Advanced Stage Of Change Research Articles

Description of Baseline Nutrition and Physical Activity Knowledge and Behavior in Acute Stroke/TIA Patients Enrolled in the Health Education on Information Retention and Behavior Change in Stroke (HERBS) Pilot Trial.

Lifestyle modifications after stroke are associated with better risk factor control and lower mortality. The primary objective of this study was to describe the knowledge of American Heart Association (AHA) recommendations for diet and exercise in survivors of stroke and transient ischemic attack (TIA). The secondary objectives were to describe their diet and exercise behaviors, self-efficacy (SE), behavioral intent (BI), stage of change, and barriers to change. Data are described from participants enrolled in a prospective educational intervention in mild stroke/TIA survivors. A multiple-choice questionnaire ascertained knowledge of AHA recommendations for diet and exercise, nutrition and physical activity behavior, SE, BI, stage of change, and barriers to change. Twenty-eight stroke/TIA survivors, with a mean age of 61.7 ± 11.8 years, completed questionnaires during their acute hospitalization. Participants underestimated the recommended intake of fruits, vegetables, whole grains, and participation in aerobic exercise and overestimated the recommended intake of sugar and salt. SE demonstrated a significant positive association with combined behavior scores (rs = 0.36, p = 0.043). Greater knowledge of the AHA recommendations was not associated with healthier behavior, greater SE, higher BI, or more advanced stage of change. The gaps between AHA recommendations and stroke/TIA patient knowledge identifies an area for potential intervention in stroke prevention and recovery.

Effectiveness of the Motivational Interviewing Techniques with Perpetrators of Intimate Partner Violence: A Non-Randomized Clinical Trial

ABSTRACT The effectiveness of perpetrators’ intervention programs (PIPs) remains controversial. Readiness and motivation for change are associated with treatment success among intimate partner violence (IPV) perpetrators. In this study, we aimed to verify whether adding Motivational Interviewing Techniques (MIT) during the intake phase of a standard PIP (SPIP) increases treatment adherence. We also sought to evaluate the effectiveness of the MIT plus SPIP concerning an SPIP alone. In this non-randomized clinical trial, 50 participants were assigned to one of the two conditions SPIP alone or MIT plus SPIP. Data were collected at baseline and the end of the intervention. Proximal outcomes (dropout, intervention dose, motivation, attitudes toward IPV, problem-solving skills) and final outcomes (IPV perpetration, risk of IPV) were assessed. The Reliable Change Index (RCI) was also computed. Results indicated that SPIP plus MIT participants concluded the curriculum in a more advanced stage of change, revealed more readiness to change, evidenced greater clinical improvements, and displayed higher reductions in attitudes toward IPV, IPV perpetration, and recidivism risk than SPIP participants. These findings point to MIT’s ability to promote readiness to change and progression into the stages of change, enhancing intervention efficacy with IPV perpetrators. (NCT05484440)

Stage-of-change Assessment Predicts Short-term Treatment Engagement for Opioid Use Disorder Patients Initiated on Buprenorphine.

IntroductionThe emergency department (ED) is an effective setting for initiating medication for opioid use disorder (MOUD); however, predicting who will remain in treatment remains a central challenge. We hypothesize that baseline stage-of-change (SOC) assessment is associated with short-term treatment retention outcomes.MethodsThis is a longitudinal cohort study of all patients enrolled in an ED MOUD program over 12 months. Eligible and willing patients were treated with buprenorphine at baseline and had addiction medicine specialist follow-up arranged. Treatment retention at 30 and 90 days was determined by review of the Prescription Drug Monitoring Program. We used uni- and multivariate logistic regression to evaluate associations between patient variables and treatment retention at 30 and 90 days.ResultsFrom June 2018–May 2019, 279 patients were enrolled in the ED MOUD program. Of those patients 151 (54.1%) and 120 (43.0%) remained engaged in MOUD treatment at 30 and 90 days, respectively. The odds of treatment adherence at 30 days were significantly higher for those with advanced SOC (preparation/action/maintenance) compared to those presenting with limited SOC (pre-contemplation/contemplation) (60.0% vs 40.8%; odds ratio 2.18; 95% confidence interval 1.15 to 4.1; P <0.05). At 30 days, multivariate logistic regression determined that advanced SOC, age >40, having medical insurance, and being employed were significant predictors of continued treatment adherence. At 90 days, advanced SOC, non-White race, age > 40, and having insurance were all significantly associated with higher likelihood of treatment engagement.ConclusionGreater stage-of-change was significantly associated with MOUD treatment retention at 30 and 90 days post index ED visit.

