No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Development and validation of an instrument to measure beliefs in physical activity among (pre)frail older adults: An integration of the Health Belief Model and the Theory of Planned Behavior
Abstract
Objective
To develop and evaluate the psychometric properties of an instrument assessing beliefs in physical activity based on the integration of the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) among (pre)frail older adults.
Methods
A literature review and semi-structured interviews were conducted to generate the initial item pool of the instrument. A rural sample of 611 (pre)frail older adults was enrolled to examine the validity and reliability of the instrument.
Results
The exploratory factor analysis extracted eight factors for this instrument, explaining 71.3% of the variance in beliefs in physical activity. The confirmatory factor analysis confirmed the eight-factor structure. Linear regression models found that the integrated HBM-TPB constructs explained 65.9% of the variance in physical activity intention and 13.6% in physical activity. The Cronbach’s alpha coefficients for the factors ranged from 0.80 to 0.98, and ICCs ranged from 0.71 to 0.85.
Conclusion
This instrument has satisfactory construct validity, predictive validity, internal consistency reliability and test-retest reliability, and it can be used in (pre)frail older adults to measure beliefs in physical activity.
Practice implications
This instrument may help health care providers understand beliefs in physical activity and facilitate targeted interventions among (pre)frail older adults.
... Lots of studies included additional variables to the TPB to better understand older adults' behaviours and to obtain better explanations for intentions or behaviours, such as functional capacity [11], physical condition [14], autonomous motivation [10] and preliminary knowledge [15], and most of them refined the structural framework and increased the predictive power of older adults' intentions or behaviours. However, the TPB has still been criticised for only taking into account planned and intentional factors (ATT, SN and PBC) due to the limitations of the essence of TPB, that is, the ignorance of the influence of unintentional, improvised and unconsidered factors on intentions or behaviours [16]. ...
... Table 2 shows the meaning of each item and the correspondence between the items and the dimension variables. The items originating from the TPB dimension variables were modified based on the study by Frater et al. [13,14,20,28,29]. Compared to the study by Liu et al. we adjusted one item to include "I like walking a lot" in attitudes; added an item to include physicians' expectations of older adults in SN, and added "I have no trouble walking to the nearby wet market" in PBC because wet markets in small towns are one of the daily destinations for older adults. ...
... The results of the path relationship are similar to those of some studies based on the TPB [9,13,28,29,37]. PBC is the strongest predictor of intentions, and it is consistent with the outcome of most studies on physical activity and walking behaviour in older adults [8,9,[11][12][13][14]. ...
Walking prevents disease and keeps older adults healthy. Studying the walking decision factors of ageing people is an imperative step in understanding and promoting their behaviour. The theory of planned behaviour (TPB) and the prototype willingness model (PWM) are two well-known frameworks that deal with reasoned and social reaction processes in decision-making. This paper used these frameworks to examine the motivational mechanisms of walking among older Chinese adults living in small towns and used the structural equation model (SEM) for regression analysis. The analysis was based on 407 questionnaires and compared two models. Model 1 is TPB and model 2 combines TPB with PWM. The results show that behaviour willingness (BW) is significantly correlated with behaviour intention (BI), and model 2 explains a higher proportion of intention variance than model 1. Perceived behavioural control (PBC) is the most significant predictor in the two models, which implies that walking usefulness and walking feasibility are critical to older adults’ willingness to walk and walking program development. Finally, the utility of the integrative model is discussed, in terms of the theoretical contribution to walking among older adults and the applied implications for the promotion of walking.
... Out of the 35 [35,38,40,42,47,49], four reported content validity [41,42,48,49], 26 reported construct validity [3, [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]53,54,56,58,60,71], and 10 reported other forms of validity [16,30,40,41,47,51,53,56,61,71]. Twelve articles completed more thorough reliability and validity assessments, meaning they evaluated at least four different clinimetric properties [3, 35,38,[40][41][42][47][48][49]51,56,71]. ...
... Out of the 35 [35,38,40,42,47,49], four reported content validity [41,42,48,49], 26 reported construct validity [3, [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]53,54,56,58,60,71], and 10 reported other forms of validity [16,30,40,41,47,51,53,56,61,71]. Twelve articles completed more thorough reliability and validity assessments, meaning they evaluated at least four different clinimetric properties [3, 35,38,[40][41][42][47][48][49]51,56,71]. ...
... Out of the 35 [35,38,40,42,47,49], four reported content validity [41,42,48,49], 26 reported construct validity [3, [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]53,54,56,58,60,71], and 10 reported other forms of validity [16,30,40,41,47,51,53,56,61,71]. Twelve articles completed more thorough reliability and validity assessments, meaning they evaluated at least four different clinimetric properties [3, 35,38,[40][41][42][47][48][49]51,56,71]. Among the 35 articles, five did not report a reference test [26,34,39,43,58], five used an unvalidated reference question(s) [16,32,40,44,55], 23 used a validated measure of PA levels [3, 16,30,33,[35][36][37][38]41,42,[45][46][47][48][49]53,54,[56][57][58][59][60][61], and 2 used accelerometry data [54,71]. ...
... However, in some studies, this impact is not significant [19]. In addition to subjective norms, researchers have discovered that descriptive norms may influence behavioral intention [21][22][23]. Both kinds of norms have a significant behavioral impact. ...
... Behavioral intention and behavior are significantly impacted by descriptive norms. Many studies have indicated that descriptive norms can influence behavioral intention and behavior [21][22][23], and the results of this study are consistent with these findings. ...
... My friends keep urging me to wear a seat belt when I sit in the back seat. Descriptive norm [21][22][23] My family always wears their seat belts when they sit in the back seat. My friends always wear their seat belts when they sit in the back seat. ...
The risk of injury and death in traffic accidents for passengers in the back and front seats can be reduced by utilizing safety belts. However, passengers use back seatbelts far less frequently than those in the front. More investigation is therefore required into the psychological constructs that affect individuals' attitudes toward using back seat belts. In this study, four models were used to analyze individual intentions and actual back seat belt use: the standard theory of planned behavior (TPB); the standard prototype willingness model (PWM); a model that integrates the TPB and PWM constructs; and a model that integrates the TPB construct, PWM constructs, descriptive norms and perceived law enforcement. The results showed that the standard PWM has much more explanatory power than the standard TPB in explaining the variance in behavioral intention and behavior. Incorporating perceived behavioral control (PBC) into the standard PWM did not improve the model fit considerably, while incorporating descriptive norms and perceived law enforcement moderately improved the model fit. Attitude greatly impacted behavioral intention and the use of back seat belts, followed by perceived law enforcement and descriptive norms, while subjective norms, prototype favorability, prototype similarity and PBC had no significant effect. Keywords: traffic safety behavior; seat belt; back seat; theory of planned behavior; prototype willingness model; perceived law enforcement 962 Electronic Research Archive Volume 31, Issue 2, 961-984.
... Health Belief Model (HBM) and the Theory of Planned Behaviour (TPB) are two commonly used theoretical models to learn about beliefs influencing exercise behaviours, and the integrated HBM and TPB has been proved to more comprehensively elucidate the beliefs related to the initiation and maintenance of exercise behaviours among (pre)frail older adults than does the HBM or TPB alone (Qiao et al., 2021). Hence, we believe that exercise interventions grounded in the integrated HBM and TPB can identify beliefs influencing exercise behaviours in the target population, translate these beliefs into exercise behaviours and ultimately achieve intended outcomes. ...
... To promote adherence to this exercise intervention, strategies are used on basis of the integration of the HBM and the TPB, which has been shown to better elucidate the cognitive underpinnings of exercise behaviours among (pre)frail older adults (Qiao et al., 2021). ...
