Kerry E. Evers

A randomized clinical trial of a population- and transtheoretical model-based stress-management intervention

Stress has been associated with a variety of chronic and acute conditions and with higher use of health care services. This research reports on 18-month outcomes of a randomized clinical trial of a stress-management program based on the transtheoretical model (TTM; J. O. Prochaska & C. C. DiClemente, 1986). A national sample of 1,085 individuals participated (age range = 18-91 years, M = 55.33; 68.9% female, 31.1% male; 84.8% Caucasian; 15.2% non-Caucasian). Both the treatment and control groups received assessments at 0, 6, 12, and 18 months. In addition to the assessments, the treatment group received 3 individualized reports (0, 3, 6 months) and a manual. The 18-month assessment was completed by 778 individuals (72%). A random effects model indicated that participants completing the study in the treatment group had significantly more individuals reporting effective stress management at follow-up time points than did completers in the control group. Results also indicate that the intervention had significant effects on stress, depression, and specific stress-management behaviors. Results provide evidence for the effectiveness of this TTM population-based stress-management intervention.

Transtheoretical Individualized Multimedia Expert Systems Targeting Adolescents' Health Behaviors

The transtheoretical model has advanced research and practice for many health behavior changes among adults, but few applications have been developed and applied among adolescents. This paper will describe an innovative and promising computer-based technology for standardized assessment and individualized theory-based intervention delivery called expert systems. Two different studies utilizing multimedia expert systems technology for assessing and intervening with adolescents targeting several health behaviors will be described. One study includes high school students and targets smoking cessation or prevention, sun protection, and dietary fat reduction. The other study includes urban adolescent female clients recruited in family planning clinics and targets condom adoption and either smoking cessation or prevention. The advantages and disadvantages of expert systems technology are reviewed. Multimedia expert system technology has the potential to enhance health promotion and adherence by integrating the strongest components from both clinical and public health models of intervention.

Transtheoretical-based bullying prevention effectiveness trials in middle schools and high schools

Background Bullying threatens the physical and mental well-being of students across a broad range of schools. Tailored interventions based on the Transtheoretical model and delivered over the Internet were designed to reduce participation in each of three roles related to bullying (bully, victim and passive bystander). Methods Effectiveness trials were completed in 12 middle schools and 13 high schools in the USA. A diverse sample of 1237 middle (6th–8th grade, with 45.1% in the 7th grade; ages 11–14) and 1215 high school (9th–11th grade, with 41.6% in the 9th grade; ages 14–17) students were available for analyses. Results Analyses showed significant treatment effects for both intervention groups when compared to control for both the middle and high school programs. Conclusions Given the relative ease of dissemination, these programs could be applied as stand-alone practices or as part of more intensive interventions.

eHealth promotion: the use of the Internet for health promotion.

The use of the Internet for health promotion is explored in this edition including growth trends, general applicability, and evaluation strategies for online interventions. This article examines the range of preliminary studies of eHealth Promotion interventions and their summary results, and reviews potential evaluation tools and their use in online programming. Also assessed is their utility in population-based programming and review-selected implications for the field.

Enhancing Multiple Domains of Well-Being by Decreasing Multiple Health Risk Behaviors: A Randomized Clinical Trial

Tailored behavior change programs have proven effective at decreasing health risk factors, but the impact of such programs on participant well-being has not been tested. This randomized trial evaluated the impact of tailored telephone coaching and Internet interventions on health risk behaviors and individual well-being. Exercise and stress management were the primary health risks of interest; improvements in other health risk behaviors were secondary outcomes. A sample of 3391 individuals who reported health risk in the areas of exercise and stress management were randomly assigned to 3 groups: telephonic coaching that applied Transtheoretical Model (TTM) tailoring for exercise and minimal tailoring (stage of change) for stress management; an Internet program that applied TTM tailoring for stress management and minimal tailoring for exercise; or a control group that received an assessment only. Participants were administered the Well-Being Assessment and, at baseline, had relatively low well-being scores (mean, 60.9 out of 100 across all groups). At 6 months, a significantly higher percentage of both treatment groups progressed to the Action stage for exercise, stress management, healthy diet, and total number of health risks, compared to the control group. Both treatment groups also demonstrated significantly greater improvements on overall well-being and the domains of emotional health, physical health, life evaluation, and healthy behaviors. There were no differences between the groups for 2 well-being domains: basic access to needs and work environment. These results indicate that scalable, tailored behavior change programs can effectively reduce health risk and accrue to improved well-being for participants.

