In this article we reply to the issues raised by the three commentaries on Ferguson's (2012) article. Watson argues that the four traits identified by Ferguson (2012) - health anxiety, alexithymia, empathy and Type D - do not lie outside the Five Factor Model (FFM). We present factor analytic data showing that health anxiety forms a separate factor from positive and negative affectivity, alexithymia forms a factor outside the FFM and while emotional empathy loads with agreeableness, cognitive empathy forms a separate factor outside the FFM. Across these analyses there was no evidence for a general factor of personality. We also show that health anxiety, empathic facets and alexithymia show incremental validity over FFM traits. However, the evidence that Type D lies outside the FFM is less clear. Matthews (2012) argues that traits have a more distributed influence on cognitions and that attention is not part of Ferguson's framework. We agree; but Ferguson's original statement concerned where traits have their maximal effect. Finally, Haslam et al. suggest that traits should be viewed from a dynamic interactionist perspective. This is in fact what Ferguson (2012) suggested and we go on to highlight that traits can also influence group processes.
Content, delivery and effects of physical activity (PA) interventions are heterogeneous. There is a need to identify intervention features (content and delivery) related to long-term effectiveness. Behaviour change techniques (BCTs) and modes of intervention delivery were coded in 19 randomised controlled trials included in a systematic review of PA interventions for adults aged 55-70 years, published between 2000 and 2010, with PA outcomes ≥12 months after randomisation; protocol registration: PROSPERO CRD42011001459. Meta-analysis, moderator analyses and meta-regression were conducted. Meta-analysis revealed that interventions were effective in promoting PA compared with no/minimal intervention comparators (d=0.29, 95% CI=0.19 to 0.40, I(2)=79.8%, Q-value=89.16 (df=18, p<0.01)). Intervention features often concurred and goal setting was the most commonly used BCT. Subgroup analyses suggested that interventions using the BCT feedback may be more effective, whilst interventions using printed materials or the BCTs information on where and when to perform the behaviour and information on consequences of behaviour to the individual may be less effective. Meta-regression revealed that neither the number of BCTs nor self-regulatory BCTs significantly related to effect size. Feedback appears to be a potentially effective candidate BCT for future interventions promoting long-term PA. Considering concurrence of intervention features alongside moderator analyses is important.
Objective: This systematic review aims to synthesize evidence on predictors of internalised HIV stigma amongst people living with HIV in Sub-Saharan Africa. Method: PRISMA guidelines were used. Studies were identified through electronic databases, grey literature, reference harvesting and contacts with key researchers. Quality of findings was assessed through an adapted version of the Cambridge Quality Checklists. Results: A total of 590 potentially relevant titles were identified. Seventeen peer-reviewed articles and one draft book chapter were included. Studies investigated socio-demographic, HIV-related, intra-personal and inter-personal correlates of internalised stigma. Eleven articles used cross-sectional data, six articles used prospective cohort data and one used both prospective cohort and cross-sectional data to assess correlates of internalised stigma. Poor HIV-related health weakly predicted increases in internalized HIV stigma in three longitudinal studies. Lower depression scores and improvements in overall mental health predicted reductions in internalized HIV stigma in two longitudinal studies, with moderate and weak effects respectively. No other consistent predictors were found. Conclusion: Studies utilizing analysis of change and accounting for confounding factors are necessary to guide policy and programming but are scarce. High-risk populations, other stigma markers that might layer upon internalised stigma, and structural drivers of internalised stigma need to be examined.
Despite decades of research, consensus regarding the dynamics of fear appeals remains elusive. A meta-analysis was conducted that was designed to resolve this controversy. Publications that were included in previous meta-analyses were re-analysed, and a number of additional publications were located. The inclusion criteria were full factorial orthogonal manipulations of threat and efficacy, and measurement of behaviour as an outcome. Fixed and random effects models were used to compute mean effect size estimates. Meta-analysis of the six studies that satisfied the inclusion criteria clearly showed a significant interaction between threat and efficacy, such that threat only had an effect under high efficacy (d = 0.31), and efficacy only had an effect under high threat (d = 0.71). Inconsistency in results regarding the effectiveness of threatening communication can likely be attributed to flawed methodology. Proper tests of fear appeal theory yielded the theoretically hypothesised interaction effect. Threatening communication should exclusively be used when pilot studies indicate that an intervention successfully enhances efficacy.
