Psychology
Children with Autism Spectrum Disorder (ASD) often experience difficulties in sensory processing, motor coordination, behavioral regulation, and adaptive functioning, which can limit participation in daily activities such as eating and social interaction. Selective eating is highly prevalent and may lead to nutritional and developmental challenges.
The Schmetterling Program was developed as an integrative, sequential intervention targeting selective eating, motor skills, and stress regulation in children with ASD. Inspired by the concept of the “butterfly effect,” the program assumes that small, individualized therapeutic changes can produce meaningful developmental improvements. It combines established behavioral strategies such as shaping, imitation chaining, and guided modeling within a sensory-motor framework.
This dissertation evaluates the effectiveness of the Schmetterling Program through three studies involving children aged 2–6 years with ASD. The first study examined the Nutritional Behavior Intervention (NBI) across three families and found improvements in dietary flexibility and adaptive behavior. The second study compared 24 children with a control group and showed reductions in selective eating, improvements in autism symptom severity, and enhanced autonomic regulation measured by heart rate variability (HRV). The third study assessed the Motor Treatment (MT) component using a multiple-baseline design and demonstrated improvements in motor coordination, sensorimotor integration, and social communication.
Overall, the findings suggest that the Schmetterling Program may improve eating behavior, motor functioning, and psychophysiological regulation in children with ASD. The results support the effectiveness of integrative, individualized, and ecologically grounded interventions. Further research is required to confirm long-term outcomes and underlying neurophysiological mechanisms.
Chronic and non-communicable diseases present ongoing challenges for healthcare systems worldwide. Digital Health Interventions (DHIs) provide a promising solution by empowering patients to engage in health-related decisions and manage their behaviours. At present, many DHIs suffer from low user adoption or fail to progress beyond research. This thesis analyses the design, build, and evaluation of such tools to guide the effective co-creation of DHIs.
Across five studies, this thesis examines the design, build, and evaluation of DHIs. The first two studies explore how to effectively plan the co-creation of DHIs, identifying both facilitators and challenges. The second study applies co-creation methods to incorporate end users in developing design specifications for a DHI. The third study evaluates the impact of including end users in the build phase, whilst the final two studies assess evaluation strategies, demonstrating how synthetic data and machine learning can be used to manage missing data and predict intervention outcomes.
Findings highlight the importance of adaptive, inclusive design processes, careful planning of co-creator involvement, and the application of behavioural science across all phases. The thesis offers practical guidance for future researchers, emphasising the value of empowering patients, addressing attrition, and applying predictive analytics to maximise the real-world impact of DHIs.
Patient safety, as a topic that has been under constant development for several decades with the aim of increasing it, is associated with an understudied target behaviour: safe communication behaviour of pregnant women.
Study one refers to N= 424 cross-sectional self-administered data. The evaluation was carried out via path modelling.
In the second study (N=367), the effectiveness of two forms of intervention developed in the project for improving safe communication was tested using repeated measures analyses of covariance (ANCOVAs) for a before-and-after comparison, whereby the online live seminar and control group followed an RCT design.
In the third study (N=1187), psychological predictors of safe communication as well as sociodemographic characteristics were identified using hierarchical regression. Risk factors associated with early drop out within the web app were identified using logistic regression.
Results from Study 1 show that an adapted HAPA fitted the data best, whereby two sequential mediations emerged. Regarding Study 2 results indicate that women participating in the digital live seminar improved their safe communication behaviour and perceived patient more compared to women using the web app. Study 3 identified that younger women are at risk for early dropout in the web app. Action planning revealed as a core finding in predicting safe communication behaviour over the course of the web app.
Psychological mechanisms and their social-cognitive determinants in the motivational phase of pregnant women's intention to communicate safely are mediated by coping-specific as well as planning-specific volitional determinants and could be identified and explained. Younger age is a risk factor for early discontinuation in the web-app. This thesis shows how digital applications could be built, developed and implemented from a psychological perspective in the future and is addressed to pregnant women, to health care providers and to researchers.
Depression is rising both in Germany and Taiwan among all age groups but specially, also among elderly. In Taiwan, a larger proportion of users of antidepressants are over 65 years of age (NHI, 2020). In Germany, 24 % of people aged 65+ reporting depression symptoms in 2017 (OECD, 2019).
Data were extracted from the DEAS and the TLSA. Both of DEAS and TLSA were a countrywide representative survey. The scale used to measure depression in the two surveys was the CES-D. Data analysis included regression models, specifically logistic regression, and Generalized Estimating Equations. The McNemar test and Mantel-Haenszel test was applied to examine the consistency of the responses of the same group of subjects before and after the test.
