a cross-over longitudinal design

Background Frequent handwashing can prevent infections, but non-compliance to hand hygiene is pervasive. Few theory- and evidence-based interventions to improve regular handwashing are available. Therefore, two intervention modules, a motivational and a self-regulatory one, were designed and evaluated. Methods In a longitudinal study, 205 young adults, aged 18 to 26 years, were randomized into two intervention groups. The Mot-SelfR group received first a motivational intervention (Mot; risk perception and outcome expectancies) followed by a self-regulatory intervention (SelfR; perceived self-efficacy and planning) 17 days later. The SelfR-Mot group received the same two intervention modules in the opposite order. Follow-up data were assessed 17 and 34 days after the baseline. Results Both intervention sequences led to an increase in handwashing frequency, intention, self- efficacy, and planning. Also, overall gains were found for the self-regulatory module (increased planning and self-efficacy levels) and the motivational module (intention). Within groups, the self-regulatory module appeared to be more effective than the motivational module, independent of sequence. Conclusions Self-regulatory interventions can help individuals to exhibit more handwashing. Sequencing may be important as a motivation module (Mot) first helps to set the goal and a self-regulatory module (SelfR) then helps to translate this goal into actual behavior, but further research is needed to evaluate mechanisms

Effekte von motivationalen, selbstregulativen und anreizbasierten Interventionen zur Veränderung des Gesundheitsverhaltens

Healthy behaviors are associated with preventing a range of diseases and thus improving an individual’s overall health status, however, non-compliance is pervasive. Research has provided compelling evidence that motivation and self- regulation processes help to explain and predict health-related behavior change (e.g., Hagger & Luszczynska, 2014; Schwarzer, Lippke, & Luszczynska, 2011). Furthermore, adding financial incentives to psychological components as part of a behavior change program is suggested to provide the most effective results in health-related behavior change (e.g., Cerasoli, Nicklin, & Ford, 2014). The aim of this thesis was to identify in which ways sequentially (SSI; Sequential-Specific Intervention) and in combination (CCSI; Component-Combined Specific Intervention) of motivational and self-regulatory components operate best for predicting health behavior changes. To explore SSI question, three experimental studies (chapter 2, chapter 3, and chapter 4) were conducted to address the question of whether the order in which the components of two psychological modules (motivation and self-regulation) are delivered, is relevant for the effectiveness of health promotion among young adults in India. To investigate the effectiveness of CCSI, one intervention study (chapter 5) was performed to explore the feasibility of a brief incentive- based intervention in comparison with a control group to promote oral self- care in outpatients already diagnosed with periodontal diseases in India. The theoretical rationale for this thesis was based on the Health Action Process Approach (HAPA; Schwarzer, 1992, 2008), which is a model of the adoption and maintenance of health behaviors. The findings from the SSI evaluations partly support the theorized sequence that motivational processes precede self- regulatory ones (Schwarzer, 2008). Here, the beneficial effects of self- regulatory strategies (i.e., self-efficacy, planning, and action control) proved more effective than the motivational components (such as risk perception, outcome expectancies, and intention). Findings attesting the effectiveness of CCSI proved effective in increasing the dental flossing levels and thus, helps to reduce the further risk of developing oral diseases in patients. Furthermore, in chapter 2 and chapter 5, mediators between behavioral intention and self-efficacy explained the working mechanisms of the interventions, indicating the importance of considering these constructs in future research. The theoretical consideration of innovative intervention designs contained in this thesis and its empirical results may guide the development of theory- and evidence-based interventions to promote fruit and vegetable intake, dental flossing, and handwashing. The highly predictive constructs of the HAPA model may indicate the suitability of the model for evaluating and developing health-related interventions in future.Ein gesunder Lebensstil hilft, Krankheiten zu vermeiden und so die Gesundheit des Individuums zu verbessern. Zahlreiche Studien konnten zeigen, dass Prozesse der Motivation und Selbstregulation die Änderung des Gesundheitsverhalten erklären und vorhersagen können (z.B., Hagger & Luszczynska, 2014; Schwarzer, Lippke, & Luszczynska, 2011). Des Weiteren gibt es Hinweise, dass die Kombination finanzieller Anreize und psychologischer Faktoren eine Verhaltensänderung am effektivsten bewirken kann (z.B., Cerasoli, Nicklin, & Ford, 2014). Ziel dieser Arbeit war es, herauszufinden, wie genau motivationale und selbstregulative Interventionskomponenten, die entweder sequentiell (SSI; Sequential-specific intervention) oder in Kombination (CCSI; Component-combined specific intervention) angeordnet werden, eine Verhaltensänderung am besten vorhersagen. Um die Frage SSI zu untersuchen, wurden drei experimentelle Studien bei jungen Erwachsenen in Indien (Kapitel 2, 3 und 4) durchgeführt. Es wurde der Frage nachgegangen, ob die Reihenfolge, in der zwei psychologischen Konstrukte implementiert werden (Motivation und Selbstregulation), relevant für die Wirksamkeit der Gesundheitsförderungsprogramme ist. Um die Wirksamkeit der CCSI zu überprüfen, wurde eine weitere Studie zu Zahnhygiene durchgeführt. Dabei wurde auch die Wirkung finanzieller Anreize analysiert. Die theoretische Grundlage dieser Arbeit war das Sozial-kognitive Prozessmodell gesundheitlichen Handelns (The Health Action Process Approach; Schwarzer, 1992, 2008). In Kapitel 1 werden der theoretische Hintergrund der Arbeit sowie die Hypothesen dargelegt. Die Ergebnisse der Untersuchungen zur Frage der Anordnung der psychologischen Konstrukte in der sequentiellen Interventionsstudie bestätigen zum Teil die theoretische Annahme, dass ein Motivationsprozess (Intentionsbildung) dem Prozess der Selbstregulation vorangeht (Schwarzer, 2008). Es konnte gezeigt werden, dass selbstregulative Strategien (d.h., Selbstwirksamkeitserwartung, Planung und Handlungskontrolle) motivationalen Komponenten (Risikowahrnehmung, Handlungsergebniserwartung und Intention) überlegen waren. Mit Bezug auf die CCSI hat die Studie bestätigt, dass die Nutzung von Zahnseide gesteigert sowie das Risiko für weitere Zahnerkrankungen erfolgreich reduziert werden kann, wenn in der Kurzintervention psychologische Komponenten mit finanziellen kombiniert werden. In Kapitel 2 und 5 werden mit Hilfe sequentieller Mediationsanalysen die Wirkmechanismen zwischen Intention und Selbstwirksamkeit der Intervention erklärt. In der vorliegenden Studie wurden theoriegeleitet innovative Interventionsdesigns eingeführt und empirisch überprüft. Die Ergebnisse dieser Arbeit können zur Weiterentwicklung theorie- und evidenzbasierter Maßnahmen zur Förderung des Obst- und Gemüsekonsum, der Zahnhygiene und der Handhygiene helfen. Das unterstreicht, dass das HAPA Modell eine gute Basis für gesundheitsbezogene Interventionen in der Zukunft darstellt

