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The Effects of Repeated Exposure to Graphic Fear Appeals on Cigarette Packages: A Field Experiment
Dijkstra, A. ; Bos, C. - \ 2015
Psychology of Addictive Behaviors 29 (2015)1. - ISSN 0893-164X - p. 82 - 90.
public-health campaigns - warning labels - smoking-cessation - disengagement beliefs - behavior-change - smokers - impact - messages - metaanalysis - adolescents
Experimental studies on the effects of graphic fear appeals on cigarette packages typically expose smokers in a single session to a fear appeal, although in practice the exposure is always repeated. The present study applied an improved study design with repeated exposure to fear appeals on cigarette packages. In this field-experiment, 118 smokers were assigned to 1 of 2 conditions with either graphic fear appeals or textual warnings on their cigarette packages. During 3 weeks, fear and disgust were assessed 6 times. The intention to quit smoking after 3 weeks and quitting activity during the 3 weeks were the dependent measures. The effects of 3 pretest individual difference moderators were tested: disengagement beliefs, number of cigarettes smoked a day, and readiness to quit. Three weeks of exposure to the graphic fear appeals led to a stronger intention to quit, but only when smokers scored low on disengagement beliefs, or were heavier smokers. In addition, smokers low in disengagement more often reported to have cut down on smoking in the graphic condition. There were no indications of habituation of fear and disgust over the 3 weeks. The effects of graphic fear appeals depended on smokers' characteristics: The moderators may explain the mixed findings in the literature. The lack of habituation may be caused by the renewal of the graphics every few days. The used field-experimental design with natural repeated exposure to graphics is promising.
Using the intervention mapping protocol to develop a maintenance programme for the SLIMMER diabetes prevention intervention
Elsman, E.B.M. ; Leerlooijer, J.N. ; Beek, J. ter; Duijzer, G. ; Jansen, S.C. ; Hiddink, G.J. ; Feskens, E.J.M. ; Haveman-Nies, A. - \ 2014
BMC Public Health 14 (2014). - ISSN 1471-2458
life-style-intervention - primary-health-care - physical-activity intervention - randomized controlled-trials - impaired glucose-tolerance - real-world settings - term weight-loss - behavior-change - planned behavior - follow-up
Background Although lifestyle interventions have shown to be effective in reducing the risk for type 2 diabetes mellitus, maintenance of achieved results is difficult, as participants often experience relapse after the intervention has ended. This paper describes the systematic development of a maintenance programme for the extensive SLIMMER intervention, an existing diabetes prevention intervention for high-risk individuals, implemented in a real-life setting in the Netherlands. Methods The maintenance programme was developed using the Intervention Mapping protocol. Programme development was informed by a literature study supplemented by various focus group discussions and feedback from implementers of the extensive SLIMMER intervention. Results The maintenance programme was designed to sustain a healthy diet and physical activity pattern by targeting knowledge, attitudes, subjective norms and perceived behavioural control of the SLIMMER participants. Practical applications were clustered into nine programme components, including sports clinics at local sports clubs, a concluding meeting with the physiotherapist and dietician, and a return session with the physiotherapist, dietician and physical activity group. Manuals were developed for the implementers and included a detailed time table and step-by-step instructions on how to implement the maintenance programme. Conclusions The Intervention Mapping protocol provided a useful framework to systematically plan a maintenance programme for the extensive SLIMMER intervention. The study showed that planning a maintenance programme can build on existing implementation structures of the extensive programme. Future research is needed to determine to what extent the maintenance programme contributes to sustained effects in participants of lifestyle interventions.
