Precontemplation Stage Research Articles

Decisional balance, self-leadership, self-efficacy, planning, and stages of change in adopting exercise behaviors in patients with stomach cancer: A cross-sectional study.

Previous studies have suggested the benefits of regular exercise in motivating the survivors of cancer; however, most survivors are insufficiently active, showing high rates of nonadherence to physical activity guidelines. Using the I-Change model, this study sought to determine the association of decisional balance and self-efficacy for exercise, planning, and self-leadership with the stages of change in exercise behavior among patients with stomach cancer. This cross-sectional study was conducted in February 2021 and included 145 patients diagnosed with primary stomach cancer via quota sampling in South Korea. Sociodemographics, comorbidity, decisional balance for exercise, self-efficacy for exercise, planning, self-leadership, and stages of change in exercise behavior were assessed. Of the participants, 4% were in the precontemplation stage of exercise behavior, 10% contemplation, 37% preparation, 23% action, and 27% maintenance. The male sex (p=0.043), higher self-efficacy for resisting relapse (p<0.0001), higher coping planning (p=0.029), and higher self-leadership for behavior awareness and volition (p=0.023) were associated with more readiness for changes in exercise behavior. From the results obtained using the I-Change model, self-efficacy for resisting relapse to previous habits, coping planning, and behavior awareness and volition were associated with more readiness for changes in exercise behavior. These findings may help reduce stomach cancer survivors' nonadherence to physical activity guidelines.

Smoking Status and Health Beliefs Related to Smoking of Nurses in Working a Cancer Hospital, in Turkey

Purpose: Few studies are available that evaluate oncology nurses’ health beliefs related to smoking and smoking status. The purpose of this study was to evaluate the health beliefs regarding smoking among nurses and status working in a cancer hospital. &#x0D; Methods: This descriptive study was conducted among 152 nurses in a cancer hospital in Turkey. Data were collected by using The Self-Report Questionnaire Regarding Health Beliefs and Smoking Cessation Self-Efficacy Questionnaire&#x0D; Results: Median age, body mass index, and working duration with cancer patients of the oncology nurses are 34.0, 23.9, and 9.0, respectively. Of the nurses, 54.1% stated that they have never smoked, while 27% smoke every day. Among regular smokers, 32.1% are in precontemplation stage. Of the participants, 91.9% noted that ‘smokers are more likely to have cancer, 45.9% that ‘it is difficult for smokers to quit smoking, and 52.3% that ‘tobacco bans are effective on quitting smoking. &#x0D; Conclusion: The majority of oncology nurses think that a healthy lifestyle is very important but a few of them follow the advice. Also even though the nurses mostly have healthy living beliefs they can’t reflect these on their behaviors. Nurses working with cancer patients must also be considered as risk groups when planning cancer prevention and tobacco control studies. It is important that nurses should be informed and supported to take part in smoking cessation interventions.

Self-changing Strategies to Quit Smoking Among Current Tobacco Smokers in General Population

Tobacco smoking is one of the important public health problems in India and the prevalence of smoking among adult males is high. Despite numerous community interventions and government legislation against smoking, cessation or prevention of tobacco smoking is still challengeable. Literature suggests that strong self-changing behaviours of smokers, facilitate the process of quit smoking. The aim of this cross sectional study was to explore self-changing strategies to quit smoking among current smokers in a selected rural population at Bangalore. A sample size of 35 from general population were conveniently selected to complete a Self-Changing Strategies of Current Smokers (SCS-CS) questionnaire about commitment to change, taking control, risk assessment, helping relationship and coping with temptation to quit smoking. Amongst all the participants (n=35) none of the females were identified. Around 12 (34.3%) of male study subjects smoked more than 10 times per day. Nearly three-fourth of current smokers (n= 25, 71.4%) never had previous quit attempts. Commitment to change strategy (mean 11.11±2.73) was high among subjects, (80% often thought to stop smoking) which facilitated to strengthen their pre-contemplation stage of change process. In-contrary participants were weak in coping process. Greater part (n=21, 60%) of the subjects ‘never’ keep themselves busy to overcome the urge to smoke thus failing to achieve the maintenance stage in change process (mean 5.57±2.83). Continuous followup and frequent cessation programme would aid to boost up the self-change strategies to quit smoking. Mental health professionals such as psychiatry nurses actively implementing the smoking cessation intervention in every care settings will increase the successful quitting.

