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PubMed2005

Applying behavior change models to understand spiritual mechanisms underlying change in substance abuse treatment.

Despite increasing attention directed to conceptual and methodological issues surrounding spirituality and despite the centrality of "spiritual transformation" in the recovery literature, there is little systematic evidence to support the role of spiritual change as a necessary condition for substance abuse behavior change. As an explicit conceptualization of mechanisms underlying behavior change is fundamental to effective interventions, this article: 1) briefly reviews relevant behavior change theories to identify key variables underlying change; 2) presents an integrative conceptual framework articulating linkages between program components, behavior change processes, spiritual change mechanisms and substance abuse outcomes; and 3) presents a discussion of how the mechanisms identified in our model can be seen in commonly used substance abuse interventions. Overall, we argue that spiritual transformation at an individual level takes place in a social context involving peer influence, role modeling, and social reinforcement.

Attitude to Health↗
PubMed1999

Behavior-changing methods for improving adherence to medication.

Long-term adherence to antihypertensive drug therapy is poor, and new strategies to predict and improve adherence to prescribed drug regimens are needed. The literature on behavior change is reviewed, and a new perspective on medication adherence is presented. Successfully adopting and continuing with a long-term medication regimen requires behavior change, and behavior change principles can be used to accelerate the adoption of adherence to medication- taking behavior. The efficacy of behavior-changing interventions, which are tailored to each patient's stage of change, has been demonstrated in several health behavior areas. Rewards, monitoring devices, and reminder techniques are most useful for individuals in later stages of behavior change, but individuals in earlier stages need consciousness-raising interventions that focus upon awareness of the benefits of therapy. Recent research has yielded reliable ways to measure the stage of change for medication adherence, providing the foundation for the application of behavior- changing principles to the pharmacologic management of hypertension.

Adaptation, Psychological↗
PubMed1995

Computerized patient records in primary care. Their role in mediating guideline-driven physician behavior change.

Implementation of practice guidelines remains problematic in spite of enormous efforts to develop and disseminate them, to establish their credibility, and to create incentives for physicians to adopt them. These strategies have failed to systematically change physician behavior because they do not address the involuntary time and mental processing constraints that have been clearly demonstrated to hamper physicians' ability to comply with guidelines. Computerized patient record systems directly address these constraints, and evidence is mounting that they are effective tools for changing physician behavior. A properly configured computerized patient record system provides decision support, facilitates work flow, and enables the routine collection of data for performance feedback. A synthesis of relevant research from the domains of practice guidelines and medical informatics strongly suggests that the operational support provided by computerized patient record systems will have a major impact on physician compliance with practice guidelines.

Ambulatory Care Information Systems↗
PubMed2006

Cancer-related beliefs and health behavior change among breast cancer survivors and their first-degree relatives.

It is unclear why some cancer survivors and their relatives are motivated by the (personal or vicarious) cancer experience to make positive health behavior changes while others are not. Consistent with Leventhal's Commonsense Model, we hypothesized that breast cancer survivors and their first-degree relatives (FDRs) would change behaviors they believed: (1) had caused the survivor's cancer or (2) could prevent a future cancer incidence. Sixty-five breast cancer survivors (stages 0-III) and 33 FDRs were recruited. Assessments occurred within three months of the survivor completing treatment (i.e. all surgery, chemotherapy, and radiation) and again three months later. Findings indicate that survivors who believed that unhealthy diet, insufficient exercise, or alcohol consumption contributed to their cancer were more likely to modify the relevant behavior. Likewise, survivors were more likely to implement healthy changes they believed would ward off a recurrence. Findings were similar when data from FDRs was added to the sample. Thus, healthy lifestyle changes after a personal (and possibly a vicarious) cancer diagnosis are tied to whether individuals believe changes can affect cancer outcomes. Given the role of health behavior change in reducing medical risks, these findings have important implications for maintaining the health of cancer survivors.

Adult↗
PubMed1999

The treatment of cyclical behavioral changes in women with mental disabilities.

