LifeStyle Management Suite of Programs offered to YMCA members in Kent County, Rhode Island

Starting in September, members of the Kent County YMCA, Warwick, Rhode Island will be offered access to Pro-Change’s award-winning suite of LifeStyle Health Behavior Change programs. As part of this pilot program, titled MyHealth at the YMCA, members will be invited to take Pro-Change’s online Health Risk Intervention (HRI) either at computer kiosks located at the YMCA or at any Internet-enabled computer. The HRI will start the change process by pinpointing the member’s stage of readiness to change for various health risks and offering targeted guidance on the most important steps that can be taken to progress to the next stage of change.

YMCA members will be invited to meet with Member Navigators, who are YMCA staff, trained to discuss the HRI feedback and to assist in setting wellness goals based on readiness. Members will have access to seven behavior change programs including, smoking cessation, stress management, depression prevention, weight management, exercising regularly, and adherence to prescribed antihypertensive and/or cholesterol lowering medication. “This pilot is a great opportunity to expand the reach of our programs to more people in Rhode Island and to test the feasibility of delivering such programs at a state-of-the-art wellness center,” said Leanne Mauriello, Ph.D., Vice President of Research and Product Development for Pro-Change.

Pro-Change’s LifeStyle Management Suite of programs won the 2009 URAC Gold Award in Health Management at the Best Practices in a Health Care Consumer Empowerment and Protection Conference. Each time a YMCA member returns to a program (no more than once a month) they receive tailored feedback on how they are doing, what change strategies they are using well, which they may be under utilizing, and what steps they can take to continue progressing. The programs are built to help those not ready, getting ready, and ready to make a behavior change.

Each LifeStyle program is complemented by an engaging interactive e-Workbook filled with activities that promote the use of recommended strategies. Easily accessed from the user’s homepage, the e-Workbooks can be used at anytime.

Cindy McDermott, Vice President, YMCA of Greater Providence, is thrilled to offer Kent County members access to evidence-based behavior change programs through this pilot program. “The access to Pro-Change programs will allow our members, with the support of a Member Navigator, the opportunity to optimize a health and wellness plan that matches their individual health and wellness goals,” said McDermott. Opportunities for expanding MyHealth at the YMCA to members of other branches will be considered upon completion of the pilot in December of 2010.

The pilot program of MyHealth at the YMCA coincides with a multi-million dollar expansion of the Kent County facility that includes reconstruction of the current location, increased space, and new and improved facilities and program offerings.

Partnerships with SmartCredit.com and DebtGoal Bring Powerful New Tools to Help Consumers Take Control of Their Credit and Pay Down Debt

Nationally-recognized personal finance expert Jean Chatzky unveiled two new programs at the FinovateSpring 2010 conference in San Francisco.

The JeanChatzky Score Builder, an application developed exclusively with SmartCredit.com™ gives consumers a simple and secure way to understand their credit score and take action to improve that score in just 120 days.

The Pay It Down!™ application, powered by DebtGoal, is an extension of Chatzky’s The Debt Diet™ program. The app simplifies and automates the development and tracking of a customized debt repayment plan. The Debt Diet program, developed with Pro-Change Behavior Systems, Inc., blends behavioral science, online exercises and Jean Chatzky’s time-tested advice to help people make long-lasting, positive change and pay down debt.

Score Builder, along with The Debt Diet and its Pay It Down! app will help Americans overhaul their relationship with money, improve their credit scores and reduce debt. “As our nation continues to emerge from a powerful and damaging recession, millions are struggling with debt and its impact on their credit scores,” said Chatzky. “We know that people are happier and less stressed when they have control of their finances. I’m pleased to offer these innovative, online solutions to help people regain that control by giving them a clearer look at their credit and debt issues, then helping them work logically toward improved credit scores and a life free of needless debt.”

Taking control of credit scores

In recent years, Americans have become increasingly aware of their credit scores and the important role these seemingly esoteric numbers play in their lives. Chatzky wants consumers to take responsibility for controlling and improving their credit scores and has introduced the JeanChatzky Score Builder app, developed exclusively with SmartCredit.com, to help them on this quest. Said Chatzky, “Consumers understand that their credit scores matter whether they’re applying for a mortgage, renting an apartment, buying auto insurance or looking for a job. Yet, they’re not sure how to improve them – and dealing directly with their creditors is often very difficult.”

Score Builder starts by helping consumers make sense of credit scores. With Jean as the ever-present guide, users are given an explanation of the positives and negatives driving their individual scores, and advice on how to improve the negative items one-by-one. Score Builder then facilitates Smart Actions™-explicit steps users can take to remove or counteract the negatives-and tracks the status of these actions by interfacing directly with creditors. This direct contact with creditors makes Score Builder particularly effective in updating incorrect consumer information, since creditors typically quickly inform the credit bureaus of changes they make to consumers’ records. By following the action steps Score Builder provides, the average user will see his credit score improve in just 120 days.

The JeanChatzky Score Builder app is now available to all SmartCredit.com members for no additional fee; non-members may initiate a 5-day free trial of SmartCredit.com, which includes Score Builder, before committing to membership. Score Builder will soon be available as a stand-alone program that gives purchasers full access to the SmartCredit.com capabilities for a fixed 120 day membership.

Bridging the gap between advice and tools

Based on the tenets in her best-selling book, Pay it Down!: Debt Free on $10 a Day, The Debt Diet incorporates behavioral science techniques developed by Pro-Change to help people deal with the core of their debt and spending issues. Chatzky appears in online videos as a helpful co-pilot and mentor, inspiring and encouraging users as they make their way through the program’s easy-to-use, interactive activities.

“With The Debt Diet, I’m helping people make systemic changes in their behavior around money, to deal with debt at its roots,” said Chatzky. “It’s really different because it identifies the individual’s readiness for change and then provides customized tools and exercises. Some people need to learn how to pay down debt, while others may have little debt, but need to learn how to build an emergency fund and save for tomorrow.”

A new enhancement to The Debt Diet is the Pay It Down! app, powered by DebtGoal. This app looks at the debt each user is carrying and then creates a customized repayment plan that shows users the fastest way to get out of debt while paying the least amount of interest. The plan is based on DebtGoal’s proprietary algorithm and removes an enormous paperwork burden from users. It can also save users thousands of dollars in interest and shave years off of their debt.

The basic version of the Pay It Down! app is available at no additional fee to Debt Diet members. The standard version, which automatically updates the user’s repayment plan when interest rates and balances change, is available for an additional fee.

Says Chatzky, “Through my partnerships with Pro-Change Behavior Systems, SmartCredit.com, and DebtGoal, I’m making it easier for people to overhaul their relationship with debt and improve their credit scores, starting at the core of the problem and progressing toward long-lasting, positive change.”

To learn more about JeanChatzky Score Builder, visit www.SmartCredit.com.
The Debt Diet with the Pay It Down! app is available at www.JeanChatzky.com/debtdiet/.

Pro-Change Granted Women’s Business Enterpise Certification

After an intensive evaluation and an onsite visit, Pro-Change Behavior Systems, Inc. is pleased to announce it was officially granted a Women’s Business Enterprise (WBE) Certification by the Women’s Business Enterprise National Council (WBENC). The WBE is a nationally-accepted certification recognized by numerous private sector companies and governmental agencies.

WBE Membership criteria demand that members provide documented evidence that at least 51% or more of a company is owned, managed, and controlled by women. Membership facilitates beneficial procurement opportunities for WBEs and corporations on a local and national level. By including women-owned businesses among their partners, corporations and government agencies demonstrate their commitment to fostering diversity and the continued development of their supplier diversity programs.

“We are pleased to be able to offer this Certification to our partners and customers to help them in their efforts to receive contracts and grants,” stated Pro-Change’s President & CEO, Dr. Janice M. Prochaska.

About Women’s Business Enterprise National Council

The Center for Women & Enterprise is the New England certifying organization for the Women’s Business Enterprise National Council (WBENC).

WBENC is the nation’s largest third-party certifier of businesses owned and operated by women in the United States. WBENC is a resource for the more than 700 U.S. companies and government agencies that rely on WBENC’s certification as an integral part of their supplier diversity programs. For more information about The Center for Women & Enterprise or Women’s Business Enterprise National Council, please visit www.cweonline.org or www.wbenc.org.

Japan to Use Pro-Change’s Smoking Cessation Program

On Thursday, June 3rd, 2010 the Nossmo Health Care Association (site in Japanese) will provide a kick-off seminar to introduce Pro-Change’s Smoking Cessation program in Japan. Speakers at the event will include Dr. Shaw Watanabe, President of Nossmo Health Care Association; Dr. Mori from the Japanese Health and Welfare Ministry, and Dr. Miyazaki from the Japanese Non-Smoking Organization.

Nossmo Health Care Association will provide onsite smoking cessation groups for employees throughout Tokyo. Pro-Change’s stage-matched smoking cessation print manuals will be the core curriculum provided. Dr. Watanabe and his staff visited Pro-Change in December 2009 to plan out strategies for licensing and using the smoking cessation program.

Eri Kubota, of the Nossmo Health Care Association, stated “that the companies in their membership association will now have the Pro-Change program available for the 30-40% of employees who are smokers. Healthcare professionals will be onsite once a month to lead the groups.”

Dr. Johnson Presents Multiple Behavior Change Research at the Society for Behavioral Medicine Conference

Sara Johnson, Senior Vice President of Research and Product Development at Pro-Change Behavior Systems, Inc. recently presented important findings regarding multiple behavior change at the 31st annual meeting of the Society of Behavioral Medicine (SBM) meeting in Seattle, Washington.

As part of a symposium on multiple behavior change interventions, Dr. Johnson shared results of three NIH-funded Small Business Innovative Research grants that suggest that behavior change co-varies. In other words, changing one behavior increases the likelihood of changing another behavior.

In the effectiveness trial of a Transtheoretical Model (TTM)-based computer-tailored intervention for medication adherence (n=404), participants in the treatment group were significantly more likely to exercise regularly and change dietary fat intake 12 months post treatment.

In a randomized trial of a TTM-based multiple behavior weight management intervention, participants were up to five times as likely to change a second behavior if they had changed one behavior. This finding was not true for the comparison condition, suggesting that the co-variation of behavior change was due in part to having received tailored interventions for the behaviors.

Finally, a randomized trial of a multiple behavior change program for obesity prevention in eight high schools revealed that students assigned to the treatment group who took action on one behavior, such as regular exercise, were more likely to take action on another behavior (e.g., fruit and vegetable intake). The same was not true for those randomized to the comparison condition.

Pro-Change is currently examining the effectiveness of novel approaches to maximizing the impact of tailored multiple behavior change interventions to leverage this co-variation effect.

Dr. Johnson stated, “Leveraging the co-variation of behavior change will allow us to enhance the effectiveness of multiple behavior change interventions while minimizing response burden and the disseminability of tailored interventions.”

The citation and abstract of this presentation appears below.

Co-Variation: A Promising Approach to Multiple Behavior Change Interventions
Authors: Sara Johnson, PhD, James Prochaska, PhD, Karen Sherman, MA Pro-Change Behavior Systems, Inc.
ABSTRACT
Transtheoretical Model (TTM)-based computer-tailored interventions for multiple behavior change (MBC) are effective. However, fully tailored interventions (FTI) for multiple behaviors increase response burden and delivery costs, limiting feasibility and dissemination potential. Leveraging co-variation of behavior change (i.e., when taking action on one treated behavior increases the odds of taking action on a second) represents an innovative approach to MBC interventions. Data from three randomized trials will be presented to demonstrate the potential of interventions utilizing co-variation. Among 404 adults (50.4% male; 83% White) in a medication adherence study, random effects modeling indicated that those receiving a FTI for adherence and minimal messaging for related behaviors were significantly more likely to reach Action (A) or Maintenance (M) for exercise (43.5% vs. 24.7%, Odds ratio (OR)=2.39, z=2.37, p<.05) and dietary fat reduction ((24.7% vs.12.5%; OR=1.57, z=2.06, p<.05). Logistic regression performed on data from 1206 adults (50.8% male; 78% White) in a weight management intervention indicated that on each pair of the three treated behaviors (exercise, healthy diet, and emotional eating), the ORs for taking action on one behavior if a participant took action on another ranged from 2.52 to 5.18 in the treatment group vs. 1.24 to 2.63 in control. Among 1800 high school students (mean age=15.97, 49.2% male; 71.5% White) who received FTIs for exercise paired with stage-matched interventions for fruit and vegetable and reducing TV time, logistic regression indicates that the OR for likelihood of reaching A/M for a behavior if A was reached on another behavior ranged from 1.99-2.36 among the treatment group at the end of treatment (6 months) as compared to 0.5-1.0 in the control group. Across all studies, progress on one behavior led to progress on another among treatment but not control participants. Suggestions for a planned co-variation approach that has the potential to produce the greatest impact with the least demands on participants will be presented.

