on correlational data in which a linking questionnaire predicted worry in daily life.

Implementation of The World Starts With Me, a comprehensive rights-based sex education programme in Uganda.

This article presents a process evaluation of the implementation of the sex education programme the World Starts With Me (WSWM) for secondary school students in Uganda. The purpose of this mixed-methods study was to examine factors associated with dose delivered (number of lessons implemented) and fidelity of implementation (implementation according to the manual), as well as to identify the main barriers and facilitators of implementation. Teachers' confidence in teaching WSWM was negatively associated with dose delivered. Confidence in educating and discussing sexuality issues in class was positively associated with fidelity of implementation, whereas the importance teachers attached to open sex education showed a negative association with fidelity. Main barriers for implementing WSWM were lack of time, unavailability of computers, lack of student manuals and lack of financial support and rewards. Other barriers for successful implementation were related to high turnover of staff and insufficient training and guidance of teachers. Teachers' beliefs/attitudes towards sexuality of adolescents, condom use and sex education were found to be important socio-cognitive factors intervening with full fidelity of implementation. These findings can be used to improve the intervention implementation and to better plan for large-scale dissemination of school-based sex education programmes in sub-Saharan Africa.

Exploring timing and delivery of lifestyle advice following an acute cardiac event hospitalization: The cardiac patient's perspective.

OBJECTIVE: To explore the perspective of cardiac patients regarding the timing and manner of delivering lifestyle advice following an acute cardiac event hospitalization. METHODS: Dutch cardiac patients who experienced a cardiac event hospitalization participated in a semi-structured interview (n = 14) or a cross-sectional survey study (n = 119). RESULTS: Our findings indicate that cardiac patients are receptive to lifestyle advice throughout the care trajectory. Advice delivered by a cardiologist had the highest self-reported impact. Furthermore, receiving advice at multiple phases during the care trajectory was associated with a greater intention to change lifestyle (B = 0.37, CI = 0.17 - 0.57). Patients favored clear-cut, feasible, and friendly but confronting advice. Moreover, they stressed the importance of advice being aligned with their identity and beliefs about the causes of their disease. CONCLUSION: The period following an acute cardiac event provides a unique opportunity to offer tailored and patient-centered lifestyle advice. This "teachable window" for lifestyle change, when used wisely, may improve health outcomes for cardiac patients. PRACTICE IMPLICATIONS: Healthcare professionals should initiate lifestyle advice already during hospitalization and continue during follow-up appointments and cardiac rehabilitation. Advice should be feasible and empathy-based, as well as tailored to the patient's needs, values, and perceptions of the causes of their cardiovascular disease.

Factors influencing the adoption, implementation, and continuation of physical activity interventions in primary health care: a Delphi study.

BACKGROUND: The introduction of efficacious physical activity interventions in primary health care is a complex process. Understanding factors influencing the process can enhance the development of effective introduction strategies. This Delphi study aimed to identify factors most relevant for the adoption, implementation, and continuation of physical activity interventions in primary health care by examining experts' opinions on the importance and changeability of factors previously identified as potentially relevant for the process. METHODS: In the first round, 44 experts scored factors on their importance for each stage of the introduction process, as well as on their changeability. In the second round, the same experts received a questionnaire containing a reduced list of factors, based on the first-round results. They were asked to indicate their top-10 most important factors for each stage, and to re-rate factors' changeability. Thirty-seven experts completed this round. RESULTS: Most important factors could be identified for each stage. Some factors were found important for a specific stage, e.g., the presence of intervention champions within the organization (adoption), provider knowledge (implementation), and the intervention's sustainability (continuation), while others were perceived important for all stages, i.e., the intervention's financial feasibility, the intervention's accessibility to the target group, and time to deliver the intervention. The majority of most important factors was perceived changeable. However, for some factors no consensus could be reached regarding their changeability. CONCLUSIONS: This study identified general and stage-specific factors relevant for the introduction of physical activity interventions in primary health care. It emphasizes the importance of taking these factors into account when designing introduction strategies, and of giving special attention to the distinct stages of the process. Due to lack of consensus on the changeability of most important factors, the extent to which these factors can be influenced by introduction strategies remains unclear.

