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

Multiple Health Behavior Change

More impact on health and well-being

Pro-Change has long been a leader in providing innovative multiple behavior change programs, which have the potential to offer significantly more impact on health and well-being.

Beginning with the development of the Managing Cholesterol Program, Pro-Change recognized how crucial it was that the fully tailored adherence program be paired with interventions for the other lifestyle behaviors that are key in managing high cholesterol. The results of the initial Small Business Innovative Research (SBIR) funded effectiveness trial exemplify the potential for coaction of behavior change when fully tailored interventions are paired with stage-matched interventions. The treatment group received a full expert system for medication adherence and stage-matched guidance for exercise and dietary fat. The treatment group was 50% more likely than the control to reach Action or Maintenance for all behaviors (Johnson et al., 2006).

The results of Pro-Change’s SBIR-funded, population-based, weight management program add to the support for effective multiple behavior TTM-based interventions. The randomized trial, which included 1277 overweight or obese adults, found significant treatment effects for healthy eating, exercise, managing emotional distress, and untreated fruit and vegetable intake. Participants in the intervention condition who received diet and physical activity interventions lost significantly more weight at follow-up than usual care participants and were significantly more likely to lose at least 5% of their baseline weight.


For Youth

Exploring innovative options

The success of multiple behavior change is also clear in younger samples. TTM-based multimedia programs for bullying prevention have had similar success in diverse populations (Evers et al., 2007). The trials included 12 elementary schools (40.6% of free lunch eligible); 12 middle schools (48.6% eligible); and 13 high schools (42.3% eligible). The programs had significant effects on three roles related to bullying (i.e., bully, bystander, victim). Overall, the odds ratios indicated that intervention groups were 3-4 times as likely as the control group to progress to Action/Maintenance (i.e., not participate in any role related to bullying) (Van Marter et al., 2006; Evers et al., 2007).

Our multiple behavior change obesity prevention program, Health in Motion, targeted three energy balance areas: increasing physical activity, eating more fruits and vegetables, and reducing TV time. (Mauriello et al., 2010; Driskell, et al., 2008; Velicer et al., 2013). The program was tested in two separate randomized clinical trials with nearly 6,000 adolescents (middle and high school students). Both trials (tested by separate groups and funded by different Institutes) demonstrated that Health in Motion is effective at increasing the targeting energy balance behaviors, reducing overall number of behavioral risks, reducing relapse, and promotion of multiple behavior changes. The middle school trial is noteworthy in two important ways. The follow-up assessment was extended to 36 months, and strong effects of Health in motion influencing energy balance behaviors persisted. Additionally, in that trial Health in Motion was used as a control program for testing a substance use prevention program (decreasing smoking and alcohol). Despite no direct treatment, the energy balance group showed significantly lower smoking and alcohol use than the substance use prevention program. It can be hypothesized that the positive healthy lifestyle messages had a great impact at preventing substance use among adolescents than direct messages against those behaviors.

Within the LifeStyle Management Suite, users participate in a multiple behavior change program, such as Managing High Blood Pressure, or participate in two or more single behavior programs, such as smoking, stress, and exercise.


Additional Reading

Prochaska JO. Multiple health behavior research represents the future of preventive medicine. Prev Med. 2008;46:281-285.

Jones, H., Edwards, L., Vallis, T. M., Ruggiero, L., Rossi, S. R., Rossi, J. S. et al. (2003). Diabetes Stages of Change (DiSC) Study. Changes in diabetes self-care behaviors make a difference in glycemic control: The diabetes stages of change (DiSC) study. Diabetes Care, 26, 732-737.

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.

Prochaska, J. O., Velicer, W. F., Redding, C., Rossi, J. S., Goldstein, M., DePue, J. et al. (2005a). Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer, and receive regular mammograms. Preventive Medicine, 41, 406-416.

Prochaska, J. O., Velicer, W. F., Rossi, J. S., & Goldstein, M. G. (2004). Stage effects in 70 comparisons in a population cessation trial. Addictive Behaviors.

Prochaska, J. O., Velicer, W. F., Rossi, J. S., Redding, C. A., Greene, G. W., Rossi, S. R. et al. (2004). Multiple Risk Expert Systems Interventions: Impact of Simultaneous Stage-Matched Expert System Interventions for Smoking, High-Fat Diet, and Sun Exposure in a Population of Parents. Health Psychology, 23, 503-516.

Citations

Driskell, M.M., Dyment S.J., Mauriello, L.M., Castle, P.H., & Sherman, K.J. (2008). Relationships among multiple behaviors for childhood and adolescent obesity prevention. Preventive Medicine, 46, 209-315. abstract

Evers, K.E., Prochaska, J.O., Van Marter, D.F., Johnson, J.L., & Prochaska, J.M. (2007). Transtheoretical-Based Bullying Prevention Effectiveness Trials In Middle Schools and High Schools. Educational Research, 49(4), 397-414.

