Self-guided Change: The most common form of long-term, maintained health behavior change

PubMed Central

Bishop, F Michler

2018-01-01

Millions of people change risky, health-related behaviors and maintain those changes. However, they often take years to change, and their unhealthy behaviors may harm themselves and others and constitute a significant cost to society. A review—similar in nature to a scoping review—was done of the literature related to long-term health behavior change in six areas: alcohol, cocaine and heroin misuse, gambling, smoking, and overeating. Based on the limited research available, reasons for change and strategies for changing and for maintaining change were also reviewed. Fifty years of research clearly indicate that as people age, in the case of alcohol, heroin and cocaine misuse, smoking, and gambling, 80–90 percent moderate or stop their unhealthy behaviors. The one exception is overeating; only 20 percent maintain their weight loss. Most of these changes, when they occur, appear to be the result of self-guided change. More ways to accelerate self-guided, health-related behavior change need to be developed and disseminated. PMID:29375888

The eHealth Behavior Management Model: a stage-based approach to behavior change and management.

PubMed

Bensley, Robert J; Mercer, Nelda; Brusk, John J; Underhile, Ric; Rivas, Jason; Anderson, Judith; Kelleher, Deanne; Lupella, Melissa; de Jager, André C

2004-10-01

Although the Internet has become an important avenue for disseminating health information, theory-driven strategies for aiding individuals in changing or managing health behaviors are lacking. The eHealth Behavior Management Model combines the Transtheoretical Model, the behavioral intent aspect of the Theory of Planned Behavior, and persuasive communication to assist individuals in negotiating the Web toward stage-specific information. It is here - at the point of stage-specific information - that behavioral intent in moving toward more active stages of change occurs. The eHealth Behavior Management Model is applied in three demonstration projects that focus on behavior management issues: parent-child nutrition education among participants in the U.S. Department of Agriculture Special Supplemental Nutrition Program for Women, Infants and Children; asthma management among university staff and students; and human immunodeficiency virus prevention among South African women. Preliminary results have found the eHealth Behavior Management Model to be promising as a model for Internet-based behavior change programming. Further application and evaluation among other behavior and disease management issues are needed.

Using Multitheory Model of Health Behavior Change to Predict Adequate Sleep Behavior.

PubMed

Knowlden, Adam P; Sharma, Manoj; Nahar, Vinayak K

The purpose of this article was to use the multitheory model of health behavior change in predicting adequate sleep behavior in college students. A valid and reliable survey was administered in a cross-sectional design (n = 151). For initiation of adequate sleep behavior, the construct of behavioral confidence (P < .001) was found to be significant and accounted for 24.4% of the variance. For sustenance of adequate sleep behavior, changes in social environment (P < .02), emotional transformation (P < .001), and practice for change (P < .001) were significant and accounted for 34.2% of the variance.

Emotional responses to behavioral economic incentives for health behavior change.

PubMed

van der Swaluw, Koen; Lambooij, Mattijs S; Mathijssen, Jolanda J P; Zeelenberg, Marcel; Polder, Johan J; Prast, Henriëtte M

2018-03-05

Many people aim to change their lifestyle, but have trouble acting on their intentions. Behavioral economic incentives and related emotions can support commitment to personal health goals, but the related emotions remain unexplored. In a regret lottery, winners who do not attain their health goals do not get their prize but receive feedback on what their forgone earnings would have been. This counterfactual feedback should provoke anticipated regret and increase commitment to health goals. We explored which emotions were actually expected upon missing out on a prize due to unsuccessful weight loss and which incentive-characteristics influence their likelihood and intensity. Participants reported their expected emotional response after missing out on a prize in one of 12 randomly presented incentive-scenarios, which varied in incentive type, incentive size and deadline distance. Participants primarily reported feeling disappointment, followed by regret. Regret was expected most when losing a lottery prize (vs. a fixed incentive) and intensified with prize size. Multiple features of the participant and the lottery incentive increase the occurrence and intensity of regret. As such, our findings can be helpful in designing behavioral economic incentives that leverage emotions to support health behavior change.

Complex systems and health behavior change: insights from cognitive science.

PubMed

Orr, Mark G; Plaut, David C

2014-05-01

To provide proof-of-concept that quantum health behavior can be instantiated as a computational model that is informed by cognitive science, the Theory of Reasoned Action, and quantum health behavior theory. We conducted a synthetic review of the intersection of quantum health behavior change and cognitive science. We conducted simulations, using a computational model of quantum health behavior (a constraint satisfaction artificial neural network) and tested whether the model exhibited quantum-like behavior. The model exhibited clear signs of quantum-like behavior. Quantum health behavior can be conceptualized as constraint satisfaction: a mitigation between current behavioral state and the social contexts in which it operates. We outlined implications for moving forward with computational models of both quantum health behavior and health behavior in general.

Conceptions of pregnancy health and motivations for healthful behavior change among women in American Samoa.

PubMed

Kocher, Erica L; Sternberg Lamb, Jeanette M; McGarvey, Stephen T; Faiai, Mata'uitafa; Muasau-Howard, Bethel T; Hawley, Nicola L

2018-02-01

American Samoan women are particularly at risk of obesity-related non-communicable disease (NCD), requiring efficacious interventions to protect their health and that of their infants. Prior studies have identified pregnancy as an ideal time for behavior change interventions related to NCD. This study aimed to understand American Samoan women's conceptions of health during pregnancy, their motivations for pregnancy behavior change, and the role of their family in both enabling and preventing these changes. Eighteen women (2-19 weeks post-partum) completed semi-structured interviews that explored their experiences of pregnancy-related behavior change and social support. A thematic analysis identified prominent themes. A stages of change framework was used to describe the sample's readiness for behavior change. Participants expressed a Westernized conception of health during pregnancy that focused on eating a balanced diet and exercising regularly; behaviors that would usually be stigmatized outside of pregnancy. Many were in the contemplative/pre-contemplative stages of change, although some reported initiating healthful behaviors in pregnancy. Participants overwhelmingly described external motivations for adopting healthy behaviors, most notably the perceived benefit to their baby. During pregnancy, women reported protective treatment from their families as a result of communal ownership over the baby that is potentially limiting for women's agency over their health. This study confirmed pregnancy as an opportune moment for health behavior intervention, especially within the context of Samoan culture. Future efforts should capitalize on external motivations for behavior change but also encourage the development of internal motivators to sustain changes initiated in pregnancy post-partum. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Editorial: 2nd Special Issue on behavior change, health, and health disparities.

PubMed

Higgins, Stephen T

2015-11-01

This Special Issue of Preventive Medicine (PM) is the 2nd that we have organized on behavior change, health, and health disparities. This is a topic of fundamental importance to improving population health in the U.S. and other industrialized countries that are trying to more effectively manage chronic health conditions. There is broad scientific consensus that personal behavior patterns such as cigarette smoking, other substance abuse, and physical inactivity/obesity are among the most important modifiable causes of chronic disease and its adverse impacts on population health. As such behavior change needs to be a key component of improving population health. There is also broad agreement that while these problems extend across socioeconomic strata, they are overrepresented among more economically disadvantaged populations and contribute directly to the growing problem of health disparities. Hence, behavior change represents an essential step in curtailing that unsettling problem as well. In this 2nd Special Issue, we devote considerable space to the current U.S. prescription opioid addiction epidemic, a crisis that was not addressed in the prior Special Issue. We also continue to devote attention to the two largest contributors to preventable disease and premature death, cigarette smoking and physical inactivity/obesity as well as risks of co-occurrence of these unhealthy behavior patterns. Across each of these topics we included contributions from highly accomplished policy makers and scientists to acquaint readers with recent accomplishments as well as remaining knowledge gaps and challenges to effectively managing these important chronic health problems. Copyright © 2015 Elsevier Inc. All rights reserved.

Challenges of implementing routine health behavior change support in a children's hospital setting.

PubMed

Elwell, Laura; Powell, Jane; Wordsworth, Sharon; Cummins, Carole

2014-07-01

Evidence indicates that health behavior change initiatives are often not implemented successfully. This qualitative study aims to understand the barriers and facilitators to implementation of health behavior change brief advice into routine practice in an acute children's hospital setting. Semi-structured interviews were conducted with health professionals working at a UK children's hospital (n=33). Participants were purposively sampled to incorporate a range of specialties, job roles and training. An inductive thematic framework analysis identified two emergent themes. These capture the challenges of implementing routine health behavior change support in a children's hospital setting: (1) 'health professional knowledge, beliefs and behaviors' and (2) 'patient and family related challenges'. This study enhances findings from previous research by outlining the challenges pediatric health professionals face in relation to supporting health behavior change. Challenges include failure to assume responsibility, low confidence, prioritization of the health provider relationship with patients and families, health provider and patient knowledge, and low patient and family motivation. Skills-based behavior change training is needed for pediatric health professionals to effectively support health behavior change. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Quality assessment of a sample of mobile app-based health behavior change interventions using a tool based on the National Institute of Health and Care Excellence behavior change guidance.

PubMed

McMillan, Brian; Hickey, Eamonn; Patel, Mahendra G; Mitchell, Caroline

2016-03-01

To quality assess a sample of health behavior change apps from the NHS Apps Library using a rating tool based on the 2014 National Institute for Health and Care Excellence behavior change guidance (NICE BCG). A qualitative analysis of the NICE BCG identified themes and questions for a quality assessment of health behavior change apps. These were refined by further discussion and piloting, and applied by two independent raters to a sample of NHS Library apps (N=49). Disagreements were resolved following discussions with a third rater. Themes identified were; purpose, planning, usability, tailoring, behavior change technique (BCT), maintenance, evaluation, data security and documentation. Overall, purpose of the apps was clear, but evidence for collaboration with users or professionals was lacking. Usability information was poor and tailoring disappointing. Most used recognized BCTs but paid less attention to behavior maintenance than initiation. Information on app evaluation and documentation was sparse. This study furthers the work of the NHS Apps Library, adapting the NICE (2014) behavior change guidance for quality assessment of behavior change apps. This study helps lay the foundations for development of a quality assurance tool for mobile health apps aimed at health behavior change. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Ethical Theories for Promoting Health through Behavioral Change.

ERIC Educational Resources Information Center

O'Connell, Janelle K.; Price, James H.

1983-01-01

Arguments based on the philosophies of natural law, utilitarianism, paternalism, and distributive justice are examined for their pertinence to health behavior change strategies. Health educators should prepare individuals to make health-generating decisions but may need to limit the conditions under which they intervene. (Author/PP)

Playing for Real: Video Games and Stories for Health-Related Behavior Change

PubMed Central

Baranowski, Tom; Buday, Richard; Thompson, Debbe I.; Baranowski, Janice

2008-01-01

Background Video games provide extensive player involvement for large numbers of children and adults, and thereby provide a channel for delivering health behavior change experiences and messages in an engaging and entertaining format. Method Twenty-seven articles were identified on 25 video games that promoted health-related behavior change through December 2006. Results Most of the articles demonstrated positive health-related changes from playing the video games. Variability in what was reported about the games and measures employed precluded systematically relating characteristics of the games to outcomes. Many of these games merged the immersive, attention-maintaining properties of stories and fantasy, the engaging properties of interactivity, and behavior-change technology (e.g., tailored messages, goal setting). Stories in video games allow for modeling, vicarious identifying experiences, and learning a story’s “moral,” among other change possibilities. Conclusions Research is needed on the optimal use of game-based stories, fantasy, interactivity, and behavior change technology in promoting health-related behavior change. PMID:18083454

Playing for real: video games and stories for health-related behavior change.

PubMed

Baranowski, Tom; Buday, Richard; Thompson, Debbe I; Baranowski, Janice

2008-01-01

Video games provide extensive player involvement for large numbers of children and adults, and thereby provide a channel for delivering health behavior change experiences and messages in an engaging and entertaining format. Twenty-seven articles were identified on 25 video games that promoted health-related behavior change through December 2006. Most of the articles demonstrated positive health-related changes from playing the video games. Variability in what was reported about the games and measures employed precluded systematically relating characteristics of the games to outcomes. Many of these games merged the immersive, attention-maintaining properties of stories and fantasy, the engaging properties of interactivity, and behavior-change technology (e.g., tailored messages, goal setting). Stories in video games allow for modeling, vicarious identifying experiences, and learning a story's "moral," among other change possibilities. Research is needed on the optimal use of game-based stories, fantasy, interactivity, and behavior change technology in promoting health-related behavior change.

Readiness for health behavior changes among low fitness men in a Finnish health promotion campaign.

PubMed

Kaasalainen, Karoliina S; Kasila, Kirsti; Komulainen, Jyrki; Malvela, Miia; Poskiparta, Marita

2016-12-01

Men have been a hard-to-reach population in health behavior programs and it has been claimed that they are less interested in health issues than women. However, less is known about that how ready men are to adopt new health behaviors. This study examined readiness for change in physical activity (PA) and eating behavior (EB) among low fitness and overweight working-aged Finnish men who participated in a PA campaign. Associations among perceived health knowledge, health behaviors, psychosocial factors and readiness for change were studied. Data comprised 362 men aged 18-64. Physical fitness was assessed with a body fitness index constructed on the basis of the Polar OwnIndex Test, a hand grip test and an Inbody 720 body composition analysis. Health behavior information was gathered by questionnaire. Descriptive and comparative analyses were conducted by χ 2 test and Kruskall-Wallis and Mann-Whitney U tests. Associations between health knowledge and health behaviors were explored with logistic regression analyses. Readiness to increase PA and change EB was positively related to higher scores in psychosocial factors, PA and healthy eating habits. Self-rated knowledge on health issues was not related to PA or readiness to change health behaviors; however, it was positively associated with healthy eating and greater perceived promoters of PA. Participants' self-rated knowledge reflected not only an interest in health but also the differences in age and education. Health programs are needed that target both PA and healthy eating in low-fit men at different ages and motivational stages. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Active assistance technology for health-related behavior change: an interdisciplinary review.

PubMed

Kennedy, Catriona M; Powell, John; Payne, Thomas H; Ainsworth, John; Boyd, Alan; Buchan, Iain

2012-06-14

Information technology can help individuals to change their health behaviors. This is due to its potential for dynamic and unbiased information processing enabling users to monitor their own progress and be informed about risks and opportunities specific to evolving contexts and motivations. However, in many behavior change interventions, information technology is underused by treating it as a passive medium focused on efficient transmission of information and a positive user experience. To conduct an interdisciplinary literature review to determine the extent to which the active technological capabilities of dynamic and adaptive information processing are being applied in behavior change interventions and to identify their role in these interventions. We defined key categories of active technology such as semantic information processing, pattern recognition, and adaptation. We conducted the literature search using keywords derived from the categories and included studies that indicated a significant role for an active technology in health-related behavior change. In the data extraction, we looked specifically for the following technology roles: (1) dynamic adaptive tailoring of messages depending on context, (2) interactive education, (3) support for client self-monitoring of behavior change progress, and (4) novel ways in which interventions are grounded in behavior change theories using active technology. The search returned 228 potentially relevant articles, of which 41 satisfied the inclusion criteria. We found that significant research was focused on dialog systems, embodied conversational agents, and activity recognition. The most covered health topic was physical activity. The majority of the studies were early-stage research. Only 6 were randomized controlled trials, of which 4 were positive for behavior change and 5 were positive for acceptability. Empathy and relational behavior were significant research themes in dialog systems for behavior change, with

Is Behavior Change a Legitimate Objective for the Health Educator?

ERIC Educational Resources Information Center

Russell, Robert D.

1983-01-01

Pros and cons of making behavior change a primary objective of health education are summarized. The individual's right to choose his/her lifestyle is emphasized; health educators are encouraged to use holistic approaches to health education, emphasizing not only physical consequences of behavior but emotional and social factors as well. (PP)

Designing serious video games for health behavior change: Current status and future directions

USDA-ARS?s Scientific Manuscript database

Serious video games for health are designed to entertain while changing a specific health behavior. This article identifies behavioral principles that can guide the development of serious video games focused on changing a variety of health behaviors, including those attempting to decrease risk of o...

The impact of self-affirmation on health-behavior change: a meta-analysis.

PubMed

Epton, Tracy; Harris, Peter R; Kane, Rachel; van Koningsbruggen, Guido M; Sheeran, Paschal

2015-03-01

Self-affirmation (induced by reflecting upon important values, attributes, or social relations) appears to reduce defensive resistance to health-risk information and increase subsequent readiness for health behavior change. However, these effects of self-affirmation have yet to be subjected to formal, quantitative integration. Consequently, the current article reports a meta-analysis of the impact of self-affirmation on outcomes at 3 key points in the process of health-behavior change: (a) message acceptance, (b) intentions to change, and (c) subsequent behavior. The literature search identified 144 experimental tests of the effects of manipulating self-affirmation on these outcomes. Effect sizes were extracted and meta-analyzed. Across 34 tests of message acceptance (N = 3,433), 64 tests of intentions (N = 5,564), and 46 tests of behavior (N = 2,715), random effects models indicated small but reliable positive effects of self-affirmation on each outcome: acceptance, d+ = .17(CI = .03 to .31); intentions, d+ = .14 (CI = .05 to .23); behavior, d+ = .32 (CI = .19 to .44). Findings held across a range of health problems and behaviors. The results suggest that deploying self-affirmation inductions alongside persuasive health information has positive effects, promoting message acceptance, intentions to change, and subsequent behavior. Though the effects are small in magnitude, they are comparable to those obtained in meta-analyses of other health-behavior change interventions. These findings are relevant to researchers and practitioners working to understand why people resist beneficial health information and how such resistance can be reduced. PsycINFO Database Record (c) 2015 APA, all rights reserved

Changing Community Health Behaviors with a Health Promotion Computer Network: Preliminary Findings from Stanford Health-Net

PubMed Central

Robinson, Thomas N.; Walters, Paul A.

1987-01-01

Computer-based health education has been employed in many settings. However, data on resultant behavior change are lacking. A randomized, controlled, prospective study was performed to test the efficacy of Stanford Health-Net in changing community health behaviors. Graduate and undergraduate students (N=1003) were randomly assigned to treatment and control conditions. The treatment group received access to Health-Net, a health promotion computer network emphasizing specific self-care and preventive strategies. Over a four month intervention period, 26% of the treatment group used Health-Net an average of 6.4 times each (range 1 to 97). Users rated Health-Net favorably. The mean number of ambulatory medical visits decreesed 22.5% more in the treatment group than in the control group (P<.05), while hospitalizations did not differ significantly between groups. In addition, perceived self-efficacy for preventing the acquisition of a STD and herpes increased 577% (P<.05) and 261% (P<.01) more, respectively, in the treatment group than in the control group. These findings suggest that access to Stanford Health-Net can result in significant health behavior change. The advantages of the network approach make it a potential model for other communities.

Active Assistance Technology for Health-Related Behavior Change: An Interdisciplinary Review

PubMed Central

Kennedy, Catriona M; Powell, John; Payne, Thomas H; Ainsworth, John; Boyd, Alan

2012-01-01

Background Information technology can help individuals to change their health behaviors. This is due to its potential for dynamic and unbiased information processing enabling users to monitor their own progress and be informed about risks and opportunities specific to evolving contexts and motivations. However, in many behavior change interventions, information technology is underused by treating it as a passive medium focused on efficient transmission of information and a positive user experience. Objective To conduct an interdisciplinary literature review to determine the extent to which the active technological capabilities of dynamic and adaptive information processing are being applied in behavior change interventions and to identify their role in these interventions. Methods We defined key categories of active technology such as semantic information processing, pattern recognition, and adaptation. We conducted the literature search using keywords derived from the categories and included studies that indicated a significant role for an active technology in health-related behavior change. In the data extraction, we looked specifically for the following technology roles: (1) dynamic adaptive tailoring of messages depending on context, (2) interactive education, (3) support for client self-monitoring of behavior change progress, and (4) novel ways in which interventions are grounded in behavior change theories using active technology. Results The search returned 228 potentially relevant articles, of which 41 satisfied the inclusion criteria. We found that significant research was focused on dialog systems, embodied conversational agents, and activity recognition. The most covered health topic was physical activity. The majority of the studies were early-stage research. Only 6 were randomized controlled trials, of which 4 were positive for behavior change and 5 were positive for acceptability. Empathy and relational behavior were significant research themes in

Perceptions of barriers and facilitators to health behavior change among veteran cancer survivors.

PubMed

Beehler, Gregory P; Rodrigues, Amy E; Kay, Morgan A; Kiviniemi, Marc T; Steinbrenner, Lynn

2014-09-01

This study aimed to identify barriers and facilitators to health behavior change related to body size in a sample of veteran cancer survivors. A qualitative study was conducted with a sample of 35 male and female cancer survivors receiving care at a Veterans Administration comprehensive cancer center. Participants completed individual interviews regarding barriers and facilitators to lifestyle change and responded to a brief questionnaire regarding current health behaviors. Participants reported suboptimal adherence to recommended health behavior goals and the majority were overweight or obese (80%). Qualitative analysis revealed numerous barriers and facilitators to health behavior change across six broad categories: environmental factors, health services delivery factors, health-related factors, factors related to attitudes toward change, factors related to enacting change, and motivational factors. Veteran cancer survivors were impacted by common barriers to change affecting the general population, cancer-specific factors related to personal diagnosis and treatment history, and health service delivery factors related to the Veterans Administration health care system. There are many barriers and facilitators that exist in diverse domains for veteran cancer survivors, each of which offers unique challenges and opportunities for improving engagement in behavior change following cancer diagnosis and treatment. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

A Behavior Change Framework of Health Socialization and Identity

ERIC Educational Resources Information Center

Stanley, Christopher T.; Stanley, Lauren H. K.

2017-01-01

An individual's identity related to health is critically important in terms of the adoption and maintenance of health behaviors, and guides approaches to health change across the lifespan. This article presents a review of the literature and proposes a health socialization and health identity framework, which may be used to clarify challenges in…

Counseling for health behavior change in people with COPD: systematic review.

PubMed

Williams, Marie T; Effing, Tanja W; Paquet, Catherine; Gibbs, Carole A; Lewthwaite, Hayley; Li, Lok Sze Katrina; Phillips, Anna C; Johnston, Kylie N

2017-01-01

Counseling has been suggested as a promising approach for facilitating changes in health behavior. The aim of this systematic review of counseling interventions for people with COPD was to describe: 1) counseling definitions, 2) targeted health behaviors, 3) counseling techniques and 4) whether commonalities in counseling techniques were associated with improved health behaviors. Ten databases were searched for original randomized controlled trials which included adults with COPD, used the term "counseling" as a sole or component of a multifaceted intervention and were published in the previous 10 years. Data extraction, study appraisal and coding for behavior change techniques (BCTs) were completed by two independent reviewers. Data were synthesized descriptively, with meta-analysis conducted where possible. Of the 182 studies reviewed as full-text, 22 were included. A single study provided a definition for counseling. Two key behaviors were the main foci of counseling: physical activity (n=9) and smoking cessation (n=8). Six studies (27%) reported underlying models and/or theoretical frameworks. Counseling was the sole intervention in 10 studies and part of a multicomponent intervention in 12. Interventions targeting physical activity included a mean of 6.3 (±3.1) BCTs, smoking cessation 4.9 (±2.9) BCTs and other behaviors 6.5 (±3.9) BCTs. The most frequent BCTs were social support unspecified (n=22; 100%), goal setting behavior (n=11), problem-solving (n=11) and instructions on how to perform the behavior (n=10). No studies shared identical BCT profiles. Counseling had a significant positive effect for smoking cessation and positive but not significant effect for physical activity. Counseling for health behavior change was rarely defined and effectiveness varied by target behavior. Provision of specific details when reporting studies of counseling interventions (definition, BCTs, dosage) would allow clarification of the effectiveness of counseling as an

Help Preferences Among Employees Who Wish to Change Health Behaviors.

PubMed

Persson, Roger; Cleal, Bryan; Jakobsen, Mette Øllgaard; Villadsen, Ebbe; Andersen, Lars L

2014-08-01

To examine the help preferences of employees in the Danish police who had acknowledged that they wished to change health behaviors. In addition, we explored whether preferences varied with age, gender, chronic health concerns, positive expectations of good health, and past experiences of in-house health promotion services (i.e., wellness service). Respondents to an electronic questionnaire who acknowledged wishing to change health behaviors in relation to smoking (n = 845), alcohol (n = 684), eating (n = 4,431), and physical activity (n = 5,179) were asked to choose up to three help alternatives on a predefined list. In descending order, smokers preferred help from nicotine gum, no help, and help and support from family and friends. Alcohol consumers preferred no help or help and support from family and friends or "other" forms. Employees who wanted to change eating habits preferred a free fruit bowl, free nutritional guidance, and healthy food at work. Employees who wanted to change physical activity patterns preferred exercise at work, offers of free exercise, and exercise in a social/collegial context. Wishing to change health behaviors is not always accompanied by perceiving a need for assistance. The no-help option was selected fairly frequently and mostly in relation to alcohol and smoking. A fruit bowl was the most preferred option for help, followed by exercise at work and free exercise. Help from traditional health services was ranked low, possibly reflecting that they are primarily viewed as a solution for stopping disease rather than promoting health. © 2013 Society for Public Health Education.

Prioritizing multiple health behavior change research topics: expert opinions in behavior change science.

PubMed

Amato, Katie; Park, Eunhee; Nigg, Claudio R

2016-06-01

Multiple health behavior change (MHBC) approaches are understudied. The purpose of this study is to provide strategic MHBC research direction. This cross-sectional study contacted participants through the Society of Behavioral Medicine email listservs and rated the importance of 24 MHBC research topics (1 = not at all important, 5 = extremely important) separately for general and underserved populations. Participants (n = 76) were 79 % female; 76 % White, 10 % Asian, 8 % African American, 5 % Hispanic, and 1 % Native Hawaiian/Pacific Islander. Top MHBC research priorities were predictors of behavior change and the sustainability, long-term effects, and dissemination/translation of interventions for both populations. Recruitment and retention of participants (t(68) = 2.17, p = 0.000), multi-behavioral indices (t(68) = 3.54, p = 0.001), and measurement burden (t(67) = 5.04, p = 0.001) were important for the underserved. Results identified the same top research priorities across populations. For the underserved, research should emphasize recruitment, retention, and measurement burden.

Social Network Assessments and Interventions for Health Behavior Change: A Critical Review.

PubMed

Latkin, Carl A; Knowlton, Amy R

2015-01-01

Social networks provide a powerful approach for health behavior change. This article documents how social network interventions have been successfully used for a range of health behaviors, including HIV risk practices, smoking, exercise, dieting, family planning, bullying, and mental health. We review the literature that suggests the relationship between health behaviors and social network attributes demonstrates a high degree of specificity. The article then examines hypothesized social influence mechanisms including social norms, modeling, and social rewards and the factors of social identity and social rewards that can be employed to sustain social network interventions. Areas of future research avenues are highlighted, including the need to examine and to adjust analytically for contamination and social diffusion, social influence versus differential affiliation, and network change. Use and integration of mhealth and face-to-face networks for promoting health behavior change are also critical research areas.

Changing adolescent health behaviors: the healthy teens counseling approach.

PubMed

Olson, Ardis L; Gaffney, Cecelia A; Lee, Pamela W; Starr, Pamela

2008-11-01

Brief motivational interventions that have been provided in addition to routine primary care have changed adolescent health behaviors. Whether health screening and motivational-interviewing-based counseling provided by clinicians during routine care can change behaviors is unknown. Healthy Teens was a primary care, office-system intervention to support efficient, patient-centered counseling at well visits. Healthy Teens utilized a personal digital assistant (PDA)-based screener that provided the clinician with information about a teen's health risks and motivation to change. Changes in adolescent self-report of diet and activity health behaviors 6 months later were assessed in two cross-sectional samples of teens from five rural practices in 2005 and 2006. Usual-care subjects (N=148) were recruited at well visits prior to the intervention, and the Healthy Teens subjects (N=136) were recruited at well visits after the Healthy Teens system was well established. At 6-month follow-up, the Healthy Teens group had significantly increased self-reported exercise levels and milk-product intake. In the models exploring covariates, the only significant predictors for improvement in exercise levels were intervention-group status (p=0.009) and post-visit interest in making a change (p=0.015). Interest in changing predicted increased milk intake (p=0.028) in both groups. When teens planned an action related to nutrition, physical activity, or both after a well visit, Healthy Teens participants were more likely to report multiple planned actions (68% Healthy Teens vs 32% usual care, p<0.05). Changes in office systems using low-cost technology to screen adolescents and promote patient-centered counseling appear to influence teens to increase exercise and milk intake.

Applying social marketing in health care: communicating evidence to change consumer behavior.

PubMed

Evans, W Douglas; McCormack, Lauren

2008-01-01

Social marketing uses commercial marketing strategies to change individual and organizational behavior and policies. It has been effective on a population level across a wide range of public health and health care domains. There is limited evidence of the effectiveness of social marketing in changing health care consumer behavior through its impact on patient-provider interaction or provider behavior. Social marketers need to identify translatable strategies (e.g., competition analysis, branding, and tailored messages) that can be applied to health care provider and consumer behavior. Three case studies from social marketing illustrate potential strategies to change provider and consumer behavior. Countermarketing is a rapidly growing social marketing strategy that has been effective in tobacco control and may be effective in countering pharmaceutical marketing using specific message strategies. Informed decision making is a useful strategy when there is medical uncertainty, such as in prostate cancer screening and treatment. Pharmaceutical industry marketing practices offer valuable lessons for developing competing messages to reach providers and consumers. Social marketing is an effective population-based behavior change strategy that can be applied in individual clinical settings and as a complement to reinforce messages communicated on a population level. There is a need for more research on message strategies that work in health care and population-level effectiveness studies.

Can Mobile Phone Apps Influence People's Health Behavior Change? An Evidence Review.

PubMed

Zhao, Jing; Freeman, Becky; Li, Mu

2016-10-31

Globally, mobile phones have achieved wide reach at an unprecedented rate, and mobile phone apps have become increasingly prevalent among users. The number of health-related apps that were published on the two leading platforms (iOS and Android) reached more than 100,000 in 2014. However, there is a lack of synthesized evidence regarding the effectiveness of mobile phone apps in changing people's health-related behaviors. The aim was to examine the effectiveness of mobile phone apps in achieving health-related behavior change in a broader range of interventions and the quality of the reported studies. We conducted a comprehensive bibliographic search of articles on health behavior change using mobile phone apps in peer-reviewed journals published between January 1, 2010 and June 1, 2015. Databases searched included Medline, PreMedline, PsycINFO, Embase, Health Technology Assessment, Education Resource Information Center (ERIC), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Articles published in the Journal of Medical Internet Research during that same period were hand-searched on the journal's website. Behavior change mechanisms were coded and analyzed. The quality of each included study was assessed by the Cochrane Risk of Bias Assessment Tool. A total of 23 articles met the inclusion criteria, arranged under 11 themes according to their target behaviors. All studies were conducted in high-income countries. Of these, 17 studies reported statistically significant effects in the direction of targeted behavior change; 19 studies included in this analysis had a 65% or greater retention rate in the intervention group (range 60%-100%); 6 studies reported using behavior change theories with the theory of planned behavior being the most commonly used (in 3 studies). Self-monitoring was the most common behavior change technique applied (in 12 studies). The studies suggest that some features improve the effectiveness of apps, such as less time

Health marketing and behavioral change: a review of the literature

PubMed Central

Chichirez, Cristina-Mihaela; Purcărea, Victor Lorin

2018-01-01

Health marketing as a part of social marketing, must influence individuals, voluntarily, through various social programmes, in order to accept, reject, modify or abandon a behavior in favour of a healthier lifestyle. Acting on individual behavior change, social marketing can influence the behaviour of those who decide public policies, with positive effects in social change. In time, in order to understand and predict a behavior, a number of theories, models and tactics were developed with the aim to identify factors and mechanisms with the greatest impact in the changing process. Cognitive- social theories proved to be more effective, because they offer guidelines for conducting research in behavioral change. PMID:29696059

Health marketing and behavioral change: a review of the literature.

PubMed

Chichirez, Cristina-Mihaela; Purcărea, Victor Lorin

2018-01-01

Health marketing as a part of social marketing, must influence individuals, voluntarily, through various social programmes, in order to accept, reject, modify or abandon a behavior in favour of a healthier lifestyle. Acting on individual behavior change, social marketing can influence the behaviour of those who decide public policies, with positive effects in social change. In time, in order to understand and predict a behavior, a number of theories, models and tactics were developed with the aim to identify factors and mechanisms with the greatest impact in the changing process. Cognitive- social theories proved to be more effective, because they offer guidelines for conducting research in behavioral change.

Gamification: what it is and why it matters to digital health behavior change developers.

PubMed

Cugelman, Brian

2013-12-12

This editorial provides a behavioral science view on gamification and health behavior change, describes its principles and mechanisms, and reviews some of the evidence for its efficacy. Furthermore, this editorial explores the relation between gamification and behavior change frameworks used in the health sciences and shows how gamification principles are closely related to principles that have been proven to work in health behavior change technology. Finally, this editorial provides criteria that can be used to assess when gamification provides a potentially promising framework for digital health interventions.

Counseling for health behavior change in people with COPD: systematic review

PubMed Central

Williams, Marie T; Effing, Tanja W; Paquet, Catherine; Gibbs, Carole A; Lewthwaite, Hayley; Li, Lok Sze Katrina; Phillips, Anna C; Johnston, Kylie N

2017-01-01

Counseling has been suggested as a promising approach for facilitating changes in health behavior. The aim of this systematic review of counseling interventions for people with COPD was to describe: 1) counseling definitions, 2) targeted health behaviors, 3) counseling techniques and 4) whether commonalities in counseling techniques were associated with improved health behaviors. Ten databases were searched for original randomized controlled trials which included adults with COPD, used the term “counseling” as a sole or component of a multifaceted intervention and were published in the previous 10 years. Data extraction, study appraisal and coding for behavior change techniques (BCTs) were completed by two independent reviewers. Data were synthesized descriptively, with meta-analysis conducted where possible. Of the 182 studies reviewed as full-text, 22 were included. A single study provided a definition for counseling. Two key behaviors were the main foci of counseling: physical activity (n=9) and smoking cessation (n=8). Six studies (27%) reported underlying models and/or theoretical frameworks. Counseling was the sole intervention in 10 studies and part of a multicomponent intervention in 12. Interventions targeting physical activity included a mean of 6.3 (±3.1) BCTs, smoking cessation 4.9 (±2.9) BCTs and other behaviors 6.5 (±3.9) BCTs. The most frequent BCTs were social support unspecified (n=22; 100%), goal setting behavior (n=11), problem-solving (n=11) and instructions on how to perform the behavior (n=10). No studies shared identical BCT profiles. Counseling had a significant positive effect for smoking cessation and positive but not significant effect for physical activity. Counseling for health behavior change was rarely defined and effectiveness varied by target behavior. Provision of specific details when reporting studies of counseling interventions (definition, BCTs, dosage) would allow clarification of the effectiveness of counseling as an

Peer Mentoring for Health Behavior Change: A Systematic Review

ERIC Educational Resources Information Center

Petosa, R. L.; Smith, Laureen H.

2014-01-01

Background: Peer mentoring can be a powerful complement to health instruction. Mentoring has been used to change health behaviors and promote sustainable lifestyle patterns in adults and, more recently, among adolescents. Purpose: This article reviews the use of peer mentoring to promote health practices and describes how this approach can be used…

Gamification: What It Is and Why It Matters to Digital Health Behavior Change Developers

PubMed Central

2013-01-01

This editorial provides a behavioral science view on gamification and health behavior change, describes its principles and mechanisms, and reviews some of the evidence for its efficacy. Furthermore, this editorial explores the relation between gamification and behavior change frameworks used in the health sciences and shows how gamification principles are closely related to principles that have been proven to work in health behavior change technology. Finally, this editorial provides criteria that can be used to assess when gamification provides a potentially promising framework for digital health interventions. PMID:25658754

Workplace exercise for changing health behavior related to physical activity.

PubMed

Grande, Antonio José; Cieslak, Fabrício; Silva, Valter

2015-01-01

Physical Activity in the workplace has received special attention from researchers who are looking to promote lifelong health and well-being. The workplace is being investigated as a possible place to assess and create strategies to help people to become healthier. The transtheoretical model and stages of change has been adapted as a tool to assess the stages of behavioral change towards exercising. To assess the change in health behavior following a three-month exercise program based in the workplace. A quasi-experimental study design was used in which 165 employees participated in the study. An intervention program of workplace exercise was applied for three months. Participants were assessed through the transtheoretical model and stages of change questionnaire before and after intervention to understand changes in their position on the behavioral change continuum. The number of employees who were physically active increased after the workplace exercise intervention (13.9% , 95% CI 9.5 to 20.1; P = 0.009). There was a significant decrease in the proportion of employees in the pre-contemplation stage (-6.1% , 95% CI 3.3 to 10.8; P = 0.045) and contemplation stage (-11.5% , 95% CI 7.5 to 17.3; P = 0.017), and a significant increase in the action stage (10.9% , 95% CI 7.0 to 16.6; P = 0.003). Engaging in workplace exercise has a significant positive effect on health behavior and willingness to become more physically active.

Determinants of intention to change health-related behavior and actual change in patients with TIA or minor ischemic stroke.

PubMed

Brouwer-Goossensen, Dorien; Genugten, Lenneke van; Lingsma, Hester; Dippel, Diederik; Koudstaal, Peter; Hertog, Heleen den

2016-04-01

To assess determinants of intention to change health-related behavior and actual change in patients with TIA or ischemic stroke. In this prospective cohort study, 100 patients with TIA or minor ischemic stroke completed questionnaires on behavioral intention and sociocognitive factors including perception of severity, susceptibility, fear, response-efficacy and self-efficacy at baseline. Questionnaires on physical activity, diet and smoking were completed at baseline and at 3 months. Associations between sociocognitive factors and behavioral intention and actual change were studied with multivariable linear and logistic regression. Self-efficacy, response efficacy, and fear were independently associated with behavioral intention, with self-efficacy as the strongest determinant of intention to increase physical activity (aBeta 0.40; 95% CI 0.12-0.71), adapt a healthy diet (aBeta 0.49; 95% CI 0.23-0.75), and quit smoking (aBeta 0.51; 95% CI 0.13-0.88). Intention to change tended to be associated with actual health-related behavior change. Self-efficacy, fear, and response-efficacy were determinants of intention to change health-related behavior after TIA or ischemic stroke. These determinants of intention to change health-related behavior after TIA or ischemic stroke should be taken into account in the development of future interventions promoting health-related behavior change in these group of patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Effect of Aditional Brief Counselling after Periodic Health Examination on Motivation for Health Behavior Change

PubMed Central

Son, Ki Young; Lee, Cheol Min; Lym, Youl Lee; Oh, Seung Won; Chung, Wonjoo; Lee, Jin-Seok; Park, DuShin; Kim, Han Suk

2012-01-01

This study was to evaluate the effect of additional brief counseling by a primary care physician on lifestyle modification of examinees after a periodic health examination. 1,000 participants of the 2007 Korean national health screening program were asked to note any variation in their health behavior after participating in the screening program. The degree of comprehensive motivation for lifestyle modification was assessed in terms of stages of health behavior change. We calculated odds ratio of positive change (enhanced stage of change) with multiple logistic regression analysis and age-adjusted proportion of positive changers. Of 989 respondents, 486 and 503 received the basic and additional programs, respectively. Additional group were more likely to be positive changer than basic group (adjusted OR 1.78; 95% CI 1.19-2.65), and this was more prominent in older age group (adjusted OR 2.38, 95% CI 1.23-4.58). The age-adjusted proportions of positive changers were 22.7% (95% CI, 17.9-28.3) and 36.2% (95% CI, 30.4-42.4) in the basic and additional groups, respectively (P < 0.001). The additional consultation led to improvements in the stage of health behavior change after the health examination. Thus, such a consultation should be considered when designing a health-screening program. PMID:23166407

Teachable moments for health behavior change and intermediate patient outcomes.

PubMed

Flocke, Susan A; Clark, Elizabeth; Antognoli, Elizabeth; Mason, Mary Jane; Lawson, Peter J; Smith, Samantha; Cohen, Deborah J

2014-07-01

Teachable moments (TM) are opportunities created through physician-patient interaction and used to encourage patients to change unhealthy behaviors. We examine the effectiveness of TMs to increase patients' recall of advice, motivation to modify behavior, and behavior change. A mixed-method observational study of 811 patient visits to 28 primary care clinicians used audio-recordings of visits to identify TMs and other types of advice in health behavior change talk. Patient surveys assessed smoking, exercise, fruit/vegetable consumption, height, weight, and readiness for change prior to the observed visit and 6-weeks post-visit. Compared to other identified categories of advice (i.e. missed opportunities or teachable moment attempts), recall was greatest after TMs occurred (83% vs. 49-74%). TMs had the greatest proportion of patients change in importance and confidence and increase readiness to change; however differences were small. TMs had greater positive behavior change scores than other categories of advice; however, this pattern was statistically non-significant and was not observed for BMI change. TMs have a greater positive influence on several intermediate markers of patient behavior change compared to other categories of advice. TMs show promise as an approach for clinicians to discuss behavior change with patients efficiently and effectively. Copyright © 2014. Published by Elsevier Ireland Ltd.

