Promote Health Behavior Change Research Articles

Motivational Interviewing as a Problem Solving Intervention to Improve Adherence: Review of the Related Literature

Patient behavior changing through adherence therapy is very difficult. Identifying the most effective approach is very important regarding adherence. Motivational Interviewing (MI) is a clinical approach involving communication, collaboration, evocation, autonomy and increasing motivation alongside the final results of behavior change. The principles underlying MI include empathy, developing differences, avoiding debate and supporting self-efficacy. MI interventions allow for the changing of the relevant cognitions and self-regulation processes that leads to adherence to the treatment. Method: A literature review was conducted focused on journals published between 2013 and 2018. Fifty relevant journals were obtained and data was extracted from 25 relevant selected journals. The search was carried out by entering the keywords ‘adherence’, ‘motivation’ and ‘MI’ into the SCOPUS, ScienceDirect, Sage, ProQuest, Elsevier, SpringerLink and Google Scholar databases. Conclusion: MI studies show that MI-based interventions are effective in promoting health behavior changes. It is also associated with positive health outcomes such as low blood pressure, diet, decreased smoking, lower cholesterol, and better blood sugar control. Keywords: adherence, motivation, MI

The CHOICE Project: A Randomised Exploratory Pilot Trial Testing the Acceptability and Preliminary Efficacy of a Public Health Communication Intervention

Referral to palliative care frequently occurs late in the illness course, despite evidence to support the benefits of early integration. A systematic approach to community engagement is required. Narrative communication is increasingly understood as a promising way of promoting health behaviour change. However few empirical approaches have been developed and tested seeking to change attitudes or behaviours related to palliative care. To evaluate the acceptability (primary outcome), feasibility, and preliminary efficacy (secondary outcome) of narrative communication as a public health intervention to educate community about palliative care. Based on the MRC Framework for the development of complex interventions, a series of 2-minute visual educational stories were developed to address common misperceptions raised by earlier qualitative data. These were piloted with a community-based sample using a phase 2, online, computer-randomised controlled trial design involving six experimental (narrative) conditions. Descriptive statistics described the sample characteristics and intervention acceptability. A repeated measures analysis of covariance (ANCOVA) assessed preliminary change in attitude to palliative care (measured on a 10-point Likert scale) post intervention, controlling for baseline variables. Of 164 participants (median age 51, range 23-82; 75% female), 150 completed post-intervention data (92% completion rate), with a mean completion time of 14.5 minutes. Visual educational stories were shown to be an acceptable approach to public health communication about palliative care, with respondents reporting a median of 7 positive ratings (IQR 6, 9) out of the 10 acceptability items. A majority of participants reported the intervention was easy to understand (100%), believable (93%), and made them feel more likely to likely to consider palliative care if they became seriously ill (68%) or talk to someone else about palliative care (65%). Most agreed it taught them something new (68%) and make them stop and think (59%). ANCOVA analyses showed a significant main effect, whereby regardless of narrative assignment, mean attitudes toward palliative care were improved after viewing the educational information (m 9.4, sd 1.0) compared to baseline (m 8.9, sd 1.6), F(1,132)=21.0, p< .001, np2 =.15 (large effect). This study provides novel pilot data addressing an important gap in the literature around the question of how to engage community about palliative care. Narrative communication is an acceptable public health intervention to communicate information about palliative care and may improve community attitudes to engagement with palliative care services.

Determinants of incentive preferences for health behavior change in Japan.

