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

Pro-Change’s Founder James O. Prochaska Receives Prestigious Award

South Kingstown, RI – September 25, 2013. James O. Prochaska, PhD, Founder of Pro-Change Behavior Systems, Inc. received the 2013 Outstanding Contribution to Health Psychology Award from the American Psychological Association.

The award honors an individual who has a long and distinguished career of scientific contributions. Prochaska pioneered the Transtheoretical Model of Behavior Change, an internationally acclaimed program that encourages people to change their behavior in stages to achieve better health and well-being. Over the past 40 years, Prochaska has written and co-written more than 350 publications including three books: Changing for Good, Systems of Psychotherapy: A Transtheoretical Analysis, and The Transtheoretical Approach: Crossing Traditional Boundaries of Therapy.

“James O. Prochaska and his talented colleagues at Pro-Change and at the University of Rhode Island have established a phenomenally productive and successful series of research projects and applications that have changed the field of psychology and transformed the global understanding of the behavioral aspects of health. Their development and application of the Transtheoretical Model has helped people change from risky to healthy behaviors, improving the quality of lives,” stated Winifred E. Brownell, Dean of the College of Arts & Science at the University of Rhode Island.

Pro-Change Partners with McGraw-Hill Higher Education to Distribute liveWell Program


South Kingstown, RI – September 18, 2013. Pro-Change Behavior Systems, Inc. is now licensing its liveWell program to McGraw-Hill Higher Education for distribution to college and university students as an adjunct to their textbooks. liveWell: A Healthy Foundation for Life is an innovative online multimedia program designed to help college students improve their well-being by exercising regularly, eating healthy, and effectively managing stress.

The evidence-based liveWell program is based on the Transtheoretical Model (TTM) (or Stages of Change model) and was developed with Small Business Innovative Research funding from the National Heart, Lung, and Blood Institute. The development of the program involved extensive end-user and expert input including formative research conducted with student focus groups, usability tests, expert interviews, and input from an interdisciplinary team of college students from various U.S. colleges and universities.

A unique aspect of liveWell is that it leverages state-of-the-science best practices for tailoring of behavior change messages. Students receive a unique combination of fully tailored (exercise) and optimally tailored (fruit and vegetable intake and stress management) messages to maximize outcomes while minimizing response burden.

Consistent with Blooms’ taxonomy (i.e., Knowledge, Comprehension, Application, Analysis, Synthesis, and Evaluation), liveWell will foster knowledge gain and comprehension. The interactive online program will also offer students the unique opportunity to directly apply their knowledge; analyze multiple dimensions of the behavior change process and aspects of the health behaviors addressed; synthesize the content by creating their own behavior change plan and goals; and evaluate their progress. Robust reporting features enable instructors to track their students’ program usage, progress, and outcomes.

“College students, in particular, are in need of prevention and intervention programs because the transition from high school to college is associated with a precipitous decline in healthy behaviors,” says Sara Johnson, PhD., Senior Vice President of Pro-Change. “Recent estimates indicate approximately one half of college men and one quarter of college women are overweight or obese. We also know that physical activity declines as young adults age and more than a quarter of college students report stress severe enough to adversely affect grades or course enrollment. Thus, the need for effective, individually tailored health promotion interventions among this group is clear. We are pleased to provide an evidence-based solution to meet that need.”

Gina Boedeker, Managing Director of Products & Markets, said “McGraw-Hill is thrilled to have this innovative product offering available for students across the country. liveWell is a wonderful addition to our expanding suite of e-books and hybrid learning solutions.”

About McGraw-Hill Higher Education

McGraw-Hill Higher Education, a unit of McGraw-Hill Education, is a leading innovator in the development of 21st century teaching and learning digital solutions for post-secondary and higher education markets worldwide. Through a comprehensive range of traditional and digital education content and tools focused on improving student learning outcomes, McGraw-Hill Higher Education empowers and prepares professionals and students to connect, learn, and succeed in the global economy. For more information, please visit www.mheducation.

Pro-Change and Cooper Consulting Partners to Partner, Improve Corporate Health

Partnership adds renowned behavior change model to Cooper Consulting Partners’ Leading a Fit Life Program

South Kingstown, RI – September 6, 2013. Pro-Change, an internationally-recognized behavior change company and Cooper Consulting Partners, a health management consultancy, part of Cooper Aerobics, has announced a partnership that will further empower businesses and their employees to make healthy changes for good.