Help Preferences among Employees Who Wish to Change Health Behaviors

ERIC Educational Resources Information Center

Persson, Roger; Cleal, Bryan; Jakobsen, Mette Øllgaard; Villadsen, Ebbe; Andersen, Lars L.

2014-01-01

Objective: To examine the help preferences of employees in the Danish police who had acknowledged that they wished to change health behaviors. In addition, we explored whether preferences varied with age, gender, chronic health concerns, positive expectations of good health, and past experiences of in-house health promotion services (i.e.,…

Can Mobile Phone Apps Influence People’s Health Behavior Change? An Evidence Review

PubMed Central

Freeman, Becky; Li, Mu

2016-01-01

Background Globally, mobile phones have achieved wide reach at an unprecedented rate, and mobile phone apps have become increasingly prevalent among users. The number of health-related apps that were published on the two leading platforms (iOS and Android) reached more than 100,000 in 2014. However, there is a lack of synthesized evidence regarding the effectiveness of mobile phone apps in changing people’s health-related behaviors. Objective The aim was to examine the effectiveness of mobile phone apps in achieving health-related behavior change in a broader range of interventions and the quality of the reported studies. Methods We conducted a comprehensive bibliographic search of articles on health behavior change using mobile phone apps in peer-reviewed journals published between January 1, 2010 and June 1, 2015. Databases searched included Medline, PreMedline, PsycINFO, Embase, Health Technology Assessment, Education Resource Information Center (ERIC), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Articles published in the Journal of Medical Internet Research during that same period were hand-searched on the journal’s website. Behavior change mechanisms were coded and analyzed. The quality of each included study was assessed by the Cochrane Risk of Bias Assessment Tool. Results A total of 23 articles met the inclusion criteria, arranged under 11 themes according to their target behaviors. All studies were conducted in high-income countries. Of these, 17 studies reported statistically significant effects in the direction of targeted behavior change; 19 studies included in this analysis had a 65% or greater retention rate in the intervention group (range 60%-100%); 6 studies reported using behavior change theories with the theory of planned behavior being the most commonly used (in 3 studies). Self-monitoring was the most common behavior change technique applied (in 12 studies). The studies suggest that some features improve the

Behavior Change or Empowerment: On the Ethics of Health-Promotion Goals.

PubMed

Tengland, Per-Anders

2016-03-01

One important ethical issue for health promotion and public health work is to determine what the goals for these practices should be. This paper will try to clarify what some of these goals are thought to be, and what they ought to be. It will specifically discuss two different approaches to health promotion, such as, behavior change and empowerment. The general aim of this paper is, thus, to compare the behavior-change approach and the empowerment approach, concerning their immediate (instrumental) goals or aims, and to morally evaluate the strengths and weaknesses of these two goal models, in relation to the ultimate goal of health promotion. The investigation shows that the behavior-change approach has several moral problems. First of all, it is overly paternalistic and often disregards the individual's or group's own perception of what is important-something that also increases the risk of failed interventions. Furthermore, it risks leading to 'victim blaming' and stigmatization, and to increased inequalities in health, and it puts focus on the 'wrong' problems, i.e., behavior instead of the 'causes of the causes'. It is thereafter shown that the empowerment approach does not have any of these problems. Finally, some specific problems for the empowerment approach are discussed and resolved, such as, the idea that empowering some groups might lead to power over others, the objection that the focus is not primarily on health (which it should be), and the fact that empowered people might choose to live lives that risk reducing their health.

Children's behavioral health system transformation: one state's context and strategies for sustained change.

PubMed

Harburger, Deborah S; Stephan, Sharon H; Kaye, Sarah

2013-10-01

The purpose of this paper was to examine the State of Maryland as a case study of sustained change efforts in the service delivery system for children with significant behavioral health needs and their families. A punctuated equilibrium paradigm is introduced to describe Maryland's behavioral health system transformation over the course of three decades. The context and specific strategies that characterized Maryland's execution of its recent Mental Health Transformation State Incentive Grant are highlighted. There is a discussion of one of the pinnacle achievements of Maryland's transformation efforts, the recent statewide establishment of care management entities for children with behavioral health challenges, and its implications for behavioral health in the context of health care reform changes. This case study illustrates how a state can systematically and incrementally develop systems of care for children and families that are values-based, sustainable, and flexible.

Effect of additional brief counselling after periodic health examination on motivation for health behavior change [corrected].

PubMed

Son, Ki Young; Lee, Cheol Min; Cho, BeLong; Lym, Youl Lee; Oh, Seung Won; Chung, Wonjoo; Lee, Jin-Seok; Park, DuShin; Kim, Han Suk

2012-11-01

This study was to evaluate the effect of additional brief counseling by a primary care physician on lifestyle modification of examinees after a periodic health examination. 1,000 participants of the 2007 Korean national health screening program were asked to note any variation in their health behavior after participating in the screening program. The degree of comprehensive motivation for lifestyle modification was assessed in terms of stages of health behavior change. We calculated odds ratio of positive change (enhanced stage of change) with multiple logistic regression analysis and age-adjusted proportion of positive changers. Of 989 respondents, 486 and 503 received the basic and additional programs, respectively. Additional group were more likely to be positive changer than basic group (adjusted OR 1.78; 95% CI 1.19-2.65), and this was more prominent in older age group (adjusted OR 2.38, 95% CI 1.23-4.58). The age-adjusted proportions of positive changers were 22.7% (95% CI, 17.9-28.3) and 36.2% (95% CI, 30.4-42.4) in the basic and additional groups, respectively (P < 0.001). The additional consultation led to improvements in the stage of health behavior change after the health examination. Thus, such a consultation should be considered when designing a health-screening program.

A chaotic view of behavior change: a quantum leap for health promotion.

PubMed

Resnicow, Ken; Vaughan, Roger

2006-09-12

The study of health behavior change, including nutrition and physical activity behaviors, has been rooted in a cognitive-rational paradigm. Change is conceptualized as a linear, deterministic process where individuals weigh pros and cons, and at the point at which the benefits outweigh the cost change occurs. Consistent with this paradigm, the associated statistical models have almost exclusively assumed a linear relationship between psychosocial predictors and behavior. Such a perspective however, fails to account for non-linear, quantum influences on human thought and action. Consider why after years of false starts and failed attempts, a person succeeds at increasing their physical activity, eating healthier or losing weight. Or, why after years of success a person relapses. This paper discusses a competing view of health behavior change that was presented at the 2006 annual ISBNPA meeting in Boston. Rather than viewing behavior change from a linear perspective it can be viewed as a quantum event that can be understood through the lens of Chaos Theory and Complex Dynamic Systems. Key principles of Chaos Theory and Complex Dynamic Systems relevant to understanding health behavior change include: 1) Chaotic systems can be mathematically modeled but are nearly impossible to predict; 2) Chaotic systems are sensitive to initial conditions; 3) Complex Systems involve multiple component parts that interact in a nonlinear fashion; and 4) The results of Complex Systems are often greater than the sum of their parts. Accordingly, small changes in knowledge, attitude, efficacy, etc may dramatically alter motivation and behavioral outcomes. And the interaction of such variables can yield almost infinite potential patterns of motivation and behavior change. In the linear paradigm unaccounted for variance is generally relegated to the catch all "error" term, when in fact such "error" may represent the chaotic component of the process. The linear and chaotic paradigms are

Using mHealth to Deliver Behavior Change Interventions Within Prenatal Care at Community Health Centers.

PubMed

Mauriello, Leanne M; Van Marter, Deborah F; Umanzor, Cindy D; Castle, Patricia H; de Aguiar, Emma L

2016-09-01

To test an iPad-delivered multiple behavior tailored intervention (Healthy Pregnancy: Step by Step) for pregnant women that addresses smoking cessation, stress management, and fruit and vegetable consumption. A randomized 2 × 5 factorial repeated measures design was employed with randomization on the individual level stratified on behavior risk. Women completed three sessions during pregnancy and two postpartum at postdelivery months 1 and 4. Women were recruited from six locations of federally funded health centers across three states. Participants (N = 335) were English- and Spanish-speaking women at up to 18 weeks gestation. The treatment group received three interactive sessions focused on two priority health behavior risks. The sessions offered individually tailored and stage-matched change strategies based on the transtheoretical model of behavior change. The usual care group received March of Dimes brochures. The primary outcome was the number of behavior risks. Stage of change and continuous measures for all behaviors also were assessed. Data were analyzed across all time points using generalized estimating equations examining repeated measures effects. Women in the treatment group reported significantly fewer risks than those in usual care at 1 month (.85 vs. 1.20, odds ratio [OR] = .70) and 4 months postpartum (.72 vs. .91, OR = .81). Healthy Pregnancy is an evidence-based and personalized program that assists pregnant women with reducing behavior risks and sustaining healthy lifestyle behaviors. © 2016 by American Journal of Health Promotion, Inc.

Designing Serious Video Games for Health Behavior Change: Current Status and Future Directions

PubMed Central

Thompson, Debbe

2012-01-01

Serious video games for health are designed to entertain while changing a specific health behavior. This article identifies behavioral principles that can guide the development of serious video games focused on changing a variety of health behaviors, including those attempting to decrease risk of obesity and type 2 diabetes. Guidelines discussed include how to develop video games that provide a solid foundation for behavior change by enhancing a player’s knowledge and skill, ways in which personal mastery experiences can be incorporated into a video game environment, using game characters and avatars to promote observational learning, creating personalized experiences through tailoring, and the importance of achieving a balance between “fun-ness” and “seriousness.” The article concludes with suggestions for future research needed to inform this rapidly growing field. PMID:22920806

Designing serious video games for health behavior change: current status and future directions.

PubMed

Thompson, Debbe

2012-07-01

Serious video games for health are designed to entertain while changing a specific health behavior. This article identifies behavioral principles that can guide the development of serious video games focused on changing a variety of health behaviors, including those attempting to decrease risk of obesity and type 2 diabetes. Guidelines discussed include how to develop video games that provide a solid foundation for behavior change by enhancing a player's knowledge and skill, ways in which personal mastery experiences can be incorporated into a video game environment, using game characters and avatars to promote observational learning, creating personalized experiences through tailoring, and the importance of achieving a balance between "fun-ness" and "seriousness." The article concludes with suggestions for future research needed to inform this rapidly growing field. © 2012 Diabetes Technology Society.

Changing health behavior motivation from I-must to I-want.

PubMed

Knecht, S; Kenning, P

2016-01-01

In the past, medicine was dominated by acute diseases. Since treatments were unknown to patients they followed their medical doctors´ directives-at least for the duration of the disease. Behavior was thus largely motivated by avoiding expected costs associated with alternative behaviors (I-must). The health challenges prevailing today are chronic conditions resulting from the way we chose to live. Traditional directive communication has not been successful in eliciting and maintaining appropriate lifestyle changes. An approach successful in other fields is to motivate behavior by increasing expected rewards (I-want). Drawing on neuroeconomic and marketing research, we outline strategies including simplification, repeated exposure, default framing, social comparisons, and consumer friendliness to foster sustained changes in preference. We further show how these measures could be integrated into the health care system. © 2016 Elsevier B.V. All rights reserved.

Are health behavior change interventions that use online social networks effective? A systematic review.

PubMed

Maher, Carol A; Lewis, Lucy K; Ferrar, Katia; Marshall, Simon; De Bourdeaudhuij, Ilse; Vandelanotte, Corneel

2014-02-14

The dramatic growth of Web 2.0 technologies and online social networks offers immense potential for the delivery of health behavior change campaigns. However, it is currently unclear how online social networks may best be harnessed to achieve health behavior change. The intent of the study was to systematically review the current level of evidence regarding the effectiveness of online social network health behavior interventions. Eight databases (Scopus, CINAHL, Medline, ProQuest, EMBASE, PsycINFO, Cochrane, Web of Science and Communication & Mass Media Complete) were searched from 2000 to present using a comprehensive search strategy. Study eligibility criteria were based on the PICOS format, where "population" included child or adult populations, including healthy and disease populations; "intervention" involved behavior change interventions targeting key modifiable health behaviors (tobacco and alcohol consumption, dietary intake, physical activity, and sedentary behavior) delivered either wholly or in part using online social networks; "comparator" was either a control group or within subject in the case of pre-post study designs; "outcomes" included health behavior change and closely related variables (such as theorized mediators of health behavior change, eg, self-efficacy); and "study design" included experimental studies reported in full-length peer-reviewed sources. Reports of intervention effectiveness were summarized and effect sizes (Cohen's d and 95% confidence intervals) were calculated wherever possible. Attrition (percentage of people who completed the study), engagement (actual usage), and fidelity (actual usage/intended usage) with the social networking component of the interventions were scrutinized. A total of 2040 studies were identified from the database searches following removal of duplicates, of which 10 met inclusion criteria. The studies involved a total of 113,988 participants (ranging from n=10 to n=107,907). Interventions included

Developing a model of health behavior change to reduce parasitic disease in Vietnam.

PubMed

Petersen, Suni; Do, Trina; Shaw, Christy; Brake, Kaile

2016-12-01

Worldwide more deaths occur due to conditions that can be ameliorated by behavior change. Changing health behaviors using models popularized in non-western countries has not proven particularly successful. The purpose of this study was to test variables elicited during qualitative interviews and cultural conversations to develop a model of health behavior change from the ground up in Vietnam. Village leaders and women representatives from the Women's Committee were trained as health advocates to facilitate changes in health practices that led to parasitic and infectious diseases. The health advocates visited 156 families to assess household conditions and assist women head-of-households in applying new behaviors to water treatment, personal hygiene, proper latrining and proximity of animals to humans. Predictors that were tested were self-efficacy, social desirability, internal and external control, and outcome expectations. The correlational and regression design resulted in self-efficacy alone predicting both home hygiene and family health with a large effect size. Social desirability appears to play a different role than in western culture studies. Outcome expectations and control were not predictive. A cultural analysis of the results is included. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Advancing Health Promotion in Dentistry: Articulating an Integrative Approach to Coaching Oral Health Behavior Change in the Dental Setting

PubMed Central

Howard, Anita R.

2015-01-01

Oral health is managed based on objective measures such as the presence and severity of dental caries and periodontal disease. In recent years, oral health researchers and practitioners have shown increasing interest in a widened array of physical, psychological, and social factors found to influence patients’ oral health. In this article, we introduce a behavior change coaching approach that can be used to enhance psychosocial diagnosis and client-centered delivery of health-promoting interventions. Briefly, this health coaching approach is based on an interactive assessment (both physical and psychological), a non-judgmental exploration of patients’ knowledge, attitudes, and beliefs, a mapping of patient behaviors that may contribute to disease progression, gauging patient motivation, and tailoring health communication to encourage health-promoting behavior change. Developed in a clinical setting, this coaching model is supported by interdisciplinary theory, research, and practice on health behavior change. We suggest that, with supervision, this coaching process may be learned. PMID:26457237

Translational behavioral medicine for population and individual health: gaps, opportunities, and vision for practice-based translational behavior change research.

PubMed

Ma, Jun; Lewis, Megan A; Smyth, Joshua M

2018-04-12

In this commentary, we propose a vision for "practice-based translational behavior change research," which we define as clinical and public health practice-embedded research on the implementation, optimization, and fundamental mechanisms of behavioral interventions. This vision intends to be inclusive of important research elements for behavioral intervention development, testing, and implementation. We discuss important research gaps and conceptual and methodological advances in three key areas along the discovery (development) to delivery (implementation) continuum of evidence-based interventions to improve behavior and health that could help achieve our vision of practice-based translational behavior change research. We expect our proposed vision to be refined and evolve over time. Through highlighting critical gaps that can be addressed by integrating modern theoretical and methodological approaches across disciplines in behavioral medicine, we hope to inspire the development and funding of innovative research on more potent and implementable behavior change interventions for optimal population and individual health.

Using health education theories to explain behavior change: a cross-country analysis. 2000-2001.

PubMed

Murray-Johnson, Lisa; Witte, Kim; Boulay, Marc; Figueroa, Maria Elena; Storey, Douglas; Tweedie, Ian

Scholars within the fields of public health, health education, health promotion, and health communication look to specific theories to explain health behavior change. The purpose of this article is to critically compare four health theories and key variables within them with regard to behavior change in the area of reproductive health. Using cross-country analyses of Ghana, Nepal, and Nicaragua (data sets provided by the Center for Communication Programs, Johns Hopkins University), the authors looked at the Health Belief Model, Theory of Reasoned Action, Extended Parallel Process Model, and Social Cognitive Theory for these two defined objectives. Results show that all four theories provide an excellent fit to the data, but that certain variables within them may have particular value for understanding specific aspects of behavior change. Recommendations for the selection of theories to use as guidelines in the design and evaluation of reproductive health programs are provided.

Developing and Pretesting a Text Messaging Program for Health Behavior Change: Recommended Steps.

PubMed

Abroms, Lorien C; Whittaker, Robyn; Free, Caroline; Mendel Van Alstyne, Judith; Schindler-Ruwisch, Jennifer M

2015-12-21

A growing body of evidence demonstrates that text messaging-based programs (short message service [SMS]) on mobile phones can help people modify health behaviors. Most of these programs have consisted of automated and sometimes interactive text messages that guide a person through the process of behavior change. This paper provides guidance on how to develop text messaging programs aimed at changing health behaviors. Based on their collective experience in designing, developing, and evaluating text messaging programs and a review of the literature, the authors drafted the guide. One author initially drafted the guide and the others provided input and review. Steps for developing a text messaging program include conducting formative research for insights into the target audience and health behavior, designing the text messaging program, pretesting the text messaging program concept and messages, and revising the text messaging program. The steps outlined in this guide may help in the development of SMS-based behavior change programs.

Age Differences in Health Behavior and Weight Changes in Japanese Workers: One-Year Follow-Up Study.

PubMed

Suka, Machi; Yamauchi, Takashi; Yanagisawa, Hiroyuki

2018-05-07

To examine one-year changes in stage of health behavior change and its associations with changes in health behavior and weight in a working population cohort. Using annual health examination data, 57,431 eligible Japanese workers aged 18-64 years were examined for their one-year changes in stage of change, eating and exercise habits, and weight. The stages of change became polarized into the precontemplation and the action/maintenance (i.e. post-action) and became stabilized with increasing age. The one-year change in stage of change was accompanied by changes in eating and exercise habits and weight. The age-dependent tendency towards bipolarization and stabilization of stages of change suggested that workplace health promotion interventions for facilitating health behavior changes should be started at younger ages.

Implementation of behavioral health interventions in real world scenarios: Managing complex change.

PubMed

Clark, Khaya D; Miller, Benjamin F; Green, Larry A; de Gruy, Frank V; Davis, Melinda; Cohen, Deborah J

2017-03-01

A practice embarks on a radical reformulation of how care is designed and delivered when it decides to integrate medical and behavioral health care for its patients and success depends on managing complex change in a complex system. We examined the ways change is managed when integrating behavioral health and medical care. Observational cross-case comparative study of 19 primary care and community mental health practices. We collected mixed methods data through practice surveys, observation, and semistructured interviews. We analyzed data using a data-driven, emergent approach. The change management strategies that leadership employed to manage the changes of integrating behavioral health and medical care included: (a) advocating for a mission and vision focused on integrated care; (b) fostering collaboration, with a focus on population care and a team-based approaches; (c) attending to learning, which includes viewing the change process as continuous, and creating a culture that promoted reflection and continual improvement; (d) using data to manage change, and (e) developing approaches to finance integration. This paper reports the change management strategies employed by practice leaders making changes to integrate care, as observed by independent investigators. We offer an empirically based set of actionable recommendations that are relevant to a range of leaders (policymakers, medical directors) and practice members who wish to effectively manage the complex changes associated with integrated primary care. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes in survivors of colorectal cancer: a randomized controlled trial.

PubMed

Hawkes, Anna L; Chambers, Suzanne K; Pakenham, Kenneth I; Patrao, Tania A; Baade, Peter D; Lynch, Brigid M; Aitken, Joanne F; Meng, Xingqiong; Courneya, Kerry S

2013-06-20

Colorectal cancer survivors are at risk for poor health outcomes because of unhealthy lifestyles, but few studies have developed translatable health behavior change interventions. This study aimed to determine the effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes among colorectal cancer survivors. In this two-group randomized controlled trial, 410 colorectal cancer survivors were randomly assigned to the health coaching intervention (11 theory-based telephone-delivered health coaching sessions delivered over 6 months focusing on physical activity, weight management, dietary habits, alcohol, and smoking) or usual care. Assessment of primary (ie, physical activity [Godin Leisure Time Index], health-related quality of life [HRQoL; Short Form-36], and cancer-related fatigue [Functional Assessment of Chronic Illness Therapy Fatigue Scale]) and secondary outcomes (ie, body mass index [kg/m(2)], diet and alcohol intake [Food Frequency Questionnaire], and smoking) were conducted at baseline and 6 and 12 months. At 12 months, significant intervention effects were observed for moderate physical activity (28.5 minutes; P = .003), body mass index (-0.9 kg/m(2); P = .001), energy from total fat (-7.0%; P = .006), and energy from saturated fat (-2.8%; P = .016). A significant intervention effect was reported for vegetable intake (0.4 servings per day; P = .001) at 6 months. No significant group differences were found at 6 or 12 months for HRQoL, cancer-related fatigue, fruit, fiber, or alcohol intake, or smoking. The CanChange intervention was effective for improving physical activity, dietary habits, and body mass index in colorectal cancer survivors. The intervention is translatable through existing telephone cancer support and information services in Australia and other countries.

Are Health Behavior Change Interventions That Use Online Social Networks Effective? A Systematic Review

PubMed Central

Lewis, Lucy K; Ferrar, Katia; Marshall, Simon; De Bourdeaudhuij, Ilse; Vandelanotte, Corneel

2014-01-01

Background The dramatic growth of Web 2.0 technologies and online social networks offers immense potential for the delivery of health behavior change campaigns. However, it is currently unclear how online social networks may best be harnessed to achieve health behavior change. Objective The intent of the study was to systematically review the current level of evidence regarding the effectiveness of online social network health behavior interventions. Methods Eight databases (Scopus, CINAHL, Medline, ProQuest, EMBASE, PsycINFO, Cochrane, Web of Science and Communication & Mass Media Complete) were searched from 2000 to present using a comprehensive search strategy. Study eligibility criteria were based on the PICOS format, where “population” included child or adult populations, including healthy and disease populations; “intervention” involved behavior change interventions targeting key modifiable health behaviors (tobacco and alcohol consumption, dietary intake, physical activity, and sedentary behavior) delivered either wholly or in part using online social networks; “comparator” was either a control group or within subject in the case of pre-post study designs; “outcomes” included health behavior change and closely related variables (such as theorized mediators of health behavior change, eg, self-efficacy); and “study design” included experimental studies reported in full-length peer-reviewed sources. Reports of intervention effectiveness were summarized and effect sizes (Cohen’s d and 95% confidence intervals) were calculated wherever possible. Attrition (percentage of people who completed the study), engagement (actual usage), and fidelity (actual usage/intended usage) with the social networking component of the interventions were scrutinized. Results A total of 2040 studies were identified from the database searches following removal of duplicates, of which 10 met inclusion criteria. The studies involved a total of 113,988 participants

Harnessing the power of conversations with virtual humans to change health behaviors.

PubMed

Albright, Glenn; Adam, Cyrille; Serri, Deborah; Bleeker, Seth; Goldman, Ron

2016-01-01

Skillful, collaborative conversations are powerful tools to improve physical and mental health. Whether you are a parent talking with your child about the dangers of substance abuse, an educator concerned about a student's signs of psychological distress, a veteran worried about a buddy who is contemplating suicide, or a healthcare professional wanting to better engage patients to increase treatment compliance, having the skill, confidence and motivation to engage in conversations can truly transform the health and well-being of those you interact with. Kognito develops role-play simulations that prepare individuals to effectively lead real-life conversations that measurably improve social, emotional, and physical health. The behavior change model that drives the simulations draws upon components of game mechanics, virtual human simulation technology and integrates evidence-based instructional design components as well as principles of social-cognitive theory and neuroscience such as motivational interviewing, emotional regulation, empathy and mindfulness. In the simulations, users or enter a risk-free practice environment and engage in a conversation with intelligent, fully animated, and emotionally responsive virtual characters that model human behavior. It is in practicing these conversations, and receiving feedback from a virtual coach, that users learn to better lead conversations in real life. Numerous longitudinal studies have shown that users who complete Kognito simulations demonstrate statistically significant and sustained increases in attitudinal variables that predict behavior change including preparedness, likelihood, and self-efficacy to better manage conversations. Pending the target population, each online or mobile simulation resulted in desired behavior changes ranging from increased referrals of students, patients or veterans in psychological distress to mental health support services, or increasing physician patient-centered communication or

Sociodemographic and social contextual predictors of multiple health behavior change: data from the Healthy Directions-Small Business study.

PubMed

Harley, Amy E; Sapp, Amy L; Li, Yi; Marino, Miguel; Quintiliani, Lisa M; Sorensen, Glorian

2013-03-01

Multiple modifiable health behaviors contribute to the chronic diseases that are the leading causes of death in the USA. Disparities for meeting recommended health behavior guidelines exist across occupational classes and socioeconomic levels. The purpose of this paper was to investigate sociodemographic and social contextual predictors of multiple health behavior change in a worksite intervention. We analyzed data on four diet and exercise variables from an intervention trial with worksite-level randomization. Eight hundred forty-one employees had complete data from baseline (response rate = 84 %) and follow-up surveys (response rate = 77 %). Multilevel logistic regression estimated associations between least absolute shrinkage and selection operator-selected sociodemographic and social contextual predictor variables and the multiple health behavior change outcome (changing 2+ versus 0 behaviors). Gender, being married/partnered, and perceived discrimination were significantly associated with multiple health behavior change. Sociodemographic and social contextual factors predict multiple health behavior change and could inform the design and delivery of worksite interventions targeting multiple health behaviors.

Social Integration and Health Behavioral Change in San Luis, Honduras

ERIC Educational Resources Information Center

McQuestion, Michael J.; Calle, Ana Quijano; Drasbek, Christopher; Harkins, Thomas; Sagastume, Lourdes J.

2010-01-01

This study explores the effects of social integration on behavioral change in the course of an intensive, community-based public health intervention. The intervention trained volunteers and mobilized local organizations to promote 16 key family health practices in rural San Luis, Honduras, during 2004 to 2006. A mixed methods approach is used.…

The role of time and risk preferences in adherence to physician advice on health behavior change.

PubMed

van der Pol, Marjon; Hennessy, Deirdre; Manns, Braden

2017-04-01

Changing physical activity and dietary behavior in chronic disease patients is associated with significant health benefits but is difficult to achieve. An often-used strategy is for the physician or other health professional to encourage behavior changes by providing advice on the health consequences of such behaviors. However, adherence to advice on health behavior change varies across individuals. This paper uses data from a population-based cross-sectional survey of 1849 individuals with chronic disease to explore whether differences in individuals' time and risk preferences can help explain differences in adherence. Health behaviors are viewed as investments in health capital within the Grossman model. Physician advice plays a role in the model in that it improves the understanding of the future health consequences of investments. It can be hypothesized that the effect of advice on health behavior will depend on an individuals' time and risk preference. Within the survey, which measured a variety of health-related behaviors and outcomes, including receipt and compliance with advice on dietary and physical activity changes, time preferences were measured using financial planning horizon, and risk preferences were measured through a commonly used question which asked respondents to indicate their willingness to take risks on a ten-point scale. Results suggest that time preferences play a role in adherence to physical activity advice. While time preferences also play a role in adherence to dietary advice, this effect is only apparent for males. Risk preferences do not seem to be associated with adherence. The results suggest that increasing the salience of more immediate benefits of health behavior change may improve adherence.

Harnessing the power of conversations with virtual humans to change health behaviors

PubMed Central

Adam, Cyrille; Serri, Deborah; Bleeker, Seth; Goldman, Ron

2016-01-01

Skillful, collaborative conversations are powerful tools to improve physical and mental health. Whether you are a parent talking with your child about the dangers of substance abuse, an educator concerned about a student’s signs of psychological distress, a veteran worried about a buddy who is contemplating suicide, or a healthcare professional wanting to better engage patients to increase treatment compliance, having the skill, confidence and motivation to engage in conversations can truly transform the health and well-being of those you interact with. Kognito develops role-play simulations that prepare individuals to effectively lead real-life conversations that measurably improve social, emotional, and physical health. The behavior change model that drives the simulations draws upon components of game mechanics, virtual human simulation technology and integrates evidence-based instructional design components as well as principles of social-cognitive theory and neuroscience such as motivational interviewing, emotional regulation, empathy and mindfulness. In the simulations, users or enter a risk-free practice environment and engage in a conversation with intelligent, fully animated, and emotionally responsive virtual characters that model human behavior. It is in practicing these conversations, and receiving feedback from a virtual coach, that users learn to better lead conversations in real life. Numerous longitudinal studies have shown that users who complete Kognito simulations demonstrate statistically significant and sustained increases in attitudinal variables that predict behavior change including preparedness, likelihood, and self-efficacy to better manage conversations. Pending the target population, each online or mobile simulation resulted in desired behavior changes ranging from increased referrals of students, patients or veterans in psychological distress to mental health support services, or increasing physician patient-centered communication or

Health behavior change: can genomics improve behavioral adherence?

PubMed

McBride, Colleen M; Bryan, Angela D; Bray, Molly S; Swan, Gary E; Green, Eric D

2012-03-01

The National Human Genome Research Institute recommends pursuing "genomic information to improve behavior change interventions" as part of its strategic vision for genomics. The limited effectiveness of current behavior change strategies may be explained, in part, by their insensitivity to individual variation in adherence responses. The first step in evaluating whether genomics can inform customization of behavioral recommendations is evidence reviews to identify adherence macrophenotypes common across behaviors and individuals that have genetic underpinnings. Conceptual models of how biological, psychological, and environmental factors influence adherence also are needed. Researchers could routinely collect biospecimens and standardized adherence measurements of intervention participants to enable understanding of genetic and environmental influences on adherence, to guide intervention customization and prospective comparative effectiveness studies.

Using Smartphones and Health Apps to Change and Manage Health Behaviors: A Population-Based Survey

PubMed Central

Dombrowski, Stephan U; Oedekoven, Monika; O´Sullivan, Julie L; Kanzler, Melanie; Kuhlmey, Adelheid; Gellert, Paul

2017-01-01

Background Chronic conditions are an increasing challenge for individuals and the health care system. Smartphones and health apps are potentially promising tools to change health-related behaviors and manage chronic conditions. Objective The aim of this study was to explore (1) the extent of smartphone and health app use, (2) sociodemographic, medical, and behavioral correlates of smartphone and health app use, and (3) associations of the use of apps and app characteristics with actual health behaviors. Methods A population-based survey (N=4144) among Germans, aged 35 years and older, was conducted. Sociodemographics, presence of chronic conditions, health behaviors, quality of life, and health literacy, as well as the use of the Internet, smartphone, and health apps were assessed by questionnaire at home visit. Binary logistic regression models were applied. Results It was found that 61.25% (2538/4144) of participants used a smartphone. Compared with nonusers, smartphone users were younger, did more research on the Internet, were more likely to work full-time and more likely to have a university degree, engaged more in physical activity, and less in low fat diet, and had a higher health-related quality of life and health literacy. Among smartphone users, 20.53% (521/2538) used health apps. App users were younger, less likely to be native German speakers, did more research on the Internet, were more likely to report chronic conditions, engaged more in physical activity, and low fat diet, and were more health literate compared with nonusers who had a smartphone. Health apps focused on smoking cessation (232/521, 44.5%), healthy diet (201/521, 38.6%), and weight loss (121/521, 23.2%). The most common app characteristics were planning (264/521, 50.7%), reminding (188/521, 36.1%), prompting motivation (179/521 34.4%), and the provision of information (175/521, 33.6%). Significant associations were found between planning and the health behavior physical activity

Using Smartphones and Health Apps to Change and Manage Health Behaviors: A Population-Based Survey.

PubMed

Ernsting, Clemens; Dombrowski, Stephan U; Oedekoven, Monika; O Sullivan, Julie L; Kanzler, Melanie; Kuhlmey, Adelheid; Gellert, Paul

2017-04-05

Chronic conditions are an increasing challenge for individuals and the health care system. Smartphones and health apps are potentially promising tools to change health-related behaviors and manage chronic conditions. The aim of this study was to explore (1) the extent of smartphone and health app use, (2) sociodemographic, medical, and behavioral correlates of smartphone and health app use, and (3) associations of the use of apps and app characteristics with actual health behaviors. A population-based survey (N=4144) among Germans, aged 35 years and older, was conducted. Sociodemographics, presence of chronic conditions, health behaviors, quality of life, and health literacy, as well as the use of the Internet, smartphone, and health apps were assessed by questionnaire at home visit. Binary logistic regression models were applied. It was found that 61.25% (2538/4144) of participants used a smartphone. Compared with nonusers, smartphone users were younger, did more research on the Internet, were more likely to work full-time and more likely to have a university degree, engaged more in physical activity, and less in low fat diet, and had a higher health-related quality of life and health literacy. Among smartphone users, 20.53% (521/2538) used health apps. App users were younger, less likely to be native German speakers, did more research on the Internet, were more likely to report chronic conditions, engaged more in physical activity, and low fat diet, and were more health literate compared with nonusers who had a smartphone. Health apps focused on smoking cessation (232/521, 44.5%), healthy diet (201/521, 38.6%), and weight loss (121/521, 23.2%). The most common app characteristics were planning (264/521, 50.7%), reminding (188/521, 36.1%), prompting motivation (179/521 34.4%), and the provision of information (175/521, 33.6%). Significant associations were found between planning and the health behavior physical activity, between feedback or monitoring and physical

Relationship transitions and change in health behavior: A four-phase, twelve-year longitudinal study.

PubMed

Josefsson, Kim; Elovainio, Marko; Stenholm, Sari; Kawachi, Ichiro; Kauppi, Maarit; Aalto, Ville; Kivimäki, Mika; Vahtera, Jussi

2018-03-19

Extensive scientific evidence shows an association between involvement in social relationships and healthy lifestyle. Prospective studies with many participants and long follow-ups are needed to study the dynamics and change in social factors within individuals over time. Our aim was to determine whether a change in relationship status (single, married, divorced, widow, cohabiting) is followed by a change in health behavior (smoking, alcohol consumption, physical activity, and body mass index). We used data from 81,925 healthy adults participating in the prospective longitudinal Finnish Public Sector Study in the period 2000-2013. We analyzed 327,700 person-observations from four data collection phases. Missing data were multiply imputed. A within-individual methodology was used to minimize the possibility of selection effects affecting the interpretation. All four health behaviors showed associations with relationship status. The effects were very similar and in the same direction in women and men, although there were gender differences in the magnitudes of the effects. The end of a relationship was followed by a decrease in body mass index, increased odds of being a smoker, increase in physical activity, and increase in alcohol consumption (widowed men). The effects were reverse when forming a new relationship. A change in relationship status is associated with a change in health behavior. The association is not explained by socioeconomic status, subjective health status, or anxiety level. People leaving or losing a relationship are at increased risk of unhealthy behavior (smoking and alcohol consumption), but at the same time they have a lower BMI and show higher physical activity compared to the time they were in a relationship. It is not clear if the cumulative health effect of these health behavior changes is positive or negative. Copyright © 2018 Elsevier Ltd. All rights reserved.

Health Behavior Change: Can Genomics Improve Behavioral Adherence?

PubMed Central

Bryan, Angela D.; Bray, Molly S.; Swan, Gary E.; Green, Eric D.

2012-01-01

The National Human Genome Research Institute recommends pursuing “genomic information to improve behavior change interventions” as part of its strategic vision for genomics. The limited effectiveness of current behavior change strategies may be explained, in part, by their insensitivity to individual variation in adherence responses. The first step in evaluating whether genomics can inform customization of behavioral recommendations is evidence reviews to identify adherence macrophenotypes common across behaviors and individuals that have genetic underpinnings. Conceptual models of how biological, psychological, and environmental factors influence adherence also are needed. Researchers could routinely collect biospecimens and standardized adherence measurements of intervention participants to enable understanding of genetic and environmental influences on adherence, to guide intervention customization and prospective comparative effectiveness studies. PMID:22390502

Developing a Model of Health Behavior Change to Reduce Parasitic Disease in Vietnam

ERIC Educational Resources Information Center

Petersen, Suni; Do, Trina; Shaw, Christy; Brake, Kaile

2016-01-01

Worldwide more deaths occur due to conditions that can be ameliorated by behavior change. Changing health behaviors using models popularized in non-western countries has not proven particularly successful. The purpose of this study was to test variables elicited during qualitative interviews and cultural conversations to develop a model of health…

Automated indexing of Internet stories for health behavior change: weight loss attitude pilot study.

PubMed

Manuvinakurike, Ramesh; Velicer, Wayne F; Bickmore, Timothy W

2014-12-09

Automated health behavior change interventions show promise, but suffer from high attrition and disuse. The Internet abounds with thousands of personal narrative accounts of health behavior change that could not only provide useful information and motivation for others who are also trying to change, but an endless source of novel, entertaining stories that may keep participants more engaged than messages authored by interventionists. Given a collection of relevant personal health behavior change stories gathered from the Internet, the aim of this study was to develop and evaluate an automated indexing algorithm that could select the best possible story to provide to a user to have the greatest possible impact on their attitudes toward changing a targeted health behavior, in this case weight loss. An indexing algorithm was developed using features informed by theories from behavioral medicine together with text classification and machine learning techniques. The algorithm was trained using a crowdsourced dataset, then evaluated in a 2×2 between-subjects randomized pilot study. One factor compared the effects of participants reading 2 indexed stories vs 2 randomly selected stories, whereas the second factor compared the medium used to tell the stories: text or animated conversational agent. Outcome measures included changes in self-efficacy and decisional balance for weight loss before and after the stories were read. Participants were recruited from a crowdsourcing website (N=103; 53.4%, 55/103 female; mean age 35, SD 10.8 years; 65.0%, 67/103 precontemplation; 19.4%, 20/103 contemplation for weight loss). Participants who read indexed stories exhibited a significantly greater increase in self-efficacy for weight loss compared to the control group (F1,107=5.5, P=.02). There were no significant effects of indexing on change in decisional balance (F1,97=0.05, P=.83) and no significant effects of medium on change in self-efficacy (F1,107=0.04, P=.84) or decisional

Automated Indexing of Internet Stories for Health Behavior Change: Weight Loss Attitude Pilot Study

PubMed Central

Manuvinakurike, Ramesh; Velicer, Wayne F

2014-01-01

Background Automated health behavior change interventions show promise, but suffer from high attrition and disuse. The Internet abounds with thousands of personal narrative accounts of health behavior change that could not only provide useful information and motivation for others who are also trying to change, but an endless source of novel, entertaining stories that may keep participants more engaged than messages authored by interventionists. Objective Given a collection of relevant personal health behavior change stories gathered from the Internet, the aim of this study was to develop and evaluate an automated indexing algorithm that could select the best possible story to provide to a user to have the greatest possible impact on their attitudes toward changing a targeted health behavior, in this case weight loss. Methods An indexing algorithm was developed using features informed by theories from behavioral medicine together with text classification and machine learning techniques. The algorithm was trained using a crowdsourced dataset, then evaluated in a 2×2 between-subjects randomized pilot study. One factor compared the effects of participants reading 2 indexed stories vs 2 randomly selected stories, whereas the second factor compared the medium used to tell the stories: text or animated conversational agent. Outcome measures included changes in self-efficacy and decisional balance for weight loss before and after the stories were read. Results Participants were recruited from a crowdsourcing website (N=103; 53.4%, 55/103 female; mean age 35, SD 10.8 years; 65.0%, 67/103 precontemplation; 19.4%, 20/103 contemplation for weight loss). Participants who read indexed stories exhibited a significantly greater increase in self-efficacy for weight loss compared to the control group (F 1,107=5.5, P=.02). There were no significant effects of indexing on change in decisional balance (F 1,97=0.05, P=.83) and no significant effects of medium on change in self

Opportunities and Challenges for Smartphone Applications in Supporting Health Behavior Change: Qualitative Study

PubMed Central

Morrison, Leanne; Conway, Gemma; Yardley, Lucy

2013-01-01

Background There is increasing interest from academics and clinicians in harnessing smartphone applications (apps) as a means of delivering behavioral interventions for health. Despite the growing availability of a range of health-related apps on the market, academic research on the development and evaluation of such apps is in the relatively early stages. A few existing studies have explored the views of various populations on using mobile phones for health-related issues and some studies are beginning to report user feedback on specific apps. However, there remains little in depth research on users’ (and potential users’) experiences and views on a wide range of features and technologies that apps are, or will soon be, capable of. In particular, research on young adults is lacking, which is an unfortunate omission considering that this group comprises of a good number of mobile technology adoptors. Objective The current study sought to explore young adults’ perspectives on apps related to health behavior change. It sought their experiences and views of features that might support health behavior change and issues that contribute to interest in and willingness to use such apps. Methods Four focus groups were conducted with 19 students and staff at a University in the United Kingdom. Participants included 13 females and 6 males with a mean age of 23.79 (SD 7.89). The focus group discussions centred on participants’ experiences of using smartphone apps to support a healthy lifestyle, and their interest in and feelings about features and capabilities of such apps. The focus groups were recorded, transcribed, and analyzed using inductive thematic analysis. Results Study findings suggested that young, currently healthy adults have some interest in apps that attempt to support health-related behavior change. Accuracy and legitimacy, security, effort required, and immediate effects on mood emerged as important influences on app usage. The ability to record and

Theories Applied to m-Health Interventions for Behavior Change in Low- and Middle-Income Countries: A Systematic Review.

