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This study aimed to investigate mechanisms explaining associations between vaccination and protective health behaviors during the COVID-19 pandemic. The study used a secondary analysis of data from a longitudinal online study at four time points between April 2020 and March 2021. Two hundred and forty participants responded to questionnaires assessing adherence to multiple COVID-19 protection behaviors, COVID-19 vaccination, behavioral specific outcome expectancies and general healthy lifestyle. Statistical analyses included z statistic for differences between correlations and moderation analysis by the SPSS PROCESS macro. The correlation between initial adherence to protective behaviors prior to availability of vaccination and actual vaccination was positive, but when vaccination was available, the concurrent correlation between these behaviors was null. Healthy lifestyle and outcome expectancies moderated the association between vaccination and adherence to protection behaviors. These results were explained by a 'redundancy effect', conceptualized as beliefs that engagement in specific health behaviors justifies evading other health behaviors. The 'redundancy effect' cancelled the initial positive correlation between vaccination and protective health behaviors, produced by a 'transfer effect', based on similarities between the perceived purposes of those behaviors. Theoretical and practical implications of the findings were discussed.

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According to previous theories of aggression, positive outcome expectancy for aggression can predict aggression, while moral disengagement and negative outcome expectancy for aggression may, respectively, serve as mediators and moderators in this prediction process. To test the hypothesis, Study 1 first developed the Aggression Outcome Expectancy Questionnaire and examined its two-factor structure, which consists of positive and negative outcome expectancy for aggression. Next, 677 college students were recruited to participate in Study 2 and were asked to complete the Aggression Outcome Expectancy Questionnaire, Civic Moral Disengagement Questionnaire, and Buss-Perry Aggression Questionnaire. The findings indicated the following: (1) The Aggression Outcome Expectancy Questionnaire for college students demonstrated acceptable reliability and construct validity, confirming the two-factor structure of aggression outcome expectancy. (2) After controlling for sex and age, moral disengagement partially mediated the relationship between positive outcome expectancy and aggression. (3) Negative outcome expectancy for aggression moderated the effect of positive outcome expectancy on aggression, as well as moral disengagement. Specifically, negative outcome expectancy for aggression attenuated the positive predictive effect of positive outcome expectancy on aggression and moral disengagement. In conclusion, the present study extends our understanding of the motivational mechanism of aggression, offering a theoretical reference for preventing and intervening in aggressive behavior among college students.

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Objective: To examine the associations of self-efficacy and outcome expectancy with adherence to continuous positive airway pressure (CPAP) therapy among Japanese men with obstructive sleep apnea (OSA) using objective adherence data for CPAP therapy. Methods: We conducted a retrospective study of 497 Japanese men with OSA who were receiving CPAP therapy. Good adherence was defined as CPAP use of ≥4 hours per night for ≥70% of nights. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations of good adherence to CPAP therapy with self-efficacy and outcome expectancy (measured with the CPAP Self-Efficacy Questionnaire for Sleep Apnea in Japanese). The models were adjusted for age, duration of CPAP therapy, body mass index, apnea-hypopnea index, Epworth Sleepiness Scale score, and comorbidities (diabetes mellitus and hypertension). Results: In total, 53.5% of participants had good adherence to CPAP therapy. The mean CPAP use was 5.18±1.53 hours/night. After adjusting for related factors, we found significant associations of good adherence to CPAP therapy with self-efficacy scores (OR, 1.10; 95% CI, 1.05-1.13; p<0.001) and outcome expectancy scores (OR, 1.10; 95% CI, 1.02-1.15; p=0.007). Conclusions: Our results indicate that self-efficacy and outcome expectancy are associated with good adherence to CPAP therapy among Japanese men with OSA.

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Healthy lifestyle levels are low among adults with hypertension (HTN). Unfortunately, psychosocial factors contributing to patients' inability to meet healthy lifestyle recommendations are not well-understood. This integrative review examined the relationships of three psychosocial factors (self-efficacy, outcome expectancy, and social support) with dietary adherence (DA) and physical activity (PA) among adults with HTN. In total, 24 peer-reviewed studies were assessed. Results showed self-efficacy had small-to-large relationships with PA (r = 0.02-0.46) and DA (r = 0.06-0.79), with the strength of the associations varying by the assessed domain and country of origin. However, few studies reported a small relationship between the remaining factors (outcome expectancy and social support) and PA and DA. Thus, more efforts are needed to delineate the contributions of social support and outcome expectancies on DA or PA. When designing an intervention that focuses on improving PA or DA among adults with HTN, these psychosocial factors should be targeted.

