Turning good intentions into actions by using the health action process approach to predict adherence to internet-based depression prevention: secondary analysis of a randomized controlled trial.
Open accessAbstract
BACKGROUND: Many individuals engaging in Internet-based interventions fail to complete these treatments as intended. The processes responsible for treatment adherence in Internet-based interventions are still poorly understood. OBJECTIVE: The aim of this study was to investigate to what extent adherence in an Internet-based intervention can be predicted by motivational and volitional factors outlined in the health action process approach (HAPA). METHODS: This study investigated motivational and volitional factors included in HAPA in a randomized controlled trial to predict treatment adherence of N=101 individuals with subclinical depression in the intervention group of a depression prevention intervention (GET.ON Mood Enhancer). Adherence was operationalized as the number of completed treatment modules. Using longitudinal structural equation modeling, HAPA variables (motivational, maintenance, and recovery self-efficacy, outcome expectancies, intention, and planning) were assessed at baseline and their associations with adherence 7 weeks later. RESULTS: Planning predicted adherence. Better planning was, in turn, associated with higher levels of maintenance self-efficacy, and the latter significantly affected treatment adherence via planning. The other hypothesized direct associations were not significant. In total, the HAPA variables accounted for 14% of variance in treatment adherence. CONCLUSIONS: Planning emerged as the strongest predictor of treatment adherence in highly motivated participants in an Internet-based intervention out of all HAPA variables investigated. Findings are in line with the hypothesis that planning facilitates the translation of good intentions into actions. The findings imply that systematically fostering planning skills and maintenance self-efficacy prior to or during Internet-based interventions would help participants to successfully complete these treatments. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005973; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00005973 (Archived by WebCite at http://www.webcitation.org/6uxCy64sy).
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High self-regulatory effort needed from participants is one key hindering factor for adherence to internet interventions.
“As already pointed out in the literature on internet-interventions, the high self-regulatory effort needed from behalf of the participants is one key hindering factor when it comes to their adherence to such treatments (Donkin and Glozier, 2012; Beatty and Binnion, 2016; Zarski et al., 2018; Flett et al., 2019; Arndt et al., 2020).”
From Can We Boost Treatment Adherence to an Online Transdiagnostic Intervention by Adding Self-Enhancement Strategies? Results From a Randomized Controlled Non-inferiority Trial (2021) · cites this paper as Zarski et al., 2018
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“This finding is in line with studies showing that interventions that require participants to engage repeatedly in strategic planning may work because mentally linking intentions to specific contexts increases the likelihood of translating intentions into actions [37,58-61].”
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ResultAllgemeine Depressions-Skala (ADS)
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BackgroundBeyond behavioural intentions: Planning mediates between intentions and physical activity
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“The high autonomy and flexibility of Internet-based interventions facilitate low-threshold access to treatment but also place high self-regulatory demands on participants and thereby entice treatment cessation [4].”
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“This finding is in line with studies showing that interventions that require participants to engage repeatedly in strategic planning may work because mentally linking intentions to specific contexts increases the likelihood of translating intentions into actions [37,58-61].”
ResultStage-specific adoption and maintenance of physical activity: testing a three-stage model
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“HAPA also assumes that individuals pass through different stages such as preintention, intention, and action when adopting new behavior [21,22].”
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“This finding is in line with studies showing that interventions that require participants to engage repeatedly in strategic planning may work because mentally linking intentions to specific contexts increases the likelihood of translating intentions into actions [37,58-61].”
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“In this phase, maintenance self-efficacy and recovery self-efficacy have shown to be crucial for individuals facing imminent barriers and for those coming to terms with relapses, respectively [32,33].”
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“technical problems and the absence of immediate feedback [62,63].”
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“In contrast, other studies have found the intrinsic motivation of individuals, their belief in their own ability to complete the intervention, and their expectancies regarding treatment outcome to be associated with adherence in Internet-based interventions [7,14,65-68].”
