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- Testing motivational and self-regulatory mechanisms of action on device-measured physical activity in the context of a weight loss maintenance digital intervention: A secondary analysis of the NoHoW trialPublication . Encantado, Jorge; Marques, Marta M.; Gouveia, Maria João; Santos, Inês; Sánchez-Oliva, David; O'Driscoll, Ruairi; Turicchi, Jake; Larsen, Sofus C.; Horgan, Graham; Teixeira, Pedro J.; Stubbs, R James; Heitmann, Berit Lilienthal; Palmeira, António L.Background To date, few digital behavior change interventions for weight loss maintenance focusing on long-term physical activity promotion have used a sound intervention design grounded on a logic model underpinned by behavior change theories. The current study is a secondary analysis of the weight loss maintenance NoHoW trial and investigated putative mediators of device-measured long-term physical activity levels (six to 12 months) in the context of a digital intervention. Methods A subsample of 766 participants (Age = 46.2 ± 11.4 years; 69.1% female; original NoHoW sample: 1627 participants) completed all questionnaires on motivational and self-regulatory variables and had all device-measured physical activity data available for zero, six and 12 months. We examined the direct and indirect effects of Virtual Care Climate on post intervention changes in moderate-to-vigorous physical activity and number of steps (six to 12 months) through changes in the theory-driven motivational and self-regulatory mechanisms of action during the intervention period (zero to six months), as conceptualized in the logic model. Results Model 1 tested the mediation processes on Steps and presented a poor fit to the data. Model 2 tested mediation processes on moderate-to-vigorous physical activity and presented poor fit to the data. Simplified models were also tested considering the autonomous motivation and the controlled motivation variables independently. These changes yielded good results and both models presented very good fit to the data for both outcome variables. Percentage of explained variance was negligible for all models. No direct or indirect effects were found from Virtual Care Climate to long term change in outcomes. Indirect effects occurred only between the sequential paths of the theory-driven mediators. Conclusion This was one of the first attempts to test a serial mediation model considering psychological mechanisms of change and device-measured physical activity in a 12-month longitudinal trial. The model explained a small proportion of variance in post intervention changes in physical activity. We found different pathways of influence on theory-driven motivational and self-regulatory mechanisms but limited evidence that these constructs impacted on actual behavior change. New approaches to test these relationships are needed. Challenges and several alternatives are discussed.
- Development and cross-cultural validation of the Goal Content for Weight Maintenance Scale (GCWMS)Publication . Encantado, Jorge; Marques, Marta M.; Palmeira, António L.; Sebire, Simon J; Teixeira, Pedro J.; Stubbs, R James; Heitmann, Berit Lilienthal; Gouveia, Maria JoãoLong-term weight management requires sustained engagement with energy-balance-related behaviours. According to self-determination theory, behaviour goals can support or undermine motivation depending on the quality of their content (i.e., extrinsic and intrinsic motivation). This study aimed to develop and validate the goal content for weight loss maintenance scale (GCWMS).
- Effectiveness of Interventions for changing more than one behavior at a time to manage chronic conditions: A systematic review and meta-analysisPublication . Silva, Carolina C.; Presseau, Justin; Van Allen, Zack; Schenk, Paulina; Moreto, M.; Dinsmore, John; Marques, Marta M.Background Health behaviors play a significant role in chronic disease management. Rather than being independent of one another, health behaviors often co-occur, suggesting that targeting more than one health behavior in an intervention has the potential to be more effective in promoting better health outcomes. Purpose We aimed to conduct a systematic review and meta-analysis of randomized trials of interventions that target more than one behavior to examine the effectiveness of multiple health behavior change interventions in patients with chronic conditions. Methods Five electronic databases (Web of Science, PubMed, CINAHL, EMBASE, and Cochrane) were systematically searched in November 2023, and studies included in previous reviews were also consulted. We included randomized trials of interventions aiming to change more than one health behavior in individuals with chronic conditions. Two independent reviewers screened and extracted data, and used Cochrane’s Risk of Bias 2 tool. Meta-analyses were conducted to estimate the effects of interventions on change in health behaviors. Results were presented as Cohen’s d for continuous data, and risk ratio for dichotomous data. Results Sixty-one studies were included spanning a range of chronic diseases: cardiovascular (k = 25), type 2 diabetes (k = 15), hypertension (k = 10), cancer (k = 7), one or more chronic conditions (k = 3), and multiple conditions (k = 1). Most interventions aimed to change more than one behavior simultaneously (rather than in sequence) and most targeted three particular behaviors at once: “physical activity, diet and smoking” (k = 20). Meta-analysis of 43 eligible studies showed for continuous data (k = 29) a small to substantial positive effect on behavior change for all health behaviors (d = 0.081–2.003) except for smoking (d = −0.019). For dichotomous data (k = 23) all analyses showed positive effects of targeting more than one behavior on all behaviors (RR = 1.026–2.247). Conclusions Targeting more than one behavior at a time is effective in chronic disease management and more research should be directed into developing the science of multiple behavior change.