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Positive outcome expectancy is a crucial cognitive factor influencing aggression, yet its neural basis remains unclear. Therefore, the present study combined voxel-based morphometry (VBM) with a resting-state functional connectivity (RSFC) analysis to investigate the brain correlates of positive outcome expectancy in aggression in young people. In the VBM analysis, multiple linear regression was conducted to explore the relationship between individual differences in aggressive positive outcome expectancy and regional gray matter volume (GMV) among 325 undergraduate students. For the RSFC analysis, seed regions were selected based on the results of the VBM analysis. Subsequently, multiple linear regression was employed to examine whether a significant correlation existed between individual differences in aggressive positive outcome expectancy and the RSFC of seed regions with other brain regions in 304 undergraduate students. The findings indicated that aggressive positive outcome expectancy was positively correlated with GMV in the posterior cingulate cortex (PCC), right temporoparietal junction (TPJ), and medial prefrontal cortex (MPFC). Moreover, it was also positively associated with RSFC between the PCC and the left dorsolateral prefrontal cortex (DLPFC). The prediction analysis indicated robust relationships between aggressive positive outcome expectancy and the GMV in the PCC, right TPJ, as well as the RSFC between the PCC and the left DLPFC. Our research provides the initial evidence for the neural basis of positive outcome expectancy in aggression, suggesting the potential role of the PCC as a hub in its neural network.

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Purpose of Review: Alcohol outcome expectancies emerge in early childhood, develop throughout adolescence, and predict alcohol outcomes well into adulthood. Social factors shape how expectancies are learned in myriad ways, yet such social learning influences seldom are examined in the context of developmental factors. This review summarized literature on the social origins of alcohol expectancies through vicarious (observational) and experiential (direct) alcohol-related learning from childhood to young adulthood within a social learning framework. Recent Findings: Young children primarily endorse negative expectancies, which decline rapidly with age amidst escalations in positive expectancies across adolescence. Parents and peers can contribute to vicarious learning about alcohol and facilitate experiential learning in different ways and to varying degrees across development. Media and social media, which children are increasingly exposed to as they mature, often depict alcohol-outcome relations that may further contribute to expectancy development in later adolescence and young adulthood. Summary: Social influences on alcohol expectancy learning are complex and change over time, although this dynamic complexity typically is not depicted in extant literature. Developmentally-informed research capturing co-occurring shifts in social influences and alcohol expectancies is needed.

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BACKGROUND: Outcome expectancy has been found to be a significant predictor of psychotherapy outcome. However, given that severity, chronicity and comorbidity are moderators of outcome expectancy, it is important to provide evidence of whether the same holds true in clinical conditions marked by these attributes, such as in borderline personality disorder (BPD). The aim of the present study was to investigate the role of patients' outcome expectancy in adolescents undergoing early intervention for BPD using pre-post difference of psychosocial functioning as outcome. METHODS: Forty-four adolescent BPD patients were treated with Dialectical Behavior Therapy for Adolescents (DBT-A) or Adolescent Identity Treatment (AIT). We investigated the effect of outcome expectancy on outcome with type of treatment as moderator. Based on the relevant literature, we assess the correlation between outcome expectancy and pretreatment symptomatology, namely BPD severity, personality functioning, childhood trauma and depression. RESULTS: The results showed a significant effect of expectancy on outcome (stand. ß = 0.30, p = 0.020) above autoregression. ANOVA analysis revealed no difference between the two treatments. Further, results indicate that pretreatment symptomatology, i.e., depression, childhood trauma and personality functioning dimensions self-direction and intimacy, are associated with early treatment expectancy. CONCLUSION: Outcome expectancy as a common factor plays a key role in successful psychotherapy with adolescent BPD patients. Elevated pretreatment depression, childhood trauma and impairment in personality functioning dimensions self-direction and intimacy are risk factors associated with lower expectancy. Low outcome expectancy should be addressed in early psychotherapy to improve the therapeutical process.

