Objective The health action process approach (HAPA) is a social-cognitive model specifying motivational and volitional determinants of health behavior. A meta-analysis of studies applying the HAPA in health behavior contexts was conducted to estimate the size and variability of correlations among model constructs, test model predictions, and test effects of past behavior and moderators (behavior type, sample type, measurement lag, study quality) on model relations. Method A literature search identified 95 studies meeting inclusion criteria with 108 independent samples. Averaged corrected correlations among HAPA constructs and multivariate tests of model predictions were computed using conventional meta-analysis and meta-analytic structural equation modeling, with separate models estimated in each moderator group. Results Action and maintenance self-efficacy and outcome expectancies had small-to-medium sized effects on health behavior, with effects of outcome expectancies and action self-efficacy mediated by intentions, and action and coping planning. Effects of risk perceptions and recovery self-efficacy were small by comparison. Past behavior attenuated the intention-behavior relationship. Few variations in model effects were observed across moderator groups. Effects of action self-efficacy on intentions and behavior were larger in studies on physical activity compared with studies on dietary behaviors, whereas effects of volitional self-efficacy on behavior were larger in studies on dietary behaviors. Conclusions Findings highlight the importance of self-efficacy in predicting health behavior in motivational and volitional action phases. The analysis is expected to catalyze future research including experimental studies targeting change in individual HAPA constructs, and longitudinal research to examine change and reciprocal effects among constructs in the model. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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A meta-analysis of the health action process approach.

In the mid-1980s, Heckhausen and Gollwitzer set out to analyze how people control their actions (see Heckhausen, Gollwitzer, & Weinert, 1987). They quickly realized that breaking action control down into different phases greatly benefited its understanding. Heckhausen and Gollwitzer’s analysis was heavily influenced by the work of Kurt Lewin (e.g., Lewin et al., 1944), for whom there was never any doubt that motivational phenomena can only be properly understood and analyzed from an action perspective that distinguishes the processes of goal setting from those of goal striving, an insight that went unheeded for several decades. Accordingly, Heckhausen and Gollwitzer (1987) proposed the “Rubicon”model of action phases, which describes the course of action as a temporal, linear path starting with a person’s wishes or desires and ending with the evaluation of the action outcomes achieved. The model was designed to raise and help answer the following questions: How do people select their goals? How do they plan the execution of goal striving? How do they enact these plans? Moreover, how do they evaluate their accomplishments? According to the Rubicon model, a course of action involves a phase of deliberating the desirability and feasibility of one’s wishes at the outset in order to arrive at a binding decision regarding which of them one wants to pursue as a goal (pre-decisional phase), a phase of planning concrete strategies for achieving this goal Practical Summary

Changing Behavior Using the Model of Action Phases

The Handbook of Behaviour Change

A Meta-Analysis of the Health Action Process Approach and Health Behaviors

Changing Behavior Using the Theory of Planned Behavior

Background: Ample evidence demonstrates that university students are at high risk for sedentary behaviors and inadequate fruit and vegetable intake (FVI). Internet-based interventions for multiple health behavior appear to be promising in changing such unhealthy habits. Limited randomized controlled trials have tested this assumption among Chinese university students. Objective: Our objective was to test the efficacy of an 8-week Web-based intervention compared with a control group condition to improve physical activity (PA) and FVI in Chinese university students. The intervention content was based on the health action process approach, and developed on the basis of previous evidence from the Western hemisphere. We evaluated self-reported data including PA and FVI, stages of change for PA and FVI, and motivational (risk perception, outcome expectancies, self-efficacy), volitional (action planning, coping planning, social support), and distal (intention, habit) indicators for PA and FVI, as well as perceived mental health outcomes (quality of life, depression). Methods: In a randomized controlled trial, we recruited 566 university students from one university in the central region of China during their general physical education class. After random allocation and exclusion of unsuitable participants, we assigned 493 students to 1 of 2 groups: (1) intervention group: first 4 weeks on PA and subsequent 4 weeks on FVI, (2) control group. We conducted 3 Web-based assessments: at the beginning of the intervention (T1, n=493), at the end of the 8-week intervention (T2, n=337), and at a 1-month follow-up after the intervention (T3, n=142). The entire study was conducted throughout the fall semester of 2015. Results: Significant time ⨯ group interactions revealed superior intervention effects on FVI; motivational, volitional, and distal indicators of FVI; and PA behavior changes, with an effect size (η2) ranging from .08 to .20. In addition, the overall intervention effects were significant for stage progression to the action group from T1 to T2 in PA (χ21=11.75, P=.001) and FVI (χ21=15.64, P=.03). Furthermore, the intervention effect was seen in the improvement of quality of life (F3,492=1.23, η2=.03, P=.02). Conclusions: This study provides evidence for the efficacy of a Web-based multiple health behavior intervention among Chinese university students tested with different outcome variables. Future research should address the high dropout rate and optimize the most effective components of this intervention. Trial Registration: Clinicaltrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/6pHV1A0G1)