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“In comparison to other studies evaluating predictors of adherence, the amount of explained variance in this analysis is relevant given the small number of variables significantly influencing treatment adherence in this sample and given the restricted variance in variables due to the homogenous study population [12,69].”
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“The study outlined below was described in greater detail elsewhere [39].”
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“The findings of previous studies can, however, explain the variance in adherence only to some extent [9-12], with findings of, inter alia, 11% [13].”
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“technical problems and the absence of immediate feedback [62,63].”
BackgroundResultPredicting transitions from preintentional, intentional and actional stages of change
Schüz, B., Sniehotta, F. F., Mallach, N., Wiedemann, A. U., & Schwarzer, R. (2008) · Health Education Research · doi:10.1093/her/cym092 · Cited by 80 · cited 3× · see citing works
“First, according to HAPA, it can be expected that differences in treatment adherence between the participants are mainly due to volitional factors such as planning because participants can already be classified as intenders due to their decision to take part in an Internet-based intervention for depression prevention…”
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“In contrast, other studies have found the intrinsic motivation of individuals, their belief in their own ability to complete the intervention, and their expectancies regarding treatment outcome to be associated with adherence in Internet-based interventions [7,14,65-68].”
ResultAttrition and Adherence in the Online Treatment of Chronic Insomnia
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“In contrast, other studies have found the intrinsic motivation of individuals, their belief in their own ability to complete the intervention, and their expectancies regarding treatment outcome to be associated with adherence in Internet-based interventions [7,14,65-68].”
ResultBuntrock, C., Ebert, D. D., Lehr, D., Cuijpers, P. J., Riper, H. M., Smit, F., & Berking, M. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-25 · Cited by 57 · cited 1× · see citing works
“The intervention was described in greater detail by Buntrock and her colleagues [1,39,46].”
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“In contrast, other studies have found the intrinsic motivation of individuals, their belief in their own ability to complete the intervention, and their expectancies regarding treatment outcome to be associated with adherence in Internet-based interventions [7,14,65-68].”
ResultPatient Expectations in Internet-Based Self-Help for Social Anxiety
Boettcher, J., Renneberg, B., & Berger, T. (2013) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2012.759615 · Cited by 47 · cited 1× · see citing works
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ResultHabibović, M., Cuijpers, P., Alings, M., van der Voort, P., Theuns, D., Bouwels, L., Herrman, J.-P., Valk, S., & Pedersen, S. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.2809 · Cited by 47 · see citing works
Diagnosing major depression in medical outpatients
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“Applicants were then screened for study inclusion and exclusion criteria, and those who met all of the criteria considered during this screening process were scheduled for the semistructured clinical interview conducted by telephone [44,45].”
MethodReuter, T., Ziegelmann, J. P., Lippke, S., & Schwarzer, R. (2009) · Rehabilitation Psychology · doi:10.1037/a0017830 · Cited by 44 · cited 1× · see citing works
“The influence of variables of the motivational and volitional phases on health behavior depends on the stage individuals are currently in (see Figure 1) [24,25].”
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“The findings of previous studies can, however, explain the variance in adherence only to some extent [9-12], with findings of, inter alia, 11% [13].”
ResultTesting two principles of the Health Action Process Approach in individuals with type 2 diabetes.
Lippke, S., & Plotnikoff, R. C. (2012) · Health Psychology · doi:10.1037/a0030182 · Cited by 43 · cited 1× · see citing works
“The influence of variables of the motivational and volitional phases on health behavior depends on the stage individuals are currently in (see Figure 1) [24,25].”
BackgroundIndividual and Household Predictors of Adolescents’ Adherence to a Web-Based Intervention
Mâsse, L. C., Watts, A. W., Barr, S. I., Tu, A. W., Panagiotopoulos, C., Geller, J., & Chanoine, J. (2014) · Annals of Behavioral Medicine · doi:10.1007/s12160-014-9658-z · Cited by 34 · cited 4× · see citing works
“In contrast, other studies have found the intrinsic motivation of individuals, their belief in their own ability to complete the intervention, and their expectancies regarding treatment outcome to be associated with adherence in Internet-based interventions [7,14,65-68].”