Johnson, S.S., Driskell, M.M., Johnson, J., Dyment, S., Prochaska, J.O., Prochaska, J.M., Bourne, L. (2006). Transtheoretical Model intervention for adherence to lipid-lowering drugs. Disease Management, 9(2), 102-114.

Johnson, S.S, Paiva, A.L. Cummins, C., Johnson, J.L. Dyment, S., Wright, J.A., Prochaska, J.O., Prochaska, JM., Sherman, K. (2008). Evidence-based Multiple Behavior Intervention for Weight Management: Effectiveness on a Population Basis. Preventive Medicine, 46, 238-246.

Mauriello, L. M., Ciavatta, M. M., Paiva, A. L., Sherman, K. J., Castle, P. H., Johnson, J. L., Prochaska, J. M. (2010). Results of a Multi-Media Multiple Behavior Obesity Prevention Program for Adolescents. Preventive Medicine, 51, 451-456.

Van Marter, D., Evers, K., Johnson, J., Dyment, S., Prochaska, J.M., and Prochaska, J.O. (November, 2006). Bullying prevention across the school years: effectiveness trial outcomes of Transtheoretical model-based programs for elementary, middle and high school students. Poster presented at the 134th Annual Meeting of the American Public Health Association: Boston, MA.

Velicer WF, Redding CA, Paiva AL, Mauriello LM, Blissmer B, Oatley K, Meier KS, Babbin SF, McGee H, Prochaska JO, Burditt C, Fernandez AC. (2013). Multiple risk factor intervention to prevent substance abuse and increase energy balance behaviors in middle school students. Translational Behavior Medicine, 3, 82-93.

Pro-Change continues to explore innovative options for maximizing the effectiveness of multiple behavior change interventions while minimizing response burden. Trials on college student health and healthy pregnancy also provide important data on the utility of optimal tailoring.

Integrating Patient Health and Population Health Using the Transtheoretical Model

Traditional patient health paradigms for treatment of health behaviors are designed for individual patients who are motivated or prepared to seek wellness programs. However, programs that passively wait and only react to patients who call or come for help end up serving small percentages of at-risk populations. There reactive programs must be complemented by innovative paradigms to reach out to the large percentages of populations who have not been adequately studied or served in the past. For solutions to match the growing demand for health behavior change programs, they will need to combine more inclusive science with more inclusive services (matched to the needs of people in each stage of change) to produce more inclusive care that can have much greater population impacts on preventing and managing chronic conditions.
This is our approach to integrating patient health and population health.

Patient Health Complemented by Population Health
  1. Individual Patient
  2. Action-Oriented
  3. Reactive Recruitment
  4. Efficacy
  5. Clinic-Based
  6. Clinician-Based
  7. Single Behavior
  8. Modular
  9. Disease Prevention & Management
  10. Fragmented
  1. Entire Populations
  2. Stage-Based
  3. Proactive Outreach
  4. Impact
  5. Home, Work Or School-Based
  6. Computer-Based
  7. Multiple Behaviors
  8. Coaction
  9. Well-Being
  10. Integrated

Multiple Behavior Change

More impact on health and well-being


Pro-Change has long been a leader in providing innovative multiple behavior change programs, which have the potential to offer significantly more impact on health and well-being.

Beginning with the development of the Managing Cholesterol Program, Pro-Change recognized how crucial it was that the fully tailored adherence program be paired with interventions for the other lifestyle behaviors that are key in managing high cholesterol. The results of the initial Small Business Innovative Research (SBIR) funded effectiveness trial exemplify the potential for coaction of behavior change when fully tailored interventions are paired with stage-matched interventions. The treatment group received a full expert system for medication adherence and stage-matched guidance for exercise and dietary fat. The treatment group was 50% more likely than the control to reach Action or Maintenance for all behaviors (Johnson et al., 2006).

The results of Pro-Change’s SBIR-funded, population-based, weight management program add to the support for effective multiple behavior TTM-based interventions. The randomized trial, which included 1277 overweight or obese adults, found significant treatment effects for healthy eating, exercise, managing emotional distress, and untreated fruit and vegetable intake. Participants in the intervention condition who received diet and physical activity interventions lost significantly more weight at follow-up than usual care participants and were significantly more likely to lose at least 5% of their baseline weight.