Interest in the use of incentives to promote health behavior change has been growing worldwide. However, to develop an effective incentive program, accurate information regarding individual preferences is essential. Therefore, the aim of this study was to clarify determinants of incentive preferences for health behavior change. A self-completed questionnaire survey regarding incentives for health behavior change was conducted in a Japanese village in 2015. The outcome measures were individual preferences for features of incentives, including item, frequency, type and value. The types of incentives were defined as follows: assured-type (given for participation); effort-type (given if participants make some kind of effort); and outcome-type (given if participants make achievements decided a priori). The associations with respondents' sex, age, presence of lifestyle-related disease and stage in the transtheoretical model of health behavior change were investigated using multivariate analysis. A total of 1469 residents responded to the survey. Significant associations with preference for different incentive features were found as follows: for monetary items, female and elderly; for high frequency, female and maintenance stage; for effort-type, male, action stage and contemplation stage; and for outcome-type, maintenance stage and action stage. Our results appeared to identify determinants of incentive preferences for health behavior change. These findings are expected to promote the development of an incentive program more in tune with individual preferences.

Optimizing Tailored Communications for Health Risk Assessment: A Randomized Factorial Experiment of the Effects of Expectancy Priming, Autonomy Support, and Exemplification.

BackgroundHealth risk assessments with tailored feedback plus health education have been shown to be effective for promoting health behavior change. However, there is limited evidence to guide the development and delivery of online automated tailored feedback.ObjectiveThe goal of this study was to optimize tailored feedback messages for an online health risk assessment to promote enhanced user engagement, self-efficacy, and behavioral intentions for engaging in healthy behaviors. We examined the effects of three theory-based message factors used in developing tailored feedback messages on levels of engagement, self-efficacy, and behavioral intentions.MethodsWe conducted a randomized factorial experiment to test three different components of tailored feedback messages: tailored expectancy priming, autonomy support, and use of an exemplar. Individuals (N=1945) were recruited via Amazon Mechanical Turk and randomly assigned to one of eight different experimental conditions within one of four behavioral assessment and feedback modules (tobacco use, physical activity [PA], eating habits, and weight). Participants reported self-efficacy and behavioral intentions pre- and postcompletion of an online health behavior assessment with tailored feedback. Engagement and message perceptions were assessed at follow-up.ResultsFor the tobacco module, there was a significant main effect of the exemplar factor (P=.04); participants who received exemplar messages (mean 3.31, SE 0.060) rated their self-efficacy to quit tobacco higher than those who did not receive exemplar messages (mean 3.14, SE 0.057). There was a three-way interaction between the effect of message conditions on self-efficacy to quit tobacco (P=.02), such that messages with tailored priming and an exemplar had the greatest impact on self-efficacy to quit tobacco. Across PA, eating habits, and weight modules, there was a three-way interaction among conditions on self-efficacy (P=.048). The highest self-efficacy scores were reported among those who were in the standard priming condition and received both autonomy supportive and exemplar messages. In the PA module, autonomy supportive messages had a stronger effect on self-efficacy for PA in the standard priming condition. For PA, eating habits, and weight-related behaviors, the main effect of exemplar messages on behavioral intentions was in the hypothesized direction but did not reach statistical significance (P=.08). When comparing the main effects of different message conditions, there were no differences in engagement and message perceptions.ConclusionsFindings suggest that tailored feedback messages that use exemplars helped improve self-efficacy related to tobacco cessation, PA, eating habits, and weight control. Combining standard priming and autonomy supportive message components shows potential for optimizing tailored feedback for tobacco cessation and PA behaviors.