State of Maine Employees Losing Pounds with Pro-Change Weight Management Program

Since September 2008 over 300 Maine State employees have lost 6100 pounds through a comprehensive multi-disciplinary team approach.

In researching programs, the Workers Compensation Division of the State of Maine discovered the Transtheoretical Model of Behavior Change. The Model resonated with what they knew−all individuals would not be ready to make the changes necessary to lead healthier lives and that those individuals would need time to make change possible. “The Transtheoretical Model became the philosophy that our ‘ME First’ obesity program was built around”, stated Rachel Maier, Program Manager of the Eastside Wellness Center in Augusta, Maine. ME First stands for Maine fighting increase risk starting today. Pro-Change’s Weight Management stage-based manuals are given to each participant and are the focus of the monthly facilitation groups held throughout the State. Pro-Change’s Weight Management manual titled “Roadways to Healthy Living” takes participants through the stages of change for healthy eating, exercising regularly, and managing emotional eating. The manual was first used in 2002 in an effective randomized clinical trial as part of a National Institutes of Health’s Small Business Research Innovation grant. Wellness coaches trained in the Transtheoretical Model and Weight Watchers’ memberships are also part of the services offered.

In 2009 another 440 employees joined the ME First program. The total for all groups to date is nearing a loss of 14,000 pounds. As a result of this program, the State of Maine has seen a reduction in medication use and now is researching decreases in worker compensation costs.

Pro-Change Provides a Direct to Consumer Option for LifeStyle Programs

Pro-Change now offers individual access to our evidence-based, award winning behavior change programs within our adult LifeStyle Management Suite. The program, called MyHealth, is available from any Internet-enabled computer and includes programs for smoking, stress management, depression prevention, weight management, exercising regularly, and adherence to prescribed antihypertensive and/or cholesterol lowering medication.

Users first take the Health Risk Intervention (HRI) which starts the change process by pinpointing the user’s stage of change for health risks and by giving targeted guidance on the most important steps that can be taken to progress to the next stage of change. The HRI is then followed by full tailored LifeStyle Management programs for the user’s risk behaviors−e.g, smoking, sedentary behavior, depression, nonadherence to medication, obesity, and unhealthy stress management.

These LifeStyle Management programs won the 2009 URAC Gold Award in Health Management at the Best Practices in Health Care Consumer Empowerment and Protection Conference. Each time a user returns to the program (no more than once a month) they receive tailored feedback on how they are doing, what change strategies they are using well, which they may be under utilizing, and what steps they can take to continue progressing.

Each LifeStyle program is complemented by engaging interactive e-Workbooks filled with exercises that promote the use of the recommended strategies. Easily accessed from the user’s homepage, these e-Workbooks also provide links to a variety of external resources that can help the user move through the stages of change. The e-Workbooks can be accessed as often as the user wants.

A one-year, renewable license for our Health Risk Intervention and the full suite of behaviors costs $35 (US dollars). This new offering permits individuals to access Pro-Change’s high impact, award winning programs that previously were only available to larger populations. To learn more and to sign up, go to www.prochange.com/myhealth.

Innovative Pro-Change Product Addresses Needs of Uninsured and Underinsured Americans

“Maximize Your Benefits: Maximize Your Health” is the theme of Pro-Change Behavior System, Inc.’s innovative Proactive Health Consumer (PHC) Program, which is uniquely positioned to address the needs of uninsured or underinsured Americans (who may soon have additional health coverage). The PHC program is designed to help all individuals—ready or not—to make informed decisions about health and health care, share in decision making with their health care providers, use health services wisely, avoid unnecessary and potentially costly care, and engage in ongoing health and wellness. Given the complexity of people’s interactions with the health care system, the PHC program addresses each user’s role as purchaser, provider, and patient.

The stakeholders in recent health care reform (e.g., AMA, AHA, Pharma, Health Plans, Employers, and Government) agreed on one thing: If the U.S. is to afford health care for all Americans, then prevention will need to be the foundation for health care. The ongoing health and wellness component of the PHC program is comprised of seven behavior change modules that won the 2009 Gold Award from URAC for Best Practices for Health Management. These evidence-based, high impact interventions treat the behaviors that have the highest disease burden, the highest health care cost burden, and the highest lost productivity burden—including smoking, obesity, nonadherence, stress, and depression. These behavior change programs will also be crucial for the newly insured who have already developed chronic conditions. The combination of these behavior change programs for multiple behaviors with the program components designed to enhance personal responsibility for health offers a truly comprehensive solution.

Central to the success of the PHC program is its ability to tailor the user’s feedback to responses provided to evidence-based assessments of up to 14 of the most important behavior change variables, beginning with readiness to change. Using proprietary technology and statistical decision-making rules, the program generates feedback customized to each user’s answers. Each time the user returns to the program, the features available are updated based on past interactions and the progress made since the last visit. Sophisticated back-end tracking supports organization specific and aggregate reporting capabilities.

To ensure access to the timely and accurate health information, the PHC program incorporates the award-winning Healthwise® Knowledgebase. Dr. Janice Prochaska, President and CEO of Pro-Change, said, “We believe strongly that offering the PHC program to the newly insured has the potential to have dramatic impacts on their health and health care. It is time for comprehensive, evidence-based solutions of this kind to facilitate true changes in how health care is delivered in the U.S.”

Preventive Medicine Cites Pro-Change’s Weight Management Article as Top Ten Download

The journal Preventive Medicine recently announced that the paper describing the effectiveness of Pro-Change Behavior System, Inc.’s multiple behavior LifeStyle Management Program for weight management ranked third on the list of top ten most frequently downloaded articles in 2009. The article entitled, “Transtheoretical Model-Based Multiple Behavior Intervention for Weight Management: Effectiveness on a Population Basis” was written by Sara Johnson, Andrea Paiva, Carol Cummins, and other colleagues at Pro-Change and originally appeared in the March 2008 issue of the journal. The paper summarizes how individualized, Transtheoretical Model-based interventions significantly impacted healthy eating, exercise, managing emotional distress, and weight at one year post-intervention and enhanced co-variation of behavior change in over 1200 overweight and obese participants. This weight management program is part of the LifeStyle Program Suite that received the Gold Award for Best Practices in Health Management from URAC in 2009.

Dr. Sara Johnson, Senior Vice President of Research and Product Development at Pro-Change, and the lead developer of the weight management program stated that, “Given the current epidemic of overweight and obesity, we’re pleased that the article is informing the field. Our goal is to widely disseminate evidence-based programs that can address the behaviors that can lead to effective weight management.”

Zeon Chemicals First to Participate in Pro-Change’s Wellness Program Access for Small Businesses

Zeon Chemicals—a small business headquartered in Louisville, Kentucky—is the first to take advantage of Pro-Change’s new small business option for access to its LifeStyle Management Programs. Zeon has purchased a small number of individual slots for its employees to use the Pro-Change Smoking program. Employees will have access to the program from any Internet-enabled computer for up to a year.

Zeon announced to their employees that they were going to be a tobacco-free worksite starting Sunday, July 4, 2010. Zeon stated that “we see eliminating the high-risk behavior of tobacco use at work as preventative and necessary to maintain the health of our employees and our health care benefits.”

Pro-Change’s program was especially appealing to Zeon since it met their employees wherever they are at in their readiness to quit smoking—not ready, getting ready, or ready. Small companies or groups can now take advantage of evidence based behavior change programs by licensing small numbers of slots for employees/members for any one program or the entire LifeStyle Management Suite of programs that includes the Health Risk Intervention along with the Smoking, Stress Management, Weight Management, Exercise, Depression Prevention, and Medication Adherence programs. Depending on the number of participants, aggregate reporting features may be available to track usage and progress through the behavior change process. This new option allows the LifeStyle programs to reach employees of small businesses, which make up the majority of our workforce, at an affordable price.

Karen Hicks, Human Resource Manager at Zeon stated, “I appreciate this opportunity to offer my employees a URAC Gold Award Program at a low cost.”

Small businesses interested in similar access for their employees should contact info@prochange.com.

URAC Podcast Highlights Pro-Change’s LifeStyle Management Program

URAC, the nation’s leading health care accreditation and education organization, has launched the latest podcast in its “Highlights in Health” series. This episode looks at Pro-Change Behavior Systems, Inc. and their LifeStyle Management Program which is helping people make positive, often lifesaving changes in the way they live.

The “Highlights in Health” podcast series recognizes innovative programs that health care organizations have developed to protect and empower consumers. Pro-Change Behavior Systems’ leadership in this area was recognized in 2009 when the company received a Gold Award at URAC’s “Best Practices in Health Care Consumer Empowerment and Protection Awards” ceremony. The podcast tells more about how this cutting-edge approach works.

“Most people know which of their behaviors are not healthy, or know they need to care for a chronic condition. However, being able to truly change a lifestyle is difficult,” said URAC President and CEO Alan P. Spielman. “There is a clear need for programs that offer guidance and counsel to those who are trying to adopt healthier behaviors. The programs that have been developed by Pro-Change fill that need.”

Chronic health conditions such as heart disease, diabetes, and obesity are the leading causes of death and disability in the United States. To manage, or sometimes even prevent, those conditions, consumers often need to make major changes in their behavior and lifestyles. The Pro-Change LifeStyle Management Program offers a suite of health behavior change programs in seven areas: smoking, weight management, stress management, depression prevention, managing cholesterol, managing high blood pressure, and exercising regularly. All of these programs are available to participants in print, on the web, and through coaches.

These comprehensive, multistage programs are based on the Transtheoretical Model of Behavior Change (TTM), which was developed more than 30 years ago by Dr. James O. Prochaska, Ph.D., a professor and director for the Cancer Prevention Research Center at the University of Rhode Island and the founder of Pro-Change Behavior Systems, Inc.

“The Transtheoretical Model allows us to help people no matter where they are in their path to change,” said Dr. Janice Prochaska, President and CEO of Pro-Change. “It’s very important for us to be able to reach out to those who are demoralized, who are not ready, or who have a lot of doubt about whether it all is worth it. Participants have told us that ‘this program really respects where I’m at. It gives me feedback that helps me understand what I need to do next.’”

The podcast also features commentary from both Dr. Janice Prochaska and Dr. Kerry Evers, Ph.D., Senior Vice President of Research and Product Development with Pro-Change Behavior Systems.

Dr. Evers describes the Model’s five stages, which are used to determine where people are in their readiness to change. “These five stages help us determine where the person’s mindset is, and what type of information will be most helpful to move them forward. We really tailor the tools to help participants be the most successful they can be.”

The majority of the LifeStyle Management Programs have been built and evaluated through rigorous research programs and clinical trials funded through the National Institutes of Health, and all of the programs have shown significant positive outcomes. For example, the Pro-Change Smoking program has shown success rates of 22 and 26 percent for people quitting smoking long-term. With the Stress Management program Pro-Change found, of those enrolled, approximately 60 to 70 percent start managing their stress effectively within six months, and continue effective management 18 months into the program and even beyond.

To learn more about Pro-Change’s programs and to listen to the podcast, visit www.urac.org/podcast/ and listen to the 12/21/09 episode. The podcast is also available via iTunes under “Highlights in Healthcare” (iTunes link).

NREPP Recognizes Pro-Change Stress Management Program

The National Registry of Evidence-based Programs and Practices (NREPP), a service of the Substance Abuse and Mental Health Services Administration (SAMHSA) recently identified Pro-Change’s Transtheoretical Model (TTM) based Stress Management Program as one of the interventions in their database that has been evaluated in Comparative Effective Research (CER). By identifying interventions that have CER support, users of NREPP will be able to more easily find programs that meet their needs.