Youth


Exploring innovative options


 

The success of multiple behavior change is also clear in younger samples. TTM-based multimedia programs for bullying prevention have had similar success in diverse populations (Evers et al., 2007). The trials included 12 elementary schools (40.6% of free lunch eligible); 12 middle schools (48.6% eligible); and 13 high schools (42.3% eligible). The programs had significant effects on three roles related to bullying (i.e., bully, bystander, victim). Overall, the odds ratios indicated that intervention groups were 3-4 times as likely as the control group to progress to Action/Maintenance (i.e., not participate in any role related to bullying) (Van Marter et al., 2006; Evers et al., 2007).

Our multiple behavior change obesity prevention program, Health in Motion, targeted three energy balance areas: increasing physical activity, eating more fruits and vegetables, and reducing TV time. (Mauriello et al., 2010; Driskell, et al., 2008; Velicer et al., 2013). The program was tested in two separate randomized clinical trials with nearly 6,000 adolescents (middle and high school students). Both trials (tested by separate groups and funded by different Institutes) demonstrated that Health in Motion is effective at increasing the targeting energy balance behaviors, reducing overall number of behavioral risks, reducing relapse, and promotion of multiple behavior changes. The middle school trial is noteworthy in two important ways. The follow-up assessment was extended to 36 months, and strong effects of Health in motion influencing energy balance behaviors persisted. Additionally, in that trial Health in Motion was used as a control program for testing a substance use prevention program (decreasing smoking and alcohol). Despite no direct treatment, the energy balance group showed significantly lower smoking and alcohol use than the substance use prevention program. It can be hypothesized that the positive healthy lifestyle messages had a great impact at preventing substance use among adolescents than direct messages against those behaviors.

Within the LifeStyle Management Suite, users participate in a multiple behavior change program, such as Managing High Blood Pressure, or participate in two or more single behavior programs, such as smoking, stress, and exercise.

Pro-Change continues to explore innovative options for maximizing the effectiveness of multiple behavior change interventions while minimizing response burden. Ongoing trials on college student health and healthy pregnancy will provide important data on the utility of optimal tailoring.

Citations

Driskell, M.M., Dyment S.J., Mauriello, L.M., Castle, P.H., & Sherman, K.J. (2008). Relationships among multiple behaviors for childhood and adolescent obesity prevention. Preventive Medicine, 46, 209-315. abstract

Evers, K.E., Prochaska, J.O., Van Marter, D.F., Johnson, J.L., & Prochaska, J.M. (2007). Transtheoretical-Based Bullying Prevention Effectiveness Trials In Middle Schools and High Schools. Educational Research, 49(4), 397-414.

Johnson, S.S., Driskell, M.M., Johnson, J., Dyment, S., Prochaska, J.O., Prochaska, J.M., Bourne, L. (2006). Transtheoretical Model intervention for adherence to lipid-lowering drugs. Disease Management, 9(2), 102-114.

Johnson, S.S, Paiva, A.L. Cummins, C., Johnson, J.L. Dyment, S., Wright, J.A., Prochaska, J.O., Prochaska, JM., Sherman, K. (2008). Evidence-based Multiple Behavior Intervention for Weight Management: Effectiveness on a Population Basis. Preventive Medicine, 46, 238-246.

Mauriello, L. M., Ciavatta, M. M., Paiva, A. L., Sherman, K. J., Castle, P. H., Johnson, J. L., Prochaska, J. M. (2010). Results of a Multi-Media Multiple Behavior Obesity Prevention Program for Adolescents. Preventive Medicine, 51, 451-456.

Van Marter, D., Evers, K., Johnson, J., Dyment, S., Prochaska, J.M., and Prochaska, J.O. (November, 2006). Bullying prevention across the school years: effectiveness trial outcomes of Transtheoretical model-based programs for elementary, middle and high school students. Poster presented at the 134th Annual Meeting of the American Public Health Association: Boston, MA.

Velicer WF, Redding CA, Paiva AL, Mauriello LM, Blissmer B, Oatley K, Meier KS, Babbin SF, McGee H, Prochaska JO, Burditt C, Fernandez AC. (2013). Multiple risk factor intervention to prevent substance abuse and increase energy balance behaviors in middle school students. Translational Behavior Medicine, 3, 82-93.

Additional Reading

Prochaska JO. Multiple health behavior research represents the future of preventive medicine. Prev Med. 2008;46:281-285.

Jones, H., Edwards, L., Vallis, T. M., Ruggiero, L., Rossi, S. R., Rossi, J. S. et al. (2003). Diabetes Stages of Change (DiSC) Study. Changes in diabetes self-care behaviors make a difference in glycemic control: The diabetes stages of change (DiSC) study. Diabetes Care, 26, 732-737.

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.

Prochaska, J. O., Velicer, W. F., Redding, C., Rossi, J. S., Goldstein, M., DePue, J. et al. (2005a). Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer, and receive regular mammograms. Preventive Medicine, 41, 406-416.

