Evidence-based health and well-being for entire populations.

Proactive Health Consumer

phc

Rising health care costs…High deductible health plans…Provider ratings…Patient portals…Retail health, telehealth, mobile health…

This is no time for consumers to be passive about health care.

The Proactive Health Consumer program (PHC), promotes behavior change and increases well-being by delivering a population based, individualized, and interactive intervention that helps individuals be proactive by taking more responsibility for their health, health care, and health care costs in their multiple roles as patients, providers, and purchasers of health care.

The program uses validated assessments and empirically based guidance to address four dimensions of being a proactive health consumer:

  • Communicating and working as a partner with health care providers;
  • Learning about and carefully thinking through the options before choosing a health plan, doctor, hospital, home care, nursing home care, and end-of-life care;
  • Taking steps to be healthy; and
  • Using health services wisely and shopping for the best quality of care at the lowest price.

PHC is a two-part self-administered program that includes:

  • A computer-tailored intervention to increase readiness to become a more active participant in one’s health and health care
  • An interactive Personal Activity Center designed to assist people with each dimension of being a proactive health consumer. Activities include interactive and editable scripts about how to talk with a doctor about difficult topics, a queue to organize and prioritize questions for a medical appointment, quizzes about health care costs and links to helpful cost and quality tools and much more.

An article on the Proactive Health Consumer program from the journal “The Art and Science of Health Promotion” is available as a PDF Download.

Contact us to learn more about our Proactive Health Consumer program.

Weight Management

Pro-Change’s Weight Management program is designed to help overweight and obese adults lose weight using these healthy strategies:

  1. Healthy Eating
    • Eating the right number of calories to reach and maintain a healthy weight
    • Eating a diet low in unhealthy saturated and trans fats
  2. Regular Exercise
  3. Managing Emotions using healthy strategies instead of eating

More than two thirds of Americans (70%) are overweight or obese. Being overweight or obese puts individuals at risk of other health problems from heart disease, stroke and cancer, to diabetes, arthritis, and sleep problems. Health care cost estimates for obesity range between $147 billion and $210 billion a year; plus $3.8 lost through obesity-related absenteeism.

The Weight Management program, available in English and Spanish, is a self-administered program that includes:

  • Online computer tailored intervention (CTI) with questions and feedback tailored to each individual’s needs
  • Dynamic web activities matched to the individual’s readiness to change (e.g., stories from people who have lost weight; games to teach portion control, how to read a food label, and how to make healthier fast-food choices; a flip book of colorful fruits and vegetables choices along with simple recipes; ideas for keeping exercise fun and exciting; and better ways to solve problems instead of eating).
  • Tailored text messaging

Online Program

We have self-directed and coaching versions of our mobile optimized Healthy Eating program.

Effectiveness

In our Weight Management randomized clinical trial1, we had the following results:

  • Study size: 1277 overweight or moderately obese adults (BMI 25-39.9) recruited nationally, primarily from large employers.
  • Effect at 24 months:
    • Significantly more (47.5% vs. 34.3%) of those receiving tailored messaging for healthy eating reached the Action or Maintenance stages than the comparison group.
    • Significantly more (44.90% versus 38.10%) of those receiving individually tailored messages for exercise reached the Action or Maintenance stages than the comparison group.
    • Significantly more (48.5% versus 39.0%) of those in the treatment group reached Action or Maintenance for fruit and vegetable consumption.
    • Among those in a pre-Action stage for both healthy eating and exercise at baseline, 29.8% of the treatment group lost 5% or more of their body weight versus 16.6% in the comparison group.

This program was developed with support from SBIR grant R44HL070549 from the National Heart Lung and Blood Institute.

Results Published

1. 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.

Abstract

Abstract:

BACKGROUND. The increasing prevalence of overweight and obesity underscore 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 2.5-5 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.

Stress Management

The Stress Management program assists adults in effectively managing stress in healthy ways, including: exercising, seeking social support, using pleasant activities and relaxation techniques.

About 78% of Americans report having at least one symptom of stress. Towers Watson reported that employers must identify stress-reduction solutions that work for their organizations or suffer the business consequences of less productive employees (low engagement and high absenteeism).

