Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer, and receive regular mammograms

Prochaska, James O.; Velicer, Wayne F.; Redding, Colleen A.; Rossi, Joseph S.; Goldstein, Michael G.; DePue, Judith D.; Greene, Geoffrey; Rossi, Stefano Marco Maria De; Sun, Xiaowu; Fava, Joseph L.; Laforge, Robert G.; Rakowski, William; Plummer, Brett A.

doi:10.1016/j.ypmed.2004.09.050

Cited by 331 publications

(286 citation statements)

References 42 publications

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“…It is also worthy to note that there were only three coaching sessions that were time limited. These results suggest that MI counselors can be more ambitious and simultaneously target multiple and not just single behavior risks in a population.Secondly, the results replicated the multiple behavior changes within a target population that have been generated by TTM tailored interventions (Johnson et al, in press;Jones et al, 2003;Prochaska et al, 2004Prochaska et al, , 2005. More innovatively, this is the first study with adults to demonstrate such results when the TTM tailoring was delivered online.…”

supporting

confidence: 60%

“…Across a growing range of population trials, the control groups attained abstinence rates of 16% to 19%, while the TTM Tailoring produced 22% to 26% abstinence at longer term follow-up (Prochaska et al, 1993(Prochaska et al, , 2001a(Prochaska et al, , 2001b(Prochaska et al, , 2004(Prochaska et al, , 2005. The abstinence rates with MI (34.6%) were higher than the 24% found with MI by Carpenter et al (2004), but that study limited their sample only to unmotivated smokers in the precontemplation or contemplation stages.…”

Section: Discussionmentioning

confidence: 95%

“…TTM tailored print feedback has also been found effective when treating: 1) three health behaviors in a population of parents whose teens were participating in health promotion at school (Prochaska et al, 2004); 2) four behaviors in a population of primary care patients (Prochaska et al, 2005); 3) three behaviors in a population of patients with diabetes (Jones et al, 2003) and 4) three behaviors in a population of overweight individuals (Johnson et al, in press). Comparable TTM tailored feedback has also been presented in a multimedia format (Redding et al, 1999), but not yet online.…”

Section: Nih Public Accessmentioning

confidence: 99%

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Initial efficacy of MI, TTM tailoring and HRI’s with multiple behaviors for employee health promotion

Prochaska¹,

Butterworth²,

Redding³

et al. 2008

Preventive Medicine

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215

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Objective-This study was designed to compare the initial efficacy of Motivational Interviewing (MI), Online Transtheoretical Model (TTM) Tailored communications and a brief Health Risk Intervention (HRI) on four health risk factors (inactivity, BMI, stress and smoking) in a worksite sample.Method-A randomized clinical trial assigned employees to one of three recruitment strategies and one of the three treatments. The treatment protocol included an HRI session for everyone and in addition either a recommended three TTM online sessions or three MI in person or telephone sessions over 6 months. At the initial post-treatment assessment at six months, groups were compared on the percentage who had progressed from at-risk to taking effective action on each of the four risks.Results-Compared to the HRI only group, the MI and TTM groups had significantly more participants in the Action stage for exercise and effective stress management and significantly fewer risk behaviors at 6 months. MI and TTM group outcomes were not different. Conclusion: This was the first study to demonstrate that MI and online TTM could produce significant multiple behavior changes. Future research will examine the long-term impacts of each treatment, their cost effectiveness, effects on productivity and quality of life, and process variables mediating outcomes. KeywordsMultiple behavior change; Motivational Interviewing; TTM Tailoring; exercise; stress; smoking; BMI Increasingly it is recognized that a major barrier to dissemination of evidence-based health promotion programs is that most programs were not designed or developed to reach at-risk populations (Glasgow et al., 2003). They were designed for and evaluated on self-selected samples of at-risk individuals. For example, in the United States Public Health Services Corresponding Author: James O. Prochaska, Ph.D., Cancer Prevention Research Center, 2 Chafee Road, University of Rhode Island, Kingston, RI 02881, Tel: 401-874-2830, Fax: 401-874-5562, jop@uri.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 1996 Clinical Guidelines for the Treatment of Tobacco, over 3,000 studies on tobacco were identified. The Guidelines were able to recommend a broad range of evidence-based interventions for motivated smokers; i.e., those prepared to quit in the next month (Fiore et al., 1996). There were no evidence-based interventions recommended for unmotivated smokers, even though they make up more than 80% of all U.S. smokers (Velicer et al., 1995) and more than 90% of daily smokers (Wewers et al., 2003). In the second edition of the Guidelines there w...

