hxrefactored - pro change behavior systems inc - kerry evers

Behavior Change Tailoring: The Transtheoretical Model Kerry E. Evers, Ph.D. Pro-Change Behavior Systems, Inc.

Behavior Change

“Up to 40 percent of annual deaths from each of five leading US causes are preventable” CDC, Morbidity and Mortality Weekly Report, May 2014

•  Health behavior change is a science •  Health behavior change interventions should be grounded in a leading

theoretical model

Theore.cal Base

“Programs to influence health behavior, including health promo8on and educa8on programs and interven8ons, are most likely to benefit par8cipants and communi8es when the program or interven8on is guided by a theory of health behavior.” Glanz, et al., 2008 -‐

There is nothing as prac8cal as a good theory. Lewin, 1935

Glanz, K, et al (Eds.) (2008). Health Behavior and Health Educa4on: Theory, Research, and Prac4ce, 4th Edi4on. San Francisco, CA: Jossey-‐Bass

Lewin, K. (1935) A dynamic theory of personality. New York: McGraw-‐Hill.

“The transtheore.cal model has been around since the late 1970s but is no less powerful now and even has special u.lity when two-‐thirds of Americans are overweight or obese and 600,000 of us are killed by cardiovascular disease per year."

Dr. Oz, Time Magazine, October 2012

Google Search conducted 3/17/2014

184,000 results for “Transtheore.cal

Model”

442,000 results for “Stages of Change”

TTM in the Public Eye

•  Search of PubMed Journal Articles •  Pubmed 1983-Present: 14,617 •  2013 Alone: 1,129

•  Search of Google Scholar •  Stage of Change Model: 1,270 •  Transtheoretical Model: 21,400

TTM in the Academic Literature

History of the TTM

•  Smoking cessa.on •  Stress management •  Depression preven.on •  Weight management •  Exercise acquisi.on •  Healthy diet •  Responsible drinking •  Medica.on adherence •  Sun exposure •  Mammography screening •  Obesity preven.on •  Debt Reduc.on

Transtheore.cal Model Applica.ons §  Collabora.on in health care §  Organ dona.on §  Returning to work §  Bullying preven.on §  Juvenile delinquency §  Da.ng violence §  Domes.c violence §  Advancing women scien.sts §  Adop.on readiness §  Professional prac.ces §  Mastering change in the workplace §  Pain Self Management §  Informed decision making

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•  Integrates ideas from several different theories and therapies •  Involves progression through five stages of change:

§ Precontempla.on – Not yet ready § Contempla.on – Geing ready § Prepara.on -‐ Ready § Ac.on -‐ Doing the healthy behavior § Maintenance -‐ Keeping up the healthy behavior

•  Certain principles and processes of change work best at each stage to reduce resistance and facilitate progress

Overview of the TTM

•  is based on principles developed from over 35 years of scientific research, intervention development, and scores of empirical studies;

•  applies the results of research funded by over $80 million worth of grants and conducted with over 150,000 research participants; and

•  is currently in use by professionals around the world.

Transtheore.cal Model:

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"Most theories are about behavior, not about behavior change." – James O. Prochaska

•  Index of readiness •  Tells WHEN people change •  Predicts who will change successfully •  A dynamic, not static, client characteristic •  Inclusive, empathic, optimistic •  Guides member-treatment matching

Stage of Change

Not Ready Have no inten4on to start taking ac4on in next 6 months

Precontempla.on

Geing Ready Intend to start in next 6 months

Contempla.on

Ready

Prac4cing the behavior Intend to start in next 30 days

Prepara.on

Recently Started to Change Overt Behavior Consistently for less than 6 months

Ac.on

Has Overtly Changed Behavior Consistently for 6 months or more

Maintenance

Pros = Advantages Of Changing

Cons = Disadvantages Of Changing

Decisional Balance:

A growing awareness that the advantages (Pros) of changing outweigh the disadvantages (Cons)

How do people move from one stage to another?

Confidence

Degree to which individuals believe they can achieve a healthy goal even under temp.ng

situa.ons

DiClemente CC, Prochaska JO, Fairhurst SK, Velicer WF. The Process of Smoking Cessa.on: An Analysis of Precontempla.on, Contempla.on, and Prepara.on Stages of Change. J Consult Clin Psychol. 1991; 59:295-‐304.

Self-‐Efficacy

•  HOW people change •  Experiential and behavioral strategies and techniques used to change

behavior •  Facilitate transitions between stages •  Used as basis of intervention design

Processes of Change

Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. (1992). In search of how people change: Applica.ons to addic.ve behaviors. American Psychologist, 47(9), 1102-‐1114.

Precontempla?on Contempla?on Prepara?on Ac?on Maintenance

Self-‐Reevalua?on

Self-‐Libera?on

Helping Rela?onships

Counter Condi?oning

Reinforcement Management

S?mulus Control

Social Libera?on

Drama?c Relief

Consciousness Raising

Environmental Reevalua?on

Processes of Change: The “How” of Change

GeNng the Facts

Use Subs?tutes

Make a Commitment

Get Support

Use Rewards

Manage your Environment

No?ce your Effects on Others

Pay AVen?on to Feelings

Create a New Self-‐Image

No?ce Social Trends

Experiential

Behavioral

One Size Fits All Targeted

Stage Matched Ac?on Oriented

Levels of Tailoring


Environmental Reevalua?on No?ce your Effects on Others


Drama?c Relief Pay AVen?on to Feelings


Helping Rela?onships Get Support

Prepara?on Ac?on Maintenance

Reinforcement Management Use Rewards

Contempla?on Prepara?on Ac?on Maintenance

S?mulus Control Manage your Environment

A-CHESS (Addiction – Comprehensive Health Enhancement Support System)

Personal Ac.vity Center (PAC)

Stage Matched Feedback

One Size Fits All Targeted Tailored

Stage Matched Stage + Pros + Cons + Self-‐Efficacy + 10 Processes

Ac?on Oriented

Depth of Tailoring

Hall, K. L. & Rossi, J. S. (2008). Meta-‐analy.c examina.on of the strong and weak principles across 48 health behaviors. Preven4ve Medicine, 46, 266-‐274.

