Relationships between personality, emotional well-being, self-efficacy and weight management among adults with type 2 diabetes: Results from a cross-sectional survey.

The objective of this study was to examine the associations between personality, general and diabetes-specific well-being and self-efficacy, and weight management indicators, among adults with type 2 diabetes. In addition, to examine whether personality provides incremental explanation of variance in weight management indicators. Australian adults with type 2 diabetes (N = 270; 56% women; age: 61±12 years) were recruited via the national diabetes registry. An online survey included measures of: personality (HEXACO-PI-R), weight management indicators (physical activity, healthy diet, body mass index [BMI]), general well-being (WHO-5), general self-efficacy (GSE), diabetes distress (DDS) and diabetes self-efficacy (DMSES). Analyses included bivariate correlations and linear regression, adjusted for demographic, clinical, and psychological variables. All six personality domains showed significant correlation with at least one weight management indicator: physical activity with extraversion (r = .28), conscientiousness (r = .18) and openness (r = .19); healthy diet with honesty-humility (r = .19), extraversion (r = .24), and agreeableness (r = .14); and BMI with emotionality (r = .20) and extraversion (r = -.20). The strongest associations with general and diabetes-specific well-being and self-efficacy were apparent for extraversion, emotionality and conscientiousness (range: r = -.47-.66). Beyond covariates, personality domains explained additional variance for physical activity (Adjusted R2 = .31, R2 difference = .03, p = .03; openness: ß = .16, p = .02, emotionality: ß = .15, p = .04) and healthy diet (Adjusted R2 = .19, R2 difference = .03, p = .02; honesty-humility: ß = .20, p = .002, extraversion: ß = .19, p = .04) but not BMI. This study shows that personality is associated with weight management indicators and psychological factors among adults with type 2 diabetes. Further research is needed, including objective measurement of weight management indictors, to examine how personality influences the experience of type 2 diabetes.

Personality and weight management in adults with type 2 diabetes: A systematic review.

Aims: Managing weight in the context of type 2 diabetes presents unique hormonal, medicinal, behavioural and psychological challenges. The relationship between weight management and personality has previously been reviewed for general and cardiovascular disease populations but is less well understood in diabetes. This systematic review investigated the relationship between personality constructs and weight management outcomes and behaviours among adults with type 2 diabetes. Methods: Medline, PubMed, Embase, PsycINFO and SPORTDiscus databases were searched to July 2021. Eligibility: empirical quantitative studies; English language; adults with type 2 diabetes; investigation of personality-weight management association. Search terms included variants of: diabetes, physical activity, diet, body mass index (BMI), adiposity, personality constructs and validated scales. A narrative synthesis, with quality assessment, was conducted. Results: Seventeen studies were identified: nine cross-sectional, six cohort and two randomised controlled trials (N=6,672 participants, range: 30-1,553). Three studies had a low risk of bias. Personality measurement varied. The Big Five and Type D personality constructs were the most common measures. Higher emotional instability (neuroticism, negative affect, anxiety, unmitigated communion and external locus of control) was negatively associated with healthy diet and physical activity, and positively associated with BMI. Conscientiousness had positive associations with healthy diet and physical activity and negative associations with BMI and anthropometric indices. Conclusions: Among adults with type 2 diabetes, evidence exists of a relationship between weight management and personality, specifically, negative emotionality and conscientiousness. Consideration of personality may be important for optimising weight management and further research is warranted. Systematic review registration: www.crd.york.ac.uk/prospero/, identifier CRD42019111002.

Early childhood attachment stability and change: a meta-analysis.

Examining degrees of stability in attachment throughout early childhood is important for understanding developmental pathways and for informing intervention. Updating and building upon all prior meta-analyses, this study aimed to determine levels of stability in all forms of attachment classifications across early childhood. Attachment stability was assessed between three developmental epochs within early childhood: infancy, toddlerhood, and preschool/early school. To ensure data homogeneity, only studies that assessed attachment with methods based on the strange situation procedure were included. Results indicate moderate levels of stability at both the four-way (secure, avoidant, resistant, and disorganised; κ = 0.23) and secure/insecure (r = 0.28) levels of assessment. Meta-regression analysis indicated security to be the most stable attachment organisation. This study also found evidence for publication bias, highlighting a preference for the publication of significant findings.

Predicting intention to receive a seasonal influenza vaccination using Protection Motivation Theory.