SLIMMER: a randomised controlled trial of diabetes prevention in Dutch primary health care: design and methods for process, effect, and economic evaluation
Duijzer, G. ; Haveman-Nies, A. ; Jansen, S.C. ; Beek, J. ter; Hiddink, G.J. ; Feskens, E.J.M. - \ 2014
BMC Public Health 14 (2014). - ISSN 1471-2458 - 9 p.
life-style intervention - impaired glucose-tolerance - real-world settings - 6-minute walk test - physical-activity - behavior-change - public-health - follow-up - sf-36 - risk
Background - Implementation of interventions in real-life settings requires a comprehensive evaluation approach. The aim of this article is to describe the evaluation design of the SLIMMER diabetes prevention intervention in a Dutch real-life setting. Methods/Design - The SLIMMER study is a randomised, controlled intervention study including subjects aged 40 through 70 years with impaired fasting glucose or high risk of diabetes. The 10-month SLIMMER intervention involves a dietary and physical activity intervention, including case management and a maintenance programme. The control group receives usual health care and written information about a healthy lifestyle. A logic model of change is composed to link intervention activities with intervention outcomes in a logical order. Primary outcome is fasting insulin. Measurements are performed at baseline and after 12 and 18 months and cover quality of life, cardio-metabolic risk factors (e.g. glucose tolerance, serum lipids, body fatness, and blood pressure), eating and physical activity behaviour, and behavioural determinants. A process evaluation gives insight in how the intervention was delivered and received by participants and health care professionals. The economic evaluation consists of a cost-effectiveness analysis and a cost-utility analysis. Costs are assessed from both a societal and health care perspective. Discussion - This study is expected to provide insight in the effectiveness, including its cost-effectiveness, and delivery of the SLIMMER diabetes prevention intervention conducted in Dutch primary health care. Results of this study provide valuable information for primary health care professionals, researchers, and policy makers.
Less is more: The effect of multiple implementation intentions targeting unhealthy snacking habits
Verhoeven, A.A.C. ; Adriaanse, M.A. ; Ridder, D.T.D. de; Vet, E.W.M.L. de; Fennis, B.M. - \ 2013
European Journal of Social Psychology 43 (2013)5. - ISSN 0046-2772 - p. 344 - 354.
behavior-change - goal achievement - personal goals - past behavior - strength - plans - metaanalysis - breaking - number - power
Implementation intentions have been shown to effectively change counter-intentional habits. Research has, however, almost solely been concerned with the effectiveness of a single plan. In the present research, we investigated the behavioral and cognitive implications of making multiple implementation intentions targeting unhealthy snacking habits and its underlying processes, linking multiple habitual snacking cues to healthy alternatives. Study 1 revealed that formulating multiple implementation intentions was not effective in decreasing unhealthy snacking, whereas formulating a single plan successfully induced behavior change. By using a lexical decision task in Study 2, it was found that when making a single plan, but not multiple plans, the healthy alternative became cognitively more accessible in response to a critical cue prime than the habitual response. However, when making additional plans in an unrelated domain, the negative effects of making multiple plans were absent. In sum, the current findings suggest that formulating multiple implementation intentions is ineffective when changing unwanted behavior. These reduced effects of multiple implementation intentions do not occur when making the plan but are rather due to interference in the enacting phase of the planning process.
Importance of the nature of comparison conditions for testing theory-based interventions: Reply
Michie, S. ; Prestwich, A. ; Bruin, M. de - \ 2010
Health Psychology 29 (2010)5. - ISSN 0278-6133 - p. 468 - 470.
The nature of comparison conditions is a much overlooked feature of designing and interpreting the results of randomized controlled trials, as outlined by Williams (see record 2010-18776-001). We agree that understanding the components and mechanisms of the comparison condition is necessary for making inferences about both intervention effectiveness (whether the intervention worked and which components may have contributed to such an effect) and about theoretical mediators (how it worked). The extent to which one can draw strong inferences regarding the efficacy and mechanisms of an intervention over the comparison is conditional upon a number of key points
Cost-effectiveness of lifestyle modification in diabetic patients
Jacobs-Van der Bruggen, M.A. ; Baal, P.H. van; Hoogenveen, R.T. ; Feenstra, T.L. ; Briggs, A.H. ; Lawson, K. ; Feskens, E.J.M. ; Baan, C.A. - \ 2009
Diabetes Care 32 (2009)8. - ISSN 0149-5992 - p. 1453 - 1458.
