Measuring beliefs about gluten free diet adherence in adult coeliac disease using the theory of planned behaviour

The theory of planned behaviour (TPB) was used to elicit the salient beliefs about gluten free diet (GFD) adherence in adults with coeliac disease (CD) and to design a TPB questionnaire to predict adherence levels. This questionnaire was administered to 265 CD participants with adherence and quality of life (QOL) measures, a GFD knowledge test, and self-reported psychiatric history. Regression analyses were used to test the fit of the TPB in predicting adherence, and to determine the nature of the relationships between adherence, QOL, knowledge, and psychiatric history. The TPB combined with self-reported depression and anxiety, and QOL explained significant variance in intention (41.0%) and adherence (33.7%). Poorer dietary adherence and psychiatric history were also associated with lower QOL. Findings suggest that the TPB provides an adequate model for predicting GFD adherence in CD, and the presence of psychiatric conditions represents a potential intervention target to improve adherence and QOL

Using the theory of planned behaviour to measure motivation for recovery in anorexia nervosa

Anorexia nervosa (AN) is a difficult to treat mental illness associated with low motivation for change. Despite criticisms of the transtheoretical stages of change model, both generally and in the eating disorders (EDs), this remains the only model to have been applied to the understanding of motivation to recover from AN. The aim of this pilot study was to determine whether the theory of planned behaviour (TPB) would provide a good fit for understanding and predicting motivation to recover from AN. Two studies were conducted – in the first study eight women who had recovered from chronic AN were interviewed about their experiences of recovery. The interview data were subsequently used to inform the development of a purpose-designed questionnaire to measure the components of the TPB in relation to recovery. In the second study, the resultant measure was administered to 67 females with a current diagnosis of AN, along with measures of eating disorder psychopathology, psychological symptoms, and an existing measure of motivation to recover (based on the transtheoretical model). Data from the interview study confirmed that the TPB is an appropriate model for understanding the factors that influence motivation to recover from AN. The results of the questionnaire study indicated that the pre-intention variables of the TPB accounted for large proportions of variance in the intention to recover (72%), and more specifically the intention to eat normally and gain weight (51%). Perceived behavioural control was the strongest predictor of intention to recover, while attitudes were more important in the prediction of the intention to eat normally/gain weight. The positive results suggest that the TPB is an appropriate model for understanding and predicting motivation in AN. Implications for theory and practice are discussed

Explaining the intention-behaviour gap in gluten free diet adherence: The moderating roles of habit and perceived behavioural control

Adherence to a strict gluten free diet (GFD) is the only treatment for coeliac disease. Nonetheless, many individuals with the disease struggle to achieve and maintain strict adherence. While the theory of planned behaviour is useful for predicting GFD adherence, an intention-behaviour gap remains. The aim of this study was to investigate the roles of habit and perceived behavioural control in moderating the intention-behaviour relationship in GFD adherence. A significant three-way interaction was found such that the association between intention and adherence was dependent on both perceived behavioural control and habit. Implications for both theory and intervention design are discussed

Active behaviour change safety interventions in the construction industry: A systematic review

© 2015 Elsevier Ltd. The aims of this paper were to systematically review the evidence for the effectiveness of active behaviour change safety interventions in the construction industry; and to determine the intervention characteristics most commonly associated with effectiveness in reducing injury rates and improving safety behaviour - intensity/frequency/duration, behaviour change techniques (BCTs) and theory-base. An electronic literature search (June 2014) was conducted to identify eligible interventions: those involving active involvement from workers/management in the construction industry; targeted one/both of the primary outcomes. All intervention designs involving construction workers aged >18 years, published in English and in a peer-reviewed journal were included. Fifteen studies were included, half of which successfully improved injury rates. Longer interventions and those that included active/volitional BCTs (feedback/monitoring rather than instruction/information) were more effective. The methodological quality of the interventions was poor and use of theory was inconsistent and infrequent. Despite some positive results, very few interventions achieved all their aims. More rigorous, theory-driven research is needed to structure intervention efforts and determine the mechanism of action of effective interventions

A Randomized Controlled Trial of an Online Intervention to Improve Gluten-Free Diet Adherence in Celiac Disease