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Outcome expectancies involving self-directed and others-directed domains are potential determinants of completed or scheduled first-dose COVID-19 vaccination (CSFCV). This study investigated factors of CSFCV, including (a) self-directed motives [personal positive outcome expectancies (POE) and personal negative outcome expectancy (NOE)], and (b) others-directed motives (societal POE and the personality trait of prosociality). It also investigated the mediations of personal POE between societal POE and CSFCV, and moderations of prosociality between personal POE/personal NOE/societal POE and CSFCV. A cross-sectional population-based telephone survey interviewed 500 people aged 18-75 in Hong Kong in May 2021. The prevalence of CSFCV was 21.0%. Significant factors of CSFCV included personal POE (i.e., physical/practical/emotional/interpersonal benefit), personal NOE, and societal POE. The association between societal POE and CSFCV was fully mediated by the overall scale and some domains of personal POE. Furthermore, the association between physical benefit and CSFCV was stronger at lower levels of prosociality; prosociality showed a stronger effect on CSFCV at lower levels of physical benefit. The results suggest that self-directed motives might be more important than others-directed motives in affecting CSFCV. The findings require confirmations from longitudinal studies and cross-country comparisons.

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BACKGROUND: Currently, laypeople can earn profit by producing content; therefore, it should be noted that the unauthorized use of intellectual creations or possessions can cause legal issues and undermine the producers' desire to create. This study verified the usefulness of the theory of planned behavior (TPB) model for predicting the illegal use of online content among South Korean college students and examined the roles played by outcome expectancies and social loafing in this model. METHODS: The participants, 369 male and female Korean college students, were aged between 18 and 31 years (M = 22.12, SD = 2.33). We measured the illegal use of online content and the factors of the TPB model, as well as outcome expectancies and social loafing with regard to participants' illegal use of online content. Correlational analysis, stepwise regression analysis, path analysis for the TPB model, and analyses of the moderated model were performed using SPSS and AMOS. RESULTS: All TPB factors, outcome expectancies, and social loafing were positively correlated with the illegal use of online content. Stepwise regression analysis showed that intention, social loafing, outcome expectancies, and perceived behavioral control were significant predictors of the illegal use of online content. A TPB model, including a direct path from perceived behavioral control to behavior, was validated to analyze the illegal use of online content. This model was found to be moderated by outcome expectancy. CONCLUSION: This study suggests that the TPB is useful for predicting the illegal use of online content and that outcome expectancies and social loafing also play an important role in the illegal use of online content among college students. The findings of this study provide useful information for future research and could aid in preventing illegal online content use among adolescents and young adults.

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The active participation of nurses in evidence-based practice (EBP) is challenging and topical, as shown by the worldwide calls for appropriate, accessible, affordable care and the de-implementation of unnecessary care. Nurses' perceived support from their managers and work environments may affect their self-efficacy and outcome expectancy in EBP, as well as hinder them in EBP. Associations between these issues have not yet been explored. This study examines the association of self-efficacy and outcome expectancy levels in EBP, as well as the perceived support for EBP from nurse leaders and in the working environment, among Dutch hospital nurses. METHODS: Questionnaires measuring nurses' self-efficacy, outcome expectancy, and perceived support for EBP from nurse leaders and their work environment were completed by 306 nurses in eight hospitals between March 2021 and June 2021. We used multilevel regression analyses to determine the associations and covariates. RESULTS: This study shows that EBP-supportive leaders and work environments positively contribute to nurses' self-efficacy and outcome expectancy in EBP, along with the covariates undertaking EBP activities and educational level. CONCLUSIONS: To improve nurses' active participation in EBP, nurses need to increase their self-efficacy and outcome expectancy in EBP. Supportive leaders and a supportive work environment do have an impact. Hence, these factors need attention when implementing EBP among nurses.