PubMed

Cho, Yoon-Min; Lee, Seohyun; Islam, Sheikh Mohammed Shariful; Kim, Sun-Young

2018-02-13

Recently there has been dramatic increase in the use of mobile technologies for health (m-Health) in both high and low- and middle-income countries (LMICs). However, little is known whether m-Health interventions in LMICs are based on relevant theories critical for effective implementation of such interventions. This review aimed to systematically identify m-Health studies on health behavioral changes in LMICs and to examine how each study applied behavior change theories. A systematic review was conducted using the standard method from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. By searching electronic databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]), we identified eligible studies published in English from inception to June 30, 2017. For the identified m-Health studies in LMICs, we examined their theoretical bases, use of behavior change techniques (BCTs), and modes of delivery. A total of 14 m-Health studies on behavioral changes were identified and, among them, only 5 studies adopted behavior change theory. The most frequently cited theory was the health belief model, which was adopted in three studies. Likewise, studies have applied only a limited number of BCTs. Among the seven BCTs identified, the most frequently used one was the social support (practical) technique for medication reminder and medical appointment. m-Health studies in LMICs most commonly used short messaging services and phone calls as modes of delivery for behavior change interventions. m-Health studies in LMICs are suboptimally based on behavior change theory yet. To maximize effectiveness of m-Health, rigorous delivery methods as well as theory-based intervention designs will be needed.

The influence of social networking sites on health behavior change: a systematic review and meta-analysis

PubMed Central

Laranjo, Liliana; Arguel, Amaël; Neves, Ana L; Gallagher, Aideen M; Kaplan, Ruth; Mortimer, Nathan; Mendes, Guilherme A; Lau, Annie Y S

2015-01-01

Objective Our aim was to evaluate the use and effectiveness of interventions using social networking sites (SNSs) to change health behaviors. Materials and methods Five databases were scanned using a predefined search strategy. Studies were included if they focused on patients/consumers, involved an SNS intervention, had an outcome related to health behavior change, and were prospective. Studies were screened by independent investigators, and assessed using Cochrane's ‘risk of bias’ tool. Randomized controlled trials were pooled in a meta-analysis. Results The database search retrieved 4656 citations; 12 studies (7411 participants) met the inclusion criteria. Facebook was the most utilized SNS, followed by health-specific SNSs, and Twitter. Eight randomized controlled trials were combined in a meta-analysis. A positive effect of SNS interventions on health behavior outcomes was found (Hedges’ g 0.24; 95% CI 0.04 to 0.43). There was considerable heterogeneity (I2 = 84.0%; T2 = 0.058) and no evidence of publication bias. Discussion To the best of our knowledge, this is the first meta-analysis evaluating the effectiveness of SNS interventions in changing health-related behaviors. Most studies evaluated multi-component interventions, posing problems in isolating the specific effect of the SNS. Health behavior change theories were seldom mentioned in the included articles, but two particularly innovative studies used ‘network alteration’, showing a positive effect. Overall, SNS interventions appeared to be effective in promoting changes in health-related behaviors, and further research regarding the application of these promising tools is warranted. Conclusions Our study showed a positive effect of SNS interventions on health behavior-related outcomes, but there was considerable heterogeneity. Protocol registration The protocol for this systematic review is registered at http://www.crd.york.ac.uk/PROSPERO with the number CRD42013004140. PMID:25005606

Multiple health behavior change in adults with or at risk for cancer: a systematic review.

PubMed

Green, Amanda C; Hayman, Laura L; Cooley, Mary E

2015-05-01

To identify components of efficacious interventions for multiple health behavior change (MHBC) in adult cancer survivors or adults at high risk for cancer. A systematic review of MHBC interventions was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Ten studies met inclusion criteria. Most studies changed at least 2 health behaviors. Diet, exercise, and smoking cessation were consistently changed with in-person interventions. Longer duration interventions using phone or mail contact had a positive association with changing diet and exercise. MHBC interventions positively influenced behavior change in adults with cancer and those at high risk for cancer. Future studies should focus on increasing dissemination and implementation of efficacious interventions.

Understanding advance care planning as a process of health behavior change.

PubMed

Fried, Terri R; Bullock, Karen; Iannone, Lynne; O'Leary, John R

2009-09-01

To explore whether models of health behavior change can help to inform interventions for advance care planning (ACP). Qualitative cross-sectional study. Community. Sixty-three community-dwelling persons aged 65 and older and 30 caregivers with experience as surrogate decision-makers. In focus groups conducted separately with older persons and caregivers, participants were asked to discuss ways they had planned for future declines in health and why they had or had not engaged in such planning. Transcripts were analyzed using grounded theory. Four themes illustrated the potential of applying models of health behavior change to improve ACP. (1) Participants demonstrated variable readiness to engage in ACP and could be in different stages of readiness for different components of ACP, including consideration of treatment goals, completion of advance directives, and communication with families and physicians. (2) Participants identified a wide range of benefits of and barriers to ACP. (3) Participants used a variety of processes of change to progress through stages of readiness, and ACP was only one of a broader set of behaviors that participants engaged in to prepare for declines in their health or for death. (4) Experience with healthcare decision-making for loved ones was a strong influence on perceptions of susceptibility and engagement in ACP. The variability in participants' readiness, barriers and benefits, perceptions of susceptibility, and use of processes to increase readiness for participating in each component of ACP suggests the utility of customized, stage-specific interventions based on individualized assessments to improve ACP.

Age Related Changes in Preventive Health Behavior.

ERIC Educational Resources Information Center

Leventhal, Elaine A.; And Others

Health behavior may be influenced by age, beliefs, and symptomatology. To examine age-related health beliefs and behaviors with respect to six diseases (the common cold, colon-rectal cancer, lung cancer, heart attack, high blood pressure, and senility), 396 adults (196 males, 200 females) divided into three age groups completed a questionnaire…

Playing for Real, Video Games and Stories for Health-Related Behavior Change

USDA-ARS?s Scientific Manuscript database

Video games provide extensive player involvement for large numbers of children and adults, and thereby provide a channel for delivering health behavior change experiences and messages in an engaging and entertaining format. Twenty-seven articles were identified on 25 video games that promoted health...

Health behavior change in advance care planning: an agent-based model.

PubMed

Ernecoff, Natalie C; Keane, Christopher R; Albert, Steven M

2016-02-29

A practical and ethical challenge in advance care planning research is controlling and intervening on human behavior. Additionally, observing dynamic changes in advance care planning (ACP) behavior proves difficult, though tracking changes over time is important for intervention development. Agent-based modeling (ABM) allows researchers to integrate complex behavioral data about advance care planning behaviors and thought processes into a controlled environment that is more easily alterable and observable. Literature to date has not addressed how best to motivate individuals, increase facilitators and reduce barriers associated with ACP. We aimed to build an ABM that applies the Transtheoretical Model of behavior change to ACP as a health behavior and accurately reflects: 1) the rates at which individuals complete the process, 2) how individuals respond to barriers, facilitators, and behavioral variables, and 3) the interactions between these variables. We developed a dynamic ABM of the ACP decision making process based on the stages of change posited by the Transtheoretical Model. We integrated barriers, facilitators, and other behavioral variables that agents encounter as they move through the process. We successfully incorporated ACP barriers, facilitators, and other behavioral variables into our ABM, forming a plausible representation of ACP behavior and decision-making. The resulting distributions across the stages of change replicated those found in the literature, with approximately half of participants in the action-maintenance stage in both the model and the literature. Our ABM is a useful method for representing dynamic social and experiential influences on the ACP decision making process. This model suggests structural interventions, e.g. increasing access to ACP materials in primary care clinics, in addition to improved methods of data collection for behavioral studies, e.g. incorporating longitudinal data to capture behavioral dynamics.

Sustainable Transportation Attitudes and Health Behavior Change: Evaluation of a Brief Stage-Targeted Video Intervention

PubMed Central

Mundorf, Norbert; Redding, Colleen A.; Paiva, Andrea L.

2018-01-01

Promoting physical activity and sustainable transportation is essential in the face of rising health care costs, obesity rates, and other public health threats resulting from lack of physical activity. Targeted communications can encourage distinct population segments to adopt active and sustainable transportation modes. Our work is designed to promote the health, social, and environmental benefits of sustainable/active transportation (ST) using the Transtheoretical Model of Change (TTM), which has been successfully applied to a range of health, and more recently, sustainability behaviors. Earlier, measurement development confirmed both the structure of ST pros and cons and efficacy measures as well as the relationship between these constructs and ST stages of change, replicating results found for many other behaviors. The present paper discusses a brief pre-post video pilot intervention study designed for precontemplators and contemplators (N = 604) that was well received, effective in moving respondents towards increased readiness for ST behavior change, and improving some ST attitudes, significantly reducing the cons of ST. This research program shows that a brief stage-targeted behavior change video can increase readiness and reduce the cons for healthy transportation choices. PMID:29346314

Sustainable Transportation Attitudes and Health Behavior Change: Evaluation of a Brief Stage-Targeted Video Intervention.

PubMed

Mundorf, Norbert; Redding, Colleen A; Paiva, Andrea L

2018-01-18

Promoting physical activity and sustainable transportation is essential in the face of rising health care costs, obesity rates, and other public health threats resulting from lack of physical activity. Targeted communications can encourage distinct population segments to adopt active and sustainable transportation modes. Our work is designed to promote the health, social, and environmental benefits of sustainable/active transportation (ST) using the Transtheoretical Model of Change (TTM), which has been successfully applied to a range of health, and more recently, sustainability behaviors. Earlier, measurement development confirmed both the structure of ST pros and cons and efficacy measures as well as the relationship between these constructs and ST stages of change, replicating results found for many other behaviors. The present paper discusses a brief pre-post video pilot intervention study designed for precontemplators and contemplators (N = 604) that was well received, effective in moving respondents towards increased readiness for ST behavior change, and improving some ST attitudes, significantly reducing the cons of ST. This research program shows that a brief stage-targeted behavior change video can increase readiness and reduce the cons for healthy transportation choices.

Optimal Health (Spirit, Mind, and Body): A Feasibility Study Promoting Well-Being for Health Behavior Change.

PubMed

Walker, Jenelle; Ainsworth, Barbara; Hooker, Steven; Keller, Colleen; Fleury, Julie; Chisum, Jack; Swan, Pamela

2015-10-01

Faith-based programs have shown beneficial effects for health and behaviors. Few have specifically intervened on the spiritual, mental (i.e., stress), and physical dimensions of well-being combined for health and healthy behaviors (i.e., exercise and diet). The purpose of this report is to describe the feasibility of executing a spirituality-based health behavior change, program founded upon the Spiritual Framework of Coping. This study was a quasi-experimental one group pretest-posttest design. Feasibility objectives were assessed, and limited efficacy of pretest and posttest measures was analyzed using paired t test (p < .05). Acceptance of the program was positive, and modest demand was shown with initial interest and an average attendance of 78.7%. The program was successfully implemented as shown by meeting session objectives and 88% homework completion. The program was practical for the intended participants and was successfully integrated within the existing environment. Limited efficacy measures showed no pre-post changes. This study provided preliminary support for the design and further testing of the theoretical components of the Spiritual Framework of Coping that informed the program.

Establishing a Relationship between Behavior Change Theory and Social Marketing: Implications for Health Education.

ERIC Educational Resources Information Center

Thackeray, Rosemary; Neiger, Brad L.

2000-01-01

Describes relationships between behavior change theory and social marketing practice, noting challenges in making behavior change theory an important component of social marketing and proposing that social marketing is the framework to which theory can be applied, creating theory-driven, consumer-focused, more effective health education programs.…

Understanding persuasion contexts in health gamification: A systematic analysis of gamified health behavior change support systems literature.

PubMed

Alahäivälä, Tuomas; Oinas-Kukkonen, Harri

2016-12-01

Gamification is increasingly used as a design strategy when developing behavior change support systems in the healthcare domain. It is commonly agreed that understanding the contextual factors is critical for successful gamification, but systematic analyses of the persuasive contexts have been lacking so far within gamified health intervention studies. Through a persuasion context analysis of the gamified health behavior change support systems (hBCSSs) literature, we inspect how the contextual factors have been addressed in the prior gamified health BCSS studies. The implications of this study are to provide the practitioners and researchers examples of how to conduct a systematic analysis to help guide the design and research on gamified health BCSSs. The ideas derived from the analysis of the included studies will help identify potential pitfalls and shortcomings in both the research and implementations of gamified health behavior change support systems. We systematically analyzed the persuasion contexts of 15 gamified health intervention studies. According to our results, gamified hBCSSs are implemented under different facets of lifestyle change and treatments compliance, and use a multitude of technologies and methods. We present a set of ideas and concepts to help improve endeavors in studying gamified health intervention through comprehensive understanding of the persuasive contextual factors. Future research on gamified hBCSSs should systematically compare the different combinations of contextual factors, related theories, chosen gamification strategies, and the study of outcomes to help understand how to achieve the most efficient use of gamification on the different aspects of healthcare. Analyzing the persuasion context is essential to achieve this. With the attained knowledge, those planning health interventions can choose the 'tried-and-tested' approaches for each particular situation, rather than develop solutions in an ad-hoc manner. Copyright © 2016

Using the Intervention Mapping and Behavioral Intervention Technology Frameworks: Development of an mHealth Intervention for Physical Activity and Sedentary Behavior Change.

PubMed

Direito, Artur; Walsh, Deirdre; Hinbarji, Moohamad; Albatal, Rami; Tooley, Mark; Whittaker, Robyn; Maddison, Ralph

2018-06-01

Few interventions to promote physical activity (PA) adapt dynamically to changes in individuals' behavior. Interventions targeting determinants of behavior are linked with increased effectiveness and should reflect changes in behavior over time. This article describes the application of two frameworks to assist the development of an adaptive evidence-based smartphone-delivered intervention aimed at influencing PA and sedentary behaviors (SB). Intervention mapping was used to identify the determinants influencing uptake of PA and optimal behavior change techniques (BCTs). Behavioral intervention technology was used to translate and operationalize the BCTs and its modes of delivery. The intervention was based on the integrated behavior change model, focused on nine determinants, consisted of 33 BCTs, and included three main components: (1) automated capture of daily PA and SB via an existing smartphone application, (2) classification of the individual into an activity profile according to their PA and SB, and (3) behavior change content delivery in a dynamic fashion via a proof-of-concept application. This article illustrates how two complementary frameworks can be used to guide the development of a mobile health behavior change program. This approach can guide the development of future mHealth programs.

Neural response to pictorial health warning labels can predict smoking behavioral change

PubMed Central

Riddle, Philip J.; Newman-Norlund, Roger D.; Baer, Jessica; Thrasher, James F.

2016-01-01

In order to improve our understanding of how pictorial health warning labels (HWLs) influence smoking behavior, we examined whether brain activity helps to explain smoking behavior above and beyond self-reported effectiveness of HWLs. We measured the neural response in the ventromedial prefrontal cortex (vmPFC) and the amygdala while adult smokers viewed HWLs. Two weeks later, participants’ self-reported smoking behavior and biomarkers of smoking behavior were reassessed. We compared multiple models predicting change in self-reported smoking behavior (cigarettes per day [CPD]) and change in a biomarkers of smoke exposure (expired carbon monoxide [CO]). Brain activity in the vmPFC and amygdala not only predicted changes in CO, but also accounted for outcome variance above and beyond self-report data. Neural data were most useful in predicting behavioral change as quantified by the objective biomarker (CO). This pattern of activity was significantly modulated by individuals’ intention to quit. The finding that both cognitive (vmPFC) and affective (amygdala) brain areas contributed to these models supports the idea that smokers respond to HWLs in a cognitive-affective manner. Based on our findings, researchers may wish to consider using neural data from both cognitive and affective networks when attempting to predict behavioral change in certain populations (e.g. cigarette smokers). PMID:27405615

Optimizing Decision Support for Tailored Health Behavior Change Applications.

PubMed

Kukafka, Rita; Jeong, In cheol; Finkelstein, Joseph

2015-01-01

The Tailored Lifestyle Change Decision Aid (TLC DA) system was designed to provide support for a person to make an informed choice about which behavior change to work on when multiple unhealthy behaviors are present. TLC DA can be delivered via web, smartphones and tablets. The system collects a significant amount of information that is used to generate tailored messages to consumers to persuade them in certain healthy lifestyles. One limitation is the necessity to collect vast amounts of information from users who manually enter. By identifying an optimal set of self-reported parameters we will be able to minimize the data entry burden of the app users. The study was to identify primary determinants of health behavior choices made by patients after using the system. Using discriminant analysis an optimal set of predictors was identified. The resulting set included smoking status, smoking cessation success estimate, self-efficacy, body mass index and diet status. Predicting smoking cessation choice was the most accurate, followed by weight management. Physical activity and diet choices were better identified in a combined cluster.

The influence of social networking sites on health behavior change: a systematic review and meta-analysis.

PubMed

Laranjo, Liliana; Arguel, Amaël; Neves, Ana L; Gallagher, Aideen M; Kaplan, Ruth; Mortimer, Nathan; Mendes, Guilherme A; Lau, Annie Y S

2015-01-01

Our aim was to evaluate the use and effectiveness of interventions using social networking sites (SNSs) to change health behaviors. Five databases were scanned using a predefined search strategy. Studies were included if they focused on patients/consumers, involved an SNS intervention, had an outcome related to health behavior change, and were prospective. Studies were screened by independent investigators, and assessed using Cochrane's 'risk of bias' tool. Randomized controlled trials were pooled in a meta-analysis. The database search retrieved 4656 citations; 12 studies (7411 participants) met the inclusion criteria. Facebook was the most utilized SNS, followed by health-specific SNSs, and Twitter. Eight randomized controlled trials were combined in a meta-analysis. A positive effect of SNS interventions on health behavior outcomes was found (Hedges' g 0.24; 95% CI 0.04 to 0.43). There was considerable heterogeneity (I(2) = 84.0%; T(2) = 0.058) and no evidence of publication bias. To the best of our knowledge, this is the first meta-analysis evaluating the effectiveness of SNS interventions in changing health-related behaviors. Most studies evaluated multi-component interventions, posing problems in isolating the specific effect of the SNS. Health behavior change theories were seldom mentioned in the included articles, but two particularly innovative studies used 'network alteration', showing a positive effect. Overall, SNS interventions appeared to be effective in promoting changes in health-related behaviors, and further research regarding the application of these promising tools is warranted. Our study showed a positive effect of SNS interventions on health behavior-related outcomes, but there was considerable heterogeneity. Protocol registration The protocol for this systematic review is registered at http://www.crd.york.ac.uk/PROSPERO with the number CRD42013004140. © The Author 2014. Published by Oxford University Press on behalf of the American Medical

Enculturating science: Community-centric design of behavior change interactions for accelerating health impact.

PubMed

Kumar, Vishwajeet; Kumar, Aarti; Ghosh, Amit Kumar; Samphel, Rigzin; Yadav, Ranjanaa; Yeung, Diana; Darmstadt, Gary L

2015-08-01

Despite significant advancements in the scientific evidence base of interventions to improve newborn survival, we have not yet been able to "bend the curve" to markedly accelerate global rates of reduction in newborn mortality. The ever-widening gap between discovery of scientific best practices and their mass adoption by families (the evidence-practice gap) is not just a matter of improving the coverage of health worker-community interactions. The design of the interactions themselves must be guided by sound behavioral science approaches such that they lead to mass adoption and impact at a large scale. The main barrier to the application of scientific approaches to behavior change is our inability to "unbox" the "black box" of family health behaviors in community settings. The authors argue that these are not black boxes, but in fact thoughtfully designed community systems that have been designed and upheld, and have evolved over many years keeping in mind a certain worldview and a common social purpose. An empathetic understanding of these community systems allows us to deconstruct the causal pathways of existing behaviors, and re-engineer them to achieve desired outcomes. One of the key reasons for the failure of interactions to translate into behavior change is our failure to recognize that the content, context, and process of interactions need to be designed keeping in mind an organized community system with a very different worldview and beliefs. In order to improve the adoption of scientific best practices by communities, we need to adapt them to their culture by leveraging existing beliefs, practices, people, context, and skills. The authors present a systems approach for community-centric design of interactions, highlighting key principles for achieving intrinsically motivated, sustained change in social norms and family health behaviors, elucidated with progressive theories from systems thinking, management sciences, cross-cultural psychology, learning

Do empowerment strategies facilitate knowledge and behavioral change? The impact of family health advocacy on health outcomes.

PubMed

Baffour, Tiffany D; Chonody, Jill M

2012-01-01

This study evaluates the impact of a Family Health Advocacy (FHA) intervention on 46 African American women ages 13 to 35 living in a rural southern community. FHA utilizes empowerment strategies to provide education and social support to reduce risk factors for poor pregnancy outcomes. Use of a paired t test demonstrated a statistically significant difference between pretest and posttest scores in the acquisition of knowledge of safer sex practices, alcohol consumption, early prenatal care, maternal infection, and nutrition. Behavioral change was not realized in the areas of nutrition or behaviors that cause risk of maternal infection. Social workers can influence behavioral change for at-risk populations by addressing microlevel barriers such as education and resources and macrolevel barriers such as advocacy for expanded health and social services.

The role of behavioral economic incentive design and demographic characteristics in financial incentive-based approaches to changing health behaviors: a meta-analysis.

PubMed

Haff, Nancy; Patel, Mitesh S; Lim, Raymond; Zhu, Jingsan; Troxel, Andrea B; Asch, David A; Volpp, Kevin G

2015-01-01

To evaluate the use of behavioral economics to design financial incentives to promote health behavior change and to explore associations with demographic characteristics. Studies performed by the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania published between January 2006 and March 2014. Randomized, controlled trials with available participant-level data. Studies that did not use financial incentives to promote health behavior change were excluded. Participant-level data from seven studies were pooled. Meta-analysis on the pooled sample using a random-effects model with interaction terms to examine treatment effects and whether they varied by incentive structure or demographic characteristics. The pooled study sample comprised 1403 participants, of whom 35% were female, 70% were white, 24% were black, and the mean age was 48 years (standard deviation 11.2 years). In the fully adjusted model, participants offered financial incentives had higher odds of behavior change (odds ratio [OR]: 3.96; p < .01) when compared to control. There were no significant interactions between financial incentives and gender, age, race, income, or education. When further adjusting for incentive structure, blacks had higher odds than whites of achieving behavior change (OR: 1.67; p < .05) with a conditional payment. Compared to lower-income participants, higher-income participants had lower odds of behavior change (OR: 0.46; p = .01) with a regret lottery. Financial incentives designed using concepts from behavioral economics were effective for promoting health behavior change. There were no large and consistent relationships between the effectiveness of financial incentives and observable demographic characteristics. Second-order examinations of incentive structure suggest potential relationships among the effectiveness of financial incentives, incentive structure, and the demographic characteristics of race and income.

Associations between Poor Sleep Quality and Stages of Change of Multiple Health Behaviors among Participants of Employee Wellness Program.

PubMed

Hui, Siu-Kuen Azor; Grandner, Michael A

2015-01-01

Using the Transtheoretical Model of behavioral change, this study evaluates the relationship between sleep quality and the motivation and maintenance processes of healthy behavior change. The current study is an analysis of data collected in 2008 from an online health risk assessment (HRA) survey completed by participants of the Kansas State employee wellness program (N=13,322). Using multinomial logistic regression, associations between self-reported sleep quality and stages of change (i.e. precontemplation, contemplation, preparation, action, maintenance) in five health behaviors (stress management, weight management, physical activities, alcohol use, and smoking) were analyzed. Adjusted for covariates, poor sleep quality was associated with an increased likelihood of contemplation, preparation, and in some cases action stage when engaging in the health behavior change process, but generally a lower likelihood of maintenance of the healthy behavior. The present study demonstrated that poor sleep quality was associated with an elevated likelihood of contemplating or initiating behavior change, but a decreased likelihood of maintaining healthy behavior change. It is important to include sleep improvement as one of the lifestyle management interventions offered in EWP to comprehensively reduce health risks and promote the health of a large employee population.

Description of Adults Seeking Hearing Help for the First Time According to Two Health Behavior Change Approaches: Transtheoretical Model (Stages of Change) and Health Belief Model.

PubMed

Saunders, Gabrielle H; Frederick, Melissa T; Silverman, ShienPei C; Nielsen, Claus; Laplante-Lévesque, Ariane

2016-01-01

Several models of health behavior change are commonly used in health psychology. This study applied the constructs delineated by two models-the transtheoretical model (in which readiness for health behavior change can be described with the stages of precontemplation, contemplation and action) and the health belief model (in which susceptibility, severity, benefits, barriers, self-efficacy, and cues to action are thought to determine likelihood of health behavior change)-to adults seeking hearing help for the first time. One hundred eighty-two participants (mean age: 69.5 years) were recruited following an initial hearing assessment by an audiologist. Participants' mean four-frequency pure-tone average was 35.4 dB HL, with 25.8% having no hearing impairment, 50.5% having a slight impairment, and 23.1% having a moderate or severe impairment using the World Health Organization definition of hearing loss. Participants' hearing-related attitudes and beliefs toward hearing health behaviors were examined using the University of Rhode Island Change Assessment (URICA) and the health beliefs questionnaire (HBQ), which assess the constructs of the transtheoretical model and the health belief model, respectively. Participants also provided demographic information, and completed the hearing handicap inventory (HHI) to assess participation restrictions, and the psychosocial impact of hearing loss (PIHL) to assess the extent to which hearing impacts competence, self-esteem, and adaptability. Degree of hearing impairment was associated with participation restrictions, perceived competence, self-esteem and adaptability, and attitudes and beliefs measured by the URICA and the HBQ. As degree of impairment increased, participation restrictions measured by the HHI, and impacts of hearing loss, as measured by the PIHL, increased. The majority of first-time help seekers in this study were in the action stage of change. Furthermore, relative to individuals with less hearing impairment

The Face of Wellness: aspirational vision of health, renewing health behavior change process and balanced portfolio approach to planning change strategies.

PubMed

O'Donnell, Michael P

2008-01-01

Health promotion needs to be made more practical and more memorable so that practitioners are not confused or overwhelmed by the theoretical and technical aspects of assuring the effectiveness of programming efforts. In this edition of The Art of Health Promotion the Editor-in-Chief of the American Journal of Health Promotion presents a planning strategy consisting of an aspirational model of health, a renewing behavior change process and a portfolio balancing approach to strategy planning.

Effective strategies for behavior change.

PubMed

Coleman, Mary Thoesen; Pasternak, Ryan H

2012-06-01

Strategies that are most effective in both prevention and management of chronic disease consider factors such as age, ethnicity, community, and technology. Most behavioral change strategies derive their components from application of the health belief model, the theory of reasoned action/theory of planned behavior, transtheoretical model, and social cognitive theory. Many tools such as the readiness ruler and personalized action plan form are available to assist health care teams to facilitate healthy behavior change. Primary care providers can support behavior changes by providing venues for peer interventions and family meetings and by making new partnerships with community organizations. Copyright © 2012 Elsevier Inc. All rights reserved.

Neural response to pictorial health warning labels can predict smoking behavioral change.

PubMed

Riddle, Philip J; Newman-Norlund, Roger D; Baer, Jessica; Thrasher, James F

2016-11-01

In order to improve our understanding of how pictorial health warning labels (HWLs) influence smoking behavior, we examined whether brain activity helps to explain smoking behavior above and beyond self-reported effectiveness of HWLs. We measured the neural response in the ventromedial prefrontal cortex (vmPFC) and the amygdala while adult smokers viewed HWLs. Two weeks later, participants' self-reported smoking behavior and biomarkers of smoking behavior were reassessed. We compared multiple models predicting change in self-reported smoking behavior (cigarettes per day [CPD]) and change in a biomarkers of smoke exposure (expired carbon monoxide [CO]). Brain activity in the vmPFC and amygdala not only predicted changes in CO, but also accounted for outcome variance above and beyond self-report data. Neural data were most useful in predicting behavioral change as quantified by the objective biomarker (CO). This pattern of activity was significantly modulated by individuals' intention to quit. The finding that both cognitive (vmPFC) and affective (amygdala) brain areas contributed to these models supports the idea that smokers respond to HWLs in a cognitive-affective manner. Based on our findings, researchers may wish to consider using neural data from both cognitive and affective networks when attempting to predict behavioral change in certain populations (e.g. cigarette smokers). © The Author (2016). Published by Oxford University Press.

Social Environmental Correlates of Health Behaviors in a Faith-Based Policy and Environmental Change Intervention.

PubMed

Hermstad, April; Honeycutt, Sally; Flemming, Shauna StClair; Carvalho, Michelle L; Hodge, Tarccara; Escoffery, Cam; Kegler, Michelle C; Arriola, Kimberly R Jacob

2018-03-01

Diet and physical activity are behavioral risk factors for many chronic diseases, which are among the most common health conditions in the United States. Yet most Americans fall short of meeting established dietary and physical activity guidelines. Faith-based organizations as settings for health promotion interventions can affect members at multiple levels of the social ecological model. The present study investigated whether change in the church social environment was associated with healthier behavior at church and in general at 1-year follow-up. Six churches received mini-grants and technical assistance for 1 year to support policy and environmental changes for healthy eating (HE) and physical activity (PA). Socioenvironmental (social support and social norms) and behavioral (HE and PA at church and in general) outcomes were derived from baseline and 1-year follow-up church member surveys ( n = 258). Three of six churches demonstrated significant improvements in all three socioenvironmental aspects of HE. Two of five churches exhibited significant socioenvironmental improvements for PA at follow-up. Church social environmental changes were related to health behaviors at church and in general ( p < .05). Change in social support for HE, social support for PA, and social norms for PA were each associated with three church-based and general behavioral outcomes. Social norms for healthy eating were related to two general behavior outcomes and social norms for unhealthy eating to one general behavioral outcome. Study findings demonstrate that socioenvironmental characteristics are essential to multilevel interventions and merit consideration in designing policy and environmental change interventions.

Health behavior changes following breast cancer treatment: a qualitative comparison among Chinese American, Korean American, and Mexican American survivors.

PubMed

Lim, Jung-won; Gonzalez, Patricia; Wang-Letzkus, Ming F; Baik, Okmi; Ashing-Giwa, Kimlin T

2013-05-01

This study explored how Chinese American, Korean American, and Mexican American women modify their health behaviors following breast cancer treatment and identified motivators and barriers that influence their changes. An exploratory, descriptive, qualitative study was undertaken using six focus groups. Discussions were transcribed and translated for content analysis. Significant differences among the ethnic groups were noted in the following health behavior practices which were most commonly stated as changed behaviors after a breast cancer diagnosis: 1) eating habits, 2) physical activity, 3) alternative medicine, 4) sleeping, 5) social activity, 6) weight control, and 7) alcohol consumption. Family, financial concerns, environment, and religious faith were commonly mentioned as motivators of and/or barriers to changes in health behaviors. Findings provide insight into different perspectives related to changes in health behaviors by ethnicity, which is critical for developing culturally tailored behavioral interventions to improve underserved breast cancer survivors' quality of life and to reduce health disparities.

How behavioral science can advance digital health.

PubMed

Pagoto, Sherry; Bennett, Gary G

2013-09-01

The field of behavioral science has produced myriad data on health behavior change strategies and leveraged such data into effective human-delivered interventions to improve health. Unfortunately, the impact of traditional health behavior change interventions has been heavily constrained by patient and provider burden, limited ability to measure and intervene upon behavior in real time, variable adherence, low rates of implementation, and poor third-party coverage. Digital health technologies, including mobile phones, sensors, and online social networks, by being available in real time, are being explored as tools to increase our understanding of health behavior and to enhance the impact of behavioral interventions. The recent explosion of industry attention to the development of novel health technologies is exciting but has far outpaced research. This Special Section of Translational Behavioral Medicine, Smartphones, Sensors, and Social Networks: A New Age of Health Behavior Change features a collection of studies that leverage health technologies to measure, change, and/or understand health behavior. We propose five key areas in which behavioral science can improve the impact of digital health technologies on public health. First, research is needed to identify which health technologies actually impact behavior and health outcomes. Second, we need to understand how online social networks can be leveraged to impact health behavior on a large scale. Third, a team science approach is needed in the developmental process of health technologies. Fourth, behavioral scientists should identify how a balance can be struck between the fast pace of innovation and the much slower pace of research. Fifth, behavioral scientists have an integral role in informing the development of health technologies and facilitating the movement of health technologies into the healthcare system.

Age- and treatment-related associations with health behavior change among breast cancer survivors.

PubMed

Anderson, Chelsea; Sandler, Dale P; Weinberg, Clarice R; Houck, Kevin; Chunduri, Minal; Hodgson, M Elizabeth; Sabatino, Susan A; White, Mary C; Rodriguez, Juan L; Nichols, Hazel B

2017-06-01

The aim of this study was to identify demographic and treatment-related factors associated with health-promoting behavior changes after a breast cancer diagnosis. Changes in health behaviors were also evaluated according to weight, exercise, diet and alcohol consumption patterns before breast cancer diagnosis. We examined self-reported behavior changes among 1415 women diagnosed with breast cancer in the NIEHS Sister Study cohort. Women reported changes in exercising, eating healthy foods, maintaining a healthy body weight, drinking alcohol, smoking, getting enough sleep, spending time with family and friends, and participating in breast cancer awareness events. On average, women were 3.7 years from their breast cancer diagnosis. Overall, 20-36% reported positive changes in exercise, eating healthy foods, maintaining a healthy weight, or alcohol consumption. However, 17% exercised less. With each 5-year increase in diagnosis age, women were 11-16% less likely to report positive change in each of these behaviors (OR = 0.84-0.89; p < 0.05), except alcohol consumption (OR = 0.97; CI: 0.81, 1.17). Women who underwent chemotherapy were more likely to report eating more healthy foods (OR = 1.47; 95% CI 1.16-1.86), drinking less alcohol (OR = 2.01; 95% CI: 1.01, 4.06), and sleeping enough (OR = 1.41; 95% CI: 1.04, 1.91). The majority of women (50-84%) reported no change in exercise, eating healthy foods, efforts to maintain a healthy weight, alcohol consumption, sleep patterns, or time spent with family or friends. Many women reported no change in cancer survivorship guideline-supported behaviors after diagnosis. Positive changes were more common among younger women or those who underwent chemotherapy. Copyright © 2017 Elsevier Ltd. All rights reserved.

Age- and treatment-related associations with health behavior change among breast cancer survivors

PubMed Central

Anderson, Chelsea; Sandler, Dale P.; Weinberg, Clarice R.; Houck, Kevin; Chunduri, Minal; Hodgson, M. Elizabeth; Sabatino, Susan A.; White, Mary C.; Rodriguez, Juan L.; Nichols, Hazel B.

2017-01-01

Objective The aim of this study was to identify demographic and treatment-related factors associated with health-promoting behavior changes after a breast cancer diagnosis. Changes in health behaviors were also evaluated according to weight, exercise, diet and alcohol consumption patterns before breast cancer diagnosis. Materials and methods We examined self-reported behavior changes among 1,415 women diagnosed with breast cancer in the NIEHS Sister Study cohort. Women reported changes in exercising, eating healthy foods, maintaining a healthy body weight, drinking alcohol, smoking, getting enough sleep, spending time with family and friends, and participating in breast cancer awareness events. Results: On average, women were 3.7 years from their breast cancer diagnosis. Overall, 20–36% reported positive changes in exercise, eating healthy foods, maintaining a healthy weight, or alcohol consumption. However, 17% exercised less. With each 5-year increase in diagnosis age, women were 11–16% less likely to report positive change in each of these behaviors (OR=0.84–0.89; p<0.05), except alcohol consumption (OR=0.97; CI: 0.81, 1.17). Women who underwent chemotherapy were more likely to report eating more healthy foods (OR =1.47; 95% CI 1.16–1.86), drinking less alcohol (OR=2.01; 95% CI: 1.01, 4.06), and sleeping enough (OR=1.41; 95% CI: 1.04, 1.91). The majority of women (50–84%) reported no change in exercise, eating healthy foods, efforts to maintain a healthy weight, alcohol consumption, sleep patterns, or time spent with family or friends. Conclusions Many women reported no change in cancer survivorship guideline-supported behaviors after diagnosis. Positive changes were more common among younger women or those who underwent chemotherapy. PMID:28254640

The Feasibility of Using Video Journaling to Collect Ecological Momentary Assessment Data: Application to Health Behavior Change Interventions

ERIC Educational Resources Information Center

Melton, Bridget F.; Bigham, Lauren E.; Bland, Helen W.

2013-01-01

The purpose of this research was to evaluate the feasibility of an ecological momentary assessment (EMA) technique in a health behavior change intervention offered within university general health courses. A six-week health behavior change project was used with two groups: video journaling and traditional (pencil and paper) group. Research…

Associations between poor sleep quality and stages of change of multiple health behaviors among participants of employee wellness program

PubMed Central

Hui, Siu-kuen Azor; Grandner, Michael A.

2015-01-01

Objective Using the Transtheoretical Model of behavioral change, this study evaluates the relationship between sleep quality and the motivation and maintenance processes of healthy behavior change. Methods The current study is an analysis of data collected in 2008 from an online health risk assessment (HRA) survey completed by participants of the Kansas State employee wellness program (N = 13,322). Using multinomial logistic regression, associations between self-reported sleep quality and stages of change (i.e. precontemplation, contemplation, preparation, action, maintenance) in five health behaviors (stress management, weight management, physical activities, alcohol use, and smoking) were analyzed. Results Adjusted for covariates, poor sleep quality was associated with an increased likelihood of contemplation, preparation, and in some cases action stage when engaging in the health behavior change process, but generally a lower likelihood of maintenance of the healthy behavior. Conclusions The present study demonstrated that poor sleep quality was associated with an elevated likelihood of contemplating or initiating behavior change, but a decreased likelihood of maintaining healthy behavior change. It is important to include sleep improvement as one of the lifestyle management interventions offered in EWP to comprehensively reduce health risks and promote the health of a large employee population. PMID:26046013

Health Behavior Changes After Genetic Risk Assessment for Alzheimer Disease: The REVEAL Study

PubMed Central

Chao, Serena; Roberts, J. Scott; Marteau, Theresa M.; Silliman, Rebecca; Cupples, L. Adrienne; Green, Robert C.

2008-01-01

Risk information for Alzheimer disease (AD) may be communicated through susceptibility gene disclosure, even though this is not currently in clinical use. The REVEAL Study is the first randomized clinical trial of risk assessment for AD with apolipoprotein E (APOE) genotype and numerical risk estimate disclosure. We examined whether APOE genotype and numerical risk disclosure to asymptomatic individuals at high risk for AD alters health behaviors. One hundred sixty-two participants were randomized to either intervention (APOE disclosure) or control (no genotype disclosure) groups. Subjects in both groups received numerical lifetime risk estimates of future AD development based on sex and family history of AD. The intervention group received their APOE genotype. Subjects were informed that no proven preventive measures for AD existed and given an information sheet on preventative therapies under investigation. Participants who learned they were ε4 positive were significantly more likely than ε4 negative participants to report AD-specific health behavior change 1 year after disclosure (adjusted odds ratio: 2.73; 95% confidence interval: 1.14, 6.54; P = 0.02). Post hoc analyses revealed similar significant associations between numerical lifetime risk estimates and self-report of AD-specific health behavior change. Despite lack of preventive measures for AD, knowledge of APOE genotype, numerical lifetime risk, or both, influences health behavior. PMID:18317253

Health behavior changes after genetic risk assessment for Alzheimer disease: The REVEAL Study.