Through the agreement, Pro-Change’s Health Risk Intervention will be incorporated into Cooper Consulting Partners Leading a Fit Life program, allowing participants to receive individualized guidance and tips to make lasting change to their health. “The partnership with Pro-Change is a natural fit,” says David Atkinson, Partner for Cooper Consulting Partners. “Pro-Change’s behavior change assessment is based on extensive scientific research and evaluates readiness and how an individual can make changes. The Leading a Fit Life program develops a personal action plan for the participant to put those healthier behaviors into practice.”

Cooper Consulting Partner’s Leading a Fit Life program is an eight-week interactive program that offers employees and their spouses the opportunity to use fitness, nutrition and stress management tools to improve health and productivity which ultimately helps to control health care cost trends.

Research has shown that up to 80 percent of people are not ready to go to action right away. “Going to action is something most people have to work up to and not everyone moves at the same pace,” says Janice M. Prochaska, PhD, President and CEO of Pro-Change. “Our Health Risk Intervention is based on science and has been shown to be effective in real-life situations. It is designed to meet those individuals participating in the Leading a Fit Life program where they are in the change process.”

About Cooper Consulting Partners
Cooper Consulting Partners, A Cooper Aerobics company, is a population health management company providing a results-based strategic approach to corporate wellness for organizations who understand that healthier employees are a business imperative. Kenneth H. Cooper’s, MD, MPH, core principal is that it is easier and less expensive to maintain good health than it is to regain it once it is lost. This philosophy drives Cooper Consulting Partners, helping companies achieve maximum health and wellness with minimum impact to the bottom line. Cooper Consulting Partners offers Executive Risk ManagementStrategic Wellness Consulting, and  Executive and Healthy Lifestyle Training. For more information call 972.560.3263 or visit cooperconsultingpartners.com.

Pro-Change’s Smoking Cessation Program Also Effective for Psychiatric Patients

South Kingstown, RI – August 21, 2013. HealthDay News recently reported the results of a new study from the American Journal of Public Health (http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301403). The study showed that psychiatric patients who participated in Pro-Change Behavior System’s individually tailored smoking cessation program while they were hospitalized for treatment of a mental illness were more likely to quit smoking and less likely to be re-hospitalized.

The findings challenge a common misperception among mental health experts that smoking is a useful tool in treating psychiatric patients. The study’s lead author, Judith J. Prochaska, PhD, an associate professor at the Stanford University School of Medicine, reported that cigarettes are still used as part of a reward system on some units and that doctors may sometimes smoke with patients as a way of creating a connection.

The study conducted by Prochaska and her colleagues included 224 inpatients at a smoke-free psychiatric hospital in California who smoked at least five cigarettes a day prior to being admitted to the hospital. The patients had a range of mental health conditions, including depression, bipolar disorder, and schizophrenia. Three-quarters were suicidal. The patients were randomized into two groups. Patients randomized to the treatment group participated in Pro-Change’s Smoking Cessation program. Those randomized to the control group received usual care–which included a pamphlet about the hazards of smoking and information on how to quit.

The Pro-Change Smoking Cessation program included a computer-tailored intervention with individualized feedback and a stage-matched print manual. Patients in the treatment group also met for 15 to 30 minutes with a counselor and were offered a 10-week supply of nicotine patches when they were ready to quit smoking. The computer-tailored intervention was repeated at 3- and 6-months post-hospitalization to provide ongoing behavior change guidance through the quitting process. Patient’s outpatient providers received a copy of the patient’s report.

At the 18 month follow-up, 20% of those in the treatment group had quit smoking, compared to just 7.7% of those in the control group. Furthermore, fewer patients (44%) in the treatment group had been re-hospitalized (44% vs. 56%). The findings indicated that helping patients quit smoking did not harm their mental health recovery and may have even improved it, Prochaska said. “I think some of the therapeutic contact that addressed participants’ tobacco dependence, and supported them with this major health goal, may have generalized to them feeling better about their mental health condition,” Prochaska said in a Stanford news release.

Sara Johnson, PhD, Senior Vice President of Research and Product Development at Pro-Change Behavior Systems said, “Given that almost half of the cigarettes in the United States are sold to those with psychiatric or addictive disorders, we commend Dr. Prochaska and her colleagues for their ongoing efforts to make our population-based tailored Smoking Cessation program available to inpatients with mental illness and to rigorously evaluate its impact in this historically under-served group.”