STUDY OBJECTIVE: This study aims to evaluate the frequency of occurrence of cyclical behavioral changes in women with mental retardation, as well as the effectiveness of several treatment modalities for this type of behavior. DESIGN: Retrospective chart analysis. SETTING: University of Michigan clinic for reproductive healthcare of women with mental disabilities. PARTICIPANTS: All clinic patients of reproductive age, presenting with cyclical behavioral changes in our clinic from November 1985 to October 1992. INTERVENTIONS: Medical treatment of cyclical behavioral changes. MAIN OUTCOME MEASURES: Presence and documentation of cyclical behavioral changes, level of retardation, type of behavior, treatment modalities and results. RESULTS: Ninety-three of 522 reproductive-age patients (18%) presented with cyclical behavioral changes. Good documentation with behavior charts was present in 46% of these records. Level of retardation among the women included: 57 (61%) severely, 12 (13%) moderately, and 1 (1%) mildly retarded. No level of retardation could be detected in 23 (25%) women. Aggressive behavior was noted in 35 (38%) women, self-mutilation in 20 (22%) a combination of both in 10 (10%) and other behavior in 28 (28%) women. Primary treatment was by physician preference. Of 46 patients who received nonsteroidal antiinflammatory drugs (NSAID), 30 (65%) showed improvement, 10 (21%) showed no improvement, and 2 patients (4%) showed worsening symptoms. Birth control pills were used in 15 patients; there were signs of improvement in 6 (40%), no improvement in 3 (20%), and worsening in 3 (20%). The use of depomedroxyprogesterone injections was successful in treating 6 of 9 patients (66%), and showed no improvement in 2 women. No statistically significant differences were found between these treatment modalities. CONCLUSIONS: Cyclical behavioral changes in women with mental retardation is a common problem (18%) and may be related to pain- possibly due to menstrual cramps, since 65% of the patients responded to NSAID. If treatment with NSAID is unsuccessful, birth control pills and depomedroxyprogesterone improved behavior in 40% to 66% of patients. Documentation is a key issue.

Adolescent↗
PubMed1993

The development of pain in young pigs associated with castration and attempts to prevent castration-induced behavioral changes.

Four experiments were conducted to examine the development of castration-induced behavioral changes, the effects of castration age on pig weight gain, and the efficacy of common analgesics for use in castrated pigs. In Exp. 1, behavioral changes associated with castration of pigs at 1, 5, 10, 15, or 20 d of age were evaluated. Castration caused measurable changes (reduced suckling, reduced standing, and increased lying times, P < .05) in the behavior of young pigs compared with that of intact pigs at all ages tested. Effects of age and interactions between age and castration treatment were not significant (P > .10) for any behaviors evaluated. In Exp. 2, the performance of pigs castrated at 1 d of age was compared with the performance of those castrated on d 14 and female littermates. Birth weights, weaning weights, and mortality were recorded. Pigs that were castrated on d 14 were heavier (P = .05) at weaning and had a higher (P < .05) weight gain during lactation compared to pigs castrated on d 1 of age. Pig mortality was similar among the treatments. In Exp. 3 and 4, the efficacies of pain-reducing drugs (non-narcotic analgesics) were evaluated for effectiveness in reducing castration-induced behavioral changes in 8-wk-old pigs. Although castration reduced (P < .05) feeding time and weight gain, neither aspirin nor butorphanol influenced behavioral changes associated with castration. We conclude that pigs show similar behavioral changes (and probably pain perception) when castrated from 1 to 20 d of age. However, pig performance data favored castration at 14 d rather than at 1 d of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1993

Beta-adrenergic receptors are involved in stress-related behavioral changes.

Cerebral noradrenergic systems have been implicated in stress-related changes in behavior. Previous studies with receptor antagonists suggested that alpha 1-adrenergic receptors were involved in defensive withdrawal in rats and in investigatory behavior in mice tested in the multicompartment chamber. However, beta-adrenoreceptor antagonists attenuated the restraint- and ICV CRF-induced changes in defensive withdrawal, suggesting that beta-adrenergic receptors may also be involved in stress-related responses. To determine whether the beta-adrenergic antagonist effect was limited to rats tested in the defensive withdrawal model, we studied the effects of L-propranolol in two other behavioral models. Propranolol pretreatment (2.5 mg/kg, IP) prevented the restraint-induced changes in the behavior of mice observed in the multicompartment chamber and the elevated plus-maze. It also decreased the plasma corticosterone response measured in restrained mice after plus-maze testing. To investigate further the role of central beta-adrenergic receptors in defensive withdrawal, the effects of the beta-adrenoreceptor agonist isoproterenol were tested. Isoproterenol (0.3-10 micrograms, ICV) produced a dose-dependent increase in defensive withdrawal, statistically significant after 3 and 10 micrograms. Propranolol prevented the isoproterenol-induced defensive withdrawal, suggesting that the effect of isoproterenol resulted from stimulation of beta-adrenergic receptors. These results support earlier data suggesting the involvement of CNS beta-adrenergic receptors in stress-related behavioral changes and suggest that beta-adrenergic agonists exert anxiolytic effects that differ from those of the benzodiazepines.

