How future orientations predict healthy outcomes: Information avoidance as a potential mechanism.

This study elucidates whether information avoidance may help explain demonstrated links between future orientation and health. In an online study, college students reported their self-reported prevention and detection health behaviors and responded to a prevention and detection health message. Path analyses indicated that information avoidance mediated the relationship with the future orientations (optimism and consideration of future consequences), such that, greater and more positive future orientations were associated with less information avoidance, and less information avoidance was associated with greater self-reported health behaviors and positive responses to health information. Correlational analyses revealed that information avoidance was particularly related to health outcomes, and to a greater extent than future orientations. Our findings join a growing literature showing the importance of information avoidance for a variety of health behaviors and suggest a potential intervention target for individuals whose characteristic ways of (not) thinking about their future might keep them unaware and unhealthy.

Experimental tests of hypothetical lottery incentives on unvaccinated adults' COVID-19 vaccination intentions.

OBJECTIVE: In May 2021, U.S. states began implementing "vaccination lotteries" encouraging COVID-19 vaccination. Drawing from Prospect Theory and math cognition research, we tested several monetary lottery structures and their framing to determine which would best motivate unvaccinated adults. METHOD: In two online experiments, U.S. adults were asked to imagine that their state implemented a vaccination lottery. In Experiment 1, participants (N = 589) were randomly assigned to 1 of 12 conditions varying the monetary amount and number of winners, holding constant a $5 million total payout. In Experiment 2, participants (N = 274) were randomly assigned to one of four conditions in a 2 (Message Framing: Gain versus Loss) by 2 (Numeric Framing: Big versus Small) factorial design; in all conditions, five people would each win $1 million. Participants rated their baseline vaccination willingness (1 = not at all to 4 = very) and postmanipulation COVID-19 vaccination intentions "if their state offered this incentive" (0 = definitely would not to 100 = definitely would). RESULTS: Intentions did not differ across conditions (Experiment 1: F[11, 561] = 1.29, p = .224, ηp² = .03; Experiment 2: Message Framing, F[1, 266)] = .01, p = .940, ηp² = .000; Numeric Framing, F[1, 266] = 1.40, p = .237, ηp² = .01; Interaction, F[1, 266] = 1.40, p = .238, ηp² = .01). When participants were shown a list of 12 lottery structures and asked which they preferred, participants on average preferred options that awarded less money to more people. However, 41.9% of participants across both experiments indicated they would not vaccinate for any lottery-based monetary incentive. CONCLUSIONS: Multiple lottery structures could be equally (un)motivating for unvaccinated adults. Structures that distribute incentives across more people or alternative public health strategies should be considered. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Field experiment of signs promoting hand hygiene during the COVID-19 pandemic.

OBJECTIVE: During the COVID-19 pandemic, the U.S. public was encouraged to practice good hand hygiene, such as hand washing or the use of hand sanitizer. Young adults reported lower levels of hand hygiene compared to adults of other ages. The aim of the current study was to test the effectiveness of different messages to promote hand sanitizer use among young adults. METHOD: Over a 6-week period, we examined whether 3 brief messages (gain-frame, static descriptive norms, dynamic descriptive norms), placed next to sanitizer dispensers in university residence halls, predicted dispenser use in comparison to dispensers with no sign. Amount of sanitizer usage was measured 3 times per week via the weight of dispenser units. We tracked and controlled for the number of positive COVID-19 cases in residence halls because we expected it might influence sanitizer usage. RESULTS: Compared to no signage, dispensers with signs had 35% greater usage, with the static descriptive norms sign associated with greatest usage (46% compared to no sign), although differences did not reach conventional levels of significance. The strongest predictor of sanitizer use was a residence hall's degree of COVID-19 risk based on the hall's case positivity. CONCLUSIONS: Dispensers with signs had higher use than those without signs, but this difference was not statistically significant. We conclude that compared to prior research, "nudges" such as evidence-based messaging may have had less of an effect on health behavior engagement due to methodological differences across studies or characteristics of the COVID-19 context. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Perceptions of physical activity and sedentary behaviour guidelines among end-users and stakeholders: a systematic review.