Psychosocial factors related to physical activity in frail and prefrail elderly people

BackgroundIncreased physical activity (PA) is a very important factor in a healthy aging lifestyle. Psychosocial factors have also a main role in the initiation and maintenance of this behavior, but nowadays its implications for frailty elderly people are unknown, therefore, the aim of this study was to identify the psychosociological variables of behavior change that influence the practice of (PA) in frail and prefrail elderly.MethodsA total of 103 frail and pre-frail elderly people (72 females) participated in this cross-sectional study, on the framework of the EXERNET-Elder3.0 project. Age ranged from 68–94 years (mean = 80.4 ± 5.9 years). Individualized face-to-face interviews according to the constructs of the Transtheoretical Model of Change (TTM) [(decisional balance (DB) and self-efficacy (SE)], social support (SS) (family and friends) and outcome expectations (OE) were administered to all participants.ResultsSignificant differences were found in DB, perceived benefits (PBn), SE, family-related SS and OE as a function of stages of change (SoC) (p < 0.005), but no significant were found in perceived barriers (PBrr) (p = 0.259) and friends-related SS (p = 0.068). According to the Scheffé post-hoc test, those in advanced SoC (Action-Maintenance), scored higher than those in lower SoC (Precontemplation-Contemplation and Preparation).ConclusionThe scores obtained from the study variables differed according to the SoC, supporting the external validity for the use of the TTM in frailty elderly. Further research is needed to determine the impact of PBrr and friends-related SS on this people, as well as to identify the validity of this model in the long-term in this population.

Psychometric properties of the traditional Chinese version of the 20-item Decisional Balance Scale

ABSTRACT Background Precise evaluation of decisional balance status of victims with substance use disorder is essential for individualized treatment plans. Decisional Balance Scale (DBS) has been proven useful for this purpose. We translated DBS to traditional Chinese (CDBS) and examined the psychometric properties. Methods A total of 173 outpatients with heroin or methamphetamine use disorder completed CDBS. We performed exploratory factor analysis to explore the structure of CDBS. We also examined internal consistency, item analysis, and test–retest reliability. The validity was tested by comparing respondents’ scoring (1) in different stages of change and (2) before/after group psychotherapy. Results The CDBS had identical structure as the original DBS. Two subscales (“Pros” and “Cons” of using drugs) were identified and each composed of 10 items. Item analysis revealed no redundant items. The Cronbach’s alpha for the Pros and Cons subscales were 0.903 and 0.884, whereas the test–retest reliability were 0.372 and 0.431, respectively. Respondents in advanced stage of change and completing group psychotherapy had decreased Pros scores and increased Cons scores. Conclusions The validity and reliability of the CDBS were fair, though the test–retest reliability was lower than expected. The results supported CDBS to assess motivation of outpatients with illicit drug use disorder.

790-P: Multicomponent Integrated Care Program Benefits on Diabetes-Related Grief and Stage of Change and Glycemic Control Association