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Previous research has demonstrated a link between maternal depressive symptoms and infant feeding behavior; however, the underlying mechanisms linking the two remain unclear. This study examined the association between maternal depressive symptoms and responsive feeding, and the potential mediating role of feeding self-efficacy and outcome expectancy. A panel study with 487 women, from pregnancy through postpartum, was conducted. Maternal depressive symptoms at one month postpartum were assessed by the Edinburgh Postnatal Depression Scale. Responsive feeding included feeding on demand and unforced feeding domains. Responsive feeding, feeding self-efficacy, and feeding outcome expectancy were assessed at three months postpartum. Maternal depressive symptoms were associated with less responsive feeding, but the association was fully mediated by feeding self-efficacy and feeding outcome expectancy. Infant feeding problems are associated with depressive symptoms in mothers. Health professionals could work with depressed mothers to enhance infant feeding by targeting feeding self-efficacy and feeding outcome expectancy.

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Childbirth self-efficacy is a useful measure for determining a woman's confidence in managing childbirth and for determining any preconceptions that require reinforcement. Childbirth self-efficacy is also particularly helpful in advising not only how to cope with birth, but also maternal well-being and fostering the improvement of a wide variety of perinatal outcomes. The present study aims to determine the factors affecting childbirth self-efficacy in pregnant women. The sample size consisted of 380 pregnant women between the ages of 18 and 45. Data were collected via face to face interviews using the Childbirth Self Efficacy Scale Short Form (CBSEI-32) in the Akdeniz University Hospital between November 2019 and February 2020 and used Chi-squared Automatic Interaction Detector analyses, resulting in a mean CBSEI-32 score of 244.279 ± 45.121. As a result of the analysis, it was seen that income status affects self-efficacy, and personal experiences such as foetal loss affect a woman's childbirth self-efficacy. In addition, it was also found that the level of prenatal education affected childbirth self-efficacy. Health professionals should assess pregnant women during the antenatal period in terms of their childbirth self efficacy and prepare personalised training programs and plan initiatives to increase perceptions of self-efficacy.IMPACT STATEMENTWhat is already known on this subject? Childbirth self-efficacy is one of the important psychological parameters to determine a woman's belief in her confidence in managing childbirth and to measure women's perceptions of her need for reinforcement.What do the results of this study add? Sociodemographic and obstetric characteristics of women affect their childbirth self-efficacy perception positively and negatively. Women's birth self-efficacy can be improved positively with prenatal education. In addition, it is one of the interesting findings of the study that the self-efficacy level of women who had a previous low experience was high.What are the implications of these findings for clinical practice and/or further research? Women's childbirth self efficacy can be improved with trainings and appropriate nursing interventions. For this reason, it is important to determine the factors affecting the self-efficacy perception of women. In future studies, the childbirth self-efficacy perceptions of women in different samples (risky pregnancy, disabled pregnant, etc.) should be measured.

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ISSUES: Knowledge on the development of alcohol outcome expectancies (AOE) is relevant because AOE predict change in drinking behaviours. The present meta-analysis integrates results of longitudinal studies on change in AOE from childhood to emerging adulthood (age 23/24). APPROACH: A systematic search in electronic databases identified 64 studies that were analysed with three-level meta-analyses. KEY FINDINGS: AOE about positive and social consequences tended to increase, on average, from childhood to middle or late adolescence, respectively. In contrast, negative AOE declined over time. Change in positive, social and tension reduction AOE were described as an inverted u-shaped curve. The strongest increase of more than two standard deviation units was observed with regard to social AOE between the age of 7 and 16, followed by small decline in the transition to emerging adulthood. IMPLICATIONS: The meta-analysis found evidence for strong increases of positive AOE from childhood to middle or late adolescence. CONCLUSIONS: The results inform about reasonable age-ranges for expectancy-challenging interventions. To obtain a clearer picture of change in AOE beyond adolescence, longitudinal research is needed on younger children and beyond college age.

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AIMS: This study aimed (1) to delineate how a web-based intervention affects the problem drinking behaviors of Japanese adults and (2) to examine the moderating effects of disorder levels and alcohol outcome expectancies on intervention outcomes. METHODS: We implemented an online two-armed parallel-group randomized controlled trial with 546 Japanese adults. Adults aged 20 years or older and who scored eight or higher on the Alcohol Use Disorder Identification Test were included in this study. Participants were randomly allocated to the intervention group or the waitlist/control group. The intervention comprised assessment of drinking behavior, personalized normative feedback, psychoeducation about the consequences of problem drinking, and a short quiz. The outcomes were weekly drinking quantity and abstinent days, largest drinking quantity in one day, and alcohol-related consequences reported at baseline and at one-, two-, and six-month follow-ups. A mixed-effects model regression was conducted to compare the intervention and control groups. RESULTS: The attrition rates at each follow-up were 52.93%, 49.45%, and 32.60%, respectively. The time × condition interaction effect on weekly drinking quantity was significant at the two- and six-month follow-ups, d = 0.28, 95% CI [0.04, 0.51], d = 0.34, 95% CI [0.05, 0.63], respectively. Moderations related to the intervention effect were not statistically significant. CONCLUSION: A web-based intervention was found to be effective for two and six months only on drinking quantity measures of Japanese adults with problem drinking. Limitations including high drop-out rates in are discussed.

