Showing papers on "Transtheoretical model published in 2017"

Current Trends in Exercise Intervention Research, Technology, and Behavioral Change Strategies for People With Disabilities: A Scoping Review.

Abstract: This review synthesized physical activity and exercise intervention literature for the past 10 yrs for people with physical and cognitive disabilities including intervention characteristics, behavior change strategies, and types of technologies used to improve targeted outcomes. Systematic searches yielded 132 eligible studies. The major disability groups were multiple sclerosis (41%), stroke (15%), and spinal cord injury (12%). Research designs primarily involved randomized controlled trials (61%) versus quasi-experimental designs (39%). Approximately 20% of the interventions used some form of the following technology: information and communication technology (48%), interactive technology (37%), or electronic gauges (30%). Eighteen percent of studies used intervention strategies based on behavioral theory, which was typically combined with technology to promote activity and increase adherence in generally larger study samples. The three prevailing theories included social cognitive theory (58%), supportive accountability theory (21%), and transtheoretical model (21%). Upon completing the intervention, studies reported primarily significant outcomes (80%). Exercise research for PWD has grown in both quantity and quality, but several gaps remain. Study findings provide a roadmap for future exercise trials on understudied populations and highlight technology and behavior change theory as drivers of future intervention research.

Transtheoretical Model of Change during Travel Behavior Interventions: An Integrative Review

Abstract: This study aims to identify the relevant empirical work, to synthesize its findings, and to thus attain a general understanding of the application of the Transtheoretical Model (TTM) in transport behavior research An integrative literature review was used to determine whether or not the implemented interventions impact the stages and processes of travel behavior change Data was collected from different databases English language articles published between 2002 and 2017 were included After sequentially narrowing the search and removing duplicates, 53 relevant papers remained, 13 of which fulfilled the stated criteria of constituting a transport intervention study using the TTM as a reference frame The final 13 studies were classified and categorized according to stages and processes in the TTM Findings showed that none of the interventions met the method requirements for a proper evaluation of design and outcome measurement Reporting did not follow a standardized structure desirable when enabling comparative analyses Allowing for these shortcomings, it is inferred that positive travel behavior changes have been obtained during some interventions Importantly, although it was stated that the empirical studies were based on the TTM, the included interventions were implemented irrespective of the individual’s stage of change For future research, it will be necessary to conduct evaluations of higher quality

A word of advice: how to tailor motivational text messages based on behavior change theory to personality and gender

Abstract: Developing systems that motivate people to change their behaviors, such as an exercise application for the smartphone, is challenging. One solution is to implement motivational strategies from existing behavior change theory and tailor these strategies to preferences based on personal characteristics, like personality and gender. We operationalized strategies by collecting representative motivational text messages and aligning the messages to ten theory-based behavior change strategies. We conducted an online survey with 350 participants, where the participants rated 50 of our text messages (each aligned to one of the ten strategies) on how motivating they found them. Results show that differences in personality and gender relate to significant differences in the evaluations of nine out of ten strategies. Eight out of ten strategies were perceived as either more or less motivating in relation to scores on the personality traits Openness, Extraversion, and Agreeableness. Four strategies were perceived as more motivating by men than by women. These findings show that personality and gender influence how motivational strategies are perceived. We conclude that our theory-based behavior change strategies can be more motivating by tailoring them to personality and gender of users of behavior change systems.

Designing Patient-Centered Text Messaging Interventions for Increasing Physical Activity Among Participants With Type 2 Diabetes: Qualitative Results From the Text to Move Intervention.

