Long-term relations between intentions, planning, and exercise: A 3-year longitudinal study after orthopedic rehabilitation.

Objective: Planning has been hypothesized to operate as a mediator linking intentions to health behaviors. To explore the temporal variation of these constructs and their interrelationships, a long-term study of intentions, planning, and physical activity was conducted. Method: A sample of 328 individuals in orthopedic rehabilitation provided data at five measurement occasions over 3 years after their discharge from rehabilitation. A process-oriented approach combining mediation analysis and latent growth curve (LGC) modeling was applied. Results: The orthopedic rehabilitation led to an initial increase in planning and behavior, followed by a decrease after 6 months and stabilization for the next 2.5 years. Intention revealed a slight but constant decrease for 6 months and remained stable up to 3 years after rehabilitation. The mediation model confirmed planning as mediator between intention and physical activity in former rehabilitation participants. Conclusions: Prior evidence on the mediating role of planning in the intention-behavior relation is corroborated and extended by the present findings at the level of long-term processes. Planning can and should be integrated in rehabilitation treatment programs to facilitate sustainable recovery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of an implementation intention intervention for promoting physical activity among individuals with spinal cord injury: A randomized controlled trial.

Objective: To evaluate the efficacy of an 8-week implementation intention intervention for promoting physical activity among individuals with spinal cord injury. Study Design: Randomized clinical trial. Method: Participants were randomly assigned to an implementation intention intervention (n = 26) or control (n = 28) condition and were asked to engage in 30 min of moderate to heavy intensity physical activity 3 times per week. Results: Participants who formed implementation intentions followed through with their physical activity intentions, engaging in more physical activity than participants in the control condition. Participants in the intervention condition also experienced sustained motivation and greater confidence to schedule physical activity compared with participants in the control condition. Implications: These findings suggest a role for implementation intentions in health promotion programs for people with spinal cord injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determinants of exercise intention and behavior during and after phase 2 cardiac rehabilitation: An application of the theory of planned behavior.

Objective: To evaluate the theory of planned behavior (TPB) as a framework for understanding exercise motivation during and after Phase 2 cardiac rehabilitation (CR). Design and Participants: Patients (57 men and 24 women) completed a TPB questionnaire that included attitudes, subjective norms, perceived behavioral control, and exercise intentions pre- and post-Phase 2 CR. Results: During Phase 2 CR, regression analyses indicated that attitude, subjective norm, and perceived behavioral control (PBC) explained 38% of the variance in exercise intention while intention explained 23% of the variance in exercise adherence. At postrehabilitation follow-up, attitudes, subjective norm, and PBC explained 51 % of the variance in exercise intention while intention explained 23% of the variance in exercise adherence. Conclusion: The TPB is a useful framework for understanding exercise intentions and behavior both during and after Phase 2 CR. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Readiness to adopt a self-management approach to cardiac health: Predicting outcomes from cardiac rehabilitation.

Purpose/Objective: To examine whether initial attitudes toward a self-management approach to cardiac health and early-treatment changes in those attitudes predict outcomes in cardiac rehabilitation. Research Method/Design: One hundred eighteen participants took part in a 12-week Phase II cardiac rehabilitation program. Questionnaires to assess readiness to engage in a self-management approach, mood, activity level, and diet were completed at pretreatment and at Weeks 3, 6, 9, and 12. Results: Repeated-measures regressions showed that participants with higher pretreatment levels of readiness to engage in a self-management approach showed more pronounced improvements in mood, activity level, and diet than did those with lower levels of readiness. Those who reported significant shifts in self-management attitudes during the first 3 weeks of the program finished treatment with greater improvements on measures of mood, cardiorespiratory fitness, activity level, and weight than did participants who reported smaller shifts. Conclusions/Implications: Results suggest that pretreatment acceptance of a self-management orientation, as well as early shifts toward such a stance, predicted treatment gains. This information may be used to improve outcomes from cardiac rehabilitation by intervening to enhance readiness in those that start at low levels or fail to engage in the initial stages of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Strategic automation of emotion regulation.

As implementation intentions are a powerful self-regulation tool for thought and action (meta-analysis by P. M. Gollwitzer & P. Sheeran, 2006), the present studies were conducted to address their effectiveness in regulating emotional reactivity. Disgust- (Study 1) and fear- (Study 2) eliciting stimuli were viewed under 3 different self-regulation instructions: the goal intention to not get disgusted or frightened, respectively, this goal intention furnished with an implementation intention (i.e., an if-then plan), and a no-self-regulation control group. Only implementation-intention participants succeeded in reducing their disgust and fear reactions as compared to goal-intention and control participants. In Study 3, electrocortical correlates (using dense-array electroencephalography) revealed differential early visual activity in response to spider slides in ignore implementation-intention participants, as reflected in a smaller P1. Theoretical and applied implications of the present findings for emotion regulation via implementation intentions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Are goal intentions or implementation intentions better predictors of health behavior? A longitudinal study in orthopedic rehabilitation.