PubMed

Chao, Serena; Roberts, J Scott; Marteau, Theresa M; Silliman, Rebecca; Cupples, L Adrienne; Green, Robert C

2008-01-01

Risk information for Alzheimer disease (AD) may be communicated through susceptibility gene disclosure, even though this is not currently in clinical use. The REVEAL Study is the first randomized clinical trial of risk assessment for AD with apolipoprotein E (APOE) genotype and numerical risk estimate disclosure. We examined whether APOE genotype and numerical risk disclosure to asymptomatic individuals at high risk for AD alters health behaviors. One hundred sixty-two participants were randomized to either intervention (APOE disclosure) or control (no genotype disclosure) groups. Subjects in both groups received numerical lifetime risk estimates of future AD development based on sex and family history of AD. The intervention group received their APOE genotype. Subjects were informed that no proven preventive measures for AD existed and given an information sheet on preventative therapies under investigation. Participants who learned they were epsilon 4 positive were significantly more likely than epsilon 4 negative participants to report AD-specific health behavior change 1 year after disclosure (adjusted odds ratio: 2.73; 95% confidence interval: 1.14, 6.54; P=0.02). Post hoc analyses revealed similar significant associations between numerical lifetime risk estimates and self-report of AD-specific health behavior change. Despite lack of preventive measures for AD, knowledge of APOE genotype, numerical lifetime risk, or both, influences health behavior.

Changes and specificities in health behaviors among healthcare students over an 8-year period

PubMed Central

Delay, J.; Grigioni, S.; Déchelotte, P.; Ladner, J.

2018-01-01

Background Healthcare students are future health care providers and serve as role models and coaches to enhance behaviors for healthy lifestyles. However healthcare students face multiple stressors that could lead to adopting risk behaviors. Objectives To assess the changes in health risk factors among healthcare students between 2007 and 2015, and to identify specific health behaviors based on the curriculum in a population of healthcare students: Methods Two cross sectionnal studies were conducted in 2007 and 2015 among nursing, medical, pharmacy, and physiotherapy students (Rouen, France). During compulsory courses and examination sessions students filled self-administered questionnaires on socio-demographic characteristics and behavior as: tobacco smoking, alcohol consumption, cannabis consumption, eating disorders, regular practice of sport, perceived health, stress and use of psychotropic drugs. Results 2,605 healthcare students were included (1,326 in 2007 and 1,279 in 2015), comprising 1,225 medical students (47.0%), 738 nursing students (28.3%), 362 pharmacy students (13.9%), and 280 physiotherapy students (10.8%). Between 2007 and 2015, occasional binge drinking and regular practice of sport increased significantly among healthcare students, respectively AOR = 1.48 CI95% (1.20–1.83) and AOR = 1.33 CI95% (1.11–1.60), regular cannabis consumption decreased significantly, AOR = 0.32 CI95% (0.19–0.54). There was no change in smoking or overweight/obese. There was a higher risk of frequent binge drinking and a lower risk of tobacco smoking in all curricula than in nursing students. Medical students practiced sport on a more regular basis, were less overweight/obese, had fewer eating disorders than nursing students. Conclusion Our findings demonstrate a stable frequency of classic behaviors as smoking but a worsening of emerging behaviors as binge drinking among healthcare students between 2007 and 2015. Health behaviors differed according to healthcare

Sharing Histories-a transformative learning/teaching method to empower community health workers to support health behavior change of mothers.

PubMed

Altobelli, Laura C

2017-08-23

One of the keys to improving health globally is promoting mothers' adoption of healthy home practices for improved nutrition and illness prevention in the first 1000 days of life from conception. Customarily, mothers are taught health messages which, even if simplified, are hard to remember. The challenge is how to promote learning and behavior change of mothers more effectively in low-resource settings where access to health information is poor, educational levels are low, and traditional beliefs are strong. In addressing that challenge, a new learning/teaching method called "Sharing Histories" is in development to improve the performance of female community health workers (CHWs) in promoting mothers' behaviors for maternal, neonatal and child health (MNCH). This method builds self-confidence and empowerment of CHWs in learning sessions that are built on guided sharing of their own memories of childbearing and child care. CHWs can later share histories with the mother, building her trust and empowerment to change. For professional primary health care staff who are not educators, Sharing Histories is simple to learn and use so that the method can be easily incorporated into government health systems and ongoing CHW programs. I present here the Sharing Histories method, describe how it differs from other social and behavior change methods, and discuss selected literature from psychology, communications, and neuroscience that helps to explain how and why this method works as a transformative tool to engage, teach, transform, and empower CHWs to be more effective change agents with other mothers in their communities, thereby contributing to the attainment of the Sustainable Development Goals.

Health Behaviors in a Representative Sample of Older Canadians: Prevalences, Reported Change, Motivation to Change, and Perceived Barriers

ERIC Educational Resources Information Center

Newsom, Jason T.; Kaplan, Mark S.; Huguet, Nathalie; McFarland, Bentson H.

2004-01-01

Purpose: Prevalence estimates of healthy behaviors and preventive care among older adults have not received sufficient attention, despite important health benefits such as longevity and better quality of life. Moreover, little is known about general population prevalences of older adults' efforts to change behavior, motivations to improve health…

Personal financial incentives for changing habitual health-related behaviors: A systematic review and meta-analysis.

PubMed

Mantzari, Eleni; Vogt, Florian; Shemilt, Ian; Wei, Yinghui; Higgins, Julian P T; Marteau, Theresa M

2015-06-01

Uncertainty remains about whether personal financial incentives could achieve sustained changes in health-related behaviors that would reduce the fast-growing global non-communicable disease burden. This review aims to estimate whether: i. financial incentives achieve sustained changes in smoking, eating, alcohol consumption and physical activity; ii. effectiveness is modified by (a) the target behavior, (b) incentive value and attainment certainty, (c) recipients' deprivation level. Multiple sources were searched for trials offering adults financial incentives and assessing outcomes relating to pre-specified behaviors at a minimum of six months from baseline. Analyses included random-effects meta-analyses and meta-regressions grouped by timed endpoints. Of 24,265 unique identified articles, 34 were included in the analysis. Financial incentives increased behavior-change, with effects sustained until 18months from baseline (OR: 1.53, 95% CI 1.05-2.23) and three months post-incentive removal (OR: 2.11, 95% CI 1.21-3.67). High deprivation increased incentive effects (OR: 2.17; 95% CI 1.22-3.85), but only at >6-12months from baseline. Other assessed variables did not independently modify effects at any time-point. Personal financial incentives can change habitual health-related behaviors and help reduce health inequalities. However, their role in reducing disease burden is potentially limited given current evidence that effects dissipate beyond three months post-incentive removal. Copyright © 2015. Published by Elsevier Inc.

Are Social Networking Sites Making Health Behavior Change Interventions More Effective? A Meta-Analytic Review.

PubMed

Yang, Qinghua

2017-03-01

The increasing popularity of social networking sites (SNSs) has drawn scholarly attention in recent years, and a large amount of efforts have been made in applying SNSs to health behavior change interventions. However, these interventions showed mixed results, with a large variance of effect sizes in Cohen's d ranging from -1.17 to 1.28. To provide a better understanding of SNS-based interventions' effectiveness, a meta-analysis of 21 studies examining the effects of health interventions using SNS was conducted. Results indicated that health behavior change interventions using SNS are effective in general, but the effects were moderated by health topic, methodological features, and participant features. Theoretical and practical implications of findings are discussed.

Socioeconomic inequalities and changes in oral health behaviors among Brazilian adolescents from 2009 to 2012

PubMed Central

Freire, Maria do Carmo Matias; Jordão, Lidia Moraes Ribeiro; Malta, Deborah Carvalho; Andrade, Silvânia Suely Caribé de Araújo; Peres, Marco Aurelio

2015-01-01

OBJECTIVE To analyze oral health behaviors changes over time in Brazilian adolescents concerning maternal educational inequalities. METHODS Data from the Pesquisa Nacional de Saúde do Escolar (Brazilian National School Health Survey) were analyzed. The sample was composed of 60,973 and 61,145 students from 26 Brazilian state capitals and the Federal District in 2009 and 2012, respectively. The analyzed factors were oral health behaviors (toothbrushing frequency, sweets consumption, soft drink consumption, and cigarette experimentation) and sociodemographics (age, sex, race, type of school and maternal schooling). Oral health behaviors and sociodemographic factors in the two years were compared (Rao-Scott test) and relative and absolute measures of socioeconomic inequalities in health were estimated (slope index of inequality and relative concentration index), using maternal education as a socioeconomic indicator, expressed in number of years of study (> 11; 9-11; ≤ 8). RESULTS Results from 2012, when compared with those from 2009, for all maternal education categories, showed that the proportion of people with low toothbrushing frequency increased, and that consumption of sweets and soft drinks and cigarette experimentation decreased. In private schools, positive slope index of inequality and relative concentration index indicated higher soft drink consumption in 2012 and higher cigarette experimentation in both years among students who reported greater maternal schooling, with no significant change in inequalities. In public schools, negative slope index of inequality and relative concentration index indicated higher soft drink consumption among students who reported lower maternal schooling in both years, with no significant change overtime. The positive relative concentration index indicated inequality in 2009 for cigarette experimentation, with a higher prevalence among students who reported greater maternal schooling. There were no inequalities for

Training tomorrow's global health leaders: applying a transtheoretical model to identify behavior change stages within an intervention for health leadership development.

PubMed

Daniels, Joseph; Farquhar, Carey; Nathanson, Neal; Mashalla, Yohana; Petracca, Frances; Desmond, Michelle; Green, Wendy; Davies, Luke; O'Malley, Gabrielle

2014-12-01

Training health professionals in leadership and management skills is a key component of health systems strengthening in low-resource settings. The importance of evaluating the effectiveness of these programs has received increased attention over the past several years, although such evaluations continue to pose significant challenges. This article presents evaluation data from the pilot year of the Afya Bora Fellowship, an African-based training program to increase the leadership capacity of health professionals. Firstly, we describe the goals of the Afya Bora Fellowship. Then, we present an adaptation of the transtheoretical model for behavior change called the Health Leadership Development Model, as an analytical lens to identify and describe evidence of individual leadership behavior change among training participants during and shortly after the pilot year of the program. The Health Leadership Development Model includes the following: pre-contemplation (status quo), contemplation (testing and internalizing leadership), preparation - (moving toward leadership), action (leadership in action), and maintenance (effecting organizational change). We used data from surveys, in-depth interviews, journal entries and course evaluations as data points to populate the Health Leadership Development Model. In the short term, fellows demonstrated increased leadership development during and shortly after the intervention and reflected the contemplation, preparation and action stages of the Health Leadership Development Model. However, expanded interventions and/or additional time may be needed to support behavior change toward the maintenance stages. We conclude that the Health Leadership Development Model is useful for informing health leadership training design and evaluation to contribute to sustainable health organizational change. © The Author(s) 2014.

The role of Compensatory Health Beliefs in eating behavior change: A mixed method study.

PubMed

Amrein, Melanie A; Rackow, Pamela; Inauen, Jennifer; Radtke, Theda; Scholz, Urte

2017-09-01

Compensatory Health Beliefs (CHBs), defined as beliefs that an unhealthy behavior can be compensated for by engaging in another healthy behavior, are assumed to hinder health behavior change. The aim of the present study was to investigate the role of CHBs for two distinct eating behaviors (increased fruit and vegetable consumption and eating fewer unhealthy snacks) with a mixed method approach. Participants (N = 232, mean age = 27.3 years, 76.3% women) were randomly assigned to a fruit and vegetable or an unhealthy snack condition. For the quantitative approach, path models were fitted to analyze the role of CHBs within a social-cognitive theory of health behavior change, the Health Action Process Approach (HAPA). With a content analysis, the qualitative approach investigated the occurrence of CHBs in smartphone chat groups when pursuing an eating goal. Both analyses were conducted for each eating behavior separately. Path models showed that CHBs added predictive value for intention, but not behavior over and above HAPA variables only in the unhealthy snack condition. CHBs were significantly negatively associated with intention and action planning. Content analysis revealed that people generated only a few CHB messages. However, CHBs were more likely to be present and were also more diverse in the unhealthy snack condition compared to the fruit and vegetable condition. Based on a mixed method approach, this study suggests that CHBs play a more important role for eating unhealthy snacks than for fruit and vegetable consumption. Copyright © 2017 Elsevier Ltd. All rights reserved.

Toward a new methodological paradigm for testing theories of health behavior and health behavior change.

PubMed

Noar, Seth M; Mehrotra, Purnima

2011-03-01

Traditional theory testing commonly applies cross-sectional (and occasionally longitudinal) survey research to test health behavior theory. Since such correlational research cannot demonstrate causality, a number of researchers have called for the increased use of experimental methods for theory testing. We introduce the multi-methodological theory-testing (MMTT) framework for testing health behavior theory. The MMTT framework introduces a set of principles that broaden the perspective of how we view evidence for health behavior theory. It suggests that while correlational survey research designs represent one method of testing theory, the weaknesses of this approach demand that complementary approaches be applied. Such approaches include randomized lab and field experiments, mediation analysis of theory-based interventions, and meta-analysis. These alternative approaches to theory testing can demonstrate causality in a much more robust way than is possible with correlational survey research methods. Such approaches should thus be increasingly applied in order to more completely and rigorously test health behavior theory. Greater application of research derived from the MMTT may lead researchers to refine and modify theory and ultimately make theory more valuable to practitioners. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Teaching motivational interviewing to first-year medical students to improve counseling skills in health behavior change.

PubMed

Poirier, Maria K; Clark, Matthew M; Cerhan, Jane H; Pruthi, Sandhya; Geda, Yonas E; Dale, Lowell C

2004-03-01

To examine the effectiveness of motivational interviewing training on improving medical students' knowledge of and confidence in their ability to counsel patients regarding health behavior change. In the spring of 2002, 42 first-year medical students participated in a counseling course on health behavior change. Three small groups focused on learning and practicing motivational interviewing techniques using brief lectures, interactive class activities, student role-plays, and simulated patients. Students completed an identical precourse and postcourse questionnaire that measured their confidence and knowledge regarding counseling skills in health behavior change. The medical students reported improved confidence in their understanding of motivational interviewing after participation in the course (very confident, 77%) compared with before the course (very confident, 2%). Each of the 8 confidence items were compared before and after the course using a signed rank test. All comparisons indicated a significant improvement (P < .001) in confidence. Regarding knowledge-based questions, students showed significant improvement; 31% of students answered all the questions correctly before the course, and 56% answered all the questions correctly after the course (P = .004). These results show that teaching motivational interviewing techniques to first-year medical students can enhance student confidence in and knowledge of providing counseling to patients regarding health behavior change.

The impact of changing attitudes, norms, and self-efficacy on health-related intentions and behavior: A meta-analysis.

PubMed

Sheeran, Paschal; Maki, Alexander; Montanaro, Erika; Avishai-Yitshak, Aya; Bryan, Angela; Klein, William M P; Miles, Eleanor; Rothman, Alexander J

2016-11-01

Several health behavior theories converge on the hypothesis that attitudes, norms, and self-efficacy are important determinants of intentions and behavior. However, inferences regarding the relation between these cognitions and intention or behavior rest largely on correlational data that preclude causal inferences. To determine whether changing attitudes, norms, or self-efficacy leads to changes in intentions and behavior, investigators need to randomly assign participants to a treatment that significantly increases the respective cognition relative to a control condition, and test for differences in subsequent intentions or behavior. The present review analyzed findings from 204 experimental tests that met these criteria. Studies were located using computerized searches and informal sources and meta-analyzed using STATA Version 11. Experimentally induced changes in attitudes, norms, and self-efficacy all led to medium-sized changes in intention (d+ = .48, .49, and .51, respectively), and engendered small to medium-sized changes in behavior (attitudes-d+ = .38, norms-d+ = .36, self-efficacy-d+ = .47). These effect sizes generally were not qualified by the moderator variables examined (e.g., study quality, theoretical basis of the intervention, methodological characteristics, and features of the targeted behavior), although effects were larger for interventions designed to increase (vs. decrease) behavioral performance. The present review lends novel, experimental support for key predictions from health behavior theories, and demonstrates that interventions that modify attitudes, norms, and self-efficacy are effective in promoting health behavior change. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Health-seeking behaviors and social change: the experience of the Hong Kong Chinese elderly.

PubMed

Holroyd, Eleanor

2002-07-01

In this article, the author outlines how the Hong Kong Chinese elderly revise, shift, and modify their health-seeking behaviors to adapt to rapid social change, presenting data drawn from three studies undertaken with elderly Chinese conducted in Hong Kong during the period 1993 to 1998. The primary data source is a qualitative survey involving interviews with 47 elderly Hong Kong Chinese men and women to ascertain their health-seeking beliefs and behaviors. The author analyzes how public policy and Confucian rhetoric constitute social guidelines, which are perceived in light of an individual's resources, gender and generational experiences and are manifest in health-seeking behaviors: seeking religious solace, preparing special food, visiting formal and informal healers, and shifting expectations of what constitutes family support. The article highlights the interface between public interpretations of old age, morality, religion, filial support, and personalized meaning as manifest in health behaviors.

Health behavior models and oral health: a review.

PubMed

Hollister, M Catherine; Anema, Marion G

2004-01-01

Dental hygienists help their clients develop health promoting behaviors, by providing essential information about general health, and oral health in particular. Individual health practices such as oral self-care are based on personal choices. The guiding principles found in health behavior models provide useful methods to the oral health care providers in promoting effective individual client behaviors. Theories provide explanations about observable facts in a systematic manner. Research regarding health behavior has explored the effectiveness and applicability of various health models in oral health behavior modification. The Health Belief Model, Transtheoretical Model and Stages of Change, Theory of Reasoned Action, Self-Efficacy, Locus of Control, and Sense of Coherence are examples of models that focus on individuals assuming responsibility for their own health. Understanding the strengths of each and their applicability to health behaviors is critical for oral health care providers who work with patients to adopt methods and modify behaviors that contribute to good oral health. This paper describes health behavior models that have been applied to oral health education, presents a critical analysis of the effectiveness of each model in oral health education, and provides examples of application to oral health education.

Health behavior change following a diagnosis of ductal carcinoma in situ: An opportunity to improve health outcomes.

PubMed

Berkman, Amy M; Trentham-Dietz, Amy; Dittus, Kim; Hart, Vicki; Vatovec, Christine M; King, John G; James, Ted A; Lakoski, Susan G; Sprague, Brian L

2015-11-01

Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer that comprises approximately 20% of new breast cancer diagnoses. DCIS is predominantly detected by screening mammography prior to the development of any clinical symptoms. Prognosis following a DCIS diagnosis is excellent, due to both the availability of effective treatments and the frequently benign nature of the disease. However, a DCIS diagnosis and its treatment have psychological and physical impacts that often lead to adverse changes in health-related behaviors, including changes in physical activity, body weight, alcohol intake, and smoking, which may represent a greater threat to the woman's overall health than the DCIS itself. Depending on age at diagnosis, women diagnosed with DCIS are 3-13 times more likely to die from non-breast cancer related causes, such as cardiovascular disease, than from breast cancer. Thus, the maintenance and improvement of healthy behaviors that influence a variety of outcomes after diagnosis may warrant increased attention during DCIS management. This may also represent an important opportunity to promote the adoption of healthy behaviors, given that DCIS carries the psychological impact of a cancer diagnosis but also a favorable prognosis. Particular focus is needed to address these issues in vulnerable patient subgroups with pre-existing higher rates of unhealthy behaviors and demonstrated health disparities. Copyright © 2015 Elsevier Inc. All rights reserved.

Can health care organizations improve health behavior and treatment adherence?

PubMed

Bender, Bruce G

2014-04-01

Many Americans are failing to engage in both the behaviors that prevent and those that effectively manage chronic health conditions, including pulmonary disorders, cardiovascular conditions, diabetes, and cancer. Expectations that health care providers are responsible for changing patients' health behaviors often do not stand up against the realities of clinical care that include large patient loads, limited time, increasing co-pays, and restricted access. Organizations and systems that might share a stake in changing health behavior include employers, insurance payers, health care delivery systems, and public sector programs. However, although the costs of unhealthy behaviors are evident, financial resources to address the problem are not readily available. For most health care organizations, the return on investment for developing behavior change programs appears highest when addressing treatment adherence and disease self-management, and lowest when promoting healthy lifestyles. Organizational strategies to improve adherence are identified in 4 categories: patient access, provider training and support, incentives, and information technology. Strategies in all 4 categories are currently under investigation in ongoing studies and have the potential to improve self-management of many chronic health conditions.

Apps seeking theories: results of a study on the use of health behavior change theories in cancer survivorship mobile apps.

PubMed

Vollmer Dahlke, Deborah; Fair, Kayla; Hong, Y Alicia; Beaudoin, Christopher E; Pulczinski, Jairus; Ory, Marcia G

2015-03-27

Thousands of mobile health apps are now available for use on mobile phones for a variety of uses and conditions, including cancer survivorship. Many of these apps appear to deliver health behavior interventions but may fail to consider design considerations based in human computer interface and health behavior change theories. This study is designed to assess the presence of and manner in which health behavior change and health communication theories are applied in mobile phone cancer survivorship apps. The research team selected a set of criteria-based health apps for mobile phones and assessed each app using qualitative coding methods to assess the application of health behavior change and communication theories. Each app was assessed using a coding derived from the taxonomy of 26 health behavior change techniques by Abraham and Michie with a few important changes based on the characteristics of mHealth apps that are specific to information processing and human computer interaction such as control theory and feedback systems. A total of 68 mobile phone apps and games built on the iOS and Android platforms were coded, with 65 being unique. Using a Cohen's kappa analysis statistic, the inter-rater reliability for the iOS apps was 86.1 (P<.001) and for the Android apps, 77.4 (P<.001). For the most part, the scores for inclusion of theory-based health behavior change characteristics in the iOS platform cancer survivorship apps were consistently higher than those of the Android platform apps. For personalization and tailoring, 67% of the iOS apps (24/36) had these elements as compared to 38% of the Android apps (12/32). In the area of prompting for intention formation, 67% of the iOS apps (34/36) indicated these elements as compared to 16% (5/32) of the Android apps. Mobile apps are rapidly emerging as a way to deliver health behavior change interventions that can be tailored or personalized for individuals. As these apps and games continue to evolve and include

Apps Seeking Theories: Results of a Study on the Use of Health Behavior Change Theories in Cancer Survivorship Mobile Apps

PubMed Central

Fair, Kayla; Hong, Y Alicia; Beaudoin, Christopher E; Pulczinski, Jairus; Ory, Marcia G

2015-01-01

Background Thousands of mobile health apps are now available for use on mobile phones for a variety of uses and conditions, including cancer survivorship. Many of these apps appear to deliver health behavior interventions but may fail to consider design considerations based in human computer interface and health behavior change theories. Objective This study is designed to assess the presence of and manner in which health behavior change and health communication theories are applied in mobile phone cancer survivorship apps. Methods The research team selected a set of criteria-based health apps for mobile phones and assessed each app using qualitative coding methods to assess the application of health behavior change and communication theories. Each app was assessed using a coding derived from the taxonomy of 26 health behavior change techniques by Abraham and Michie with a few important changes based on the characteristics of mHealth apps that are specific to information processing and human computer interaction such as control theory and feedback systems. Results A total of 68 mobile phone apps and games built on the iOS and Android platforms were coded, with 65 being unique. Using a Cohen’s kappa analysis statistic, the inter-rater reliability for the iOS apps was 86.1 (P<.001) and for the Android apps, 77.4 (P<.001). For the most part, the scores for inclusion of theory-based health behavior change characteristics in the iOS platform cancer survivorship apps were consistently higher than those of the Android platform apps. For personalization and tailoring, 67% of the iOS apps (24/36) had these elements as compared to 38% of the Android apps (12/32). In the area of prompting for intention formation, 67% of the iOS apps (34/36) indicated these elements as compared to 16% (5/32) of the Android apps. Conclusions Mobile apps are rapidly emerging as a way to deliver health behavior change interventions that can be tailored or personalized for individuals. As these

An evaluation of a storybook targeting parental attitudes, intention, and self-efficacy to change their child's oral health behavior.

PubMed

O'Malley, Lucy; Adair, Pauline; Burnside, Girvan; Robinson, Louise; Coffey, Margaret; Pine, Cynthia

2017-02-01

Methods for reducing dental disease have traditionally focused on health education rather than targeting psychosocial determinants of the core behaviors through behavior change strategies. This study tested a novel intervention in the form of a children's story (Kitten's First Tooth) embedded with behavior change techniques (Abraham & Michie, 2008) with the aim of investigating how effective the intervention was at improving parents' efficacy and intention to enact oral health behaviors for their child. A controlled before and after study conducted in a deprived area of England (n = 149; child mean age 4 years) with an intervention and control group. Changes in task specific parental self-efficacy (PSE) and intention were measured using the Oral Health Behaviors Questionnaire (OHBQ; Adair et al., 2004) at baseline and 3 months following intervention. Of the 149 participants, 129 returned both baseline and evaluation questionnaires (retention 86.6%), 125 of these pairs of questionnaires were used in the analysis (83.4%). The OHBQ was analyzed using a general linear model (ANCOVA). A significant difference was found in favor of the intervention group for PSE related to child tooth brushing behaviors, F ( 1,1 ) = 12.04, p = .001, however no change was observed for PSE related to control of dietary sugars. A theorized children's story can be effective as an oral health promotion intervention by supporting parents to improve their child's oral health-related behavior. Change was observed for child tooth brushing but not sugar control. This may reflect story contents or may be indicative of difficulties of changing dietary behavior. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Combinations of techniques that effectively change health behavior: evidence from Meta-CART analysis.

PubMed

Dusseldorp, Elise; van Genugten, Lenneke; van Buuren, Stef; Verheijden, Marieke W; van Empelen, Pepijn

2014-12-01

Many health-promoting interventions combine multiple behavior change techniques (BCTs) to maximize effectiveness. Although, in theory, BCTs can amplify each other, the available meta-analyses have not been able to identify specific combinations of techniques that provide synergistic effects. This study overcomes some of the shortcomings in the current methodology by applying classification and regression trees (CART) to meta-analytic data in a special way, referred to as Meta-CART. The aim was to identify particular combinations of BCTs that explain intervention success. A reanalysis of data from Michie, Abraham, Whittington, McAteer, and Gupta (2009) was performed. These data included effect sizes from 122 interventions targeted at physical activity and healthy eating, and the coding of the interventions into 26 BCTs. A CART analysis was performed using the BCTs as predictors and treatment success (i.e., effect size) as outcome. A subgroup meta-analysis using a mixed effects model was performed to compare the treatment effect in the subgroups found by CART. Meta-CART identified the following most effective combinations: Provide information about behavior-health link with Prompt intention formation (mean effect size ḡ = 0.46), and Provide information about behavior-health link with Provide information on consequences and Use of follow-up prompts (ḡ = 0.44). Least effective interventions were those using Provide feedback on performance without using Provide instruction (ḡ = 0.05). Specific combinations of BCTs increase the likelihood of achieving change in health behavior, whereas other combinations decrease this likelihood. Meta-CART successfully identified these combinations and thus provides a viable methodology in the context of meta-analysis.

Dyadic planning of health-behavior change after prostatectomy: a randomized-controlled planning intervention.

PubMed

Burkert, Silke; Scholz, Urte; Gralla, Oliver; Roigas, Jan; Knoll, Nina

2011-09-01

In this study, we investigated the role of dyadic planning for health-behavior change. Dyadic planning refers to planning health-behavior change together with a partner. We assumed that dyadic planning would affect the implementation of regular pelvic-floor exercise (PFE), with other indicators of social exchange and self-regulation strategies serving as mediators. In a randomized-controlled trial at a German University Medical Center, 112 prostatectomy-patients with partners were randomly assigned to a dyadic PFE-planning condition or one of three active control conditions. Questionnaire data were assessed at multiple time points within six months post-surgery, measuring self-reported dyadic PFE-planning and pelvic-floor exercise as primary outcomes and social exchange (support, control) and a self-regulation strategy (action control) as mediating mechanisms. There were no specific intervention effects with regard to dyadic PFE-planning or pelvic-floor exercise, as two active control groups also showed increases in either of these variables. However, results suggested that patients instructed to plan dyadically still benefited from self-reported dyadic PFE-planning regarding pelvic-floor exercise. Cross-sectionally, received negative control from partners was negatively related with PFE only in control groups and individual action control mediated between self-reported dyadic PFE-planning and PFE for participants instructed to plan PFE dyadically. Longitudinally, action control mediated between self-reported dyadic PFE-planning and pelvic-floor exercise for all groups. Findings provide support for further investigation of dyadic planning in health-behavior change with short-term mediating effects of behavior-specific social exchange and long-term mediating effects of better self-regulation. Copyright © 2011 Elsevier Ltd. All rights reserved.

Comparing strategies to assess multiple behavior change in behavioral intervention studies.

PubMed

Drake, Bettina F; Quintiliani, Lisa M; Sapp, Amy L; Li, Yi; Harley, Amy E; Emmons, Karen M; Sorensen, Glorian

2013-03-01

Alternatives to individual behavior change methods have been proposed, however, little has been done to investigate how these methods compare. To explore four methods that quantify change in multiple risk behaviors targeting four common behaviors. We utilized data from two cluster-randomized, multiple behavior change trials conducted in two settings: small businesses and health centers. Methods used were: (1) summative; (2) z-score; (3) optimal linear combination; and (4) impact score. In the Small Business study, methods 2 and 3 revealed similar outcomes. However, physical activity did not contribute to method 3. In the Health Centers study, similar results were found with each of the methods. Multivitamin intake contributed significantly more to each of the summary measures than other behaviors. Selection of methods to assess multiple behavior change in intervention trials must consider study design, and the targeted population when determining the appropriate method/s to use.

Associations between change in sedentary behavior and outcome in standard behavioral weight loss treatment.

PubMed

Kerrigan, Stephanie G; Call, Christine; Schaumberg, Katherine; Forman, Evan; Butryn, Meghan L

2018-03-01

Sedentary behavior, particularly in prolonged periods, is an important determinant of health. Little research exploring changes in sedentary behavior during behavioral weight loss programs exists. This study evaluated the magnitude of changes in total and prolonged sedentary behavior and how these changes related to changes in weight and cardiovascular outcomes during a behavioral weight loss program. Participants (n = 450) in two lifestyle modification programs underwent assessments of sedentary behavior (by accelerometry), weight, waist circumference, blood pressure, and resting heart rate at baseline and after 6 months of treatment. Sedentary behavior was defined as both total and prolonged (≥30 continuous minutes) sedentary minutes/day. Reductions in total and prolonged sedentary time were significant and were accounted for by increases in moderate-to-vigorous physical activity (MVPA). Only changes in MVPA significantly predicted change in weight when entered into a model simultaneously with changes in sedentary behavior. Changes in total and prolonged sedentary time were not associated with changes in waist circumference, heart rate, or blood pressure. Change in sedentary time was not independently associated with change in health outcomes during a behavioral weight loss treatment. High variability in changes in sedentary time indicate that individual differences may be important to examine. Reducing sedentary time may not be powerful enough to impact these health outcomes above the effects of other changes made during these programs; alternatively, it may be that increasing focus in treatment on reducing sedentary time may engender greater decreases in sedentariness, which could lead to better health outcomes.

Making healthy behaviors the easy choice for employees: a review of the literature on environmental and policy changes in worksite health promotion.

PubMed

Kahn-Marshall, Jennifer L; Gallant, Mary P

2012-12-01

As employers look for ways to reduce rising health care costs, worksite health promotion interventions are increasingly being used to improve employee health behaviors. An alternative approach to traditional worksite health promotion programs is the implementation of environmental and/or policy changes to encourage employees to adopt healthier behaviors. This review examines the evidence for the effectiveness of worksite health promotion programs using environmental and/or policy changes either alone or in combination with individually focused health behavior change strategies. A review of the relevant literature, published between 1995 and 2010, identified 27 studies that met all inclusion criteria. Limited evidence was found for the effectiveness of environmental and/or policy changes alone (n = 11) to change employee behavior, but more promising results were identified with multicomponent interventions (n = 16). There is a strong need for improvement in the design and evaluation of future health promotion programs focusing solely on environmental and/or policy changes at the worksite.

Behavioral changes following participation in a home health promotional program in King County, Washington.

PubMed Central

Leung, R; Koenig, J Q; Simcox, N; van Belle, G; Fenske, R; Gilbert, S G

1997-01-01

This study examined behavioral changes in households after participation in a home environmental assessment. Home assessment visits by a trained coach, which involved a walk-through in the home with the home residents, were conducted in 36 homes. The walk-through included a list of recommended behavioral changes that the residents could make to reduce their exposures to home pollutants in areas such as dust control, moisture problems, indoor air, hazardous household products, and hobbies. Recruited households were surveyed 3 months after the home assessment to evaluate their implementation of the recommendations. Following the home visits, 31 of 36 households reported making at least one behavioral change, and 41% of the recommendations made by the volunteer coaches were implemented. In conclusion, this study found that the majority of the households who participated in the home assessment reported implementing at least one recommendation. This home health promotional method was effective in influencing behavioral changes. PMID:9349831

Application of persuasion and health behavior theories for behavior change counseling: design of the ADAPT (Avoiding Diabetes Thru Action Plan Targeting) program.

PubMed

Lin, Jenny J; Mann, Devin M

2012-09-01

Diabetes incidence is increasing worldwide and providers often do not feel they can effectively counsel about preventive lifestyle changes. The goal of this paper is to describe the development and initial feasibility testing of the Avoiding Diabetes Thru Action Plan Targeting (ADAPT) program to enhance counseling about behavior change for patients with pre-diabetes. Primary care providers and patients were interviewed about their perspectives on lifestyle changes to prevent diabetes. A multidisciplinary design team incorporated this data to translate elements from behavior change theories to create the ADAPT program. The ADAPT program was pilot tested to evaluate feasibility. Leveraging elements from health behavior theories and persuasion literature, the ADAPT program comprises a shared goal-setting module, implementation intentions exercise, and tailored reminders to encourage behavior change. Feasibility data demonstrate that patients were able to use the program to achieve their behavior change goals. Initial findings show that the ADAPT program is feasible for helping improve primary care providers' counseling for behavior change in patients with pre-diabetes. If successful, the ADAPT program may represent an adaptable and scalable behavior change tool for providers to encourage lifestyle changes to prevent diabetes. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Using Mobile & Personal Sensing Technologies to Support Health Behavior Change in Everyday Life: Lessons Learned

PubMed Central

Klasnja, Predrag; Consolvo, Sunny; McDonald, David W.; Landay, James A.; Pratt, Wanda

2009-01-01

Lifestyle modification is a key facet of the prevention and management of chronic diseases. Mobile devices that people already carry provide a promising platform for facilitating these lifestyle changes. This paper describes key lessons learned from the development and evaluation of two mobile systems for encouraging physical activity. We argue that by supporting persistent cognitive activation of health goals, encouraging an extensive range of relevant healthy behaviors, focusing on long-term patterns of activity, and facilitating social support as an optional but not primary motivator, systems can be developed that effectively motivate behavior change and provide support when and where people make decisions that affect their health. PMID:20351876

Future directions of multiple behavior change research.

PubMed

Geller, Karly; Lippke, Sonia; Nigg, Claudio R

2017-02-01

Non-communicable diseases (i.e., chronic diseases including cardiovascular disease, cancer, chronic respiratory disease, diabetes and obesity) result in 36 million deaths each year. Individuals' habitual participation in a single health-risk behaviors substantially contribute to morbidity and mortality (e.g., tobacco use, daily fast food intake, etc.); however, more concerning is the impact of typically co-occurring or clustering of multiple health-risk behaviors. This burden can be minimized through successful cessation of health-risk behaviors and adoption of healthy behaviors; namely healthy lifestyle adoption or multiple health behavior change (MHBC). MHBC is a developing field and future research recommendations are provided to advance MHBC research. A valid measure of MHBC (i.e., lifestyle) is warranted to provide the needed basis for MHBC investigations and evaluations. MHBC is thought to occur through shared co-variation of underlying motivating mechanisms, but how these relationships influence behavior remains unclear. A better understanding of the relationship between behaviors and the related motivating mechanisms (and potential cross-relationship of influences) is needed. Future research should also aim to improve lifestyles through understanding how to change multiple health behaviors. Finally, MHBC research should target the development of sustainable interventions which result in lasting effects (e.g., capacity, systems, policy and environmental changes), with dissemination considered during development. Focusing MHBC research in these areas will increase our understanding and maximize the impact on the health of populations.

The Impact of Information Technology on Patient Engagement and Health Behavior Change: A Systematic Review of the Literature

PubMed Central

Rashrash, Mohamed; Phalakornkule, Kanitha; Carpenter, Janet S; Jones, Josette F

2016-01-01

Background Advancements in information technology (IT) and its increasingly ubiquitous nature expand the ability to engage patients in the health care process and motivate health behavior change. Objective Our aim was to systematically review the (1) impact of IT platforms used to promote patients’ engagement and to effect change in health behaviors and health outcomes, (2) behavior theories or models applied as bases for developing these interventions and their impact on health outcomes, (3) different ways of measuring health outcomes, (4) usability, feasibility, and acceptability of these technologies among patients, and (5) challenges and research directions for implementing IT platforms to meaningfully impact patient engagement and health outcomes. Methods PubMed, Web of Science, PsycINFO, and Google Scholar were searched for studies published from 2000 to December 2014. Two reviewers assessed the quality of the included papers, and potentially relevant studies were retrieved and assessed for eligibility based on predetermined inclusion criteria. Results A total of 170 articles met the inclusion criteria and were reviewed in detail. Overall, 88.8% (151/170) of studies showed positive impact on patient behavior and 82.9% (141/170) reported high levels of improvement in patient engagement. Only 47.1% (80/170) referenced specific behavior theories and only 33.5% (57/170) assessed the usability of IT platforms. The majority of studies used indirect ways to measure health outcomes (65.9%, 112/170). Conclusions In general, the review has shown that IT platforms can enhance patient engagement and improve health outcomes. Few studies addressed usability of these interventions, and the reason for not using specific behavior theories remains unclear. Further research is needed to clarify these important questions. In addition, an assessment of these types of interventions should be conducted based on a common framework using a large variety of measurements; these

Federal Parity and Access to Behavioral Health Care in Private Health Plans.

PubMed

Hodgkin, Dominic; Horgan, Constance M; Stewart, Maureen T; Quinn, Amity E; Creedon, Timothy B; Reif, Sharon; Garnick, Deborah W

2018-04-01

The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) sought to improve access to behavioral health care by regulating health plans' coverage and management of services. Health plans have some discretion in how to achieve compliance with MHPAEA, leaving questions about its likely effects on health plan policies. In this study, the authors' objective was to determine how private health plans' coverage and management of behavioral health treatment changed after the federal parity law's full implementation. A nationally representative survey of commercial health plans was conducted in 60 market areas across the continental United States, achieving response rates of 89% in 2010 (weighted N=8,431) and 80% in 2014 (weighted N=6,974). Senior executives at responding plans were interviewed regarding behavioral health services in each year and (in 2014) regarding changes. Student's t tests were used to examine changes in services covered, cost-sharing, and prior authorization requirements for both behavioral health and general medical care. In 2014, 68% of insurance products reported having expanded behavioral health coverage since 2010. Exclusion of eating disorder coverage was eliminated between 2010 (23%) and 2014 (0%). However, more products reported excluding autism treatment in 2014 (24%) than 2010 (8%). Most plans reported no change to prior-authorization requirements between 2010 and 2014. Implementation of federal parity legislation appears to have been accompanied by continuing improvement in behavioral health coverage. The authors did not find evidence of widespread noncompliance or of unintended effects, such as dropping coverage of behavioral health care altogether.

Social influence and motivation to change health behaviors among Mexican origin adults: Implications for diet and physical activity

PubMed Central

Ashida, Sato; Wilkinson, Anna V.; Koehly, Laura M.

2011-01-01

Purpose To evaluate whether influence from social network members is associated with motivation to change dietary and physical activity behaviors. Design Baseline assessment followed by mailing of family health history-based personalized messages (2 weeks) and follow-up assessment (3 months). Setting Families from an ongoing population-based cohort in Houston, TX. Subjects 475 adults from 161 Mexican origin families. Out of 347 households contacted, 162 (47%) participated. Measures Family health history, social networks, and motivation to change behaviors. Analysis Two-level logistic regression modeling. Results Having at least one network member who encourages one to eat more fruits and vegetables (p=.010) and to engage in regular physical activity (p=.046) was associated with motivation to change the relevant behavior. About 40% of the participants did not have encouragers for these behaviors. Conclusions Identification of new encouragers within networks and targeting natural encouragers (e.g., children, spouses) may increase the efficacy of interventions to motivate behavioral changes among Mexican origin adults. PMID:22208416

Social influence and motivation to change health behaviors among Mexican-origin adults: implications for diet and physical activity.

