Behavior Change Skills Research Articles

Physical activity enhancement among Japanese college freshmen through the concept of “Physical Activity Pyramid” and behavior change skills

Physical activity enhancement among Japanese college freshmen through the concept of “Physical Activity Pyramid” and behavior change skills

行動変容技法を取り入れた体育授業が男子大学生の身体活動量と運動セルフ・エフィカシーにもたらす効果

行動変容技法を取り入れた体育授業が男子大学生の身体活動量と運動セルフ・エフィカシーにもたらす効果

Prospective study of individual, social, and environmental predictors of physical activity: women's leisure running

Background: Understanding and influencing the determinants of physical activity is an important public health challenge. We used prospective data to examine the influence of individual, social, and environmental factors on physical activity behaviour, using regular running as the behavioural model. Methods: Over 500 middle-aged women completed two consecutive questionnaires in 2000 and 2002. Logistic regression analyses were used to examine factors predicting adoption of and regression from regular leisure-time running during the follow-up. Results: Women who frequently used behavioural change skills were more likely to adopt regular running (OR=4.0, CI=1.7-9.5). There was an interaction between the enjoyment of running and family support: those who rated enjoyment of running high and reported high family support were less likely to adopt running (OR= 0.2, CI = 0.1-0.5). Women who reported infrequent use of motives were more likely (OR = 3.3, CI = 1.6-6.9) to regress from regular running. There was an interaction between perceived health and the neighbourhood environment: those who perceived themselves to be in poor health and had an unattractive neighbourhood were more likely (OR = 2.7, CI = 0.9-8.3) to regress from regular running. Conclusions: Behavioural skills and enjoyment may be of particular importance for the adoption of regular activity; social support and an aesthetically attractive neighbourhood are likely to have a key role in encouraging maintenance. (c) 2004 Elsevier Ltd. All rights reserved.

Employing behavioral methods to improve the context of care in a public psychiatric hospital: Realizing improvements in the interpersonal behavior of direct-care providers

Many behaviorally trained scientist-practitioners have noted the poor utilization of behavioral technology in inpatient psychiatric treatment settings. However, few studies have examined how behavior change skills can be applied to address this organizational behavior problem. This article outlines a series of projects to develop and implement a training program for direct-care psychiatric staff in the use of behavioral methods in their daily staff-patient interactions. It outlines not only the strategy of program development and implementation but also the organizational issues that enhanced its implementation over time. A variety of organizational behavior change considerations are discussed. The authors emphasize that behavioral methods have value not only for improving direct patient care but also for improving the support for such efforts within the organization. The importance of applying behavior change skills to organizational behavior to improve the context of care is discussed.

Employing behavioral methods to improve the context of care in a public psychiatric hospital: some applications to health care management.

While intervention procedures grounded in behavioral science have proven useful in the provision of direct care and in organizational management, they are seldom used effectively in many psychiatric care organizations. Behavioral practitioners often acknowledge this fact but few have applied their behavior change skills to change the behavior of the organization that is failing. This report outlines several examples of how behavioral technology was employed from an administrative perspective to encourage and strengthen needed changes in the interdisciplinary clinical care procedures of a public psychiatric hospital. The potential of these procedures for administering health care provision as well as the challenges encountered in realizing such applications are discussed.

Employing behavioral methods to improve the context of care in a public psychiatric hospital: Reducing hospital reliance on seclusion/restraint and psychotropic PRN medication

Many behaviorally trained scientist-practitioners have noted the poor utilization of behavioral interventions in psychiatric treatment settings. However, few have applied their behavior change skills to improve the organizational systems that are failing. This study first reviews the additive impact of a three-phase organizational change program, grounded in behavioral science, to reduce seclusion/restraint reliance in a public psychiatric hospital. It then describes a variation of the procedure that was subsequently applied to the problem of psychotropic prn medication reliance, both within the hospital and to a specific ward that evinces relatively high reliance. Significant reductions were realized in reliance on these procedures for the management of difficult cases. The results supplement previous evidence of the value of behavioral methods for individualized and ward-level program interventions by demonstrating that they also hold value for identifying relevant organizational problems and for instigating, strengthening, and maintaining organizational system changes to improve the quality of care. The advantages of a grounding in behavioral science and intervention methods for the provision of health care in management of public systems, as well as guidelines for behavioral clinicians who wish to enhance their impact on such systems, are discussed.

