Readiness For Behavior Change Research Articles

Obesity management in the pediatric patient.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. The purpose of this review is to discuss treatment modalities for obesity in children and adolescents, including nonpharmacological, pharmacological, and surgical interventions. The prevalence of pediatric obesity has dramatically risen, with rates of 20.7% and 22.2% among children and adolescents, respectively. Obesity is a complex medical condition with multifactorial risk factors, including diet and exercise, social determinants of health, and environmental and genetic factors. The management approach among children and adolescents with obesity includes nutrition counseling, increased physical activity, and readiness for behavioral change. Pharmacotherapy may be recommended, yet the literature has not elucidated the most appropriate first-line treatment. Metformin and orlistat have been studied and may be considered in pediatric patients with comorbid complications, including type 2 diabetes and nonalcoholic fatty liver disease. Phentermine and topiramate in combination, as well as glucagon-like peptide-1 receptor agonists, have provided modest benefits in weight reduction among youth. Setmelanotide has a unique mechanism of action and may be considered for those with obesity due to genetic disorders. Bariatric surgery should be reserved for adolescents meeting criteria for severe obesity. Treatment for obesity in children and adolescents includes a comprehensive approach with structured lifestyle programs, mental health support, and mitigation of social determinants of health. Pharmacotherapy may also be considered, yet no medication is recommended over another, giving flexibility for shared decision-making with the patient and family regarding comorbidities and potential drug interactions. Adolescents with severe obesity who meet specified criteria may also be referred for surgical evaluation.

Behavioral change readiness among obese adolescents in Jakarta, Indonesia

BACKGROUND Prochaska’s transtheoretical model of behavioral change process, consisting of stages and processes of change, should be monitored to evaluate obesity management, particularly in adolescents. Two of four processes of change are supporting relationships, which promote behavioral change, and weight management actions, which are activities that push individuals to a particular direction in patients’ weight loss progress. This study aimed to determine the participants’ current stages of change, nutritional status, and their relationship with the processes of change.
 METHODS This cross-sectional study used secondary data collected in 2018 from 115 obese adolescents aged 15–21 years in Jakarta, Indonesia, using an Indonesian-translated and validated questionnaire adapted from Andrés et al’s study. The questionnaire evaluated participants’ processes of change, focusing on scores of supporting relationships (5 items) and weight management actions (10 items).
 RESULTS Of the participants, 71.3% were classified as obese grade I, and 28.7% were obese grade II. Most participants were in the contemplation (31.3%) and action (31.3%) stages. The mean supporting relationships and weight management actions scores were different between participants with obese I and obese II (66.67 versus 80, p = 0.004; 64.17 versus 70, p = 0.008, respectively). Meanwhile, no differences were identified in supporting relationships and weight management actions scores in all stages of change.
 CONCLUSIONS Adolescents with obesity and higher BMI (based on the obesity grading of the WHO Asia Pacific) tended to have significantly higher scores for supporting relationships and weight management actions, indicating that external reinforcement and immediate weight loss actions played pivotal roles in readiness for behavioral change.

Lifestyle and preventive behaviors among adults during the early phase of the COVID-19 movement control order (MCO) in Malaysia.

Enforcement of the movement control order (MCO) in Malaysia caused by COVID-19 impacted people's health, social, behaviors, and economic consequences. Thus, this study aims to identify adults' lifestyle and preventive behaviors during the MCO's early phase. This study was conducted in April 2020 using a convenience sampling technique. A total of 9987 adults aged 18 years and above from all over Malaysia participated in the study. The questionnaire was distributed through online platforms, such as Facebook, Telegram, WhatsApp, and the official website. Descriptive statistics and Chi-square test were used to describe the categorical data and the independent T-test and one-way ANOVA tests were performed to compare continuous variables between two or more groups. The level of statistical significance was set at P < .05. Selangor showed the highest participation (28.4%) and most of the respondents were females (68.2%), married (67.8%), and aged between 36 and 45 years old (34.1%). This study found that 10.3% were smokers, and 46.7% of the smokers intended to quit smoking. Most respondents took their three main meals daily (72.4%), but not even half completed daily food groups (45.1%). The frequent activities were internet surfing (18.8%) and house chores (18.2%). Almost 98% of the respondents agreed to implement preventive behaviors. This study also revealed that attitudes toward preventive behaviors significantly differed across genders, age groups, categories of marital status, and monthly income categories (P < .05). Furthermore, regarding readiness for behavior change after MCO end, only gender shows a significance difference (P < .05). This study shed light on understanding public behavior during the early phase of the pandemic that may significantly impact public health in designing relevant regulations and policies to reduce the spread of COVID-19 infections and preparing strategies for future outbreaks or pandemics. As COVID-19 evolves, continuous efforts to promote positive behavioral changes in lifestyle and preventive behavior are needed to ensure the public practices a healthy lifestyle and complies with pandemic preventive measures.

