founder pro-change behavior systems, inc. passing through the stages: are you ready for disease...
TRANSCRIPT
![Page 1: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/1.jpg)
Founder Pro-Change Behavior Systems, Inc.
Passing Through the Stages: Passing Through the Stages: Are You Ready for Disease Are You Ready for Disease
Management?Management?
James O. Prochaska, Ph.D.
Director and ProfessorCancer Prevention Research Center
University of Rhode Island
![Page 2: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/2.jpg)
Stages of ChangeStages of Change
PRECONTEMPLATION CONTEMPLATION
PREPARATION ACTION
MAINTENANCE TERMINATION
![Page 3: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/3.jpg)
Intervention IssuesIntervention Issues
1. Recruitment1. Recruitment
2. Retention2. Retention
3. Progress3. Progress
4. Process4. Process
5. Outcomes5. Outcomes
![Page 4: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/4.jpg)
Percent of Smokers by Stage Percent of Smokers by Stage Across Three Different SamplesAcross Three Different Samples
Sample Precont. Cont. Prep. N
Rhode Island 42.1 40.3 17.6 4,1444 Worksites 41.1 38.7 20.1 4,785California 37.3 46.7 16.0 9,534
![Page 5: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/5.jpg)
ORIGINAL IMPACT EQUATIONORIGINAL IMPACT EQUATION
IMPACT = REACH X EFFICACYIMPACT = REACH X EFFICACY
IMPACT = (5% REACH) X (30% ABSTINENCE) = 1.5%IMPACT = (5% REACH) X (30% ABSTINENCE) = 1.5%
IMPACT = (75% REACH) X (20% ABSTINENCE) = 15%IMPACT = (75% REACH) X (20% ABSTINENCE) = 15%
![Page 6: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/6.jpg)
Four Leading Recruitment Strategies
1.1. Persuasive CommunicationsPersuasive Communications
2.2. Positive ReinforcementPositive Reinforcement
3.3. Personal OutreachPersonal Outreach
4.4. Negative ReinforcementNegative Reinforcement
![Page 7: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/7.jpg)
43
45
47
49
51
53
55
Premature Termination
Appropriate Termination
Continuers
PC
T S
core
s
C A M
![Page 8: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/8.jpg)
Stage TransitionsStage Transitions
44
46
48
50
52
54
56
PC Cont Prep Action Maint
ProsCons
![Page 9: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/9.jpg)
Stages by ProcessesStages by Processes
CONSCIOUSNESS RAISINGDRAMATIC RELIEFENVIRONMENTAL REEVALUATION
SELF REEVALUATION
PRECONTEMPLATION CONTEMPLATION PREPARATION
![Page 10: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/10.jpg)
Stages by ProcessesStages by Processes
PREPARATION ACTION MAINTENANCE
SELF LIBERATION
COUNTERCONDITIONINGSTIMULUS CONTROL
REINFORCEMENT MANAGEMENTHELPING RELATIONSHIPS
![Page 11: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/11.jpg)
1. Action-oriented Manuals1. Action-oriented Manuals
2. Stage-Matched Manuals2. Stage-Matched Manuals
3. Stage-Matched Computers & Manuals3. Stage-Matched Computers & Manuals
4. Counselors & Stage-Matched 4. Counselors & Stage-Matched
ComputersComputers
Treatment GroupsTreatment Groups
![Page 12: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/12.jpg)
![Page 13: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/13.jpg)
![Page 14: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/14.jpg)
![Page 15: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/15.jpg)
0
10
20
30
Pretest 6 12 18
Action Manuals
Stage Manuals
Computers+
Counselors+
Assessment Periods
Per
cen
tag
e
![Page 16: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/16.jpg)
0
5
10
15
20
25
30
Counseling
Computer
Baseline
Per
cen
tage
6 months 12 months 18 months
Assessment Periods
Computer vs. CounselingComputer vs. Counseling
![Page 17: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/17.jpg)
PROACTIVE CESSATION WITH PROACTIVE CESSATION WITH ADOLESCENTS IN PRIMARY CAREADOLESCENTS IN PRIMARY CARE
Tailored InterventionsTailored Interventions
23.9%23.9%
Assessment OnlyAssessment Only
11.4%11.4%
![Page 18: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/18.jpg)
Proactive Cessation with Depressed Proactive Cessation with Depressed Patients Patients
Abstinence at 18 MonthsAbstinence at 18 Months
Tailored Tailored Intervention +Intervention +
24.6%24.6%
Assessment Assessment OnlyOnly
19.1%19.1%
![Page 19: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/19.jpg)
Race
0
5
10
15
20
25
30
12 24Assessment (Month)
Po
int
Pre
vale
nce
Ab
stin
ence
White
Black
![Page 20: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/20.jpg)
Age
0
5
10
15
20
25
30
35
40
12 24
Assessment (Month)
Po
int
Pre
vale
nce
Ab
stin
ence
<=24 25-34 35-44 45-54 55-64 65+
![Page 21: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/21.jpg)
Percentage in Action/MaintenancePercentage in Action/Maintenancefor Stress Managmentfor Stress Managment
0
10
20
30
40
50
60
70
Baseline 6 month 12 month 18 month
TreatmentControl
2 significant (p < .001) at 6, 12, & 18 monthsPre-Action at Baseline Only