Dealing with Alcohol-Related Posts on Social Media: Using a Mixed-Method Approach to Understand Young Peoples' Problem Awareness and Evaluations of Intervention Ideas.

Young individuals frequently share and encounter alcohol-related content (i.e., alcohol posts) on social networking sites. The prevalence of these posts is problematic because both the sharing of and exposure to these posts can increase young individuals' alcohol (mis)use. Consequently, it is essential to develop effective intervention strategies that hinder young individuals from sharing these posts. This study aimed to develop such intervention strategies by following four steps: (1) assessing young individuals' problem awareness of alcohol posts, (2) unraveling individuals' own intervention ideas to tackle the problem of alcohol posts, (3) examining their evaluations of theory/empirical-based intervention ideas, and (4) exploring individual differences in both problem awareness and intervention evaluations. To reach these aims, a mixed-method study (i.e., focus-group interviews and surveys) among Dutch high-school and college students (Ntotal = 292, Agerange = 16-28 years) was conducted. According to the results, most youth did not consider alcohol posts to be a problem and were, therefore, in favor of using automated warning messages to raise awareness. However, these messages might not work for every individual, as group differences in problem awareness and intervention evaluations exist. Overall, this study puts forward potential intervention ideas to reduce alcohol posts in digital spheres and can therefore serve as a steppingstone to test the actual effects of the ideas.

My future-self has (not) quit smoking: An experimental study into the effect of a future-self intervention on smoking-related self-identity constructs.

OBJECTIVES: Envisioning one's (non)smoking future may make (un)desired future identities more accessible, salient, and personally relevant and facilitate smoking cessation. The current study assessed whether a future-self intervention can weaken smoker self-identity and expected identity loss when quitting smoking, and strengthen quitter- and nonsmoker self-identity, while accounting for personal factors-socioeconomic position, nicotine dependence, consideration of future consequences, and clarity of the envisioned future-self. Additionally, it examined the association between smoking-related identity and quitting intention and behavior. METHODS: This longitudinal online experimental study randomized 233 adult smokers to an intervention condition (where they completed mental imagery, visual, and verbal tasks about a future (non)smoking self), or to a passive control condition. Smoker-, quitter-, nonsmoker self-identity and identity loss were measured post-intervention and after one- and three-months. Quit intention and attempts were measured at baseline and after one month. RESULTS: There was a consistent increase in non-smoker self-identity, and decrease in smoker self-identity and identity loss over a period of six months for all participants, but no significant difference in smoking-related identity between the intervention and control group. While personal factors did not moderate the effect of the intervention, we found that smoking-related identity constructs do vary with nicotine dependence, consideration of future consequences, and clarity of the envisioned future-self. Quitting behavior is primarily associated with non-smoker self-identity. CONCLUSIONS: Although the future-self intervention did not significantly influence smoking-related identity or behavior, identity-in particular, non-smoker self-identity-is important to consider in smoking cessation interventions. More research is needed to find effective operationalizations for identity-based interventions in the context of smoking.

Making sense of a myocardial infarction in relation to changing lifestyle in the five months following the event: An interpretative phenomenological analysis.

OBJECTIVE: Previous research has shown that experiencing an acute cardiac event, such as a myocardial infarction (MI), can lead to lifestyle changes. This study aimed to explore the potential of a MI as a 'teachable moment' (TM) for positive lifestyle changes and to identify psychosocial sensemaking processes that facilitate or hinder the presence of a TM. METHOD: We conducted semi-structured interviews with 14 patients who suffered their first MI and were hospitalized in a larger Dutch city. Participants were interviewed twice, respectively one and five months after their hospitalization. They were encouraged to explain how they experienced their MI and how this had affected their lifestyle. We used an Interpretative Phenomenological Analysis approach to the data collection and analysis. FINDINGS: The participants varied in their willingness to adopt a healthy lifestyle due to their MI. Most participants experienced their event as a TM for changing specific health behaviors, for example facilitated by reflecting on self-concept or social roles and by constructing and comprehending a personal narrative of their MI. Some participants struggled to follow through on their intentions to change their behavior, for example because of a negative attitude towards a healthy behavior or because they perceived it as incongruent to their identity. Only three participants maintained most former health behaviors, for example because they failed to acknowledge their MI as severe or because of earlier life events that elicited more blunted cognitive responses. CONCLUSION: Cardiac patients may experience a TM, which is the consequence of interrelated processes of psychosocial sensemaking. As this does not occur at a singular time point, we suggest using the term 'teachable window' rather than 'moment'. Given these findings, there is a window of opportunity to provide continuous psychosocial and lifestyle support during and after hospitalization for acute cardiac events.