Small Incentives Improve Weight Loss in Women From Disadvantaged Backgrounds

Women from lower-income backgrounds have the highest rates of obesity. Thus, effective programs for this high-risk population are urgently needed. Evidence suggests that adding financial incentives to treatment helps to engage and promote health behavior change in lower-income populations; however, this has never been tested in women for obesity treatment. The purpose of this study was to examine whether adding small financial incentives to Internet weight loss treatment yields better weight loss outcomes in women from lower-income backgrounds compared with the same treatment without incentives. Weight losses in lower-versus higher-income women were also compared. Data were pooled from two randomized trials in which women (N=264) received either Internet behavioral weight loss treatment (IBWL) or IBWL plus incentives (IBWL+$). Weight was objectively assessed. Data were collected and analyzed from 2011 to 2017. Women from lower-income backgrounds had significantly better weight loss outcomes in IBWL+$ compared with IBWL alone (6.4 [SD=4.9%] vs 2.6 [SD=4.6%], p=0.01). Moreover, a greater percentage achieved a ≥5% weight loss in IBWL+$ vs IBWL alone (52.6% vs 38.1%, p=0.01). Interestingly, the comparison between lower-income versus higher-income groups showed that, in IBWL alone, women with lower income achieved significantly poorer weight losses (3.4 [SD=4.2%] vs 4.9 [SD=4.0%], p=0.03). By contrast, in IBWL+$, weight loss outcomes did not differ by income status (5.0 [SD=5.6%] vs 5.3 [SD=3.8%], p=0.80), and a similar percentage of lower- versus higher-income women achieved a ≥5% weight loss (52.6% vs 53.8%, p=0.93). An Internet behavioral weight loss program plus financial incentives may be an effective strategy to promote excellent weight losses in women with lower income, thereby enhancing equity in treatment outcomes in a vulnerable, high-risk population. These data also provide important evidence to support federally funded incentive initiatives for lower-income, underserved populations.

Acceptance and Commitment Therapy for Health Behavior Change: A Contextually-Driven Approach.

Promoting health behavior change presents an important challenge to theory and research in the field of health psychology. In this paper, we introduce a context-driven approach, the Acceptance and Commitment Therapy (ACT) model which is built on Relational Frame Theory. The ACT-based intervention aims to promote individuals’ new health behavior patterns through the improvement of the key construct of psychological flexibility, which is defined as the ability to contact the present moment more fully with acceptance and mindfulness as a conscious human being. Building on the psychological flexibility model, implemented through the six core ACT processes, individuals improve maintenance of long term health behavior change through committed acts in service of chosen values while acknowledging and accepting the existence of contrary thoughts, rules, and emotions as part of themselves but not determinant of their behaviors. Taking advantage of this context-driven approach of health behavior change, we recommend researchers and practitioners to design their health behavior change intervention programs based on ACT.

Understanding acceptability of and engagement with Web-based interventions aiming to improve quality of life in cancer survivors: A synthesis of current research.

This review sought to summarize existing knowledge to inform the development of an online intervention that aims to improve quality of life after cancer treatment. To inform our intervention, we searched for studies relating to Web-based interventions designed to improve quality of life in adults who have completed primary treatment for breast, prostate, and colorectal cancer (as these are 3 of the most common cancers and impact a large number of cancer survivors). We included a variety of study designs (qualitative research, feasibility/pilot trials, randomized trials, and process evaluations) and extracted all available information regarding intervention characteristics, experiences, and outcomes. Data were synthesized as textual (qualitative) data and analyzed by using thematic analysis. Fifty-seven full text articles were assessed for eligibility, and 16 papers describing 9 interventions were analyzed. Our findings suggest that cancer survivors value interventions that offer content specific to their changing needs and are delivered at the right stage of the cancer trajectory. Social networking features do not always provide added benefit, and behavior change techniques need to be implemented carefully to avoid potential negative consequences for some users. Future work should aim to identify appropriate strategies for promoting health behavior change, as well as the optimal stage of cancer survivorship to facilitate intervention delivery. The development of Web-based interventions for cancer survivors requires further exploration to better understand how interventions can be carefully designed to match this group's unique needs and capabilities. User involvement during development may help to ensure that interventions are accessible, perceived as useful, and appropriate for challenges faced at different stages of the cancer survivorship trajectory.