BACKGROUND: Many of the world's population, across all age groups and abilities, are not meeting or even aware of internationally recommended physical activity (PA) and sedentary behaviour (SB) guidelines. In order to enhance awareness and uptake, guidelines should be perceived positively by targeted users. The purpose of this study was to review the literature on end-user and stakeholder perceptions of PA and SB guidelines. METHODS: The electronic databases APA PsycInfo, CINAHL, MEDLINE, and SPORTDiscus, using EBSCOhost Research Platform, and Web of Science were searched from inception to June, 2021 with keyword synonyms for "perceptions", "PA guidelines", and "SB guidelines". Studies of any design that collected stakeholder and/or end-user responses to a PA and/or SB guideline were included and assessed for risk of bias. The PA and/or SB guideline could be any type of official form (e.g., national documents, organizational guidelines, expert consensus statements, etc.) from any country, that targets individuals at the regional, provincial/statewide, national, or international level, and includes all types of guidelines (e.g., strength, aerobic, clinical, nonclinical, screen-time, sitting, etc.). Data were extracted and analyzed using thematic synthesis. RESULTS: After screening 1399 abstracts and applying citation screening, 304 full-texts were retrieved. A total of 31 articles met the inclusion criteria. End-users and stakeholders for PA guidelines across all age groups expressed the need for simplified language with more definitions, relatable examples and imagery, and quantification of PA behaviours. There was concern for the early years and child PA guidelines leading to guilt amongst parents and the SB guidelines, particularly the recommendations to limit screen-time, being unrealistic. General age group PA guidelines were not perceived as usable to populations with differing abilities, clinical conditions, and socioeconomic status. Guidelines that targeted clinical populations, such as persons with multiple sclerosis and persons with spinal cord injury, were well received. CONCLUSIONS: There is a clear need to balance the evidence base with the pragmatic needs of translation and uptake so that the guidelines are not ignored or act as a barrier to actual engagement.

Associations Between Fear of COVID-19, Mental Health, and Preventive Behaviours Across Pregnant Women and Husbands: An Actor-Partner Interdependence Modelling.

The present cross-sectional study examined the actor-partner interdependence effect of fear of COVID-19 among Iranian pregnant women and their husbands and its association with their mental health and preventive behaviours during the first wave of the COVID-19 pandemic in 2020. A total of 290 pregnant women and their husbands (N = 580) were randomly selected from a list of pregnant women in the Iranian Integrated Health System and were invited to respond to psychometric scales assessing fear of COVID-19, depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. The findings demonstrated significant dyadic relationships between husbands and their pregnant wives' fear of COVID-19, mental health, and preventive behaviours. Pregnant wives' actor effect of fear of COVID-19 was significantly associated with depression, suicidal intention, mental quality of life, and COVID-19 preventive behaviours but not anxiety. Moreover, a husband actor effect of fear of COVID-19 was significantly associated with depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. Additionally, there were significant partner effects observed for both the pregnant wives and their husbands concerning all outcomes. The present study used a cross-sectional design and so is unable to determine the mechanism or causal ordering of the effects. Also, the data are mainly based on self-reported measures which have some limitations due to its potential for social desirability and recall biases. Based on the findings, couples may benefit from psychoeducation that focuses on the effect of mental health problems on pregnant women and the foetus.

Beliefs and Social Norms as Precursors of Environmental Support: The Joint Influence of Collectivism and Socioeconomic Status.

The present research investigates how the cultural value of collectivism interacts with socioeconomic status (SES) to influence the basis of action. Using a U.S. national sample (N = 2,538), the research examines how these sociocultural factors jointly moderate the strength of two precursors of environmental support: beliefs about climate change and perceived descriptive norms. SES and collectivism interacted with climate change beliefs such that beliefs predicted environmental support (i.e., proenvironmental behaviors and policy support) more strongly for those who were high in SES and low in collectivism than for all other groups. This interaction was explained, in part, by sense of control. For descriptive norms, SES and collectivism did not interact but rather norms predicted action most strongly for those high in collectivism and high in SES. These findings demonstrate the theoretical and applied importance of examining multiple sociocultural characteristics together to understand the factors that drive action.