... Prior finding indicates that exercise interventions among the (pre) frail should prioritize enhancing their control to exercise, educating them coping strategies to overcome potential barriers, shaping their responsibility for and positive attitudes towards exercise and disclosing exercise information of peers and negative consequences of physical inactivity (Qiao et al., 2021). Considering the weakened intention-behaviour relationship among (pre)frail older adults confirmed in prior research, action planning (specific instructions on when, where and how to perform a behaviour) and coping planning (the generation of alternative behaviours to overcome barriers) have been added to bridge the intention-behaviour gap in this study (Qiao et al., 2021;Schwarzer, 2008;Sutton, 2008). ...
Aim
This study is aimed to evaluate the effectiveness of a theory‐driven exercise intervention for Chinese community‐dwelling (pre)frail older adults, and to clarify the underlying mechanisms of the exercise intervention in this population.
Design
A stepped‐wedge cluster‐randomized trial.
Methods
A stepped‐wedge cluster‐randomized trial will be conducted among (pre)frail older adults at six communities in a county of central China. A 12‐week multicomponent exercise intervention based on the integration of the Health Belief Model (HBM) and the Theory of Planned Behaviour (TPB) will be implemented to all participants during the study period. The primary outcomes are frailty, muscle mass, muscle strength and physical performance. Secondary outcomes include beliefs in exercise, exercise behaviours and other physical, mental and social functioning. Assessments will be conducted at baseline and at week 12, 24 and 36. A multilevel regression model will be used to evaluate the effectiveness of exercise interventions. A multilevel mediation model will be used to clarify the underlying mechanisms of this exercise intervention.
Discussion
This study is expected to provide an effective and practical mode for exercise interventions among Chinese community‐dwelling (pre)frail older adults, and contribute to the existing evidence in this field.
Trial registration
Chinese Clinical Trial Registry ChiCTR2100041981.
... TPB and HBM are good theories for predicting consumer preference, and in a specific sense, constructs of HMB are better predictors (Ataei et al., 2021). (Huang et al., 2020;Qiao et al., 2021) the healthy eating intention and behaviour are better explained by combining constructs of TPB and HBM, and perceived susceptibility, perceived severity, and perceived benefit affect the attitude of consumers. Individuals' health concerns affect their preference for well-being food consumption (Apaolaza et al., 2018). ...
... The seven factors were identified: behaviour, cues in action, social influence, perceived benefits, self-efficacy, perceived susceptibility, and readiness to act. These factors are supported by previous studies done on constructs of HBM and TPB together (Huang et al., 2020;Qiao et al., 2021) and HMB only (Champion & Skinner, 2008;Le et al., 2021;Wang et al., 2021) in similar contexts. The results indicate that constructs of HBM play an essential role in determining consumers liking for traditional Indian cooking practices. ...
Food plays a vital role in the growth and development of human beings and helps fight many diseases, shaping consumers' intentions and actual behaviour. Consumers prefer a healthy lifestyle in the current COVID-19 situation, where immunity is one of the most critical factors in fighting the deadly coronavirus. The constructs of the health belief model (HBM) and the theory of planned behaviour (TPB) plays an essential role in shaping consumers' preferences for food. To identify the determinants of consumers' choice for traditional Indian cooking practices, a mixed-method approach was followed in the study. Qualitative research prepared the base for quantitative research. First, an open-ended personal interview of 12 respondents was conducted to develop a questionnaire used for the quantitative survey. Exploratory factor analysis results helped identify the seven factors, i.e., behaviour, cues in action, social influence, perceived benefits, self-efficacy, perceived susceptibility, and readiness, as determinants of consumers' preference for traditional Indian cooking practices.
... For instance, behavioral intention items were developed using stems such as "I expect/I want/I plan/I intend + target behavior", while attitude items employed bipolar adjectives (e.g., useful-useless, pleasant-unpleasant, good-bad) to capture instrumental, experiential, and overall evaluations of the behavior. Guided by these principles, the research team categorized identified references [34,35,[49][50][51][52][53], independently extracted scale items, and resolved discrepancies through three rounds of discussions to develop the item pool. Existing items were adapted, while novel items addressing context-specific gaps were drafted. ...
Prom
The Chinese version of the Adult Sedentary Behavior Reduction Intention Questionnaire, a 16-item self-reported tool based on the Theory of Planned Behavior (TPB), was developed to assess adults’ intentions to reduce sedentary behavior.
Measurement property
Internal consistency is used to measure the reliability of the questionnaire, while content and structural validity are studied to assess its validity.
Design
A mixed-methods exploratory sequential design with two phases.
Sample
Adults aged over 18 years diagnosed with coronary heart disease, with a total daily sedentary time exceeding 6 h, normal cognitive function, and willingness to participate in the study were included.
Methods
The study was conducted in two phases. In Phase 1, an initial item pool was developed through a literature review and refined using two rounds of Delphi expert consultation. Expert positivity, authority levels (Cr), coefficients of variation (CV), and Kendall’s W coefficient were calculated to assess representativeness, credibility, and consensus. A pilot study evaluated face validity and finalized the scale. In Phase 2, a cross-sectional study involving 316 participants was conducted to assess psychometric properties. Reliability was evaluated using Cronbach’s α and split-half reliability, while content validity was assessed using the content validity index (I-CVI). Construct validity was examined through confirmatory factor analysis (CFA).
Results
Phase 1 resulted in a preliminary questionnaire with four dimensions and 16 items. Sixteen experts completed two rounds of Delphi consultation, with high response rates (85% and 94.1%) and authority levels (Cr = 0.88 and 0.91). Consensus was strong (CV = 0.05 ~ 0.23; Kendall’s W = 0.338 and 0.382, p < 0.001). Phase 2 validation showed a Cronbach’s α of 0.967, with individual dimensions ranging from 0.911 to 0.950. I-CVI ranged from 0.813 to 1. The adjusted model indices met the fitting criteria.
Conclusions
The developed questionnaire is a reliable and valid tool for assessing Chinese adults’ intentions to reduce sedentary behavior. Grounded in TPB, it provides a theoretical foundation for future intervention studies aimed at addressing sedentary lifestyles.
... Theoretical frameworks like the Theory of Planned Behavior (TPB) and the Health Belief Model (HBM) are foundational tools for understanding health-related behaviors. Both frameworks have been extensively used to study individuals' decision-making processes, particularly in the context of public health [19][20][21]. The TPB emphasizes three key determinants of behavior: attitudes (personal evaluation of the behavior), subjective norms (perceived social pressure to perform or not perform the behavior), and perceived behavioral control (belief in one's ability to carry out the behavior) [22]. ...
This study examines the factors influencing the behavioral intention and compliance behavior of Transportation Network Vehicle Service (TNVS) drivers during the COVID-19 pandemic. Grounded in the Theory of Planned Behavior (TPB) and the Health Belief Model (HBM), the study integrates psychological, environmental, and organizational factors to explain TNVS drivers’ adherence to safety protocols. Data were collected from 342 TNVS drivers in the National Capital Region (NCR) and CALABARZON through a structured survey. Structural Equation Modeling (SEM) was employed to analyze the relationships among variables and assess the determinants of compliance behavior. The results indicate that attitude toward compliance (β = 0.453, p < 0.001), risk perception (β = 0.289, p = 0.001), availability of personal protective equipment (PPE) (β = 0.341, p < 0.001), passenger compliance (β = 0.293, p = 0.002), company policies (β = 0.336, p = 0.001), and organizational support systems (β = 0.433, p < 0.001) significantly influence behavioral intention. In turn, behavioral intention strongly predicts compliance behavior (β = 0.643, p < 0.001), confirming its mediating role in linking influencing factors to actual adherence. However, stress and fatigue (β = 0.131, p = 0.211), ride conditions (β = 0.198, p = 0.241), and communication and training (β = 0.211, p = 0.058) showed non-significant relationships, suggesting that their direct effects on behavioral intention are limited. The model explains 69.1% of the variance in compliance behavior, demonstrating its robustness. These findings highlight the importance of fostering positive attitudes, ensuring adequate resource availability, and reinforcing organizational support to improve TNVS drivers’ compliance with safety measures. Practical recommendations include implementing educational campaigns, ensuring PPE access, strengthening company policies, and promoting passenger adherence to safety protocols. The study contributes to the broader understanding of health behavior in the ride-hailing sector, offering actionable insights for policymakers, ride-hailing platforms, and public health authorities. Future research should explore additional contextual factors, gender-based differences, and regional variations, as well as assess long-term compliance behaviors beyond the pandemic context.
