Stages Of Behavior Change Research Articles

Perceived Susceptibility to and Severity of Cardiovascular Disease Is Associated With Intent to Change Behavior Among Women 25-55 Years Old.

Risk factors for cardiovascular disease (CVD) among young and middle-aged women have increased, whereas CVD knowledge and awareness remain low. The objective of this study was to describe the relationship between the stage of behavior change and awareness, knowledge, and perceptions of CVD among women 25-55 years and identify predictors of the stage of behavior change. A cross-sectional online survey of women ages 25-55 years living in the United States was conducted. Awareness was measured with the question "What is the leading cause of death for women in the United States?" Knowledge, perceptions, and the stage of behavior change were measured with the Heart Disease Fact Questionnaire, Health Beliefs Related to CVD, and Precaution Adoption Process Model instruments, respectively. Chi-square and t tests were used to determine differences between awareness, knowledge, and perceptions based on the stage of behavior change. Multiple logistic regression was used to evaluate the relationship between the stage of behavior change and awareness, knowledge, and perceptions. A total of 149 primarily minority women (n = 105) were included (mean age = 37.15 ± 7.86 years). The perception of CVD susceptibility was associated with increased intention to change behavior (odds ratio, 1.247; 95% confidence interval, 1.101-1.414; P < .001). The perception of CVD severity was associated with reduced intention to change behavior (odds ratio, 0.809; P = .004). Women who believed they were susceptible to CVD and did not perceive CVD as severe were more likely to report intent to change behavior, suggesting perception of CVD risk is more important than awareness or knowledge. Addressing misperceptions may be a strategy for primary risk reduction.

The Association Between the Perception of Exercise Benefits and Barriers and Exercise Self-Efficacy During the Induction Phase of Dialysis in Patients with End-Stage Kidney Disease: A Cross-Sectional Study

Background/Objectives: The physical function of patients with chronic kidney disease gradually declines as kidney function deteriorates, and this decline becomes more pronounced after the initiation of dialysis. Encouraging the development of exercise habits from the initiation phase of dialysis is crucial. Increased exercise self-efficacy is essential for establishing these habits. However, the related factors at this stage are unclear. This study hypothesized that perceptions of exercise benefits and barriers are related to exercise self-efficacy and aimed to investigate this association. Methods: This single-center, cross-sectional study included 72 patients and assessed the stages of exercise behavior change, perceptions of exercise benefits and barriers, and exercise self-efficacy. Multiple regression analysis was used to examine the association between exercise self-efficacy and perceptions of the benefits and barriers of exercise. Results: Perceptions of exercise benefits were still significantly associated with self-efficacy for exercise after adjustment for age, gender, history of cardiovascular disease, diabetic kidney disease, living alone, employment, and physical function (β = 0.474, p &lt; 0.001). Similarly, perceptions of exercise barriers were also significantly associated with self-efficacy for exercise (β = −0.410, p = 0.001). A subgroup analysis that only examined participants without exercise habits revealed a similar association. Conclusions: Perceptions of exercise benefits and barriers may be associated with exercise self-efficacy in patients with end-stage kidney disease during the initiation phase of dialysis. As patients are temporarily hospitalized during this phase, it provides an opportunity for intervention. Exercise education and supportive environments during hospitalization may enhance perceptions of exercise benefits, reduce perceptions of exercise barriers, and improve exercise self-efficacy.

Changes Take Place in Stages! A Gradational Perspective on the Influence of Homeowners Associations on the Adoption of Wildlife-Friendly Landscape Maintenance

Lack of demand for professional wildlife-friendly landscape maintenance (WFLM) is not well understood, and further complicated by institutional and non-institutional influences. Framed by the Transtheoretical Model of Change, this study evaluated behaviors and perceptions pertaining to WFLM. A cross-sectional research design with quota sampling gathered stage of change, perceived motivators and barriers, processes of change, and self-efficacy from 1,219 Florida residents who hired a professional for landscape maintenance services. Comparisons were conducted to disentangle the relationship between living in a homeowners association and requesting WFLM. More residents were in earlier pre-action stages than later behavioral stages. There were stronger perceptions of some external barriers and motivators among homeowners association residents with perceptions of neighbors’ expectations being the greater motivator and barrier among this audience segment. Findings reveal a need to support residents in earlier stages of behavior change and integrate social norms into behavior change programs, especially within homeowners associations.