Objective: To compare the predictive power of goal intentions and implementation intentions. Design: Both constructs were expected to explain physical exercise at 3 points in time (with follow-ups at 6 and 12 months) in a sample of 368 persons participating in orthopedic rehabilitation. Results: Goal intentions and implementation intentions predicted exercise during rehabilitation. In contrast, goal intentions failed to predict exercise at later points in time, whereas implementation intentions continued to be associated with exercise 12 months later. Conclusions: Implementation intentions rather than goal intentions predict behavior as it becomes routine. As automatic processes such as behavior elicited by planning are largely age invariant, strengthening those processes might help to overcome volitional problems across all age groups represented in rehabilitation settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing attendance for psychotherapy: Implementation intentions and the self-regulation of attendance-related negative affect.

The present study evaluated an implementation intention intervention that aimed to increase attendance at scheduled, initial appointments for psychotherapy by helping clients to manage negative feelings about attendance. Participants received a postal questionnaire that measured their views about attending psychotherapy. One half of the sample was randomly assigned to an implementation intention induction that was embedded in the questionnaire. Intention-to-treat analysis (N=390) indicated that participants who formed implementation intentions were more likely to attend compared to controls (75% vs. 63%), and this effect was even stronger among participants who returned the questionnaire (83% vs. 57%). Whereas anticipated affective costs (e.g., shame) had a negative impact on attendance for most participants, this effect was attenuated when participants formed implementation intentions and perceived that attendance would be beneficial. Thus, implementation intention formation can help clients to deal effectively with negative feelings that might otherwise prevent them attending their first psychotherapy appointment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of an efficacy-enhancing message to influence the self-regulatory efficacy of cardiac rehabilitation participants: A field experiment.

Objective: To examine whether a message designed to target sources of self-efficacy information could increase self-regulatory efficacy for independent exercise among cardiac rehabilitation (CR) participants. Study Design: Randomized controlled field experiment. Method: Fifty-four participants completed premanipulation measures of self-regulatory efficacy and exercise intentions, then were randomly assigned to read either an efficacy-enhancing or control message. Participants completed postmanipulation measures of self-regulatory efficacy, intentions, agreement with action plans, and behavioral commitment. Results: A 2 × 2 repeated-measures multivariate analysis of variance revealed a significant Message × Time interaction (p     

Durable effects of implementation intentions: Reduced rates of confirmed pregnancy at 2 years.

Objective: To assess the long-term impact of implementation intention formation in reducing consultations for emergency contraception and pregnancy testing among teenage women. Design: Teenage women visiting a family planning clinic were randomly assigned to implementation intention versus control conditions. Main outcome measures: Objective measures of consultation outcomes were obtained from clinic records at 2-year follow-up (N = 227). Results: Rates of consultation for emergency contraception and pregnancy testing in the implementation intentions condition were 19% and 33% lower, respectively, compared to the rates observed in the control condition. Pregnancy rates were 43% lower. Intervention participants who consulted for emergency contraception and pregnancy testing at baseline were more than twice as likely to change to consulting for contraceptive supplies over the follow-up period compared to equivalent control participants (19% vs. 9%). Conclusion: The impact of implementation intention formation on reducing pregnancy risk among teenagers is durable over 2 years. Implementation intentions were successful in changing behavior among precisely those participants who were at greatest risk of becoming pregnant. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Can implementation intentions and text messages promote brisk walking? A randomized trial.

Objective: To test the efficacy in promoting brisk walking of two theory-based interventions that incorporate implementation intentions and text message (Short Message Service; SMS) reminders directed at one’s walking-related plans or goals. Design: Participants (N = 149) were randomized to one of three conditions (implementation intention + SMS plan reminder, implementation intention + SMS goal reminder, control) before completing measures at baseline and follow-up 4 weeks later. At follow-up, the experimental groups were given a surprise recall task concerning their plans. All participants completed an equivalent goal recall task. Main Outcome Measures: Validated self-report measures of physical activity and measures of implementation intention and goal recall, weight, and waist-to-hip ratio. Results: Both intervention groups increased their brisk walking relative to the control group, without reducing other physical activity. The goal reminder group lost the most weight. The SMS plan reminder group recalled more of their plans than the SMS goal reminder group, but the latter were more successful in goal recall. Conclusion: Both interventions can promote brisk walking in sedentary populations. Text messages aid the recall of, and could enhance interventions that target, implementation intentions and goals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of experimenter-provided and self-generated implementation intentions to reduce alcohol consumption in a sample of the general population: A randomized exploratory trial.