Abstract: Background: Type 2 diabetes mellitus (T2DM) is a disease affecting approximately 29.1 million people in the United States, and an additional 86 million adults have prediabetes. Diabetes self-management education, a complex health intervention composed of 7 behaviors, is effective at improving self-care behaviors and glycemic control. Studies have employed text messages for education, reminders, and motivational messaging that can serve as “cues to action,” aiming to improve glucose monitoring, self-care behaviors, appointment attendance, and medication adherence. Objectives: The Text to Move (TTM) study was a 6-month 2-parallel group randomized controlled trial of individuals with T2DM to increase physical activity, measured by a pedometer. The intervention arm received text messages twice daily for 6 months that were tailored to the participant’s stage of behavior change as defined by the transtheoretical model of behavior change. Methods: We assessed participants’ attitudes regarding their experience with text messaging, focusing on perceived barriers and facilitators, through two focus groups and telephone interviews. All interviews were audiorecorded, transcribed verbatim, coded, and analyzed using a grounded theory approach. Results: The response rate was 67% (31/46 participants). The average age was 51.4 years and 61% (19/31 participants) were male. The majority of individuals were English speakers and married, had completed at least 12th grade and approximately half of the participants were employed full-time. Overall, participants were satisfied with the TTM program and recalled the text messages as educational, informational, and motivational. Program involvement increased the sense of connection with their health care center. The wearing of pedometers and daily step count information served as motivational reminders and created a sense of accountability through the sentinel effect. However, there was frustration concerning the automation of the text message program, including the repetitiveness, predictability of text time delivery, and lack of customization and interactivity of text message content. Participants recommended personalization of texting frequency as well as more contact time with personnel for a stronger sense of support, including greater surveillance and feedback based on their own results and comparison to other participants. Conclusions: Participants in a theory-based text messaging intervention identified key facilitators and barriers to program efficacy that should be incorporated into future texting interventions to optimize participant satisfaction and outcomes. Trial Registration: Clinicaltrials.gov NCT01569243; http://clinicaltrials.gov/ct2/show/NCT01569243 (Archived by Webcite at http://www.webcitation.org/6pfH6yXag) [JMIR Mhealth Uhealth 2017;5(4):e54]

Application of the transtheoretical model to sedentary behaviors and its association with physical activity status.

Abstract: Background The Transtheoretical Model (TTM) is a successful framework for guiding behavior change programs for several health behaviors, yet its application to reduce of sedentary behavior has been neglected. In addition, no data exist regarding the association between determinants of sedentary behaviors based on the TTM and physical activity behavior. The purpose of this study was to investigate college students' stages of motivational readiness to avoid sedentary behaviors and relevant psychological determinants using newly developed TTM questionnaires and to identify the association between current physical activity and sedentary behaviors based on TTM constructs. Methods Data were obtained from 225 college students enrolled in health education and physical education courses. Participants completed a package of questionnaires including validated TTM, physical activity and sitting time questionnaires. Participants also wore an accelerometer for seven consecutive days. MANOVAs were conducted to determine mean differences in psychological constructs across the TTM stages, and Chi-square tests and Spearman correlation were used to evaluate the associations between current physical activity and sedentary behavior. Results A majority of the participants were in the sedentary stages, and men and women differed in proportion of individuals in the stages (78.0% vs. 68.1%, respectively). The gender difference was also found in use of the processes of change. In general, the mean scores of the TTM constructs increased as the stages progressed. No significant associations were found between the TTM constructs for sedentary behavior and current physical activity levels (p>0.05). Conclusions A high proportion of college students were in sedentary stages regardless of physical activity levels, but different distributions in men and women. Participants in earlier stages were less likely to utilize the TTM constructs to reduce sedentary behaviors than those in later stages. A lack of association between physical activity and the psychological determinants of sedentary behavior was found.

Development of tailored nutrition information messages based on the transtheoretical model for smartphone application of an obesity prevention and management program for elementary-school students.

Abstract: BACKGROUND/OBJECTIVES: Easy access to intervention and support for certain behaviors is important for obesity prevention and management. The available technology such as smartphone applications can be used for intervention regarding healthy food choices for obesity prevention and management in elementary-school students. The transtheoretical model (TTM) is comprised of stages and processes of change and can be adopted to tailored education for behavioral change. This study aims to develop TTM-based nutrition contents for mobile applications intended to change eating behaviors related to weight gain in young children. SUBJECTS/METHODS: A synthesized algorithm for tailored nutrition messages was developed according to the intake status of six food groups (vegetables, fruits, sugar-sweetened beverages, fast food and instant food, snacks, and late-night snacks), decision to make dietary behavioral changes, and self-confidence in dietary behavioral changes. The messages in this study were developed from December 2014 to April 2015. After the validity evaluation of the contents through expert consultation, tailored nutrition information messages and educational contents were developed based on the TTM. RESULTS: Based on the TTM, stages of subjects are determined by their current intake status, decision to make dietary behavioral changes, and self-confidence in dietary behavioral changes. Three versions of tailored nutrition messages at each TTM stage were developed so as to not send the same messages for three weeks at most, and visual materials such as figures and tables were developed to provide additional nutritional information. Finally, 3,276 tailored nutrition messages and 60 nutrition contents for applications were developed. CONCLUSIONS: Smartphone applications may be an innovative medium to deliver interventions for eating behavior changes directly to individuals with favorable cost-effectiveness. In addition, using the TTM for tailored nutrition education for healthy eating is an effective approach.

