The objective of this meta-analysis is to analyze the association between positive expectations (hope and optimism) and health behaviors. Systematic searches were conducted in five electronic databases from March to August 2023. A meta-analytic approach was used, applying Fisher’s z-transformation to Pearson’s weighted r coefficient. From 17,470 records identified, 22 studies were included. The overall pooled effect size showed a significant relationship between health behaviors, optimism (r = 0.32, 95% CI = 0.22–0.40), and hope (r = 0.25, 95% CI = 0.17–0.33). Subgroup analyses suggested that associations varied according to age group and cultural group. Furthermore, meta-regression analysis also indicated that the type of healthy behavior significantly moderates the associations, while the average age showed a small and insignificant effect, especially in relation to optimism. These findings suggest that positive expectations are consistently associated with health-related behaviors.
AdelinejadFAlipourF (2022) Investigating the relationship between perceived social support and preventive behaviors in the COVID-19 epidemic mediated by hope and mental wellbeing: A case study of women living in Tehran City, Iran. Health in Emergencies & Disasters Quarterly7(2): 87–96.
2.
AndersonCLFeldmanDB (2020) Hope and physical exercise: The contributions of hope, self-efficacy, and optimism in accounting for variance in exercise frequency. Psychological Reports123(4): 1145–1159.
3.
AndersonEDurstineJL (2019) Physical activity, exercise, and chronic diseases: A brief review. Sports Medicine and Health Science1(1): 3–10.
4.
AuerbachMVLobelMCannellaDT (2014) Psychosocial correlates of health-promoting and health-impairing behaviors in pregnancy. Journal of Psychosomatic Obstetrics and Gynecology35(3): 76–83.
5.
AyresCGMahatG (2012) Social support, acculturation, and optimism: understanding positive health practices in Asian American college students. Journal of Transcultural Nursing23(3): 270–278.
6.
BarinasJLMcDermottRCWilliamsSG, et al. (2022) Positive and negative psychosocial factors related to healthy and unhealthy weight control among nursing students. Journal of Professional Nursing42: 290–300.
7.
BoehmJKChenYKogaH, et al. (2018) Is optimism associated with healthier cardiovascular-related behavior? Meta-analyses of 3 health behaviors. Circulation Research122(8): 1119–1134.
8.
BorensteinMHedgesLVHigginsJP, et al. (2009) Introduction to Meta-Analysis. John Wiley and Sons, Ltd.
9.
BoylanJMCundiffJMJakubowskiKP, et al. (2018) Pathways linking childhood SES and adult health behaviors and psychological resources in black and white men. Annals of Behavioral Medicine52(12): 1023–1035.
10.
BronkKCHillPLLapsleyDK, et al. (2009) Purpose, hope, and life satisfaction in three age groups. Journal of Positive Psychology4(6): 500–510.
11.
CappsKPUpdegraffJA (2024) How future orientations predict healthy outcomes: Information avoidance as a potential mechanism. Journal of Health Psychology29(8): 848–862.
ChopikWJKimESSchwabaT, et al. (2020) Changes in optimism and pessimism in response to life events: Evidence from three large panel studies. Journal of Research in Personality88: 103985.
14.
ConversanoCRotondoALensiE, et al. (2010) Optimism and its impact on mental and physical well-being. Clinical Practice and Epidemiology in Mental Health6: 25–29.
15.
CornBWFeldmanDBHullJG, et al. (2022) Dispositional hope as a potential outcome parameter among patients with advanced malignancy: An analysis of the ENABLE database. Cancer128(2): 401–409.
16.
DillardAEllisE (2017) Optimism and Its Associations With Health Behavior and Responses to Health Communication. Oxford Research Encyclopedia of Communication.
17.
EdwardsLMMcConnellK (2023) Hope across cultural groups. Current Opinion in Psychology49: 101505.
18.
EggerMSmithGDSchneiderM, et al. (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical Research ed.)315(7109): 629–634.
19.
FeldmanDBSillsJR (2013) Hope and cardiovascular health-promoting behaviour: Education alone is not enough. Psychology and Health28(7): 727–745.
20.
FengHYangLLiangYY, et al. (2023) Associations of timing of physical activity with all-cause and cause-specific mortality in a prospective cohort study. Nature Communications14(1): 930.
21.
FischerRChalmersA (2008) Is optimism universal? A meta-analytical investigation of optimism levels across 22 nations. Personality and Individual Differences45(5): 378–382.
22.
Flores-LucasVMartínez-SinovasRLópez-BenítezR, et al. (2023) Hope and flourishing: A cross-cultural examination between Spanish and South African samples. In: KrafftAMGuseTSlezackovaA (eds) Hope Across Cultures: Lessons From the International Hope Barometer. Springer Nature, pp.295–326.
23.
