The effectiveness of an intervention designed based on health action process approach on diet and medication adherence among patients with type 2 diabetes: a randomized controlled trial

Background Diabetes is a major cause of worldwide morbidity and mortality. Diet and medication non-adherence are common among individuals with diabetes, making glycemic control difficult to attain. This study aimed to evaluate an intervention designed based on Health Action Process Approach (HAPA) to improve adherence to diet and medication among patients with type 2 diabetes in Tehran, Iran. Methods The study was a randomized controlled trial. A total of 248 patients with type 2 diabetes who had low diet and medication adherence were randomly allocated into two intervention (n = 124) and control (n = 124) groups. Intervention group received educational intervention during three months. HAPA constructs, diet and medication adherence, and Hemoglobin A1c (HbA1c) levels were assessed at baseline, one month and six months after the intervention. Mixed Model Analysis was used to compare between and within group changes in the outcomes. Results There was a statistically significant improvement in HbA1c levels after six months (7.77 ± 1.36% vs. 8.07 ± 1.52%, 95% CI, p < 0.001). Diet and medication adherence, intention, task self-efficacy, coping self-efficacy, recovery self-efficacy, action and coping planning, barriers, benefits and perceived social support were significantly improved one month and six months after the intervention (p < 0.001). Conclusion Our intervention designed based on health action process approach led to improvements in diet and medication adherence, and HbA1c among the patients within one and six months. Trial registration: IRCT, IRCT20151208025431N4. Registered 10 March 2018, https://fa.irct.ir

ANALYSIS OF MOTIVATION PHASE OF THE HAPA THEORY (HEALTH ACTION PROCESS APPROACH) AND INTENTION TO EXCLUSIVE BREASTFEEDING IN THE SIDOSERMO PRIMARY HEALTHCARE CENTER, SURABAYA

ABSTRACTExclusive breastfeeding can encourage optimal growth and development, especially during the child’s critical period which spans from when the baby is born until 2 years old. The objective of this study was to analyze the motivational phase of the Health Action Process Approach (HAPA) theory with the intention of exclusive breastfeeding in the work area of the Sidosermo Primary Healthcare Center. This study was a quantitative cross-sectional study with an observational research design. The sampling technique was conducted through the systematic random sampling technique with a total sample of 32 people. The study showed that risk perception has a significant influence on the intention of exclusive breastfeeding with a significance value of 0.014 < α (0.05) and an odds ratio of 0.101. This suggests that respondents who had the right perception about exclusive breastfeeding are 0.101 times more likely to exclusively breasfeed their child than respondents who had a wrong perception. This study also showed that there was a significant influence between self-efficacy towards the intention of exclusive breastfeeding, with a significance value of 0.006 < α (0.05). Respondents who felt that they were able to give exclusive breastfeeding were 17 times more likely to provide exclusive breastfeed than those who felt they were less able. The results of this study indicated that there was an influence between the outcome expectancies with the intention of exclusive breastfeeding with a significance value of 0.004 < α (0.05) and an odds ratio of 28.8. It means that respondents who had high expectations had 28.8 times more intention to provide exclusive breastfeeding than respondents who had low expectations. Keywords: exclusive breastfeeding, intention, Health Action Process Approach (HAPA)