Perceptions and Feasibility of Actions Related to Sodium Reduction among Restaurant Owners and Cooks in Seongnam, South Korea: Comparison According to Stages of Behavioral Change.

With the increase in meals eaten outside the home, sodium reduction in restaurant foods is essential for reducing sodium intake. This study aimed to assess the stages of behavioral change for reducing sodium and the differences in perceptions among restaurant staff by stage. Restaurant owners and cooks (n = 313) in Seongnam, South Korea were surveyed on their stage of behavioral change, practices, and perceptive factors related to sodium reduction in restaurant meals using a questionnaire. The proportion of behavioral change by stage was 20.4% in the maintenance and action (MA) stage, 32.3% in the preparation (P) stage, and 47.3% in the pre-preparation (PP) stage, which included contemplation and pre-contemplation stages. The items that represent differences among the groups were recognition of social environment for sodium reduction, practice of weighing condiments and measuring salinity, and feasibility of actions related to low-sodium cooking. Logistic regression analysis was used to estimate odds ratios for practice and perceptive factors by using stage of behavioral change as the independent variable. Factors associated with being in the MA stage were weighing condiments, measuring salinity, and high feasibility of actions related to low-sodium cooking. Recognition of sodium labeling and anticipation of better taste by reducing sodium increased the odds of being in the P stage rather than the PP stage. These results suggest that customized stepwise education and support are needed for the efficacy of restaurant-based sodium reduction programs.

Ergenler Arasında Fiziksel Aktivite, Egzersiz Öz-Yeterlilik Düzeyi ve Davranış Değişikliği Aşamalarının Değerlendirilmesi

Objective: This study aims to assess the level of physical activity, exercise self-efficacy, and the stages of change for exercise behavior among adolescents.Materials and Methods: This research was conducted as descriptive. The study population consisted of 529 students attending at a high school. No sample selection method was used. The whole of the population was tried to be reached and the study was carried out with 500 students. The data for the study were collected using a personal information questionnaire, the Exercise Self-efficacy Scale Questionnaire, the Exercise Stages of Change Short Form and International Physical Activity Questionnaire-Short Form.Results: The study found that 37,6% of the adolescents were physically active at a moderate level and 36,4% were in the pre-contemplation stage of exercise change phases. The mean exercise self-efficacy score among the adolescents was moderate (13,64±6,06). Data analysis showed that as the physical activity levels of adolescents increased, their exercise self-efficacy scores increased.Conclusion: It was found that exercise self-efficacy scores of adolescents increased as both exercise change stages and physical activity levels increased. It is recommended to provide training for adolescents in order to make their conditions suitable for physical activity, to provide appropriate time and to increase the desire of young people in this regard. It is recommended that the trainings be conducted taking into account the stages of change adolescents are in.

An application of the transtheoretical model to climate change prevention: Validation of the climate change stages of change questionnaire in middle school students and their schoolteachers

Certain behaviors, especially when adopted by a majority, can help limit the magnitude of climate change. In this cross-sectional study, the stages of change from the Transtheoretical Model (TTM) are applied to environmentally-significant behavior. We develop and test a new scale – the Climate Change Stages of Change Questionnaire (CCSOCQ) – for measuring five discrete stages involved in changing behavior to address climate change (precontemplation, contemplation, preparation, action, and maintenance). In total, 3,469 middle-school students (Mage = 13.4) and 347 schoolteachers completed the CCSOCQ and a measure of engagement with sustainable development. Analyses indicated the CCSOCQ captured the five stages outlined by the TTM and had adequate psychometric properties. Further supporting predictions of the TTM, engagement with sustainable development was lowest in the precontemplation stage and highest in the action stage. We conclude the TTM has potential for describing how and why people alter their behavior to address climate change. Supplemental data for this article is available online at https://doi.org/10.1080/13504622.2021.1998382 .

