The Journal of School Nursing2024, Vol. 40(2) 155–165© The Author(s) 2021Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/10598405211046198journals.sagepub.com/home/jsn
Most people start experimenting with and/or initiating health-compromising behaviors and establishing behavioral patterns during adolescence. Possible selves and episodic future thinking have been used to foster behavioral changes. In this study, we aimed to (1) develop a program incorporating possible selves and episodic future thinking to decrease the risks associated with health-compromising behaviors, and (2) examine the feasibility and fidelity of implementing this intervention among Taiwanese adolescents. A novel combination of existing intervention approaches tailored for the Taiwanese context was applied to develop a school-based intervention, which we named the Future Mapping Master program. This program contains four core units: exploring the self, setting goals, developing strategies and problem solving, and understanding the threats of health-compromising behaviors. It includes daily episodic future thinking visualization exercises. The feasibility evaluation was conducted with 88 adolescents aged 12–14 years. Feedback from teachers and students supported the proposed program’s feasibility and revealed favorable reactions to the intervention. The Future Mapping Master program is feasible and offers promising strategies for implementation in Taiwanese school settings.
Keywordsself-cognition, adolescence, prevention, alcohol drinking, disordered eating, school setting
Adolescence is the time when youths begin to speculate about who they are and what the future will hold for them. In this period they explore and establish their identities and behavioral patterns. From early adolescence (i.e., the junior high school period), youths begin to experiment with health-compromising behaviors (e.g., drinking, smoking, drug use, and disordered eating), which could lead to significant, but preventable, health problems and early mortality in both adolescence and adulthood (Bonnie & O’Connell, 2004; DiFranza et al., 2007; Hingson et al., 2006; Miller et al., 2007). According to the 2018 Taiwan Youth Health Survey and Global Youth Tobacco Survey (Health Promotion Administration, Ministry of Health and Welfare, 2019), by junior high school age (12–15 years), 52% of adolescents reported having used alcohol, 9% of adolescents reported having been drunk, 15% of adolescents reported drinking in the last month; 13% of adolescents reported having smoked cigarettes, and 4% of adolescents reported smoking in the last month. The development of effective prevention and early intervention to address such healthcompromising behaviors to substantially improve adolescent health and reduce societal costs and medical expenditure is therefore a critical public health issue in Taiwan.
Despite significant efforts devoted to the implementation and evaluation of interventions to promote adolescent health and mitigate adolescent health-compromising behaviors over the past few decades, fostering abstinence from healthcompromising behaviors remains a challenge (Hale et al., 2014; MacArthur et al., 2018). Moreover, a growing body of research suggests that health-compromising behaviors often cooccur rather than occur in isolation (Mathur et al., 2020; Raffoul & Kirkpatrick, 2020). For example, drinking, smoking, drug use, and disordered eating are highly correlated and frequently co-occur among adolescents (Chen et al., 2009; Ferriter & Ray, 2011; Kuo et al., 2002; Marshall, 2014). Therefore, interventions targeting multiple health-compromising behaviors simultaneously may be more effective and efficient than targeting a single healthcompromising behavior.
There is growing recognition that the self plays an important role in regulating behaviors (Paquin & Keating, 2017; Rhodes et al., 2016), particularly in the identity development stage during adolescence. Possible selves and episodic future thinking engage one’s mental time travel, and targeting these constructs may result in behavioral changes (Arnold et al., 2011; Snider et al., 2016; Stein et al., 2016; Wu et al., 2017). Possible selves—cognitions about the self in the future—are developmental memory structures about what one hopes to be (e.g., “I hope to have many friends”), is afraid of becoming (e.g., “I am afraid of being a failure”), and expects to become (e.g., “I expect to have a successful career”) in a variety of content domains (Markus & Nurius, 1986). Possible selves form from personal experience, values, and goals, which are contextualized and highly personalized (Markus & Nurius, 1986; Oyserman & Fryberg, 2006). Rather than vague desires or dreams, they include vivid images of the self in a future state as well as strategies for achieving or avoiding possible selves (Markus & Nurius, 1986; Oyserman et al., 2004). Possible selves prioritize person-in-context and function as highly personalized goals; therefore, they play an important role in motivating and regulating goal-directed behavior (Markus & Nurius, 1986; Oyserman et al., 2004). A recent systematic review by Corte et al. (2020) showed that the development of possible selves influences both health-compromising and health-promoting behaviors (e.g., physical activity) in adolescents.