RATIONALE: Seasonal influenza vaccination rates are below the recommended targets, contributing to significant preventable harms. Protection Motivation Theory (PMT), a widely applied model of motivation to respond to threats, may provide some insights into strategies to increase the rate of vaccine uptake. Yet, previous research has omitted some of the proposed predictors of intention when applying this model to vaccination. OBJECTIVE: The aim of the study is to assess the utility of the PMT in predicting intention to obtain the seasonal influenza vaccine. This study will be the first to examine the role of all six PMT constructs in predicting intention to receive the seasonal influenza vaccine. METHOD: A cross-sectional study of 547 US residents was conducted using Amazon MTurk. RESULTS: All constructs show significant bivariate correlations in the direction expected from the prior literature. Further examination of the theory within a linear regression model, however, found that perceived costs of vaccinating (i.e., response costs) did not uniquely account for variance in intention. All other components, perceived severity of and susceptibility to influenza, the perceived benefits of not vaccinating (i.e., maladaptive response rewards), the self-efficacy to vaccinate, and the perceived efficacy of vaccinating in preventing influenza (i.e., response efficacy) were unique predictors of intention. Overall, the PMT accounted for 62% of the variance in intention to vaccinate. CONCLUSIONS: The study is the first to investigate influenza vaccination using all six theorised predictors of intention from the PMT. The findings highlight the importance of the simultaneous inclusion of all components of the model in assessing their potential utility as targets for intervention. Importantly, the results identify under-utilised constructs in the promotion of vaccine uptake, such as maladaptive response rewards, which should be considered targets for future intervention.

A systematic mapping review of the associations between pregnancy intentions and health-related lifestyle behaviours or psychological wellbeing.

The aim of this study was to conduct a systematic mapping review of the literature that explored associations of pregnancy intentions with health-related lifestyle behaviours and psychological wellbeing before and during pregnancy. Six databases were searched (May 2017) for papers relating to pregnancy intentions, health-related lifestyle behaviours, and psychological wellbeing. The literature was mapped according to the preconception or pregnancy period; prospective or retrospective variable assessment; and reported lifestyle behaviours and psychological wellbeing outcomes. Of 19,430 retrieved records, 303 studies were eligible. Pregnancy intentions were considered during the preconception period in 103 studies (only 23 assessed prospectively), and during the pregnancy period in 208 studies (141 prospectively). Associations between pregnancy intention and preconception behaviours/psychological wellbeing were primarily reported for supplement use (n = 58) and were lacking for diet/exercise, and psychological factors. For behaviours/psychological wellbeing during pregnancy, associations with pregnancy intention were focused on prenatal care (n = 79), depression (n = 61), and smoking (n = 56) and were lacking for diet/exercise. Only 7 studies assessed pregnancy intentions with a validated tool. Despite a large body of literature, there were several methodological limitations identified, namely assessment of pregnancy intentions with non-validated measures and the reliance on retrospective assessment. Future primary studies are needed to fill gaps in our understanding regarding energy-balance-related behaviours. Future studies (including reviews/meta-analyses) should take care to address the noted limitations to provide a comprehensive and accurate understanding of the relationships between pregnancy intentions and health-related lifestyle behaviours and psychological wellbeing before and during pregnancy.

Efficacy of psychotherapy for bulimia nervosa and binge-eating disorder on self-esteem improvement: Meta-analysis.

OBJECTIVES: This meta-analysis examined the effects of psychotherapy for bulimia nervosa (BN) and binge-eating disorder (BED) on self-esteem improvement. METHOD: Randomized controlled trials (RCTs) of psychological treatments that assessed self-esteem change in eating disorders were included. Thirty-four RCTs were included; most sampled BED and then BN. Hedge's g effects were entered into random effects models. RESULTS: Psychotherapy for BN led to significantly greater post-treatment improvements in self-esteem than control conditions (g = 0.45; 95% CI [0.17, 0.73]). This effect was smaller when only analysing low risk of bias trials (g = 0.28; 95% CI [0.05, 0.51]). Psychotherapy for BED also led to significantly greater post-treatment improvements in self-esteem than controls (g = 0.20; 95% CI [0.05, 0.35]), with some evidence that guided self-help was associated with the largest effects. This effect, however, was overestimated after adjustment for publication bias (g = 0.10; 95% CI [-0.05, 0.26]). There was no evidence that cognitive-behavioural therapy was superior to non-cognitive-behavioural therapy interventions in improving self-esteem. There was no relationship between symptom improvement and self-esteem improvement in a meta-regression. CONCLUSIONS: Psychotherapy may lead to small improvements in self-esteem in BN and BED. Additional RCTs with follow-up assessments are required to make more definitive conclusions about the effects of psychotherapy for eating disorders on self-esteem in the long-term.

