Measure Of Readiness Research Articles

Food insecurity and physical activity insecurity among rural Oregon families.

Among rural families, rates of both child obesity and household food insecurity (FI) are higher compared to non-rural families. These disparities result from a complex interplay of social and environmental conditions that influence behavior. The Transtheoretical Model suggests individual readiness to change underlies success in modifying obesity-preventing behaviors; however, whether an association between readiness to change obesity-related behaviors and FI status among rural families exists is unknown. We examined the association between readiness to change family-level nutrition and physical activity (PA) behaviors that predict child obesity and family FI status within a sample of rural families to better understand these relationships. Families (n = 144) were recruited from six rural Oregon communities in 2013. Families completed a FI screener and the Family Stage of Change Survey (FSOC), a measure of readiness to change family-level nutrition and PA behaviors associated with obesity. Demographic differences by FI status were explored, and regression was applied to examine relationships between FI and FSOC scores, adjusting for relevant covariates. Among FI families (40.2%), more were non-white (77.8% vs. 22.2%; p = 0.036) and had lower adult education (30.4% vs. 11.8% with > high school degree; p = 0.015) compared to non-FI families. After adjusting for education, race, ethnicity, and eligibility for federal meal programs, readiness to provide opportunities for PA was lower among FI families (p = 0.002). These data highlight a need to further investigate how food insecurity and low readiness to provide PA opportunities, i.e. “physical activity insecurity” may be contributing to the higher obesity rates observed among rural children and families.

Predicting unplanned readmissions to a pediatric cardiac intensive care unit using predischarge Pediatric Early Warning Scores.

Unplanned readmission to the pediatric cardiac intensive care unit (CICU) is associated with significant morbidity and mortality. The Pediatric Early Warning Score (PEWS) predicts ward patients at risk for decompensation but has not been previously reported to identify at-risk patients with cardiac disease prior to ward transfer. This study aimed to determine whether PEWS prior to transfer may serve as a predictor of unplanned readmission to the CICU. All patients discharged from a tertiary children's hospital CICU from September 2012 through August 2015 were included for analysis. PEWS assessment was performed following transfer to the cardiac ward, and starting in January 2014, PEWS scores were also assigned by bedside CICU nurse prior to transfer from the CICU. Scores exceeding a predetermined threshold prompted further stability assessment by provider team prior to transfer. Among 1320 discharges of 1082 patients during the study period, there were 130 unplanned readmissions during their hospitalization. Following implementation of pretransfer PEWS scoring, there was no significant reduction in unplanned readmission frequency (10.2% vs 9.2%, P = .39). A secondary analysis of PEWS scores revealed cardiac scoring as a strong discriminator of those likely to experience an unplanned readmission, independent of other significant clinical predictors of readmission (OR 1.78, 95% CI 1.17-2.71, P = .007). The resultant multivariate model was a good predictor of unplanned readmission (AUC 0.77, 95% CI 0.71-0.83, P < .001). While implementation of a pretransfer PEWS assessment did not reduce the frequency of unplanned readmissions in this small single-center cohort, a multivariate model including pretransfer elements of an early warning scoring system, along with other patient characteristics serves as a good discriminator of patients likely to experience an unplanned readmission following CICU discharge. Further prospective investigation is needed to define objective measures of pretransfer discharge readiness to potentially reduce the likelihood of unplanned readmissions.

Improving coverage measurement for reproductive, maternal, neonatal and child health: gaps and opportunities.