... Self-efficacy in the HBM and perceived behavioral control in the TPB are almost identical, and some studies have combined these two constructs, see (Qiao et al., 2021;Shukri et al., 2022). In this study, self-efficacy and perceived behavioral control were integrated, and three items were used to assess pedestrians' perceived behavioral control of violating traffic regulations while walking, for example, "Walking through a red light is simple for me if I'm in a rush to cross the street" (1 = "strongly disagree", 5 = "strongly agree"). ...
... There were several theories regarding the relationship between physical activities and health promotion, including health behavior theories [27], theory of planned behavior [28], multi-theory model of health behavior change [29], and health belief model [30]. ...
Background
Despite the existing literature highlights the central roles of sociodemographic factors, fruit & vegetable (F&V) intake, and physical activities for maintaining good health, less is known about the associations in the Chinese context. This study attempted to explore the associations of servings of F&V intake and levels of physical activities with poor self-rated health (SRH) among Chinese older adults.
Methods
Data were drawn from the Study on Global Ageing and Adult Health-China (SAGE-China) issued by the World Health Organization and included 7560 respondents aged ≥60 years in China. After screening out the potential confounding factors, multiple logistic regression models were adopted to explore the associations of sociodemographic factors, servings of F&V intake, and levels of physical activities with poor SRH.
Results
Among the sample, nearly a quarter reported poor health status. There were significant gender differences in the case of servings of F&V intake and levels of physical activities. Logistic regressions indicated that higher fruit intake was associated with lower likelihood of vigorous level of physical activity as compared to zero intake. Likewise, higher vegetable intake (≥10 servings) was associated with a higher likelihood of vigorous & moderate level of physical activity when compared to lower intake (≤ 4 servings). Higher fruit intake was associated with a lower likelihood of poor SRH. Similarly, vegetable intake (5 servings: AOR = 0.69, 95%CI: 0.58–0.83; 6–9 servings: AOR = 0.72, 95%CI: 0.59–0.87) was significantly associated with poor SRH. Additionally, vigorous level of physical activity (AOR = 0.79, 95%CI: 0.65–0.97) and vigorous fitness/leisure (AOR = 0.57, 95%CI: 0.39–0.84) were significantly associated with poor SRH.
Conclusion
This study suggested that older adults with high fruit intake had lower probability of performing vigorous & moderate level of physical activity, while those with high vegetable intake had higher probability of performing vigorous & moderate level of physical activity. Likewise, the older adults with high F&V intake and higher probability of performing vigorous level of physical activity, walk/bike activity, and vigorous/moderate fitness/leisure had less likelihood to face the risk for poor SRH outcomes. The appropriate servings of F&V intake and levels of physical activity should be highlighted.
... Perceived susceptibility explains a person's subjective assessment of vulnerability to a given health problem. Perceived severity explains the subjective assessment of a given health problem's seriousness or gravity and its potential consequences (Imoh, 2008;Mojaye, 2008;Qiao et al., 2021). ...
Social media technologies have become significant sources of public health information, especially in times of infectious disease outbreaks such as COVID-19. Using online survey data collected from social media users in Nigeria, this study investigates the influence of social media exposure for COVID-19 risk information on risk perception and affective responses towards the outbreak of COVID-19. It also explores gender and information sources’ roles in the construction of perceived risk towards the pandemic. Findings showed that social media exposure tends to significantly influence risk perception, fear, and anger towards COVID-19, which varies across gender. However, social media’s COVID-19 information sources are not significant predictors of public risk perception and affective responses towards COVID-19. Therefore, public health stakeholders should ensure correct health information to reduce panic and increase volitional control in public during risky situations.
Introduction
Mild cognitive impairment (MCI) is an intermediate phase between normal cognitive ageing and dementia and poses a serious threat to public health worldwide; however, it might be reversible, representing the best opportunity for secondary prevention against serious cognitive impairment. As a non-pharmacological intervention for those patients, interventions that combine physical exercise and cognitive training, whether delivered simultaneously or sequentially, may have superior effects on various cognitive domains, including global cognition, memory, executive function and attention. The supportive evidence remains incomplete. This study aims to assess the effectiveness of a combined exercise and cognitive intervention in Chinese older adults with mild cognitive impairment (COGITO), empowered by digital therapy and guided by the Health Action Process Model and the Theory of Planned Behaviour (HAPA-TPB theory) in a home-based setting.
Methods and analysis
This study is a randomised controlled, assessor-blinded multi-centre study. Four parallel groups will include a total of 160 patients, receiving either a combined exercise and cognitive intervention, an isolated exercise intervention, an isolated cognitive intervention or only health education. These interventions will be conducted at least twice a week for 50 min each session, over 3 months. All interventions will be delivered at home and remotely monitored through RehabApp and Mini-programme, along with an arm-worn heart rate telemetry device. Specifically, supervisors will receive participants’ real-time training diaries, heart rates or other online monitoring data and then provide weekly telephone calls and monthly home visits to encourage participants to complete their tasks and address any difficulties based on their training information. Eligible participants are community-dwelling patients with no regular exercise habit and diagnosed with MCI. The primary outcome is cognitive function assessed by the Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog) and Community Screening Instrument for Dementia (CSI-D), with baseline and three follow-up assessments. Secondary outcomes include quality of life, physical fitness, sleep quality, intrinsic capacity, frailty, social support, adherence, cost-effectiveness and cost-benefit.
Ethics and dissemination
The study was approved by the Institutional Review Board of Peking University. Research findings will be presented to stakeholders and published in peer-reviewed journals and at provincial, national and international conferences.
Trial registration number
ChiCTR2300073900.
Objectives:
Rear-seat belts have been shown to significantly reduce the severity of road vehicle collisions and fatalities. However, their use by rear-seat passengers is significantly less than that by front-seat passengers. Thus, the psychological factors underlying individuals' decision to wear a seat belt in the rear seat require further investigation.
Methods:
An extended theory of planned behavior (eTPB) was used to examine individuals' behavior of wearing a rear-seat belt. An online survey was conducted and a total of 515 valid questionnaires were collected in China.
Results:
While attitude, descriptive norms, and law enforcement all have a significant effect on individuals' intention to wear a seat belt in the rear, subjective norms and perceived behavioral control do not. Individuals' attitudes toward wearing a seat belt in the rear seat are significantly influenced by law enforcement and behavioral intention, but not by perceived behavioral control. The mediation effect analysis reveals that law enforcement has the greatest overall effect on behavior, followed by attitude and descriptive norms.
Conclusions:
The results of this paper contribute to more effective recommendations to improve the use of rear seat belts and to safeguard rear seat passengers.
Background
Sedentary behavior is gradually becoming the mainstream trend in people’s lifestyles, with a significant increase observed worldwide and across all age groups. The measure of adults’ intention to reduce sedentary behavior provides a significant reference for the intervention strategies. However, the measurement tool is lacking. Given that the Theory of Planned Behavior (TPB) serves as a robust psychosocial theory framework, widely applied in predicting various health behaviors, this study aims to extend this theory into the realm of sedentary behavior by developing and validating a questionnaire to evaluate adult intentions of reducing their sedentary behavior.
