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PURPOSE: This study aims to explore obesity-related behaviors (ORB) and health-related quality of life (HRQoL) in socioeconomically vulnerable children, while also examining potential associations between these variables. DESIGN AND METHODS: A total of 721 children enrolled in after-school care programs for socioeconomically vulnerable children participated in this study. Height (in cm) and weight (in kg) were measured directly by trained research assistants. ORB, including eating behaviors and physical activity, was assessed utilizing the Nutrition Quotient Questionnaire. HRQoL was measured utilizing the PedsQL™ 4.0. Data were analyzed using logistic regression. RESULTS: The findings revealed that participants exhibited lower levels of ORB and reduced HRQoL, particularly in the physical health dimension of HRQoL. Inadequate physical activity and poor dietary habits were strongly associated with a 2.625-fold (OR = 2.625, 95% CI = 1.867-3.691) and a 4.251-fold (OR = 4.251, 95% CI = 2.466-7.328) increase, respectively, in the likelihood of having low HRQoL. Surprisingly, the study did not find a significant link between ORB levels and obesity, and obesity status did not predict a higher probability of low HRQoL. CONCLUSIONS: This study underscores the need for tailored interventions designed specifically for children from socioeconomically vulnerable families to address their unique challenges. PRACTICE IMPLICATIONS: This research provides valuable insights for pediatric nurses and healthcare providers, highlighting the crucial role of promoting healthy ORB in socioeconomically vulnerable children to address disparities in childhood obesity and HRQoL.
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Weight bias internalization (WBI), the process of internalizing negative attitudes and stereotypes towards overweight individuals, significantly impacts self-worth and health behaviors, such as exercise avoidance. In the current study, we focused on the mediating role of fitness-related self-conscious emotions, particularly shame and guilt. A cross-sectional study involving 150 self-described overweight Dutch women (age M = 49.63 ± 10.72) was conducted online. Participants completed measures assessing weight bias internalization, exercise avoidance, and body/fitness-related self-conscious emotions. Data were analyzed using linear regression and mediation analysis, controlling for age, BMI, and exercise frequency. The results show that weight bias internalization, guilt-free shame, and shame-free guilt uniquely predict exercise avoidance. Guilt-free shame partially mediated the relationship between weight bias internalization and exercise avoidance, indicating that increased internalized weight bias led to higher levels of guilt-free shame, which in turn contributed to exercise avoidance. Shame-free guilt did not act as a unique mediator. These findings underscore the importance of addressing weight bias internalization and fitness-related self-conscious emotions, particularly guilt-free shame, in interventions targeting exercise avoidance among overweight individuals. Strategies promoting self-compassion and reducing shame may prove beneficial in improving exercise behaviors and overall well-being.
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COVID-19 brought significant changes to the role of school nurses, necessitating the development of remote health education programs. However, there is a lack of evidence and pedagogical lessons for digitally transforming education for socially vulnerable children. This qualitative study analyzes the health educational needs and barriers faced by children and service providers in a childcare-based obesity prevention program during the pandemic in South Korea. Through a thematic content analysis, four core themes emerged: (a) heightened concerns about obesity and the pandemic's impact on facilities, (b) unexpected positive outcomes of the program, (c) digital readiness gaps, and (d) insufficient program satisfaction (better than nothing). When designing a digital-based health education program for vulnerable children, assessing individual readiness and facility suitability is crucial. Additionally, school nurses should incorporate hybrid pedagogy, integrating technology-mediated activities. By leveraging technology effectively and considering individual and environmental factors, educators can provide comprehensive and accessible health education.
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COVID-19 and the resulting measures to curb the spread of the virus have significantly changed our lives, including our nutritional choices. In this rapid scoping review an overview is provided of what psychological factors may be associated with peoples' eating behaviour during COVID-19 restrictions. Relevant literature was identified using PubMed, PsycInfo, CINAHL and MEDLINE databases from 2019 onwards. For included studies, information on study characteristics, eating behaviours, and psychological factors were extracted. 118 articles were included, representing 30 countries. Findings indicated that most people consumed more and unhealthy food in times of COVID-19 restrictions, while some consumed less but often for the wrong reasons. Several psychological factors, related to (1) affective reactions, (2) anxiety, fear and worriers, (3) stress and (4) subjective and mental wellbeing were found to be associated with this increase in food consumption. These outcomes may help to be better inform future interventions, and with that, to be better prepared in case of future lockdown scenarios.
Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Pandemics , Communicable Disease Control , Anxiety , Databases, FactualABSTRACT
AIMS: When attempting to stop smoking, discrete smoking events ('lapses') are strongly associated with a return to regular smoking ('relapse'). No study has yet pooled the psychological and contextual antecedents of lapse incidence, captured in ecological momentary assessment (EMA) studies. This systematic review and meta-analysis aimed to synthesize within-person psychological and contextual predictor-lapse associations in smokers attempting to quit. METHODS: We searched Ovid MEDLINE, Embase, PsycINFO and Web of Science. A narrative synthesis and multi-level, random-effects meta-analyses were conducted, focusing on studies of adult, non-clinical populations attempting to stop smoking, with no restrictions on setting. Outcomes were the association between a psychological (e.g. stress, cravings) or contextual (e.g. cigarette availability) antecedent and smoking lapse incidence; definitions of 'lapse' and 'relapse'; the theoretical underpinning of EMA study designs; and the proportion of studies with pre-registered study protocols/analysis plans and open data. RESULTS: We included 61 studies, with 19 studies contributing ≥ 1 effect size(s) to the meta-analyses. We found positive relationships between lapse incidence and 'environmental and social cues' [k = 12, odds ratio (OR) = 4.53, 95% confidence interval (CI) = 2.02, 10.16, P = 0.001] and 'cravings' (k = 10, OR = 1.71, 95% CI = 1.34, 2.18, P < 0.001). 'Negative feeling states' was not significantly associated with lapse incidence (k = 16, OR = 1.10, 95% CI = 0.98, 1.24, P = 0.12). In the narrative synthesis, negative relationships with lapse incidence were found for 'behavioural regulation', 'motivation not to smoke' and 'beliefs about capabilities'; positive relationships with lapse incidence were found for 'positive feeling states' and 'positive outcome expectancies'. Although lapse definitions were comparable, relapse definitions varied widely across studies. Few studies explicitly drew upon psychological theory to inform EMA study designs. One of the included studies drew upon Open Science principles. CONCLUSIONS: In smokers attempting to stop, environmental and social cues and cravings appear to be key within-person antecedents of smoking lapse incidence. Due to low study quality, the confidence in these estimates is reduced.
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Smokers , Smoking Cessation , Adult , Humans , Smokers/psychology , Smoking Cessation/psychology , Incidence , Ecological Momentary Assessment , SmokingABSTRACT
We examine whether information about a female candidate's relationship history, obtained from social media profiles, affects evaluations of her suitability for a student union board position. Moreover, we investigate whether it is possible to mitigate any bias against women with multiple partners by providing information about the origins of prejudice. We utilized a 2 (relationship history: multiple vs. one partner(s)) X 2 (mitigating information: explaining prejudice against promiscuous women vs. explaining prejudice against outgroups) experimental design across two studies. Participants were female students (Study 1: n = 209 American students; Study 2; n = 119 European students), who indicated whether they would hire the applicant for a job, and evaluated this applicant. Results show that generally, participants tended to evaluate the candidate with multiple partners less positively than the candidate with only one partner: They were less likely to hire her (Study 1), evaluated her less positively (Study 1), and considered her less of a fit with the organization (Study 1 and 2). The results regarding providing additional information were not consistent. Our findings suggest that private social media information can influence applicant evaluations and hiring decisions, and therefore organizations should be careful when utilizing social information in recruitment processes.