Mapping the evidence on identity processes and identity-related interventions in the smoking and physical activity domains: a scoping review protocol.

INTRODUCTION: Smoking and insufficient physical activity (PA), independently but especially in conjunction, often lead to disease and (premature) death. For this reason, there is need for effective smoking cessation and PA-increasing interventions. Identity-related interventions which aim to influence how people view themselves offer promising prospects, but an overview of the existing evidence is needed first. This is the protocol for a scoping review aiming to aggregate the evidence on identity processes and identity-related interventions in the smoking and physical activity domains. METHODS: The scoping review will be guided by an adaption by Levac et al of the 2005 Arksey and O'Malley methodological framework, the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses: Extension for Scoping Review (PRISMA-ScR) and the 2017 Joanna Briggs Institute guidelines. It will include scientific publications discussing identity (processes) and/or identity-related interventions in the context of smoking (cessation) and/or physical (in)activity, in individuals aged 12 and over. A systematic search will be carried out in multiple databases (eg, PubMed, Web of Science). Records will be independently screened against prepiloted inclusion/exclusion criteria by two reviewers, using the Active Learning for Systematic Reviews machine learning artificial intelligence and Rayyan QCRI, a screening assistant. A prepiloted charting table will be used to extract data from included full-text articles. Findings will be reported according to the PRISMA-ScR guidelines and include study quality assessment. ETHICS AND DISSEMINATION: Ethical approval is not required for scoping reviews. Findings will aid the development of future identity-related interventions targeting smoking and physical inactivity.

The development and validation of scales to measure the presence of a teachable moment following a cardiovascular disease event.

Better conceptually-driven research is necessary to learn more about 1) the characteristics of life events as teachable moments (TMs) and 2) the potential of life events to evoke lifestyle change intention (LCI). This study aimed to develop and validate two scales for the purposes of TM research in the context of cardiovascular disease (CVD): the CardiacTM and CardiacLCI-scales. After the initial development of items based on a theoretical framework and literature search, six experts rated the content validity of both scales as sufficient. The item list was further adjusted after think-aloud sessions with two CVD patients. The resulting scales were presented online in a cross-sectional survey, which yielded 625 responses of Dutch CVD patients (June 2020). To test construct validity, we conducted Exploratory Factor Analysis (EFA) with Varimax rotation on a random split-half of the sample (n = 300) and evaluated the factor structure with Confirmatory Factor Analysis (CFA) on the holdout sample (n = 325). EFA and CFA on the CardiacTM-scale (α = 0.88) revealed a 28-item six-factor structure explaining 61.0% of the variance, with adequate goodness-of-fit statistics (CFI = 0.87; TLI = 0.85; SRMR = 0.07) and internally reliable factors (Affective impact, Risk CVD, Changed self-concept, CVD group identity, Risk non-communicable disease, Anticipated regret). The CardiacLCI-scale (α = 0.81) revealed an 11-item two-factor structure explaining 51.5% of the variance, with adequate model fit (CFI = 0.92; TLI = 0.90; SRMR = 0.08) and internally reliable factors (Event-related lifestyle change and General healthy lifestyle). The scales may be used to expand knowledge around life events as TMs and to support conversation regarding lifestyle after cardiac and other life events.

The COVID-19 Crisis as a Teachable Moment for Lifestyle Change in Dutch Cardiovascular Disease Patients.