The study found that in Germany, subjects with heart disease, cancer, and poor self-rated health (SRH) were more likely to suffer from depression. In Taiwan, subjects with diabetes, heart disease, stroke, cancer, and poor SRH were more likely to be depressed. Both countries showed that the drinking and exercise groups had a lower chance of developing depression. Widowhood increased the risk of developing depression, but there was no gender difference.
In addition to maintaining and improving physical health, exercise has been proven in this study to relieve psychological depression. Partnerships, on the other hand, provide social bonding and social support for middle-aged and older adults. Without a spouse, there is an association with more psychological health constraints like depression in older people living in Germany and Taiwan. Getting out and building relationships with friends and exercising together could be a good way to decrease the risk of depression among the elderly. According to attachment theory, having a stable relationship with some friends can also help the emotions of the elderly recover from the death of their spouse.
Sustainable behaviour change in healthcare is a complex process influenced by a variety of dynamic factors. This thesis aims to close existing research gaps concerning psychological factors of patient safety behaviours to develop effective interventions to improve patient safety in the exemplary field of obstetrics.
Study 1 made 267 observations of hand hygiene behaviour over three time periods. Questionnaire data on psychological determinants were analysed with multiple regression and multiple mediation analyses. Study 2 reports results of path analyses and multiple regression analyses concerning a survey with N = 137 obstetric healthcare workers. Pre- and post-intervention data was compared in a repeated-measures multiple analysis of variance. In Study 3, a randomized-controlled trial was conducted with pregnant women. The intervention group (NT1 = 225; NT2 = 142) received an online training and was compared to a passive control group (NT1 = 199; NT2 = 144) using multilevel analyses and intention-to-treat analyses after multiple imputation.
In Study 1, it was found that adherence to hand hygiene recommendations increased during COVID-19 pandemic, depending on self-efficacy. Study 2 showed that perceived patient safety risks were associated with communication behaviour. After the intervention, fewer patient safety risks were reported and coping self-efficacy increased. In Study 3, intention-to-treat analyses confirmed a higher intervention effect for communication behaviour, perceived quality of birth, and coping planning in the intervention group.
This thesis emphasizes the role of psychology to understand behavioural determinants and change patient safety behaviour in healthcare. To improve interventions in healthcare, structured implementation guidelines should be used in multidisciplinary programmes. Future research needs to apply more high-quality research designs, look at multidisciplinary outcome measures, and target more diverse and marginalized groups.
The COVID-19 pandemic as a crisis has been associated with changes in daily interaction, social connectedness, mental health, support structures, and the provision of (mental) health care treatment. This thesis aims to examine 3 main targets: psychological well-being during crises, psychological mechanisms related to reactions and consequences of individuals and systems, and the effectiveness of digital interventions to support mental health.
In 5 studies the following were examined: (1) triggers of preventable adverse events (pAEs) through evaluating the psychometric properties of a questionnaire; (2) hand hygiene behavior along the Health Action Process Approach (HAPA) through structural equation modeling; (3) differences in worries and mental health of the general population and psychosomatic rehabilitation patients; (4) evaluation of the intercorrelation between psychological variables along the Evolutionary Theory of Loneliness via a serial mediation model; (5) evaluation of the effectiveness of digital (psycho)therapeutic interventions.
In study 1, 5 areas of triggers of pAEs were defined and the questionnaire showed good psychometric properties. Study 2 has shown that hand hygiene behavior could be explained along the HAPA with the pattern being invariant for mental health. Study 3 has demonstrated higher mental health-related symptoms for psychosomatic rehabilitation patients who also reported different worries than the general population. Study 4 has shown a serial and individual mediation effect of loneliness and anxiety between distress and depression. Adding digital interventions to the traditional therapy approach supported the reduction of psychological symptoms as shown in study 5.
The findings of this thesis contribute to a greater understanding of psychological mechanisms evaluated by reactions and consequences associated with the COVID-19 pandemic and allow for several practical, theoretical, and methodological conclusions to be drawn.
As children develop, they learn to copy from others, interpret their intentions, and evaluate their reliability as sources of information (social learning). Today, these ‘others’ include not only children's peers, parents, or teachers, but also technological devices with which they can interact, including in educational settings. Social robots occupy a particular niche among such technologies, with the ability to embody specific social behaviours such as gaze, gesture, and verbal communication. Nonetheless, the technology underlying the design of social robots remains far from perfect, and opportunities for failures are rife. Understanding how the social capabilities inherent with social robots interact with these inevitable failures is therefore necessary for the design of robust educational interactions with robots. Consequently, the goal of this thesis is to develop an understanding of how errors impact children's social attitudes and behaviour towards social robots. First, a meta-analysis on children's trust in social robots was conducted, creating a theoretical baseline from which to study robot errors. Second, a learning task and measurements for use in child-robot-interaction (cHRI) were developed, through which robot errors could be manipulated and their effect on constructs such as trust, liking, and perceived agency captured. Third, the role of robot errors in a real-world implementation of the learning task was examined. Finally, how current social cognition paradigms can be used to explain children's perceptions of robot errors was explored. Throughout these studies, a theme emerged towards errors not being detrimental to children's perceptions of social robots, at least for more short-term interactions. The significance of robot errors and, more generally, social behaviour when evaluating social robots as tutors is discussed. The thesis concludes with recommendations for how cHRI research can draw from psychology in the design of future cHRI studies.
