Predictors of Long-term Exercise Maintenance among College Aged Adults: Role of Body Image Anxiety

Background and Purpose: Participation in regular exercise is low among young adults and is contributing to a rapid increase in obesity and chronic health conditions. Enhancing motivation is a key element in exercise initiation and maintenance. The current investigation considers factors relevant to the transtheoretical model (TTM), self-determination theory (SDT), self-efficacy (SE), and body image anxiety (BIA) in relation to college students’ motivation to exercise. Design and Main Outcome Measures: In this cross sectional study, lower division college students (N=614, 64% female, 36% male) completed an online survey of exercise behavior, motivation, SE and BIA. Results: BIA was related to both controlled extrinsic (external and introjected regulations) and autonomous extrinsic (integrated regulation) SDT motivational variables, as well as intrinsic motivation. Exercise maintenance was most strongly associated with integrated regulation, a “selfdetermined” motivational state, and SE. Conclusion: The current study provides support for the central tenet of SDT indicating that intrinsic and extrinsic motivation are not mutually exclusive constructs. Helping individuals with BIA develop a more intrinsic approach to exercise is integral for fostering long-term exercise maintenance. Thus, future research should focus on developing interventions that enhance integrated regulation and SE in order to promote exercise maintenance and reduce associated BIA

Disease Prevention without Relapse: Processes of Change for HPV Vaccination

Background: Human papillomavirus is the most prevalent sexually transmitted infection in the United States and is associated with 70% of cervical cancers as well as over 90% of genital warts. Although the HPV vaccine appears in the US immunization schedule during adolescence, a large percentage of women reach adulthood without being vaccinated. The Transtheoretical Model’s (TTM) Processes of Change (POC) construct provides an assessment of participants’ experiences with HPV vaccination and is a central component of computer-tailored interventions designed to increase compliance with medical recommendations, such as vaccination. This study describes development and validation of a POC measure for increasing HPV vaccination among young adult women. Methods: Cross-sectional measurement development was conducted using an online survey to reach a sample of 340 female college students representing vaccinated and unvaccinated women. Factor analytic structural equation modeling as well as evaluations of the stage by POC were used to evaluate the validity of the POC measure. Results: Confirmatory analyses supported the theoretically expected ten-factor, fully correlated model as the best fit for the data. Expected Stage of Change to POC relationships were also confirmed insofar as each POC was significantly associated with Stage of Change, with the exception of dramatic relief. Follow-up analyses suggested that individuals in the Precontemplation stage used all POC less frequently than individuals in all other stages. Conclusions: The POC measure was found to be internally and externally valid in a sample of college-attending women. The POC measure developed may be used to tailor stage-matched interventions that increase use of experiential and behavioral strategies important for increasing HPV vaccination in this high-risk population

Treated individuals who progress to action or maintenance for one behavior are more likely to make similar progress on another behavior: Coaction results of a pooled data analysis of three trials

Objective: This study compared, in treatment and control groups, the phenomena of coaction, which is the probability that taking effective action on one behavior is related to taking effective action on a second behavior. Methods: Pooled data from three randomized trials of Transtheoretical Model (TTM) tailored interventions (n = 9461), completed in the U.S. in 1999, were analyzed to assess coaction in three behavior pairs (diet and sun protection, diet and smoking, and sun protection and smoking). Odds ratios (ORs) compared the likelihood of taking action on a second behavior compared to taking action on only one behavior. Results: Across behavior pairs, at 12 and 24 months, the ORs for the treatment group were greater on an absolute basis than for the control group, with two being significant. The combined ORs at 12 and 24 months, respectively, were 1.63 and 1.85 for treatment and 1.20 and 1.10 for control. Conclusions: The results of this study with addictive, energy balance and appearance-related behaviors were consistent with results found in three studies applying TTM tailoring to energy balance behaviors. Across studies, there was more coaction within the treatment group. Future research should identify predictors of coaction in more multiple behavior change interventions

Self-Efficacy for Adoption and Maintenance of Exercise Among Fibromyalgia Patients: A Pilot Study

Objective. While multimodal treatment approaches for fibromyalgia (FM), incorporating exercise, have been found most effective, information about factors associated with exercise adoption and maintenance is lacking. Design, Setting, and Methods. Women veterans with FM (N = 19) completed an anonymous Internet survey measuring FM impact (FI), adoption of exercise behavior, and self-efficacy for exercise. Using classifications of behavior specified by the transtheoretical model, the self-efficacy of participants classified in the action or maintenance (AM) stages was compared with those in earlier stages (precontemplation through preparation) of exercise readiness. Multivariate analysis of variance analyses examined differences in FI domains by stage of change. Analysis of covariance examined whether exercise self-efficacy differed by stage of change while controlling for FI. Results. Higher levels of self-efficacy were detected among participants in the AM stages. Participants in the AM stages also reported higher levels of FI symptoms. After controlling for FI, self-efficacy did not differ significantly between the 2 groups; however the effect size was large (η2 = .11). Conclusions. Findings of this pilot study suggest a role for self-efficacy in exercise adoption and maintenance, even in the setting of higher FM symptoms. Replication of this study with a larger sample size is warranted

Testing demographic differences for alcohol use initiation among adolescents for the decisional balance and situational temptation prevention inventories