PubMed

Ashida, Sato; Wilkinson, Anna V; Koehly, Laura M

2012-01-01

To evaluate whether influence from social network members is associated with motivation to change dietary and physical activity behaviors. Baseline assessment followed by mailing of family health history-based personalized messages (2 weeks) and follow-up assessment (3 months). Families from an ongoing population-based cohort in Houston, Texas. 475 adults from 161 Mexican-origin families. Out of 347 households contacted, 162 (47%) participated. Family health history, social networks, and motivation to change behaviors. Two-level logistic regression modeling. Having at least one network member who encourages one to eat more fruits and vegetables (p = .010) and to engage in regular physical activity (p = .046) was associated with motivation to change the relevant behavior. About 40% of the participants did not have encouragers for these behaviors. Identification of new encouragers within networks and targeting natural encouragers (e.g., children, spouses) may increase the efficacy of interventions to motivate behavioral changes among Mexican-origin adults.

Proposing a conceptual framework for integrated local public health policy, applied to childhood obesity--the behavior change ball.

PubMed

Hendriks, Anna-Marie; Jansen, Maria W J; Gubbels, Jessica S; De Vries, Nanne K; Paulussen, Theo; Kremers, Stef P J

2013-04-18

Childhood obesity is a 'wicked' public health problem that is best tackled by an integrated approach, which is enabled by integrated public health policies. The development and implementation of such policies have in practice proven to be difficult, however, and studying why this is the case requires a tool that may assist local policy-makers and those assisting them. A comprehensive framework that can help to identify options for improvement and to systematically develop solutions may be used to support local policy-makers. We propose the 'Behavior Change Ball' as a tool to study the development and implementation of integrated public health policies within local government. Based on the tenets of the 'Behavior Change Wheel' by Michie and colleagues (2011), the proposed conceptual framework distinguishes organizational behaviors of local policy-makers at the strategic, tactical and operational levels, as well as the determinants (motivation, capability, opportunity) required for these behaviors, and interventions and policy categories that can influence them. To illustrate the difficulty of achieving sustained integrated approaches, we use the metaphor of a ball in our framework: the mountainous landscapes surrounding the ball reflect the system's resistance to change (by making it difficult for the ball to roll). We apply this framework to the problem of childhood obesity prevention. The added value provided by the framework lies in its comprehensiveness, theoretical basis, diagnostic and heuristic nature and face validity. Since integrated public health policies have not been widely developed and implemented in practice, organizational behaviors relevant to the development of these policies remain to be investigated. A conceptual framework that can assist in systematically studying the policy process may facilitate this. Our Behavior Change Ball adds significant value to existing public health policy frameworks by incorporating multiple theoretical perspectives

Understanding the relationship of maternal health behavior change and intervention strategies in a Nicaraguan NGO network.

PubMed

Valadez, Joseph J; Hage, Jerald; Vargas, William

2005-09-01

Few studies of community interventions examine independent effects of investments in: (1) capital (i.e., physical, human and social capital), and (2) management systems (e.g., monitoring and evaluation systems (M&E)) on maternal and child health behavior change. This paper does this in the context of an inter-organizational network. In Nicaragua, international non-governmental organizations (NGOs) and local NGOs formed the NicaSalud Federation. Using Lot Quality Assurance Sampling (LQAS), 14 member organizations took baselines measures of maternal safe motherhood and child health behavior indicators during November 1999 and August 2000, respectively, and final evaluation measures in December 2001. In April 2002, retrospective interviews were conducted with supervisors and managers in the 14 organizations to explore changes made to community health strategies, factors associated with the changes, and impacts they attributed to participating in NicaSalud. Physical capital (density of health huts), human capital (density and variety of paramedical personnel) and social capital (density of health committees) were associated with pregnant women attending antenatal care (ANC) 3+ times, and/or retaining ANC cards. The variety of paramedic personnel was also associated with women making post-partum visits to clinics. Physical capital (density of health huts) and social capital (density of health committees and mothers' clubs) were associated with child diarrhea case management indicators. One safe motherhood indicator (delivery of babies by a clinician) was not associated with intervention strategies. At the management level, NicaSalud's training of members to use LQAS for M&E was associated with the number of strategic and tactical changes they subsequently made to interventions (organizational learning). Organizational learning was related to changes in maternal and child health behaviors of the women (including changes in the proportion using post-partum care). As the

The gap between behavioral risk status and willingness to change behavior among healthcare professionals.

PubMed

Kasila, K; Hallman, M; Kautiainen, H; Vanhala, M; Kettunen, T

2018-01-01

This study explored behavioral health risk factors among healthcare professionals and investigated the at-risk persons' satisfaction with their health habits and ongoing change attempts. The study was based on a cross-sectional web-based survey directed at the nurses and physicians ( N = 1233) in Finnish healthcare. Obesity, low physical activity, smoking, and risky alcohol drinking were used as behavioral health risk factors. In all, 70% of the participants had at least one behavioral risk factor, and a significant number of at-risk persons were satisfied with their health habits and had no ongoing change process. Good self-rated health and good self-rated work ability were significantly associated with whether a participant had a behavioral health risk factor. Overall, unhealthy behaviors and a lack of ongoing change attempts were commonly observed among healthcare professionals. Work in healthcare is demanding, and healthy lifestyles can support coping. Thus, healthy lifestyle programs should also be targeted to healthcare professionals.

Cardiovascular Health Behavior and Health Factor Changes (1988 –2008) and Projections to 2020

PubMed Central

Huffman, Mark D.; Capewell, Simon; Ning, Hongyan; Shay, Christina M.; Ford, Earl S.; Lloyd-Jones, Donald M.

2014-01-01

Background The American Heart Association’s 2020 Strategic Impact Goals target a 20% relative improvement in overall cardiovascular health with the use of 4 health behavior (smoking, diet, physical activity, body mass) and 3 health factor (plasma glucose, cholesterol, blood pressure) metrics. We sought to define current trends and forward projections to 2020 in cardiovascular health. Methods and Results We included 35 059 cardiovascular disease–free adults (aged ≥20 years) from the National Health and Nutrition Examination Survey 1988–1994 and subsequent 2-year cycles during 1999–2008. We calculated population prevalence of poor, intermediate, and ideal health behaviors and factors and also computed a composite, individual-level Cardiovascular Health Score for all 7 metrics (poor=0 points; intermediate=1 point; ideal=2 points; total range, 0–14 points). Prevalence of current and former smoking, hypercholesterolemia, and hypertension declined, whereas prevalence of obesity and dysglycemia increased through 2008. Physical activity levels and low diet quality scores changed minimally. Projections to 2020 suggest that obesity and impaired fasting glucose/diabetes mellitus could increase to affect 43% and 77% of US men and 42% and 53% of US women, respectively. Overall, population-level cardiovascular health is projected to improve by 6% overall by 2020 if current trends continue. Individual-level Cardiovascular Health Score projections to 2020 (men=7.4 [95% confidence interval, 5.7–9.1]; women=8.8 [95% confidence interval, 7.6–9.9]) fall well below the level needed to achieve a 20% improvement (men=9.4; women=10.1). Conclusions The American Heart Association 2020 target of improving cardiovascular health by 20% by 2020 will not be reached if current trends continue. PMID:22547667

I Will If You Will: Similarity in Married Partners' Readiness to Change Health Risk Behaviors

ERIC Educational Resources Information Center

Franks, Melissa M.; Shields, Cleveland G.; Lim, Eunjung; Sands, Laura P.; Mobley, Stacey; Boushey, Carol J.

2012-01-01

Married men and women (N = 1,899 couples) reported readiness to eat a healthier diet, lose weight, and get more exercise (stage of change) and indicated whether they were confident to make these changes (self-efficacy). Husbands' and wives' reports of readiness to change each health behavior were positively associated. Furthermore, women who…

Key enablers to facilitate healthy behavior change: workshop summary.

PubMed

Teyhen, Deydre S; Aldag, Matt; Centola, Damon; Edinborough, Elton; Ghannadian, Jason D; Haught, Andrea; Jackson, Theresa; Kinn, Julie; Kunkler, Kevin J; Levine, Betty; Martindale, Valerie E; Neal, David; Snyder, Leslie B; Styn, Mindi A; Thorndike, Frances; Trabosh, Valerie; Parramore, David J

2014-05-01

The increases in preventable chronic diseases and the rising costs of health care are unsustainable. The US Army Surgeon General's vision to transition from a health care system to a system of health requires the identification of key health enablers to facilitate the adoption of healthy behaviors. In support of this vision, the US Army Telemedicine and Advanced Technology Research Center hosted a workshop in April 2013 titled "Incentives to Create and Sustain Change for Health." Members of government and academia participated to identify key health enablers that could ultimately be leveraged by technology. The key health enablers discussed included (1) public health messaging, (2) changing health habits and the environmental influence on health, (3) goal setting and tracking, (4) the role of incentives in behavior-change intervention, and (5) the role of peer and social networks on change. This report summarizes leading evidence and the group consensus on evidence-based practices with respect to the key enablers in creating healthy behavior change.

The business cycle and health behaviors.

PubMed

Xu, Xin

2013-01-01

While it is well documented that economic expansions provide widespread and immediate financial benefits, the evidence on how an economic downturn affects individual's health behaviors is surprisingly mixed. In this paper, we take a structural approach to investigate the effects of wages and working hours on health behaviors of low-educated persons using variations in wages and hours caused by changes in local economic activity. In the empirical analysis, we adopt a two-sample instrumental variables approach to combine the data on individual health behaviors from the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS) with the data on individual employment from the Current Population Survey (CPS). The total sample size of the combined CPS-BRFSS data for the time period of 1984-2005 is 967,594, while that of the combined CPS-NHIS data for the time period of 1976-2001 is 364,078. We find that increases in wages caused by economic expansions are associated with greater consumption of cigarettes in the United States. We also find that increases in hours of work caused by economic expansions are associated with more cigarette consumption, but less physical activity and physician visits. More importantly, the evidence suggests that most of such effects associated with changes in hours of work can be attributed to the changes at the extensive margin of employment, meaning the changes in employment status, rather than the changes at the intensive margin, meaning changes in hours of work conditional on being employed. These findings imply that changes in employment may have heterogeneous impacts on time-intensive and less time-intensive health behaviors and also provide additional evidence on the importance of time in health production, particularly for time-intensive activities. Copyright © 2012 Elsevier Ltd. All rights reserved.

The role of serious mental illness in motivation, participation and adoption of health behavior change among obese/sedentary Latino adults.

PubMed

Jimenez, Daniel E; Thomas, Lauren; Bartels, Stephen J

2017-11-10

Serious mental illness (SMI; e.g. schizophrenia, schizoaffective disorder, delusional disorder, bipolar disorder, severe major depressive disorder, and psychotic disorders) and Latino ethnicity can produce a compounded health disparity, placing individuals at particularly high risk for excess morbidity and premature mortality. In this study we sought to identify the role of SMI in motivation, participation, and adoption of health behavior change among overweight Latino adults. Qualitative, semi-structured interviews were conducted with 20 overweight Latinos with SMI who were enrolled in a randomized trial evaluating the effectiveness of a motivational health promotion intervention adapted for persons with SMI, In SHAPE. The interviews explored the complicated role having an SMI had in the lives of the Latino participants. SMI had both positive and negative impact on Latino participants' health behaviors. The nature of their mental illness along with medication side effects (e.g. lethargy, weight gain, etc.) negatively impacted their ability to making lasting health behavior change. However, the regular appointments with various specialists provided them with structure that they otherwise would have lacked and gave them a reason to get out of the house. This exploratory research provides insight into the experience of overweight Latinos with SMI and the ways in which SMI impacts their participation in health behavior change. An understanding of the positive and negative effects of SMI on health behavior change will inform the development of health promotion interventions targeted at Latinos with SMI.

Preventing skin cancer through behavior change. Implications for interventions.

PubMed

Rossi, J S; Blais, L M; Redding, C A; Weinstock, M A

1995-07-01

Sun exposure is the only major causative factor for skin cancer for which prevention is feasible. Both individual and community-based interventions have been effective in changing sun exposure knowledge and attitudes but generally have not been effective in changing behaviors. An integrative model of behavior change is described that has been successful in changing behavior across a wide range of health conditions. This model holds promise for developing a rational public health approach to skin cancer prevention based on sound behavioral science.

More Than a Text Message: Dismantling Digital Triggers to Curate Behavior Change in Patient-Centered Health Interventions

PubMed Central

2017-01-01

Digital triggers such as text messages, emails, and push alerts are designed to focus an individual on a desired goal by prompting an internal or external reaction at the appropriate time. Triggers therefore have an essential role in engaging individuals with digital interventions delivered outside of traditional health care settings, where other events in daily lives and fluctuating motivation to engage in effortful behavior exist. There is an emerging body of literature examining the use of digital triggers for short-term action and longer-term behavior change. However, little attention has been given to understanding the components of digital triggers. Using tailoring as an overarching framework, we separated digital triggers into 5 primary components: (1) who (sender), (2) how (stimulus type, delivery medium, heterogeneity), (3) when (delivered), (4) how much (frequency, intensity), and (5) what (trigger’s target, trigger’s structure, trigger’s narrative). We highlighted key considerations when tailoring each component and the pitfalls of ignoring common mistakes, such as alert fatigue and habituation. As evidenced throughout the paper, there is a broad literature base from which to draw when tailoring triggers to curate behavior change in health interventions. More research is needed, however, to examine differences in efficacy based on component tailoring, to best use triggers to facilitate behavior change over time, and to keep individuals engaged in physical and mental health behavior change efforts. Dismantling digital triggers into their component parts and reassembling them according to the gestalt of one’s change goals is the first step in this development work. PMID:28550001

Being questioned and receiving advice about alcohol and smoking in health care: Associations with patients' characteristics, health behavior, and reported stage of change

PubMed Central

2010-01-01

Background Alcohol habits are more rarely addressed than other health behavior topics in Swedish health care. This study examined whether differences between topics could be explained by their different associations with patient characteristics or by the differences in the prevalence of the disadvantageous health behavior, i.e., excessive alcohol use and smoking. The study moreover examined whether simply being asked questions about behavior, i.e., alcohol use or smoking, was associated with reported change. Methods The study was based on a cross-sectional postal survey (n = 4 238, response rate 56.5 percent) representative of the adult population in Stockholm County in 2003. Retrospective self-reports were used to assess health care visits during the past 12 months, the questions and advice received there, patients characteristics, health behavior, and the present stage of change. Logistic regression analysis was used to estimate the associations among the 68 percent who had visited health care. Results Among the health care visitors, 23 percent reported being asked about their alcohol habits, and 3 percent reported receiving advice or/and support to modify their alcohol use - fewer than for smoking, physical exercise, or diet. When regression models adjusted for patient characteristics, the differences between health behaviors in the extent of questioning and advice remained. However, when the models also adjusted for smoking and alcohol consumption there was no difference between smoking and alcohol-related advice. In fact one-third of the present smokers and two-fifths of the persons dependent on alcohol reported having receiving advice the previous 12 months. Those who reported being asked questions or receiving advice more often reported a decreased alcohol use and similarly intended to cease smoking within 6 months. Questions about alcohol use were moreover related to a later stage of stage of change independently of advice among women but not among men

A Review of the Literature on Remote Monitoring Technology in Incentive-Based Interventions for Health-Related Behavior Change.

PubMed

Kurti, Allison N; Davis, Danielle R; Redner, Ryan; Jarvis, Brantley P; Zvorsky, Ivori; Keith, Diana R; Bolivar, Hypatia A; White, Thomas J; Rippberger, Peter; Markesich, Catherine; Atwood, Gary; Higgins, Stephen T

2016-06-01

Use of technology (e.g., Internet, cell phones) to allow remote implementation of incentives interventions for health-related behavior change is growing. To our knowledge, there has yet to be a systematic review of this literature reported. The present report provides a systematic review of the controlled studies where technology was used to remotely implement financial incentive interventions targeting substance use and other health behaviors published between 2004 and 2015. For inclusion in the review, studies had to use technology to remotely accomplish one of the following two aims alone or in combination: (a) monitor the target behavior, or (b) deliver incentives for achieving the target goal. Studies also had to examine financial incentives (e.g., cash, vouchers) for health-related behavior change, be published in peer-reviewed journals, and include a research design that allowed evaluation of the efficacy of the incentive intervention relative to another condition (e.g., non-contingent incentives, treatment as usual). Of the 39 reports that met inclusion criteria, 18 targeted substance use, 10 targeted medication adherence or home-based health monitoring, and 11 targeted diet, exercise, or weight loss. All 39 (100%) studies used technology to facilitate remote monitoring of the target behavior, and 26 (66.7%) studies also incorporated technology in the remote delivery of incentives. Statistically significant intervention effects were reported in 71% of studies reviewed. Overall, the results offer substantial support for the efficacy of remotely implemented incentive interventions for health-related behavior change, which have the potential to increase the cost-effectiveness and reach of this treatment approach.

What Is the Story with Narratives? How Using Narratives in Journalism Changes Health Behavior.

PubMed

Shaffer, Victoria A; Scherer, Laura D; Focella, Elizabeth S; Hinnant, Amanda; Len-Ríos, María E; Zikmund-Fisher, Brian J

2018-09-01

Health journalists frequently use narratives to bring news stories to life, with little understanding about how this influences the health behavior of readers. This study was designed to examine the effect of a New York Times health news article about a person who developed a life-threatening illness after using ibuprofen on readers' future use of ibuprofen. We recruited an Internet sample (N = 405) to participate in a longitudinal study examining ibuprofen use before, immediately following, and two weeks after reading the story. Ibuprofen use two-weeks after reading the heath news article was significantly lower than baseline use. Furthermore, intentions to use ibuprofen were also significantly reduced suggesting that the observed behavior change may persist beyond the two-week period studied. Health journalists should be cautious in their use of stories about health outcomes, particularly when those stories deviate from data about objective risks.

Proposing a conceptual framework for integrated local public health policy, applied to childhood obesity - the behavior change ball

PubMed Central

2013-01-01

Background Childhood obesity is a ‘wicked’ public health problem that is best tackled by an integrated approach, which is enabled by integrated public health policies. The development and implementation of such policies have in practice proven to be difficult, however, and studying why this is the case requires a tool that may assist local policy-makers and those assisting them. A comprehensive framework that can help to identify options for improvement and to systematically develop solutions may be used to support local policy-makers. Discussion We propose the ‘Behavior Change Ball’ as a tool to study the development and implementation of integrated public health policies within local government. Based on the tenets of the ‘Behavior Change Wheel’ by Michie and colleagues (2011), the proposed conceptual framework distinguishes organizational behaviors of local policy-makers at the strategic, tactical and operational levels, as well as the determinants (motivation, capability, opportunity) required for these behaviors, and interventions and policy categories that can influence them. To illustrate the difficulty of achieving sustained integrated approaches, we use the metaphor of a ball in our framework: the mountainous landscapes surrounding the ball reflect the system’s resistance to change (by making it difficult for the ball to roll). We apply this framework to the problem of childhood obesity prevention. The added value provided by the framework lies in its comprehensiveness, theoretical basis, diagnostic and heuristic nature and face validity. Summary Since integrated public health policies have not been widely developed and implemented in practice, organizational behaviors relevant to the development of these policies remain to be investigated. A conceptual framework that can assist in systematically studying the policy process may facilitate this. Our Behavior Change Ball adds significant value to existing public health policy frameworks by

Predictors of health behaviors after the economic downturn: a longitudinal study.

PubMed

Macy, Jonathan T; Chassin, Laurie; Presson, Clark C

2013-07-01

Economic declines and their associated stress, shortage of financial resources, and changes in available time can impair health behaviors. This study tested the association between change in working hours, change in employment status, and financial strain and health behaviors measured after the 2008 recession after controlling for pre-recession levels of the health behaviors. The moderating influences of demographic factors and pre-recession levels of the health behaviors on the association between change in working hours and employment status and financial strain and the health behaviors were also tested. Participants (N = 3984) were from a longitudinal study of a U.S. Midwestern community-based sample. Regression analyses tested the unique relations between change in hours worked per week, change in employment status, and financial strain and five health behaviors over and above demographic factors and pre-recession levels of the same behavior. Models included predictor by covariate interactions. Participants who reported higher levels of financial strain engaged in lower levels of all but one of the five health behaviors, but there were no significant main effects of a change in the number of hours worked per week or change in employment status. Significant interactions revealed moderation of these relations by demographic characteristics, but findings differed across health behaviors. Financial strain negatively affected engagement in multiple healthy behaviors. Promoting the maintenance of healthy behaviors for disease prevention is an important public health goal during times of economic decline. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Crucible simulation: Behavioral simulation improves clinical leadership skills and understanding of complex health policy change.

PubMed

Cohen, Daniel; Vlaev, Ivo; McMahon, Laurie; Harvey, Sarah; Mitchell, Andy; Borovoi, Leah; Darzi, Ara

2017-05-11

The Health and Social Care Act 2012 represents the most complex National Health Service reforms in history. High-quality clinical leadership is important for successful implementation of health service reform. However, little is known about the effectiveness of current leadership training. This study describes the use of a behavioral simulation to improve the knowledge and leadership of a cohort of medical doctors expected to take leadership roles in the National Health Service. A day-long behavioral simulation (The Crucible) was developed and run based on a fictitious but realistic health economy. Participants completed pre- and postsimulation questionnaires generating qualitative and quantitative data. Leadership skills, knowledge, and behavior change processes described by the "theory of planned behavior" were self-assessed pre- and postsimulation. Sixty-nine medical doctors attended. Participants deemed the simulation immersive and relevant. Significant improvements were shown in perceived knowledge, capability, attitudes, subjective norms, intentions, and leadership competency following the program. Nearly one third of participants reported that they had implemented knowledge and skills from the simulation into practice within 4 weeks. This study systematically demonstrates the effectiveness of behavioral simulation for clinical management training and understanding of health policy reform. Potential future uses and strategies for analysis are discussed. High-quality care requires understanding of health systems and strong leadership. Policymakers should consider the use of behavioral simulation to improve understanding of health service reform and development of leadership skills in clinicians, who readily adopt skills from simulation into everyday practice.

Changing patterns of adolescent sexual behavior: consequences for health and development.

PubMed

Friedman, H L

1992-07-01

Sexuality is a fundamental quality of human life, important for health, happiness, individual development, and indeed for the preservation of the human race. During the dynamic period of adolescence in which the passage from childhood to maturity takes place, sexuality takes on new dimensions; feelings become more intense, relationships become more complex, and the consequences of sexual behavior are radically altered. This not only affects the behavior of young people but also of those who interact with them, their families and peers, and those who work in the health, education, youth, social welfare, and other sectors. In the contemporary world the conditions of life for many young people have also changed, and with it patterns of sexual behavior. In general, earlier puberty, later marriage, a decline in the family leading to less control and more autonomy, and intense exposure to sexual stimuli via the mass media and travel across cultural boundaries have made pre-marital adolescent sexual activity more common. This has added to traditional problems of early marriage, newer problems of early pregnancy, childbirth, and induced abortion outside of marriage, sexually transmitted diseases, and human immunodeficiency syndrome infection leading to acquired immunodeficiency syndrome. But the work of the World Health Organization (WHO), along with many others in the field, strongly suggests that given appropriate information and services, trust and equity between the sexes, young people will behave responsibly and well. In this paper some of the findings from methods developed by WHO for research, training, advocacy, and evaluation, and findings in relation to patterns and determinants of sexual and reproductive health and development will be described, and future directions suggested.

More Than a Text Message: Dismantling Digital Triggers to Curate Behavior Change in Patient-Centered Health Interventions.

PubMed

Muench, Frederick; Baumel, Amit

2017-05-26

Digital triggers such as text messages, emails, and push alerts are designed to focus an individual on a desired goal by prompting an internal or external reaction at the appropriate time. Triggers therefore have an essential role in engaging individuals with digital interventions delivered outside of traditional health care settings, where other events in daily lives and fluctuating motivation to engage in effortful behavior exist. There is an emerging body of literature examining the use of digital triggers for short-term action and longer-term behavior change. However, little attention has been given to understanding the components of digital triggers. Using tailoring as an overarching framework, we separated digital triggers into 5 primary components: (1) who (sender), (2) how (stimulus type, delivery medium, heterogeneity), (3) when (delivered), (4) how much (frequency, intensity), and (5) what (trigger's target, trigger's structure, trigger's narrative). We highlighted key considerations when tailoring each component and the pitfalls of ignoring common mistakes, such as alert fatigue and habituation. As evidenced throughout the paper, there is a broad literature base from which to draw when tailoring triggers to curate behavior change in health interventions. More research is needed, however, to examine differences in efficacy based on component tailoring, to best use triggers to facilitate behavior change over time, and to keep individuals engaged in physical and mental health behavior change efforts. Dismantling digital triggers into their component parts and reassembling them according to the gestalt of one's change goals is the first step in this development work. ©Frederick Muench, Amit Baumel. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.05.2017.

Building new computational models to support health behavior change and maintenance: new opportunities in behavioral research.

PubMed

Spruijt-Metz, Donna; Hekler, Eric; Saranummi, Niilo; Intille, Stephen; Korhonen, Ilkka; Nilsen, Wendy; Rivera, Daniel E; Spring, Bonnie; Michie, Susan; Asch, David A; Sanna, Alberto; Salcedo, Vicente Traver; Kukakfa, Rita; Pavel, Misha

2015-09-01

Adverse and suboptimal health behaviors and habits are responsible for approximately 40 % of preventable deaths, in addition to their unfavorable effects on quality of life and economics. Our current understanding of human behavior is largely based on static "snapshots" of human behavior, rather than ongoing, dynamic feedback loops of behavior in response to ever-changing biological, social, personal, and environmental states. This paper first discusses how new technologies (i.e., mobile sensors, smartphones, ubiquitous computing, and cloud-enabled processing/computing) and emerging systems modeling techniques enable the development of new, dynamic, and empirical models of human behavior that could facilitate just-in-time adaptive, scalable interventions. The paper then describes concrete steps to the creation of robust dynamic mathematical models of behavior including: (1) establishing "gold standard" measures, (2) the creation of a behavioral ontology for shared language and understanding tools that both enable dynamic theorizing across disciplines, (3) the development of data sharing resources, and (4) facilitating improved sharing of mathematical models and tools to support rapid aggregation of the models. We conclude with the discussion of what might be incorporated into a "knowledge commons," which could help to bring together these disparate activities into a unified system and structure for organizing knowledge about behavior.

[Changes in behaviors and indicators of mental health between 2006 and 2010 in the French working population].

PubMed

Malard, L; Chastang, J-F; Niedhammer, I

2017-08-01

The 2008 economic crisis may have had an impact on mental health but the studies on this topic are sparse, in particular among the working population. However, mental health at work is a crucial issue involving substantial costs and consequences. The aim of the study was to assess changes in behaviors and indicators of mental health in the French working population between 2006 and 2010, and to explore the differential changes according to age, origin, occupation, activity sector, public/private sector, self-employed/employee status and work contract. The data came from the prospective national representative Santé et itinéraire professionnel (SIP) survey, including a sample of 5600 French workers interviewed in 2006 and 2010. The behaviors and indicators of mental health studied were excessive alcohol consumption, smoking, sleep problems (sleep disorders and/or insufficient sleep duration), psychotropic drug use (antidepressants, anxiolytics and/or hypnotics), and poor self-reported health. Generalized estimating equations were used to analyze changes in behaviors and indicators of mental health, and the analyses were adjusted for age. Covariates (age, origin, occupation, activity sector, public/private sector, self-employed/employee status and type of contract) were added separately to assess differential changes. Increases in excessive alcohol consumption among women, sleep problems among men, and smoking, insufficient sleep duration and poor self-reported health for both genders were observed in the French working population between 2006 and 2010. Some differential changes were observed, negative changes being more likely to affect young workers and workers with a permanent contract. Prevention policies should consider that behavior and indicators of mental health may deteriorate in times of economic crisis, especially among some sub-groups of the working population, such as young workers and workers with a permanent contract. These changes might

Identifying Opinion Leaders to Promote Behavior Change

ERIC Educational Resources Information Center

Valente, Thomas W.; Pumpuang, Patchareeya

2007-01-01

This article reviews 10 techniques used to identify opinion leaders to promote behavior change. Opinion leaders can act as gatekeepers for interventions, help change social norms, and accelerate behavior change. Few studies document the manner in which opinion leaders are identified, recruited, and trained to promote health. The authors categorize…

The Role of Incentives in Changing the Behavior of Spinal Care Providers: A Primer on Behavioral Economics in Health Care.

PubMed

Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R

2016-12-01

As spinal care transitions from individual practitioners working in a volume-based reimbursement system toward multidisciplinary health care organizations working in a population-based model with value-based reimbursement, it is critical that insurance companies, administrators, and spine care provider have a clear understanding of how incentives change physician behavior. This article will introduce the concept of behavior economics, and discuss 9 principles relevant to physician decision-making.

Sobering stories: narratives of self-redemption predict behavioral change and improved health among recovering alcoholics.

PubMed

Dunlop, William L; Tracy, Jessica L

2013-03-01

The present research examined whether the production of a narrative containing self-redemption (wherein the narrator describes a positive personality change following a negative experience) predicts positive behavioral change. In Study 1, we compared the narratives of alcoholics who had maintained their sobriety for over 4 years with those of alcoholics who had been sober 6 months or less. When describing their last drink, the former were significantly more likely to produce a narrative containing self-redemption than the latter. In Study 2, we examined the relation between the profession of self-redemption and behavioral change using a longitudinal design, by following the newly sober alcoholics from Study 1 over time. Although indistinguishable at initial assessment, newly sober alcoholics whose narratives included self-redemption were substantially more likely to maintain sobriety in the following months, compared to newly sober alcoholics who produced nonredemptive narratives; 83% of the redemptive group maintained sobriety between assessments, compared to 44% of nonredemptive participants. Redemptive participants in Study 2 also demonstrated improved health relative to the nonredemptive group. In both studies, the effects of self-redemption on sobriety and health held after controlling for relevant personality traits, alcohol dependence, recovery program involvement, initial physical and mental health, and additional narrative themes. Collectively, these results suggest that the production of a self-redemptive narrative may stimulate prolonged behavioral change and thus indicate a potentially modifiable psychological process that exhibits a major influence on recovery from addiction. PsycINFO Database Record (c) 2013 APA, all rights reserved

Developing and Evaluating Digital Interventions to Promote Behavior Change in Health and Health Care: Recommendations Resulting From an International Workshop.

PubMed

Michie, Susan; Yardley, Lucy; West, Robert; Patrick, Kevin; Greaves, Felix

2017-06-29

Devices and programs using digital technology to foster or support behavior change (digital interventions) are increasingly ubiquitous, being adopted for use in patient diagnosis and treatment, self-management of chronic diseases, and in primary prevention. They have been heralded as potentially revolutionizing the ways in which individuals can monitor and improve their health behaviors and health care by improving outcomes, reducing costs, and improving the patient experience. However, we are still mainly in the age of promise rather than delivery. Developing and evaluating these digital interventions presents new challenges and new versions of old challenges that require use of improved and perhaps entirely new methods for research and evaluation. This article discusses these challenges and provides recommendations aimed at accelerating the rate of progress in digital behavior intervention research and practice. Areas addressed include intervention development in a rapidly changing technological landscape, promoting user engagement, advancing the underpinning science and theory, evaluating effectiveness and cost-effectiveness, and addressing issues of regulatory, ethical, and information governance. This article is the result of a two-day international workshop on how to create, evaluate, and implement effective digital interventions in relation to health behaviors. It was held in London in September 2015 and was supported by the United Kingdom's Medical Research Council (MRC), the National Institute for Health Research (NIHR), the Methodology Research Programme (PI Susan Michie), and the Robert Wood Johnson Foundation of the United States (PI Kevin Patrick). Important recommendations to manage the rapid pace of change include considering using emerging techniques from data science, machine learning, and Bayesian approaches and learning from other disciplines including computer science and engineering. With regard to assessing and promoting engagement, a key

Developing and Evaluating Digital Interventions to Promote Behavior Change in Health and Health Care: Recommendations Resulting From an International Workshop

PubMed Central

Yardley, Lucy; West, Robert; Patrick, Kevin; Greaves, Felix

2017-01-01

Devices and programs using digital technology to foster or support behavior change (digital interventions) are increasingly ubiquitous, being adopted for use in patient diagnosis and treatment, self-management of chronic diseases, and in primary prevention. They have been heralded as potentially revolutionizing the ways in which individuals can monitor and improve their health behaviors and health care by improving outcomes, reducing costs, and improving the patient experience. However, we are still mainly in the age of promise rather than delivery. Developing and evaluating these digital interventions presents new challenges and new versions of old challenges that require use of improved and perhaps entirely new methods for research and evaluation. This article discusses these challenges and provides recommendations aimed at accelerating the rate of progress in digital behavior intervention research and practice. Areas addressed include intervention development in a rapidly changing technological landscape, promoting user engagement, advancing the underpinning science and theory, evaluating effectiveness and cost-effectiveness, and addressing issues of regulatory, ethical, and information governance. This article is the result of a two-day international workshop on how to create, evaluate, and implement effective digital interventions in relation to health behaviors. It was held in London in September 2015 and was supported by the United Kingdom’s Medical Research Council (MRC), the National Institute for Health Research (NIHR), the Methodology Research Programme (PI Susan Michie), and the Robert Wood Johnson Foundation of the United States (PI Kevin Patrick). Important recommendations to manage the rapid pace of change include considering using emerging techniques from data science, machine learning, and Bayesian approaches and learning from other disciplines including computer science and engineering. With regard to assessing and promoting engagement, a key

[Health behaviors between a health promotion demonstration health center and a general health center].

PubMed

Lee, Taewha; Lee, Chung-Yul; Kim, Hee-Soon; Ham, Ok-Kyung

2005-06-01

The purpose of the study was to compare community residents' perceptions, participation, satisfaction, and behavioral changes between a health promotion demonstration health center and general health center. The design of the study was ex-post facto that compared community residents in demonstration health centers and general health centers. The sample included 2,261 community residents who were conveniently selected from demonstration (792 participants) and general health centers (1,496 participants). The results of the study were as follows: 1) Perception and participation rates of exercise, nutrition, and hypertension management programs were significantly higher in the participants of demonstration health centers than those of general health centers.; 2) Satisfaction rates of all programs except the smoking cessation program were significantly higher in the participants of demonstration health centers than those of general health centers. However, only the exercise rate among risk behaviors of participants was significantly higher in demonstration health centers than general health centers. Systematic efforts for health promotion were effective not only in improving the community's awareness, participation, and satisfaction of the program, but also in changing health behaviors. This evidence should be used to foster and disseminate health promotion programs to other health centers to improve community residents' health status and quality of life.

Applying behavioral science to behavior change communication: the pathways to change tools.

PubMed

Petraglia, Joseph; Galavotti, Christine; Harford, Nicola; Pappas-DeLuca, Katina A; Mooki, Maungo

2007-10-01

Entertainment-education (EE) is a popular vehicle for behavior change communication (BCC) in many areas of public health, especially in the developing world where soap operas and other serial drama formats play a central role in encouraging people to avoid risky behavior. Yet BCC/EE developers have been largely unable to integrate behavioral theory and research systematically into storylines and scripts, depending instead on external, technical oversight of what should be an essentially local, creative process. This article describes how the Modeling and Reinforcement to Combat HIV/AIDS project at the Centers for Disease Control and Prevention has developed a set of tools through which creative writers can exercise greater control over the behavioral content of their stories. The Pathways to Change tools both guide scriptwriters as they write BCC/EE storylines and help project managers monitor BCC/EE products for theoretical fidelity and sensitivity to research.

In Pursuit of Theoretical Ground in Behavior Change Support Systems: Analysis of Peer-to-Peer Communication in a Health-Related Online Community.

PubMed

Myneni, Sahiti; Cobb, Nathan; Cohen, Trevor

2016-02-02

Research studies involving health-related online communities have focused on examining network structure to understand mechanisms underlying behavior change. Content analysis of the messages exchanged in these communities has been limited to the "social support" perspective. However, existing behavior change theories suggest that message content plays a prominent role reflecting several sociocognitive factors that affect an individual's efforts to make a lifestyle change. An understanding of these factors is imperative to identify and harness the mechanisms of behavior change in the Health 2.0 era. The objective of this work is two-fold: (1) to harness digital communication data to capture essential meaning of communication and factors affecting a desired behavior change, and (2) to understand the applicability of existing behavior change theories to characterize peer-to-peer communication in online platforms. In this paper, we describe grounded theory-based qualitative analysis of digital communication in QuitNet, an online community promoting smoking cessation. A database of 16,492 de-identified public messages from 1456 users from March 1-April 30, 2007, was used in our study. We analyzed 795 messages using grounded theory techniques to ensure thematic saturation. This analysis enabled identification of key concepts contained in the messages exchanged by QuitNet members, allowing us to understand the sociobehavioral intricacies underlying an individual's efforts to cease smoking in a group setting. We further ascertained the relevance of the identified themes to theoretical constructs in existing behavior change theories (eg, Health Belief Model) and theoretically linked techniques of behavior change taxonomy. We identified 43 different concepts, which were then grouped under 12 themes based on analysis of 795 messages. Examples of concepts include "sleepiness," "pledge," "patch," "spouse," and "slip." Examples of themes include "traditions," "social support

Health promotion in the Danish maritime setting: challenges and possibilities for changing lifestyle behavior and health among seafarers

PubMed Central

2013-01-01

Background Seafaring is a risky occupation when compared to land-based industries as incidence rates of mortality and morbidity are higher. This trend is partly due to a higher number of accidents but also higher incidence of lifestyle-related diseases like cardiovascular disease and lung cancer. In Denmark, the proportion of smokers as well as of overweight and obese persons is higher among seafarers compared to the general population. This high burden of risk indicates that this occupational group might be a growing challenge at sea in regard to safety and health issues and there is a need to further our understanding of the health promotion approaches that work. Methods A single-group pre-post design was conducted in 2008–2009 in order to identify changes in lifestyle related behaviors and health risk factors among seafarers (N: 606) in two Danish shipping companies after implementing two structural health promotion interventions (healthy cooking courses for ship cooks and improvement of fitness facilities) as well as health education interventions (smoking cessation courses, individual exercise guidance and extra health check-ups) at the maritime workplace. Baseline and follow-up data were collected with a self-administrated standardized questionnaire and individual health profiling assessing parameters such as physical health and physical fitness. In addition, qualitative interviews with participants and non-participants were conducted in order to gain in-depth information on experiences with the intervention processes. Results Significant changes were identified for levels of fitness, daily sugar intake and metabolic syndrome. However, these results were not associated with participating in the health educational interventions. One possible explanation for the improved fitness rate could be the upgrading of fitness equipment onboard the ships provided by the management level. The decrease in daily sugar intake and prevalence of seafarers with metabolic

Health promotion in the Danish maritime setting: challenges and possibilities for changing lifestyle behavior and health among seafarers.

PubMed

Hjarnoe, Lulu; Leppin, Anja

2013-12-11

Seafaring is a risky occupation when compared to land-based industries as incidence rates of mortality and morbidity are higher. This trend is partly due to a higher number of accidents but also higher incidence of lifestyle-related diseases like cardiovascular disease and lung cancer. In Denmark, the proportion of smokers as well as of overweight and obese persons is higher among seafarers compared to the general population. This high burden of risk indicates that this occupational group might be a growing challenge at sea in regard to safety and health issues and there is a need to further our understanding of the health promotion approaches that work. A single-group pre-post design was conducted in 2008-2009 in order to identify changes in lifestyle related behaviors and health risk factors among seafarers (N: 606) in two Danish shipping companies after implementing two structural health promotion interventions (healthy cooking courses for ship cooks and improvement of fitness facilities) as well as health education interventions (smoking cessation courses, individual exercise guidance and extra health check-ups) at the maritime workplace. Baseline and follow-up data were collected with a self-administrated standardized questionnaire and individual health profiling assessing parameters such as physical health and physical fitness. In addition, qualitative interviews with participants and non-participants were conducted in order to gain in-depth information on experiences with the intervention processes. Significant changes were identified for levels of fitness, daily sugar intake and metabolic syndrome. However, these results were not associated with participating in the health educational interventions. One possible explanation for the improved fitness rate could be the upgrading of fitness equipment onboard the ships provided by the management level. The decrease in daily sugar intake and prevalence of seafarers with metabolic syndrome might be associated with

Predicting the changes in depressive symptomatology in later life: how much do changes in health status, marital and caregiving status, work and volunteering, and health-related behaviors contribute?