A Pilot Evaluation of a University Health and Wellness Coaching Program for College Students.

Poor mental well-being has been associated with negative student success outcomes among college students. Health and wellness coaching programs have been implemented in college campuses to address gaps in well-being support services. This pilot study evaluated a health and wellness coaching program at a large, urban university. A total of 499 students expressed interest in the program with 120 responding to a retrospective survey about their experience. Findings revealed that most students attended coaching for issues related to time and stress management or factors that commonly influence stress. Overall, students who participated in coaching were successful at improving their self-efficacy toward behavior change, changing their behavior, and achieving their goals. Students reported attending an average of four sessions with number of sessions attended being associated with increased confidence and motivation. In addition, autonomy, competence, and relatedness felt within the relationship with the coach were correlated with increased motivation, confidence, and readiness for behavior change. There was some relapse in terms of goal attainment observed with 17.4% of students who met their goals being unable to maintain progress. The program participants appeared to have enjoyed the process with 96% of students saying they would recommend the program to a friend. Health and wellness coaching programs may alleviate the burden of stress and other subclinical mental health concerns as well as decrease the number of students requiring services from more intensive mental health resources on campus.

Applying Stages of Change Model to Examine Online Peer Communication on Binge Eating

ABSTRACT Despite the distress and disruption associated with eating disorder (ED), people struggling with EDs are often ambivalent about their eating issues and unmotivated for recovery. Rather than seek professional help, these people tend to turn to online ED groups for information and support. Using the stages of change model, this study investigates the characteristics of online peer communication around binging vis-à-vis participants’ motivation and readiness for behavioral change. Our results illustrate how individuals with binging issues in different motivational stages discuss their problematic eating online and provides insights into their ambivalence toward treatment and relapses into binging. This study further clarifies how people with binging issues feel trapped in a cycle of dieting-binging, which is observed to be undergirded by unresolved weight-related issues, and how they cope with the stressful relationship between eating and body weight through their postings on social media. These findings suggest that healthcare providers should promote healthier methods of addressing the weight gain from binge eating and provide support tailored to individuals’ motivational stage in breaking the dieting-binging cycle.

Impact of a brief training on motivational interviewing and the 5A's approach on weight-related counseling practices of pediatricians.

BackgroundPediatric primary healthcare providers are well‐positioned to provide healthy lifestyle and weight management related counseling but many lack training in evidence‐based messages and methods.ObjectivesWe assessed the impact of a brief, easy‐to‐access training for pediatric healthcare providers, (the Strong4Life Provider Training), designed to introduce/review current evidence‐based messages and methods and improve healthy weight‐related assessment and counseling practices.MethodsFollowing their well‐child visit, a convenience sample of children 12–17 years and parents of children 6–11 years (N = 121) of randomly selected Strong4Life trained (N = 15) and untrained (N = 15) pediatricians were administered a survey designed to assess the frequency, content, and patient satisfaction with weight management‐related counseling provided. Results from parents and patients of trained pediatricians (N = 62) compared to those from parents and patients of untrained pediatricians (n = 59) were compared using chi‐square tests. Generalized estimating equations were used to account for lack of independence among respondents from the same practice. P‐values less than 0.05 were considered to be statistically significant.ResultsParents/patients of trained pediatricians were more likely than those of an untrained pediatrician to report having been asked about child's consumption of fruit/vegetables, 57 (92%) versus 44 (75%), p = 0.04 and sugary drinks, 50 (81%) versus 29 (49%), p = 0.005, and their readiness for behavior change, 47 (76%) versus 29 (49%), p = 0.005, and to set a behavior change goal, 36 (59%) versus. 23 (40%), p = 0.005. Regardless of training status, physical activity, screen time, and weight status were assessed for most patients, and most were satisfied with the discussion. Few (21%) were asked about barriers to behavior change.