Alcohol use by middle school-aged students is a public health concern because of the numerous adverse social, health and psychological outcomes. Prevention programs attempt to intervene before alcohol use begins. A tailored, computer-delivered program for the prevention of alcohol use and a series of new transtheoretical model measures were developed, including decisional balance (Pros and Cons) of alcohol use and Situational Temptations to Try Alcohol. This study investigated if there were any demographic differences on these measures in a sample of 6th grade middle school students from 20 schools (N = 4151) at baseline. Three factorial analysis of variance tests were conducted to explore the impact of race (whites vs. non-whites), ethnicity (Hispanics vs. Non-Hispanics) and gender (males vs. females). A significant two-way interaction effect was found between gender and ethnicity for Pros of Alcohol Use. A significant three-way interaction effect was found between gender, race and ethnicity for Cons of Alcohol Use. Main effects were found for the three demographic factors for Situational Temptations to Try Alcohol. However, the effect sizes for the interaction effects and main effects were very small (all below η2 = .01), suggesting that race/ethnicity and gender alone may not be highly influential factors in the Decisional Balance for the Prevention of Alcohol and Situational Temptations to Try Alcohol in adolescence. The implications for these results and alcohol use prevention among this group are discussed

Psychometric assessment of the processes of change scale for sun protection

The fourteen-factor Processes of Change Scale for Sun Protection assesses behavioral and experiential strategies that underlie the process of sun protection acquisition and maintenance. Variations of this measure have been used effectively in several randomized sun protection trials, both for evaluation and as a basis for intervention. However, there are no published studies, to date, that evaluate the psychometric properties of the scale. The present study evaluated factorial invariance and scale reliability in a national sample (N = 1360) of adults involved in a Transtheoretical model tailored intervention for exercise and sun protection, at baseline. Invariance testing ranged from least to most restrictive: Configural Invariance (constraints only factor structure and zero loadings); Pattern Identity Invariance (equal factor loadings across target groups); and Strong Factorial Invariance (equal factor loadings and measurement errors). Multi-sample structural equation modeling tested the invariance of the measurement model across seven subgroups: age, education, ethnicity, gender, race, skin tone, and Stage of Change for Sun Protection. Strong factorial invariance was found across all subgroups. Internal consistency coefficient Alpha and factor rho reliability, respectively, were.83 and.80 for behavioral processes,.91 and.89 for experiential processes, and.93 and.91 for the global scale. These results provide strong empirical evidence that the scale is consistent, has internal validity and can be used in research interventions with population-based adult samples

Using Relational Agents to Promote Exercise and Sun Protection: Assessment of Participants’ Experiences With Two Interventions

Background: Relational agents (RAs) are electronic computational figures designed to engage participants in the change process. A recent study, Project RAISE, tested the effectiveness of RAs, combined with existing computer-based interventions to increase regular exercise and sun protection behaviors. Results showed these interventions can be effective but need further development. Objective: The purpose of this study was to examine participants� experiences using RAs to increase participant engagement and promote behavior change . Methods: A qualitative approach was primarily utilized. A 25-question interview guide assessed different components of participants� experiences with the intervention, including motivation, engagement, satisfaction or dissatisfaction, quality of their interaction with the RA, and behavior change. Quantitative assessment of satisfaction was based on a scale of 1 to 10, with 1 representing least satisfied and 10 representing most satisfied. A summative analytic approach was used to assess individuals� qualitative responses. A single analysis of variance (ANOVA) examined levels of satisfaction by gender. Results: Of the original 1354 participants enrolled in Project RAISE, 490 of 1354 (36%) were assigned to the RA group. A sample of 216 out of 490 (44%) participants assigned to the RA group completed the interventions, and follow-up assessments were contacted to participate in the semistructured interview. A total of 34 out of 216 (16%) completed the interview. Participants were motivated by, and satisfied with, the intervention. Participants viewed the RA as supportive, informative, caring, and reported positive behavior change in both exercise and sun protection. Some participants (15/34, 44%) noted the RA was less judgmental and less �overbearing� compared with a human counselor; other participants (12/34, 35%) said that the interaction was sometimes repetitive or overly general. The majority of participants (22/34, 65%) viewed the RA as an important contributor to their behavior change for exercise, sun protection, or both. Levels of satisfaction ranged between 7 and 10. There were no gender differences noted in levels of satisfaction (P=.51). Conclusions: RAs provide an innovative and attractive platform to increase exercise and sun protection behaviors and potentially other health behaviors

"Energy is a Finite Resource": Designing Technology to Support Individuals across Fluctuating Symptoms of Depression

While the HCI field increasingly examines how digital tools can support individuals in managing mental health conditions, it remains unclear how these tools can accommodate these conditions' temporal aspects. Based on weekly interviews with five individuals with depression, conducted over six weeks, this study identifies design opportunities and challenges related to extending technology-based support across fluctuating symptoms. Our findings suggest that participants perceive events and contexts in daily life to have marked impact on their symptoms. Results also illustrate that ebbs and flows in symptoms profoundly affect how individuals practice depression self-management. While digital tools often aim to reach individuals while they feel depressed, we suggest they should also engage individuals when they are less symptomatic, leveraging their energy and motivation to build habits, establish plans and goals, and generate and organize content to prepare for symptom onset