Self-care behavior is the cornerstone in diabetes care. Strategies to promote behavior change and overcome grief process to improve diabetes outcomes have been poorly studied. We examined a quality initiative Multicomponent Integrated Care (MIC) program on Grief Stage (GS) and Stage of Change (SOC) allocation and its association with A1c in persons with type 2 diabetes (PwT2D) in a public primary care T2D clinic. DIABEMPIC is a 5-months empowerment-based program including: interdisciplinary case management team, diabetes self-management education, individual/group sessions, shared medical appointments, audit and feedback, and guaranteed supply of medications. We evaluated the effect of the intervention using a ’before and after’ design. Advanced stages were defined by higher than “anger” and higher than “contemplation” for GS and SOC, respectively. Total PwT2D were 451, the mean (SD) age was 54.6 (11) years, 66% were female, diabetes duration was 12 (8) years and baseline A1c was 9.5% (2.1). Baseline GS: denial 43.6%, anger 25.1%, bargaining 22.8%, depression 8.2% and acceptance 0.3%. Baseline SOC: precontemplation 55.4%, contemplation 40.6%, determination 2.5%, action 2.5% and maintenance 0%. GS and SOC improved after the intervention (83% and 68.7% presented advanced stages, respectively), p&amp;lt;0.001. A1c decreased 2.7% (2.2), p-value &amp;lt;0.001. Advanced GS and SOC were associated with an A1c ≦ 8% (OR 0.29, 95% CI, 0.16-0.52 and OR 0.21, 95% CI, 0.12-0.38, respectively). Also, these advanced stages had higher decrease of A1c (-0.8, -0.7%, respectively) than those who persist in earlier stages (p&amp;lt;0.001). We report a high prevalence of initial GS and SOC in PwT2D and poor glycemic control. MIC program participation was associated with improving GS and SOC. Advanced stages of GS and SOC at the end of the program were associated with better glycemic control. MIC strategies must be considered to promote behavior change and overcome grief process in PwT2D. Disclosure R. Silva-Tinoco: Speaker’s Bureau; Self; Novo Nordisk Inc. O. Salas-Martínez: None. V. delaTorre-Saldaña: None. E.B. Guzman: None. E.C. Cuatecontzi: None. D. Cabrera-Gerardo: None. L. Castillo-Martinez: None. H. Gallardo-Rincón: None. J. Serna: None. A. Gonzalez-Cantu: None. M. Romero-Ibarguengoitia: None.

Applying the transtheoretical model to adolescent academic performance using a person-centered approach: A latent cluster analysis

According to the transtheoretical model (TTM), intentional behavioral change to improve academic performance at school is a process that involves a progression through five discrete stages: precontemplation, contemplation, preparation, action, and maintenance. The current person-centered study assessed the emotional and sociocognitive characteristics of adolescent students (n = 343) with distinct academic performance stage of change profiles. Latent class analysis revealed five emergent groups. These groups mapped well onto the different academic performance stages of change: (1) students in a precontemplation stage; (2) students transitioning from precontemplation to contemplation; (3) students in a contemplation/preparation stage; (4) students in an action/maintenance stage; and (5) students outside the change process due to strong prior academic performances. In accordance with the TTM, group differences in personality, wellbeing, emotional/behavioral problems, learning approaches, and engagement with school indicated students in the more advanced stages of change had more adaptive psychological resources.

Relationship between Stages of Change and Glycemic Control in Patients with Type 2 Diabetes Mellitus in a Primary Health-care Setting.

ABSTRACTIntroduction:Advanced stages of change (SOC) are usually associated with lower glycated hemoglobin (HbA1c) scores in patients with type 2 diabetes mellitus (T2DM). Additionally, these patients’ adherence to antidiabetic medications is crucial to achieve controlled HbA1c scores. The purpose of this study was to determine the relationship between SOC and HbA1c as well as between medication adherence and HbA1c in patients with T2DM in a primary health-care setting in Qatar.Materials and Methods:A cross-sectional observational study was conducted in patients with T2DM at the noncommunicable diseases clinics at Mesaimeer Healthcare Center and West Bay Health Care Center. Medication adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8), whereas a two-item SOC questionnaire was used to measure the SOC. HbA1c values were obtained from the electronic database at the clinic. Spearman rank correlations were performed, with the significance level set at α < 0.05.Results:A total of 387 patients were included in the analysis. More than 75% of them reported that they were in the maintenance stage, and 35.4% of them had a controlled diabetes status. There was no significant correlation between SOC and HbA1c or between medication adherence and HbA1c.Conclusions:There was no relationship between SOC and HbA1c or between medication adherence and HbA1c in patients with T2DM, indicating that in this study, self-reported measures are not associated with the HbA1c scores of patients.

Individualized motivational plans in batterer intervention programs: A randomized clinical trial.