Possible self-intervention is an approach to foster plausible future self-images/goals using an individual’s inner resources, which has the potential to affect a variety of health behaviors and psychological well-being (Clark et al., 2005; Oyserman et al., 2002, 2006, 2007). Possible selves in combination with strategies and action plans for achievement are more likely to link to self-regulatory behaviors than possible selves without strategies (Oyserman & James, 2009). Oyserman et al. developed a school-based self-intervention to improve academic-related behaviors and school performance by promoting the development of academic-related possible selves and plausible strategies for attaining these selves among adolescents at high risk of academic drop-out (Oyserman et al., 2002, 2006, 2007). This intervention was designed to guide adolescents in visualizing and elaborating their possible selves by enhancing individual articulation of future self or personal goals through activities to develop skills, strategies, and action plans for achieving their possible selves/goals. The positive effects of this approach were brought about through changes in the development of academic-related possible selves and increased linkage between possible selves and strategies to attain them (Oyserman et al., 2006). Moreover, Clark et al. (2005) modified Oyserman’s program to reduce sexual risk for seventh graders from lowincome families. Their intervention provided evidence that focusing on individual risk behaviors is not effective. Rather, interventions that guide adolescents to identify their possible selves in domains (e.g., occupation) and help them develop the skills/strategies to achieve these selves motivated adolescents to take action toward positive futures and avoid negative consequences. This, in turn, reduces adolescents’ risky behaviors (Clark et al., 2005).
Another strategy that has been used in this regard is episodic future thinking, which is the projection of oneself into the future to pre-experience forthcoming events, which promotes clarification and awareness of one’s future, enhances learning about the self, and extends the subjective time from past and present to future (Atance & O’Neill, 2001; Schacter et al., 2017). Prospective thinking and imagery enhance either consideration of distant rewards or the value of delayed outcomes between temporal-distanced choices (Wu et al., 2017). D’Argembeau et al. (2011) explain that episodic future thinking is a transitory pattern of activation of enduring memory structures about the self, including general personal knowledge, episodic memories of past selves, and future-oriented personal goals. Indeed, personal future-oriented goals are essential to construct episodic future thinking because they facilitate access to relevant details (D’Argembeau & Mathy, 2011; Wu et al., 2017). An episodic future thinking intervention involves guiding individuals to think and/or write narrative descriptions of their future in detail, either content domain-specific (e.g., personal, relational, professional, or exercise) or content-free instruction, and to practice an imagery exercise that coincides with their written story (McCue et al., 2019). Researchers have used episodic future thinking interventions to improve substance-use behaviors (Sofis et al., 2021; Stein et al., 2018; Voss et al., 2021), eating behaviors (Daniel et al., 2015; Rung & Madden, 2018), and psychiatric disorders (Hallford et al., 2018) among adolescents and adults. Neuroscience studies also show that episodic future thinking shifts the time perspective of intertemporal decision-making, suggesting this may form part of dopaminergic neurotransmission (Lin & Epstein, 2014). However, little is known about the effects of an episodic future thinking intervention in developing the memory structure about one’s future self (i.e., plausible possible self). Although the manipulation of episodic future thinking makes prospective thinking salient, without the development of a plausible possible self, the effects are not long-lasting, that is, they cannot sustain motivation or change long-term behavior (Oyserman & James, 2009, 2011).
