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PubMed1997

The challenge of behavior change.

In a culture that is becoming increasingly automated, motivating individuals to choose to be active remains a great challenge. Recognizing that individuals differ in their motivation to become active and then tailoring the counseling message according to the individual's readiness for change have been shown to help spur behavior change. Developing means for designing interventions for moderate activity and additional recommendations for patient-treatment matching will help to promote physical activity.

Choice Behavior↗

PubMed2004

A longitudinal study of pubertal timing and extreme body change behaviors among adolescent boys and girls.

Recent studies have examined the prevalence of disordered eating and other health risk behaviors among adolescent boys and girls. However, these studies generally have not examined predictors of these behaviors, and have not embedded the investigations within a theoretical framework. This study employed a longitudinal design to evaluate the validity of a biosocial model in explaining health risk behaviors related to extreme body change strategies (disordered eating, exercise dependence, use of food supplements, steroid use) among adolescents. The participants were 430 adolescent boys (mean age = 13.33 years) and 451 adolescent girls (mean age = 13.28 years) who completed measures of pubertal timing, perceived popularity with peers, body dissatisfaction, focus on sport, involvement in competitive sport, strategies to lose weight, strategies to increase muscle, disordered eating, use of food supplements and steroids, and exercise dependence. It was found that both early and late maturing girls were at greatest risk of engaging in health risk behaviors, whereas boys demonstrated more variability in the relationship between pubertal timing and extreme body change behaviors. The results of this study provide important insights into the role of pubertal development in the adoption of extreme body change behaviors among adolescents.

Adolescent↗

PubMedDate not supplied

The art of motivating behavior change: the use of motivational interviewing to promote health.

Health promotion and disease prevention have always been essential to public health nursing. With the changing health care system and an increased emphasis on cost-containment, the role of the nurse is expanding even more into this arena. A challenge for public health nurses, then, is to motivate and facilitate health behavior change in working with individuals, families, and communities and designing programs based on theory. Leading causes of death continue to relate to health behaviors that require change. The purpose of this article is to integrate theory with practice by describing the Transtheoretical Model of Change as well as the principles of motivational interviewing that can be used in motivating behavioral change. A case scenario is presented to illustrate the use of the models with effective interviewing skills that can be used to enhance health. Implications for practice with an emphasis on providing an individually tailored matched intervention is stressed.

Behavior Therapy↗

PubMedDate not supplied

Coronary risk factor behavior change in hospital personnel following a screening program.

We conducted a worksite cardiovascular disease (CVD) awareness and education program at a large medical center. The program consisted of employee screening for blood pressure and total serum cholesterol level, dissemination of information on risk factors for CVD, counseling on behavior change, and evaluation of the screening event as an educational tool. During this five-day event, 2,284 employees were screened for hypertension and hypercholesterolemia. Consenting employees completed a health risk appraisal survey (n = 2,255) and received counseling on their results and CVD risk factors. Appropriate referrals to health care professionals and educational programs were made according to national guidelines. We developed three-month and six-month follow-up surveys and distributed them to all participating employees. The analysis of these data suggests some positive impact upon behavior change within this employee population. In addition to the two follow-up surveys, we held a second blood pressure and serum cholesterol screening eight months after the initial screening. Comparison of the levels taken from both screenings (n = 234) suggests that worksite screening programs may influence significant serum cholesterol and blood pressure reductions in high-risk employees.

Adult↗

PubMedDate not supplied

The primary prevention of heart disease in women through health behavior change promotion in primary care.

PURPOSE: To summarize recent evidence-based recommendations for physical activity promotion, dietary improvement, and tobacco cessation from the U.S. Preventive Services Task Force (USPSTF) and the Task Force on Community Preventive Services (CTF), and examine their applicability to the primary prevention of cardiovascular disease (CVD) in women through primary care interventions. METHODS: For the behaviors cited, USPSTF and CTF recommendations and their associated systematic evidence reviews (SERs) were retrieved. Individual articles from the USPSTF healthy diet and physical activity SERs that met our inclusion criteria were systematically examined to determine the applicability of this research to women. We supplemented findings from these sources with comprehensive federal research summaries and SERs from focused searches of systematic review databases relevant to primary CVD prevention in women through healthy behavior change. MAIN FINDINGS: The USPSTF strongly recommends primary care interventions for tobacco cessation. Strong CTF recommendations for multicomponent systems supports for clinicians, telephone support for quitters, and reduced patient costs for effective cessation therapies guide complementary approaches to assist clinicians. The USPSTF recommends intensive behavioral dietary counseling by specialists for high-risk CVD patients, but found insufficient evidence to recommend for routine healthy diet or physical activity promotion in primary care. The evidence base for these recommendations generally applies to women. Better reporting of gender and minority subgroup outcomes will assist more in-depth understanding of potential differences in either the processes or outcomes of behavior change interventions. CONCLUSIONS: Primary care clinicians, including obstetrician-gynecologists, can contribute to preventing CVD in women through implementing credible evidence-based recommendations for clinical interventions in tobacco and healthy diet. Researchers can further our understanding of gender-specific issues in healthy behavior interventions by reporting process and outcome data for gender and minority subgroups.