BackgroundResultInfluentialBaseline Motivation Type as a Predictor of Dropout in a Healthy Eating Text Messaging Program
Coa, K. I., & Patrick, H. (2016) · JMIR mhealth and uhealth · doi:10.2196/mhealth.5992 · Cited by 33 · cited 1× · see citing works
“There is empirical evidence showing that the intrinsic motivation to commence an intervention, treatment expectancy, and the ability to focus on future goals influence adherence and attrition in Internet-based interventions [7,14-16].”
BackgroundChanges in social-cognitive variables are associated with stage transitions in physical activity
Parschau, L., Richert, J., Koring, M., Ernsting, A., Lippke, S., & Schwarzer, R. (2011) · Health Education Research · doi:10.1093/her/cyr085 · Cited by 25 · cited 1× · see citing works
“Thus, in line with HAPA, motivational variables seem to no longer exert influence once participants have developed the motivation and intention to participate in an intervention [64].”
Result
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Ajzen, I., & Schmidt, P. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.002 · Cited by 303 · see citing works
Changing Behavior Using the Model of Action Phases
Keller, L., Gollwitzer, P. M., & Sheeran, P. (2020) · The Handbook of Behavior Change · doi:10.1017/9781108677318.006 · Cited by 147 · see citing works
Yeager, C. M., & Benight, C. C. (2018) · mHealth · doi:10.21037/mhealth.2018.08.04 · Cited by 115 · see citing works
“A strength of this model is the empirical support (60,81), the theoretical basis that incorporates social cognitive predictors into the engagement model, and a comprehensive conceptualization engagement.”
BackgroundJiang, Y., Liu, F., Guo, J., Sun, P., Chen, Z., Li, J., Cai, L., Zhao, H., Gao, P., Ding, Z., et al. (2020) · Journal of Medical Internet Research · doi:10.2196/17089 · Cited by 112 · see citing works
“Zarski et al [36] proposed that the systematic development of planning skills and the maintenance of self-efficacy before or during internet-based interventions would help participants successfully complete treatments.”
BackgroundChanging Behavior Using the Health Action Process Approach
Schwarzer, R., & Hamilton, K. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.007 · Cited by 107 · see citing works
Lin, J., Faust, B., Ebert, D. D., Krämer, L., & Baumeister, H. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.9925 · Cited by 97 · see citing works
“This assumption is supported by a recent study of Zarski et al [79], where planning, out of all the investigated HAPA variables, was the strongest predictor of treatment adherence in highly motivated participants in an IMI.”
ResultArresting fake news sharing on social media: a theory of planned behavior approach
Pundir, V., Devi, E. B., & Nath, V. (2021) · Management Research Review · doi:10.1108/mrr-05-2020-0286 · Cited by 99 · see citing works
Chao, D. Y., Lin, T. M., & Ma, W.-Y. (2019) · JMIR Diabetes · doi:10.2196/11017 · Cited by 82 · see citing works
“The personalized interactive education approach used in this study was associated with greater overall compliance with recommended health behaviors [1,19,27,34,35].”
