Andrea L. Paiva

Results of a multi-media multiple behavior obesity prevention program for adolescents.

BACKGROUND This study reports on effectiveness trial outcomes of Health in Motion, a computer tailored multiple behavior intervention for adolescents. METHODS Using school as level of assignment, students (n=1800) from eight high schools in four states (RI, TN, MA, and NY) were stratified and randomly assigned to no treatment or a multi-media intervention for physical activity, fruit and vegetable consumption, and limited TV viewing between 2006 and 2007. RESULTS Intervention effects on continuous outcomes, on movement to action and maintenance stages, and on stability within action and maintenance stages were evaluated using random effects modeling. Effects were most pronounced for fruit and vegetable consumption and for total risks across all time points and for each behavior immediately post intervention. Co-variation of behavior change occurred within the treatment group, where individuals progressing to action or maintenance for one behavior were 1.4-4.2 times more likely to make similar progress on another behavior. CONCLUSION Health in Motion is an innovative, multiple behavior obesity prevention intervention relevant for all adolescents that relies solely on interactive technology to deliver tailored feedback. The outcomes of the effectiveness trial demonstrate both an ability to initiate behavior change across multiple energy balance behaviors simultaneously and feasibility for ease of dissemination.

Common Factors Predicting Long-term Changes in Multiple Health Behaviors

This study was designed to assess if there are consistent treatment, stage, severity, effort and demographic effects which predict long-term changes across the multiple behaviors of smoking, diet and sun exposure. A secondary data analysis integrated data from four studies on smoking cessation (N = 3927), three studies on diet (N = 4824) and four studies on sun exposure (N = 6465). Across all three behaviors, behavior change at 24 months was related to treatment, stage of change, problem severity and effort effects measured at baseline. There were no consistent demographic effects. Across multiple behaviors, long-term behavior changes are consistently related to four effects that are dynamic and open to change. Behavior changes were not consistently related to static demographic variables. Future intervention research can target the four effects to determine if breakthroughs can be produced in changing single and multiple behaviors.

Treated individuals who progress to action or maintenance for one behavior are more likely to make similar progress on another behavior: Coaction results of a pooled data analysis of three trials

OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

Motivation for blood donation among African Americans: developing measures for stage of change, decisional balance, and self-efficacy constructs

Despite a specific need for transfused blood among African Americans due to higher rates of sickle cell disease, African Americans donate blood significantly less frequently than their White counterparts. This study describes the development and validation of culturally adapted measures of the transtheoretical model (TTM) constructs of Stage of Change, Decisional Balance, and Self-efficacy applied to blood donation in an African American sample. Exploratory and confirmatory analyses produced one pros and two cons scales for the Decisional Balance Inventory, and one scale for the Situational Self-efficacy Measure. Expected patterns for the Decisional Balance and Self-efficacy Scales by Stage of Change were found, but only the pros and one cons scale varied significantly. Results provide support for use of the TTM applied to blood donation and have important implications for development of effective assessment and intervention tools to increase blood donation among the African American population.

Coaction in multiple behavior change interventions: consistency across multiple studies on weight management and obesity prevention.

OBJECTIVE Coaction refers to the extent to which taking action on one behavior increases the odds of taking action on a second behavior. This integrative study examines the generalization of coaction in three studies on weight-related behaviors. METHOD Data from three randomized trials of tailored interventions (n = 1,277, n = 1,800, and n = 6,000) were examined to determine if coaction of behavior change occurred differentially in treatment and control groups. In each analysis, the likelihood of progressing to the Action or Maintenance stages for the target behaviors was evaluated using logistic regression. RESULTS Despite differences in populations, targeted behaviors, levels of tailoring in interventions, and timing of follow-up assessments, 17 out of 24 (70.8%) logistic regressions revealed significant coaction in the treatment group as opposed to only three out of 24 (12.5%) in the control condition. In 23/24 analyses, coaction of behavior change was larger on an absolute basis in the treatment group. Individuals in the treatment group progressing to Action/Maintenance for one behavior were 1.4-5 times more likely to make progress on another behavior compared to those in the treatment group who did not make such progress on the first behavior. CONCLUSIONS This study demonstrates that despite considerable variability in study design, coaction reliably occurs more in the presence of Transtheoretical-Model based multiple behavior change interventions. Additional studies are needed to replicate these results in other behavioral areas and to examine the predictors of differential coaction. The ability to consistently create coaction within multiple behavior interventions can increase the efficacy and cost-effectiveness of multiple behavior change interventions.

