On 2017 Nov 08, BSH Cancer Screening, Help-Seeking and Prevention Journal Club commented:

The BSH Cancer Screening, Help-Seeking and Prevention Journal Club read with great interest this paper, which we feel provides a useful addition to the literature. In this paper, the authors present a framework for the complex relations between cognition and affect in predicting health behaviour. The authors describe the model that is currently used most often in health behaviour research, which looks at the independent effects of cognition and effect on health behaviour (the “main effects approach”). They then convincingly argue that this model does not consider possible interconnections of thought and feeling and describe three alternative models that may be better at explaining subsequent health behaviour: a mediation model (either an affect-preceding-cognition model or a cognition-preceding-affect model), a moderation model, and a contextualised effects model, which are helpfully explained graphically in the Figure on page 3 of the paper. The authors also provide empirical evidence from the health behaviour literature to support each of these models, and argue that these complex relations should be routinely examined in health behaviour research.

Our group recognised the importance and relevance of this topic to much of our work on the determinants and possible points for intervention in cancer screening, help-seeking, and cancer prevention. The authors provide a good reminder of how theory can be improved to better understand behaviour, which is relevant to our work on, for example, cancer screening as a teachable moment or cancer worry as determinant of screening uptake, but is also applicable to a wide range of other health behaviours such as smoking, exercise, and healthy eating.

However, the paper also raised some questions in our group. First, it was unclear to us which model would be applicable under what circumstances. For example, is this a function of the behaviour or of the affective state that is under study, or could this also be construed as characteristic of an individual or group of individuals? For example, for some people, perhaps those who are more organised or conscientious, the cognition-preceding-affect model may better predict subsequent behaviour, while for others, perhaps those who are struggling to cope due to life difficulties or mental health issues, the affect-preceding-cognition model may better predict behaviour. The authors acknowledge that the models they present are “not mutually exclusive” (p.4), and so “multiple types of relations could be involved in determining engagement in a particular health behaviour” (p.4), but this does not provide much guidance on how these models might guide our formulation of hypotheses to be tested in a particular study. Relatedly, it is unclear how these models can (or should) be applied to existing health behaviour models, and to what extent they require an overhaul of these existing models. Our group noted that the inclusion of these complex relationships could water down existing theoretical models, especially if the specific relationship cannot be identified a priori on theoretical grounds but is a function of the behaviour, affective state, individual, or group under study. From the empirical examples that the authors provide throughout, it is unclear whether the complex relations in those studies were pre-specified based on theoretical grounds, or merely exploratory in nature. In their Discussion on p.11, the authors seem to acknowledge that inclusion of the often-neglected interconnections between cognition and affect will require an exploratory, theory-building approach. Our group would have found it helpful if the authors had provided more practical advice on how to formulate a priori hypotheses about these complex relations, and perhaps some worked examples.

Other questions that were raised by our group are of a more pragmatic nature, such as what the implications of the inclusion of complex relations between cognition and affect would have on study sample size and power (especially if not pre-defined a priori but tested post hoc). A related concern was how to practically take the ideas presented by the authors forward, given that mediation and moderation analyses may require a slightly different skill set, and one that many social scientists may not be very familiar with.

Overall, however, the group felt that these concerns -especially those of a more practical nature- do not override the importance of taking forward the excellent ideas presented in this paper, which could herald a new era for health behaviour research, both in terms of theory and practice.

On 2017 Nov 08, BSH Cancer Screening, Help-Seeking and Prevention Journal Club commented:

The BSH Cancer Screening, Help-Seeking and Prevention Journal Club read with great interest this paper, which we feel provides a useful addition to the literature. In this paper, the authors present a framework for the complex relations between cognition and affect in predicting health behaviour. The authors describe the model that is currently used most often in health behaviour research, which looks at the independent effects of cognition and effect on health behaviour (the “main effects approach”). They then convincingly argue that this model does not consider possible interconnections of thought and feeling and describe three alternative models that may be better at explaining subsequent health behaviour: a mediation model (either an affect-preceding-cognition model or a cognition-preceding-affect model), a moderation model, and a contextualised effects model, which are helpfully explained graphically in the Figure on page 3 of the paper. The authors also provide empirical evidence from the health behaviour literature to support each of these models, and argue that these complex relations should be routinely examined in health behaviour research.

Our group recognised the importance and relevance of this topic to much of our work on the determinants and possible points for intervention in cancer screening, help-seeking, and cancer prevention. The authors provide a good reminder of how theory can be improved to better understand behaviour, which is relevant to our work on, for example, cancer screening as a teachable moment or cancer worry as determinant of screening uptake, but is also applicable to a wide range of other health behaviours such as smoking, exercise, and healthy eating.

However, the paper also raised some questions in our group. First, it was unclear to us which model would be applicable under what circumstances. For example, is this a function of the behaviour or of the affective state that is under study, or could this also be construed as characteristic of an individual or group of individuals? For example, for some people, perhaps those who are more organised or conscientious, the cognition-preceding-affect model may better predict subsequent behaviour, while for others, perhaps those who are struggling to cope due to life difficulties or mental health issues, the affect-preceding-cognition model may better predict behaviour. The authors acknowledge that the models they present are “not mutually exclusive” (p.4), and so “multiple types of relations could be involved in determining engagement in a particular health behaviour” (p.4), but this does not provide much guidance on how these models might guide our formulation of hypotheses to be tested in a particular study. Relatedly, it is unclear how these models can (or should) be applied to existing health behaviour models, and to what extent they require an overhaul of these existing models. Our group noted that the inclusion of these complex relationships could water down existing theoretical models, especially if the specific relationship cannot be identified a priori on theoretical grounds but is a function of the behaviour, affective state, individual, or group under study. From the empirical examples that the authors provide throughout, it is unclear whether the complex relations in those studies were pre-specified based on theoretical grounds, or merely exploratory in nature. In their Discussion on p.11, the authors seem to acknowledge that inclusion of the often-neglected interconnections between cognition and affect will require an exploratory, theory-building approach. Our group would have found it helpful if the authors had provided more practical advice on how to formulate a priori hypotheses about these complex relations, and perhaps some worked examples.

Other questions that were raised by our group are of a more pragmatic nature, such as what the implications of the inclusion of complex relations between cognition and affect would have on study sample size and power (especially if not pre-defined a priori but tested post hoc). A related concern was how to practically take the ideas presented by the authors forward, given that mediation and moderation analyses may require a slightly different skill set, and one that many social scientists may not be very familiar with.

Overall, however, the group felt that these concerns -especially those of a more practical nature- do not override the importance of taking forward the excellent ideas presented in this paper, which could herald a new era for health behaviour research, both in terms of theory and practice.