Objective: To test the effectiveness of implementation intentions to decrease alcohol consumption and control for possible demand characteristics by employing an active control condition and contrasting experimenter-provided with self-generated implementation intentions. Design: Two hundred forty-eight participants were randomly allocated to 1 of 4 conditions: questionnaire-only; questionnaire plus planning instruction; questionnaire, planning instruction plus experimenter-provided implementation intention; or questionnaire, planning instruction plus self-generated implementation intention. Main Outcome Measure: Alcohol intake. Results: There were clinically and statistically significant decreases in alcohol consumption in the 2 experimental conditions, but not in the 2 control conditions, F(3, 237) = 3.34, p p2 = .04. There were no significant differences between experimenter-provided and self-generated implementation intentions (p = .62). Compliance moderated the effects of self-generated implementation intentions only, such that alcohol intake only significantly decreased in participants who complied with the instructions, F(1, 52) = 4.20, p p2 = .07. However, simply choosing an experimenter-provided implementation intention was just as effective as writing it out in full, implying that implementation intentions work even with minimal information processing. Conclusion: The findings further support use of implementation intentions to protect against health risk behaviors and are congruent with laboratory research showing that implementation intentions are a case of strategic automaticity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When planning is not enough: The self-regulatory effect of implementation intentions on changing snacking habits.

Objective: This study examined whether matching implementation intentions to people's regulatory orientation affects the effectiveness of changing unhealthy snacking habits. Design: Participants' regulatory orientation was either measured (as a chronic trait) or manipulated (as a situational state), and participants were randomly assigned to implementation intention conditions to eat more healthy snacks or avoid eating unhealthy ones. Main Outcome Measures: A self-reported online food diary of healthy and unhealthy snacks over a 2-day period. Results: Participants with weak unhealthy snacking habits consumed more healthy snacks when forming any type of implementation intentions (regardless of match or mismatch with their regulatory orientation), while participants with strong unhealthy snacking habits consumed more healthy snacks only when forming implementation intentions that matched their regulatory orientations. Conclusion: Results suggest that implementation intentions that match regulatory orientation heighten motivation intensity and put snacking under intentional control for people with strong unhealthy snacking habits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementation intention formation reduces consultations for emergency contraception and pregnancy testing among teenage women.

Objective: This study examined the impact of implementation intention formation in reducing consultations for emergency contraception and pregnancy testing in young women. Design: Teenage girls (N = 261) visiting a family planning clinic were randomly assigned to implementation intention versus control conditions and completed questionnaires at recruitment. Main Outcome Measures: Objective measures of consultation outcomes were obtained from clinic records at baseline and 9-month follow-up (n = 200). Results: Forming implementation intentions significantly reduced consultations for emergency contraception and pregnancy testing at follow-up compared with the control group (38% vs. 55%). There were also differences between the groups in consultation outcomes over time. For instance, whereas 31% of implementation intention participants changed from consulting for emergency contraception and pregnancy testing at baseline to consulting for contraceptive supplies only at follow-up, only 16% of control participants did so. Conclusion: These results suggest that implementation intention formation is a simple yet effective means of promoting pregnancy prevention among teenagers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementation intentions, occupational stress, and the exercise intention-behavior relationship.

Many individuals intend to exercise, but fail to link this intention to behavior. The present study examined the impact of an implementation intention intervention (i.e., instructions to form specific if-then plans) on an exercise intention-behavior relationship among working adults who varied in reported occupational stress levels. Results indicated that implementation intentions backfired, such that participants who did not form an implementation intention exercised significantly more than participants who formed an implementation intention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term effects of implementation intentions on prevention of smoking uptake among adolescents: A cluster randomized controlled trial.

Objective: To test the efficacy of implementation intentions in reducing smoking uptake in a sample of adolescents. Design: Classes of adolescents (aged 11–12 years) were randomly allocated to one of four conditions: implementation intention, self-efficacy, two control conditions. An implementation intention or a self-efficacy manipulation (both formed in relation to how to refuse offers of cigarettes) was completed by intervention condition participants at 0, 4, 8, 12, 16, 20, and 24 months. Main Outcome Measures: Long-term smoking behavior (self-report and objective) was assessed at 48 months post-baseline. Results: There were no differences between the two control conditions and the self-efficacy condition. Controlling for baseline smoking, sex, attitudes to smoking, friends and family smoking, and the multilevel nature of the data, intention-to-treat analyses indicated the implementation intention manipulation significantly reduced self-reported smoking compared to the other three conditions combined. Analyses on objectively assessed smoking (carbon monoxide breath measure) in a random subsample of participants also indicated that the implementation intention manipulation compared to the other three conditions significantly reduced smoking. Conclusion: Implementation intentions can reduce smoking in adolescent samples. Implications for using implementation intentions to reduce smoking in adolescents are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of implementation intentions on the self-reported frequency of drivers' compliance with speed limits.

