When an Event Sparks Behavior Change: An Introduction to the Sentinel Event Method of Dynamic Model Building and Its Application to Emergency Medicine

Abstract

Experiencing a negative consequence related to one’s health behavior, like a medical problem leading to an emergency department visit, can promote behavior change, giving rise to the popular concept of the “teachable moment.” However, the mechanisms of action underlying this process of change have received scant attention. In particular, most existing health behavior theories are limited in explaining why such events can inspire short-term change in some, and long-term change in others. Expanding on recommendations published in the 2009 Academic Emergency Medicine consensus conference on public health in emergency medicine, we propose a new method for developing conceptual models that explain how negative events, like medical emergencies, influence behavior change, called the Sentinel Event Method. The method itself is atheoretical; instead, it defines steps to guide investigations that seek to relate specific consequences or events to specific health behaviors. This method can be used to adapt existing health behavior theories to study the event-behavior change relationship, or to guide formulation of completely new conceptual models. This paper presents the tenets underlying the Sentinel Event Method, describes the steps comprising the process, and illustrates its application to emergency medicine through an example of a cardiac-related emergency department visit and tobacco use.

Brief in Person Interventions for Adolescents and Young Adults Following Alcohol-Related Events in Emergency Care: A Systematic Review and European Evidence Synthesis

“…Furthermore, due to ethical considerations control group participants received some kind of an active intervention in all studies included in this review, potentially contributing to a systematic underestimation of effects under real-world conditions. On the other hand, it is also possible that the ED visit itself represents an event that triggers behaviour change [65] in a way that BIs do not add a significant additional effect, potentially even more so for young individuals treated following an alcohol-related event. Segatto et al [46] reported the only RCT that did not find positive effects of the BI on any outcome.…”

Cognitive and affective predictors of smoking after a sentinel health event

“…Across many medical settings, it is quite common to observe sudden, unplanned behavior change after an acute illness or diagnosis (Boudreaux, Bock, & OHea, 2012). In a compelling exposition of the relation between medical events and smoking cessation, McBride and colleagues (2003) point out that several indirect lines of evidence converge to support the premise that sentinel health events can trigger behavior change.…”

“…Using smoking as an illustrative example, they noted that patients who experience an important health event, such as pregnancy, hospitalization, or a serious disease diagnosis, have significantly higher rates of cessation than the general population, or patients simply attending an outpatient clinic appointment or well visit. Boudreaux and colleagues (2012) have also demonstrated that patients experiencing medical emergencies, like myocardial infarctions, who are assigned to control conditions in clinical trials can still exhibit long-term cessation rates. The Sentinel Event Model (SEM; Boudreaux et al, 2012) theorizes that cognitive and emotional factors interact, and change over time, after a health event and thus result in health behavior change.…”

“…Boudreaux and colleagues (2012) have also demonstrated that patients experiencing medical emergencies, like myocardial infarctions, who are assigned to control conditions in clinical trials can still exhibit long-term cessation rates. The Sentinel Event Model (SEM; Boudreaux et al, 2012) theorizes that cognitive and emotional factors interact, and change over time, after a health event and thus result in health behavior change. Specifically, when applied to smoking cessation and cardiac symptoms, the authors of the SEM have focused on causal attribution of a medical problem (to what factors a person attributes his/her present medical problem), perceived illness severity of a medical problem (how serious or life threatening a person perceives his/her medical problem), and fear secondary to an acute health event (i.e., event-related fear) and their associations with intentions to quit smoking.…”

Primary Care in the Emergency Department – An Untapped Resource for Public Health Research and Innovation

“…Beyond simply acting as an entry point to primary care, emergency physicians can provide the first crucial steps in managing these conditions, and coordinate follow-up care with outpatient clinics. An ED visit may act as a "sentinel event" and has the potential to effect long-term changes in patient behaviour (20).…”