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BACKGROUND: In the earlier developed and evaluated 12-week UPcomplish intervention, the aim was to reduce sedentary behaviour (SB) among office workers and increase their quality of life (QoL). In the current study, we explored moderators of effectiveness. METHOD: We applied a stepped wedge design with five intervention groups starting with time lags of seven weeks (n = 142, 96 females). Participants wore the VitaBit to continuously measure SB and received surveys about QoL and psychosocial determinants at the beginning, middle, and end of the intervention. We regressed baseline participant characteristics and behaviours onto intra-individual improvements (centred around calendar week means) in determinants, SB, performance objectives, and QoL. RESULTS: Those scoring high in baseline intention, task performance, stress, vitality, and emotional well-being improved less in these variables. Baseline stress (ß = - 0.05 [SE = 0.01; 95% CI = - 0.08, - 0.02; pcorrected = .02]) and emotional well-being (ß = 0.02 [SE = 0.01; 95% CI = 0.01, 0.03; pcorrected = .02]) were associated with improvement in contextual performance. Baseline attitude (ß = - 12.92 [SE = 3.93; 95% CI = - 20.80, - 5.04; pcorrected = .02]) and perceived behavioural control (PBC; ß = - 9.27 [SE = 3.04; 95% CI = - 15.37, - 3.16; pcorrected = .03]) were negatively associated with improvements in emotional well-being. Post hoc analyses with a sub-group scoring lower in determinants revealed that improvement in PBC was positively associated with SB registration. CONCLUSION: Participants scoring low in baseline determinants might profit from UPcomplish via an increase in PBC. In combination with changes within organizations (e.g. the implementation of standing desks), UPcomplish might potentially reduce SB. TRIAL REGISTRATION: NL7503 - registered 1 February 2019.
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Quality of Life , Sedentary Behavior , Female , Humans , Surveys and Questionnaires , AttitudeABSTRACT
The process of developing a behavior change intervention can cover a long time period. However, in times of need, this development process has to be more efficient and without losing the scientific rigor. In this article, we describe the just-in-time, planned development of an online intervention in the field of higher education, promoting COVID-19 vaccination among university students, just before they were eligible for being vaccinated. We demonstrate how intervention development can happen fast but with sufficient empirical and theoretical support. In the developmental process, Intervention Mapping (IM) helped with decision-making in every step. We learned that the whole process is primarily depending on the trust of those in charge in the quality of the program developers. Moreover, it is about applying theory, not about theory-testing. As there was no COVID-19-related evidence available, evidence from related fields helped as did theoretical knowledge about change processes, next to having easy access to the target population and important stakeholders for informed qualitative and quantitative research. This project was executed under unavoidable time pressure. IM helped us with systematically developing an intervention, just-in-time to positively affect vaccine acceptance among university students.
Subject(s)
COVID-19 Vaccines , COVID-19 , Humans , Universities , COVID-19/prevention & control , Vaccination , StudentsABSTRACT
The COVID-19 pandemic has highlighted the importance of technology for communication and social interactions. Especially for children in low-income families-a vulnerable population suffering from health and digital disparities-the situation worsened during the pandemic. Earlier studies in times of COVID-19 suggested that the children in Korea who usually do homework and dine at community childcare centers (CCCCs, free after-school care places) need to learn more about how to eat healthily and how to interact with others using digital technology. Therefore, to reduce these children's health and digital inequalities, an interactive live and online cooking program was developed and provided to 313 children and 95 staff members at the 29 CCCCs located in the southern provinces in South Korea. The aim of the current study was to explore the experiences of children and staff with the program. After surveying their experiences, a high degree of satisfaction was found (children: 3.60 ± 0.10; staff: 3.63 ± 0.08 points out of 4.00). Aspects that needed improvement in the program were related to (in)experience in online technology, the frequency and timing of the cooking classes, and the communication between the centers and (online) chefs. In addition, in a word cloud analysis, terms such as 'fun', 'delicious', and 'want' were highlighted for children, and terms such as 'participating' and 'preparation' dominantly appeared for the staff. In the analysis of negative experiences, terms related to environmental factors such as 'sound', 'hear', and 'voice' were highlighted. This novel but preliminary approach for children from low-income families, by integrating cooking with digital technology, indicates that with enough digital support, the CCCCs are a promising platform to promote healthy eating and digital literacy. Optimizing and disseminating these strategies during this pandemic period, and future pandemics, could be beneficial to keep children in their communities healthy, and ultimately reduce socioeconomic health disparities.
