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PubMed1978

Shaping the future of health education: from behavior change to social change.

The view that individual behavior change is the primary goal of health education presents several serious problems. Although individual behavior does contribute to health and disease, social organization is perhaps a more powerful influence. The use of behavior change as the primary tool for health education raises grave ethical issues. Health education which seeks to change individual behavior has also failed to have a significant impact on public health. An alternative strategy is health education for social change. The goal of this approach is to involve people in collective action to create health promoting environments and life-styles. Several contemporary models for and principles characteristic of health education for social change are described.

Behavior Therapy↗

PubMed1991

Gender, knowledge about AIDS, reported behavioral change, and the sexual behavior of college students.

This article reports on an analysis of the relationships among knowledge about AIDS, self-reported changes in sexual behavior, and independent measures of those behaviors--condom use, coital frequency, and number of partners. The sample consisted of 195 sexually active, heterosexual college students attending a northeastern state university in spring 1988. With other relevant variables held constant, statistically significant associations in the predicted direction were found between knowledge and reported change and each of the dependent variables among the men, especially the men not involved in relationships. Among women, however, the only significant association was that between reporting the beginning of condom use and the frequency with which condoms were used in the past year. Possible reasons for these gender differences are discussed.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Postoperative behavioral changes following anesthesia with sevoflurane.

BACKGROUND: Behavioral disturbance following hospitalization is a relatively frequent event, some children still having negative behavioral changes (NBC) 1 month following their operation. Sevoflurane has a propensity to induce 'excitement' during induction of anaesthesia, and delirium in the immediate postoperative phase. The aim of this study was to evaluate whether this translates into prolonged behavioral change. METHODS: A total of 120 children presenting for daycase surgical procedures under anesthesia were included in the study. Children were randomized to induction and maintenance of anesthesia with sevoflurane or halothane. No additional sedative drugs were administered. Postoperative behavioral change was assessed using the Post-Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 7 and 30. RESULTS: The Sevoflurane group (n = 63) were more distressed on emergence of anesthesia than the Halothane group (n = 57) (P < 0.05). About 58.3, 46.8 and 38.3% of all children exhibited NBC on postoperative days 1, 7 and 30, respectively. There was no association between anesthetic agent and behavior. There was a significant relationship between decreasing age and NBC (P < 0.005). CONCLUSIONS: Children anesthetized with sevoflurane exhibit more immediate postoperative distress than those anesthetized with halothane. This difference is not carried over into the longer posthospital period. Negative behavioral changes occur more frequently with decreasing age.

Age Factors↗

PubMedDate not supplied

Continuing education evaluation of behavior change.

Using the Cervero model of behavior change and questionnaires developed by Brigham, Ryan, and Elkins (1996), this study assessed the impact of a workshop on behavior change. Data on the individual professional (receptiveness), proposed change (feasibility), social system (climate), and program (quality), as well as self-report data about outcomes (expertise and actions) were included. Information on perceived expertise was obtained before the workshop, immediately after the workshop, and 3 months after the workshop. Information on actions initiated by the participants was obtained 3 months after the workshop. There were 70 participants in this study, with a variety of educational backgrounds and nursing experience. A matched test comparing expertise between time 1 and time 2, as well as time 1 and time 3 was significant at p = 0.00. There were significant correlations among the four variables influencing behavior change and actions and expertise. All except one participant in the study reported taking specific actions after the workshop. The mean number of actions taken was 4.0, with a range from 1 to 9. These findings indicate that a continuing education program can lead to behavior change.

Adult↗

PubMed1991

Knowledge, attitudes, and perceived risk of AIDS among urban Rwandan women: relationship to HIV infection and behavior change.

We examined factors associated with perceived risk of AIDS, behavior change, and HIV infection in a representative sample of 1458 child-bearing urban women in Rwanda, central Africa. Although 68% of women reported only one lifetime partner, and the majority (87%) lived with a husband or steady partner, the prevalence of HIV antibodies was still high (32%). Before receiving their HIV test results, the women completed a questionnaire about AIDS knowledge, attitudes, and practices. Knowledge about HIV transmission was high, with 96-98% of women correctly identifying the three primary routes of infection. However, only 16% of women reported taking any action to avoid AIDS in the previous year, and most (11%) had done so merely by asking their male partners to change their behavior. Only 7% of women had ever tried condoms, and many (68%) thought they could be dangerous to use. Women who perceived themselves at risk of AIDS (57%) were more likely to report changing behavior; they were also more likely to be infected with HIV. Other factors associated with behavior change included having known someone with AIDS, having discussed AIDS with a male partner, and believing that condoms are not dangerous. Future interventions should enhance perception of risk, encourage male sexual partners to reduce risky behavior, and increase familiarity with condoms.