Digital therapeutic for hypertension improves physician-patient communication and clinical inertia: a survey of physicians who implemented CureApp HT in clinical practice.

In the 2019 Guidelines for the Management of Hypertension by the Japanese Society for Hypertension, lifestyle modification is recommended for all individuals except those with normal blood pressure. However, no detailed methods have been established to achieve the target blood pressure and resolve clinical inertia. CureApp HT, a digital therapeutic for hypertension that contributes to blood pressure reduction through lifestyle modification, was approved as software as a medical device for reimbursement by Japanese national health insurance in September 2022. This study aimed to survey physicians who implemented CureApp HT to assess how it changes physician-patient communication and contributes to clinical inertia resolution. A questionnaire survey was conducted at three time points: before the first prescription (first survey), 3 months (second survey), and 6 months (third survey) after the first prescription for physicians who had implemented CureApp HT. The primary outcome was the total score of five items on a Likert scale related to physician-patient communication, and it was analyzed based on the 47 physicians who responded to all three questionnaires. The total score of physician-patient communication significantly improved after 6 months of the introduction of CureApp HT, reflecting that physicians observed positive changes in patients' knowledge and attitudes regarding hypertension treatment. Furthermore, the number of physicians who set a target home blood pressure of 125/75 mmHg for their patients significantly increased. CureApp HT allows physicians to recognize changes in patients' disease knowledge and treatment attitudes, enabling them to set more stringent blood pressure targets and addressing clinical inertia. Physicians who implemented CureApp HT recognized changes in the patients' stages of behavioral change through improvements in patients' knowledge of the disease and their attitudes towards treatment, and by experiencing more effective communication, they set stricter blood pressure targets.

Gradual behaviour change towards meat reduction revisited: Applying the decisional balance scale in a Dutch study

Meat moderation is needed to mitigate climate change and to address issues related to animal welfare and public health. Yet little is known on the process that consumers go through towards meat-reduced diets. Strässner and Hartmann (2023) recently developed the decisional balance scale (DB scale) for meat reduction, in order to get a better understanding of the trade-offs that consumers encounter in this dietary shift. The current study sets out to replicate their German study in the Dutch context. A survey has been conducted among a representative sample of Dutch adults (N = 1982). Overall, the present study corroborated Strässner and Hartmann's findings. Similar to the German situation, Legitimation is the most important barrier, and the Downsides of factory farming is the most important motivator for meat reduction in the Netherlands. The present study extends the German study by comparing the DB scale with other established scales in research on meat reduction. Although several motivational elements related to the legitimacy of eating meat, health impact and production of meat appear in different instruments, the DB scale sets itself apart in adding practical elements (feasibility). Finally, the insights in the decision balance of population subgroups at different stages of behaviour change (no intention, intention, performing) showed that the further in the meat reduction process, the more the pros outweigh the cons. With this, the current study provides valuable insights in bolstering consumers in meat moderation. Our findings support the idea of a gradual shift and reveal that there is potential for acceleration in behaviour change towards meat reduction to be found in adjusting the self-evidence of high-intensity livestock farming systems and the meat-centric food consumption culture.

Association of watching sports games with subsequent health and well-being among adults in Japan: An outcome-wide longitudinal approach