Tailoring Stroke Counseling for Risk Reduction Intervention to African American Men

Early life course achievement and maintenance of ideal cardiovascular health is associated with reduced risk of developing stroke later in life. The Stroke Counseling for Risk Reduction (SCORRE) intervention is an age-and-culturally relevant intervention originally designed to correct inaccurate stroke risk perceptions and improve lifestyle behaviors to reduce stroke risk in AAs age 20-35. In a study testing SCORRE, fewer men participated, but most were not at a stage of readiness for behavior change; many did not think they were at risk despite averaging three modifiable risk factors, and while improvements in outcomes were observed in women they were not in men. These differences led to tailoring SCORRE to young AA men. The methods for tailoring SCORRE and resulting strategies for attracting, engaging, and empowering them towards stroke risk reduction, including hypotheses concerning food supply, housing, economic and social relationships, education, and mental health care will be raised for discussion.

Neural and Behavioral Correlates of Impaired Insight and Self-Awareness in Substance Use Disorder.

Clinical insight is an emerging interest in substance use disorder research, but is difficult to study empirically. We reviewed recent research examining the behavioral and neural correlates of several psychological processes tapping into self-awareness that may in turn contribute to insight. Individuals with substance use disorder exhibit deficits in self-monitoring (especially self-report / behavior dissociations), metacognition, alexithymia, readiness for behavior change, and interoception. Behavioral impairments have been further linked to neural abnormalities in a diverse network of brain regions encompassing cortical midline areas, insula, and frontal cortex, among others. Various treatment modalities may target these deficits, though corresponding effects on neural circuitry remain to be determined. Compromised insight in substance use disorder may be relevant to a constellation of behaviors that suggest a lack of behavioral awareness linked to drug use. Future work needs to refine and advance the measurements, continuing to investigate insight problems in addiction that may become important therapeutic targets.

Healthy behavior – a conscious choice or unwanted trouble? Study among active population in Bulgaria

Abstract Background Official statistics in Bulgaria, as well as a number of empirical studies, show wide spreading of behaviour risk factors and their associated diseases in Bulgarian population. Legislative measures and health promotion programs aim to curb the unhealthy behavior and to incite conscious healthy choices. The purpose of this report is to investigate the attitude of active age people to behaviour change and the barriers they encounter in its implementation. Methods Data were collected by direct individual self-administered questionnaire, within a larger research project on health of active population in Bulgaria. It includes 326 employees in a study representing different branches, companies and professions. Questions have asked about distribution of risk factors and attitude to potential behavior change. Data processing was performed by SPSS v.24. Results Number of people willing, considering or already making a change depends on the factor studied. Respondents ready to make a change in their diet are 44.6%. Over ¼ of them have already started or trying to confirm this change. In the last 12 months 56.3% have made efforts to improve their physical activity, but in 75.7% of cases the activities were irregular, low-intense and don't fully comply with WHO recommendations. The desire to improve physical activity is significantly higher in people performing intellectual work (p &amp;lt; 0.05). Although 47.5% of the study subjects identify themselves as smokers, 64.1% of them don't have a sense of risky behavior and have no intention to eradicate this habit, 9.8% consider that negative effects will not affect them and 26.1% define behavior change as a long, difficult, expensive and inconvenient process they can't cope with. Conclusions Study results confirm high distribution of behavior risk factors in Bulgarian active population. A conscious readiness for behavior change is closely related to the factor, professional characteristics of people and their health knowledge. Key messages There is a wide spreading of life-style risk factors in active age population in Bulgaria. Behavior change and adoption of healthy behavior is a necessity and a conscious choice for many people. A conscious readiness for adoption of healthy habits depends on the factor, knowledge about its harmful effect, profession, as well as difficulties that people face in the process of behavior change.

