Basis of Intentions as a Moderator of the Intention–Health Behavior Relationship

Objective: Previous research has shown that the degree to which individuals base their intentions on particular underlying cognitions (i.e., motives) significantly moderates the intention– behavior relationship. Studies have individually examined the moderating effect of intentions based on overall attitude, affective attitudes, injunctive norms, and moral norms. The present research used a within-persons approach to simultaneously test the moderating effects of intentions based on instrumental attitude, affective attitude, anticipated affective reactions, injunctive norms, descriptive norms, and moral norms on the intention– behavior relationship and the impact of controlling for intention stability, self-efficacy, and past behavior. Method: The main outcome measures were the self-reported performance of 20 health behaviors. Adults (N 366) completed questionnaires assessing instrumental attitude, affective attitude, anticipated affective reactions, injunctive norms, descriptive norms, moral norms, self-efficacy and past behavior at baseline; intentions at baseline and 1-month follow-up; and behavior at 2-month follow-up for 20 health behaviors. Results: When tested simultaneously using multilevel modeling the only significant moderator of the intention– behavior relationship was the extent to which intentions were based on anticipated affective reactions (intentions more strongly based on anticipated affective reactions were significantly stronger predictors of behavior). This effect remained when we also controlled for intention stability (which also moderated the intention– behavior relationship), self-efficacy, and past behavior. Conclusions: Intentions based on anticipated affective reactions may be particularly important predictors of health behaviors. Studies manipulating such intentions to test their effects on behavior change are required

Role of affective attitudes and anticipated affective reactions in predicting health behaviors

Objective: Two measures of affect-affective attitude (AA) and anticipated affective reaction (AAR)- have frequently been used individually, but rarely simultaneously, in correlational studies predicting health behaviors. This research assessed their individual and combined impact in predicting intention and action for a range of health behaviors, controlling for theory of planned behavior (TPB) variables. Method: Self-reported intentions and performance of health behaviors were the main outcome measures. Design: Study 1 is a meta-analysis of published studies (k = 16) measuring the relevant variables. In Study 2, adults (N = 426) completed questionnaires assessing TPB variables, past behavior, AA, AAR, and subsequent behavior for a range of health behaviors. Results: Across both studies, AA and AAR were only moderately intercorrelated, although both had significant correlations with both intentions and behavior. AA was a significant predictor of intentions and behavior after controlling for TPB variables (Studies 1 and 2) plus past behavior (Study 2). In Study 1, AAR was a significant predictor of behavior, but not intentions, when controlling for TPB variables. In Study 2, AAR was a significant predictor of intentions when controlling for both TPB variables plus past behavior (Study 2), but was not a significant predictor of behavior when controlling for either of these variables. Several relationships were moderated by health-behavior category. Conclusions: Both AA and AAR are important predictors of health behaviors and can have independent effects on intentions and action. Studies manipulating both variables to test their independent and combined effects on behavior change are required

Tackling student binge drinking: pairing incongruent messages and measures reduces alcohol consumption

Objectives: Excessive alcohol consumption is a persistent problem in Northern European cultures. Across a 2-week period, we tested the effect of varying message frames, message types, and response measures, in reducing alcohol consumption. Design: Three hundred and twenty-three respondents were allocated to a 2 (message frame: gain vs. loss) × 2 (message type: health vs. social) × 2 (response type: engaging vs. refraining) mixed design. Method: Binge drinking and units consumed were measured at Time 1 and Time 2 (2 weeks later). Participants read (following Time 1) a gain- or loss-framed message on binging emphasizing either social or health consequences and answered engaging in or refraining from drinking attitude measures. Results: No main effects were identified. The key finding was that gain-framed messages, when used in conjunction with engage response measures (an incongruous pairing), were highly effective in reducing alcohol consumption 2 weeks later compared with the other message frame/response measure combinations. Conclusions: We suggest that for prevention behaviours, gain-framed messages, when paired with engage response measures, initiate an inconsistency resolution process. Together, our findings emphasize the importance of message frame and response type when seeking to reduce alcohol consumption using persuasive health messages

Applying the Reasoned Action approach to understanding health protection and health risk behaviors

The Reasoned Action Approach (RAA) developed out of the Theory of Reasoned Action and Theory of Planned Behavior but has not yet been widely applied to understanding health behaviors. The present research employed the RAA in a prospective design to test predictions of intention and action for groups of protection and risk behaviors separately in the same sample. To test the RAA for health protection and risk behaviors. Measures of RAA components plus past behavior were taken in relation to eight protection and six risk behaviors in 385 adults. Self-reported behavior was assessed one month later. Multi-level modelling showed instrumental attitude, experiential attitude, descriptive norms, capacity and past behavior were significant positive predictors of intentions to engage in protection or risk behaviors. Injunctive norms were only significant predictors of intention in protection behaviors. Autonomy was a significant positive predictor of intentions in protection behaviors and a negative predictor in risk behaviors (the latter relationship became non-significant when controlling for past behavior). Multi-level modelling showed that intention, capacity, and past behavior were significant positive predictors of action for both protection and risk behaviors. Experiential attitude and descriptive norm were additional significant positive predictors of risk behaviors. The RAA has utility in predicting both protection and risk health behaviors although the power of predictors may vary across these types of health behavior

Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: a systematic review

Objective The aim of this systematic review was to develop a ‘contributory factors framework’ from a synthesis of empirical work which summarises factors contributing to patient safety incidents in hospital settings. Design A mixed-methods systematic review of the literature was conducted. Data sources Electronic databases (Medline, PsycInfo, ISI Web of knowledge, CINAHL and EMBASE), article reference lists, patient safety websites, registered study databases and author contacts. Eligibility criteria Studies were included that reported data from primary research in secondary care aiming to identify the contributory factors to error or threats to patient safety. Results 1502 potential articles were identified. 95 papers (representing 83 studies) which met the inclusion criteria were included, and 1676 contributory factors extracted. Initial coding of contributory factors by two independent reviewers resulted in 20 domains (eg, team factors, supervision and leadership). Each contributory factor was then coded by two reviewers to one of these 20 domains. The majority of studies identified active failures (errors and violations) as factors contributing to patient safety incidents. Individual factors, communication, and equipment and supplies were the other most frequently reported factors within the existing evidence base. Conclusions This review has culminated in an empirically based framework of the factors contributing to patient safety incidents. This framework has the potential to be applied across hospital settings to improve the identification and prevention of factors that cause harm to patients

Changing self-reported physical activity using different types of affectively and cognitively framed health messages, in a student population

The present research focused upon the power of different messages to increase selfreported physical activity. 596 participants were randomised to one of five conditions that varied in the content of message: short-term affective, short-term cognitive, longterm affective, long-term cognitive and a no message control. Physical activity was measured at baseline and follow-up (7 days later) using the Godin Leisure Time Exercise Questionnaire over the subsequent 7 day period. The affective short-term message (ASM) was shown to be equally effective at increasing self-reported physical activity as a cognitive long-term message (CLM). Furthermore, when controlling for baseline activity levels, the ASM emerged as being the message that produced the highest levels of self-reported physical activity at follow-up. The findings point to the value of distinguishing between health messages in terms of the focus on affective and cognitive outcomes and the temporal nature of the outcomes (short-term or longterm)

Measuring the built environment in studies of child health – a meta-narrative review of associations

Although the built environment (BE) is important for children’s health there is little consensus about which features are most important due to differences in measurement and outcomes across disciplines. This meta-narrative re-view was undertaken by a multi-disciplinary team of researchers to summarise ways in which BE are measured, and how these link to children’s health. A structured search of four databases across the relevant disciplines retrieved 108 relevant references. The health-related outcomes most commonly addressed were active travel, physical activ-ity and play, and obesity. Many studies used objective (GIS and street audits) or standardised subjective (per-ceived), measurements of the built environment. However, there was a wide variety, and sometimes inconsistency, in their use. There were clear associations between the BE and health. Objective physical activity and self-reported active travel were positively associated with higher street connectivity or walkability measures; while self-reported physical activity and play had the strongest association with reduced street connectivity, indicated by quieter, one-way streets. Future research should implement consistent BE measures to ensure key features are explored. A systems approach will be particularly relevant for addressing place-based health inequalities, given potential un-intended health consequences of making changes to the built environment

Patient involvement in patient safety: Protocol for developing an intervention using patient reports of organisational safety and patient incident reporting

Background Patients have the potential to provide a rich source of information on both organisational aspects of safety and patient safety incidents. This project aims to develop two patient safety interventions to promote organisational learning about safety - a patient measure of organisational safety (PMOS), and a patient incident reporting tool (PIRT) - to help the NHS prevent patient safety incidents by learning more about when and why they occur. Methods To develop the PMOS 1) literature will be reviewed to identify similar measures and key contributory factors to error; 2) four patient focus groups will ascertain practicality and feasibility; 3) 25 patient interviews will elicit approximately 60 items across 10 domains; 4) 10 patient and clinician interviews will test acceptability and understanding. Qualitative data will be analysed using thematic content analysis. To develop the PIRT 1) individual and then combined patient and clinician focus groups will provide guidance for the development of three potential reporting tools; 2) nine wards across three hospital directorates will pilot each of the tools for three months. The best performing tool will be identified from the frequency, volume and quality of reports. The validity of both measures will be tested. 300 patients will be asked to complete the PMOS and PIRT during their stay in hospital. A sub-sample (N = 50) will complete the PMOS again one week later. Health professionals in participating wards will also be asked to complete the AHRQ safety culture questionnaire. Case notes for all patients will be reviewed. The psychometric properties of the PMOS will be assessed and a final valid and reliable version developed. Concurrent validity for the PIRT will be assessed by comparing reported incidents with those identified from case note review and the existing staff reporting scheme. In a subsequent study these tools will be used to provide information to wards/units about their priorities for patient safety. A patient panel will provide steering to the research. Discussion The PMOS and PIRT aim to provide a reliable means of eliciting patient views about patient safety. Both interventions are likely to have relevance and practical utility for all NHS hospital trusts

Starting School: a large-scale start of school assessment within the ‘Born in Bradford’ longitudinal cohort [version 1; peer review: 1 approved with reservations]

The Born in Bradford (BiB) cohort of 13,776 children born between 2007-2011 and their parents provides a rich data resource for researchers exploring protective and risk factors influencing long-term developmental and health outcomes. Educational attainment is a critical factor related to later health. Literacy and communication, fine motor skills and social and emotional health are key ‘early’ predictors of educational attainment and can be used to identify children in need of additional support. We describe our BiB ‘Starting School’ data collection protocol which assessed literacy and communication, fine motor skills and social and emotional health on 3,444 BiB children aged 4-5 years old. These measures supplement the existing dataset, and complement the routine educational, health and social care data available for the cohort