The Pros & Cons of Changing Across Stage of Change: 48 Behaviors

Confidence

Degree to which individuals believe they can achieve a healthy goal even under temp.ng

situa.ons

DiClemente CC, Prochaska JO, Fairhurst SK, Velicer WF. The Process of Smoking Cessa.on: An Analysis of Precontempla.on, Contempla.on, and Prepara.on Stages of Change. J Consult Clin Psychol. 1991; 59:295-‐304.

Self-‐Efficacy

Computer-‐Tailored Interven.ons (CTI)

Reliable, valid assessments of most important behavior change constructs

Evidence-‐based, sta.s.cally-‐derived decision-‐making rules

Individualized, tailored behavior change guidance

Feedback dynamically updated based on new

assessment data

Questions

Internet-based expert system Data collection/analysis/feedback/assessment

Responses

Tailored Feedback

Individuals

0

5

10

15

20

25

Precontemplation Contemplation

Norma.ve Tailoring

0

5

10

15

20

25

30

35

Precontemplation Contemplation Preparation Action Maintenance

Rate of Change

Rate of Change

Norma.ve & Ipsa.ve Clinical Guidance

Norma.ve & Ipsa.ve Tailored Feedback

Processes Feedback: Sample Screen

•  Fred Pennic Outlined findings from Mobiuity Report •  Create an individualized solu.on •  Analy.c models that trigger the appropriate interven.ons and outcomes for each user

•  Personalized communica.ons to increase engagement •  Low-‐effort data collec.on

4 Best Prac.ces for Crea.ng Behavior Changing Mobile Health Apps

hop://www.hitconsultant.net/2013/07/26/4-‐best-‐prac.ces-‐for-‐crea.ng-‐behavior-‐changing-‐mobile-‐health-‐apps/

•  Theore.cal variables that produce large effect sizes when included in tailored communica.ons compared to tailored communica.ons that exclude these variables:

§  Stages of Change § Pros and Cons of Changing §  Self-‐Efficacy § Processes of Change § Aitudes §  Social Support

Tailored Communica.ons that Tailor Each of the Following Variables

Theore.cal Variables that Produce Smaller Effect Sizes

Perceived Suscep.bility

Noar, S. M., Benac, C. N., & Harris, M. S. (2007). Does tailoring maoer? Meta-‐analy.c review of tailored print health behavior change interven.ons. Psychological Bulle4n, 133, 673-‐693.

Theore.cal Variables that DO NOT Make a Difference

Behavior Inten.ons

Social Norms

Noar, S. M., Benac, C. N., & Harris, M. S. (2007). Does tailoring maoer? Meta-‐analy.c review of tailored print health behavior change interven.ons. Psychological Bulle4n, 133, 673-‐693.

Number of Tailoring Variables that make a difference

0-‐2 < 3-‐5 > 6-‐9

Compara.ve Outcomes of Interven.ons

Johnson, J.L., Prochaska, J.O., Paiva, A.L., Fernandez, A.C., DeWees, S.L., and Prochaska, J.M. (2013) Advancing Bodies of Evidence for Popula.on-‐based Health Promo.on Programs: Randomized Controlled Trials and Case Studies. Popula4on Health Management, 16(6), 373-‐380.

Well-‐Being: Change Over Time

Prochaska, J.O., Evers, K.E., Castle, P.H., Johnson, J.L., Prochaska, J.M., Rula, E.Y., Coberley, C., & Pope, J.E. (2012). Enhancing Mul.ple Domains of Well-‐being by Decreasing Mul.ple Health Risk Behaviors: A Randomized Clinical Trial. Popula4on Health Management, 15 (5), 276-‐286.

Improvements in Well-‐Being

Overall Individual Domains

Prochaska, J.O., Evers, K.E., Castle, P.H., Johnson, J.L., Prochaska, J.M., Rula, E.Y., Coberley, C., & Pope, J.E. (2012). Enhancing Mul.ple Domains of Well-‐being by Decreasing Mul.ple Health Risk Behaviors: A Randomized Clinical Trial. Popula4on Health Management, 15 (5), 276-‐286.

Contacts

Pro-‐Change Behavior Systems, Inc. • www.prochange.com

Online Basic Transtheore?cal Model Training • www.prochange.com/e-learning

Demo of Domes?c Violence Program • www.prochange.com/domesticviolencedemo

Demo of Healthy Pregnancy Program • www.prochange.com/pregnancydemo

Coaches Guide for Using TTM with Clients • www.prochange.com

Online MyHealth Behavior Change Programs • www.prochange.com/myhealth

Mastering Change in the Workplace • www.prochange.com/products

Janice M. Prochaska •  [email protected]

hxrefactored - pro change behavior systems inc - kerry evers

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