Taken together, possible selves and episodic future thinking interventions have demonstrated effectiveness in changing behaviors. A possible self-intervention tends to focus on the end goal but not on imagining future-oriented events that may be necessary to transform the goal into an enduring cognitive structure. However, existing episodic future thinking interventions usually do not consider personal goals, which are central to constructing future thinking and related planning and decision-making. A recent meta-analysis of neuroimaging studies also provided evidence that the processing of personal goals during episodic future thinking activates the medial prefrontal cortex—the part of the brain that is involved in thinking about the future, self-referential processing, and impulse control (Stawarczyk & D’Argembeau, 2015). Thus, including episodic future thinking in possible self-interventions may be an effective method for future interventions to mitigate and sustain behaviors.
Our aims were (1) to develop an intervention to decrease the risk of engaging in health-compromising behaviors and (2) to examine the feasibility (acceptability, practicability, demand, implementation, and limited-efficacy testing) and fidelity of intervention implementation among Taiwanese adolescents. Our fundamental hypothesis was that interventions that promote the formation and elaboration of possible selves and enhance episodic future thinking for personal goals will reduce the intensity and frequency of healthcompromising behaviors. A school-based intervention was chosen because previous research suggested that targeting schools is not only practical, but also may substantially contribute to the prevention of multiple health-compromising behaviors among adolescents (Hale et al., 2014).
A comprehensive review of previous empirical and theoretical studies about possible selves and episodic future thinking as well as existing intervention programs guided the development of this intervention program. All study activities were approved by a university’s human research ethics committee (HREC). A stepwise process was applied and addressed as follows:
A novel combination of existing intervention approaches mentioned in the introduction was used to develop a new and potentially universal possible self-based intervention, which we named Future Mapping Master. This program incorporates episodic future thinking into a possible selfintervention program as part of the current school curriculum. The intervention program was developed based on the essential components and concepts of existing possible selfinterventions and episodic future thinking interventions for behavioral changes. Two senior health-education schoolteachers, who hold master’s degrees and have more than 10 years of teaching experience, were invited to join the research team and work with the researchers to design class activities based on the core components of the intervention. A teacher guide with lesson plans and related teaching materials and aids (e.g., course teaching slides, worksheets, posters, and board game cards) was devised.
The intervention program aimed to encourage adolescents to make their own future images realistic by mapping their future goals and conceiving action strategies to pursue their possible selves, and in turn prevent/reduce their compromising behaviors. The possible selfcomponent of the Future Mapping Master intervention comprised four core units: (1) exploring the self, (2) goal setting, (3) strategy development and problem-solving, and (4) threats of health-compromising behaviors (see Table 1). Each unit comprised one 45 min class, once a week, and the entire program was delivered within 4 weeks by the trained schoolteachers. The intervention activities, teaching materials, and teaching aids were designed for each of the four core units. Activities included thinking about the self (now and in the future), small-group discussions, watching short videos, storytelling, playing board games, and class discussions/sharing. These different strategies were used to promote students’ thinking, expression, communication, and sharing, therefore allowing students not only the opportunity to think about themselves, but also to learn about others’ thoughts, strategies, and/or resources.
Moreover, given that continuity of thought and the compilation of goals/possible selves is critical for maintenance, a supplement―episodic future thinking―was incorporated into the Future Mapping Master intervention program. Students were asked to perform a 5-min imagery exercise daily, including both imagination and writing tasks, during the 4 weeks as homework. The imagery exercise steps were taught at the end of each unit. The instructions changed slightly each week based on the content of each unit (see Table 2).
Since each adolescent has a unique collection of possible selves (Markus & Nurius, 1986), if the researchers had assigned the specific content domain of the intervention (e.g., academics, occupation, exercise, and drinking), some of the adolescents may have lost interest and focus. The literature indicates that having more positive possible selves (across content domains) and/or having a most important possible self, related to academics, for example, protects adolescents (sixth to ninth graders) from engaging in healthcompromising behaviors (Aloise-Young et al., 2001; Lee et al., 2015). Moreover, a possible self needs to be relevant to one’s personal situation and should be perceived as important to influence one’s motivation (Oyserman et al., 2015). Therefore, rather than the content-specific approach, an intervention with a content-free approach to generate adolescents’ possible selves was applied. This approach allowed adolescents to choose individual interests across the various content domains, which was, therefore, more likely to enhance the motivation of adolescents to work on their self-selected most important possible selves. For alignment and consistency, episodic future thinking also focused on each individual’s most important possible self (personal goal).