“Pro-Change is thrilled that NREPP is adding the CER search feature to their web site. It will allow researchers, clinicians, and other decision makers to identify interventions that have been evaluated and compared in real world settings,” said Dr. Kerry Evers, Senior Vice-President of Research and Product Development. Dr. Evers was the Principal Investigator and developer of Pro-Change’s Stress Management Program.

According to the U.S. Department of Health and Human Services, CER is the conduct and synthesis of research comparing the benefits and harms of different interventions and strategies to prevent, diagnose, treat, and monitor health conditions in “real world” settings. The purpose of this research is to improve health outcomes by developing and disseminating evidence-based information to patients, clinicians, and other decision makers, responding to their expressed needs about which interventions are most effective for which patients under specific circumstances.

The goals of CER are to:

• Assess a comprehensive array of health-related outcomes for diverse patient populations and subgroups
• Include medications, procedures, medical and assistive devices and technologies, diagnostic testing, behavioral change, and delivery system strategies
• Use a variety of data sources and methods to assess comparative effectiveness and actively disseminate the results.

NREPP rates the quality of the research supporting intervention outcomes and the quality and availability of training and implementation materials on a scale of 0.0 – 4.0. Pro-Change’s Stress Management Program was added to the database in February 2008. The program received a 3.8 overall rating for readiness for dissemination.

Pro-Change Teams up with Arizona State University’s New Doctor of Behavioral Health Program

Pro-Change Behavior Systems, Inc. is pleased to announce a contract with Arizona State University’s (ASU) Doctor of Behavioral Health Program to disseminate Pro-Change resources to students. As part of their course work, doctoral students will receive training in the Transtheoretical Model of Behavior Change (TTM) to provide them with the basic concepts and strategies needed to effectively use the TTM when working with patients.

Student practitioners will then utilize Pro-Change’s LifeStyle Management Program Suite with their patients. This suite includes a set of Pro-Changes’ LifeStyle Management Programs that won the 2009 URAC Gold Award for Best Practices in Health Management. The programs work with individuals to help them identify their readiness to change in relation to seven behaviors closely tied to preventing and managing chronic disease. The LifeStyle Management programs offer individuals access to a health risk intervention, computerized tailored interventions, and interactive stage-matched e-workbooks, all based on the TTM. Student practitioners will “prescribe” our suite of programs to their patients then use patients’ feedback reports to guide them through the stages of change.

ASU’s Doctor of Behavioral Health (DBH) program is the culmination of Dr. Nicholas Cummings’ vision of creating a doctoral training program tailored to the emerging need for innovative behavioral clinicians to practice in primary care and medical settings. The DBH curriculum and practicum are designed to offer a unique blend of evidence-based behavioral interventions, medical literacy, health systems, and entrepreneurship skills that will meet the needs of the health-care, reform-driven marketplace. The explicit goal of the DBH program is to graduate clinicians who can deliver and document interventions that produce clinical and functional improvement, patient and provider satisfaction, and cost savings by decreasing overuse of medical resources and the cost of lost productivity to employers. Dr. Ronald O’Donnell, Director, stated that he believes that “an upgrade to a doctorate for master’s-level clinicians based on this unique foundation of skills will result in graduates being highly valued in a marketplace that is searching for cost-effective care.”

The DBH program will be integrated with existing cutting-edge degree programs such as Nursing and Healthcare Innovation, the Medical School and the Doctorate in Physical Activity, Nutrition and Wellness. For more information about this unique program, please see www.dbh.asu.edu.

Pro-Change’s President and CEO, Janice Prochaska, stated that “Pro-Change is honored to be an integral part of this first program in the country for Doctoral of Behavioral Health training.”

Dr. Kerry Evers to Attend the “Forum on the Future Impact of Neuroscience and Behavior Change”

Dr. Kerry Evers of Pro-Change Behavior Systems, Inc. is one of 20 experts who have been invited by the Robert Wood Johnson Foundation (RWJF) and the Monitor Institute to the “Forum on the Future Impact of Neuroscience and Behavior Change” to take place on November 11-12 at RWJF’s Princeton headquarters. RWJF’s Pioneer Portfolio and the Monitor Institute are convening a small group of researchers, academics, physicians, and industry leaders in the fields of neurotechnology, neurodevelopment, and behavior change. The forum is designed to shine a light on key areas of innovation, to highlight new opportunities for key players, and to forge a greater sense of connectivity among leading thinkers in these three fields.

Over the course of two days, participants will engage in a series of highly iterative, forward-looking discussions on neurotechnology, neurodevelopment, and behavior change. This will culminate in a wrap-up session that will integrate the thinking across all three areas and highlight connections and implications for the future of health and health care. The meetings will help identify key areas of exploration and development, inspire a greater sense of connectivity, and potentially create a new way of engaging with key stakeholders to foster and leverage ideas and innovation.

“I am honored to be included in this distinguished group of individuals and organizations and excited to be involved in what is sure to be invigorating discussions,” stated Dr. Evers.

Financial Expert and Author Jean Chatzky Launches Debt Diet Online in Collaboration With Pro-Change

Financial expert and author, Jean Chatzky yesterday launched a new online tool – Debt Diet Online at www.JeanChatzky.com/debtdiet. The tool, developed in collaboration with Pro-Change, uses behavior change science to deliver guidance based on how ready an individual is to take on debt challenges. Debt Diet Online is a tailored program with strategies to help people get out of debt and start building wealth with just $10 per day.

“We’ve all seen the tremendous difficulties Americans are facing with debt and often it’s so overwhelming that you wonder how to get started,” says financial expert and author, Jean Chatzky. “Debt Diet Online provides the right information and the motivation to make the right choices every day and take back control of your finances.”

A culture of easy credit combined with the current recession and high unemployment has landed many Americans in a mountain of debt. The first step is often the hardest, which is why Chatzky collaborated with preeminent behavior change experts at Pro-Change to get users ready to implement Chatzky’s proven strategies and to ensure they do so successfully. Based on the user’s stage of readiness, the tool is customized with step-by-step coaching, driven by time-tested, effective behavior change principles. This is the first product of its kind that combines proven financial strategies with behavior change principles.

“We’ve spent over 30 years studying how people can make lasting change in their lives—from stopping smoking to losing weight to reducing stress,” says Founder James Prochaska, Ph.D. of Pro-Change. “Reducing debt is a major challenge for Americans today and Debt Diet Online is a great opportunity to apply our knowledge with Jean Chatzky’s insights to help people make real, positive change in their lives.”

Debt Diet Online uses an algorithm to determine which of six stages of readiness applies to the user:

• Not Yet Ready: Not intending to start eliminating debt
• Getting Ready: Looking to start paying down debt in the next six months
• Ready: Planning to start reducing debt in the coming month
• Taking Action: Already started to eliminate debt and looking to stay on track
• Staying with It: Well on track with reducing debt and want to know how to handle the unexpected
• You Have No Debt: Next Step is to Start Building Savings: Debt is gone and want to learn how to build savings

Debt Diet Online then delivers information based on the user’s stage of readiness. For $30, users can access the online tool where they are guided through—with the end goal of changing behavior, eliminating debt, and building sustainable wealth.

Learn more at www.JeanChatzky.com or www.JeanChatzky.com/debtdiet.

Pro-Change Announces Effectiveness of Health in Motion, A Multi-Media Obesity Prevention Program for Adolescents

Pro-Change Behavior Systems, Inc. recently completed a five year program of research funded by the National Heart, Lung, and Blood Institute (NHLBI) and led by Principal Investigator, Dr. Leanne Mauriello, to develop and test a multi-media obesity prevention program for adolescents. Health in Motion is a population-based program relevant for all teens that focuses on helping them adopt or maintain physical activity, fruit and vegetable consumption, and limiting television time according to national guidelines. Each of these behaviors is important for leading a healthy lifestyle and preventing overweight and obesity.

Health in Motion is a self-directed, computer-based program that can be easily delivered to adolescents across multiple settings. Once the teen logs on, the intervention administers on-screen assessments and offers immediate, tailored and stage-matched feedback based on the Transtheoretical Model of Behavior Change. Each intervention session is designed to be delivered within 30 minutes. A fully tailored intervention is offered for physical activity and optimally tailored sections are offered for fruit and vegetable consumption and TV viewing. Multimedia components, including audio, videos, animations, and interactive feedback screens, engage the users and help to relay important behavioral change strategies. A demonstration version of Health in Motion can be viewed at www.prochange.com/obesitydemo.

As part of a 14-month clinical effectiveness trial Health in Motion was delivered to 1800 students from 8 high schools across the country. The majority of students were White (71.5%), female (50.8%), of normal weight according to their body mass index (74.7%), and on average 16 years old. The treatment group received three intervention sessions and two follow-up assessments, while the control group received four assessment-only sessions. Results of the trial demonstrate the effectiveness of the program to initiate behavior change for all three behaviors and to treat multiple risks simultaneously.

At the end of the intervention, the treatment group increased their physical activity of at least 60 minutes by 1 additional day (while the control group increased that much activity by 1/3 of a day), increased their fruit and vegetable consumption by 1.5 servings per day (while the control group increased by ½ of a serving), and reduced their daily television viewing by 1 hour (while the control group reduced by ½ an hour). At the 12 month follow-up time point, the treatment group continued to outperform the control group on all three of these measures.

The intervention also was successful at moving treatment group participants from a pre-action stage (in which participants were not doing the target behavior) to the action or maintenance stages (in which participants had begun to do the target behavior), with 28.5% of the treatment group moving to action or maintenance for physical activity, 35.5% moving to action or maintenance for fruit and vegetable consumption, and 43% moving to action or maintenance for TV viewing. These effects were relatively stable for the treatment group out to the 12 month follow-up time point.

A noteworthy success of Health in Motion is its ability to treat multiple risks simultaneously. Among treatment group participants those students who progressed to action or maintenance for one behavior were 4.2 to 2.1 times more likely to make the same progress on another behavior. This finding was not found among control group participants. Findings also indicate the ability of the intervention to reduce the number of behavioral risks among treatment group participants. Among students with at least one behavioral risk at baseline, the treatment group reported fewer risks than the control group at the 2, 6, and 12 month time points. In addition, among those with zero behavioral risks at baseline, the control group reported significantly more risks at the 2, 6, and 12 month time points than the treatment group. These findings reflect the crux of treating multiple risks simultaneously. An intervention that can help students reduce multiple risks, help students adopt more than one healthy behavior, and prevent students from acquiring risks stretches the impact seen to date with single behavior interventions. Overall, these findings exemplify the ability of Health in Motion to promote the adoption of multiple health behaviors while also reducing relapse and risk acquisition.

The effectiveness of Health in Motion to help students who previously where not doing healthy lifestyle behaviors at recommended levels adopt the target behaviors to national guidelines, and help many of them continue doing the behaviors out to 12 months post intervention culminates this five year program of research and program development. Adoption and maintenance of these lifestyle behaviors particularly when promoted through a feasible and easily adoptable intervention strategy can lend greatly towards helping teens adopt healthy behaviors that may prevent the onset of adult obesity and the consequential health impacts that obesity bears to individuals, and society as a whole.

Over 10 presentations on this research have been made at several national conferences and three publications have resulted to date. Discussions with potential commercialization partners have ensued and elicited much enthusiasm for marketing Health in Motion to schools, youth organizations, health care providers, and to health promotion, disease management, and insurance benefit companies. Health in Motion is now available to license. Contact Janice M. Prochaska, President and CEO, at jmprochaska@prochange.com, for more information.

American Journal of Health Promotion Highlights Pro-Change’s Work

The July/August issue of the American Journal of Health Promotion‘s section on the Art of Health Promotion highlights Pro-Change’s new Proactive Health Consumer (PHC) program. The article entitled “Proactive Health Consumerism: An Important New Tool for Worksite Health Promotion” focuses on the fundamentals of the PHC approach, applies lessons learned to develop effective PHC, suggests how PHC programs could be integrated with employers or health plan offerings, and gives strategies for assuring a successful PHC program.

The article can be found in the July/August 2009 issue, Volume 23, pages 1-8 and is authored by Sara S. Johnson, Carol O. Cummins, Kerry E. Evers, Janice M. Prochaska, and James O. Prochaska.

To see a demo of the PHC program, please visit www.prochange.com/phcdemo.