ObjectiveAlthough the health benefits of playing sports are well-known, the association between watching sports and health is not well understood. We examined the longitudinal association of watching sports with 20 different health and well-being outcomes. MethodsThree-wave cohort data from 6327 adults (4851 workers) in the Meiji Yasuda LifeStyle study were used to draw causal inferences. We assessed the frequency of watching sports games on media or in-person using a self-reported questionnaire in 2018. Outcomes, including health behaviors, physical, mental, and work-related outcomes, were evaluated in 2019. In 2017, sociodemographic factors, prior exposure, and outcome values were evaluated and used as covariates. Three different statistical models (logistic, modified Poisson, or linear regression) were used according to the nature of the outcome variable. ResultsWatching sports on media had a favorable dose-response association with a lower risk of becoming physically inactive and skipping breakfast, as well as higher happiness (p for trend < 0.05). Conversely, watching sports on media had an adverse dose-response association with higher body mass index and increased risks of developing hypertension and diabetes (p for trend < 0.05). Watching sports in-person had a dose-response association with lower risks of exhibiting the precontemplation stage of health behavior change, moderate/severe psychological distress, and dyslipidemia (p for trend < 0.05). ConclusionsDespite the observed detrimental association between watching sports and cardiometabolic health, which should be interpreted cautiously and studied further, the study findings suggest that watching sports could be a new modifiable protective factor for developing healthy lifestyles and improving mental well-being.

Smoking knowledge and smoking cessation intention according to the stage of change in smoking cessation behavior among smokers in their 20s

Smoking knowledge and smoking cessation intention according to the stage of change in smoking cessation behavior among smokers in their 20s

Quantification of Acanthamoeba spp. Motility.

Acanthamoeba keratitis is a severe ocular infection that poses treatment challenges and can lead to blindness. Despite its ubiquity and potential contamination of contact lenses after water exposure, the natural behavior of this pathogen remains elusive. Understanding Acanthamoeba's movement patterns can inform us about how it colonizes contact lenses and contaminates the patient's cornea. It is fortunate that Acanthamoeba spp. are visible via brightfield microscopy starting at 4x magnification. Previous techniques have been developed to quantify Acanthamoeba motility in regard to cytopathic effects or under-exposure to the electric field. Here, we describe a method to track and quantify Acanthamoeba spp. motility long-term (hours to days), which is a protocol applicable to multiple amoeba strains, surfaces, and nutritional status of amoeba. This procedure is germane to determining many core motility quantifications, such as distance, speed, confinement, and directionality, which are necessary to monitor different stages of infection, proliferation, or behavioral change.

Personalizing travel behaviour change interventions using the trans-theoretical model and multimodality data

IntroductionBehaviourally informed soft policies, such as nudges, have become popular in areas like health, environment, and energy use as cost-effective instruments to change behaviour and decision-making. However, the effectiveness of soft policies in the transport sector is modest at best. One reason for this relative ineffectiveness might be their one-size-fits-all nature, and personalizing soft interventions has been suggested to increase their effectiveness. The Trans-theoretical Model (TTM) suggests that people progress through five stages of behavioural change, from pre-contemplating a behaviour to maintaining the behaviour, and behavioural interventions could be designed for specific stages. However, it is not always feasible to conduct surveys to place people at different stages of the TTM.MethodsThis paper explores whether it is possible to use multimodality data taken from a travel diary to place people at different stages of the TTM. The analysis uses an existing dataset from 826 respondents that includes self-reported TTM stages regarding cycling and data on multimodality. In the analysis, the multimodality data are used to allocate respondents to categories and assign them to TTM stages. The performances of the stage assignment approaches are evaluated using the self-reported TTM data and confusion matrices.FindingsThe accuracy of the allocation of participants to TTM stages using multimodality data is approximately 75%. The accuracy is higher for early stages (pre-contemplation) and later stages (maintenance) of the TTM. A data-driven approach to dealing with multimodality data performs slightly better than an approach that relies on pre-defined categorization.ConclusionThe paper suggests that it will be possible in the future to personalise behavioural interventions according to the stages of the TTM even in the absence of self-reported survey data that classifies people to TTM stages if objective multimodality data are available.

