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Abstract

Offers transtheoretical therapy as one alternative when seeking a synthesis for the increasing proliferation of therapeutic systems. From a comparative analysis of 18 leading systems, 5 basic processes of change were identified by the present 1st author (1979). They are consciousness raising (feedback, education), conditional stimuli (counterconditioning, stimulus control), catharsis (corrective emotional experiences, dramatic relief), choosing (self-liberation, social liberation), and contingency control (reevaluation, contingency management). Each process can be applied at the level of either the individual's experience or environment. The present authors (see record 1982-31158-001) have identified the following stages of change: contemplation, termination, action, and maintenance. The verbal processes of change—consciousness raising, catharsis, and choosing—are most important during the 1st 2 stages, while behavior therapies (conditional stimuli and contingency control) are needed once a commitment is made. It is suggested that in the transtheoretical model, cognitive restructuring is seen as the result of the individual effectively applying the appropriate processes of change during each of the appropriate stages of change. (27 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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... The unique and personal implications of health behaviors and decisions on one's body, health and physiological state, which refer to humans' most basic set of considerations and needs (Maslow, 1943), suggest that health behavior decision processes are likely to be different than other types of behaviors, such as tax-compliance or pro-environmental behavior. Indeed, while classic policy compliance and law obedience scholarships stress the role of perceived legitimacy of the government or sense of moral duty or obligation in compiling with governmentally desired behavior (Fine & van Rooij, 2021;Levi, 1988;Murphy, 2004;Scholz & Lubell, 1998;Thomassen et al., 2017;Tyler, 1990), health behavior theories highlight a complex set of cognitive perceptions and evaluations regarding the promoted behaviors, as behavioral determinants (Green, 1974;Hayden, 2022;Irwig‫‬ et al., 2008;Janz & Becker, 1984;Prochaska & DiClemente, 1982;Rosenstock, 1974). This emphasizes the likelihood that decision-making processes regarding health-behavior-related instructions are different than those operated in other domains. ...
... While the first stresses the effect of trusted sources of information on cognitive appraisals of promoted actions (Chaiken, 1980;Chetioui et al., 2021;P. Liu et al., 2019;O'Keefe, 2015;Petty & Cacioppo, 1986;Thaker et al., 2017;Visschers et al., 2011;Wallace et al., 2020), the latter, as mentioned above, and particularly the HBM, focus on cognitive appraisals of actions and their outcomes as a prominent factor in determining health behavior (Green, 1974;Hayden, 2022;Irwig‫‬ et al., 2008;Janz & Becker, 1984;Prochaska & DiClemente, 1982;Rosenstock, 1974). ...
... Furthermore, as will be elaborated in the next section, prominent theories on health behavior set their main focus on cognitive mechanisms of appraisal of the behavior of interest, at the heart of the health behavior decision-making process (Green, 1974;Hayden, 2022;Irwig‫‬ et al., 2008;Janz & Becker, 1984;Prochaska & DiClemente, 1982;Rosenstock, 1974). This differs from classic political and law obedience literature, which, as mentioned above, points at a different set of considerations when deciding to comply with laws and regulations in other realms, namely legitimacy and a sense of obligation and duty to comply (Fine & van Rooij, 2021;Levi, 1988;Murphy, 2004;Scholz & Lubell, 1998;Thomassen et al., 2017;Tyler, 1990). ...
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Trust in government is considered a prominent factor for enhancing public compliance with government policies and instructions. The Coronavirus pandemic demonstrates the crucial role public compliance with governmentally issued health guidelines has in mitigating the pandemic. However, the mechanism explaining the trust-compliance association, particularly in regard to health-behavior compliance, is unclear. This article develops a new theoretical model, the Mediated Trust Model (MTM), for explaining the relationship between trust in government and public compliance with health instructions. The model extends the classic Health Belief Model for predicting health behavior by claiming that the perceptions regarding the instructions' costs, benefits and one's ability to perform them are affected by trust in government and mediate the trust-compliance association. The MTM was tested in four cross-sectional studies performed during the first 20 months of the Coronavirus pandemic in Israel on 3732 participants, for various health instructions. Implications for public health literature, policy compliance theory and policy makers are discussed.
... We designed the intervention using the transtheoretical model focussing on the decision-making of the individual, tailored to their level of knowledge and motivation. 18 Through the monthly visits by trained SGH members and the structured education by them over six sessions, we intended to increase the awareness about the healthy behaviour among the beneficiaries and help them to self-reappraise to realise that the healthy behaviour is part of who they want to be. We felt that sharing experiences in the peer group meetings and support offered by their peer would (1) arouse them emotionally to adopt healthy behaviours, (2) provide opportunities to show that society is supportive of the healthy behaviour, (3) lead to commitment to change behaviour based on the belief that achievement of the healthy behaviour is possible and (4) help them in finding supportive relationships that encourage the desired change. ...
