Author: Austin Baldwin

Have you ever set your alarm to exercise in the morning but didn’t get out of bed, or planned to go to the gym in the evening but ended up going home instead? The key to following through on plans and intentions may be quite simple. Mental contrasting is a simple cognitive technique in which people specify a goal they are trying to reach, and then they identify and imagine the most positive outcome they expect from reaching their goal and the most relevant obstacle they are likely to face in trying to realize their goal. This simple technique was recently tested in a randomized controlled trial (RCT) and the results were published in Health Psychology.

Theoretically, mental contrasting works because the contrasting of benefits and obstacles makes an individual’s efforts to change their behavior more realistic and helps to maintain motivation when challenges inevitably occur. Mental contrasting has previously been shown to be effective in a number of different contexts. In this study, the researchers tested whether adding a mental contrasting task to making plans and setting goals for regular exercise would lead to more exercise over a four-week period. In addition, they tested the possibility that focusing the mental contrasting on the affective benefits and obstacles of exercise (e.g., it will result in more energy, it will be unpleasant while doing it) would be more effective than either focusing on instrumental benefits and obstacles (e.g., it will improve my health, it will require too much time) or a standard mental contrasting without any particular focus. This hypothesis is based in the growing evidence showing that affective factors, such as how people feel during and after exercise, are critical determinants of regular exercise.

Participants who were randomly assigned to do the mental contrasting with an affective-focus reported significantly more weekly minutes of physical activity at the end of four weeks than participants in the instrumental benefits-focused condition or the standard condition. On average, they reported nearly 300 more metabolic equivalent of task (MET) minutes than the other two groups, the equivalent of about 60 additional minutes per week of brisk walking.

The findings from this study are valuable for at least three reasons. First, this was a well-designed RCT. To test the effects of intervention techniques on behavior, the RCT is the gold standard design. Thus, we can have greater confidence that the affect-focused mental contrasting has a causal effect on exercise behavior. Second, the mental contrasting technique used here is simple and straightforward, and it could easily be used as standard practice to increase the likelihood that people follow through on their exercise plans. Third, the findings add to the growing body of evidence for the importance of affective factors in the decisions people make about exercise.

Reference. Ruissen, G.R., Rhodes, R.E., Crocker, P.R.E., & Beauchamp, M.R. (2018). Affective mental contrasting to enhance physical activity: A randomized controlled trial. Health Psychology, 37, 51-60.

Although the Food and Drug Administration (FDA) has approved a vaccine that protects against the human papillomavirus (HPV) – a sexually transmitted virus that can cause several cancer types, including cervical cancer, current vaccination rates for the 3-dose series among US adolescents are low (39.7% for girls, 21.6% for boys).

In a recent paper our group published in the journal Patient Education and Counseling, we describe a new mobile app-based intervention we developed to address the problem of low HPV vaccination rates. The app is based on self-persuasion, the process of generating one’s own arguments for engaging in a specific behavior. Self-persuasion may be a particularly useful strategy for increasing adolescent HPV vaccination rates because many parents of adolescents are undecided or hesitant about the vaccine, and using parents’ own arguments for the vaccine may help them decide.

In this paper, we report on the development of the mobile app to promote parental self-persuasion for adolescent HPV vaccination and the evaluation of whether the app is easy and practical for parents to use. As part of the research study, parents viewed an informational video about HPV and the vaccine, answered a number of questions about different topics related to the vaccine, and then verbalized in their own words why it is important for their adolescent to get the vaccine.

We found that parents rated the app as easy to use and helpful for thinking about the HPV vaccine. In addition, although most of the parents were undecided about the vaccine when they began the study, 82% of parents reported deciding to get their adolescent vaccinated after using the app.

The self-persuasion app we developed is an excellent example of translating an established and effective behavior change approach – self-persuasion – into an innovative and effective way to impact population health. By developing the intervention within a mobile app, there is strong potential to make the intervention widely available to parents of adolescents who are making decisions about the HPV vaccine.

Reference. Baldwin, A.S., Denman, D.C., Sala, M., Marks, E.G., Shay, L.A., Fuller, S., Persaud, D., Lee, S.C., Skinner, C.S., Wiebe, D.J., & Tiro, J.T. (2017). Translating self-persuasion into an HPV vaccine promotion intervention for safety-net patients. Patient Education and Counseling, 100, 736-741.

In 2006, the Food and Drug Administration (FDA) approved a vaccine for adolescent girls and young adult women that protects against the human papillomavirus (HPV) – a sexually transmitted virus that can cause several cancer types, including cervical cancer. In 2009, the FDA approved the vaccine for adolescent boys and young adult men.
The US government recommends an 80% vaccination rate by 2020, but current rates for the 3-dose series among US adolescents is well below this rate (39.7% for girls, 21.6% for boys), particularly among traditionally underserved adolescents seen in safety-net clinics (uninsured, low-income, and racial and ethnic minorities). Thus, low vaccination rates are an important public health issue.

In a paper our group recently published in the journal JMIR Research Protocols, we describe an innovative project designed to address the problem of suboptimal HPV vaccination rates in safety-net pediatric clinics. Self-persuasion, the process of generating one’s own arguments for engaging in a specific behavior, is an effective behavior change strategy. Moreover, it may be a particularly useful strategy for adolescent HPV vaccination because many parents of adolescents are undecided or ambivalent about the vaccine. Leveraging parents’ own arguments for the vaccine may help to address their indecision or ambivalence. However, it is not yet known how to develop and implement self-persuasion for HPV vaccination in a safety-net clinic setting.

In the paper, we describe the 3-stage project that is funded by the National Cancer Institute to develop and implement a self-persuasion intervention for adolescent HPV vaccination. In the intervention, we will use an iPad application we developed to help parents learn about HPV and the vaccine and to think about and verbalize their own reasons for why getting the vaccine is important. The three stages of the project all have a distinct purpose. In Stage 1, we have conducted formative studies to understand parents’ ability to generate their own arguments for HPV vaccination and to understand how parents and healthcare providers discuss the vaccine with one another. In Stage 2, we will conduct a randomized intervention to understand what aspects of self-persuasion (verbalization, choosing argument topics) are most effective and to identify the optimal approach to self-persuasion in this population. In Stage 3, we will conduct a pilot trial to establish the feasibility of using the iPad-based intervention before a clinic appointment and to determine its effect on parent-provider discussions about the vaccine.

This project is an excellent example of an integration of basic and applied behavioral science to address an important public health issue. From a basic science perspective, the project uses an effective behavior change approach in an innovative way. Plus, the findings from the study will add to our understanding which aspects of self-persuasion are most effective. From an applied science perspective, the project will result a feasible intervention that can be realistically implemented in pediatric clinics. This type of collaboration between basic and applied behavioral science is important to advancing our understanding of how best to address important health issues, like HPV vaccination.

Reference. Tiro, J.A., Lee, S.C., Marks, E.G., Persaud, D., Skinner, C.S., Street, R.L., Wiebe, D.J., Farrell, D., Bishop, W.P., Fuller, S., & Baldwin, A.S. (2016). Developing a tablet-based self-persuasion intervention promoting adolescent HPV vaccination: Protocol for a three-stage mixed-methods study. JMIR Research Protocols, 5, e19.