FruhSMTaylorSEGravesRJ, et al. (2021) Relationships among hope, body satisfaction, wellness habits, and stress in nursing students. Journal of Professional Nursing37(3): 640–647.
24.
GalvimALOliveiraIMMartinsTV, et al. (2019) Adherence, adhesion, and dropout reasons of a physical activity program in a high social vulnerability context. Journal of Physical Activity and Health16(2): 149–156.
25.
GlanzKRimerBKViswanathK (2015) Health Behavior. Theory, Research, and Practice. John Wiley & Sons, Inc.
26.
González-CanteroJOOropezaRPadrósF, et al. (2017) Capital psicológico y su relación con el estilo de vida de universitarios mexicanos. Nutricion Hospitalaria34(2): 439–443.
27.
GoodinBRKronfliTKingCD, et al. (2013) Testing the relation between dispositional optimism and conditioned pain modulation: Does ethnicity matter?Journal of Behavioral Medicine36(2): 165–174.
28.
GriffithZMPoletJLintunenT, et al. (2024) Social cognition, personality and social-political correlates of health behaviors: Application of an integrated theoretical model. Social Science & Medicine347(1982): 116779.
29.
HaggerMS (2025) Psychological Determinants of Health Behavior. Annual Review of Psychology76(1): 821–850.
30.
HarrerMCuijpersPFurukawaTA, et al. (2021) Doing Meta-Analysis With R: A Hands-On Guide. Chapman & Hall/CRC Press.
31.
HerzogRÁlvarez-PasquinMJDíazC, et al. (2013) Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs, and attitudes? A systematic review. BMC Public Health13(1): 154–217.
32.
HigginsJPThompsonSGDeeksJJ, et al. (2003) Measuring inconsistency in meta-analyses. BMJ327(7414): 557–560.
33.
HigginsJPTThomasJChandlerJ, et al. (2024) Cochrane Handbook for Systematic Reviews of Interventions Version 6.5. Cochrane.
34.
IronsonGSolomonGFBalbinEG, et al. (2002) The Ironson-woods spirituality/religiousness index is associated with long survival, health behaviors, less distress, and low cortisol in people with HIV/AIDS. Annals of Behavioral Medicine24(1): 34–48.
35.
JinSZhengLWenJ, et al. (2022) The relationship between active coping and hope during the COVID-19 pandemic: The mediating role of meaning in life. Journal of Health Psychology27(12): 2685–2695.
36.
JohnsonLPotterLCBeechingH, et al. (2023) Interventions to improve health and the determinants of health among sex workers in high-income countries: A systematic review. Lancet Public Health8(2): e141–e154.
37.
JonesTDeMoreMCohenLL, et al. (2008) Childhood healthcare experience, healthcare attitudes, and optimism as predictors of adolescents' healthcare behavior. Journal of Clinical Psychology in Medical Settings15(3): 234–240.
38.
KhanMMHillPLO’BrienC (2023) Hope and healthy lifestyle behaviors in older adulthood. Aging & Mental Health27(7): 1436–1442.
39.
KrafftAMGuseTSlezackovaA (2023) Introduction and research agenda. In: KrafftAMGuseTSlezackovaA (eds) Hope Across Cultures: Lessons From the International Hope Barometer. Springer Nature, pp.1–22.
40.
KristiansenMIrshadTWorthA, et al. (2014) The practice of hope: A longitudinal, multi-perspective qualitative study among South Asian Sikhs and Muslims with life-limiting illness in Scotland. Ethnicity and Health19(1): 1–19.
41.
KupcewiczEMiklaMKadučákováH, et al. (2022) Health behaviours and the sense of optimism in nursing students in Poland, Spain and Slovakia during the COVID-19 pandemic. International Journal of Environmental Research and Public Health19(4): 2388.
42.
LaranjeiraCQueridoA (2022) Hope and optimism as an opportunity to improve the “positive mental health” demand. Frontiers in Psychology13: 827320.
43.
LinyanLIBoqingC (2023) Hope and paradox in contemporary Chinese society: A moment for cultural transformation?American Sociologist54(1): 101–122.
44.
LipseyMWWilsonDB (2001) Practical Meta-Analysis. Sage Publications, Inc.
45.
MargulisAVPladevallMRiera-GuardiaN, et al. (2014) Quality assessment of observational studies in a drug-safety systematic review, comparison of two tools: The Newcastle–Ottawa Scale and the RTI item bank. Clinical Epidemiology6: 359–368.
46.
MarquesSCGallagherMW (2017) Age differences and short-term stability in hope: Results from a sample aged 15 to 80. Journal of Applied Developmental Psychology53: 120–126.
47.
MilaniakIDębskaGDębska-ślizieńA, et al. (2024) Personal resources and expectations and health behaviors among solid organ transplant recipients-A multicenter study. Transplantation Proceedings56(4): 926–934.