¡Cocinar Para Su Salud! Development of a Culturally Based Nutrition Education Curriculum for Hispanic Breast Cancer Survivors Using a Theory-Driven Procedural Model

Abstract: We developed a theory-based dietary change curriculum for Hispanic breast cancer survivors with the goal of testing the effects of the intervention on change in dietary intake of fruits/vegetables and fat in a randomized, clinical trial. Social cognitive theory and the transtheoretical model were used as theoretical frameworks to structure curriculum components using the Nutrition Education DESIGN Procedure. Formative assessments were conducted to identify facilitators and barriers common to Hispanic women and test the degree of difficulty and appropriateness of program materials. Focus groups provided valuable insight and informed preimplementation modifications to the dietary program. The result was a systematically planned, evidence-based, culturally tailored dietary intervention for Hispanic breast cancer survivors, iCocinar Para Su Salud! (Cook for Your Health!). The methodology described here may serve as a framework for the development of future dietary interventions among diverse and minority populations. Short- and long-term study results will be reported elsewhere.

Predictors of Entering a Hearing Aid Evaluation Period: A Prospective Study in Older Hearing-Help Seekers.

Abstract: This study aimed to determine the predictors of entering a hearing aid evaluation period (HAEP) using a prospective design drawing on the health belief model and the transtheoretical model. In total, 377 older persons who presented with hearing problems to an ENT-specialist (n = 110) or a hearing aid dispenser (n = 267) filled in a baseline questionnaire. After four months, it was determined via a telephone interview whether or not participants had decided to enter a HAEP. Multivariable logistic regression analyses were applied to determine which baseline variables predicted HAEP status. A priori, candidate predictors were divided into ‘likely’ and ‘novel’ predictors based on the literature. The following variables turned out to be significant predictors: more expected hearing aid benefits, greater social pressure, and greater self-reported hearing disability. In addition, greater hearing loss severity and stigma were predictors in women but not in men. Of note, the predictive effect of self-reported hearing disability was modified by readiness such that with higher readiness, the positive predictive effect became stronger. None of the ‘novel’ predictors added significant predictive value. The results support the notion that predictors of hearing aid uptake are also predictive of entering a HAEP. This study shows that some of these predictors appear to be gender-specific or are dependent on a person’s readiness for change. After assuring the external validity of the predictors, an important next step would be to develop prediction rules for use in clinical practice, so that older persons’ hearing help seeking journey can be facilitated.

The effects of a self-efficacy intervention on exercise behavior of fitness club members in 52 weeks and long-term relationships of transtheoretical model constructs

Abstract: The transtheoretical model of behavior change (TTM) is often used to understand changes in health-related behavior, like exercise. Exercise behavior in fitness clubs is an understudied topic, but preliminary studies showed low frequencies and large numbers of drop-out. An initial 12-week self-efficacy intervention reported significant effects on exercise behavior. The objective of this follow up study is testing effects on exercise behavior over 52 weeks and the long-term relationships of all TTM constructs. In total 122 participants (Mage 42.02 yr.; SD 12.29; 67% females) were recruited and randomly assigned to group 1 (control), group 2 (self-set activities) and group 3 (self-set goals coaching). All participants were monitored 52-weeks. Measurements at baseline, 4, 8, 12, 26 and 52 weeks, using validated scales for stages of change, self-efficacy, decisional balance and processes of change. Exercise behavior and drop-outs were registered. An ANOVA revealed that group 3 significantly (p < 0.05) differed in exercise sessions from group 1 and 2 during the 12 weeks. A chi-square test indicated significant differences for continuing exercising after the intervention: 7 of group 1; 6 of group 2; 19 of group 3. In total 5 demonstrated regular exercise behavior at 26 weeks, and 3 at 52 weeks. Self-efficacy, decisional balance, and processes of change showed limited long-term changes over the later stages of change. At all measurements, participants reported more pros than cons and used more behavioral than cognitive processes. Exercise behavior of members in fitness clubs demonstrated dramatic developments in 52 weeks. The frequencies of sessions were so low that health effects will be minimal. The integrative character of the TTM appears to be weak; the data indicated limited relationships. More research is needed to understand exercise behavior and define optimal strategies to increase exercise attendance and decrease drop-outs in the long term.