BackgroundRegular monitoring of coverage for reproductive, maternal, neonatal, and child health (RMNCH) is central to assessing progress toward health goals. The objectives of this review were to describe the current state of coverage measurement for RMNCH, assess the extent to which current approaches to coverage measurement cover the spectrum of RMNCH interventions, and prioritize interventions for a novel approach to coverage measurement linking household surveys with provider assessments.MethodsWe included 58 interventions along the RMNCH continuum of care for which there is evidence of effectiveness against cause–specific mortality and stillbirth. We reviewed household surveys and provider assessments used in low– and middle–income countries (LMICs) to determine whether these tools generate measures of intervention coverage, readiness, or quality. For facility–based interventions, we assessed the feasibility of linking provider assessments to household surveys to provide estimates of intervention coverage.ResultsFewer than half (24 of 58) of included RMNCH interventions are measured in standard household surveys. The periconceptional, antenatal, and intrapartum periods were poorly represented. All but one of the interventions not measured in household surveys are facility–based, and 13 of these would be highly feasible to measure by linking provider assessments to household surveys.ConclusionsWe found important gaps in coverage measurement for proven RMNCH interventions, particularly around the time of birth. Based on our findings, we propose three sets of actions to improve coverage measurement for RMNCH, focused on validation of coverage measures and development of new measurement approaches feasible for use at scale in LMICs.

Exploring Out-of-School Play and Educational Readiness

Play researchers and theorists have cautioned that children’s early play is changing in a manner that is detrimental to their development. Meanwhile U.S. governmental pressures and increasingly higher standards for education are changing the landscape of kindergarten and early learning. This study investigates the relationship between children’s out-of-school play and their educational readiness. Parents of kindergarten students in a suburban Midwestern school district completed the Child Play Survey on time their children spent in out-of-school play. Kindergarten teachers rated students on three domains of readiness using the newly devised Illinois Kindergarten Individual Development Survey (KIDS 2015): Attention to Learning—Self-Regulation (ATL-REG); Social and Emotional Development (SED); and Language and Literacy Development (LLD). Correlational and regression analyses suggest that time in out-of-school play is not positively associated to teacher ratings of academic and behavioral performance in kindergarten. Rather, increased time in outdoor play on school days and non-school days resulted in lower scores on all three readiness domains. Time in outdoor play was correlated to free-reduced lunch eligibility, the socioeconomic measure utilized in the study. Parent education level, income level, attendance at 3-year-old preschool and daycare attendance were found to positively influence readiness measures. Implications for future research are presented.

When I grow up: assessing American children's perspectives on college and career readiness through drawings

AbstractCollege and career readiness has become a key educational priority in the United States. Framed by neoliberal discourses, current conceptions of college and career readiness narrowly define literacy as discrete sets of cognitive skills and curricular knowledge and reduce literacy learning to scores on high‐stakes assessments. To disrupt these neoliberal ideologies, we invited 24 American children in a summer reading programme to share their perspectives on college and career readiness. Twelve boys and 12 girls created a series of drawings depicting their dream careers, the people helping them achieve their career goals and the specific literacy skills they perceived as necessary for future career success. Afterwards, the children discussed the meanings of their drawings through interviews. Analyses revealed that American children visually represented and verbally articulated college and career readiness as (1) aspiring towards productive professional work, (2) envisioning complex professional literacy repertories and (3) acknowledging the importance of family, community and school in college and career preparation. Our findings urge American schools to shift from standardised, high‐stakes measures of college and career readiness towards multiple, learner‐oriented measures which make visible the creativity, critical thinking and communicative literacies that children will need to fulfill their personal and professional aspirations.

Predicting Undergraduate Student Retention in STEM Majors Based on Career Development Factors

A research gap exists with regard to examining the influence of career interventions and career readiness assessments on student retention in college majors related to science, technology, engineering, and mathematics (STEM). To address this gap, the authors examined 3 variables as potential predictors of retention in STEM‐related majors: (a) a STEM‐focused career planning intervention, (b) students' initial major declarations, and (c) changes in scores on a measure of career readiness. Results revealed that all 3 independent variables were significant predictors of STEM retention but did not accurately predict students who would not be retained. These results have implications for undergraduate STEM initiatives, college counselors and career advisors, and researchers investigating the predictors of STEM retention. Future research should include additional predictor variables.