Pro-Change’s CEO Given Achievement Award by Providence Business News


South Kingstown, RI – August 8, 2013. Janice M. Prochaska, PhD, President and CEO of Pro-Change Behavior Systems, Inc., was one of twelve women who received an Achievement Award at the 5th Annual Providence Business News Business Women’s Awards luncheon.

The event spotlighted twelve talented and dedicated women working in southeastern New England. Prochaska was recognized for being well ahead of the curve in establishing disease prevention and wellness programs and evaluating their effectiveness. Pro-Change is recognized for being on the cutting edge of changing people’s behavior to help improve their health and well-being. To do so, Pro-Change applies the best that the science of behavior change has to offer to produce high-impact solutions.

Pro-Change’s Drs. Prochaska Featured in Health Literacy’s 100th Podcast

Click here for full Podcast.


South Kingstown, RI – August 1, 2013. Health Literacy Out Loud’s 100th podcast, titled “Stages of Change and Health Communication,” went live July 30, 2013. In the podcast, James O. Prochaska, PhD, Founder of Pro-Change and Janice M. Prochaska, President & CEO talk with Helen Osborne about:

  • What the Stages of Change model is and how it got started
  • Why the Stages of Change model is relevant to health literacy and health communication, including its role in informed decision making
  • How listeners can use the Stages of Change model when communicating about health and communicating about health literacy

Recognized for her expertise in health literacy, Helen Osborne, M.Ed., helps professionals communicate health information in ways that patients, caregivers, and the public can understand. Among Helen’s many “hats,” she produces and hosts the podcast interview series, Health Literacy Out Loud (HLOL). In honor of the 100th episode of HLOL, Helen chose to interview James and Janice Prochaska on the Stages of Change behavior theory. Helen wanted to honor the Prochaskas this way, saying that “The Stages of Change model has meant so much to me and everyone else who strives to communicate health information in ways others can understand, accept, and act upon.” To hear the podcast, go to www.healthliteracy.com/hlol-stages-of-change.

Pro-Change’s Comments on the Rand Study “Do Wellness Programs Work?”

South Kingstown, RI – June 27, 2013. A growing number of sources are suggesting that wellness programs do not work. Can we answer in the affirmative that wellness programs do work? The Rand Report
(http://www.rand.org/pubs/research_reports/RR254.html) clearly indicates that such a sweeping claim cannot be supported. But why would one assume that such a heterogeneous field – filled all too often with fads, fashions, and far too few facts – would be found to have much impact?

The more critical question is: Can wellness programs work? Here we can respond affirmatively and with confidence. A national Task Force for Community Preventive Services (CHES) has been developing bodies of evidence for recommendations, predictions, evaluations, and innovations for population-based health promotion or wellness programs (Zaa et al., 2005; Soler et al., 2010). The Task Force relies on an impressive range of criteria on which confidence can be based. These include the number of studies, the consistency of results in the same direction, the magnitude of the effects and the consistency of the magnitude, the type of study design, the quality of the study implementation, and length of follow-up. To these criteria, we have added the number of replications across different types of populations, diverse sub-populations and multiple health risk behaviors, and the percentage of participants in programs. We also added strength of outcome measures. Simply measuring improvement is not as strong as the percentage of participants who progress from being at-risk at baseline to not-at-risk at long-term follow-up (e.g., from smoking to not smoking).

A Task Force team applied their original criteria to employee health promotion programs that included HRA assessments with feedback reported at least twice plus at least one additional health promotion program. Across 51 studies, they found average participation rates of about 50% and average follow-ups of about 2 ¾ years. They had confidence in concluding that these wellness programs can produce important effects with exercise (a median success rate of 15.3% from 15 arms from 12 studies) and smoking cessation (a median abstinence rate of 17.8% from 30 arms from 24 studies). Smaller effects were found with high-fat diets (median decrease of 5.4%) and no effects for fruit and vegetable consumption).