Class Time Physical Activity Programs for Primary School Aged Children at Specialist Schools: A Systematic Mapping Review.

Children with disabilities tend to be less active than typically developing peers and may therefore miss important developmental benefits. Class time physical activity (PA) programs can provide additional PA to children and have shown to contribute to numerous benefits in mainstream classrooms. However, it is unclear whether class time PA opportunities are provided in specialist education settings. This review aimed to identify and map class time PA programs that have been implemented in specialist schools and classes. Nine electronic databases were searched. Grey literature searches were also conducted. Programs were included if they were implemented in a primary/elementary specialist school or class, involved a PA component, were conducted during class time and involved more than one child from the class participating. Included programs were mapped and narratively synthesised according to activity type. Of the 2068 records screened, 34 programs were included. Programs involving dance/drama activities (k = 11) were most common and programs involving stretching activities (k = 2) were least frequently implemented. Twenty-three programs had been evaluated, of which only two were randomised controlled trials. More class time PA opportunities are warranted in specialist education settings. Further research is required to build the evidence base for these programs.

Couple relationship quality and offspring attachment security: a systematic review with meta-analysis.

This paper provides a meta-analytic examination of strength and direction of association between parents' couple relationship quality and early childhood attachment security (5 years and under). A comprehensive search of four EBSCOhost databases, Informit, Web of Science, and grey literature yielded 24 studies meeting eligibility criteria. Heterogeneity of the couple quality construct and measurement was marked. To disaggregate potentially differentially acting factors, we grouped homogeneous studies, creating two predictor variables defined as "positive dyadic adjustment" and "inter-parental conflict". Associations of each construct with offspring attachment security were examined in two separate meta-analyses. Inter-parental conflict was inversely associated (8 studies, k = 17, r = -0.28, CI = [-0.39 to -0.18]), and dyadic adjustment was not associated with offspring attachment security (5 studies, k = 12, r = 0.14, CI = [-0.03 to 0.32]). The study supports finer distinctions of couple relationship constructs and measurement in developmental research, assessment, and intervention.

The mediating and moderating role of planning on mothers' decisions for early childhood dietary behaviours.

OBJECTIVE: Examine the roles of action and coping planning on the intention-behaviour relationship for mothers' decisions for their young children's dietary behaviours. DESIGN: Prospective design with two waves of data collection, one week apart. MAIN OUTCOME MEASURES: Mothers (N = 197, Mage = 34.39, SD = 5.65) of children aged 2-3 years completed a main questionnaire assessing planning constructs and intentions, and a one-week follow-up of the target behaviours - 'healthy eating' and 'discretionary choices'. RESULTS: Intention was the strongest predictor of behaviour for both dietary behaviours. For healthy eating, intention moderated the indirect relationship between intention-behaviour via planning; coping planning was less important when intention was strong. Further, intention was not a direct predictor of behaviour when intention was relatively low. Action planning was not a direct predictor of either behaviour after accounting for intention and coping planning; action planning on behaviour was mediated by coping planning (only for healthy eating). Intention was not a direct predictor of coping planning; intention on coping planning was mediated by action planning. Neither type of planning predicted discretionary choices. CONCLUSION: Current findings contribute novel information on the mechanisms underpinning the effect of action and coping planning on the intention-behaviour relationship.

Does the Theory of Planned Behaviour Explain Condom Use Behaviour Among Men Who have Sex with Men? A Meta-analytic Review of the Literature.

The aim of this meta-analysis was to explore whether the constructs in the theory of planned behaviour (TPB; i.e., attitude, subjective norm, perceived behavioural control, intention) explain condom use behaviour among men who have sex with men (MSM). Electronic databases were searched for studies that measured TPB variables and MSM condom use. Correlations were meta-analysed using a random effects model and path analyses. Moderation analyses were conducted for the time frame of the behavioural measure used (retrospective versus prospective). Attitude, subjective norm and perceived behavioural control accounted for 24.0 % of the variance in condom use intention and were all significant correlates. Intention and PBC accounted for 12.4 % of the variance in condom use behaviour. However, after taking intention into account, PBC was no longer significantly associated with condom use. The strength of construct relationships did not differ between retrospective and prospective behavioural assessments. The medium to large effect sizes of the relationships between the constructs in the TPB, which are consistent with previous meta-analyses with different behaviours or target groups, suggest that the TPB is also a useful model for explaining condom use behaviour among MSM. However, the research in this area is rather small, and greater clarity over moderating factors can only be achieved when the literature expands.