- (The Retirement Preparation of Korean Households - Focusing on the Life Span)

Korean Abstract: 본 연구는 한국 가계의 전반적인 은퇴준비도를 행복의 관점에서 접근함으로써 평균수명의 증가에 따른 삶의 질적 수준을 계량화하는 은퇴준비도 측정 방법을 제안하였다. 한국 가계의 행복수명을 실증적으로 측정하기 위한 모형을 검증하고 부족한 부분의 점검을 위하여 선행연구 고찰과 지표개발에 관한 전문가조사 및 예비조사를 실시하였으며 활동수명, 관계수명, 건강수명, 경제수명으로 각각 명명한 행복수명 지표의 네 가지 하위영역과 문항을 구체적으로 정의하고 정교화 하였다. 측정도구 구성에는 목표와 계획, 실행 정도의 합으로 각 영역별 행복점수를 측정하는 SPA 모델을 활용하였다. 연구결과 첫째, 행복수명의 평균은 평균 74.9세로 기대수명보다 평균 8.2세 더 낮고, 93%에 이르는 대다수 응답자의 행복수명이 기대수명보다 짧아 전 생존 기간 동안 행복한 삶을 이어나가는 것이 어려울 것으로 나타났다. 둘째, 비재무적 은퇴 준비에 있어서 남성의 활동수명과 관계수명, 건강수명이 여성보다 평균 3세~6.5세 낮았다. 남성의 은퇴 이후 시간활용, 가족관계와 대인관계 유지 노력이 필요하며 건강관련 행동 및 습관 교정도 이루어져야 할 것이다. 셋째, 재무적 은퇴 준비를 나타내는 경제수명은 최근 3년간의 물가상승률과 금리로 추정한 결과 평균 74.8세로, 평균 8.3년의 기간을 경제적 준비 없이 보내야 하는 것으로 분석되었다. 본 연구에서 측정한 행복수명 지표는 효율적인 방법으로 재무적, 비재무적 은퇴준비도를 측정할 수 있도록 하였으며, 경제수명에서 물가상승률과 금리 및 위험관리와 보험에 대한 고려까지 포함한 포괄적인 지표로 구성되었다는 데 의의가 있다. 특히 은퇴기에 지출이 크게 증가하는 중증질환 치료비와 장기간병비를 별도의 항목으로 측정하여 은퇴필요자금에 반영하였으며, 경제적 준비의 일환으로 보험으로부터의 비용 충당 정도를 함께 고려하였다. Korean Abstract: This study suggests a qualitative measure of the retirement readiness according to the life expectancy in terms of the happy life expectancy. The model was verified by empirically measuring the happiness life span of Korean households. In order to check the deficiencies, we conducted preliminary research, expert research, and preliminary research. Four sub-domains were named and elaborated, viz. activity life, relationship life, health life, and economic life. We used the SPA model to measure the happiness index of each area by summing its levels of satisfaction, planning and action. The results of this study are as follows: First, the average happiness life span is 74.9 years, which is 8.2 years lower than the average life expectancy. The happiness life span of 93% of the respondents is shorter than their life expectancy. Second, in terms of the non-financial retirement preparation, the relationship, activity, and healthy life span expectancy of the males are 3 ~ 6.5 years lower than those of the females. Third, the economic life expectancy for financial retirement was 74.8 years, with an average life expectancy of 8.3 years without economic preparation. The happy life index is a comprehensive index composed of the financial and non- financial retirement readiness measured in an efficient manner, including economic growth, interest rates, risk management and consideration of insurance. Especially, the medical expenses for severe illness and long-term care costs were measured separately from the retirement funds, and the cost of insurance was considered as part of the economic preparation.

