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PubMedDate not supplied

Treatment fidelity in behavior change research: a case example.

BACKGROUND: Treatment fidelity refers to the methodological strategies used to monitor and enhance the reliability and validity of behavioral interventions. Assuring optimal treatment fidelity also may decrease the costs of a study and help the research team explain findings. APPROACH: The Behavioral Change Consortium developed a comprehensive model of treatment fidelity that incorporates 5 areas: (a) study design, (b) training providers, (c) delivery of treatment, (d) receipt of treatment, and (e) enactment of treatment skills. The definitions of these areas and a case example (Testing the Effectiveness of the Exercise Plus Program) are provided. RESULTS: There was evidence of treatment fidelity related to delivery based on careful monitoring of the study implementation. A comprehensive plan for training of the interventionists was provided, although evidence of treatment fidelity to training was not quantified. There were evidence based on observations of treatment sessions of delivery and receipt of the intervention and evidence of enactments based on evaluation of exercise calendars. DISCUSSION: The development and implementation of a treatment fidelity plan requires a careful conceptualization of what is relevant to treatment fidelity in any given study. Monitoring of treatment fidelity ideally requires direct or indirect observations of sessions, which can be built into the study design so that costs are minimal in terms of time and resources. Monitoring treatment fidelity allows research teams to truly test interventions and to develop and implement interventions that ultimately improve the overall health and well-being of individuals.

Models, Nursing↗

PubMed2001

Dementia-related behavioral changes - a physician's office-based study.

This is a physician's office-based retrospective study of 161 dementia patients with (94) and without (67) behavioral symptoms. Those with disturbed behavior were subdivided into patients with behavior changes at initial evaluation and those encountered in existing dementia. The two main groups and the subgroups were studied in relation to individual and disease characteristics. The targeted behaviors (aggression, psychosis, aberrant motor behavior and miscellaneous) were analyzed in relation to four dementia-related domains namely cognitive impairment, language impairment, stage of illness (CDR) and functional disability (Rankin grades). No differences were observed between the two main groups in relation to age and gender and to cognitive impairment, language impairment and disability except for stage of illness (P=0.01). There were no significant differences in terms of age and gender in the two subgroups and in the frequency of single targeted behaviors but for psychosis which was the most commonly recorded disturbed behavior. There was no correlation between the single targeted behaviors and the different domains examined but for aberrant motor behavior and stage of illness (P=0.04) in the subgroups.

Journal Article↗

PubMed1991

Information acquisition and behavioral change: a social marketing application.

Previous literature provides insight into the importance of beliefs and other intrapersonal variables for health-related information acquisition and behavioral change. The results of an empirical investigation evidence the unique strength of the role of core health beliefs for each of the multi-level measures. Directions for the development of effective marketing strategy are discussed.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Low-glycemic index carbohydrates: an effective behavioral change for glycemic control and weight management in patients with type 1 and 2 diabetes.

PURPOSE: This retrospective study evaluated the incorporation of low-glycemic index (GI) carbohydrates into daily meal planning as an effective behavioral lifestyle change to improve glycemic control and weight management in patients with type 1 and 2 diabetes. METHODS: Twenty-one subjects participated in this study. All office visits and interview sessions took place in a 2-physician private medical practice setting in Wayne, New Jersey. Patients' pre- and postcounseling HbA1c and body mass index (BMI) values and their antidiabetic medication dosages were recorded. Audiotaped interviews were conducted using the 10-question Glycemic Index Foods Quiz (GIFQ) and the 29-question Interview Questionnaire (IQ). The GI values of pre- and postcounseling meals were calculated. Assessment was based on triangulating the subjects' adherence to the low-GI carbohydrate behavioral change and the primary outcome measures: HbA1c and BMI. RESULTS: Low-GI medical nutrition therapy (LGI-MNT) counseling reduced HbA1c by 19% (mean drop of 1.5 U) and decreased BMI by 8% (mean loss of 17 pounds). This was accomplished by the participants independently lowering the GI values of their meals by 25% (mean reduction of 15 points). Results were achieved over a time frame of 3 to 36 months from the initial LGI-MNT counseling session. CONCLUSIONS: Daily incorporation of low-GI carbohydrates in meal planning can be an effective diabetes self-management strategy for glycemic control and weight management. The documented responses to the subjects' conceptual and practical knowledge of the GI confirm their acceptance of this approach as a permanent behavioral lifestyle change and not a "diet." The positive results of this study attest to what worked for these subjects, inviting diabetes educators to consider offering low-GI dietary advice to their diabetes patients.

