Transcript Slide 1

Partnering for Higher Impact
Programs to Enhance Health and
Well-Being
James O. Prochaska, Ph.D.
Director and Professor
Cancer Prevention Research Center
University of Rhode Island
Founder
Pro-Change Behavior Systems, Inc.
• Goal:
To partner to produce
breakthroughs that will increase
impacts on the health and well
being of entire populations and
reduce costs related to health
care, disability and lost
productivity.
Inclusive Care from Two Clusters of
Paradigms for Individual Patients and
Entire Populations
Patient Health
Individual Patients
Complemented by
Population Health
Entire Populations
Stages of Change
Efficacy: Clinical Guidelines for
Treating Tobacco Use
I.
Fiore et al., 1996: 3000 studies on tobacco
II.
Fiore et al., 2000, 2008: 6000 studies
III.
Many evidence-based treatments for motivated
smokers (i.e. those in preparation stage)
IV.
No evidence-based treatments for unmotivated
smokers
A. > 80% of all U.S. smokers
Fiore et al., 1996: 3000 studies on tobacco. Fiore et al., 2000: 6000 studies
Inclusive Care from Two Clusters of
Paradigms for Individual Patients and Entire
Populations
Patient Health
Action Oriented
Complemented by
Population Health
Stage-based
Stage Transitions
56
54
Pros
Cons
52
50
48
46
44
PC
Cont
PR
Action
Maint
The pros and cons of changing across stages of change for 48 behaviors
Hall, K. L. & Rossi, J. S. (2008). Meta-analytic examination of the strong and weak principles across 48 health behaviors.
Preventive Medicine, 46, 266-274.
Proactive Engagement
•Proactive Engagement
•Communication Campaign
•Incentives
Inclusive Care from Two Clusters of
Paradigms for Individual Patients and
Entire Populations
Patient Health
Passive Reactive
Complemented by
Population
Health
Proactive
Programs have to communicate that
they are tailored to needs of each
patient:
1. Wherever you are at, we can
work with that!™
2. Traffic light: Red light not
ready; Yellow light getting
ready; Green light ready.
When extrinsic motivation, like
incentives are used, programs have to
help transform extrinsic into intrinsic
motivation.
A. Air Force example with smoking
Intervention Targeting and Tailoring
Pros & Cons
Self-Efficacy
Processes
Stage of Change
One Size Fits All
Targeted (Stage(Stage-Matched)
Tailored (Individualized)
Inclusive Care from Two Clusters of
Paradigms for Individual Patients
and Entire Populations
Patient Health
Standardized
Complemented by
Population Health
Tailored
Computer-Tailored Interventions
(CTI)
Reliable, valid assessments of
most important behavior change
constructs
Evidence-based,
statistically-derived
decision-making rules
Individualized, tailored
behavior change guidance
Feedback dynamically
updated based on new
assessment data
ADDING TTM-TAILORED INTERVENTIONS TO
MIDWIFE COUNSELING WITH PREGNANT
SMOKERS
Adding TTM-tailored Interventions Produced 8.2
Times the Impacts of Midwife Counseling Alone
1.
2.
3.
4.
5.
Increased Recruitment;
Increased Retention;
Increased Efficacy;
Decreased Mis-reporting;
Produced 8.2 times greater impacts
Inclusive Care from Two Clusters of
Paradigms for Individual Patients
and Entire Populations
Patient Health
Clinician Delivered
Complemented by
Population Health
Technology Delivered
Inclusive Care from Two Clusters of
Paradigms for Individual Patients
and Entire Populations
Patient Health
Clinic Based
Complemented by
Population Health
Home Based
ROBUST
RESULTS
Gender
Point Prevalence Abstinence
30
25
20
15
10
Male
Female
5
0
12
24
Assessment (Month)
Velicer, WF, Redding, CA, Sun, X, & Prochaska, JO. (2007). Demographic variables, smoking variables, and outcome across five studies.
Health Psychology, 26, 278-287.