Methods
A preliminary item pool for the questionnaire was created through a literature review, followed by two rounds of Delphi expert consultation and a small-sample pilot study, resulting in the initial version of the questionnaire. A total of 316 adults with an average daily sedentary behavior duration of ≥6 hours were involved in the survey to determine its psychometric properties using reliability analysis, content validation, and confirmatory factor analysis.
Results
An initial version of the questionnaire with four dimensions (behavioral intention, subjective norms, attitudes, and perceived behavioral control) and 16 items was obtained. Subsequent psychometric property validation results showed that the overall Cronbach’s α coefficient for the questionnaire was 0.967, with Cronbach’s α coefficients for each dimension ranging from 0.911 to 0.950. The item-level content validity index (I-CVI) ranged from 0.813 to 1. The adjusted model indices were c²/df = 2.931, GFI = 0.906, AGFI = 0.857, IFI = 0.976, NFI = 0.965, TLI = 0.968, CFI = 0.976, and RMSEA = 0.078, all of which met the fitting criteria.
Conclusions
A theory-driven instrument is suitable for its use with Chinese adults to assess their level of intentions and the factors affecting the sedentary behavior, which provides the basis for future intervention studies.
In China, bicycles are a popular mode of transportation for senior citizens. A disproportionate number of traffic-related fatalities and injuries involve cyclists. The violation of cycling laws is a significant cause of cyclist crashes. Few studies have analyzed the cycling violation behaviour of seniors. Therefore, it is essential to examine the factors that influence older individuals' intention to engage in cycling violation behaviours. In this study, the effects of social-demographic characteristics, the exogenous constructs in the health belief model (HBM), and the theory of planned behaviour (TPB) on senior cyclists' violation intention were investigated using hierarchical regression analysis. Interviews were conducted with older cyclists in urban areas of Wuhan City, all above 60 years of age. The results showed that very little variance in behavioural intention could be explained by social-demographic factors. The TPB has a significantly greater capacity than the HBM to explain variance in behavioural intention. Perceived susceptibility, perceived benefit, cues to action, subjective norm and attitude significantly impacted behavioural intention, whereas perceived severity, perceived barrier and self-efficacy did not.
Introduction
Walking is a vital part of an older person's daily routine. It is critical to get insight into the determinants of older people's behavioral intention (BI) to walk in the neighborhood to encourage walking among them. However, research on older people's walking habits is lacking, particularly in developing countries like China.
Methods
501 complete responses were collected from a face-to-face survey conducted in Nanjing City. Four models were analyzed and compared in this paper. The theory of planned behavior (TPB) was examined in Model 1. The descriptive norm (DN) was added to the TPB in Model 2. Walking environment components were added to the TPB in Model 3. The TPB was supplemented with DN and walking environment constructs in Model 4.
Results
Model 1 and Model 2 explain 71.3% and 74.9% of the variance in BI, respectively, meaning that the explanatory power increases by 3.6% when DN is taken into account. Model 3 explains 80.2% of the variance in BI, implying that when the walking environment constructs are included, the explanatory power increases by 8.9%. Model 4 has the greatest explanatory power (82.0%) on BI. Attitude (ATT), perceived behavioral control (PBC), and DN have significant associations with older people's BI, whereas subjective norm (SN) does not. In terms of constructs of the walking environment, perceived comfort has a significant association with behavioral intention, but perceived safety does not.
Conclusions
How others act around an individual, other than how they approve of that individual's actions, has a significant impact on older people's walking intentions. PBC is highly correlated with older people's BI. The findings also emphasize the need of improving the walking environment for older individuals.
Objectives
To describe new WHO 2020 guidelines on physical activity and sedentary behaviour.
Methods
The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations.
Results
The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150–300 min of moderate-intensity, or 75–150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold.
Conclusion
These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018–2030 and to strengthen surveillance systems that track progress towards national and global targets.
Aging in humans is highly heterogeneous and its variability increases with increasing age (1). As a consequence, chronological age is of limited utility for diagnosis, prognostication and treatment guidance. In addition, age by itself is of limited use for the assessment of population health, for the evaluation of initiatives designed to promote healthy aging and for health/social care planning. For these purposes, we continue to rely on age augmented by the reporting of disease through the international classification of disease (ICD)(2). However, as societies age around the world, there is a need to improve the ability to evaluate population health including the maintenance of physical and cognitive function from a holistic point of view and this can be done by enhancing ICD reporting.
Background
Overweight and obesity have become a significant public health concern in both developing and developed countries. Due to the health implications of weight-reduction behaviors, it is important to explore the factors that predict their occurrence. Therefore, the present study was performed to examine factors affecting the behavioral intention of weight management as well as assess the predictive power of the Health Belief Model (HBM) for body mass index (BMI).
Methods
This cross-sectional study was conducted among 336 female students recruited from dormitories of Tabriz University of Medical Sciences, using quota sampling technique. Data were collected by a structured questionnaire in seven parts (including perceived severity, perceived susceptibility, perceived benefit, perceived barrier, cue to action, self-efficacy in dieting and physical activity, and behavioral intention of weight management), based on the HBM. Structural equation modeling (SEM) was conducted to identify the relationship between HBM constructs and behavioral intention of weight management. Linear regression model was performed to test the ability of the HBM to predict students’ BMIs.
Results
Higher level of perceived threats (sum of perceived susceptibility and severity) (β = 0.41, P<0.001), perceived benefits (β = 0.19, P = 0.009), self-efficacy in exercise (β = 0.17, P = 0.001), and self-efficacy in dieting (β = 0.16, P = 0.025) scales was significantly related to greater behavioral intention of weight management. Moreover, perceived threat mediated the relationships between perceived cue to action, perceived benefits, self-efficacy in exercise, and weight management practices. The fit indices of the SEM model seemed acceptable. The final regression model explained approximately 40% of variance in BMI (P<0.001). Additionally, perceived severity, barrier, and self-efficacy in dietary life were the significant variables to predict students’ BMIs.
Conclusions
These findings suggest that health education programs based on the HBM needs to be integrated in preventive health programs and health interventions strategies to ensure adherence and well-being of the participants.
Background:
Age-related frailty is a multidimensional dynamic condition associated with adverse patient outcomes and high costs for health systems. Several interventions have been proposed to tackle frailty. This correspondence article describes the journey through the development of evidence- and consensus-based guidelines on interventions aimed at preventing, delaying or reversing frailty in the context of the FOCUS (Frailty Management Optimisation through EIP-AHA Commitments and Utilisation of Stakeholders Input) project (664367-FOCUS-HP-PJ-2014). The rationale, framework, processes and content of the guidelines are described.
Main text:
The guidelines were framed into four questions - one general and three on specific groups of interventions - all including frailty as the primary outcome of interest. Quantitative and qualitative studies and reviews conducted in the context of the FOCUS project represented the evidence base. We followed the GRADE Evidence-to-Decision frameworks based on assessment of whether the problem is a priority, the magnitude of the desirable and undesirable effects, the certainty of the evidence, stakeholders' values, the balance between desirable and undesirable effects, the resource use, and other factors like acceptability and feasibility. Experts in the FOCUS consortium acted as panellists in the consensus process. Overall, we eventually recommended interventions intended to affect frailty as well as its course and related outcomes. Specifically, we recommended (1) physical activity programmes or nutritional interventions or a combination of both; (2) interventions based on tailored care and/or geriatric evaluation and management; and (3) interventions based on cognitive training (alone or in combination with exercise and nutritional supplementation). The panel did not support interventions based on hormone treatments or problem-solving therapy. However, all our recommendations were weak (provisional) due to the limited available evidence and based on heterogeneous studies of limited quality. Furthermore, they are conditional to the consideration of participant-, organisational- and contextual/cultural-related facilitators or barriers. There is insufficient evidence in favour of or against other types of interventions.