Treatment compliance and motivation to change are among the main challenges to improving batterer intervention program (BIP) effectiveness. This study examined whether adding an individualized motivational plan (IMP) to a standard BIP (SBIP) increased intervention effectiveness relative to BIP alone. One hundred sixty males convicted of intimate partner violence were randomly assigned to receive 70 hr of either SBIP or SBIP plus IMP. The IMP is based on motivational interviewing, stages of change, and strength-based theory principles. We collected the data at baseline, at the end of the 9-month program and at 6-month follow-up. Final outcome was recidivism (recidivism data obtained from official databases, self-reported recidivism, and therapists' assessment of recidivism risk), and proximal outcomes included treatment compliance (dropout and intervention dose), and stage of change. We analyzed the results using both intent-to-treat (ITT) and per-protocol (PP) approaches. Findings indicated that the SBIP plus IMP participants received significantly more intervention dose (R² = .08), finished the intervention in a more advanced stage of change (ITT, R² = .17; PP, R² = .22), reported less physical violence after treatment (ITT, odds ratio = .63; PP, odds ratio = .34), and had a higher reduction in recidivism risk (ITT, R² = .64; PP, R² = .56) than SBIP participants. These results highlight the relevance of alternative approaches, including strategies to increase treatment compliance and motivation for change, in BIPs. (PsycINFO Database Record

Cigarette Smoking Cessation Intervention for Buprenorphine Treatment Patients.

IntroductionPatients receiving medication assisted therapy (MAT) for opioid use disorder have high cigarette smoking rates. Cigarette smoking interventions have had limited success. We evaluated an intervention to increase cigarette abstinence rates in patients receiving buprenorphine-assisted therapy.MethodsCigarette smokers (N = 175; 78% male; 69% Caucasian; 20% Hispanic), recruited from a buprenorphine clinic were randomly assigned to either an extended innovative system intervention (E-ISI) or to Standard Treatment Control (STC). The E-ISI combined motivational intervention with extended treatment (long-term nicotine replacement therapy , varenicline, and extended cognitive behavioral therapy). STC received written information about quit-lines, medication, and resources. Assessments were held at baseline and 3, 6, 12, and 18 months. Seven-day biochemically verified point-prevalence cigarette abstinence was the primary outcome measure.ResultsFifty-four percent of E-ISI participants entered the extended treatment intervention; E-ISI and STC differed at 3 months on abstinence status but not at months 6, 12, and 18. E-ISI participants were more likely to attempt to quit, to have a goal of complete abstinence, and to be in a more advanced stage of change than STC participants. A higher number of cigarettes smoked and the use of cannabis in the previous 30 days predicted continued smokingConclusionsThe E-ISI was successful in increasing motivation to quit smoking but did not result in long-term abstinence. The failure of treatments that have been efficacious in the general population to produce abstinence in patients receiving MAT of opioid use disorder suggests that harm reduction and other innovative interventions should be explored.ImplicationsThis study demonstrates that an intervention combining motivational interviewing with an extended treatment protocol can increase cigarette quit attempts, enhance cigarette abstinence goals, and further movement through stages of change about quitting smoking in patients receiving MAT for opioid use disorder who smoke cigarettes. The intervention did not increase abstinence rates over those observed in a standard treatment control, however. The latter finding supports those of earlier investigators who also failed to find efficacy for smoking cessation in this population and who also used interventions effective in the general population. This pattern of findings suggests that patients with opioid use disorder can be motivated to change smoking behavior, but alternative and innovative approaches to cigarette smoking treatment should be studied.

Using a Mobile App to Promote Smoking Cessation in Hospitalized Patients.

BackgroundThe potential of interactive health education for preventive health applications has been widely demonstrated. However, use of mobile apps to promote smoking cessation in hospitalized patients has not been systematically assessed.ObjectiveThis study was conducted to assess the feasibility of using a mobile app for the hazards of smoking education delivered via touch screen tablets to hospitalized smokers.MethodsFifty-five consecutive hospitalized smokers were recruited. Patient sociodemographics and smoking history was collected at baseline. The impact of the mobile app was assessed by measuring cognitive and behavioral factors shown to promote smoking cessation before and after the mobile app use including hazards of smoking knowledge score (KS), smoking attitudes, and stages of change.ResultsAfter the mobile app use, mean KS increased from 27(3) to 31(3) (P<0.0001). Proportion of patients who felt they “cannot quit smoking” reduced from 36% (20/55) to 18% (10/55) (P<0.03). Overall, 13% (7/55) of patients moved toward a more advanced stage of change with the proportion of patients in the preparation stage increased from 40% (22/55) to 51% (28/55). Multivariate regression analysis demonstrated that knowledge gains and mobile app acceptance did not depend on age, gender, race, computer skills, income, or education level. The main factors affecting knowledge gain were initial knowledge level (P<0.02), employment status (P<0.05), and high app acceptance (P<0.01). Knowledge gain was the main predictor of more favorable attitudes toward the mobile app (odds ratio (OR)=4.8; 95% confidence interval (CI) (1.1, 20.0)). Attitudinal surveys and qualitative interviews identified high acceptance of the mobile app by hospitalized smokers. Over 92% (51/55) of the study participants recommended the app for use by other hospitalized smokers and 98% (54/55) of the patients were willing to use such an app in the future.ConclusionsOur results suggest that a mobile app promoting smoking cessation is well accepted by hospitalized smokers. The app can be used for interactive patient education and counseling during hospital stays. Development and evaluation of mobile apps engaging patients in their care during hospital stays is warranted.

