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PubMed1975

A mother instruction program: behavior changes with and without therapeutic intervention.

Mother-child behavior changes over therapeutic intervention and no-contact periods were compared. Fifteen dyads had 8 weeks of instruction followed by no contact; 15 followed a reversed schedule. Overall change was about the same in both groups, and both changed more during instruction than during no-contact periods. Mothers receiving immediate instruction showed greater and more systematic immediate changes following instruction. Children in the group with later follow-up exhibited a greater proportion of behavior change during that no-contact period than during instruction. Thus, no-contact periods cannot be considered no-change periods, though immediate intervention probably ensures more systematic change than intervention preceded by waiting-list experience.

Behavior Therapy↗

PubMedDate not supplied

Predictors of dietary change in Mexican American families participating in a health behavior change program.

Previous research indicates that Mexican Americans have dietary patterns related to cardiovascular disease risk factors. Research on health beliefs in this ethnic group suggests that Mexican Americans may be less amenable to interventions based on cognitive-behavioral change models. Our study derives from the experience in a community trial, the San Diego Family Health Project, in which Mexican American families were recruited for a structured heart health intervention program. We examined correlations between one-year dietary change scores (three-day sodium, three-day fat, 24-hour sodium, 24-hour fat) and a set of predictor variables derived from social learning theory. Both adults and children had lower intake scores after the intervention, except for children's 24-hour sodium scores. Our correlational analysis found only weak and somewhat inconsistent relationships between theoretically based predictor and outcome variables for adults. The children's results showed statistically significant correlations between two theoretical variables (self-efficacy and supporting others' dietary change) and three-day fat and 24-hour sodium intake. We discuss the implications for cardiovascular disease risk reduction interventions with Mexican Americans.

Adult↗

PubMed2000

Teaching behavior change skills to first-year medical students: a small group experiential approach.

PURPOSE: Develop and evaluate a course to help first-year medical students learn about health-related behavior change by focusing on their personal health goals. COURSE METHODS: Students each identified two health-related behavior change goals for themselves. Lectures presented relevant content concerning behavior change. In small group, experiential sessions, students formed five-person teams and rotated positions as "patient," "doctor," "manager" and observers. "Doctors" and "patients" had one or two follow-up visits. Students evaluated their goal attainment and the value of their experience as "patient" and as "doctor." SAMPLE: 100 first-year medical students. RESULTS: Students chose exercise, nutrition, academic, interpersonal and psychological goals. Rating of the educational values and goal attainments were variable. Mean rating for educational value was 40%, and for goal attainment 55%. CONCLUSIONS: Experiential learning is valuable in introducing medical students to behavior change. Students learn from both the role of change agent and the role of "patient." Although the design of the course was cost-effective, with appropriate modifications considerably more impact could be gained from such a course. To improve this type of experiential learning we recommend careful attention to goal-setting, and more attention to developing the learners' feedback-giving and facilitation skills.

Journal Article↗

PubMed1997

Late adolescent risk-taking: effects of perceived benefits and perceived risks on behavioral intentions and behavioral change.

To assess the predictive utility of perceived benefits and risks of risk-taking behaviors (RTBs) on behavioral intentions and behavioral change, data were collected from 187 male and female late adolescent college students (ages 17-20). Perceived benefits, perceived risks, behavioral intentions, and involvement for 18 RTBs were assessed at T1 and T2 (3 months later). Factor analyses were performed on T1 involvement data, and six RTB factors emerged: Alcohol RTBs, Illegal Drug RTBs, Stereotypic Male RTBs, Social RTBs, Sex RTBs, and Imprudent RTBs. Regression analyses indicated that perceived benefits accounted for significant variance in behavioral intentions for each of the six factors and Overall RTB; perceived risks accounted for significant variance in behavioral intentions for five of the factors. Similar regression analyses indicated that perceived benefits accounted for significant variance in behavior change (over a 3 month period) for each of the six factors and the Overall RTB score, whereas perceived risks accounted for significant variance for only one factor (Illegal Drug RTBs). The result suggest that, among late adolescents, perceived benefits are better determinants of behavior change for RTBs than are perceived risks. Both perceived benefits and perceived risks, however, are important determinants of behavioral intentions. These findings support previous work identifying adolescents as "sensation seekers". Interventions should address perceived benefits of RTB, rather than relying solely on promoting knowledge of the risks. Assessment of adolescent RTB should continue to use multi-item measures to obtain a broad picture of the variety of behaviors commonly endorsed by adolescents.