Pendampingan Remaja untuk Berhenti Merokok dengan Pendekatan Transtheoretical Model (Stages of Change) di Posyandu Remaja Desa Mliwis Boyolali

The partner for community service activities was the youth posyandu in Tambakboyo Hamlet, Mliwis. Adolescent boys at Mitra Posyandu have a smoking habit. There were 25% of teenage boys who have tried to stop smoking but failed. The problems faced by posyandu partners are the difficulty of generating teenagers' intention to stop smoking, teenagers also don't know how to stop smoking, and there are still many teenagers who relapse or smoke again even though they are already at the action stage. The aim of this program was to provide smoking cessation education and health messages with the stages of change in smoking behavior in each adolescent using a transtheoretical model approach and monitoring and strengthening smoking cessation by adolescent cadres. The methods used were socializing activities to youth posyandu, providing media on how to stop smoking, providing education regarding efforts to stop smoking, training youth cadres, designing applications for monitoring efforts to stop smoking, and assisting teenagers to stop smoking. The results of this service were that there was an increase in adolescent knowledge by 0.17% after being given smoking cessation education, the formation of peer counselors consisting of adolescent cadres, the existence of health media in the form of pocket books and booklets, and the creation of the Smoke Stop Step (3S) application to monitor efforts of quit smoking. After using the application and providing health messages according to the smoking cessation stages, there were 3 teenagers who started to intend to stop smoking and 1 teenager entered the preparatory stage (preparing to stop smoking).

The strongest predictors of compliance with health protocols among marketers and guilds based on the transtheoretical model

BackgroundGlobal communication, an integral part of modern life, increases the risk of transmitting infectious diseases to individuals. Based on the transtheoretical model (TTM), this study aimed to identify the most effective factors in adherence to health protocols among marketers and guilds.MethodsThis cross-sectional study was conducted among 400 market sellers and guilds of Ardabil City, Iran, in 2023. The TTM questionnaire was distributed among the participants which included four sub-constructs: (1) stages of change, (2) process of change, (3) self-efficacy, and (4) decisional balance. The data were analyzed using SPSS version 20. One-way ANOVA and linear regression tests were employed to evaluate the prediction of effective factors of the stage transition.ResultsMost participants (63.5%) were between 21 and 40. Most participants (65.5%) were in the passive stages of change (precontemplation, contemplation, and preparation). Pros (β = 0.133, P < 0.001) and behavioral processes of change (β = 0.058, P < 0.001) were the strongest predictors of the stage of change or improvement of stages of participants’ willingness to follow health protocols.ConclusionA correct understanding of the stages of behavior change can strengthen strategies for promoting healthy behaviors. Also, understanding the benefits of healthy behavior means compliance with health protocols and behavioral processes such as stimulus control, reinforcement management, counterconditioning, and self-liberation, along with high self-efficacy, have an impact on improving the stages of behavior change.

Penerapan Motivational Interviewing terhadap Peningkatan Stages of Change pada Pasien Penyalahgunaan NAPZA: Case Report

Subtance abuse abuse (Narcotics, Psychotropics, and other Addictive Substances) is carried out illegally and is a complex problem in Indonesia. Substance abuse can affect changes in a person's behavior which can be overcome with motivational interviewing (MI) interventions. This study aims to see the effect of the application of motivational interviewing (MI) on the stages of change in behavior in patients who are being rehabilitated by drugs. This research method uses case reports to evaluate nursing implementation using motivational interviewing to improve behavior change in substance abuse patients who are being rehabilitated with three evaluations during 15 days of meetings. The stages of change measurement tool used is the URICA questionnaire. The results of this study showed that the patient's URICA value on the first day was 11.2 (contemplation) which increased after being given a motivational interviewing intervention on the fifteenth day to 12.9 (action). There is an influence between the application of motivational interviewing on increasing stages of change in subtance abuse patients so that it is hoped that this motivational interviewing can be used in a structured way.