When Is Congruency Helpful? Interactive Effects of Frame, Motivational Orientation, and Perceived Message Quality on Fruit and Vegetable Consumption

Health messages framed to be congruent with people’s motivational orientation have been shown to be generally effective in promoting health behavior change, but some inconsistencies have been found. This study tested whether the perceived quality of a health message moderated the congruency effect in the domain of fruit and vegetable (FV) consumption. Undergraduate participants (N = 109) read a health message promoting FV intake in which the frame (gain vs. loss) was either congruent or incongruent with their approach/avoidance motivational orientation. Perceived message quality and intention to increase FV intake were assessed after message exposure, and self-reported FV intake was assessed one week later. A significant interaction between congruency and perceived message quality was found on both intention and FV intake. When messages were congruent, higher intentions and FV intake were observed when perceived message quality was high, but the reverse pattern was observed when perceived message quality was low. The findings support the potential utility of using congruently-framed messages to promote fruit and vegetable consumption, while also underscoring the necessity of using high-quality messages in order for congruency to influence health-related behaviors.

Chinese Health Improvement Profile for people with severe mental illness: A cluster-randomized, controlled trial.

The aim of the present study was to establish the feasibility of conducting a full-scale trial and to estimate the preliminary effect of a Chinese Health Improvement Profile (CHIP) intervention on self-reported physical well-being of people with severe mental illness (SMI). The study used a parallel-group, open-label, cluster-randomized, controlled trial (RCT) design. Twelve community psychiatric nurses (CPN) and their corresponding 137 patients with SMI were randomized into the CHIP or treatment-as-usual (TAU) groups. After training, the CPN completed the CHIP at baseline and 12months, and the findings were used to devise an individualized care plan to promote health behaviour change. Patients were assessed at baseline and 6 and 12months after starting the intervention. There was an observed positive trend of improvement on the physical component subscale of SF12v2 in the CHIP group compared to the TAU group after 12months, but the difference did not reach statistical significance (P=0.138). The mental component subscale showed a similar positive trend (P=0.077). CHIP participants were more satisfied with their physical health care than TAU patients (P=0.009), and the CPN were positive about the usefulness/acceptability of the intervention. There were significant within-group improvements in the total numbers of physical health risks, as indicated by the CHIP items (P=0.005). The findings suggest that it is feasible to conduct a full-scale RCT of the CHIP in future. The CHIP is an intervention that can be used within routine CPN practice, and could result in small-modest improvements in the physical well-being of people with SMI.

Development of a multi-component lifestyle intervention for preventing type 2 diabetes and cardiovascular risk factors in adults with intellectual disabilities.

We report on the development of the 'STOP Diabetes' education programme, a multi-component lifestyle behaviour change intervention for the prevention of type 2 diabetes and cardiovascular risk factors in adults with intellectual disabilities (ID). We combined qualitative stakeholder interviews with evidence reviews to develop the intervention, guided by the MRC Framework and informed by intervention mapping and two existing diabetes prevention programmes. We conducted two pilot cycles drawing on additional stakeholder interviews to inform and refine the intervention. The STOP Diabetes education programme employed a theoretical framework, using sound learning and behavioural principles and concrete kinaesthetic methods, to provide the grounding for innovative games and activities to promote health behaviour change in adults with ID. Qualitative data also suggested that two educators and one support person delivering a programme of one carer session followed by seven 2.5-h sessions over 7 weeks was acceptable to service users, carers and educators and appeared to benefit the participants. The STOP Diabetes education programme was successfully developed and is suitable for a definitive randomized controlled trial.

