The O’Neil Center, whose mission is to advance the science of patient and family engagement, recently sat down with Kerry E. Evers, Ph.D., Senior Vice President of Research and Product Development at Pro-Change Behavior Systems, Inc., to learn about the Transtheoretical Model. The interview, which focuses on the change process and how it impacts person and family engagement, was published in the O’Neil Center Newsletter in two parts. To read the interview that discusses multiple behavior change, patient and family engagement, and tailoring, click here.
GetWellNetwork, Inc., the leading provider of Interactive Patient Care, formed the O’Neil Center to provide a center of gravity for thought leadership, research, and innovation in patient engagement for providers across the world. The center combines guidance from prominent health care thought leaders, research findings, tools, methodologies, and resources to answer the “what” and “how” of patient engagement. The O’Neil Center is the industry’s first, single source “think tank” for patient and family engagement into healthcare delivery across the care continuum. “We are very pleased that Pro-Change’s tools for patient engagement are being highlighted by the O’Neil Center,” stated Janice M. Prochaska, Ph.D., President and CEO of Pro-Change. “We look forward to years of learning from them.”
Part I of the O’Neil Center interview with Dr. Kerry Evers
Pro-Change is home to the Transtheoretical Model. Tell us about the model.
Who developed it and how does it work?
The Transtheoretical Model (TTM) is a theoretical model of how people make behavior changes. It was developed more than 30 years ago by Dr. Jim Prochaska, the founder of Pro-Change Behavior Systems, and his colleagues. It looks at the behavior change process through a series of five stages of change. Instead of simply saying a person is doing something or not doing something, the model looks at how ready a person is to make a change. The five stages of change are:
The stages of change are key, but they are only one part of the full model. The TTM also includes the principles and processes of change – the “hows” of change that determine how we interact with people in each of the five stages of change to move them to the next stage. For example, many of us were taught that simply increasing someone’s knowledge about why they should do something – exercise more, for example, or quit smoking or eat more fruits and vegetables – won’t motivate them to take action on that behavior. While education is often not enough, it is certainly a critical part of the overall behavior change process. The success of using a process of change such as increasing knowledge depends on a person’s stage of change. Increasing knowledge of the behavior is especially important in Precontemplation when people are not yet thinking about taking action. By increasing their knowledge about the benefits of why the change is important, we help them move forward to Contemplation, the stage where they start to think about making a change. That’s the first step toward success. So the key is to use the full TTM, which includes tailoring the principles of change to the correct stage of change.
What types of behavior change is the TTM typically used for?
It’s been used in many different areas. Initially, the focus was on smoking cessation and other addiction behaviors including alcohol and substance use. But it’s now been applied to a wide variety of behaviors across many different countries and cultures, languages and age groups. It’s been shown to be effective with older elementary school students, middle school students, high school, college, all the way to older 2 adults. The behaviors include health behaviors such as exercise, healthy eating, weight management, medication adherence, and stress and depression management. The TTM is also used in violence prevention programs such as dating violence prevention, domestic violence prevention and bullying behaviors. It’s also useful for organizational change, financial behavior and more. It’s really widereaching in terms of how it’s been applied.
What about its application to person and family engagement?
We have several projects that focus on helping people become more involved in their health care. The
Proactive Health Consumer program helps individuals more fully engage with the health care system by
becoming more informed about their choices, sharing in decision-making with their health care
provider, making financially responsible choices and, of course, engaging in healthy behaviors. The
program is targeted to consumers’ roles as patients or users of health care, purchasers of health care,
and providers of care to family members such as children or elderly parents. The program focuses on
behavior changes that result in people using the tools that are out there, such as claims trackers or
decision aids for a health condition. These tools are available from a variety of sources but most people
don’t use them. They’re just not ready to become proactive about their health care. So our focus is on
the process of getting them to become more proactive and engaged.
Why aren’t people ready to be proactive?
For a variety of reasons. Sometimes, it’s because they don’t realize that there is a need to change. They
may not grasp that there is an issue that might be harmful to them. It could be that they have tried to
change and failed and they’re demoralized. Or, they think they can’t do it or don’t feel empowered to do
it. What our programs focus on is, as I said, each person’s stage of change and what it will take to move
them forward to the next stage. We don’t pressure them to take action right away. We actually bring
them through the whole change process, one stage at a time. And that leads to much more sustained
engagement and behavior change in the long run.
Why do you think change is such an important factor in helping people become more activated in the
It is a change process. As I mentioned, we know that simply educating people that smoking is bad for
them or that they shouldn’t be doing something doesn’t always mean that they’re going to stop. I think
for many people, becoming engaged in their health care is something new. As the health care system is
changing, people are taking on different roles and responsibilities and it is a change in the way that they
behave and interact. By getting them more engaged and proactive about their health care, they take
more control of it, they are more educated about what’s happening, and they also make better
decisions about their care. There are so many changes going on in the health care system right now that
without having some level of engagement, people can feel a little bit lost.