EVALUATION OF THE HEALING MENTAL HEALTH PROGRAM

INTRODUCTION &amp; AIMS The HEALTMing Mental Health (HEALTM-MH) program was a free community-based program offered by Exercise &amp; Sport Science Australia, supported by the Australian Sports Commission, Sport Australia Participation Grants program. HEALTM-MH was targeted at Australians living with mental health conditions in rural or remote areas. Our aim is to present an evaluation of the program effectiveness. METHODS The standard program included one-hour of supervised group exercise per week and a one-hour lifestyle education session for 8-weeks. All outcome data, including The Stages of Behaviour Change, were collected by the site facilitators and was provided in an anonymised format for analysis and reporting. Participants were included in the analysis if they had completed more than 50% of the sessions. RESULTS A total of 182 participants were recruited which included 117 who were enrolled in the adult mental health program, 32 in the standard adult program and 33 in a teen mental health program. All programs were delivered between May and October 2022 by trained HEALTM providers, with 18 sites having AEPs leading the program, and one site was led by a registered nurse. Included in analysis were 99 participants (31 males, 68 females) with a mean age of 59.5 years. There was a statistically significant change toward the desired outcome for fourteen of fifteen measures from pre- to post-testing. Twelve of these measures recorded the desired target change at the population (grouped) level. CONCLUSION The targeted behaviour change was for a one stage shift which was achieved with most participants in the action or maintenance stage by the end of the program. The provision of the HEALTM-MH program was beneficial for those who attended more than 50% of the sessions. The program may increase physical activity and healthy lifestyle choices in individuals who selfreport a mental health disorder.

Enhancing physical activity participation among female employees: evaluating the effectiveness of an educational intervention.

This paper evaluates the effectiveness of an educational intervention based on the transtheoretical model aimed at increasing physical activity (PA) participation among female employees in Bandar Abbas city (Iran) healthcare centers in December 2017 and August 2018. Using a semi-experimental interventional study design with a randomized and multi-stage method, 100 participants were included in both the intervention (n=50) and control groups (n=50). Data collection involved questionnaires assessing demographic information (age, gender, marital status and education), stages of change in PA behavior, Perceived Benefits, Barriers and Self-efficacy. The data were analyzed using SPSS-16, employing both descriptive (mean, SD, frequency, percentage) and inferential statistics (t-tests, chi-squared tests, etc.). Prior to the educational intervention, 19 participants (0.38%) in the intervention group engaged consistently in PA (stages 4-5). After 3 and 6 months of intervention, these numbers increased to 29 (0.58%) and 25 (0.50%), respectively. This improvement was statistically significant compared to the pre-intervention stage (P<0.001). The findings highlight the importance of theory-based behavior change models and health education programs in promoting PA and combating sedentary lifestyles. Although focused on a specific population in Bandar Abbas, the intervention can serve as a model for similar programs targeting diverse social classes and populations.

Factors Associated with Lower Social Activity in German Older Adults at Increased Risk of Dementia: A Cross-Sectional Analysis.

Studies demonstrate associations between low social activity in older adults and cognitive decline. Little has been investigated regarding which factors are associated with low social activity in older adults at increased risk of dementia. We investigate which sociodemographic, psychological, health-related, and environmental factors are associated with low social activity in older adults at increased risk of dementia. Additionally, we describe the stages of health behavior change, the types of social activities, and the duration of the current level of social activity. We used baseline data of 1,015 participants from the AgeWell.de trial. We conducted logistic and Poisson regression analyses to investigate factors associated with low social activity. We report descriptive statistics on the stages of change in the sample, the types of social activities most frequently pursued, and the duration of the current level of social activity. Lower income, non-usage of public transport, depressive symptoms, cognitive, mobility, and hearing impairment were negatively associated with social activity. The majority of the sample was in the maintenance stage, followed by the precontemplation stage. The most common social activities were traveling and hobbies with others. Participants have maintained their current level of social activity for several years. We identified a lack of resources (income, transport), depressive symptoms and poorer health (cognitive, mobility and hearing impairment) as barriers to social activity. Interventions promoting social activity in older adults at risk of dementia may specifically target individuals with these risk factors. Low-threshold opportunities for social activity may be particularly beneficial.

Effectiveness of a Lifestyle Improvement Support App in Combination with a Wearable Device in Japanese People with Type 2 Diabetes Mellitus: STEP-DM Study.