Profiles of readiness: Using a blended framework to explore what it takes for faculty to be ready to change instructional practice

In answer to calls for research about professional change, this study addressed the question: What is involved in college science faculty readiness for change in instructional practice? The setting was a professional development experience in oceanography/marine science and paleoclimatology among 32 faculty from 2- and 4-year colleges. Ten of the 32 participated in interviews, and all provided survey responses and documents used in the study. Cycles of inductive analysis generated three example case stories to illustrate a new model for exploring faculty readiness for change in teaching. The model blends results from the health sciences on readiness for behavioral change with research on the personal, external, professional, and consequence domains of a professional change environment. The blended model attends to how an instructor draws on the domains to (a) see an instructional challenge as requiring intentional action to be resolved; (b) notice new significance (for the instructor) in some aspect of instructional practice; (c) feel able to manage instructional stressors/challenges; (d) have commitment to initiate/sustain change; and (e) perceive adequate support in undertaking change. Profiles of instructional readiness for change are represented by composite cases named Lee, Pat, and Chris. In the case of Lee, factor (c) drove change efforts; for Pat, factors (a) and (b) were in the forefront; and for Chris it was factors (d) and (e). The three cases are valuable both as sketches of the blended model in use and as touchstones for future research and development related to postsecondary faculty professional learning.

A structural equation modeling associating obesity and body dissatisfaction with health-related biopsychosocial parameters in adolescents

This cross-sectional study investigated the associations of obesity and body dissatisfaction (BD) with health-related biopsychosocial parameters in adolescents, and the magnitude of these associations. The sample was composed of 239 overweight/obese adolescents aged between 15 and 18 years. Data was analyzed by means of a structural equation model, composed of obesity as the exogenous variable and five endogenous variables: BD, health-related quality of life (HRQoL), physical fitness (PF), readiness for behavior change (RBC), and eating habits. The model adjustment indicators were considered adequate (RMSEA = .03, χ2(df) = 124.6(94), CFI = .96, TLI = .95, GFI = .94). We identified a direct and negative relationship between obesity and BD (r = −.698, p < .001), and a direct relationship between these variables and HRQoL (Obesity: r = −.539, p < .001; BD: r = −.563, p < .001), PF (Obesity: r = −.424, p = .015; BD: r = −.393, p = .020), RBC (Obesity: r = −.445, p = .10; BD: r = −.448, p = .007), and eating habits (Obesity: r = .311, p = .032; BD: r = .363, p = .028). BD seems to play an important mediating role in health-related biopsychosocial parameters in adolescents. In addition, the negative consequences of BD on HRQoL, PF, eating habits and RBC appear to occur in a similar magnitude to those caused by obesity itself.

0536 Motivation at Pretreatment and its Correlates in a Trial of Digital CBT For Insomnia: Preliminary Findings

Abstract Introduction Pretreatment motivation is a critical variable in any intervention seeking to modify behaviors. Lack of motivation may hamper the effects of cognitive-behavioral therapy for insomnia (CBT-I), especially when delivered online. This study aims to investigate baseline correlates of pretreatment motivation and its influence on treatment outcomes in the context of digitalized CBT-I. Methods This is a secondary analysis of an ongoing pragmatic trial conducted in primary care clinics of Québec City, Canada. The trial was designed to assess the efficacy of a stepped-care intervention for chronic insomnia in which participants received a digital CBT-I (SHUTi), alone or in addition to sleep medication they were already using. Pre-treatment motivation was measured using two items based on the perceived importance of improving sleep and readiness to change behaviors to improve sleep (Score range: 0 to 20; cronbach’s alpha 0.79). Baseline questionnaires included an extended version of Insomnia Severity Index (ISI), Fatigue Severity Scale (FFS), Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9). Treatment outcome was measured by a change in ISI scores (i.e. ISI post - ISI pre). Results A total of 28 participants were included in the analysis. All participants preferentially selected ISI either as monotherapy (n=13)or in combination with their usual sleep medication (n=15). Participants’ motivation before treatment was high (Mean: 18.04; SD: 1.93). We did not find any associations between motivation and ISI score change or incidence of dropout. However, baseline fatigue was positively correlated with pretreatment motivation (r = 0.51, p = 0.005) and more severe insomnia symptoms were also associated with higher motivation (r=0.43, p=0.03). Specifically, perceived importance was associated with both nighttime and daytime insomnia symptoms while readiness for behavioral change was only associated with daytime impairments on energy, mood and social activities (all p = 0.01). Baseline anxiety and depressive symptoms were not correlated with motivation. Conclusion Insomnia-related daytime impairments and elevated fatigue levels appear to be linked to pretreatment motivation, especially for behavioral changes. Further study with greater statistic power is warranted to understand the relationship between participants’ motivation and treatment adherence or outcomes. Support CIHR0083000212