Current theoretical bases for nutrition intervention and their uses.

Abstract: This chapter discusses contemporary theoretical basis for dietary interventions for disease prevention and management and their applications in practice. This chapter (1) introduces key concepts related to the application of theory in understanding and improving diet and eating-related behaviors, (2) reviews behavioral issues related to adopting healthful diets, (3) discusses dietary interventions, and (4) highlights important issues and constructs that cut across theories. Six theoretical models that are in current use and can be particularly useful for understanding the processes of changing eating habits in clinical and community settings are described: social cognitive theory, the stages of change construct from the transtheoretical model, consumer information processing, the theory of planned behavior, multiattribute utility theory, and the social ecological model. The central elements of each theory and how they can be used to guide dietary interventions are described in this chapter.

Dental flossing behaviour and its determinants among students in a suburb area of Tehran-Iran: using Transtheoretical Model.

Abstract: Objectives Oral health problems are a global concern particularly among underprivileged groups. This study aimed to use TTM model to assess the flossing behaviour and its determinants among students in a suburb area and compare the flossing behaviour between boys and girls using TTM. Methods Cluster sampling was employed to recruit 653 high school students from eight schools in Tehran suburban area, Iran. Two self-administrated questionnaires: (i) stage of change questionnaire and (ii) TTM constructs questionnaire including demographic features, decisional balance (perceived benefits and barriers), self-efficacy and process of change were used to assess the flossing behaviour and its psychological determinants. The statistical analysis of the data included Kruskal–Wallis test, t-test, anova, Spearman correlation and binary logistic regression using SPSS ver15 software. Results In this study, 301 (46.1%) and 352 (53.9%) of participants were women and men, respectively. Nearly half of the students (51.4%) were in precontemplation stage with the rest distributed among the other stages of flossing behaviour change. There was no statistically significant difference between genders regarding the stages of change (P < 0.05). Flossing behaviour is related to TTM constructs such as self-efficacy, perceived benefits, low perceived barriers and process of changes. Conclusion According to the results of this study, TTM is useful in determining the stages of interdental cleaning behaviour among students. However, further interventional researches are suggested to support the potential for eventual use of the TTM as a framework for understanding the determinants of interdental cleaning behaviour.

A Systematic Review of Rural, Theory-based Physical Activity Interventions.

Abstract: Objectives This systematic review synthesized the scientific literature on theory-based physical activity (PA) interventions in rural populations. Methods PubMed, PsycINFO, and Web of Science databases were searched to identify studies with a rural study sample, PA as a primary outcome, use of a behavioral theory or model, randomized or quasi-experimental research design, and application at the primary and/or secondary level of prevention. Results Thirty-one studies met our inclusion criteria. The Social Cognitive Theory (N = 14) and Transtheoretical Model (N = 10) were the most frequently identified theories; however, most intervention studies were informed by theory but lacked higher-level theoretical application and testing. Interventions largely took place in schools (N = 10) and with female-only samples (N = 8). Findings demonstrated that theory-based PA interventions are mostly successful at increasing PA in rural populations but require improvement. Conclusions Future studies should incorporate higher levels of theoretical application, and should explore adapting or developing rural-specific theories. Study designs should employ more rigorous research methods to decrease bias and increase validity of findings. Follow-up assessments to determine behavioral maintenance and/or intervention sustainability are warranted. Finally, funding agencies and journals are encouraged to adopt rural-urban commuting area codes as the standard for defining rural.