Objective: When lifestyle changes are needed, life events or crises such as COVID-19 may function as "teachable moments". This study aimed to explore whether the pandemic can provoke a teachable moment regarding lifestyle change in cardiovascular disease patients. Method: In this cross-sectional survey study, 830 cardiovascular disease patients reported their intentions to change lifestyle, instigated by the corona crisis, together with risk perception, affective impact, and changed self-concept, based on a "teachable moments" framework. Results: Between 8 and 28% of the sample reported increased intentions to optimize lifestyle behaviors, particularly related to general lifestyle (28%), physical activity (25%), and diet (21%). Multivariate regression analyses revealed that changed self-concept was associated with higher intentions to improve general lifestyle (B = 0.26; CI = 0.19-0.33), physical activity (B = 0.23; CI = 0.16-0.30), and smoking (B = 0.29; CI = 0.01-0.57). In addition, changed self-concept and affective impact were both significantly associated with higher intentions to improve diet (resp. B = 0.29; CI = 0.21-0.36 and B = 0.12; CI = 0.04-0.21) and to limit alcohol consumption (resp. B = 0.22; CI = 0.13-0.30 and B = 0.11; CI = 0.01-0.20). We did not find evidence for an important role of risk perception on behavior change intentions. Conclusion: The COVID-19 crisis evoked a potential teachable moment for lifestyle change in cardiovascular disease patients, driven by a change in a patient's self-concept and to a lesser extent by an affective impact of the COVID-19 crisis. These results suggest an important window of opportunity for healthcare professionals to utilize the pandemic to promote a healthy lifestyle to their patients.

Stakeholder Values and Preferences in Lower Limb Amputation for No-Option Chronic Limb Threatening Ischemia.

PURPOSE: This study focusses on identifying values and preferences of patients, caregivers and healthcare professionals who have dealt with lower limb amputation for no-option chronic limb threatening ischemia. No-option chronic limb threatening ischemia is defined as limb ischemia for which no treatment options exist and where lower limb amputation is necessary in the short term. The values and preferences identified in this study can help improve decision-making processes. PATIENTS AND METHODS: This was a qualitative study, using semi-structured interviews to gather data from patients, caregivers and healthcare professionals. Participants were selected from the patient and employee population of an academic medical center in The Netherlands. Nine patients and seven caregivers who dealt with lower limb amputation for no-option chronic limb threatening ischemia six to twelve months prior to the interview and were not cognitively impaired were selected. Nine healthcare professionals dealing with patients with no-option chronic limb threatening ischemia and lower limb amputation were selected. RESULTS: Lower limb amputation was explicitly discussed late in the disease process, sometimes during an emergency setting. Patients stated goals were never discussed, healthcare professionals stated they were. The most important goal for patients was to live independently after lower limb amputation. Patients and caregivers feel healthcare professionals should be upfront about the possible necessity of lower limb amputation. Reasons to undergo lower limb amputation were absence of treatment options, pain and wanting to enjoy life again. Participants indicated accelerating lower limb amputation was not a viable option. CONCLUSION: All stakeholders reported overlapping values and preferences regarding main reasons for lower limb amputation, the primary goals after lower limb amputation, and the absence of a desire to accelerate lower limb amputation. The main difference in values and preferences is the preferred timing of discussing lower limb amputation.

With a little help from my goals: integrating intergoal facilitation with the theory of planned behaviour to predict physical activity.

OBJECTIVE: Integration of a multiple goal theory approach into the theory of planned behaviour (TPB) to investigate how the perceived facilitating and conflicting relationships in multiple goal pursuit predict performance of a health-related behaviour. DESIGN: Prospective design with 8-week follow-up. METHODS: At baseline, perceived intergoal facilitation and intergoal conflict were measured using personal projects analysis supplemented with standard TPB measures for physical activity (PA). Self-reported PA was measured at follow-up 8 weeks later. N=137 participants completed measures at both time points (55.4% response rate at follow-up). RESULTS: Hierarchical regression showed that perceived intergoal facilitation, but not intergoal conflict, directly predicted PA beyond intention and perceived behavioural control (PBC), accounting for more than 4% of additional variance in PA. Intergoal facilitation had an indirect effect on intention through attitude and PBC, and intention partially mediated the effect of intergoal facilitation on behaviour. CONCLUSION: The perceived facilitating effect of pursuing other personal goals predicts the performance of a health-related behaviour over and above single behaviour-focused social cognitions.