<p>Background: Obesity is the number one health risk facing Americans. The obesity epidemic in America is attributed to physical inactivity, unhealthy food choices, and excessive food intake. Structured weight loss programs have been successful in initiating behavior change and weight loss; however, weight is almost always regained over time. The rate of weight gain is highest immediately after cessation of a structured weight loss program. Thus, effective interventions are needed that can successfully be used following a structured weight loss program to sustain weight loss and prevent weight relapse. Due to low cost, ubiquity, and ease of use, healthcare communicated through mobile technology, or "mHealth", may be able to serve as an effective medium to reach a large number of people to facilitate weight loss behaviors. Short message service (SMS), also known as text messaging, is easy to use, ubiquitous, affordable, and can target people directly where they are regardless of geographic location, socioeconomic status, or demographic factors. A review of the literature demonstrated limited information regarding message content, timing and frequency of message delivery and only 3 of 14 SMS-related interventions reviewed demonstrated a statistically significant effect on weight loss, diet or exercise. Additionally, information on how to integrate and leverage SMS as a health promotion tool for weight loss was also limited in the literature.</p><p>The Behavior Change Process model was used as a guide to understand how to develop an intervention to help people sustain recent weight loss. Furthermore, research suggests interventions that target and frame messages about how people reach goals in their life through either a prevention or promotion focus may be beneficial at motivating people to self-regulate and sustain recent behavioral changes. The goal of this study was to design an intervention that would help people stay in the continued response phase of the Behavior Change Process and help prevent weight relapse. Using the Behavior Change Process and regulatory focus theory, an intervention was developed that leveraged short message service (SMS) to deliver messages to people who have recently lost weight in attempt to help them sustain weight loss and prevent relapse.</p><p>Methods: First, a pilot study was conducted to inform the development of a SMS software application, the development of message content and the frequency and timing of message delivery. Second, an exploratory 3-arm mixed methods randomized controlled trial was conducted to test the feasibility, acceptability, perception of the usefulness, and efficacy of a weight loss sustaining mHealth SMS intervention among people with obesity. Participants (N=120) were randomized to a promotion message group, a prevention message group, or an attention-control general health message group. Participants completed baseline assessments, and reported their weight at 1 and 3 months post-baseline to assess efficacy of the intervention on sustaining weight loss. In addition, participants partook in a phone interview follow completion of the intervention to assess acceptability and usefulness. </p><p>Results: Participants found the message content and intervention acceptable and a majority perceived value in receiving messages via SMS that promote weight loss sustaining behaviors. Interview data implied that the intervention served as a reminder and daily cue to action. Participants were favorable towards receiving a daily reminder, which they noted helped them to stay focused, and in some cases to keep them motivated to continue losing weight. And a majority, 42 (91%) who participated in a telephone interview said that they preferred to get messages on their cell phone due to accessibility and convenience. A minimum of one message per day delivered at approximately 8:00 A.M. was deemed the optimal delivery time and frequency. This was particularly true for weight loss, which many participants reported as a daily struggle that begins every morning. With regards to sustaining weight loss, there was a statistical trend in sustained weight loss at months 1 and 3 in the promotion and prevention framed message groups compared to the control group in both the intent-to-treat and evaluable case analyses. Clinically, there was a significant decrease in mean weight of approximately 5 pounds at month 3 in the promotion and prevention groups compared to the control. Additionally, effect sizes indicated a large effect of the intervention on sustaining weight loss in the promotion and prevention groups relative to the control group.</p><p>Conclusion: Overall results showed that at the continued response phase of the behavioral change process, it was feasible to design an application to deliver promotion and prevention framed weight loss sustaining messages. In particular, prevention framed messages may have been more useful in helping participants sustain weight loss. Though there was less than 80% power to detect a statistically significant difference, the observed effect sizes in this study were significant and demonstrated a large effect of the promotion and prevention interventions on sustaining weight loss relative to control. Furthermore, there was a clinically significant increase in mean weight loss and in the number of people who sustained weight loss in the promotion and prevention intervention groups compared to control.</p><p>These findings may serve as a reference for future interventions designed to help people thwart relapse and transition from a state of sustaining recent weight loss behaviors to a state of maintenance. Technological tools such as this SMS intervention that are constructed and guided by evidence-based content and theoretical constructs show promise in helping people sustain healthy behaviors that can lead to improved health outcomes.</p> / Dissertation