Are subsidies for climate action effective? Two case studies in the Netherlands

An often used policy instrument to promote climate change mitigation and adaptation action are subsidies. Yet, it remains unclear to what extent subsidies are effective in motivating behavioural change. Subsidies are effective if they lead to adoption of the behaviour by individuals different from those who would adopt otherwise. On the bases of two theoretical frameworks, we examine the effectiveness of two subsidy schemes in the Netherlands. In Study 1 (n = 151), we applied the Transtheoretical Model and argued that a subsidy for climate adaptation measures is effective if it not only attracts those in the action and preparation stages of the model, but also people in the precontemplation and contemplation stage. In Study 2 (n = 367), we applied the Diffusion of Innovations Theory and argued that a subsidy for electric vehicles is effective if it attracts not only innovators and early adopters, but also early and late majority adopters. In both studies, we examined the extent to which subsidies remove financial barriers and serve as a cue to action. In Study 1, we found that the subsidies primarily attracted people who were in the action and preparation stages. In Study 2, we found that a subsidy for electric vehicles did not attract more early and late majority adopters compared to those who adopted an electric vehicle without a subsidy. In both studies we found that the subsidy mainly served as a cue to action, and was less likely to remove financial barriers.

Cognitive and Emotional Appraisal of Motivational Interviewing Statements: An Event-Related Potential Study.

The counseling process involves attention, emotional perception, cognitive appraisal, and decision-making. This study aimed to investigate cognitive appraisal and the associated emotional processes when reading short therapists' statements of motivational interviewing (MI). Thirty participants with work injuries were classified into the pre-contemplation (PC, n = 15) or readiness stage of the change group (RD, n = 15). The participants viewed MI congruent (MI-C), MI incongruent (MI-INC), or control phrases during which their electroencephalograms were captured. The results indicated significant Group × Condition effects in the frontally oriented late positive complex (P600/LPC). The P600/LPC's amplitudes were more positive-going in the PC than in the RD group for the MI congruent statements. Within the PC group, the amplitudes of the N400 were significantly correlated (r = 0.607–0.649) with the participants' level of negative affect. Our findings suggest that the brief contents of MI statements alone can elicit late cognitive and emotional appraisal processes beyond semantic processing.

Evaluating Knowledge and Stages of Nutritional Behavior Change in Diabetic Patients Covered by Comprehensive Health Service Centers in Ghayenat City in 2020

Background: Diabetes is one of the most common chronic and non-communicable metabolic diseases and one of the major public health problems. Lifestyle and diet are remarkable factors in controlling diabetes. Objectives: This study aimed to determine the level of knowledge and stages of nutritional behavior change in diabetic patients. Methods: In this descriptive-analytical study, a simple random sampling method was used to select 330 diabetic patients covered by comprehensive health service centers in Ghayenat city, South Khorasan Province, Iran. The research instrument addressed the participants’ demographic information, knowledge, and stages of nutritional behavior change in diabetic patients. The ordinal logistic regression was used to examine factors affecting behavior change. In this regard, the significance level was set to be P &lt; 0.05. Results: The participants’ mean age was 57.86 ± 11.72 years, and 63.7% of the patients were female. The mean score of knowledge was 15.73 ± 2.61, and 52.8, 16.9, 8.9, 11.3, and 10.1 percent of the participants were in the maintenance, action, preparation, contemplation, and pre-contemplation stages. The ordinal Logistic regression model revealed that the main factors affecting behavior change were knowledge, level of income, and a family member with diabetes (P &lt; 0.05). Conclusions: Given that about two-thirds of diabetic patients take no training course on diabetes, that above forty percent of these individuals have no proper knowledge about the disease, and that half of the patients are in the pre-maintenance stages of behavior change, holding a training course is of paramount importance for patients.

Perceptions of Behavioral Awareness, Intention, and Readiness for Advance Care Planning: A Mixed-Method Study among Older Indigenous Patients with Late-Stage Cancers in Remote Areas of Eastern Taiwan.

