Reconceptualizing decisional balance in an adolescent sun protection intervention: Mediating effects and theoretical interpretations.

Abstract

The Transtheoretical model (TTM) integrates principles of operant learning, such as stimulus control and reinforcement, and psychological factors, such as decisional balance. Understanding interrelationships between decisions, behavior, and consequences from multiple theoretical perspectives can advance theory and inform development of more effective interventions. This analysis examined the mediating effects of a special case of the decisional balance construct where the pros of competing behaviors (i.e. sun protection vs. exposure) were measured rather than the pros and cons of the same behavior. Participants included 819 adolescents (10-16 yrs old, 53.5% girls, 58.4% Caucasian) randomized to a 24-month expert system intervention (Sunsmart) or a physical activity and nutrition comparison group. Self-report measures included sun protection behaviors, pros for protection, and pros for exposure. Mediation analysis using latent growth curve models found both the treatment-to-mediator and mediator-to-behavior paths significant for decisional balance, producing an indirect effect of .323 (p < .01) and good model fit (CFI=.973, RMSEA=.055). Multiple strategies for conceptualizing and measuring decisional balance appear to be valid. Results are interpreted from the TTM and operant perspectives.

Adaptive goal setting and financial incentives: a 2 × 2 factorial randomized controlled trial to increase adults’ physical activity

“…Basic principles of positive reinforcement [18, 19] and behavioral economics [20–25] are integrated into many theoretical approaches (e.g., Transtheoretical Model [26, 27], Social Cognitive Theory [28, 29], and Ecological Models [30, 31]) and have been proposed as unifying behavior change principles behind preventive medicine [32]. Positive reinforcement should be preferred because gain-based approaches produce fewer psychological side effects (e.g., aggression, frustration) than approaches based on aversive control such as penalties (e.g., loss of reward) [33] and may be more effective than non-contingent or interval-based (delayed) reinforcement for long-term behavior change [20, 31, 32].…”

Beliefs and Intentions for Skin Protection and UV Exposure in Young Adults

“…Higher scores (1 = strongly disagree, 5 = strongly agree) indicate greater beliefs in the effectiveness of sunscreen. Outcome evaluations for skin protection were assessed using a decisional balance scale calculated by dividing the average response to items on a pros of skin protection scale by the average response to items on a cons of skin protection scale (1 = not very important, 5 = extremely important) 25, 39, 40. A sample pros item is “Using sunscreens allows me to enjoy the outdoors with less worry.” A sample cons item is “Sunscreen is more trouble than it’s worth.”…”

“…Higher scores (1 = low, 5 = high) indicate a greater belief in one’s ability to tan without burning. Outcome evaluations for UV exposure was assessed using a decisional balance scale calculated by dividing the average response to items on a pros of UV exposure scale by the average response to items on a cons of UV exposure scale (1 = not very important, 5 = extremely important) 25, 39, 40. A sample pros item is “I look better when I have a tan.” A sample cons item is “Having a tan is unhealthy.”…”

“…Less favorable attitudes toward a tanned appearance, behavioral outcome beliefs that skin protection will be effective, and outcome evaluation beliefs that protected skin is desirable are associated with skin protection behavior 9, 25–27. Normative beliefs about the sunscreen use of friends and family members have been shown to be positively associated with these intentions and behaviors among both adolescents and adults 13.…”

Adapting the Stage of Change model to investigate adolescent behavior related to reducing second hand smoke exposure

“…The core of Prochaska's Stage of Change model is based on the following five stages: 1) Pre-contemplation: no intention to change behavior in the foreseeable future; 2) Contemplation: being aware of the problem, and thinking about changing behavior; 3) Preparation: intention to change behavior in the next month, and have successfully tried to change behavior in the past year; 4) Action: behavior is changed in order to overcome a problem, which requires time and energy; and 5) Maintenance: prevent relapse, consolidate gains attained during action, and maintenance of action for ≥6 months [10]. This model has been used to investigate and characterize numerous health behaviors among adolescents, including smoking cessation [11][12][13], substance abuse [12,14], sun protection [15], fruit and vegetable consumption [16], dietary adherence [17], contraceptive use [18], and physical activity [19]. For example, results from a study by Dino et al indicated that adolescents' stage of change at baseline predicted smoking cessation intervention outcomes three months post-baseline [11].…”