- Users’ experiences with the nohow web-based toolkit with weight and activity tracking in weight loss maintenance: Long-term randomized controlled trialPublication . Mattila, Elina; Hansen, Susanne; Bundgaard, Lise; Ramsey, Lauren; Dunning, Alice; Silva, Marlene N.; Harjumaa, Marja; Ermes, Miikka; Marques, Marta M.; Matos, Marcela; Larsen, Sofus C.; Encantado, Jorge; Santos, Inês; Horgan, Graham; O'Driscoll, Ruairi; Turicchi, Jake; Duarte, Cristiana; Palmeira, AL; Stubbs, R James; Heitmann, Berit Lilienthal; Lähteenmäki, LiisaBackground: Digital behavior change interventions (DBCIs) offer a promising channel for providing health promotion services. However, user experience largely determines whether they are used, which is a precondition for effectiveness. Objective: The primary aim of this study is to evaluate user experiences with the NoHoW Toolkit (TK)—a DBCI that targets weight loss maintenance—over a 12-month period by using a mixed methods approach and to identify the main strengths and weaknesses of the TK and the external factors affecting its adoption. The secondary aim is to objectively describe the measured use of the TK and its association with user experience. Methods: An 18-month, 2×2 factorial randomized controlled trial was conducted. The trial included 3 intervention arms receiving an 18-week active intervention and a control arm. The user experience of the TK was assessed quantitatively through electronic questionnaires after 1, 3, 6, and 12 months of use. The questionnaires also included open-ended items that were thematically analyzed. Focus group interviews were conducted after 6 months of use and thematically analyzed to gain deeper insight into the user experience. Log files of the TK were used to evaluate the number of visits to the TK, the total duration of time spent in the TK, and information on intervention completion. Results: The usability level of the TK was rated as satisfactory. User acceptance was rated as modest; this declined during the trial in all the arms, as did the objectively measured use of the TK. The most appreciated features were weekly emails, graphs, goal setting, and interactive exercises. The following 4 themes were identified in the qualitative data: engagement with features, decline in use, external factors affecting user experience, and suggestions for improvements. Conclusions: The long-term user experience of the TK highlighted the need to optimize the technical functioning, appearance, and content of the DBCI before and during the trial, similar to how a commercial app would be optimized. In a trial setting, the users should be made aware of how to use the intervention and what its requirements are, especially when there is more intensive intervention content.
- Keep on running – a randomized controlled trial to test a digital evidence-based intervention for sustained adoption of recreational running: rationale, design and pilot feasibility studyPublication . Pereira, Hugo V.; Teixeira, Pedro J.; Marques, Marta M.; Carraça, Eliana V.; Silva, Marlene N.; Encantado, Jorge; Santos, Inês; Palmeira, António L.Background: This paper describes the rationale, intervention development, study design and results from the pilot feasibility study of the Keep On Running (KOR) trial. KOR aims to test a web-based brief theory-based intervention, targeting maintenance of recreational running behavior over time (i.e. relapse preventing). Methods: Intervention development was based both on Self- Determination Theory and on Self-Regulation Theory. As part of it, a pilot study was implemented (n=18) to measure intervention adherence and participant satisfaction in order to establish the feasibility and acceptability of the intervention toolkit. Furthermore, this pilot study was also used to test the feasibility and acceptability of the questionnaires selected to be part of the later RCT. Results: Pilot intervention acceptability was good, but overall adherence was low. Features such as feedback and social sharing should be added to the toolkit. The main trial should lessen questionnaire length and include data from usual monitoring gadgets and apps (APIs). The protocol of the RCT was adjusted to test the efficacy of the refined final version of the intervention, and the RCT that will test it, contributing to the understanding of recreational running sustainability, allowing the optimization of future interventions aimed at physical activity promotion.