The first Patient Right to Autonomy Act enacted in Asia in 2019 has enabled every Taiwanese citizen to plan for his/her end-of-life (EOL) in case of incompetency. Advance care planning (ACP) has been highly promoted for individuals with terminal, life-threatening illnesses, particularly in the mainstream society, and efforts have been made by the Taiwanese government to train health care providers in order to optimize patients’ quality of dying. However, such advanced decisions and discussions regarding life-sustaining treatment and EOL care remain scarce among older ethnically minority patients. A multiple-case study employing a mixed-method (n = 9) was undertaken to explore indigenous patients’ ACP perceptions. Both quantitative and qualitative information was obtained from indigenous patients, a minority group whose socio-economic and educational status are different from the general Taiwanese population. An initiative was made to describe ACP behavioral awareness, intention, and readiness of older terminal patients from four tribes with seven late-stage cancers in remote, mountainous areas of eastern Taiwan. Our findings showed that according to the Transtheoretical Model, terminal indigenous patients’ ACP readiness was at a precontemplation stage. Their lack of fundamental ACP awareness, insufficient healthcare resources, life-sustaining value in a Christian faith context, and the prevalent health disparity in the remote communities have negatively affected indigenous patients’ intention to participate in ACP. We provide suggestions to further promote ACP in this group and suggest that health information should be tailored at various readiness stages in order to overcome barriers and decrease ACP literacy discrepancies. This study calls attention to an understudied area of ACP behaviors, an overlooked need in EOL care for older cancer patients of unique cultural backgrounds, and the imperativeness to ensure cultural minority group’s EOL care is consistent with patients’ preferences.

Investigating Exercise Readiness and Life Stress among Undergraduate Students at an Historically Black University

ABSTRACT Background Given the disparity of research regarding Historically Black College and University (HBCU) students’ health and chronic disease risk, investigation of exercise readiness and life stress is warranted. Purpose This study investigated exercise readiness and life stress among undergraduate students at an HBCU. Method The quantitative cross-sectional study utilized a Stages of Change framework. A survey determined exercise readiness and life stress scores among HBCU undergraduates (n = 304). Results Most respondents (57%) were exercising regularly and classified in the Action and Maintenance stages. Approximately 44% reported normal Body Mass Index (BMI), and nearly 50% were overweight or obese. Life stress scores ranged from 1 to 31 (M = 14.23, SD = 6.05). Scores were highest in the Precontemplation stage (M = 15.64, SD = 4.31) and lowest in the Contemplation stage (M = 12.54, SD = 5.64). Median life stress scores were not statistically different between exercise readiness groups χ2 (4) = 55.61, p = .193. Discussion Freshmen, especially females, should be encouraged to continue exercising to maintain a healthy BMI and reduce chronic disease risk. Translation for Health Education Practice HBCU exercise interventions call for a socio-ecological approach based on current readiness stage distribution.

Applying "Stages of Readiness to Change" Model to Dentists' Decisions to Participate in Medicaid: An Exploratory Study.

BackgroundThe Stages of Readiness to Change (SOC) behavioral model describes behavior change as a process and distinguishes individuals based on their current behavior and readiness to change that behavior. SOC can be used to improve dentists’ participation in a state public dental benefit program (Medicaid) by targeting them at different SOC with interventions, strategies, and tools tailored to those stages. Therefore, this study assessed the usefulness of using SOC to describe dentists’ attitudes towards and participation in Medicaid. Dentists’ participation in Medicaid is of interest to policymakers, and this study demonstrates a method to identify potential opportunities for intervention.MethodsA modified SOC algorithm used data from a periodic survey of Iowa Dentists to categorize dentists (N=514) into: 1) pre-contemplation, 2) considering participation (SOC contemplation and preparation), 3) acting (SOC action and maintenance), and 4) risk of relapse (at risk for discontinuing participation). The four SOC stages were compared using ANOVA and post hoc Tukey’s test among: practice characteristics, Dentists Altruism scale, Attitude about Program Administration scale, Attitude about Medicaid patients scale and Perception of Importance of Medicaid Problems scale.ResultsAmong survey respondents, 36% were categorized as pre-contemplation, 6% were considering Medicaid participation, 12% were acting as Medicaid providers with minimal risk of relapse, and 46% were participating and at risk of discontinuing. Dentists’ attitudes towards program administration, Medicaid patients, and access to care varied across the SOC cycle.ConclusionNearly, 46% dentists in this analysis were identified as at risk of discontinuing participation – a much larger proportion than dentists considering Medicaid participation. Categorizing dentists using this approach has important implications for programmatic interventions. For example, policymakers targeting our study population could focus their efforts on reducing the likelihood of dentists dropping out of the program, with less emphasis targeting dentists in the precontemplation stage.