Measuring the Processes of Change From the Transtheoretical Model for Physical Activity and Exercise in Overweight and Obese Adults.

This study aimed to test three factorial structures conceptualizing the processes of change (POC) from the transtheoretical model and to examine the relationships between the POC and stages of change (SOC) among overweight and obese adults. Cross-sectional study. This study was conducted at the University Hospital of Montpellier, France. A sample of 289 overweight or obese participants (199 women) was enrolled in the study. Participants completed the POC and SOC questionnaires during a 5-day hospitalization for weight management. Structural equation modeling was used to compare the different factorial structures. The unweighted least-squares method was used to identify the best-fit indices for the five fully correlated model (goodness-of-fit statistic = .96; adjusted goodness-of-fit statistic = .95; standardized root mean residual = .062; normed-fit index = .95; parsimonious normed-fit index = .83; parsimonious goodness-of-fit statistic = .78). The multivariate analysis of variance was significant (p < .001). A post hoc test showed that individuals in advanced SOC used more of both experiential and behavioral POC than those in preaction stages, with effect sizes ranging from .06 to .29. This study supports the validity of the factorial structure of POC concerning physical activity and confirms the assumption that, in this context, people with excess weight use both experiential and behavioral processes. These preliminary results should be confirmed in a longitudinal study.

Description of Adults Seeking Hearing Help for the First Time According to Two Health Behavior Change Approaches: Transtheoretical Model (Stages of Change) and Health Belief Model.

Several models of health behavior change are commonly used in health psychology. This study applied the constructs delineated by two models-the transtheoretical model (in which readiness for health behavior change can be described with the stages of precontemplation, contemplation and action) and the health belief model (in which susceptibility, severity, benefits, barriers, self-efficacy, and cues to action are thought to determine likelihood of health behavior change)-to adults seeking hearing help for the first time. One hundred eighty-two participants (mean age: 69.5 years) were recruited following an initial hearing assessment by an audiologist. Participants' mean four-frequency pure-tone average was 35.4 dB HL, with 25.8% having no hearing impairment, 50.5% having a slight impairment, and 23.1% having a moderate or severe impairment using the World Health Organization definition of hearing loss. Participants' hearing-related attitudes and beliefs toward hearing health behaviors were examined using the University of Rhode Island Change Assessment (URICA) and the health beliefs questionnaire (HBQ), which assess the constructs of the transtheoretical model and the health belief model, respectively. Participants also provided demographic information, and completed the hearing handicap inventory (HHI) to assess participation restrictions, and the psychosocial impact of hearing loss (PIHL) to assess the extent to which hearing impacts competence, self-esteem, and adaptability. Degree of hearing impairment was associated with participation restrictions, perceived competence, self-esteem and adaptability, and attitudes and beliefs measured by the URICA and the HBQ. As degree of impairment increased, participation restrictions measured by the HHI, and impacts of hearing loss, as measured by the PIHL, increased. The majority of first-time help seekers in this study were in the action stage of change. Furthermore, relative to individuals with less hearing impairment, individuals with more hearing impairment were at more advanced stages of change as measured by the URICA (i.e., higher contemplation and action scores relative to their precontemplation score), and they perceived fewer barriers and more susceptibility, severity, benefits and cues to action as measured by the HBQ. Multiple regression analyses showed participation restrictions (HHI scores) to be a highly significant predictor of stages of change explaining 30% to 37% of the variance, as were duration of hearing difficulty, and perceived benefits, severity, self-efficacy and cues to action assessed by the HBQ. The main predictors of stages of change in first-time help seekers were reported participation restrictions and duration of hearing difficulty, with constructs from the health belief model also explaining some of the variance in stages of change scores. The transtheoretical model and the health belief model are valuable for understanding hearing health behaviors and can be applied when developing interventions to promote help seeking.

