Chapter 4 Message-Passing Programming. The Message-Passing Model.
Passing Through the Stages: Are You Ready for Disease Management?
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Transcript of Passing Through the Stages: Are You Ready for Disease Management?
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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
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Stages of ChangeStages of Change
PRECONTEMPLATION CONTEMPLATION
PREPARATION ACTION
MAINTENANCE TERMINATION
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Intervention IssuesIntervention Issues
1. Recruitment1. Recruitment
2. Retention2. Retention
3. Progress3. Progress
4. Process4. Process
5. Outcomes5. Outcomes
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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
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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%
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Four Leading Recruitment Strategies
1.1. Persuasive CommunicationsPersuasive Communications
2.2. Positive ReinforcementPositive Reinforcement
3.3. Personal OutreachPersonal Outreach
4.4. Negative ReinforcementNegative Reinforcement
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43
45
47
49
51
53
55
Premature Termination
Appropriate Termination
Continuers
PC
T S
core
s
C A M
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Stage TransitionsStage Transitions
44
46
48
50
52
54
56
PC Cont Prep Action Maint
ProsCons
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Stages by ProcessesStages by Processes
CONSCIOUSNESS RAISINGDRAMATIC RELIEFENVIRONMENTAL REEVALUATION
SELF REEVALUATION
PRECONTEMPLATION CONTEMPLATION PREPARATION
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Stages by ProcessesStages by Processes
PREPARATION ACTION MAINTENANCE
SELF LIBERATION
COUNTERCONDITIONINGSTIMULUS CONTROL
REINFORCEMENT MANAGEMENTHELPING RELATIONSHIPS
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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
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0
10
20
30
Pretest 6 12 18
Action Manuals
Stage Manuals
Computers+
Counselors+
Assessment Periods
Per
cen
tag
e
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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
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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%
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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%
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Race
0
5
10
15
20
25
30
12 24Assessment (Month)
Po
int
Pre
vale
nce
Ab
stin
ence
White
Black
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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+
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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
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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%
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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
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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
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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
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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
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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
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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%
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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
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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
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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
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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
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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
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Multiple Behavior Change Strategies
I. Sequential
II. Simultaneous: Modular
III. Simultaneous: Co-variation
IV. Simultaneous: Integrative
A. Bullying Prevention
B. Pro-active Health Consumer
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NEW IMPACT EQUATIONNEW IMPACT EQUATION
IMPACT = REACH X EFFICACY IMPACT = REACH X EFFICACY
X (X ( BEHAVIORS CHANGED) BEHAVIORS CHANGED)