Adrenergic beta-Agonists↗
PubMed1995

Goal setting as a strategy for health behavior change.

This article discusses the beneficial effects of setting goals in health behavior change and maintenance interventions. Goal setting theory predicts that, under certain conditions, setting specific difficult goals leads to higher performance when compared with no goals or vague, nonquantitative goals, such as "do your best." In contrast to the graduated, easy goals often set in health behavior change programs, goal setting theory asserts a positive linear relationship between degree of goal difficulty and level of performance. Research on goal setting has typically been conducted in organizational and laboratory settings. Although goal setting procedures are used in many health behavior change programs, they rarely have been the focus of systematic research. Therefore, many research questions still need to be answered regarding goal setting in the context of health behavior change. Finally, initial recommendations for the successful integration of goal setting theory in health behavior change programs are offered.

Goals↗
PubMed2005

Effects of behavioral changes in a smallpox attack model.

The impact of individual and community behavioral changes in response to an outbreak of a disease with high mortality is often not appreciated. Response strategies to a smallpox bioterrorist attack have focused on interventions such as isolation of infectives, contact tracing, quarantine of contacts, ring vaccination, and mass vaccination. We formulate and analyze a mathematical model in which some individuals lower their daily contact activity rates once an epidemic has been identified in a community. Transmission parameters are estimated from data and an expression is derived for the effective reproduction number. We use computer simulations to analyze the effects of behavior change alone and in combination with other control measures. We demonstrate that the spread of the disease is highly sensitive to how rapidly people reduce their contact activity rates and to the precautions that the population takes to reduce the transmission of the disease. Even gradual and mild behavioral changes can have a dramatic impact in slowing an epidemic. When behavioral changes are combined with other interventions, the epidemic is shortened and the number of smallpox cases is reduced. We conclude that for simulations of a smallpox outbreak to be useful, they must consider the impact of behavioral changes. This is especially true if the model predictions are being used to guide public health policy.

Behavior↗
PubMed2001

Modeling and reinforcement to combat HIV: the MARCH approach to behavior change.

Theory and research suggest that behavioral interventions to prevent HIV/AIDS may be most effective when they are personalized and affectively compelling, when they provide models of desired behaviors, and when they are linked to social and cultural narratives. Effective strategies must also take into account the opportunities and obstacles present in the local environment. The Modeling and Reinforcement to Combat HIV (MARCH) projects combine key aspects of individual behavior change with efforts to change social norms. There are 2 main components to the program: entertainment as a vehicle for education (longrunning serialized dramas on radio or television portray role models evolving toward the adoption of positive behaviors) and interpersonal reinforcement at the community level (support from friends, family members, and others can help people initiate behavior changes; support through changes in social norms is necessary for behavioral effects to be sustained over time). Both media and interpersonal intervention activities should be linked to existing resources in the community and, wherever possible, provide increased access to preventive services, supplies, and other supporting elements.

Africa, Central↗
PubMed1997

Behavior changes exhibited by siblings of pediatric oncology patients: a comparison between maternal and sibling descriptions.

The purpose of this study was to identify the coping strategies used by the well siblings of pediatric oncology patients as identified by both the mother and the well siblings. The findings of this research study showed that both mothers and the well siblings were able to identify behavioral changes (95.2% of the mothers and 85.7% of the well siblings identified behavior changes). Behavior changes identified by both the siblings and mothers included being more sensitive to the needs of others, being more thoughtful, playing with friends, fighting, trouble sleeping, and complaints of headaches. Nurses can conduct thorough assessments of sibling behavior changes when a child family member has been diagnosed with cancer. From these assessments, nurses can provide care to assist the entire family during the ill child's treatment.

Adaptation, Psychological↗
PubMed1991

Prediction of motivation and behavior change following health promotion: role of health beliefs, social support, and self-efficacy.

