Health Psychology最新文献

Objective: To evaluate the effectiveness of a virtual community of practice (vCoP) in improving the activation of individuals with ischemic heart disease (IHD).

Method: We conducted a randomized controlled trial. A total of 282 patients with IHD from Madrid, Catalonia, and the Canary Islands were randomly allocated to an intervention or a control group. Patients were anonymized and the statistician was blinded to group allocation. The intervention was a multicomponent-tailored vCoP built on the Web 2.0 concept and focused on skills toward patient empowerment. The primary outcome was the Patient Activation Measure score. Secondary outcomes were self-efficacy to manage the disease, adherence to the Mediterranean diet, level of physical activity, depression, anxiety, medication adherence, and health-related quality of life. A linear regression model of mixed effects was carried out to estimate the effect of participating in the vCoP.

Results: Significant differences in adherence to the Mediterranean diet were found favoring the intervention at 6, 12, and 18 months, B = 0.86, 95% confidence interval (CI) [0.36, 1.35]. No significant changes among data collection points were found for the other variables.

Conclusion: Our results suggest that vCoPs can be helpful for improving adherence to the Mediterranean diet in individuals with IHD, but not for improving their activation or quality of life. However, considerable uncertainty remains due to participants' high dropout rate. Further research is needed to identify the behavioral change mechanisms of such an intervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Most cancer patients undergoing hematopoietic stem cell transplant report elevated symptoms and reduced health-related quality of life during peritransplant. These concerns can become persistent. A prior randomized controlled trial showed that expressive helping-a low-burden, brief intervention combining expressive writing with a novel peer support writing exercise-reduced psychological distress and physical symptoms in long-term transplant survivors with moderate/high persistent symptoms. The Writing for Insight, Strength, and Ease trial evaluated the use of expressive helping during peritransplant, when symptoms peak and early intervention could prevent the development of persistent symptoms.

Method: Three hundred sixty-six adult blood cancer patients (44.3% female, 74.6% White, 13.4% Black, 11.5% Hispanic/Latinx) scheduled for allogeneic (33.9%) or autologous (66.1%) transplant were randomized to complete either expressive helping or a neutral writing task in four writing sessions beginning pretransplant and ending 4 weeks posthospital discharge. Symptom severity (primary outcome), distress (depressive symptoms, generalized and cancer-specific anxiety), health-related quality of life, and fatigue were measured in multiple assessments from prerandomization to 12 months postintervention. Primary endpoints at 3 and 12 months postintervention estimated short- and long-term intervention effects. Moderation analyses explored subgroup differences in intervention efficacy.

Results: Mixed models with repeated measures analyses revealed no statistically or clinically significant intervention effects on primary or secondary outcomes. Moderation analyses did not identify subgroups of participants who benefitted from the intervention.

Conclusion: Findings do not support use of expressive helping during peritransplant. We recommend that survivors with persistent symptoms complete expressive helping at least 9 months posttransplant, consistent with evidence from a prior trial. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Psychological stress has long been posited as a potential risk factor for breast cancer. We aimed to examine the relationship between occupational stress and the incidence of invasive breast cancer among postmenopausal women from the Women's Health Initiative Observational Study.

Method: Occupational stress was characterized through linkage of Standard Occupational Classification codes for participants' jobs to the Occupational Information Network. Following the Karasek job strain model, we cross-categorized demand and control and created four categories of occupational strain. Cox proportional hazards regression models were used to calculate hazard ratios and 95% confidence intervals (CIs).

Results: Women with a history of high-strain work (high demand and low control) compared to low-strain work (low demand and high control) were 9% more likely to develop invasive breast cancer during follow-up (hazard ratios = 1.09; 95% CI [1.00, 1.19]) when controlling for age, race/ethnicity, geographical region, education, marital status, and familial history of breast cancer. This weak association between high-strain work and risk of breast cancer was rather consistent across analyses, but CIs included the null value in most models.

Conclusions: Our results highlight the potential importance of the occupational domain as a source of stress for women and suggest a possible, but yet tenuous, role in chronic disease etiology. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: A health action process approach (HAPA)-based intervention was designed to support moderate-to-vigorous physical activity (MVPA) in individuals with osteoarthritis of the knee (OAK). In secondary analyses of the randomized controlled trial "preventing the impairment of primary osteoarthritis by high-impact long-term physical exercise regimen-psychological adherence program," we examined long-term effects of the intervention on HAPA determinants and MVPA, and explored the former as mediators of change.