Executive function predicts school readiness in autistic and typical preschool children

Children’s emerging executive functions (EF) have been shown to be critical for a whole range of other functions, including school readiness and later academic success. Here we examine for the first time whether individual differences in EF are uniquely associated with autistic children’s readiness to learn in school, beyond general and developmental influences in age and ability. Thirty autistic and 30 typical preschool children, matched on age and ability, were assessed on EF (working memory, inhibition, set-shifting) and school readiness measures. Autistic children performed significantly worse on school readiness measures and EF measures relative to typical children. Furthermore, individual differences in children’s EF skills, especially in inhibitory control and working memory, were uniquely related to variation in their school readiness for both autistic and non-autistic children. The findings from this cross-sectional study provide further support for the potential role of EF in explaining the variability in autistic children’s functional outcomes.

Nursing stress and satisfaction outcomes resulting from implementing a team nursing model of care in a rural setting

Objective: With increasing demands to provide a cost efficient nursing service, changes to nursing skill mix are being implemented globally. Team nursing as a model of care is seen as a way to address both patient care and safety issues. The aim of this study was to explore job satisfaction (JS) and stress outcomes of nursing staff when introducing team nursing as model of care within the Australian healthcare environment.Methods: An experimental study was utilised. Nursing staff (n = 63) were surveyed, using the Person Centred Nursing Index (PCNI) tool, prior to the implementation of a team nursing model of care and then again six months post implementation of the model (n = 64). Data was analysed to determine if there was a statistically significant difference in the average theme between pre and post surveys.Results: Nursing stress (NS) was reduced and JS was increased post implementation of the new model of care. JS and organisational traits, JS and work stress (WS), were positively related and increased post implementation. WS and nursing care (NC), organisational traits and NC were positively related but showed no statistically significant change after the implementation. This study demonstrated that in introducing a new model of care, levels of stress staff increased yet unexpectedly JS also improved.Conclusions: Decisions to adopt team nursing as the model of care should be based on a broad range of considerations not simply on fiscal considerations and should include staff readiness, staff mix and supportive measures to introduce a changed model of care.

Abstract NS1: Development of the Preparedness Assessment for the Transition Home After Stroke (PATH-s) Instrument

Introduction: Care transitions from the inpatient rehabilitation facility (IRF) to home after stroke are often ineffective and inefficient, resulting in unmet patient and caregiver needs, increased safety risks, high rates of preventable readmissions, and increased health care costs. There is no assessment instrument specifically designed to evaluate caregiver readiness for this transition. The purpose of this study is to describe the development of the Preparedness Assessment for the Transition Home after Stroke (PATH-s) instrument. Methods: A cross-sectional study was conducted to establish the psychometric properties of the PATH-s instrument using a convenience sample of 60 caregivers of stroke patients with moderate to severe impairment during IRF admission. A sequential, multi-method approach to instrument development beginning with item generation from qualitative research findings followed by (a) review of items by expert case managers, (b) development of an alternative Likert format, (c) selection of the format that provides greatest clarity, and (d) cognitive appraisal interviews with caregivers with associated instrument revision was used to develop a measure of readiness for the transition from IRF to home for stroke caregivers. Results: The novel PATH-s instrument is a 15-item, 4-point scale that has demonstrated validity. Next steps include additional psychometric testing of the PATH-s to understand the predictive validity to stratify the degree of risk of adverse health effects for stroke survivors and caregivers following transition from the IRF to home. Conclusion: The PATH-s may support a primary prevention strategy to identify gaps in preparedness for stroke survivor-caregiver dyads during this high risk transition, with the long-range goal to mitigate the effects of suboptimal preparation and the associated adverse effects associated with this transition on the health of stroke survivor and caregiver. Once gaps are identified, care plans can be tailored to address gaps and better prepare caregivers for the transition home. This optimized approach to transitions management will address the National Quality Strategy “Triple Aim” to improve quality of care, improve health, and reduce costs for the care delivery system.

Social Skills and School Readiness in Young Children Exposed to Violence.

