Stages of Change were assessed for three stage definitions and two modes of health-enhancing physical activity (HEPA) in a representative telephone survey in Switzerland (participation 55.8%; n = 1471). Two five-stage definitions focusing either on intention to change or current behavior were integrated into a seven-stage concept, taking into account both aspects. The two target behaviors were activities with at least moderate intensity and activities with vigorous intensity. According to the two five-stage definitions, at least half of the participants were either in precontemplation (focus on intention) or in preparation (focus on behavior). Upon classification into the seven stages these large stage groups were differentiated. There were differences in the pros for change between the new stages of the seven-stage concept. One in seven participants was regularly active according to the moderate criteria, but not using the vigorous criteria, and one in every eight participants reported the inverse. Results show that an individual can be in different Stages of Change depending on the stage definition and be regularly active or not depending on the target behavior. The practical implications of the seven-stage algorithm and a two-dimensional matrix to classify participants for both moderate and vigorous intensity activities in an Internet-based HEPA program are presented.

Background A novel incentive scheme based on a joint agreement of a large Swiss health insurance with 56 physician networks was implemented in 2018. This study evaluated the effect of its implementation on adherence to evidence-based guidelines among patients with diabetes in managed care models. Methods We performed a retrospective cohort study, using health care claims data from patients with diabetes enrolled in a managed care plan (2016–2019). Guideline adherence was assessed by four evidence-based performance measures and four hierarchically constructed adherence levels. Generalized multilevel models were used to examine the effect of the incentive scheme on guideline adherence. Results A total of 6′273 patients with diabetes were included in this study. The raw descriptive statistics showed minor improvements in guideline adherence after the implementation. After adjusting for underlying patient characteristics and potential differences between physician networks, the likelihood of receiving a test was moderately but consistently higher after the implementation of the incentive scheme for most performance measures, ranging from 18% (albuminuria: OR, 1.18; 95%-CI, 1.05–1.33) to 58% (HDL cholesterol: OR, 1.58; 95%-CI, 1.40–1.78). Full adherence was more likely after implementation of the incentive scheme (OR, 1.37; 95%-CI, 1.20–1.55), whereas level 1 significantly decreased (OR, 0.74; 95%-CI, 0.65 – 0.85). The proportions of the other adherence levels were stable. Conclusion Incentive schemes including transparency of the achieved performance may be able to improve guideline adherence in patients with diabetes and are promising to increase quality of care in this patient population.

The assessed DMP will hardly generate net savings in the first year, but may be cost neutral.

Zusammenfassung. Gemäß Transtheoretischem Modell unterstützen zehn Änderungsstrategien den Prozess einer Verhaltensänderung. Basierend auf Erkenntnissen aus der Rauchentwöhnung postuliert das Modell, dass in der ersten Phase des Veränderungsprozesses (Precontemplation, Contemplation, Preparation) primär kognitiv-affektive Strategien, in der zweiten Phase (Action, Maintenance) behaviorale Strategien eingesetzt werden. Dies wurde für den Bereich der körperlichen Aktivität mit Daten von 644 Besuchern eines internetbasierten Expertensystems zur Bewegungsförderung überprüft. Innerhalb der ersten drei Stadien der Verhaltensänderung wurden mehr kognitiv-affektive Strategien, innerhalb der letzten zwei Stadien mehr behaviorale Strategien gebraucht. Der Einsatz der kognitiv-affektiven Strategien nahm von der ersten zur zweiten Phase ab, während der Gebrauch der behavioralen Strategien zunahm. Der Einsatz der kognitiv-affektiven Strategien stieg vom ersten zum zweiten Stadium signifikant an. Der Gebrauch der behavioralen Strategien nahm vom ersten bis zum vierten Stadium kontinuierlich zu. Die aus dem Modell abgeleiteten Erwartungen wurden für die dichotome Phaseneinteilung vollständig, für den Verlauf über die fünf Stadien teilweise bestätigt.