HxRefactored - Pro Change Behavior Systems Inc - Kerry Evers


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HxRefactored - Pro Change Behavior Systems Inc - Kerry Evers

  1. 1. Behavior Change Tailoring: The Transtheoretical Model Kerry E. Evers, Ph.D. Pro-Change Behavior Systems, Inc.
  2. 2. Behavior  Change   “Up to 40 percent of annual deaths from each of five leading US causes are preventable” CDC, Morbidity and Mortality Weekly Report, May 2014
  3. 3. •  Health behavior change is a science •  Health behavior change interventions should be grounded in a leading theoretical model Theore.cal  Base   “Programs  to  influence  health  behavior,   including  health  promo8on  and   educa8on  programs  and  interven8ons,   are  most  likely  to  benefit  par8cipants   and  communi8es  when  the  program  or   interven8on  is  guided  by  a  theory  of   health  behavior.”                                                                                                                                                 Glanz,  et  al.,  2008        -­‐   There  is  nothing  as  prac8cal  as  a   good  theory.                                                                    Lewin,  1935     Glanz,  K,    et    al  (Eds.)  (2008).  Health  Behavior  and  Health  Educa4on:  Theory,  Research,  and  Prac4ce,  4th  Edi4on.  San  Francisco,  CA:  Jossey-­‐Bass    Lewin,  K.  (1935)  A  dynamic  theory  of  personality.  New  York:  McGraw-­‐Hill.  
  4. 4. “The  transtheore.cal  model  has   been  around  since  the  late  1970s   but  is  no  less  powerful  now  and   even  has  special  u.lity  when   two-­‐thirds  of  Americans  are   overweight  or  obese  and  600,000   of  us  are  killed  by  cardiovascular   disease  per  year."   Dr.  Oz,  Time  Magazine,  October  2012  
  5. 5. Google  Search  conducted  3/17/2014 184,000  results  for   “Transtheore.cal   Model”   442,000  results  for   “Stages  of  Change”   TTM  in  the  Public  Eye  
  6. 6. •  Search of PubMed Journal Articles •  Pubmed 1983-Present: 14,617 •  2013 Alone: 1,129 •  Search of Google Scholar •  Stage of Change Model: 1,270 •  Transtheoretical Model: 21,400 TTM  in  the  Academic  Literature  
  7. 7. History  of  the  TTM  
  8. 8. •  Smoking  cessa.on   •  Stress  management   •  Depression  preven.on   •  Weight  management   •  Exercise  acquisi.on   •  Healthy  diet   •  Responsible  drinking   •  Medica.on  adherence   •  Sun  exposure   •  Mammography  screening   •  Obesity  preven.on   •  Debt  Reduc.on   Transtheore.cal  Model  Applica.ons   §  Collabora.on  in  health  care   §  Organ  dona.on   §  Returning  to  work   §  Bullying  preven.on   §  Juvenile  delinquency   §  Da.ng  violence     §  Domes.c  violence   §  Advancing  women  scien.sts   §  Adop.on  readiness   §  Professional  prac.ces   §  Mastering  change  in  the  workplace   §  Pain  Self  Management   §  Informed  decision  making   10
  9. 9. •  Integrates  ideas  from  several  different  theories  and  therapies   •  Involves  progression  through  five  stages  of  change:     § Precontempla.on  –  Not  yet  ready   § Contempla.on  –  Geing  ready   § Prepara.on  -­‐  Ready   § Ac.on  -­‐  Doing  the  healthy  behavior   § Maintenance  -­‐  Keeping  up  the  healthy  behavior     •  Certain  principles  and  processes  of  change  work  best  at  each   stage  to  reduce  resistance  and  facilitate  progress   Overview  of  the  TTM  
  10. 10. •  is based on principles developed from over 35 years of scientific research, intervention development, and scores of empirical studies; •  applies the results of research funded by over $80 million worth of grants and conducted with over 150,000 research participants; and •  is currently in use by professionals around the world. Transtheore.cal  Model:    
  11. 11. 13 "Most  theories  are  about  behavior,     not  about  behavior  change."  –  James  O.  Prochaska  
  12. 12. •  Index of readiness •  Tells WHEN people change •  Predicts who will change successfully •  A dynamic, not static, client characteristic •  Inclusive, empathic, optimistic •  Guides member-treatment matching Stage  of  Change  
  13. 13. Not    Ready     Have  no  inten4on  to   start  taking  ac4on  in   next  6  months   Precontempla.on  
  14. 14. Geing  Ready     Intend  to  start  in  next  6   months   Contempla.on  
  15. 15. Ready   Prac4cing  the  behavior   Intend  to  start  in  next  30   days       Prepara.on  
  16. 16. Recently  Started  to   Change  Overt  Behavior     Consistently  for  less   than  6  months   Ac.on  
  17. 17. Has  Overtly  Changed   Behavior     Consistently  for  6   months  or  more   Maintenance  
  18. 18. Pros  =   Advantages   Of  Changing   Cons  =   Disadvantages   Of  Changing   Decisional  Balance:   A  growing  awareness  that  the  advantages  (Pros)   of  changing  outweigh  the  disadvantages  (Cons)   How  do  people  move  from  one  stage  to  another?