Healthy behaviour, such as smoking cessation and adherence to prescribed medications, mitigates illness risk factors but health behaviour change can be challenging. Mobile phone short-message service (SMS) messages are increasingly used to deliver interventions designed to enhance healthy behaviour. This meta-analysis used a random-effects model to synthesise 38 randomised controlled trials that investigated the efficacy of SMS messages to enhance healthy behaviour. Participants (N = 19641) lived in developed and developing countries and were diverse with respect to age, ethnicity, socio-economic background, and health behaviours targeted for change. SMS messages had a small, positive, significant effect (g = 0.291) on a broad range of healthy behaviour. This effect was maximised when multiple SMS messages per day were used (g = 0.395) compared to using lower frequencies (daily, multiple per week, and once-off) (g = 0.244). The low heterogeneity in this meta-analysis (I(2) = 38.619) supports reporting a summary effect size, and implies that the effect of SMS messaging is robust, regardless of population characteristics or healthy behaviour targeted. SMS messaging is a simple, cost effective intervention that can be automated and can reach any mobile phone owner. While the effect size is small, potential health benefits are well worth achieving.
BACKGROUND: Both during and after treatment, cancer survivors experience declines in physical and psychosocial quality of life (QoL). Prior research indicates that exercise interventions alleviate problems in physical functioning and some aspects of psychological functioning. For survivors seeking social support, exercise programs that are conducted in group settings may foster optimal QoL improvement (by addressing additional issues related to isolation, social support) over individually-based exercise programs. METHODS: We reviewed literature on group cohesion in exercise studies, and conducted a meta-analysis to test the hypothesis that group as compared to individual exercise interventions for breast cancer survivors would show greater improvement in QoL. RESULTS: As currently implemented, group exercise interventions showed no advantage. However, they typically did not provide any evidence that they capitalized upon potentially beneficial group processes. CONCLUSIONS: Future exercise intervention studies could investigate the effect on QoL of deliberately using group dynamics processes, such as team building experiences and group goal setting to foster group cohesion.
This paper sets out the case that personality traits are central to health psychology. To achieve this, three aims need to be addressed. First, it is necessary to show that personality influences a broad range of health outcomes and mechanisms. Second, the simple descriptive account of Aim 1 is not sufficient, and a theoretical specification needs to be developed to explain the personality health
link and allow for future hypothesis generation. Third, once Aims 1 and 2 are met, it is necessary to demonstrate the clinical utility of personality. In this review I make the case that all three Aims are met. I develop a theoretical framework to understand the links between personality and health drawing on current theorising in the biology, evolution, and neuroscience of personality. I identify traits (i.e., alexithymia, Type D, hypochondriasis, and empathy) that are of particular concern to health psychology and set these with in evolutionary cost benefit analysis. The literature is reviewed within a three-level hierarchical model
(individual, group, and organisational) and it is argued that health psychology needs to move from its traditional focus on the individual level to engage group and organisational levels.
Financial incentives to improve health have received increasing attention, but are subject to ethical concerns. Monetary Contingency Contracts (MCCs), which require individuals to deposit money that is refunded contingent on reaching a goal, are a potential alternative strategy. This review evaluates systematically the evidence for weight loss-related MCCs. Randomized controlled trials testing the effect of weight loss-related MCCs were identified in online databases. Random effects meta-analyses were used to calculate overall effect sizes for weight loss and participant retention. The association between MCC characteristics and weight loss/participant retention effects were calculated using meta-regression. There was a significant small-to-medium effect of MCCs on weight loss during treatment when one outlier study was removed. Group refunds, deposit not paid as lump sum, participant setting own deposit size, and additional behaviour change techniques were associated with greater weight loss during treatment. Post-treatment, there was no significant effect of MCCs on weight loss. There was a significant small-to-medium effect of MCCs on participant retention during treatment. Researcher-set deposits paid as one lump sum, refunds delivered on an all-or-nothing basis and refunds contingent on attendance at classes were associated with greater retention during treatment. Post treatment, there was no significant effect of MCCs on participant retention. The results support the use of MCCs to promote weight loss and participant retention up to the point that the incentive is removed, and identifies the conditions under which MCCs work best.