Adaptation, Psychological↗

PubMedDate not supplied

Behavior changes & disease prevention: MCW research shows effectiveness of HIV/AIDS risk reduction interventions. Medical College of Wisconsin.

Many of the diseases that cause premature illness and death--including some cancers, heart disease, and AIDS--could be prevented if persons made behavior changes to reduce their risk for developing the illnesses. Over the past two decades, there have been great advances in our scientific understanding of how to promote health risk behavior change. This paper briefly reviews elements and examples of effective behavior change interventions, including programs that can be offered in service settings as well as community-level interventions. The prevention of diseases through behavioral public health interventions requires the investment of funds but can reduce burdens on health care systems, reduce the human toll caused by premature deaths, and be highly cost-effective. A remarkable number of diseases could be prevented if individuals were effectively assisted in changing the risk behaviors responsible for those illnesses. The causal association between cigarette smoking and lung cancer, other pulmonary diseases, and cardiovascular disease is well-known, and millions of premature deaths could be prevented if people stopped smoking cigarettes. Deaths due to cardiovascular disease could be dramatically reduced if persons made behavioral and lifestyle changes to improve their fitness through exercise, obesity reduction, and maintenance of low blood cholesterol levels. The World Health Organization estimates that over 45 million persons worldwide have already contracted HIV infection, and nearly 1 million of these cases are in the United States. Over 40,000 Americans continue to contract HIV infection each year. Virtually every new case of HIV infection is preventable if individuals at risk made changes in their sexual or drug use practices. While lung cancer, cardiovascular disease, and AIDS are three of the clearest examples, persons' behavior plays a direct or a contributing role in the development of many other diseases that cause premature death or that worsen health and life quality. Recognition of the link between behavior and preventable illness--and recognition that enormous health, economic, and quality of life benefits could be realized through healthier behavior patterns--is not new. We have known all of this for a long time. We have also known for a very long time that helping people to successfully change risky behavior habits is often very difficult. Over the past 20 years, a field of scientific study and applied practice has developed with the purpose of better understanding why persons engage in health risk behavior patterns and developing approaches to help people change these patterns. Under the rubric of "behavioral medicine", this field makes use of behavioral science theory and behavior change techniques applied to health and disease prevention.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Teaching motivational interviewing to first-year medical students to improve counseling skills in health behavior change.

OBJECTIVE: To examine the effectiveness of motivational interviewing training on improving medical students' knowledge of and confidence in their ability to counsel patients regarding health behavior change. SUBJECTS AND METHODS: In the spring of 2002, 42 first-year medical students participated in a counseling course on health behavior change. Three small groups focused on learning and practicing motivational interviewing techniques using brief lectures, interactive class activities, student role-plays, and simulated patients. Students completed an identical precourse and postcourse questionnaire that measured their confidence and knowledge regarding counseling skills in health behavior change. RESULTS: The medical students reported improved confidence in their understanding of motivational interviewing after participation in the course (very confident, 77%) compared with before the course (very confident, 2%). Each of the 8 confidence items were compared before and after the course using a signed rank test. All comparisons indicated a significant improvement (P < .001) in confidence. Regarding knowledge-based questions, students showed significant improvement; 31% of students answered all the questions correctly before the course, and 56% answered all the questions correctly after the course (P = .004). CONCLUSION: These results show that teaching motivational interviewing techniques to first-year medical students can enhance student confidence in and knowledge of providing counseling to patients regarding health behavior change.

Counseling↗

PubMed2006

Conceptualizing the Influence of Social Agents of Behavior Change: A Meta-Analysis of the Effectiveness of HIV-Prevention Interventionists for Different Groups.

