Schüz et al. 2020 Socioeconomic status moderates the effects of health cognitions on health behaviors within participants- two multibehavior studies - POSTPRINT

Background: Socioeconomic differences in health-related behaviors are a major cause ofhealth inequalities. However, the mechanisms (mediation / moderation) by which socioeconomic status (SES) affects health behavior are a topic of ongoing debate.Purpose: Current research on SES as moderator of the health cognitions - health behavior relation is inconsistent. Previous studies are limited by diverse operationalizations of SES and health behaviors, demographically narrow samples, and between-person designs addressing within-person processes. This paper presents two studies addressing these shortcomings in a within-person multi-behavior framework using hierarchical linear models.Methods: Two online studies, one cross-sectional and one 4-week longitudinal, assessed 1,005 (Study 1; Amazon MTurk; US only) and 1,273 participants (Study 2; Prolific; international). Self-reports of multiple SES indicators (education, income, occupation status; ZIP code in Study 1), health cognitions (from the Theory of Planned Behavior) and measures of 6 health behaviors were taken. Multilevel models with cross-level interactions tested wither the within-person relationships between health cognitions and behaviors differed by between-person SES .Results: Education significantly moderated intention-behavior and attitude-behavior relationships in both studies, with more educated individuals showing stronger positive relationships. In addition, ZIP-level SES (Study 1) moderated attitude-behavior effects such that these relationships were stronger in participants living in areas with higher SES. Conclusions: Education appears to be an important resource for the translation of intentions and attitudes into behavior. Other SES indicators showed less consistent effects. This has implications for interventions aiming at increasing intentions to change health behaviors, as some interventions might inadvertently increase health inequalities.

Schüz et al. 2020 Socioeconomic status moderates the effects of health cognitions on health behaviors within participants- two multibehavior studies - POSTPRINT

Background: Socioeconomic differences in health-related behaviors are a major cause ofhealth inequalities. However, the mechanisms (mediation / moderation) by which socioeconomic status (SES) affects health behavior are a topic of ongoing debate.Purpose: Current research on SES as moderator of the health cognitions - health behavior relation is inconsistent. Previous studies are limited by diverse operationalizations of SES and health behaviors, demographically narrow samples, and between-person designs addressing within-person processes. This paper presents two studies addressing these shortcomings in a within-person multi-behavior framework using hierarchical linear models.Methods: Two online studies, one cross-sectional and one 4-week longitudinal, assessed 1,005 (Study 1; Amazon MTurk; US only) and 1,273 participants (Study 2; Prolific; international). Self-reports of multiple SES indicators (education, income, occupation status; ZIP code in Study 1), health cognitions (from the Theory of Planned Behavior) and measures of 6 health behaviors were taken. Multilevel models with cross-level interactions tested wither the within-person relationships between health cognitions and behaviors differed by between-person SES .Results: Education significantly moderated intention-behavior and attitude-behavior relationships in both studies, with more educated individuals showing stronger positive relationships. In addition, ZIP-level SES (Study 1) moderated attitude-behavior effects such that these relationships were stronger in participants living in areas with higher SES. Conclusions: Education appears to be an important resource for the translation of intentions and attitudes into behavior. Other SES indicators showed less consistent effects. This has implications for interventions aiming at increasing intentions to change health behaviors, as some interventions might inadvertently increase health inequalities.

Health Cognitions, Decision-Making, and Behavior

Social comparison processes exert a ubiquitous influence on people’s thoughts, decisions, and behaviors related to their health. Moreover, many comparative perceptions (e.g., perceived personal risk, estimation of social norms) are miscalibrated with reality. The way in which people compare themselves with others on a wide variety of dimensions can have important implications for their long-term health, and health communications may be more influential to the extent that they heed people’s interest in social comparisons and acknowledge the role of biases in these comparisons. This chapter reviews the various influences that social comparisons can have on health outcomes, with a particular focus on health cognitions, decision-making, and behavior.

Part II: Psychological Factors In Delayed And Failed Recovery and Unnecessary Disability

Part two of this two-part article on psychological factors in delayed and failed recovery and resultant unnecessary work disability (DFRUD) considers both conceptual and practical interventions, including specific evaluation and treatment methods. The authors propose five categories of intervention for DERUD: 1) advance and operationalize our knowledge base; 2) make conceptual and practical shifts in our approaches; 3) place greater emphasis on prevention; 4) improve recognition of potentially difficult cases, and 5) apply specific management approaches and tools. Further, the authors propose conceptual and practical changes that should be made: Eliminate the dualistic separation of mind and body and the scientific reductionism that follows; change the focus from disability to capability; reduce improper workers’ compensation claims; improve the administrative and medical management of valid claims; enhance collegiality and communication among all stakeholders; and adopt a cost-utility vs absolute cost approach. The overarching goals of managing DFRUD include optimizing administrative and clinical treatment of the worker; protecting all stakeholders from excess; and overcoming barriers to intervention. To these ends, three activities can optimize the process: Intervene early; avoid iatrogenicity (ie, shorten claim durations and reduce costs); and stratify risk and employ stepped care. Barriers to meaningful intervention in DFRUD include questions of jurisdiction and responsibility for management (eg, does management of DFRUD fall to insurers or clinicians); who will pay; what are the maladaptive health cognitions and/or psychiatric comorbidities; and how can clinician behavior be altered to implement evidence-based practice?

Socioeconomic Status Moderates the Effects of Health Cognitions on Health Behaviors within Participants: Two Multibehavior Studies

Background Socioeconomic differences in health-related behaviors are a major cause of health inequalities. However, the mechanisms (mediation/moderation) by which socioeconomic status (SES) affects health behavior are a topic of ongoing debate. Purpose Current research on SES as moderator of the health cognitions–health behavior relation is inconsistent. Previous studies are limited by diverse operationalizations of SES and health behaviors, demographically narrow samples, and between-person designs addressing within-person processes. This paper presents two studies addressing these shortcomings in a within-person multibehavior framework using hierarchical linear models. Methods Two online studies, one cross-sectional and one 4 week longitudinal, assessed 1,005 (Study 1; Amazon MTurk; USA only) and 1,273 participants (Study 2; Prolific; international). Self-reports of multiple SES indicators (education, income, occupation status; ZIP code in Study 1), health cognitions (from the theory of planned behavior), and measures of six health behaviors were taken. Multilevel models with cross-level interactions tested whether the within-person relationships between health cognitions and behaviors differed by between-person SES. Results Education significantly moderated intention-behavior and attitude-behavior relationships in both studies, with more educated individuals showing stronger positive relationships. In addition, ZIP-level SES (Study 1) moderated attitude-behavior effects such that these relationships were stronger in participants living in areas with higher SES. Conclusions Education appears to be an important resource for the translation of intentions and attitudes into behavior. Other SES indicators showed less consistent effects. This has implications for interventions aiming at increasing intentions to change health behaviors, as some interventions might inadvertently increase health inequalities.