Objectives: To test the effectiveness of an interactive online intervention to improve gluten free diet adherence in adults with celiac disease. Methods: A Randomized controlled trial was conducted. A total of 189 adults with biopsy-confirmed celiac disease were recruited and randomized to receive the intervention (n=101) or to a waitlist control condition (n=88). Post-intervention data was available for 70 intervention and 64 waitlist participants. Three month follow-up data was obtained for 46/50 completers from the intervention group. The primary outcome measure was gluten-free diet adherence. Secondary outcomes were gluten-free diet knowledge, quality of life and psychological symptoms. Results: Results were based on intention-to-treat analyses. The intervention group evidenced significantly improved gluten-free diet adherence, and gluten-free diet knowledge following the treatment period relative to the waitlist control group. The change in knowledge did not contribute to the change in adherence. These improvements were maintained at 3-month’ follow-up. Conclusions: The online program was effective in improving adherence and represents a promising resource for individuals with celiac disease who are struggling to achieve or maintain adequate gluten free diet adherence

Understanding and predicting a complex behaviour using n-of-1 methods : Photoprotection in xeroderma pigmentosum

Acknowledgements: We would like to thank Lesley Foster (research nurse) for all her work in setting up the n-of-1 study with patients; the XP national clinical team (Hiva Fassihi, Tanya Henshaw, Sally Turner, Isabel Garrood, Alan Lehmann) and members of the PPI panel (Cathy Coleman, Ben Fowler, Sandra Webb, Ros Tobin) for input into design of materials. Funding: This research is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (RP-PG- 1212-20009). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS, or the Department of Health.Peer reviewedPostprin

Predicting intention and behaviour following participation in a theory-based intervention to improve gluten free diet adherence in coeliac disease

© 2015 Taylor & Francis. Objective: To determine whether changes in theory of planned behaviour (TPB) constructs could predict intention and gluten-free diet (GFD) adherence following participation in an online theory-based intervention designed to improve adherence in coeliac disease. Design: Theory-based process evaluation of the mechanisms of change over the course of a six-week online intervention. Measures of GFD adherence and TPB variables were administered at baseline and follow-up (immediate post-intervention: n = 74; three-month: n = 68; six-month: n = 65). Hierarchical regression analyses using residualised change scores were conducted at each time point (dependent variables: intention and adherence). Results: Baseline intention and GFD adherence were the strongest predictors of follow-up intention and adherence, respectively. Change in attitude accounted for significant variance in intention. Change in intention accounted for significant variance in GFD adherence immediately post-intervention; by the six-month follow-up change in perceived behavioural control was the stronger predictor. Conclusions: Partial support for the hypotheses suggests that, for certain behaviours, the TPB may be relevant in explaining the mechanism of action responsible for changes in intention and behaviour following participation in a behaviour change intervention. Additional predictive pathways are also likely to exist and, in the area of GFD adherence, may include habit strength and actual behavioural control

Identifying the psychosocial predictors of ultraviolet exposure to the face in patients with xeroderma pigmentosum:A study of the behavioural factors affecting clinical outcomes in this genetic disease

BACKGROUND: For patients with xeroderma pigmentosum (XP), the main means of preventing skin and eye cancers is extreme protection against ultraviolet radiation (UVR), particularly for the face. We have recently developed a methodology for objectively measuring photoprotection behaviour (‘UVR dose to facial skin’) and have found that the degree of photoprotection varies greatly between patients with XP. We have previously identified factors affecting photoprotection behaviour in XP using a subjective measure of photoprotection. Here, we have used this objective methodology to identify the factors which determine photoprotection behaviour in XP. METHODS: We studied 29 psychological, social, demographic and clinical variables in 36 patients with XP. We have previously objectively measured UVR protection (by measuring the dose of UVR reaching the skin of the face over a 3-week period) in these patients. Here, we use linear mixed-effects model analysis to identify the factors which lead to the differences in degree of photoprotection observed in these patients. RESULTS: Psychosocial factors accounted for as much of the interindividual variation in photoprotection behaviour (29%) as demographic and clinical factors (24%). Psychosocial factors significantly associated with worse UVR protection included: automaticity of the behaviours, and a group of beliefs and perceptions about XP and photoprotection known to associate with poor treatment adherence in other diseases. CONCLUSIONS: We have identified factors contributing to poor photoprotection in XP. Identifying these potentially reversible psychosocial features has enabled us to design an intervention to improve photoprotection in patients with XP, aiming to prevent skin and eye cancers in these patients