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Promotion of COVID-19 vaccination requires understanding its determinants, an important one of which is outcome expectancy. However, reliable and valid measurement tools are absent. This study thus developed and validated an Outcome Expectancy Scale for COVID-19 Vaccination (OES-COVID-19). An inductive approach was used for scale development; content validity of the items was then assessed by an independent evaluation expert panel. Iteratively, 17 scale items were created and validated in a population-based telephone survey conducted among 500 adults of the general population in Hong Kong, China, from August to September 2021. Using half of the sample (n = 249), exploratory factor analyses identified four factors of the OES-COVID-19, including (a) positive contribution to society, (b) functional benefits, (c) protective effect, and (d) negative impacts. Confirmatory factor analysis of these factors conducted on the second subsample (n = 251) was satisfactory. The OES-COVID-19 showed good psychometric properties in terms of internal consistency, absence of floor/ceiling effects, and concurrent validity. The newly created and validated OES-COVID-19 is deemed suitable for application. It may advance future studies related to COVID-19 vaccination behavior and intention, and potentially allows for comparisons across studies. Further validation with modifications across countries, populations, and phase of the pandemic are warranted.

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BACKGROUND: Perceptions related to COVID-19 vaccination are evolving over time, leading to potential changes in vaccination intention among unvaccinated people, which helps in the predictions of vaccination rates. This study investigated the changes in COVID-19 vaccination intention at the population level during a post-rollout period and two potential mechanisms underlying the change via the mediation/suppression effects that involve the perceived benefits/severe side effects of vaccination. METHODS: Two serial random population-based telephone surveys interviewed 358 and 145 Chinese adults (aged 18-70) who were unvaccinated and who were unscheduled for COVID-19 vaccination, respectively, in May and August 2021 in Hong Kong, China. RESULTS: The prevalence of vaccination intention increased from 14.5% to 22.8%, while the levels of perceived benefits (protection and travel-related advantages due to vaccination) and the perceived risk of severe side effects resulting from COVID-19 vaccination both significantly declined over time. Structural equation modeling found a simultaneous partial suppression effect via perceived benefits and a partial mediation effect via perceived severe side effects between the time when the surveys were conducted and COVID-19 vaccination intention, with adjustment for background factors. CONCLUSION: Perceptions related to COVID-19 vaccination are likely to change over time and partially account for changes in vaccination intention, sometimes in opposite directions. Ongoing health promotion may take such changes into account. Serial surveillance is warranted to monitor these changes.

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BACKGROUND: In some individuals who smoke, the COVID-19 pandemic has triggered an increase in the motivation to quit smoking due to the potential higher risk of severe COVID-19 infection. However, this change is not universal, and the motivation to quit appears dependent upon factors such as fear of COVID-19 and perceived risk from COVID-19. In the current investigation both COVID-19 severity and infection probability beliefs were measured to isolate which beliefs correlated with the motivation to quit smoking. METHODS: UK-based smokers (N = 243) completed an online survey between September and October 2020, in which they reported their current motivation to quit smoking, fear of COVID-19, and their beliefs about how severe COVID-19 infection would be and how probable COVID-19 infection was. RESULTS: The only significant predictor of the motivation to quit smoking was the perceived probability of COVID-19 infection, ß = .22, p < .001, 95CI[.10, .34]. This relationship remained when controlling for the general perceived probability and severity of other smoking-related health risks, ß = .20, p = .002, 95CI[.08,.32], suggesting a COVID-19-specific effect. Further, perceived probability of COVID-19 infection mediated the positive impact of fear of COVID-19 on motivation, ß = .07, p = .006, 95CI[.03,.13]. CONCLUSIONS: The result places the perceived probability of COVID-19 infection as a central predictor of the motivation to quit during the pandemic. Based on this evidence, messaging aiming to facilitate smoking cessation during the pandemic should focus on the highly contagious nature of the virus to increase the motivation to quit.

