To conduct a meta-analysis of computer technology-based HIV prevention behavioral interventions aimed at increasing condom use among a variety of at-risk populations.
Systematic review and ...meta-analysis of existing published and unpublished studies testing computer-based interventions.
Meta-analytic techniques were used to compute and aggregate effect sizes for 12 randomized controlled trials that met inclusion criteria. Variables that had the potential to moderate intervention efficacy were also tested.
The overall mean weighted effect size for condom use was d = 0.259 (95% confidence interval = 0.201, 0.317; Z = 8.74, P < 0.001; N = 4639), indicating a statistically significant impact of the interventions. This effect size compares favorably to previously tested interventions delivered by human facilitators. Statistically significant effect sizes were also found for frequency of sexual behavior, number of partners, and incident sexually transmitted diseases. In addition, interventions were significantly more efficacious when they were directed at men or women (versus mixed sex groups), utilized individualized tailoring, used a Stages of Change model, and had more intervention sessions.
Computer technology-based HIV prevention interventions have similar efficacy to more traditional human-delivered interventions. Given their low cost to deliver, ability to customize intervention content, and flexible dissemination channels, they hold much promise for the future of HIV prevention.
This study aimed to investigate (a) what clients’ within-treatment activity preferences were; (b) whether a match between preferences and psychotherapy approach predicted outcomes and alliance; (c) ...whether scores on preference dimensions, per se, predicted outcomes and alliance. Participants were 470 clients engaging in one of five approaches with trainee psychotherapists. We used the Cooper–Norcross Inventory of Preferences to identify clients’ within-treatment activity preferences; and multilevel modelling to examine the relationship between these preferences – and a match on these preferences – to outcomes and alliance. Clients had an overall preference for therapist directiveness and emotional intensity. We found no evidence of a preference matching effect. Clients who expressed a desire for focused challenge over warm support showed greater progress. Client preferences for focused challenge may be indicative of their readiness to change and indicate a positive prognosis. Further research should directly observe therapeutic practices and assess a range of client variables.
The transtheoretical model has been used as a model of behavior change for tobacco users. However, it does not account for perceptions of past behavior that may provide additional guidance toward ...smoking cessation. No studies have examined associations between the transtheoretical model, content themes of smoking experiences, and counterfactual thoughts (i.e. “If only. . .then. . .”). Mturk participants (N = 178; 47.8% female) completed measures of smoking attitudes, behavior, and stage and processes of change use. Participants described a past negative smoking event and an event-related counterfactual thought-listing task. Participants in the precontemplation stage endorsed fewer processes of change. Also, participants in the action stage reported significantly more counterfactuals about cravings (e.g. If only I could have controlled my urge to smoke. . .) inferring that they may be identifying cravings or urges as relevant barriers toward smoking cessation. Identifying these self-relevant thoughts may provide additional ways to address and overcome barriers toward achieving long-term smoking cessation.
Synthetic cannabinoids (SCs) are low-cost substances that have been associated with adverse health outcomes and an increase in emergency department visits over recent years, particularly among people ...experiencing homelessness. This mixed methods study explored the connection between homelessness, SC use, and readiness to quit in order to inform the development of harm reduction strategies. Individuals (18+) residing in homeless encampments in Houston, TX with experiences of SC use were eligible to participate. Participants (N = 65) completed an interviewer-administered survey about their SC use. Most participants were Black/African American (65.7%), male (82.9%), and most (75.4%) reported using SCs to avoid positive drug tests. Many wanted to quit using SCs (69.2%) and already employed harm reduction strategies while using SCs. Organizations supporting individuals experiencing homelessness who use SCs should focus on reducing barriers to stopping SC use and increasing the availability of housing and supportive services.
Effective lifestyle intervention is essential to promote transition from an addictive life to a drug-free lifestyle. This study retrospectively evaluated the Lifestyle Redesign Program (LRP), a ...lifestyle intervention featured with motivational enhancement, in promoting drug-free and engaging lifestyle in young drug users in Hong Kong.
Retrospective observational design with single-group pre-and-post intervention comparison was adopted. Participants were recruited from two residential detoxification centers. Demographics, abstinence information, engagement status, and outcome measures including self-efficacy on drug avoidance, perceived general health and quality of life were collected. Data were analyzed with descriptive statistics, paired t-test and Spearman's rank-order correlation.
A total of 86 participants were recruited. Seventy-two of them (83.7%) maintained abstinence for at least 2 months and 64 of them (74.4%) had meaningful engagement in terms of competitive employment or study after completing the LRP. Statistically significant improvements were found in self-efficacy on drug avoidance (t = 8.3, p < .01, d = 0.90), perceived general health (t = 7.4, p < .01, d = 0.79), and overall quality of life (t = 5.4 to 8.3, p < .01, d = 0.59 to 0.89).
The findings provide preliminary evidence that LRP is associated with promoting abstinence and achieving healthy lifestyle for young drug users. More controlled studies are recommended to rigorously examine its effectiveness.
Background
Little is known about the mechanisms of change underlying brief interventions and the patient characteristics that may affect them. The present study tested whether the stages of change ...mediate the effects of a BMI with and without a telephone booster relative to brief advice (i.e., multiple mediation). Further, the present study tested whether the effects of the BMI conditions on the stages of change were contingent on patients’ alcohol use severity (i.e., moderated mediation).
Methods
The present study is a secondary analysis using data from injured adult patients at 3 trauma centers who were screened for inclusion in the study and randomly assigned to brief advice (n = 200), BMI (n = 203), or BMI with a telephone booster (n = 193) (Field et al., 2014). Participants completed a baseline assessment and 3‐, 6‐, and 12‐month follow‐up assessments that included self‐report measures of the stages of change, alcohol use, and alcohol‐related problems, as well as other variables of interest.