Method: N = 241 individuals with OAK (63% women, aged 44-80 years) were randomly assigned to the 12-month intervention condition (IC) or active control condition (CC). Between 2016 and 2020, self-reported HAPA determinants (action and coping planning, maintenance and recovery self-efficacy, action control) and collaborative planning were assessed at 0, 6, 12, 18, and 24 months, accelerometer-assessed MVPA at 0, 12, and 24 months. Multilevel and manifest path models were fit.

Results: Compared to the CC, action planning was higher in the IC at 6, 12, and 24 months. Maintenance and recovery self-efficacy were stable in the IC but decreased in the CC. MVPA decreased in both conditions. More action planning in the IC at 12 months was related to higher MVPA at 24 months, but, as in all other models, the indirect effect was nonsignificant.

Conclusions: The intervention partly stabilized or enhanced HAPA determinants but did not increase MVPA in a Western, highly-educated sample with OAK. Future work might use blended-care approaches enriched by mobile applications for continuous MVPA support. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Theoretical work suggests that moral psychological processes-those pertaining to the interests or welfare of others-are a key driver of overtreatment at the end of life. We examined patient moral processes and their associations with distress and treatment decision-making.

Method: During structured interviews with 116 patients with advanced cancer and a poor prognosis, Likert scale items were used to operationalize (a) moral emotions: feeling shame and guilt about cancer getting worse, (b) moral motives for cancer treatment: perceiving an obligation to family for continuing potentially nonbeneficial treatments, and (c) moral performance: putting up the appearance of feeling better than how one is really feeling (5-point response scale, not at all to a great deal). Several distress and end-of-life decision-making variables were also assessed.

Results: Most patients reported moral motives for cancer treatments and engaging in moral performance (35%-88% responded "a little" or higher for each of the 10 items). The mean moral motives score was associated with a higher likelihood of choosing life-extending care over comfort care (t = -3.16, p = .002) and a lower likelihood of having an advance care planning discussion (t = 3.19, p = .002). Moral performance was associated with worse distress regarding prognosis (r_s = .32, p = .001), worse psychological symptoms (r_s = -.26, p = .004), and less peaceful acceptance of cancer (r_s = -.25, p = .006).

Conclusions: For patients with advanced cancer, moral processes are prevalent and influential on how they behave and make treatment decisions. Attention must be paid to how these moral processes can result in more intensive treatments than warranted. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The effectiveness of behavioral interventions is typically evaluated relative to control conditions using null hypothesis significance testing (i.e., p < .05) or effect sizes. These criteria overlook comparisons with previous interventions and do little to promote a cumulative science of behavior change. We conducted a systematic review of the effectiveness of interventions to promote colorectal cancer screening (CCS) and generated benchmarks via the percentile distribution of ORs, screening rates for intervention and control arms, and differential screening rates (intervention minus control rate) in respective trials.

Method: Literature searches identified 187 eligible tests (N = 371,018).

Results: Random effects meta-analysis computed a sample-weighted OR = 1.69 (95% CI [1.55, 1.84]) and meta-regression showed that there was no improvement in the effectiveness of CCS interventions between 1996 and 2022. Benchmarking indicated that the median effect size was OR = 1.32, equivalent to a 35.7% screening rate in the intervention arm, and a 5.9% differential screening rate. Benchmarks were also generated for different types of screening (e.g., fecal immunochemical test, colonoscopy), sample characteristics (e.g., race, socioeconomic status), and methodological features (e.g., control conditions).

Conclusions: Interventions to promote CCS have a small effect and effectiveness has not increased over time. The percentile values for effect sizes and screening rates reported here can be used to benchmark the effectiveness of future trials. Benchmarking offers a way to evaluate interventions that are grounded in accumulated evidence and can inform judgments about tradeoffs among effectiveness, reach, and cost. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: This field experiment examined the efficacy of a behavioral nudge intervention towards lowering sugar intake in Indonesia. Specifically, two competing hypotheses were tested as to whether behavioral nudge played an additive role (i.e., the Incremental Hypothesis) or contributed to a ceiling effect (i.e., the Saturation Hypothesis) alongside social context and competition in a multimodal intervention program.

Method: This field experiment used a three-factorial mixed design involving 403 Indonesian participants based on power statistical analysis: 2 (sugar content nudge: lower sugar tea vs. regular sugar tea default) × 2 (social context: individual vs. group) × 2 (competition: absent vs. present).

Results: Nudging was the most powerful intervention in reducing sugar intake, but its effectiveness might be attenuated by social loafing even within Indonesia's collectivist culture. Competition did not work synergistically with nudging but was effective under the nonnudge condition.