IMPACT OF SOFTWARE FOR MOBILE DEVICES ON THE BEHAVIOR OF ADOLESCENTS IN OBESITY PREVENTION

ABSTRACT Objective: to analyze the impact of educational software on the behavior of adolescents about obesity prevention in two public schools of Divinópolis-MG. Method: uncontrolled clinical trial involving 238 adolescents, in the city of Divinópolis, MG, Brazil. Between June and October 2018, weight and height were measured, 24-hour dietary recall was performed, physical activity level was verified, socioeconomic classification and the stage of readiness for behavioral change was evaluated. The McNemar test was used to compare the qualitative variables. For the effect of the intervention on the quantitative variables, the Generalized Estimating Equations model was used. In the intervention, the educational game Healthy Running was used, developed for this study. Data were collected before and two months after the intervention. Results: among the participants, 62.6% are female, with a median age of 16.7 years, ranging from 15 to 19 years. Regarding the nutritional situation before the intervention, 18.5% had excess weight. As to the level of physical activity is concerned, 50.4% were classified as active. After the intervention, the z-score of body mass index for males showed a significant improvement (p&lt;0.000), as well as the level of physical activity (p&lt;0.001). Conclusion: the use of the educational game was valid and presented relevant results in improving the adolescents' behavior regarding food and physical activity. The use of the educational game can be considered appropriate to support education in the health area.

Readiness for Behavior Change in Patients Living With Ischemic Heart Disease.

Readiness for behavioral change may be evaluated by assessing the patient's stage of change, as described in the transtheoretical model. Identifying readiness to change in patients with ischemic heart disease may enhance the effectiveness of interventions that target risk reduction and lifestyle modification. This study was designed to assess the readiness of patients with ischemic heart disease to change health behaviors as well as to identify the factors that significantly predict this change. A descriptive correlation design approach was adopted, and a convenience sample of 122 patients with ischemic heart disease was recruited from an outpatient cardiac clinic. Readiness for behavioral change was evaluated by assessing the stages of change of the participants, as described in the transtheoretical model. Data on readiness to change were collected using the "readiness for lifestyle change inventory." A total of 62.2% and 43.4% of the participants were in the precontemplation phase of change for "cease smoking" and "be physically active," respectively; about 33% of the patients were in the maintenance phase for "control weight"; 36.1% were in the maintenance phase for "reduce consumption of high-fat foods"; and 51.6% and 57.4% were in the maintenance phase for "eat fruits and vegetables" and "practice relaxation," respectively. Participants who were overweight or obese showed higher readiness to practice physical activity, and those with high cholesterol levels showed a higher readiness to reduce the amount of fat in their diet. Higher income was found to predict higher readiness to eat fruits and vegetables. Patients are not adequately ready to change their health-related behaviors. Higher cardiovascular risk predicts higher readiness to change health behaviors.

Extending alcohol brief advice into non-clinical community settings: a qualitative study of experiences and perceptions of delivery staff

BackgroundAt a population level, the majority of alcohol-related harm is attributable to drinkers whose consumption exceeds recommended drinking levels, rather than those with severe alcohol dependency. Identification and Brief Advice (IBA) interventions offer a cost-effective approach for reducing this harm. Traditionally, IBA interventions have been delivered in healthcare settings and therefore contextual influences on their use in non-clinical settings are not well understood.MethodsQualitative face-to-face and telephone interviews with staff responsible for delivering a pilot IBA intervention across community settings in the UK. Interviews were recorded and transcribed verbatim. Inductive thematic analysis was used to identify key issues and the constant comparison method was employed to compare barriers and facilitators to implementation across and within settings.ResultsA number of facilitators and barriers to delivery and implementation was identified across settings. These included familiarity with the customer base, working within public spaces, and assimilation of the intervention within existing role boundaries. Despite underlying concerns relating to the sensitive nature of the topic, most delivery staff felt their respective settings were appropriate for the delivery of the intervention and had proactively engaged members of the public with varying levels of risky drinking and readiness for behaviour change. Perceptions of actual or potential intervention success were conceptualised in relation to existing day-to-day role boundaries and responsibilities and the contexts in which they took place.ConclusionsFindings support the potential value of multi-setting community approaches to facilitate more inclusive engagement with IBA. By comparing experiences and views from staff responsible for delivering the intervention across different community settings, our findings provide insight into how intervention acceptability and success are framed across settings, and how the intervention is assimilated within everyday practice and role boundaries. This study also highlights key areas to be addressed when implementing IBAs in non-clinical community settings by staff with diverse levels of health-related knowledge, skills and support needs. Although essential, the need for adaptable training and delivery approaches across different setting types is likely to result in methodological challenges that need to be addressed when evaluating future interventions and setting-specific influences on behaviour change and health outcomes.