PubMed

Choi, Namkee G; Bohman, Thomas M

2007-02-01

This study examined the unique effects of four variable groups on changes in older adults' depressive symptoms for a 2-year period: (1) baseline health and disability status, (2) changes in health and disability since baseline, (3) stability and changes in marital and caregiving status and in work and volunteering, and (4) stability and changes in health-related behaviors. With data from the 1998 and 2000 interview waves of the Health and Retirement Study, the authors used gender-separate multistep (hierarchical) residualized regression analyses in which the Center for Epidemiological Studies Depression scale (CES-D) score at follow-up is modeled as a function of the effect of each group of independent variables. As hypothesized, changes in health, disability, marital, and caregiving status explained a larger amount of variance than the existing and stable conditions, although each group of variables explained a relatively small amount (0.3-3.4%) of variance in the follow-up CES-D score.

Perception, attitude and behavior in relation to climate change: A survey among CDC health professionals in Shanxi province, China

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wei, Junni, E-mail: junxinni@163.com; Hansen, Alana, E-mail: alana.hansen@adelaide.edu.au; Zhang, Ying, E-mail: ying.zhang@sydney.edu.au

Background: A better understanding of public perceptions, attitude and behavior in relation to climate change will provide an important foundation for government's policy-making, service provider's guideline development and the engagement of local communities. The purpose of this study was to assess the perception towards climate change, behavior change, mitigation and adaptation measures issued by the central government among the health professionals in the Centres for Disease Control and Prevention (CDC) in China. Methods: In 2013, a cross-sectional questionnaire survey was undertaken among 314 CDC health professionals in various levels of CDC in Shanxi Province, China. Descriptive analyses were performed. Results:more » More than two thirds of the respondents believed that climate change has happened at both global and local levels, and climate change would lead to adverse impacts to human beings. Most respondents (74.8%) indicated the emission of greenhouse gases was the cause of climate change, however there was a lack of knowledge about greenhouse gases and their sources. Media was the main source from which respondents obtained the information about climate change. A majority of respondents showed that they were willing to change behavior, but their actions were limited. In terms of mitigation and adaptation measures issued by the Chinese Government, respondents' perception showed inconsistency between strategies and relevant actions. Moreover, although the majority of respondents believed some strategies and measures were extremely important to address climate change, they were still concerned about economic development, energy security, and local environmental protection. Conclusion: There are gaps between perceptions and actions towards climate change among these health professionals. Further efforts need to be made to raise the awareness of climate change among health professionals, and to promote relevant actions to address climate change in the

Psychosocial predictors of four health-promoting behaviors for cancer prevention using the stage of change of Transtheoretical Model.

PubMed

Choi, Jean H; Chung, Kyong-Mee; Park, Keeho

2013-10-01

The present study aimed to examine whether demographic as well as psychosocial variables related to the five stages of change of the Transtheoretical Model can predict non-clinical adults' cancer preventive and health-promoting behaviors. This study specifically focused on cancer, one of the major chronic diseases, which is a serious threat of national health. A total of 1530 adults participated in the study and completed questionnaires. Collected data were analyzed by using multinominal logistic regression. The significant predictors of later stages varied among the types of health-promoting behaviors. Certain cancer preventive health-promoting behaviors such as well-balanced diet and exercise were significantly associated with psychosocial variables including cancer prevention-related self-efficacy, personality traits, psychosocial stress, and social support. On the other hand, smoking cessation and moderate or abstinence from drinking were more likely to be predicted by demographic variables including sex and age. The present study found that in addition to self-efficacy-a relatively well-studied psychological variable-other personality traits and psychological factors including introversion, neuroticism, psychosocial stress, and social support also significantly predicted later stages of change with respect to cancer preventive health-promoting behaviors. The implications of this study are also discussed. Copyright © 2013 John Wiley & Sons, Ltd.

Complementary Tools to Empower and Sustain Behavior Change: Motivational Interviewing and Mindfulness.

PubMed

Sohl, Stephanie Jean; Birdee, Gurjeet; Elam, Roy

2016-11-01

Improving health behaviors is fundamental to preventing and controlling chronic disease. Healthcare providers who have a patient-centered communication style and appropriate behavioral change tools can empower patients to engage in and sustain healthy behaviors. This review highlights motivational interviewing and mindfulness along with other evidence-based strategies for enhancing patient-centered communication and the behavior change process. Motivational interviewing and mindfulness are especially useful for empowering patients to set self-determined, or autonomous, goals for behavior change. This is important because autonomously motivated behavioral change is more sustainable. Additional strategies such as self-monitoring are discussed as useful for supporting the implementation and maintenance of goals. Thus, there is a need for healthcare providers to develop such tools to empower sustained behavior change. The additional support of a new role, a health coach who specializes in facilitating the process of health-related behavior change, may be required to substantially impact public health.

Complementary Tools to Empower and Sustain Behavior Change: Motivational Interviewing and Mindfulness

PubMed Central

Sohl, Stephanie Jean; Birdee, Gurjeet; Elam, Roy

2015-01-01

Improving health behaviors is fundamental to preventing and controlling chronic disease. Healthcare providers who have a patient-centered communication style and appropriate behavioral change tools can empower patients to engage in and sustain healthy behaviors. This review highlights motivational interviewing and mindfulness along with other evidence-based strategies for enhancing patient-centered communication and the behavior change process. Motivational interviewing and mindfulness are especially useful for empowering patients to set self-determined, or autonomous, goals for behavior change. This is important because autonomously motivated behavioral change is more sustainable. Additional strategies such as self-monitoring are discussed as useful for supporting the implementation and maintenance of goals. Thus, there is a need for healthcare providers to develop such tools to empower sustained behavior change. The additional support of a new role, a health coach who specializes in facilitating the process of health-related behavior change, may be required to substantially impact public health. PMID:28239308

Exploring the Role of In-Person Components for Online Health Behavior Change Interventions: Can a Digital Person-to-Person Component Suffice?

PubMed Central

Kane, Deborah; Senn, Charlene Y; Woodruff, Sarah J

2018-01-01

The growth of the digital environment provides tremendous opportunities to revolutionize health behavior change efforts. This paper explores the use of Web-based, mobile, and social media health behavior change interventions and determines whether there is a need for a face-to-face or an in-person component. It is further argued that that although in-person components can be beneficial for online interventions, a digital person-to-person component can foster similar results while dealing with challenges faced by traditional intervention approaches. Using a digital person-to-person component is rooted in social and behavioral theories such as the theory of reasoned action, and the social cognitive theory, and further justified by the human support constructs of the model of supportive accountability. Overall, face-to-face and online behavior change interventions have their respective advantages and disadvantages and functions, yet both serve important roles. It appears that it is in fact human support that is the most important component in the effectiveness and adherence of both face-to-face and online behavior change interventions, and thoughtfully introducing a digital person-to-person component, to replace face-to-face interactions, can provide the needed human support while diminishing the barriers of in-person meetings. The digital person-to-person component must create accountability, generate opportunities for tailored feedback, and create social support to successfully create health behavior change. As the popularity of the online world grows, and the interest in using the digital environment for health behavior change interventions continues to be embraced, further research into not only the use of online interventions, but the use of a digital person-to-person component, must be explored. PMID:29643048

Child mental health in Jordanian orphanages: effect of placement change on behavior and caregiving.

PubMed

MacKenzie, Michael J; Gearing, Robin E; Schwalbe, Craig S; Ibrahim, Rawan W; Brewer, Kathryne B; Al-Sharaihah, Rasha

2014-12-21

To assess the mental health and behavioral problems of children in institutional placements in Jordan to inform understanding of current needs, and to explore the effects of placement change on functioning and staff perceptions of goodness-of-fit. An assessment was completed of 134 children between 1.5-12 years-of-age residing in Jordanian orphanages. The Child Behavior Checklist was used to assess prevalence rates of problems across externalizing and internalizing behavior and DSM-IV oriented subscales. Also included was caregiver perceived goodness-of-fit with each child, caregiving behavior, and two placement change-clock variables; an adjustment clock measuring time since last move, and an anticipation clock measuring time to next move. 28% were in the clinical range for the internalizing domain on the CBCL, and 22% for the externalizing domain. The children also exhibited high levels of clinical range social problems, affective disorder, pervasive developmental disorder, and conduct problems. Internalizing problems were found to decrease with time in placement as children adjust to a prior move, whereas externalizing problems increased as the time to their next age-triggered move drew closer, highlighting the anticipatory effects of change. Both behavioral problems and the change clocks were predictive of staff perceptions of goodness-of-fit with the children under their care. These findings add to the evidence demonstrating the negative effects of orphanage rearing, and highlight the importance of the association between behavioral problems and child-caregiver relationship pathways including the timing of placement disruptions and staff perceptions of goodness-of-fit.

A behavior change model for internet interventions.

PubMed

Ritterband, Lee M; Thorndike, Frances P; Cox, Daniel J; Kovatchev, Boris P; Gonder-Frederick, Linda A

2009-08-01

The Internet has become a major component to health care and has important implications for the future of the health care system. One of the most notable aspects of the Web is its ability to provide efficient, interactive, and tailored content to the user. Given the wide reach and extensive capabilities of the Internet, researchers in behavioral medicine have been using it to develop and deliver interactive and comprehensive treatment programs with the ultimate goal of impacting patient behavior and reducing unwanted symptoms. To date, however, many of these interventions have not been grounded in theory or developed from behavior change models, and no overarching model to explain behavior change in Internet interventions has yet been published. The purpose of this article is to propose a model to help guide future Internet intervention development and predict and explain behavior changes and symptom improvement produced by Internet interventions. The model purports that effective Internet interventions produce (and maintain) behavior change and symptom improvement via nine nonlinear steps: the user, influenced by environmental factors, affects website use and adherence, which is influenced by support and website characteristics. Website use leads to behavior change and symptom improvement through various mechanisms of change. The improvements are sustained via treatment maintenance. By grounding Internet intervention research within a scientific framework, developers can plan feasible, informed, and testable Internet interventions, and this form of treatment will become more firmly established.

In Pursuit of Theoretical Ground in Behavior Change Support Systems: Analysis of Peer-to-Peer Communication in a Health-Related Online Community

PubMed Central

Cobb, Nathan; Cohen, Trevor

2016-01-01

Background Research studies involving health-related online communities have focused on examining network structure to understand mechanisms underlying behavior change. Content analysis of the messages exchanged in these communities has been limited to the “social support” perspective. However, existing behavior change theories suggest that message content plays a prominent role reflecting several sociocognitive factors that affect an individual’s efforts to make a lifestyle change. An understanding of these factors is imperative to identify and harness the mechanisms of behavior change in the Health 2.0 era. Objective The objective of this work is two-fold: (1) to harness digital communication data to capture essential meaning of communication and factors affecting a desired behavior change, and (2) to understand the applicability of existing behavior change theories to characterize peer-to-peer communication in online platforms. Methods In this paper, we describe grounded theory–based qualitative analysis of digital communication in QuitNet, an online community promoting smoking cessation. A database of 16,492 de-identified public messages from 1456 users from March 1-April 30, 2007, was used in our study. We analyzed 795 messages using grounded theory techniques to ensure thematic saturation. This analysis enabled identification of key concepts contained in the messages exchanged by QuitNet members, allowing us to understand the sociobehavioral intricacies underlying an individual’s efforts to cease smoking in a group setting. We further ascertained the relevance of the identified themes to theoretical constructs in existing behavior change theories (eg, Health Belief Model) and theoretically linked techniques of behavior change taxonomy. Results We identified 43 different concepts, which were then grouped under 12 themes based on analysis of 795 messages. Examples of concepts include “sleepiness,” “pledge,” “patch,” “spouse,” and �

Healthy Behavior Change of Adults with Mental Retardation: Attendance in a Health Promotion Program

ERIC Educational Resources Information Center

Mann, Joshua; Zhou, Huafeng; McDermott, Suzanne; Poston, Mary Beth

2006-01-01

Participation in a health promotion program for 192 overweight and obese adults with mental retardation was associated with behavior change resulting in reduction of body mass index--BMI (weight in kg, divided by height in meters, squared) by the end of the program. We analyzed the mediating and intermediate factors contributing to weight…

Surviving and thriving with cancer using a Web-based health behavior change intervention: randomized controlled trial.

PubMed

Bantum, Erin O'Carrol; Albright, Cheryl L; White, Kami K; Berenberg, Jeffrey L; Layi, Gabriela; Ritter, Phillip L; Laurent, Diana; Plant, Katy; Lorig, Kate

2014-02-24

Given the substantial improvements in cancer screening and cancer treatment in the United States, millions of adult cancer survivors live for years following their initial cancer diagnosis and treatment. However, latent side effects can occur and some symptoms can be alleviated or managed effectively via changes in lifestyle behaviors. The purpose of this study was to test the effectiveness of a six-week Web-based multiple health behavior change program for adult survivors. Participants (n=352) were recruited from oncology clinics, a tumor registry, as well as through online mechanisms, such as Facebook and the Association of Cancer Online Resources (ACOR). Cancer survivors were eligible if they had completed their primary cancer treatment from 4 weeks to 5 years before enrollment. Participants were randomly assigned to the Web-based program or a delayed-treatment control condition. In total, 303 survivors completed the follow-up survey (six months after completion of the baseline survey) and participants in the Web-based intervention condition had significantly greater reductions in insomnia and greater increases in minutes per week of vigorous exercise and stretching compared to controls. There were no significant changes in fruit and vegetable consumption or other outcomes. The Web-based intervention impacted insomnia and exercise; however, a majority of the sample met or exceeded national recommendations for health behaviors and were not suffering from depression or fatigue at baseline. Thus, the survivors were very healthy and well-adjusted upon entry and their ability to make substantial health behavior changes may have been limited. Future work is discussed, with emphasis placed on ways in which Web-based interventions can be more specifically analyzed for benefit, such as in regard to social networking. Clinicaltrials.gov NCT00962494; http://www.clinicaltrials.gov/ct2/show/NCT00962494 (Archived by WebCite at http://www.webcitation.org/6NIv8Dc6Q).

Does knowledge of coronary artery calcium affect cardiovascular risk perception, likelihood of taking action, and health-promoting behavior change?

PubMed

Johnson, Jennie E; Gulanick, Meg; Penckofer, Sue; Kouba, Joanne

2015-01-01

Evidence indicates that a healthy lifestyle can reduce cardiovascular disease risk, yet many people engage in unhealthy behaviors. New technologies such as coronary artery calcium (CAC) screening detect atherosclerosis before clinical disease is manifested. Knowledge of an abnormal finding could provide the "teachable moment" to enhance motivation for change. The aim of this study was to examine how knowledge of CAC score affects risk perception, likelihood of taking action, and health-promoting behavior change in persons at high risk for cardiovascular disease. This study used a descriptive prospective design with 174 high-risk adults (≥3 major risk factors) recruited at a radiology center offering CAC scans. Baseline self-report surveys using the Perception of Risk of Heart Disease Scale, the Benefits and Barriers Scale, the Quality of Life Index, and the Health-Promoting Lifestyle Profile II were completed immediately after a screening CAC scan but before results were known. Follow-up occurred 3 months later using mailed packets. Participants' mean age was 58 years; 62% were men, 89% were white, and most were well educated. There was no significant change in risk perception scores over time or between groups, except for a positive interaction in the moderate-risk group (CAC scores of 101-400) (P = .004). Quality of life remained unchanged. Health-promoting behavior changes increased in all groups over time (P < .001). McNemar χ² analysis indicated that risk reduction medication use increased in all groups, with a significant increase in statin (P < .001) and aspirin (P < .001) intake. Predictors of behavior change were perceived barriers (β = -.41; P < .001) and quality of life (β = .44; P < .001). Knowledge of CAC score does impact risk perception for some at-risk groups. This knowledge does enhance motivation for behavior change. Knowledge of CAC score does not impact quality of life. It is hoped that through improved understanding of the effect of CAC

Exploring the Role of In-Person Components for Online Health Behavior Change Interventions: Can a Digital Person-to-Person Component Suffice?

PubMed

Santarossa, Sara; Kane, Deborah; Senn, Charlene Y; Woodruff, Sarah J

2018-04-11

The growth of the digital environment provides tremendous opportunities to revolutionize health behavior change efforts. This paper explores the use of Web-based, mobile, and social media health behavior change interventions and determines whether there is a need for a face-to-face or an in-person component. It is further argued that that although in-person components can be beneficial for online interventions, a digital person-to-person component can foster similar results while dealing with challenges faced by traditional intervention approaches. Using a digital person-to-person component is rooted in social and behavioral theories such as the theory of reasoned action, and the social cognitive theory, and further justified by the human support constructs of the model of supportive accountability. Overall, face-to-face and online behavior change interventions have their respective advantages and disadvantages and functions, yet both serve important roles. It appears that it is in fact human support that is the most important component in the effectiveness and adherence of both face-to-face and online behavior change interventions, and thoughtfully introducing a digital person-to-person component, to replace face-to-face interactions, can provide the needed human support while diminishing the barriers of in-person meetings. The digital person-to-person component must create accountability, generate opportunities for tailored feedback, and create social support to successfully create health behavior change. As the popularity of the online world grows, and the interest in using the digital environment for health behavior change interventions continues to be embraced, further research into not only the use of online interventions, but the use of a digital person-to-person component, must be explored. ©Sara Santarossa, Deborah Kane, Charlene Y Senn, Sarah J Woodruff. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 11.04.2018.

Leading during change: the effects of leader behavior on sickness absence in a Norwegian health trust.

PubMed

Bernstrøm, Vilde Hoff; Kjekshus, Lars Erik

2012-09-17

Organizational change often leads to negative employee outcomes such as increased absence. Because change is also often inevitable, it is important to know how these negative outcomes could be reduced. This study investigates how the line manager's behavior relates to sickness absence in a Norwegian health trust during major restructuring. Leader behavior was measured by questionnaire, where employees assessed their line manager's behavior (N = 1008; response rate 40%). Data on sickness absence were provided at department level (N = 35) and were measured at two times. Analyses were primarily conducted using linear regression; leader behavior was aggregated and weighted by department size. The results show a relationship between several leader behaviors and sickness absence. The line managers' display of loyalty to their superiors was related to higher sickness absence; whereas task monitoring was related to lower absence. Social support was related to higher sickness absence. However, the effect of social support was no longer significant when the line manager also displayed high levels of problem confrontation. The findings clearly support the line manager's importance for employee sickness absence during organizational change. We conclude that more awareness concerning the manager's role in change processes is needed.

Possible Solutions as a Concept in Behavior Change Interventions.

PubMed

Mahoney, Diane E

2018-04-24

Nurses are uniquely positioned to implement behavior change interventions. Yet, nursing interventions have traditionally resulted from nurses problem-solving rather than allowing the patient to self-generate possible solutions for attaining specific health outcomes. The purpose of this review is to clarify the meaning of possible solutions in behavior change interventions. Walker and Avant's method on concept analysis serves as the framework for examination of the possible solutions. Possible solutions can be defined as continuous strategies initiated by patients and families to overcome existing health problems. As nurses engage in behavior change interventions, supporting patients and families in problem-solving will optimize health outcomes and transform clinical practice. © 2018 NANDA International, Inc.

Theory's role in shaping behavioral health research for population health.

PubMed

King, Abby C

2015-11-26

The careful application of theory often is used in the behavioral health field to enhance our understanding of how the world currently works. But theory also can help us visualize what the world can become, particularly through its potential impacts on population-wide health. Applying a multi-level ecological perspective can help in expanding the field's focus upward toward the population at large. While ecological frameworks have become increasingly popular, arguably such perspectives have fallen short of their potential to actively bridge conceptual constructs and, by extension, intervention approaches, across different levels of population impact. Theoretical and conceptual perspectives that explicitly span levels of impact offer arguably the greatest potential for achieving scientific insights that may in turn produce the largest population health effects. Examples of such "bridging" approaches include theories and models that span behavioral + micro-environment, behavioral + social/cultural, and social + physical environment constructs. Several recommendations are presented related to opportunities for leveraging theories to attain the greatest impact in the population health science field. These include applying the evidence obtained from person-level theories to inform methods for positively impacting the behaviors of community gatekeepers and decision-makers for greater population change and reach; leveraging the potential of residents as "citizen scientists"--a resource for enacting behavioral health changes at the individual, environmental, and policy levels; using empirical observations and theory in equal parts to build more robust, relevant, and solution-oriented behavior change programs; exploring moderators and mediators of change at levels of impact that go beyond the individual; and considering the circumstances in which applying conceptual methods that embrace a "complexity" as opposed to "causality" perspective may lead to more

Partnering With Community-Dwelling Individuals With Diabetes for Health Behavior Change Using Action Plans: An Innovation in Health Professionals Education and Practice.

PubMed

Barry Hultquist, Teresa; Brown, Sara Goomis; Geske, Jenenne; Kaiser, Katherine Laux; Waibel-Rycek, Denise

2015-11-01

Health care practitioners support or hinder an individual's attempts to self-manage health behavior. Practitioners must understand an individual's health needs and goals to effectively partner for behavior change. Self-management support (SMS) promote efforts toward positive health behavior change. Practitioners need training to provide effective SMS, beginning with their formal education. The purpose of this educational practice project was to integrate an evidence-based intervention (SMS using action plans) into a nursing curriculum. Three sequential steps included (1) providing foundational SMS education, (2) SMS application with students' personal action plans, and (3) implementing SMS with community-dwelling individuals with diabetes. Students (n = 130) partnered with participants (n = 85), developing short- (n = 240) and long-term (n = 99) action plans during home visits. The average baseline Diabetes Empowerment Scale score measuring participant's perceived psychosocial diabetes management self-efficacy was 4.3 (1-5 scale, SD = 0.51, n = 83). Most common short-term actions related to physical activity (n = 100, 42%) and healthy eating (n = 61, 25%). Average participant confidence level was 7.7 (SD = 1.9, 0-10 scale). Short-term goal evaluation (n = 209) revealed 66% (n = 137) were met more than 50% of the time. Both participants (99%) and students (99%) expressed satisfaction with home visit and action plan experiences. This teaching-learning experience is replicable and applicable to any professional health care student. © 2015 Society for Public Health Education.

The Pace of Technologic Change: Implications for Digital Health Behavior Intervention Research.

PubMed

Patrick, Kevin; Hekler, Eric B; Estrin, Deborah; Mohr, David C; Riper, Heleen; Crane, David; Godino, Job; Riley, William T

2016-11-01

This paper addresses the rapid pace of change in the technologies that support digital interventions; the complexity of the health problems they aim to address; and the adaptation of scientific methods to accommodate the volume, velocity, and variety of data and interventions possible from these technologies. Information, communication, and computing technologies are now part of every societal domain and support essentially every facet of human activity. Ubiquitous computing, a vision articulated fewer than 30 years ago, has now arrived. Simultaneously, there is a global crisis in health through the combination of lifestyle and age-related chronic disease and multiple comorbidities. Computationally intensive health behavior interventions may be one of the most powerful methods to reduce the consequences of this crisis, but new methods are needed for health research and practice, and evidence is needed to support their widespread use. The challenges are many, including a reluctance to abandon timeworn theories and models of health behavior-and health interventions more broadly-that emerged in an era of self-reported data; medical models of prevention, diagnosis, and treatment; and scientific methods grounded in sparse and expensive data. There are also many challenges inherent in demonstrating that newer approaches are, indeed, effective. Potential solutions may be found in leveraging methods of research that have been shown to be successful in other domains, particularly engineering. A more "agile science" may be needed that streamlines the methods through which elements of health interventions are shown to work or not, and to more rapidly deploy and iteratively improve those that do. There is much to do to advance the issues discussed in this paper, and the papers in this theme issue. It remains an open question whether interventions based in these new models and methods are, in fact, equally if not more efficacious as what is available currently. Economic

Perception, attitude and behavior in relation to climate change: a survey among CDC health professionals in Shanxi province, China.

PubMed

Wei, Junni; Hansen, Alana; Zhang, Ying; Li, Hong; Liu, Qiyong; Sun, Yehuan; Bi, Peng

2014-10-01

A better understanding of public perceptions, attitude and behavior in relation to climate change will provide an important foundation for government׳s policy-making, service provider׳s guideline development and the engagement of local communities. The purpose of this study was to assess the perception towards climate change, behavior change, mitigation and adaptation measures issued by the central government among the health professionals in the Centres for Disease Control and Prevention (CDC) in China. In 2013, a cross-sectional questionnaire survey was undertaken among 314 CDC health professionals in various levels of CDC in Shanxi Province, China. Descriptive analyses were performed. More than two thirds of the respondents believed that climate change has happened at both global and local levels, and climate change would lead to adverse impacts to human beings. Most respondents (74.8%) indicated the emission of greenhouse gases was the cause of climate change, however there was a lack of knowledge about greenhouse gases and their sources. Media was the main source from which respondents obtained the information about climate change. A majority of respondents showed that they were willing to change behavior, but their actions were limited. In terms of mitigation and adaptation measures issued by the Chinese Government, respondents׳ perception showed inconsistency between strategies and relevant actions. Moreover, although the majority of respondents believed some strategies and measures were extremely important to address climate change, they were still concerned about economic development, energy security, and local environmental protection. There are gaps between perceptions and actions towards climate change among these health professionals. Further efforts need to be made to raise the awareness of climate change among health professionals, and to promote relevant actions to address climate change in the context of the proposed policies with local

A structural model of health behavior: a pragmatic approach to explain and influence health behaviors at the population level.

PubMed

Cohen, D A; Scribner, R A; Farley, T A

2000-02-01

Behavior is influenced by individual-level attributes as well as by the conditions under which people live. Altering policies, practices, and the conditions of life can directly and indirectly influence individual behavior. This paper builds on existing ecological theories of health behavior by specifying structural mechanisms by which population-level factors effect change in individual health behaviors. This paper moves ecological theory from model building to a pragmatic characterization of structural interventions. We examined social and environmental factors beyond individual control and mechanisms as to how they influence behavior. Four categories of structural factors are identified: (1) availability of protective or harmful consumer products, (2) physical structures (or physical characteristics of products), (3) social structures and policies, and (4) media and cultural messages. The first three can directly influence individuals through facilitating or constraining behavior. The fourth, media, operates by changing individual-level attitudes, beliefs, and cognitions, as well as group norms. Interventions that target the four identified structural factors are a means to provide conditions that not only reduce high-risk behavior but also prevent the adoption of high-risk behaviors. Structural interventions are important and underutilized approaches for improving our nation's health. Copyright 2000 American Health Foundation and Academic Press.

Leading during change: the effects of leader behavior on sickness absence in a Norwegian health trust

PubMed Central

2012-01-01

Background Organizational change often leads to negative employee outcomes such as increased absence. Because change is also often inevitable, it is important to know how these negative outcomes could be reduced. This study investigates how the line manager’s behavior relates to sickness absence in a Norwegian health trust during major restructuring. Methods Leader behavior was measured by questionnaire, where employees assessed their line manager’s behavior (N = 1008; response rate 40%). Data on sickness absence were provided at department level (N = 35) and were measured at two times. Analyses were primarily conducted using linear regression; leader behavior was aggregated and weighted by department size. Results The results show a relationship between several leader behaviors and sickness absence. The line managers’ display of loyalty to their superiors was related to higher sickness absence; whereas task monitoring was related to lower absence. Social support was related to higher sickness absence. However, the effect of social support was no longer significant when the line manager also displayed high levels of problem confrontation. Conclusions The findings clearly support the line manager’s importance for employee sickness absence during organizational change. We conclude that more awareness concerning the manager’s role in change processes is needed. PMID:22984817

Behavioral science perspectives on health hazard/health risk appraisal.

PubMed Central

Becker, M H; Janz, N K

1987-01-01

Health-promotion efforts often employ HRA as a device for providing an individual with quantitative information about the consequences of personal health-related behaviors and as an attempt to motivate the client to adopt recommendations directed at establishing a healthier lifestyle. From a behavioral science perspective, the HRA approach and process contain elements that (at least in retrospective analysis) appear to be founded in relevant bodies of theory. First, HRA seems to be a reasonably efficient mechanism for transmitting information relative to associations between personal health behaviors and mortality risks. Moreover, while general knowledge and advice about the untoward consequences of risk factors (such as smoking, obesity, high blood pressure, etc.) are currently widespread, HRA provides new and specific information: the client's own relative risks. Some individuals who voluntarily participate in HRA bring to the experience an already high level of readiness to take action; for them, the technique may constitute the final necessary stimulus or "cue to action" [12]. Referring to a "borrowing from the future" phenomenon, Green points out that "some educational efforts are really only triggers to behavior that would have changed eventually anyway" [44, p. 159]. Thus, where motivation is sufficiently high, receipt of HRA feedback information may by itself be capable of inducing behavior change. Second, the focus on awareness and personalization of mortality risk fits well with most theoretical formulations concerning attitudes and beliefs involved in health-related decision making. Although the emphasis on mortality and often distant negative outcomes is problematic, increasing the client's perception of personal vulnerability is a psychologically defensible approach, and fear arousal can generate attitude change (although questions of appropriate level, duration of effects obtained, acceptability, etc. still need to be resolved). Third, HRA might be

Health behavior theories as predictors of hearing-aid uptake and outcomes.

PubMed

Saunders, Gabrielle H; Frederick, Melissa T; Silverman, ShienPei C; Nielsen, Claus; Laplante-Lévesque, Ariane

2016-07-01

To understand hearing behaviors of adults seeking help for the first time through the application of two models of health behavior change: the transtheoretical model and the health belief model. The relationships between attitudes and beliefs were examined relative to hearing-aid uptake and outcomes six months later. One hundred and sixty adults completed the University of Rhode Island change assessment (targeting the transtheoretical model), and the hearing beliefs questionnaire (targeting the health belief model), as well as the hearing handicap inventory and the psychosocial impact of hearing loss scale, within two months of an initial hearing assessment. Six months later, participants completed these same questionnaires, while those who had taken up hearing aids also completed hearing-aid outcome questionnaires. (1) Attitudes and beliefs were associated with future hearing-aid uptake, and were effective at modeling this behavior; (2) attitudes and beliefs changed following behavior change, and (3) attitudes and beliefs following behavior change were better predictors of hearing-aid outcomes than pre-behavior change attitudes and beliefs. A counseling-based intervention targeting the attitudes and beliefs assessed by the transtheoretical model and the health belief model has the potential to increase uptake of hearing health care.

Training Peer Sexual Health Educators: Changes in Knowledge, Counseling Self-Efficacy, and Sexual Risk Behavior

ERIC Educational Resources Information Center

Ehrhardt, Britt L.; Krumboltz, John D.; Koopman, Cheryl

2007-01-01

Peer sexual health education programs are widespread on college campuses, but little research has assessed the effect of these programs on the peer educators. This study employed a repeated measures design to examine changes over the academic quarter in the knowledge, counseling self-efficacy, and sexual behavior of 70 college students enrolled in…

Developing games for health behavior change: Getting started

USDA-ARS?s Scientific Manuscript database

Many investigators are considering developing video games for health (video-G4Hs) but have questions about how to get started. This report provides guidance for investigators considering a G4H as a behavioral intervention procedure from a team of experienced G4H developers. Thirteen commonly asked q...

State of the evidence regarding behavior change theories and strategies in nutrition counseling to facilitate health and food behavior change.

PubMed

Spahn, Joanne M; Reeves, Rebecca S; Keim, Kathryn S; Laquatra, Ida; Kellogg, Molly; Jortberg, Bonnie; Clark, Nicole A

2010-06-01

Behavior change theories and models, validated within the field of dietetics, offer systematic explanations for nutrition-related behavior change. They are integral to the nutrition care process, guiding nutrition assessment, intervention, and outcome evaluation. The American Dietetic Association Evidence Analysis Library Nutrition Counseling Workgroup conducted a systematic review of peer-reviewed literature related to behavior change theories and strategies used in nutrition counseling. Two hundred fourteen articles were reviewed between July 2007 and March 2008, and 87 studies met the inclusion criteria. The workgroup systematically evaluated these articles and formulated conclusion statements and grades based upon the available evidence. Strong evidence exists to support the use of a combination of behavioral theory and cognitive behavioral theory, the foundation for cognitive behavioral therapy (CBT), in facilitating modification of targeted dietary habits, weight, and cardiovascular and diabetes risk factors. Evidence is particularly strong in patients with type 2 diabetes receiving intensive, intermediate-duration (6 to 12 months) CBT, and long-term (>12 months duration) CBT targeting prevention or delay in onset of type 2 diabetes and hypertension. Few studies have assessed the application of the transtheoretical model on nutrition-related behavior change. Little research was available documenting the effectiveness of nutrition counseling utilizing social cognitive theory. Motivational interviewing was shown to be a highly effective counseling strategy, particularly when combined with CBT. Strong evidence substantiates the effectiveness of self-monitoring and meal replacements and/or structured meal plans. Compelling evidence exists to demonstrate that financial reward strategies are not effective. Goal setting, problem solving, and social support are effective strategies, but additional research is needed in more diverse populations. Routine documentation

Targeting Health Behaviors to Reduce Health Care Costs in Pediatric Psychology: Descriptive Review and Recommendations

PubMed Central

Hommel, Kevin A.

2016-01-01

Objective Recent efforts to enhance the quality of health care in the United States while reducing costs have resulted in an increased emphasis on cost containment and the introduction of new payment plans. The purpose of this review is to summarize the impact of pediatric health behavior change interventions on health care costs. Methods A review of PubMed, PsycINFO, and PEDE databases identified 15 articles describing the economic outcomes of pediatric health behavior change interventions. Data describing the intervention, health outcome, and economic outcome were extracted. Results All interventions targeting cigarette smoking (n = 3) or the prevention of a chronic medical condition (n = 5) were predicted to avert hundreds of dollars in health care costs per patient. Five of the seven interventions targeting self-management were associated with reductions in health care costs. Conclusions Pediatric health behavior change interventions may be a valuable component of efforts to improve population health while reducing health care costs. PMID:26359311

Does the perception that God controls health outcomes matter for health behaviors?

PubMed

Karvinen, Kristina H; Carr, Lucas J

2014-04-01

The purpose of this study was to examine the associations between God Locus of Health Control, health behaviors, and beliefs utilizing a cross-sectional online survey (N = 549). Results indicated that God Locus of Health Control was correlated with alcohol use, physical activity, perceived risk of chronic disease, and beliefs that poor health behaviors contribute to chronic disease (all p values < .05). Multiple regression analyses including covariates and other locus of control variables revealed that God Locus of Health Control was only an independent correlate of the belief that physical inactivity contributed to chronic disease. Insights from this study may be important for future faith-based health behavior change interventions.

Financing results and value in behavioral health services.

PubMed

2003-11-01

Current changes require that behavioral health care leaders understand how public and private financing mechanisms interact and how, now more than ever, behavioral health care leadership must span multiple systems and financing streams. Understanding how financing mechanisms work, what they create, and what they cause is essential if we are to make the most of increasingly limited and increasingly complex resource streams in today's health care market. This article explores a different paradigm of what adds value to publicly funded behavioral health care systems, and provides the framework for the American College of Mental Health Administration's call to behavioral health care administrators to take a new approach to the considerations behind funding decisions and payment mechanisms.

The Benefits and Challenges of Multiple Health Behavior Change in Research and in Practice

PubMed Central

Prochaska, Judith J.; Nigg, Claudio R.; Spring, Bonnie; Velicer, Wayne F.; Prochaska, James O.

2009-01-01

Objective The major chronic diseases are caused by multiple risks, yet the science of multiple health behavior change (MHBC) is at an early stage, and factors that facilitate or impede scientists’ involvement in MHBC research are unknown. Benefits and challenges of MHBC interventions were investigated to strengthen researchers’ commitment and prepare them for challenges. Method An online anonymous survey was emailed to listservs of the Society of Behavioral Medicine between May 2006 and 2007. Respondents (N = 69) were 83% female; 94% held a doctoral degree; 64% were psychologists, 24% were in public health; 83% targeted MHBC in their work. Results A sample majority rated 23 of the 24 benefits, but only 1 of 31 challenge items, as very-to-extremely important. Those engaged in MHBC rated the total benefits significantly higher than respondents focused on single behaviors, F(1,69) = 4.21, p<.05, and rated the benefits significantly higher than the challenges: paired t(57) = 7.50, p<.001. The two groups did not differ in ratings of challenges. Conclusion It appears individuals focused solely on single behaviors do not fully appreciate the benefits that impress MHBC researchers; it is not that substantial barriers are holding them back. Benefits of MHBC interventions need emphasizing more broadly to advance this research area. PMID:19948184

Identifying opinion leaders to promote behavior change.

PubMed

Valente, Thomas W; Pumpuang, Patchareeya

2007-12-01

This article reviews 10 techniques used to identify opinion leaders to promote behavior change. Opinion leaders can act as gatekeepers for interventions, help change social norms, and accelerate behavior change. Few studies document the manner in which opinion leaders are identified, recruited, and trained to promote health. The authors categorize close to 200 studies that have studied or used opinion leaders to promote behavior change into 10 different methods. They present the advantages and disadvantages of the 10 opinion leader identification methods and provide sample instruments for each. Factors that might influence programs to select one or another method are then discussed, and the article closes with a discussion of combining and comparing methods.

Power of Peer Support to Change Health Behavior to Reduce Risks for Heart Disease and Stroke for African American Men in a Faith-Based Community.

PubMed

Lee, Sohye; Schorr, Erica; Hadidi, Niloufar Niakosari; Kelley, Robin; Treat-Jacobson, Diane; Lindquist, Ruth

2018-02-01

Peer support has powerful potential to improve outcomes in a program of health behavior change; yet, how peer support is perceived by participants, its role, and how it contributes to intervention efficacy is not known, especially among African Americans. The purpose of this study was to identify the subjectively perceived experience and potential contributions of peer support to the outcomes of a peer group behavioral intervention designed to change health behavior to reduce risks for heart disease and stroke in African American men in a faith-based community. A peer support group intervention was implemented to increase health knowledge and to improve health behaviors in line with the American Heart Association's Life Simple 7 domains (get active, control cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar, and stop smoking). Fourteen peer group sessions and eight follow-up interviews with program participants were recorded, transcribed, and analyzed. Seven key themes emerged, including (1) enhancing access to health behavior information and resources, (2) practicing and applying problem-solving skills with group feedback and support, (3) discussing health behavior challenges and barriers, (4) sharing health behavior changes, (5) sharing perceived health outcome improvements and benefits, (6) feelings of belonging and being cared for, and (7) addressing health of family and community. Qualitative findings revealed a positive perception of peer support and greater understanding of potential reasons why it may be an effective strategy for African American men.

Applying a new theory to smoking cessation: case of multi-theory model (MTM) for health behavior change.

PubMed

Sharma, Manoj; Khubchandani, Jagdish; Nahar, Vinayak K

2017-01-01

Background: Smoking continues to be a public health problem worldwide. Smoking and tobacco use are associated with cardiovascular diseases that include coronary heart disease, atherosclerosis, cerebrovascular disease, and abdominal aortic aneurysm. Programs for quitting smoking have played a significant role in reduction of smoking in the United States. The smoking cessation interventions include counseling, nicotine replacement therapy, buproprion therapy, and varenicline therapy. The success rates with each of these approaches vary with clear need for improvement. Moreover, there is a need for a robust theory that can guide smoking cessation counseling interventions and increase the success rates. A fourth generation approach using multi-theory model (MTM) of health behavior change is introduced in this article for smoking cessation. An approach for developing and evaluating an intervention for smoking cessation is presented along with a measurement tool. Methods: A literature review reifying the MTM of health behavior change for smoking cessation has been presented. An instrument designed to measure constructs of MTM and associated smoking cessation behavior has been developed. Results: The instrument developed is available for validation, reliability and prediction study pertaining to smoking cessation. The intervention is available for testing in a randomized control trial involving smokers. Conclusion: MTM is a robust theory that holds promise for testing and application to smoking cessation.

Targeting couple and parent-child coercion to improve health behaviors.

PubMed

Smith Slep, Amy M; Heyman, Richard E; Mitnick, Danielle M; Lorber, Michael F; Beauchaine, Theodore P

2018-02-01

This phase of the NIH Science of Behavior Change program emphasizes an "experimental medicine approach to behavior change," that seeks to identify targets related to stress reactivity, self-regulation, and social processes for maximal effects on multiple health outcomes. Within this framework, our project focuses on interpersonal processes associated with health: coercive couple and parent-child conflict. Diabetes and poor oral health portend pain, distress, expense, loss of productivity, and even mortality. They share overlapping medical regimens, are driven by overlapping proximal health behaviors, and affect a wide developmental span, from early childhood to late adulthood. Coercive couple and parent-child conflict constitute potent and destructive influences on a wide range of adult and child health outcomes. Such interaction patterns give rise to disturbed environmental stress reactivity (e.g., disrupted sympathetic nervous and parasympathetic nervous systems) and a wide range of adverse health outcomes in children and adults, including dental caries, obesity, and diabetes-related metabolic markers. In this work, we seek to identify/develop/validate assays assessing coercion, identify/develop and test brief interventions to reduce coercion, and test whether changes in coercion trigger changes in health behaviors. Copyright © 2017 Elsevier Ltd. All rights reserved.

