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Description: The purpose of this review is to identify the social cognition constructs associated with the intention to perform, and actual performance of, self-management behaviors in patients with familial hypercholesterolemia (FH), and to estimate the size and variability of the associations between these constructs and FH management behavioral intentions and behavior using meta-analysis. The social cognition constructs will be derived from leading social cognition theories such as social cognitive theory (Bandura, 1986), protection motivation theory (Rogers, 1975), and the theories of reasoned action and planned behavior (Ajzen, 1991; Ajzen & Fishbein, 1980). The review will focus on three key FH self-management behaviors: taking cholesterol-lowing medication, physical activity participation, and following a cholesterol-lowing diet. We also aim to test the unique effects of the social cognition constructs on FH self-management behavioral intentions and behavior by testing the fit of a model specifying theory-based relations between the theoretical constructs and outcomes with the meta-analytic data. FH is an inherited dominant disorder that affects lipoprotein metabolism, which, if left untreated, leads to an increased risk of early-onset atherosclerotic cardiovascular disease (Bouhairie & Goldberg, 2015; Migliara et al., 2017). The disorder affects 1 in 250 individuals worldwide (Lui et al., 2020). This risk can be ameliorated by pharmacological treatment and participation in ‘lifestyle’ behaviors. Specifically, effective FH management requires adherence to cholesterol-lowing medication (e.g., statins) coupled with following a cholesterol-lowering diet and participating in regular moderate-to-vigorous physical activity. Successful management of FH, therefore, requires long-term adherence to physician endorsed and evidence-based pharmacological and lifestyle behavior guidelines (Diamond et al., 2021). However, many FH patients fail to adhere to guidelines, which likely contributes to an increased risk of CVD. As a consequence, effective behavioral interventions are considered essential to promote engagement in FH management behaviors with the goal of improving outcomes in FH patients and have been identified as a priority by FH organizations (Krauss et al., 2000; The Family Heart Foundation, 2022). Development of optimally-efficacious behavioral interventions in FH necessitates a fundamental understanding of the determinants of FH management behaviors and the processes involved and may signal potentially modifiable targets for interventions. To this end, researchers have applied social cognition theories to identify the belief-based correlates of intention or motivation to engage in FH management behaviors and identify candidate constructs that may inform the development of intervention content (e.g., Hagger et al., 2019; Razali et al., 2020). A number of social cognition theories have been applied to predict management behaviors in the context of FH, such as social cognitive theory (Bandura, 1986), protection motivation theory (Rogers, 1975), and the theories of reasoned action and planned behavior (Ajzen, 1991). Consistent with these theories, constructs such as attitudes, subjective norms, risk perceptions, and self-efficacy or perceived behavioral control have been shown to be associated with the intention to participate in these behaviors, and intentions act as a mediator of these constructs in these management behaviors (Hagger et al., 2019; Razali et al., 2020). While there have been a number of studies examining the effects of social cognition constructs on intentions and behavior in the context of FH, there has been no formal synthesis of this research. We aim to fill this evidence gap by meta-analyzing the extant research examining associations between these social cognition constructs from multiple theories on intentions toward, and actual participation in, FH management behaviors including medication adherence, diet, and physical activity. The value of this research is that it will identify the size of the averaged correlations of these constructs with intentions and behavior in FH patients across studies, and the associated variability in the correlations, correcting for artifactual bias using meta-analysis. It will also enable a test of the unique or independent effects of these constructs on intentions and behavior by fitting integrated model specifying relations between these theory-based constructs and FH management intentions and behavior to the matrix of meta-analytically derived correlations among them. The analysis is expected to contribute important data to inform an evidence base of potentially modifiable constructs that could be targeted in interventions aimed at promoting participation in FH management behaviors. The analysis also has the potential to identify candidate moderators (gender, behavior type, and average sample age) of the relationships between the social cognition constructs and intentions to perform, and actual participation in, FH management behaviors. However, the extent to which we will be able to test these moderator effects will depend on the number of studies available for inclusion in the meta-analysis. References Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211. https://doi.org/10.1016/0749-5978(91)90020-t Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall, Inc. Bouhairie, V., & Goldberg, A. (2015). Familial Hypercholesterolemia. Cardiology Clinics, 33(2), 169-179. https://doi.org/10.1016/j.ccl.2015.01.001 Diamond, D., Alabdulgader, A., de Lorgeril, M., Harcombe, Z., Kendrick, M., & Malhotra, A. et al. (2020). Dietary recommendations for Familial Hypercholesterolemia: An evidence-free zone. BMJ Evidence-Based Medicine, 26(6), 295-301. https://doi.org/10.1136/bmjebm-2020-111412 Hagger, M., Hamilton, K., Hardcastle, S., Hu, M., Kwok, S., & Lin, J. et al. (2019). Predicting intention to participate in self-management behaviors in patients with Familial Hypercholesterolemia: A cross-national study. Social Science &Amp; Medicine, 242. https://doi.org/10.1016/j.socscimed.2019.112591 Krauss, R., Eckel, R., Howard, B., Appel, L., Daniels, S., & Deckelbaum, R. et al. (2000). AHA dietary guidelines. Circulation, 102(18), 2284-2299. https://doi.org/10.1161/01.cir.102.18.2284 Lui, D., Lee, A., & Tan, K. (2020). Management of Familial Hypercholesterolemia: Current status and future perspectives. Journal of the Endocrine Society, 5(1). https://doi.org/10.1210/jendso/bvaa122 Migliara, G., Baccolini, V., Rosso, A., D’Andrea, E., Massimi, A., Villari, P., & De Vito, C. (2017). Familial Hypercholesterolemia: A systematic review of guidelines on genetic testing and patient management. Frontiers in Public Health, 5, 1-8. https://doi.org/10.3389/fpubh.2017.00252 Razali, S., Yap, B., Chua, Y., & M Nawawi, H. (2020). Determinants for healthy lifestyle of patients with Familial Hypercholesterolemia. Environment-Behavior Proceedings Journal, 5(14), 75-81. https://doi.org/10.21834/ebpj.v5i14.2335 Rogers, R. (1975). A Protection Motivation Theory of fear appeals and attitude change1. The Journal of Psychology, 91(1), 93-114. https://doi.org/10.1080/00223980.1975.9915803