An expert panel review (including six researchers in relevant fields of adolescent health, health promotion, and health education as well as two middle-school teachers) evaluated the appropriateness of the intervention program and whether the activities were consistent with the learning objectives and core components of the program (version 1). The evaluation criteria included clarity of the teaching goals, rationality of the instructional design, effectiveness of the teaching strategies, and consistency between teaching content and teaching goals. The experts reviewed a draft of the intervention program and judged whether the content met the said criteria or whether revision was required. The program was then revised according to the feedback and comments received from the experts (version 2).
The research team met with several teachers and directors from junior high schools to review and discuss the possibility of implementing the program. Based on their suggestions, the intervention program was planned to be provided by current counseling or health education teachers in junior high schools. One school counselor and one health education teacher were trained using the teaching manual and relevant materials by the research team through either phone calls or in-person discussions. The training continued until teachers’ understanding and confidence/ability were confirmed by the research team.
A feasibility study was conducted to examine the feasibility and fidelity of the intervention implementation (version 2) for the Future Mapping Master program and included two phases. In the first phase, we tested the feasibility of implementing the Future Mapping Master program in one public junior high school (46 students comprising two classes) in southern Taiwan. In the second phase, we investigated the feasibility of implementing the Future Mapping Master program, in addition to conducting pretests and posttests of health-compromising behaviors, in two public junior high schools (42 students; one class from each school) in southern Taiwan. The pretests and posttests were administered immediately before and after the four-unit intervention. Overall, a convenience sample of 88 seventh graders (four classes) participated in the feasibility study. We included all students in these four classes since all of them and their parents agreed to participate. The mean age was 12.9 years (SD = 0.5), and 52% of the students were boys. All students’ parents/guardians received a letter that addressed the study purpose, procedure, and activities, and assured participants that data collection would be anonymized. The waiver of parental written permission was granted by the HREC. The research assistants explained the study information to the students and obtained their written informed consent prior to the study. The students were free to withdraw at any time without adverse personal consequences. Those who completed the intervention homework and pretests and posttests of health-compromising behaviors received stationery as a thank you gift. Given that the program was incorporated into the current school curriculum, we provided the stationery merely as a gift of gratitude, rather than to promote the students’ motivation to participate in the study.
In addition to the evaluation forms, the following strategies were performed to minimize potential respondent bias for intervention fidelity. Debriefing was conducted between the teachers and a research team member after the completion of each unit to discuss the overall teaching experience as well as the problems and course adjustments required. After completing the four-unit intervention implementation, the research team met with the teachers who conducted the intervention to discuss and gather additional detailed information about their feedback, clarify any difficulties, and clarify students’ engagement. The intervention activities and teaching strategies were then modified according to teachers’ and students’ feedback (version 3).
Feasibility. Feasibility was assessed among the students using five indicators—acceptability, practicability, demand, implementation, and limited-efficacy testing (Bowen et al., 2009). The questionnaire on feasibility contained two parts. The first section comprised eight closed-ended questions, which were answered with a five-point Likert scale (1–5, from strongly disagree to strongly agree) to evaluate students’ thoughts about each unit, including acceptability—satisfaction (overall feeling of the teaching activities; 2 items; α = .84–.86; e.g., “I like today’s course”), practicality—the ability of participants to carry out intervention activities (achievement of learning objectives; 5 items; α = .95–.97; e.g., “This course helps me better understand what I think about the future or what I want to be in the future”), and demand—expressed interest or intention to use (interest in teaching activities; 1 item; e.g., “I think the activity of this course is very interesting”). The items of practicality varied based on the learning objectives of each unit. The second section was an open-ended question (e.g., “Do you have any other thoughts or suggestions for this unit?”) to obtain students’ narrative descriptions for related reflection and feedback. Moreover, implementation was assessed by calculating the completion rate of the four-unit intervention. Limited-efficacy testing assessed whether the intervention yielded the intended effects by evaluating changes in health-compromising behaviors.