Discretionary Salt Intake and Readiness for Behavioral Change Among Women in Tehran.

Background:Since women's readiness for dietary behavioral change can be one of the most effective fundamental measures for reducing dietary salt intake in line with preventing chronic diseases in developing countries, the present study is aimed to determine the readiness for behavioral change in discretionary salt intake among women living in Tehran.Methods:The present cross-sectional study was conducted on 561 women referring to the women care units across city of Tehran. The self-administered questionnaire included assessment of nutrition-related knowledge on salt intake and its association with diseases, discretionary salt intake, stages of change, and self-efficacy of women. In addition, the logistic regression test was used to determine the predictors of women's readiness for behavioral change in discretionary salt intake.Results:40% women had someone in the family who had such a limitation (salt intake-limited exposure group), while 81.6% always or often added salt to their foods. Moreover, one-third of the participants were in the stage of pre-contemplation and 41.2% were in the stage of preparation for reducing salt intake. Self-efficacy and salt intake-limited exposure were the two most important determinants of the women's readiness for behavioral change in discretionary salt intake, respectively: (OR = 1.1 95% CI: 1.06--1.14 P < 0.001; OR = 1.58, 95% CI: 1.03--2.42 P < 0.03).Conclusions:Results of the present study showed that increased self-efficacy is associated with higher levels of behavioral change among women. Since self-efficacy is very important for initiating and maintaining the behavioral change, women's empowerment for reducing salt intake necessitates putting the emphasis on increased self-efficacy as well as community-based nutritional interventions.

Ready or Not: Examining Self-Reported Readiness for Behavior Change at Intake Assessment for Adults With an Eating Disorder.

We explored whether a single-item self-report measure (i.e., the Readiness Ruler) was an appropriate measure of treatment engagement in adult outpatients with eating disorders. In total, 108 women diagnosed with an eating disorder completed the Readiness Ruler and measures of symptom severity at intake to a hospital-based outpatient treatment program. Treatment engagement was operationalized as attendance to a minimum of one session of a cognitive-behavioral therapy (CBT) treatment group, the number of CBT group sessions attended, and whether the participants dropped out of the CBT group prematurely. Results suggest that the Readiness Ruler was not associated with attending the CBT group. Among the participants who attended the program, the Readiness Ruler was not associated with the number of CBT group sessions attended or CBT group dropout. Higher Readiness Ruler score was associated with more severe symptomatology. In conclusion, the Readiness Ruler may not be a good predictor of CBT group treatment engagement for individuals with eating disorders and may instead be a proxy for symptom severity.

Evaluation of a Multimodal, Direct-to-Patient Educational Intervention Targeting Barriers to Osteoporosis Care: A Randomized Clinical Trial.