Prochaska, J. O., Velicer, W. F., Rossi, J. S., & Goldstein, M. G. (2004). Stage effects in 70 comparisons in a population cessation trial. Addictive Behaviors.

Prochaska, J. O., Velicer, W. F., Rossi, J. S., Redding, C. A., Greene, G. W., Rossi, S. R. et al. (2004). Multiple Risk Expert Systems Interventions: Impact of Simultaneous Stage-Matched Expert System Interventions for Smoking, High-Fat Diet, and Sun Exposure in a Population of Parents. Health Psychology, 23, 503-516.

Our Research

The foundation of our programs comes from research conducted with over 150,000 participants and funded by over $80 million of federal grants. Powerful databases let us track which strategies have been most successful for specific populations so we can continuously improve our programs.

Powerful enough to generate tens of thousands of messages on the most important change processes, these databases give participants guidance that is appropriate not only to their Stage of Change but also to their pros and cons of change, confidence to make and sustain change, and the processes of change they should be using.

What sets us apart from other behavior change programs is the depth and extent of scientific research on which our programs are based and the fact that we continue to use the outcomes generated by our systems to refine our methods and content.

Pro-Change’s approach to programs has been shown to be effective with:

  • 80% of at-risk populations participating
  • 80% or more of those participants who are not yet ready to change and are not seeking services
  • Minority populations
  • Low education populations
  • Children, adolescents, and older adults
  • Populations with mental illness

Pro-Change’s research and innovations have been recognized by awards like the 2009 URAC Gold Award in Health Management and the 2007 Tibbetts Award for significant achievements related to the Small Business Innovation Research grants and the AHRQ Innovation Exchange in 2008 and 2012. Since 2014, we have had NCQA certification for our HRI (Health Appraisal), first under Health Information Products and currently under Wellness and Health Promotions. In 2016, Pro-Change was granted NCQA WHP certification for our Self-Management Tools.

Pro-Change staff have published research papers in multiple peer-reviewed journals including:

    • Addictive Behaviors
    • Administration and Policy in Mental Health
    • Adolescent Medicine
    • Alcoholism Treatment Quarterly
    • American Journal of Health Promotion
    • American Journal of Public Health and Disease Management
    • Child Welfare
    • Children & Youth Services
    • Cognitive Therapy and Research
    • Consulting Psychology Journal
    • Disease Management
    • Educational Research
    • Families in Society
    • Family and Intimate Partner Violence Quarterly
    • Financial Counseling and Planning Education
    • Health Care Financing Review
    • Health Psychology
    • Health Service Research
    • International Journal of Consumer Studies
    • Japanese Journal of Behavioral Medicine
    • Japanese Psychological Research
    • Journal of Alcohol and Drug Education
    • Journal of Clinical Sleep Medicine
    • Journal of Health Psychology
    • Journal of Medical Internet Research
    • Journal of Midwifery and Women’s Health
    • Journal of Occupational and Environmental Medicine
    • Journal of Personal Finance
    • Journal of Psychotherapy Integration
    • Journal of Rehabilitation
    • Journal of School Nursing
    • Journal of Social Work Practice in the Addictions
    • Journal of Women and Minorities in Science and Engineering
    • Managed Care Interface
    • Population Health Management
    • Preventive Medicine
    • Psychology of Violence
    • Psychology of Well-Being
    • Psychotherapy
    • Public Health Nursing
    • Sex Roles: A Research Journal
    • Social Work
    • Social Work in Health Care
    • Teaching of Psychology
    • The Journal of Rehabilitation
    • Violence and Victims

 

Pro-Change staff have presented research papers and have presented at numerous conferences including:

  • Academy Health
  • Alliance for Continuing Medical Education Conference
  • Art and Science of Health Promotion Conference
  • American Psychological Association (APA)
  • American Public Health Association (APHA)
  • American Telemedicine Association
  • Art and Science of Health Promotion Conference
  • Conference Board Employee Health Care Conference
  • Population Health Alliance
  • Corporate Health Congress (Brazil)
  • Disease Management Association of America (DMAA)
  • European Health Psychology Society Conference
  • Health 2.0
  • Information Therapy Conference
  • Integrated Benefits Institute
  • International Conference on Violence, Abuse and Trauma
  • International Congress of Behavioral Medicine (ICBM)
  • International Forum for Investor Education/International Organization of Securities
  • Commissions Global Investor Education Conference
  • Interstitial Cystitis Association
  • National Business Coalition on Health
  • National Conference on Health Productivity and Human Capital
  • New York State Public Health Association
  • Onsite Clinic Conference
  • Research Society on Alcoholism (RSA)
  • Society for Industrial and Organizational Psychology (SIOP)
  • Society of Behavioral Medicine (SBM)
  • WELCOA