Extensive evidence documents that prenatal maternal stress predicts a variety of adverse physical and psychological health outcomes for the mother and baby. However, the importance of the ways that women cope with stress during pregnancy is less clear. We conducted a systematic review of the English-language literature on coping behaviors and coping styles in pregnancy using PsycInfo and PubMed to identify 45 cross-sectional and longitudinal studies involving 16,060 participants published between January 1990 and June 2012. Although results were often inconsistent across studies, the literature provides some evidence that avoidant coping behaviors or styles and poor coping skills in general are associated with postpartum depression, preterm birth, and infant development. Variability in study methods including differences in sample characteristics, timing of assessments, outcome variables, and measures of coping styles or behaviors may explain the lack of consistent associations. In order to advance the scientific study of coping in pregnancy, we call attention to the need for a priori hypotheses and greater use of pregnancy-specific, daily process, and skills-based approaches. There is promise in continuing this area of research, particularly in the possible translation of consistent findings to effective interventions, but only if the conceptual basis and methodological quality of research improve.
Although research has consistently established that depression and elevated depressive symptoms are associated with an increased risk of acute coronary syndrome (ACS) recurrence and mortality, clinical trials have failed to show that conventional depression interventions offset this risk. As depression is a complex and heterogeneous syndrome, we believe that using simpler, or intermediary, phenotypes rather than one complex phenotype may allow better identification of those at particular risk of ACS recurrence and mortality and may contribute to the development of specific depression treatments that would improve medical outcomes. Although there are many possible intermediary phenotypes, specifiers, and dimensions of depression, we will focus on only two when considering the relation between depression and risk of ACS recurrence and mortality: Inflammation-Induced Incident Depression and Anhedonic Depression. Future research on intermediary phenotypes of depression is needed to clarify which are associated with the greatest risk for ACS recurrence and mortality and which, if any, are benign. Theoretical advances in depression phenotyping may also help elucidate the behavioral and biological mechanisms underlying the increased risk of ACS among patients with specific depression phenotypes. Finally, tests of depression interventions may be guided by this new theoretical approach.
Decades of empirical research have demonstrated psychological and behavioural consequences of false-positive medical tests. To organise this literature and offer novel predictions, we propose a model of how false-positive mammography results affect return for subsequent mammography screening. We propose that false-positive mammography results alter how women think about themselves (e.g., increasing their perceived likelihood of getting breast cancer) and the screening test (e.g., believing mammography test results are less accurate). We further hypothesise that thoughts elicited by the false-positive experience will, in turn, affect future use of screening mammography. In addition, we discuss methodological considerations for statistical analyses of these mediational pathways and propose two classes of potential moderators. While our model focuses on mammography screening, it may be applicable to psychological and behavioural responses to other screening tests. The model is especially timely as false-positive medical test results are increasingly common, due to efforts to increase uptake of cancer screening, new technologies that improve existing tests' ability to detect disease at the cost of increased false alarms, and growing numbers of new medical tests.
Yoga is increasingly used in clinical settings for a variety of mental and physical health issues, particularly stress-related illnesses and concerns, and has demonstrated promising efficacy. Yet the ways in which yoga reduces stress remain poorly understood. To examine the empirical evidence regarding the mechanisms through which yoga reduces stress, we conducted a systematic review of the literature, including any yoga intervention that measured stress as a primary dependent variable and tested a mechanism of the relationship with mediation. Our electronic database search yielded 926 abstracts, 71 of which were chosen for further inspection, 5 of which were selected for the final the systematic review. These five studies examined three psychological mechanisms (positive affect, mindfulness, self compassion) and four biological mechanisms (posterior hypothalamus, IL-6, CRP, cortisol). Positive affect, self-compassion, inhibition of the posterior hypothalamus, and salivary cortisol were all shown to mediate the relationship between yoga and stress. It is striking that the literature describing potential mechanisms is growing rapidly, yet only seven mechanisms have been empirically examined; more research is necessary. Also, future research ought to include more rigorous methodology, including sufficient power, study randomization, and appropriate control groups.
