Expanding the analysis of mechanisms of action in behavioral interventions: cognitive change versus cognitive activation.

OBJECTIVE

To understand the mechanisms of action underlying behavioral interventions, researchers typically examine whether the treatment changes cognitions and whether changes in cognition predict behavior (). This current research explores an alternative mechanism whereby the intervention increases the impact of pre-existing cognitions on behavior (). We tested whether cognitive change or cognitive activation explains the impact of cigarette pack messages on smoking restraint.

DESIGN

The research comprised a validation experiment ( = 135) and a 4-week RCT ( = 719) with smokers.

MAIN OUTCOME MEASURES

At both baseline and follow-up of the RCT, smokers self-reported threat appraisals, coping appraisals, and smoking restraint.

RESULTS

Intervention messages heightened the accessibility of threat appraisals compared to control messages (validation experiment). In the RCT, smoking restraint increased among intervention participants but not controls. Trial arm showed no corresponding change in threat or coping appraisals. However, trial arm interacted with baseline health cognitions such that synergies between threat appraisal components, and between threat appraisals and coping appraisals, predicted smoking restraint for intervention participants but not for controls.

CONCLUSION

Our findings support a cognitive activation process whereby health messages on cigarette packs increase the impact of pre-existing threat appraisals on smoking restraint.