Many citizens experience ambivalence – having simultaneously positive and negative evaluations – about changing their behaviour towards a more environmentally friendly lifestyle. Based on 36 studies, this study identifies and synthesises the current evidence on how ambivalence impacts environmental behaviours. In most studies, ambivalence is shown to be directly and negatively associated with environmental behaviours, i.e., higher levels of ambivalence are linked to lower levels of environmentally friendly and unfriendly behaviours. This applies to both types of ambivalence: objective (OA) and subjective (SA). Mediator analyses show, in line with the theory, that SA, not OA, drives behavioural change. In addition, results indicate that ambivalence moderates the relationship between independent–dependent variables mainly negatively, for example, by weakening attitude–behaviour relationships. This review shows the potential of ambivalence to facilitate behaviour change: SA about environmentally friendly behaviour can hinder, whereas SA about environmentally unfriendly behaviour can motivate, behaviour change. In addition, this review highlights some significant knowledge gaps in this body of research. A lack of validated standardised measurements of ambivalence makes it challenging to compare studies and reach conclusions about underlying theoretical constructs. Methods, research designs, and theoretical underpinnings need improvement to fully understand ambivalence and progress towards the transition of environmentally friendly behaviours.
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The central goal of this study is to clarify to what degree former education and students' personal characteristics (the 'Big Five personality characteristics', personal orientations on learning and students' study approach) may predict study outcome (required credits and study continuance). Analysis of the data gathered through questionnaires of 1,471 Universities of Applied Sciences students make clear that former Education did not come forth as a powerful predictor for Credits or Study Continuance. Significant predictors are Conscientiousness and Ambivalence and Lack of Regulation. The higher the scores on Conscientiousness the more credits students are bound to obtain and the more likely they will continue their education. On the other hand students with high scores on Ambivalence and Lack of Regulation will most likely obtain fewer Credits or drop out more easily. The question arises what these results mean for the present knowledge economy which demands an increase of inhabitants with an advanced level of education. Finally, implications and recommendations for future research are suggested.
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PurposeThe majority of older patients, scheduled for a cardiac procedure, do not adhere to international dietary intake and physical activity guidelines. The purpose of this study was to explore barriers and facilitators regarding dietary intake and physical activity behaviour change in older patients undergoing transcatheter aortic valve implantation (TAVI).MethodsWe conducted a qualitative study using semi-structured interviews with patients undergoing TAVI. Interviews were analysed by two independent researchers using thematic analysis, the capability, opportunity and motivation behaviour model was used as a framework.ResultsThe study included 13 patients (82 ± 6 years old, 6 females) until data saturation was reached. Six themes were identified, which were all applicable to both dietary intake and physical activity. Three following themes were identified as barriers: (1) low physical capability, (2) healthy dietary intake and physical activity are not a priority at an older age and (3) ingrained habits and preferences. Three following themes were identified as facilitators: (1) knowledge that dietary intake and physical activity are important for maintaining health, (2) norms set by family, friends and caregivers and (3) support from the social environment.ConclusionOur study found that older patients had mixed feelings about changing their behaviour. The majority initially stated that dietary intake and physical activity were not a priority at older age. However, with knowledge that behaviour could improve health, patients also stated willingness to change, leading to a state of ambivalence. Healthcare professionals may consider motivational interviewing techniques to address this ambivalence.
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This chapter helps the reader to define the principles of motivational interviewing (MI) and coaching, understand the intervention and tasks associated with the integrated case management process, relate patient engagement and adherence to motivational coaching and to understand patient-centered preference engagement and share decision-making (SDM) activities. “MI is a person-centered counseling style for addressing the common problem of ambivalence about change”. It is an effective intervention to enhance motivation for behavioral change. While performing MI, the case manager tunes the patient’s process of becoming (more) motivated and the case manager’s process of promoting intrinsic motivation, through four MI processes: engaging, focusing, evoking, and planning. These central processes help the case manager navigate effectively through MI conversations about behavioral change. Both SDM and MI are solidly based on a good and trusting working relationship between patient and case manager.