This theoretical paper reviews an emerging literature which attempts to bring together an important area of social psychology and neuropsychology. The paper presents a rationale for the integration of the social identity and clinical neuropsychological approaches in the study of acquired brain injury (ABI). The paper begins by reviewing the social and neuropsychological perspectives of ABI. Subsequently, theoretical and empirical studies that demonstrate the social influences on neuropsychology and the inherently social nature of mind are considered. Neuropsychological understandings of social identities and their potential relationships to the variability in ABIs are also discussed. The values of these understandings to ABI rehabilitation are then examined. The paper concludes by suggesting an agenda for future research that integrates the social identity and neuropsychological paradigms so that psychology might grow in its store of applicable knowledge to enhance support and rehabilitation for those with ABI.
Interventions to change health-related behaviours typically have modest effects and may be more effective if grounded in appropriate theory. Most theories applied to public health interventions tend to emphasise individual capabilities and motivation, with limited reference to context and social factors. Intervention effectiveness may be increased by drawing on a wider range of theories incorporating social, cultural and economic factors that influence behaviour. The primary aim of this paper is to identify theories of behaviour and behaviour change of potential relevance to public health interventions across four scientific disciplines: psychology, sociology, anthropology and economics. We report in detail the methodology of our scoping review used to identify these theories including which involved a systematic search of electronic databases, consultation with a multidisciplinary advisory group, web searching, searching of reference lists and hand searching of key behavioural science journals. Of secondary interest we developed a list of agreed criteria for judging the quality of the theories. We identified 82 theories and 9 criteria for assessing theory quality. The potential relevance of this wide-ranging number of theories to public health interventions and the ease and usefulness of evaluating the theories in terms of the quality criteria are however yet to be determined.
This paper explores the question: what are barriers to health behaviour theory development and modification, and what potential solutions can be proposed? Using the reasoned action approach (RAA) as a case study, four areas of theory development were examined: (1) the theoretical domain of a theory; (2) tension between generalisability and utility, (3) criteria for adding/removing variables in a theory, and (4) organisational tracking of theoretical developments and formal changes to theory. Based on a discussion of these four issues, recommendations for theory development are presented, including: (1) the theoretical domain for theories such as RAA should be clarified; (2) when there is tension between generalisability and utility, utility should be given preference given the applied nature of the health behaviour field; (3) variables should be formally removed/amended/added to a theory based on their performance across multiple studies and (4) organisations and researchers with a stake in particular health areas may be best suited for tracking the literature on behaviour-specific theories and making refinements to theory, based on a consensus approach. Overall, enhancing research in this area can provide important insights for more accurately understanding health behaviours and thus producing work that leads to more effective health behaviour change interventions.
The International Classification of Functioning Disability and Health (ICF) offers an agreed language on which a scientific model of functional outcomes can be built. The ICF defines functional outcomes as activity and activity limitations (AL) and defines both in behavioural terms. The ICF, therefore, appears to invite explanations of AL as behaviours. Studies of AL find that psychological variables, especially perceptions of control, add to biomedical variables in predicting AL. Therefore, two improved models are proposed, which integrate the ICF with two psychological theories, the theory of planned behaviour (TPB) and social cognitive theory (SCT). These models have a sound evidence base as good predictors of behaviour, include perceived control constructs and are compatible with existing evidence about AL. When directly tested in studies of community and clinic-based populations, both integrated models (ICF/TPB and ICF/SCT) outperform each of the three basic models (ICF, TPB and SCT). However, when predicting activity rather than AL, the biomedical model of the ICF does not improve prediction of activity by TPB and SCT on their own. It is concluded that these models offer a better explanation of functional outcomes than the ICF alone and could form the basis for the development of improved models.