Blood Glucose↗

PubMed2006

Acute toxicity, behavioral changes, and histopathological effects of deltamethrin on tissues (gills, liver, brain, spleen, kidney, muscle, skin) of Nile tilapia (Oreochromis niloticus L.) fingerlings.

Deltamethrin, a synthetic pyrethroid contaminating aquatic ecosystems as a potential toxic pollutant, was investigated in the present study for acute toxicity. The purpose of this study was to evaluate LC(50) values of deltamethrin on Nile tilapia (Oreochromis niloticus L.) fingerlings and investigate histopathological responses of fish exposed to deltamethrin. The 48 h LC(50) value for Nile tilapia fingerlings was estimated as 4.85 microg/L using static test system. In addition, behavioral changes at each deltamethrin concentration were observed closely. All fish, exposed to 5 microg/L deltamethrin revealed severe morphological alterations in the gills and liver. In the gills hyperemia, fusion of secondary lamellae and telangiectasis were observed; whereas hydropic degenerations in liver were observed in all examined fish. The results are significant for reporting acute deltamethrin toxicity in terms of behavioral and histopathological changes: Deltamethrin is highly toxic to fingerlings.

Animals↗

PubMed1983

Perceived behavioral changes observed with adaptive seating devices and training programs for multihandicapped, developmentally disabled individuals.

The purpose of this study was to assess, by analyzing survey responses, the perceived behavioral changes that were observed when adaptive seating devices and training programs were provided to multihandicapped, developmentally disabled individuals. Results for 41 clients were analyzed. Statistical analysis revealed that significant changes in social interaction, positioning, tracking, grasping, and self-feeding were perceived by parents, guardians, or trainers. The necessity of a prospective study to analyze data about the influence of behavior programs used with adaptive seating devices is discussed.

Adaptation, Psychological↗

PubMed1999

Do the psychosocial and behavioral changes that accompany motherhood influence the impact of pregnancy on long-term weight gain?

The aim of the present study was to assess whether the psychosocial and behavioral changes that occur during and after pregnancy influence long-term weight gain. The study examined 74 mothers enrolled in the Antenatal Care (ANC) Project (a randomized controlled trial of antenatal care based in South London), all of whom had volunteered to take part in a subsequent follow-up study. Data on body weight at the beginning of pregnancy; lifestyle and behavior during pregnancy; antenatal care and obstetric history; together with measures of postnatal depression and parenting stress following pregnancy were taken from the existing ANC Project database. Additional measurements of height and weight together with information on a variety of lifestyle changes and psychosocial characteristics, were gathered during semi-structured interviews at each mother's home, two and a half years after their children had been born. The results show that pregnancy-related weight gains are not simply the result of retaining weight that is gained during pregnancy, but that they also originate from gaining additional weight in the postpartum period. Mothers who felt they ate more after their children were born, had significantly greater long-term weight gains (2.78 (1.42) kg) than those who felt that they had not increased their food intake (-1.15 (0.76) kg; t = 2.49, p = 0.016). Similarly, mothers who felt they had greater access to food postpartum, had significantly greater long-term weight gains (1.70 (0.87) kg) than those who felt they did not have greater access to food (-1.37 (1.13) kg; t = 2.18, p = 0.032). There was some evidence that the lifestyle changes which accompany pregnancy and motherhood increase some women's vulnerability to eating disorder psychopathology. Mothers who felt they did less exercise after pregnancy than they did before, were also at greater risk of long-term weight gain (p = 0.028), as were mothers with low numbers of supportive individuals (p = 0.033). Neither the stress of parenting nor maternal depression were significantly associated with an increased risk of long-term weight gain (p > 0.05).

Adult↗

PubMed2005

Effects of selective tumor necrosis factor-alpha inhibition to pain-behavioral changes caused by nucleus pulposus-induced damage to the spinal nerve in rats.