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supporting

confidence: 60%

Section: Discussionmentioning

confidence: 95%

Section: Nih Public Accessmentioning

confidence: 99%

See 1 more Smart Citation

Initial efficacy of MI, TTM tailoring and HRI’s with multiple behaviors for employee health promotion

Prochaska¹,

Butterworth²,

Redding³

et al. 2008

Preventive Medicine

Self Cite

215

197

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…For example, the maintenance stage was defined as receiving mammograms two years in a row (Prochaska et al, 2005), and as receiving two mammograms in four years (Messina et al, 2002). One study simply mailed a different packet of information to participants based on their stage of change (Prochaska et al, 2005). In contrast, another study applied the TTM by using computer-assisted telephone interviewing and adjusted responses based on the participant's stage of change, in addition to sending a follow-up mailing according to participant's new stage of change after the intervention (Crane et al, 1998b).…”

Section: Discussionmentioning

confidence: 99%

Tailored interventions to promote mammography screening: A meta-analytic review

Sohl¹,

Moyer²

2007

Preventive Medicine

175

141

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Objective-To evaluate the effectiveness of tailored interventions, designed to reach one specific person based on her unique characteristics, for promoting mammography use.Method-This systematic review used meta-analytic techniques to aggregate the effect size of 28 studies published from 1997 through 2005. Potential study-level moderators of outcomes (sample, intervention, and methodological characteristics) were also examined.Results-A small but significant aggregate odds ratio effect size of 1.42 indicated that women exposed to tailored interventions were significantly more likely to get a mammogram (p < 0.001).The type of population recruited and participants' pre-intervention level of mammography adherence did not significantly influence this effect. Tailored interventions that used the Health Belief Model and included a physician recommendation produced the strongest effects. Interventions delivered in person, by telephone, or in print were similarly effective. Finally, defining adherence as a single recent mammogram as opposed to regular or repeated mammograms yielded higher effect sizes. Tailored interventions, particularly those that employ the Health Belief Model and use a physician recommendation, are effective in promoting mammography screening. Future investigations should strive to use more standardized definitions of tailoring and assessments of mammography outcomes. Conclusion-

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Simultaneous vs Sequential Counseling for Multiple Behavior Change

Hyman

Pavlik

Taylor³

et al. 2007

Arch Intern Med

172

122

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Background: Many patients in primary care settings present with multiple behavioral risk factors for cardiovascular disease. Research has provided little information on the most effective ways to approach multiple behavior change counseling in clinical settings. Methods:We implemented a randomized trial in a publicly funded primary care setting to test whether a sequential presentation of stage of change-based counseling to stop smoking, reduce dietary sodium level to less than 100 mEq/L per day, and increase physical activity by at least 10 000 pedometer steps per week would be more effective than simultaneous counseling. African Americans with hypertension, aged 45 to 64 years, initially nonadherent to the 3 behavioral goals, were randomized to the following conditions: (1) 1 in-clinic counseling session on all 3 behaviors every 6 months, supplemented by motivational interviewing by telephone for 18 months; (2) a similar protocol that addressed a new behavior every 6 months; or (3) 1-time referral to existing group classes ("usual care"). The pri-mary end point was the proportion in each arm that met at least 2 behavioral criteria after 18 months.Results: A total of 289 individuals (67.3% female) were randomized, and 230 (79.6%) completed the study. At 18 months, only 6.5% in the simultaneous arm, 5.2% in the sequential arm, and 6.5% in the usual-care arm met the primary end point. However, results for single behavioral goals consistently favored the simultaneous group. At 6 months, 29.6% in the simultaneous, 16.5% in the sequential, and 13.4% in the usual-care arms had reached the urine sodium goal (P=.01). At 18 months, 20.3% in the simultaneous, 16.9% in the sequential, and 10.1% in the usualcare arms were urine cotinine negative (P=.08).Conclusions: Long-term multiple behavior change is difficult in primary care. This study provides strong evidence that addressing multiple behaviors sequentially is not superior to, and may be inferior to, a simultaneous approach.

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Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer, and receive regular mammograms

Cited by 331 publications

References 42 publications

Initial efficacy of MI, TTM tailoring and HRI’s with multiple behaviors for employee health promotion

Initial efficacy of MI, TTM tailoring and HRI’s with multiple behaviors for employee health promotion

Tailored interventions to promote mammography screening: A meta-analytic review

Simultaneous vs Sequential Counseling for Multiple Behavior Change

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