Dr. Kerry Evers Selected to Attend National Security Forum

Dr. Kerry Evers, Senior Vice President of Research and Product Development at Pro-Change, was one of 130 civilian leaders in business, education, and government from across the country to receive a personal invitation from the Secretary of the Air Force to attend the 56th Annual National Security Forum (NSF) at the Air War College at Maxwell Air Force Base in Alabama earlier this year. The purpose of NSF is to expose influential citizens to senior U.S. and international officers and civilian equivalents in order to engage each other’s ideas and perspectives on Air Force, national, and international security issues.

This year’s forum included discussions of cybersecurity, the robotics revolution and conflict in the 21st century, diplomacy and security challenges in the broader Middle East, unwrapping the mysteries of Iran, and North Korea’s nuclear diplomacy. Speakers included Ambassador Ryan Crocker, the former U.S. Ambassador to Iraq; Dr. Peter Singer, Director, 21st Century Defense Initiative at the Brookings Institute; and The Honorable Michael B. Donley, Secretary of the Air Force.

Dr. Evers commented, “The week was a remarkable opportunity to engage with senior military leaders for in-depth discussions of current and future issues facing the Air Force and the other branches of the military. It was an incredible follow-up to my experience in the European Command last fall.” In 2008, Kerry was selected by the U.S. Office of the Secretary of Defense as one of 50 leaders from across the country to participate in the 76th Joint Civilian Orientation Conference (JCOC). This prestigious conference provided a forum of free exchange among influential citizens, Department of Defense officials, and military leadership while touring military installations throughout Europe.

Pro-Change Releases New Integrated Program to Help Employees Be More Proactive About Their Health and Health Care

Pro-Change is pleased to announce our new Proactive Health Consumer Program: Making Health Happen (PHC). Rising costs are driving health plans and employers to look for ways to encourage members/employees to become proactive health consumers who take responsibility for their health, health care, and cost of care—for themselves and on behalf of their families.

The Transtheoretical Model (TTM) based PHC program is designed to guide those not ready, getting ready, and ready to take charge of their health and health care. A computerized-tailored intervention segues into a dynamic web portal containing interactive activities, health decision-making guidance, lifestyle behavior change interventions, and a health information database all designed to promote and reinforce skills and resources needed for health care consumerism.

The four main components of the program address:

1. Sharing in decision making with health care providers;
2. Making informed decisions regarding health insurance coverage, health care providers, tests, treatments, and end-of-life care;
3. Using health services wisely and in a financially responsible way; and
4. Engaging in ongoing health and wellness via award winning programs for healthy lifestyle management.

This innovative program will lead the field of behavior change into a new era. Originally, the field focused on disease management, then disease prevention. Over the years the focus evolved to health promotion and then wellness. Today, the focus is shifting to well-being. PHC is the first program that integrates health and financial well-being using the integrative construct of proactive health consumerism.

After viewing our program demo, one person remarked, “This is the first program I’ve seen that integrates health care and healthy lifestyles.” Another viewer said, “This is a truly holistic approach.” Now see it for yourself.

To view our demo, go to: www.prochange.com/phcdemo.

Three Pro-Change Staff Members to Present Research at SBM

Three members of Pro-Change Behavior Systems, Inc. will present at two different Paper Sessions at the Society of Behavioral Medicine (SBM) Annual Conference in Montreal, Canada on April 22-25, 2009.

The three presentations are based on a recently completed five year program of research funded by the National Heart, Lung, and Blood Institute (NHLBI). The research was led by Principal Investigator, Dr. Leanne Mauriello to develop and test a multi-media obesity prevention program for adolescents. Health in Motion is a population-based program relevant for all teens that focuses on helping them adopt or maintain physical activity, fruit and vegetable consumption, and limiting television time according to national guidelines. Each of these behaviors is important for leading a healthy lifestyle and preventing overweight and obesity.

At the “It’s All Fun and Games: Multimedia Approaches to LifeStyle Change” Paper Session, Dr. Mauriello will present the 12-month outcomes from the effectiveness trial of Health in Motion. Students (N=1800) from eight high schools participated in the 14- month trial. The program was effective at moving students in the treatment group to action or maintenance for all three behaviors. In addition, the treatment group reported exercising at least 60 minutes on more days and eating more fruits and vegetables at all time points then the control group. Significant group differences were not found for hours of TV per day.

At the “Prevention is Key: Weight Gain Prevention Research” Paper Session, Patricia Castle, M.A., will present on “Multiple Behavior Risk Reduction and Risk Acquisition Results from Adolescent Obesity Prevention Program.” At follow-up, those students in the treatment group reported significantly fewer health risks compared to the control group. Also, among those students with zero health risks at the start of the program, the treatment group reported less acquisition of risks compared to the control group at the end of treatment. These findings highlight the effectiveness and importance of treating multiple risks simultaneously. This paper won the Annual Award of the Multiple Health Behavior Change Special Interest Group of SBM.

Also at this Paper Session, Karen Sherman, B.A., will present on the “Co-variation of Multiple Behavior Change: Synergistic Effects of an Obesity Prevention Program.” Findings demonstrate that progress (movement to Action or Maintenance) on one behavior led to progress on another behavior among treatment but not control group participants. The treatment group exhibited significant co-variation among behaviors at each time point. These results indicate the synergistic effects possible when impacting multiple behaviors.

Janice M. Prochaska, President & CEO of Pro-Change Behavior Systems, Inc. stated, “We are pleased to have the opportunity to share the successful results of this effectiveness trial with members of SBM.”

For citations and abstracts of the papers, please see our Youth Obesity Prevention page.

Pro-Change’s New Proactive Health Consumer Program featured by the Center for Information Therapy

The Center for Information Therapy (IxCenter) is featuring for the month of April, Pro-Change’s new Proactive Health Consumer Program: Making Health Happen (PHC) through its website’s Monthly Member Spotlight.

The PHC program also will be demonstrated as part of “The Opening Great Debate: Ix and Health 2.0 – Synergies or Tensions?” at the Health 2.0 Meets Ix Conference in Boston on April 22, 2009. It is fitting that the Center for Information Therapy, an early project collaborator, is the first to present the program to the public. The IxCenter’s President, Joshua Seidman, commented, “The PHC tool represents a great step forward in integrating the different types of information that consumers need to navigate an increasingly complex health care delivery system.”

The Proactive Health Consumer Program promotes active participation in managing health and health care costs for one’s self and family using validated assessments and empirically-based guidance. PHC is the first program that integrates health and financial well-being using the integrative construct of proactive health consumerism. The Transtheoretical Model (TTM) based PHC program is designed to guide those not ready, getting ready, and ready to take charge of their health and health care. An individualized, computerized-tailored intervention segues into a dynamic web portal containing interactive activities, health decision making guidance, lifestyle behavior change interventions, and the Healthwise^® Knowledgebase, all designed to promote and reinforce skills and resources needed for health care consumerism.

The four main components of the program address:

1. Sharing in decision making with health care providers;
2. Making informed decisions regarding health plans, providers, tests, treatments, and end-of-life care;
3. Using health services wisely and in a financially responsible way; and
4. Engaging in ongoing health and wellness activities.

For more information about the Proactive Health Consumer program, see our PHC page.

URAC Awards Pro-Change Gold Award for Best Practices in Health Management

Pro-Change Behavior Systems was presented the Gold Award for Health Management by leading health care accreditation organization, URAC. The honor was announced at the 2009 Best Practices in Health Care Consumer Empowerment and Protection Awards Gala on April 1-2 in Orlando, Florida. The awards are designed to recognize innovative leadership and successful programs in consumer-focused health care management.

Pro-Change was honored for its LifeStyle Management Program Suite, a set of programs that works with individuals to help them identify their readiness to change in relation to seven behaviors closely tied to preventing and managing chronic disease. The LifeStyle Management programs offer individuals access to a health risk intervention, a computerized tailored intervention, and an interactive stage-matched workbook, all based on the Transtheoretical Model.

Seventy submissions were evaluated by a 27-member panel of prestigious, independent judges including experts in program evaluation, care coordination, health information technology, employer and purchaser decision making and patient safety. Honors were awarded in six categories: Health Plans and Health Networks, Health Management, Health Information/Decision Support, Pharmacy Quality Management, Consumer Decision-Making, and Consumer Health Improvement.

“Our Best Practices awards program is a unique celebration of the best the health care industry has to offer. These companies have made a difference in the lives of consumers by implementing leading-edge programs with results that matter,” said Alan P. Spielman, president and CEO of URAC. “At a time when health care reform is in the spotlight, achievements from companies like Pro-Change are even more important.”

“We are honored to be recognized by URAC,” stated Janice M. Prochaska, President & CEO of Pro-Change. “We appreciate the importance of URAC’s goal to raise the quality and impact of the evidence needed to support health management programs.”

Pro-Change Announces Collaboration to Measure Continuing Medical Education (CME) Outcomes

Pro-Change Behavior Systems, Inc. today announced they will work with Quintiles Medical Education, Consensus Medical Communications, and Medical Education Resources in 2009 to comprehensively measure outcomes for continuing medical education initiatives for the effective treatment of hepatitis C virus (HCV).

These initiatives will be delivered live, on-line, and via print. Consistent with the most recent Alliance for Continuing Medical Education competencies regarding partnering with external partners, Pro-Change will develop a common set of measures related to performance improvement in the treatment of HCV. These measures, based on the Transtheoretical Model (TTM) of Behavior Change, will be used for all of the educational activities developed by each partner in this unique collaboration.

The principles of the TTM will also be used to guide the inclusion of behavior change messaging within each CME activity.

The goal is to move CME to performance improvement, going beyond the traditional goal of improving knowledge. Including messages that match the readiness of the entire target audience is expected to increase effectiveness of CME activities for treatment of HCV. The overall educational initiatives are supported by an independent educational grant from Roche Pharmaceuticals.

David Schlumper of Quintiles stated that he “is confident that the collaboration with Pro-Change will bring about improvements in measuring and accomplishing performance improvements and will ultimately improve patient care.”

Becky Carney of Consensus Medical Communications stated that she “values the opportunity to partner with other CME stakeholders to take full advantage of the skills and resources of each group. This allows us to best support education that drives improvements in clinician behaviors which promote optimized patient outcomes.”

Janice M. Prochaska, Ph.D. Elected to the NRPA Board of Trustees

The National Recreation and Park Association (NRPA) has elected Janice M. Prochaska to the national association. The announcement was made during NRPA’s 43rd Annual Congress & Exposition in Baltimore, Maryland.

“Janice is an asset to NRPA,” said Lois G. Finkelman, NRPA Chair of the Board of Trustees. “She has supported the park and recreation movement and NRPA’s mission on many levels throughout her career. Her expertise and leadership skills will continue to help NRPA achieve its organizational goals and Strategic Plan. Janice has previously served on the Board of Trustees for four years where she has been a strong advocate to integrate health into the mission of NRPA.” NRPA will flourish under her leadership.

Dr. Prochaska is the President and CEO of Pro-Change Behavior Systems, Inc. She serves on the South Kingstown Parks and Recreation Commission, Star Island Corporation, and numerous other local organizations. In 2007 Dr. Prochaska accepted on behalf of Pro-Change the National Tibbetts Award for excellence in the Small Business Innovation Research Program.

The National Recreation and Park Association is a national not-for-profit organization dedicated to advancing park, recreation and conservation efforts that enhance quality of life for all people. Through its network of some 21,000 recreation and park professionals and citizens, NRPA encourages the promotion of healthy lifestyles, recreation initiatives, and conservation of natural and cultural resources.

Headquartered in Ashburn, Va., NRPA works closely with local, state, and national recreation and park agencies, citizen groups and corporations to carry out its objectives. Priorities include advocating favorable legislation and public policy; continuing education for park and recreation professionals and citizens; providing professional certification, university accreditation, research and technical assistance; and increasing public awareness of the importance of parks and recreation. For more information, visit www.nrpa.org.

Personal Finance Employee Education Foundation Recognizes Transtheoretical Model As Gold Standard for Financial Program Providers

In a special publication of the Personal Finance Employee Education Foundation (PFEEF), the article “Strategies for Motivating Employees to Develop Positive Financial Behaviors: An application of the Transtheoretical Model of Behavior Change” (Xiao, J.J., Prawitz, A.D., Prochaska, J.M., O’Neill, B., Kim, J., & Garman, T., 2008; pages 1-8) was published. In the article, the PFEEF recognizes the Transtheoretical Model of Behavior Change as the gold standard for financial program providers to utilize in their communications.