Dimensions of health beliefs (perceived risk of behavior and benefit of behavior change), social support (family and others' support for change), and self-efficacy (magnitude and strength) were examined in 215 patients undergoing a prospective trial of health promotion in a primary care medical practice. Discriminant analyses were performed to evaluate how well these dimensions predicted motivation for change and lifestyle behavior change. These relationships were examined for six lifestyle areas: cigarette smoking, dealing with stress, amount and type of food eaten, use of seat belts, and exercise habits. The analyses demonstrated a statistically and clinically significant prediction of motivation by one or more health belief and self-efficacy dimensions for most lifestyle areas. The strongest single predictors were perceived benefits and self-efficacy strength, which were each significant predictors of motivation in four lifestyle areas (P less than 0.05). Support dimensions, as measured, were not shown to have predictive value in most areas. Behavior change was poorly predicted by beliefs, support, and self-efficacy for most lifestyle areas. However, adding motivation to the discriminant function equation resulted in significant predictions in all six lifestyle areas (P less than 0.05), with an average correct classification rate of 71%. This finding strongly suggests that motivation is a very important intervening variable when evaluating health promotion and resulting behavior change.

Adolescent↗
PubMed2004

The effectiveness of Web-based vs. non-Web-based interventions: a meta-analysis of behavioral change outcomes.

BACKGROUND: A primary focus of self-care interventions for chronic illness is the encouragement of an individual's behavior change necessitating knowledge sharing, education, and understanding of the condition. The use of the Internet to deliver Web-based interventions to patients is increasing rapidly. In a 7-year period (1996 to 2003), there was a 12-fold increase in MEDLINE citations for "Web-based therapies." The use and effectiveness of Web-based interventions to encourage an individual's change in behavior compared to non-Web-based interventions have not been substantially reviewed. OBJECTIVE: This meta-analysis was undertaken to provide further information on patient/client knowledge and behavioral change outcomes after Web-based interventions as compared to outcomes seen after implementation of non-Web-based interventions. METHODS: The MEDLINE, CINAHL, Cochrane Library, EMBASE, ERIC, and PSYCHInfo databases were searched for relevant citations between the years 1996 and 2003. Identified articles were retrieved, reviewed, and assessed according to established criteria for quality and inclusion/exclusion in the study. Twenty-two articles were deemed appropriate for the study and selected for analysis. Effect sizes were calculated to ascertain a standardized difference between the intervention (Web-based) and control (non-Web-based) groups by applying the appropriate meta-analytic technique. Homogeneity analysis, forest plot review, and sensitivity analyses were performed to ascertain the comparability of the studies. RESULTS: Aggregation of participant data revealed a total of 11,754 participants (5,841 women and 5,729 men). The average age of participants was 41.5 years. In those studies reporting attrition rates, the average drop out rate was 21% for both the intervention and control groups. For the five Web-based studies that reported usage statistics, time spent/session/person ranged from 4.5 to 45 minutes. Session logons/person/week ranged from 2.6 logons/person over 32 weeks to 1008 logons/person over 36 weeks. The intervention designs included one-time Web-participant health outcome studies compared to non-Web participant health outcomes, self-paced interventions, and longitudinal, repeated measure intervention studies. Longitudinal studies ranged from 3 weeks to 78 weeks in duration. The effect sizes for the studied outcomes ranged from -.01 to .75. Broad variability in the focus of the studied outcomes precluded the calculation of an overall effect size for the compared outcome variables in the Web-based compared to the non-Web-based interventions. Homogeneity statistic estimation also revealed widely differing study parameters (Q(w16) = 49.993, P < or = .001). There was no significant difference between study length and effect size. Sixteen of the 17 studied effect outcomes revealed improved knowledge and/or improved behavioral outcomes for participants using the Web-based interventions. Five studies provided group information to compare the validity of Web-based vs. non-Web-based instruments using one-time cross-sectional studies. These studies revealed effect sizes ranging from -.25 to +.29. Homogeneity statistic estimation again revealed widely differing study parameters (Q(w4) = 18.238, P < or = .001). CONCLUSIONS: The effect size comparisons in the use of Web-based interventions compared to non-Web-based interventions showed an improvement in outcomes for individuals using Web-based interventions to achieve the specified knowledge and/or behavior change for the studied outcome variables. These outcomes included increased exercise time, increased knowledge of nutritional status, increased knowledge of asthma treatment, increased participation in healthcare, slower health decline, improved body shape perception, and 18-month weight loss maintenance.

Adult↗
PubMed2002

Are biomarkers useful treatment aids for promoting health behavior change? An empirical review.