Adolescent↗

PubMedDate not supplied

Effectiveness of a behavioral change intervention in Thai elders after knee replacement.

BACKGROUND: After total knee replacement, elders need an effective intervention to change exercise and physical activity behavior. OBJECTIVES: This study examined the effects of a behavioral change intervention (BCI) on self-efficacy and outcome expectations for exercise and functional activity, physical activity participation, and physical performance of older adults. METHODS: The study was based on the social cognitive theory (SCT), with a longitudinal quasi-experimental, pretest-posttest control group design. Sixty-three Thai elders undergoing knee replacement surgery were studied. The experimental group received a BCI based on SCT given by the investigator. Outcome measures were the Self-Efficacy for Exercise Scale (SEES) and Self-Efficacy for Functional Activity Scale (SEFAS), the Outcome Expectations for Exercise Scale (OEES) and Outcome Expectations for Functional Activity Scale (OEFAS), the Physical Performance Test (PPT), and the Physical Activity Diary (PAD). RESULTS: The experimental group had significantly greater improvements in self-efficacy for exercise, outcome expectations for exercise, and functional activity, significantly more participation in exercise and walking, and significantly greater improvement in physical performance than did the control group at postoperative weeks 2 and 6. DISCUSSION: The BCI based on SCT was effective in changing the outcomes in the expected direction. This BCI may be applicable, with modifications, to elders in other situations in which changing behavior is the key to recovery.

Aged↗

PubMed1992

Maintenance of behavioral change in a cohort of homosexually active men.

OBJECTIVES: To assess associations of perceptions of sexual behavior change with actual risk behaviors and psychosocial variables, and to determine whether perceptions of behavior change predict subsequent behavior. DESIGN: Cohort study of homosexually active men. SETTING: Community health center in Boston, Massachusetts, USA. PATIENTS, PARTICIPANTS: Two hundred and sixty-two cohort members who participated in follow-up in 1989 and who had at least one subsequent visit. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Composite risk behavior variable, based on unprotected anogenital contact and number of partners. RESULTS: Of the 96% who had effected behavior change, 47% perceived that they were able to maintain those changes consistently and 58% wanted to make more changes. Perceptions of consistent maintenance were associated with lower risk behavior, lower perceived riskiness of behaviors and susceptibility to AIDS, and fewer barriers to behavior change. Desire for more change was associated with increased behavioral effort, fewer barriers to condom use, and greater perceived riskiness of current behavior. Among those with lower risk behaviors, perceived inconsistent maintenance predicted relapse to more risky behavior at the following visit. CONCLUSIONS: Perceived maintenance of behavior change is potentially useful in identifying individuals at risk of relapse from safer sex.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Behavior change in diabetes education.

PURPOSE: The purpose of this paper is to explore how diabetes education produces change in self-care behavior. METHODS: Published research on diabetes education relevant to behavior change was examined and a framework was formulated for the study of behavior change. RESULTS: Research indicates that education improves patient self-management, which in turn improves glycemic control and health status. Yet, there is relatively little information on what types of education produce what particular benefits for which types of patients. Moreover, we do not know the benefits of various forms of education (for selected groups) relative to their costs. Empirical studies of how education produces behavior change are few, but much preliminary work has been done to identify potential behavioral determinants that can be targeted by interventions. Theoretical models of behavior change have been advanced (e.g., stages of change) but they have yet to be rigorously tested. CONCLUSIONS: Initial answers to the research questions can be generated by conducting more sophisticated analyses of the type of data already being collected. However, obtaining complete answers to some of these questions will require more extensive data collection, including large-scale studies of multiple interventions in multiple patient groups.

Attitude to Health↗

PubMed1996

Appetitive sexual behavior in male rats: 1. The role of olfaction in level-changing behavior.