Although the use of application (app)s and wearable devices supporting diabetes treatment has spread rapidly in recent years, evidence of their impact, especially in combination of them, is limited. TOMOCO™ is a lifestyle improvement support app that features interactive virtual conversations according to the programmed algorithm guiding users toward their goals of lifestyle improvement. We hypothesized that TOMOCO™ in combination with Fitbit, which accurately tracks users' activity level, would encourage people with type 2 diabetes mellitus (T2DM) to change their lifestyles and improve their glycated hemoglobin (HbA1c) levels without changes in conventional therapy. Thus, we performed the present study to explore the effectiveness of this combination in Japanese participants with T2DM who had not achieved their glycemic targets. In this single-arm exploratory study, participants with T2DM used the TOMOCO™ and Fitbit in addition to the conventional diet/exercise therapy and anti-diabetic drug for 12weeks. They were provided with feedback/advice by health care providers based on the TOMOCO™ and Fitbit records. The primary endpoint was the change in HbA1c from baseline to the end of the observation period. Data were expressed as mean ± standard deviation. Fifty-nine (96.7%) of the 61 participants (male, 42 [71.2%]; age, 60.1 ± 8.7years; HbA1c level, 7.48 ± 0.37% at screening) completed the study. At the end of the observation period, the HbA1c was significantly reduced (- 0.41 ± 0.41%, p < 0.001). This trend was consistent across the preselected patient characteristics, including sex, age, and body mass index. However, it was more pronounced in the participants with earlier stages of behavioral changes defined by the transtheoretical model at baseline. The unique features of TOMOCO™ in combination with Fitbit, together with conventional therapy, may promote a healthy lifestyle and thus contribute to improving HbA1c in people with T2DM. jRCT1070220007.

Abstract P203: Healthy Diet Perception, Cardiovascular Disease, and Risk Factors in Americans

Introduction: Healthy diet perception may influence cardiovascular (CV) outcomes. Misperceptions on the healthfulness of one’s diet can interfere with the precontemplative and contemplative stages of behavioral change if individuals overestimate their diet quality. Using a nationally-representative sample, we explored the prevalence of healthy diet misperception in the general population and in those with CV diseases, as well as whether misperceptions are associated with clinical CV risk factors. Methods: We included adults≥20 years old from the National Health and Nutrition Examination Survey 2017-2020. Using survey data on participants’ perception of their own diet and diet recall data to calculate Healthy Eating Index-2015 (HEI), we divided participants into dietary quantiles. We categorized healthy diet perception (HDP) as overestimated (perceived&gt;HEI quantile), accurate (perceived=HEI quantile), or underestimated (perceived&lt;HEI quantile). We categorized those who self-reported hypertension, coronary heart disease, myocardial infarction, congestive heart failure, and stroke as having CV disease. Clinical CV risk factor measures were body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin A1c, total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). We used multiple logistic regression to measure the association between CV disease and HDP and multiple linear regression for HDP and CV risk factors, stratified by presence of CV disease. Results: Of 7,710 adults, 4,470 (57.5 weighted %) overestimated HDP; 1,924 (25.6 weighted %) underestimated HDP; and 1,316 (16.9 weighted %) correctly estimated HDP. After adjusting for age, sex, and education level, having CV disease was not associated with incorrectly estimating HDP (adjusted OR 1.08; 95% CI 0.93, 1.26) or overestimating HDP (adjusted OR 1.21; 95% CI 1.00, 1.48), compared to correctly estimating HDP. Among those with CV disease, overestimating HDP was associated with higher BMI (adjusted difference 1.9 m/kg 2 ; 95% CI 0.8, 2.9) and lower HDL (adjusted difference -2.8 mg/dL; 95% CI -5.1, -0.5). Among those without CV disease, overestimating HDP was only associated with higher BMI (adjusted difference 1.9; 95% CI 0.8, 2.9) Conclusions: More than half of Americans overestimate their diet quality, and adults with CV disease do not estimate diet quality more accuracy than those without CV disease. Among adults with CV disease, misperceptions in diet quality were associated with worse CV risk factor profiles, highlighting the need to assess and educate patients with CV disease on personal diet quality as part of healthy lifestyle promotion. Among those without CV disease, dietary misperceptions were associated with higher BMI, suggesting that increasing awareness of one's diet is also important in CV disease prevention.