A randomized trial of two methods for engaging treatment-refusing drug users through concerned significant others.

In a randomized clinical trial, 90 concerned significant others (CSOs) of treatment-refusing illicit drug users were assigned to either (a) community reinforcement and family training (CRAFT), which teaches behavior change skills, (b) CRAFT with additional group aftercare sessions after the completion of the individual sessions; or (c) Al-Anon and Nar-Anon facilitation therapy (Al-Nar FT). All protocols received 12 hr of manual-guided individual treatment. Follow-up rates for the CSOs were consistently at least 96%. The CRAFT conditions were significantly more effective than Al-Nar FT in engaging initially unmotivated drug users into treatment. CRAFT alone engaged 58.6%, CRAFT + aftercare engaged 76.7%, and Al-Nar FT engaged 29.0%. No CSO engaged a treatment-refusing loved one once individual sessions had been completed.

“Sticking to it—Diabetes Mellitus”: A Pilot Study of an Innovative Behavior Change Program for Women with Type 2 Diabetes

The goal of this project was to evaluate an innovative educational program for women with type 2 diabetes facilitated by trained lay health advisors from the local university extension service. The program focused on adherence to behaviors recommended to achieve optimal blood glucose control. We evaluated whether primary care physicians would refer to this program, whether the program would reach diabetic women in rural areas, and whether the program improved health behaviors and glycemic control. Women over 40 with type 2 diabetes were recruited through their primary care physician's offices. Eligible participants were randomly assigned to intervention (program) or control (usual care) groups. The six-session educational program focused on encouraging behavior change through instructor and group support, learning specific behavior change skills, and developing a confident attitude about self-management of diabetes. Physicians supported referral to the program, and the utilization of a lay health advisor for delivery of the program in rural areas was feasible. At 6-month follow-up the mean change in hemoglobin A1c and body mass index did not differ significantly between the intervention (n=67) and control (n=65) groups. However, participants felt better about their ability to control their diabetes and demonstrated an improvement in behaviors related to control.

More training in behavioural change skills

More training in behavioural change skills

Teaching behavior change skills to first-year medical students: a small group experiential approach.

Develop and evaluate a course to help first-year medical students learn about health-related behavior change by focusing on their personal health goals. COURSE METHODS: Students each identified two health-related behavior change goals for themselves. Lectures presented relevant content concerning behavior change. In small group, experiential sessions, students formed five-person teams and rotated positions as "patient," "doctor," "manager" and observers. "Doctors" and "patients" had one or two follow-up visits. Students evaluated their goal attainment and the value of their experience as "patient" and as "doctor." 100 first-year medical students. Students chose exercise, nutrition, academic, interpersonal and psychological goals. Rating of the educational values and goal attainments were variable. Mean rating for educational value was 40%, and for goal attainment 55%. Experiential learning is valuable in introducing medical students to behavior change. Students learn from both the role of change agent and the role of "patient." Although the design of the course was cost-effective, with appropriate modifications considerably more impact could be gained from such a course. To improve this type of experiential learning we recommend careful attention to goal-setting, and more attention to developing the learners' feedback-giving and facilitation skills.

Do dietitians feel that they have had adequate training in behaviour change methods?

Aim To investigate dietitians’ perceived adequacy of pre‐ and postregistration training in a range of behaviour change techniques, current main approach to dietary treatment and perceived usefulness of future training in five core behaviour change modalities.Method A questionnaire was designed and distributed to all dietitians registered in the BDA membership base (n = 4202).Results Three hundred and ninety‐four questionnaires were returned. The majority of these respondents had obtained their degree since 1982 (77%), since when courses were more likely to have contained a psychological component. Despite the fact that facilitating dietary behaviour change is a key dietetic role, respondents felt that they had not received adequate training in behaviour change skills in their dietetic training. Training was perceived to be most satisfactory in active listening skills, but this was perceived as barely adequate. Training was perceived as particularly poor in: applying theories of cognitive and behavioural therapy (CBT); motivational techniques; group work skills; and in both theory and skills of relapse prevention. Although 40% of respondents reported receiving explicitly psychologically based training, skills‐based training (mainly counselling) was reported by only 25% and was limited by being mainly short 1‐ or 2‐day courses. Overall, where further training was obtained it was perceived to be more adequate than that reported within preregistration dietetic training.Conclusion Respondents felt that they had not received adequate training in behaviour change skills in their dietetic training. The application of CBT, motivational techniques and relapse prevention was perceived as particularly deficient in training and the majority of respondents felt that future training would be useful or very useful. In the current health service climate, where evidence‐based practice is crucial for all practitioners with the emphasis on improved quality of care with measurable outcomes, research must be funded and undertaken to support attempts to improve dietitians’ effectiveness as behaviour change agents.