Building on the Task Force’s body of evidence, we found much higher impacts for all four of these behaviors with results from 26 arms of population-based RCTs. These results are included in a paper that will be published soon
(http://online.liebertpub.com/doi/abs/10.1089/pop.2012.0094). Unfortunately, the Rand Study did not build on the CHES body of evidence nor did it include the range or rigor of criteria that were used in their review of wellness programs. It is well known that the easiest way to prove the null hypothesis (e.g., wellness programs do not work) is to rely on weak studies. The poorer the studies, the more error and noise is produced, preventing the likelihood of detecting adequate signals of significant effects. The companies reviewed by Rand were as small as 50 employees. As with any program, product or service, there are various levels of quality and one cannot conclude that wellness programs don’t work because the “average” results aren’t impressive. Employers need to use best practices to increase the probability their efforts will reap positive outcomes. One best practice is to use programs that have been scientifically tested and shown to work and not fall to marketing claims that lack peer-reviewed evidence of their offerings.

The Rand review reports that “employers are using incentives” to increase employee engagement in wellness programs. We have been using plan design incentives with our clients for more than a decade and have been able to consistently achieve over 80% of participation rates.

What we can conclude from the Rand Report is that employers need such growing bodies of evidence, based on a broad range of rigorous criteria, in order to benchmark alternative wellness programs. With such benchmarking tools, employers will be able to predict whether they are providing high impact programs, average impact programs, or programs that will produce minor impacts and major disappointments.

Pro-Change, Care New England, and VAL Health to Pilot an Innovative Smoking Cessation Program

South Kingstown, RI – June 12, 2013. This month, Care New England will launch a pilot of an innovative smoking cessation program for its health plan members. The program integrates Pro-Change’s evidence-based behavior change program, including individually tailored text messages with VAL Health’s unique approach to incentives.

Pro-Change’s Smoking Cessation Program (www.prochange.com/smoking-cessation-program) is built for smokers who are not ready to quit, getting ready to quit, ready to quit, in the process of quitting, and staying quit. The URAC award-winning program has an impressive cessation rate of 25%-30%. Recent research indicates that adding individually tailored text messages to the program increased effectiveness by 10 percentage points.

The 6-month pilot with Care New England health plan members will be integrated with VAL Health Rewards, an innovative program that applies the principles of behavioral economics to improve the impact and efficiency of incentive programs.

All Care New England’s benefit-eligible employees and their spouses and dependents who smoke will be eligible to participate in the program. A special bonus award is available if more than one member in a household participates.

“We are very excited to be working with Pro-Change and VAL Health Rewards on this new program. Unlike many other smoking cessation programs, this pilot helps to assess how ready a person is to quit and then provides tailored support based upon that assessment. Many, but not all, participants will quit. However, the research shows that most who complete the program will be better prepared to quit” said Domenic Delmonico, Senior Vice President and executive sponsor of the program for CNE.

About VAL Health
VAL Health is a leading behavioral economics consulting firm. Its health related incentive solutions are derived from team members’ rigorous scientific studies that demonstrate how one offers incentives is often more important than the size of the incentive. VAL Health applies behavioral economic science into practice to develop high impact wellness programs for employers and health plans, and customized incentive programs for health-related technology companies to increase participation and engagement. For more information, please visit www.valhealth.com.

About Care New England
Care New England Health System is positioned to transition into the new era of health care delivery with a high quality continuum of care. Its strength are based on complementary programs and distinctive competencies of partner hospitals and agencies including Kent, Butler, and Women and Infants Hospitals, the VNA and the Care New England Wellness Center. For more information, please visit www.carenewengland.org.

Pro-Change’s Lessons Learned on Patient Engagement

South Kingstown, RI – May 31, 2013. From research gleaned through 30 population-based randomized clinical trials, Pro-Change has found that there are six phases and five factors on a continuum of patient engagement.

The six phases of patient engagement are:


The five factors that drive those phases are: proactivity, stage of change, communications, incentives, tailoring, and transforming.

Most health professionals have been trained to passively wait for patients to reach out to them for help with high-risk and high-cost behaviors like smoking, unhealthy diets, and sedentary lifestyles. Unfortunately, few patients reached out because they were not experiencing pain, illness, or distress from these “silent killers.” Now, with Accountable Care Organizations and pay for performance models, health professionals need to be trained to proactively reach out to entire populations, not just those ready to change.

Once recruited, retention is the next challenge. Historically, discontinuation or drop-out from action-oriented interventions ranged from 70% to 80% for weight management and addictive behaviors, and about 50% for use of prescribed medications. The number one factor that predicted who was recruited and who was retained was stage of change. This factor needs to drive the design of behavior change programs and the health communications used to engage patients.