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Background: The diet of toddlers is often not in accordance with dietary recommendations, putting them at risk of poor health outcomes later in life. Parents can struggle to provide their toddler with a healthy diet and interventions are needed. Helping parents to form healthy feeding habits may facilitate healthy feeding behaviours. Therefore, the aim of this study was to establish the feasibility of a 6-week online intervention to build healthy feeding behaviours in parents of toddlers. Methods: Parents and primary caregivers of children aged 2-3 (N = 75) were recruited to complete a 6-week online intervention consisting of 6 modules targeting habit formation, planning, goal setting, self-efficacy, interpersonal influences and picky eating. Demographics and feeding behaviours were measured with self-report at baseline and follow-up. Intervention acceptability and feasibility ratings were also gathered post-intervention. Results: Most participants were recruited online, highly educated and in a relationship. After 6-weeks, 17 participants completed the follow-up questionnaire, 11 of whom indicated that they had completed the whole intervention. Improvements were found for some feeding behaviours. Generally, participants who completed the programme reported that they found it acceptable. Conclusions: This study provides insights for future intervention development. Firstly, an online healthy feeding intervention seems to be acceptable but may need to focus on fewer change techniques. Further, engagement should be improved by including target group members and compulsory reminders. The target behaviours seem to be relevant. Online recruitment seems to be preferable and reaches parents and primary caregivers nationwide.
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OBJECTIVE: To evaluate the performance of a UK based prediction model for estimating fat-free mass (and indirectly fat mass) in children and adolescents in non-UK settings. DESIGN: Individual participant data meta-analysis. SETTING: 19 countries. PARTICIPANTS: 5693 children and adolescents (49.7% boys) aged 4 to 15 years with complete data on the predictors included in the UK based model (weight, height, age, sex, and ethnicity) and on the independently assessed outcome measure (fat-free mass determined by deuterium dilution assessment). MAIN OUTCOME MEASURES: The outcome of the UK based prediction model was natural log transformed fat-free mass (lnFFM). Predictive performance statistics of R2, calibration slope, calibration-in-the-large, and root mean square error were assessed in each of the 19 countries and then pooled through random effects meta-analysis. Calibration plots were also derived for each country, including flexible calibration curves. RESULTS: The model showed good predictive ability in non-UK populations of children and adolescents, providing R2 values of >75% in all countries and >90% in 11 of the 19 countries, and with good calibration (ie, agreement) of observed and predicted values. Root mean square error values (on fat-free mass scale) were <4 kg in 17 of the 19 settings. Pooled values (95% confidence intervals) of R2, calibration slope, and calibration-in-the-large were 88.7% (85.9% to 91.4%), 0.98 (0.97 to 1.00), and 0.01 (-0.02 to 0.04), respectively. Heterogeneity was evident in the R2 and calibration-in-the-large values across settings, but not in the calibration slope. Model performance did not vary markedly between boys and girls, age, ethnicity, and national income groups. To further improve the accuracy of the predictions, the model equation was recalibrated for the intercept in each setting so that country specific equations are available for future use. CONCLUSION: The UK based prediction model, which is based on readily available measures, provides predictions of childhood fat-free mass, and hence fat mass, in a range of non-UK settings that explain a large proportion of the variability in observed fat-free mass, and exhibit good calibration performance, especially after recalibration of the intercept for each population. The model demonstrates good generalisability in both low-middle income and high income populations of healthy children and adolescents aged 4-15 years.
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Data Analysis , Ethnicity , Adolescent , Calibration , Child , Deuterium , Female , Humans , Indicator Dilution Techniques , MaleABSTRACT
Ecological Momentary Assessment (EMA) involves repeated, real-time sampling of health behaviours in context. We present the state-of-knowledge in EMA research focused on five key health behaviours (physical activity and sedentary behaviour, dietary behaviour, alcohol consumption, tobacco smoking, sexual health), summarising theoretical (e.g., psychological and contextual predictors) and methodological aspects (e.g., study characteristics, EMA adherence). We searched Ovid MEDLINE, Embase, PsycINFO and Web of Science until February 2021. We included studies focused on any of the aforementioned health behaviours in adult, non-clinical populations that assessed ≥1 psychological/contextual predictor and reported a predictor-behaviour association. A narrative synthesis and random-effects meta-analyses of EMA adherence were conducted. We included 633 studies. The median study duration was 14 days. The most frequently assessed predictors were 'negative feeling states' (21%) and 'motivation and goals' (16.5%). The pooled percentage of EMA adherence was high at 81.4% (95% CI = 80.0%, 82.8%, k = 348) and did not differ by target behaviour but was somewhat higher in student (vs. general population) samples, when EMAs were delivered via mobile phones/smartphones (vs. handheld devices), and when event contingent (vs. fixed) sampling was used. This review showcases how the EMA method has been applied to improve understanding and prediction of health behaviours in context.