MethodSubthreshold depression – concept, operationalisation and epidemiological data. A scoping review
Volz, H., Stirnweiß, J., Kasper, S. F., Möller, H., & Seifritz, E. (2022) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2022.2087530 · Cited by 77 · see citing works
Gardner, B., Rebar, A. L., & Lally, P. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.041 · Cited by 69 · see citing works
Changing Behavior Using Social Cognitive Theory
Łuszczyńska, A., & Schwarzer, R. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.003 · Cited by 71 · see citing works
Warner, L. M., & French, D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.032 · Cited by 53 · see citing works
Changing Behavior Using Ecological Models
Salmon, J., Hesketh, K. D., Arundell, L., Downing, K. L., & Biddle, S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.017 · Cited by 51 · see citing works
Changing Behavior Using Self-Determination Theory
Hagger, M. S., Hankonen, N. E., Chatzisarantis, N. L. D., & Ryan, R. M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.008 · Cited by 49 · see citing works
Planning and Implementation Intention Interventions
Rhodes, R. E., Grant, S. J., & de Bruijn, G. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.039 · Cited by 41 · see citing works
Attitudes and Persuasive Communication Interventions
Hamilton, K., & Johnson, B. T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.031 · Cited by 40 · see citing works
Changing Behavior Using Habit Theory
Orbell, S., & Verplanken, B. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.013 · Cited by 39 · see citing works
Changing Behavior: A Theory- and Evidence-Based Approach
Hagger, M. S., Cameron, L. D., Hamilton, K., Hankonen, N. E., & Lintunen, T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.001 · Cited by 39 · see citing works
Tarrant, M., Haslam, C., Carter, M., Calitri, R., & Haslam, S. A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.044 · Cited by 37 · see citing works
Lawler, K., Earley, C., Timulák, L., Enrique, Á., & Richards, D. (2021) · JMIR Formative Research · doi:10.2196/26221 · Cited by 38 · see citing works
Lippke, S., Gao, L., Keller, F. M., Becker, P., & Dahmen, A. (2021) · Journal of Medical Internet Research · doi:10.2196/31274 · Cited by 36 · see citing works
“It is important to understand why patients display intervention adherence and study retention (as opposed to dropping out [3,6-8]): Different factors can predict whether patients remain in the assigned therapy and the study in general.”
InfluentialChanging Behavior Using Integrated Theories
Hagger, M. S., & Hamilton, K. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.015 · Cited by 39 · see citing works
Changing Behavior Using the Transtheoretical Model
DiClemente, C. C., & Graydon, M. M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.010 · Cited by 31 · see citing works
Wu, W., Hu, L., Chen, Y., Cao, F., Ding, S., Wu, T., & Xu, J. (2022) · BMC Oral Health · doi:10.1186/s12903-022-02219-w · Cited by 31 · see citing works
“Discussion The HAPA model was first proposed by Schwarzer [8] and has been currently widely used in many fields, such as measuring social distancing behavior [17], physical activity [18, 19], dieting [20], depression prevention [21], and oral hygiene [7, 18, 22].”
MethodRenfrew, M. E., Morton, D. P., Morton, J. K., Hinze, J. S., Przybylko, G., & Craig, B. A. (2020) · Journal of Medical Internet Research · doi:10.2196/19945 · Cited by 31 · see citing works
“Examples of individual factors include whether a person self-selects into a study and invests effort [25], planning and self-efficacy [21,26], compatibility with personal values [8], motivation factors [6,22], focus on immediate benefit rather than long-term goals, perceived treatment credibility…”
Changing Behavior Using the Health Belief Model and Protection Motivation Theory
Orbell, S., Zahid, H., & Henderson, C. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.004 · Cited by 32 · see citing works
Leach, B., Parkinson, S., Gkousis, E., Abel, G., Atherton, H., Campbell, J., Clark, C. E., Cockcroft, E., Marriott, C., Pitchforth, E., et al. (2022) · Journal of Medical Internet Research · doi:10.2196/33911 · Cited by 27 · see citing works
“Helping patients form specific plans around the use of digital services was shown to be one of the strongest predictors of adherence in an RCT of an internet-based intervention for depression [74].”
