The impact of behavioral counseling on stage of change in fat intake, physical activity, and cigarette smoking in adults at increased risk of coronary heart disease

Abstract

A B S T R A C TObjectives. This study assessed stages of change in fat intake, physical activity, and cigarette smoking during a randomized controlled trial of behavioral counseling.Methods. Twenty general practices (primary health care centers) were randomized to lifestyle counseling by behavioral methods or to usual health promotion. A total of 883 patients were selected for the presence of 1 or more of the following risk factors: cigarette smoking, high cholesterol, or a combination of a high body mass index and low physical activity. Stage of change (precontemplation, contemplation, preparation, and action/maintenance) was assessed at baseline and after 4 and 12 months.Results. Encouraging smoking cessation, dietary fat reduction, and regular physical activity is a central element of cardiovascular disease prevention through lifestyle change. 1 The stage of change model has become increasingly influential as a framework for understanding healthrelated behavior and directing efforts in health promotion.2,3 The model postulates that individuals can be allocated to different stages of readiness for change (from precontemplation through contemplation, preparation, and action to maintenance of successful change) and that baseline stage is a predictor of behavior change. 4-6The stage of change framework suggests that intervention programs might be tailored to the individual's stage of readiness. The Change of Heart Study is a randomized controlled trial that compares brief behavioral counseling with usual health promotion advice among patients at increased risk of coronary heart disease in a primary care setting, 7 where there is limited evidence regarding the effects of stage-oriented programs.8-10 The behavioral and biological risk factor results of this study, which have been described elsewhere, show greater reductions in fat intake and the number of cigarettes smoked and greater increases in physical activity in the behavioral intervention group than in the control group at 4 and 12 months.11 In this article, we present stage of change outcomes in the study and address (1) whether behavioral intervention was more effective than normal practice in achieving the target stage (action/maintenance), (2) whether the likelihood of achieving the target stage for each behavior varied with initial stage, and (3) whether any advantage of behavioral intervention was equally evident for patients at different stages of readiness at baseline. Methods Study DesignThis randomized trial involved 20 general practices (primary care centers), half allocated to behavioral intervention and half to control conditions. 7 Patients with 1 or more of the following modifiable risk factors were recruited: regular cigarette smoking (more than 1 cigarette per day), high cholesterol (6.5-9.0 mmol/L), or a combination of high body mass index (BMI; 25-35 kg/m 2 ) and low physical activity (fewer than 12 episodes in the past 4 weeks of vigorous or moderate exercise lasting 20 minutes). Patients were excluded if they were on active follow-up or ...

Assessing motivation and readiness to change for weight management and control: an in-depth evaluation of three sets of instruments

“…The stage of change construct of the TTM model can facilitate intervention-tailoring by matching specific treatment strategies to individuals’ motivation and RTC ( Jordan and Nigg, 2002 ). In other words, a stage-matched intervention for at-risk participants such as overweight and obese individuals can contribute to increase the chances of becoming more physically active and to decrease dietary fat intake, compared to a non-stage matched intervention ( Steptoe et al, 2001 ). Promptly identifying stages and processes of change in weight-management can therefore help clinicians and other professionals developing a more suitable weight-specific intervention in order to determine which behaviors an individual should target for change, at various points during treatment.…”

Comparison of Public Health Nurse’s Lifestyle Counseling Skills for Clients with Different Readiness of Behavior Changes in Primary Care Settings

“…It has been said that lifestyle counseling leveraging the stages of behavior change theory should focus on increasing awareness of the issues and changing attitudes when it addresses clients at the precontemplation stage, and on the initiation of action through the identification of specific goals and skills when it addresses clients at the contemplation stage [12]. Thus, the results of this study show that clearly explaining the relationship between lifestyle and diseases to the client is a major challenge for PHNs with limited experience.…”

“…The stages of behavior change theory classify the readiness of the client into five stagesprecontemplation, contemplation, preparation, action and maintenance-and defines their characteristics and support methods [7] [8]. This theory has often been used for health counseling and educational programs for lifestyle improvement [9] [10], as well as for assessing the achievement levels of such programs [11] [12]. Thus, PHNs need to leverage the stages of behavior change theory in providing lifestyle counseling.…”

The Application of Behavioral Counseling with Positive Techniques Reinforcement to Improve Self-Confidence

“…Kebiasaan-kebiasaan yang tidak adaptif dilemahkan dan dihilangkan, perilaku adptif ditimbulkan dan dikuhkuhkan (Komalasari, dkk, 2011:154). (Damayanti & Aeni, 2016;Denison, O'Reilly, Schmid, Kennedy, & Sweat, 2008;Foa, Rothbaum, Riggs, & Murdock, 1991;Konseling et al, 2016;Siswa, Viii, Smp, Sawan, & Pelajaran, 2013;Steptoe, Kerry, Rink, & Hilton, 2001;Sutarjo, Wmp, & Suarni, 2014;Whitlock, Orleans, Pender, & Allan, 2002) Model konseling behavioral dalam penelitian ini menggunakan teknik positive reinforcement (penguatan positif). Penguatan positif yaitu salah satu teknik yang dalam pembentukan tingkah laku dari teori konseling behavioral.…”