Level-changing behavior is a form of anticipatory behavior of a male rat, when tested in a bilevel testbox. The male explores the testcage prior to introduction of a female. The female is introduced after 5 min. The number of level changes displayed by the male in this period reflects appetitive aspects of sexual behavior and it was suggested that analysis of this level-changing behavior may function as assessment of sexual motivation. In this study the increase of anticipatory level changes over repeated weekly tests was dependent upon (sexual) olfactory stimulation. The number of anticipatory level changes was reliably reduced by administration of the opioid antagonist naloxone, suggesting that endogenous opioids facilitate this behavior. These results suggest that the increase of anticipatory level changes over repeated tests is a response to olfactory stimuli and reflects appetitive aspects of sexual behavior, which are stimulated by endogenous opioids. These results are in accordance with the concept that analysis of anticipatory level-changing behavior can be used to assess sexual motivation.

Animals↗

PubMed2006

Age group and health status effects on health behavior change.

The authors explored health behavior change during 5 years, considering age/cohort, health status, and gender effects. The authors divided the sample (n = 1,064) into 4 age/cohort groups: young adults (n = 139; 19-42 years), middle-aged adults (n = 386; 43-62 years), young-old adults (n = 296; 63-72 years), and old-old adults (n = 243; 73+ years) and health status: cardiovascular disease and physical disability. Smoking and seat belt behaviors remained stable, whereas alcohol, food consumption, food preparation, physical activity, dental, and medical behaviors showed change. Change in health behaviors differed by age/cohort group and health status for food consumption, food preparation, and medical care, primarily showing negative change for old-old adults and positive change for individuals with cardiovascular disease. Health behavior interventions need to focus on the old-old, individuals with physical disability, and on smoking and seat belt use. These specific populations and behaviors need to be targeted to promote positive health behavior change, to limit future onsets of disability and morbidity, and to prevent the occurrence of premature death.

Adult↗

PubMed2005

Changes in physical therapy providers' use of fall prevention strategies following a multicomponent behavioral change intervention.

BACKGROUND AND PURPOSE: An abundance of evidence suggests that interventions targeting fall risk factors are effective; however, it remains unknown whether, or to what extent, this body of evidence has affected the clinical practice of physical therapy providers. The purposes of this study were: (1) to describe knowledge of, and attitudes toward, fall risk factors and fall reduction strategies; (2) to assess self-reported use of fall reduction strategies with patients; and (3) to identify factors associated with increased use of fall reduction strategies with patients among physical therapy providers exposed to a behavioral change strategy. SUBJECTS AND METHODS: A cross-sectional survey of physical therapy providers from hospital-based and freestanding outpatient physical therapy facilities throughout north-central Connecticut was conducted between October 2002 and April 2003. The participants were 94 physical therapy providers who had been exposed to the Connecticut Collaboration for Fall Prevention (CCFP) behavioral change effort. The CCFP program uses multicomponent professional behavioral change strategies to embed fall risk factor assessment and management, based on evidence from randomized controlled trials, into the clinical care of older patients. A telephone questionnaire--focusing on fall risk factor knowledge and attitudes and self-reported fall risk factor assessment and management practices before and after exposure to the CCFP efforts--was administered to consenting physical therapy providers. RESULTS: Environmental hazards and gait and balance deficits were named as fall risk factors by 86 (91%) and 73 (78%) participants, respectively. All of the targeted risk factors were mentioned by at least 30% of the participants. Sixty-four participants (68%) reported increased fall reduction practice behaviors. The area of multiple medications was noted most frequently, with 77 participants (82%) noting new practices related to medication use. Only knowledge of fall risk factors and pre-CCFP behaviors were associated with increased fall reduction practices. DISCUSSION AND CONCLUSION: Physical therapy providers reported an increase in practice behaviors in response to the multicomponent behavioral change strategy. Knowledge of fall risk factors was associated with increased fall reduction practice behaviors, most likely due to the focused nature of the education strategy.

Accident Prevention↗

PubMed2000

Brief negotiation program for promoting behavior change: the Kaiser Permanente approach to continuing professional development.