What about engagement from a clinician’s or caregiver’s perspective? How do you motivate them to
We do a lot of work with clinicians to help them understand the behavior change process. Clinicians can
get very demoralized if they’ve been telling a client that there is something they could be doing that
would improve their health, or their life in general, and the person doesn’t make that change. By
educating them on the TTM and the science of behavior change, we can help them refine in small ways
how they interact with someone – to recognize the little changes going on and how they can provide
more engaging messages to help each individual along the process. Historically, if you have someone
who is in Precontemplation you try to move them directly to Action. If you tell someone they need to
cut down on their drinking and they have no intention of stopping drinking, the person is either going to
lie about it, become very defensive, or find another provider. By helping providers understand what the
behavior change process is, we can help not only the patient but also the provider be more effective.
See next month’s edition of the newsletter for Part II of Dr. Evers’ interview.
Pro-Change Behavior Systems, Inc. announced today that Senior Vice President of Research and Product Development Kerry E. Evers, Ph.D., has been named to the board of directors and national board of advisors of the Institute for Interactive Patient Care (IIPC).
IIPC is a research-based health care organization dedicated to empowering patients and improving health outcomes through patient engagement. Its mission is to foster widespread adoption of patient and family/caregiver engagement strategies, which have been shown to optimize patient care outcomes. To achieve this, IIPC participates in high-quality research and advocates for advances in policy, standards, and payment reform. IIPC fills a unique role in health care by servicing as a reliable source of information and evidence-based data on the impact and efficacy of engagement.
Dr. Evers joins a group of prominent leaders in health care and patient engagement strategies on IIPC’s independent board of directors. The board oversees the selection and governance of a National Board of Advisors, which guides, validates, and disseminates the research conducted by IIPC. Through its national board of advisors, IIPC provides a forum in which health care leaders worldwide learn about, adopt, and promote the establishment of patient engagement standards.
“The Institute for Interactive Patient Care is dedicated to empowering persons and their families in care, while improving health outcomes, through furthering research about patient and family engagement,” said Karen Drenkard, Ph.D., RN, NEA-BC, FAAN, President of IIPC. “We are thrilled to have the scientific expertise of Dr. Kerry Evers as a member of our Board of Directors, and appreciate the outstanding knowledge and talent that she will add to our important work.”
Orbis Partners, Inc. and Pro-Change Behavior Systems, Inc. have signed a three-year contract to have Orbis distribute Pro-Change’s juvenile justice program, Rise Above Your Situation (RAYS). Orbis will also provide training to probation officers and counselors to facilitate the use of the program.
The RAYS program is designed as an adjunct to traditional juvenile justice programs. It is a multimedia, computer-tailored intervention that relies on the Transtheoretical Model of Behavior Change (TTM) to help youth progress through the stages of change for ending criminal behavior and substance abuse.
“We are very excited to partner with Pro-Change, and we believe that RAYS will be an important complement to our products and services, to support good case planning for youth involved in the juvenile justice system,” said Dr. David Robinson, President and CEO of Orbis Partners. “Ultimately, we believe this innovative tool will help many youth make commitments to work on change. It is consistent with many of the components of Orbis Partners’ Collaborative Case Work model used in several juvenile justice jurisdictions and youth service agencies.”
RAYS integrates best practices from existing evidence-based programs for juvenile offenders and substance abusers, and helps youth set personal goals.
The RAYS program includes:
In a feasibility test involving 60 system-involved youth and their probation officers/counselors, evaluations of the program were very positive:
The RAYS program is currently being tested in a cluster-randomized trial funded by the National Institute on Drug Abuse. The trial involves 700 moderate- to high-risk juvenile offenders in Iowa recruited by 54 probation officers randomly assigned the RAYS condition or usual care.
Probation officer and counselor comments regarding the strengths of the RAYS program:
The program provides structure in the use of evidence-based practices.
The reports facilitate communication and connection.
The reports help to diffuse tension and conflict.
What youth have said about RAYS:
As an adjunct to other juvenile justice services, RAYS can offer youth specialists a new tool for helping youth move toward the positive change that is necessary for success.
After an intensive evaluation and an onsite visit last year, Pro-Change Behavior Systems, Inc. is pleased to announce it was officially recertified as a Women’s Business Enterprise (WBE) by the Women’s Business Enterprise National Council (WBENC). The WBE is a nationally-accepted certification recognized by numerous private sector companies and governmental agencies.
WBE membership criteria demand that members provide documented evidence that at least 51% or more of a company is owned, managed, and controlled by women. Membership facilitates beneficial procurement opportunities for WBEs and corporations on a local and national level. By including women-owned businesses among their partners, corporations and government agencies demonstrate their commitment to fostering diversity and the continued development of their supplier diversity programs.