Our Stress program has been recognized by SAMHSA and AHRQ Health Care Innovation Exchange for its quality of underlying research and readiness for dissemination.

The Stress Management program, available in English and Spanish, is a self-administered program that includes:

  • Online computer tailored intervention (CTI) with questions and feedback tailored to each individual’s needs
  • Dynamic web activities matched to the individual’s readiness to change (e.g. a quiz to understand stress, an assessment of the causes of stress in the individual’s life and the symptoms of stress; stress management techniques from relaxation to time management; ways to get support and plan for situations that can cause stress)
  • Tailored text messaging

Online Program

We have self-directed and coaching versions of our digital Stress Management program.

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Effectiveness

In an effectiveness trial, a national sample of adults was given Pro-Change’s 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.1

In two replication trials, 74% and 65% were effectively managing their stress at 6-month follow-up.2, 3

Development of this program was supported by Small Business Innovation Research Grant R44 CA81948 from the National Cancer Institute. In the effectiveness trial, a national sample of adults was given Pro-Change’s Stress Management intervention.

Results Published

1. Evers, K.E., Prochaska, J.O., Johnson, J.L., Mauriello, L.M., Padula, J.A., & Prochaska, J.M. (2006). A randomized clinical trial of a population and transtheoretical-based stress management intervention. Health Psychology 25 (4), 521-529. abstract
Abstract: Stress has been associated with a variety of chronic and acute conditions and with higher use of health care services. This research reports on 18-month outcomes of a randomized clinical trial of a stress management program based on the transtheoretical model (TTM, J.0. Prochaska & C.C. DiClemente, 1986). A national sample of 1,085 individuals participated (age range = 18-91 years, M = 55.33; 68.9% Female, 31.1% male; 84.8% Caucasian; 15.2% non-Caucasian). Both the treatment and control groups received assessments at 0, 6, 12, and 18 months. In addition to the assessments, the treatment group received 3 individualized reports (0,3,6 months) and a manual. The 18-month assessment was completed by 778 individuals (72%). A random effects model indicated that participants completing the study in the treatment group had significantly more individuals reporting effective stress management at follow-up time points than did completers in the control group. Results also indicate that the intervention had significant effects on stress, depression, and specific stress-management behaviors. Results provide evidence for the effectiveness of this TTM population-based stress-management intervention.
2.Prochaska, J.O., Butterworth, S., Redding, C. A., Burden, V., Perrin, N., Leo, M., Flaherty-Rob, M., Prochaska, J.M.(2008). Initial efficacy of MI, TTM Tailoring and HRI’s with multiple behaviors for employee health promotion. Preventive Medicine, 46, 226-231.
3. Prochaska, J.O., Evers, K.E., Castle, P.H., Johnson, J.L., Prochaska, J.M., Rula, E.Y., Coberley, C., & Pope, J.E. (2012). Enhancing multiple domains of well-being by decreasing multiple health risk behaviors: A randomized clinical trial. Population Health Management, 15(5), 276-286.

Tobacco Cessation

Pro-Change’s Tobacco Cessation program assists smokers in all stages of quitting and helps those who have quit to stay smoke-free.

Fifteen percent of U.S. adults smoke. Most of those smokers want to quit; they’re just not ready.

Multiple studies have found TTM based individualized interventions for smoking cessation to produce long-term abstinence rates within the range of 22 – 26%. Those interventions have also consistently outperformed alternative interventions including action-oriented self-help programs1, non-interactive manual-based programs2, and other common interventions.3 These interventions continued to move smokers to abstinence even after the studies concluded. For a summary of smoking cessation clinical outcomes, see Velicer et al., 2007.4

The Tobacco Cessation program, available in English and Spanish, is a two-part, self-administered program that includes:

  • Online computer tailored intervention (CTI) with questions and feedback tailored to each individual’s needs
  • Dynamic web activities matched to the individual’s readiness to change (e.g., stories and suggestions from people who quit; cost and savings calculators; a nicotine dependency survey and feedback; a timeline to better health and much more.