https://repository.hkbu.edu.hk/cgi/viewcontent.cgi?article=7295&context=hkbu_staff_publication

Web-Based Intervention for Physical Activity and Fruit and Vegetable Intake Among Chinese University Students: A Randomized Controlled Trial.

Background: Web-based and theory-based interventions for multiple health behaviors appears to be a promising approach with respect to the adoption and maintenance of a healthy lifestyle in cardiac patients who have been discharged from the hospital. Until now, no randomized controlled trials have tested this assumption among Chinese rehabilitation patients with coronary heart disease using a Web-based intervention. Objective: The study aim was to evaluate the effect of an 8-week Web-based intervention in terms of physical activity (PA), fruit and vegetable consumption (FVC), lifestyle changes, social-cognitive outcomes, and health outcomes compared with a waiting control group in Chinese cardiac patients. The intervention content was theory-based on the health action process approach. Self-reported data were evaluated, including PA, FVC, healthy lifestyle (the synthesis of PA and FVC), internal resources (combination of intention, self-efficacy, and planning), and an external resource (social support) of PA and FVC behaviors, as well as perceived health outcomes (body mass index, quality of life, and depression). Methods: In a randomized controlled trial, 136 outpatients with coronary heart disease from the cardiac rehabilitation center of a hospital in China were recruited. After randomization and exclusion of unsuitable participants, 114 patients were assigned to 1 of the 2 groups: (1) the intervention group: first 4 weeks on PA and subsequent 4 weeks on FVC and (2) the waiting control group. A total of 2 Web-based assessments were conducted, including 1 at the beginning of the intervention (T1, N=114), and 1 at the end of the 8-week intervention (T2, N=83). The enrollment and follow-up took place from December 2015 to May 2016. Results: The Web-based intervention outperformed the control condition for PA, FVC, internal resources of PA and FVC, and an external resource of FVC, with an eta-squared effect size ranging from 0.06 to 0.43. Furthermore, the intervention effect was seen in the improvement of quality of life (F1,79=16.36, P<.001, η2=.17). When predicting a healthy lifestyle at follow-up, baseline lifestyle (odds ratio, OR 145.60, 95% CI 11.24-1886; P<.001) and the intervention (OR 21.32, 95% CI 2.40-189.20; P=.006) were found to be significant predictors. Internal resources for FVC mediated the effect of the intervention on the adoption of a healthy lifestyle (R2adj=.29; P=.001), indicating that if the intervention increased the internal resource of behavior, the adoption of a healthy lifestyle was more likely. Conclusions: Patients’ psychological resources such as motivation, self-efficacy, planning, and social support as well as lifestyle can be improved by a Web-based intervention that focuses on both PA and FVC. Such an intervention enriches extended rehabilitation approaches for cardiac patients to be active and remain healthy in daily life after hospital discharge. Trial Registration: ClinicalTrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/6pHV1A0G1)

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Evaluation of a Web-Based Intervention for Multiple Health Behavior Changes in Patients With Coronary Heart Disease in Home-Based Rehabilitation: Pilot Randomized Controlled Trial

Steps to and correlates of health-enhancing physical activity in adulthood: An intercultural study between German and Chinese individuals

The current study evaluated the construct validity, internal consistency reliability, discriminant, and concurrent validities, along with the measurement invariance of the Brief Self-Control Scale ...

Gang Yan Si

Papers

Web-Based Intervention for Physical Activity and Fruit and Vegetable Intake Among Chinese University Students: A Randomized Controlled Trial.

Evaluation of a Web-Based Intervention for Multiple Health Behavior Changes in Patients With Coronary Heart Disease in Home-Based Rehabilitation: Pilot Randomized Controlled Trial

Steps to and correlates of health-enhancing physical activity in adulthood: An intercultural study between German and Chinese individuals

Further examination of the psychometric properties of the Brief Self-Control Scale: evidence from Chinese athletes and students