Donation Intentions among African American College Students: Decisional Balance and Self-efficacy Measures

Although the need for transplantation among African Americans is high, their donation rates are disproportionately low. This study describes the development and validation of culturally adapted psychosocial measures, including Transtheoretical Model constructs, Stages of Change, Decisional Balance, and Self-efficacy, related to deceased organ and tissue donation for an African American college population. Exploratory and confirmatory analyses for Decisional Balance and Self-efficacy measures demonstrated factor structures similar to previous studies of other behavioral applications, indicated excellent model fit and showed good internal and external validity. This study developed brief measures with good psychometric properties for an emerging behavior change domain in a new population.

Results of a Transtheoretical Model-Based Alcohol, Tobacco and Other Drug Intervention in Middle Schools

BACKGROUND Early use of alcohol, tobacco, and other drugs threatens the physical and mental well-being of students and continued use negatively affects many areas of development. An internet-based, tailored intervention based on the Transtheoretical Model of Behavior Change was delivered to middle school students to reduce alcohol, tobacco, and other drug use. This internet-based approach requires very little faculty and staff time, which is efficient given curricular demands. METHODS Twenty-two middle schools in the United States were matched and randomly assigned to either the intervention or control conditions (N=1590 students who had ever used substances). Participants received one pre-test assessment, three thirty-minute intervention sessions over three months, and two post-test assessments (3 and 14 months after pre-test, respectively). RESULTS Random effects logistic models showed significant treatment effects for the intervention group when compared to the control group at the 3-month post-test. CONCLUSIONS This program has the potential to be applied as stand-alone practice or as part of more intensive interventions to promote substance use cessation.

Kidney patients' intention to receive a deceased donor transplant: development of stage of change, decisional balance and self-efficacy measures.

In order to sustain life, patients whose kidneys fail must receive dialysis or obtain a transplant. This study reports on the development and validation of measures of Stage of Change, Decisional Balance and Self-efficacy based on the Transtheoretical Model (TTM) to assess patients’ readiness to receive a deceased donor transplant. We surveyed 293 transplant-eligible kidney patients about their deceased donation readiness. Exploratory and confirmatory analyses for all measures demonstrated factor structures similar to previous application of the TTM to other health behaviors, excellent model fit and good internal and external validity. These brief, reliable instruments with good psychometric properties can guide the development of improved, individually-tailored transplant education for patients.

Development and Validation of Green Eating Behaviors, Stage of Change, Decisional Balance, and Self-Efficacy Scales in College Students

OBJECTIVE To develop and validate an instrument to assess environmentally conscious eating (Green Eating [GE]) behavior (BEH) and GE Transtheoretical Model constructs including Stage of Change (SOC), Decisional Balance (DB), and Self-efficacy (SE). DESIGN Cross-sectional instrument development survey. SETTING/PARTICIPANTS Convenience sample (n = 954) of 18- to 24-year-old college students from a northeastern university. ANALYSIS The sample was randomly split: (N1) and (N2). N1 was used for exploratory factor analyses using principal components analyses; N2 was used for confirmatory analyses (structural modeling) and reliability analyses (coefficient α). The full sample was used for measurement invariance (multi-group confirmatory analyses) and convergent validity (BEH) and known group validation (DB and SE) by SOC using analysis of variance. RESULTS Reliable (α > .7), psychometrically sound, and stable measures included 2 correlated 5-item DB subscales (Pros and Cons), 2 correlated SE subscales (school [5 items] and home [3 items]), and a single 6-item BEH scale. Most students (66%) were in Precontemplation and Contemplation SOC. Behavior, DB, and SE scales differed significantly by SOC (P < .001) with moderate to large effect sizes, as predicted by the Transtheoretical Model, which supported the validity of these measures. CONCLUSIONS AND IMPLICATIONS Successful development and preliminary validation of this 25-item GE instrument provides a basis for assessment as well as development of tailored interventions for college students.

Measuring kidney patients' motivation to pursue living donor kidney transplant: Development of Stage of Change, Decisional Balance and Self-Efficacy measures

While educational interventions to increase patient motivation to pursue living donor kidney transplant have shown success in increasing living donor kidney transplant rates, there are no validated, theoretically consistent measures of Stage of Change, a measure of readiness to pursue living donor kidney transplant; Decisional Balance, a weighted assessment of living donor kidney transplant’s advantages/disadvantages; and Self-Efficacy, a measure of belief that patients can pursue living donor kidney transplant in difficult circumstances. This study developed and validated measures of these three constructs. In two independent samples of kidney patients (N1 = 279 and N2 = 204), results showed good psychometric properties and support for their use in the assessment of living donor kidney transplant interventions.