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Background With less than 20% of people with hypertension achieving their target blood pressure (BP) goals, uncontrolled hypertension remains a major public health problem in India. We conducted a study to assess the effectiveness of a community-based education and peer support programme led by women’s self-help group (SHG) members in reducing the mean systolic BP among people with hypertension in urban slums of Kochi city, Kerala, India. Methods A cluster randomised controlled pragmatic trial was conducted where 20 slums were randomised to either the intervention or the control arms. In each slum, participants who had elevated BP (>140/90) or were on antihypertensive medications were recruited. The intervention was delivered through women’s SHG members (1 per 20–30 households) who provided (1) assistance in daily hypertension management, (2) social and emotional support to encourage healthy behaviours and (3) referral to the primary healthcare system. Those in the control arm received standard of care. The primary outcome was change in mean systolic BP (SBP) after 6 months. Results A total of 1952 participants were recruited—968 in the intervention arm and 984 in the control arm. Mean SBP was reduced by 6.26 mm Hg (SE 0.69) in the intervention arm compared with 2.16 mm Hg (SE 0.70) in the control arm; the net difference being 4.09 (95% CI 2.15 to 4.09), p<0.001. Conclusion This women’s SHG members led community intervention was effective in reducing SBP among people with hypertension compared with those who received usual care, over 6 months in urban slums of Kerala, India. Trial registration number CTRI/2019/12/022252.
... In light of the patients' and providers' emotions, helping patients make decisions about end-of-life care is a skill that can be learned and must continually be refreshed [15]. It helps to begin by understanding the Transtheoretical Model of the Stages of Change that identifies movement from precontemplation through contemplation to planning, action, and maintenance [16]. Using this framework, motivational interviewing is an incredibly powerful tool for eliciting the patient's perspectives on change in an emotionally safe discussion. ...
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Palliative care discussions offer a unique opportunity for helping patients choose end-of-life (EOL) treatments. These are among the most difficult decisions in later life, and protecting patients’ ability to make these choices is one of healthcare’s strongest ethical mandates. Yet, traditional approaches to advance care planning (ACP) have only been moderately successful in helping patients make decisions that lead to treatments concordant with their values. In particular, neglect of attention to the emotions that occur during consideration of the end of one’s life contributes to patients’ difficulty with engaging in the process and following through on decisions. To improve ACP outcomes, providers can address the patient’s emotional experiences, and can use motivational interviewing as a way attend to elicit them and incorporate them into care planning. Applying personalizing emotion-attuned protocols like Conditional Medical Orders (CMO) also promotes this end.
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Background Firearm injury is a leading cause of preventable death in the USA. Healthcare providers are uniquely poised to focus on firearm safety and injury prevention from an apolitical harm reduction lens; however, few providers and healthcare settings incorporate firearm injury prevention strategies into usual care. We outline the first protocol to determine how to implement universal Firearm Injury and Mortality Prevention (FIMP) strategies that identify and address firearm access and violence risk in healthcare settings as part of routine care using the Consolidated Framework for Implementation Research (CFIR) to inform implementation and evaluation. Methods The components of our FIMP strategy, including universal screening, intervention for patients at risk, and resources, will be developed from existing evidence-based strategies for firearm access and violence risk ( intervention characteristics ). The implementation process will include components of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for substance use, adapted to FIMP ( implementation process ). To engage stakeholders, harmonize language, and garner support, an Executive Advisory Board (EAB) will be formed, consisting of the site- and system-level stakeholders ( inner setting ) and community stakeholders, including influential figures such as local religious and spiritual leaders, individuals with lived experience, and community-based organizations ( outer setting ). Pre-implementation surveys will identify the characteristics of individuals and guide the development of education prior to implementation. Patient-level screening data will be analyzed to identify the risk factors, implementation will be evaluated using mixed methods, and a limited-efficacy study will evaluate whether strategies were successful in driving behavior change. Discussion This study protocol has breakthrough and methodological innovations, by addressing FIMP as part of usual care to directly mitigate firearm injury risk among youth, adults, and household members (e.g., children) and by using rigorous methods to inform healthcare industry implementation of FIMP strategies. The expected outcomes of this study protocol will provide a solid basis for larger-scale dissemination and evaluation of implementation, effectiveness, and usability across broader pediatric and adult healthcare settings. This project will advance the implementation science and have a positive impact on the health of our patients and communities by preventing firearm injury and mortality and shifting the paradigm to view FIMP through a public health lens.
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Cites recent evidence which suggests that wolpe's theoretical formulations are inadequate in accounting for the effectiveness of the therapeutic approach of systematic desensitization. Of the elements traditionally included in the desensitization procedure, neither training in muscle relaxation, the construction of a graded hierarchy of fear-relevant scenes, nor the concomitance of instructed imagination to muscle relaxation are necessary conditions for treatment success. Instructed imagination by itself is considered the only necessary element of the desensitization procedure. The effectiveness of the procedure does not appear to be due to the traditionally stated mutual antagonism between muscle relaxation and anxiety, but rather to social variables in the patient-therapist relationship and cognitive variables involving (a) expectancy of therapeutic gain, (b) information feedback of success, (c) training in the control of attention, and (d) vicarious learning of the contingencies of behavior. (43 ref.)
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Productive thinking is an aspect of intelligence which has been generally overlooked in most theoretical conceptualizations of human intelligence. A listing of approximately 40 intellectual factors culled from the research literature are presented. Of these numerous factors, the vast majority have to do with thinking and the remainder are memory factors. These factors are categorized according to a scheme suggested by the author. The "implications of the factors and their system were pointed out for factor theory and practice, for general psychological theory, and for the concept of intelligence and practices of intelligence testing." 31 references.
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