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.