Conclusions:
We provided guidelines based on quantitative and qualitative evidence, adopting methodological standards, and integrating relevant stakeholders' inputs and perspectives. We identified the need for further studies of a higher methodological quality to explore interventions with the potential to affect frailty.
Aim:
The objective of this study is to identify the role of factors influencing women's breast cancer screening (BCS) intentions in Changchun city based on the health belief model (HBM) and the theory of planned behavior (TPB).
Methods:
A cross-sectional study of 422 women aged 17-75 years was conducted in Changchun, northern China, in 2018. Data were collected using a questionnaire that included three parts. We used descriptive analysis, correlation analysis and multiple regressions to analyze data in spss version 23.0.
Results:
Career (P = 0.004), clinical examination (P = 0.002), X-ray examination (P = 0.026), screening costs accepted (100-300 RMB) (P = 0.001), perceived behavioral benefit (P = 0.000), self-efficacy (P = 0.000), subjective norms (P = 0.000), behavioral attitudes (P = 0.000) and perceived behavioral control (P = 0.000) had significant associations with BCS intentions. This study tested the applicability of the HBM (adjusted R2 = 4.7%, ΔR2 = 5.6%) and the TPB (adjusted R2 = 8.3%, ΔR2 = 3.8%) in the prediction of BCS intentions. It was found that the predictive power of the integrated model (adjusted R2 = 39%, ΔR2 = 30.8%) is better than that of each of the single models. Therefore, the integrated model has better predictive power.
Conclusion:
An exploration of the factors affecting BCS intentions based on the HBM and the TPB is beneficial for reduced mortality and the development of measures to increase women's BCS awareness, thus providing a basis for future research on the factors affecting BCS intentions.
Objectives: The evidence for Theory of Planned Behavior (TPB) on explaining weight-reduction behaviors (healthy eating [HE] and physical activity [PA]) is inconsistent. Meanwhile, research has acknowledged that the role of weight-related self-stigma may influence HE and PA engagement. We proposed and evaluated an extended TPB model incorporating weight-related self-stigma. Methods: Through convenience sampling, we assessed the TPB factors of university students with overweight (65 men and 39 women). The students completed several questionnaires assessing subjective norms (from normative beliefs), attitudes, perceived behavioral control (from control beliefs), and behavioral intentions (on HE and PA). They also responded to questions regarding their weight-related self-stigma, HE (measured using a questionnaire on maladaptive eating behaviors), and PA. Results: The extended TPB partially explained HE and PA behaviors: weight-related self-stigma was significantly and directly associated with both HE (β = 0.27; p = .001) and PA (β = -0.30; p = .006). Perceived behavioral control was only indirectly associated with PA through intention. Behavioral intention was significantly associated with PA (β = 0.26; p = .044), but not with HE (β = -0.001; p = .99). Conclusions: Our findings partially support the extended TPB; however, our findings should be interpreted with caution because of the poor generalizability caused by our convenience sampling method.
INTRODUCTION
Nowadays with respect to the automation of the lifestyle, immobility statistics in middle-aged women has increased and they are at risk for complications of immobility. One of the models used to identify factors associated with physical activity is Health Belief Model utilized in different age and different cultural backgrounds and different results have been obtained from those studies. The purpose of this study was to investigate the factors affecting on physical activity in middle-aged women using Health Belief Model.
MATERIALS AND METHODS
This descriptive-correlation study was conducted on 224 middle-aged women referring to health centers in Isfahan. Health Belief Model structures including perceived susceptibility and severity, perceived barriers and benefits, and self-efficacy were measured by questionnaire and physical activity was assessed using the international physical activity questionnaire. Collected data were analyzed using descriptive statistics and Pearson correlation coefficient test and regression analysis.
RESULTS
There wasn’t significant correlation between perceived susceptibility (P = 0.263, r = 0.075) and perceived severity with physical activity duration (P = 0.127, r = 0.058) but there was positive and weak correlation between physical activity duration with perceived benefits (P = 0.001 and r = 0.26) and perceived self-efficacy (P = 0.001, r = 0.54) and had weak and inverse correlation with perceived barriers (P = 0.001, r = -0.25). Regression analysis also showed that from among all the Health Belief Model structures just self-efficacy structure has influenced on behavior independently and other structures are affected by it.
CONCLUSION
The obtained results implied on a correlation between benefits, barriers and perceived self-efficacy with and moderate physical activity. Therefore it is necessary to develop appropriate educational programs with emphasis on structures of Health Belief Model that has the maximum impact on physical activity in middle-aged women.
Background
Mexico is one of the countries with the highest rates of overweight and obesity around the world, with 68.8% of men and 73% of women reporting both. This is a public health problem since there are several health related consequences of not exercising, like having cardiovascular diseases or some types of cancers. All of these problems can be prevented by promoting exercise, so it is important to evaluate models of health behaviors to achieve this goal. Among several models the Health Belief Model is one of the most studied models to promote health related behaviors. This study validates the first exercise scale based on the Health Belief Model (HBM) in Mexicans with the objective of studying and analyzing this model in Mexico. Methods
Items for the scale called the Exercise Health Belief Model Scale (EHBMS) were developed by a health research team, then the items were applied to a sample of 746 participants, male and female, from five cities in Mexico. The factor structure of the items was analyzed with an exploratory factor analysis and the internal reliability with Cronbach’s alpha. ResultsThe exploratory factor analysis reported the expected factor structure based in the HBM. The KMO index (0.92) and the Barlett’s sphericity test (p < 0.01) indicated an adequate and normally distributed sample. Items had adequate factor loadings, ranging from 0.31 to 0.92, and the internal consistencies of the factors were also acceptable, with alpha values ranging from 0.67 to 0.91. Conclusions
The EHBMS is a validated scale that can be used to measure exercise based on the HBM in Mexican populations.
Objective
To investigate how attitudes and beliefs about exercise relate to physical activity behavior in older adults with knee pain attributable to osteoarthritis (OA).
Methods
We conducted secondary data analyses of a randomized controlled trial of exercise interventions (ISRCTN: 93634563). Participants were adults ≥45 years old with knee pain attributable to OA (n = 514). Crude and adjusted cross‐sectional and longitudinal associations between baseline Self‐Efficacy for Exercise (SEE), Positive Outcome Expectations for Exercise (POEE), Negative Outcome Expectations for Exercise scores, and physical activity level, at baseline, 3 months, and 6 months (measured by self‐report using the Physical Activity Scale for the Elderly [PASE]), and important increases in physical activity level (from baseline to 6‐month followup) were investigated using multiple linear and logistic regression.
Results
Cross‐sectional associations were found between SEE and PASE scores (β = 4.14 [95% confidence interval (95% CI) 0.26, 8.03]) and POEE and PASE scores (β = 16.71 [95% CI 1.87, 31.55]), adjusted for sociodemographic and clinical covariates. Longitudinal associations were found between baseline SEE and PASE scores at 3 months (β = 4.95 [95% CI 1.02, 8.87]) and 6 months β = 3.71 (0.26, 7.16), and baseline POEE and PASE at 3 months (β = 34.55 [95% CI 20.13, 48.97]) and 6 months (β = 25.74 [95% CI 11.99, 39.49]), adjusted for baseline PASE score and intervention arm. However, no significant associations with important increases in physical activity level were found.
Conclusion
Greater exercise self‐efficacy and more positive exercise outcome expectations were associated with higher current and future physical activity levels. These may be targets for interventions aimed at increasing physical activity.
