A Virtual Reality-Based Cognitive Restorative Intervention Using Nature to Improve Attention, Self-Care, and Health-Related Quality of Life in Heart Failure.

There is strong evidence to support self-monitoring as a strategy to promote health behavior change. Regular self-monitoring, defined in weight loss interventions as the recording of diet and physical activity behaviors, significantly enhances weight-related behaviors and outcomes, including dietary habits, physical activity, and overall weight management. Despite evidence of its effectiveness, many participants do not adhere to self-monitoring as prescribed in health behavior change interventions. Among those who do, self-monitoring tends to decline over time. Although self-monitoring technologies have advanced, persistent barriers remain, such as forgetting to log behaviors, the time required for tracking, and the psychological effects of monitoring and feedback. However, the underlying reasons why participants often struggle with adhering to self-monitoring practices remain insufficiently explored. A small number of recent studies point toward the potential effect of health information avoidance as a barrier to self-monitoring in behavior change interventions. Information avoidance is the tendency of individuals to avoid information they perceive as potentially distressing. It can result in behaviors to prevent the obtainment of health information that may be undesirable. In behavioral weight-related interventions, self-monitoring diet, physical activity, or body weight can be distressing, particularly for individuals who tend to avoid weight-related information. For example, Schumacher and colleagues found that greater self-reported weight-related information avoidance at baseline resulted in poorer self-monitoring of physical activity and body weight (but was unrelated to dietary self-monitoring) among participants in a 12-week behavioral weight loss intervention. In a similar study of participants in a 12-month behavioral weight loss intervention, Crane et al. found that high weight-related information avoidance at baseline predicted a faster rate of disengagement in dietary self-monitoring behaviors. The relationship between dietary information avoidance and self-monitoring of dietary intake is less well-researched. Previous studies have sought to examine participants’ information avoidance for specific foods. In a study focused on red meat risk information, Gaspar et al. found that participant avoidance of red meat risk information was low overall, yet was positively correlated with favorable attitudes toward red meat intake. Similarly, while Kim and colleagues found a low level of information avoidance overall in their study examining avoidance of added sugar information, individuals with lower added sugar information avoidance tended to purchase products with less added sugar. Both studies found that greater dietary information avoidance was associated with less healthy dietary patterns. However, whether this information avoidance influenced health behavior change processes (e.g. self-monitoring) and outcomes is understudied. To date, we are unaware of any studies that have sought to measure food- or beverage-specific information avoidance, such as sugar-sweetened beverage (SSB) intake information avoidance, and its effect on dietary self-monitoring.