This study focuses on persuasive design concerning the household users&rsquo / energy saving behavior while using electrical household appliances for the housework. Household users form a balance at home determined by the household resources they have, and they do not want to change this fragile balance because it is established as a result of household users&rsquo / habitual behavior. It is crucial to persuade household users to save energy at home without disturbing the balance among resources. Persuasion becomes an effective tool at this stage. The study provides an efficient reallocation of the resources for energy saving behavior, which is supported by household resource reallocation and persuasion literature, and an empirical study.

Prior research suggests that fear of cancer recurrence is very common among cancer survivors. This study examined the extent to which Protection Motivation Theory variables of threat appraisal and coping appraisal accounted for differences in fear of recurrence and performance of health behaviors in cancer patients who recently completed treatment. It was hypothesized that greater fear of recurrence would be related to a combination of high threat appraisal and low coping appraisal. Also, it was hypothesized that higher rates of health behaviors would be related to higher threat appraisals for cancer recurrence and higher coping appraisals for reducing risk of recurrence by improving diet or exercising. A sample of 155 early-stage breast cancer patients (mean age = 59 years) who completed surgery, chemotherapy, and/or radiotherapy between 6-24 months previously (mean = 12 months) completed measures of fear of recurrence, threat appraisal (perceived risk and severity of a potential cancer recurrence), fruit and vegetable intake in the past month, exercise for the past week, and coping appraisal (perceived response efficacy and self-efficacy to perform diet and exercise recommendations to reduce recurrence risk). Basic demographic and clinical information was also collected. The study findings supported the hypothesis that the combination of threat and coping appraisal beliefs explain which breast cancer survivors report higher fear of recurrence. However, the observed results did not support the hypothesized interaction between threat and coping appraisal for predicting either diet or exercise habits. Instead, coping appraisal alone predicted both fruit and vegetable consumption and exercise habits. Future research should focus on examining these relationships longitudinally and further assess coping appraisal and how it impacts fear of recurrence.

A survey of residential solar photovoltaic (PV) adopters in Texas was administered and the results are presented and discussed. A 40% response rate was achieved and 365 complete responses were received. In addition to demographics, the survey uncovered aspects related to the decision-making process, information search, financial attractiveness of PV, and post-installation experience. Peer-effects did not have a large influence on the adoption of residential PV in Texas, but the potential for increasing the number of communication/information channels to increase the adoption rate of PV exists. Adopters experienced little uncertainty at the time of PV installation because sufficient dependable information was available during the search process. Overall, they are satisfied with PV. Contextual factors, such as income and the ability to purchase a PV system rather than lease one, influence behavior. Those who decreased electricity consumption post-adoption were more motivated to adopt by environmental concern and a general interest in energy than those who increased electricity consumption post-adoption. Those who experienced behavior changes also experienced an increase in awareness of electricity use post-adoption, while those who did not experience a behavior change reported no change in awareness post-adoption. Change in awareness of electricity use is less dependent on the attitudinal and contextual factors, such as environmental concern, motivation for adoption, age, and income, that influence consumption change. The potential for further analysis of the survey results is great and will likely yield additional conclusions about the consequences of the adoption of PV. Coupling the survey results with historical electricity bill data will yield stronger conclusions about behavior change. Surveying geographical areas outside of Texas is recommended. / text