Intervention fidelity. A form to evaluate intervention fidelity among the teachers was developed according to a framework proposed by Carroll et al. (2007) and modified by Hasson (2010). The content included two aspects: (1) adherence (i.e., content and frequency/duration [dosage, dose delivery]) and (2) potential moderators (i.e., participant responsiveness and quality of delivery). An 11-point Likert scale (scored 0–10) was used to rate content adherence (5 items, from not at all achieved to completely achieved), potential moderators of participant responsiveness (4 items, from not at all considered to extremely considered), and quality of delivery (4 items, from very unsatisfied to very satisfied). Example items were as follows: for content adherence, “What was the overall achievement of the teaching objectives in this unit?”; for participant responsiveness, “Overall, how was students’ participation in the teaching activities in this unit?”; and for quality of delivery, “Overall, how satisfied were you with the teaching activities in this unit?” Frequency/duration of adherence was addressed with openended questions: “What percent of the unit did you adjust?” “What were the reasons you made these teaching adjustments?” and “What was adjusted and how did you adjust it?”
Health-compromising behaviors. Alcohol use, alcohol problems, and disordered eating behaviors over the past month were measured. Participant responses for their frequency of alcohol use (one item) were dichotomized (yes/no). Furthermore, the 23-item Rutgers Alcohol Problem Index was used to assess any alcohol-related problems (White & Labouvie, 1989). Respondents then indicated how often they had experienced problems while drinking alcohol or as a result of their drinking, ranging from 0 (never) to4 (more than 10 times). The responses for each item were then dichotomized into “yes” (any alcohol-related problems) and “no.” The sum of the “yes” items was then calculated. The 26-item Eating Attitude Test-26 was used to determine the presence of extreme weight-control behaviors (Garner et al., 1982). Responses were assigned a score of 0 for “never,” “rarely,” or “sometimes,” with a score of 1 for “often,” a score of 2 for “usually,” and a score of 3 for “always.”
For the content validity of the intervention program, we examined whether each unit met the four criteria―clarity of the teaching goal, rationality of instructional design, the effectiveness of teaching strategies, and consistency between teaching content and teaching goal―using percentages. Moreover, the narrative descriptions of students’ and teachers’ feedback and the mean scores for the evaluation of teaching processes from the feasibility study were presented. The McNemar and Wilcoxon signed-rank tests were used to examine the changes in the healthcompromising behaviors immediately before and after the intervention.
Across the four criteria and units, 60% of the experts thought the program content met the criteria. The most common reasons for not meeting the criteria concerned the instructions and design of the group activities rather than the consistency between teaching content/learning objectives and core components of the intervention program. Therefore, the program activities were revised based on experts’ comments and suggestions. The intervention program (version 2), teaching manual, and relevant materials were then developed.
Concerning students’ evaluations of feasibility, across four units, the average scores ranged as follows: acceptability was 3.7–4.1, practicability was 3.9–4.2, and demand was 3.7–4.1. Moreover, students’ narrative feedback showed that through this program, they had a chance to think about their futures, including what they want to be and do, and what difficulties they may encounter. They also learned how to set goals to reach their possible selves/future goals and how risky behaviors would affect their goal pursuits. Some students also thought that the program facilitated their ideas about possible selves. Overall, the students liked this program, although they also felt that the content and activities were difficult to accomplish.
For the implementation, 4 students (4.5%) did not complete all four units of the intervention program due to their absence from school on the days the intervention courses were implemented. No students declined to participate in the feasibility study. Regarding the limited-efficacy testing, there was a trend toward lower health-compromising behaviors from the preintervention stage to immediately after the intervention. The percentages of alcohol use (16.7% vs. 14.3%) and alcohol-related problems (7.5% vs. 2.4%) decreased from the preintervention stage to immediately after the intervention (Table 3). The disordered eating behaviors mean scores were 9.2 (SD = 7.4) and 8.6 (SD = 6.5) before and immediately after the intervention, respectively. No statistically significant differences were observed between the preintervention and postintervention stages.