Sticking to it: A Multifactor Cancer Risk-Reduction Program for Low-Income Clients

This study describes the results of implementing an educational program called “Sticking to It,” which was designed to engage participants in developing behavior change skills that may reduce risk for various types of cancer. Paraprofessional instructors delivered a 6-week interactive group program. Self-report questionnaires were completed at program start, program end, and 6-month follow-up to determine behavior change stages for cancer risk-reduction behaviors and confidence in performing behavior change skills. Three hundred eighty-six individuals participated in the program (62% completion rate). Participants self-reported success in making positive movement in stages of behavior change for the five health behaviors addressed in the program (fruit and vegetable consumption, physical activity, low-fat eating, smoking cessation, and sun exposure) and maintained these changes at the 6-month follow-up. Significant increases in confidence to perform most behavior change skills from pre- to postprogram and follow-up also were reported.

Results of a multifactor cardiovascular risk reduction program in the czech republic: The healthy dubec project

Czech cardiovascular disease (CVD) morbidity and mortality rates are among the highest in the world. A 2-year community-based project was designed to increase CVD awareness and knowledge and behavior change skills, thus stimulating change in CVD-related behaviors. Dubec, a Czech town located just outside Prague, was the study community. Risk-factor surveys were conducted before and after the intervention (1992 and 1994). The intervention combined communitywide health education and intensive medical treatment of individuals at high risk for CVD.

Knowledge of Cardiovascular Disease Prevention: An Analysis from Two New England Communities

Background. Cardiovascular disease (CVD) mortality has been decreasing in the United States, possibly due in part to educational programs about CVD prevention. This study investigates CVD risk-reduction knowledge among demographic subgroups in two New England cities and how the level of knowledge changed in these subgroups over time.Methods. Six independent cross-sectional surveys including a series of open-ended recall CVD knowledge questions were conducted biennially from 1981 to 1993 as part of the outcome evaluation for the Pawtucket Heart Health Program. We constructed a raw CVD knowledge score and then created an analysis of variance model with knowledge score as the dependent variable and explanatory variables including demographics, survey, and city.Results. CVD prevention knowledge improved significantly over time in both cities and in every demographic subgroup, increasing rapidly from 1981 to about 1988 and then plateauing between 1988 and 1993. Adjusted knowledge scores were higher for people born in the United States, women, more educated individuals, and those who spoke English at home. The increase in knowledge over time came mainly from an increase in the identification of physical inactivity, and blood cholesterol/high fat diet as CVD risk factors, while there was a decrease in the identification of overweight and blood pressure.Conclusions. In order to assure that reductions in CVD morbidity and mortality will be sustained, national educational efforts which stress behavior change skills as well as knowledge must continue. These programs should focus particularly on higher risk subgroups, and risk factors such as weight reduction and blood pressure control should be special priorities.

BEHAVIORAL SKILLS AND PHYSICAL ACTIVITY OUTCOMES DURING AN 18-MONTH PHONE/MAIL INTERVENTION FOR RECENT COLLEGE GRADUATES

1318 Data from an 18-month phone and mail intervention, Project GRAD (Graduate Ready for Activity Daily), were examined to determine to what extent use of behavior change skills explains change in physical activity outcomes. An innovation of this study was assessing use of skills contemporaneously rather than retrospectively. Recent college graduates (N=170; M age=24.1; 51% female) who had participated in the semester-long GRAD intervention were included in this follow-up study. Behavioral skills included goal setting, decisional balance, self-talk, stress management, time management, enjoyment, social support, activism, and relapse prevention. Use of skills was measured by structured telephone interviews throughout the 18-month intervention. Strength, vigorous, and moderate intensity activities, as well as total physical activity, were assessed using the 7-Day PAR (Blair, 1984). Women reported using a significantly greater number of skills than men (p<.01); specifically, more positive self-talk, decisional balance, enjoyment, social support, and relapse prevention (p<.05). Regressions revealed that women who reported more goal setting and relapse prevention reported more vigorous activity (p<.05). For women, strength, moderate, and total activity were not significantly predicted by the total number of skills used or any specific skill. Men who reported increasing enjoyment reported more moderate intensity activity (p<.05). Surprisingly, men who reported using more relapse prevention reported less vigorous activity (p<.01), and men who reported using more stress management reported less strength activity (p<.05). Results indicate that women may use more behavioral skills than men, and these skills differentially predict physical activity outcomes. This may have important implications for tailoring physical activity interventions for men and women, and may be useful for identifying which components of an intervention may be most related to physical activity outcomes. Supported by NIH #HL49505.