Barriers, motivators and strategies for sustainable mobility at the USP campus in São Carlos, Brazil

Abstract: The objective of this study was to investigate barriers, motivators and strategies to potentially promote sustainable mobility for graduate and undergraduate students, staff and faculty members at the University of Sao Paulo campus in Sao Carlos, Brazil. The transtheoretical model of behavior change was used to support the data analysis. Users from all the groups claimed that they would possibly change to another travel mode. Among those who said they would change to sustainable modes (16.7% of all respondents), 27.1% stated they would rather walk, whereas 46.2% would cycle. However, 13.6% of the respondents claimed they would change to cars, which would mean an additional demand of approximately 330 parking spaces on the campus. Owning a motorized vehicle was identified as the main obstacle to adopting sustainable modes.

Decisional balance and self-efficacy of physical activity among the elderly in Rasht in 2013 based on the transtheoretical model.

Abstract: BACKGROUND Regular physical activity has been considered as health promotion, and identifying different effective psycho-social variables on physical has proven to be essential. OBJECTIVE To identify the relationship between decisional balance and self-efficacy in physical activities using the transtheoretical model in the members of a retirement center in Rasht, Guillen. METHODS A descriptive cross-sectional study was conducted in 2013 by using convenient sampling on 262 elderly people who are the members of retirement centers in Rasht. Data were collected using Stages of change, Decisional balance, Self-efficacy and Physical Activity Scale for the Elderly (PASE). Data was analyzed using SPSS-16 software, descriptive and analytic statistic (Pearson correlation, Spearman, ANOVA, HSD Tukey, linear and ordinal regression). RESULTS The majority of participants were in maintenance stage. Mean and standard deviation physical activity for the elderly was 119.35±51.50. Stages of change and physical activities were significantly associated with decisional balance and self-efficacy (p<0.0001); however, cons had a significant and reverse association. According to linear and ordinal regression the only predicator variable of physical activity behavior was self-efficacy. CONCLUSION By increase in pros and self-efficacy on doing physical activity, it can be benefited in designing appropriate intervention programs.

A behavioral strategy to minimize air pollution exposure in pregnant women: a randomized controlled trial

Abstract: Pregnant women and their fetus belong to a sensitive group in response to air pollution hazards. The aim of this study was to evaluate the effectiveness of a theory-based educational program to change pollution exposure behavior in pregnant women. In this randomized controlled trial, pregnant women attending a prenatal clinic in Tehran, Iran were selected and randomized into the experimental and control groups. The inclusion criteria were age between 18 and 35 years, having a history of pregnancies without adverse outcomes and not suffering from chronic diseases. Data collected at baseline and 2-month follow-up. At baseline face-to-face interviews were conducted using a valid and reliable questionnaire including items on demographic characteristics, stages of change, self-efficacy, decisional balance and practice regarding air pollution preventive behaviors. The intervention composed of three parts: motivational interviewing, a booklet and daily small message service (SMS). The control group received no intervention except receiving usual care. Follow-up data were collected after the intervention. Data were analyzed performing t-test, Mann–Whitney U test, and chi-squared. In all the data for 104 pregnant women (53 in the intervention and 51 in the control group) were analyzed. The mean age of participants was 27.2 (SD = 4.11) years and it was 22.89 (SD = 8.75) weeks for gestational age. At baseline there were no significant statistical differences between intervention and control groups on the study measures while we found significant group differences in terms of stages of change, self-efficacy, perceived benefits and practice regarding air pollution preventive behaviors at follow-up assessment (P < 0.05). The findings indicated that the TTM-based intervention was effective in increasing air pollution preventive behaviors among pregnant women. This study provided a framework to modify some psychosocial determinants of air pollution preventive behavior other than knowledge using constructs of Transtheoretical model of behavior change, additionally results suggests the importance of education and makes enlightenment of the air pollution risk knowledge accelerate. IRCT2012091010804N1

Self-efficacy, pros, and cons as variables associated with adjacent stages of change for regular exercise in Japanese college students.

Abstract: This study examined self-efficacy (confidence to exercise), pros (exercise's advantages), and cons (exercise's disadvantages) as variables associated across the transtheoretical model's six stages of change in 403 Japanese college students. A series of logistic regression analyses were conducted. Results showed that higher pros and lower cons were associated with being in contemplation compared to precontemplation. Lower cons were associated with being in preparation compared to contemplation. Higher self-efficacy was associated with being in action compared to preparation as well as being in maintenance compared to action. Lower cons were associated with being in termination compared to maintenance.