“There are numerous people in the personal financial management field who already utilize the Transtheoretical Model of Change” stated Dr. Tom Garman, President of the Personal Finance Employee Education Foundation. “If employers are serious about helping employees change their personal financial behaviors for the better—such as contributing the maximum to their 401(k) retirement plan—now is the time to use Transtheoretical Model principles to help.”

Pro-Change Behavior Systems Inc. has worked with the lead author of the PFEEF article, Dr. Jing Xiao of the University of Rhode Island, for over five years on several of his projects. Dr. Janice Prochaska, PhD, president and CEO of Pro-Change Behavior Systems Inc., is one of the key coauthors of the article, which is available (pdf) on the PFEEF web site.

URAC Names Pro-Change Finalist for Best Practices Award

URAC, a leading independent accrediting organization, has announced that a distinguished panel of judges selected Pro-Change Behavior Systems Inc. as one of 23 finalists in its Best Practices in Health Care Consumer Empowerment and Protection Awards competition. The competition drew entries from across the nation. The finalists will be honored during the 2009 Best Practices Conference & Exhibit, April 1-2, 2009 in Orlando, Fla.

Finalists are invited to present their winning programs at the Best Practices Conference & Exhibit and URAC educational events throughout the year. Presentations will showcase best practices in two categories: consumer decision-making and consumer health improvement.

Pro-Change Behavior Systems Inc. submitted the LifeStyle Management Program Suite to URAC for consideration of Best Practices in consumer health improvement. The LifeStyle Management Suite, based on the Transtheoretical Model, include a Health Risk Intervention as well as seven computerized tailored interventions for changing health risk behaviors stage by stage. The seven behaviors in the LifeStyle Management Program are: Stress Management, Smoking Cessation, Physical Activity, Weight Management, Managing your Cholesterol, Managing your High Blood Pressure and Depression Prevention. The computerized tailored interventions that make up the LifeStyle Management Program help participants use principles and processes of change that move them to the next stage of change in the adoption of effective prevention behaviors. The interventions work directly with participants to prevent adverse health outcomes that can result from chronic disease or result in chronic disease. For more information, see our products page.

“The Best Practices Awards and Conference provide a unique opportunity for leaders in health care management to learn what premier companies are doing to advance consumer protection and empowerment,” said Alan Spielman, URAC’s president and CEO. “It is a one-of-a kind conference, designed to inspire the industry as a whole to rapidly adopt proven practices that advance patient safety and empower consumers with improved decision-making tools.”

Entries were judged by a distinguished panel of judges, chaired by epidemiologist Thomas W. Wilson, Ph.D, DrPH, Trajectory HealthCare, LLC. The 30-member panel included the best and most widely recognized experts in program evaluation, care coordination, health information technology, employer and purchaser decision making and patient safety. Entries were reviewed and scored by the judges based on objective criteria.

“We are very honored to be one of the 23 finalists recognized for their work in developing evidence based health behavior change programs” stated Janice Prochaska, PhD, President and CEO of Pro-Change Behavior Systems Inc.

All finalists are invited to attend a black tie dinner event during the conference, when they will discover how they will be distinguished as award winners. Gold, Silver, Bronze and Honorable Mention Award winners in each of the four organization categories will be announced at the dinner. Platinum Award winners will also be announced, in the two topic categories.

For a complete list of judges, go to www.urac.org/bestpractices/websitejudges.asp.

Stress Management Program Recognized by the Agency for Healthcare Research and Quality

Pro-Change Behavior Systems, Inc. today announced that the Agency for Healthcare Research and Quality (AHRQ) has included a profile of Pro-Change’s Stress Management Program as part of their Health Care Innovations Exchange.

The Stress Management Program is currently being utilized by HealthString LLC, Quality Health Solutions, Healthways, and Medifit. HealthString’s use of the program is highlighted in the Innovations Exchange profile.

Supported by a grant from the National Cancer Institute, the Stress Management Program assists individuals in managing their stress more effectively using practices such as relaxation, exercise, meditation, and social support.

Dr. Kerry Evers of Pro-Change designed the Stress Management Program based on the Transtheoretical Model and studied its effectiveness in a randomized controlled trial with adults from across the United States. At the 18-month follow-up, a significantly larger proportion of the treatment group (62%) was effectively managing their stress when compared to the control group. The intervention also produced significant reductions in stress and depression, and an increase in the use of stress management techniques when compared to the control group.

AHRQ’s Health Care Innovations Exchange is a Web-based resource designed to support health care professionals in sharing and adopting innovations that improve health care quality. The Innovations Exchange allows a variety of health practitioners to explore innovative strategies and quality-related tools, learn how to improve their organization’s ability to innovate and adopt new ideas, and interact with innovators and adopters.

The Stress Management Program’s profile is titled ‘Individualized Stress Management Program Encourages Healthy Behaviors and Coping Techniques’. The profile describes in detail how HealthString, LLC uses the Stress Management Program, part of Pro-Change’s LifeStyle Management Programs. HealthString is a personal health network which works to empower individuals to proactively manage their health by enabling behavior changes that lead to a healthier lifestyle. Use of the Stress Management Program allows HealthString clients to work towards that goal.

In response to receiving the AHRQ recognition, Liz Pampel Willock, President, Chief Compliance & Privacy Officer of HealthString stated, “Pro-Change Behavior Systems understands how people make effective and lasting change to improve their health, and HealthString uses several of Pro-Change’s Lifestyle Management Programs with success for our members. The Stress Management Program is a perfect fit for HealthString’s consumer-centered approach: strategic behavior change support and coaching that is dynamically tailored to an individual’s needs.”

To view a demo of the stress management program go to: www.prochange.com/stressdemo.

To read the full outcome articles see:

Evers, K.E., Prochaska, J.O., Mauriello, L.M., Padula, J.A. and Prochaska, J.M. (2006). A randomized clinical trial of a population and transtheoretical-based stress management intervention. Health Psychology 25 (4), 521-529. abstract

Prochaska, J. O., Butterworth, S., Redding, C. A., Burden, V., Perrin, N., Leo, M. et al. (2008). Initial efficacy of MI, TTM tailoring and HRI’s with multiple behaviors for employee health promotion. Preventive Medicine, 46, 226-231. abstract

Pro-Change Completes Pilot Test of Healthy Pregnancy Program

Pro-Change Behavior Systems, Inc. has developed a prototype version of a computer-tailored multiple behavior intervention to promote health during pregnancy. Healthy Pregnancy: Step by Step is an interactive program that addresses smoking cessation and maintenance, stress management, and healthy eating, all three of which are critical health behaviors for a healthy pregnancy and positive birth outcomes. A pilot test was conducted during the summer of 2008 with 87 women at three locations of the Community Health Center, Inc. of Connecticut. The overwhelming majority of women (90%) rated the program exceptionally high on all fourteen evaluation items including that the program could help them be healthier, that they learned new information about having a healthy pregnancy, and that they would recommend the program to a friend. In addition, after the one session pilot program women reported recognizing increased benefits to changing their health behaviors and intention to make behavioral changes. Participants reported planning to smoke fewer cigarettes, to increase effective stress management, and to eat more servings of fruits and vegetables each day.

The ease by which the Community Health Center was able to recruit participants, the ability for the program to be incorporated easily into prenatal care, the comfortableness of participants with using the computer program, and enthusiasm expressed during key informant interviews all lend to the feasibility of dissemination this program. The positive acceptability and feasibility results of the pilot test build confidence both that the program can be effective at impacting the health behaviors of women at a critical time and that it can be disseminated easily on a population-basis through several distribution channels. Dr. Daren Anderson, M.D., served as an advisory council member, and identified the program as, “a brilliant, scalable, and operational program.”

This research was funded by the Centers for Disease Control and Prevention. Pro-Change is preparing a grant proposal to apply for Phase II funding to complete and enhance the development of the intervention and to test it in a clinical effectiveness trial. The Phase II product will include multiple time points and a Spanish module for the computer-based program, in addition to print-based individualized reports and a stage-based behavior change manual. Once proven effective, this program can be disseminated for use in health clinics and provider offices throughout the country, as well as through health promotion and wellness organizations. Stage-based manuals for smoking cessation, healthy eating, stress management, and depression prevention designed specifically for pregnant and postpartum women will be available for purchase in December. For more information, or for a demonstration of this program, please contact Janice M. Prochaska, President and CEO at jmprochaska@prochange.com.

UPDATE: A guided demonstration of the healthy pregnancy pilot program is now available.

New Partnership with Vital Decisions Will Help Patients with Serious Illnesses

Pro-Change is assisting Vital Decisions in its mission to help empower seriously ill patients and their families to exert control in the decisions associated with their care at the end of life and to align these care decisions with their personal preferences and values.

Pro-Change will design Transtheoretical Model of Behavior Change assessments for identifying a patient’s stage of readiness to actively participate in the planning of their care. Interventions and goals will be developed for those not yet ready, those getting ready and those ready to make a plan.

Vital Decisions will use the assessments, interventions, and goals to facilitate their care planning program, “The Living Well Program”. This program, consisting of a series of telephone based counseling sessions, is guided by the patients’ personal preferences and priorities in the areas of independence, interactivity and comfort, and the actions that are required to be taken by the patient to realize their preferences.

The goal of this collaborative effort is to help seriously ill patients take control by articulating their preferences and choices, and to assist them in documenting and communicating those choices to loved ones and medical care providers. “Using the Transtheoretical Model will help us to improve the quality of our service and the value that we are able to provide to patients,” stated Mitchell Daitz, President of Vital Decisions.

Dr. Kerry E. Evers Selected for Prominent Military Conference

The U.S. Office of the Secretary of Defense has selected Kerry E. Evers, Ph.D., Director at Pro-Change Behavior Systems, Inc. as one of 50 leaders from across the country to participate in the 76th Joint Civilian Orientation Conference (JCOC) September 19 to 26th. The oldest existing Pentagon outreach program, JCOC has been held 75 times since its inception in 1948. This prestigious conference seeks to increase public understanding of national defense through a forum of free exchange among influential citizens, Department of Defense officials, and military leadership.

The program immerses civilian leaders in military activity for seven days and allows them to observe and participate in U.S. military life around the globe to better understand the full-scope of U.S. military efforts.

JCOC 76 will showcase the United States European Command (EUCOM), which maintains responsibility for all of Europe, most of Africa, and parts of the Middle East. Dr. Evers will visit at least five countries over the 7-day period; exact locations of this year’s conference are not known until participants are briefed in Washington, DC. on September 19th.

Selection for JCOC is competitive as over 400 names are typically submitted each year. Each conference looks for a geographical, occupational, and cultural cross-section of influential Americans who are leaders in their fields. Dr. Evers was nominated by the Department of the Navy on behalf of the Navy Warfare Development Command (NWDC), currently located at Navy Station Newport, RI.

At Pro-Change, Dr. Evers develops and disseminates health behavior change programs with areas of interest including health promotion, international health, and the use of technology in healthcare. She hopes to relate her expertise in health care to improving the lives of U.S. troops.

“This is a once-in-a-lifetime trip that will give me a unique perspective on the troops and their health-related issues. I’m excited for the opportunity and I look forward to returning and sharing the amazing experience that I know I’ll have,” says Dr. Evers.

Eight Major Peer Reviewed Articles Support Transtheoretical Model

Recently eight major articles were published in peer reviewed journals that tested and supported fundamental theoretical, empirical, and practical applications of the Transtheoretical Model of Behavior Change (TTM). Using cutting edge methodologies these studies demonstrate how TTM is continuing to advance the field’s ability to understand, predict, and change risk behaviors critical to the prevention and management of chronic diseases. “These advances help drive Pro-Change’s research and development of new TTM programs,” stated Janice M. Prochaska, President & CEO of Pro-Change Behavior Systems, Inc.