Parental Influences on Child Weight: Perception, Willingness to Change, and Barriers

Background: Although parents are primary to development of obese genic behaviors, many parents do not perceive their child’s obesity as problematic and are not ready to make changes to address their child’s weight. The purpose of the study is to examine relationships between parental perception of child weight, parental readiness to change behaviors, and barriers to behavior change. Methods: A sample of low-socioeconomic and minority parents of 6-12 year old children who are overweight or obese completed questionnaires on perception of their child’s weight, stage of readiness to change behaviors for their child’s weight (SOC), and barriers to changing child weight control behaviors. Parents were blinded to the purpose of the study. Child weight status was categorized ‘overweight’ (BMI ≤85th-95th percentile) or ‘obese’ (BMI ≥95th percentile). Results: Of the 48 parent-child dyads, 77.1% of parents underestimated their child’s weight status and 54.2% perceived their child as normal weight. Older (p=0.045) and married parents (p=0.025) were more likely to perceive their child as overweight. Accurate parental perception was significantly associated with advanced stage of change (SOC; r=0.358, p=0.012). Conclusions: Parents of overweight or obese children underestimated their child’s weight status. Parental perception of child weight was associated with the parent’s SOC for their child’s weight.

Stages of change in adults who have failed an online hearing screening.

Hearing screening has been proposed to promote help-seeking and rehabilitation in adults with hearing impairment. However, some longitudinal studies point to low help-seeking and subsequent rehabilitation after a failed hearing screening (positive screening result). Some barriers to help-seeking and rehabilitation could be intrinsic to the profiles and needs of people who have failed a hearing screening. Theories of health behavior change could help to understand this population. One of these theories is the transtheoretical (stages-of-change) model of health behavior change, which describes profiles and needs of people facing behavior changes such as seeking help and taking up rehabilitation. According to this model, people go through distinct stages toward health behavior change: precontemplation, contemplation, action, and finally, maintenance. The present study describes the psychometric properties (construct validity) of the stages of change in adults who have failed an online hearing screening. Stages of change were measured with the University of Rhode Island Change Assessment (URICA). Principal component analysis is presented, along with cluster analysis. Internal consistency was investigated. Finally, relationships between URICA scores and speech-in-noise recognition threshold, self-reported hearing disability, and self-reported duration of hearing disability are presented. In total, 224 adults who had failed a Swedish online hearing screening test (measure of speech-in-noise recognition) completed further questionnaires online, including the URICA. A principal component analysis identified the stages of precontemplation, contemplation, and action, plus an additional stage, termed preparation (between contemplation and action). According to the URICA, half (50%) of the participants were in the preparation stage of change. The contemplation stage was represented by 38% of participants, while 9% were in the precontemplation stage. Finally, the action stage was represented by approximately 3% of the participants. Cluster analysis identified four stages-of-change clusters: they were named decision making (44% of sample), participation (28% of sample), indecision (16% of sample), and reluctance (12% of sample). The construct validity of the model was good. Participants who reported a more advanced stage of change had significantly greater self-reported hearing disability. However, participants who reported a more advanced stage of change did not have a significantly worse speech-in-noise recognition threshold or reported a significantly longer duration of hearing impairment. The additional stage this study uncovered, and which other studies have also uncovered, preparation, highlights the need for adequate guidance for adults who are yet to seek help for their hearing. The fact that very few people were in the action stage (approximately 3% of the sample) signals that screening alone is unlikely to be enough to improve help-seeking and rehabilitation rates. As expected, people in the later stages of change reported significantly greater hearing disability. The lack of significant relationships between stages-of-change measures and speech-in-noise recognition threshold and self-reported duration of hearing disability highlights the complex interplay between impairment, disability, and behaviors in adults who have failed an online hearing screening and who are yet to seek help.

