On the need to investigate the barriers to physical activity that are specific to stigmatized individuals

Understanding what predicts behavior change is a hot topic in health psychology, especially with regard to physical activity. While existing research has revealed key factors of physical activity (e.g., reasoned cognitions, automatic processes), it fails to accurately identify those that are specific to the most inactive populations (e.g., older adults, obese individuals, women, people living with chronic disease). In this commentary, we propose to articulate current approaches of health behavior change with the social psychology of stereotypes, based on the observation that inactive groups are often targeted by negative stereotypes. This articulation may allow to better identify the barriers to physical activity that are specific to individuals from the most inactive groups. More particularly, we propose that low self-control resources and self-perceptions may be key factors of physical inactivity in these individuals. This proposition could in turn help to explain why some behavioral change techniques that are efficient in healthy or young adults are inefficient in other individuals.

Smokers' Engagement Behavior on Facebook regarding to Smoking Cessation Verbalization and Facebook Reaction Usage: Content Analysis (Preprint)

BACKGROUND The Transtheoretical Model recommends "processes of change", while the Motivational Interviewing approach offers “motivational language” as indicators of health behavior change. The relationship between these indicators and the usage of Facebook reaction buttons is little known. However, this relationship may highlight how to evaluate one of the most popular engagement indicators (Facebook reactions) in online health behavior change interventions. OBJECTIVE The study aim was to understand the relationship between processes of change, motivational language, Facebook users’ gender, and the Facebook reaction buttons. METHODS A total of 821 comments were analyzed in the current study (N=821), which came from different Facebook users, and responded to image-based, smoking cessation support contents. The processes of change (experiential and behavioral processes) and the motivational language (change talk and sustain talk) in the investigated comments were identified. The presence, the number, and the proportion of these linguistic categories were compared with the Facebook users’ gender and the usage of reaction buttons. RESULTS The Facebook users who used the “Haha” reaction button wrote significantly higher proportion of sustain talk than those who used the “Like” or “Love” reaction (P=.011). No significant difference in the number or proportion of linguistic categories was found between those who used the "Like" reaction button, and those who did not use reaction buttons. The Facebook users who combined the comment and “Love” reaction wrote significantly more change talk than those who used the “Haha” and “Like” reactions, or those who did not utilize these buttons (P<.001). Significant female dominance was observed in the presence, the number, and the proportion of experiential processes and change talk (P<.05). In addition, significant male predominance was found in the presence, the number, and the proportion of sustain talk (P<.05). CONCLUSIONS The "Haha" reaction may be a negative engagement indicator, the "Like" reaction may be a neutral engagement indicator, and the "Love" reaction may be a positive engagement indicator in terms of the smoking cessation during Facebook-based interventions. Furthermore, female engagement may be characterized by utilizing the terms of experiential processes and change talk, while the usage of sustain talk can be typical for male engagement. We recommend the evaluation of processes of change and motivational utterances in participants' comments during online public health interventions.

Using Health Concept Surveying to Elicit Usable Evidence: Case Studies of a Novel Evaluation Methodology

Background Developers, designers, and researchers use rapid prototyping methods to project the adoption and acceptability of their health intervention technology (HIT) before the technology becomes mature enough to be deployed. Although these methods are useful for gathering feedback that advances the development of HITs, they rarely provide usable evidence that can contribute to our broader understanding of HITs. Objective In this research, we aim to develop and demonstrate a variation of vignette testing that supports developers and designers in evaluating early-stage HIT designs while generating usable evidence for the broader research community. Methods We proposed a method called health concept surveying for untangling the causal relationships that people develop around conceptual HITs. In health concept surveying, investigators gather reactions to design concepts through a scenario-based survey instrument. As the investigator manipulates characteristics related to their HIT, the survey instrument also measures proximal cognitive factors according to a health behavior change model to project how HIT design decisions may affect the adoption and acceptability of an HIT. Responses to the survey instrument were analyzed using path analysis to untangle the causal effects of these factors on the outcome variables. Results We demonstrated health concept surveying in 3 case studies of sensor-based health-screening apps. Our first study (N=54) showed that a wait time incentive could influence more people to go see a dermatologist after a positive test for skin cancer. Our second study (N=54), evaluating a similar application design, showed that although visual explanations of algorithmic decisions could increase participant trust in negative test results, the trust would not have been enough to affect people’s decision-making. Our third study (N=263) showed that people might prioritize test specificity or sensitivity depending on the nature of the medical condition. Conclusions Beyond the findings from our 3 case studies, our research uses the framing of the Health Belief Model to elicit and understand the intrinsic and extrinsic factors that may affect the adoption and acceptability of an HIT without having to build a working prototype. We have made our survey instrument publicly available so that others can leverage it for their own investigations.