Background and aimsThis study assessed the association between frailty and sociodemographic, socioeconomic and lifestyle factors in community-dwelling older people. Methods
This was a cross-sectional survey in a population-based sample of 542 community-dwelling subjects aged 65 years and older living in a metropolitan area in Italy. Frailty was evaluated by means of the FRAIL scale proposed by the International Association of Nutrition and Aging. Basal and instrumental activities of daily living (ADL, IADL), physical activity, sociodemographic (age, gender, marital status and cohabitation), socioeconomic (education, economic conditions and occupational status) and lifestyle domains (cultural and technological fruition and social activation) were assessed through specific validated tools. Statistical analysis was performed through multinomial logistic regression. ResultsImpairments in ADL and IADL were significantly associated with frailty, while moderate and high physical activity were inversely associated with frailty. Moreover, regarding both socioeconomic variables and lifestyle factors, more disadvantaged socioeconomic conditions and low levels of cultural fruition were significantly associated with frailty. Conclusions
Socioeconomic and lifestyle factors, particularly cultural fruition, are associated with frailty independently from functional impairment and low physical activity. Cultural habits may therefore represent a new target of multimodal interventions against geriatric frailty.
Disease preventing methods focus mostly on lifestyle factors such as physical activity, healthy diet and not smoking. Previous studies verified using theory and models to change unhealthy behaviors, so that health belief model (HBM) is a useful framework for describing the healthy nutrition behavior.
This study aimed to predict factors related to unhealthy nutrition and inactive life in students of Tehran University, Tehran, Iran based on the Health Belief Model (HBM).
In this cross sectional study, proportional quota sampling from three different educational levels was conducted from October to December 2012. A self-administered validated instrument based on the Health Belief Model (HBM) with 69 items and four sections was used to collect data. In this study through using linear and logistic regression, the effect of body mass index, age, gender, marriage, self-efficacy, cues to action, knowledge, perceived severity, susceptibility, benefits and barriers on nutrition and physical activity behavior were assessed. SPSS version 18 was used to analyze data.
Totally, 368 students including 318 female students (86.4%) and 50 male students (13.6%) with a mean age of 24.9 years (SD = 4.55) took part in the study. Among all independent variables, gender (P < 0.001), knowledge (P = 0.023) and perceived barriers (P = 0.004) predicted nutrition behavior. In case of physical activity, knowledge (P = 0.011), perceived severity (P = 0.009), perceived barriers (P = 0.019) and self-efficacy (P = 0.033) had significance association with physical activity behavior.
This study indicated that health belief model contrasts could predict the risky behavior of university students due to heart disease. However, more researches are needed to verify the predictors of high risky behaviors in students.
To examine the test-retest reliabilities and relative validities of the Chinese version of short International Physical Activity Questionnaire (IPAQ-S-C), the Global Physical Activity Questionnaire (GPAQ-C), and the Total Energy Expenditure Questionnaire (TEEQ-C) in a population-based prospective study, the Taizhou Longitudinal Study (TZLS).
A longitudinal comparative study.
A total of 205 participants (male: 38.54%) aged 30-70 years completed three questionnaires twice (day one and day nine) and physical activity log (PA-log) over seven consecutive days. The test-retest reliabilities were evaluated using intra-class correlation coefficients (ICCs) and the relative validities were estimated by comparing the data from physical activity questionnaires (PAQs) and PA-log.
Good reliabilities were observed between the repeated PAQs. The ICCs ranged from 0.51 to 0.80 for IPAQ-C, 0.67 to 0.85 for GPAQ-C, and 0.74 to 0.94 for TEEQ-C, respectively. Energy expenditure of most PA domains estimated by the three PAQs correlated moderately with the results recorded by PA-log except the walking domain of IPAQ-S-C. The partial correlation coefficients between the PAQs and PA-log ranged from 0.44 to 0.58 for IPAQ-S-C, 0.26 to 0.52 for GPAQ-C, and 0.41 to 0.72 for TEEQ-C, respectively. Bland-Altman plots showed acceptable agreement between the three PAQs and PA-log.
The three PAQs, especially TEEQ-C, were relatively reliable and valid for assessment of physical activity and could be used in TZLS.
Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Research dealing with various aspects of* the theory of planned behavior (Ajzen, 1985,
1987) is reviewed, and some unresolved issues are discussed. In broad terms, the theory is
found to be well supported by empirical evidence. Intentions to perform behaviors of different
kinds can be predicted with high accuracy from attitudes toward the behavior, subjective
norms, and perceived behavioral control; and these intentions, together with perceptions of
behavioral control, account for considerable variance in actual behavior. Attitudes, subjective
norms, and perceived behavioral control are shown to be related to appropriate sets of salient
behavioral, normative, and control beliefs about the behavior, but the exact nature of these
relations is still uncertain. Expectancy value formulations are found to be only partly
successful in dealing with these relations. Optimal rescaling of expectancy and value
measures is offered as a means of dealing with measurement limitations. Finally, inclusion of
past behavior in the prediction equation is shown to provide a means of testing the theory*s
sufficiency, another issue that remains unresolved. The limited available evidence concerning
this question shows that the theory is predicting behavior quite well in comparison to the
ceiling imposed by behavioral reliability.
The health belief model (HBM) is the most commonly used conceptual framework for evaluating osteoporosis health belief and behaviors. The purpose of this study was to develop and evaluate the psychometric properties of a health belief model based questionnaire for exercise behavior for preventing osteoporosis among women aged 30 years and over.
This was a cross sectional study of a convenience sample of women aged 30 years and over in Tehran, Iran using a theory-based instrument (HOPE). The instrument contained 39 items covering issues relate to osteoporosis prevention behavior. In this methodological study, exploratory and confirmatory factor analyses were used for psychometric evaluation. The Cronbach's alpha coefficient and Intraclass Correlation Coefficient (ICC) was used to evaluate the reliability of the scale.
In all 240 women participated in the study. The mean age of participant was 39.2 +/- 7.8 years. The initial analysis extracted nine factors for the questionnaire that jointly accounted for 66.5% of variance observed. Confirmatory factor analysis showed that the data obtained was fit with Health Belief Model (HBM) and self-regulation construct (X2 = 1132.80, df = 629, P < 0.0001, CFI = 0.94, GFI = 0.91, RMSEA = 0.05 and SRMR = 0.06). The Cronbach's alpha coefficient for the subscales ranged from 0.72 to 0.90 and Intraclass Correlation Coefficient (ICC) ranged from 0.71 to 0.98; well above acceptable thresholds.
The HOPE was found to be appropriate instrument for measuring health belief and self-regulation for prevention of osteoporosis.
The Theory of Planned Behavior (TPB) is one of the main theoretical models in the study of the different variables, which influence in the practise of physical activity. The aim in this study was to develop a questionnaire based on TPB in physical activity context providing evidence for the validity of the obtained measures. The instrumental project included three independent studies. The first study entailed the construction and qualitative assessment of the items. In the second study, the analysis of factorial structure was performed by means of exploratory measures, and it showed that the reliability of measures was adequate. The third study provided evidence on the dimensionality of the scale. The confirmatory factorial analysis guaranteed the stability of factorial structure proposed by the TPB and provided evidence for the internal validity of the inventory. Moreover, this study provided evidence of its external validity.
Exploratory factor analysis (EFA) is a complex, multi-step process. The goal of this paper is to collect, in one article, information that will allow researchers and practitioners to understand the various choices available through popular software packages, and to make decisions about "best practices" in exploratory factor analysis. In particular, this paper provides practical information on making decisions regarding (a) extraction, (b) rotation
The seven articles in this issue, and the accompanying meta-analysis in Health Psychology Review [McEachan, R.R.C., Conner, M., Taylor, N., & Lawton, R.J. (2011). Prospective prediction of health-related behaviors with the theory of planned behavior: A meta-analysis. Health Psychology Review, 5, 97-144], illustrate the wide application of the theory of planned behaviour [Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179-211] in the health domain. In this editorial, Ajzen reflects on some of the issues raised by the different authors. Among the topics addressed are the nature of intentions and the limits of predictive validity; rationality, affect and emotions; past behaviour and habit; the prototype/willingness model; and the role of such background factors as the big five personality traits and social comparison tendency.