Witnessing violence is associated with negative outcomes for preschool-aged children, including lowered school readiness; however, not all children evidence negative outcome, indicating the presence of protective factors. This study examined social skills as a moderator of the relation between violence exposure and school readiness in preschoolaged children. Seventy-eight children completed a measure of school readiness, and their caregiver completed measures of social skills, witnessed violence exposure, and direct victimization. Results revealed that social skills moderated the witnessed violence- school readiness association, controlling for direct victimization and family income. When children evidenced more appropriate social skills, witnessed violence and school readiness were inversely related. However, for children whose caregivers endorsed less appropriate social skills, there was no association between witnessed violence and school readiness.

Common Core Standards and their Impact on Standardized Test Design: A New York Case Study

With adoption of the Common Core (CCSS) in a majority of U.S. states came development of new high-stakes exams. Though researchers have investigated CCSS and related policies, less attention has been directed toward understanding how standards are translated into testing. Due to the influence that high-stakes tests exert on classroom teaching, research is needed to investigate what kinds of changes in test content are associated with CCSS, as well as the potential impact of these changes on students and teachers. Accordingly, this case study examines changes made to one high-stakes exam by comparing pre- and post-CCSS literacy tests administered to high school students in New York. The study responds to the following: (1) How did the adoption of CCSS alter the design of high school literacy exams in New York? (2) To what extent do exams represent measures of college readiness as opposed to early college equivalence? (3) What are the implications of CCSS exam adaptations for the goal of preparing students to be college and career ready? Findings suggest that the rush to implement more rigorous CCSS exams resulted in an exceedingly long and difficult exam that is more representative of early college equivalence rather than of college readiness.

Grey matter abnormalities in children and adolescents with functional neurological symptom disorder.

ObjectiveFunctional neurological symptom disorder refers to the presence of neurological symptoms not explained by neurological disease. Although this disorder is presumed to reflect abnormal function of the brain, recent studies in adults show neuroanatomical abnormalities in brain structure. These structural brain abnormalities have been presumed to reflect long-term adaptations to the disorder, and it is unknown whether child and adolescent patients, with illness that is typically of shorter duration, show similar deficits or have normal brain structure.MethodHigh-resolution, three-dimensional T1-weighted magnetic resonance images (MRIs) were acquired in 25 patients (aged 10–18 years) and 24 healthy controls. Structure was quantified in terms of grey matter volume using voxel-based morphometry. Post hoc, we examined whether regions of structural difference related to a measure of motor readiness to emotional signals and to clinical measures of illness duration, illness severity, and anxiety/depression.ResultsPatients showed greater volumes in the left supplementary motor area (SMA) and right superior temporal gyrus (STG) and dorsomedial prefrontal cortex (DMPFC) (corrected p < 0.05). Previous studies of adult patients have also reported alterations of the SMA. Greater SMA volumes correlated with faster reaction times in identifying emotions but not with clinical measures.ConclusionsThe SMA, STG, and DMPFC are known to be involved in the perception of emotion and the modulation of motor responses. These larger volumes may reflect the early expression of an experience-dependent plasticity process associated with increased vigilance to others' emotional states and enhanced motor readiness to organize self-protectively in the context of the long-standing relational stress that is characteristic of this disorder.

Maternal support of young children’s planning and spatial concept learning as predictors of later math (and reading) achievement

The goal of this study was to examine maternal support of spatial concept learning and planning at 36 months as predictors of children’s math achievement at 4 ½ years and first grade. Observational measures of videotaped mother-child interactions from the Boston site of the NICHD Study of Early Child Care and Youth Development (N=140) were used to examine the effectiveness of support for spatial concept learning and planning during a block building play activity. Trained observers rated maternal support of children’s learning of spatial concepts through spatial language and gestures, with higher ratings involving explanations and encouragement of children’s use of spatial concepts. This measure was predictive of math achievement at 4 ½ years when controlling for length of the parent-child observation, child gender, ethnicity, and IQ at 2 years, as well as maternal years of education, verbal intelligence, income-to-needs averaged from 1 to 36 months, parenting stress, general cognitive stimulation, and maternal support of numerical concepts during the same observation. Maternal support of children’s planning skills, also rated by trained observers during the block building activity, involved identifying incremental steps to reach the block building goal, with higher ratings given for encouraging planning on the part of the child. This measure was predictive of math achievement at 4 ½ years, as well as reading achievement at both 4 ½ years and first grade, suggesting that maternal planning support has associations with the two key measures of school readiness, while maternal spatial support may be specific to mathematics.

