Initial efficacy of MI, TTM tailoring and HRI’s with multiple behaviors for employee health promotion

Objective: This study was designed to compare the initial efficacy of Motivational Interviewing (MI), Online Transtheoretical Model (TTM)-tailored communications and a brief Health Risk Intervention (HRI) on four health risk factors (inactivity, BMI, stress and smoking) in a worksite sample. Method: A randomized clinical trial assigned employees to one of three recruitment strategies and one of the three treatments. The treatment protocol included an HRI session for everyone and in addition either a recommended three TTM online sessions or three MI in person or telephone sessions over 6 months. At the initial post-treatment assessment at 6 months, groups were compared on the percentage who had progressed from at risk to taking effective action on each of the four risks. Results: Compared to the HRI only group, the MI and TTM groups had significantly more participants in the Action stage for exercise and effective stress management and significantly fewer risk behaviors at 6 months. MI and TTM group outcomes were not different. Conclusion: This was the first study to demonstrate that MI and online TTM could produce significant multiple behavior changes. Future research will examine the long-term impacts of each treatment, their cost effectiveness, effects on productivity and quality of life and process variables mediating outcomes

Applying the Transtheoretical Model of Change to Consumer Debt Behavior

The Transtheoretical Model of Change (TMM) provided the framework for developing a measure to assess readiness to get out of credit card debt with consumers who are having credit card debt troubles. Key constructs of TTM include stages of change, decisional balance, self-efficacy, and processes of change. The items for the measure were developed by qualitative interviews with experts in credit counseling and consumers with debt troubles. A survey was then completed with a reliability and validity of the measure. The results have potential for use by counseling practitioners, educators and researchers

Transtheoretical Model-based multiple behavior intervention for weight management: Effectiveness on a population basis

Background: The increasing prevalence of overweight and obesity underscores the need for evidence-based, easily disseminable interventions for weight management that can be delivered on a population basis. The Transtheoretical Model (TTM) offers a promising theoretical framework for multiple behavior weight management interventions. Methods: Overweight or obese adults (BMI 25–39.9; n = 1277) were randomized to no-treatment control or home-based, stage-matched multiple behavior interventions for up to three behaviors related to weight management at 0, 3, 6, and 9 months. All participants were re-assessed at 6, 12, and 24 months. Results: Significant treatment effects were found for healthy eating (47.5% versus 34.3%), exercise (44.90% versus 38.10%), managing emotional distress (49.7% versus 30.30%), and untreated fruit and vegetable intake (48.5% versus 39.0%) progressing to Action/Maintenance at 24 months. The groups differed on weight lost at 24 months. Co-variation of behavior change occurred and was much more pronounced in the treatment group, where individuals progressing to Action/Maintenance for a single behavior were 2.5–5 times more likely to make progress on another behavior. The impact of the multiple behavior intervention was more than three times that of single behavior interventions. Conclusions: This study demonstrates the ability of TTM-based tailored feedback to improve healthy eating, exercise, managing emotional distress, and weight on a population basis. The treatment produced a high level of population impact that future multiple behavior interventions can seek to surpass

The preventive services use self-efficacy (PRESS) scale in older women: development and psychometric properties

Background\ud Preventive services offered to older Americans are currently under-utilized despite considerable evidence regarding their health and economic benefits. Individuals with low self-efficacy in accessing these services need to be identified and provided self-efficacy enhancing interventions. Scales measuring self-efficacy in the management of chronic diseases exist, but do not cover the broad spectrum of preventive services and behaviors that can improve the health of older adults, particularly older women who are vulnerable to poorer health and lesser utilization of preventive services. This study aimed to evaluate the psychometric properties of a new preventive services use self-efficacy scale, by measuring its internal consistency reliability, assessing internal construct validity by exploring factor structure, and examining differences in self-efficacy scores according to participant characteristics.\ud \ud Methods\ud The Preventive Services Use Self-Efficacy (PRESS) Scale was developed by an expert panel at the University of Pittsburgh Center for Aging and Population Health - Prevention Research Center. It was administered to 242 women participating in an ongoing trial and the data were analyzed to assess its psychometric properties. An exploratory factor analysis with a principal axis factoring approach and orthogonal varimax rotation was used to explore the underlying structure of the items in the scale. The internal consistency of the subscales was assessed using Cronbach’s alpha coefficient.\ud \ud Results\ud The exploratory factor analysis defined five self-efficacy factors (self-efficacy for exercise, communication with physicians, self-management of chronic disease, obtaining screening tests, and getting vaccinations regularly) formed by 16 items from the scale. The internal consistency of the subscales ranged from .81 to .94. Participants who accessed a preventive service had higher self-efficacy scores in the corresponding sub-scale than those who did not.\ud \ud Conclusions\ud The 16-item PRESS scale demonstrates preliminary validity and reliability in measuring self-efficacy in the use of preventive services among older women. It can potentially be used to evaluate the impact of interventions designed to improve self-efficacy in the use of preventive services in community-dwelling older women

¿Porqué no se mueven los continentes? ¿porqué no cambian las personas?