ANALYSIS ON USE OF THE FITBIT SYSTEM TO PROMOTE HEALTHY BEHAVIOR CHANGE IN OVERWEIGHT AND OBESE ADOLESCENTS

BACKGROUND: One in three Canadian Children are overweight or obese. Wearable activity trackers such as the FitbitTM system (wristband + App) may represent an effective tool for promoting healthier behaviors in overweight/obese youth. OBJECTIVES: In this pilot study, our primary objective was to establish the feasibility of using the Fitbit System to promote health behavior change in overweight/obese youth by assessing participant adherence to our intervention and the required human resources to support the study. Our secondary objective was to determine youth perspectives on the acceptability of, and satisfaction with the Fitbit System. DESIGN/METHODS: Participants wore Fitbit pedometers for 24-weeks, and for 12-weeks of follow-up. Data collected included weekly objective Fitbit data (i.e. step count, active minutes, time in bed, etc.) and subjective data (i.e. goal setting, motivating factors, frequency of data checking) using monthly questionnaires. A physical activity questionnaires (PAQ) and ASA24™-kid Self-administrated food log were completed at baseline and after 24-weeks of Fitbit use. RESULTS: 18 overweight and obese adolescents were recruited (12 F). Average step count decreased over time (R2­ = - 0.22, p = 0.02). Fitbit daytime (R2­ = - 0.85, p < 0.001) and nighttime (R2­ = - 0.69, p < 0.001) use declined progressively over 24-weeks and in the 12-week follow-up period. Food logging adherence was poor throughout. Participants were not motivated to set new goals. In the final survey, participants reported they enjoyed the Fitbit (median Likert Score 4 out 4) and 9/15 participants said they would continue to use Fitbit System. Pre- and post PAQ scores did not change significantly (t30 = 0.07, p = 0.47). Only 1 participant completed the post-study ASA24 questionnaire preventing pre and post intervention comparison. The research team provided 58 reminders to participants to sync their Fitbit data with their App, conducted 77 phone calls, sent and received 36 emails, and had 7 face-to-face meetings with study participants during the study period. CONCLUSION: Long-term Fitbit use attenuated over time. Participants’ self-reported use of Fitbit and goal setting was low. Poor response rates on surveys limited our analysis, despite frequent reminders by the research team. The human resources required to conduct this pilot study indicate a larger study is likely unfeasible. On its own, the Fitbit system may not be an effective means to promote adoption of healthier behaviors in overweight and obese adolescents.

Preventive Health Behaviors Among Low-Income African American and Hispanic Populations: Can Colonoscopy Screening Serve as a Teachable Moment?

Teachable moments (TMs) are situations with potential for promoting health behavior change. Little is known as to whether colonoscopy screening itself may serve as a TM, particularly among low-income or minority populations. Research in this area is needed to inform efforts to address the disproportionate burden of colorectal cancer (CRC) experienced by minorities. This study aims to describe attitudes related to physical activity (PA) and healthy eating among a low-income Hispanic and African American sample, assess whether colonoscopy completion may encourage changes in dietary behavior or PA, and determine the type of interventions minority participants would prefer to promote preventive behaviors. Average-risk African American and Hispanic individuals who are referred for a screening colonoscopy at a Primary Care Clinic between May 2008 and December 2011 were eligible. Data were collected at three time points: at recruitment, 2weeks before their colonoscopy, and 1month after their colonoscopy (n=537). The difference in change in PA from baseline to post-colonoscopy follow-up between those who had a colonoscopy and those who did not was significant (p=.04). Those who completed a colonoscopy increased their PA by 0.26days on average, whereas, those who did not decreased their PA by 0.46days. Findings suggest that the time following colonoscopy completion may be ideal to provide health promotion for PA and healthy eating. Future research is needed to explore the mechanisms that influence health behavior change as a result of colonoscopies to inform the development of interventions in this area.

Self-affirmation increases defensiveness toward health risk information among those experiencing negative emotions: Results from two national samples.

Self-affirmation can promote health behavior change and yield long-term improvements in health via its effect on receptiveness to risk information in behavior change interventions. Across 2 studies, we examined whether the emotional state of the person presented with health risk information moderates self-affirmation effectiveness. Data were collected from 2 U.S. national samples (n = 652, n = 448) via GfK, an Internet-based survey company. Female alcohol consumers completed an emotion induction (fear, anger, or neutral). They then completed a standard self-affirmation (or no-affirmation) essay-writing task, and subsequently received a health message linking alcohol to breast cancer. There was a significant interaction between emotion and self-affirmation conditions, such that self-affirmation reduced the specificity of health behavior change plans among those experiencing negative emotion (Study 1: B = -0.55, p < .001), with consistent but not significant effects for anger (Study 2: B = -.47, p = .069. Among self-affirmed participants, essays were rated as significantly less self-affirming for individuals experiencing negative emotion (or anger). Mediation analyses limited to the self-affirmation condition revealed an indirect effect of negative emotion condition on health behavior change plan specificity via self-affirmation ratings of essay content in Study 1: β = 0.04, p = .041. The salutary effect of self-affirmation on plan specificity was reversed with negative emotion. These findings may be attributed to disruption of the self-affirmation process. Individuals who enter interventions using self-affirmation in a negative emotion state may be less prepared to benefit from other intervention content, and may even be less likely to change health behaviors as a result of the intervention. (PsycINFO Database Record