Application of nucleus pulposus to the spinal nerve and displacement of the adjacent nerve results in behavioral changes in rats. It has been reported that treatment with the tumor necrosis factor-alpha (TNFalpha) inhibitor, infliximab, significantly reduces spontaneous pain behavior in this animal model. However, there have been no reports of the effects of infliximab on mechanical or thermal hyperalgesia using this model. Disk incision and adjacent spinal nerve displacement were performed with (n = 6) or without (n = 6) injection of infliximab. A control group also underwent sham surgery (n = 6). The animals were tested for 3 days before and on days 1, 3, 7, 14, and 21 after surgery. Non-noxious mechanical thresholds were tested by determining the hind paw withdrawal response to von Frey hair stimulation of the plantar surface of the footpad with a touch stimulator. Thermal nociceptive thresholds were tested using a sensitive thermal testing device. While disk incision with displacement surgery rats showed mechanical and thermal hyperalgesia after surgery on the experimental side, neither rats treated with infliximab nor the sham operation controls showed these effects. Injection of infliximab seemed to prevent mechanical and thermal hyperalgesia caused by the combination of disk incision and nerve displacement.

Animals↗

PubMed1978

Behavioral changes in nonambulatory, profoundly mentally retarded individuals.

Nonambulatory, profoundly mentally retarded (NPMR) individuals seldom have been studied as a distinct population. This investigation sought to describe the pshysical, etiological, and behavioral characteristics of NPMR children and adults and to evaluate the effects of intensive physical and social stimulation on their ongoing behavior. Sixteen NPMR subjects were studied for 2 1/2 years. All were PMR, bedridden, abnormally small, and unresponsive to external stimulation. Baseline data concerning developmental status, diurnal patterns of sleep and activity, behavior in a novel situation, ongoing ward behavior, and anthropometric measures were obtained. Subjects were highly variable in their responses to items from the Bayley Scales of Infant Development, with overall performance below that of a normal six month old. Although subjects showed some diurnal pattern of sleep, they frequently fell asleep for short periods at random time during the day. In a novel situation subjects responded minimally to stimulus objects, or not at all. Typically, their ongoing ward behavior consisted of very low level activity, involving small peripheral limb movements, wandering or blinking eyes, mouthing or grimacing, and repetitive, reflexive types of patterns labeled "fixed action sequences." Experimental treatment consisted of three phases of daily stimulation. (1) Subjects were placed in an upright or elevated position in specially constructed "playpens." (2) Subjects were placed in "playpens" and many toys were presented. (3) Subjects were positioned in pairs so that direct physical contact was provided. Each phase resulted in changed behavioral profiles during treatment. Furthermore, all experimental subjects showed beneficial effects of treatment in their ongoing ward behavior, diurnal sleep patterns, Bayley performance, or response to novel situations. Implications of this research extend to understanding environmentally induced changes in neurological maturation and social development in individuals previously thought to be hopelessly devastated. The descriptive data are intended to provide a useful framework for further systematic research with NPMR populations.

Adolescent↗

PubMed1999

Corticotropin-releasing factor receptor type 1 mediates emotional stress-induced inhibition of food intake and behavioral changes in rats.

We investigated whether corticotropin-releasing factor (CRF) receptor type 1 (CRFR1) is involved in emotional stress-induced inhibition of food intake and behavioral changes in rats. The inhibition of food intake and increase in locomotor activity induced by emotional stress using a communication box were reversed by both intracerebroventricular injection of alpha-helical CRF (9-41), a non-selective CRF receptor antagonist, and intraperitoneal injection of a selective non-peptidic CRFR1 antagonist. These results suggest that CRFR1 mediates at least in part the emotional stress-induced inhibition of feeding behavior and increase in locomotor activity.

Animals↗

PubMed2004

Women's inhibitors and facilitators associated with making behavioral changes after myocardial infarction.

The researchers interviewed 40 women 6 to 24 months after their first myocardial infarction to determine facilitators and barriers to making desired health behavioral changes. Nurses at the bedside are in a unique position to discuss the importance of attending cardiac rehabilitation with women after myocardial infarction, assist them to assess their individualized barriers and facilitators to attending, and help them develop strategies to overcome barriers to promote attendance.

Adult↗

PubMed1990

Training social initiations to a high-functioning autistic child: assessment of collateral behavior change and generalization in a case study.

