Influenza vaccination of healthcare workers (HCW) is important for protecting staff and patients, yet vaccine coverage among HCW remains below recommended targets. Psychological theories of behavior change may help guide interventions to improve vaccine uptake. Our objectives were to: (1) review the effectiveness of interventions based on psychological theories of behavior change to improve HCW influenza vaccination rates, and (2) determine which psychological theories have been used to predict HCW influenza vaccination uptake. MEDLINE, EMBASE, CINAHL, PsycINFO, The Joanna Briggs Institute, SocINDEX, and Cochrane Database of Systematic Reviews were searched for studies that applied psychological theories of behavior change to improve and/or predict influenza vaccination uptake among HCW. The literature search yielded a total of 1810 publications; 10 articles met eligibility criteria. All studies used behavior change theories to predict HCW vaccination behavior; none evaluated interventions based on these theories. The Health Belief Model was the most frequently employed theory to predict influenza vaccination uptake among HCW. The remaining predictive studies employed the Theory of Planned Behavior, the Risk Perception Attitude, and the Triandis Model of Interpersonal Behavior. The behavior change framework constructs were successful in differentiating between vaccinated and non-vaccinated HCW. Key constructs identified included: attitudes regarding the efficacy and safety of influenza vaccination, perceptions of risk and benefit to self and others, self-efficacy, cues to action, and social-professional norms. The behavior change frameworks, along with sociodemographic variables, successfully predicted 85-95% of HCW influenza vaccination uptake. Vaccination is a complex behavior. Our results suggest that psychological theories of behavior change are promising tools to increase HCW influenza vaccination uptake. Future studies are needed to develop and evaluate novel interventions based on behavior change theories, which may help achieve recommended HCW vaccination targets.

We manipulated both alcohol intoxication and sexual arousal and presented male participants (N = 79) with a video vignette in which two undergraduates decide whether to have unprotected sexual intercourse. Participants were asked what they would do if they were in a similar situation, and we found that among sober participants, those assigned to a sexually arousing or neutral condition did not differ in their intentions to engage in unprotected sexual intercourse. Among intoxicated participants (M blood alcohol level = 0.08%), however, those assigned to the sexually arousing condition reported that they were more likely to have unprotected sex than did those assigned to the neutral cue condition. These findings support alcohol myopia theory (Steele & Josephs, 1990 Steele , C. M. , & Josephs , R. A. ( 1990 ). Alcohol myopia: Its prized and dangerous effects . American Psychologist , 45 , 713 – 721 . [Google Scholar] ) and are consistent with prior nonexperimental work (MacDonald, MacDonald, Zanna, & Fong, 2000 MacDonald , T. K. , Fong , G. T. , Zanna , M. P. , & Martineau , A. M. ( 2000 ). Alcohol myopia and condom use: Can alcohol intoxication be associated with more prudent behavior? Journal of Personality and Social Psychology , 78 , 605 – 619 . [Crossref], [PubMed], [Web of Science ®] [Google Scholar] ). Through the use of an experimental design, this study makes a new contribution by demonstrating that sexual arousal and alcohol intoxication interact to exert a causal influence on intentions to engage in risky sexual behavior.

Attachment insecurity has been associated with negative behaviors during conflict and decreased relationship satisfaction. We theorize that individuals high in attachment anxiety and/or avoidance are less mindful during conflict with their romantic partners, and thus more likely to ruminate. Decreased mindfulness and higher levels of rumination may be important mechanisms in the relationship between attachment insecurity and conflict behavior, as it may be more difficult to engage in constructive problem-solving skills when one is distracted from the present moment. We conducted an online survey assessing 360 participants’ attachment orientations, levels of mindfulness and rumination, behavior during conflict, and experience with mindfulness activities. Using a serial mediation model, we found that mindfulness and rumination mediated the relationship between attachment insecurity and negative conflict behaviors. We further discovered that individuals high in attachment insecurity were more likely to report negative experiences with mindfulness activities (i.e., meditation and yoga), and that this relationship was mediated by higher levels of experiential avoidance, or a fear of engaging with one’s own thoughts and feelings. We discuss the importance of increasing mindfulness and decreasing both rumination and experiential avoidance to assist individuals high in attachment insecurity in navigating relationship conflict using more constructive and relationship-promoting strategies.