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Biomedical subjects

Geoffrey C Williams

Publications and source records attributed to Geoffrey C Williams.

15 recordsLinked to original sources
PubMed2006

Validating the theoretical structure of the Treatment Self-Regulation Questionnaire (TSRQ) across three different health behaviors.

Nearly 40% of mortality in the United States is linked to social and behavioral factors such as smoking, diet and sedentary lifestyle. Autonomous self-regulation of health-related behaviors is thus an important aspect of human behavior to assess. In 1997, the Behavior Change Consortium (BCC) was formed. Within the BCC, seven health behaviors, 18 theoretical models, five intervention settings and 26 mediating variables were studied across diverse populations. One of the measures included across settings and health behaviors was the Treatment Self-Regulation Questionnaire (TSRQ). The purpose of the present study was to examine the validity of the TSRQ across settings and health behaviors (tobacco, diet and exercise). The TSRQ is composed of subscales assessing different forms of motivation: amotivation, external, introjection, identification and integration. Data were obtained from four different sites and a total of 2731 participants completed the TSRQ. Invariance analyses support the validity of the TSRQ across all four sites and all three health behaviors. Overall, the internal consistency of each subscale was acceptable (most alpha values >0.73). The present study provides further evidence of the validity of the TSRQ and its usefulness as an assessment tool across various settings and for different health behaviors.

Adolescent↗
PubMed2006

Testing a self-determination theory intervention for motivating tobacco cessation: supporting autonomy and competence in a clinical trial.

A longitudinal randomized trial tested the self-determination theory (SDT) intervention and process model of health behavior change for tobacco cessation (N = 1006). Adult smokers were recruited for a study of smokers' health and were assigned to intensive treatment or community care. Participants were relatively poor and undereducated. Intervention patients perceived greater autonomy support and reported greater autonomous and competence motivations than did control patients. They also reported greater medication use and significantly greater abstinence. Structural equation modeling analyses confirmed the SDT process model in which perceived autonomy support led to increases in autonomous and competence motivations, which in turn led to greater cessation. The causal role of autonomy support in the internalization of autonomous motivation, perceived competence, and smoking cessation was supported.

Adult↗
PubMed2006

A self-determination multiple risk intervention trial to improve smokers' health.

BACKGROUND: Little is known about how interventions motivate individuals to change multiple health risk behaviors. Self-determination theory (SDT) proposes that patient autonomy is an essential factor for motivating change. OBJECTIVE: An SDT-based intervention to enhance autonomous motivation for tobacco abstinence and improving cholesterol was tested. DESIGN: The Smokers' Health Study is a randomized multiple risk behavior change intervention trial. SETTING: Smokers were recruited to a tobacco treatment center. PATIENTS: A total of 1.006 adult smokers were recruited between 1999 and 2002 from physician offices and by newspaper advertisements. INTERVENTIONS: A 6-month clinical intervention (4 contacts) to facilitate internalization of autonomy and perceived competence for tobacco abstinence and reduced percent calories from fat was compared with community care. Clinicians elicited patient perspectives and life strivings, provided absolute coronary artery disease risk estimates,enumerated effective treatment options, supported patient initiatives,minimized clinician control, assessed motivation for change, and developed a plan for change. OUTCOME MEASURES: Twelve-month prolonged tobacco abstinence, and change in percent calories from fat and low-density lipoprotein-cholesterol (LDL-C) from baseline to 18 months. RESULTS- Intention to treat analyses revealed that the intervention significantly increased 12-month prolonged tobacco abstinence (6.2% vs 2.4%; odds ratio [OR]=2.7, P=.01, number needed to treat [NNT] =26), and reduced LDL-C (-8.9 vs -4.1 mg/dL; P=.05). There was no effect on percent calories from fat. CONCLUSIONS: An intervention focused on supporting smokers'autonomy was effective in increasing prolonged tobacco abstinence and lowering LDL-C. Clinical interventions for behavior change may be improved by increasing patient autonomy and perceived competence.

Humans↗
PubMed2006

Prevalence of the metabolic syndrome among patients receiving clozapine.

OBJECTIVE: This study compared the prevalence of the metabolic syndrome among outpatients with schizophrenia and schizoaffective disorder receiving clozapine with a matched comparison group from the National Health and Nutrition Examination Survey. METHOD: Ninety-three outpatients and a matched group of 2,701 comparison subjects were compared according to National Cholesterol Education Program criteria. Outpatient data were obtained through physical assessments, laboratory testing, and reviews of medical records. RESULTS: The prevalence of the metabolic syndrome was significantly higher among clozapine patients (53.8%) than among the comparison group (20.7%). For clozapine patients, logistic regression analysis revealed significant associations with age, body mass index, and duration of clozapine treatment. Only age and body mass index were associated with the prevalence of metabolic syndrome in both groups. CONCLUSIONS: Patients receiving clozapine are at significantly increased risk for developing the metabolic syndrome. Psychiatrists and other providers should consider performing regular physical health monitoring to prevent long-term adverse health consequences.

Adolescent↗
PubMed2005

Emergency physicians' fear of malpractice in evaluating patients with possible acute cardiac ischemia.