Fully tailored text messaging is available. In a recent trial, the addition of tailored text messaging increased the effectiveness of our best practices by nearly 15 percentage points to 40.3%. In addition, the text messages increased engagement with the program, and qualitative feedback regarding the text message portion of the program has been overwhelmingly positive.

Online Program

We have self-directed and coaching versions of our online Tobacco Cessation program.
Smoking PAC screenshot
Fully tailored text messaging is available.

Youth Tobacco Cessation

We have a tobacco cessation program specifically for youth built on the same Transtheoretical Model principals as the adult program.

Effectiveness

In a recent trial, the addition of tailored text messaging increased the effectiveness of our best practices by nearly fifteen percentage points. In addition, the text messages increased engagement with the program.

(Sample = 446)
At 3-month follow-up:

  • 25.7% successfully quit smoking
  • 40.3% successfully quit smoking when the program was augmented with tailored text messaging

(Jordan & Evers)

(Sample = 224 in inpatient psychiatry unit)
At 18-month follow-up:

  • 20% successfully quit smoking

(Prochaska et al., 2014, Hickman, et al, 2015)

Previous Studies

  • Long-Term abstinence rates of 22% – 26% have been found for interventions tailored on the 14 TTM variables for smoking cessation

(Prochaska et al., 1993, 2001a; Velicer et al., 1995, 2007)

Publications Cited

1.Prochaska, J.O., DiClemente, C.C., Velicer, W.F., and Rossi, J.S. (1993) Standardized, individualized, interactive and personalized self-help programs for smoking cessation. Health Psychology, 12, 299-405.
2.Velicer, W.F. and Prochaska, J.O. (1999). An expert system for smoking cessation. Patient Education and Counseling, 36, 119-129.
3.Prochaska, J.O., Velicer, W.F., Fava, J.L., Rossi, J.S. and Tsoh, J.Y. (2001b). Evaluating a population-based recruitment approach and a stage-based expert system intervention for smoking cessation. Addictive Behaviors, 26, 583-602.
4.Velicer, W.F., Sun, X., Redding, C.A., and Prochaska, J.O. (2007). Demographic variables, smoking variables, and outcomes across five studies. Health Psychology, 26, 278-287.

Other Publications

Jordan, P.J., Lid, V., Evers, K.E.(2012) Cell phone-enhanced expert systems to promote smoking cessation in Veterans [Abstract].  Telemedicine and e-Health, 18, A-28.
Prochaska, J.J., Hall, S., Delucchi, K., & Hall, S.M. (2014). Efficacy of initiating tobacco dependence treatment in inpatient psychiatry: a randomized controlled trial. American Journal of Public Health, 104, 1557-1565.
Hickman, N.J., Delucchi, K.L., & Prochaska, J.J. (2015). Treating tobacco dependence at the intersection of diversity, poverty, and mental illness: A randomized feasibility and replication trial. Nicotine & Tobacco Research, 17, 1012-1021.
Prochaska, J.O., Velicer, W.F., Fava, J.L., Ruggiero, L., Laforge, R.G., Rossi, J.S. et al. (2001a). Counselor and stimulus control enhancements of a stage-matched expert system intervention for smokers in a managed care setting. Preventive Medicine, 32, 23-32.
Velicer, W.F., Fava, J.L., Prochaska, J.0., Abrams, D.B., Emmons, K.M., & Pierce, J. (1995). Distribution of smokers by stage in three representative samples. Preventive Medicine, 24, 401-411.

Medication Adherence

  • One in three American adults (29%) has high blood pressure and only half of them have their hypertension under control.
  • One in three American adults (31.7%) has high bad cholesterol levels and fewer than one in three of them have their cholesterol levels under control.

Yet many patients have not made a decision to take prescribed medicines, or if they have, end up missing doses.

Pro-Change’s Medication Adherence programs are designed to complement physician-prescribed programs of treatment and deal with consistently taking:

  • Blood pressure lowering (antihypertensive) medication, and
  • Cholesterol (lipid) lowering medication.

Because Pro-Change programs target the entire population of patients, our programs are especially effective in improving prescription acquisition and adherence as well as increasing healthy eating, moderate exercise, and other important lifestyle behaviors.