Heterogeneity in farmers’ stage of behavioural change in intercropping adoption: an application of the Transtheoretical Model

Despite its potential economic and environmental benefits, intercropping adoption remains limited in Europe. Drawing upon the Transtheoretical Model, this paper views adoption decision as stages of behavioural change. The paper aims to investigate socioeconomic, behavioural, and policy factors associated with stage of change in intercropping adoption in Sweden. Exploratory factor analysis and generalized ordered logit regression were performed on data from a nation-wide farmer survey conducted in 2021 with 388 usable replies. Results show that farmers with better knowledge of intercropping, a higher evaluation of financial benefits and ease of intercropping, and ley growers were more likely to progress to higher stages of the adoption process. Farmers who have higher perceived seed separation costs, a lower education level, and are older tend to remain at lower stages. Perceived environmental benefits of intercropping, household income, and instrumental values of farming could turn non-adopters into either potential adopters or actual adopters. We found no significant association between policy support and stage of change in intercropping adoption. Policy implications aimed at fostering intercropping adoption were discussed.

The Effect of Diabetes Self-management Education Provided by Certified Diabetes Educator Compared to Usual Diabetes Education on Glycemic Level and Stage of Behavior Change in Adult with Types 2 Diabetes Mellitus

Objective: To explore the effect of diabetes self-management education and support (DSMES) provided by Siriraj certified diabetes educators (CDE) compared to usual diabetes education (DE) on glycemic level and stage of behavior change in patients with type 2 diabetes mellitus (T2D). Materials and Methods: Patients with T2D having A1C 8-12% were recruited between 2019-2020 to receive DSMES from CDE. Patients received the usual DE from healthcare professionals in 2016 were randomly selected from their medical records. Results: 76 patients were enrolled in each group. Mean±SD age was 59.4±11.5 years. After receiving DSMES and DE, A1C decreased dramatically at 3 months in both groups without significant difference between the groups (9.4±1.1% to 8.0±1.2% vs. 9.5±1.1% to 8.1±1.5%, respectively). However, the DEMES group can further decrease A1C to 7.8±1.2% while A1C in the usual DE group increased to 8.5±1.6% at 12 months (p=0.028). In the DSMES group, most patients can move to the next stage of behavior change and reported a better QOL (89.4±11.6 vs. 92.6±12.2, p=0.018). Conclusion: The receipt of DSMES from CDE significantly improved the level of A1C, the stage of behavior change, and QOL. Its benefit on the glycemic level can last at least one year.

A brief measure of non-drug reinforcement: Association with treatment outcomes during initial substance use recovery

BackgroundTranslational research demonstrates that drug use is inversely associated with availability and engagement with meaningful non-drug reinforcers. Evaluation of non-drug reinforcement in treatment-receiving clinical populations is limited, likely owing to the time intensive nature of existing measures. This study explores the association of non-drug reinforcers with treatment outcomes using a novel, brief measure of past month non-drug reinforcement quantifying three elements: relative frequency, access, and enjoyability. MethodsRespondents enrolled in substance use treatment (residential, intensive outpatient, and medically managed withdrawal) in clinics across the United States (N = 5481) completed standardized assessments of non-drug reinforcement and treatment outcomes (i.e., return to use and life satisfaction) one-month after treatment discharge. Non-drug reinforcement measures (availability, engagement, enjoyability) were used as predictors of return to use and life satisfaction using generalized linear models. ResultsNon-drug reinforcement indices were associated with return to use and life satisfaction in unadjusted models (e.g., 12.4 % versus 58.3 % return to use for those with the highest and lowest availability, respectively). Consistent results were observed in models adjusted for sociodemographic variables and risk factors (i.e., sleep disturbance, anhedonia, stress). Comparisons by drug class generally showed lower non-drug reinforcement among patients reporting heroin or methamphetamine as their primary drug. ConclusionsResults highlight the importance of non-drug reinforcement during the first month following treatment. Rapid measurement of non-drug reinforcement in stepped care settings may illuminate critical deficits in early stages of behavior change, identify those at greatest risk for return to use, and provide targets for treatment to improve recovery trajectories.