Age- and treatment-related associations with health behavior change among breast cancer survivors

ObjectiveThe aim of this study was to identify demographic and treatment-related factors associated with health-promoting behavior changes after a breast cancer diagnosis. Changes in health behaviors were also evaluated according to weight, exercise, diet and alcohol consumption patterns before breast cancer diagnosis. Materials and methodsWe examined self-reported behavior changes among 1415 women diagnosed with breast cancer in the NIEHS Sister Study cohort. Women reported changes in exercising, eating healthy foods, maintaining a healthy body weight, drinking alcohol, smoking, getting enough sleep, spending time with family and friends, and participating in breast cancer awareness events. ResultsOn average, women were 3.7 years from their breast cancer diagnosis. Overall, 20–36% reported positive changes in exercise, eating healthy foods, maintaining a healthy weight, or alcohol consumption. However, 17% exercised less. With each 5-year increase in diagnosis age, women were 11–16% less likely to report positive change in each of these behaviors (OR = 0.84–0.89; p < 0.05), except alcohol consumption (OR = 0.97; CI: 0.81, 1.17). Women who underwent chemotherapy were more likely to report eating more healthy foods (OR = 1.47; 95% CI 1.16–1.86), drinking less alcohol (OR = 2.01; 95% CI: 1.01, 4.06), and sleeping enough (OR = 1.41; 95% CI: 1.04, 1.91). The majority of women (50–84%) reported no change in exercise, eating healthy foods, efforts to maintain a healthy weight, alcohol consumption, sleep patterns, or time spent with family or friends. ConclusionsMany women reported no change in cancer survivorship guideline-supported behaviors after diagnosis. Positive changes were more common among younger women or those who underwent chemotherapy.

A mixed methods study of peer-to-peer support in a group-based lifestyle intervention for adults with serious mental illness.

There is potential for peer support to enhance healthy lifestyle interventions targeting changes in body weight and fitness for adults with serious mental illness. The purpose of this study was to explore peer-to-peer support among individuals participating in a group lifestyle intervention that included social media to enhance in-person weight management sessions. A mixed methods study design was used to explore participants' perceptions and experiences of support from other group members during a 6-month group lifestyle intervention. Twenty-five individuals with serious mental illness reported their perceptions of the peer group environment and social support during the intervention. Seventeen of these individuals also participated in focus group interviews further exploring their experiences with group members. More than 80% of participants agreed that other group members were trustworthy and dependable, and 92% reported a high level of shared purpose and active participation in the group. Participants described how shared learning and group problem-solving activities fostered friendships and provided essential support for health behavior change. Sharing information, personal successes and challenges, and "being in the same boat" as other group members were key features of peer-to-peer support. Findings from this exploratory study suggest that participants enrolled in a group-based lifestyle intervention for people with serious mental illness experience peer-to-peer support in various ways that promote health behavior change. These findings highlight opportunities to enhance future lifestyle interventions with collaborative learning and social network technologies that foster peer support among participants. (PsycINFO Database Record

The impact of changing attitudes, norms, and self-efficacy on health-related intentions and behavior: A meta-analysis.