Evaluating theories of behavior change: A Hierarchy of criteria applied to the Transtheoretical model

Critical Issue

• Organizes different criteria suggested by different scientific theorists

Abstract

The most common criteria recommended by philosophers of science for evaluating theories were organized within a hierarchy ranging from the least to the most risky tests for theories of health behavior change. The hierarchy progressed across: (1) Clarity; (2) Consistency; (3) Parsimony; (4) Testable; (5) Predictive Power; (6) Explanatory Power; (7) Productivity; (8) Generalisable; (9) Integration; (10) Utility; (11) Efficacy; and (12) Impact. The hierarchy was applied to the Transtheoretical Model (TTM) as an example of a health behavior change theory. The application was from the perspective of critics and advocates of TTM. Examples of basic and applied research challenging and supporting TTM across the hierarchy of criteria are presented. The goal is to provide a model for comparing alternative theories and to evaluate progress across the hierarchy within a particular theory. As theories meet criteria at each step in the hierarchy, the research and applications they generate can have increasing impacts on the science and practice of health behavior change.

Prochaska, J. O., Wright, J. A., & Velicer, W. F. (in press). Evaluating theories of behavior change: A Hierarchy of criteria applied to the Transtheoretical model. Applied Psychology: An International Review, 00, 00-00.

Testing Theory-Using Quantitative Predictions of Effect Size

Critical Issues

• Generates quantitative theoretical statements
• Provides means of testing specificity of a theory

Abstract

Traditional Null Hypothesis Testing procedures are poorly adapted to theory testing. The methodology can mislead researchers in several ways, including: (a) A lack of power can result in an erroneous rejection of the theory; (b) the focus on directionality (ordinal tests) rather than more precise quantitative predictions limits the information gained; and (c) the misuse of probability values to indicate effect size. An alternative approach is proposed which involves employing the theory to generate explicit effect size predictions that are compared to the effect size estimates and related confidence intervals to test the theoretical predictions. This procedure is illustrated employing the Transtheoretical Model. Data from a sample (N=3,967) of smokers from a large New England HMO system was used to test the model. There were a total of 15 predictions evaluated, each involving the relation between Stage of Change and one of the other 15 Transtheoretical Model variables. For each variable, omega-squared and the related confidence interval was calculated and compared to the predicted effect sizes. Eleven of the 15 predictions were confirmed, providing support for the theoretical model. Quantitative predictions represent a much more direct, informative, and strong test of a theory than the traditional test of significance.

Velicer, W.F., Cumming, G., Fava, J.L., Rossi, J.S., Prochaska, JO, & Johnson, J. L. (in press). Testing Theory-Using Quantitative Predictions of Effect Size. Applied Psychology: An International Review, 00, 00-00.

Validity of Stage Assessment in the Adoption and Maintenance of Physical Activity and Fruit and Vegetable Consumption

Critical Issue

• Strongly supports stage as non-linear change

Abstract

Objective. Stage assessments are examined to develop and test refined measurements that can be used for classifying individuals. Design. Stages were assessed in 1,850 persons in terms of their physical activity and dietary behaviors. Main Outcome Measures. Stages for both behaviors were compared to behavior and other test variables. Misclassification, sensitivity, specificity, Receiver-Operation- Curves, and discontinuity patterns were computed. Discontinuity patterns were tested with trends across stages and planned contrasts between adjacent stages. Results. In comparison to previous studies, sensitivity (70%-80%) and specificity (80%-87%) were high. When using lower level criteria (such as less intensive activity), sensitivity was lower, whereas specificity was higher. When behavioral maintenance was assessed, results suggested that the temporal cut-off point between Action and Maintenance was equally optimal at different cut-off points. Applying contrast analyses, nonlinear trends across the stages and a match of 87% of predictions of stage differences resulted. Conclusion. Stage assumptions are supported in general, and refined stage assessment in particular. Levels of psychological variables (e.g., easiness, habit) may discriminate stages as well as or even better than temporal stage definitions.

Lippke, S., Ziegelmann, J.P., Schwarzer, R. & Velicer, W.F. (in press). Validity of Stage Assessment in the Adoption and Maintenance of Physical Activity and Fruit and Vegetable Consumption. Health Psychology, 00, 00-00.

Stage and Non-stage Theories of Behavior and Behavior Change: A Comment on Schwarzer

Critical Issue

• Includes analogy to punctuated equilibrium Theory in Natural Sciences

Abstract

Schwarzer characterizes theories as being Continuum Models or Stage Models. We prefer the labels Theories of Behavior and Theories of Behavior Change. The stage concept is designed to represent the temporal dimension. In this way, individuals are viewed as evolving over time. Theories of behavior change also focus on dynamic variables, i.e. variables that are open to change while theories of behavior will focus on static variables. Schwarzer focuses on the Health Action Process Approach (HAPA), which distinguishes between pre-intentional motivational processes and post-intentional volition processes and makes a compelling case that theories of behavior change need to differentiate between at least two stages, motivation and action, if they are to fill the intention–behavior gap. In some HAPA studies, these two stages are expanded into three stages. The issue of how many stages there are and what are the best ways to represent, assess and treat the different stages represents an important research focus. This response discusses several reasons to believe that the stage differentiation of five stages included as part of the Transtheoretical Model is superior to the two- or three-stage model included as part of HAPA.

Velicer, W. F, & Prochaska, J. O. (2008). Stage and Non-stage Theories of Behavior and Behavior Change: A Comment on Schwarzer. Applied Psychology: An International Review, 57, 75-83.

Meta-Analytic Examination of the Strong and Weak Principles Across 48 Health Behaviors

Critical Issue

• TTM relation between stage and decisional balance replicates across 48 different behaviors

Abstract

Objective. The strong and weak principles of change state that progress from the precontemplation to the action stage of change is associated with a one standard deviation increase in the pros and a one-half standard deviation decrease in the cons of change. In this study these relationships, originally developed by Prochaska [Prochaska, J.O., 1994. Strong and weak principles for progressing from precontemplation to action on the basis of 12 problem behaviors. Health Psychology, 13, 47–51.] Based on an examination of 12 studies of 12 different behaviors, were re-examined using many more datasets and much more rigorous statistical methods. Methods. The current study analyzes 120 datasets from studies conducted between 1984 and 2003 across and within 48 health behaviors, including nearly 50,000 participants from 10 countries. The datasets were primarily analyzed utilizing metaanalytic techniques. Results. Despite the range of behaviors and populations, the results were remarkably consistent with the original results (pros=1.00 standard deviation, cons=0.56 standard deviation). Few potential moderators showed any impact on effect size distributions. Conclusions. This updated and enhanced examination of two important principles of behavior change is a significant contribution to the field of multiple health risk behaviors, as it clearly demonstrates the consistency of the theoretical principles across multiple behaviors, which has implications for developing multiple health risk behavior interventions.Hall, K., Rossi, J. S. (2008). Meta-Analytic Examination of the Strong and Weak Principles Across 48 Health Behaviors. Preventive Medicine, 46-266-274

Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions

Critical Issue

• Evaluates consistency of tailoring and stage effects across intervention studies

Abstract

Although there is a large and growing literature on tailored print health behavior change interventions, it is currently not known if or to what extent tailoring works. The current study provides a meta-analytic review of this literature, with a primary focus on the effects of tailoring. A comprehensive search strategy yielded 57 studies that met inclusion criteria. Those studies—which contained a cumulative N=58,454—were subsequently meta-analyzed. The sample size-weighted mean effect size of the effects of tailoring on health behavior change was found to be r = .074. Variables that were found to significantly moderate the effect included (a) type of comparison condition, (b) health behavior, (c) type of participant population (both type of recruitment and country of sample), (d) type of print material, (e) number of intervention contacts, (f) length of follow-up, (g) number and type of theoretical concepts tailored on, and (h) whether demographics and/or behavior were tailored on. Implications of these results are discussed and future directions for research on tailored health messages and interventions are offered.

Noar, S.M., Benac, C. N., & Harris, M. S. (2007). Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychological Bulletin, 133, 673-693.

Demographic variables, smoking variables, and outcome across five studies

Critical Issue

• Compares stage effect to severity and demographic effects on intervention Outcomes

Abstract

Objective: Intervention effectiveness can potentially be affected by membership in different demographic subgroups (race, ethnicity, gender, age, and education level) or smoking behavior variables (time to first cigarette, longest previous quit attempt, number of attempts in the past year, number of cigarettes, and stage of change). Previous research on these 2 sets of variables has produced mixed results. Design: This secondary data analysis combined data from 5 effectiveness trials (a random digit- dial sample [N=1,358], members of an HMO [N=207], parents of students recruited for a school-based study [N=347], patients from an insurance provider list [N=535], and employees [N=175]) in which smokers were all proactively recruited from a defined population and all received the same expert system intervention. The intervention produced a consistent 22% to 26% point prevalence cessation rate across the 5 studies. Main Outcome Measures: The main outcome measures were 24-hr point prevalence, 7-day point prevalence, 30-day prolonged abstinence, and 6- month prolonged abstinence. Results: There were no significant differences in outcome across gender, race, and ethnicity subgroups. There were significant differences and small effect sizes for age and education subgroups. There were significant differences and large effect sizes for all 5 smoking behavior variables. Discussion: Demographic variables are static variables; whereas the smoking variables are more dynamic, that is, open to change. Given the dynamic nature of the smoking variables and the large effect sizes, interventions tailored on the smoking variables should be more successful.

Velicer, W. F, Redding, C. A., Sun, X. & Prochaska, J. O. (2007). Demographic variables, smoking variables, and outcome across five studies. Health Psychology, 26, 278-287.

Transtheoretical Model-based multiple behavior intervention for weight management: effectiveness on a population basis

Critical Issue

• Demonstrates Transtheoretical Model Tailoring produced significant change in multiple behavior related to healthy weight management.

Abstract

Background. The increasing prevalence of overweight and obesity underscores the need for evidence-based, easily disseminable interventions for weight management that can be delivered on a population basis. The Transtheoretical Model (TTM) offers a promising theoretical framework for multiple behavior weight management interventions. Methods. Overweight or obese adults (BMI 25–39.9; n=1277) were randomized to no-treatment control or home-based, stage-matched multiple behavior interventions for up to three behaviors related to weight management at 0, 3, 6, and 9 months. All participants were re-assessed at 6, 12, and 24 months. Results. Significant treatment effects were found for healthy eating (47.5% versus 34.3%), exercise (44.90% versus 38.10%), managing emotional distress (49.7% versus 30.30%), and untreated fruit and vegetable intake (48.5% versus 39.0%) progressing to Action/Maintenance at 24 months. The groups differed on weight lost at 24 months. Co-variation of behavior change occurred and was much more pronounced in the treatment group, where individuals progressing to Action/Maintenance for a single behavior were 2.5 to 5 times more likely to make progress on another behavior. The impact of the multiple behavior intervention was more than three times that of single behavior interventions. Conclusions. This study demonstrates the ability of TTM-based tailored feedback to improve healthy eating, exercise, managing emotional distress, and weight on a population basis. The treatment produced a high level of population impact that future multiple behavior interventions can seek to surpass.

Johnson, S. S., Paiva, A. L., Cummins, C. O., Johnson, J. L., Dyment, S. J., Wright, J. A., Prochaska, J. O., Prochaska, J. M., & Sherman, K. (2008). Transtheoretical Model-based multiple behavior intervention for weight management: effectiveness on a population basis. Preventive Medicine, 46, 238-246.

Four Pro-Change Staff Present Intervention Findings at Society of Behavioral Medicine Conference

Members of Pro-Change Behavior Systems, Inc. recently presented to standing room only audiences at the Society of Behavioral Medicine Annual Conference in San Diego. Topics ranged from depression prevention to multiple health risk intervention to smoking cessation. Also presented as part of symposia were findings on theory-based approaches to health interventions across various communication channels and a Transtheoretical Model based approach to health coaching using Computerized Tailored Interventions (CTIs).

The first symposium, organized by Dr. Kerry Evers and entitled “Innovative, Theory-Based Approaches to Health Interventions Across Various Communication Channels,” included overviews of three health interventions being distributed through distinct communication channels. All three interventions utilized a theoretical framework as the centerpiece for content development and offered examples of successfully disseminating innovative, science-based health interventions. The presentation by Dr. Leanne Mauriello reviewed the overarching use of theory in the development of healthy lifestyle and obesity prevention CTIs for student populations.

The second symposium entitled “Disseminating and Implementing Computerized Tailored Intervention Now and in the Future: Who’s Reached and Who’s Not” focused on how new technologies can contribute to health disparities due to the relatively slow diffusion of innovations, particularly to underserved populations. CTIs have growing evidence of efficacy and effectiveness as innovative technologies but also have barriers to reaching those who could benefit from them. Dissemination and implementation research is critical to an understanding of how best to expand the reach and impact of CTIs. Dr. Evers discussed barriers from the industry perspective and strategies for dissemination and commercialization.