The Well-Being Assessment for Productivity A Well-Being Approach to Presenteeism

Objective: To develop a presenteeism assessment, the Well-Being Assessment for Productivity (WBA-P), that provides an informative evaluation of job performance loss due to well-being related barriers. Method: The WBA-P was developed using exploratory and confirmatory factor analysis using survey data from 1827 employed individuals. Evidence of criterion-related validity was established using multivariate analysis of variance across measures of health and well-being. Results: A hierarchical, two-factor model demonstrated good fit and included factors capturing productivity loss from personal reasons (WBA-PP) and work environment (WBA-PW). Significant interactions existed between these and previously validated presenteeism measures with respect to physical and emotional health, risk factors, and life evaluation. Conclusions: This initial psychometric evidence suggests that the WBA-P and its subscales are valid measures of presenteeism that capture actionable well-being–related performance barriers.

Efficacy and effectiveness trials: examples from smoking cessation and bullying prevention.

If health psychology is to maximize impacts on health, there will need to be a shift from relying primarily on efficacy trials to increasing reliance on effectiveness trials. Efficacy trials use homogeneous, highly motivated samples with minimal complications from a single setting receiving intensive treatments delivered under highly controlled conditions. Two effectiveness trials on bullying prevention illustrate the use of a heterogeneous population from multiple sites receiving a low intensity tailored treatment delivered under highly variable conditions. In spite of considerable noise the effectiveness trials produced robust results (odds ratios of about four) that bode well for population impacts under real-world dissemination.

Development of Review Criteria to Evaluate Health Behavior Change Websites

A growing number of major health care organizations, such as the American Heart Association and the Mayo Clinic, are investing considerable resources in developing and marketing Internet-based programs for health promotion and disease management. These programs have the potential to provide some of the best-tailored interventions in behavior change science at relatively low costs. This report discusses review criteria developed in order to conduct a systematic evaluation of Internet programs for preventive behaviors (alcohol, diet, exercise and smoking) and disease management (pediatric asthma, depression and diabetes.) These criteria can be used to develop and evaluate the quality of health promotion programs on the Internet.

Longitudinal Changes in Stages of Change for Condom Use in Women

Purpose. This study identifies how women naturally progress through the Transtheoretical Model stages of condom use over a 1 year period, using the longitudinal dynamic methodology of latent transition analysis (LTA). Design. As part of a larger study of human immunodeficiency virus risk in women, participants were assessed for their stage of condom use two times, 1 year apart. Subjects. A total of 491 women who completed both assessments of the study were included in this analysis. Measures. Stage of condom use was assessed using two questions, which placed women into one of five stages of change for condom use (α = .90). Results. Latent transition analysis identified the best-fitting model of naturalistic stage progression, which included both forward and backward movement. Precontemplation and maintenance were found to be the most stable stages (more than 50% of the participants remaining in that stage 1 year later), and the action stage was the least stable (15 % remaining in this stage). Transition probabilities for all stages showed a high rate of relapse in the sample. Conclusions. A high proportion of women will remain within their stage of condom use over a 1-year period if no intervention is introduced. Interventions that are aimed at increasing condom use in women need to incorporate relapse prevention. In addition, the transition probabilities for the stages will help establish reasonable rates of change for intervention programs.

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.