Stages of Change in Adults With Acquired Hearing Impairment Seeking Help for the First Time

This study investigated the application of the transtheoretical (stages-of-change) model in audiologic rehabilitation. More specifically, it described the University of Rhode Island Change Assessment (URICA) scores of adults with acquired hearing impairment. It reported the psychometric properties (construct, concurrent, and predictive validity) of the stages-of-change model in this population. At baseline, 153 adults with acquired hearing impairment seeking help for the first time completed the URICA as well as measures of degree of hearing impairment, self-reported hearing disability, and years since hearing impairment onset. Participants were subsequently offered intervention options: hearing aids, communication programs, and no intervention. Their intervention uptake and adherence were assessed 6 months later and their intervention outcomes were assessed 3 months after intervention completion. First, the stages-of-change construct validity was evaluated by investigating the URICA factor structure (principal component analysis), internal consistency, and correlations between stage scores. The URICA scores were reported in terms of the scores for each stage of change, composite scores, stages with highest scores, and stage clusters (cluster analysis). Second, the concurrent validity was assessed by examining associations between stages of change and degree of hearing impairment, self-reported hearing disability, and years since hearing impairment onset. Third, the predictive validity was evaluated by investigating associations between stages of change and intervention uptake, adherence, and outcomes. First, in terms of construct validity, the principal component analysis identified four instead of three stages (precontemplation, contemplation, preparation, and action) for which the internal consistency was good. Most of the sample was in the action stage. Correlations between stage scores supported the model. Cluster analysis identified four stages-of-change clusters, which the authors named active change, initiation, disengagement, and ambivalence. In terms of concurrent validity, participants who reported a more advanced stage of change had a more severe hearing impairment, reported greater hearing disability, and had a hearing impairment for a longer period of time. In terms of predictive validity, participants who reported a more advanced stage of change were more likely to take up an intervention and to report successful intervention outcomes. However, stages of change did not predict intervention adherence. The majority of the sample was in the action stage. The construct, concurrent, and predictive validity of the stages-of-change model were good. The stages-of-change model has some validity in the rehabilitation of adults with hearing impairment. The data support that change might be better represented on a continuum rather than by movement from one step to the next. Of all the measures, the precontemplation stage score had the best concurrent and predictive validity. Therefore, further research should focus on addressing the precontemplation stage with a measure suitable for clinical use.

Virtual training and coaching of health behavior: Example from mindfulness meditation training

ObjectiveComputer-based virtual coaches are increasingly being explored for patient education, counseling, and health behavior training and coaching. The objective of this research was to develop and evaluate a Virtual Mindfulness Coach for training and coaching in mindfulness meditation. MethodsThe coach was implemented as an embodied conversational character, providing mindfulness training and coaching via mixed initiative, text-based, natural language dialog with the student, and emphasizing affect–adaptive interaction. (The term ‘mixed initiative dialog’ refers to a human–machine dialog where either can initiate a conversation or a change in the conversation topic.) ResultsFindings from a pilot evaluation study indicate that the coach-based training is more effective in helping students establish a regular practice than self-administered training using written and audio materials. The coached group also appeared to be in more advanced stages of change in terms of the transtheoretical model, and have a higher sense of self-efficacy regarding establishment of a regular mindfulness practice. ConclusionThese results suggest that virtual coach-based training of mindfulness is both feasible, and potentially more effective, than a self-administered program. Of particular interest is the identification of the specific coach features that contribute to its effectiveness. Practice implicationsVirtual coaches could provide easily accessible and cost-effective customized training for a range of health behaviors. The affect–adaptive aspect of these coaches is particularly relevant for helping patients establish long-term behavior changes.