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Motivational interviewing (MI) may be an effective intervention to improve medication adherence in patients with schizophrenia. However, for this patient group, mixed results have been found in randomized controlled trials. Furthermore, the process of becoming (more) motivated for long-term medication adherence in patients with schizophrenia is largely unexplored
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Socially aware persuasive games that use immersive technologies often appeal to empathy, prompting users to feel and understand the struggles of another. However, the often sought-after standing in another's shoes' experience, in which users virtually inhabit another in distress, may complicate other-oriented empathy. Following a Research through Design approach, we designed for other-oriented empathy - focusing on a partaker-perspective and diegetic reflection - which resulted in Permanent; a virtual reality game designed to foster empathy towards evacuees from the 2011 Fukushima Daiichi nuclear disaster. We deployed Permanent 'in the wild' and carried out a qualitative study with 78 participants in the Netherlands and Japan to capture user experiences. Content Analysis of the data showed a predominance of other-oriented empathy across countries, and in our Thematic Analysis, we identified the themes of 'Spatial, Other, and Self -Awareness', 'Personal Accounts', 'Ambivalence', and 'Transdiegetic Items', resulting in design insights for fostering other-oriented empathy through virtual reality.
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Set up: Focus on ethical agency, of which ethical sensitivity is a part Best practice unit (i.e. a community of practice with inquisitive objectives): cooperation of 12 social workers (of 6 different welfare organizations) and 2 researchers (UAS teachers) Practice based co-research: involving social workers as reflective and inquisitive professionals with regard to their own practice Phenomenological design: focus on (interpreting) experiences
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Background: For patients with coronary artery disease (CAD), smoking is an important risk factor for the recurrence of a cardiovascular event. Motivational interviewing (MI) may increase the motivation of the smokers to stop smoking. Data on MI for smoking cessation in patients with CAD are limited, and the active ingredients and working mechanisms of MI in smoking cessation are largely unknown. Therefore, this study was designed to explore active ingredients and working mechanisms of MI for smoking cessation in smokers with CAD, shortly after a cardiovascular event. Methods: We conducted a qualitative multiple case study of 24 patients with CAD who participated in a randomized trial on lifestyle change. One hundred and nine audio-recorded MI sessions were coded with a combination of the sequential code for observing process exchanges (SCOPE) and the motivational interviewing skill code (MISC). The analysis of the cases consisted of three phases: single case analysis, cross-case analysis, and cross-case synthesis. In a quantitative sequential analysis, we calculated the transition probabilities between the use of MI techniques by the coaches and the subsequent patient statements concerning smoking cessation. Results: In 12 cases, we observed ingredients that appeared to activate the mechanisms of change. Active ingredients were compositions of behaviors of the coaches (e.g., supporting self-efficacy and supporting autonomy) and patient reactions (e.g., in-depth self-exploration and change talk), interacting over large parts of an MI session. The composition of active ingredients differed among cases, as the patient process and the MI-coaching strategy differed. Particularly, change talk and self-efficacy appeared to stimulate the mechanisms of change “arguing oneself into change” and “increasing self-efficacy/confidence.”
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Artikel proefschrift Jos Dobber verschenen in Frontiers in Psychiatry 24 maart 2020: Background: Trials studying Motivational Interviewing (MI) to improve medication adherence in patients with schizophrenia showed mixed results. Moreover, it is unknown which active MI-ingredients are associated with mechanisms of change in patients with schizophrenia. To enhance the effect of MI for patients with schizophrenia, we studied MI's active ingredients and its working mechanisms. Methods: First, based on MI literature, we developed a model of potential active ingredients and mechanisms of change of MI in patients with schizophrenia. We used this model in a qualitative multiple case study to analyze the application of the active ingredients and the occurrence of mechanisms of change. We studied the cases of fourteen patients with schizophrenia who participated in a study on the effect of MI on medication adherence. Second, we used the Generalized Sequential Querier (GSEQ 5.1) to perform a sequential analysis of the MI-conversations aiming to assess the transitional probabilities between therapist use of MI-techniques and subsequent patient reactions in terms of change talk and sustain talk. Results: We found the therapist factor “a trusting relationship and empathy” important to enable sufficient depth in the conversation to allow for the opportunity of triggering mechanisms of change. The most important conversational techniques we observed that shape the hypothesized active ingredients are reflections and questions addressing medication adherent behavior or intentions, which approximately 70% of the time was followed by “patient change talk”. Surprisingly, sequential MI-consistent therapist behavior like “affirmation” and “emphasizing control” was only about 6% of the time followed by patient change talk. If the active ingredients were embedded in more comprehensive MI-strategies they had more impact on the mechanisms of change. Conclusions: Mechanisms of change mostly occurred after an interaction of active ingredients contributed by both therapist and patient. Our model of active ingredients and mechanisms of change enabled us to see “MI at work” in the MI-sessions under study, and this model may help practitioners to shape their MI-strategies to a potentially more effective MI.
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