Health literacy, social cognition constructs, and health behaviors and outcomes: A meta-analysis.

OBJECTIVE: Observed disparities in health behaviors and outcomes may be associated with socio-structural variables and individuals' beliefs concerning health behaviors. We proposed and tested a model in which the effects of health literacy, an independent predictor, on two target outcomes, health behavior participation and health-related outcomes, were mediated by belief-based constructs from social cognition theories. METHOD: Studies (k = 203, N = 210,622) reporting relations between health literacy, social cognition constructs (attitudes, self-efficacy, knowledge, risk perceptions), and health behaviors and outcomes were identified in a systematic database search. Relations among proposed model variables, including indirect effects of health literacy on health behavior and outcomes mediated by social cognition constructs, were tested using random effects multilevel meta-analysis and meta-analytic structural equation modeling. RESULTS: The analysis revealed nonzero averaged correlations between health literacy, social cognition constructs, and health behavior and outcomes with small-to-medium effect sizes. Structural equation modeling indicated that self-efficacy and attitudes partially mediated the relationship between health literacy and health behavior and outcomes. Sensitivity analyses revealed that model effects did not vary substantively when omitting studies targeting health-risk behavior, studies using comprehension measures of health literacy, and studies in countries with high education provision. CONCLUSION: Findings indicate that relations between health literacy and health behavior and outcomes are partly accounted for by health behavior beliefs suggesting a potential mechanism by which health literacy may relate to health behavior and outcomes. Given these findings are based on correlational data, further corroboration is needed in studies adopting longitudinal or experimental designs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Role of Risk Perceptions and Affective Consequences in COVID-19 Protective Behaviors.

BACKGROUND: Slowing the spread of the novel coronavirus (COVID-19) requires behavioral changes such as physical distancing (e.g., staying a 6-foot distance from others, avoiding mass gatherings, reducing houseguests), wearing masks, reducing trips to nonessential business establishments, and increasing hand washing. Like other health behaviors, COVID-19 related behaviors may be related to risk representations. Risk representations are the cognitive responses a person holds about illness risk such as, identity (i.e., label/characteristics of risk), cause (i.e., factors causing condition), timeline (i.e., onset/duration of risk), consequences (i.e., intrapersonal/interpersonal outcomes), behavioral efficacy (i.e., if and how the condition can be controlled/treated), and illness risk coherence (i.e., extent to which representations, behaviors, and beliefs are congruent). The current study applies the Common-Sense Model of Self-Regulation (CSM-SR) to evaluate how risk representations may relate to COVID-19 protective and risk behaviors. METHODS: Participants include 400 workers from Amazon's Mechanical Turk aged ≥ 18 years and US residents. Participants completed an online survey measuring risk representations (B-IPQ) and COVID-19 related behaviors, specifically, physical distancing, hand washing, and shopping frequency. RESULTS: Risk coherence, consequences, timeline, emotional representation, and behavioral efficacy were related to risk and protective behaviors. CONCLUSIONS: Risk representations vary in their relationship to COVID-19 risk and protective behaviors. Implications include the importance of coherent, targeted, consistent health communication, and effective health policy in mitigating the spread of COVID-19.

Known knowns and known unknowns on behavior change interventions and mechanisms of action.

Systematic reviews and meta-analyses play an important role in summarising current research on the efficacy of behaviour change interventions and their mechanisms of action. The reviews in this special issue represent a 'step change' in evaluating current evidence on behaviour change interventions and mechanisms. This article outlines the findings and emerging issues identified in the reviews ('known knowns'), and summarises evidence gaps to be addressed in future research ('known unknowns'). Findings indicate that tests of mechanisms of behaviour change interventions are not routinely conducted in primary studies and research syntheses; reviews and studies do not sufficiently account for study quality; substantive variability exists in descriptions of intervention content and putative mediators implicated in their mechanisms of action; limited data is available on the efficacy of many behaviour change techniques; and moderators of intervention effects and mechanisms are seldom taken into account. Possible solutions include testing effects of isolated behaviour change techniques and mechanisms of action; routine evaluation of study quality in behavioural intervention research; development of an evidence base linking behaviour change techniques with theory-based constructs that comprise mechanisms of action; adoption of fit-for-purpose methods for synthesising behavioural intervention mechanisms of action; and routine testing of moderators in intervention research.