Managing High Blood Pressure

bloodpressure

The Managing High Blood Pressure program includes a fully tailored computer intervention for the acquisition of, adherence to, and prevention of discontinuation of antihypertensive medication(s). The CTI also provides stage-matched feedback for each of the lifestyle changes required to manage high blood pressure (e.g. exercise, fruit and vegetable consumption, limiting saturated fats, moderate sodium and alcohol intake, and smoking cessation) as per national treatment guidelines from the Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

Managing Cholesterol

cholesterol

The Managing Cholesterol program provides fully tailored feedback to increase readiness to begin taking or adhere to a prescription of lipid-lowering agents, as well as stage-matched guidance on the lifestyle behaviors recommended for adults with hyperlipidemia (e.g., The Therapeutic Lifestyle Changes Diet, exercise, and smoking cessation).

Online Program

We have self-directed and coaching versions of our online Medication Adherence program.

Effectiveness

Adherence to Antihypertensive Medication

  • 73% adherence at 12-month follow-up for antihypertensive medication

Over 1,000 members of a New England group practice who were prescribed antihypertensive medication participated in Pro-Change’s Adherence to Antihypertensive Medication intervention.1 The vast majority (73%) of the intervention group who were previously not adhering to their prescribed medication regimen were adhering at the 12-month follow-up.

Developed with support from Small Business Innovation Research (SBIR) grant R44HL063481 from the National Heart, Lung and Blood Institute (NHLBI).

Adherence to Lipid-Lowering Drugs

  • 56% adherence at 18-month follow-up for lipid lowering medication

Members of a large New England health plan and various employer groups who were prescribed a cholesterol lowering medication participated in Pro-Change’s Adherence to Lipid-Lowering Drugs intervention.2 More than half of the intervention group (56%) who were previously not adhering to their prescribed medication regimen were adhering at the 18-month follow-up. Additionally, a vast majority (85%) of those in the intervention group who were already adhering to their medication were prevented from relapsing into poor medication adherence.

Results Published

1.Johnson, S.S., Driskell, M.M., Johnson, J.L., Prochaska, J.M., Prochaska, J.O., Zwick, W. (2006). Efficacy of a transtheoretical model-based expert system for antihypertensive adherence. Disease Management, 9, 291-301.
2.Johnson, S.S., Driskell, M.M., Johnson, J.L., Dyment, S.J., Prochaska, J.M., and Bourne, L. (2006). Transtheoretical model intervention for adherence to lipid-lowering drugs. Disease Management, 9, 102-114.

Regular Exercise

The Exercise program assists adults to exercise regularly at National Guidelines for at least 150 minutes a week at a moderate intensity level, or 75 minutes a week at a vigorous intensity level, or a combination equal to 150 minutes of moderate intensity aerobic activity a week.

Regular exercise is important for over 75 reasons including reaching and maintaining a healthy weight, keeping an immune system in top shape, increasing energy, reducing stress, being fit, and as a part of overall health and well-being. Yet only one in five Americans meets national guidelines for regular exercise.

We know that it’s not always easy to start getting regular exercise and stick with it. This program can help those who are not ready to start exercising regularly, as well as those who must work to keep it up.

The Exercise program, available in English and Spanish, is a two-part, self-administered program that includes:

  • Online computer tailored intervention with questions and feedback tailored to each person’s individuals needs
  • Dynamic web activities matched to the individual’s readiness to change (e.g., a list of over 75 good reasons to exercise; a flip book linking physical activities to exercise interests; handling roadblocks that can keep people from exercising regularly; setting goals and making an action plan; rallying support and handling setbacks).
  • Tailored text messaging

Online Program

We have self-directed and coaching versions of our mobile optimized Regular Exercise program.

Exercise Program

Effectiveness

Outcome data from national population-based effectiveness trials of our Regular Exercise program indicated that:

  • At 6-months follow-up, 45% were meeting national guidelines for regular exercise.1
  • When the program was delivered by coaches, at 6-month follow-up, 57% met national guidelines for regular exercise.2

See our Weight Management program page for additional study details.

This program was developed with support from SBIR grant R44HL070549 from the National Heart Lung and Blood Institute.