A meta-analysis of 166 HIV-prevention interventions tested theoretical predictions about the effects of experts, lay community members, and similar and dissimilar others, as agents of change. In general, expert interventionists produced greater behavior change than lay community members, and the demographic and behavioral similarity between the interventionist and the recipients facilitated behavioral change. Equally importantly, there were differences across groups in the efficacy of various sources, especially among populations of low status and/or power. These findings support the hypothesis that unempowered populations are more sensitive to characteristics of the interventionists who can facilitate access to various resources. In addition, they suggest the need to ensure the availability of health professionals from diverse demographic and behavioral backgrounds.

Behavior Therapy↗

PubMed2005

Medical homes for at-risk children: parental reports of clinician-parent relationships, anticipatory guidance, and behavior changes.

BACKGROUND: Family-centeredness, compassion, and trust are 3 attributes of the clinician-parent relationship in the medical home. Among adults, these attributes are associated with patients' adherence to clinicians' advice. OBJECTIVES: The objectives were (1) to measure medical home attributes related to the clinician-parent relationship, (2) to measure provision of anticipatory guidance regarding injury and illness prevention, (3) to relate anticipatory guidance to parental behavior changes, and (4) to relate medical home attributes to anticipatory guidance and parental behavior changes. METHODS: A cross-sectional study of data collected among at-risk families when children were 1 year of age, in a randomized, controlled trial of a home-visiting program to prevent child abuse and neglect, was performed. Modified subscales of the Primary Care Assessment Survey were used to measure parental ratings of clinicians' family-centeredness, compassion, and trust. Parental reports of provision of anticipatory guidance regarding injury and illness prevention topics (smoke alarms, infant walkers, car seats, hot water temperature, stair guards, sunscreen, firearm safety, and bottle propping) and behavior changes were recorded. RESULTS: Of the 564 mothers interviewed when their children were 1 year of age, 402 (71%) had a primary care provider and had complete data for anticipatory guidance items. By definition, poverty, partner violence, poor maternal mental health, and maternal substance abuse were common in the study sample. Maternal ratings of clinicians' family-centeredness, compassion, and trust were fairly high but ranged widely and varied among population subgroups. Families reported anticipatory guidance for a mean of 4.6 +/- 2.2 topics relevant for discussion. Each medical home attribute was positively associated with parental reports of completeness of anticipatory guidance, ie, family-centeredness (beta = .026, SE = .004), compassion (beta = .019, SE = .005), and trust (beta = .016, SE = .005). Parents' perceptions of behavior changes were positively associated with trust (beta = .018, SE = .006). Analyses were adjusted for potential confounding by randomized, controlled trial group assignment, receipt of >or=5 well-child visits, and baseline attributes. CONCLUSIONS: Among at-risk families, we found an association between parental ratings of the medical home and parental reports of the completeness of anticipatory guidance regarding selected injury and illness prevention topics. Parents' trust of the clinician was associated with parent-reported behavior changes for discussed topics.

Child↗

PubMed2002

Behavior change counseling in the emergency department to reduce injury risk: a randomized, controlled trial.