Early college high school achievement outcomes in North Carolina: End of grade and ACT performance

High school reform in the United States has a long and unremarkable history with regard to improving the outcomes of traditionally underrepresented youth. Beginning in 2002, North Carolina began to implement the Early College High School model. In 2012 the state of North Carolina adopted a new accountability program that includes the ACT as a measure of college readiness in addition to the long-standing end-of-course assessments in English, algebra, and biology. Several reports and research studies have been conducted to evaluate the performance outcomes of early college students to traditionally prepared high school students and found in general early college students do as well if not better than their peers. This study examines four years of performance outcomes using the North Carolina End of Grade Tests and one year of ACT results for all students in the testing program. Of particular interest was examining the achievement gaps between Hispanic, Black, and White students over time and then assessing EOC and ACT performance as an indicator of college readiness. The findings indicate that (a) early college high school students tend to perform better on EOC and ACT assessments, (b) that the benefits of attending an early college can in many cases mitigate the effects of race, gender, and poverty, and (c) early college students may be more college ready than traditionally prepared peers.

Migrant preschool children's school readiness and early elementary school performance

ABSTRACTLittle is known about the early educational performance of children in migrant farmworker families. The authors examined the school readiness and early school success of 289 four-year-old preschool children of migrant families attending Redlands Christian Migrant Association centers. Children's school readiness was assessed and public school records were used for longitudinal follow-up. Children improved on age-4 school readiness domains, and although some struggled with emergent English literacy, many performed well on school readiness measures and later coursework. Children quickly became proficient in oral English, and had above-average school attendance. Many scored low on high-stakes tests; however, typically well enough for grade promotion. Students in the sample were comparable to similar students in poverty. School teachers and administrators should have high expectations for students from migrant families because many of them do stay in the public school system, and appear to be quite resilient despite many challenges they face.

Predictors of HIV Care Engagement, Antiretroviral Medication Adherence, and Viral Suppression Among People Living with HIV Infection in St. Petersburg, Russia.

Over 1 million HIV infections have been diagnosed in Russia, and HIV care uptake and viral suppression are very low. 241 HIV-positive individuals in St. Petersburg were enrolled through social networks, provided blood for viral load testing, and completed measures of medication-taking adherence, readiness, and self-efficacy; psychosocial well-being; and substance use. Outcomes included attending an HIV care appointment in the past 6months, >90% ART adherence, and undetectable viral load. 26% of participants had no recent care appointment, 18% had suboptimal adherence, and 56% had detectable viral load. Alcohol use consistently predicted all adverse health outcomes. Having no recent care visit was additionally associated with being single and greater past-month drug injection frequency. Poor adherence was additionally predicted by lower medication-taking self-efficacy and lower anxiety. Detectable viral load was additionally related to younger age. Comprehensive interventions to improve HIV care in Russia must address substance abuse, anxiety, and medication-taking self-efficacy.

