Introduction
Materials and methods
Participants
Intervention measures
Time | Aims | Methods | Implement and contents | HAPA variables basics |
---|---|---|---|---|
The first intervention | To cultivate the awareness and willingness of participants about Internet use behaviors | (1) Health education courses | Implement: Health education courses were conducted in class units and were taught by trained teachers who majored in health education. Each course lasted for 45 min for every class in every intervention. It was carried out by a combination of teacher teaching, videoes and scenario simulation. The courseware used in this intervention was copied to the school teachers, and they repeated the intervention contents to the participants in the daily class meetings. Contents: The main contents embraced publicizing the harms caused by excessive Internet use and the benefits of reducing Internet use time, with the objective of promoting the action self-efficacy about Internet use behaviors. | Risk perception Outcome expectancy Action self-efficacy |
(2) Customized manuals | Implement: The manuals were uniformly produced by the research team and distributed to all participants after the health education courses. Contents: The main contents were similar to the content of the health education courses, including the harms caused by excessive Internet use, the benefits of reducing Internet use time, and the correct approaches to surf online. | |||
The second intervention | To consolidate the effect of the first intervention and to promote the formation of the intention. | Health education courses | Implement: The implementation method was the same as the first intervention. Contents: The content emphasized and deepened the content of the first time. | Risk perception Outcome expectancy Action self-efficacy Intention |
The third intervention | To help participants formulating plans. | (1) Health education courses | Implement: The implementation method was the same as the first intervention. Contents: The main contents were how to make plans to help the participants to turn their intention into actual behaviors, including the duration, the implementation of the plan, etc. | Planning |
(2) Guidance on plan formulation | Implement: After the health education courses, one-to-one guidance was provided for the participants by the trained teachers. Contents: The guidance content was about clarifying the plan’s objectives, implementation methods, duration, possible obstacles, obstacle solutions, etc. | |||
The fourth intervention | To strengthen the maintenance self-efficacy and reduce the online time. | (1) Health education courses | Implement: The implementation method was the same as the first intervention. Contents: The main contents were the introduction of specific cases (including successful cases and failure cases of reducing online time) and analysis of the reasons for success or failure. | Maintenance self-efficacy |
(2) Provide physical exercise equipment | Provided freely table tennis rackets, skipping ropes, and other sports equipment to every class. | Internet use behaviors |
Measures
Sociodemographic characteristics
Internet use behaviors
Variables of the HAPA model
Data collection and analysis
Results
Sociodemographic characteristics and scores of the HAPA model variables
Left-behind status | Gender | Grade | ||||
---|---|---|---|---|---|---|
yes | no | male | female | seventh | tenth | |
Outcome expectancy | 4.85 ± 0.79 | 4.84 ± 0.87 | 4.80 ± 0.81 | 4.90 ± 0.82 | 4.81 ± 1.02 | 4.85 ± 0.78 |
Risk perception | 3.22 ± 0.89 | 3.16 ± 0.85 | 3.16 ± 0.88 | 3.24 ± 0.87 | 3.01 ± 0.96 | 3.23 ± 0.86 |
Action self-efficacy b* | 2.95 ± 0.87 | 2.99 ± 0.97 | 2.86 ± 0.98 | 3.08 ± 0.81 | 2.99 ± 1.17 | 2.96 ± 0.85 |
Intention | 4.18 ± 1.23 | 4.07 ± 1.27 | 4.03 ± 1.25 | 4.25 ± 1.23 | 3.88 ± 1.65 | 4.19 ± 1.15 |
Planningc* | 3.62 ± 1.41 | 3.83 ± 1.40 | 3.54 ± 1.45 | 3.84 ± 1.34 | 3.13 ± 1.58 | 3.78 ± 1.36 |
Maintenance self-efficacy | 4.13 ± 1.11 | 4.19 ± 1.10 | 4.15 ± 1.08 | 4.15 ± 1.14 | 3.96 ± 1.26 | 4.18 ± 1.08 |