OBJECTIVE: To determine whether a brief session of behavior change counseling (BCC), offered to injured adolescents in the emergency department (ED) as a therapeutic intervention, could be used to change injury-related risk behaviors and the risk of reinjury. STUDY DESIGN: A randomized, controlled trial. PARTICIPANTS: Adolescents between 12 and 20 years old who were undergoing treatment for an injury in the ED and who were cognitively able to participate in the intervention. SETTING: An urban ED at a level 1 pediatric trauma center. INTERVENTION: Study participants completed a baseline risk behavior prevalence assessment. Participants were then randomly assigned to receive BCC or routine ED care. Those in the treatment group underwent a brief session of BCC with a study social worker focused on changing an identified injury-related risk behavior (seatbelt use, bicycle helmet use, driving after drinking, riding with an impaired driver, binge drinking, or carrying a weapon). Participants were recontacted 3 months and 6 months after enrollment to assess the prevalence of positive behavior change and the interim occurrence of medically treated injuries. RESULTS: We enrolled 631 participants (78% of those eligible) and obtained follow-up for 76% at 3 months and 75% at 6 months. The relative risk of a positive behavior change with respect to seatbelt use was 1.34 (95% confidence interval [CI]: 1.00, 1.79) at 3 months, favoring the intervention group. The relative risk for the same outcome was 1.47 (95% CI: 1.09, 1.96) at 6 months. A positive change in bicycle helmet use was 1.81 (95% CI: 1.02, 3.18) times more likely at 3 months and 2.00 (95% CI: 1.00, 4.00) times more likely at 6 months in the intervention group. There was no effect of the intervention on changes in other target behaviors. Over the 6-month follow-up period, the risk of reinjury requiring medical attention did not differ between treatment groups. CONCLUSIONS: Brief BCC can be delivered to adolescents undergoing treatment for injury in the ED and can be used to address injury-related risk behaviors. The intervention was associated with a greater likelihood of positive behavior change in seatbelt and bicycle helmet use. This effect lasted over 6 months of follow-up. BCC was not associated with changes in other risk behaviors and could not be shown to significantly reduce the risk of reinjury.

Accident Prevention↗

PubMed1990

A program for health behavior change in a preventive cardiology center.

The Preventive Cardiology Center at the University of California, San Diego, was designed to conduct training, service activities, and research related to behavioral modification of cardiovascular disease (CVD) risk. A primary aim is to train medical students and other health care professionals in the application of scientifically established methods of behavior change. This training takes place in the context of a behavior-change program for patients with CVD risk factors. Participants at increased risk for CVD and their families are recruited to the Preventive Cardiology Center. A comprehensive assessment of physiological and behavioral risk factors leads to the development of dietary and/or exercise behavior-change targets. A five-session group intervention instructs participants how to change health behaviors. Behavioral techniques included in the program include self-monitoring, goal-setting, social support, self-reward, self-talk, and problem solving. Students and others are trained through readings, videotapes, and coleading of intervention groups.

Academic Medical Centers↗

PubMed2001

Professional advice and readiness to change behavioral risk factors among members of a managed care organization.

OBJECTIVE: To ascertain factors related to readiness to change behavioral risk factors in members of a managed care organization (MCO). STUDY DESIGN: Cross-sectional study. PATIENTS AND METHODS: A telephone survey reached 4667 (73%) of 6409 adult members of a Minnesota MCO attending 2 primary care clinics. Of these, 3826 members (82%) completed an interview designed to identify behavioral risk factors (smoking, consuming a high-fat diet, and physical inactivity) and readiness to change these behaviors. RESULTS: Among MCO members consuming a high-fat diet, those most ready to change were older, were women, used more preventive services, and reported receiving professional advice about diet. For physical inactivity, those most ready to change were younger, women, and more educated; used more preventive services; and reported receiving professional advice about physical activity. Among smokers, those with higher readiness to change smoked fewer than 15 cigarettes a day, had higher self-efficacy, had no other smokers in the household, and reported receiving professional advice about smoking. After controlling for demographic variables and for use of preventive services, greater readiness to change for smoking (beta = 0.336, odds ratio [OR] = 1.40, P = .056), physical activity (beta = 0.651, OR = 1.92, P < .001), and diet (beta = 0.532, OR = 1.70, P < .001) was associated with having received professional advice to change these behaviors. CONCLUSIONS: Levels of readiness to change behaviors in MCO members who smoke, are inactive, or consume high-fat diets are similar to those reported in other populations. The association of professional advice to change behaviors with increased readiness to change for smoking, physical activity, and diet suggests that receiving professional advice on these topics might assist patients in changing adverse health-related behaviors.

Adult↗

PubMed1993

AIDS-related knowledge, fear, and behavioral change among nurses in Taiwan.