Osteoporosis treatment rates are declining, even among those with past fractures. Novel, low-cost approaches are needed to improve osteoporosis care. We conducted a parallel group, controlled, randomized clinical trial evaluating a behavioral intervention for improving osteoporosis medication use. A total of 2684 women with self-reported fracture history after age 45 years not using osteoporosis therapy from US Global Longitudinal Study of Osteoporosis in Women (GLOW) sites were randomized 1:1 to receive a multimodal, tailored, direct-to-patient, video intervention versus usual care. The primary study outcome was self-report of osteoporosis medication use at 6 months. Other outcomes included calcium and vitamin D supplementation, bone mineral density (BMD) testing, readiness for behavioral change, and barriers to treatment. In intent-to-treat analyses, there were no significant differences between groups (intervention versus control) in osteoporosis medication use (11.7% versus 11.4%, p = 0.8), calcium supplementation (31.8% versus 32.6%, p = 0.7), vitamin D intake (41.3% versus 41.9%, p = 0.8), or BMD testing (61.8% versus 57.1%, p = 0.2). In the intervention group, fewer women were in the precontemplative stage of behavior change, more women reported seeing their primary care provider, had concerns regarding osteonecrosis of the jaw, and difficulty in taking/remembering to take osteoporosis medications. We found differences in BMD testing among the subgroup of women with no prior osteoporosis treatment, those who provided contact information, and those with no past BMD testing. In per protocol analyses, women with appreciable exposure to the online intervention (n = 257) were more likely to start nonbisphosphonates (odds ratio [OR] = 2.70; 95% confidence interval [CI] 1.26-5.79) compared with the usual care group. Although our intervention did not increase the use of osteoporosis therapy at 6 months, it increased nonbisphosphonate medication use and BMD testing in select subgroups, shifted participants' readiness for behavior change, and altered perceptions of barriers to osteoporosis treatment. Achieving changes in osteoporosis care using patient activation approaches alone is challenging. © 2018 American Society for Bone and Mineral Research.

Making Every Contact Count (MECC) – Chronic Disease Risk Factor and Brief Advice Recording

Introduction: Making Every Contact Count (MECC) is about encouraging and assisting people to make healthier choices to achieve positive long-term behaviour change. In order to achieve this, organisations must build a culture that supports health improvement through the contacts it has with patients.Health Behaviours such as tobacco use, diet, physical activity and alcohol consumption make a significant contribution to the health status of individuals and populations. These along with socio-economic determinants of health are the main risk factors for the development of chronic and non-communicable diseases. Approximately 80% of heart disease, stroke, and Type 2 Diabetes and over one third of cancers could be prevented by eliminating these risk factors. Aim: The purpose of this study was to explore the feasibility of recording of risk factors and recording of brief advice in relation to obesity, smoking, alcohol, physical activity and blood pressure for all adult patients in the hospital and primary care settings. In the primary care setting the study will also aim to evaluate the effectiveness of the brief interventions delivered, in reducing these chronic disease risk factors in the study populations.Method: The first part of this project was conducted in the Medical Assessment Unit and Day Services Unit at St. Luke’s hospital, Kilkenny for a period of 1 month from October 23rd to November 23rd 2016. A risk factor dataset was used for the recording of risk factors and brief advice given to patients. Training was provided for staff members. A resource pack was provided on the wards to assist with providing brief advice.In terms of the Primary Care setting, this stage of the project is being conducted in conjunction with the Irish College of General Practitioners (ICGP). 20 General Practitioners will participate in the project. The electronic patient record will be adapted to provide a user-friendly and efficient portal for recording of patient’s risk factors and brief advice given.Quantitative and qualitative data will be obtained in both settings on the feasibility of implementing this project.Results: 191 risk factor dataset forms were collected after the 1 month pilot project in St Luke’s Hospital. This represents approximately 18% of the total number of patients who attended the 2 units during the study period. Smoking and alcohol were the most frequently recorded risk factors at 79% and 74% respectively. BMI was the least frequently recorded risk factor at 52%. The principle challenges which staff identified to implementing this project included a lack of time, a high staff workload and the patient’s readiness for behaviour change. Staff also raised the issue as to whether the acute setting is the most appropriate site for this work.Conclusion: The findings to date in the acute setting have highlighted important issues related to the feasibility of this work. There was considerable practical difficulty and time involved in finding hospital wards and staff who were willing to participate and implement this project. A recurring finding was that staff felt they did not have the necessary time to undertake training and implement this work. Some risk factors such as body weight were identified as particularly difficult to discuss with patients.The evidence from this work, both quantitative and qualitative, will be integrated to provide meaningful information to the service providers and planners to guide future service development and to form the basis for innovation and change in practice and service delivery for primary and secondary prevention of chronic conditions.

Maltese Antibiotic Stewardship Programme in the Community (MASPIC): protocol of a prospective quasiexperimental social marketing intervention

IntroductionAntibiotic misuse is a key driver of antibiotic resistance. In 2015/2016, Maltese respondents reported the highest proportions of antibiotic consumption in Europe. Since antibiotics are prescription-only medicines in Malta, research...