“We are pleased to be able to offer this Certification to our partners and customers to help them in their efforts to receive contracts and grants,” stated Pro-Change’s President & CEO, Janice M. Prochaska, PhD.
Health Promotion in the Workplace: Improving Awareness, Enhancing Motivation, Building Skills, and Creating Opportunities, edited by Michael P. O’Donnell, MBA, MPH, PhD, is a collaborative effort of the top health promotion scientists and practitioners in the field.
James O. Prochaska, PhD, Founder of Pro-Change Behavior Systems, Inc., and Janice M. Prochaska, PhD, President and CEO, contributed a chapter on the Transtheoretical Model from conceptual framework, to a review of the empirical literature, to studies challenging the Model, to increasing impacts with multiple behavior change programs, and to enhance motivation and skill-building.
The book, available on Amazon.com, has already been well received with hundreds of orders placed from students, consultants, employers, and health promotion vendors all over the United States, as well as Asia and South America. Efforts to translate Health Promotion in the Workplace into Chinese, Japanese, and Portuguese are underway.
“The Coaction Issue” of The Art of Health Promotion was just published in the American Journal of Health Promotion. It includes three articles co-authored by Pro-Change Behavior System’s Sara Johnson, PhD, Kerry Evers, PhD, and Patricia Castle, PhD. The articles summarize and highlight several recent advances in multiple behavior change interventions, such as coaction and paired action.
You can register now for a free webinar that will feature “The Coaction Issue:
Thinking Differently about Steps to Behavior Change” on March 24, 2015, at 1pm Eastern. The Webinar, hosted by Dr. Paul Terry, editor of The Art of Health Promotion, will include Dr. Johnson, Dr. Evers, and Marie-Josée Shaar of Smarts and Stamina.
To learn more, view the articles on coaction in the March/April 2015 issue of the American Journal of Health Promotion.
(2015) The Art of Health Promotion. American Journal of Health Promotion: March/April 2015, Vol. 29, No. 4, pp. TAHP-1-TAHP-12. doi: http://dx.doi.org/10.4278/ajhp.29.4.tahp
“What’s Next for Health Promotion? What New Approaches Will Produce the Best Outcomes” is the title of the 25th Annual Art & Science of Health Promotion Conference in San Diego, CA from March 30th to April 3rd.
Kerry E. Evers, PhD, Senior Vice President at Pro-Change Behavior Systems, Inc., will present on “Disruptive Technology: Help or Hindrance?” The focus will be on how to best integrate best practice into expanding technology innovations and how evolving best practices will integrate not only innovations in the health promotion, but those from the technology arena as well.
Sara S. Johnson, PhD, Senior Vice President, will present two sessions–one on “Innovations in Health Promotion: Exploring and Promoting Synergies between Cultural and Individual Change Initiatives.” Dr. Johnson sees the biggest impact on health will likely result from simultaneous policy, environmental, culture initiatives, combined with high-quality evidence-based individually tailored behavior change programs. Dr. Johnson’s second presentation, “Integrating Best Practices is a Next Practice,” conducted with Karen Horgan, CEO of VAL Health, will highlight successful initiatives that combined Pro-Change’s award-winning Transtheoretical Model evidence-based behavior change programs with VAL Health’s evidence-based incentive solutions that build on behavioral economics to increase engagement and improve outcomes.
Leanne M. Mauriello, PhD, Vice President at Pro-Change, at a Poster Session, will share the outcomes in a presentation entitled “Using mHealth to Deliver Behavior Change Interventions within Prenatal Care at Community Health Centers.” The multi-behavior change program was tested in a randomized controlled trial targeting smoking cessation, healthy eating, and stress management. The program produced strong engagement, retention, and significant reduction in numbers of risks post-delivery.
Pro-Change is proud to have such a strong presence at the 25th Annual Art & Science of Health Promotion Conference to present the very best in the science and practice of health promotion,” stated Janice M. Prochaska, PhD, President and CEO.
Sara Johnson, PhD, Senior Vice President at Pro-Change Behavior Systems, Inc., has been ranked in the Top 10 of WELCOA’s Top 100 Health Promotion Professionals. Out of 210 nominees, 100 were chosen as the best of the best, then 10 were scored in the upper echelon by an elite judging panel of health promotion leaders.
It was Sara’s vision for the future of health promotion, her leadership, and her innovative approach to her work that set her apart and placed her in the Top 10.
In her nearly 20 years in the health promotion field, Sara has relentlessly pursued innovations in health promotion and opportunities to integrate science and practice. For a full description of her achievements in developing award-winning health behavior change programs, her contributions to the science of behavior change, her leadership in the field, and her goals to advance the industry, please go to