The historic model for behavior change of large percentages of patients (and of professionals) has been an action model, in which individuals are seen as changing when they quit smoking or start taking their medications as prescribed. If professionals are trying to engage them in a disease prevention or management program, patients assume it is action oriented. Why should patients agree to participate in a program for which they are not prepared? Programs need to be appropriate for patients in all stages of change.

Patient communications needs to convey that “Wherever you are at, we can work with that!”TM Using a traffic light as an icon for readiness to change, communications can let patients know “red light = not ready, yellow light = getting ready, green light = ready. Ready or not, we can be of help.” Of course, the program must actually be designed to respect wherever the patients are at.

Incentives are an increasingly important factor to engage populations. Employers particularly rely heavily on such extrinsic motivations, because most employees are not prepared to participate but they are prepared to trade time for money. The problem is that populations can simply go through the motions for money, without putting in the effort. Transforming from extrinsic to intrinsic motivation is the next driving factor. This begins the progress phase, as individuals advance from one stage to the next as a result of having received tailored feedback. Once patients progress, it means they are engaged not just in the treatment process but also in the change process. Historically, we equated treatment with change, but many people can remain in treatment and not progress. Programs need valid, brief measures that assess progress that would not be observable to participants. For example, the sooner patients receive feedback that their cholesterol is decreasing, the more likely they will continue to adhere to cholesterol lowering drugs.

Over time, progress leads to success as patients change their health status for costly behaviors. To maximize success, programs need to sustain engagement from one year to the next. The greater the percentage of populations engaging in treatment and change processes over time, the more programs can reduce risks and costs, and increase health, well-being and productivity.

The bottom line: It’s time to use the lessons we have learned from the science of behavior change to increase patient engagement, rather than repeating history.

Pro-Change At Cutting Edge of Multiple Behavior Change Research: Plays Key Role in Translational Behavioral Medicine Journal’s Special Section

South Kingstown, RI – May 1, 2013. Kerry E. Evers, PhD, Senior Vice President at Pro-Change Behavior Systems, Inc. is the Co-Editor of the Special Section Multiple Health Behavior Change in the latest issue (March 2013) of the Translational Behavioral Medicine Journal: Practice, Policy, and Research. In her editorial, Dr. Evers comments on the “Advances in Multiple Health Behavior Change Research” and describes the Special Section as “spanning different populations (e.g., adults and adolescents, employees, health clinic patients), methods (e.g., quantitative and qualitative), and modalities (e.g., survey and intervention research).”

Two of the eight peer-reviewed papers published in the Special Section highlight Pro-Change’s programs, one on youth obesity prevention, and the other on adult stress management, weight management, and smoking cessation.

The article by Yin et al., titled “Treatment-enhanced Paired Action Contributes Substantially to Change Across Multiple Behaviors: Secondary Analyses of Five Randomized Trials,” explores different analytical methods to determine the consistency, robustness, and synergy in patterns of multiple concurrent behavior change outcomes. Data from five randomized trials of computer-tailored interventions that simultaneously treated multiple health behaviors were analyzed. Three of those five trials used Pro-Change programs. Yin et al. found that paired action (changes on both behaviors in a pair) contributed substantially more to the treatment related outcomes than changes in just one of the behaviors in a pair. These results help us to understand how Pro-Change programs can increase impacts on multiple behaviors and populations.

The Bottom Line Statement in the Policy Brief by Amy A. Eyler, PhD, of Washington University, states that Pro-Change’s Health in Motion youth program “was not only effective in initiating and maintaining energy balance behaviors, but also in reducing smoking and alcohol acquisition in early adolescents.” Eyler is highlighting Velicer’s et al’s study “Multiple Behavior Interventions to Prevent Substance Abuse and Increase Energy Balance Behaviors in Middle School Students.” Health in Motion has been used by middle and high schools, by dependents of employees, and YMCAs, and could be used by Accountable Care Organizations for families and communities.

About Translational Behavioral Medicine Journal
Translational Behavioral Medicine: Practice, Policy, and Research (TBM) is an official international peer-reviewed publication of the Society of Behavioral Medicine. TBM’s mission is to engage, inform, and dialogue between research, practice, and policy. TBM features original empirical studies on the effectiveness or implementation of interventions which explicitly state the impact of the findings for researchers, practitioners, and policy makers. For more information, please go to