BACKGROUND: Behavior change counseling is one of the most difficult and constant challenges faced by health providers. It has a significant impact on clinical outcomes as well as patient and provider satisfaction. By encouraging patients to participate in a partnership with health care professionals, Brief Negotiation offers techniques to motivate behavior change successfully. We review the key components of Brief Negotiation and describe how one large group model health maintenance organization was able to identify key staff members, develop educational opportunities and implement Brief Negotiation system-wide into standard care practices. OBJECTIVES: To expose a maximum number of health care professionals to a recommended model of behavior change counseling; to increase the satisfaction and confidence of health care professionals in counseling for behavior change; and to increase the likelihood of improved patient health outcomes. METHOD: Two departments created one-day, two-day, six-hour and one-to-two-hour skill-based programs targeted to physicians, nurse practitioners, care managers, clinical health educators, behavioral medicine specialists, physical therapists, pharmacists and medical assistants. Practice protocols, strategic departmental alliances and intranet sites complemented the educational interventions. RESULTS: Over 1000 health care professionals have been exposed to the Brief Negotiation model in over two years. A mailed survey to graduates of the one- and two-day programs indicated that 67% of physicians and 79% of other health professionals felt more confident about working with patients on behavior change after having attended the Brief Negotiation program. CONCLUSIONS: System-wide professional development requires multiple exposures to the Brief Negotiation model, considerable resources for curriculum development, training time and follow-up, and credible clinical trainers. Questions remain about the amount of training needed for long-term clinician behavior change and for improved health outcomes in patients.

Journal Article↗

PubMed2001

Evaluation of Selected Behavior Change Theoretical Models Used in Weight Management Interventions.

Purpose: This paper evaluates selected behavior change theoretical models used in weight reduction interventions and presents recommendations for the use of theory in weight reduction research. Overweight and obesity are complex problems, requiring long-term behavioral change. Behavioral treatments for overweight and obesity are as varied as the elements of behavior, and the long-term efficacy of most approaches is poor. Because of the complexity of both the problem and its treatment, investigations must target the development of cause-effect explanations. CONCLUSIONS: Many of the behavioral change intervention studies reviewed lacked external validity, primarily due to the failure to consider salient moderators. The theoretical models reviewed in this paper were primarily tested on white, employed populations. These and other data suggest that extant theoretical approaches may not be salient in certain groups. IMPLICATIONS: Practice implications include: 1) assess indicators for readiness to engage in weight reduction efforts; 2) base interventions on multiple theories; and 3) develop context-based interventions. Future research should include a focus on innovative methods in theory development, development of theory acknowledging mediator/moderator interactions, development of theory in context, and development of theory reflecting cultural meaning and diversity.

Journal Article↗

PubMed2006

A cohort study of the incidence and risk factors for negative behavior changes in children after general anesthesia.

BACKGROUND: Hospitalization and anesthesia can have a substantial psychological impact on children, which may be manifested by negative behavioral change. The primary aims of this study were to estimate the incidence of negative behavior change postanesthesia in a large cohort of children, and to identify the possible risk factors. METHODS: One thousand two hundred and fifty children aged from 3 to 12 years scheduled for anesthesia for a variety of procedures were enrolled. The absolute version of the Vernon Post Hospitalization Behavior Questionnaire (PHBQ) was used to assess behavior change at 3 and 30 days postanesthesia. Deterioration in seven or more items of behavior was defined to be a significant negative behavior change. Demographic data, anesthesia details, type and extent of preparation, details of procedure and length of hospitalization were recorded. Child temperament, child anxiety and parental anxiety were also measured. RESULTS: Twenty-four percent of children had significant negative behavior change at day 3 and 16% at day 30. After logistic regression, factors associated with significant negative behavior change at 3 days were increased parental state anxiety, younger age, overnight admission, lower birth order and preparation via having a discussion with the anesthetist. At day 30, longer hospitalization, younger age, reading the anesthesia preparation book and a previous difficult anesthesia experience were associated with significant negative behavior change. Also at day 30, reading the anesthesia preparation book was strongly associated with negative behavior change in children having short procedures, but not longer procedures. However, at both 3 and 30 days, the amount of variability explained by factors included in the models was low. CONCLUSIONS: Significant negative behavior change can occur in children after anesthesia. It is difficult to precisely predict in which children this will occur, however, some individual, family and procedural variables are associated with significant negative behavior change. If used, preparation should be considered according to level of surgical complexity.

Age Factors↗

PubMed1995

An analysis of the process of human immunodeficiency virus sexual risk behavior change.

Few studies have tried to identify the process of risk behavior change. In this paper, we present a method for the analysis of the process of risk behavior change; the methodology involves using time series data to form transition probability matrices. We apply the method to human immunodeficiency virus (HIV) sexual risk behavioral data from a cohort of gay men in Amsterdam. We determine the process of risk behavior change in this cohort, and we demonstrate that it is not possible to deduce the process simply from an examination of the static pattern. Our results imply that the risk behavior change that is observed in this cohort may be viewed as a homogeneous one-step Markovian process. This process of risk behavior change has implications for the long-term prediction of HIV seroconversion rates and for the design and evaluation of HIV behavioral intervention studies and vaccine trials. Our results also have implications for the interpretation of relapse behavior.