![Page 22: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/22.jpg)
Risk Factors: Smoking, Avoid High Fat, Regular Exercise Risk Factors: Smoking, Avoid High Fat, Regular Exercise (3x/wk @ 20 min.), Use Sunscreen after 15 min. exposure(3x/wk @ 20 min.), Use Sunscreen after 15 min. exposure
0
1
2
3
4
Number ofNumber ofRiskRiskFactors in Factors in PreparationPreparationAmongAmong3,6163,616Current Current SmokersSmokers
Number inPreparation
Stage
63%
27%
8%
2%0%
![Page 23: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/23.jpg)
Point Prevalence Smoking CessationPoint Prevalence Smoking Cessation
0%
5%
10%
15%
20%
25%
30%
35%
Baseline 12 Month 24 Month
Per
cent
in A
ctio
n/M
aint
enan
ce
Expert System
Assessment Only
![Page 24: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/24.jpg)
Diet Point PrevalenceDiet Point Prevalence
0%
5%
10%
15%
20%
25%
30%
35%
40%
Baseline 12 Month 24 Month
TreatmentControl
% in
Act
ion
and
Mai
nten
ance
![Page 25: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/25.jpg)
Sun Point PrevalenceSun Point Prevalence
0%
5%
10%
15%
20%
25%
30%
35%
40%
Baseline 12 Month 24 Month
TreatmentControl
% in
Act
ion
and
Mai
nten
ance
![Page 26: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/26.jpg)
TWO YEARS OF PRIMARY TWO YEARS OF PRIMARY CARE COUNSELINGCARE COUNSELING
I.I. No effects on any of the four target behaviorsNo effects on any of the four target behaviors
II.II. No increased effect on four behaviors treated No increased effect on four behaviors treated effectively with TTM-tailored interventionseffectively with TTM-tailored interventions
![Page 27: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/27.jpg)
TWO YEARS OF WORKSITE TWO YEARS OF WORKSITE CAMPAIGNCAMPAIGN
I. No effects on any of the multiple targeted I. No effects on any of the multiple targeted behaviorsbehaviors
II.II. No increased effect on multiple behaviors No increased effect on multiple behaviors treated effectively with TTM-tailored treated effectively with TTM-tailored interventionsinterventions
![Page 28: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/28.jpg)
Diabetes Self Management Outcomes: Diabetes Self Management Outcomes: Percent in Action or Maintenance at 12 MonthsPercent in Action or Maintenance at 12 Months
II.
SMBG
A. Canada
B. Hawaii
I. Smoking:
A. Canada
B. Hawaii
III.
Diet
A. Canada
B. Hawaii
Treatment Assessment
26 % 15 %
25.9 % 15.9 %
40.6 %
24.1 %
31.8 %
11.5 %
38% 25 %
28 % 18%
![Page 29: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/29.jpg)
Co-variation: The increased probability of Co-variation: The increased probability of progressing to action on a second behavior progressing to action on a second behavior (e.g. diet) when individuals have (e.g. diet) when individuals have progressed to action on an initial behavior progressed to action on an initial behavior (e.g. smoking).(e.g. smoking).
Co-variation in Co-variation in Odds Ratio Odds Ratio
Control GroupControl Group .85 .85TTM Intervention GroupTTM Intervention Group 3.443.44
![Page 30: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/30.jpg)
ADHERENCEADHERENCETreatment Success by GroupTreatment Success by Group
Pre-action at BaselinePre-action at Baseline
0%
10%
20%
30%
40%
50%
60%
70%
Baseline 6 mo 12 mo 18 mo
![Page 31: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/31.jpg)
ADHERENCEADHERENCERegression from A/M by GroupRegression from A/M by Group
Post-action at Baseline Post-action at Baseline
50%55%
60%65%70%
75%80%85%90%
95%100%
Baseline 6 mo 12 mo 18 mo
![Page 32: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/32.jpg)
Exercise Staging – Adherence Group Exercise Staging – Adherence Group Progression to A/M by Group Progression to A/M by Group
(pre-action at baseline)(pre-action at baseline)
0%5%
10%15%20%25%
30%35%40%45%50%
Baseline 6 mo 12 mo 18 mo
% in
A/M
![Page 33: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/33.jpg)
Dietary Fat Staging – Adherence GroupDietary Fat Staging – Adherence GroupProgression to A/M by Group Progression to A/M by Group
(pre-action at baseline)(pre-action at baseline)
0%
5%
10%
15%
20%
25%
30%
Baseline 6 mo 12 mo 18 mo
% i
n A
/M
![Page 34: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/34.jpg)
Multiple Behavior Change Strategies
I. Sequential
II. Simultaneous: Modular
III. Simultaneous: Co-variation
IV. Simultaneous: Integrative
A. Bullying Prevention
B. Pro-active Health Consumer
![Page 35: Founder Pro-Change Behavior Systems, Inc. Passing Through the Stages: Are You Ready for Disease Management? James O. Prochaska, Ph.D. Director and Professor](https://reader036.vdocuments.us/reader036/viewer/2022062322/5697bfe31a28abf838cb52cb/html5/thumbnails/35.jpg)
NEW IMPACT EQUATIONNEW IMPACT EQUATION
IMPACT = REACH X EFFICACY IMPACT = REACH X EFFICACY
X (X ( BEHAVIORS CHANGED) BEHAVIORS CHANGED)