Point Prevalence Abstinence
Race
30
25
20
15
10
White
5
Black
0
12
24
Assessment (Month)
Velicer, WF, Redding, CA, Sun, X, & Prochaska, JO. (2007). Demographic variables, smoking variables, and outcome across five studies.
Health Psychology, 26, 278-287.
Point Prevalence Abstinence
Hispanic
40
35
30
25
20
15
10
No
5
Yes
0
12
24
Assessment (Month)
Velicer, WF, Redding, CA, Sun, X, & Prochaska, JO. (2007). Demographic variables, smoking variables, and outcome across five studies. Health
Psychology, 26, 278-287.
Age
Point Prevalence Abstinence
40
35
<=24
30
25-34
25
20
35-44
15
45-54
10
55-64
5
65+
0
12
24
Assessment (Months)
Velicer, WF, Redding, CA, Sun, X, & Prochaska, JO. (2007). Demographic variables, smoking variables, and outcome across five studies. Health
Psychology, 26, 278-287.
Proactive Cessation With
Adolescents in Primary Care
Tailored Intervention
Assessment Only
23.9%
11.4%
Hollis, JF, Polen, MR, Whitlock, EP; Lichtenstein, E., Mullooly, JP, Velicer, W.F., & Redding, C.A. (2005). TEEN REACH: Outcomes from a
randomized controlled trial of a tobacco reduction program among teens seen in primary medical care. Pediatrics, 115, 981-999.
Proactive Cessation with Depressed
Patients: Abstinence at 18 Months
Tailored Intervention +
Assessment Only
24.6%
19.1%
Hall, S. M., Tsoh, J. V., Prochaska, J. J., Eisendrath, S., Humfleet, G. L., Gorecki, J. A. et al. (2006). Treatment for Cigarette
Smoking Among Depressed Mental Health Outpatients: A Randomized Clinical Trial. American Journal of Public Health,
96, 1808-1814.
Proactive Cessation with Patients
Hospitalized for Mental Illness
Tailored
Assessment
20%
8%
Prochaska, J.J. (2010). Failure to treat tobacco use in mental health and addiction settings: a form of harm reduction? Drug
and Alcohol Depend, 110 (3); 177-182.
Inclusive Care from Two Clusters
of Paradigms for Individual
Patients and Entire Populations
Patient Health
Single Target
Complemented by
Population Health
Multiple Targets
Coaction: The increased probability
of progressing to Action on a second
behavior (e.g. diet) when individuals
have progressed to Action on an
initial behavior (e.g. smoking).
Coaction in
Odds Ratios
Control Group
1.00
TTM Intervention Group 1.50-3.50
Percentage
Adherence: Regression from A/M by Group
Post-action at Baseline
100
95
90
85
80
75
70
65
60
55
50
Treatment
Control
Baseline
6 months
12 months
18 months
Johnson, SS, Driskell, MM, Johnson, JL, Dyment, SJ, Prochaska, JO, Prochaska, JM, & Bourne, L. (2006). Transtheoretical model intervention for
adherence to lipid-lowering drugs. Disease Management, 9, 102-114.
Exercise Staging: Adherence Group
Progression to A/M by Group (pre-action at
baseline)
50
% in A/M
40
30
20
Treatment
Control
10
0
Baseline
6 months
12 months
18 months
Johnson, SS, Driskell, MM, Johnson, JL, Dyment, SJ, Prochaska, JO, Prochaska, JM, & Bourne, L. (2006). Transtheoretical model intervention for
adherence to lipid-lowering drugs. Disease Management, 9, 102-114.
Dietary Fat Staging: Adherence Group
Progression to A/M by Group (pre-action at baseline)
30
% in A/M
25
20
15
10
Treatment
Control
5
0
Baseline
6 months
12 months 18 months
Johnson, SS, Driskell, MM, Johnson, JL, Dyment, SJ, Prochaska, JO, Prochaska, JM, & Bourne, L. (2006). Transtheoretical model intervention for
adherence to lipid-lowering drugs. Disease Management, 9, 102-114.