Evaluating brief motivational and self-regulatory hand hygiene interventions: A cross-over longitudinal design

Background: Frequent handwashing can prevent infections, but non-compliance to hand hygiene is pervasive. Few theory- and evidence-based interventions to improve regular handwashing are available. Therefore, two intervention modules, a motivational and a self-regulatory one, were designed and evaluated. Methods: In a longitudinal study, 205 young adults, aged 18 to 26 years, were randomized into two intervention groups. The Mot-SelfR group received first a motivational intervention (Mot; risk perception and outcome expectancies) followed by a self-regulatory intervention (SelfR; perceived self-efficacy and planning) 17 days later. The SelfR-Mot group received the same two intervention modules in the opposite order. Follow-up data were assessed 17 and 34 days after the baseline. Results: Both intervention sequences led to an increase in handwashing frequency, intention, self-efficacy, and planning. Also, overall gains were found for the self-regulatory module (increased planning and self-efficacy levels) and the motivational module (intention). Within groups, the self-regulatory module appeared to be more effective than the motivational module, independent of sequence. Conclusions: Self-regulatory interventions can help individuals to exhibit more handwashing. Sequencing may be important as a motivation module (Mot) first helps to set the goal and a self-regulatory module (SelfR) then helps to translate this goal into actual behavior, but further research is needed to evaluate mechanisms

Combining self-management cues with incentives to promote interdental cleaning among Indian periodontal disease outpatients

Background: Periodontal disease is a significant public health issue worldwide. Motivational techniques in combination with financial incentives are shown to lead to effective behavior change. The current study sought to examine whether a brief oral health promotion program (self-management cues that were based on self-efficacy and self-regulatory skills) in combination with an incentive (free dental treatment) would make a difference in the adoption of regular dental flossing in a population of Indian periodontal disease outpatients. Methods: One hundred and twelve participants (n = 55 oral health promotion intervention group; n = 57 control group) were assigned to the intervention (self-management cues + incentive) or control groups, and follow-up assessments were performed three weeks later. Flossing frequency, behavioral intentions, and perceived self-efficacy served as dependent variables. Data were analyzed with mixed models, ANCOVAs, and path analyses. Results: The intervention yielded effects on flossing frequency (p 0.01) at follow-up. Women developed stronger intentions than men. Moreover, by path analysis a sequential mediation chain was found that demonstrated an indirect effect of the intervention on flossing via self-efficacy and intentions: the intervention predicted changes in self-efficacy which, in turn, were associated with changes in intentions, predicting flossing frequency at follow up, while controlling for baseline behavior, gender, and age. Conclusions: Combining incentives with minimal self-management cues has been found effective in improving interdental cleaning intentions and habits in periodontal disease patients, and the facilitating role of dental self-efficacy has been demonstrated