Results
The results demonstrated significant and consistent mediation at p < 0.05 wherein BMI with a telephone booster increased action at 3‐month follow‐up leading to reduced likelihood of at‐risk drinking, less alcohol use, and fewer alcohol problems at both 6‐ and 12‐month follow‐up. However, moderated mediation analyses suggested that the effects of the BMI conditions on the stages of change were not contingent on patients’ alcohol use severity.
Conclusions
This study contributes to the understanding of stages of change as potential mechanisms of change in BMI. Directions for future research are discussed.
This study evaluated the effects of brief motivational intervention for alcohol use and problems through stages of change among non‐treatment seeking, injured patients. In a multiple mediation model, results showed that scores on the action stage consistently mediated alcohol use and problems at P < 0.05 following brief intervention with a telephone booster. In contrast, participants who continued to experience ambivalence were more prone to at risk drinking and alcohol problems. Using individual stages of change scores in multiple mediation instead of overall readiness, this research provides additional insights into mechanisms of change following brief motivational intervention.
The transtheoretical model (TTM) of behavioral change posits that individuals move through five stages of change when adopting new behaviors: pre-contemplation, contemplation, preparation, action, ...and maintenance. The aim of this study was to determine the proportion of patients with HIV/AIDS within a Ugandan fishing community in the different physical activity (PA) stages. We also explored differences in variables, motives, and barriers for PA across the stages.
In total, 256 individuals (77 men, 40.5 ± 10.3 years) completed the Patient-centered Assessment and Counseling for Exercise Questionnaire, the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptoms, and the Alcohol Use Disorders Identification Test. They were also asked about their most important PA motive and barrier.
Seventy-five individuals (29%) were in the (pre-)preparatory stages, 140 (55%) in the action and 41 (16%) in the maintenance stage. Those in the (pre-)preparatory stages had higher PHQ-9 total scores (p < 0.001) and were more likely to report barriers than those in the later stages (p < 0.001). Compared with those in the (pre-)preparatory stage, patients in the action stage experienced less body weakness (p = 0.015).
Depression and barriers to PA should be considered in people with HIV/AIDS in low-resource settings when implementing interventions to assist them to become more active.
Implications for rehabilitation
People with HIV/AIDS are among the most physically inactive clinical populations.
Clinicians should consider depression when motivating patients with HIV in low resourced settings to become active.
Clinicians should consider body weakness when motivating patients with HIV in low resourced settings to become active.
The purpose of the present research was to examine how self-determined and non-self-determined motivation for eating was related to healthy and unhealthy eating behaviors at different stages of ...change. In Study 1 (n = 360), the structure of a new scale designed to measure healthy and unhealthy eating behaviors based on recent recommendations of the Canadian Food Guide was examined through Principal Component Analysis. Study 2 (n = 711) retested the structure of the scale and also examined whether women reported different patterns of motivation and eating behaviors depending on their stage of change for eating regulation. In Study 3 (n = 264), moderated mediation models were used to examine if eating behaviors served to mediate the relationship between motivation and waist circumference, and whether stages of change moderated the link from motivation to eating behaviors. Overall, the studies provided evidence for the 2-factor structure of the scale, where the first factor represents healthy eating and the second factor represents unhealthy eating behaviors. It was also demonstrated that as women moved along the stages of change for eating regulation, they reported higher levels of self-determined motivation and lower levels of non-self-determined motivation, as well as a higher consumption of healthy foods and a lower consumption of unhealthy foods. Finally, findings indicated that healthy eating fully mediated the relationship between self-determined motivation and waist circumference, and that the relationship between self-determined motivation and healthy eating was moderated by stages of change. Together, these studies highlight the interactive roles of motivation and stages of change in their association with healthy and unhealthy eating behaviors, as well as the importance of healthy eating for a lower waist circumference.
The Transtheoretical Model (TTM) of behavior change predicts that patients go through different stages of change prior to changing their problematic behavior. This study aims to evaluate the utility ...and validity of this model in a sample of 549 court-ordered partner violent men. Three types of perpetrators with respect to their readiness to change were revealed. Those in more advantage stage of change use more processes to change their problem and present with higher levels of intimate partner violence (IPV). Low readiness to change levels and treatment drop-out predict short-term criminal justice recidivism, while treatment drop-out predicts medium and long-term recidivism. Results highlight the applicability of the TTM in IPV and its usefulness in designing behavioral interventions with this population.
Persuasive games are widely implemented in the healthcare domain to promote behaviour change among individuals. Previous research shows that using persuasive games increases motivation and awareness, ...leading to a positive change in behaviour. However, there is little knowledge on which persuasive strategies will motivate people at different Stages of Behaviour Change and whether tailoring persuasive games to match users' stages of change will increase their effectiveness with respect to their motivational appeal towards promoting disease awareness and prevention using the ARCS motivation scales and their intention to adopt the precautionary measures. To address this gap, using COVID-19 as a case study, we designed two different versions of a persuasive game, called COVID Pacman, using different persuasive strategies. The two versions of the game target the same goal of motivating the adoption of precautionary measures. We conducted a quantitative study (N=127) followed by semi-structured interviews of 18 participants. The results of conducting an ANOVA on the quantitative data and thematic analysis on the qualitative study show that tailoring the persuasive games to individual's stages of change by using appropriate persuasive strategies increased their effectiveness with respect to their ability to motivate people to adopt the precautionary measures towards disease prevention compared to the non-tailored version.
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