STUDY OBJECTIVE: We evaluate the association between emergency physicians' fear of malpractice and the triage and evaluation patterns of patients with symptoms suggestive of acute coronary syndrome. METHODS: We surveyed 33 emergency physicians of 2 university hospitals during the preintervention phase of an implementation trial of the Agency for Health Care Policy and Research Unstable Angina guideline in 1,134 study patients. The survey included a 6-item instrument that addressed concerns about malpractice and a measure of general risk aversion. We used hierarchical logistic regression to model emergency department (ED) triage decisions and diagnostic testing as a function of fear of malpractice, with adjustment for patient characteristics, Agency for Health Care Policy and Research guideline risk group, study site, and clustering by emergency physician. RESULTS: Overall, emergency physicians in the upper tertile of malpractice fear were less likely to discharge low-risk patients compared with emergency physicians in the lower tertile (adjusted odds ratio [OR] 0.34; 95% confidence interval [CI] 0.12 to 0.99; P=.05). Patients treated by emergency physicians in this group were also more likely to be admitted to an ICU or telemetry bed (adjusted OR 1.7; 95% CI 1.2 to 2.4). In addition, emergency physicians in the upper tertile of malpractice fear were more likely to order chest radiography, as well as cardiac troponin. Malpractice fear accounted for a similar amount of variance after controlling for emergency physicians' risk aversion. CONCLUSION: Malpractice fear accounts for significant variability in ED decisionmaking and is associated with increased hospitalization of low-risk patients and increased use of diagnostic tests.

Adult↗
PubMed2005

Promoting glycemic control through diabetes self-management: evaluating a patient activation intervention.

This study compared an activation intervention to passive education in a randomized attention-control trial of 232 patients with type 2 diabetes. The activation intervention was based on Expanding Patient Involvement in Care (EPIC) trials, and was compared to time-matched passive education viewing of ADA video-tapes. Patient demographics and clinical characteristics of their diabetes were assessed with questionnaires, active involvement was assessed via ratings of taped interactions between patients and providers, and serum samples were analyzed for HbA1c. Patients in the activation condition were rated as more actively involved in discussions of diabetes self-management, and rated active involvement was predictive of improvement in glycemic control. No effect of the activation intervention was found on HbA1c. Thus, the activation intervention increased the active involvement of patients with type 2 diabetes in visits with practitioners, and active involvement led to improved glycemic control. However, the activation intervention did not improve glycemic control directly.

Blood Glucose Self-Monitoring↗
PubMed2005

Variation in perceived competence, glycemic control, and patient satisfaction: relationship to autonomy support from physicians.

There is considerable variation in care provided to patients with diabetes related to metabolic control, preventive services, and degree of patient-centered support. This study evaluates the relation of self-determination theory (SDT) constructs of clinician autonomy support, and patient competence to glycemic control, depressive symptoms, and patient satisfaction from baseline surveys of 634 patients of 31 Colorado primary care physicians participating in a program to improve diabetes care. Spearman correlations of autonomy support from one's clinician with patient competence, HbA1c, depressive symptoms and satisfaction were significant (R = -0.11 to 0.55, P < 0.005). Structural equation modeling demonstrated that autonomy support was significantly related to perceived competence, depressive symptoms, patient satisfaction, and indirectly to glycemic control. Perceived competence was significantly related to depressive symptoms, patient satisfaction and glycemic control. Further, the motivation constructs from SDT accounted for 5% of the variance in glycemic control, 8% of the variance in depression, and 42% of the variance in patient satisfaction. Quality improvement efforts need to pay greater attention to patient competence, satisfaction, and depression, in addition to glycemic control. Clinician autonomy support was found to be reliably measured and moderately correlated with psychosocial and biologic outcomes related to diabetes self-management. These results suggest training clinicians to increase their support of patient autonomy may be one important avenue to improve diabetes outcomes.

Adult↗
PubMed2005

Measuring tobacco dependence treatment outcomes: a perspective from the behavior change consortium.

The Behavior Change Consortium (BCC) served as a consortium of 15 National Institutes of Health-funded trials intended to link theories of health behavior change to outcomes related to improved diet, exercise, and/or tobacco cessation. Five sites developed and tested interventions aimed at changing tobacco use behaviors, and the remaining 10 focused on changing diet and/or physical activity. The BCC's tobacco dependence workgroup functioned to identify measures of tobacco use and dependence for use across the 15 BCC trials. The BCC tobacco intervention trials described herein were categorized by type of trial; theory(ies) on which each was based; and the "thickness," or intensity, of the intervention. Between-site differences across these parameters posed conceptual and analytic challenges for combining data for cross-site analyses, which were integral to the BCC mission of identifying mechanisms of health behavior change. The lessons learned by the BCC tobacco dependence workgroup regarding the measurement and analysis of tobacco outcomes among BCC trials are discussed, including the challenges and the opportunities regarding the preparation for cross-site analyses. The workgroup concludes that trials should report both assessment of a prolonged period of abstinence of 6 months or longer, in addition to the traditional 7-day point prevalence outcome.

Behavior Therapy↗
PubMed2004

Testing a self-determination theory process model for promoting glycemic control through diabetes self-management.

