Enhancing multiple domains of well-being by decreasing multiple health risk behaviors: a randomized clinical trial

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Enhancing multiple domains of well-being by decreasing multiple health risk behaviors: a randomized clinical trial
Enhancing multiple domains of well-being by decreasing multiple health risk behaviors

Prochaska et al (2012) - Full Text Available

Background: The Transtheoretical Model (TTM) integrates important dimensions of behavior change. Through the stages of change that it identifies, the model integrates common processes of change found in several theories, and thus is called ‘trans-theoretical.” In addition to the stages of change (changes of motivational readiness through time), the model includes constructs such as decisional balance (benefits and costs of changing); self-efficacy (confidence to engage in a behavior and temptation); and 10 processes of change (activities in order to progress through the stages). Thus, according to this model, some of the processes are more effective at specific stages and a matching of process to stage is instrumental in achieving the desired change. 

The research team designed a Randomized Control Trial of behavior change interventions for improving wellbeing, which are theoretically based on the TTM. The study employs a broad understanding of “wellbeing” that includes multiple domains. It aims to see how these domains of wellbeing could be enhanced simultaneously (and multiple behavior risk factors also reduced) by three types of interventions: 

  1. An online intervention of 3 sessions, fully tailored according to the TTM, with a purpose to motivate the behavior of stress management. Full tailoring means that the intervention is adjusted to the appropriate stage of change through all 14 variables of the TTM given above. 
  2. A telephone coaching intervention of 3 sessions, optimally tailored with the purpose to motivate exercise behavior. Optimal tailoring means that the intervention is adjusted to the appropriate stage of change through 3-5 of the variables of the TTM, which are deemed to be most relevant. The coaching is provided by a professional coach on the phone, who inputs the client’s answers to questions to the computer and receives from the program the most appropriate response to be given for the particular stage of change. 
  3. A control group with no intervention

The trial started out with over 3000 participants recruited through the internet and randomized to the three groups; however quite a few dropped out by the end of the trial. Nevertheless, the large sample allowed for completing the trail and coming to the conclusion, that both interventions, designed according to the principles of the TTM, led to improvement in multiple health risk behaviors and wellbeing. It led to an increase in the percentage of people who were in the Thriving condition, according to the wellbeing measure. While the study was not designed to compare the three interventions, there is some evidence that the magnitude of change was greater in the coaching intervention, which was provided by a health professional, rather than by an internet based agent. 

Implications for practice: The conclusions from the above trail illustrate the potential of coaching based on the TTM to motivate behavior change and increase wellbeing. TTM ideas can inform coaching and have been applied to coaching for health behavior change for exercise, weight management, smoking, immunization and others. Coaching informed by the TTM would take into account that not everyone is ready to change, that change happens at a different pace for different people, and would aim to identify the stage which the client is in at that particular time. Further, when identifying the stage of change, the coach could consider which questions and recommendations (eg., “let’s come up with some pros of changing this behavior that you will focus on”) could be most effective for the particular person at the particular stage, and what would be necessary to move the client to the next stage. 

Prochaska, J. O., Evers, K. E., Castle, P. H., Johnson, J. L., Prochaska, J. M., Rula, E. Y., . . . Pope, J. E. (2012). Enhancing multiple domains of well-being by decreasing multiple health risk behaviors: a randomized clinical trial. Popul Health Manag, 15(5), 276-286. doi: 10.1089/pop.2011.0060

Publisher: 
Population Health Management, 2012, Vol. 15, No. 5

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