Current literature documents a phenomenon of fear that affects the willingness of health care professionals to care for persons with acquired immunodeficiency syndrome (AIDS). We attempted to identify differences between nurses who exhibit fearful attitudes toward AIDS and those who do not, based on knowledge and behavior. Taiwan, site of the study, is only beginning to identify the first of its citizens with AIDS. The subjects were a population of caregivers from a culture with little exposure, therefore, either through education or experience, to the disease and the issues it engenders. A cross-sectional, self-administered survey was conducted in 1990 of 1759 nurses in 12 institutions throughout Taiwan. Data on AIDS-related knowledge, fear, and behavior, as well as selected demographic data, were gathered. Analysis revealed significantly less fear of AIDS among nurses who reported three behavioral changes related to AIDS than among those who reported fewer changed behaviors (F = 4.43, df = 3; P < 0.004); those with higher levels of education (F = 3.54, df = 3; P < 0.014); and those who were single rather than married (t = 2.81; P < 0.005).

Acquired Immunodeficiency Syndrome↗

PubMed1976

Behavioral change in the chronicity pattern of dementia in the institutional geriatric resident.

To determine whether behavioral change as a result of environmental stimulation can be reported in individualized terms for the aged with organic brain syndrome or senile dementia, a program of multimodal group interactive therapy was started in an extended care facility. During a 1.5-year period, the study included 108 residents, whose average age was 84 years. The technique used was a combination of modified Reality Orientation, Remotivation, Activity and Milieu therapies. Thirteen groups residing in different wings of the facility were treated for 55 sessions by 11 activity specialists and 2 elderly volunteers under the supervision of the consulting clinical psychologist. Data were collected on emerging behavioral changes with respect to awareness, attention, verbalized ideation, voice quality, speech quantity, sociability, self-care, quality of affect, energy level, expressed somatic concern and physical movement. Of the initial 108 residents, 80 had chronic brain syndrome of varying severity or senile dementia. During treatment, 35 of these 80 residents (44 percent) were improved, 17 (20 percent) were unchanged, 14 (18 percent) became worse, and 14 (18 percent) remained unrated. The results warrant a redifinition of the psychotherapeutic approach. It should include factors other than the severity and chronicity of disease in determining the prognosis for behavioral change in geriatric institutional residents.

Behavior↗

PubMed2003

The transtheoretical model applied to an oral self-care behavioral change: development and testing of instruments for stages of change and decisional balance.

PURPOSE: The Transtheoretical Model is a theory-based approach for conceptualizing behavioral change. Inherent in this model is the determination and use of appropriate interventions to assist clients in improving their health behaviors. In the Transtheoretical Model, behavioral change progresses through a series of stages (precontemplation, contemplation, preparation, action, and maintenance) where movement from stage to stage is dependent upon decisional balance (the pros and cons that influence the decision). The purpose of this study was to develop instruments to test the validity and reliability of two components of the Transtheoretical Model--stages of change and decisional balance--as they relate to a new application in oral self-care behavior. An additional purpose was to determine if there was an association between these two components that would be applicable to a specific oral self-care behavior. METHODS: A three-part questionnaire was developed consisting of 1) stages of change instrument (4 items), 2) decisional balance instrument (40 items), and 3) demographic and dental experience information (9 items). Regular interdental cleaning was chosen as a behavior representing a commitment to oral self-care. The study population consisted of 709 subjects aged 35 to 55 who were recruited from 17 dental practices. RESULTS: A 70% (n = 521) response rate was obtained. Based upon the stages of change portion of the questionnaire, nearly 60% (n = 309) of the subjects were in the maintenance stage, while 21% (n = 109) were in precontemplation, with the rest distributed among the other stages. Reliability of the instrument was established with Kappa scoring. The decisional balance instrument was subjected to factor analysis resulting in a final decisional balance instrument of 28 items. There was a statistically significant relationship between the two components of stages of change and decisional balance. CONCLUSIONS: Stages of change and decisional balance instruments were developed and shown to be valid and reliable. Based upon the oral self-care behavior defined in this study, these instruments can identify an individual's current behavior and assess readiness to change by analyzing the distribution of the pros and cons a person considers when making a behavioral change. Understanding a client's behavioral stage would enable the practitioner to select and provide appropriate interventions. Further research should focus upon development of stage-appropriate intervention strategies and techniques, in order to move individuals along the continuum of stages toward behavioral change. Additionally, research with parallel and diverse populations is indicated.