Background: Digital physical activity interventions can be effective, but how their components influence complex health behavior change processes has rarely been investigated in older adults.
Objective: Applying principles from social cognitive theory, missing value treatment and person-centered analyses, this thesis aims to tackle three research gaps in the form of barriers to physical activity behavior change in digital interventions targeted at older adults.
Methods: Study 1 covers social-cognitive mechanisms in the effect of tailored, theory-based digital interventions on movement in the physical activity stage of change. In study 2, lifestyle profiles consisting of six self-reported, health-related behaviors were researched using latent profile analysis. Adjusted risk ratios were calculated to identify dropout-vulnerable risk profiles. In Study 3, latent class growth analysis was used to determine trajectory subgroups regarding physical activity and sedentary behavior.
Results: In study 1, the hypothesized positive effects on stage of change were partly mediated by social-cognitive predictor changes. There were heterogenous intervention mechanisms. Four latent health-related lifestyle profiles were identified in study 2. Membership of the “socially inactive lifestyle” profile was associated with an elevated risk of dropping out. Study 3 identified two latent physical activity and sedentary behavior change trajectories, respectively. Significant positive trajectories were only observed in the highly sedentary.
Discussion and Conclusion: This thesis lays out a theoretical and methodological basis of how areas of heterogeneity in the physical activity behavior change process of older adults participating in digital interventions can be analyzed. Characterizing distinct subgroups and their needs can advance tailoring of intervention components and behavior change strategies, and ultimately improve acceptance, retention, and long-term intervention effectiveness.
Despite numerous attempts to reduce socioeconomic disparity in education, the gap in educational attainment and expectations among students with different socioeconomic backgrounds persists. This thesis is an attempt to extend our understanding of the social-psychological mechanisms that could explain this gap and inform solutions that would promote greater equality in education. It presents three manuscripts, which together propose that (1) the link between socioeconomic background and educational attainment can be explained by self-efficacy beliefs, and (2) childhood socioeconomic status and self-efficacy bias the process of judgement that precedes achievement-oriented behaviour. Building on the existing literature and research, in the first study I assess the roles of self-efficacy antecedents in the relationship between socioeconomic background and educational expectations. The findings demonstrate that self-efficacy antecedents fully explain the effects of income, social class, and primary caregiver’s education on educational expectations of students. Further, in a theoretical piece, I propose that pre-existing self-efficacy beliefs guide the selection and interpretation of the immediate information relevant in the process of appraisal of problem-focused coping potential. Finally, building on the results of the first study and the proposed theoretical framework, I test the effects of childhood status on the appraisal of coping potential and attribution of the outcome when people solve cognitive tasks. The findings demonstrate that the effect of childhood status varies across tasks with different difficulty and among people who succeeded and failed. I situate these findings within broader research on socioeconomic disparity in education and discuss their implications for theory, research, and practice.
A healthy lifestyle plays a key role in maintaining both the quality and the length of life. Interrelation of behaviors (internet use and health behaviors) and higher-level goals (perceived quality of life, work-life balance) are examined in this research.
The first study focuses on the interrelation between internet use and physical activity. While doing so, it identifies the differences across age groups. The second study focuses on the different contributions of work-time and leisure-time internet use to perceived quality of life, taking stress management and health behaviors into account. The third study focuses on the interrelation between multiple health behaviors and work-life balance, as well as the mediator roles of perceived stress and problematic internet use, and the moderator role of the resident countries.
The results of the first study show positive associations between physical activity variables. Positive associations between internet use and physical activity emerges in late adolescents, whereas negative associations between internet use and physical activity planning emerges in middle-aged adults. The results of the second study reveal that leisure-time internet use, but not work-time internet use, is positively associated with problematic internet use. Participants whose work-time internet use could be considered balanced indicates a higher perceived quality of life. The results of the third study indicate the mediator roles of perceived stress and problematic internet use between health behaviors and work-life balance. Among the residents of Germany, a partial mediation is revealed, whereas among the residents of China, a full mediation is found.
Conclusions are given in the form of research, practical and theoretical implications. In today’s digital society, a proper combination of multiple health behaviors and appropriate internet use can benefit individuals’ quality of life and work-life balance.