48.
NudelmanGShilohS (2015) Mapping health behaviors: Constructing and validating a common-sense taxonomy of health behaviors. Social Science & Medicine146: 1–10.
49.
OhJPurolMFWeidmannR, et al. (2022) Health and well-being consequences of optimism across 25 years in the Rochester Adult Longitudinal Study. Journal of Research in Personality99: 104237.
50.
PageMJMcKenzieJEBossuytPM, et al. (2021) The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ (Clinical research ed.)372(71): n71.
51.
PetersonC (2000) The future of optimism. American Psychologist55(1): 44–55.
52.
RasmussenHNEnglandEColeBP (2023) Hope and physical health. Current Opinion in Psychology49: 101549.
53.
RasmussenHNScheierMFGreenhouseJB (2009) Optimism and physical health: A meta-analytic review. Annals of Behavioral Medicine37(3): 239–256.
54.
RichardsonMGarnerPDoneganS (2019) Interpretation of subgroup analyses in systematic reviews: A tutorial. Clinical Epidemiology and Global Health7(2): 192–198.
55.
Rodriguez-HanleyASnyderCR (2000) The demise of hope: On losing positive thinking. In: SnyderCR (ed.) Handbook of Hope: Theory, Measures, and Applications. Academic Press, pp.39–54.
56.
RogowskaAMNowakPFKwaśnickaA (2021) Healthy behavior as a mediator in the relationship between optimism and life satisfaction in health sciences students: A cross-sectional study. Psychology Research and Behavior Management14: 1877–1888.
57.
ScheierMFCarverCS (1985) Optimism, coping, and health: Assessment and implications of generalized outcome expectancies. Health Psychology4(3): 219–247.
58.
SchiavonCCMarchettiEGurgelLG, et al. (2017) Optimism and hope in chronic disease: A systematic review. Frontiers in Psychology7: 2022.
59.
SchroderKEESchwarzerR (2005) Habitual self-control and the management of health behavior among heart patients. Social Science & Medicine60(4): 859–875.
60.
SchwabaTRobinsRWSanghaviPH, et al. (2019) Optimism development across adulthood and associations with positive and negative life events. Social Psychological and Personality Science10(8): 1092–1101.
61.
SharmaMRomasJA (2012) Theoretical Foundations of Health Education and Health Promotion. Jones & Bartlett Publishers.
62.
ShortSEMollbornS (2015) Social determinants and health behaviors: Conceptual frames and empirical advances. Current Opinion in Psychology5: 78–84.
63.
SidikKJonkmanJN (2005) Simple heterogeneity variance estimation for meta-analysis. Journal of the Royal Statistical Society: Serie C (Applied Statistics)54(2): 367–384.
64.
SnyderCR (2002) Hope theory: Rainbows in the mind. Psychological Inquiry13(4): 249–275.
65.
TargherGByrneCDLonardoA, et al. (2016) Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: A meta-analysis. Journal of Hepatology65(3): 589–600.
66.
TomljenovicHBubicA (2021) Cognitive and emotional factors in health behaviour: Dual-process reasoning, cognitive styles and optimism as predictors of healthy lifestyle, healthy behaviours and medical adherence. Current Psychology40(7): 3256–3264.
67.
VelićSQamaEDivianiN, et al. (2023) Patients’ perception of hope in palliative care: A systematic review and narrative synthesis. Patient Education and Counseling115: 107879.
68.
WickhamSRAmarasekaraNABartonicekA, et al. (2020) The big three health behaviors and mental health and well-being among young adults: A cross-sectional investigation of sleep, exercise, and diet. Frontiers in Psychology11: 579205.
69.
WongMYCOuKLChungPK (2022) Healthy lifestyle behavior, goal setting, and personality among older adults: A synthesis of literature reviews and interviews. Geriatrics7(6): 131.
70.
YaoYChenJDongD, et al. (2022) The relationship between exercise and mental health outcomes during the COVID-19 pandemic: From the perspective of hope. International Journal of Environmental Research and Public Health19(7): 4090.
71.
YıldırımMArslanG (2022) Exploring the associations between resilience, dispositional hope, preventive behaviours, subjective well-being, and psychological health among adults during early stage of COVID-19. Current Psychology41(8): 5712–5722.
72.
Zambrano BermeoRNEstrada GonzalezCGuerraEDPH (2023) Influence of personal factors on health-promoting behavior in college students: A structural equation modeling approach. Journal of Multidisciplinary Healthcare16: 1259–1270.
73.
ZhangXWangDLiF (2022) Physical exercise, social capital, hope, and subjective well-being in China: A parallel mediation analysis. International Journal of Environmental Research and Public Health20(1): 303.