Predicting Colorectal Cancer Screening among Adults Who Have Never Been Screened: Testing the Interaction between Message Framing and Tailored Risk Feedback.

Providing adults tailored risk estimates of getting colorectal cancer (CRC) can increase screening. A concern is that receipt of lower risk estimates will demotivate screening; this effect may be curbed by matching level of risk with message framing. Theoretically, pairing lower risk estimates with gain-frame messages, and higher risk estimates with loss-frame messages, should increase screening and screening intentions more than pairing lower risk estimates with loss-frame messages/higher risk estimates with gain-frame messages. These effects may be mediated by how screening is construed (e.g., to find health problems vs. to reaffirm one is healthy). These predictions were tested experimentally among 560 men and women ages 50-75 who have never screened. Participants at baseline received online a tailored comparative risk estimate with gain- or loss-frame information on screening. Screening was assessed six months later. Among the 400 reached at six months, 9.5% reported screening. There were no main effects or interactions between risk feedback and framing predicting construals, screening intentions, or screening. Worry about getting CRC and screening intentions predicted screening. While hypothesized interactions were not found, future research should explore further mechanisms through which online interventions utilizing risk feedback and framing motivate screening among adults who have never screened.

Associations between social control, motivation, and exercise: How romantic partners influence exercise during young adulthood.

This study investigated whether positive and negative romantic partner social control attempts (persuasion and pressure, respectively) were related to approach-avoidance motives and exercise among young adults (N = 98), using daily reports. Daily persuasion was linked to higher daily approach motives. At the person level, persuasion was associated with higher approach and avoidance motives in addition to more frequent, longer exercise. Pressure was associated with higher daily relationship stress, which was associated with higher daily avoidance motives. At the person level, pressure was related to less frequent, shorter exercise. Thus, romantic partners' social control use correlates with exercise motives and behavior.

Education differences in cancer fatalism: The role of information-seeking experiences.

Cancer fatalism is the belief that cancer is uncontrollable and lethal. Individuals with less education are more likely to hold fatalistic beliefs about cancer, but the mechanism accounting for the relationship is unknown. We tested whether negative health information seeking experiences explain this relationship. Structural equation modeling was used to test this relationship across three datasets from the Health Information National Trends Survey. Across all datasets, the model showed good fit: Cycle 1 (coefficient of determination = .11, comparative fit index = .96, root mean square error of approximation = .047), Cycle 2 (coefficient of determination = .06, comparative fit index = .96, root mean square error of approximation = .046), and Cycle 3 (coefficient of determination = .08, comparative fit index = .95, root mean square error of approximation = .052). The link between lower education level and higher cancer fatalism was partially mediated by negative health information seeking experiences.

Sleep hygiene behaviours in Iranian adolescents: an application of the Theory of Planned Behavior.

Poor sleep quality and inadequate sleep in adolescents are a rising trend globally. The Theory of Planned Behaviour (TPB)-which centres on an individual's attitude toward performing the behaviour, subjective norms and perceived behavioural control-has been applied to examine sleep hygiene behaviours in young adults. We expanded on prior works by using a longitudinal design to examine the effects of TPB factors, together with sleep hygiene knowledge and planning constructs, on sleep hygiene behaviours and on sleep quality and health in a group of Iranian adolescents. A total of 1822 healthy adolescents (mean age = 13.97) from 25 high schools in Qazvin, Iran, completed a self-reported survey at baseline and 6 months later. Structural equation modelling (SEM) was used to delineate the pathway from adolescents' sleep hygiene knowledge, TPB constructs of their behavioural intentions and sleep hygiene behaviours and their sleep quality and self-reported health. The SEM model demonstrated that although behavioural intention, coping planning and action planning predicted the sleep hygiene behaviours positively 6 months later with acceptable model fit [comparative fit index (CFI) = 0.936; Tucker-Lewis index (TLI) = 0.902; root mean square error of approximation (RMSEA) = 0.080; standardized root mean square residual (SRMR) = 0.044], sleep hygiene knowledge did not predict behavioural intentions significantly. Sleep hygiene behaviours were associated with sleep quality and psychiatric wellbeing. Thus, the TPB, combined with coping and action planning, is useful in understanding the sleep hygiene behaviours of adolescents. Health-care providers may want to emphasize TPB constructs and coping and action planning to improve adolescents' sleep hygiene behaviours, rather than rely solely upon increasing adolescents' sleep hygiene knowledge.