BackgroundInfluentialChanging Behavior by Changing Environments
Marteau, T. M., Fletcher, P. C., Hollands, G. J., & Munafo, M. R. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.014 · Cited by 27 · see citing works
Design, Implementation, and Evaluation of Behavior Change Interventions: A Ten-Task Guide
Abraham, C., & Denford, S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.019 · Cited by 26 · see citing works
Changing Behavior Using the Reflective-Impulsive Model
Deutsch, R., & Strack, F. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.012 · Cited by 28 · see citing works
Buller, M., Bettinghaus, E., Fluharty, L., Andersen, P., Slater, M., Henry, K. L., Liu, X., Fullmer, S., & Buller, D. (2019) · Health Education Research · doi:10.1093/her/cyy054 · Cited by 22 · see citing works
Tang, C., Raat, H., Yan, M., Qiang, Z., Li, K., Jiang, M., Tang, W., Chen, J., Zhao, Y., & Liu, Q. (2021) · BMC Public Health · doi:10.1186/s12889-021-10999-z · Cited by 24 · see citing works
Dyadic Behavior Change Interventions
Scholz, U., Berli, C., Lüscher, J., & Knoll, N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.043 · Cited by 23 · see citing works
Developing Behavior Change Interventions
Hankonen, N. E., & Hardeman, W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.021 · Cited by 26 · see citing works
Rothman, A. J., Klein, W. M. P., & Sheeran, P. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.020 · Cited by 25 · see citing works
Abel, G., Atherton, H., Sussex, J., Akter, N., Aminu, A. Q., Bak, W., Bryce, C., Clark, C. E., Cockcroft, E., Evans, H., et al. (2024) · Health and Social Care Delivery Research · doi:10.3310/jkyt5803 · Cited by 23 · see citing works
Imagery, Visualization, and Mental Simulation Interventions
Hagger, M. S., & Conroy, D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.033 · Cited by 22 · see citing works
Changing Behavior Using the Common-Sense Model of Self-Regulation
Cameron, L. D., Fleszar‐Pavlović, S. E., & Khachikian, T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.005 · Cited by 23 · see citing works
Engagement of Stakeholders in the Design, Evaluation, and Implementation of Complex Interventions
Hudson, J. L., Moon, Z., Hughes, L. D., & Moss-Morris, R. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.024 · Cited by 20 · see citing works
Uri Gneezy, B., Kajackaite, A., & Meier, S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.036 · Cited by 20 · see citing works
Ruiter, R. A. C., Crutzen, R., de Leeuw, E., & Kok, G. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.018 · Cited by 17 · see citing works
Meyers, M., Margraf, J., & Velten, J. (2020) · JMIR Research Protocols · doi:10.2196/20326 · Cited by 18 · see citing works
Changing Behavior Using Social Identity Processes
Reynolds, K. J., Branscombe, N. R., Subašić, E., & Willis, L. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.016 · Cited by 17 · see citing works
Isbăşoiu, A. B., Tulbure, B. T., Rusu, A., & Sava, F. A. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.752249 · Cited by 14 · see citing works
Gordon, D., Hensel, J. M., Bouck, Z., Desveaux, L., Soobiah, C., Saragosa, M., Jeffs, L. P., Bhatia, S., & Shaw, J. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03391-z · Cited by 15 · see citing works
“note that high autonomy and flexibility of web-based interventions supports low-threshold access to treatment but that this places high self-regulatory demands on participants which may entice treatment cessation [19].”
BackgroundWebb, T. L., & de Bruin, M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.037 · Cited by 14 · see citing works
Fromberger, P., Schröder, S., Bauer, L., Siegel, B., Tozdan, S., Briken, P., Buntrock, C., Etzler, S., Rettenberger, M., Leha, A., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.575464 · Cited by 14 · see citing works
Critical and Qualitative Approaches to Behavior Change
Chamberlain, K., & Lyons, A. C. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.030 · Cited by 12 · see citing works
Braun, L., Freund, J., Thielecke, J., Baumeister, H., Ebert, D. D., & Titzler, I. (2022) · JMIR Mental Health · doi:10.2196/39122 · Cited by 11 · see citing works
“In quantitative studies, various factors were found to be possible predictors of intervention adherence, including guidance [11], the use of persuasive design elements [12,13], or individual factors such as planning [14].”