Subject(s)
Ecological Momentary Assessment , Sedentary Behavior , Adult , Humans , Exercise , Research Design , Health BehaviorABSTRACT
Aim: The current study aims to qualitatively identify determinants, barriers and facilitators of physical activity among a population with mental health disorders. Subject and methods: Seventeen participants with moderate mental disorders were recruited. Semi-structured interviews were conducted to identify physical activity facilitators and barriers. Data were organized and analysed in ATLAS.ti, mainly based on a generic qualitative research approach. Results: Most participants found physical activity important and expressed a positive attitude towards it. In general, higher self-efficacy and more social support were beneficial for participants' physical activity levels. Reasons/facilitating factors to be more physically active were: having fun, good weather, progress, routine, self-compassion and a stimulating environment. Barriers were not having fun, being busy, mental complaints, lack of energy, procrastination and physical complaints. Conclusion: Future interventions could promote physical activity among people with moderate mental disorders to help them identify and overcome barriers. The newly identified determinant 'self-compassion' could be an interesting target for promoting physical activity in this group of people with moderate mental disorders.
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BACKGROUND: Although several COVID-19 vaccines are available, the current challenge is achieving high vaccine uptake. We aimed to explore university students' intention to get vaccinated and select the most relevant determinants/beliefs to facilitate informed decision making around COVID-19 vaccine uptake. METHODS: A cross-sectional online survey with students (N = 434) from Maastricht University was conducted in March 2021. The most relevant determinants/beliefs of students' COVID-19 vaccine intention (i.e., determinants linked to vaccination intention, and with enough potential for change) were visualized using CIBER plots. RESULTS: Students' intention to get the COVID-19 vaccine was high (80%). Concerns about safety and side effects of the vaccine and trust in government, quality control, and the pharmaceutical industry were identified as the most relevant determinants of vaccine intention. Other determinants were risk perception, attitude, perceived norm, and self-efficacy beliefs. CONCLUSION: Our study identified several determinants of COVID-19 vaccine intention (e.g., safety, trust, risk perception, etc.) and helped to select the most relevant determinants/beliefs to target in an intervention to maximize COVID-19 vaccination uptake. Concerns and trust related to the COVID-19 vaccine are the most important targets for future interventions. Other determinants that were already positive (i.e., risk perception, attitudes, perceived norms, and self-efficacy) could be further confirmed.
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Halfway through 2021 in the midst of a public health crisis, a new academic year was fast approaching. Dutch universities were preparing to reopen their campuses to students and personnel in a safe manner. As the vaccination uptake was increasing and societies were slowly reopening, inviting students and personnel to campus became the next step to "the new normal". To absorb this change seamlessly, it was considered important to investigate personnel's beliefs about returning to campus and their perceptions of a safe working environment. An online survey was conducted among personnel (N = 1965) of Maastricht University, the Netherlands. University personnel's beliefs about a safe return to campus were assessed. The data were collected between 11 June and 28 June 2021. This study showed that, while most personnel (94.7%) were already vaccinated or willing to do so, not all personnel did feel safe to return to campus in September 2021. Over half of the respondents (58%) thought that the university is a safe place to return to work when the new academic year starts. However, the remainder of personnel felt unsafe or were uncertain for various reasons such as meeting in large groups or becoming infected. Moreover, when returning to campus, employees stated that they would require some time to reacclimate to their former work culture. The group who felt relatively more unsafe indicated that returning in September was too risky and that they worried about being infected. They wanted the safety guidelines to still be in force. On the other hand, the "safe" group stated safely returning to be "certainly possible" and trusted that others would still stick to the prevention guidelines. The findings led to practical recommendations for the University Board as they were preparing for organizing research and teaching for the upcoming academic year in the context of the COVID-19 pandemic. A brief intervention was developed: a webinar in which the data were linked to the board's plans for safe returning. This study demonstrates that university boards may use research among personnel to develop adequate measures promoting safety and feelings of safety among personnel in similar future situations.