- 8º Congresso nacional de psicologia da saúde : actasPublication . Leal, Isabel; Ribeiro, J. Pais; Marques, Marta M.; Pimenta, FilipaA Sociedade Portuguesa de Psicologia da Saúde (SPPS) tem como acontecimento central das suas actividades regulares a realização de um congresso de dois em dois anos. Nestes congressos tem sido nosso objectivo a criação de um espaço de encontro entre académicos e profissionais da psicologia que, nas diversas interfaces que a Psicologia e a Saúde comportam, desenvolvem as suas investigações e/ou as suas actividades profissionais. Este ano, o 8º Congresso Nacional de Psicologia da Saúde, decorre no ISPA em Lisboa, nos dias 11, 12 e 13 de Fevereiro e propõe como tema “Sexualidade, Género e ”, razão pela qual os conferencistas convidados, a comissão cientifica que se encarregou de organizar a maioria dos simpósios e muitas das comunicações apresentadas oralmente ou sob a forma de poster, tenham caído neste âmbito. Como habitualmente, no primeiro dia do Congresso ficam disponíveis os resumos submetidos e revistos pela Comissão Cientifica, e as Actas do Congresso em que são apresentadas os trabalhos que os participantes quiseram submeter, e foram aprovados para publicação, sobre o essencial das suas apresentações. Este ano, além desses materiais, resolvemos lançar um livro que reúne um conjunto de textos que, tendo sido submetidos como actas o foram igualmente aos prémios de “investigador de mérito” e de “jovem investigador de mérito”. Estes prémios, que há vários anos a SPPS patrocina, pretendem distinguir trabalhos que, pela sua qualidade podem, e devem, servir de referência para anos vindouros. Os resumos são publicados num número especial da revista “Psicologia, Saúde & Doenças” e as Actas deste congresso surgem, pela primeira vez, em formato digital. O curto espaço que decorre entre a entregue dos textos para publicação e o Congresso e a necessidade de composição dos mesmos, exigiria da parte 1 8º CONGRESSO NACIONAL DE PSICOLOGIA DA SAÚDE dos colegas que desejam ver os seus trabalhos publicados, um cuidado e rigor que, nem sempre se verificam. O nosso pedido expresso que as publicações obedeçam a critérios APA, não é muitas vezes respeitado, tal como não não é o tamanho dos textos, o número de textos enviados, a congruência de títulos e mesmo de autores entre os resumos submetidos e os textos depois enviados para publicação, os prazos em que são enviados, já para não falar do não pagamento atempado da inscrição. Embora as actas não sejam, assumidamente, uma publicação de primeira linha, devem no entanto, ter a dignidade e a observação dos critérios científicos estabelecidos que continuem a justificar a sua publicação. Assim, cabe aos organizadores destas actas a ingrata tarefa de por um lado recusar linearmente muitos textos que não preenchem estes quesitos e, também, editar muitos outros para que possam ser publicados. Tudo isto num espaço de tempo muito curto. Estas observações tornam-se pertinentes na circunstância habitual de os autores se confrontarem com a não inclusão de textos que enviaram e que não vão encontrar aqui publicados e, também, de verificarem que quadros ou imagens enviadas não puderam, por razões técnicas, ser reproduzidos. Ainda assim, são muitos os textos publicados. Tivemos em atenção a qualidade e pertinência do material submetido para não aplicarmos rigidamente princípios estipulados que deixariam de fora ainda mais textos. Neste percurso, de mais de quinze anos de publicações regulares de actas dos congressos, consideramos que a qualidade do material apresentado tem, genericamente, melhorado pelo que esperamos que os desafios com que a comunidade cientifica, em geral, e a psicologia da saúde em particular, se confrontam, possibilitem, além de uma melhoria crescente de qualidade do material publicado o espelhar dos contextos de intervenção e investigação que se vão oferecendo à psicologia da saúde.
- Testing motivational and self-regulatory mechanisms of action on device-measured physical activity in the context of a weight loss maintenance digital intervention: A secondary analysis of the NoHoW trialPublication . Encantado, Jorge; Marques, Marta M.; Gouveia, Maria João; Santos, Inês; Sánchez-Oliva, David; O'Driscoll, Ruairi; Turicchi, Jake; Larsen, Sofus C.; Horgan, Graham; Teixeira, Pedro J.; Stubbs, R James; Heitmann, Berit Lilienthal; Palmeira, António L.Background: To date, few digital behavior change interventions for weight loss maintenance focusing on longterm physical activity promotion have used a sound intervention design grounded on a logic model underpinned by behavior change theories. The current study is a secondary analysis of the weight loss maintenance NoHoW trial and investigated putative mediators of device-measured long-term physical activity levels (six to 12 months) in the context of a digital intervention. Methods: A subsample of 766 participants (Age = 46.2 ± 11.4 years; 69.1% female; original NoHoW sample: 1627 participants) completed all questionnaires on motivational and self-regulatory variables and had all devicemeasured physical activity data available for zero, six and 12 months. We examined the direct and indirect effects of Virtual Care Climate on post intervention changes in moderate-to-vigorous physical activity and number of steps (six to 12 months) through changes in the theory-driven motivational and self-regulatory mechanisms of action during the intervention period (zero to six months), as conceptualized in the logic model. Results: Model 1 tested the mediation processes on Steps and presented a poor fit to the data. Model 2 tested mediation processes on moderate-to-vigorous physical activity and presented poor fit to the data. Simplified models were also tested considering the autonomous motivation and the controlled motivation variables independently. These changes yielded good results and both models presented very good fit to the data for both outcome variables. Percentage of explained variance was negligible for all models. No direct or indirect effects were found from Virtual Care Climate to long term change in outcomes. Indirect effects occurred only between the sequential paths of the theory-driven mediators. Conclusion: This was one of the first attempts to test a serial mediation model considering psychological mechanisms of change and device-measured physical activity in a 12-month longitudinal trial. The model explained a small proportion of variance in post intervention changes in physical activity. We found different pathways of influence on theory-driven motivational and self-regulatory mechanisms but limited evidence that these constructs impacted on actual behavior change. New approaches to test these relationships are needed. Challenges and several alternatives are discussed.
