Given the proliferating aging population, increasing moderate-to-vigorous physical activity (MVPA) and exercise is critical because it enhances overall well-being and reduces the rates of many adverse age-related health conditions. However, intervention efforts to establish sustained changes in MVPA have yielded limited success due their sole focus on conscious factors (e.g., changing goals and intentions). Thus, older adults continue to represent the highest proportion of sedentary adults, despite their knowledge of the widespread health benefits associated with PA and exercise or even their intentions to engage in such behaviors. Consequently, the benefits of PA and exercise are not being fully realized and health problems perpetuate. Developing evidence-based interventions that establish sustained changes in MVPA and exercise behaviors in older adults is a major public health priority, but this requires going beyond social-cognitive constructs. The broad goal of my dissertation is to advance scientific understanding about the neural systems associated with changes in MVPA behaviors among sedentary older adults. Emerging evidence indicates that nonconscious processes also regulate exercise behaviors, stemming from accumulated affective responses from past exercise experiences (e.g., pleasant vs unpleasant). Grounded by current understanding about affect's role on decision-making, the present study hypothesized that physiological changes induced by single bouts of PA serve as somatic markers in the brain that guide future PA-related behaviors. Specifically, my dissertation extended previous research by testing whether acute exercise responses in affect-related brain systems predict PA behavior change following a 3-month exercise intervention. This hypothesis is supported by prior research indicating that self-reported changes in affect (i.e., pleasant/unpleasant feelings) during moderate-intensity exercise reliably predicts future MVPA behavior. The results of my dissertation advances previous findings by investigating how these affective responses to exercise are represented in the brain and how they relate to PA behavior change. I tested my central hypothesis through the following two specific aims: In Specific Aim 1, I investigated whether the acute physiological and neural responses to exercise were related to the subjective experience of exercise in older adults. Healthy, low-active, older participants (N = 34, Age = 67.2 years, 21 females) completed an acute exercise procedure consisting of two within-subjects exercise conditions occurring on separate counter-balanced sessions. During the active condition, participants cycled at a moderate intensity (65% of maximum heart rate), and during the passive condition, their legs were moved by motorized pedals on the same machine and at the same pedal rate as in the active condition. To investigate exercise-related changes in brain function, functional MRI scans were acquired before and after the acute exercise. Additionally, salivary samples were collected throughout the experiment to provide objective biomarkers that have been linked with psychological changes. Finally, participants provided self-reported changes in affect. I found that acute exercise was associated with increases in salivary markers of sympathetic activity and decreases in salivary cortisol levels with no significant differences between conditions. Acute exercise also resulted in observable increases in positive affect with no differences between conditions. Finally, no observable acute exercise-related changes in functional connectivity occurred. In Specific Aim 2, I identified predictors of exercise behavior change from objectively-measured biomarkers and neural systems that are acutely responsive to exercise. After completing the acute exercise sessions, participants began a 3-month supervised exercise intervention. To assess intervention-related changes in unsupervised PA behavior, participants wore a PA monitoring device for 7 days before and immediately after the intervention. Individuals who exhibited a stronger acute functional connectivity response between nucleus accumbens (NAcc) and medial prefrontal cortex (mPFC) before the intervention were more likely to increase their unsupervised levels of MVPA after the intervention. Given the role of NAcc-mPFC circuitry in affect-based decision making and self-referential processing, the present findings suggest that enhanced cognitive appraisal and awareness of affective changes are related to more sustained changes in long term behavior. This study is the first to demonstrate neurobiological evidence supporting the relationship between positive affective responses to acute exercise and long-term changes in exercise behavior. This research advocates the utility of affect-based measures in tailoring exercise interventions for sedentary older adults.

During a period between 2011-2014, Gamification was the next big thing. Nowadays, however, Gamification has been established as a legitimate research topic with several dedicated conferences. This report aims to shed light on the existing literature within the area through a literature review and highlight existing gaps. Further, this paper strives towards showcasing some of the effects that Gamification could have on information security awareness to combat the vast amounts of security-related incidents in today's organizations. Moreover, that security incidents are frequent and often expensive, and sometimes occur due to employee negligence gives organizations incentives to educate its workforce in security training and awareness sessions. Existing empirical research within Gamification and information security delivers belief regarding its beneficial aspects to organizations and employees alike. Through training and education, the number of security-related incidents can be limited. However, research on how Gamification can help foster safe behavior in organizations is a path that remains to be explored in full.