Explaining the intention-behaviour gap in gluten-free diet adherence: The moderating roles of habit and perceived behavioural control.

Adherence to a strict gluten-free diet is the only treatment for coeliac disease. Nonetheless, many individuals with the disease struggle to achieve and maintain strict adherence. While the theory of planned behaviour is useful for predicting gluten-free diet adherence, an intention-behaviour gap remains. The aim of this study was to investigate the roles of habit and perceived behavioural control in moderating the intention-behaviour relationship in gluten-free diet adherence. A significant three-way interaction was found such that the association between intention and adherence was dependent on both perceived behavioural control and habit. Implications for both theory and intervention design are discussed.

Interaction effects in the theory of planned behaviour: Predicting fruit and vegetable consumption in three prospective cohorts.

OBJECTIVE: The theory of planned behaviour (TPB) has been criticized for not including interactions between major constructs thought to underlie behaviour. This study investigated the application of the TPB to the prediction of fruit and vegetable consumption across three prospective cohorts. The primary aim of the study was to investigate whether interactions between major constructs in the theory would increase the ability of the model to predict intention to consume fruit and vegetables (i.e., attitude × perceived behavioural control [PBC], subjective norm × PBC, subjective norm × attitude) and self-reported fruit and vegetable intake (i.e., PBC × intention). DESIGN: Secondary data analysis from three cohorts: One predictive study (cohort 1) and two intervention studies (cohorts 2 and 3). METHOD: Participants completed a TPB measure at baseline and a measure of fruit and vegetable intake at 1 week (cohort 1; n = 90) or 1 month (cohorts 2 and 3; n = 296). RESULTS: Attitude moderated the impact of PBC on intention. PBC moderated the impact of intention on behaviour at 1 week but not 1 month. CONCLUSION: The variance accounted for by the interactions was small. However, the presence of interactions between constructs within the TPB demonstrates a need to consider interactions between variables within the TPB in both theoretical and applied research using the model.

Factors affecting acceptability of an email-based intervention to increase fruit and vegetable consumption.

BACKGROUND: Fresh Facts is a 30-day email-delivered intervention designed to increase the fruit and vegetable consumption of Australian young adults. This study investigated the extent to which the program was acceptable to members of the target audience and examined the relationships between participant and intervention characteristics, attrition, effectiveness, and acceptability ratings. METHODS: Young adults were randomised to two levels of message frequency: high-frequency (n = 102), low-frequency (n = 173). Individuals in the high-frequency group received daily emails while individuals in the low-frequency group received an email every 3 days. RESULTS: Individuals in the high-frequency group were more likely to indicate that they received too many emails than individuals in the low-frequency group. No other differences in acceptability were observed. Baseline beliefs about fruit and vegetables were an important predictor of intervention acceptability. In turn, acceptability was associated with a number of indicators of intervention success, including change in fruit and vegetable consumption. CONCLUSIONS: The findings highlight the importance of considering the relationship between these intervention and participant factors and acceptability in intervention design and evaluation. Results support the ongoing use of email-based interventions to target fruit and vegetable consumption within young adults. However, the relationships between beliefs about fruit and vegetable consumption and acceptability suggest that this intervention may be differentially effective depending on individual's existing beliefs about fruit and vegetable consumption. As such, there is a pressing need to consider these factors in future research in order to minimize attrition and maximize intervention effectiveness when interventions are implemented outside of a research context.

A randomised controlled trial of a theory of planned behaviour to increase fruit and vegetable consumption. Fresh Facts.

Young adults are less likely than other adults to consume fruit and vegetables. Fresh Facts is a theory of planned behaviour based intervention designed to promote fruit and vegetable consumption. The present study sought to evaluate Fresh Facts using a randomised controlled trial. Australian young adults (n = 162) were allocated to the Fresh Facts intervention or to the control group in 2011. Intervention participants received automated email messages promoting fruit and vegetable consumption every 3 days over the course of the 1 month intervention. Messages targeted attitude, subjective norm, and perceived behavioural control. Theory of planned behaviour variables and fruit and vegetable intake were measured at baseline and post-intervention (Day 30). Significant increases in attitude and subjective norm relative to control were found among Fresh Facts participants. However, intention, perceived behavioural control and fruit and vegetable consumption did not change as a result of the intervention. Changes in intention reported by each participant between baseline and follow-up were not correlated with corresponding changes in fruit and vegetable consumption. Fresh Facts was not successful in increasing fruit and vegetable consumption. Current evidence does not support the use of the theory of planned behaviour in the design of interventions to increase fruit and vegetable intake in this population.