People don’t change because they can’t, don’t want to, don’t know how, or don’t know what to change. The transtheoretical model provides and integrative model for understanding reasons for not changing, as well as readiness to change. Stages and levels of change guide therapists in their work in helping clients change. Clients in the precontemplative stage typically cannot change without special help. Those in the contemplation stage are not sure they want to change. Those in the preparation stage are afraid they do not know to successfully change. The levels of change help guide therapists and clients on what to change.La gente no cambia porque no puede, no quiere, no sabe cómo, o no sabe qué cambiar. El modelo transteórico ofrece un modelo integrador de comprensión de las razones para no cambiar, así como de la predisposición al cambio. Los estadios y niveles de cambio guían a los terapeutas en su trabajo de ayudar a cambiar a los clientes. Los clientes en el estadio precontemplativo generalmente no pueden cambiar sin una ayuda especial. Los que se encuentran en el estadio de contemplación no están seguros de querer cambiar. Quienes se hallan en el estadio de preparación temen no saber cómo cambiar con éxito. Los niveles de cambio ayudan a guiar el terapeuta y los clientes con respecto a qué cosa cambiar

Digitally assisted interventions for the treatment and prevention of risky behavior in adults: Incorporating the transtheoretical model

To have a significant and sustainable impact on attaining and maintaining healthy behaviors, the Transtheoretical Model of Behavior Change addresses the needs of entire populations, not just the minority who are motivated to take immediate action for better health. The six stages of change are outlined as well as the 10 processes of change or strategies to progress from one stage to the next. Digitally assisted interventions tailored to specific stages of change allow programs supported by computer-based tools and methodologies to be interactive and individualized for treatment and prevention of entire populations with risk behaviors like smoking, inactivity, unhealthy diets, alcohol misuse, and ineffectively managed stress. Digitally assisted interventions include mobile phones, personal digital assistants, smartphones, portable media players, tablets, and smart books. The devices have a range of functions from mobile cellular communication using text messages, photos and videos, telephone, and worldwide web access to multimedia playback and software application support. They allow temporal synchronization of the intervention delivery and allow the intervention to engage people’s attention when it is most relevant. The chapter presents examples of transtheoretical, digitally assisted interventions for use by both clients and coaches. Evidence is presented that compares the effectiveness of the digital programs

Why don\u27t continents move? Why don\u27t people change?

People don\u27t change because they can\u27t, don\u27t want to, don\u27t know how, or don\u27t know what to change. The transtheoretical model provides an integrative model for understanding reasons for not changing, as well as readiness to change. Stages and levels of change guide therapists in their work in helping clients change. Clients in the precontemplative stage typically cannot change without special help. Those in the contemplation stage are not sure they want to change. Those in the preparation stage are afraid they do not know how to successfully change. The levels of change help guide therapists and clients on what to change

Helping Cure Healthcare Systems: Changing Minds and Behaviour

Proactive approaches to chronic disease management need to complement passive-reactive treatment of acute diseases. Such programmes need to be applied across the continuum of care from wellness to prevention to early detection to secondary prevention and to chronic care. Proactive recruitment to action-oriented programmes results in few patients showing up, finishing up or ending up better off and can demoralise patients and professionals. However, programmes matched to each stage of change can produce unprecedented participation and impact rates. Interactive technologies for health behavioural change have the potential to be to behavioural medicine what pharmaceuticals are to traditional medicine. They are the most cost-effective method for delivering the `maximum science' about major health problems to entire populations in user friendly ways and with no known adverse effects.Disease management programmes, Patient compliance, Patient education, Pharmacoeconomics

Predicting termination and continuation status in psychotherapy using the transtheoretical model

Measures from the transtheoretical model of change were compared to traditional client characteristic variables as predictors of termination and continuation status of clients entering psychotherapy. Client characteristics were not significant predictors but the transtheoretical variables of stages, processes of change, and decisional balance for therapy were excellent predictors. A discriminative function using the transtheoretical variables correctly classified 92% of the clients into two groups: (a) premature terminators and (b) appropriate terminators and therapy continuers. Discussion focused on the importance of matching therapy to client\u27s stage of change in order to reduce the average rate of 40% of clients terminating therapy prematurely