physical-activity - self-management - behavior-change - interventions - program - weight - trial - maintenance - prevention - education
OBJECTIVE To explore the potential long-term health and economic consequences of lifestyle interventions for diabetic patients. RESEARCH DESIGN AND METHODS A literature search was performed to identify interventions for diabetic patients in which lifestyle issues were addressed. We selected recent (2003–2008), randomized controlled trials with a minimum follow-up of 12 months. The long-term outcomes for these interventions, if implemented in the Dutch diabetic population, were simulated with a computer-based model. Costs and effects were discounted at, respectively, 4 and 1.5% annually. A lifelong time horizon was applied. Probabilistic sensitivity analyses were performed, taking account of variability in intervention costs and (long-term) treatment effects. RESULTS Seven trials with 147–5,145 participants met our predefined criteria. All interventions improved cardiovascular risk factors at =1 year follow-up and were projected to reduce cardiovascular morbidity over lifetime. The interventions resulted in an average gain of 0.01–0.14 quality-adjusted life-years (QALYs) per participant. Health benefits were generally achieved at reasonable costs (=€50,000/QALY). A self-management education program (X-PERT) and physical activity counseling achieved the best results with =0.10 QALYs gained and =99% probability to be very cost-effective (=€20,000/QALY). CONCLUSIONS Implementation of lifestyle interventions would probably yield important health benefits at reasonable costs. However, essential evidence for long-term maintenance of health benefits was limited. Future research should be focused on long-term effectiveness and multiple treatment strategies should be compared to determine incremental costs and benefits of one over the other.
I eat healthfully but I am not a freak. Consumers’ everyday life perspective on healthful eating
Bouwman, L.I. ; Molder, H.F.M. te; Koelen, M.A. ; Woerkum, C.M.J. van - \ 2009
Appetite 53 (2009)3. - ISSN 0195-6663 - p. 390 - 398.
food choice - vegetable consumption - nutrition education - script formulations - behavior-change - social-context - dietary change - promotion - community - fruit
The gap between the awareness and understanding of healthful eating on the one hand and actual eating practices on the other has been addressed in several ways in the literature. In this paper, we consider it from an everyday life perspective. Using discourse analysis, we analyse how Dutch consumers account for their everyday food choices. We show how Dutch consumers use three interpretative repertoires to confirm the importance of health, while not portraying themselves as too self- and health-conscious eaters. The first repertoire associates healthful eating with common knowledge and ‘scripted’ actions, thereby suggesting that such eating is self-evident rather than difficult. The second repertoire constructs eating for health and pleasure as uncomplicated, by emphasizing consumers’ relaxed way of dealing with both. The third repertoire constructs unhealthful eating practices as naturally requiring compensation in the form of certain products or pills. We discuss how the use of these repertoires may pose socio-interactional barriers to the pursuance of healthful eating behaviour. The depiction of one's eating habits as uncomplicated, self-evidently healthful and - when bad - easy to compensate for, does not seem to provide a basis for critical considerations about these eating habits. If structural change in eating practices is to be achieved, nutrition promotion must invest in creating a new social standard that both avoids ‘overdoing’ bio-medical health and challenges people's construction of their eating habits as naturally healthful
Potentials and pitfalls for nutrition counselling in general practice
Verheijden, M.W. ; Bakx, J.C. ; Weel, C. van; Staveren, W.A. van - \ 2005
European Journal of Clinical Nutrition 59 (2005)Suppl.1. - ISSN 0954-3007 - p. S122 - S129.
coronary-heart-disease - primary-care physicians - dietary-fat intake - transtheoretical model - integrative model - behavior-change - increased risk - prevention - health - intervention
This paper was based on collaborative research efforts from Wageningen University and the University Medical Centre St Radboud in The Netherlands and describes the rationale for web-based nutrition counselling applications in general practice as well as some of the frequently used models and theories (predominantly the Stages of Change Model). General practitioners can play an important role in cardiovascular risk reduction by giving nutrition counselling to patients at elevated cardiovascular risk. Unfortunately, general practitioners perceive barriers that may limit their nutrition counselling practices. Some of these barriers may be overcome using computer and Internet technologies. Computerized reminders for preventive services, and websites with reliable high-quality information may prove to be valuable additions to usual care. Cooperation with dieticians may also lead to improvements in nutrition counselling in general practice. For example, general practitioners could use their unique position to create awareness and motivation among patients. They could subsequently refer motivated patients to dieticians for detailed personal dietary advice.