Concerning teachers’ evaluations of fidelity, across four units, the average scores ranged as follows: content adherence = 8.4–10, quality of delivery = 8.3–9.8, and participant responsiveness = 8.3–10. For the frequency/duration of adherence, the teachers expressed that they adjusted ∼10–15% of the course content in units 1–3. Specifically, the entire class sharing sessions were left out to have enough time to complete the course activities. This adjustment was consistent with teachers’ concerns regarding timing. Owing to the fact that most class activities required students to think, discuss, and write down their thoughts, students required time to think about themselves and understand how to do these activities. The teachers were also required to provide additional explanations and guidance for each activity. Therefore, the program activities and learning materials were not completed by the original proposed time. Further, since all activities were ordered and connected to each other, the teachers felt that they could not just move to the next activity if the students did not complete the previous one. Furthermore, the teachers expressed that the Future Mapping Master intervention program could be incorporated into the curriculum of a counseling activity/career planning course as the concepts and strategies of intervention were consistent with the teaching and learning goals of the existing course.
Accordingly, based on students’ and teachers’ feedback, the Future Mapping Master program was adapted by combining some course activities, decreasing the number of learning materials, and/or revising the teaching/instruction strategies to improve timing and decrease the workload of each unit. After an in-person discussion with the teachers about the revised teaching activities, the Future Mapping Master program was finalized (version 3).
The purpose of this study was to develop the Future Mapping Master intervention program, which incorporated episodic future thinking into a possible self-based intervention. The feasibility of the intervention implementation was also tested. This paper described the process of developing the Future Mapping Master intervention program for junior high school students in Taiwan to decrease their risk of engaging in health-compromising behaviors. Moreover, the evaluations from both students and teachers showed that the students were interested in the program and that the course activities helped them achieve the learning objectives. The intervention was acceptable in terms of adherence, quality of delivery, and participant responsiveness. One of the objectives was to embed the Future Mapping Master intervention program in current high school curriculum guidelines; consistently, our study showed that schoolteachers could easily follow the teaching manual to integrate this program into their existing curriculums.
During the developmental phase of the intervention program, the research-based team members reviewed the theories/concepts of possible selves and episodic future thinking as well as the existing intervention programs. Although intervention programs based on the same theoretical approach—possible selves—have been developed in the United States, and their effectiveness determined (Clark et al., 2005; Oyserman et al., 2002, 2006, 2007), the previous interventions focused on content-specific possible selves (i.e., academic and occupation) and targeted adolescents’ academic performance or risky sexual behaviors. Further, they included 9 to 12 sessions, and some included parents and community members. Owing to the differences in purposes and school systems, those interventions could not be applied to Taiwanese adolescents and schools. Therefore, we used those interventions as a fundamental reference and integrated the requirements of Taiwanese adolescents to identify the core components of the Future Mapping Master intervention program. In addition, considering the applicability of intervention implementation, the length and content were adjusted and designed into four units (one per week) to fit the Taiwanese school curriculum and course arrangement.
To make the program practical and appropriate for adolescents in Taiwan, middle-school teachers were invited to participate in the development of the intervention program. Identifying the appropriate course, school requirements, and students’ needs were challenges in the intervention development process. When the second version of the Future Mapping Master intervention program was developed, the research team met with several teachers and directors from junior high schools to review and discuss the possibility of implementing the intervention. Based on their suggestions, the intervention program in the feasibility study was taught by counseling and health education teachers in junior high schools. However, after completing the intervention, teachers expressed that the Future Mapping Master intervention program would be better suited as part of the curriculum of a counseling activity/career planning course. Accordingly, interdisciplinary collaboration with schoolteachers proved necessary for the development of this school-based intervention.