A structural model of health behavior modification among patients with cardiovascular disease.

PubMed

Goong, Hwasoo; Ryu, Seungmi; Xu, Lijuan

2016-02-01

The purpose of the study was to test a structural equation model in which social support, health beliefs, and stage of change predict the health behaviors of patients with cardiovascular disease. A cross-sectional correlational design was used. Using convenience sampling, a survey about social support, health belief, stage of change, and health behavior was completed by 314 adults with cardiovascular disease from outpatient clinics in 2 university hospitals in Korea. Data were analyzed using a structural equation model with the Analysis of Moment program. The participants were aged 53.44±13.19 years (mean±SD), and about 64% of them were male. The proposed model fit the data from the study well, explaining 19% and 60% of the variances in the stage of change and health behavior, respectively. The findings indicate that the performance of health behavior modification among the patients with cardiovascular disease can be explained by social support, health belief, and stage of change based on a health-belief and stage-of-change model. Further studies are warranted to confirm the efficacy of health-promoting strategies in initiating and maintaining the performance of health behaviors by providing social support from family and medical staff and enhancing health belief. Copyright © 2015 Elsevier Inc. All rights reserved.

A longitudinal examination of the interrelationship of multiple health behaviors.

PubMed

deRuiter, Wayne K; Cairney, John; Leatherdale, Scott T; Faulkner, Guy E J

2014-09-01

Evaluating the interrelationship of health behaviors could assist in the development of effective public health interventions. Furthermore, the ability to identify cognitive mediators that may influence multiple behavioral changes requires evaluation. To evaluate covariation among health behaviors, specifically alcohol consumption, leisure-time physical activity, and smoking, and examine whether mastery acts as a mediating social-cognitive mechanism that facilitates multiple health behavior change in a longitudinal analysis. In 2010, secondary data analysis was conducted on the first seven cycles of the Canadian National Population Health Survey. Data collection began in 1994-1995 and has continued biennially. At the time of this analysis, only seven cycles of data (2006-2007) were available. Parallel process growth curve models were used to analyze covariation between health behaviors and the potential mediating effects of perceived mastery. Increases in leisure-time physical activity were associated with reductions in tobacco use, whereas declines in alcohol consumption were associated with decreases in tobacco use. Covariation between alcohol consumption and leisure-time physical activity did not reach statistical significance. For the most part, mastery was unsuccessful in mediating the interrelationship of multiple behavioral changes. Health behaviors are not independent but rather interrelated. In order to optimize limited prevention resources, these results suggest that population-level intervention efforts targeting multiple modifiable behavioral risk factors may not need to occur simultaneously. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

Behavioral Health Integration in Large Multi-group Pediatric Practice.

PubMed

Schlesinger, Abigail Boden

2017-03-01

There is increasing interest in methods to improve access to behavioral health services for children and adolescents. Children's Community Pediatric Behavioral Health Service (CCPBHS) is an integrated behavioral health service whose method of (a) creating a leadership team with empowered administrative and clinical stakeholders who can act on a commitment to change and (b) having a clear mission statement with integrated administrative and clinical care processes can serve as a model for implementing integration efforts within the medical home. Community Pediatrics Behavioral Health Service (CPBHS) is a sustainable initiative that improved the utilization of physical health and behavioral health systems for youth and improved the utilization of evidence-based interventions for youth served in primary care.

Personality Change following Internet-Based Cognitive Behavior Therapy for Severe Health Anxiety

PubMed Central

Hedman, Erik; Andersson, Gerhard; Lindefors, Nils; Gustavsson, Petter; Lekander, Mats; Rück, Christian; Andersson, Erik; Ljótsson, Brjánn

2014-01-01

Personality traits have traditionally been viewed as stable, but recent studies suggest that they could be affected through psychological treatment. Internet-based cognitive behavior therapy (ICBT) for severe health anxiety (DSM-IV hypochondriasis) has been shown to be effective in reducing health anxiety, but its effect on measures of personality traits has not been investigated. The main aim of this study was to investigate the impact of ICBT on personality traits in the three broad dimensions - neuroticism, extraversion and aggression. We hypothesized that participants in ICBT would reduce their level of neuroticism compared to controls that did not receive the active treatment. No specific predictions were made regarding extraversion and aggression. Data from a randomized controlled trial were used in which participants were allocated to 12 weeks of ICBT (n = 40) or to a basic attention control condition (n = 41). Personality traits were assessed with the Swedish Universities Scales of Personality and the primary outcome of health anxiety was the Health Anxiety Inventory. There was a significant interaction effect of group and time on neuroticism-related scales, indicating larger pre- to post-treatment reductions in the Internet-based CBT group compared to the control condition. Analyses at 6-month follow-up showed that changes were stable. Traits relating to extraversion and aggression were largely unchanged. This study is the first to demonstrate that a brief ICBT intervention for severe health anxiety causes long-term changes in measures of personality traits related to neuroticism. The treatment thus has a broader impact than just reducing health anxiety. Trial Registration Clinicaltrials.gov (ID NCT00828152) PMID:25437150

Sleep, health behaviors, and behavioral interventions: Reducing the risk of cardiovascular disease in adults

PubMed Central

Kaar, Jill L; Luberto, Christina M; Campbell, Kirsti A; Huffman, Jeff C

2017-01-01

Numerous health behaviors, including physical activity, diet, smoking, and sleep, play a major role in preventing the development and progression of cardiovascular disease (CVD). Among these behaviors, sleep may play a pivotal role, yet it has been studied somewhat less than other behaviors and there have been few well-designed sleep intervention studies targeting CVD. Furthermore, despite the fact that these behaviors are often interrelated, interventions tend to focus on changing one health behavior rather than concurrently intervening on multiple behaviors. Psychological constructs from depression to positive affect may also have a major effect on these health behaviors and ultimately on CVD. In this review, we summarize the existing literature on the impact of sleep and other cardiac health behaviors on CVD onset and prognosis. We also describe interventions that may promote these behaviors, from established interventions such as motivational interviewing and cognitive behavioral therapy, to more novel approaches focused on mindfulness and other positive psychological constructs. Finally, we outline population-health-level care management approaches for patients with psychiatric conditions (e.g., depression) that may impact cardiac health, and discuss their potential utility in improving mental health, promoting health behaviors, and reducing CVD-related risk. Much work is still needed to better understand how sleep and other health behaviors may uniquely contribute to CVD risk, and additional high-quality studies of interventions designed to modify cardiac health behaviors are required to improve cardiovascular health in individuals and the population at large. PMID:28603586

[Health and health-related behaviors according to sexual attraction and behavior].

PubMed

Pérez, Glòria; Martí-Pastor, Marc; Gotsens, Mercè; Bartoll, Xavier; Diez, Elia; Borrell, Carme

2015-01-01

to Describe perceived health, mental health and certain health-related behaviors according to sexual attraction and behavior in the population residing in Barcelona in 2011. Perceived health, mental health, chronic conditions and health-related behaviors were analyzed in 2675 people aged 15 to 64 years. The Barcelona Health Survey for 2011 was used, which included questions on sexual attraction and behavior. Multivariate robust Poisson regression models were fitted to obtain adjusted prevalence ratios. People feeling same-sex attraction reported a higher prevalence of worse perceived and mental health. These people and those who had had sex with persons of the same sex more frequently reported harmful health-related behaviors. Lesbian, gay, transgender and bisexual people may have health problems that should be explored in depth, prevented, and attended. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

The Variables Associated With Health Promotion Behaviors Among Urban Black Women.

PubMed

Hepburn, Millie

2018-04-24

To improve understanding of variables impacting health promotion behaviors among urban Black women. A cross-sectional survey was used. Urban Black women (N = 132) between the ages of 30 to 64 years participated. The study was conducted in a U.S. metropolitan region in 2015. Health literacy (Newest Vital Sign [NVS]), self-efficacy (New General Self-Efficacy Scale [NGSE]), and readiness for change (Health Risk Instrument [HRI]) were correlated with health promotion behaviors (Health Promotion Lifestyle Profile II [HPLPII]). Univariate statistics addressed demographic characteristics; bivariate/simultaneous linear regression determined the relationships between the NVS, NGSE, and HRI to health promotion behaviors (HPLPII). Demographics: 72.6% completed high school and 25% completed college, and the mean body mass index (BMI) was >32. Positive correlations existed between each variable to health promotion behaviors: NVS (r = .244, p < .002), NGSE (r = .312, p < .001), HRI (r = .440, p < .001), and accounted for 29.8% of variances in health promotion behaviors. Education and health literacy were also correlated (r s = .414, p = .001). Although health literacy, self-efficacy, and readiness for change are associated with health promotion behaviors, readiness for change was the most highly correlated. The development and incorporation of interventions to promote health promotion behaviors should include readiness for change, health literacy, BMI, and education, especially among urban Black women in order to reduce critical health disparities. Community-based and culturally relevant strategies in promoting health that are integrated into existing lifestyles and designed to impact readiness for change will have the greatest impact on reducing health disparities both in the United States and in countries experiencing rapid urbanization. For example, healthy eating behaviors or increased physical activity may be best adopted when integrated into existing community

Development of a Behavior Change Intervention to Improve Sexual Health Service Use Among University Undergraduate Students: Mixed Methods Study Protocol.

PubMed

Cassidy, Christine; Steenbeek, Audrey; Langille, Donald; Martin-Misener, Ruth; Curran, Janet

2017-11-02

University students are at risk for acquiring sexually transmitted infections and suffering other negative health outcomes. Sexual health services offer preventive and treatment interventions that aim to reduce these infections and associated health consequences. However, university students often delay or avoid seeking sexual health services. An in-depth understanding of the factors that influence student use of sexual health services is needed to underpin effective sexual health interventions. In this study, we aim to design a behavior change intervention to address university undergraduate students' use of sexual health services at two universities in Nova Scotia, Canada. This mixed methods study consists of three phases that follow a systematic approach to intervention design outlined in the Behaviour Change Wheel. In Phase 1, we examine patterns of sexual health service use among university students in Nova Scotia, Canada, using an existing dataset. In Phase 2, we identify the perceived barriers and enablers to students' use of sexual health services. This will include focus groups with university undergraduate students, health care providers, and university administrators using a semistructured guide, informed by the Capability, Opportunity, Motivation-Behaviour Model and Theoretical Domains Framework. In Phase 3, we identify behavior change techniques and intervention components to develop a theory-based intervention to improve students' use of sexual health services. This study will be completed in March 2018. Results from each phase and the finalized intervention design will be reported in 2018. Previous intervention research to improve university students' use of sexual health services lacks a theoretical assessment of barriers. This study will employ a mixed methods research design to examine university students' use of sexual health service and apply behavior change theory to design a theory- and evidence-based sexual health service intervention. Our

Diabetes-Related Behavior Change Knowledge Transfer to Primary Care Practitioners and Patients: Implementation and Evaluation of a Digital Health Platform

PubMed Central

Vallis, Michael; Piccinini-Vallis, Helena; Imran, Syed Ali; Abidi, Syed Sibte Raza

2018-01-01

Background Behavioral science is now being integrated into diabetes self-management interventions. However, the challenge that presents itself is how to translate these knowledge resources during care so that primary care practitioners can use them to offer evidence-informed behavior change support and diabetes management recommendations to patients with diabetes. Objective The aim of this study was to develop and evaluate a computerized decision support platform called “Diabetes Web-Centric Information and Support Environment” (DWISE) that assists primary care practitioners in applying standardized behavior change strategies and clinical practice guidelines–based recommendations to an individual patient and empower the patient with the skills and knowledge required to self-manage their diabetes through planned, personalized, and pervasive behavior change strategies. Methods A health care knowledge management approach is used to implement DWISE so that it features the following functionalities: (1) assessment of primary care practitioners’ readiness to administer validated behavior change interventions to patients with diabetes; (2) educational support for primary care practitioners to help them offer behavior change interventions to patients; (3) access to evidence-based material, such as the Canadian Diabetes Association’s (CDA) clinical practice guidelines, to primary care practitioners; (4) development of personalized patient self-management programs to help patients with diabetes achieve healthy behaviors to meet CDA targets for managing type 2 diabetes; (5) educational support for patients to help them achieve behavior change; and (6) monitoring of the patients’ progress to assess their adherence to the behavior change program and motivating them to ensure compliance with their program. DWISE offers these functionalities through an interactive Web-based interface to primary care practitioners, whereas the patient’s self-management program and

Changing health behaviors to improve health outcomes after angioplasty: a randomized trial of net present value versus future value risk communication.

PubMed

Charlson, M E; Peterson, J C; Boutin-Foster, C; Briggs, W M; Ogedegbe, G G; McCulloch, C E; Hollenberg, J; Wong, C; Allegrante, J P

2008-10-01

Patients who have undergone angioplasty experience difficulty modifying at-risk behaviors for subsequent cardiac events. The purpose of this study was to test whether an innovative approach to framing of risk, based on 'net present value' economic theory, would be more effective in behavioral intervention than the standard 'future value approach' in reducing cardiovascular morbidity and mortality following angioplasty. At baseline, all patients completed a health assessment, received an individualized risk profile and selected risk factors for modification. The intervention randomized patients into two varying methods for illustrating positive effects of behavior change. For the experimental group, each selected risk factor was assigned a numeric biologic age (the net present value) that approximated the relative potential to improve current health status and quality of life when modifying that risk factor. In the control group, risk reduction was framed as the value of preventing future health problems. Ninety-four percent of patients completed 2-year follow-up. There was no difference between the rates of death, stroke, myocardial infarction, Class II-IV angina or severe ischemia (on non-invasive testing) between the net present value group and the future value group. Our results show that a net present risk communication intervention did not result in significant differences in health outcomes.

The role of health-related behaviors in the socioeconomic disparities in oral health.

PubMed

Sabbah, Wael; Tsakos, Georgios; Sheiham, Aubrey; Watt, Richard G

2009-01-01

This study aimed to examine the socioeconomic disparities in health-related behaviors and to assess if behaviors eliminate socioeconomic disparities in oral health in a nationally representative sample of adult Americans. Data are from the US Third National Health and Nutrition Examination Survey (1988-1994). Behaviors were indicated by smoking, dental visits, frequency of eating fresh fruits and vegetables and extent of calculus, used as a marker for oral hygiene. Oral health outcomes were gingival bleeding, loss of periodontal attachment, tooth loss and perceived oral health. Education and income indicated socioeconomic position. Sex, age, ethnicity, dental insurance and diabetes were adjusted for in the regression analysis. Regression analysis was used to assess socioeconomic disparities in behaviors. Regression models adjusting and not adjusting for behaviors were compared to assess the change in socioeconomic disparities in oral health. The results showed clear socioeconomic disparities in all behaviors. After adjusting for behaviors, the association between oral health and socioeconomic indicators attenuated but did not disappear. These findings imply that improvement in health-related behaviors may lessen, but not eliminate socioeconomic disparities in oral health, and suggest the presence of more complex determinants of these disparities which should be addressed by oral health preventive policies.

Cardiovascular health behavior and health factor changes (1988-2008) and projections to 2020: results from the National Health and Nutrition Examination Surveys.

PubMed

Huffman, Mark D; Capewell, Simon; Ning, Hongyan; Shay, Christina M; Ford, Earl S; Lloyd-Jones, Donald M

2012-05-29

The American Heart Association's 2020 Strategic Impact Goals target a 20% relative improvement in overall cardiovascular health with the use of 4 health behavior (smoking, diet, physical activity, body mass) and 3 health factor (plasma glucose, cholesterol, blood pressure) metrics. We sought to define current trends and forward projections to 2020 in cardiovascular health. We included 35 059 cardiovascular disease-free adults (aged ≥20 years) from the National Health and Nutrition Examination Survey 1988-1994 and subsequent 2-year cycles during 1999-2008. We calculated population prevalence of poor, intermediate, and ideal health behaviors and factors and also computed a composite, individual-level Cardiovascular Health Score for all 7 metrics (poor=0 points; intermediate=1 point; ideal=2 points; total range, 0-14 points). Prevalence of current and former smoking, hypercholesterolemia, and hypertension declined, whereas prevalence of obesity and dysglycemia increased through 2008. Physical activity levels and low diet quality scores changed minimally. Projections to 2020 suggest that obesity and impaired fasting glucose/diabetes mellitus could increase to affect 43% and 77% of US men and 42% and 53% of US women, respectively. Overall, population-level cardiovascular health is projected to improve by 6% overall by 2020 if current trends continue. Individual-level Cardiovascular Health Score projections to 2020 (men=7.4 [95% confidence interval, 5.7-9.1]; women=8.8 [95% confidence interval, 7.6-9.9]) fall well below the level needed to achieve a 20% improvement (men=9.4; women=10.1). The American Heart Association 2020 target of improving cardiovascular health by 20% by 2020 will not be reached if current trends continue.

Needs Assessment for Behavioral Health Workforce: a State-Level Analysis.

PubMed

Nayar, Preethy; Apenteng, Bettye; Nguyen, Anh T; Shaw-Sutherland, Kelly; Ojha, Diptee; Deras, Marlene

2017-07-01

This study describes trends in the supply and the need for behavioral health professionals in Nebraska. A state-level health workforce database was used to estimate the behavioral health workforce supply and need. Compared with national estimates, Nebraska has a lower proportion of all categories of behavioral health professionals. The majority of Nebraska counties have unusually high needs for mental health professionals, with rural areas experiencing a decline in the supply of psychiatrists over the last decade. Availability of robust state-level health workforce data can assist in crafting effective policy for successful systems change, particularly for behavioral health.

Gender and Ethnic Differences in Health-Promoting Behaviors of Rural Adolescents

ERIC Educational Resources Information Center

Rew, Lynn; Arheart, Kristopher L.; Horner, Sharon D.; Thompson, Sanna; Johnson, Karen E.

2015-01-01

Although much is known about health-risk behaviors of adolescents, less is known about their health-promoting behaviors. The purpose of this analysis was to compare health-promoting behaviors in adolescents in Grades 9-12 by gender and ethnicity and explore how these behaviors changed over time. Data were collected from 878 rural adolescents…

Implicit Processes, Self-Regulation, and Interventions for Behavior Change.

PubMed

St Quinton, Tom; Brunton, Julie A

2017-01-01

The ability to regulate and subsequently change behavior is influenced by both reflective and implicit processes. Traditional theories have focused on conscious processes by highlighting the beliefs and intentions that influence decision making. However, their success in changing behavior has been modest with a gap between intention and behavior apparent. Dual-process models have been recently applied to health psychology; with numerous models incorporating implicit processes that influence behavior as well as the more common conscious processes. Such implicit processes are theorized to govern behavior non-consciously. The article provides a commentary on motivational and volitional processes and how interventions have combined to attempt an increase in positive health behaviors. Following this, non-conscious processes are discussed in terms of their theoretical underpinning. The article will then highlight how these processes have been measured and will then discuss the different ways that the non-conscious and conscious may interact. The development of interventions manipulating both processes may well prove crucial in successfully altering behavior.

Implicit Processes, Self-Regulation, and Interventions for Behavior Change

PubMed Central

St Quinton, Tom; Brunton, Julie A.

2017-01-01

The ability to regulate and subsequently change behavior is influenced by both reflective and implicit processes. Traditional theories have focused on conscious processes by highlighting the beliefs and intentions that influence decision making. However, their success in changing behavior has been modest with a gap between intention and behavior apparent. Dual-process models have been recently applied to health psychology; with numerous models incorporating implicit processes that influence behavior as well as the more common conscious processes. Such implicit processes are theorized to govern behavior non-consciously. The article provides a commentary on motivational and volitional processes and how interventions have combined to attempt an increase in positive health behaviors. Following this, non-conscious processes are discussed in terms of their theoretical underpinning. The article will then highlight how these processes have been measured and will then discuss the different ways that the non-conscious and conscious may interact. The development of interventions manipulating both processes may well prove crucial in successfully altering behavior. PMID:28337164

Longitudinal Effects of Health-Harming and Health-Protective Behaviors within Adolescent Romantic Dyads

PubMed Central

Aalsma, Matthew C.; Carpentier, Melissa; Azzouz, Faouzi; Fortenberry, Dennis

2012-01-01

Most models exploring adolescent health behavior have focused on individual influences to understand behavior change. The goal of the current study was to assess the role of adolescent romantic partners on the expression of health behavior. Our sample utilized two waves of data from the US National Longitudinal Study of Adolescent Health (1994, 1996), which included 80 romantic dyads (160 individuals). A longitudinal multilevel analysis was conducted. We assessed individual and romantic partner health-harming behaviors (i.e., delinquency, alcohol use, smoking, and marijuana use), health-protective behaviors (i.e., physical activity, physical inactivity, sleep patterns, seatbelt use, and contraception motivations), as well as the role of gender and age. Participants average age was 16 years at baseline. We found evidence for partner similarity and partner influence with the majority of health-harming behaviors. Specifically, partner influence was evident for smoking and alcohol use with partner influence approaching significance for marijuana use. We found limited evidence for partner similarity and partner influence for health-protective behaviors. The importance of assessing romantic dyads was evident in these data. Interventions focusing on health-harming behavior for adolescent populations are important public health goals. It is recommended that future intervention efforts with adolescent health-harming behaviors should target not only peers, but also consider the role of romantic partners. PMID:22424832

Enhancing health knowledge, health beliefs, and health behavior in Poland through a health promoting television program series.

PubMed

Chew, Fiona; Palmer, Sushma; Slonska, Zofia; Subbiah, Kalyani

2002-01-01

This study examined the impact of a health promoting television program series on health knowledge and the key factors of the health belief model (HBM) that have led people to engage in healthy behavior (exercising, losing weight, changing eating habits, and not smoking/quitting smoking). Using data from a posttest comparison field study with 15) viewers and 146 nonviewers in Poland, we found that hierarchical regression analysis showed stronger support for the HBM factors of efficacy, susceptibility, seriousness, and salience in their contribution toward health behavior among television viewers compared with nonviewers. Cues to action variables (including television viewing) and health knowledge boosted efficacy among viewers. Without the advantage of receiving health information from the television series, nonviewers relied on their basic disease fears on one hand, and interest in good health on the other to take steps toward becoming healthier. A health promoting television series can increase health knowledge and enhance health beliefs, which in turn contribute to healthy behaviors.

Educating dental students about diet-related behavior change: does experiential learning work?

PubMed

Taylor, George W; Stumpos, Madelyn L; Kerschbaum, Wendy; Inglehart, Marita Rohr

2014-01-01

The objective of this study was to explore whether an experiential exercise in a nutrition class would a) increase dental students' motivation to change their own diet-related behavior, b) improve their understanding of theoretical concepts related to behavior change, and c) improve their attitudes towards educating their patients about diet-related behavior. Data were collected from 218 senior dental students in one dental school (2010: 106; 2011: 112) during their nutrition class. The students agreed at the beginning that it was important to change their own diet-related behavior. After one week, the majority agreed that they had changed how they felt and thought about the targeted behavior and what they actually did. After three weeks and at the end of the term, they rated the exercise as helpful for gaining a better understanding of health education theories. The majority indicated that the exercise had helped them understand the difficulty of diet-related behavior change and that it had increased their interest in helping patients change their diet-related behavior. In conclusion, this study suggests that experiential learning about diet-related behavior change is likely to affect students' own behavior positively and to result in increased understanding of behavior change theories and positive behavioral intentions concerning future health education efforts with patients.

Determinants of responsibility for health, spiritual health and interpersonal relationship based on theory of planned behavior in high school girl students.

PubMed

Rezazadeh, Afsaneh; Solhi, Mahnaz; Azam, Kamal

2015-01-01

Adolescence is a sensitive period of acquiring normal and abnormal habits for all oflife. The study investigates determinants of responsibility for health, spiritual health and interpersonal relations and predictive factors based on the theory of planned behavior in high school girl students in Tabriz. In this Cross-sectional study, 340 students were selected thorough multi-stage sampling. An author-made questionnaire based on standard questionnaires of Health Promotion and Lifestyle II (HPLPII), spiritual health standards (Palutzian & Ellison) and components of the theory of planned behavior (attitudes, subjective norms, perceived behavioral control, and behavioral intention) was used for data collection. The questionnaire was validated in a pilot study. Data were analyzed using SPSS v.15 and descriptive and analytical tests (Chi-square test, Pearson correlation co-efficient and liner regression test in backward method). Students' responsibility for health, spiritual health, interpersonal relationships, and concepts of theory of planned behavior was moderate. We found a significant positive correlation (p<0/001) among all concepts of theory of planned behavior. Attitude and perceived behavioral control predicted 35% of intention of behavioral change (p<0.001). Attitude, subjective norms, and perceived behavioral control predicted 74% of behavioral change in accountability for health (p<0.0001), 56% for behavioral change in spiritual health (p<0.0001) and 63% for behavioral change in interpersonal relationship (p<0.0001). Status of responsibility for health, spiritual health and interpersonal relationships of students was moderate. Hence, behavioral intention and its determinants such as perceived behavioral control should be noted in promoting intervention programs.

Targeting Health Behaviors to Reduce Health Care Costs in Pediatric Psychology: Descriptive Review and Recommendations.

PubMed

McGrady, Meghan E; Hommel, Kevin A

2016-09-01

Recent efforts to enhance the quality of health care in the United States while reducing costs have resulted in an increased emphasis on cost containment and the introduction of new payment plans. The purpose of this review is to summarize the impact of pediatric health behavior change interventions on health care costs. A review of PubMed, PsycINFO, and PEDE databases identified 15 articles describing the economic outcomes of pediatric health behavior change interventions. Data describing the intervention, health outcome, and economic outcome were extracted. All interventions targeting cigarette smoking (n = 3) or the prevention of a chronic medical condition (n = 5) were predicted to avert hundreds of dollars in health care costs per patient. Five of the seven interventions targeting self-management were associated with reductions in health care costs. Pediatric health behavior change interventions may be a valuable component of efforts to improve population health while reducing health care costs. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A Simulation Modeling Framework to Optimize Programs Using Financial Incentives to Motivate Health Behavior Change.

PubMed

Basu, Sanjay; Kiernan, Michaela

2016-01-01

While increasingly popular among mid- to large-size employers, using financial incentives to induce health behavior change among employees has been controversial, in part due to poor quality and generalizability of studies to date. Thus, fundamental questions have been left unanswered: To generate positive economic returns on investment, what level of incentive should be offered for any given type of incentive program and among which employees? We constructed a novel modeling framework that systematically identifies how to optimize marginal return on investment from programs incentivizing behavior change by integrating commonly collected data on health behaviors and associated costs. We integrated "demand curves" capturing individual differences in response to any given incentive with employee demographic and risk factor data. We also estimated the degree of self-selection that could be tolerated: that is, the maximum percentage of already-healthy employees who could enroll in a wellness program while still maintaining positive absolute return on investment. In a demonstration analysis, the modeling framework was applied to data from 3000 worksite physical activity programs across the nation. For physical activity programs, the incentive levels that would optimize marginal return on investment ($367/employee/year) were higher than average incentive levels currently offered ($143/employee/year). Yet a high degree of self-selection could undermine the economic benefits of the program; if more than 17% of participants came from the top 10% of the physical activity distribution, the cost of the program would be expected to always be greater than its benefits. Our generalizable framework integrates individual differences in behavior and risk to systematically estimate the incentive level that optimizes marginal return on investment. © The Author(s) 2015.

A simulation modeling framework to optimize programs using financial incentives to motivate health behavior change

PubMed Central

Basu, Sanjay; Kiernan, Michaela

2015-01-01

Introduction While increasingly popular among mid- to large-size employers, using financial incentives to induce health behavior change among employees has been controversial, in part due to poor quality and generalizability of studies to date. Thus, fundamental questions have been left unanswered: to generate positive economic returns on investment, what level of incentive should be offered for any given type of incentive program and among which employees? Methods We constructed a novel modeling framework that systematically identifies how to optimize marginal return on investment from programs incentivizing behavior change by integrating commonly-collected data on health behaviors and associated costs. We integrated “demand curves” capturing individual differences in response to any given incentive with employee demographic and risk factor data. We also estimated the degree of self-selection that could be tolerated, i.e., the maximum percentage of already-healthy employees who could enroll in a wellness program while still maintaining positive absolute return on investment. In a demonstration analysis, the modeling framework was applied to data from 3,000 worksite physical activity programs across the nation. Results For physical activity programs, the incentive levels that would optimize marginal return on investment ($367/employee/year) were higher than average incentive levels currently offered ($143/employee/year). Yet a high degree of self-selection could undermine the economic benefits of the program; if more than 17% of participants came from the top 10% of the physical activity distribution, the cost of the program would be expected to always be greater than its benefits. Discussion Our generalizable framework integrates individual differences in behavior and risk to systematically estimate the incentive level that optimizes marginal return on investment. PMID:25977362

A Comparative Effectiveness Education Trial for Lifestyle Health Behavior Change in African Americans

ERIC Educational Resources Information Center

Halbert, Chanita Hughes; Bellamy, Scarlett; Briggs, Vanessa; Delmoor, Ernestine; Purnell, Joseph; Rogers, Rodney; Weathers, Benita; Johnson, Jerry C.

2017-01-01

Obesity and excess weight are significant clinical and public health issues that disproportionately affect African Americans because of physical inactivity and unhealthy eating. We compared the effects of alternate behavioral interventions on obesity-related health behaviors. We conducted a comparative effectiveness education trial in a…

Embedded health behaviors from adolescence to adulthood: the impact of tobacco.

PubMed

Booth-Butterfield, Melanie

2003-01-01

Prevention of cancer risk behaviors before they become embedded in an individual's life is crucial. Health-related behaviors should be viewed for their embeddedness, critical aspects of which are (a) the complexity of the behavior itself; (.b) factors, both biological and psychological, within the individual communicator; (c) and external situational or sociocultural factors. The more extensively a behavior is embedded, the more difficult it will be to alter. Relative levels of embeddedness of the risk behavior and its entanglement with other nonrisky behaviors will evolve and change throughout one's life course. Smoking across the life span provides an excellent example of a thoroughly integrated, embedded behavior. How smoking is embedded with other behaviors changes from adolescence, where biological factors may be less salient and habit strength less pronounced, through adulthood, where habit strength is greater but health concerns are a more predictive factor. Researchers can produce more focused communication interventions by examining how health-endangering behaviors are embedded among benign behaviors or among other potentially dangerous behaviors. Ideally, the pattern of health behavior embeddedness should be analyzed prior to developing intervention communication strategies.

Diabetes-Related Behavior Change Knowledge Transfer to Primary Care Practitioners and Patients: Implementation and Evaluation of a Digital Health Platform.

PubMed

Abidi, Samina; Vallis, Michael; Piccinini-Vallis, Helena; Imran, Syed Ali; Abidi, Syed Sibte Raza

2018-04-18

Behavioral science is now being integrated into diabetes self-management interventions. However, the challenge that presents itself is how to translate these knowledge resources during care so that primary care practitioners can use them to offer evidence-informed behavior change support and diabetes management recommendations to patients with diabetes. The aim of this study was to develop and evaluate a computerized decision support platform called "Diabetes Web-Centric Information and Support Environment" (DWISE) that assists primary care practitioners in applying standardized behavior change strategies and clinical practice guidelines-based recommendations to an individual patient and empower the patient with the skills and knowledge required to self-manage their diabetes through planned, personalized, and pervasive behavior change strategies. A health care knowledge management approach is used to implement DWISE so that it features the following functionalities: (1) assessment of primary care practitioners' readiness to administer validated behavior change interventions to patients with diabetes; (2) educational support for primary care practitioners to help them offer behavior change interventions to patients; (3) access to evidence-based material, such as the Canadian Diabetes Association's (CDA) clinical practice guidelines, to primary care practitioners; (4) development of personalized patient self-management programs to help patients with diabetes achieve healthy behaviors to meet CDA targets for managing type 2 diabetes; (5) educational support for patients to help them achieve behavior change; and (6) monitoring of the patients' progress to assess their adherence to the behavior change program and motivating them to ensure compliance with their program. DWISE offers these functionalities through an interactive Web-based interface to primary care practitioners, whereas the patient's self-management program and associated behavior interventions are

Developing Games for Health Behavior Change: Getting Started

PubMed Central

Buday, Richard; Thompson, Debbe; Lyons, Elizabeth J.; Lu, Amy Shirong; Baranowski, Janice

2013-01-01

Abstract Many investigators are considering developing videogames for health (video-G4Hs) but have questions about how to get started. This report provides guidance for investigators considering a G4H as a behavioral intervention procedure from a team of experienced G4H developers. Thirteen commonly asked questions are answered, including defining a G4H, considerations in developing a team, considerations in G4H design, and anticipating unintended consequences. PMID:24443708

Temporal Immediacy: A Two-System Theory of Mind for Understanding and Changing Health Behaviors.

PubMed

Cook, Paul F; Schmiege, Sarah J; Reeder, Blaine; Horton-Deutsch, Sara; Lowe, Nancy K; Meek, Paula

Health promotion and chronic disease management both require behavior change, but people find it hard to change behavior despite having good intentions. The problem arises because patients' narratives about experiences and intentions are filtered through memory and language. These narratives inaccurately reflect intuitive decision-making or actual behaviors. We propose a principle-temporal immediacy-as a moderator variable that explains which of two mental systems (narrative or intuitive) will be activated in any given situation. We reviewed multiple scientific areas to test temporal immediacy as an explanation for findings. In an iterative process, we used evidence from philosophy, cognitive neuroscience, behavioral economics, symptom science, and ecological momentary assessment to develop our theoretical perspective. These perspectives each suggest two cognitive systems that differ in their level of temporal immediacy: an intuitive system that produces behavior in response to everyday states and a narrative system that interprets and explains these experiences after the fact. Writers from Plato onward describe two competing influences on behavior-often with moral overtones. People tend to identify with the language-based narrative system and blame unhelpful results on the less accessible intuitive system, but neither is completely rational, and the intuitive system has strengths based on speed and serial processing. The systems differ based on temporal immediacy-the description of an experience as either "now" or "usually"-with the intuitive system generating behaviors automatically in real time and the narrative system producing beliefs about the past or future. The principle of temporal immediacy is a tool to integrate nursing science with other disciplinary traditions and to improve research and practice. Interventions should build on each system's strengths, rather than treating the intuitive system as a barrier for the narrative system to overcome. Nursing

Perceived Health Competence Predicts Health Behavior and Health-Related Quality of Life in Patients with Cardiovascular Disease

PubMed Central

Bachmann, Justin M.; Goggins, Kathryn M.; Nwosu, Samuel K.; Schildcrout, Jonathan S.; Kripalani, Sunil; Wallston, Kenneth A.

2017-01-01

Objective Evaluate the effect of perceived health competence, a patient’s belief in his or her ability to achieve health-related goals, on health behavior and health-related quality of life. Methods We analyzed 2063 patients hospitalized with acute coronary syndrome and/or congestive heart failure at a large academic hospital in the United States. Multivariable linear regression models investigated associations between the two-item perceived health competence scale (PHCS-2) and positive health behaviors such as medication adherence and exercise (Health Behavior Index) as well as health-related quality of life (5-item Patient Reported Outcome Information Measurement System Global Health Scale). Results After multivariable adjustment, perceived health competence was highly associated with health behaviors (p<0.001) and health-related quality of life (p<0.001). Low perceived health competence was associated with a decrease in health-related quality of life between hospitalization and 90 days after discharge (p<0.001). Conclusions Perceived health competence predicts health behavior and health-related quality of life in patients hospitalized with cardiovascular disease as well as change in health-related quality of life after discharge. Practice implications Patients with low perceived health competence may be at risk for a decline in health-related quality of life after hospitalization and thus a potential target for counseling and other behavioral interventions. PMID:27450479

Perceived health competence predicts health behavior and health-related quality of life in patients with cardiovascular disease.

PubMed

Bachmann, Justin M; Goggins, Kathryn M; Nwosu, Samuel K; Schildcrout, Jonathan S; Kripalani, Sunil; Wallston, Kenneth A

2016-12-01

Evaluate the effect of perceived health competence, a patient's belief in his or her ability to achieve health-related goals, on health behavior and health-related quality of life. We analyzed 2063 patients hospitalized with acute coronary syndrome and/or congestive heart failure at a large academic hospital in the United States. Multivariable linear regression models investigated associations between the two-item perceived health competence scale (PHCS-2) and positive health behaviors such as medication adherence and exercise (Health Behavior Index) as well as health-related quality of life (5-item Patient Reported Outcome Information Measurement System Global Health Scale). After multivariable adjustment, perceived health competence was highly associated with health behaviors (p<0.001) and health-related quality of life (p<0.001). Low perceived health competence was associated with a decrease in health-related quality of life between hospitalization and 90days after discharge (p<0.001). Perceived health competence predicts health behavior and health-related quality of life in patients hospitalized with cardiovascular disease as well as change in health-related quality of life after discharge. Patients with low perceived health competence may be at risk for a decline in health-related quality of life after hospitalization and thus a potential target for counseling and other behavioral interventions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Interrelationships between Health Behaviors and Coping Strategies among Informal Caregivers of Cancer Survivors

ERIC Educational Resources Information Center

Litzelman, Kristin; Kent, Erin E.; Rowland, Julia H.

2018-01-01

Background: Recent research among cancer survivors suggests that health behaviors and coping are intertwined, with important implications for positive behavior change and health. Informal caregivers may have poor health behaviors, and caregivers' health behaviors have been linked to those of survivors. Aims: This hypothesis generating study…

Behavior Change Techniques in Apps for Medication Adherence: A Content Analysis.

PubMed

Morrissey, Eimear C; Corbett, Teresa K; Walsh, Jane C; Molloy, Gerard J

2016-05-01

There are a vast number of smartphone applications (apps) aimed at promoting medication adherence on the market; however, the theory and evidence base in terms of applying established health behavior change techniques underpinning these apps remains unclear. This study aimed to code these apps using the Behavior Change Technique Taxonomy (v1) for the presence or absence of established behavior change techniques. The sample of apps was identified through systematic searches in both the Google Play Store and Apple App Store in February 2015. All apps that fell into the search categories were downloaded for analysis. The downloaded apps were screened with exclusion criteria, and suitable apps were reviewed and coded for behavior change techniques in March 2015. Two researchers performed coding independently. In total, 166 medication adherence apps were identified and coded. The number of behavior change techniques contained in an app ranged from zero to seven (mean=2.77). A total of 12 of a possible 96 behavior change techniques were found to be present across apps. The most commonly included behavior change techniques were "action planning" and "prompt/cues," which were included in 96% of apps, followed by "self-monitoring" (37%) and "feedback on behavior" (36%). The current extent to which established behavior change techniques are used in medication adherence apps is limited. The development of medication adherence apps may not have benefited from advances in the theory and practice of health behavior change. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Goal setting for health behavior change: evidence from an obesity intervention for rural low-income women.

PubMed

Ries, A V; Blackman, L T; Page, R A; Gizlice, Z; Benedict, S; Barnes, K; Kelsey, K; Carter-Edwards, L

2014-01-01

Rural, minority populations are disproportionately affected by overweight and obesity and may benefit from lifestyle modification programs that are tailored to meet their unique needs. Obesity interventions commonly use goal setting as a behavior change strategy; however, few have investigated the specific contribution of goal setting to behavior change and/or identified the mechanisms by which goal setting may have an impact on behavior change. Furthermore, studies have not examined goal setting processes among racial/ethnic minorities. Using data from an obesity intervention for predominately minority women in rural North Carolina, this study sought to examine whether intervention participation resulted in working on goals and using goal setting strategies which in turn affected health behavior outcomes. It also examined racial/ethnic group differences in working on goals and use of goal setting strategies. Data came from a community-based participatory research project to address obesity among low-income, predominately minority women in rural North Carolina. A quasi-experimental intervention design was used. Participants included 485 women aged 18 years and over. Intervention participants (n=208) received health information and goal setting support through group meetings and tailored newsletters. Comparison participants (n = 277) received newsletters on topics unrelated to obesity. Surveys assessed physical activity, fruit and vegetable intake, goal-related stage of change, and use of goal setting strategies. Chi squared statistics were used to assess intervention group differences in changes in goal-related stage of change and use of goal setting strategies as well as racial/ethnic group differences in stage of change and use of goal setting strategies at baseline. The causal steps approach of Baron and Kenny was used to assess mediation. Intervention compared to comparison participants were more likely to move from contemplation to action/maintenance for the

Making Healthy Behaviors the Easy Choice for Employees: A Review of the Literature on Environmental and Policy Changes in Worksite Health Promotion

ERIC Educational Resources Information Center

Kahn-Marshall, Jennifer L.; Gallant, Mary P.