Adult↗

PubMed1996

AIDS knowledge, concerns, and behavioral changes among inner-city high school students.

Knowledge of AIDS, attitudes toward AIDS and condoms, and behavioral changes because of AIDS were studied in 771 students, Grades 9-12 (mean age, 16 years) who completed anonymous questionnaires in gym classes of a New York City high school. Students demonstrated good knowledge of AIDS, with some misconceptions, and significant concerns about AIDS, with some behavioral changes, but most continued to engage in high-risk behaviors. These data indicate that efforts aimed at HIV/AIDS prevention in adolescents must translate knowledge and concerns into behavioral change.

Acquired Immunodeficiency Syndrome↗

PubMed2005

A review of rating scales for measuring behavior change due to frontal systems damage.

OBJECTIVE: To perform a critical review of scales designed to measure frontal behavior change. BACKGROUND: Changes in cognition due to frontal disease or damage have been well described, but noncognitive changes in behavior are often more deleterious functionally for frontal patients. METHOD: The review concentrates on five behavior rating scales: the Behavior Rating Inventory of Executive Functions (BRIEF), the Dysexecutive Questionnaire (DEX), the Frontal Behavior Inventory (FBI), the Frontal Systems Behavior Scale (FrSBe), the Iowa Rating Scales of Personality Change (IRSPC), and the Neuropsychiatric Inventory (NPI). Other scales purporting to measure specific aspects of frontal functioning, but having less research support, are described briefly. RESULTS AND CONCLUSIONS: The BRIEF and FrSBe have good reliability and large-scale norms. No norms are available for the other scales. The FrSBe and IRSPC have been shown to be valid in discriminating frontal from nonfrontal lesioned patients, but this has not been shown in the other scales. The FBI and NPI require trained raters, whereas the FrSBe, IRSPC, and BRIEF are administered to patients and/or family informants directly. The NPI and FBI are sensitive to certain changes in behavior attributed to frontal systems disruption but have been used primarily in dementia.

Brain Injuries↗

PubMed2005

The utility of the Trans-theoretical Model of Behavior Change in the treatment of sex offenders.

This paper discusses the use of the Trans-theoretical Model of Behavior Change in the treatment of sex offenders. Constructs within this theory are the Stages of Change, Processes of Change and Decisional Balance. The first section of this paper provides a brief description of these constructs. The second section provides a brief review of research related to these constructs and discusses the implications of this research in relation to the treatment of sex offenders. The third section of this paper provides a practical description of the use of the constructs of the Trans-theoretical Model of Behaviour Change in the treatment of sex offenders. Although the validity of this model among sex offenders requires further investigation, the Trans-theoretical Model of Behavior Change appears to have considerable utility as an overarching theoretical model to conceptualize and facilitate behavior change among sex offenders.

Behavior Control↗

PubMed2004

Engaging food service workers in behavioral-change partnerships.

When food inspectors pay educational visits to food service establishments, the goal is prevention. For that reason, such visits form a valuable component in local-government programs to improve food safety. The efficacy of educational programs can be measurably improved by the application of behavioral-change theory. The study reported here was conducted with the cooperation of Key Arena Sportservice, a large sports arena in downtown Seattle, Washington. The facility serves 1.2 million customers per year through 40 individual food service operations staffed by approximately 250 workers. Analysis of facility inspection reports for the period 1998 through 2001 identified three key types of violation. Problematic food preparation processes were analyzed and modified through the application of behavioral-change theory. Food safety inspection reports were used to detect and evaluate changes in behavior. Results from the study appear to support the authors' hypothesis, which was that sustainable improvements in food safety, as measured by food service inspection scores, can be achieved through the systematic application of behavioral-change theory in active partnership with industry.

Behavior Therapy↗