Dissonance-based interventions for health behaviour change: a systematic review.

PURPOSE: Increasing evidence suggests that various health behaviours are amenable to change following the induction of cognitive dissonance. This systematic review sought to evaluate the effectiveness and methodological quality of dissonance-based health behaviour interventions and to explore identified sources of heterogeneity in intervention effects. METHODS: Bibliographic databases were searched for relevant articles from inception to March 2012. Only studies targeting non-clinical health behaviour in non-clinical populations were included in the review. One author extracted data and assessed quality of evidence and a second author verified all content. RESULTS: Reports of 20 studies were included. A variety of health behaviours and outcome measures were addressed across studies. Most studies produced one or more significant effects on measures of behaviour, attitude or intention. Across studies, methodological risk for bias was frequently high, particularly for selection bias. Gender and self-esteem were identified as potential moderator variables. CONCLUSIONS: The evidence for the effectiveness of dissonance-based interventions was generally positive. The hypocrisy paradigm was found to be the most commonly applied research paradigm and was most effective at inciting change across a range of health behaviours. There was no observable link between type of target behaviour and positive outcomes. Researchers are encouraged to minimize potential for bias in future studies and explore moderators of the dissonance effect. STATEMENT OF CONTRIBUTION: What is already known on this subject? A recent meta-analysis indicates that dissonance-based interventions primarily based on the induced compliance paradigm are effective for eating disorder prevention (Stice, Shaw, Becker, & Rohde, 2008, Prev. Sci., 9, 114). However, it is currently unclear whether such outcomes are generalizable to interventions targeting non-clinical health behaviours such as smoking, sun protection and sexual risk taking. Other research indicates that studies based on the hypocrisy paradigm may lead to changes in non-clinical health behaviours (Stone & Fernandez, 2008, Soc. Personal. Psychol. Compass, 2, 1024; Stone & Focella, 2011, Self Identity, 10, 295) although this literature lacks systematic evaluation of interventions across a range of experimental paradigms. What does this study add? The hypocrisy paradigm appears most effective in inciting change across a range of non-clinical health behaviours. The dissonance effect may be moderated by variables such as self-esteem and gender. Risk of bias needs to be minimised to increase the validity of studies within this topic area.

Randomised controlled trial of a brief theory-based intervention promoting breakfast consumption.

The present study sought to test the efficacy of a brief theory-based intervention to promote regular consumption of breakfast, and to expand previous results suggesting that the theory of planned behaviour (TPB) can be meaningfully applied to breakfast consumption. A four-armed randomised controlled trial was conducted. Participants (n=349) were allocated to receive either a (1) positively framed attitude intervention, (2) negatively framed attitude intervention, (3) Perceived Behavioural Control (PBC) intervention, or (4) control task. Attitude, subjective norm, PBC and behaviour were measured at baseline and 4-week follow-up. All three interventions employed persuasive communication and an implementation intention task. The intervention did not result in expected increases in breakfast consumption, or in changes in attitude, subjective norm or PBC. However, baseline attitude, subjective norm and PBC predicted 39.3% of baseline intention. Baseline intention in turn predicted 33% of breakfast consumption at 4 weeks. Change in breakfast consumption was predicted by change in attitude, subjective norm, and PBC between baseline and follow-up. Despite a lack of intervention effects, the TPB provided a good model of breakfast consumption over the four-week follow-up period. By expanding on previous work investigating breakfast consumption using the TPB, this study provides further support for the argument that that theory based interventions could result in meaningful increases in breakfast consumption.

Evaluating a nursing communication skills training course: The relationships between self-rated ability, satisfaction, and actual performance.

Effective communication is a vital component of nursing care, however, nurses often lack the skills to communicate with patients, carers and other health care professionals. Communication skills training programs are frequently used to develop these skills. However, there is a paucity of data on how best to evaluate such courses. The aim of the current study was to evaluate the relationship between student self rating of their own ability and their satisfaction with a nurse training course as compared with an objective measure of communication skills. 209 first year nursing students completed a communication skills program. Both qualitative and quantitative data were collected and associations between measures were investigated. Paired samples t-tests showed significant improvement in self-rated ability over the course of the program. Students generally were very satisfied with the course which was reflected in both qualitative and quantitative measures. However, neither self-rated ability nor satisfaction was significantly correlated with the objective measure of performance, but self-rated ability and satisfaction were highly correlated with one another. The importance of these findings is discussed and implications for nurse education are proposed.