Multiple risk expert system interventions: Impact of simultaneous stage-matched expert system interventions for smoking, high fat diet and sun exposure in a population of parents

Cancer Prevention Research Center, University of Rhode Island, Kingston, RI 02881-0808, USA.
Health Psychology (Impact Factor: 3.95). 10/2004; 23(5):503-16. DOI: 10.1037/0278-6133.23.5.503
Source: PubMed

ABSTRACT Three stage-based expert system interventions for smoking, high-fat diet, and unsafe sun exposure were evaluated in a sample of 2,460 parents of teenagers. Eighty-four percent of the eligible parents were enrolled in a 2-arm randomized control trial, with the treatment group receiving individualized feedback reports for each of their relevant behaviors at 0, 6, and 12 months as well as a multiple behavior manual. At 24 months, the expert system outperformed the comparison condition across all 3 risk behaviors, resulting in 22% of the participants in action or maintenance for smoking (vs. 16% for the comparison condition), 34% for diet (vs. 26%), and 30% for sun exposure (vs. 22%). Proactive, home-based, and stage-matched expert systems can produce significant multiple behavior changes in at-risk populations where the majority of participants are not prepared to change.

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Available from: Wayne F Velicer, Aug 22, 2015
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    • "The intervention effect was considerably smaller (0.12 points) than that reported in the U.S. SCAPE intervention (Glanz et al., 2010) (0.23 points) where intervention delivery was via a tailored mail intervention package . However, other studies using telephone-delivered intervention sessions, similarly achieved only small improvements in sunscreen use, and no significant change in sun avoidance (Head et al., 2013; Prochaska et al., 2004). Armstrong et al.'s intervention was more successful using SMS-delivered reminders with a significant increase in the proportion of participants who dispensed sunscreen daily (56%) compared to control (30%) (Armstrong et al., 2009 "
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    ABSTRACT: Objective. To test the impact of a theory-based, SMS (text message)-delivered behavioural intervention (Healthy Text) targeting sun protection or skin self-examination behaviours compared to attention control. Method. Overall, 546 participants aged 18-42 years were randomised using a computer-generated number list to the skin self-examination (N = 176), sun protection (N = 187), or attention control (N = 183) text messages group. Each group received 21 text messages about their assigned topic over 12 months (12 weekly messages for 3 months, then monthly messages for the next 9 months). Data were collected via telephone survey at baseline, 3, and 12 months across Queensland from January 2012 to August 2013. Results. One year after baseline, the sun protection (mean change 0.12; P = 0.030) and skin self-examination groups (mean change 0.12; P = 0.035) had significantly greater improvement in their sun protection habits (SPH) index compared to the attention control group (reference mean change 0.02). The increase in the proportion of participants who reported any skin self-examination from baseline to 12 months was significantly greater in the skin self-examination intervention group (103/163; 63%; P < 0.001) than the sun protection (83/173; 48%) or attention control (65/165; 36%) groups. There was no significant effect of the intervention for participants' self-reported whole-body skin self-examination, sun tanning, or sunburn behaviours. Conclusion. The Healthy Text intervention was effective in inducing significant improvements in sun protection and any type of skin self-examination behaviours.
    Preventive Medicine 12/2014; 71. DOI:10.1016/j.ypmed.2014.12.009 · 2.93 Impact Factor
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    • "The causes of wellbeing and illbeing involve a complex adaptive network of components and processes that we are now beginning to be able to specify, measure and treat according to the principles of personcentered medicine. people are not initially aware of the causes of their problems, interventions that enhance awareness are effective in motivating lifestyle change and thereby enhancing health [32] [33]. Although the components of wellbeing described here may appear to be more relevant to mental health, what we present is actually a general model for the causes of all aspects of health. "
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    ABSTRACT: The causes of wellbeing and illbeing interact with feedback dynamics resulting in the same set of traits giving rise to a variety of health outcomes (multi-finality) and different traits giving rise to the same health outcome (equi-finality). As a result, a full understanding of health and its disorders must be in terms of a complex adaptive system of causes, rather than in terms of categorical diagnoses or sets of symptoms. The three domains of person-centered integrative diagnosis (PID) are considered here as interacting components of a complex adaptive system comprised of health status (functioning/wellness versus disability/disorder), experience of health (self-awareness/fulfillment versus misunderstanding/suffering) and contributors to health (protective versus risk factors). The PID domains thereby allow healthcare and health promotion to be understood in terms of measurable components of a complex adaptive system. Three major concepts of health are examined in detail to identify their dynamic origins: Psychological Maturity, Flourishing and Resilience. In humanistic psychology, psychological maturity (i.e. healthy personality, mental wellbeing) involves the development of high self-directedness, high co-operativeness and high self-transcendence, but self-transcendence is nevertheless devalued in individualistic and materialistic cultures except when people must face adversity and ultimate situations like suffering or the threat of death. Psychological Maturity develops through two complementary processes often labeled as Flourishing and Resilience. Flourishing is the development of one's potential to live optimally, especially as the result of favorable circumstances, whereas Resilience is positive adaptation to life despite adverse circumstances. As a result of the complex feedback dynamics between the processes of flourishing and resilience, each person is a unique individual who has a variety of paths for achieving positive health and wellbeing open to him or her. Person-centered health promotion and care can thereby be approached as a creative life project that can be conducted with the assistance of healthcare workers who are both therapeutic allies and well-informed experts.
    06/2012; 2(2):179-187. DOI:10.5750/ijpcm.v2i2.213
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    • "Parent Study (Study 1). Among 2,460 (83.6%) of Rhode Island parents recruited (Prochaska et al., 2004), 2435 participants were included in this study. Patient Study (Study 2). "
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    ABSTRACT: This study compared, in treatment and control groups, the phenomena of coaction, which is the probability that taking effective action on one behavior is related to taking effective action on a second behavior. Pooled data from three randomized trials of Transtheoretical Model (TTM) tailored interventions (n=9461), completed in the U.S. in 1999, were analyzed to assess coaction in three behavior pairs (diet and sun protection, diet and smoking, and sun protection and smoking). Odds ratios (ORs) compared the likelihood of taking action on a second behavior compared to taking action on only one behavior. Across behavior pairs, at 12 and 24 months, the ORs for the treatment group were greater on an absolute basis than for the control group, with two being significant. The combined ORs at 12 and 24 months, respectively, were 1.63 and 1.85 for treatment and 1.20 and 1.10 for control. The results of this study with addictive, energy balance and appearance-related behaviors were consistent with results found in three studies applying TTM tailoring to energy balance behaviors. Across studies, there was more coaction within the treatment group. Future research should identify predictors of coaction in more multiple behavior change interventions.
    Preventive Medicine 03/2012; 54(5):331-4. DOI:10.1016/j.ypmed.2012.02.017 · 2.93 Impact Factor
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