Reactions to online colorectal cancer risk estimates among a nationally representative sample of adults who have never been screened.

Data on the public's reactions to online tailored colorectal cancer (CRC) risk estimates are sparse. We assessed among 560 men and women aged 50-75 with no CRC screening history reactions to online tailored CRC estimated comparative risk (i.e., self vs. other their age and sex). Assessed were reactions to estimate (i.e., repeating back estimate, match between perceived comparative risk and estimate, accuracy and usefulness of estimate, emotional reactions), risk appraisals and screening intentions. 73% of the sample accurately repeated back their estimate; the match between perceived comparative risk and the estimate was lowest among those informed of being at higher risk. Higher estimates were viewed as less useful and evoked more negative emotions. Viewing the estimate as more useful and experiencing more negative emotions were related with higher risk appraisals and, in turn, screening intentions. These data indicate that adults at higher comparative risk resist accepting a higher risk status.

When Is Congruency Helpful? Interactive Effects of Frame, Motivational Orientation, and Perceived Message Quality on Fruit and Vegetable Consumption.

Health messages framed to be congruent with people's motivational orientation have been shown to be generally effective in promoting health behavior change, but some inconsistencies have been found. This study tested whether the perceived quality of a health message moderated the congruency effect in the domain of fruit and vegetable (FV) consumption. Undergraduate participants (N = 109) read a health message promoting FV intake in which the frame (gain vs. loss) was either congruent or incongruent with their approach/avoidance motivational orientation. Perceived message quality and intention to increase FV intake were assessed after message exposure, and self-reported FV intake was assessed one week later. A significant interaction between congruency and perceived message quality was found on both intention and FV intake. When messages were congruent, higher intentions and FV intake were observed when perceived message quality was high, but the reverse pattern was observed when perceived message quality was low. The findings support the potential utility of using congruently-framed messages to promote fruit and vegetable consumption, while also underscoring the necessity of using high-quality messages in order for congruency to influence health-related behaviors.

Substituting activities mediates the effect of cognitive flexibility on physical activity: a daily diary study.

Pursuit of physical activity goals often requires modifying plans, but research on these flexible processes is limited. Cognitive flexibility may heighten one's likelihood of using flexible self-regulatory strategies (e.g., substitution), thereby increasing physical activity. This study used daily diary methodology to test the indirect effect of cognitive flexibility on physical activity via activity substitution. A sample of 128 college students (73% female, mean age 19.9) completed baseline measures and cognitive flexibility assessments, then logged physical activity daily for 2 weeks. Activity substitution was defined as adopting an alternate activity on a day another planned activity was unfulfilled. Controlling for baseline activity, intentions, and time, a multilevel mediation model revealed a significant indirect effect of cognitive flexibility on physical activity via activity substitution (b = 81.36, p = .041). Our results indicate that people with greater cognitive flexibility are more likely to use flexible self-regulation, leading to greater physical activity.

The relationship between the theory of planned behavior and medication adherence in patients with epilepsy.