Enhancing Islamic financial literacy through community-based workshops: a transtheoretical model

PurposeThis study aims to propose a comprehensive education model to enhance Islamic financial literacy to elevate the prominence of Islamic finance.Design/methodology/approachThe study conceptualized a framework of Islamic finance education using Prochaska and DiClemente’s transtheoretical model (TTM) of change aided by a review of the essential literature on Islamic financial literacy. The study also includes critical reflection based on the real firsthand experiences of delivering 16 voluntary non-formal community-based Islamic finance workshops for Indonesian diaspora in the UK and the Republic of Ireland from December 2014 to July 2016.FindingsThis study provides an inclusive conceptualization of an Islamic finance education approach to creating awareness in communities of applying Islamic financial principles in daily life. It also elaborates stage-appropriate strategies that cover the pre-contemplation, contemplation, preparation, action and maintenance stages that vary by upon individuals based on their readiness to adopt Islamic finance principles.Research limitations/implicationsThis study is not merely based on a conceptual examination of literature but also incorporates critical reflection on a series of community-based Islamic finance workshops conducted by the authors. It therefore offers the potential to present an under-researched model used to enhance Islamic finance literacy as one of the pillars in supporting the development of the Islamic economic and financial sector.Practical implicationsThis study provides guidelines and various practical ideas that scholars and any concerned parties can use to offer community-based Islamic finance educational activities aimed at supporting the future organic growth of Islamic finance.Originality/valueThe study expands the use of Prochaska and DiClemente’s TTM (which has been widely cited in health-related behavioral research) and brings a unique theoretical lens, notably within the Islamic finance literature. The use of the TTM was established in psychology and health-related behavioral science, particularly in relation to elucidating how people cease unhealthy behaviors (e.g. alcohol and smoking addictions) and how they develop healthy behaviors. This paper brings the TTM into another context on how to stimulate individuals, particularly Muslims, to shift from “riba addiction” and develop sharia-compliant financial behaviors.

Personality as a predictor of HbA1c level in patients with type 2 diabetes mellitus.

Type 2 diabetes mellitus (T2DM) is the most common type of diabetes, accounting for around 90% of all cases worldwide. One means to strengthen the prevention and treatment of diabetes is via changes in self-management and lifestyle behaviors. However, lifestyle and personal health behaviors are strongly influenced by personality traits, and thus personality may play a significant role in such aspects as medication compliance, exercise habits, blood glucose monitoring, diet control, and maintenance of an ideal body weight.In this study, we examined whether certain personality traits of patients with T2DM are correlated with higher glycohemoglobin (HbA1c) levels.A total of 214 participants with T2DM were recruited from an outpatient setting. χ2 test and logistic regression analyses with 5 models were employed.The OR for the “neuroticism” trait was 3.199 (95% CI = 1.228–8.331, P = .017), and those with this trait were 3.199 times more likely to have higher HbA1c levels than those with the “openness-extraversion” personality trait. This strong relationship between neuroticism and a higher HbA1c level was also evident in models 2, 3, 4, and 5. One-way ANOVA also indicated that the group with the neuroticism personality trait had significantly different mean fasting glucose, HbA1c, triglyceride, and high-density lipoprotein cholesterol levels.We found that a personality characterized by neuroticism is an independent predictor of higher HbA1c level in this study. We also found that people in the pre-contemplation and contemplation stages of exercise have higher HbA1c levels.

Enhancing organizational readiness for implementation: constructing a typology of readiness-development strategies using a modified Delphi process