This study tested the efficacy of implementation intentions in the context of drivers' speeding behavior. Participants (N = 300) completed self-report measures of goal intention and behavior, and they were randomly assigned to an experimental condition, which required them to specify an implementation intention, or a control condition. One month postbaseline, self-reported compliance with speed limits significantly increased for experimental participants but not for control participants. The effects of specifying an implementation intention on behavior increased with the strength of drivers' goal intentions. Finally, analysis of participants' implementation intentions revealed that specifying more behavioral strategies increased the frequency with which participants reported complying with the speed limit. Implications of the findings are discussed in relation to enhancing road safety interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting walking intentions and exercise in individuals with intermittent claudication: An application of the theory of planned behavior.

Objective: To identify determinants of intention and walking activity among individuals with intermittent claudication using the theory of planned behavior. Study Design and Participants: Prospective, correlational study of men and women (n = 62) with intermittent claudication. Method: Baseline questionnaire assessing theory of planned behavior measures regarding walking. Telephone follow-up assessing frequency and duration of walking during the previous week. Results: Attitudes, subjective norms, and perceived behavioral control explained 67% of the variance in intentions. Perceived behavioral control explained 8% of the variance in walking activity. Conclusion: Findings support the theory of planned behavior for predicting intentions and warrant future examination of perceived behavioral control as a determinant of exercise. A basis for developing interventions to facilitate walking among this population is provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical activity after cardiac rehabilitation: Evidence that different types of self-efficacy are important in maintainers and relapsers.

Objective: To test whether maintenance self-efficacy predicts physical activity among individuals who maintain an active lifestyle and whether recovery self-efficacy predicts physical activity among those who relapse to a less active lifestyle. Study Design and Participants: In a longitudinal study, data were collected from 114 participants 4-10 days after a myocardial infarction (MI), 2 weeks after rehabilitation (2 months after MI), and 8 months after MI. Results: In a subgroup of participants who maintained regular activity at 8 months after MI, maintenance self-efficacy predicted physical activity. Among participants who had relapsed by 8 months after MI, recovery self-efficacy predicted physical activity. Conclusions: Those who conduct interventions among cardiac rehabilitation patients should aim to increase recovery self-efficacy among those patients who are at risk for relapse and to increase maintenance self-efficacy among those patients who are likely to maintain their level of physical activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Which survey questions change behavior? Randomized controlled trial of mere measurement interventions.

Objective: Evidence indicates that receiving a questionnaire about a behavior increases the likelihood that the person will perform that behavior—a phenomenon termed the mere measurement effect. This research tested the role of (a) the type of questions, and (b) questionnaire completion in optimizing the impact of mere measurement interventions designed to retain novice blood donors. Design: Novice blood donors (N = 4391) were randomly allocated to four conditions that varied the content of a questionnaire about blood donation (behavioral intention-only, behavioral intention plus regret, implementation intention-only, implementation intention plus regret) or to a no-questionnaire control condition. Main Outcome Measures: Objective measures of registration at blood drives were obtained at 6 and 12 months postbaseline. Results: Participants in the implementation intention-only condition donated more frequently at 6 months compared to participants in each of the other conditions. At 12 months both implementation intention conditions outperformed the other conditions. Implementation intentions increased the frequency of donations over 1 year by 12%. Measuring anticipated regret did not augment the impact of interventions whereas questionnaire completion had an important impact on donation behavior. Conclusion: Questions about implementation intentions but not behavioral intentions promote retention of novice blood donors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Planning to lose weight: Randomized controlled trial of an implementation intention prompt to enhance weight reduction among overweight and obese women.

Objective: The trial investigates the effects of augmenting an established weight-reduction intervention with implementation intention prompts. Design: Fifty-five overweight or obese women (ages 18 to 76 years; body mass index from 25.28 to 48.33) enrolled in a commercial weight reduction program were randomly assigned to either an implementation intention prompt or a control condition. Data were collected twice, with a time gap of 2 months. Main Outcome Measures: The primary outcome was participants' change in weight and body mass index from preintervention to follow-up. Results: Repeated measures analysis of variance revealed a significant Time = Condition interaction: On average, implementation intention prompt participants lost 4.2 kg (95% confidence interval = 3.19, 5.07), whereas control participants lost 2.1 kg (95% confidence interval = 1.11, 3.09). The change in frequency of planning mediated the effects of the intervention on weight and body mass index change. Conclusion: Among obese or overweight women participating in a commercial weight loss program, those who learn to form implementation intentions can achieve greater weight reduction. Planning facilitation is a key mechanism explaining enhanced weight loss generated by implementation intention formation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)