PURPOSE: The aim of this study was to apply the theory of planned behavior (TPB) with two other factors (action planning and coping planning) to the medication adherence of adults with epilepsy. METHODS: We measured the elements of the theory of planned behavior (attitude, subjective norm, perceived behavioral control, and behavioral intention), action planning, and coping planning at baseline among adults with epilepsy (n=567, mean±SD age=38.37±6.71years, male=48.5%). Medication adherence was measured using the Medication Adherence Report Scale (MARS) and antiepileptic serum level at the 24-month follow-up. Structural equation modeling (SEM) examined three models relating TPB elements to medication adherence. RESULTS: Three SEM models all had satisfactory fit indices. Moreover, attitude, subjective norms, perceived behavioral control, and intention together explained more than 50% of the variance for medication adherence measured using MARS. The explained variance increased to 61.8% when coping planning and action planning were included in the model, with coping planning having greater association than action planning. In addition, MARS explained 3 to 5% of the objective serum level. CONCLUSION: The theory of planned behavior is useful in understanding medication adherence in adults with epilepsy, and future interventions may benefit by improving such beliefs as well as beliefs about coping planning.

Fear of Ebola: The Influence of Collectivism on Xenophobic Threat Responses.

In response to the Ebola scare in 2014, many people evinced strong fear and xenophobia. The present study, informed by the pathogen-prevalence hypothesis, tested the influence of individualism and collectivism on xenophobic response to the threat of Ebola. A nationally representative sample of 1,000 Americans completed a survey, indicating their perceptions of their vulnerability to Ebola, ability to protect themselves from Ebola (protection efficacy), and xenophobic tendencies. Overall, the more vulnerable people felt, the more they exhibited xenophobic responses, but this relationship was moderated by individualism and collectivism. The increase in xenophobia associated with increased vulnerability was especially pronounced among people with high individualism scores and those with low collectivism scores. These relationships were mediated by protection efficacy. State-level collectivism had the same moderating effect on the association between perceived vulnerability and xenophobia that individual-level value orientation did. Collectivism-and the set of practices and rituals associated with collectivistic cultures-may serve as psychological protection against the threat of disease.

Improving Medical Decision Making and Health Promotion through Culture-Sensitive Health Communication: An Agenda for Science and Practice.

This review introduces the concept of culture-sensitive health communication. The basic premise is that congruency between the recipient's cultural characteristics and the respective message will increase the communication's effectiveness. Culture-sensitive health communication is therefore defined as the deliberate and evidence-informed adaptation of health communication to the recipients' cultural background in order to increase knowledge and improve preparation for medical decision making and to enhance the persuasiveness of messages in health promotion. To achieve effective health communication in varying cultural contexts, an empirically and theoretically based understanding of culture will be indispensable. We therefore define culture, discuss which evolutionary and structural factors contribute to the development of cultural diversity, and examine how differences are conceptualized as scientific constructs in current models of cultural differences. In addition, we will explicate the implications of cultural differences for psychological theorizing, because common constructs of health behavior theories and decision making, such as attitudes or risk perception, are subject to cultural variation. In terms of communication, we will review both communication strategies and channels that are used to disseminate health messages, and we will discuss the implications of cultural differences for their effectiveness. Finally, we propose an agenda both for science and for practice to advance and apply the evidence base for culture-sensitive health communication. This calls for more interdisciplinary research between science and practice but also between scientific disciplines and between basic and applied research.

Impact of Cultural Exposure and Message Framing on Oral Health Behavior: Exploring the Role of Message Memory.

BACKGROUND: Health messages are more effective when framed to be congruent with recipient characteristics, and health practitioners can strategically choose message features to promote adherence to recommended behaviors. We present exposure to US culture as a moderator of the impact of gain-frame versus loss-frame messages. Since US culture emphasizes individualism and approach orientation, greater cultural exposure was expected to predict improved patient choices and memory for gain-framed messages, whereas individuals with less exposure to US culture would show these advantages for loss-framed messages. METHODS: 223 participants viewed a written oral health message in 1 of 3 randomized conditions-gain-frame, loss-frame, or no-message control-and were given 10 flosses. Cultural exposure was measured with the proportions of life spent and parents born in the US. At baseline and 1 week later, participants completed recall tests and reported recent flossing behavior. RESULTS: Message frame and cultural exposure interacted to predict improved patient decisions (increased flossing) and memory maintenance for the health message over 1 week; for example, those with low cultural exposure who saw a loss-frame message flossed more. Incongruent messages led to the same flossing rates as no message. Memory retention did not explain the effect of message congruency on flossing. LIMITATIONS: Flossing behavior was self-reported. Cultural exposure may only have practical application in either highly individualistic or collectivistic countries. CONCLUSIONS: In health care settings where patients are urged to follow a behavior, asking basic demographic questions could allow medical practitioners to intentionally communicate in terms of gains or losses to improve patient decision making and treatment adherence.