BackgroundKnowledge about the development of organizational readiness for implementation (ORI) is limited. ORI, referred to as the willingness and capacity of all relevant stakeholders to change practice, is critical for increasing the adoption rate of evidence-based practices and improving implementation outcomes. However, no methodology currently guides ORI’s enhancement or addresses differences in readiness needs across an organization. This study used the transtheoretical model (TTM) as a framework for classifying a well-established compilation of implementation strategies into three readiness stages: pre-contemplation, contemplation, and preparation.MethodsA modified Delphi method was used to establish consensus among a panel of purposefully selected research and field implementation experts. The Delphi process involved three rounds of online questionnaires. The third round also included a live video discussion to clarify definitions in an effort to increase consensus among experts.ResultsOf the 73 strategies reviewed, the experts identified 75% (n = 55) as relevant for pre-implementation and reached a high-level agreement on the assignment of 7% (n = 5) of the strategies to the pre-contemplation stage (ORI-1), 25% (n = 18) to the contemplation stage (ORI-2), and 52% (n = 38) to the preparation stage (ORI-3). Several strategies were identified as relevant to more than one stage.ConclusionsParticipating experts were able to reach high-level agreement on the relevance of specific sets of implementation strategies to each of the three ORI stages. The lowest number of strategies was assigned to ORI-1 and the highest number to ORI-3. Given the overlap of strategies across ORI stages, there is a need to better understand the specific utilization of such strategies at different stages. Future studies are needed to empirically evaluate the relevance and applicability of this expert-informed typology based on implementers’ experiences in the field.

Smoking Characteristics and Readiness-to-Quit Status Among Smokers Attending Preoperative Assessment Clinic - A Prospective Cohort Study.

BackgroundPerioperative smoking is associated with an increased incidence of general postoperative morbidity and mortality. The perioperative period is recognized as an important “teachable moment” that can motivate patients to adopt health changing behaviors.ObjectiveIn this study, we aimed to determine the prevalence of smokers among elective surgical patients in an Asian tertiary hospital. We also investigated their smoking characteristics, previous quitting attempts, readiness-to-quit status as well as knowledge of smoking-related postoperative complications.MethodsWe conducted a single-center prospective cohort study among all patients who attended a preoperative assessment clinic within a 2-month period (August to September 2020) using a preoperative smoking questionnaire.ResultsA total of 3362 patients participated in the study, of which 348 (10.4%) were current smokers. More than half (65.6%) of the smokers had previously attempted to quit smoking, with most (78%) having made more than one attempt. Forty-nine percent of current smokers were in the pre-contemplation stage of quitting and thirty-one percent were in the contemplation stage. Only twenty-one percent were in the preparation stage of quitting. Thirty-eight percent of patients recognized the importance of smoking cessation perioperatively but only twenty-eight percent were confident of quitting perioperatively. Less than sixty percent of smokers were aware of at least one type of smoking-related postoperative complication. Less than half of the patients (45%) had ever received advice on perioperative smoking cessation from the surgeons.ConclusionA thorough understanding of smokers’ smoking characteristics, barriers to quit and readiness-to-quit status are crucial to establishing a successful multidisciplinary perioperative smoking cessation program. Counselling should address knowledge deficits and be tailored to a patient’s stage-of-change in order to seize this precious perioperative “teachable moment”.

Case Study: Mexican Obese Child

ObjectivesIntroduction: The risk of overweight and obesity development, is determined by the exposure to many factors. Around 40% of Mexican kids are living with this disease. MethodsCase Description: A 14-year-old patient is referred to a nutritional support appointment. The patient had no interest on her health, but her brother wanted to help her. Assessment: The first 3 months of life exclusive breastfeeding, after that formula and juices. She began gaining weight at age seven. Height (1.62 m), weight (80.4 kg), fat mass (40%), waist (96 cm) and neck circumference (37 cm). Glucose 98 mg/dL, cholesterol 189 mg/dL, triacylglicerides 250 mg/dL, HDL 45 mg/dL and LDL 140 mg/dL. Energy intake 1800 calories with high sugar consumption (1 liter of soda/day). Sedentary behavior with 6 hours/day on a screen. She was on the pre-contemplation stage of the Transtheoretical Model. Diagnosis: Obesity, related to a high consumption of sugar and a sedentary lifestyle, evidenced by food analysis and family report. Intervention: We developed a strategy of food exchange based on colored-coins in order to get the patient involved in the process. The patient’s brother took responsibility to help his sister with food selection. SMART goals were stablished, involving less soda consumption and daily physical activity. Monitoring and Evaluation: During her follow-up (1st month), the patient reduced 1.7 kg, 3 cm waist, glucose, cholesterol, triacylglicerides and LDL levels. ResultsDiscussion: When treating overweight children, the family and environment play a crucial roll. Getting her brother involved in the process was a good strategy, because he spent most part of the day with her; and was aware of her eating patterns. In this specific case, a colored-coin and food lists strategy was implemented, taking into account her initial lack of interest. This strategy helped her cognitive development, thus she moved in to the action stage of the Transtheoretical Model. ConclusionsConclusions: Child obesity treatment requires a multidisciplinary approach, but most of all, family commitment. In this case, the brother roll was an essential part of the treatment success. Our responsibility as health workers is to guide lifestyle changes and help to implement them. With this kid, the colored-coin game was the key to getting her attention in her eating habits. Funding SourcesN/A.