Re-Thinking Health Behaviour Change Models From an Integrated Perspective

Scientific evidence indicates that theory-based health interventions are more effective in promoting health behavior change (BC) and in maintaining health changes over time. Previous work identified more than 80 BC theories; however, there is little guidance on how to best choose between them. More than creating new theories, an essential challenge now is to integrate these theories to reach a more complete understanding of the BC process. The chapter is an effort to integrate some of the most central theories in this field, aiming to reach an integrated framework by 1) identifying and merging similarities between theories, reducing conceptual complexity, and by 2) building from dissimilarities as key aspects to overcome limitations. This framework is a practical visual tool that intends to support researchers and practitioners working in the field, guiding on the crucial constructs to address in interventions to promote health BC. This framework also integrates the ACP model as an approach that offers valuable insights to support communication in health interventions.

Mindfulness-Informed Guided Imagery to Target Physical Activity: A Mixed Method Feasibility and Acceptability Pilot Study

Physical activity offers substantial mind-body health benefits and reduced mortality, yet many individuals are chronically underactive. Physical activity interventions may benefit from integrative approaches that join components of mindfulness and neurobiological models of behavior. Mindfulness increases one’s awareness of cognitions and physical sensations to potentially facilitate self-regulation, while neurobiological models such as the dual system model of health behavior offer guidance on improving physical activity intervention targets. This 2-phase study includes an initial development process to create brief (∼4 min) mindfulness informed guided imagery audio files that target distinct cognitive and affective processes to promote physical activity. In the second phase, participants completed a 2-week pilot intervention study to gather qualitative and quantitative data on intervention feasibility and acceptability. Participants endorsed the mindfulness informed guided imagery as easy to use, enjoyable and helpful. Over a 2-week intervention period participants reported positive shifts in behavior change, physical activity enjoyment, increased mindfulness during physical activity, and increased physical exercise self-efficacy and satisfaction. Interview data revealed that participants increased their frequency of physical activity and tended to experience positive affect during physical activity, engaged in future oriented thinking and were able to view physical activity in a more positive light. Findings support the feasibility and acceptability of an integrative online mindfulness informed guided imagery intervention to promote physical activity enjoyment and engagement. This study extends health behavior change intervention research and provides supporting evidence for a flexible and tailorable online mindfulness-based intervention.

The Evaluation of a Family-Engagement Approach to Increase Physical Activity, Healthy Nutrition, and Well-Being in Children and Their Parents

Prevention programs often are directed at either parents or children separately, thereby ignoring the intergenerational aspect of health and well-being. Engaging the family is likely to improve both the uptake and long-term impact of health behavior change. We integrated an intergenerational approach into a frequently used shared assessment tool for children's care needs. The current study's aim was 2-fold: to monitor this family-engagement tool's effects on both children and their parents' health behaviors and well-being, and to examine the different dynamics of health behavioral change within a family.Method: We followed 12 children ages 10–14 years and their parents for 12 weeks using an explanatory mixed-methods design comprising interviews, questionnaires, and an n-of-1 study. During home visits at the beginning and end of the study, we interviewed children and their parents about their expectations and experiences, and measured their height and weight. Furthermore, we collected secondary data, such as notes from phone and email conversations with parents, as well as evaluation forms from professionals. In the n-of-1 study, families were prompted three times a week to describe their day and report on their vegetable intake, minutes of exercise, health behavior goals, and psychosomatic well-being. The interviews, notes, and evaluation forms were analyzed using qualitative content analyses. For the n-of-1 study, we performed multi-level time-series analyses across all families to assess changes in outcomes after consulting the family-engagement tool. Using regression analyses with autocorrelation correction, we examined changes within individual families.Results: Five child-mother dyads and three child-mother-father triads provided sufficient pre- and post-data. The mean minutes of children's physical activity significantly increased, and mothers felt more energetic, but other outcomes did not change. In consultations related to overweight, the family-engagement tool often was used without setting specific or family goals.Conclusions: The family-engagement approach elicited positive effects on some families' health and well-being. For multifaceted health problems, such as obesity, family-engagement approaches should focus on setting specific goals and strategies in different life domains, and for different family members.

The Dyadic Health Influence Model

Relationship partners affect one another’s health outcomes through their health behaviors, yet how this occurs is not well understood. To fill this gap, we present the Dyadic Health Influence Model (DHIM). The DHIM identifies three routes through which a person (the agent) can impact the health beliefs and behavior of their partner (the target). An agent may (a) model health behaviors and shape the shared environment, (b) enact behaviors that promote their relationship, and/or (c) employ strategies to intentionally influence the target’s health behavior. A central premise of the DHIM is that agents act based on their beliefs about their partner’s health and their relationship. In turn, their actions have consequences not only for targets’ health behavior but also for their relationship. We review theoretical and empirical research that provides initial support for the routes and offer testable predictions at the intersection of health behavior change research and relationship science.