  19. 19. Confidence   Degree  to  which  individuals  believe  they  can   achieve  a  healthy  goal  even  under  temp.ng   situa.ons   DiClemente  CC,  Prochaska  JO,  Fairhurst  SK,  Velicer  WF.  The  Process  of  Smoking  Cessa.on:  An  Analysis  of  Precontempla.on,  Contempla.on,  and  Prepara.on  Stages  of  Change.  J  Consult   Clin  Psychol.  1991;  59:295-­‐304.   Self-­‐Efficacy  
  20. 20. •  HOW people change •  Experiential and behavioral strategies and techniques used to change behavior •  Facilitate transitions between stages •  Used as basis of intervention design Processes  of  Change  
  21. 21. Prochaska,  J.O.,  DiClemente,  C.C.,  &  Norcross,  J.C.  (1992).    In  search  of  how  people  change:  Applica.ons  to  addic.ve  behaviors.  American   Psychologist,  47(9),  1102-­‐1114.   Precontempla?on   Contempla?on   Prepara?on   Ac?on   Maintenance   Self-­‐Reevalua?on   Self-­‐Libera?on   Helping  Rela?onships   Counter  Condi?oning   Reinforcement  Management   S?mulus  Control   Social  Libera?on   Drama?c  Relief   Consciousness  Raising   Environmental  Reevalua?on   Processes  of  Change:  The  “How”  of  Change   GeNng  the  Facts   Use  Subs?tutes   Make  a  Commitment   Get  Support   Use  Rewards   Manage  your  Environment   No?ce  your  Effects  on  Others   Pay  AVen?on  to  Feelings   Create  a  New  Self-­‐Image   No?ce  Social  Trends   Experiential Behavioral
  22. 22. One  Size  Fits  All   Targeted   Stage  Matched  Ac?on  Oriented   Levels  of  Tailoring  
  23. 23. Precontempla?on   Contempla?on   Prepara?on   Ac?on   Maintenance   Environmental  Reevalua?on   No?ce  your  Effects  on  Others  
  24. 24. Precontempla?on   Contempla?on   Prepara?on   Ac?on   Maintenance   Drama?c  Relief   Pay  AVen?on  to  Feelings  
  25. 25. Precontempla?on   Contempla?on   Prepara?on   Ac?on   Maintenance   Helping  Rela?onships  Get  Support  
  26. 26. Prepara?on   Ac?on   Maintenance   Reinforcement  Management  Use  Rewards  
  27. 27. Contempla?on   Prepara?on   Ac?on   Maintenance   S?mulus  Control  Manage  your  Environment   A-CHESS (Addiction – Comprehensive Health Enhancement Support System)
  28. 28. Personal  Ac.vity  Center  (PAC)  
  29. 29. Stage  Matched  Feedback  
  30. 30. One  Size  Fits  All   Targeted   Tailored   Stage  Matched   Stage  +  Pros  +  Cons  +     Self-­‐Efficacy  +  10  Processes   Ac?on  Oriented   Depth  of  Tailoring  
  31. 31. Hall,  K.  L.  &  Rossi,  J.  S.  (2008).  Meta-­‐analy.c  examina.on  of  the  strong  and  weak  principles  across  48  health  behaviors.  Preven4ve  Medicine,  46,  266-­‐274.   The  Pros  &  Cons  of  Changing  Across  Stage  of  Change:  48  Behaviors  
  32. 32. Confidence   Degree  to  which  individuals  believe  they  can   achieve  a  healthy  goal  even  under  temp.ng   situa.ons   DiClemente  CC,  Prochaska  JO,  Fairhurst  SK,  Velicer  WF.  The  Process  of  Smoking  Cessa.on:  An  Analysis  of  Precontempla.on,  Contempla.on,  and  Prepara.on  Stages  of  Change.  J  Consult   Clin  Psychol.  1991;  59:295-­‐304.   Self-­‐Efficacy  
  33. 33. Computer-­‐Tailored  Interven.ons  (CTI)   Reliable,  valid  assessments  of  most   important  behavior  change   constructs   Evidence-­‐based,     sta.s.cally-­‐derived     decision-­‐making  rules   Individualized,  tailored   behavior  change  guidance   Feedback  dynamically  updated   based  on  new     assessment  data    
  34. 34. Questions Internet-based expert system Data collection/analysis/feedback/assessment Responses Tailored Feedback Individuals
