High Impact Tools for High Impact Tools for Health PromotionHealth Promotion
James O. Prochaska, Ph.D.James O. Prochaska, Ph.D.Director and Professor
Cancer Prevention Research CenterUniversity of Rhode Island
FounderPro-Change Behavior Systems, L.L.C.
The Stages of Change:The Stages of Change:
MaintenanceMaintenance
ActionAction
PreparationPreparation
ContemplationContemplation
PrecontemplationPrecontemplation
Intervention IssuesIntervention Issues
1. Recruitment1. Recruitment2. Retention2. Retention3. Progress3. Progress4. Process4. Process5. Outcomes5. Outcomes
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
43
45
47
49
51
53
55
Premature Termination
Appropriate Termination
Continuers
PC
T S
core
s
C A M
Stage TransitionsStage Transitions
44
46
48
50
52
54
56
PC Cont Prep Action Maint
ProsCons
Pros and Cons of Arranging Pros and Cons of Arranging Follow-up AppointmentsFollow-up Appointments
40
45
50
55
60
PC C P A M
Pros
Cons
T S
core
s
Stage
Stages by ProcessesStages by Processes
CONSCIOUSNESS RAISINGDRAMATIC RELIEFENVIRONMENTAL REEVALUATION
SELF REEVALUATION
PRECONTEMPLATION CONTEMPLATION PREPARATION
Stages by ProcessesStages by Processes
PREPARATION ACTION MAINTENANCE
SELF LIBERATION
COUNTERCONDITIONINGSTIMULUS CONTROL
REINFORCEMENT MANAGEMENTHELPING RELATIONSHIPS
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
0
10
20
30
Pretest 6 12 18
Action Manuals
Stage Manuals
Computers+
Counselors+
Assessment Periods
Per
cen
tag
e
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
0
5
10
15
20
25
30
ReactiveRecruitment
ProactiveRecruitment
Baseline
Per
cen
tage
6 months 12 months 18 months
Assessment Periods
Proactive vs. Reactive RecruitmentProactive vs. Reactive Recruitment
Percentage in Action/MaintenancePercentage in Action/Maintenance
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
Smoking Point PrevalenceSmoking Point PrevalenceHomeHome
0%
5%
10%
15%
20%
25%
30%
35%
40%
Baseline 12 Month 24 Month
TreatmentControl
% in
Act
ion
and
Mai
nten
ance
Diet Point PrevalenceDiet Point Prevalence(all subjects - PO1 School Adult Sample)(all subjects - PO1 School Adult Sample)
0%
5%
10%
15%
20%
25%
30%
35%
40%
Baseline 12 Month 24 Month
TreatmentControl
% in
Act
ion
and
Mai
nten
ance
Sun Point PrevalenceSun Point PrevalenceHomeHome
0%
5%
10%
15%
20%
25%
30%
35%
40%
Baseline 12 Month 24 Month
TreatmentControl
% in
Act
ion
and
Mai
nten
ance
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%
Impact of Stage-Matched Impact of Stage-Matched ProgramsPrograms
Efficacy X Participation = ImpactEfficacy X Participation = Impact
Individual/Clinic:Individual/Clinic:– 30% X 5% = 1.5%30% X 5% = 1.5%
Public Health/Community:Public Health/Community:– 6% X 75% = 4.5%6% X 75% = 4.5%
Stage-Matched Proactive:Stage-Matched Proactive:– 20% X 75% = 20% X 75% = 15%15%
Population Health ParadigmsPopulation Health Paradigms
Old Paradigm Old Paradigm Complemented byComplemented by New ParadigmNew Paradigm 1. Individualized Patient1. Individualized Patient 1. Entire Populations1. Entire Populations
2. Passive-Reactive Services2. Passive-Reactive Services 2. Proactive Services2. Proactive Services
3. Passive Reactive Patients3. Passive Reactive Patients 3. Proactive Populations3. Proactive Populations
4. Action-Oriented4. Action-Oriented 4. Stage-based4. Stage-based
5. Expert Clinicians5. Expert Clinicians 5. Expert Systems5. Expert Systems
6. Standard Treatment6. Standard Treatment 6. Tailored Treatment6. Tailored Treatment
7. Clinic Based7. Clinic Based 7. Home/Work Based7. Home/Work Based
8. Single Behavior8. Single Behavior 8. Multiple Behaviors8. Multiple Behaviors
9. Single Level 9. Single Level InterventionsInterventions
10. Efficacy Trials 10. Efficacy Trials
9. Multiple Level 9. Multiple Level
Interventions Interventions
10. Effectiveness Trials10. Effectiveness Trials
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