Diet↗

PubMed1989

The beneficial outcomes of the arthritis self-management course are not adequately explained by behavior change.

Evaluation of the Arthritis Self-Management Course revealed significant positive changes in the practice of behaviors that were taught and in health outcomes. However, utilizing a variety of statistical techniques, we were able to demonstrate only weak associations between changes in behavior and changes in health status. This suggests the need to examine the mechanisms by which health education affects health status.

Aged↗

PubMed2006

Specifying the determinants of the initiation and maintenance of behavior change: an examination of self-efficacy, satisfaction, and smoking cessation.

Using data from smokers (N = 591) who enrolled in an 8-week smoking cessation program and were then followed for 15 months, the authors tested the thesis that self-efficacy guides the decision to initiate smoking cessation but that satisfaction with the outcomes afforded by quitting guides the decision to maintain cessation. Measures of self-efficacy and satisfaction assessed at the end of the program, 2 months, and 9 months were used to predict quit status at 2, 9, and 15 months, respectively. At each point, participants were categorized as either initiators or maintainers on the basis of their pattern of cessation behavior. Across time, self-efficacy predicted future quit status for initiators, whereas satisfaction generally predicted future quit status for maintainers. Implications for models of behavior change and behavioral interventions are discussed.

Adolescent↗

PubMed2003

Readiness for behavioral changes in patients with heart failure.

BACKGROUND: Successful self-care in heart failure often requires lifestyle changes such as avoiding sodium, excess fluid intake, alcohol, and tobacco; exercising regularly; and losing weight. The Transtheoretical Model, a framework for making behavioral changes, proposes that change requires a series of stages. OBJECTIVES: To identify the stage of readiness for change in 6 lifestyle behaviors important in heart failure and to determine differences in signs and symptoms of heart failure, self-reported knowledge of the disease, and self-reported behavior between patients who have taken action and patients who have not. METHOD: A mail survey of 250 patients with heart failure. RESULTS: Most respondents reported consistent avoidance of tobacco (90.6%), alcohol (87.9%), sodium (81%), and excess fluid (72.6%) and regular participation in exercise (67.1%) and trying to lose weight (64.7%). Yet only 38.7% had a regular exercise program, and 94.2% had eaten high-sodium foods in the preceding 24 hours. Knowledge of heart failure was low (mean score, 67.4%) and did not differ by stage of change. Only 30.4% of the respondents were at their desired weight, and most overweight subjects had been trying to lose weight for more than 6 months. CONCLUSIONS: Although respondents thought they were consistently adhering to recommended guidelines for changes in lifestyle, actual reported behaviors did not always support this evaluation. Use of the stage of change tool to assess stage of readiness to make lifestyle changes may not work well in patients with heart failure, perhaps because of the number and complexity of the changes needed.

Adult↗

PubMed1994

Behavioral changes following chronic myocardial infarction in rats.

Myocardial infarction evokes major physiological changes because of the acute loss of functional cardiac tissue, resulting in more or less severe symptoms of congestive heart failure. In addition, general well-being of patients, their quality of life, is reduced. This includes anxiety/depression, loss of interest in environment and social interactions, sexual problems, and sleep disturbances. Postinfarction treatment is aimed mainly at improving life expectancy, whereas less attention is paid to the quality of that life. The aim of the present study was to determine behavioral changes after myocardial infarction in a (otherwise proven as clinically relevant) rat model for heart failure after myocardial infarction. We have chosen for behavioral tests based upon certain aspects of quality of life in patients. Anxiety/depression, interest in environment, and mobility, tested in an open field, revealed that infarcted rats are more anxious (as inferred from a higher preference for the safe corner area and less visits to the middle area), have less interest in a new environment [as indicated by less exploratory behavior and a longer time before they go into the new area (free exploration)], and showed less mobility (as indicated by reduced distance walked and less time spent on walking). In a test on social interaction, infarcted rats spent less time on social behavior and displayed even somewhat more walking away, suggesting active avoidance of social interaction. The observed behavioral changes in infarcted rats match very well with the aspects of reduced quality of life in postinfarct patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2004

Schizophrenia-like behavioral changes after partial hippocampal kindling.