abstract: As the designer is asked to design, create, or simply solve a problem, many factors go into that process. It generally begins with defining the scope or problem that undergoes an iterative process utilizing different tools and techniques to generate the desired outcome. This is often referred to as the design process. Notwithstanding the many factors that influence this process, this study investigates the use of theory for behavior change and its effect on the design process. While social behavioral theories have been extensively discussed in the realm of design, and a well-developed body of literature exists, there is limited knowledge about how designers respond to and incorporate theory into their design process. Fogg’s persuasive design (2003), Lockton’s design with intent (2009) and Tromp’s social implication framework (2011) stand as exemplars of new strategies developed towards design for behavior change that are able to empower designers’ mindsets, providing them with a uniquely insightful perspective to entice change. Instead of focusing on the effectiveness of the design end product, this study focuses on how theory-driven approaches affect the ideation and framing fragment of the design process. A workshop case study with senior design students was utilized with focused observations and post-workshop interviews to answer the research questions. This study contributes by providing a useful method of documenting a behavioral economics theory to the design process in a workshop setting. It also provides insights on how behavioral change theory application can be incorporated in a segment of the design process. / Dissertation/Thesis / Masters Thesis Design 2019

Background: The incidence and prevalence of chronic disease (CD) has increased in recent decades due to the advent of CD management and life-extending technologies. To address this burden on the population and healthcare system, evidence-based CD prevention programs have been developed to reduce the incidence and therefore the prevalence of these diseases. Despite the development and dissemination of effective interventions, African-Americans and Hispanics have disproportionately higher prevalence of CD and associated risk factors and disproportionately lower participation in CD prevention programs. Overweight/obesity and CDs may have intergenerational effects, with overweight adults being more likely to have overweight children who are in turn more likely to become overweight adults with CDs. These dissertative projects sought to disrupt this intergenerational cycle of CD by exploring how to engage people of minority background in CD prevention programs, to determine the acceptability and feasibility of a CD prevention program adapted to social media, the preferred method of health education for women of childbearing age, and to identify areas in Florida that would benefit from a CD prevention program such as this. Methods: Four focus groups of residents of disadvantaged and medically underserved areas and nine key informant interviews with local business owners were conducted using a standardized questionnaire to asses health beliefs, barriers to healthy behaviors, and preferred methods of health communication among the target population. These data were thematically analyzed in Atlas.ti version 8.0. Results of this analysis informed the adaptation of an existing CD prevention program, the national Diabetes Prevention Program (nDPP), to a social media platform, Facebook, to address the needs of the community. The first four weeks of the nDPP were adapted to Facebook using Powtoon and Canva software, were assessed for fidelity by a certified nDPP Lifestyle Coach, and underwent an iterative editing process in collaboration with a community partner, REACHUP, Inc., to ensure cultural appropriateness. Height, weight, and waist circumference were measured pre- and post-intervention via a standardized protocol. Perceived stress, social support, depressive symptoms, and health-related quality of life were also assessed pre- and post-intervention. The final dissertative project utilized the Centers for Disease Control and Prevention and Robert Wood Johnson Foundation’s 500 Cities Data in conjunction with USDHHS locations of existing federally qualified health centers (FQHCs) to identify urban census tracts in Florida with high prevalence of CD and associated risk factors and inadequate access to FQHCs. Results: Overall, residents and business owners in medically underserved areas of west central Florida identified distrust of medical professionals and pharmaceuticals as a barrier to receiving health care. Lack of transportation and safe recreational areas, were barriers to participating in health behaviors, though participants were concerned about how to prevent and manage diabetes, heart disease, and cancer. The preferred identified method of health communication for women of childbearing was social media, with Facebook being the most used social medium. The nDPP was chosen for adaptation to Facebook because it addressed most of the concerns of the target community. This Facebook-based adaptation of the nDPP, called HealthyLIFE, had no statistically significant results, though there were encouraging reductions in depressive symptom, perceived stress, and health-related quality of life. Tampa, St. Petersburg, Lakeland, and Jacksonville were the urban areas of Florida with the greatest prevalence of CD and associated risk factors, with areas with low insurance, low physical activity, poor physical health, high levels of poverty, high concentration of people of minority background, and high prevalence of stroke and diabetes were statistically significantly more likely to be within 0.5 miles of an FQHC. Discussion: The results of this dissertation demonstrate the need for qualitative research to inform interventions to disrupt the etiology of chronic disease at the population level, particularly for people of minority background and low socioeconomic status who may experience greater barriers to participating in healthy behaviors and accessing preventive healthcare services. Integrating this type of data into the design and implementation of chronic disease prevention programs and targeting these programs to geographic areas with high prevalence of CD and associated risk factors can increase uptake by populations with historically low participation in these programs. With FQHCs serving less than 25% of urban census tracts with high prevalence of chronic disease and associated risk factors, there is a need for cost-efficient, effective, scalable, and accessible chronic disease prevention programs like HealthyLIFE to improve population health and reduce health disparities between racial and socioeconomic groups.