Several health behavior theories converge on the hypothesis that attitudes, norms, and self-efficacy are important determinants of intentions and behavior. However, inferences regarding the relation between these cognitions and intention or behavior rest largely on correlational data that preclude causal inferences. To determine whether changing attitudes, norms, or self-efficacy leads to changes in intentions and behavior, investigators need to randomly assign participants to a treatment that significantly increases the respective cognition relative to a control condition, and test for differences in subsequent intentions or behavior. The present review analyzed findings from 204 experimental tests that met these criteria. Studies were located using computerized searches and informal sources and meta-analyzed using STATA Version 11. Experimentally induced changes in attitudes, norms, and self-efficacy all led to medium-sized changes in intention (d+ = .48, .49, and .51, respectively), and engendered small to medium-sized changes in behavior (attitudes-d+ = .38, norms-d+ = .36, self-efficacy-d+ = .47). These effect sizes generally were not qualified by the moderator variables examined (e.g., study quality, theoretical basis of the intervention, methodological characteristics, and features of the targeted behavior), although effects were larger for interventions designed to increase (vs. decrease) behavioral performance. The present review lends novel, experimental support for key predictions from health behavior theories, and demonstrates that interventions that modify attitudes, norms, and self-efficacy are effective in promoting health behavior change. (PsycINFO Database Record

Visualizing actions from a third‐person perspective: effects on health behavior and the moderating role of behavior difficulty

AbstractVisualizing behavior from a third‐person (vs. first‐person) perspective can produce stronger motivation to enact the behavior. However, the effects of perspective on health behaviors have been mixed. Hypothesizing that the difficulty of the visualized behavior might moderate the effect of perspective, two experiments manipulated the difficulty of the visualized behaviors (fruit/vegetable consumption; exercise) plus perspective and subsequently measured motivation (Experiments 1 and 2) and behavior (Experiment 2). In both experiments, the third‐person perspective produced stronger motivation to perform the easier, but not the more difficult, behavior. This effect extended to behavior in Experiment 2. Under certain conditions, encouraging people to visualize behavior from a third‐person perspective could represent a useful and cost‐effective means of promoting health behavior change.

Telephonic Health Coaching: An Innovative Method to Promote Health Behavior Change among Participants in Supplemental Nutrition Assistance Program-Education (SNAP-Ed)

Participants will: -Identify the key elements of a telephonic health coaching intervention for SNAP-Ed clients. -Describe a method to evaluate SNAP-Ed clients' progress towards dietary and physical activity goals generated during the health coaching process.

Embedding Socio-Behavioral Frameworks in Community Rehabilitation: Evaluation of a Service Change Program

ABSTRACTBackground: Paradigms which emphasize the social determinants of health and client self-management, and approaches which promote health behavior change, are rarely operationalized within rehabilitation settings. The aim of this study was to investigate the processes required for this model of care change within an existing allied health community rehabilitation service. Methods: The service change program consisted of training elements in the areas of the social determinants of health, client self-management and health behavior change techniques as well as associated operational changes to reflect this paradigm shift. Results: The training packages implemented appear to have improved staff knowledge and skills within these socio-behavioral areas. Clinicians self-reported improvement with client care; however, these changes were not reflected in the chart audit. Conclusions: Clinician training is required to build both knowledge and skills in the areas of the social determinants of health, client self-management and health behavior change principles. In addition, clinicians should be equipped with frameworks to assist with operationalizing these principles.

Psychological and behavioral effects of genetic risk testing for obesity: a systematic review.

Interest is growing in the use of genetic risk testing for lifestyle-related chronic diseases, including obesity, to promote health behavior change. A systematic review of the literature was conducted to determine the effects that genetic risk feedback for obesity may have on psychological and behavioral factors influencing weight. The MEDLINE/PubMed online database was searched using predefined search terms. The studies revealed that risk feedback may increase motivation to improve health behaviors, especially among individuals at higher genetic risk. Overweight and obese individuals seemed to experience additional psychological benefits when provided an external explanation for their weight status. While the psychological benefits are promising, the clinical utility of genetic risk testing for obesity remains uncertain.