The effect of hippocampal kindling on behavioral changes following 10 and 21 hippocampal afterdischarges (ADs) or electrographic seizures was examined in behaving rats. As compared to control, non-stimulated rats, 21 but not 10 hippocampal ADs resulted in a decrease in social contact, an increase in social isolation, and an increase in climbing and chasing behavior tested in an open field 3 days after cessation of kindling. Porsolt forced swimming test was not different among the control, 10- or 21-AD groups of rats. A deficit in sensorimotor gating, measured by prepulse inhibition of an acoustic startle, was observed in kindled as compared to control rats at 2 weeks after 21 ADs, but not after 10 ADs. Similarly, methamphetamine (1 mg/kg i.p.) induced higher locomotor activity in kindled rats, as compared to controls, after 21 ADs but not after 10 ADs. Spontaneous locomotor activity in a novel cage, without drug administration, was not different between kindled and control rats. These findings suggest that behavioral alterations after repeated hippocampal electrographic seizures may be mediated by increased dopaminergic functions, which may also mediate the psychiatric symptoms in human epileptic patients.

Acoustic Stimulation↗

PubMed1983

Partial kindling and emotional bias in the cat: lasting aftereffects of partial kindling of the ventral hippocampus. I. Behavioral changes.

Repeated electrical evocation of afterdischarges in the perforant-path ventral hippocampal system of the cat produces lasting changes in species characteristic behavioral responses to environmental threat. After 7 to 12 afterdischarges, cats showed greatly enhanced defensive (withdrawal) responses to rats, and mildly enhanced defensive responses toward mice. Measures of predatory attack which negatively correlate with withdrawal from rats were also changed in a direction consistent with the increase in withdrawal tendency. There was little effect of afterdischarges on the same parameters of attack on mice. Thus the stimulation seemed to attenuate predatory aggression by increasing defensive sensitivity to the threat posed by prey self-defense, and not by reducing predatory motivation per se. The change in defensiveness was not restricted to the predatory test situation, however. Tests of defensive response to conspecific threat vocalizations revealed an increased defensive responding to this stimulus as well. On the other hand, there was no change in social responsiveness shown toward a highly familiar human. Given the sudden onset (1 hr to 24 hr after the last afterdischarge), the long-lasting nature of the change (30-60 days) which persisted in the absence of seizures, and the generality of expression of the behavioral change, it was concluded that the afterdischarges produced an interictally maintained alteration in a defensive personality characteristic of the cats.

Aggression↗

PubMed2026

Identifying stakeholder behaviors for competency-based pharmacy education: A stage 1 behavior change wheel analysis.

INTRODUCTION/OBJECTIVES: Competency-Based Pharmacy Education (CBPE) is a strategic priority for preparing graduates to meet evolving healthcare needs. However, efforts to implement CBPE can stall due to behavioral challenges among faculty, administrators, preceptors, and learners. This study aimed to apply Stage 1 of the Behavior Change Wheel (BCW) to identify stakeholder-specific behaviors and associated determinants needed to implement the five core components of CBPE. METHODS: A multi-method approach grounded in the BCW, the Capability, Opportunity, Motivation - Behavior (COM-B) model, and the Theoretical Domains Framework (TDF) was used. Data were gathered through (1) targeted literature review; (2) structured focus groups with competency-based education experts and pharmacy education stakeholders; and (3) an iterative consensus process. Behaviors were mapped to the five CBPE components: (1) defined competencies, (2) developmental progression, (3) tailored instruction, (4) authentic experiential learning, and (5) programmatic assessment, and then mapped to COM-B and TDF constructs. RESULTS: Over fifty stakeholder-specific behaviors were identified and specified across the CBPE framework. This revealed shared barriers such as limited instructional design knowledge (psychological capability), insufficient assessment of infrastructure (physical opportunity), and misaligned professional identity (reflective motivation). Key TDF domains included knowledge, environmental context, beliefs about capabilities, and professional roles. The behavioral problem statements, specifications, and determinants were identified to support future intervention planning. CONCLUSION: This Stage 1 analysis provides a behaviorally grounded foundation for CBPE implementation by identifying stakeholder behaviors and conditions that enable change. These findings will inform the development of readiness-to-change assessments and targeted interventions (BCW Stages 2 and 3), supporting scalable and sustainable CBPE transformation in pharmacy education.