Indiana University-Purdue University Indianapolis (IUPUI) / The smoking rate of low-income pregnant women is almost 4 times the rate for higher-income women. A better understanding of smoking within the low-income population is needed. The purpose of this dissertation was to study smoking and related factors for pregnant and postpartum women living in poverty. The first component used Rodger’s evolutionary concept analysis method and uncovered three attributes, four antecedents, and three consequences for smoking cessation. The second (N = 1,554) and third (N = 71,944) components were a secondary data analysis of first-pregnancy Medicaid-eligible women enrolled in the Nurse-Family Partnership program from 2011-2016. The second component explored patterns of smoking and depression and their associations. Eight distinct patterns of smoking and depression were found. Smokers were more likely than nonsmokers to have depressive symptoms at the end of pregnancy (OR = 1.37 [1.04, 1.81] and 12 months post-delivery (OR = 1.93 [1.47, 2.51]. The third component investigated covariates present during early pregnancy and their relationships with smoking status and sought to find best fitting predictive models. Multivariable logistic regression showed cigarette use in the 3 months prior to pregnancy and at program intake were significant predictors for smoking status at the end of pregnancy and 12 months post-delivery. Interactive Matrix Language, Structured Query Language, and iterations of logistic regression identified 5 covariates (high school education, cigarette use prior to pregnancy, smoking status at pregnancy baseline, depression, and self-mastery) for the best fitting model at the end of pregnancy and three additional covariates (post-secondary education, marital status, and race) for the 12 months post-delivery model. The area under the receiver operator characteristic curve was 0.9681 for the end of pregnancy model and 0.9269 for 12 months post-delivery model, indicating excellent prediction ability of the models. Results can be integrated in smoking prevention education, screening, and cessation intervention programs.

No description available.

Over one third of breast cancer survivors report “fear of recurrence” as the primary concern after diagnosis and treatment. Behavior changes such as exercise and weight loss post cancer may reduce recurrence risk. How perceived recurrence risk affects behavior change is unknown. We evaluated this association in the Breast Cancer Survivorship Study, a cross-sectional study of 301 breast cancer survivors. Data on perceived recurrence risk (local and distant) and health behavior change (alcohol, exercise, nutrition, smoking, sun exposure, supplement use, weight) were assessed by mailed questionnaire. Multivariable logistic regressions were used to evaluate associations between perceived recurrence risk and health behavior change, and multinomial logistic regression to assess direction of change. 47.6% of women perceived their local recurrence risk <10%, while 36.3% perceived distant between 10-30%. Participants mean age was 60 years and had predominantly early stage cancer. Over 90% of women reported making a behavior change. Significant associations were found between higher perceived recurrence risk and behavior changes of nutrition (OR 3.1, 95% CI 1.6-6.3) and sun exposure (OR 2.5, 95% CI 1.2- 5.0). Exploratory direction of change analyses found women with higher perceived recurrence risk were more likely to make positive changes in nutrition (OR 4.0, 95% CI 1.9-8.2) and sun exposure (OR 2.5, 95% CI 1.2-5.2). Overall, we found trends that women are likely to make specific behavior changes as their perceived recurrence risk increases. Findings provide a baseline for future research to identify survivors more likely to make behavior changes that affect their long term health.