The Role of Neural Reward Expectancy and Valuation in Readiness to Change Among Treatment Seeking Veterans With Alcohol Use Disorder (AUD)

Reward processing encompasses valuation, expectancy, effort, and response and has transdiagnostic relevance, including to addiction. We sought to identify the reward circuit basis of “gain” anticipation versus “loss” anticipation (anticipatory valuation bias) during the Monetary Incentive Delay (MID) task and the contribution of reward circuit anticipatory valuation bias in ambivalence toward reducing alcohol consumption (precontemplation stage of change).

Motivational Stage at Continuous Glucose Monitoring (CGM) Initiation in Pediatric Type 1 Diabetes Is Associated With Current Glycemic Control but Does Not Predict Future CGM Adherence or Glycemic Control

ObjectivesThe Timing of Initiation of Continuous Glucose Monitoring in Established Pediatric Diabetes (CGM TIME) Trial is a multicenter, randomized controlled trial in children with type 1 diabetes, comparing simultaneous pump and CGM with CGM initiation 6 months later (Paradigm, Veo, Enlite Sensor, Medtronic Canada). This study addresses the ability of SOCRATES (Stages Of Change Readiness And Treatment Eagerness Scale) to classify children and parents into distinct motivational stages and identify the stages’ association with glycated hemoglobin (A1C) at trial entry and outcomes 6 months after CGM initiation. MethodsNinety-eight of 99 eligible children 10 to 18 years of age and 137 of 141 eligible parents completed SOCRATES at trial entry and 6 months later. Parent-child agreement for motivational stage was determined by weighted kappa. Linear regression was used to examine association between motivational stage and i) A1C at trial entry and ii) change in A1C and CGM adherence 6 months after CGM initiation. ResultsMore than 87% of children and 88% of parents were classified into distinct motivational stages, with weak parent-child agreement. At trial entry, motivational stage was associated with A1C, which was 1.02% higher for children in the Action stage than in the Precontemplation stage (p<0.0001). When compared with children of parents in Precontemplation, A1C for children of parents in the Maintenance and Action stages were 0.83% (p=0.02) and 0.36% (p=0.048) higher, respectively. Precontemplation was associated with shorter diabetes duration. Motivational stage at CGM initiation did not predict change in A1C or CGM adherence 6 months later. ConclusionsSOCRATES can categorize children with type 1 diabetes and their parents into motivational stages. Although motivational stage was associated with glycemic control at trial entry, it did not predict future diabetes-related behaviour or A1C.

Variable-length Cognitive Processing Therapy for posttraumatic stress disorder in active duty military: Outcomes and predictors

Cognitive Processing Therapy (CPT) is an evidence-based therapy recommended for posttraumatic stress disorder (PTSD). However, rates of improvement and remission are lower in veterans and active duty military compared to civilians. Although CPT was developed as a 12-session therapy, varying the number of sessions based on patient response has improved outcomes in a civilian study. This paper describes outcomes of a clinical trial of variable-length CPT among an active duty sample. Aims were to determine if service members would benefit from varying the dose of treatment and identify predictors of treatment length needed to reach good end-state (PTSD Checklist-5 ≤ 19). This was a within-subjects trial in which all participants received CPT (N = 127). Predictor variables included demographic, symptom, and trauma-related variables; internalizing/externalizing personality traits; and readiness for change. Varying treatment length resulted in more patients achieving good end-state. Best predictors of nonresponse or needing longer treatment were pretreatment depression and PTSD severity, internalizing temperament, being in precontemplation stage of readiness for change, and African American race. Controlling for differences in demographics and initial PTSD symptom severity, the outcomes using a variable-length CPT protocol were superior to the outcomes of a prior study using a fixed, 12-session CPT protocol. ClinicalTrials.gov IdentifierNCT023818.