Education, Pharmacy↗

PubMed2006

Repeated quinpirole treatments produce neurochemical sensitization and associated behavioral changes in female hamsters.

RATIONALE: Repeated stimulation of dopaminergic pathways with dopamine receptor agonists can produce both neurochemical and behavioral sensitization. OBJECTIVES: The present study was designed to examine whether repeated treatment with the D2-like dopamine receptor agonist, quinpirole, would produce neurochemical sensitization of D1 dopamine receptor-mediated processes and associated behavioral changes in female hamsters in a manner analogous to that previously used to sensitize heterologous dopamine signaling pathways in derived cell lines. MATERIALS AND METHODS: Female hamsters received two injections of quinpirole (1.5 mg/kg) or saline each week for 7 weeks, during which time pouching behavior and body weight were monitored. Over the next 2 weeks, hamsters were tested for differences in prepulse inhibition of the acoustic startle response (PPI) and sexual behavior. Adenylate cyclase activation assays were then performed on dissected tissue from the nucleus accumbens and caudate-putamen. RESULTS: Repeated treatment with quinpirole increased pouching behavior and body weight and disrupted PPI. No changes in sexual activity in response to repeated quinpirole were found. Prior quinpirole treatment enhanced D1 dopamine receptor-stimulated adenylate cyclase activity in the caudate-putamen that was blocked by co-incubation with the D1 dopamine antagonist, SCH23390. CONCLUSIONS: These results show that repeated activation of D2-like receptors in vivo can produce changes in feeding behavior and sensory processing that is associated with sensitization of D1 dopamine receptor-mediated signaling in the caudate-putamen.

Adenylyl Cyclases↗

PubMed1984

Sudden behavioral change. Guide to initial evaluation.

Described is an approach to understanding sudden behavioral change that is based on a simplified conceptual model of the functional anatomy of the CNS. The model explores the behavioral correlates of three interrelated CNS functional axes: vertical, lateral, and horizontal.

Attention↗

PubMed1997

Chymopapain-induced reduction of proinflammatory phospholipase A2 activity and amelioration of neuropathic behavioral changes in an in vivo model of acute sciatica.

The mechanism of action underlying chymopapain (Chymodiactin) chemonucleolysis remains obscure. Radiographic studies suggest that chymopapain does not alter disc fragment size acutely; nonetheless, patients often report symptom resolution within a few days, even hours, of treatment. The authors postulate that, in addition to its chemonucleolytic action, chymopapain may possess antiinflammatory properties. To test this hypothesis, the authors assessed the ability of chymopapain to modulate the activity of the proinflammatory enzyme phospholipase A2 (PLA2) and to ameliorate behavioral changes associated with inflammatory neuropathy in an in vivo model of sciatica. Thirty-nine male Fischer rats were randomly assigned to one of three treatment groups: 1) saline, 2) betamethasone, or 3) chymopapain. All of the rats underwent unilateral sciatic nerve ligation with loose chromic gut suture to induce inflammatory mononeuropathy. The animals were tested for thermal and mechanical hyperalgesia on Days 0 (preoperation), 7 (pretreatment), and 14 (prior to death). Three animals were killed on Day 0 to determine the baseline PLA2 activity within unmanipulated rat sciatic nerves. On Day 7, three animals from each group were killed to assess PLA2 activity prior to treatment. The remainder were given a single infusion of saline, betamethasone (0.3 mg/kg), or chymopapain (100 pKat U) around the inflamed nerve. On Day 14, the remaining animals were killed and their sciatic nerves were removed. The tissue was homogenized and the PLA2 activity was determined using [14C]arachidonate-labeled Escherichia coli phospholipid membrane as a substrate. Lipids were extracted and separated by thin-layer chromatography. All animals developed behavioral changes consistent with inflammatory mononeuropathy 24 to 72 hours postoperatively; these included gait disturbance, flexion deformity, and hyperalgesia of the involved hindlimb. The degree of mechanical and thermal hyperalgesia was comparable between groups at Day 7. By Day 14, the thermal hyperalgesia had resolved; the mechanical hyperalgesia was less evident in the betamethasone- and chymopapain-treated groups than in the saline-treated controls (p = 0.003; saline- vs. chymopapain-treated groups p = 0.004; saline- vs. betamethasone-treated groups p = 0.008). The mean PLA2 activity at baseline (Day 0) was 11.6 +/- 4.9 nmol phospholipid hydrolyzed per minute per milligram of protein. The PLA2 activity at Day 7 was 74.4 +/- 18.2 (ligated side) and 21.2 +/- 11.7 (nonligated side). At Day 14, PLA2 activity was reduced in the chymopapain- (47.8 +/- 12.3) and betamethasone- (39.7 +/- 9.5) treated groups compared with the saline control group (62.3 +/- 11.2), (saline- vs. chymopapain-treated groups p < 0.05; saline- vs. betamethasone-treated groups p < 0.01). The PLA2 activity in nonligated specimens was 18.6 +/- 10.1. These data indicate that chymopapain exhibits antiinflammatory properties in vivo, reducing PLA2 activity and ameliorating mechanical hyperalgesia in this model of inflammatory sciatic neuropathy.