Return-to-Work Self-Efficacy: Development and Validation of a Scale in Claimants with Musculoskeletal Disorders

Introduction We report on the development and validation of a 10-item scale assessing self-efficacy within the return-to-work context, the Return-to-Work Self-Efficacy (RTWSE) scale. Methods Lost-time claimants completed a telephone survey 1 month (n = 632) and 6 months (n = 446) after a work-related musculoskeletal injury. Exploratory (Varimax and Promax rotation) and confirmatory factor analyses of self-efficacy items were conducted with two separate subsamples at both time points. Construct validity was examined by comparing scale measurements and theoretically derived constructs, and the phase specificity of RTWSE was studied by examining changes in strength of relationships between the RTWSE Subscales and the other constructs at both time measures. Results Factor analyses supported three underlying factors: (1) Obtaining help from supervisor, (2) Coping with pain (3) Obtaining help from co-workers. Internal consistency (alpha) for the three subscales ranged from 0.66 to 0.93. The total variance explained was 68% at 1-month follow-up and 76% at 6-month follow-up. Confirmatory factor analyses had satisfactory fit indices to confirm the initial model. With regard to construct validity: relationships of RTWSE with depressive symptoms, fear-avoidance, pain, and general health, were generally in the hypothesized direction. However, the hypothesis that less advanced stages of change on the Readiness for RTW scale would be associated with lower RTWSE could not be completely confirmed: on all RTWSE subscales, RTWSE decreased significantly for a subset of participants who started working again. Moreover, only Pain RTWSE was significantly associated with RTW status and duration of work disability. With regard to the phase specificity, the strength of association between RTWSE and other constructs was stronger at 6 months post-injury compared to 1 month post-injury. Conclusions A final 10-item version of the RTWSE has adequate internal consistency and validity to assess the confidence of injured workers to obtain help from supervisor and co-workers and to cope with pain. With regard to phase specificity, stronger associations between RTWSE and other constructs at 6-month follow-up suggest that the association between these psychological constructs consolidates over time after the disruptive event of the injury.

Efficacy of a Web-Based, Tailored, Alcohol Prevention/Intervention Program for College Students: Initial Findings

Objective: Reduce college student at-risk drinking (ARD) using a Web-based brief motivational alcohol prevention/intervention called Michigan Prevention and Alcohol Safety for Students (M-PASS). Participants: Participants included 1,137 randomly sampled first-year college students, including 59% female, 80% white, and averaged age 18.1 years. Methods: Intervention group participants (n = 616) attended 4 online M-PASS sessions, receiving feedback tailored to individual drinking patterns and concepts from 4 behavior change theories. Control group participants (n = 521) completed a mid-phase survey, and both groups were surveyed at baseline and posttest. Results: Evidence of M-PASS's efficacy was found. The intervention was associated with advanced stage of change, lower tolerance of drinking and drink/driving, fewer reasons to drink, and use of more strategies to avoid ARD. Preliminary evidence of behavioral change was also found. Efficacy was greater for women than men. Conclusions: Web-based programs may be useful in reducing alcohol-related risk among college students. Further evaluation is needed.

Healthy Eating and Harambee: Curriculum Development for a Culturally-Centered Bio-Medically Oriented Nutrition Education Program to Reach African American Women of Childbearing Age

The purpose was to develop, implement and evaluate a peer-led nutrition curriculum Healthy Eating and Harambee that addresses established objectives of maternal and infant health and to shift the stage for African American women of childbearing age in Genesee County toward healthier dietary patterns using a socio-cultural and biomedical orientation. The PEN-3 model, which frames culture in the context of health promotion interventions, was integrated with the Transtheoretical Model to guide this 13-week pre-test/post-test curriculum. Materials developed included soul food plate visuals, a micronutrient availability worksheet, a fruit stand, and gardening kits. Learning activities included affirmations, stories, case-scenarios, point-of-purchase product recognition, church health teams, and community health fairs. We investigated health-promoting dietary behaviors (consumption of more fruits and vegetables (F&V), serving more F&V to their families, and moderating dietary sodium and fat intakes), and biomedical behaviors (self-monitoring blood pressure and exercising) across five stages of change. Session attendance and program satisfaction were assessed. N = 102 women participated (mean age = 27.5 years). A majority (77%) reported adopting at least one healthy eating behavior (moderating sodium, serving more F&V to their families), 23% adopted at least two such behaviors (reading food labels for sodium; using culinary herbs/spices; serving more F&V to their families), and 45% adopted both dietary (moderating sodium; eating more fruits) and biomedical behaviors. Participants and facilitators favorably evaluated the curriculum and suggested improvements. A multi-conceptual approach coupled with cultural and biomedical tailoring has potential to promote young African American women's movement to more advanced stages of change and improve self-efficacy for fruit and vegetable intake, dietary sodium moderation, and self-monitoring blood pressure and physical activity.