BackgroundMaximizing User Engagement with Behavior Change Interventions
Yardley, L., Morrison, L. G., Müller, I., & Bradbury, K. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.025 · Cited by 11 · see citing works
Effective Communication Supported by an App for Pregnant Women: Quantitative Longitudinal Study
Kötting, L., Anand-Kumar, V., Keller, F. M., Henschel, N. T., & Lippke, S. (2024) · JMIR Human Factors · doi:10.2196/48218 · Cited by 9 · see citing works
The Science of Behavior Change: The Road Ahead
Hagger, M. S., Cameron, L. D., Hamilton, K., Hankonen, N. E., & Lintunen, T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.046 · Cited by 11 · see citing works
Côté‐Allard, U., Pham, M. H., Schultz, A. K., Nordgreen, T., & Tørresen, J. (2022) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2022.3204737 · Cited by 10 · see citing works
“demographic, psychometric, treatment credibility) relates to adherence [23], [24], [25], [26], [27], [28].”
Althammer, S. E., Wöhrmann, A. M., & Michel, A. (2023) · Journal of Medical Internet Research · doi:10.2196/42510 · Cited by 11 · see citing works
“This contributes to nascent efforts to identify factors that may increase adherence, building on findings showing feedback and content-focused or adherence-focused guidance [87,88], motivational and volitional processes [20], and engaging content and time efficiency [89] as such factors.”
Autonomy-Supportive Interventions
Reeve, J., & Cheon, S. H. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.035 · Cited by 9 · see citing works
Implementation Science and Translation in Behavior Change
Łuszczyńska, A., Łobczowska, K., & Horodyska, K. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.023 · Cited by 9 · see citing works
de Ridder, D. T. D., Gillebaart, M., & Friese, M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.040 · Cited by 9 · see citing works
Epton, T., & Armitage, C. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.038 · Cited by 8 · see citing works
Wu, J., Wang, X., Xu, M., Liu, K.-P., Xu, L., & Zhang, Y. (2025) · BMC Oral Health · doi:10.1186/s12903-025-06297-4 · Cited by 7 · see citing works
“Zarski et al. emphasized the fact that self-efficacy in digital health interventions is vital with respect to participants’ likelihood of completing treatments successfully [40].”
Evaluation of Behavior Change Interventions
Matthews, L., & Simpson, S. A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.022 · Cited by 7 · see citing works
Kuesten, C. L., Dang, J., Nakagawa, M., Bi, J., & Meiselman, H. L. (2022) · Food Quality and Preference · doi:10.1016/j.foodqual.2022.104545 · Cited by 7 · see citing works
Motivational Interviewing Interventions
Berman, A. H., Beckman, M., & Lindqvist, H. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.045 · Cited by 7 · see citing works
Economic and Behavioral Economic Approaches to Behavior Change
Brown, P. M., Cameron, L. D., Wilkinson, M., & Taylor, D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.042 · Cited by 6 · see citing works
Changing Behavior Using Integrative Self-Control Theory
Hofmann, W., Dohle, S., & Diel, K. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.011 · Cited by 6 · see citing works
Predicting prospective resident entrustment: From evaluation to action
Chen, X. P., Cochran, A. L., Harzman, A. E., & Ellison, E. C. (2021) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2021.01.020 · Cited by 6 · see citing works
Conner, M. T., Williams, D. M., & Rhodes, R. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.034 · Cited by 6 · see citing works
Rouvere, J., Blanchard, B. E., Johnson, M., Fillipo, I. G., Mosser, B. A., Romanelli, M., Nguyen, T., Rushton, K., Marion, J., Althoff, T., et al. (2024) · JMIR Human Factors · doi:10.2196/57082 · Cited by 5 · see citing works
“Intention to act, planning, and action (clicking a link) may occur within a time span ranging from seconds to minutes, rather than days to weeks as in usual applications of the HAPA model [12,20-25].”
MethodAddressing Underserved Populations and Disparities in Behavior Change
Schüz, B., & Hooper, M. W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.027 · Cited by 5 · see citing works
Editorial: Digital mental health: Interventions and assessment
Costescu, C. A., Podina, I. R., & Voinescu, A. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1014527 · Cited by 5 · see citing works
Changing Behavior in the Digital Age
Kavanagh, D. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.029 · Cited by 4 · see citing works
Zarski, A., Sextl-Plötz, T., Schmidt-Hantke, J., Hess, N. S., & Buntrock, C. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1626428 · Cited by 4 · see citing works
Eisele‐Metzger, A., Schagg, D., Krämer, L. V., Küffner, R., Reusch, A., & Göhner, W. (2021) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2021.1872128 · Cited by 3 · see citing works
“Action and coping planning have been repeatedly found to influence the actual behavior (Zarski et al., 2018).”