2012-01-01

As employers look for ways to reduce rising health care costs, worksite health promotion interventions are increasingly being used to improve employee health behaviors. An alternative approach to traditional worksite health promotion programs is the implementation of environmental and/or policy changes to encourage employees to adopt healthier…

How Do Mobile Phone Diabetes Programs Drive Behavior Change?

PubMed Central

Nundy, Shantanu; Mishra, Anjuli; Hogan, Patrick; Lee, Sang Mee; Solomon, Marla C.; Peek, Monica E.

2015-01-01

Purpose The purpose of this study was to investigate the behavioral effects of a theory-driven, mobile phone–based intervention that combines automated text messaging and remote nursing, using an automated, interactive text messaging system. Methods This was a mixed methods observational cohort study. Study participants were members of the University of Chicago Health Plan (UCHP) who largely reside in a working-class, urban African American community. Surveys were conducted at baseline, 3 months (mid-intervention), and 6 months (postintervention) to test the hypothesis that the intervention would be associated with improvements in self-efficacy, social support, health beliefs, and self-care. In addition, in-depth individual interviews were conducted with 14 participants and then analyzed using the constant comparative method to identify new behavioral constructs affected by the intervention. Results The intervention was associated with improvements in 5 of 6 domains of self-care (medication taking, glucose monitoring, foot care, exercise, and healthy eating) and improvements in 1 or more measures of self-efficacy, social support, and health beliefs (perceived control). Qualitatively, participants reported that knowledge, attitudes, and ownership were also affected by the program. Together these findings were used to construct a new behavioral model. Conclusions This study’s findings challenge the prevailing assumption that mobile phones largely affect behavior change through reminders and support the idea that behaviorally driven mobile health interventions can address multiple behavioral pathways associated with sustained behavior change. PMID:25278512

Behavior Change Techniques in Physical Activity eHealth Interventions for People With Cardiovascular Disease: Systematic Review

PubMed Central

Duff, Orlaith Mairead; Walsh, Deirdre MJ; Furlong, Bróna A; O'Connor, Noel E; Woods, Catherine B

2017-01-01

Background Cardiovascular disease (CVD) is the leading cause of premature death and disability in Europe, accounting for 4 million deaths per year and costing the European Union economy almost €196 billion annually. There is strong evidence to suggest that exercise-based secondary rehabilitation programs can decrease the mortality risk and improve health among patients with CVD. Theory-informed use of behavior change techniques (BCTs) is important in the design of cardiac rehabilitation programs aimed at changing cardiovascular risk factors. Electronic health (eHealth) is the use of information and communication technologies (ICTs) for health. This emerging area of health care has the ability to enhance self-management of chronic disease by making health care more accessible, affordable, and available to the public. However, evidence-based information on the use of BCTs in eHealth interventions is limited, and particularly so, for individuals living with CVD. Objective The aim of this systematic review was to assess the application of BCTs in eHealth interventions designed to increase physical activity (PA) in CVD populations. Methods A total of 7 electronic databases, including EBSCOhost (MEDLINE, PsycINFO, Academic Search Complete, SPORTDiscus with Full Text, and CINAHL Complete), Scopus, and Web of Science (Core Collection) were searched. Two authors independently reviewed references using the software package Covidence (Veritas Health Innovation). The reviewers met to resolve any discrepancies, with a third independent reviewer acting as an arbitrator when required. Following this, data were extracted from the papers that met the inclusion criteria. Bias assessment of the studies was carried out using the Cochrane Collaboration’s tool for assessing the risk of bias within Covidence; this was followed by a narrative synthesis. Results Out of the 987 studies that were identified, 14 were included in the review. An additional 9 studies were added following a

Predicting behavior change from persuasive messages using neural representational similarity and social network analyses.

PubMed

Pegors, Teresa K; Tompson, Steven; O'Donnell, Matthew Brook; Falk, Emily B

2017-08-15

Neural activity in medial prefrontal cortex (MPFC), identified as engaging in self-related processing, predicts later health behavior change. However, it is unknown to what extent individual differences in neural representation of content and lived experience influence this brain-behavior relationship. We examined whether the strength of content-specific representations during persuasive messaging relates to later behavior change, and whether these relationships change as a function of individuals' social network composition. In our study, smokers viewed anti-smoking messages while undergoing fMRI and we measured changes in their smoking behavior one month later. Using representational similarity analyses, we found that the degree to which message content (i.e. health, social, or valence information) was represented in a self-related processing MPFC region was associated with later smoking behavior, with increased representations of negatively valenced (risk) information corresponding to greater message-consistent behavior change. Furthermore, the relationship between representations and behavior change depended on social network composition: smokers who had proportionally fewer smokers in their network showed increases in smoking behavior when social or health content was strongly represented in MPFC, whereas message-consistent behavior (i.e., less smoking) was more likely for those with proportionally more smokers in their social network who represented social or health consequences more strongly. These results highlight the dynamic relationship between representations in MPFC and key outcomes such as health behavior change; a complete understanding of the role of MPFC in motivation and action should take into account individual differences in neural representation of stimulus attributes and social context variables such as social network composition. Copyright © 2017 Elsevier Inc. All rights reserved.

Relationship between Health Literacy, Health-Related Behaviors and Health Status: A Survey of Elderly Chinese.

PubMed

Liu, Yong-Bing; Liu, Liu; Li, Yan-Fei; Chen, Yan-Li

2015-08-18

Despite the large volume of research dedicated to health-related behavior change, chronic disease costs continue to rise, thus creating a major public health burden. Health literacy, the ability to seek, understand, and utilize health information, has been identified as an important factor in the course of chronic conditions. Little research has been conducted on the relationship between health literacy and health-related behaviors and health status in elderly Chinese. The aim of this study was to elucidate the relationship between health literacy and health-related behaviors and health status in China. The subjects enrolled in this study were selected based on a stratified cluster random sampling design. Information involving >4500 older adults in 44 pension institutions in Urumqi, Changji, Karamay, and Shihezi of Xinjiang between September 2011 and June 2012 was collected. The Chinese Citizen Health Literacy Questionnaire (China Health Education Centre, 2008) and a Scale of the General Status were administered and the information was obtained through face-to-face inquiries by investigators. A total of 1452 respondents met the inclusion criteria. A total of 1452 questionnaires were issued and the valid response rate was 96.14% (1396 of 1452). Factors affecting health literacy and the relationship to health literacy were identified by one-way ANOVA and a multiple linear regression model. The average health literacy level of the elderly in nursing homes was relatively low (71.74 ± 28.35 points). There were significant differences in the health literacy score among the factors of age, gender, race, education level, household income, marital conditions, and former occupation (p < 0.001). The health literacy score was significantly associated with smoking, drinking, physical exercise, and health examination (p < 0.001). The elderly with higher health literacy scores were significantly less likely to have risky behaviors (smoking, regular drinking, and lack of physical

IDEAS (Integrate, Design, Assess, and Share): A Framework and Toolkit of Strategies for the Development of More Effective Digital Interventions to Change Health Behavior

PubMed Central

Robinson, Thomas N; King, Abby C

2016-01-01

Developing effective digital interventions to change health behavior has been a challenging goal for academics and industry players alike. Guiding intervention design using the best combination of approaches available is necessary if effective technologies are to be developed. Behavioral theory, design thinking, user-centered design, rigorous evaluation, and dissemination each have widely acknowledged merits in their application to digital health interventions. This paper introduces IDEAS, a step-by-step process for integrating these approaches to guide the development and evaluation of more effective digital interventions. IDEAS is comprised of 10 phases (empathize, specify, ground, ideate, prototype, gather, build, pilot, evaluate, and share), grouped into 4 overarching stages: Integrate, Design, Assess, and Share (IDEAS). Each of these phases is described and a summary of theory-based behavioral strategies that may inform intervention design is provided. The IDEAS framework strives to provide sufficient detail without being overly prescriptive so that it may be useful and readily applied by both investigators and industry partners in the development of their own mHealth, eHealth, and other digital health behavior change interventions. PMID:27986647

Advancing Models and Theories for Digital Behavior Change Interventions.

PubMed

Hekler, Eric B; Michie, Susan; Pavel, Misha; Rivera, Daniel E; Collins, Linda M; Jimison, Holly B; Garnett, Claire; Parral, Skye; Spruijt-Metz, Donna

2016-11-01

To be suitable for informing digital behavior change interventions, theories and models of behavior change need to capture individual variation and changes over time. The aim of this paper is to provide recommendations for development of models and theories that are informed by, and can inform, digital behavior change interventions based on discussions by international experts, including behavioral, computer, and health scientists and engineers. The proposed framework stipulates the use of a state-space representation to define when, where, for whom, and in what state for that person, an intervention will produce a targeted effect. The "state" is that of the individual based on multiple variables that define the "space" when a mechanism of action may produce the effect. A state-space representation can be used to help guide theorizing and identify crossdisciplinary methodologic strategies for improving measurement, experimental design, and analysis that can feasibly match the complexity of real-world behavior change via digital behavior change interventions. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Private Health Plans’ Contracts with Managed Behavioral Healthcare Organizations

PubMed Central

Garnick, Deborah W.; Horgan, Constance M.; Merrick, Elizabeth L.; Hodgkin, Dominic; Reif, Sharon; Quinn, Amity E.; Stewart, Maureen; Creedon, Timothy B.

2015-01-01

Contracts between health plans and managed behavioral health care organizations (MBHOs) influence access and quality of behavioral health care. This report presents information on performance requirements, information sharing, and financial risk from a nationally representative survey of private health plans. Most contracts include geographic access to providers (93.3%) and NCQA’s performance standards (84.2%). Health plans and MBHOs share data (99.0%), generally by the MBHO sending information to the health plan (96.3%). About a quarter of contracts impose financial penalties (23.0%), but few include incentives related to performance standards (<1.0%). Contract terms can shape the provision of behavioral health services in response to changes such as parity legislation or health reform. If current trends continue towards increases in value-based purchasing in the privately financed behavioral health sector, the focus on quality in contracts between health plans and MBHOs will be critical to understand. PMID:26276421

Influencing behavioral change by customer engagement amongst youth.

PubMed

Singh, Sonal

2011-01-01

It is widely accepted that many social and health problems have underlying behavioral causes. Because these problems are rooted in human behavior, solutions to deal with them also lie in human behavior. This paper examines ways of integrating customer engagement in social programs to influence and initiate behavior change effectively with a special focus on youth. This work followed a theoretical deduction by use of a literature review. Social marketing places emphasis on behavior change, and one of the key challenges for social marketers is to ensure a perceived value for customers in taking up and maintaining positive behavior. If perceptions, beliefs, attitudes, and values influence behavior, then the central focus should be on the youth. Integrating youth is a prerequisite for effective social marketing programs and ultimately behavioral change. This approach will pave the way for effective brand positioning and brand loyalty in social marketing which has been lacking and requires more attention from researchers and policymakers. This paper outlines theoretical developments in social marketing that will increase the effectiveness of social marketing programs overall. Existing social marketing literature typically focuses on social marketing interventions and behavioral change. This paper uses customer engagement within a social marketing context so that social marketing programs are perceived as brands to which youth can relate.

Influencing behavioral change by customer engagement amongst youth

PubMed Central

Singh, Sonal

2011-01-01

It is widely accepted that many social and health problems have underlying behavioral causes. Because these problems are rooted in human behavior, solutions to deal with them also lie in human behavior. This paper examines ways of integrating customer engagement in social programs to influence and initiate behavior change effectively with a special focus on youth. This work followed a theoretical deduction by use of a literature review. Social marketing places emphasis on behavior change, and one of the key challenges for social marketers is to ensure a perceived value for customers in taking up and maintaining positive behavior. If perceptions, beliefs, attitudes, and values influence behavior, then the central focus should be on the youth. Integrating youth is a prerequisite for effective social marketing programs and ultimately behavioral change. This approach will pave the way for effective brand positioning and brand loyalty in social marketing which has been lacking and requires more attention from researchers and policymakers. This paper outlines theoretical developments in social marketing that will increase the effectiveness of social marketing programs overall. Existing social marketing literature typically focuses on social marketing interventions and behavioral change. This paper uses customer engagement within a social marketing context so that social marketing programs are perceived as brands to which youth can relate. PMID:24600281

Fostering change in back pain beliefs and behaviors: when public education is not enough.

PubMed

Gross, Douglas P; Deshpande, Sameer; Werner, Erik L; Reneman, Michiel F; Miciak, Maxi A; Buchbinder, Rachelle

2012-11-01

Mass media campaigns designed to alter societal views and individual behaviors about back pain have been undertaken and evaluated in multiple countries. In contrast to the original Australian campaign, subsequent campaigns have been less successful, with improvements observed in beliefs without the corresponding changes in related behaviors. This article summarizes the results of a literature review, expert panel, and workshop held at the Melbourne International Forum XI: Primary Care Research on Low Back Pain in March 2011 on the role and interplay of various social behavior change strategies, including public education, law and legislation, healthy public policy, and social marketing in achieving a sustained reduction in the societal burden of back pain. Given the complexities inherent to health-related behaviors change, the Rothschild framework is applied in which behavior change strategies are viewed on a continuum from public education at one end through law and health policy at the other. Educational endeavors should likely be augmented with social marketing endeavors and supportive laws and health policy to foster sustained change in outcomes such as work disability and health utilization. Practical suggestions are provided for future interventions aimed at changing back pain-related behaviors. Evaluation of previous back pain mass media campaigns reveals that education alone is unlikely to foster positive and persisting behavioral change without concomitant strategies. Copyright © 2012 Elsevier Inc. All rights reserved.

Early life adversity reduces stress reactivity and enhances impulsive behavior: Implications for health behaviors

PubMed Central

Lovallo, William R.

2012-01-01

Altered reactivity to stress, either in the direction of exaggerated reactivity or diminished reactivity, may signal a dysregulation of systems intended to maintain homeostasis and a state of good health. Evidence has accumulated that diminished reactivity to psychosocial stress may signal poor health outcomes. One source of diminished cortisol and autonomic reactivity is the experience of adverse rearing during childhood and adolescence. The Oklahoma Family Health Patterns Project has examined a cohort of 426 healthy young adults with and without a family history of alcoholism. Regardless of family history, persons who had experienced high degrees of adversity prior to age 16 had a constellation of changes including reduced cortisol and heart rate reactivity, diminished cognitive capacity, and unstable regulation of affect, leading to behavioral impulsivity and antisocial tendencies. We present a model whereby this constellation of physiological, cognitive, and affective tendencies is consistent with altered central dopaminergic activity leading to changes in brain function that may foster impulsive and risky behaviors. These in turn may promote greater use of alcohol other drugs along with adopting poor health behaviors. This model provides a pathway from early life adversity to low stress reactivity that forms a basis for risky behaviors and poor health outcomes. PMID:23085387

[Health knowledge, health promoting behavior and factors influencing health promoting behavior of north korean defectors in South Korea].

PubMed

Choe, Myoung Ae; Yi, Myungsun; Choi, Jung An; Shin, Gisoo

2012-10-01

The purpose of this study was to identify health knowledge, health promoting behavior and factors influencing health promoting behavior of North Korean defectors in South Korea. Participants in this study were 410 North Korean defectors, over 20 years of age residing in Seoul. They were recruited by snowball sampling. Data were collected from April to June, 2010. Health knowledge, health promoting behavior, self-efficacy, perceived barriers to health promoting behavior and social support were measured by structured questionnaires, and perceived physical and mental health status were measured by one item with 10-point numeric rating scale. The data were analyzed using t-test, ANOVA, and multiple regression. Health knowledge, health promoting behavior, and perceived barriers to health promoting behavior were moderate while self-efficacy and social support were high. Factors influencing health promoting behavior of the participants were found to be self-efficacy, social support and perceived barrier to health promoting behavior. The results of this study indicate that nursing intervention programs enhancing self-efficacy, social support and reducing perceived barriers to health promoting behavior need to be developed for North Korean defectors in South Korea.

Sedentary Behavior and Health: Broadening the Knowledge Base and Strengthening the Science.

PubMed

Hadgraft, Nyssa; Owen, Neville

2017-06-01

We provide an overview of a recently published, edited book in a rapidly emerging field of research, policy, and practice for physical activity: Sedentary Behavior and Health. In this commentary, we highlight the broad perspectives provided in the 27 chapters of Sedentary Behavior and Health and suggest a research strategy to move the field forward-not only with scientific rigor, but also with breadth of scholarship. The book's chapters provide an overview of the background to and contexts for sedentary behavior and health. They then highlight the importance of understanding health consequences and underlying mechanisms; introduce key measurement technology and analytic strategies; consider sedentary behavior in subpopulations; describe conceptual models and theories to guide sedentary behavior interventions; and explain what is known about interventions in different settings. Considering the breadth of perspectives brought to bear on the field and the plethora of opportunities for research, policy, and practice, we suggest 3 elements of an interdisciplinary research strategy drawing upon the primary knowledge bases of physical activity and health: through the experimental methods of exercise science, through the observational tools of epidemiology, and through the conceptual approaches and methods of behavioral science. A better understanding of the health consequences of sedentary behavior and how they may be influenced can be encompassed by 3 key questions: What changes are needed to most effectively influence sedentary behaviors? What elements of sedentary behavior should be changed to improve health outcomes? What are the feasibility of and the benefits from changing sedentary behavior?

Health behaviors in family members of patients completing cancer treatment.

PubMed

Mazanec, Susan R; Flocke, Susan A; Daly, Barbara J

2015-01-01

To describe the impact of the cancer experience on the health behaviors of survivors' family members and to determine factors associated with family members' intentions for health behavior change. Descriptive, cross-sectional, correlational. A National Cancer Institute-designated comprehensive cancer center in the midwestern United States. 39 family members and 50 patients with diagnoses of breast, colorectal, head and neck, lung, or prostate cancer who were completing definitive cancer treatment. Patients and family members were approached in the clinic at three weeks or fewer before the completion of their course of treatment. Family members completed surveys and a structured interview in person or via telephone. Intention, perceived benefit, and confidence about eating a healthful diet, physical activity, and smoking cessation; emotional distress; and family cohesion, conflict, and expressiveness. Family members had high ratings for intention, perceived benefit, and confidence related to the behaviors of eating a healthful diet and performing 30 minutes of daily moderate-intensity physical activity. They also had high ratings for the extent to which the cancer experience had raised awareness of their cancer risk and made them consider undergoing screening tests for cancer; ratings were lower for making changes in their health behaviors. Family members expressed strong intentions to engage in health-promoting behaviors related to physical activity and nutrition at the post-treatment transition. Oncology nurses are in a key position to engage family members and patients in behavior change. Nurses should assess family members at the completion of treatment for distress and provide interventions to influence the trajectory of distress in survivorship.

Development of a Behavior Change Intervention to Encourage Timely Cancer Symptom Presentation Among People Living in Deprived Communities Using the Behavior Change Wheel.

PubMed

Smits, Stephanie; McCutchan, Grace; Wood, Fiona; Edwards, Adrian; Lewis, Ian; Robling, Michael; Paranjothy, Shantini; Carter, Ben; Townson, Julia; Brain, Kate

2018-05-18

Targeted public awareness interventions are needed to improve earlier cancer diagnosis and reduce socioeconomic inequalities in cancer outcomes. The health check (intervention) is a touchscreen questionnaire delivered by trained lay advisors that aims to raise awareness of cancer symptoms and risk factors and encourage timely help seeking. This study aimed to apply the Behavior Change Wheel to intervention refinement by identifying barriers and facilitators to timely symptom presentation among people living in socioeconomically deprived communities. Primary data (six focus groups with health professionals, community partners and public) and secondary data (systematic review of barriers and facilitators to cancer symptom presentation) were mapped iteratively to the Behavior Change Wheel. Barriers and facilitators were identified from the systematic review and focus groups comprising 14 members of the public aged over 40, 14 community partners, and 14 healthcare professionals. Barriers included poor symptom knowledge and lack of motivation to engage in preventive or proactive behaviors. Facilitators included cues/prompts to action, general practitioner preparedness to listen, and social networks. The following behavior change techniques were selected to address identified barriers and facilitators: information about health consequences, prompts/cues, credible sources, restricting physical and social environment, social support, goal setting, and action planning. The Behavior ChangeWheel triangulated findings from primary and secondary data sources. An intervention combining education and enablement could encourage timely symptom presentation to primary care among people living in socioeconomically deprived communities. Social encouragement and support is needed to increase symptom knowledge, challenge negative cancer beliefs, and prompt decisions to engage with the healthcare system.

Efficacy of oral health promotion in primary care practice during early childhood: creating positive changes in parent's oral health beliefs and behaviors.

PubMed

Mattheus, Deborah J

2014-06-01

Nurse practitioners frequently provide care to children suffering from poor oral health. Creative approaches to impacting dental disease are needed due to the current lack of traditional dental providers. This study investigated the effects of oral health promotion provided by primary care providers on parental oral health beliefs and behaviors. Participants receiving standard oral care during two well child visits and two additional enhanced oral health visits (n=44) were compared to participants receiving standard oral care during two well child visits alone (n=40). Results revealed changes in parent's perception of the importance of oral care for their children's primary teeth compared to general healthcare needs (p<0.05), response to brushing their children's teeth (p<0.0001), confidence in brushing their teeth (p<0.05) and frequency of brushing (p<0.0001) in both groups. This small but important study shows that oral health programs in primary care can produce changes that can improve oral health outcomes. Parents and children exposed to oral health programs during their frequent well child care visits in the first years of life may help decrease the rate of early childhood caries and improve their quality of life.

Relationship between Health Literacy, Health-Related Behaviors and Health Status: A Survey of Elderly Chinese

PubMed Central

Liu, Yong-Bing; Liu, Liu; Li, Yan-Fei; Chen, Yan-Li

2015-01-01

Background: Despite the large volume of research dedicated to health-related behavior change, chronic disease costs continue to rise, thus creating a major public health burden. Health literacy, the ability to seek, understand, and utilize health information, has been identified as an important factor in the course of chronic conditions. Little research has been conducted on the relationship between health literacy and health-related behaviors and health status in elderly Chinese. The aim of this study was to elucidate the relationship between health literacy and health-related behaviors and health status in China. Methods: The subjects enrolled in this study were selected based on a stratified cluster random sampling design. Information involving >4500 older adults in 44 pension institutions in Urumqi, Changji, Karamay, and Shihezi of Xinjiang between September 2011 and June 2012 was collected. The Chinese Citizen Health Literacy Questionnaire (China Health Education Centre, 2008) and a Scale of the General Status were administered and the information was obtained through face-to-face inquiries by investigators. A total of 1452 respondents met the inclusion criteria. A total of 1452 questionnaires were issued and the valid response rate was 96.14% (1396 of 1452). Factors affecting health literacy and the relationship to health literacy were identified by one-way ANOVA and a multiple linear regression model. Results: The average health literacy level of the elderly in nursing homes was relatively low (71.74 ± 28.35 points). There were significant differences in the health literacy score among the factors of age, gender, race, education level, household income, marital conditions, and former occupation (p < 0.001). The health literacy score was significantly associated with smoking, drinking, physical exercise, and health examination (p < 0.001). The elderly with higher health literacy scores were significantly less likely to have risky behaviors (smoking, regular

Behavior Change Techniques in Physical Activity eHealth Interventions for People With Cardiovascular Disease: Systematic Review.

PubMed

Duff, Orlaith Mairead; Walsh, Deirdre Mj; Furlong, Bróna A; O'Connor, Noel E; Moran, Kieran A; Woods, Catherine B

2017-08-02

Cardiovascular disease (CVD) is the leading cause of premature death and disability in Europe, accounting for 4 million deaths per year and costing the European Union economy almost €196 billion annually. There is strong evidence to suggest that exercise-based secondary rehabilitation programs can decrease the mortality risk and improve health among patients with CVD. Theory-informed use of behavior change techniques (BCTs) is important in the design of cardiac rehabilitation programs aimed at changing cardiovascular risk factors. Electronic health (eHealth) is the use of information and communication technologies (ICTs) for health. This emerging area of health care has the ability to enhance self-management of chronic disease by making health care more accessible, affordable, and available to the public. However, evidence-based information on the use of BCTs in eHealth interventions is limited, and particularly so, for individuals living with CVD. The aim of this systematic review was to assess the application of BCTs in eHealth interventions designed to increase physical activity (PA) in CVD populations. A total of 7 electronic databases, including EBSCOhost (MEDLINE, PsycINFO, Academic Search Complete, SPORTDiscus with Full Text, and CINAHL Complete), Scopus, and Web of Science (Core Collection) were searched. Two authors independently reviewed references using the software package Covidence (Veritas Health Innovation). The reviewers met to resolve any discrepancies, with a third independent reviewer acting as an arbitrator when required. Following this, data were extracted from the papers that met the inclusion criteria. Bias assessment of the studies was carried out using the Cochrane Collaboration's tool for assessing the risk of bias within Covidence; this was followed by a narrative synthesis. Out of the 987 studies that were identified, 14 were included in the review. An additional 9 studies were added following a hand search of review paper references

Case-mix adjustment of consumer reports about managed behavioral health care and health plans.

PubMed

Eselius, Laura L; Cleary, Paul D; Zaslavsky, Alan M; Huskamp, Haiden A; Busch, Susan H

2008-12-01

To develop a model for adjusting patients' reports of behavioral health care experiences on the Experience of Care and Health Outcomes (ECHO) survey to allow for fair comparisons across health plans. Survey responses from 4,068 individuals enrolled in 21 managed behavioral health plans who received behavioral health care within the previous year (response rate = 48 percent). Potential case-mix adjustors were evaluated by combining information about their predictive power and the amount of within- and between-plan variability. Changes in plan scores and rankings due to case-mix adjustment were quantified. The final case-mix adjustment model included self-reported mental health status, self-reported general health status, alcohol/drug treatment, age, education, and race/ethnicity. The impact of adjustment on plan report scores was modest, but large enough to change some plan rankings. Adjusting plan report scores on the ECHO survey for differences in patient characteristics had modest effects, but still may be important to maintain the credibility of patient reports as a quality metric. Differences between those with self-reported fair/poor health compared with those in excellent/very good health varied by plan, suggesting quality differences associated with health status and underscoring the importance of collecting quality information.

A multilevel modeling approach to examining the implementation-effectiveness relationship of a behavior change intervention for health care professional trainees.

PubMed

Tomasone, Jennifer R; Sweet, Shane N; McReynolds, Stuart; Martin Ginis, Kathleen A

2017-09-01

Changing Minds, Changing Lives, a seminar-mediated behavior change intervention, aims to enhance health care professionals' (HCPs') social cognitions for discussing leisure-time physical activity (LTPA) with patients with physical disabilities. This study examines which seminar implementation variables (presenter characteristics, delivery components) predict effectiveness using multilevel modeling. HCP trainees (n = 564) attended 24 seminars and completed Theory of Planned Behavior-based measures for discussing LTPA at pre-, post-, 1-month post-, and 6-months post-seminar. Implementation variables were extracted from presenter-completed questionnaires/checklists. Seminars presented by a HCP predicted positive changes in all cognitions pre-post but negative changes in attitudes and perceived behavioral control (PBC) over follow-up (ps < .05). The number of seminars the presenter had delivered predicted negative changes in attitudes and PBC during follow-up (ps < .001). Inclusion of audiovisual components predicted positive changes in attitudes pre-post (p < .001). Presenter characteristics may be "key ingredients" to educational interventions for HCPs; however, future studies should examine additional implementation variables.

Missing the mark for patient engagement: mHealth literacy strategies and behavior change processes in smoking cessation apps.

PubMed

Paige, Samantha R; Alber, Julia M; Stellefson, Michael L; Krieger, Janice L

2018-05-01

To examine how Transtheoretical Model (TTM)'s processes of change and mHealth literacy strategies are employed in mobile smoking cessation apps. A purposive sample of 100 iTunes apps were coded to assess descriptive (price, type, developer, user-rating) and engagement metrics, including processes of change and mHealth literacy strategies (plain language, usability, interactivity). One-way ANOVAs and independent samples t-tests examined associations between descriptive and engagement metrics. Over half of the apps included 7 (78%) processes of change. Fewer included self-liberation (36%) and reinforcement management (34%). Most apps incorporated plain language, but few integrated usability and interactivity strategies. Hypnotherapy and informational apps included more behavioral processes of change than apps incorporating a combination of features, including gaming, cigarette trackers, and motivational coaching (p<0.01). Apps included behavior change processes but rarely incorporated usability and interactivity features to promote patient engagement. Engagement metrics did not vary by app user-ratings, price-to-download, or developer, including for-profit organizations or government and educational institutions. Providers should acknowledge the popularity of smoking cessation apps as potential cessation aids and communicate their benefits and drawbacks to patients. Future efforts to improve smoking cessation apps should focus on enhancing the quality of tailored and interactive content. Copyright © 2017 Elsevier B.V. All rights reserved.

Issue Paper on Physiological and Behavioral Changes in ...

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This issue paper provides a summary of information from the published literature related to behavioral and physiological changes during pregnancy and lactation that may affect women’s exposure or susceptibility to environmental contaminants, provides potentially useful exposure factor data for this population of women, and highlights data gaps. Background Exposures to environmental contaminants can pose a risk to pregnant women’s health, the developing fetus, children, and adults later in their lives. Assessing risks to this potentially susceptible population requires an understanding of the physiological and behavioral changes that occur during pregnancy and lactation. Many physiological and anatomical changes occur in a woman’s organ systems during the course of pregnancy and lactation. For example, blood volume and cardiac output increase during pregnancy, and other metabolic functions are altered to provide for the demands of the fetus. Nutritional demands are greater during pregnancy and lactation. There also are changes in behavior during both pregnancy and lactation. For example, water consumption during pregnancy and lactation increases. These behavioral and physiological changes can lead to different environmental exposures than these women might otherwise experience in the absence of pregnancy or lactation. The purpose of the issue paper is to provide a summary of data available on physiological and behavioral changes in pregnant a

The role of behavioral health services in accountable care organizations.

PubMed

Kathol, Roger G; Patel, Kavita; Sacks, Lee; Sargent, Susan; Melek, Stephen P

2015-02-01

Nationally, care delivery organizations are developing accountable care organizations (ACOs), but few have an appreciation of the importance of behavioral health services or knowledge about how to include them in an ACO since their funding and delivery are currently segregated from other medical services. This commentary reviews data on the impact of patients with concurrent medical and behavioral health conditions. They indicate that three-fourths of patients with behavioral health disorders are seen in the medical setting, but are largely untreated because few medical patients choose to access the behavioral health sector, which is where behavioral health providers are paid to work. Untreated behavioral health conditions in medical patients are associated with persistent medical illness and significantly increased total medical healthcare service use and cost, especially in those with chronic medical conditions. At a national level, those with behavioral health conditions use one-third of total healthcare resources. This will not change unless at-risk ACOs can effectively correct the mismatch between behavioral health patients and behavioral healthcare delivery. The authors suggest that ACO subcontracting for traditional segregated behavioral health services, whether from local provider groups or external vendors, will not achieve ACO-mandated access, treatment, and cost reduction goals. Rather, behavioral health specialists will need to become core ACO member providers. This will allow them to be deployed along with other member providers using value-added delivery approaches in the medical setting to integrate medical and behavioral health service delivery, and to achieve synergistic health and cost improvement.

Mass media and behavior change: hand in hand.

PubMed

1992-01-01

Since the early 1980s, Johns Hopkins University's Population communication Services has conducted evaluations of mass media campaigns in developing countries which communications personnel have designed to change health and sex behavior. The mass media campaigns involved relaying health and family planning information via radio, television, and pamphlets. The evaluations showed that these campaigns were an effective technique to promote behavior change, e.g. they have boosted demand for contraceptives, condom sales, clinic visits, and inquiries to hotlines. A 6-part television drama incorporating health and family planning into its storyline stimulated behavior change in Pakistan in 1991. 36% of people surveyed after the drama series said they would limit the number of children they would have. 44% planned to improve communication with their spouse. An amusing television promotion in Brazil which ran for 6 months in the late 1980s prompted 58% of new clinic patients in 1 town to seek a vasectomy. 1 clinic experienced an 81% increase in vasectomies. A 6-month campaign to promote condom use in Colombia in 1988-89 resulted in a 75% rise in condom sales. In the mid 1980, a 6-9 month mass media popular music campaign (2 songs and videos disseminated via television, radio, and print materials) in Mexico and Latin America strove to encourage youth to be responsible for their sexual behavior. During the campaign, an adult counseling center received an 800% increase in letters (50-450 letters/month). 4 radio and 5 television spots promoting health and family planning in Kwara State, Nigeria in 1984-87 increased family planning acceptors 500% from 258 to 1526 in the 7 existing clinics. Other successful campaigns took place in the Philippines, Zimbabwe, Indonesia, Turkey, Bolivia and Honduras.

Responsiveness of a simple tool for assessing change in behavioral intention after continuing professional development activities.

PubMed

Légaré, France; Freitas, Adriana; Turcotte, Stéphane; Borduas, Francine; Jacques, André; Luconi, Francesca; Godin, Gaston; Boucher, Andrée; Sargeant, Joan; Labrecque, Michel

2017-01-01

Continuing professional development (CPD) activities are one way that new knowledge can be translated into changes in practice. However, few tools are available for evaluating the extent to which these activities change health professionals' behavior. We developed a questionnaire called CPD-Reaction for assessing the impact of CPD activities on health professionals' clinical behavioral intentions. We evaluated its responsiveness to change in behavioral intention and verified its acceptability among stakeholders. We enrolled 376 health professionals who completed CPD-Reaction before and immediately after attending a CPD activity. We contacted them three months later and asked them to self-report on any behavior change. We compared the mean rankings on each CPD-Reaction construct before and immediately after CPD activities. To estimate its predictive validity, we compared the median behavioral intention score (post-activity) of health professionals reporting a behavior change three months later with the median behavioral intention score of physicians who reported no change. We explored stakeholders' views on CPD-Reaction in semi-structured interviews. Participants were mostly family physicians (62.2%), with an average of 19 years of clinical practice. Post-activity, we observed an increase in intention-related scores for all constructs (P < 0.001) with the most appreciable for the construct beliefs about capabilities. A total of 313 participants agreed to be contacted at follow up, and of these only 69 (22%) reported back. Of these, 43 (62%) self-reported a behavior change. We observed no statistically significant difference in intention between health professionals who later reported a behavior change and those who reported no change (P = 0.30). Overall, CPD stakeholders found the CPD-Reaction questionnaire of interest and suggested potential solutions to perceived barriers to its implementation. The CPD-Reaction questionnaire seems responsive to change in

Evaluating Behavioral Health Surveillance Systems.

PubMed

Azofeifa, Alejandro; Stroup, Donna F; Lyerla, Rob; Largo, Thomas; Gabella, Barbara A; Smith, C Kay; Truman, Benedict I; Brewer, Robert D; Brener, Nancy D

2018-05-10

In 2015, more than 27 million people in the United States reported that they currently used illicit drugs or misused prescription drugs, and more than 66 million reported binge drinking during the previous month. Data from public health surveillance systems on drug and alcohol abuse are crucial for developing and evaluating interventions to prevent and control such behavior. However, public health surveillance for behavioral health in the United States has been hindered by organizational issues and other factors. For example, existing guidelines for surveillance evaluation do not distinguish between data systems that characterize behavioral health problems and those that assess other public health problems (eg, infectious diseases). To address this gap in behavioral health surveillance, we present a revised framework for evaluating behavioral health surveillance systems. This system framework builds on published frameworks and incorporates additional attributes (informatics capabilities and population coverage) that we deemed necessary for evaluating behavioral health-related surveillance. This revised surveillance evaluation framework can support ongoing improvements to behavioral health surveillance systems and ensure their continued usefulness for detecting, preventing, and managing behavioral health problems.

A qualitative study exploring health perceptions and factors influencing participation in health behaviors in colorectal cancer survivors.

PubMed

Hardcastle, Sarah J; Maxwell-Smith, Chloe; Zeps, Nik; Platell, Cameron; O'Connor, Moira; Hagger, Martin S

2017-02-01

The purpose of the study was to explore colorectal cancer survivors' health perceptions following cessation of active treatment for cancer and to explore the factors influencing participation in health-promoting behaviors that may help reduce cardiovascular disease risk. Face-to-face interviews were conducted with participants that had completed active treatment for cancer within the previous 2 years. Participants were colorectal cancer survivors (N = 24, men = 11, women = 13, M age = 69.38 years, SD = 4.19) recruited from a private hospital in Perth, Australia on the basis that they had existing morbidities that put them at increased risk of cardiovascular disease. Interview transcripts were analyzed using thematic analysis. Five main themes emerged: back to normal; the pleasures in life: 'is it worth it?'; beliefs about health behavior; skepticism of eating guidelines; and lack of motivation. The majority of participants felt they were in good health and had made a full recovery. Participants questioned whether it was worth changing their lifestyle given their life stage and referred to the desire to enjoy life. Lay health beliefs, skepticism of eating guidelines, and a lack of motivation were barriers to change. Interventions should target lay beliefs and skepticism in relation to health behaviors in order to reinforce the importance and value of participating in health-related behavior. Findings may inform the development of effective, patient-centered interventions that target lay health beliefs and build motivation for health behavior change. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Can functional magnetic resonance imaging studies help with the optimization of health messaging for lifestyle behavior change? A systematic review.

PubMed

Whelan, Maxine E; Morgan, Paul S; Sherar, Lauren B; Orme, Mark W; Esliger, Dale W

2017-06-01

Unhealthy behaviors, including smoking, poor nutrition, excessive alcohol consumption, physical inactivity and sedentary lifestyles, are global risk factors for non-communicable diseases and premature death. Functional magnetic resonance imaging (fMRI) offers a unique approach to optimize health messages by examining how the brain responds to information relating to health. Our aim was to systematically review fMRI studies that have investigated variations in brain activation in response to health messages relating to (i) smoking; (ii) alcohol consumption; (iii) physical activity; (iv) diet; and (v) sedentary behavior. The electronic databases used were Medline/PubMed, Web of Science (Core Collection), PsychINFO, SPORTDiscuss, Cochrane Library and Open Grey. Studies were included if they investigated subjects aged ≥10years and were published before January 2017. Of the 13,836 studies identified in the database search, 18 studies (smoking k=15; diet k=2; physical activity/sedentary behavior k=1) were included in the review. The prefrontal cortex was activated in seven (47%) of the smoking-related studies and the physical activity study. Results suggest that activation of the ventromedial, dorsolateral and medial prefrontal cortex regions were predictive of subsequent behavior change following exposure to aversive anti-smoking stimuli. Studies investigating the neurological responses to anti-smoking material were most abundant. Of note, the prefrontal cortex and amygdala were most commonly activated in response to health messages across lifestyle behaviors. The review highlights an important disparity between research focusing on different lifestyle behaviors. Insights from smoking literature suggest fMRI may help to optimize health messaging in relation to other lifestyle behaviors. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparative efficacy of simultaneous versus sequential multiple health behavior change interventions among adults: A systematic review of randomised trials.

PubMed

James, Erica; Freund, Megan; Booth, Angela; Duncan, Mitch J; Johnson, Natalie; Short, Camille E; Wolfenden, Luke; Stacey, Fiona G; Kay-Lambkin, Frances; Vandelanotte, Corneel

2016-08-01

Growing evidence points to the benefits of addressing multiple health behaviors rather than single behaviors. This review evaluates the relative effectiveness of simultaneous and sequentially delivered multiple health behavior change (MHBC) interventions. Secondary aims were to identify: a) the most effective spacing of sequentially delivered components; b) differences in efficacy of MHBC interventions for adoption/cessation behaviors and lifestyle/addictive behaviors, and; c) differences in trial retention between simultaneously and sequentially delivered interventions. MHBC intervention trials published up to October 2015 were identified through a systematic search. Eligible trials were randomised controlled trials that directly compared simultaneous and sequential delivery of a MHBC intervention. A narrative synthesis was undertaken. Six trials met the inclusion criteria and across these trials the behaviors targeted were smoking, diet, physical activity, and alcohol consumption. Three trials reported a difference in intervention effect between a sequential and simultaneous approach in at least one behavioral outcome. Of these, two trials favoured a sequential approach on smoking. One trial favoured a simultaneous approach on fat intake. There was no difference in retention between sequential and simultaneous approaches. There is limited evidence regarding the relative effectiveness of sequential and simultaneous approaches. Given only three of the six trials observed a difference in intervention effectiveness for one health behavior outcome, and the relatively consistent finding that the sequential and simultaneous approaches were more effective than a usual/minimal care control condition, it appears that both approaches should be considered equally efficacious. PROSPERO registration number: CRD42015027876. Copyright © 2016 Elsevier Inc. All rights reserved.