The present case study used a multiple treatment design to assess the effects of two interventions--peer social initiations and target child initiations--on the social and disruptive behavior of a high-functioning autistic child. Intervention included initiation training and videotaped feedback highlighting successful and unsuccessful initiations. During Interventions 1 and 2, nonhandicapped peers were trained to initiate social interaction with the autistic child, resulting in an increase in social interaction which dramatically decreased in a reversal phase. Social interaction quickly increased again in Intervention 3 when the autistic child was trained to initiate interaction using the same procedures. During Interventions 1 and 2 no decrease in the autistic child's disruptive behaviors was observed; however during Intervention 3 these behaviors decreased to a low rate. Social validation, generalization, and maintenance of these behavior changes are discussed.

Attention↗

PubMed2001

Social-cognitive theory mediators of behavior change in the National Institute of Mental Health Multisite HIV Prevention Trial.

The National Institute of Mental Health Multisite HIV Prevention Trial was a trial of an intervention to reduce sexual HIV risk behaviors among 3,706 low-income at-risk men and women at 7 U.S. research sites. The intervention, based on social-cognitive theory and designed to influence behavior change by improving expected outcomes of condom use and increasing knowledge, skills, and self-efficacy to execute safer sex behaviors, was effective relative to a control condition in reducing sexual risk behavior. At 3 months after completion of the intervention, measures of these potential mediators were higher in the intervention than in the control condition. Although the effect of the intervention on sexual risk behavior was significantly reduced when the variables were controlled statistically, supporting the hypothesis of their mediation of the intervention effect, most of the effect remained unexplained, indicating the influence of unmeasured factors on outcome.

Adolescent↗

PubMed2004

Behavior-change trials to assess the feasibility of improving complementary feeding practices and micronutrient intake of infants in rural Bangladesh.

This study used simple rapid-assessment techniques to test the feasibility of increasing the consumption of complementary foods by infants by asking mothers to increase meal quantity or frequency or by altering the viscosity/energy density of the food. The feasibility of using micronutrient supplements either added directly to food or administered as liquid drops was also examined. The study was conducted in rural Bangladesh and involved four separate short-term behavioral change trials. Depending on the trial, fieldworkers recruited 30 to 45 infants 6 to 12 months of age. Following recommendations to increase the amount of food provided to infants, the mean intakes from single meals increased from 40 +/- 23 g on day 1 to 64 +/- 30 g on day 7 (p < 0.05). In a second trial, the mean meal frequency increased from 2.2 +/- 1.3 on day 1 to 4.1 +/- 1.3 on day 7 (p < 0.05). Provision of high-energy-density diets, prepared by decreasing viscosity with alpha-amylase or by hand-mashing rice and dhal into a paste before feeding, increased single-meal energy consumption from 54 +/- 35 kcal to 79 +/- 52 kcal or 75 +/- 37 kcal (p < 0.05), respectively. Both types of micronutrient supplements were well accepted and used according to recommendations. In conclusion, it was possible to change short-term child-feeding behaviors to promote increased food intake, mealfrequency, energy density, and micronutrient consumption. Because each of these interventions lasted for only about 1 week, however, the long-term sustainability of these changes is not known. Moreover, the effect of increased feeding of complementary foods on intakes of breastmilk and total daily consumption of energy and nutrients requires further study.

Bangladesh↗

PubMed1986

Are the neurochemical and behavioral changes induced by lesions of the nucleus basalis in the rat a model of Alzheimer's disease?