BACKGROUND: Nearly half of the leading causes of death in our society are attributable to behavioral risk factors. As such, it is critical that we continue to develop and refine effective interventions for health behavior change. Some researchers have suggested that using biomarkers to educate individuals about their health status and disease risk may be an effective strategy to promote behavior change. This tactic is also commonly employed by healthcare providers, but its empirical support is unclear. This article reviews the research literature to determine the effectiveness of using biomarker feedback to motivate and enable health behavior change. Potential limitations of this treatment strategy and issues requiring additional research are also discussed. METHODS: Articles were identified through PubMed (MEDLINE), PsychInfo, and the reference lists of pertinent manuscripts and book chapters. RESULTS: Eight published, randomized trials were identified that met criteria for review. The results of this work were mixed, but suggest that biological information conveying harm exposure, disease risk, or impaired physical functioning may increase motivation to change. Subsequent behavior change is also affected by the availability and intensity of concomitant treatment. CONCLUSIONS: Preliminary findings suggest that combining biomarkers with appropriate behavioral treatment may enhance health behavior change, but more research in this area is warranted.

Disease Transmission, Infectious↗
PubMed1984

[A chronobiological study of behavioral changes in rats].

A chronobiological study of behavioral changes in Wistar Kyoto rats (WKY), spontaneously hypertensive rats (SHR) and stroke prone spontaneously hypertensive rats (SHRSP) was undertaken. Attention was focused on changes in ambulatory activity and drinking behavior using an Ambulo-Drinkometer, the effects of centrally acting antihypertensive drugs, and the relationship between behavioral changes and humoral factors. (1) The experiment was performed during a light-dark alternation cycle. Approximately 10 days were required for rats to acclimate to new cages. (2) Using power spectral analysis, a 24 hr periodicity was dominant in both sexes of WKY and SHRSP. A 120 hr periodicity was demonstrated in female SHRSP. This long periodicity may have been due to a female sexual rhythm. (3) Ambulatory activity of WKY and SHRSP tended to decrease with age. (4) After abrupt cessation of clonidine administration, an ambulatory ultradian rhythm was demonstrated. Guanfacine treated SHR showed less change in ambulatory ultradian rhythm than clonidine treated SHR. (5) Using a Drinkometer with attached metabolic cages, drinking counts, urinary volumes, urinary aldosterone and catecholamine excretion rates were higher during the dark phase than during the light phase. It was demonstrated that analysis of rhythmicities and measurement of behavioral amplitude are both needed in the study of behavioral pharmacology.

Acclimatization↗
PubMed1996

Do tailored behavior change messages enhance the effectiveness of health risk appraisal? Results from a randomized trial.

Health risk appraisal (HRA) remains one of the most widely used health promotion tools despite only equivocal evidence for its effectiveness. Theories of behavior change predict conventional HRA's ineffectiveness because risk information alone is seldom sufficient to change complex behaviors. In this study, a randomized trial compared the effects of feedback from an enhanced HRA with a typical HRA and a control group among adult patients from eight family medicine practices. The enhanced HRA assessed behavior-specific psychosocial factors and provided patients with computer-generated, individually-tailored behavior change information in addition to typical HRA risk feedback. Changes in seven behaviors were assessed at a 6 month follow-up. Overall, patients receiving enhanced HRA feedback were 18% more likely to change at least one risk behavior than were patients receiving typical HRA feedback or no feedback (OR = 1.18, 95% CI = 1.00, 1.39). The enhanced HRA feedback appeared to promote changes in cholesterol screening, dietary fat consumption and physical activity, but not in smoking, seat belt use, mammography and Pap smears. We conclude that the addition of theory-based, individually-tailored behavior change information may improve the effectiveness of HRA.

Adolescent↗
PubMed2003

Maintenance of health behavior change in preventive cardiology. Internalization and self-regulation of new behaviors.

Long-term health behavior maintenance remains a challenge for patients and health behavior interventionists. Resource-intensive systems of external reinforcement and behavioral cues can support behavior maintenance; an alternative approach is to promote patient internalization and self-regulation of health behaviors. Based in part on organismic internalization theory, self-determination theory, and the experience of patients successful at maintaining health behaviors, the health behavior internalization model (HBIM) is proposed to describe motivational factors associated with internalization processes and hypothesizes that integrated internalization may be associated with long-term health behavior maintenance. The HBIM identifies four self-needs (ownership, self-determination, security, and support) and four behavior-related needs (preference, context, competence, and coping) as motivating health behavior internalization. Behavior change strategies promoting integrated internalization are identified from self-determination theory, motivational interviewing, and transtheoretical model interventions. Other health behavior change constructs are reviewed in relation to internalization processes, and potential limits to the model are discussed.

Adult↗