Dr. Janet Johnson, presenting for Dr. Deborah Levesque, described a randomized trial of a stage-based CTI for depression in primary care. The treatment produced reliable and clinically significant improvement in level of depression, prevention of major depression among patients experiencing only subclinical symptoms at baseline, and progress to the Action or Maintenance stage among patients in a Pre-Action stage at baseline. Strengths of the Pro-Change approach include its low cost, easy access at home, and foundation in an empirically validated model of behavior change.

Another presentation discussed a study of a brief stage-tailored health risk CTI delivered by Quality Health Solutions, Inc. The study conducted by Pro-Change investigated the prevalence of multiple behavioral risk factors among a set of employees, changes in risk status following the brief stage-matched intervention, and relationships between changes in risk status and worker productivity and quality of life. Dr. Janet Johnson presented evidence supporting relationships between the reductions in behavioral risks and improvements in productivity and quality of life.

The final presentation discussed a meta-analytic study of the effectiveness of Transtheoretical Model (TTM) based smoking interventions over time. The TTM is the theoretical foundation for many diverse smoking cessation interventions, with variable outcomes. Systematic, narrative reviews of the TTM’s efficacy have arrived at conflicting conclusions. The current study found, in general, that participants in treatment conditions were anywhere from 25% to 56% more likely to have quit smoking compared to participants in comparison conditions. Moreover, effect sizes were sustained at long-term 24-month follow-ups. Patricia Castle, M.A. showed that the patterns of effects over time support the efficacy of TTM cessation interventions across a range of settings. Pro-Change’s programs apply TTM tailoring in the manner that produces the best effects.

About the Presentations

“Innovative, Theory-Based Approaches to Health Interventions Across Various Communication Channels,” Kerry E. Evers, Ph.D., Pro-Change Behavior Systems, Inc.; Jay Maddock, University of Hawaii at Manoa; Leanne M. Mauriello, Ph.D., Pro-Change Behavior Systems, Inc. abstract

Abstract: In the past decade the development and testing of health promotion and behavior change interventions have proliferated. Some of the challenges for the future include wider reach, broader dissemination channels, and continued attention focused on promoting science and evidence-based practices. Innovative strategies for integrating theoretical models in the development of health interventions and for designing for dissemination from the start of development are important for the future. The appeal and disadvantages of different communication channels in regard to implementation and practicality need to be considered, as well as recommendations for integration of health interventions across communication channels.

“A Transtheoretical Model-Based Approach to Health Coaching using Computerized Tailored Interventions.” Kerry E. Evers, Ph.D., Sara S. Johnson, Ph.D., Janice M. Prochaska, Ph.D., Pro-Change Behavior Systems, Inc. abstract

Abstract: The World Health Organization (WHO) has estimated that by 2015, world deaths from lifestyle diseases will double unless major efforts are taken to change lifestyle behaviors (WHO, 2007). Computerized Tailored Interventions (CTIs) based on the Transtheoretical Model (TTM) have been shown to be effective for a variety of behaviors. Using assessment data from all of the constructs of the TTM, CTIs often use expert system technology to provide dynamically tailored, individualized feedback to participants. The programs rely on empirically derived decision rules and expert system logic to match intervention strategies to where individuals are in the process of change and facilitate forward stage movement. This theoretically driven, individualized approach has been successful for increasing stress management, exercise, and weight management in home- and worksite-based interventions delivered via print or the Internet in participants’ homes or through their employers. CTI can also enhance the delivery and maximize the effectiveness of telephone coaching sessions, a common communication vehicle for health behavior change and disease management programs that is in high demand among many employers and health plans. The expert system technology that is central to CTIs can increase fidelity of the intervention by replacing traditional clinical decision making on the part of the coach with evidence-based behavior change guidance. The coach is ushered through brief but reliable and valid assessments that are tailored to the individual participant. The expert system can then generate feedback based on empirical decision-making rules. An added advantage of the integration of CTIs into coaching calls is that the participant can interact with the intervention online between sessions to further facilitate progress.

“Randomized Trial of a Stage-Based Intervention for Depression in Primary Care,” Deborah A. Levesque, Ph.D., Deborah F. Van Marter, M.P.H., Janice M. Prochaska, Ph.D., Pro-Change Behavior Systems, Inc.; Robert J. Schneider, Ed.D., Mark R. Bauer, M.D., Harvard Vanguard Medical Associates, David N. Goldberg, M.D., John Stroger Hospital of Cook County; James O. Prochaska, Ph.D., University of Rhode Island. abstract

Abstract: Depression Prevention: Nine hundred and two adults at risk for depression were recruited from primary care waiting rooms and by telephone. The treatment group received a stage-based manual and an individualized printed report in the mail at baseline, and additional individualized reports at 1 and 3 months follow-up. The treatment and control groups were assessed by phone at 0 and 9 months. At nine months with individuals who were in a Pre-Action stage for depression prevention at baseline, treatment group participants were significantly more likely than controls to experience a clinically significant reduction in depression (37% vs. 17%, respectively), to be in the Action or Maintenance stage for depression prevention (70% vs. 55% respectively), and to be taking antidepressant medication if prescribed (71% vs. 50%). Among study participants who were in the Action or Maintenance stage at baseline, the intervention prevented the onset of depression (11% of treatment participants vs. 19% of control participants experienced a new episode of Major Depression during the follow-up period).

“Results of a brief stage tailored health risk intervention and relationship to quality of life and productivity,” Janet L. Johnson, Ph.D. and Patricia H. Castle, M.A. abstract

Abstract: This study looks at behavior change and impacts on quality of life and productivity among employees who participated in a health risk intervention that provided stage targeted messages on multiple health behaviors. Participants who completed an assessment in both 2006 and 2007 included 3492 employees at a Midwestern university. The majority were female (73.1%) and white (92.7%) with a mean age of 42 (sd=10.9). Among those at risk for each behavior at time 1, 25.8% stopped smoking, 34.0% began exercising regularly, 30.3% began eating a healthy diet, 58.8% began effectively managing stress, 52.4% began drinking responsibly, 68.0% began preventing depression at time 2. The behaviors that showed the greatest proportion of people who had not been at risk regressing into at-risk status were exercise (21.4%), fruit and vegetable intake (20.5%), healthy eating (10.8%), and stress management (11.6%). Individuals showed positive change (i.e. reduced risk) on an average of .68 behaviors, t(3491)=43.46, p<.001, d=.74. The negative change (increased risk) averaged .49 behaviors (t(3491)=39.14, p<.001, d=.66). The negative change appears to be driven by the higher rates of new risk for exercise and eating behaviors. By summing the change scores we calculate an average net change of .19 behaviors which represents a small significant improvement in overall behavioral risk status, t(3491)=8.94, p<.001, d=.15. The relationship of behavior change to quality of life and productivity measures were also examined. Among those who were at risk for a behavior at time 1, small improvements on productivity and quality of life were found for those who were not at risk at time 2, (eta-squared= .01 to .07). Similarly, among those who were not at risk at time 1, those who became at risk at time 2 showed small declines in productivity and quality of life (eta-squared=.01 to .07). Behavior change can significantly impact quality of life and productivity. By using stage tailored messages to improve behavior change, quality of life and productivity can also be impacted.

“The Use of Theory in Developing Interactive Interventions to Promote Healthy Lifestyles among Student Populations,” Leanne M. Mauriello, Ph.D., Carol O. Cummins, M.Ed., M.L.I.S., Karen J. Sherman, B.A., & Sharon J. Dyment, M.P.H., Pro-Change Behavior Systems, Inc. abstract

Abstract: As the rates of obesity increase and the consequences become more severe, the successful promotion of healthy lifestyle behaviors to student populations becomes ever more important. Risk factors for chronic disease begin in childhood, adolescence, and young adulthood, and consequently, prevention efforts must begin early. Interactive technologies are a promising means for developing and disseminating health behavior change interventions on a population basis to students. With improved program retention, wider reach, and less reliance on staff for delivery, interactive technologies offer a cost-effective means of delivering interventions. In addition, youthful users enjoy the appeal and interactivity of such programs. Despite the benefits, to date there has been a lack of effective evidence-based, theory-grounded interactive interventions for youth in the areas of obesity prevention and healthy lifestyle promotion. Innovative, multiple behavior, theory-based, interactive interventions are in development for student populations, ranging from elementary school to college populations. The Transtheoretical Model (TTM) guided the development of each of these interventions, including the development of measures, the creation of tailored feedback messages, the selection of images, and the design of interactive components such as online workbooks, videos, and testimonials. It is important to carefully and thoroughly utilize a theoretical framework throughout all aspects of intervention development.

“A Meta-Analytic Study of TTM Smoking Cessation Interventions,” Patricia H. Castle, M.A., Pro-Change Behavior Systems, Inc.; Colleen A. Redding, Joseph S. Rossi, University of Rhode Island. abstract

Abstract: Smoking causes 35% of all cancers, 33% of all heart attacks and strokes, and 90% of COPD. In spite of its risks, 22% of the population still smokes. These facts underscore the importance of population-based smoking cessation interventions. The Transtheoretical Model (TTM) is the theoretical foundation for many diverse smoking cessation interventions, with variable outcomes. Systematic reviews of the TTM’s efficacy have arrived at conflicting conclusions. This study compared effect sizes across 24 randomized controlled trials (including a combined sample size of N=27,190) of TTM cessation treatments using meta-analytic procedures to examine the 24-hour point prevalence smoking abstinence rates across time. These 24 studies were conducted in a range of community (37.5%), school (4.2%), and health care (58.3%) settings; most targeted smoking only (91.7%), many used proactive recruitment strategies (79.2%), and more than half were conducted outside the U. S. (62.5%). Intervention modalities ranged from counseling (41.9%) to computer-based expert systems (32.3%). Most comparison groups were usual care (79.2%) and the remainder were assessment only (20.8%). Odds ratios (OR) and 95% confidence intervals were computed revealing a series of significant pooled ORs over time ranging from 1.25 – 1.56 across time points ranging from 1 month to 24 months. Overall effect sizes were larger for studies that used (1) three/four TTM constructs compared to one/two constructs, and (2) a computerized tailored expert system modality compared to counseling. In general, participants in treatment conditions were anywhere from 25% to 56% more likely to have quit smoking compared to participants in comparison conditions. Moreover, effect sizes were sustained at long-term 24-month follow-ups. These patterns of pooled effect sizes over time support the efficacy of TTM cessation interventions across a range of settings.

CDC Awards Pro-Change Grant to Promote Health Behaviors During Pregnancy

Pro-Change has received a grant from the Centers for Disease Control and Prevention (CDC) to develop a computer-based tailored intervention to promote healthy behaviors during pregnancy. The pilot program will be conducted in July and August 2008 at sites of the Community Health Center, Inc., one of the leading health care providers in Connecticut.

Focus groups and interviews with underserved pregnant women and key informants are guiding the development of an intervention that is acceptable, medically accurate, and easily disseminated. The intervention is based on the Transtheoretical Model of Behavior Change, which matches change principles and processes to each person’s stage readiness to guide individuals through the change process. It is designed to promote the adoption and maintenance of healthy behaviors among pregnant women, ultimately for use in health clinics and provider offices throughout the country, as well as health promotion and wellness organizations.

The intervention will address three important behaviors for a healthy pregnancy: smoking cessation and maintenance, stress management, and healthy eating, with an emphasis on fruit and vegetable consumption. The intervention content will assist women with behavior changes during pregnancy, with an emphasis on strategies for sustaining behavior changes postpartum.

One of the specific aims of the program is to assess the most cost-effective and acceptable methods for disseminating the proposed intervention. Input from leaders in maternal and child health, and the disease management industry including Healthways, Inc. will help identify dissemination channels.

Roughly 100 participants are being recruited from the Community Health Center, Inc. of Connecticut. Leanne Mauriello, Ph.D. the principal investigator of the grant stated that, “A population-based, healthy pregnancy behavioral intervention suite based on scientific and theoretical underpinnings and designed for broad and flexible dissemination provides an innovative approach to supporting maternal and child health.”