Gesundheitsbezogene Verhaltensänderungen in der nachberuflichen Lebensphase

Zusammenfassung Hintergrund Im Anschluss an die Erwerbszeit gestaltet sich das Gesundheitsverhalten bei Menschen im Ruhestand unterschiedlich. Doch welche Möglichkeiten bestehen aus Sicht der Betroffenen, um gesundheitsrelevante Veränderungsabsichten leichter umzusetzen? Und wie können daraus neue Gewohnheiten etabliert werden? Methodik Im August 2020 erfolgte die Datenerhebung im Rahmen einer qualitativen Forschung durch Face-to-face-Interviews mit deduktiv ausgewählten Personen in der nachberuflichen Lebensphase. Das gewonnene Material wurde systematisch und regelgeleitet auf Basis der qualitativen Inhaltsanalyse nach Mayring ausgewertet. Zur Orientierung diente ein Kodierleitfaden in Anlehnung an das HAPA-Modell (Health Action Process Approach model). Ergebnisse Die Aussagen der Befragten deuten auf eine starke Absichtsbildung als bedeutendsten Vorhersagewert für eine längerfristige Durchführung von gesundheitsfördernden Handlungen hin. Weitere Verstärker zeigen sich in der selbstbestimmten Schaffung neuer Gewohnheiten, der Visualisierung von Vorteilen, einem Barrierenmanagement, Erfolgserlebnissen, Ersatzbefriedigungen und individuellen Handlungsplänen, die auch Freude bereitende Aspekte beinhalten. Schlussfolgerung Unter Beachtung mehrerer beeinflussender Faktoren könnten die Erfolgsaussichten bei selbstgesteckten Gesundheitszielen wirksam erhöht werden. In Eigenregie oder gemeinschaftlich erstellte Konzepte würden dabei als Verstärker wirken. Zu diesem Zweck könnte ein niedrigschwelliges Seminarangebot unterstützend zur Verfügung gestellt und ggf. in Kooperation mit Ärzt*innen, Krankenhäusern oder Rehabilitationseinrichtungen forciert werden. Auch situative Einflüsse scheinen die Absichtsbildung zu beeinflussen und sollten daher in das HAPA-Modell (Health Action Process Approach model) integriert werden.

Predicting physical activity change in cancer survivors: an application of the Health Action Process Approach

Purpose Previous research has not examined the utility of the Health Action Process Approach (HAPA) to predict physical activity (PA) change in cancer survivors. The aim of the study was to investigate the efficacy of a HAPA-based model in predicting temporal change in moderate-to-vigorous physical activity (MVPA) in cancer survivors. Methods Participants enrolled in the Wearable Activity Technology and Action Planning (WATAAP) trial completed validated questionnaires (n = 64) to assess HAPA constructs (action and maintenance self-efficacy, outcome expectancies, action planning, risk perceptions, and intention) and wore an ActiGraph to measure PA at baseline, 12 weeks, and 24 weeks later. Data were analyzed using variance-based structural equation modeling with residualized change scores for model variables. Results Consistent with predictions, changes in action self-efficacy (β = 0.490, p < 0.001, ES = 0.258) and risk perceptions (β = 0.312, p = 0.003, ES = 0.099) were statistically significant predictors of intention change over time. Changes in intention (β = 0.217, p = 0.029, ES = 0.040) and action planning (β = 0.234, p = 0.068, ES = 0.068) predicted changes in MVPA. Overall, the model accounted for significant variance in intention (R2 = 0.380) and MVPA (R2 = 0.228) change. Conclusions Changes in intention and action planning were important correlates of MVPA change over 24 weeks. Further, changes in action self-efficacy and risk perceptions predicted changes in intention. Implications for cancer survivors: interventions that foster risk perceptions and self-efficacy, strengthen intentions, and promote action planning may be effective in promoting sustained PA change in cancer survivors.

Using Intervention Mapping in the Systematic Development of a Behaviour Change Intervention to Enhance Exercise Adherence among People with Persistent Musculoskeletal Pain

Purpose: This article describes the first four steps of the intervention mapping framework used to design a programme aimed at increasing adherence to prescribed exercise by people with persistent musculoskeletal pain. Method: In Step 1, a systematic review and qualitative study was completed to inform Step 2 and the identification of the Health Action Process Approach as an appropriate theoretical framework for establishing two programme objectives: enhancing self-management and providing tailored and accessible exercise instructions. Step 3 encompassed the selection of the programme methods, and the programme is described in Step 4. The resulting programme provides virtually delivered motivational interviewing and an app-based exercise programme to support individuals’ adherence to exercise. Results: The resulting intervention was assessed in a proof-of-concept feasibility and acceptability study and was shown to be feasible and acceptable. Refinements to the programme included additional tailoring of the exercise app and modifying the motivational interviewing schedule. Conclusions: Using the intervention mapping approach enabled us to successfully develop an intervention aimed at supporting the development of self-management behaviours and addressing maladaptive beliefs as a means of enhancing individuals’ adherence to exercise. Evaluation and implementation of the intervention should now be carried out.