Food insecurity and physical activity insecurity among rural Oregon families.

Abstract: Among rural families, rates of both child obesity and household food insecurity (FI) are higher compared to non-rural families. These disparities result from a complex interplay of social and environmental conditions that influence behavior. The Transtheoretical Model suggests individual readiness to change underlies success in modifying obesity-preventing behaviors; however, whether an association between readiness to change obesity-related behaviors and FI status among rural families exists is unknown. We examined the association between readiness to change family-level nutrition and physical activity (PA) behaviors that predict child obesity and family FI status within a sample of rural families to better understand these relationships. Families (n = 144) were recruited from six rural Oregon communities in 2013. Families completed a FI screener and the Family Stage of Change Survey (FSOC), a measure of readiness to change family-level nutrition and PA behaviors associated with obesity. Demographic differences by FI status were explored, and regression was applied to examine relationships between FI and FSOC scores, adjusting for relevant covariates. Among FI families (40.2%), more were non-white (77.8% vs. 22.2%; p = 0.036) and had lower adult education (30.4% vs. 11.8% with > high school degree; p = 0.015) compared to non-FI families. After adjusting for education, race, ethnicity, and eligibility for federal meal programs, readiness to provide opportunities for PA was lower among FI families (p = 0.002). These data highlight a need to further investigate how food insecurity and low readiness to provide PA opportunities, i.e. “physical activity insecurity” may be contributing to the higher obesity rates observed among rural children and families.

Effectiveness of an interprofessional education model based on the transtheoretical model of behaviour change to improve interprofessional collaboration.

Abstract: This study aimed to assess the effectiveness of an interprofessional education model (IPE) based on the transtheoretical model to improve the participants’ interprofessional collaborative practice....

Using the transtheoretical model to predict physical activity level of overweight adults with serious mental illness

Abstract: Although physical activity (PA) is recommended for individuals with serious mental illness (ISMI), most of them are inactive or insufficiently active. The transtheoretical model (TTM) has been proposed to explain the motivational factors associated with PA however, there is little evidence of its applicability to ISMI. So, the objective was to analyse whether TTM components are related to PA in overweight ISMI. In this cross-sectional study, participants completed the Global Physical Activity Questionnaire to assess their PA level and TTM components: stages of change (SOC), decisional balance (pros and cons), self-efficacy and processes of change (POC; experiential and behavioural). 43 overweight ISMI (27 males, mean age 29.0 ± 6.64, mean BMI 31.91 ± 5.10kg/m2, 30% with schizophrenia, and 44% inactive), referred to a PA programme were recruited. PA was positively correlated with POC and perceived pros, with TTM constructs accounting for 14.5% of PA variance. Mean level of behavioural POC and perceived pros were higher in physically active than in inactive participants. So, this study confirms that TTM components are associated with PA in overweight ISMI. Therefore, the TTM should be considered when planning PA interventions for ISMI.

Teen Choices, an Online Stage-Based Program for Healthy, Nonviolent Relationships: Development and Feasibility Trial.

Abstract: This paper describes the theoretical foundation, development, and feasibility testing of an online, evidence-based intervention for teen dating violence prevention designed for dissemination. Teen Choices: A Program for Healthy, Non-Violent Relationships relies on the Transtheoretical Model of Behavior Change and expert system technology to deliver assessments and feedback matched to stage of change for using healthy relationship skills. The program also tailors feedback to dating status, risk level, and other key characteristics. Ninety-nine students from high schools in Tennessee and Rhode Island completed a Teen Choices session and 97 completed an 11-item acceptability evaluation. 100% of participants completed the intervention session as intended. Evaluations of the program were favorable. For example, 88.7% agreed the program feedback was easy to understand, and 86.7% agreed that the program could help people develop healthier relationships. Findings provide encouraging evidence of the acceptability and feasibility of this approach to dating violence prevention.

Pain Self-Management for Veterans: Development and Pilot Test of a Stage-Based Mobile-Optimized Intervention.