Conclusion: Our results are consistent with those of previous research showing that behavioral nudging has a stronger impact on behavioral change than nonnudge strategies. Contrary to some previous research, people in collectivist Indonesia did engage in social loafing: achievement motivation is not necessarily enhanced in a team of people in a collectivist culture. The Nudge × Competition interaction supports the saturation hypothesis in favor of behavioral nudging: using more than one intervention, when a potent strategy such as nudging is present, might result in diminishing returns that could reduce the overall benefit-cost profile of such multimodal intervention programs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Sex-related disparities impact adherence to essential health behaviors like a cardiac-healthy diet, exercise, and smoking cessation. However, the influence of gender on these behaviors remains unexplored. The current study examined heterogeneity in adherence to health behavior over time by studying the effects of sex and gender differences among patients who have undergone percutaneous coronary intervention (PCI).

Method: A total of 512 participants (M_age = 64.37 ± 8.98; 84% male) responded to self-report questions concerning overall adherence, stress management, and dietary habits based on the Medical Outcomes Study. We added additional items to assess smoking status, medication adherence, and adequate physical activity. Assessments occurred following PCI (baseline) and 6- and 12-months post-PCI. A follow-up study also examined gender-related characteristics. Linear and logistic mixed models investigated the influence of sex, gender, their interaction, and various covariates on health behavior.

Results: Dietary behavior and medication adherence improved initially but stabilized after the first month. Physical activity improved but then decreased over time. Women and feminine individuals adhered more to stress reduction and dietary guidelines, while men and gender-conforming women (i.e., women with feminine norms) were more compliant with physical activity.

Conclusion: The current study demonstrated that cardiac rehabilitation interventions focused on diet, physical activity, and stress reduction may benefit from taking a sex- and gender-sensitive approach. However, more evidence is needed on whether sex- and gender-sensitive interventions are beneficial in terms of improving health behavior among PCI patients. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: This study examined the interactive relations of experienced interpersonal discrimination, sex, and religious affiliation with pulse wave velocity (PWV), a noninvasive measure of arterial stiffness and indicator of subclinical cardiovascular disease (CVD) prognostic for clinical CVD.

Method: We used multivariable linear regression analyses with cross-sectional data from 797 African American midlife adults in the Healthy Aging in Neighborhoods of Diversity Across the Life Span study in Baltimore, Maryland, to examine the interactive relations of both linear and quadratic discrimination, religious affiliation status, and sex with PWV in models adjusted for age and poverty status.

Results: Findings revealed a significant three-way interaction of Discrimination² × Religious Affiliation Status × Sex with PWV (B = 0.004, SE = 0.001, p = .004). Simple effect analyses showed a U-shape relation for only religiously affiliated men (B = 0.001, SE = 0.001, p = .008). Both lower and higher levels of discrimination were related to higher PWV. No such relations emerged among unaffiliated men or women. Findings remained robust after sensitivity analyses adjusted for depressive symptoms, cigarette use, obesity, marital status, hypertension, Type 2 diabetes, CVD medical history, cholesterol, lipid-lowering medication use, systolic blood pressure, and heart rate.

Conclusion: Religiously affiliated African American men who reported the lowest and highest experienced discrimination showed a heightened risk for subclinical CVD. Having a religious identity might either play a role in suppressing men's unwanted memories of discrimination or increase men's susceptibility to and salience of mistreatment, which might manifest in adverse cardiovascular health outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: In France, uptake of the recommended human papillomavirus (HPV) vaccination remains low. The vaccine cannot be administered without parental consent, but studies have shown that adolescents can make informed decisions about their health. We aimed at understanding the weight of adolescents' vaccination intention in parents' vaccination decision, using data from parent-adolescent dyads collected at baseline of a randomized trial of vaccine promotion interventions.

Method: About 649 parent-adolescent dyads from 61 middle schools in France independently completed an online questionnaire on their knowledge and attitudes toward HPV vaccination, structured around the seven psychological domains of vaccine readiness (VR). We used multivariate and path analyses to understand the family decision-making process.

Results: HPV vaccination was reported by 50.1% of adolescents and 45.5% of parents. Individual antecedents of VR were poorly correlated within dyads (r = .14-.36). Vaccine intentionality among parents of girls depended both on their own VR (β = .53, p < .001) and on their daughters' vaccine intention (β = .25, p < .001). But among parents of boys, vaccine intention depended only on their own VR (β = .72, p < .001). Adolescents' VR depended more strongly on the social environment's attitude among boys than among girls (β = .54 vs. .34, p < .01).

Conclusions: The defined model showed shared decision processes between parents and adolescent girls, but not boys, which can be understood in the context of a recent expansion of HPV vaccination to boys. Beyond this, it suggests that promotion targeting adolescents and their social environment can have a positive influence on parental intentions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).