Results Published

1. Prochaska JO, Butterworth S, Redding CA, Burden V, Perrin N, Leo M, Flaherty-Robb M, Prochaska JM. (2008). Initial efficacy of MI, TTM tailoring and HRI’s with multiple behaviors for employee health promotion. Preventive Medicine, 6(3):226-31.
2. Prochaska, J.O., Evers, K.E., Castle, P.H., Johnson, J.L., Prochaska, J.M., Rula, E.Y., Coberley, C., & Pope, J.E. (2012). Enhancing multiple domains of well-being by decreasing multiple health risk behaviors: A randomized clinical trial. Population Health Management, 15(5), 276-286.
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.abstract
Abstract:
BACKGROUND. The increasing prevalence of overweight and obesity underscore 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 2.5-5 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.

Healthy Eating

The Pro-Change Program for Healthy Eating comprehensively and broadly addresses healthy eating for adults at a healthy weight to promote the adoption of a pattern of eating that allows individuals to maintain their weight; encourages the consumption of a variety of food high in nutrients; and encourages the limitation of saturated fat, trans fat, sodium, added sugars, and refined grains.

Only 30% of Americans are at a healthy weight. This program aims to prevent overweight and obesity among this healthy minority.

The Healthy Eating Program, available in English and Spanish, is a self-administered program that includes:

  • Online computer tailored intervention that assesses and provides individualized feedback on fruit and vegetable intake, which is a marker behavior for healthy eating. Consistent with national dietary recommendations, the program provides tailored feedback on other important elements of nutrition, including servings of whole grains, low-fat dairy products, and lean proteins.
  • Dynamic web activities matched to the individual’s readiness to change (e.g., a healthy eating quiz; games to teach portion control, how to read a food label, and how to make healthier fast-food choices; a flip book of colorful fruits and vegetables choices along with simple recipes; suggestions for healthy snacks, healthy restaurant choices, and making healthy choices on a budget).
  • Tailored text messaging

Online Program

We have self-directed and coaching versions of our mobile optimized Healthy Eating program.

 

Healthy Eating

Effectiveness

Our Weight Management clinical trial showed that significantly more healthy eating program participants had reached the Action or Maintenance stages than the comparison group. See our Weight Management program page for study details.

Depression Prevention

The Depression Prevention program is designed for people who may be experiencing symptoms of depression, to help them improve their mood and sense of well-being, and to prevent symptoms from becoming worse.

Depression has significant individual, family, and societal costs. Nineteen million Americans experience depression each year. Depression is a major cause of disability, absenteeism, presenteeism, and productivity loss among working-age adults.

By using this two-part, self-administered program program, participants learn how people change, how ready they are to manage their depression, and specific skills which help prepare them to make changes related to adopting five effective strategies to manage depression.

Our Depression Prevention Program was recognized in 2012 by SAMSHA and AHRQ Innovation Exchange for its quality of underlying research and readiness for dissemination. It is available in English and Spanish.

Online Program

We have self-directed and coaching versions of our online Depression Prevention program.

Effectiveness

Our clinical effectiveness trial1, of the Depression Prevention program included 902 adults at risk for depression recruited from primary care waiting rooms and by telephone. The treatment group received a stages of change manual and a computer tailored individualized printed report in the mail, and additional individualized reports at one and three months follow-up.

At 9-month follow-up:

  • 73% were consistently using effective strategies to prevent depression
  • 73% experienced a reduction in symptoms of depression
  • 35% experienced a reliable and clinically significant reduction in symptoms of depression 1

Among study participants who were managing their depression, the intervention prevented the onset of depression (12% of treatment participants vs. 20% of control participants experienced a new episode of Major Depression during the follow-up period).

Developed with support from Small Business Innovation Research (SBIR) grant R44 MH60522 from the National Institute of Mental Health (NIMH).

Results Published

1.Levesque, D.A., Van Marter, D.F., Schneider, R.J., Bauer, M.R., Goldberg, D.N., Prochaska, J.O., & Prochaska, J.M. (2011). Randomized trial of a computer-tailored intervention for patients with depression. American Journal of Health Promotion, 26, 77-89.