Regular physical activity is considered a cornerstone for managing type 2 diabetes. However, in Canada, most individuals with type 2 diabetes do not meet national physical activity recommendations. When designing a theory-based intervention, one should first determine the key determinants of physical activity for this population. Unfortunately, there is a lack of information on this aspect among adults with type 2 diabetes. The purpose of this cross-sectional study is to fill this gap using an extended version of Ajzen's Theory of Planned Behavior (TPB) as reference.
A total of 501 individuals with type 2 diabetes residing in the Province of Quebec (Canada) completed the study. Questionnaires were sent and returned by mail.
Multiple hierarchical regression analyses indicated that TPB variables explained 60% of the variance in intention. The addition of other psychosocial variables in the model added 7% of the explained variance. The final model included perceived behavioral control (beta = .38, p < .0001), moral norm (beta = .29, p < .0001), and attitude (beta = .14, p < .01).
The findings suggest that interventions aimed at individuals with type 2 diabetes should ensure that people have the necessary resources to overcome potential obstacles to behavioral performance. Interventions should also favor the development of feelings of personal responsibility to exercise and promote the advantages of exercising for individuals with type 2 diabetes.
This prospective study explored whether extending the Theory of Planned Behaviour (TPB) with additional variables (descriptive norm, moral norm, anticipated affective reaction, self-identity and past behaviour) would account for additional variance in physical activity intentions and behaviour. Four interactions with past behaviour were also investigated. UK college employees participated in this study (n = 200, Time 1; n = 146, Time 2). Moral norm, self-identity and past behaviour each explained additional variance in intentions, over and above the TPB variables. Past behaviour moderated the impact of descriptive norm on intentions. Intentions, self-identity and past behaviour were significant predictors of behaviour, as measured by a self-report physical activity questionnaire. To increase physical activity, interventions might target moral norm and self-identity for physical activity. Focusing on positive descriptive norms might benefit sedentary individuals. The significant role of past behaviour is less useful in directing interventions.
Objective: Examine if family history of cancer serves as a cue to action prompting adults to assess their personal risk of cancer, consider the consequences, and engage in physical activity (PA) if they believe it will reduce their risk.
Design: Cross-sectional survey of adults with and without a close relative with cancer.
Main Outcome Measures: Health Belief Model (HBM) constructs of perceived cancer vulnerability, perceived cancer severity, response effectiveness of PA, self-efficacy for PA, and barriers to PA, and moderate-to-vigorous intensity PA (MVPA).
Results: Perceived barriers and self-efficacy correlated with MVPA in both groups (p < .05), and perceived vulnerability and response effectiveness correlated with MVPA in participants with a close relative with cancer (p < .05). In multiple regression analyses, HBM constructs accounted for 18.5% and 8.3% of the variability in MVPA among participants with and without a close relative with cancer, respectively. Participants with a close relative with cancer had greater perceived vulnerability to cancer compared to participants without a close relative with cancer (p < .001).
Conclusion: Adults with and without a close relative with cancer may be differentially influenced by HBM constructs, and as a result may respond differently to PA interventions and public health messaging.
Purpose:
To examine associations of health belief and health literacy with Pap smear practice among Asian immigrant women in South Korea.
Methods:
This study used a descriptive, cross-sectional study design. A survey was conducted among 196 migrant women who were married to South Korean men, using a questionnaire translated into English, Chinese, Vietnamese, and Korean. Trained research assistants read the questionnaire and the participants gave their answers.
Results:
The most common birthplace of the immigrant women was Vietnam (43.0%), followed by China (12.2%) and the Philippines (5.6%). Of the participants, 76.5% answered that they had never had a Pap smear test. Multiple logistic regression analysis revealed that age and functional health literacy were associated with Pap smear practice among Asian immigrant women. With a one-year increase in participants' age, Pap smear practice increased 1.15 times (OR = 1.15, 95% CI: 1.07, 1.23). Furthermore, with a one point increase in functional health literacy, Pap smear practice increased 1.18 times (OR = 1.18, 95% CI: 1.02, 1.37).
Conclusions:
Results suggest that more information about Pap smear tests should be provided to young immigrant women. Health providers should be made aware that Pap smear practice among young immigrant women might be infrequent and should actively recommend that they receive the tests. To improve Pap smear practice among immigrant women, it is also crucial for educational strategies to include functional health literacy. Nurses could play an important role in explaining and recommending the Pap smear test through communication with immigrant women.
Background:
Chronic pain (CP) is prevalent among older adults in many Western countries and its prevalence, factors, and self-reported or objective measured health impacts have been well documented. However, there is limited information on these aspects among Chinese community-dwelling older adults.
Aims:
Our aim was to assess the prevalence of CP and identify its associated factors as well as health impacts among older adults in China.
Design:
Cross-sectional design.
Settings:
Community settings.
Participants/subjects:
A total of 1219 community-dwelling adults aged 60 years or older.
Methods:
Data on CP, sociodemographic characteristics, comorbidity, cognitive function, and physical activity, as well as self-reported outcomes (functional disability, depression, quality of sleep, and undernutrition) and objective measured physical function, were obtained.
Results:
Among 1,219 participants, 41.1% reported CP, of whom 16.6% experienced moderate to severe pain. The risk of CP was higher among older women with comorbidity and with depression and lower among older adults with higher educational level as well as with adequate physical activity. CP had significant associations with inadequate physical activity, functional disability, depression, poorer quality of sleep, and undernutrition, as well as worsening physical performance, poorer standing balance, and chair stands.
Conclusions:
CP is a common problem among Chinese community-dwelling older adults, particularly among the most vulnerable subgroups, and has substantial impacts on self-reported functional disability, depression, poor quality of sleep, and undernutrition, as well as objective measured physical function. Therefore it is relevant for older adults to develop effective CP management programs.
Guided by the theory of planned behavior (TPB), this study examined the relationships between three constructs of TPB (attitude, subjective norm, perceived behavioral control [PBC]) and physical activity intention and behavior among Chinese female college students, and evaluated whether the relationships differed between healthy and vulnerable individuals within this population. Participants included 436 female college students (301 healthy and 135 vulnerable; Mean age = 19.24 years; SD = 0.97 years) recruited from five universities in China, and the data collection was completed in Fall 2015. Path analysis supported the direct and indirect relations of TPB constructs to physical activity intention and behavior among female college students, and the path model was invariant across the two groups. The vulnerable group reported significantly lower attitude, subjective norm, intention, and physical activity behavior than the healthy group but not for PBC. These findings suggest fostering positive attitudes and intention toward physical activity are important among Chinese female college students, regardless of their health status.
Objectives
To examine the psychometric properties of the Health Belief Model Scale (HBMS) and Theory of Planned Behavior Scale (TPBS), and determine construct validity by evaluating which subscales were most associated with intention to participate in an Exercise-related Injury Prevention Program (ERIPP) within physically active adults.
Design
Cross-sectional.
Methods
Two hundred and eighty-four physically active individuals volunteered to participate in this study and completed the HBMS and TPBS on one occasion. The HBMS consisted of 39 items and the TPBS consisted of 22 items. Both scales aimed to assess attitudes and perceptions of ERIPP participation. Exploratory factor analysis evaluated the loading factors of the HBMS and TPBS. Linear regression determined if the HBMS and TPBS subscales were predictors of intention to participate in an ERIPP.