Perceptions of risk for health outcomes are integral to many theories of health behaviour, and are often targeted in interventions. Evidence suggests that affective responses to risk, including worry, are empirically distinguishable from commonly used perceived risk measures such as perceived susceptibility. The aims of this meta-analysis were to (1) examine if perceived susceptibility and worry can be independently influenced, and what manipulation types are most effective at changing each construct and (2) examine the efficacy of interventions to change worry and perceived susceptibility. Thirty-eight studies using 43 separate samples provided 78 independent comparisons that were meta-analysed using the inverse variance method with random-effects modelling. The overall effect size (d) was 0.50, 95% CI [0.362, 0.632] for perceived susceptibility; and 0.25, 95% CI [0.148, 0.349] for worry. Effect sizes for perceived susceptibility were significantly related to those for worry, B=0.495, p < 0.001. Moderators of these effects are discussed. The present meta-analysis provides further evidence that perceived susceptibility and worry are distinguishable but related constructs, and that it is possible to perturb one and not the other.
This study aimed to quantify correlations between Theory of Planned Behaviour (TPB) variables and (i) intentions to consume alcohol and (ii) alcohol consumption. Systematic literature searches identified 40 eligible studies that were meta-analysed. Three moderator analyses were conducted: pattern of consumption, gender of participants, and age of participants. Across studies, intentions had the strongest relationship with attitudes (r+ = .62), followed by subjective norms (r+ = .47) and perceived behavioural control (PBC; r+ = .31). Self-efficacy (SE) had a stronger relationship with intentions (r+ = .48) compared with perceived control (PC; r+ = -.10). Intention had the strongest relationship with alcohol consumption (r+ = .54), followed by SE (r+ = .41). In contrast, PBC and PC had negative relationships with alcohol consumption (r+ = -.05 and -.13, respectively). All moderators affected TPB relationships. Patterns of consumption with clear definitions had stronger TPB relations, females reported stronger attitude-intention relations than males, and adults reported stronger attitude-intention and SE-intention relations than adolescents. Recommendations for future research include targeting attitudes and intentions in interventions to reduce alcohol consumption, using clear definitions of alcohol consumption in TPB items to improve prediction, and assessing SE when investigating risk behaviours.
The aim of this study was to review published studies on the cultural aspects of screening and care of Arab cancer patients living in Israel. The literature published from the beginning of recording, available up to December 2012, was systematically reviewed. Fifteen studies on perceptions of cancer screening and five studies on different aspects of coping with cancer were identified. Non-attendance of screening for early detection of breast or colorectal cancer was reported to be associated with higher personal barriers (the health belief model) and higher cultural and social barriers. Perceptions of cancer risk, causes, outcomes and personal responsibility were widespread from traditional to more modern biomedical views, and sometimes integrated. Among breast cancer patients, effects of a collective and family centred way of life and strong support by one's spouse were evident, followed by a change towards closer spousal relations. Religious coping strategies were the most prevalent among breast cancer patients and were related to better well-being. An integration of traditional and modern perceptions of cancer, attitudes towards screening and coping with cancer were evident. More research is needed in order to advance a culturally competent care of cancer patients and of interventions that encourage screening for the early detection of cancer.
Researchers in the field of health psychology have increasingly been involved in translating a body of knowledge about psychological factors associated with health-relevant behaviours, into the development and evaluation of interventions that seek to apply that knowledge. In this paper we argue that a changing economic and political climate, and the strong behavioural contribution to disease morbidity and mortality in developed nations, requires health psychologists to plan more rigorously for, and communicate more effectively, about how health promotion, social cognition and behaviour change interventions will have impact and be increasingly embedded into health services or health promotion activity. We explain academic and wider socio-economic uses of 'impact' in health services research. We describe the relationship between impact and dissemination, and impact as distinct from, but often used interchangeably with the terms 'implementation', 'knowledge transfer' and 'knowledge translation' (KT). The evidence for establishing impact is emergent. We therefore draw on a number of impact planning and KT frameworks, with reference to two self- management interventions, to describe a framework that we hope will support health psychologists in embedding impact planning and execution in research. We illustrate this further in an on-line annexe with reference to one of our own interventions, Mums-and-MS (see Supplemental Material).
