Adolescent Behavior Clinical Trial
Official title:
Synergistic Effects of Implementation Intention and Self-efficacy on Behavior Change and Body Fat: a Randomized Controlled Trial of Interventions Promoting Physical Activity
This longitudinal experimental study tested the effects of three brief interventions: (1)
prompting the formation of plans (or implementation intentions), (2) prompting self-efficacy
beliefs, and (3) prompting planning + self-efficacy in adolescents aged 14-18 years relative
to an active 'education only' control group.
It was hypothesized that participants assigned to the interventions would exhibit a smaller
increase in body fat at 14-month follow-up compared to controls. The study also investigated
whether the combined planning + self-efficacy intervention would have larger effects on the
main outcome (body fat) than single-component interventions. Second, it was hypothesized that
the effects of the intervention conditions on body fat at 14-month follow-up would be
mediated by their respective psychological and behavioral constructs: self-efficacy and
planning at T2 (Mediator 1), and by moderate-to-vigorous physical activity (MVPA) at T3
(Mediator 2). It was expected that the effects of the interventions including the planning
component (i.e., planning intervention and self-efficacy + planning intervention) would be
mediated by respective cognitions, i.e. planning, whereas the effects of the interventions
including self-efficacy component (i.e., self-efficacy intervention and self-efficacy +
planning intervention) would be mediated by self-efficacy. Finally, it was explored whether
the effects of the intervention (both direct and indirect effects, via their respective
psychological variables and MVPA) on body fat would be moderated by the presence of built PA
facilities, located in the proximity of schools.
The experimental procedures were integrated into a health promotion and education program.
Pre-manipulation education: Across the study groups, participants received a common healthy
lifestyle education program, focusing on nutrition and physical activity, which was a part of
the school curriculum. The combination of nutrition and PA interventions is in line with best
practice guidelines for interventions promoting healthy body weight. The education program
was delivered by teachers and a group format was used. The groups discussed food composition,
safe food handling, food labeling, nutrient needs for age and gender groups, dietary
guidelines, and clinical nutrition issues. The program did not include behavior change
techniques and was not accompanied by changes in policies.
The intervention conditions were delivered via a combination of printed forms with
paper-and-pencil exercises and face-to-face sessions. All experimental conditions included an
initial session (completing the forms individually in the groups + face-to-face component)
and sets of handouts for three following weeks. The face-to-face component was delivered
within three days of completing the initial forms. The initial session was followed by a
booster session (group + face-to-face components), delivered at 2-month follow-up. Across the
groups, completing the forms (individual component) took approximately 30 minutes and was
conducted in classrooms. The face-to-face components took 45-60 minutes and were conducted in
the offices of school nurses or school psychologists.
Group intervention component. At the baseline participants completed the intervention
materials individually, using self-copy paper; the copies were collected for fidelity
analysis and originals were left for participants. The paper-and-pencil materials followed a
similar format in four groups in terms of word count, visual format, and the number and
length of sections requiring participants filling in the blanks.
Face-to-face intervention component. During the face-to-face component (at the baseline and
during the booster sessions) all participants received feedback on their body weight,
information regarding their physical activity levels and energy expenditure based on
participant's age, gender, body weight, followed by moderate-to-vigorous physical activity
recommendations (body mass and body fat measured during the booster session was not
recorded). Next, all participants and experimenters jointly reviewed the forms completed
during the group component. Adolescents reported included plans and were prompted to provide
even more detailed responses to questions included in the forms. Experimenters asked
participants to read the content of the form loudly; looked for sections which were
incomplete and encouraged adolescents to complete these sections; prompted participants to
provide detailed responses.
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