GPs' assessment of patients' readiness to change diet, activity and smoking
Verheijden, M.W. ; Bakx, J.C. ; Delemarre, I.C.G. ; Wanders, A.J. ; Woudenbergh, N.M. van; Bottema, B.J. ; Weel, C. van; Staveren, W.A. van - \ 2005
British Journal of General Practice 55 (2005)515. - ISSN 0960-1643 - p. 452 - 457.
coronary-heart-disease - physical-activity - transtheoretical model - integrative model - general-practice - behavior-change - increased risk - primary-care - fat intake - stage
The Stages of Change Model is increasingly used for lifestyle counselling. In general practice, the use of algorithms to measure stage of change is limited, but for successful counselling it is important to know patients' readiness to change. Aim: To assess the accuracy of the assessment of patients' readiness to change fat consumption, physical activity, and smoking by GPs and general practice registrars. Design of Study: Cross-sectional questionnaire-based survey. Setting: One hundred and ninety-nine patients at elevated cardiovascular risk aged 40-70 years, 24 GPs, and 21 registrars in Dutch general practices. Method: Patients were asked to complete an algorithm to measure their motivation to change fat consumption, physical activity, and smoking. GPs and registrars were given descriptions of the stages of change for the three lifestyles, and were asked to indicate the description that matched their patient. Cohen's ¿ was calculated as measure of agreement between patients and GPs/registrars. Results: Registrars' patients were younger, and less often overweight and hypertensive than GPs' patients. Cohen's ¿ for smoking was moderate (0.50, 95% confidence interval [CI] = 0.34 to 0.67 for GPs and 0.47, CI = 0.27 to 0.68 for registrars). Agreement for fat and activity was poor to fair. No differences in accuracy were observed between GPs and registrars (P = 0.07-0.83). Conclusions: Low accuracy indicates that counselling in general practice is often targeted at the wrong people at the wrong time. Improvements can possibly be achieved by making registration of lifestyle parameters in patient records common practice, and by simply asking patients where they stand in respect to lifestyle change
Stage-matched nutrition guidance: stages of change and fat consumption in Dutch patients at elevated cardiovascular risk
Verheijden, M.W. ; Veen, J.E. van der; Bakx, J.C. ; Akkermans, R. ; Hoogen, H.J.M. van den; Staveren, W.A. van; Weel, C. van - \ 2004
Journal of Nutrition Education and Behavior 36 (2004)5. - ISSN 1499-4046 - p. 228 - 237.
coronary-heart-disease - primary-care physicians - reducing dietary-fat - transtheoretical model - behavior-change - health behaviors - general-practice - family-practice - intervention - barriers
Objective: To assess the effects of stage-matched nutrition counseling on stages of change and fat intake. Design: Controlled clinical trial. Setting: 9 family practices in a family medicine practice network. Participants: 143 patients at elevated cardiovascular risk, aged 40 to 70 years. Intervention: Intervention patients received stage-matched counseling from their family physician and a dietitian. Control patients received usual care. Main Outcome Measures: Stages of change and fat intake were measured at baseline and after 6 and 12 months. Analysis: Chi-squared tests, t tests, and regression analyses (alpha = .05) were conducted. Results; More patients in the intervention group than in the control group were in the postpreparation stage after 6 months (70% vs 35%; P <.01) but not after 12 months (70% vs 55%; P = .10). Between 0 and 12 months, the reduction in total fat intake (-5.6% kcal vs -2.4% kcal) was largest in the intervention group. Conclusions and Implications: Stage-matched nutrition counseling promotes movement through stages of change, resulting in a reduced fat intake. Our results partly support stages of change as a tool for behavior change. Movement across stages of change was not a mediating factor in the intervention effects. Research should focus on feasible ways to keep patients in the postpreparation stage.