From Reducing Multiple
Risks to Enhancing Multiple
Domains for Well-Being
Well-being RCT
• Determine the effects on multiple risks and
multiple domains of well-being of Pro-Change’s
effective LifeStyle Programs:
• Online program for stress management
• Telephonic coaching program for exercise
management
• 3 group design
Prochaska, J.O., Evers, K.E., Castle, P.H., Johnson, J.L., Prochaska, J.M., Rula, E.Y., Coberley, C., & Pope, J.E. (2012). Enhancing Multiple Domains
of Well-being by Decreasing Multiple Health Risk Behaviors: A Randomized Clinical Trial. Population Health Management, 15 (5), 276-286.
Baseline Demographics
•
•
•
•
•
•
39 States represented
59% female
52% currently employed
5.2% full time student
42.7% never smoke
20% reported no depression
Age:
Mean = 48.35 (13.53)
Range = 18-86
Chronic conditions:
Mean = 3.74 (3.09)
Range = 0-34
Behavior risks:
Mean = 4.14 (1.44)
Range = 0-9
Baseline Demographics:
BMI
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Underweight
Normal
Overweight
Obese
Baseline Stage of Change
Regular Exercise
PC
C
PR
A
M
30.2% (1250)
32.7% (1354)
27.4% (1132)
5.8% (239)
3.9% (161)
Stress Management
PC
C
PR
A
M
31.0% (1282)
26.3% (1089)
22.8% (941)
8.1% (336)
11.8% (488)
Exercise:
Movement to A/M at T2
Group
Exercise Coach
57.3%
Stress Online
46.6%
Control
37.3%
Stress Management:
Movement to A/M at T2
Group
Exercise Coach
74.9%
Stress Online
64.7%
Control
53.1%
Life Evaluation Categories:T1
70%
60%
50%
40%
Suffering
Struggling
Thriving
30%
20%
10%
0%
Control
Stress
Exercise
Life Evaluation: T1-T2 Difference
MI
30%
20%
10%
Suffering
Struggling
Thriving
0%
-10%
-20%
-30%
Control
Stress
Exercise
Comparative Outcomes of Health
Promotion Interventions
CDC 2010 Review of 59 Worksite RCTs and Case Studies
70%
% Progressing from 'At Risk' to 'Not At Risk'
Our 16 TTM RCTs
60%
Our TTM Case Study
50%
40%
30%
20%
10%
n/a
n/a
0%
Exercise
-10%
Healthy Eating
Fruit &
Vegetable
Smoking
Stress
Management
Depression
Prevention
Johnson, J.L., Prochaska, J.O., Paiva, A.L., Fernandez, A.C., DeWees, S.L., and Prochaska, J.M. (2013) Advancing Bodies of Evidence for Population-based Health
Promotion Programs: Randomized Controlled Trials and Case Studies. Population Health Management, 16(6), 373-380.
Inclusive Care from Two Clusters of
Paradigms for Individual Patients
and Entire Populations
Patient Health
Fragmented
Complemented by
Population Health
Integrated
Inclusive Care from Two Clusters of
Paradigms for Individual Patients and
Entire Populations
Patient Health
Best of Biology
Complemented by
Population Health
Best of Behavior Change
Future Visions
Percentage of Treatment and Control
Groups who at Year 1 Lost 5%+ of
Baseline Weight
Inclusive Care from Two Clusters of Paradigms for
Individual Patients and Entire Populations
Patient Health
Complemented by
Population Health
1. Individual Patients
1. Entire Populations
2. Action Oriented
2. Stage Based
3. Passive Reactive
3. Proactive
4. Standardized
4. Tailored
5. Clinician Delivered
5. Technology Delivered
6. Clinic Based
6. Home Based
7. Single Target Behavior
7. Multiple Target Behaviors
8. Fragmented
8. Integrated
9. Best of Biology
9. Best of Behavior Change
Inclusive Care
Inclusive Research + Inclusive
Practice =
Inclusive Care
New Goal: To help
More Individuals to Thrive
More Families to Thrive
More Schools to Thrive
More Companies to Thrive
More Communities to Thrive