Abstract: Background: Chronic pain is a significant public health burden affecting more Americans than cardiovascular disease, diabetes, and cancer combined. Veterans are disproportionately affected by chronic pain. Among previously deployed soldiers and veterans, the prevalence of chronic pain is estimated between 44% and 60%. Objective: The objective of this research was to develop and pilot-test Health eRide: Your Journey to Managing Pain, a mobile pain self-management program for chronic musculoskeletal pain for veterans. Based on the transtheoretical model of behavior change, the intervention is tailored to veterans’ stage of change for adopting healthy strategies for pain self-management and their preferred strategies. It also addresses stress management and healthy sleep, two components of promising integrated treatments for veterans with pain and co-occurring conditions, including posttraumatic stress disorder (PTSD) and traumatic brain injury. In addition, Health eRide leverages gaming principles, text messaging (short message service, SMS), and social networking to increase engagement and retention. Methods: Pilot test participants were 69 veterans recruited in-person and by mail at a Veterans Health Administration facility, by community outreach, and by a Web-based survey company. Participants completed a mobile-delivered baseline assessment and Health eRide intervention session. During the next 30 days, they had access to a Personal Activity Center with additional stage-matched activities and information and had the option of receiving tailored text messages. Pre-post assessments, administered at baseline and the 30-day follow-up, included measures of pain, pain impact, use of pain self-management strategies, PTSD, and percentage in the Action or Maintenance stage for adopting pain self-management, managing stress, and practicing healthy sleep habits. Global impressions of change and program acceptability and usability were also assessed at follow-up. Results: Among the 44 veterans who completed the 30-day post assessment, there were statistically significant pre-post reductions in pain (P<.001) and pain impact (P<.001); there was some reduction in symptoms of PTSD (P=.05). There were significant pre-post increases in the percentage of participants in the Action or Maintenance stage for adopting pain self-management (P=.01) and for managing stress (P<.001) but not for practicing healthy sleep habits (P=.11). The global impressions of change measure showed that a majority had experienced some level of improvement. User ratings of acceptability were quite high; ratings of usability fell slightly below the mean for digital programs. Conclusions: Preliminary data demonstrate the potential impact of the Health eRide program for chronic musculoskeletal pain for veterans. The results underscore that simultaneously addressing other behaviors may be a promising approach to managing pain and comorbid conditions. Additional formative research is required to complete development of the Health eRide program and to address areas of usability requiring improvement. A randomized trial with longer follow-up is needed to demonstrate the program’s long-term effects on pain and pain self-management.

Experts get me started, peers keep me going: comparing crowd- versus expert-designed motivational text messages for exercise behavior change

Abstract: We present a comparative analysis of motivational messages designed with a theory-driven approach. A previous study [4] involved crowdsourcing to design and evaluate motivational text messages for physical activity, and showed that these peer-designed text messages aligned to behavior change strategies from theory. However, the messages were predominantly rated as motivating in the later stages of behavior change, not in the earlier stages, including those strategies intended for the earlier stages. We speculated that the peers that designed the messages aligned to the strategies did not have sufficient expertise to motivate people in earlier stages. Therefore, we replicated the study with experts. We found that for two of the strategies expert-designed messages were found more motivating in the earliest stage, while for several of the strategies peer-designed messages were rated more motivating for later stages. We conclude that when using these strategies in behavior change technology, expert-designed messages could be more motivating in the earliest stage, while peer-designed messages could be more motivating in the later stages.

A behavioural approach in the development of work-related interventions for cancer survivors: an exploratory review.

Abstract: The application of behavioural change models and theories has not been studied, and behavioural determinants have not been considered, in the context of cancer and work. The aim of this study is to assess the relevance of a behavioural approach in the development of work-related interventions for cancer survivors. Two search strategies were conducted to identify studies on (1) lifestyle interventions (exercise, smoking, alcohol intake and diet), based on behavioural models and theories, in cancer survivors; (2) behavioural determinants regarding work. Medline, Embase, PsycInfo, CINAHL and the Cochrane Controlled Trial Register were searched (2000–2015). Studies were assessed on their eligibility, and findings were listed and categorised. Thirty-four studies exploring lifestyle interventions in cancer survivors were retrieved. The behavioural change models and theories most regularly used were the Transtheoretical Model and Social Cognitive Theory. Furthermore, 26 studies on the role of behavioural determinants regarding work were found. The most frequently considered determinants were self-efficacy, social norms, workers' expectations towards work or recovery, attitude, motivation and meaning of work. The results indicate the significance of behavioural change models and theories and of behavioural determinants in related research areas, which encourages a behavioural approach in the development of work-related interventions for cancer survivors.