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In this White Paper, we outline recommendations from the perspective of health psychology and behavioural science, addressing three research gaps: (1) What methods in the health psychology research toolkit can be best used for developing and evaluating digital health tools? (2) What are the most feasible strategies to reuse digital health tools across populations and settings? (3) What are the main advantages and challenges of sharing (openly publishing) data, code, intervention content and design features of digital health tools? We provide actionable suggestions for researchers joining the continuously growing Open Digital Health movement, poised to revolutionise health psychology research and practice in the coming years. This White Paper is positioned in the current context of the COVID-19 pandemic, exploring how digital health tools have rapidly gained popularity in 2020-2022, when world-wide health promotion and treatment efforts rapidly shifted from face-to-face to remote delivery. This statement is written by the Directors of the not-for-profit Open Digital Health initiative (n = 6), Experts attending the European Health Psychology Society Synergy Expert Meeting (n = 17), and the initiative consultant, following a two-day meeting (19-20th August 2021).
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COVID-19 , Pandemics , Humans , Pandemics/prevention & control , Health Promotion , Global HealthABSTRACT
RATIONALE: Translating research evidence into clinical practice to improve care involves healthcare professionals adopting new behaviours and changing or stopping their existing behaviours. However, changing healthcare professional behaviour can be difficult, particularly when it involves changing repetitive, ingrained ways of providing care. There is an increasing focus on understanding healthcare professional behaviour in terms of non-reflective processes, such as habits and routines, in addition to the more often studied deliberative processes. Theories of habit and routine provide two complementary lenses for understanding healthcare professional behaviour, although to date, each perspective has only been applied in isolation. OBJECTIVES: To combine theories of habit and routine to generate a broader understanding of healthcare professional behaviour and how it might be changed. METHODS: Sixteen experts met for a two-day multidisciplinary workshop on how to advance implementation science by developing greater understanding of non-reflective processes. RESULTS: From a psychological perspective 'habit' is understood as a process that maintains ingrained behaviour through a learned link between contextual cues and behaviours that have become associated with those cues. Theories of habit are useful for understanding the individual's role in developing and maintaining specific ways of working. Theories of routine add to this perspective by describing how clinical practices are formed, adapted, reinforced and discontinued in and through interactions with colleagues, systems and organisational procedures. We suggest a selection of theory-based strategies to advance understanding of healthcare professionals' habits and routines and how to change them. CONCLUSION: Combining theories of habit and routines has the potential to advance implementation science by providing a fuller understanding of the range of factors, operating at multiple levels of analysis, which can impact on the behaviours of healthcare professionals, and so quality of care provision.
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Habits , Health Personnel , Cues , Delivery of Health Care , Humans , Quality of Health CareABSTRACT
PURPOSE: In this study, we aimed to test the relationship between compulsive exercise and self-esteem, body image, and body satisfaction as potential predictors of eating disorders. METHODS: Self-report measures of compulsive exercise beliefs and behaviors, self-esteem, body image, and body satisfaction, were completed by 120 female participants through an online questionnaire. Factor analyses with varimax rotation were performed to create exercise-frequency groups. ANOVA's were performed on Body Mass Index (weight adjusted for height squared, BMI), current minus ideal weight, self-esteem, body image, and body satisfaction to determine if there were differences depending on these exercise groups. RESULTS: Factor analysis revealed two factors for compulsive exercise beliefs and behaviors: (1) Exercise Fixation, and (2) Exercise Frequency and Commitment. Based on those factors, participants were subdivided into four clusters: (1) pathological obligatory exercisers, (2) exercise fixators, (3) committed exercisers, and (4) non-exercisers. No differences were found between these groups for BMI or current minus ideal weight. Pathological obligatory exercisers and committed exercisers spend significantly more hours on exercise weekly compared to exercise fixators or non-exercisers. No differences between pathological obligatory exercisers, exercise fixators, and non-exercisers were found on self-esteem or body satisfaction, where the committed exercisers scored significantly better. Both committed exercisers and non-exercisers scored significantly better on body image flexibility compared to pathological obligatory exercisers and exercise fixators. CONCLUSION: Compulsive exercise has both an exercise volume and an emotional component. The level of compulsive exercise is linked to one's self-esteem, body image, and body satisfaction and those factors could be a target for future interventions.