BackgroundChanging Behavior Using Control Theory
Mansell, W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.009 · Cited by 2 · see citing works
Schröder, S., Buntrock, C., Neumann, L., Müller, J. L., & Fromberger, P. (2023) · JMIR Formative Research · doi:10.2196/48880 · Cited by 2 · see citing works
“In addition to the above named scales, scales were measured on FC [31], planning behavior [39], and study compensation for hypotheses that were not part of this study.”
MethodBehavior Change in Community Contexts
Trickett, E. J., & Paterson, S. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.028 · Cited by 2 · see citing works
Cost-Effectiveness Evaluations of Behavior Change Interventions
Wang, T., Downes, M., Byrnes, J., & Scuffham, P. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.026 · Cited by 1 · see citing works
Expanding the UTAUT2 Model to Understand Student Engagement in On-Campus Stress Management Programs
John, D. T., Rechberg, K.-H., Guthardt, L., Helten, A.-K., Sahan, F., Lehr, D., Pryss, R. C., Schobel, J., & Apolinário-Hagen, J. (2026) · European Journal of Health Psychology · doi:10.1027/2512-8442/a000201 · Cited by 1 · see citing works
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Cuestionario pop [a] Carlos Iglesias: "'Un franco, 14 pesetas' es la 'peli' que más veces he visto"
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Hagger, M. S., Cameron, L. D., Hamilton, K., Hankonen, N. E., & Lintunen, T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.047
Pro-health measures as a creator of new behavior norms and attitudes
Fałek, P., Adamczyk, T., Fałek, A., & Burdan, F. (2023) · Folia Medica Cracoviensia · doi:10.24425/fmc.2022.144081
Schröder, S., Tozdan, S., Briken, P., Müller, J. L., & Fromberger, P. (2025) · BMC Psychology · doi:10.1186/s40359-025-02366-z
“The scales were answered on the same 5-point Likert scale, except for planning behavior, which was adopted from Zarski et al. [50] and was answered on a 4-point Likert scale ranging from 1 ( not true at all ) to 4 ( exactly true ).”
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Maciejewski, J., Lesnierowska, M., Carlbring, P., & Smoktunowicz, E. (2026) · Internet Interventions · doi:10.1016/j.invent.2026.101006
“At the same time, its influence on adherence may be indirect: in a HAPA-based analysis of an internet-based depression prevention program, maintenance self-efficacy predicted adherence only through planning, with planning the single significant direct predictor of adherence (Zarski et al., 2018).”
- Authors
- Zarski, A.-C., Berking, M., Reis, D., Lehr, D., Buntrock, C., Schwarzer, R., & Ebert, D. D.
- Affiliations
- Leuphana University of Lüneburg (DE)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- University of Koblenz and Landau (DE)
- Uniwersytet SWPS (PL)
- Corresponding author
- Zarski, Anna-Carlotta
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2018-01-11
- Volume
- 20
- Issue
- 1
- Pages
- e9
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC5785685
- OpenAlex
- W2783942684
- Cited by
- 87
- References
- 64
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 8 · 2021: 10 · 2020: 51 · 2019: 2 · 2018: 3
- FWCI
- 20.81
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Multilingual Matters (Channel View Publications) (publishedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- medication adherence, Health Action Process Approach, online intervention, depression prevention, subthreshold depression, planning, outcome expectations, intention, motivational factors
- MeSH terms
- Adult, Depression, Female, Humans, Longitudinal Studies, Male, Motivation, Patient Compliance, Perception, Surveys and Questionnaires, Health Behavior, Self Efficacy, Internet, Intention, Self Report
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