Date of Award

December 2018

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Nursing

First Advisor

Rachel F Schiffman

Keywords

ecological momentary assessment, health behavior change, osteoporosis, self-management, self-regulation

Abstract

Despite the known associations between unhealthy behaviors and disease, reduced quality of life, and morbidity, individuals struggle to initiate and maintain health behavior change. Self-regulation is a process that includes activities in which people engage to achieve a goal. Poor self-regulation (i.e., inability to set specific, achievable goals; impaired planning skills; limited emotional control) may contribute to unhealthy behaviors across the lifespan. Self-regulation as a concept is inconsistently applied and inadequately understood. The purpose of this secondary analysis of Ecological Momentary Assessment (EMA) data was to develop an in-depth description of self-regulation, as conceptualized in Ryan’s Integrated Theory of Health Behavior Change (2009), during the first three months of a behavior change intervention promoting osteoporosis prevention. Participants were 95 healthy women, ages 40 to 60, with no previous diagnosis of osteoporosis, who received a theory-based, individually-tailored intervention delivered via a smartphone app promoting health behavior change in four areas: calcium intake, physical activity, strength, and balance. The EMAs (each consisting of two questions) provided real-time, ecologically valid measurements of participants self-reported engagement in the osteoporosis preventions areas and, which self-regulation activities were performed. A total of 13,310 EMAs were completed during the 12 weeks. Calcium intake was reported most frequently during this period (n = 7368; 55.4% of all EMAs), followed by physical activity (n = 6038; 45.4% of all EMAs). Goal-setting (self-regulation activity), planning (self-regulation activity), and self-management behaviors (proximal outcome) were the most frequently reported activities across all four prevention areas. The self-regulation activity of tracking was reported at higher frequencies for calcium and physical activity than for balance or strength. For balance and strength, participants were more likely to report engaging in the self-regulation activity of self-evaluation. Findings suggest that participants do not equally pursue multiple prevention areas simultaneously nor do they equally utilize multiple, self-regulation activities. This study’s description of an imperfectly understood concept, frequently incorporated in self-management and health behavior change interventions, suggests that theoretical assumptions of how people pursue change does not coincide with their real-world treatment of the behavior change process. Future research would include self-regulation activity use among different populations with different health risks and conditions. Policy and practice should consider piloting programs that include, at minimum, the self-regulation activities of goal-setting and planning as vital to any health behavior change skillset presented to patients or the public.

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