Internet use behaviorsa, b**, c** | 15.50 ± 3.43 | 15.73 ± 3.64 | 14.95 ± 3.48 | 16.23 ± 3.41 | 14.13 ± 3.42 | 15.82 ± 3.45 |
Applicability of the HAPA model in internet use behaviors
Correlation analysis of the HAPA model variables
Outcome expectancy | Risk perception | Action self-efficacy | Intention | Planning | Maintenance self-efficacy | Internet use behaviors | |
---|---|---|---|---|---|---|---|
Outcome expectancy | 1 | ||||||
Risk perception | 0.107 | 1 | |||||
Action self-efficacy | 0.231*** | −0.205*** | 1 | ||||
Intention | 0.258*** | −0.200*** | 0.637*** | 1 | |||
Planning | 0.122* | −0.184** | 0.317*** | 0.361*** | 1 | ||
Maintenance self-efficacy | 0.064 | −0.176*** | 0.257*** | 0.235*** | 0.449*** | 1 | |
Internet use behaviors | 0.096 | −0.178** | 0.266*** | 0.353*** | 0.414*** | 0.205*** | 1 |
Model fitting and analysis results
Standardized coefficient (95% CI) | Unstandardized coefficient (standard error) | P-value | ||
---|---|---|---|---|
Direct effects | Action self-efficacy→ Intention** | 0.660 (0.525, 0.779) | 0.904 (0.104) | 0.001 |
Risk perception→ Intention | −0.088(− 0.193, 0.023) | −0.124 (0.077) | 0.114 | |
Outcome expectancy→ Intention* | 0.144 (0.021, 0.265) | 0.224 (0.093) | 0.023 | |
Intention→ Planning** | 0.293 (0.176, 0.413) | 0.332 (0.069) | 0.001 | |
Maintenance self-efficacy→ Planning** | 0.424 (0.272, 0.560) | 0.584 (0.110) | 0.001 | |
Maintenance self-efficacy→ Internet use behaviors | 0.008(−0.180, 0.189) | 0.006 (0.073) | 0.976 | |
Planning→ Internet use behaviors** | 0.494 (0.346, 0.643) | 0.274 (0.051) | 0.001 | |
Indirect effects | Outcome expectancy→ Intention→ Planning* | 0.042 (0.006, 0.088) | 0.074 (0.037) | 0.023 |
Outcome expectancy→ Intention→ Planning→ Internet use behaviors* | 0.021 (0.003, 0.048) | 0.020 (0.011) | 0.023 | |
Risk perception→ Intention→ Planning | −0.026(−0.063, 0.006) | − 0.041 (0.028) | 0.114 | |
Risk perception→ Intention→ Planning→ Internet use behaviors | −0.013(− 0.033, 0.003) | −0.011 (0.008) | 0.114 | |
Action self-efficacy→ Intention→ Planning** | 0.193 (0.116, 0.279) | 0.300 (0.068) | 0.001 | |
Action self-efficacy→ Intention→ Planning→ Internet use behaviors** | 0.095 (0.048, 0.154) | 0.082 (0.025) | 0.001 | |
Intention→ Planning→ Internet use behaviors** | 0.145 (0.072, 0.231) | 0.091 (0.027) | 0.001 | |
Maintenance self-efficacy→ Planning→ Internet use behaviors** | 0.209 (0.117, 0.314) | 0.160 (0.044) | 0.001 |
Effectiveness of interventions based on the HAPA model
Experimental group (n = 327) | Control group (n = 448) | |||||||
---|---|---|---|---|---|---|---|---|
Before | After | Incremental effect | P value | Before | After | Incremental effect | P value | |
Risk perception | 3.29 ± 0.97 | 3.20 ± 0.88 | −0.09 | 0.122 | 3.02 ± 1.04 | 2.77 ± 0.98 | −0.25 | < 0.001 |
Outcome expectancy | 3.86 ± 0.72 | 4.85 ± 0.82 | 0.99 | < 0.001 | 3.84 ± 0.76 | 4.56 ± 1.10 | 0.72 | < 0.001 |
Action self-efficacy | 2.92 ± 0.92 | 2.97 ± 0.90 | 0.05 | 0.388 | 2.74 ± 1.00 | 2.83 ± 0.90 | 0.09 | 0.09 |
Intention | 3.55 ± 1.18 | 4.14 ± 1.24 | 0.59 | < 0.001 | 3.71 ± 1.16 | 4.09 ± 1.39 | 0.38 | < 0.001 |
Planning | 3.70 ± 1.40 | 3.69 ± 1.41 | −0.01 | 0.851 | 3.55 ± 1.47 | 3.55 ± 1.59 | 0 | 0.961 |
Maintenance self-efficacy | 3.43 ± 1.27 | 4.15 ± 1.11 | 0.72 | < 0.001 | 3.53 ± 1.33 | 3.94 ± 0.82 | 0.41 | < 0.001 |
Variables | Baseline survey N (%) | The third survey N (%) | The fifth survey N (%) | P-value |
---|---|---|---|---|
Excessive Internet user | 327 (100.0%) | 256 (78.29%) | 229 (70.0%) | |
Internet use behaviors* | ||||
Average daily Internet time from Monday to Friday ≥ 2 h | 169 (51.7%) | 179 (54.74%) | 155 (47.4%) | 0.258 |
Average daily Internet time on weekends ≥ 4 h | 187 (57.2%) | 176 (53.82%) | 128 (39.1%) | < 0.001 |
Usually daily game time ≥ 2 h | 167 (51.1%) | 136 (41.59%) | 115 (35.2%) | < 0.001 |
Have been online overnight at least once in the past 30 days | 75 (22.9%) | 53 (16.21%) | 64 (19.5%) | 0.289 |