Carine MESLOT, équipe ThEMAS, soutiendra sa thèse le vendredi 2 décembre 2016 à 15h00.
"Factors and Cue-dependent plans in Health Behaviours : Applications to Physical Activity and Medication Adherence"
Lieu : UFR PhITEM Physique, Ingénierie, Terre, Environnement, Mécanique, Bâtiment A, Salle de TD A117 (1er étage),
126 rue de la piscine – Domaine Universitaire, 38400 St Martin d’Hères
Sous la direction de :
Benoît Allenet, directeur de thèse
Aurélie Gauchet, co-encadrante de thèse, LIP
Monsieur Olivier DESRICHARD, Professeur à l’Université de Genève, Rapporteur
Monsieur Greg DÉCAMPS, Maitre de Conférences - HDR à l’Université de Bordeaux, Rapporteur
Monsieur Benoît ALLENET, Professeur à l’Université Grenoble Alpes, Directeur de thèse
Monsieur Nikos L. D. CHATZISARANTIS, Professeur à Curtin University, Examinateur
Madame Aurélie GAUCHET, Maitre de Conférences à l’Université Grenoble Alpes, Co-Encadrante de thèse
Monsieur Martin S. HAGGER, Professeur à Curtin University, Examinateur
Individuals do not always enact their intentions into behaviours, which may lead to severe outcomes especially in health-related fields. Self-regulation strategies, like cue-dependent plans interventions, have shown efficiency to help to counter the intention-behaviour gap. Yet, no review has been realised recently to bring a qualitative and quantitative analyses of this effect.
Firstly, we carried out a qualitative review to evaluate the effectiveness of cue-dependent planning intervention to increase health-related behaviours. We included 329 studies with experimental and prospective designs that measured or evaluated the effect of cue-dependent plans (e.g. implementation intention, action planning, coping planning) on health-related behaviours, among general, clinical and student population. The qualitative analysis revealed for instance that implementation intentions were used in majority, even if the if-then format was not systematically adopted. However, we noticed confusion between the terminologies of the plans and the theories. A quantitative review will be realised to evaluate the effect size and the moderators that could magnify or diminish the effects of cue-dependent planning interventions on health-related behaviours.
Secondly, we presented two studies that tested the effectiveness of cue-dependent planning interventions on physical activity, which was the most represented health outcome in cue-dependent planning interventions, according to our review. Motivational (mental simulation) and volitional (implementation intention) interventions were combined to promote physical activity participation. The first study, adopting a cluster randomised controlled trial design among students, did not show any significant effect neither of the mental simulation plus implementation intention intervention, nor of the implementation intention intervention compared to the control condition. The second study adopted a more rigorous methodology with a full-factorial randomised controlled design, with a larger sample and objective measures of physical activity (attendance to gym centre). Nevertheless, the study revealed no statistically significant main or interactive effects of the mental simulation and implementation intention conditions on physical activity outcomes. Findings were not in line with previous research that showed effects of cue-dependent plans to promote physical activity. This adds to the necessity of identifying the moderators of these interventions in health behaviours.
Thirdly, cue-dependent planning interventions are needed in illness behaviours. In chronic disease, non-adherence to medication is a public health problem that can lead to negative health outcomes. Even if the patients want to take their treatment, they may, for instance, forget it and fail to enact the behaviour. We tested the ability of an intervention adopting implementation intention and coping planning to promote medication adherence. In a randomized controlled trial, outpatients with cardiovascular diseases were randomly allocated to either an implementation intention and coping planning condition, or to a no-planning control condition. Findings revealed no significant effect of the intervention on medication adherence. However, post hoc moderator analyses showed that the beliefs moderated the effect of the intervention, which was effective in patients with lower necessity beliefs compared to those with higher necessity beliefs. The design used in the study did not enable to test the direct an interactive effect on medication adherence, so it would be necessary to replicate these findings with a full factorial design among patients with cardiovascular diseases.
Fourthly, a medication adherence measure to identify the barriers to medication adherence is needed among chronic patients. Therefore, we developed a medication adherence questionnaire based on semi-structured interviews with patients and caregivers and on literature review (194 items). An expert committee gathered to exclude the non-relevant items (62 items). Then, 116 patients with diabetes mellitus type 2, chronic obstructive pulmonary disease and heart failure filled in the questionnaire. An exploratory factor analysis reduced the scale in a final version with 14 items and 4 dimensions : the general beliefs, the specific beliefs, the management of the treatment, and the relation between the patient and the healthcare system. Showing good psychometric properties so far, the next stage will be to validate the scale among 330 patients against clinical criteria with a confirmatory factorial analysis. Finally, it will be necessary to evaluate the sensibility of the scale with the help of an intervention that will be based on cue-dependent plan. On the long view, this scale may be complementary to cue-dependent planning interventions with the identification of the barriers to medication adherence for each patient, and to propose a tailored intervention, like coping planning to manage the personal barriers to medication adherence.
Up to this point, the studies and the qualitative review showed that it remains important for the interventions to state explicitly the format used, to be clear about the theory and the type of plan used, to adopt full factorial designs when needed, to take into account the intention (by measuring it or manipulating it), and to use manipulation checks, among a sufficient amount of participants. Testing the moderators with the meta-analysis, which is the next step, will enable to know the magnitude of the effect and also to know under which conditions the cue-dependent planning interventions are effective, with the format used, the need of assistance, the presence of boosters, for which follow-up, for which health-related outcome and among which population.
Keywords : Health Behaviour Change Intervention, Implementation Intention, Coping Planning, Action Planning, Medication Adherence, Physical Activity