Acute Disease↗

PubMed1987

L-deprenyl in Alzheimer's disease. Preliminary evidence for behavioral change with monoamine oxidase B inhibition.

Since monoamine neurotransmitter disturbances exist in some cases of dementia of the Alzheimer's type (DAT), monoamine-enhancing drugs may ameliorate some symptoms of DAT. L-Deprenyl is a monoamine oxidase (MAO) inhibitor that is generally free of undesired effects. At low doses (10 mg/d) it selectively inhibits MAO-B, an enzyme whose level is elevated in the brains of patients with DAT who are studied post mortem. At higher doses it has more complex effects, including inhibition of MAO-A plus MAO-B. We administered 10 mg/d and 40 mg/d of L-deprenyl to 17 patients with DAT in a double-blind, placebo-controlled, serial treatment. Total Brief Psychiatric Rating Scale scores decreased significantly during 10-mg/d treatment, with decreases in measures of anxiety/depression, tension, and excitement. Approximately one half of the patients' conditions were judged to be improved clinically, with evidence of increased activity and social interaction along with reduced tension and retardation. Similar but smaller changes were observed during 40-mg/d treatment. The behavioral changes were associated with improvement in performance on a complex cognitive task requiring sustained effort. There were minimal physiologic and side effects. The greater effect of low-dose L-deprenyl therapy suggests that it is the inhibition of MAO-B, and not MAO-A, that may be important in the behavioral effects of L-deprenyl administration to patients with DAT.

Adult↗

PubMed1998

Sexual behavior of young men in Thailand: regional differences and evidence of behavior change.

An anonymous, self-administered behavioral survey was conducted in Royal Thai Army (RTA) conscripts from 19 provinces throughout Thailand in May 1996. All (to a maximum of 350) Thai men who entered the RTA in each province were selected. Data from 5474 men were included in this analysis. High-risk behaviors were reported nationwide; however, some regional differences were found. Men from the upper North were more likely to have had a commercial sex worker (CSW) as their first sexual partner (42%) than men from any other region. However, in the past year, reported sex with CSWs in the upper North (41%) was similar to or lower than those in other regions. Consistent condom use with CSWs was higher in the North than in any other region. Condom use at first sex with CSWs increased with later years at first sex in all regions. These data suggest that past higher-risk behavior among young men in the upper northern part of Thailand may have contributed to the concentration of the HIV epidemic in that region. Risk behaviors, particularly unprotected sex, appear to be decreasing nationwide.

Adult↗

PubMed2003

Evaluation of physical activity web sites for use of behavior change theories.

Physical activity (PA) Web sites were assessed for their use of behavior change theories, including constructs of the health belief model, Transtheoretical Model, social cognitive theory, and the theory of reasoned action and planned behavior. An evaluation template for assessing PA Web sites was developed, and content validity and interrater reliability were demonstrated. Two independent raters evaluated 24 PA Web sites. Web sites varied widely in application of theory-based constructs, ranging from 5 to 48 on a 100-point scale. The most common intervention strategies were general information, social support, and realistic goal areas. Coverage of theory-based strategies was low, varying from 26% for social cognitive theory to 39% for health belief model. Overall, PA Web sites provided little assessment, feedback, or individually tailored assistance for users. They were unable to substantially tailor the on-line experience for users at different stages of change or different demographic characteristics.

Behavior Therapy↗