Intervention effects on stage transitions for adolescent smoking and alcohol use acquisition.

Abstract: The health impacts of smoking and alcohol abuse have been long established with smoking representing one of the most preventable causes of disease and alcohol use the most popular psychoactive substance among adolescents. The current study evaluated stage of change progression in a large (N = 4,158) school-based, computer-delivered, transtheoretical model (TTM)-tailored multiple behavior intervention focused on preventing acquisition of smoking and alcohol use in adolescents. Assessments began in sixth grade and continued yearly until eighth grade, with a follow-up in ninth grade. Markov modeling was used to (a) characterize the best pattern of stage movement (e.g., no stage change, stage-sequential change, stages skipped), (b) test whether the identified pattern was stable over time (e.g., between assessments and after intervention completion), and (c) to determine whether the substance use prevention (SP) intervention effectively kept adolescents in acquisition stages (e.g., prevents stage movement toward substance use), relative to the comparison intervention. Major findings supported positive effects for both the intervention and comparison condition, which focused on energy balance (EB) behaviors and provided no direct intervention on substance use behaviors. Substantial differences in stage membership and transitions across intervention conditions highlighted the process of smoking and alcohol use acquisition in middle school students across each intervention condition. (PsycINFO Database Record

The Development of Health for Hearts United: A Longitudinal Church-based Intervention to Reduce Cardiovascular Risk in Mid-life and Older African Americans.

Abstract: This article describes Health for Hearts United, a longitudinal church-based intervention to reduce cardiovascular disease (CVD) risk in mid-life and older African Americans. Using community-based participatory research (CBPR) approaches and undergirded by both the Socio-ecological Theory and the Transtheoretical Model of Behavior Change, the 18-month intervention was developed in six north Florida churches, randomly assigned as treatment or comparison. The intervention was framed around three conceptual components: awareness building (individual knowledge development); clinical learning (individual and small group educational sessions); and efficacy development (recognition and sustainability). We identified three lessons learned: providing consistency in programming even during participant absences; providing structured activities to assist health ministries in sustainability; and addressing changes at the church level. Recommendations include church-based approaches that reflect multi-level CBPR and the collaborative faith model.

Analysis of Health Behavior Theories for Clustering of Health Behaviors.

Abstract: Objectives The objective of this article was to review the utility of established behavior theories, including the Health Belief Model, Theory of Reasoned Action, Theory of Planned Behavior, Transtheoretical Model, and Health Promotion Model, for addressing multiple health behaviors among people who smoke. It is critical to design future interventions for multiple health behavior changes tailored to individuals who currently smoke, yet it has not been addressed. Methods Five health behavior theories/models were analyzed and critically evaluated. A review of the literature included a search of PubMed and Google Scholar from 2010 to 2016. Two hundred sixty-seven articles (252 studies from the initial search and 15 studies from the references of initially identified studies) were included in the analysis. Result Most of the health behavior theories/models emphasize psychological and cognitive constructs that can be applied only to one specific behavior at a time, thus making them not suitable to address multiple health behaviors. However, the Health Promotion Model incorporates "related behavior factors" that can explain multiple health behaviors among persons who smoke. Conclusion Future multiple behavior interventions guided by the Health Promotion Model are necessary to show the utility and applicability of the model to address multiple health behaviors.

Application of the transtheoretical model to identify predictors of physical activity transition in university students

Abstract: Within the physical activity domain the majority of transtheoretical model research has employed a cross sectional research design. While useful for characterizing participants within the various stages of change, it fails to capture the dynamic nature of change. The purpose of the current study was to identify predictors of naturally occurring transitional shift patterns in physical activity behavior observed over six months among 202 university students. The full set of variables from the transtheoretical model as well as exercise METS was examined. Results indicated that stable active participants reported more exercise METs at baseline than both activity adopters and perpetual preparers in multinomial logistic regression analysis (p<.01). Stable active participants were also significantly different in their cognitive process of change scores compared to activity adopters (p<.05). Activity adopters differed from stable active participants in their initial decisional balance scores (p<.05). These findings should help inform theory development and physical activity interventions and programs.