Although significant behavioral changes were not achieved in this feasibility study, preliminary patterns/trends suggesting fewer health-compromising behaviors were indicated. A few possible reasons may explain these findings. First, the small sample size and relatively low number of health-compromising behaviors analyzed in this sample may have limited the ability to identify behavioral changes. Moreover, we only measured health-compromising behaviors immediately before and after the intervention’s implementation because the main focus of this study was to evaluate the feasibility of the intervention. Because significant behavioral changes usually occur over time, there may not have been sufficient time for adolescents who had engaged in health-compromising behaviors to undergo significant changes. Indeed, the current intervention was more focused on the role of prevention and early interference rather than treatment. Therefore, future studies with longer-term follow-up evaluation plans, as well as those that compare intervention and control groups, are required to appropriately determine this intervention’s effectiveness.
A limitation of this study is the use of convenience samples of teachers and students from southern Taiwan to conduct the feasibility testing. We therefore did not receive feedback from teachers and students from varied backgrounds. However, since the samples were drawn from schools with average levels of student performance in Taiwan, the intervention program may still be applied to other schools, particularly in Taiwan. Future studies with larger sample sizes and diverse student characteristics from different regions are required to confirm the feasibility of this intervention.
This paper addressed the developmental process of the Future Mapping Master intervention program and provided evidence to support the feasibility of the intervention’s implementation. The findings not only suggest the feasibility of the Future Mapping Master intervention program in a junior high school setting, but also provide a new perspective about the possibility of combining health education in other courses. Traditionally, health education activities, including the correction and counseling of students with healthcompromising behaviors, are the responsibility of school nurses alone which places significant pressure on them. The present study provides a preventative focus and begins with fostering positive possible selves, which may be promising in terms of preventing and decreasing healthcompromising behaviors, and may also decrease the burden on school nurses. Indeed, it may be more efficient for school nurses to provide health education activities in combination with formal health-related or counseling courses and to collaborate with other school teachers. Participating in delivering the Future Mapping Master intervention program is one possibility for school nurses to collaborate with counseling and health education teachers.
In addition, goals for future investigation include identifying the intervention efficacy and mechanism(s) behind the intervention effects to decrease adolescents’ risks for engaging in health-compromising behaviors. Moreover, the effects of an episodic future thinking intervention in developing students’ plausible possible selves will also be identified. These findings will provide empirical evidence to inform stakeholders to consider either applying possible self and episodic future thinking approaches to future interventions, or to embed the Future Mapping Master intervention program in current junior high school curriculums to promote adolescent health. In addition to the implementation of education policy, school nurses and teachers have an opportunity to evaluate adolescent’s possible selves and health-compromising behaviors while they work with adolescents. The Future Mapping Master intervention program provides theoreticaland empirical-based strategies for school nurses and teachers in junior high schools to promote adolescent’s possible selves and health development. For example, based on the evaluation of school nurses and teachers, these strategies could be adopted to provide personalized intervention implementation tailored to each adolescent’s unique requirements. School nurses and teachers could work with adolescents individually to guide them to think about their selves, establish future goals, develop strategies to achieve their possible selves, and understand the negative impacts of healthcompromising behaviors, which, in turn, may decrease health-compromising behaviors and facilitate positive development in adolescents.
The authors thank the school administrators, teachers, and students who participated in the feasibility testing and the research partners who contributed to this work.
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Taiwan Ministry of Science and Technology (MOST 107-2628-B-006-002). The Taiwan Ministry of Science and Technology had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Chia-Kuei Lee, PhD, RN https://orcid.org/0000-0003-0597-0420
Li-Ling Liao, PhD https://orcid.org/0000-0003-0867-2699
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Chia-Kuei Lee PhD, RN, is at the Department of Nursing, College of Medicine, National Cheng Kung University.
Li-Ling Liao, PhD, is at the Department of Health Management, I-Shou University.
1 Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
2 Department of Health Management, I-Shou University, Kaohsiung, Taiwan
Corresponding Author:Li-Ling Liao, PhD, Department of Health Management, I-Shou University, 8 Yida Road, Kaohsiung 82445, Taiwan.Email: hililin@isu.edu.tw