Physical activity (PA) can have a positive impact upon health and well-being for people with spinal cord injury (SCI). Despite these benefits, people with SCI are within the most physically inactive segment of society that comprises disabled people. This original meta-synthesis of qualitative research was undertaken to explore the barriers, benefits and facilitators of leisure time physical activity (LTPA) among people with SCI. Articles published since 2000 were identified through a rigorous search of electronic databases, supported with a hand search of relevant journals and papers. In total, 64 papers were read in full, and based on inclusion criteria, 18 were relevant for review. The key themes constructed from the data were summarised, compared and synthesised. Eight interrelated concepts were identified as barriers, benefits and/or facilitators of LTPA: (i) well-being (WB); (ii) environment; (iii) physical body; (iv) body-self relationship; (v) physically active identity; (vi) knowledge; (vii) restitution narrative; (viii) perceived absences. Based on the synthesised evidence, healthcare professionals need to appreciate the relationships between the barriers, benefits and facilitators of LTPA in order to successfully promote a physically active lifestyle. Equally, a more critical attitude to PA promotion is called for in terms of possible adverse consequences.
Previous research suggests that patients with type 2 diabetes quickly adjust to their diagnosis, but most studies tend to focus on emotional outcomes. This systematic review also examines patients’ cognitive and behavioural responses in the first year after diagnosis, based on empirical studies published between 1993 and 2008. A total of 24 studies are presented in order from most to least rigorous design. A further distinction is made between being diagnosed in the context of a screening programme and other forms of diagnoses. This review confirms that the diagnosis of type 2 diabetes has limited long-term emotional impact, if at all, regardless of how patients are detected. Examination of cognitive and behavioural responses indicate that most patients underestimate the seriousness of their diabetes, overestimate their ability to control it and show limited engagement in the management of their disease. The results also indicate considerable variations in adjustment to the illness. These are related to symptom experience, prior knowledge, and information provision and treatment. Overall, this review shows that a lack of emotional distress does not necessarily indicate a successful adjustment but may instead reflect patients’ tendency to avoid dealing with and managing their diabetes until the first signs and symptoms appear, potentially undermining the effectiveness of early detection and treatment.
Financial incentive interventions are increasingly used as a method of encouraging healthy behaviours, from attending for vaccinations to taking part in regular physical activity. There is a growing body of research on the effectiveness of financial incentive interventions for health behaviours. Wide variations in the nature of these interventions make it difficult to draw firm conclusions about what makes an effective incentive, for whom and under what circumstances. Whilst there has been some recognition of the theoretical complexity of financial incentive interventions for health behaviours, there is no framework that categorises these interventions. This limits the research community's ability to clearly establish which components of financial incentives interventions are more and less effective, and how these components might interact to enable behavioural change. We propose a framework for describing health-promoting financial incentive interventions. Drawing on our experience of a recently completed systematic review, we identify nine domains that are required to describe any financial incentive intervention designed to help individuals change their health behaviours. These are: direction, form, magnitude, certainty, target, frequency, immediacy, schedule and recipient. Our framework should help researchers and policy-makers identify the most effective incentive configurations for helping individuals adopt healthy behaviours.
Self-efficacy is central to health behaviour theories due to its robust predictive capabilities. In this paper, we present and review evidence for a self-efficacy-as-motivation argument in which standard self-efficacy questionnaires - i.e., ratings of whether participants 'can do' the target behaviour - reflect motivation rather than perceived capability. The potential implication is that associations between self-efficacy ratings (particularly those that employ a 'can do' operationalisation) and health-related behaviours simply indicate that people are likely to do what they are motivated to do. There is some empirical evidence for the self-efficacy-as-motivation argument, with three studies demonstrating causal effects of outcome expectancy on subsequent self-efficacy ratings. Three additional studies show that - consistent with the self-efficacy-as-motivation argument - controlling for motivation by adding the phrase 'if you wanted to' to the end of self-efficacy items decreases associations between self-efficacy ratings and motivation. Likewise, a qualitative study using a thought-listing procedure demonstrates that self-efficacy ratings have motivational antecedents. The available evidence suggests that the self-efficacy-as-motivation argument is viable, although more research is needed. Meanwhile, we recommend that researchers look beyond self-efficacy to identify the many and diverse sources of motivation for health-related behaviours.