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BACKGROUND: Ketamine has remained the most commonly used illicit drug among adolescents in Taiwan. A dual process model proposes that addictive behaviors develop in adolescents as a result of an imbalance between an appetitive, approach-oriented system (implicit and explicit attitudes) and a regulatory executive system (cool and hot executive functions). We aimed to examine the appetitive and regulatory processes in adolescent ketamine users in comparison to matched healthy adolescents. Method: The participants were 30 adolescent ketamine users and 32 nondrug controls, matched with gender, age, education years, and education systems. Both groups completed the affective priming task (APT), the stop-signal task (SST), an Iowa Gambling Task (IGT), and finally a Drug Use Disorders Identification Test: Extended (DUDIT-E). Results: The controls had higher positive and negative outcome expectancy with respect to using ketamine compared to the adolescent ketamine users. There was no significant between-group performance difference in APT. The adolescent ketamine users may have shown marginally poorer performance compared to the controls in hot executive functions (IGT), but their cold executive functions (SST) remained intact. Conclusion: The current study reported that the adolescent ketamine users may not have imbalanced dual processes (biased appetitive motivation and impaired regulatory executive process). A different therapeutic focus on adolescent ketamine users may be developed accordingly. More advocacies on ketamine's aversive outcomes are needed, particularly on campus in order to reduce substance misuse.

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Appetitive traits influence food intake and weight gain throughout the life-course. Here, we investigated whether maternal attitudes to following healthy infant feeding guidelines could modify this association. Baseline data from 544 mother-infant formula-feeding dyads recruited to the Baby Milk Trial were included in this observational, cross-sectional analysis. Infant appetitive traits (food responsiveness and satiety responsiveness), maternal attitudes to following healthy infant feeding guidelines (self-efficacy, outcome-expectancy, intentions) and infant milk intakes were reported by mothers through questionnaires. Infant weight was measured using standard procedures. Associations between the maternal attitudes score or infant appetitive traits with infant milk intake and infant weight were evaluated in linear regression models adjusted for infant sex and age. To identify effect modification, the interaction term between the maternal attitudes score and infant appetitive trait was added to the model. Infants' mean age and weight were 2.3 months (SD = 0.9) and 5.5 kg (SD = 0.9), respectively. The mean daily infant milk intake reported by mothers was 895 ml/day (SD = 215). Higher maternal attitudes score was associated with lower infant milk intake (Beta = -68.4 ml/day/unit (95% CI: 96.6, -40.2)) and infant weight (Beta = -0.13 SD/unit (-0.25, -0.02)). The maternal attitudes score showed interactions with infant food responsiveness on infant milk intake (p = 0.049), and with infant satiety responsiveness on infant weight (p = 0.01). In both cases, a higher maternal attitudes score attenuated the associations between infant appetitive traits and those outcomes. This analysis provides evidence that positive maternal attitudes to following healthy infant feeding guidelines attenuate the effects of infant appetitive traits on infant milk intake and body weight.

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A 6-month self-efficacy intervention was compared with attention-control intervention on physical activity, clinical outcomes, and mediators immediate postintervention and 6-month postintervention in 182 older adults with knee osteoarthritis and hypertension using a randomized controlled trial design. The intervention group received six weekly individual physical therapy sessions for lower-extremity exercise and fitness walking and nine biweekly nurse telephone counseling sessions. The attention-control group received six weekly and nine biweekly nurse telephone sessions on health topics. Lower-extremity exercise was assessed by e-diary; fitness walking was assessed by accelerometer and e-diary; blood pressure was assessed by automated monitor; function was assessed by performance-based tests and questionnaires; and pain, self-efficacy, and outcome expectancy were assessed by questionnaires. Self-reported lower-extremity exercise and fitness walking, function, pain, self-efficacy, and outcome expectancy showed significant group or group by time effects favoring intervention. The intervention did not improve physical activity by accelerometer and blood pressure. Mean minutes of fitness walking fell short of the 150 min/week goal.

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