A review of the work on the neurochemical, electroencephalographic and behavioral changes induced in the rat by lesions of the nucleus basalis is presented. The similarities and differences between the effects of the lesions and the neurochemical and clinical alterations characterizing senile dementia of Alzheimer type are pointed out. The decrease in choline acetyltransferase (ChAT) activity in the cortex following unilateral or bilateral electrolytic or neurotoxic lesions of the nucleus basalis are described and compared with the decrease in ChAT activity found in the cortex and hippocampus of patients affected by senile dementia. At variance with the latter condition, in rats with lesions of the nucleus basalis a spontaneous recovery in cortical ChAT activity has been observed 3-6 months after the lesion. The lesions of the nucleus basalis decrease high affinity choline uptake activity which, however, undergoes a rapid recovery. Lesions also decrease spontaneous and drug-stimulated ACh release from the cerebral cortex. Transitory changes in the number of muscarinic binding sites have been reported in the cerebral cortex of the lesioned rats while a decrease in the number of muscarinic binding sites has generally been found in the cerebral cortex of patients with senile dementia. [3H] glutamate uptake in the striatum of the lesioned rats was not affected. In both lesioned rats and patients affected by senile dementia, a decrease of low voltage high frequency electrocortical activity has been reported. Unilateral and bilateral lesions of the nucleus basalis bring about an impairment of the acquisition of active and passive avoidance responses and of the rewarded alternation discriminatory tasks involving working memory and spatial memory. On the other hand, memory impairment is a typical symptom of senile dementia. In conclusion, the lesions of the nucleus basalis only partly mimic the complex clinical picture of senile dementia of Alzheimer type. They offer, nevertheless, a useful tool for understanding the critical role of the central cholinergic pathways in some of the cognitive processes and identifying potentially useful pharmacological treatments.

Alzheimer Disease↗

PubMedDate not supplied

Stage of behavior change for condom use: the influence of partner type, relationship and pregnancy factors.

A theoretical model was used to examine the influence of relationship factors, pregnancy intentions, contraceptive behavior and other psychosocial characteristics on stages of behavior change in condom use among heterosexual black women of reproductive age. Data from an inner-city street survey compared women who were not contemplating condom use, women who were attempting to use condoms or had used them consistently for short periods of time, and those who had achieved long-term consistent use. Women's relationship with their main partner appears to be an important factor in understanding their use of condoms both with main partners and with other partners. For condom use with the main partner, factors such as emotional closeness and partner support were significant predictors of the likelihood that women would be attempting to use condoms rather than not contemplating use. Cohabitation and the belief that condom use builds trust were significant predictors of long-term consistent condom use. Having a regular or main partner was strongly associated with intentions to use condoms with other partners. Women who wanted to become pregnant were much less likely to intend to use condoms with their main partner, and women using oral contraceptives were less likely to be long-term consistent condom users.

Adolescent↗

PubMed2005

A test of major assumptions about behavior change: a comprehensive look at the effects of passive and active HIV-prevention interventions since the beginning of the epidemic.

This meta-analysis tested the major theoretical assumptions about behavior change by examining the outcomes and mediating mechanisms of different preventive strategies in a sample of 354 HIV-prevention interventions and 99 control groups, spanning the past 17 years. There were 2 main conclusions from this extensive review. First, the most effective interventions were those that contained attitudinal arguments, educational information, behavioral skills arguments, and behavioral skills training, whereas the least effective ones were those that attempted to induce fear of HIV. Second, the impact of the interventions and the different strategies behind them was contingent on the gender, age, ethnicity, risk group, and past condom use of the target audience in ways that illuminate the direction of future preventive efforts.

Adult↗

PubMed1987

Behavioral changes during exposure to 1,1,1-trichloroethane: time-course and relationship to blood solvent levels.

We report the results of an exposure chamber study in which volunteers were exposed to 0, 950 mg.m-3 (175 ppm) and 1,990 mg.m-3 (350 ppm) of 1,1,1-trichloroethane for 3.5 hours. The time-course of the behavioral changes and the relationship to blood concentrations of 1,1,1-trichloroethane were investigated. A pattern of performance deficits consistent with earlier work was found for some of the tests of psychomotor performance. The time-course of these appeared to be rapid, occurring in some cases within 20 minutes of exposure. For those tasks shown to be sensitive to 1,1,1-trichloroethane exposure, the development of performance changes followed the time-course of blood solvent levels. Two behavioral tests not previously used in this type of work were also employed. One was concerned with the distractability of attention and concentration (the Stroop test), and the other was concerned with analysing grammatical statements (the syntactic reasoning test). Different effects were found. In the Stroop test, enhanced performance was observed following exposure; however, the syntactic reasoning test was found to be resistant to solvent effects. Measures of short-term subjective well-being were not affected by exposure. It is suggested that the observations of time-course effects in performance and their relationship to change in blood solvent levels have implications for psychological test selection and for study designs for examining field exposure.

Analysis of Variance↗