Research about Libyan female leadership is scarce. This thesis is the first qualitative study to explore, describe and explain the experiences and perspectives of Libyan female leaders in senior positions, within the Ministries of Education and Health. It introduces a deep study, rich in information which reflects the female leadership phenomenon that has been never done before in the Libyan context. A qualitative methodology, semi-structured interviews and a narrative approach were selected. This provided the researcher with a deep insight into the individual's stories. This research also used Multifactor questionnaire as a supporting instrument. One of the contributions of this thesis is its investigation of the role of `Glass Ceiling', `Glass Cliff concepts among Libyan female leaders. Both concepts in practice work slightly different, because of the Arabic concept of Wasta. Wasta relates to social relationships can have a negative impact making the glass ceiling harder to break and glass cliff more risky. However it can also have a positive impact making the glass ceiling more easily breakable and glass cliff less risky. A further contribution is the application of a feminist and constructiyist research philosophy which currently appears to be unique in Libyan studies. In addition, this thesis illustrated the support of Islam and Libyan leader Muammer AlGaddfi for women. This makes Libya different from other Arabic and Muslim countries. This thesis challenged the perception in Western literature that Arabic women are invisible in many Arabic countries; by providing evidence of senior women leaders and their experiences or voices being recorded. The Libyan female leaders stated that they tend to apply different leadership styles which could be interpreted as being in the transactional transformational distribution and authentic leadership traditions. Concepts of power, leader -manager differences, situations such as family circumstances and national cultures were explored to help the researcher to interpret and understand the stories of Libyan female leaders.

Bakgrund: Fetma är en folkhälsosjukdom som drabbar många barn. Barn som är överviktiga och feta förblir det också vanligtvis som vuxna. Fetma kan ge följdkomplikationer som diabetes, och hjärt- och kärlsjukdomar. Det gör att ansträngningar bör vidtas för att motverka barnfetman.  Skolor anses vara ett bra forum för att upptäcka och hjälpa barn med, eller med risk för, fetma. Syfte: Syftet med den här studien är att beskriva interventioner som gett positiva resultat vad gäller viktreducering och livsstilsförändring i samband med barnfetma. Studien har begränsats till att studera artiklar som rör barn i åldrarna 2-16 år. Metod: Studien är en litteraturstudie där tio vetenskapliga artiklar valdes ut för att analyseras och som sedan generade i ett resultat som presenterar interventionernas effekt mot barnfetma. Resultat: Interventioner som genomfördes i skolor tillsammans med elever och lärare och interventioner som involverade barn och föräldrar visade alla på signifikanta minskningar i BMI eller i ökad kunskap om nutrition och motion. Slutsats: Skolor bör bli bättre på att använda skolgårdar för fysisk aktivitet och lärare bör utbildas för att kunna ge barnen tillräckligt med kunskap för att göra bra livsval. Föräldrar bör iaktta sitt eget beteende till mat och fysisk aktivitet eftersom det leder till en minskad risk för att barnen drabbas av övervikt och fetma. / Background: Obesity is a public health disease that affects many children. Children who are overweight and obese, is usually also as adults. Obesity can cause complications such as diabetes and cardiovascular disease. Efforts towards that prevalence will increase must be done. Schools are considered a good forum to identify and help children with, or at risk for, obesity. Objective: Identify interventions and studies of interest to prevent childhood obesity, for children aged 2-16 years, with positive results in weight reduction or other lifestyle changes. Methods: The study is a literature review where ten scientific papers were selected to be analyzed and then generated in a result that presents the interventions' effect against childhood obesity. Results: Interventions were made in schools together with students and teachers, and interventions involving children and parents, they showed all the significant reductions in BMI or increased knowledge about nutrition and exercise. Conclusions: Schools should be better to use the schools playgrounds for physical activity and authority of the teachers to provide children with enough knowledge to make good healthy choices. Parents should observe their own behavior to food and physical activity for children to have a reduced risk of becoming overweight or obese.