Delay and death-thought accessibility: a meta-analysis.

The dual-process component of Terror Management Theory (TMT) proposes that different types of threats lead to increases in death-thought accessibility (DTA) after different delay intervals. Experimental studies of terror management threats' effect on DTA were collected and coded for their use of explicitly death-related (vs. not explicitly death-related) threats, and for their use of delay and task-switching during the delay. Results reveal that studies using death-related threats achieved larger DTA effect-sizes when they included more task-switching or a longer delay between the threat and the DTA measurement. In contrast, studies using threats that were not explicitly death-related achieved smaller DTA effect-sizes when they included more task-switching between the threat and the DTA measurement. These findings provide partial support for the dual-process component's predictions regarding delay and DTA. Limitations and future directions are discussed.

A randomized controlled multimodal behavioral intervention trial for improving antiepileptic drug adherence.

PURPOSE: Medication nonadherence is one of the most important reasons for treatment failure in patients with epilepsy. The present study investigated the effectiveness of a multicomponent intervention to improve adherence to antiepileptic drug (AED) medication in patients with epilepsy. METHODS: In a prospective, randomized multicenter trial, three sessions of face-to-face motivational interviewing (MI) in combination with complementary behavior change techniques were compared with standard care. Motivational interviewing prompted change talk and self-motivated statements from the patients, planning their own medication intake regimen and also identifying and overcoming barriers that may prevent adherence. Participants were provided with calendars to self-monitor their medication taking behavior. A family member and the health-care team were invited to attend the last session of MI in order to improve the collaboration and communication between patients, their caregiver or family member, and their health-care provider. At baseline and 6-month follow-up, psychosocial variables and medical adherence were assessed. RESULTS: In total, 275 participants were included in the study. Compared with the active control group, patients in the intervention group reported significantly higher medication adherence, as well as stronger intention and perceptions of control for taking medication regularly. The intervention group also reported higher levels of action planning, coping planning, self-monitoring, and lower medication concerns. CONCLUSIONS: This study shows that MI can be effective in clinical practice to improve medication adherence in patients with epilepsy. It also provides evidence that combining volitional interventions, including action planning, coping planning, and self-monitoring with motivational interviewing can promote the effectiveness of the medical treatments for epilepsy by improving adherence.

Message framing for health: moderation by perceived susceptibility and motivational orientation in a diverse sample of Americans.

OBJECTIVE: The present study examined how gain- and loss-framed informational videos about oral health influence self-reported flossing behavior over a 6-month period, as well as the roles of perceived susceptibility to oral health problems and approach/avoidance motivational orientation in moderating these effects. METHOD: An age and ethnically diverse sample of 855 American adults were randomized to receive no health message, or either a gain-framed or loss-framed video presented on the Internet. Self-reported flossing was assessed longitudinally at 2 and 6 months. RESULTS: Among the entire sample, susceptibility interacted with frame to predict flossing. Participants who watched a video where the frame (gain/loss) matched perceived susceptibility (low/high) had significantly greater likelihood of flossing at recommended levels at the 6-month follow-up, compared with those who viewed a mismatched video or no video at all. However, young adults (18-24) showed stronger moderation by motivational orientation than by perceived susceptibility, in line with previous work largely conducted with young adult samples. CONCLUSION: Brief informational interventions can influence long-term health behavior, particularly when the gain- or loss-frame of the information matches the recipient's beliefs about their health outcome risks.