Cognition↗

PubMed1999

Theories and intervention approaches to health-behavior change in primary care.

CONTENT: Providers typically rely on health information and their professional status to convince patients to change. Health-behavior theories and models suggest more effective methods for accomplishing patient compliance and other behavior change related to treatment regimens. Behavior modification stresses the remediation of skill deficits or using positive and negative reinforcement to modify performance. Like behavior modification, the Health Belief Model stresses a reduction of environmental barriers to behavior. Social Learning Theory suggests that perceptions of skills and reinforcement may more directly determine behavior. Self-management models put the above theories into self-change actions. Social support theories prioritize reinforcement delivered through social networks, whereas the Theory of Reasoned Action emphasizes perceptions of social processes. Finally, the Transtheoretical Model speaks of the necessity to match interventions to cognitive-behavioral stages. Strategies derived from each of these theories are suggested herein.

Behavior Therapy↗

PubMed1988

AIDS and behavioral change to reduce risk: a review.

Published reports describing behavioral changes in response to the threat of AIDS (acquired immunodeficiency syndrome) are reviewed. These studies demonstrate rapid, profound, but expectably incomplete alterations in the behavior of both homosexual/bisexual males and intravenous drug users. This is true in the highest risk metropolitan areas such as New York City and in areas with lower AIDS incidence. Risk reduction is occurring more frequently through the modification of sexual or drug-use behavior than through its elimination. In contrast to aggregate data, longitudinal descriptions of individual behavior demonstrate considerable instability or recidivism. Behavioral change in the potentially vulnerable heterosexual adolescent and young adult populations is less common, as is risk reduction among urban minorities. Reports of AIDS-related knowledge and attitudes generally parallel the pattern of behavioral changes. Nonetheless, few studies investigate the relationship of knowledge and attitudes to risk reduction. Future studies should provide much-needed information about the determinants as well as the magnitude of behavioral changes required to reduce the further spread of AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Thermodynamic nonequilibrium phase change behavior and thermal properties of biological solutions for cryobiology applications.

Understanding the phase change behavior of biomaterials during freezing/thawing including their thermal properties at low temperatures is essential to design and improve cryobiology applications such as cryopreservation and cryosurgery. However, knowledge of phase change behavior and thermal properties of various biomaterials is still incomplete, especially at cryogenic temperatures (< or = -40 degrees C). Moreover, in these applications, chemicals are often added to improve their outcome, which can result in significant variation in the phase change behavior and thermal properties from those of the original biomaterials. These chemical additives include cryoprotective agents (CPAs), antifreeze protein (AFP), or cryosurgical adjuvants like sodium chloride (NaCl). In the present study, phase change behavior and thermal properties of saline solutions--either water-NaCl or phosphate buffered saline (PBS)--with various chemical additives were investigated. The chemical additives studied are glycerol and raffinose as CPAs, an AFP (Type III, molecular weight = 6500), and NaCl as a cryosurgical adjuvant. The phase change behavior was investigated using a differential scanning calorimeter (DSC) and a cryomicroscope. The specific and latent heat of these solutions were also measured with the DSC. The saline solutions have two distinct phase changes--water/ice and eutectic phase changes. During freezing, eutectic solidification of both water-NaCl and PBS are significantly supercooled below their thermodynamic equilibrium eutectic temperatures. However, their melting temperatures are close to thermodynamic equilibrium during thawing. These eutectic phase changes disappear when even a small amount (0.1 M glycerol) of CPA was added, but they are still observed after the addition of an AFP. The specific heats of these solutions are close to that of ice at very low temperatures (< or = -100 degrees C) regardless of the additives, but they increase between -100 degrees C and -30 degrees C with the addition of CPAs. The amount of latent heat, which is evaluated with sample weight, generally decreases with the addition of the additives, but can be normalized to approximately 300 J/g based on the weight of water which participates in the phase change. This illustrates that thermal properties, especially latent heat, of a biomaterial should be evaluated based on the understanding of its phase change behavior. The results of the present study are discussed in the context of the implications for cryobiology applications.

Biomimetic Materials↗