Within pediatric mental health, of the only 25% of children with emotional and behavioral disorders that receive mental health services many receive treatments and interventions that are not based upon evidence. The question remains how to support mental health clinicians to utilize the evidence we have regarding the treatment of pediatric mental health disorders. Research findings consistently demonstrate that there are a variety of successful interventions which can be effective in changing clinical behaviors. However, further research is required to develop and validate a coherent theoretical framework of health professional behavioral change to better inform the choice of interventions. This study applied theory-driven approaches to predict pediatric mental health clinician behavior in the utilization of evidence-based practice. A national web based survey of pediatric outpatient mental health clinicians (N=154) applying the Theory of Planned Behavior and Operant Learning Theory (Habit and Reinforcement) was conducted. The clinical behaviors of interest were: 1) Recommendation of medication consultation/prescription for the treatment of ADHD; 2) Recommendation of parent training regarding child behavior management; and 3) Utilization of evidence-based group therapy with the specific objective of reducing wait lists. Behavioral intention, a theoretically derived measure, was the main outcome measure. Habit uniquely accounted for 61%, 20% and 25% of the variance, respectively in the three behaviors of interest (parent management, medication, and group treatment for waitlist management). Attitude uniquely contributed a further 5% of the variance in intention in medication consultation/prescription while Reinforcement uniquely explained an additional 10% of the intention to use group treatment. Habit is the single greatest predictor of pediatric mental health clinician behavioral intention in the utilization of evidence-based practice. Habit describes why clinicians are engaging in a behavior (it is what they’ve always done), but the other theoretical predictors tell us something about how to change this habit.

This thesis is an investigation of the self-reported health behaviour changes made by adults in the Canadian Community Health Survey 2007, categorized by BMI category. Descriptive analyses and forward stepwise regression were performed to determine variables associated with HBC. The final sample n = 111,449. Overall, 58% of individuals had made a HBC in the past year. Increased exercise was the most common HBC (29%), followed by improved eating habits (10%) and losing weight (7%). Only 51% experienced barriers to HBC; lack of will power was most commonly cited. Overweight and obese individuals were more likely to undertake HBC. In the regression model, opinion of own weight was the strongest predictor of HBC, followed by fruit and vegetable consumption, number of consultations with doctor, smoking status, and perceived health.

In medical settings, a teachable moment (TM) has been described as an event which may lead to psychological changes prompting individuals to engage in health promoting behaviors. A cancer screening (CS) has been suggested as a potential TM because several types of positive health behavior change (HBC), ranging from dietary changes to smoking cessation, have been linked to CS. However, most research has examined the TM in CS settings using cross-sectional and prospective methodologies and has lacked a theory-driven model. Moreover, few intervention studies have attempted to capitalize on the potential TM in CS settings. In light of this, the primary purpose of this study was to examine the potential for routine ovarian CS to serve as a TM to enhance the potential for HBC using a theory-driven conceptual model of a TM. A prospective, longitudinal design was used to track changes in positive affect, self-efficacy (SE), HBC intentions and HBC following participation in routine ovarian CS. The impact of a brief, written intervention intended to enhance SE to engage in HBC was also examined. There were three total study assessments: the baseline (T1), 24-hour follow-up (T2), and one month follow-up (T3) assessment. Results indicated positive affect and positive consequences of screening increased over time (p’s<.01) and increases in positive affect were positively associated with greater healthy diet HBC. Additionally, greater positive consequences of screening at T2 predicted greater exercise HBC. No significant changes were observed in exercise or healthy diet intentions over time; there were no differential effects based upon the intervention for positive affect, SE, HBC, or HBC intentions (p’s>.05). Healthy diet SE and exercise SE remained stable (p>.05) but were found to be a robust predictor for both exercise and healthy diet HBC intentions. While several of our hypotheses were supported, the brief health information intervention did not appear to impact SE, HBC intentions, or actual HBC. To better equip health providers in CS settings, studies should continue examining both the potential for CS settings to serve as a TM to enhance HBC and how receipt of a normal test result impacts this potential.

The education system in Guatemala struggles to meet the needs of students with disabilities. There are often not enough trained special educators to meet the demand. In addition, general educators are often not trained to adequately meet diverse needs in their classrooms. Thus, schools are often unable to fully meet the needs of students with disabilities. This study sought to identify a method by which teachers could be virtually trained on a teacher behavior (i.e., specific praise) that could help meet diverse student needs. A multiple probe design across participants was used to determine if virtual training could be effective in training teachers to use new teacher behaviors. The results of the study are discussed, along with implications for future research.