  35. 35. 0 5 10 15 20 25 Precontemplation Contemplation Norma.ve  Tailoring  
  36. 36. 0 5 10 15 20 25 30 35 Precontemplation Contemplation Preparation Action Maintenance Rate  of  Change  
  37. 37. Rate  of  Change  
  38. 38. Rate  of  Change  
  39. 39. Norma.ve  &  Ipsa.ve  Clinical  Guidance  
  40. 40. Norma.ve  &  Ipsa.ve  Tailored  Feedback  
  41. 41. Processes  Feedback:  Sample  Screen  
  42. 42. •  Fred  Pennic  Outlined  findings  from  Mobiuity  Report     •  Create  an  individualized  solu.on   •  Analy.c  models  that  trigger  the  appropriate  interven.ons  and   outcomes  for  each  user     •  Personalized  communica.ons  to  increase  engagement   •  Low-­‐effort  data  collec.on   4  Best  Prac.ces  for  Crea.ng  Behavior  Changing  Mobile  Health  Apps     hop://www.hitconsultant.net/2013/07/26/4-­‐best-­‐prac.ces-­‐for-­‐crea.ng-­‐behavior-­‐changing-­‐mobile-­‐health-­‐apps/  
  43. 43. •  Theore.cal  variables  that  produce  large  effect  sizes  when  included  in   tailored  communica.ons  compared  to  tailored  communica.ons  that   exclude  these  variables:   §  Stages  of  Change   §  Pros  and  Cons  of  Changing   §  Self-­‐Efficacy   §  Processes  of  Change   §  Aitudes   §  Social  Support   Tailored  Communica.ons  that  Tailor  Each  of  the  Following   Variables  
  44. 44. Theore.cal  Variables  that  Produce  Smaller  Effect  Sizes   Perceived  Suscep.bility     Noar,  S.  M.,  Benac,  C.  N.,  &  Harris,  M.  S.  (2007).  Does  tailoring  maoer?  Meta-­‐analy.c  review  of  tailored  print  health  behavior  change  interven.ons.  Psychological  Bulle4n,  133,   673-­‐693.  
  45. 45. Theore.cal  Variables  that  DO  NOT    Make  a  Difference   Behavior   Inten.ons   Social   Norms     Noar,  S.  M.,  Benac,  C.  N.,  &  Harris,  M.  S.  (2007).  Does  tailoring  maoer?  Meta-­‐analy.c  review  of  tailored  print  health  behavior  change  interven.ons.  Psychological  Bulle4n,  133,   673-­‐693.  
  46. 46. Number  of  Tailoring  Variables  that  make  a  difference   0-­‐2     <   3-­‐5     >   6-­‐9  
  47. 47. Compara.ve  Outcomes  of  Interven.ons   Johnson,  J.L.,  Prochaska,  J.O.,  Paiva,  A.L.,  Fernandez,  A.C.,  DeWees,  S.L.,  and  Prochaska,  J.M.  (2013)  Advancing  Bodies  of  Evidence  for  Popula.on-­‐ based  Health  Promo.on  Programs:  Randomized  Controlled  Trials  and  Case  Studies.  Popula4on  Health  Management,  16(6),  373-­‐380.  
  48. 48. Well-­‐Being:  Change  Over  Time   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  Mul.ple  Domains     of  Well-­‐being  by  Decreasing  Mul.ple  Health  Risk  Behaviors:  A  Randomized  Clinical  Trial.  Popula4on  Health  Management,  15  (5),  276-­‐286.  
  49. 49. Improvements  in  Well-­‐Being   Overall   Individual  Domains   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  Mul.ple  Domains     of  Well-­‐being  by  Decreasing  Mul.ple  Health  Risk  Behaviors:  A  Randomized  Clinical  Trial.  Popula4on  Health  Management,  15  (5),  276-­‐286.  
  50. 50. Contacts   Pro-­‐Change  Behavior  Systems,  Inc.   •  www.prochange.com Online  Basic  Transtheore?cal  Model  Training     •  www.prochange.com/e-learning Demo  of  Domes?c  Violence  Program     •  www.prochange.com/domesticviolencedemo Demo  of  Healthy  Pregnancy  Program   •  www.prochange.com/pregnancydemo Coaches  Guide  for  Using  TTM  with  Clients   •  www.prochange.com Online  MyHealth  Behavior  Change  Programs   •  www.prochange.com/myhealth Mastering  Change  in  the  Workplace   •  www.prochange.com/products Janice  M.  Prochaska   •  jmprochaska@prochange.com