A global assessment of adaptation investment from the perspectives of equity and efficiency

Equity and efficiency should be considered when allocating resources for climate change adaptation. More than a decade after the Least Developed Countries Fund approved adaptation funds for 18 countries in 2003, it is possible to take the stock of investment data and to test empirically whether equity and efficiency have been factored into adaptation investment decision-making. To evaluate equity, one must determine if resources were distributed to areas of greatest need. Vulnerability assessments provide information on the global distribution of the need for adaptation. To evaluate efficiency, one must compare cost and benefit of an investment. Although it is difficult to assess ex-ante the cost and benefit of investment strategies, it is possible to measure efficient use of expenditures with readiness assessment, as a metric of capacity to deploy adaptation resources. We used vulnerability and readiness measures of the Notre Dame Global Adaptation Initiative (ND-GAIN) Country Index as proxies of equity and efficiency. This article quantitatively interrogates—through the lens of public fund allocation—the roles of vulnerability and readiness in shaping adaptation investment decisions. Our findings suggest that countries facing increasing impacts from climate change have received more adaptation investments from international sources than countries with less vulnerability. Further, international investments also preferentially flow to countries that are more ready to deploy adaptation resources. Since the most vulnerable countries are likely to be less ready for investment, our findings support the efforts to improve the investment potential of the most vulnerable countries by investing first to enhance their readiness, in order to unlock adaptation solutions.

Associates of Engagement in Adult-Oriented Follow-Up Care for Childhood Cancer Survivors

PurposeUnderstanding how to predict appropriate uptake of adult-oriented medical care is important for adult patients with pediatric-onset chronic health conditions with continued health vulnerability. We examined associates of engagement in adult survivors of childhood cancer following transfer to adult-oriented care. MethodsAdult survivors of childhood cancer (N = 80), within 1–5 years post transfer from pediatric to adult-oriented follow-up care, completed assessments of engagement with recommended adult-oriented follow-up care and psychosocial and transition readiness measures. Measures were validated with adolescent and young adults and/or intended to measure readiness to transition to adult care. ResultsEarlier age at diagnosis, parental involvement in health care decision-making, higher motivation, and increased comfort speaking to providers about health concerns were significantly associated with attendance at adult-oriented follow-up care visits. ConclusionsAssociates of engagement in adult care are complex, representing social-ecological variables. Current measures of transition readiness or adolescent and young adult health-related measures may not adequately capture the associates of engagement in care or identify targets of intervention to promote successful transfer of care. Identifying patients at risk for loss to follow-up will be useful to design interventions for young adult survivors of childhood cancer and other young adults with pediatric-onset chronic conditions who require ongoing adult-oriented care.

Patient centered care: A path to better health outcomes through engagement and activation.

Patient Activation and Health confidence are constructs to assess patient engagement and are utilized to encourage patient engagement. A health care provider may increase patient engagement further by utilizing behavior change theories and models such as the Trans-Theoretical Model of Change (TTM), Self-Determination Theory (SDT) and Motivational Interviewing (MI) to realize effective and lasting health behavior change by placing accountability increasingly on the patient/caregiver to choose to make changes in their health behavior on their terms. Reducing or eliminating harmful behaviors such as smoking and/or beginning or increasing beneficial health behaviors such as diet modification or performance of an exercise program, patients realize improved outcomes and better health. The purpose of this article is to define health confidence as a measurement tool for patient engagement, use the TTM as a measure of the patient's readiness to change, use TTM, SDT and MI as interventional approaches to effect patient change of behavior encouraged by physical therapists and incorporate the ICF as a means of identifying barriers and facilitators and incorporate the bio-psychosocial model for patient-centered care to improve health behavior, health and patient outcomes. Patient-centered care requires involvement of the patient and/or their caregiver at the center of the plan. Use of the International Classification of Functioning, Disability and Health (ICF) to identify facilitators and barriers unique to the patient/caregiver offers another opportunity to successfully engage the patient by incorporating the patient's bio-psychosocial support system into care delivery and for sustainability. The ICF is a taxonomy and classification system that prompts clinicians to identify environmental factors (facilitators and barriers) that will influence the patient's ability to perform during therapy session and to sustain the interventions and employ suggestions outside of formal therapy sessions. Using the facilitators to encourage sustainable change and removing barriers, patients are more likely to realize positive health behavior change and in turn demonstrate improved outcomes and health as a result of physical therapy intervention.