- Components of multiple health behaviour change interventions for patients with chronic conditions: a systematic review and meta-regression of randomized trialsPublication . Silva, Carolina C.; Presseau, Justin; Van Allen, Zack; Dinsmore, John; Schenk, Paulina; Moreto, M.; Marques, Marta M.Interventions addressing more than one health behaviour at a time could be an efficient way of intervening to manage chronic conditions. Within a systematic review of multiple health behaviour change (MBHC) interventions, we identified key components of interventions in patients with chronic conditions, assessed how they are linked to theory, behaviour change techniques implemented, and evaluated their impact on intervention effectiveness. Studies were identified by systematically searching five electronic databases. Subgroup analyses and metaregressions were conducted to analyse the association between intervention components and behavioural changes. In total, 61 studies were included spanning different chronic conditions (e.g., cardiovascular conditions, type 2 diabetes). Most interventions sought to change behaviours simultaneously (72%), often targeting the ‘physical activity, diet and smoking’ cluster of behaviours (33%), and were not theory informed (55%). A total of 36 behaviour change techniques were identified, most commonly goal setting behaviour and self-monitoring of behaviour. Subgroup analyses indicated that MHBC interventions delivered entirely face-to-face might not be as effective for physical activity outcomes, and not using goal setting (behaviour) might be more effective for smoking cessation outcomes. Metaregressions indicated that a longer intervention duration may work best to achieve better physical activity outcomes. This review provides a comprehensive understanding of interventions and contributes to the field of MHBC by facilitating data-driven insights for future optimisation and dissemination.
- Systematic Review of Psychological and Behavioral Correlates of Recreational RunningPublication . Pereira, Hugo Vieira; Palmeira, A.L.; Encantado, Jorge; Marques, Marta M.; Santos, Inês; Carraça, Eliana V.; Teixeira, Pedro J.Introduction: The aim of this review was to systematically synthesize the published literature describing the psychological and behavioral correlates of recreational running in adults, defined as running for leisure, with or without a competitive component. Methods: Quantitative research published in peer-reviewed journals until January 2021 were included. Studies were identified through MEDLINE, PsycINFO, SPORTDiscus, and Web of Science and were included in this review if they (1) were aimed at recreational running, (2) included general adult samples (18 years or older, without a diagnosed medical condition or metabolic disorder), and (3) assessed psychological or behavioral correlates of recreational running. Results: Fifty-six articles reporting 58 studies met the eligibility criteria and were included. There were 27 cross-sectional studies, 12 longitudinal studies, and 19 trials (8 non-controlled trials, 5 controlled trials, and 6 randomized controlled trials) (n = 37,501, 1877 years old, 43% women). Twenty-eight studies assessed antecedents of running behavior, and 25 studies used running behavior as treatment or predictor of a given effect or outcome. Four studies examined both predictors and outcomes of running. Thirty-one studies showed poor quality, while 20 had fair and 7 good quality. Motives were the most frequently studied antecedent of running behavior (k = 19), and results suggest that the highest-ranked or more prevalent motives were physical health, psychological motives, and personal achievement. Additionally, perceived control, attitude toward running, intention and subjective norms, self-efficacy, and social support may have also played a role in the adoption of recreational running. Moreover, improvements in mood (k = 10) and well-being (k = 10) were the most frequently reported positive outcomes of running. Reductions in depression, anxiety, and stress were also reported in included studies. Discussion: To our knowledge, this is the first systematic review on this topic. The identification of behavioral and psychological correlates of recreational running across populations can contribute to inform and guide a public policy agenda, focused on helping people sustain regular physical activity, through a modality they have chosen and appear to enjoy. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=68954, identifier: CRD42017068954.