This scoping review focused on answering key questions about the focus, quality and generalisability of the quantitative evidence on the determinants of adherence to social distancing measures in research during the first wave of COVID-19. The review included 84 studies. The majority of included studies were conducted in Western Europe and the USA. Many lacked theoretical input, were at risk for bias, and few were experimental in design. The most commonly coded domains of the TDF in the included studies were ‘Environmental Context and Resources’ (388 codes across 76 studies), ‘Beliefs about Consequences’ (34 codes across 21 studies), ‘Emotion’ (28 codes across 12 studies), and ‘Social Influences’ (26 codes across 16 studies). The least frequently coded TDF domains included ‘Optimism’ (not coded), ‘Intentions’ (coded once), ‘Goals’ (2 codes across 2 studies), ‘Reinforcement’ (3 codes across 2 studies), and ‘Behavioural Regulation’ (3 codes across 3 studies). Examining the focus of the included studies identified a lack of studies on potentially important determinants of adherence such as reinforcement, goal setting and self-monitoring. The quality of the included studies was variable and their generalisablity was threatened by their reliance on convenience samples.
Self-regulation is one primary mechanism in interventions for health behaviour change and has been examined in numerous recent meta-analyses, which this meta-review systematically synthesizes. The meta-review protocol was pre-registered in PROSPERO (CRD42017074018): Meta-analyses of any intervention and health behaviour/outcome were eligible if they quantitatively assessed self-regulation and appeared between January 2006 and August 2017. Following a systematic literature search, we identified 12,198 abstracts, and 66 meta-analyses were ultimately eligible; 27% reported a protocol, 11% used GRADE; 58% focused on RCTs. Reviews satisfied only a moderate number of items on the AMSTAR 2 (M = 45.45%, SD = 29.57%). Only 6% of meta-analyses directly examined whether changes in self-regulation predicted behaviour change (i.e., self-efficacy and physical activity, l = 2; frequency of self-monitoring and goal attainment, l = 1; cognitive bias modification and addiction, l = 1). Meta-analyses more routinely assessed self-regulation by comparing the efficacy of intervention components (97%), such as those from behaviour change taxonomies. Meta-analyses that focused on intervention components identified several as successful, including personalized feedback, goal setting, and self-monitoring; however, none were consistently successful in that each worked only for some health behaviours and with particular populations. There was also inconclusive evidence for some components given that they were only examined in low quality reviews. Future reviewers should utilize advanced methods to assess mechanisms, and study authors should report hypothesized mechanisms to facilitate synthesis.
A central tension described in Ogden's (2016) editorial is that between the variability (the "mess") that appears inherent to human behavior - in this case in response to health-related interventions - and the determinacy science seeks. For those studying and modeling human behavior, it is hard not to be dumfounded by its "ill-fitting, multiple-influenced, volatile, situational and porous nature" (p. 318, Rowson, 2015). Yet, individual behavior is far too important an affair today not to be approached scientifically, thus seeking some level of predictability. Ogden's argument is that as this process is advancing, specifically through the effort of systematization illustrated by the work of Michie et al. (e.g., Michie, Atkins, & West, 2014), so is a profession, ultimately an entire field, at risk of perishing. My own view is that, as a scientific field, health behavior change is in its early stages and it is far too early for major paradigm shifts. Instead, I foresee a future where progress in this field will contribute to improve interventions for all but where complexity and insufficient evidence will regularly force interventionists to rely on other sources of information to make decisions. Indeed, this is precisely where I would relocate the central tension of the field: to the fact that while health psychologists are in demand to build interventions that work today, currently these have to be based on rather limited data about what works, why, for whom, and under which circumstances.
Having become an academic 30 years ago due to the love of ideas and debate, and having spent most of those 30 years not doing this, I have welcomed the chance to think again and before I respond want to thank my commentators for engaging in this process so fully! My call to celebrate variability and critique of the Behaviour Change Technique Taxonomy (BCTT) and the Behaviour Change Wheel (BCW)has not gone without criticism and within these commentaries authors have argued for the benefits of systematisation and consensual frameworks (Johnston, 2016), the feasibility of being innovative within a process of description and prescription (Albarracin & Glassman, 2016), the usefulness of coding and mapping (Abraham, 2016; Peters and Kok, 2016), and the absence of any clear alternative approach to improving behaviour change interventions (Teixeira, 2016). Yet across these very disparate viewpoints three tensions within health psychology have been highlighted which I think remain central to the debate about systematisation. In this response I will briefly discuss these tensions and their implications.