Results
Nine factors were identified within the HBMS and five factors were identified within the TPBS. The subscales of the HBMS and TPBS had acceptable internal consistencies. Perceived benefits, social norms, and social influence from the TPBS and perceived benefits, individual self-efficacy, and general health cues from the HBMS were positively and significantly associated with intention to participate while perceived barriers had a negative association.
Conclusions
The HBMS and TPBS demonstrated strong psychometric properties to assess behavioral determinants of ERIPP participation within physically active adults. The social influence, social norm, and individual self-efficacy subscales were the best predictors of intention to participate followed by benefits, general health cues, and barriers.
Frailty is a term that presents many difficulties for policy makers and clinicians due to the lack of consensus in defining frailty in a way that meets the needs of older people. A principle-based concept analysis was used to examine the scientific literature across four perspectives: medicine, nursing, social sciences, and occupational and physiotherapy. The purpose was to identify the conceptual components of frailty as revealed by analysis of the literature, and to develop a theoretical definition of frailty. The findings exposed commonalities in implied meanings both within and across perspectives. The strengths of frailty as a concept are revealed in the implications for clinical practice and relevance to health professionals. The limitations reflect a concept that is still evolving and further research is recommended but this should not stop health professionals engaging in this process. The definition developed in this study will enhance existing knowledge and promote a shared understanding to unite different disciplines in recognising frailty as an important concept.
Objective:
To identify Behaviour Change Techniques (BCTs) applied in interventions to enhance physical activity (PA) adherence in patients with chronic musculoskeletal conditions and to investigate the effectiveness of these interventions in increasing PA adherence.
Methods:
A systematic search of seven databases was conducted. We included (cluster/quasi-) randomised controlled trials comparing behaviour change interventions to no/placebo/minimal interventions or usual care and involving at least a three-month post-intervention follow-up. Methodological quality was assessed, study characteristics and BCTs were narratively summarised and a meta-analysis was conducted.
Results:
Across 22 included studies, we coded 8-18 BCTs (mean = 11.2) in intervention and 0-12 (mean = 3.5) in control groups. Common BCTs were "graded tasks", "goal setting", "self-monitoring", "problem solving" and "feedback". Meta-analyses of 17 studies revealed a small medium-term effect (3-6 months post-intervention, standardised mean difference (SMD) = 0.20, 95% CI 0.08-0.33) and no long-term effect (7-12 months post-intervention, SMD = 0.13, 95% CI -0.02 to 0.28). Subgroup analysis yielded a higher effect (SMD = 0.29, 95% CI 0.19-0.40) for interventions using a greater number of BCTs.
Conclusion:
There is moderate quality evidence that interventions using BCTs are effective to enhance medium-term physical activity adherence.
Practice implication:
While superiority of single BCTs was not shown, it is likely that using more BCTs results in better adherence.
Objective:
To cross-culturally adapt and test the FRAIL scale in Chinese community-dwelling older adults.
Design:
Cross-sectional study.
Methods:
The Chinese FRAIL scale was generated by translation and back-translation. An urban sample of 1235 Chinese community-dwelling older adults was enrolled to test its psychometric properties, including convergent validity, criterion validity, known-group divergent validity, internal consistency and test-retest reliability.
Results:
The Chinese FRAIL scale achieved semantic, idiomatic, and experiential equivalence. The convergent validity was confirmed by statistically significant kappa coefficients (0.209-0.401, P < .001) of each item with its corresponding alternative measurement, including the 7th item of the Center for Epidemiologic Studies-Depression Scale, the Timed Up and Go test, 4-m walking speed, polypharmacy, and the Short-Form Mini Nutritional Assessment. Using the Fried frailty phenotype as an external criterion, the Chinese FRAIL scale showed satisfactory diagnostic accuracy for frailty (area under the curve = 0.91). The optimal cut-point for frailty was 2 (sensitivity: 86.96%, specificity: 85.64%). The Chinese FRAIL scale had fair agreement with the Fried frailty phenotype (kappa = 0.274, P < .001), and classified more participants into frailty (17.2%) than the Fried frailty phenotype (3.9%). More frail individuals were recognized by the Chinese FRAIL scale among older and female participants than their counterparts (P < .001), respectively. It had low internal consistency (Kuder-Richardson formula 20 = 0.485) and good test-retest reliability within a 7- to 15-day interval (intraclass correlation coefficient = 0.708).
Conclusions:
The Chinese FRAIL scale presents acceptable validity and reliability and can apply to Chinese community-dwelling older adults.
Frailty is common and associated with poorer outcomes in the elderly, but its role as potential cardiovascular disease (CVD) risk factor requires clarification. We thus aimed to meta-analytically evaluate the evidence of frailty and pre-frailty as risk factors for CVD. Two reviewers selected all studies comparing data about CVD prevalence or incidence rates between frail/pre-frail vs. robust. The association between frailty status and CVD in cross-sectional studies was explored by calculating and pooling crude and adjusted odds ratios (ORs) ±95% confidence intervals (CIs); the data from longitudinal studies were pooled using the adjusted hazard ratios (HRs). Eighteen cohorts with a total of 31,343 participants were meta-analyzed. Using estimates from 10 cross-sectional cohorts, both frailty and pre-frailty were associated with higher odds of CVD than robust participants. Longitudinal data were obtained from 6 prospective cohort studies. After a median follow-up of 4.4 years, we identified an increased risk for faster onset of any-type CVD in the frail (HR = 1.70 [95%CI, 1.18-2.45]; I2 = 66%) and pre-frail (HR = 1.23 [95%CI, 1.07-1.36]; I2 = 67%) vs. robust groups. Similar results were apparent for time to CVD mortality in the frail and pre-frail groups. In conclusion, frailty and pre-frailty constitute addressable and independent risk factors for CVD in older adults.
Physical activity is associated with various health benefits for people with mental illness (PMI). Very few studies to date have examined the factors associated with physical activity among PMI in the Chinese context. The present study examined the factors related to physical activity using the Health Belief Model, and the association between physical activity and perceived health among 443PMIin Hong Kong using stratified sampling. Results from the structural equation modeling showed that among all the factors of the Health Belief Model, self-efficacy was significantly related to higher levels of physical activity while perceived barriers were significantly related to lower levels of physical activity. In addition, physical activity was significantly related to better perceived health and fewer number of health needs. Interventions to promote physical activity among PMI should aim to increase their self-efficacy in initiating and adhering to physical activity, and to remove barriers to physical activity.
There is strong experimental evidence to indicate that regular aerobic exercise can prevent disease, decrease the risk of failing, reduce physical disability, improve sleep, and enhance mood and general well being. Despite these benefits, approximately 50% of sedentary adults who start an exercise program stop them within the first 6 months of involvement. To help older adults initiate and adhere to a regular exercise program, a seven step approach was developed and implemented in a continuing care retirement community (CCRC). The seven steps include: (1) education; (2) exercise pre-screening; (3) setting goals; (4) exposure to exercise; (5) role models; (6) verbal encouragement; and (7) verbal reinforcement/rewards. Following implementation of the seven step approach, 40 (19%) of the 212 residents living in the CCRC exercise regularly.
This article discusses the development of a new model representing the synthesis of two models that are often used to study health behaviors: the Health Belief Model and the Theory of Reasoned Action. The new model was developed as the theoretic framework for an investigation of the factors affecting participation by Mexican migrant workers in tuberculosis screening. Development of the synthesized model evolved from the concern that models used to investigate health-seeking behaviors of mainstream Anglo groups in the United States might not be appropriate for studying migrant workers or persons from other cultural backgrounds.
Analysis on exercise behavior and its influencing factors among patients with hypertension in Beijing by Health belief Model
- Sun
Patterns and determinants of physical activity of elderly people in China
- Yang