Journal of Preventive Medicine Special Issue Includes Pro-Change Articles on Multiple Behavior Change

The Journal of Preventive Medicine’s (AJPM) March 2008 issue is a special issue on multiple behavior change. All three articles submitted by Pro-Change were accepted and appear in this special issue.

Until recently, there was no programmatic research demonstrating the effectiveness of interventions designed to simultaneously change two or more target behaviors. In this special issue, the Pro-Change team demonstrated simultaneous behavior change applying tailored interventions based on the Transtheoretical Model (TTM).

The first article features an intervention for healthy weight management. The study demonstrated the ability of tailored feedback to improve healthy eating, exercise, weight, and managing emotional distress on a population basis. The treatment produced the highest population impact to date on multiple health risk behaviors. The article citation and abstract are available on our Weight Management page.

The study in the second article was designed to compare the initial efficacy of Motivational Interviewing (MI) and Pro-Change’s online TTM-tailored communications on four health risk factors (inactivity, weight, stress, and smoking) to a brief Health Risk Intervention (HRI) delivered by Quality Health Solutions in a worksite sample. The results found that the MI and TTM groups, when compared with an HRI-only group, had significantly more participants in the Action stage for exercise and effective stress management and significantly fewer risk behaviors at six months. This was the first study to demonstrate that MI and online TTM could produce significant multiple behavior changes. The article citation and abstract are available on our TTM page.

The third article features measurement development on the topic of childhood and adolescent obesity prevention. Nationwide samples of students in grades 4 through 12 completed self-administered questionnaires assessing TTM constructs and behavioral indicators for physical activity, fruit and vegetable consumption, and limiting television time. Analyses were conducted to compare the prevalence of students at-risk for the target behaviors across the age groups and to examine the interrelationships of the target behavior risks. Across the three age groups, physical activity and fruit and vegetable consumption declined, while limiting TV time increased. Across all three samples, being at-risk for one behavior almost always significantly increased the odds of being at-risk for another behavior. The findings of this study provide further evidence for the need for early promotion of healthy lifestyle behaviors. The article citation and abstract are available on our Adolescent Obesity Prevention page.

“Given a window of intervention opportunity, a higher impact paradigm is to target multiple behaviors,” states Janice M. Prochaska, president & CEO of Pro-Change Behaviors Systems, Inc. “Our growing evidence supports the ability of multiple risk behavior change interventions to produce increased impacts on public health.”

Stress Management Program Earns High Ratings from SAMHSA

The National Registry of Evidence-Based Programs and Practices (NREPP), a service of the Substance Abuse and Mental Health Services Administration (SAMHSA), recently gave high ratings to the Pro-Change Stress Management Program.

Supported by a grant from the National Cancer Institute, the Pro-Change Stress Management Program assists individuals in managing their stress more effectively using practices such as relaxation, time management, and social support activities.

NREPP is an interactive resource for professionals in the fields of Substance Abuse and Mental Health. Their ratings and intervention summaries synthesize and evaluate research so as to help potential users of interventions better understand their scientific evidence base. NREPP rates the quality of the research supporting intervention outcomes and the quality and availability of training and implementation materials on a scale of 0.0 – 4.0.

The Pro-Change Stress Management program received overall ratings ranging from 2.9 – 3.5 for the quality of the research and a 3.8 overall rating for readiness for dissemination. Specific strengths cited included rigorous study design, relatively long-term follow-up (18 months), use of two well-recognized measures of stress and depression, assessors blind to the experimental condition, and appropriate statistical analyses.

Both online and offline versions of the Stress Management program are available for implementation. The program is completely self-directed; no training is required. Technical assistance is available to support users before and during implementation. The computerized nature of the program ensures implementation fidelity, and the interactive computer application allows administrators to monitor program use and progress.

In a clinical trial of the program’s effectiveness, Dr. Kerry Evers of Pro-Change conducted a study of a national sample of adults who received the Stress Management intervention. At the 18-month follow-up, a significantly larger proportion of the treatment group (62%) was effectively managing their stress when compared to the control group. The intervention also produced significant reductions in stress and depression, and an increase in the use of stress management techniques when compared to the control group.

To view a demo of the stress management program go to www.prochange.com/stressdemo. To read the full outcome article see Evers, K.E., Prochaska, J.O., Mauriello, L.M., Padula, J.A. and Prochaska, J.M. (2006). A randomized clinical trial of a population and transtheoretical-based stress management intervention. Health Psychology 25 (4), 521-529. An abstract of this article is available on our Stress Management product page.

Dr. Janice M. Prochaska to Serve on Social Work Editorial Board

President Elvira Craig de Silva of the National Association of Social Workers has appointed Janice M. Prochaska, Ph.D., President and CEO of Pro-Change Behavior Systems, Inc., as one of the seven members of the Social Work Editorial Board.

The Social Work journal, established in 1956, is the professional journal published by the National Association of Social Work (NASW), which is provided to all NASW members as a membership benefit. The journal’s purpose is to improve practices and advance knowledge in social work and social welfare.

Prochaskas to Present a Master Tutorial on Organizational Change at SIOP Conference

Drs. Janice and James Prochaska of Pro-Change Behavior Systems Inc., along with Paul Mastrangelo, Ph.D. of Genesee Survey Services, Inc. will present a Master Tutorial on How People Change: In the Workplace at the 23rd Annual Society for Industrial and Organizational Psychology (SIOP) Conference in San Francisco on April 12, 2008.

Special Issue of Preventive Medicine Will Feature Three Pro-Change Articles

The journal of Preventive Medicine in early 2008 will publish a special issue on multiple behavior change. All three articles submitted by Pro-Change were accepted. They include: Transtheoretical Model-based Multiple Behavior Intervention for Weight Management: Effectiveness on a Population Basis; Relationships Among Multiple Behaviors for Childhood and Adolescent Obesity Prevention; and Initial Efficacy of MI, TTM Tailoring, and HRI’s with Multiple Behaviors for Employee Health Promotion.

Recognized for its authoritative contributions to the entire field of preventive medicine and public health, Preventive Medicine: An International Journal Devoted to Practice and Theory is a respected source of information on applied research into all aspects of prevention.

Dr. Sara Johnson Presents Full-Day Workshop at IBM

Pro-Change director Sara Johnson, Ph.D. was recently invited to present a full-day workshop for IBM’s Global Well-being Services and Health Benefits Division.

The workshop outlined strategic approaches to elicit employee behavior change and drive smarter, more cost-effective use of health services and greater attention to healthy living. Attendees reviewed a definition of “proactive health consumerism” and the Transtheoretical Model of Behavior Change, which demonstrates that individuals progress through a series of distinct stages en route to adopting and maintaining health behaviors.

Dr. Johnson presented examples of the Transtheoretical Model’s successful application to multiple behavior change (e.g., weight management). These findings support the notion that different intervention and communication strategies are needed to engage and impact people in different stages. Current activities within Global Health and Well-being that leverage a stage-based approach to promoting proactive health consumerism were discussed, and participants then were challenged to outline intervention strategies that employ a stage-based approach to promoting proactive health consumerism among employees.

Dr. James Prochaska Presents Key Note Address at Information Therapy Conference

Tailoring Information Therapy: Applying Next-Generation Analytics and Behavior Change Theory was the key note address delivered by James O. Prochaska, Ph.D., Founder of Pro-Change Behavior Systems, Inc. at the sixth Annual Information Therapy Conference in Park City, Utah.

The science for how we tailor interventions, target health information, and engage consumers is expanding rapidly. Dr. Prochaska spoke on how this new science can be effectively translated into Information Theory innovation. Following the key note, Kerry Evers, Ph.D. demonstrated Pro-Change’s LifeStyle management programs and how they are presently being used by Healthways, Inc.

Tibbetts Award Presented to Pro-Change

Pro-Change Behavior Systems, Inc. received a Tibbetts Award in recognition of significant achievements involving technological innovation related to the Small Business Innovation Research Program (SBIR). Pro-Change President & CEO, Janice M. Prochaska, accepted the award at a ceremony in Washington, D. C. on October 10, 2007. Pro-Change was selected for its outstanding SBIR research, dissemination, and commercialization of health behavior change programs funded by grants from the National Institutes of Health and the Centers for Disease and Prevention.

Named for Roland Tibbetts, acknowledged as the father of the SBIR Program, these prestigious national awards are given annually to small firms judged to exemplify the best in SBIR achievement. The Small Business Technology Council (SBTC), a council of the National Small Business Association, is the lead sponsor of the award.

Janice Prochaska with Roland Tibbetts, left and Jere Glover.

CDC Funds Development of Healthy Pregnancy Program

The Centers for Disease Control and Prevention (CDC) has awarded Pro-Change a Phase I Small Business Innovation Research (SBIR) grant to develop a computer-based healthy pregnancy program for underserved pregnant women. The program will offer tailored advice on smoking cessation and maintenance, stress management, and healthy eating. Dr. Leanne Mauriello, Principal Investigator, is leading formative research and pilot testing in collaboration with the Community Health Center, Inc. of Connecticut.

HealthString Signs Contract With Pro-Change

HealthString signed a contract with Pro-Change Behavior Systems, Inc. to license seven online Transtheoretical Model health behavior change programs: stress management, weight management, depression prevention, exercising regularly, smoking cessation, and managing high blood pressure and managing high cholesterol through medication adherence, diet, and exercise.

HealthString is a secure, online, dynamic personal health network that improves accessibility and use of important personal health information via the Internet. HealthString empowers individuals to proactively manage their health by enabling behavior changes that lead to a healthier lifestyle. With HealthString consumers have access to personal RN Health Coaches and technology to improve the quality of care and the quality of personal health.

Study Shows Pro-Change Programs Produce Multiple Behavior Changes

A study done at Oregon Health & Science University demonstrated that Motivational Interviewing and Pro-Change’s LifeStyle online programs produced significant multiple behavior changes. A total of 25.2% of eligible employees were recruited for the online Pro-Change interventions. Quality Health Solutions brokered the collaboration of Pro-Change, OHSU, and the University of Rhode Island for the grant funded by the Centers for Disease Control and Prevention.

For more information, see:
Prochaska, J.O., et al., Initial efficacy of MI, TTM tailoring and HRI’s with multiple behaviors for employee health promotion, Preventive Medicine (2007).

Abstract:
Objective. This study was designed to compare the initial efficacy of Motivational Interviewing (MI), Online Transtheoretical Model (TTM)-tailored communications and a brief Health Risk Intervention (HRI) on four health risk factors (inactivity, BMI, stress and smoking) in a worksite sample.

Method. A randomized clinical trial assigned employees to one of three recruitment strategies and one of the three treatments. The treatment protocol included an HRI session for everyone and in addition either a recommended three TTM online sessions or three MI in person or telephone sessions over 6 months. At the initial post-treatment assessment at 6 months, groups were compared on the percentage who had progressed from at risk to taking effective action on each of the four risks.

Results. Compared to the HRI only group, the MI and TTM groups had significantly more participants in the Action stage for exercise and effective stress management and significantly fewer risk behaviors at 6 months. MI and TTM group outcomes were not different.

Conclusion. This was the first study to demonstrate that MI and online TTM could produce significant multiple behavior changes. Future research will examine the long-term impacts of each treatment, their cost effectiveness, effects on productivity and quality of life and process variables mediating outcomes.

Depression Prevention Research Grant Completed

Pro-Change has completed a Phase 2 NIH Small Business Innovation Research (SBIR) grant for Depression Prevention.

Research Findings:

Nine hundred and two adults at risk for depression were recruited from primary care waiting rooms and by telephone. The treatment group received a stage-based manual and an individualized printed report in the mail at baseline, and additional individualized reports at 1 and 3 months follow-up. The treatment and control groups were assessed by phone at 0 and 9 months. At nine months with individuals who were in a pre-Action stage for depression prevention at baseline, treatment group participants were significantly more likely than controls to experience a clinically significant reduction in depression (37% vs. 17%, respectively), to be in the Action or Maintenance stage for depression prevention (70% vs. 55% respectively), and to be taking antidepressant medication if prescribed (71% vs. 50%). Among study participants who were in the Action or Maintenance stage at baseline, the intervention prevented the onset of depression (11% of treatment participants vs. 19% of control participants experienced a new episode of Major Depression during the follow-up period).

Pro-Change Celebrates 10th Anniversary

Ten years ago today, Pro-Change began as a company with its first contract with Electronic Data Systems (EDS).