A longitudinal study tested the self-determination theory (SDT) process model of health behavior change for glycemic control within a randomized trial of patient activation versus passive education. Glycosylated hemoglobin for patients with Type 2 diabetes (n=159) was assessed at baseline, 6 months, and 12 months. Autonomous motivation and perceived competence were assessed at baseline and 6 months, and the autonomy supportiveness of clinical practitioners was assessed at 3 months. Perceptions of autonomy and competence were promoted by perceived autonomy support, and changes in perceptions of autonomy and competence, in turn, predicted change in glycemic control. Self-management behaviors mediated the relation between change in perceived competence and change in glycemic control. The self-determination process model fit the data well.

Adult↗
PubMed2003

Actualizing Gadow's moral framework for nursing through research.

The purpose of this paper is to describe how Sally Gadow's perspectives on existential advocacy as the moral framework for the nurse-patient relationship were synthesized with a general theory of motivation, self-determination theory (SDT), to inform the design of a study in which the influence of interpersonal care on the process of tobacco dependence treatment was explored. Consistent with the tenets of existential advocacy, participants who perceived their care providers as interpersonally sensitive and bringing more of their whole selves to the care encounter reported more autonomous motivation and felt competence for stopping smoking. The integration of existential advocacy with SDT, which led to the empirical work in which Gadow's ideas were actualized and her model supported, is described. Study findings are discussed in light of Gadow's philosophical views, and implications for nursing highlighted.

Humans↗
PubMed2003

Health care practitioners' motivation for tobacco-dependence counseling.

Smoking cessation counseling by practitioners occurs at low rates in spite of strong evidence that counseling increases quit rates and reduces patient mortality. In a preliminary study, 1060 New York State physicians completed a survey concerning use of the Agency for Health Care Policy and Research (AHCPR) Guidelines, perceived autonomy and perceived competence for counseling, perceived autonomy support from insurers, and barriers to counseling. Considered together, perceived autonomy, perceived competence and perceived autonomy support predicted time devoted to counseling and use of the AHCPR guidelines. The primary, longitudinal study of 220 health care practitioners who attended a smoking cessation workshop predicted change in the practitioners' perceived autonomy and perceived competence for counseling as a function of the degree to which they experienced the workshop instructor as autonomy-supportive. In turn, change in perceived autonomy predicted change in time spent counseling and change in use of the AHCPR guidelines.

Counseling↗
PubMed2002

Patient-centered diabetes self-management education.

Diabetes self-management education (DSME) has been shown to improve health outcomes. Yet, relatively little is known about how DSME has its effects. Literature reviewed from the past 3 years indicates that if DSME is to become more effective interventions need to be theory-based, to increase patient involvement in their care, and to encompass a broader array of evidenced-based outcomes. Outcomes reviewed go beyond knowledge and glycemic control to include prevention of diabetes, quality of life, and reduction of cardiovascular risk. The ability of practitioners and health care systems to implement, adopt, and maintain patient-centered interventions over time is discussed. By linking theory to behavior, and broadening the outcomes examined, advances can continue to be made in closing the gap between the scientific base for the treatment of diabetes, and the care and outcomes patients experience. Further research on patient-centered approaches that promote self-management is seen as critical in closing this gap.

Diabetes Mellitus↗
PubMed2002

Self-determination, smoking, diet and health.

A Clinical Trial will test (1) a Self-Determination Theory (SDT) model of maintained smoking cessation and diet improvement, and (2) an SDT intervention, relative to usual care, for facilitating maintained behavior change and decreasing depressive symptoms for those who quit smoking. SDT is the only empirically derived theory which emphasizes patient autonomy and has a validated measure for each of its constructs, and this is the first trial to evaluate an SDT intervention. Adult smokers will be stratified for whether they are at National Cholesterol Education Program (1996) recommended goal for low-density lipoprotein cholesterol (LDL-C). Those with elevated LDL-C will be studied for diet improvement as well as smoking cessation. Six-month interventions involve a behavior-change counselor using principles of SDT to facilitate autonomous motivation and perceived competence for healthier behaving. Cotinine-validated smoking cessation and LDL-C-validated dietary recall of reduced fat intake, as well as depressive symptoms, will be assessed at 6 and 18 months. Structural equation modeling will test the model for both behaviors within the intervention and usual-care conditions.

Adult↗
PubMed2002

Facilitating autonomous motivation for smoking cessation.

Physicians used either an autonomy-supportive or a controlling interpersonal style to counsel smokers based on National Cancer Institute guidelines. Physician autonomy support was rated from audiotapes, and patients' perceived competence and autonomous motivation for quitting were self-reported on questionnaires. Validated point prevalences for 6, 12, and 30 months and for continuous cessation were examined. The intervention did not have a direct effect on quit rates; however, structural equation modeling supported the self-determination process model of smoking cessation. The model indicated that the autonomy-supportive intervention was rated as more autonomy supportive, that rated autonomy support predicted autonomous motivation, and that autonomous motivation predicted cessation at all points in time. Perceived competence contributed independent variance to cessation only at 6 months.

Adult↗