Access to safe water, sanitation, and hygiene (WASH) is a fundamental human right and a critical component of public and environmental health. Inadequate access to WASH facilities and practices can give rise to preventable diarrheal and waterborne diseases, which can have severe consequences on individuals' health and well-being. This is especially true in low- and middle-income countries such as India. To address these issues, the S.M. Sehgal Foundation identified water quality and hygiene needs in Bihar, India, and thus launched a behavior change intervention called "WASH for Healthy Homes." The intervention aimed to promote the use of silver-ceramic pot filters and safe handwashing practices in five communities of the Vaishali District. While behavior change is a common approach to address WASH issues, evaluating the outcomes of such interventions is crucial for determining the most effective strategies and conditions under which they can be successful. Therefore, this study assessed the effectiveness of the WASH for Healthy Homes intervention and identified factors that influenced its success. A mixed methods approach was utilized that combined statistical analyses of pre- and post-intervention survey data with a thematic analysis of interview and focus group discussion data. Results demonstrated that the intervention was successful in increasing the adoption of the silver-ceramic pot filter and overall safe handwashing practices within the study communities. Success of the WASH for Health Homes intervention was facilitated by participants' health concerns, trust in the field coordinator and social peers, the aesthetic appeal of the treated water, and repeated intervention messaging. However, adoption of intervention behaviors was hindered by several factors, including economic barriers, gender roles in decision-making, the effects of children and elderly in the household, and low attendance during intervention sessions. The research findings provide valuable insights that can help nonprofits better design and execute behavior change interventions, especially in the face of increasing WASH challenges. / Master of Science / Access to safe water, sanitation, and hygiene is a basic human right and critical for human health. Unfortunately, many people, especially those in low- and middle-income countries like India, lack adequate access to these facilities, leading to waterborne diseases and other health problems. To address this issue, the S.M. Sehgal Foundation launched a behavior change program called "WASH for Healthy Homes" to promote the use of water filters and safe handwashing practices in rural Bihar, India. To determine the success of the intervention and identify factors that influenced its effectiveness, this study used a variety of methods including statistics, interviews, and focus group discussions. Results showed that the program was successful in increasing the adoption of the filter and safe handwashing practices. Success was due to participants' health concerns, trust in the field coordinator and their peers, the aesthetic appeal of the filtered water, and repeated messaging. However, there were also barriers to adoption, such as economic barriers, gender roles, and low attendance during intervention sessions. These findings are important for nonprofits to better design and execute behavior change interventions in the face of growing WASH challenges.

INTRODUCTION: Worksite health promotion programs (WHPP) promote maintenance and changes of health-related behaviors of employees. Some companies opt to contract with a third party provider to implement a WHPP. PURPOSE: This study evaluated the participation rates, availability and use of health coaching, and changes in biometric data over a 2-year time period of employees in 13 companies for whom the WHPP was implemented by Wellness Corporate Solutions (WCS). METHODS: We had 2 years of biometric, health risk appraisal (HRA), or health coaching data on 4,473 employees. The statistical analysis included biometric screening data (percent body fat, body mass index (BMI), total cholesterol (TC), high- and low-density lipoproteins (HDL-C, LDL-C), TC/HDL ratio, triglycerides, glucose, systolic and diastolic blood pressures (SBP and DBP)) from all 13 companies and health coaching data from five companies. RESULTS: Employee participation rates of the 13 companies ranged from 35% to 75%. Five of the 13 companies provided voluntary telephonic health coaching to employees participating in their WHPPs. Of those employees for which we had 2-year data, 125 (12.9%) actually participated in health coaching. Only one of the 13 companies demonstrated improvement in all 10 biometric measurements and 1 company demonstrated improvement in only one biometric measurement. The biometric measurements that showed the greatest improvements over time were triglycerides, blood pressure, BMI, and TC. There was no association found between the number of variables that improved and employee participation rate (p = 0.8814) or the type of incentives offered to employees (p = 0.1389). Availability and use of health coaching did not appear to affect the number of variables that improved. Compared to employees who did not use health coaching, there were significantly greater changes in DBP, HDL-C, and BMI (p < 0.05) in employees who used health coaching. The magnitude of change in variables of interest was dependent, in part, on the baseline value. CONCLUSIONS: Voluntary participation in WHPPs results in positive changes in health-related biometric variables. Health coaching can positively affect the magnitude of change in some biometric variables and the magnitude of change is likely related to the baseline value and the frequency of coaching interactions. Further research should evaluate the benefits of various forms and frequencies of health coaching. Worksite health promotion programs and health coaching may also have a positive impact on other variables (e.g., employee attitudes and morale) not addressed in this study.

Yes / Background: Understanding the factors that make it more or less likely that healthcare practitioners (HCPs) will perform certain patient safety behaviors is important in developing effective intervention strategies. A questionnaire to identify determinants of HCP patient safety behaviors does not currently exist. This study reports the development and initial validation of the Influences on Patient Safety Behaviors Questionnaire (IPSBQ) based on the Theoretical Domains Framework. Methods: Two hundred and thirty-three HCPs from three acute National Health Service Hospital Trusts in the United Kingdom completed the 34-item measure focusing on one specific patient safety behavior (using pH as the first line method for checking the position of a nasogastric tube). Confirmatory factor analysis (CFA) was undertaken to generate the model of best fit. Results: The final questionnaire consisted of 11 factors and 23 items, and CFA produced a reasonable fit: χ2 (175) = 345.7, p < 0.001; CMIN/DF = 1.98; GFI = 0.90 and RMSEA = 0.06, as well as adequate levels of discriminant validity, and internal consistency (r = 0.21 to 0.64). Conclusions: A reliable and valid theoretically underpinned measure of determinants of HCP patient safety behavior has been developed. The criterion validity of the measure is still unknown and further work is necessary to confirm the reliability and validity of this measure for other patient safety behaviors.