Evaluation of a University Course to Promote Physical Activity: Project GRAD

Project GRAD (Graduate Ready for Activity Daily) evaluates a university course to promote physical activity. In a randomized study, 338 university seniors participated in either an intervention or control course for academic credit, and posttest data were collected on 321. The control course was knowledge-oriented. The intervention course taught behavior change skills in weekly lectures and peer-led labs. Physical activity was assessed with 7-Day Physical Activity Recall interviews. The intervention had no significant effects on men. Among women, the intervention increased total physical activity during leisure, strengthening exercises, and flexibility exercises. This university course had the intended effects of promoting healthful patterns of physical activity among women, but no effects were observed on men, who were more active than women at baseline.

Teaching dental undergraduates behaviour change skills.

This paper describes an active learning-based education tool which enables dental students to learn preventive techniques relevant to patient dental health behaviour. 2 studies were conducted involving 33, 2nd year (study 1) and 9, 3rd year (study 2) undergraduate dental students. In study 1, snacking behaviour and its antecedents were analysed from detailed 3-day diet diaries completed by the students. Study 2 entailed the students changing one aspect of their sugar/diet behaviour using self-management techniques. It is concluded that dental students can successfully (a) identify antecedents to sugar snacking behaviours on several levels, i.e., cognitive, emotional and situational, (b) set goals and use behaviour change techniques to modify these behaviours, and (c) appreciate that this experience is relevant to similar preventive techniques that they will use in clinical practice. Training in the application of these skills to their own maladaptive behaviours provides a strong educational tool based on psycho-educational theories.

Integrating cognitive behavioural therapy into dietetic practice: a challenge for dietitians

Historically, State Registered Dietitians have not received in‐depth training in behaviour change skills. Training in this area has been viewed as peripheral rather than fundamental. Whilst a permanent long‐term cure for obesity remains elusive, cognitive behavioural therapy is state of the art in the treatment of obesity. It reliably achieves 10% pretreatment body weight loss in the short‐term. Interesting new developments are occurring in this field which may affect long‐term outcome favourably. This paper examines what can be achieved with traditional dietary therapy in the treatment of obesity, what can be achieved with cognitive behavioural therapy and considers whether dietitians should receive further training in key behaviour change theory and skills. It is recommended that the integration of the fields of nutrition and behavioural psychology is placed centrally on the agenda of State Registered Dietitians.

A global look at compliance in health/safety and rehabilitation.

The problem of compliance with safety and/or treatment programs is enormous. The purpose of this paper is to provide a foundation for development of a more global view of compliance. A literature review on the influence of motivation, attitude formation, and health beliefs and their impact on health behaviors is provided. Traditionally, compliance means that the patient does what the health professional wants. What is needed is for the patient to internalize a program. We must sell programs to the patient! Compliance with programs depends on the person's behavior-change skills and the supports or barriers encountered in the behavior change attempts. Knowing the person's concept of the condition and his power over it, known as the locus of control, is critical. Successful therapists help patients decide to follow a program. Successful sales people know their product, learn the prospect's dominant buying motive, combine facts with benefits, and present arguments that fit the person's belief system and norms.

Long-term follow-up of a pilot project on smoking prevention with adolescents.

Seventh graders (N = 353) in one junior high school received an experimental smoking prevention program aimed at teaching students to resist the social pressures to smoke cigarettes. Seventh graders (N = 217) in another school served as controls. Teams of high-school students trained in basic behavior change skills led seven classroom sessions of instruction in counter-arguing during the school year. Significant differences were found between groups in reported smoking at a 9-month posttest. Results were maintained at 21- and 33-month follow-ups.